Leading Our Communities Through COVID-19 by Sanford Health

LEADING OUR COMMUNITIES THROUGH COVID-19

SANFORD HEALTH

2022 COVID-19 Impact Report 2020–2021 IN REVIEW

TABLE OF CONTENTS

A letter from our CEO

Investing in our workforce

Responding to the crisis

Caring for patients and residents

Leading vaccine advocacy

Driving research and innovation

Guiding our communities

Here for all. Here for good.

2022 COVID-19 Impact Report

A LETTER FROM OUR CEO The privilege of caring for and supporting our patients and residents, people and communities who place their trust in us is a responsibility we do not take for granted. Throughout the last two years of the COVID-19 pandemic, Sanford Health has met the needs of our communities by investing in our workforce, strengthening our system preparedness, setting the highest standard of care for COVID-19 response in rural America, delivering the vaccine to hundreds of thousands of people across our vast, geographic footprint and advancing research to bring new treatments – and hope – to our patients. We will be forever grateful to our dedicated caregivers who have met every challenge, often at great personal sacrifice and sometimes in the face of loss within their own families and communities, while continuing to help us carry out our mission every day. Even as we have faced record patient volumes, unprecedented workforce challenges and enduring mental health concerns, our clinicians and caregivers have demonstrated the ability, the courage and the resolve to provide high-quality care for all who rely on us. This pandemic is not over, but hope is on the horizon, and it’s because of the tremendous efforts of our entire Sanford Family. The best of science and medicine will continue to guide us as we put this global health crisis in our rearview mirror. This report reflects on all the ways that Sanford Health has supported and led our communities through the COVID-19 pandemic while continuing to care for those who come to us in their time of greatest need.

BILL GASSEN President and CEO, Sanford Health

2022 COVID-19 Impact Report

INVESTING IN OUR WORKFORCE Protecting and supporting our workforce was an early priority during a time of great uncertainty and has continued throughout the pandemic. Our commitment to our people included investments to maintain the stability of our workforce and new programs to support employee well-being.

HIGHLIGHTS

FAMILY STABILITY PLAN

NEW CHILDCARE OPTIONS

In early 2020, Sanford Health announced a plan to help our hourly workers most impacted financially by the COVID-19 pandemic. This $21.6 million investment included a one-time stability payment, three months of paid health insurance premiums and PTO flexibility.

New community partnerships in Sioux Falls, Fargo and Bemidji made sure Sanford Health employees and other health care workers and first responders could respond to COVID-19 without worrying about childcare.

EMPLOYEE CRISIS FUND

When the COVID-19 pandemic hit, the Sanford Family raised more than $1.6 million for the Employee Crisis Fund. Because of that generosity, more than 1,800 colleagues and their families have been able to put food on the table, pay monthly bills and simply make ends meet during a time of unprecedented challenges.

Unlike many health systems across the country, Sanford Health has had no companywide layoffs or furloughs at any time during the pandemic.

EMPLOYEE WELL-BEING

The pandemic has placed extraordinary stress on our health care teams and contributed to higher rates of mental health challenges. Sanford Health has led efforts to combat work-related stress and burnout through resiliency groups, trainings, a clinical assistance program, counseling, a physician wellness council and comprehensive mental health resources to help our employees take care of themselves physically and emotionally while caring for patients on the frontlines during the COVID-19 pandemic.

COMPENSATION INVESTMENTS

In 2021, Sanford Health made unprecedented investments in employee compensation increases and bonuses totaling $167 million. This included historic increases for providers, nurses and other frontline caregivers: •$ 105 million in additional employee compensation •$ 33 million in additional physician compensation •$ 8 million in additional advanced practice provider compensation •$ 21 million in annual employee bonuses, double the traditional amount

2022 COVID-19 Impact Report

Caring for our people National COVID Collaborative Sanford Health was invited to join a national initiative with Fortune 500 companies, which recognized private sector leaders committed to establishing and maintaining healthy and safe workplaces for employees. AMA employee well-being recognition The American Medical Association honored Sanford Health as a recipient of the 2021 Joy in Medicine, one of 44 health systems recognized for their commitment to health care team well-being and programs to combat work-related stress and burnout. Forbes Best Employers 2021 Sanford Health was recognized by Forbes as the Best Employer in both South Dakota and North Dakota in 2021. The ranking was based on employee ratings on a variety of criteria, including workplace safety, compensation and opportunities for advancement. Rewarding our tireless employees Market leaders have continued to support and recognize employees who have gone above and beyond to care for patients, including reward and recognition programs to support frontline staff in each region.

