4A (Expenses $ 125707157 including grants of $ 0) (Revenue $ 165683064)
INPATIENT HEALTHCARE SERVICES - PROVIDING INPATIENT SERVICES CONSISTENT WITH OUR CORE VALUES BY PROVIDING ACCESS TO COMPREHENSIVE, HIGH QUALITY, COMPASSIONATE, AND EFFICIENT HEALTHCARE SERVICES. LAWRENCE GENERAL HOSPITAL IS A 186 BED HOSPITAL THAT PROVIDED 46,135 PATIENT DAYS OF INPATIENT SERVICES WITH 10,543 DISCHARGES DURING FY 2022.

4B (Expenses $ 93754632 including grants of $ 0) (Revenue $ 122399511)
OUTPATIENT HEALTHCARE SERVICES - PROVIDING OUTPATIENT SERVICES CONSISTENT WITH OUR CORE VALUES BY PROVIDING ACCESS TO COMPREHENSIVE, HIGH QUALITY, COMPASSIONATE, AND EFFICIENT HEALTHCARE SERVICES. DURING FY 2022, LAWRENCE GENERAL HOSPITAL HAD 351,088 OUTPATIENT VISITS.

PART V, SECTION B, LINE 5
IN 2022 THE HOSPITAL PARTNERED WITH THE GREATER LAWRENCE FAMILY HEALTH CENTER TO UPDATE ITS CHNA (FOR TAX YEAR 2021) AND AGAIN USED A PARTICIPATORY, COLLABORATIVE APPROACH TO LOOK AT HEALTH IN ITS BROADEST CONTEXT. THE ASSESSMENT PROCESS INCLUDED: SYNTHESIZING EXISTING DATA ON SOCIAL, ECONOMIC, & HEALTH INDICATORS IN THE REGION; ADMINISTERING A PUBLIC SURVEY COMPLETED BY 750 RESPONSES FROM RESIDENTS IN THE COMMUNITIES OF LAWRENCE, METHUEN, ANDOVER, NORTH ANDOVER, AND HAVERHILL. CONDUCTING 25 KEY STAKEHOLDER INTERVIEWS, 4 FOCUS GROUPS AND 3 COMMUNITY LISTENING SESSIONS (TWO IN ENGLISH, ONE IN SPANISH). TO IDENTIFY THE PERCEIVED HEALTH NEEDS, CHALLENGES TO ACCESSING SERVICES, CURRENT STRENGTHS AND ASSETS, AND OPPORTUNITIES FOR ACTION IN THE COMMUNITY. THE CNHA PROCESS WAS GUIDED BY THE COMMUNITY BENEFIT ADVISORY COMMITTEE OF 44 COMMUNITY PROVIDER STAKEHOLDERS. THIS CHNA ENGAGED OVER 1000 PEOPLE FROM ACROSS THE GREATER LAWRENCE REGION. IN CONDUCTING ITS MOST RECENT CHNA, THE HOSPITAL INCLUDED MEMBERS FROM THE COMMUNITY WHO HAVE EXTENSIVE EXPERIENCE IN MATTERS OF PUBLIC HEALTH. THIS INCLUDED LOCAL PUBLIC HEALTH OFFICIALS, CLINICAL AND SOCIAL SERVICE PROVIDERS, OTHER COMMUNITY-BASED ORGANIZATIONS, GOVERNMENT OFFICIALS, AND COMMUNITY RESIDENTS.

PART V, SECTION B, LINE 11
THE HOSPITAL IS STILL IN THE PROCESS OF ADDRESSING ALL THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA.

PART V, SECTION B, LINE 16A
HTTPS://WWW.LAWRENCEGENERAL.ORG/GETMEDIA/0B32C276-6207-4D33-8D11-BB7D060E7 978/FINANCIAL-ASSISTANCE-POLICY_ENGLISH.PDF HTTPS://WWW.LAWRENCEGENERAL.ORG/GETMEDIA/CD17E685-3AEB-46E9-863C-B4B20F282 F7E/FINANCIAL-ASSISTANCE-POLICY_SPANISH.PDF

PART V, SECTION B, LINE 16B
HTTPS://WWW.LAWRENCEGENERAL.ORG/GETMEDIA/F27C5764-EC09-471C-9881-00DDB51FA 227/SELF-PAY-DISCOUNT_ENGLISH.PDF HTTPS://WWW.LAWRENCEGENERAL.ORG/GETMEDIA/D5A72D8F-3A41-4E6A-AA84-C0B3A48E4 76B/SELF-PAY-DISCOUNT_SPANISH.PDF

