I had a question specifically about the health upgrades. The rules currently state that you need to collect three upgrades, but there are actually four. Even though collecting only three of them would get you to maximum life capacity after collecting all eight crystals, is it truly necessary to collect all four to qualify for 100%?

No, altho honestly im still not sure about this category. Part of me wants it to be more different, but that pretty much means getting crystal balls, which doesn't really feel right either.

Yeah I agree, crystal balls don't really feel like "items".

Okay so for now, we go with the rules as they are currently written.