BY THE NUMBERS 86% of physicians and advanced practice providers surveyed said Sanford Health did “extremely or somewhat well” handling the challenges of COVID-19.

Corporate staff support frontline GSS providers A Good Samarian Society workforce support program invited corporate services staff to volunteer for shifts in local nursing homes. Employees from corporate headquarters worked more than 1,000 hours in dietary and nursing roles, allowing frontline staff to take some much-deserved time off over the holidays.

“ At Sanford Health, our people are treated as human beings first and as clinicians second. We have a comprehensive strategy to support the well-being of our caregivers and promote awareness and prevention of mental health issues. We want our clinicians to know that it’s OK to not be OK sometimes.” LUIS GARCIA, MD President, Sanford Clinic 2022 COVID-19 Impact Report

“There are days where I thought I was experiencing the toughest one yet but at the end, I am still standing — and so is my team — because we are constantly supporting one another. On those intense days, you’re building resilience, and that resilience is where you find your compassion. Those are the moments where I can dig deep for my team and for our patients.” CARRIE HAWLEY, MBA-HCM, BSN, RN Supervisor, Nursing Ambulatory, Sanford Health Watertown Clinic

“Early on in the pandemic, we recognized the need to not only help our communities respond to the pandemic, but to support our health care team and their families as well. In just five weeks, over $1 million was raised to support Sanford Health and Good Samaritan Society family members facing personal and financial hardship.” DEB KOSKI, CFRE Chief Philanthropy Officer, Sanford Health Foundation

2022 COVID-19 Impact Report

RESPONDING TO THE CRISIS Sanford Health made mission-critical investments at the very first signals of the COVID-19 pandemic, strengthening system preparedness and improving access to care. We were able to leverage our integrated health care system to ensure resources and supplies were secured and efficiently deployed to areas most in need. Expanding capacity for COVID-19 patients in our medical centers allowed us to serve as a safety net for the region.

HIGHLIGHTS

COVID-19 INCIDENT COMMAND

PPE AND CRITICAL SUPPLIES

In March 2020, an enterprise incident command team was established in Sioux Falls. As an integrated health system, our central operations center connects clinicians and leaders to share information and respond to emerging issues. Using artificial intelligence and realtime data, surge models helped to track and forecast positive cases, hospitalizations, bed capacity and staffing.

In early 2020, Sanford Health purchased critical supplies, life saving equipment and personal protective items, which positioned us to implement strong safety measures for our people, patients and residents, including providing masks for all employees in clinical settings and ensuring long-term care facilities had access to needed supplies.

COVID-19 TESTING

Sanford Health invested early in standing up robust testing capabilities, including some of the earliest available tests for COVID-19. Tests were immediately available at Sanford Health clinics and medical centers and were processed at the Sanford Health laboratory in Sioux Falls, with patients receiving results in 24-48 hours. Since the start of the pandemic Sanford Health has completed over 1 million COVID-19 laboratory tests.

Harnessing our integrated system Good Samaritan Society, Sanford Health stronger together The strength of our two organizations working as one has had significant benefits during the pandemic. The Good Samaritan Society had access to resources like PPE and COVID-19 testing when many in the long-term care industry struggled to secure supplies and equipment. Testing kits were shipped from the Sanford lab to Good Samaritan Society locations across the nation.

DRIVE-UP TESTING SITES

During the early days of the pandemic, Sanford Health recognized the need for drive-up COVID-19 testing locations, and in less than 24 hours, opened its first testing site in Sioux Falls. Soon after, additional drive-up testing sites were stood up in Aberdeen, South Dakota; Fargo and Bismarck, North Dakota; and Bemidji, Minnesota.

CLINICAL UPSKILLING

RURAL ACCESS TO CARE

Sanford Health launched a clinical upskill training program to increase staffing resources for essential roles and meet evolving workforce needs in clinical support and patient care positions. More than 900 upskilled staff served as another example of the strength of our communities and willingness to help however needed.

From Chamberlain, South Dakota, to Halstad, Minnesota, administrators of clinics, hospitals and long-term care facilities in small towns worked to keep patients, residents and health care workers as safe as possible. They quickly stood up testing sites, surge plans and dedicated care teams to serve remote rural areas.

2022 COVID-19 Impact Report

“ We have worked really hard and have been successful in gathering the right supplies for our caregivers.” DEAN WEBER Vice President, Supply Chain, Sanford Health

“We built on-the-fly, established testing algorithms that were very complex, routing testing based on patient risk and status. The work that happened behind the scenes was incredible. Everybody had the same goal in mind and executed efficiently. Timing is everything and we are so fortunate that our organization supported the idea of establishing a reference lab when we did.” ROCHELLE ODENBRETT System Executive Director of Sanford Laboratories

“Everyone was expected to participate and bring ideas forward regardless of their title. We knew we had to do this together and it was going to take all of us working together to do it. That was probably the moment where I was most proud of the whole team and the organization. We were here as colleagues, as friends and as partners.” MATT HOCKS Executive Vice President, Chief Operating Officer, Sanford Health

2022 COVID-19 Impact Report

CARING FOR PATIENTS AND RESIDENTS Sanford Health set the highest standard for the COVID-19 response in rural America, earning national attention for our life-saving monoclonal antibody outpatient program and successful vaccination rollout across our footprint. People clamoring for pandemic updates turned to Sanford Health News, a trusted source of information for patients, employees, the public and journalists. Surveys showed that Sanford Health was the most trusted local health system for providing information about COVID-19 and the system of choice for medical care during the pandemic.

HIGHLIGHTS

COVID-19 HOME MONITORING

Sanford Health stood up a home monitoring program to provide patients diagnosed with COVID-19 real-time access to a registered nurse while they recovered at home. At the height of the pandemic prior to vaccination and monoclonal antibody infusions, home monitoring was an innovative way to support our patients and communities. Thermometers, pulse oximeters and twice-daily check-ins have saved lives.

MONOCLONAL ANTIBODY INFUSIONS

Sanford Health has been one of the nation’s leaders in providing access to life-saving monoclonal antibody treatments. We have invested significant system resources to ensure that high-risk COVID-19 patients – including those who live in rural areas or reside within Good Samaritan Society locations – have timely access to this treatment option.

SAFETY NET SYSTEM

With many hospitals over capacity, Sanford Health served as a safety net, caring for patients being diverted from neighboring health systems across the Upper Midwest and beyond.

SANFORD HEALTH NEWS

4.7 MILLION VIEWS March 2020 – December 2021

44,343 VIEWS March 18, 2020

COVID-19 SANFORD HOME HEALTH MONITORING PLAN

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MONOCLONAL VIRTUAL ANTIBODY CARE INFUSIONS

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PREVENTIVE SAFETY NET SYSTEM CARE

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2022 COVID-19 Impact Report

Answering the call New COVID-19 units Sanford Bismarck opened a 7,500 square foot special care unit capable of holding 19 COVID-19 patients, located off-site from the hospital. Patients who were less critical were moved to this unit to allow for space within the medical center for more patients. The Bismarck team stood up this unit in nine days to meet the rapidly rising needs of the community. Adding new beds to meet community needs During the first COVID-19 surge in the fall and winter of 2020, Sanford Fargo added 175 hospital beds – more beds than the size of most hospitals in North Dakota. Our promise to the patients in the region was that they would have a hospital bed close to home if they needed medical care. In Bemidji, Minnesota, Sanford converted the 4th floor of the hospital into a cohort COVID-19 unit, added 4 ICU beds and transitioned all ICU beds to negative pressure rooms to care for COVID-19 patients. Across the system, Sanford Health added more than 320 beds. Expanding hospital capacity Twice during the pandemic, the Good Samaritan Society and Sanford Medical Center Fargo worked together to expand hospital capacity as patient volumes surged. An unused wing at the Good Samaritan Society’s basic care unit in Arthur, North Dakota, was transformed into a 24-bed skilled nursing center.

iPads keep long-term care residents connected When the pandemic brought on visitor restrictions and increased isolation among senior care locations everywhere, leaders of the Good Samaritan Society wanted to keep residents engaged while keeping them safe. It wasn’t long before the organization stepped in to help maintain that family connection by purchasing 1,000 iPads for its skilled and assisted living locations across 22 states. Daily letters bring joy The Good Samaritan Society set up a feature on its website called Send-A-Note, allowing anyone to send a note to residents or staff in a Society location. Kirby Feldmann, from Racine, Wisconsin, started sending daily letters to 80 senior care locations. Her letters brought joy to residents who, at the time, were unable to visit with family or friends.

BY THE NUMBERS 10,000 COVID-19 hospitalized patients trusted us with their care 13,000 monoclonal antibody infusions administered, preventing over 900 hospitalizations and as many as 130 deaths

Providing culturally competent COVID-19 care When Worthington, Minnesota, a town of 13,000, experienced an outbreak of COVID-19, Sanford Health responded to the community’s need by standing up a drivethrough testing site. More than 2,000 tests were completed in two days. Sanford Health also provided culturally competent education and care for the ethnically diverse community, including interpreters as well as multilingual access through video conferencing and a nurse triage line.

Over 377,000 telehealth visits scheduled over the last two years More than 6,000 obstetrics video visits logged by clinicians ,200 patients enrolled 3 in our COVID-19 home monitoring program

“ Any patient who has their COVID lab obtained at Sanford will receive a call with a positive test and be proactively screened and offered the opportunity to have a monoclonal antibody infusion. It is an important way for Sanford to support our patients and community. We actually have infusion centers across our footprint, not just in our major medical centers. Because of the rural nature of where we care for our patients, it’s incredibly important for our teams and our employees to understand that we can get care close to home.” ERICA DEBOER, RN, MA, CCRN-K, CNL Chief Nursing Officer, Sanford Health 2022 COVID-19 Impact Report

“It’s really hard to describe the significance. So much planning went into this. There was so much anticipation and I think a lot of relief that we’re all hoping to get from this vaccine.” JESSE BREIDENBACH, PHARMD System Executive Director, Pharmacy, Sanford Health

“Good Sam is very rural. We have about half of our facilities in towns of less than 5,000 people. The incredible opportunity, especially in partnership with Sanford Health, is telehealth. Bringing big-city expertise to a country nursing home. The distance doesn’t have to be a barrier to world-class care anymore.” GREGORY JOHNSON, MD Chief Medical Officer, Good Samaritan Society

“The most important way you can support our health care workers is by doing what you can to not become one of their patients. They are tired but they are doing exactly what they are trained to do: they work hard and take care of the sickest people.” JEREMY CAUWELS, MD Chief Physician, Sanford Health

2022 COVID-19 Impact Report

LEADING VACCINE ADVOCACY In a span of 13 months, Sanford Health administered nearly 540,000 vaccinations. Sanford Health’s vaccine advocacy during the COVID-19 pandemic has saved thousands of lives across our rural footprint.

HIGHLIGHTS

MASSIVE VACCINATION EFFORT

EMPLOYEE VACCINE MANDATE

LEADING LONG-TERM CARE

Months of preparation for the COVID-19 vaccines paid off, with ultra-cold freezers, rural couriers and distribution plans in place. Despite harsh winter weather and a population spread out across more than 200,000 square miles, Sanford Health was recognized for our successful early vaccination rollout across the Dakotas and Minnesota.

Sanford Health was proud to be one of the first health systems in the country to require all employees to get a COVID-19 vaccination to protect our patients, longterm care residents and our people. The vaccine mandate has worked. The Good Samaritan Society was one of the first longterm care providers in the country to require the COVID-19 vaccine for all 15,000 employees. We have achieved a compliance rate of 100% creating a safer care environment for all who come through our doors.

As the nation’s largest nonprofit provider of senior care and services, the Good Samaritan Society was an authoritative voice, demonstrating moral leadership and influencing policy. The Good Samaritan Society prioritized vaccinations for its residents who were most at risk of hospitalization from COVID-19. Within the first month after the vaccine became available, over 90% of residents had already received their first shot. A precipitous decline in COVID-19 cases followed, offering a hopeful sign for the future. The Good Samaritan Society also led the way when boosters were recommended for older adults, successfully achieving a booster rate of over 90% among residents, far surpassing the industry average of 63%.

Delivering the vaccine Serving as a rural vaccine hub As an initial hub for the Pfizer vaccine distribution with ultra-cold storage, Sanford Bemidji played a significant role in ensuring hospitals within the Northwest Regional Healthcare Coalition received vaccine allocations. The Sanford Bemidji pharmacy team led the charge in coordinating and delivering the vaccine to sites as far as three hours away. Providing convenient access to the vaccine Sanford Fargo led a unified effort with other health care organizations to establish a centralized location for vaccinations in an empty department store providing easy access to the community.

EDUCATION AND ADVOCACY

Sanford Health launched an ongoing public education and advocacy campaign to share facts about the safety and efficacy of the vaccine, combatting misinformation and debunking myths through consumer-friendly content on Sanford Health News, social media and other channels. Weekly live Q&A sessions with health experts delivered timely news and information. These efforts earned national recognition from Voices for Vaccines as well as an Anthem Award in partnership with the Cura Foundation.

SERVING VETERANS

VACCINATION BLITZ

Sanford Health joined forces with the Veterans Administration (VA) to ensure that older veterans living in small rural towns across our footprint didn’t have to travel far to seek vaccines.

Sanford Health organized a systemwide immunization blitz making it easy and convenient for patients to get their influenza and COVID-19 vaccinations simultaneously at driveup locations and primary care and specialty clinics.

2022 COVID-19 Impact Report

“We’re not going to go backward. We have an answer, and that answer is to mandate the vaccine.” NATHAN SCHEMA President and CEO, Good Samaritan Society

“I’m just so proud of all of our teams and how we’ve come together. I’m proud of our organization for the fact that they value and they prioritize rural. It’s kind of emotional. I was in Worthington, Minnesota, last week and saw the first vaccine going out … all this planning and here we are actually you know, rolling it out. It’s very exciting.” ALYSSA HOWARD, PHARMD, MHA Director of Pharmacy, Sioux Falls Network, Sanford Health

2022 COVID-19 Impact Report

DRIVING RESEARCH AND INNOVATION Sanford Health has paved the way with comprehensive clinical trials to better understand, study, treat and prevent COVID-19. Throughout the course of the pandemic, Sanford Research reviewed over 100 COVID-19 clinical trials for feasibility at our site. Clinical trials are key to advancing the science of medicine to ensure our patients benefit from new discoveries as quickly as possible.

HIGHLIGHTS

LEADING WITH CLINICAL TRIALS

COVID-19 REGISTRY

LEVERAGING DATA ANALYTICS

Sanford Health conducted treatment trials for COVID-19 including the use of monoclonal and polyclonal antibodies, convalescent plasma, oral antivirals and other innovative options for the most ill patients.

In the early days of the pandemic, Sanford Health’s integrated team of research and health care leaders created a unique and powerful COVID-19 patient registry that would capture every patient who tested positive for the virus. As we move forward, the COVID-19 registry will assist researchers in understanding the disease through the recovery process and potentially answer questions regarding immunity, reinfection, severe illness and long-term health complications.

By November 2020, the Sanford Research team was able to leverage the treasure trove of data in our COVID-19 Registry, augmented with a customized algorithm built by Sanford Health data scientists, physicians and researchers, to deliver life-saving monoclonal antibody treatments to COVID-19 patients at highest risk of complications. The algorithm, embedded into the electronic medical record, also supported our vaccination rollout to deliver vaccines efficiently and equitably to vulnerable populations.

Sanford employees join COVID study In the early days of the pandemic when antibody testing for COVID-19 became available, Sanford Health conducted a study of our own employees to better understand how many were being exposed and infected. The SURVIVE study examined antibodies as well as the employees' own reports of their exposures or illnesses to better understand patterns of COVID-19 infection in our health care workers.

Over 145,000 COVID-positive patients have been recruited to join Sanford Health’s COVID-19 research registry.

FUTURE RESEARCH NEEDS Sanford Research, through collaboration with the Dakota Cancer Collaborative on Translational Activity, has been selected to participate in the national RECOVER program – aimed at characterizing incidence and prevalence of long-term effects from SARS CoV-2 infection. The cohort study will further define the spectrum of clinical symptoms and investigate the biological mechanisms at play in “long-haul syndrome.” Sanford Health is one of 20 sites to be selected for this project nationally.

“With our research here and with our partners across the world, we have a much better understanding of what COVID is about now. We’ve been leading clinical trials so if you’re hospitalized, we have options for you. Our physicians have done a phenomenal job in terms of understanding what is the best care for someone who has COVID right now.” DAVID A. PEARCE, PHD President, Innovation, Research and World Clinics

2022 COVID-19 Impact Report

GUIDING OUR COMMUNITIES Throughout the pandemic, we’ve partnered with businesses, schools, state and city leaders and other health systems across the upper Midwest, to support and guide our communities – a reminder that we are stronger together.

HIGHLIGHTS

CRITICAL PARTNERSHIPS

COMMUNITY ROUNDTABLES

COMMUNITY ENGAGEMENT

Across the enterprise, Sanford Health collaborated closely with elected officials and other health systems to organize the response, influence policy and ensure a unified message as the pandemic unfolded. Sanford Health leaders worked closely with state and local government agencies and officials, and neighboring health systems to align on public education, outreach and care delivery.

As part of ongoing efforts to promote the importance and safety of COVID-19 vaccines, Sanford Health convened virtual meetings with community, business and school leaders, providing updates on the latest COVID-19 information, recommendations for keeping workplaces and schools safe and an opportunity to respond to questions.

Sanford Health reached out to community leaders and identified opportunities for partners to make a difference including providing financial gifts to our employee crisis fund and donating blood. Sanford Health clinicians and leaders in Sioux Falls, Fargo, Bemidji, Bismarck and across our footprint in smaller, rural locations urged their communities to do their part to slow the spread by getting vaccinated and boosted.

Leading conversations Virtual community forums In Bemidji, Dr. David Wilcox, VP medical officer, led in-person and virtual roundtables with community partners throughout the pandemic including regional and local school boards, superintendents, educators, university professors and students, childcare providers, business leaders, city and county government officials as well as other hospitals across the region. These roundtables offered transparency, open dialogue and support to our community. Faith, science and vaccines The Good Samaritan Society’s Senior Pastor hosted a discussion on faith, science and vaccines. Joined by two professors from Augustana University, the conversation explored the intersection of these topics and how getting the vaccine is a way to faithfully love and care for ourselves and our neighbors.

“ We can predict and prevent COVID-19. We can’t predict when you are going to have a heart attack, when you are going to have a car accident, when you are going to fall and break your hip.” DAVID WILCOX, MD Vice President Medical Officer Sanford Health of Northern Minnesota

“ We continue to need your help. In the hospital, we see those who are greatly affected by COVID-19. We need you to get vaccinated. We need you to get boosted.”

“ We still have to be diligent in what we’re doing, but the vaccine gives us a fighting chance to defeat this pandemic.”

MIKE WILDE, MD Vice President Medical Officer Sanford Sioux Falls

TODD SCHAFFER, MD President and CEO Sanford Bismarck

“ The vast, vast majority of patients are unvaccinated. Please, please get the vaccine. This is not a personal health issue; this is a public health issue.” DOUG GRIFFIN, MD Vice President Medical Officer Sanford Fargo 2022 COVID-19 Impact Report

Here for all. Here for good. Since the emergence of COVID-19, Sanford Health has led the way through every stage of the pandemic. Our people rose to unprecedented challenges to bring the best of care to every community we serve. The pandemic has tested us in profound ways. But our response demonstrates what’s possible when we harness the power of resilience, courage and innovation to achieve the extraordinary in our role as caregivers. It’s also a reminder that we’re here for each other – to hold one another up no matter what – especially during times of challenge. We should be proud of how we’ve come together to safely care for our communities and each other. We remain resolute in our commitment to keeping our patients and residents, people and communities healthy and safe, now and for generations to come.

2022 COVID-19 Impact Report

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