PART V, SECTION B, LINE 16C
HTTPS://WWW.LAWRENCEGENERAL.ORG/GETMEDIA/D4299C26-36DE-47DD-B63F-1EC99F623 97F/PLAIN-LANGUAGE-FINANCIAL-ASSISTANCE_ENGLISH.PDF HTTPS://WWW.LAWRENCEGENERAL.ORG/GETMEDIA/83E19E4A-E24E-4A7C-BEAB-09741893C E47/PLAIN-LANGUAGE-FINANCIAL-ASSISTANCE_SPANISH.PDF

PART V, SECTION B, LINE 24
THE HOSPITAL CHARGES SELF-PAY PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE AN AMOUNT EQUAL TO THE GROSS CHARGE AMOUNT.

PART I, LINE 6A:
THE HOSPITAL FILES A REPORT EACH AND EVERY TAX YEAR WITH THE ATTORNEY GENERAL. THIS REPORT IS PUBLICALLY AVAILABLE.

PART I, LINE 7:
THE COST-TO-CHARGE RATIO WAS USED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNT USED TO CALCULATE THE AMOUNTS IN THE TABLE OF LINE 7.

PART III, SECTION A, LINE 2:
AMOUNT REPRESENTS BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS. BAD DEBT EXPENSE IS THE SUM OF (A) ACTUAL BAD DEBT WRITE-OFFS DURING THE YEAR (B) LESS RECOVERIES MADE DURING THE YEAR AND (C) ADJUSTMENTS FOR ALLOWANCES MADE AT FISCAL YEAR-END.

PART III, SECTION A, LINE 4:
THE FOOTNOTES OF THE FINANCIAL STATEMENTS DESCRIBE THE FOLLOWING: AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS RECORDED TO REPORT ACCOUNTS RECEIVABLE AT THEIR NET REALIZABLE VALUE. THE ESTIMATED LOSSES ARE BASED UPON HISTORICAL COLLECTION EXPERIENCE TOGETHER WITH A REVIEW OF THE CURRENT STATUS OF THE EXISTING RECEIVABLES.

PART III, SECTION B, LINE 8:
"THE HOSPITAL'S OPERATIONS IN ITS FISCAL YEAR 2022 WERE SIGNIFICANTLY AND NEGATIVELY IMPACTED BY THE COVID 19 PANDEMIC. WHILE THE HOSPITAL PROVIDED A SIGNIFICANT LEVEL OF INPATIENT AND EMERGENCY CARE TO PATIENTS STRICKEN BY THE DISEASE, IT REALIZED A SUBSTANTIAL LOSS FROM OPERATIONS DUE TO THE SUSPENSION OF ELECTIVE/NON - EMERGENT CARE AND A COLLATERAL LOSS OF OUTPATIENT REVENUE DUE TO DECLINES IN VOLUME IN AREAS SUCH AS PHYSICAL AND OCCUPATIONAL THERAPY, ENDOSCOPY AND IMAGING. IN TOTAL, THE HOSPITAL INCURRED A LOSS OF MORE THAN $5 MILLION IN PROVIDING CARE TO MEDICARE PATIENTS AND AN ESTIMATED LOSS OF APPROXIMATELY $1.3 MILLION PROVIDING CARE TO MEDICAID PATIENTS COVERED BY THE COMMONWEALTH OF MASSACHUSETTS FEE FOR SERVICE MASSHEALTH PLAN. HOSPITAL LOSSES FOR MEDICAID MEMBERS COVERED UNDER MASSHEALTH'S MANAGED CARE PLANS TOTALLED APPROXIMATELY $10 MILLION. THE LOSSES DESCRIBED ABOVE DO NOT REFLECT AMOUNTS RECEIVED FROM THE COMMONWEALTH OF MASSACHUSETTS TO SUPPORT OVERALL HOSPITAL OPERATIONS DUE TO LOST REVENUES AND ADDITIONAL EXPENSES EXPERIENCED AS A RESULT OF THE COVID PANDEMIC. THESE ADDITIONAL AMOUNTS INCLUDE FUNDING PROVIDED THROUGH THE COMMONWEALTH'S PARTICIPATION IN THE AMERICAN RESCUE PLAN ACT (""ARPA""). SUCH ARPA FUNDING COVERED DISRUPTION IN THE HOSPITAL'S OVERALL OPERATIONS AND NOT SOLELY LOSSES ASSOCIATED WITH THE PROVISION OF SERVICES TO PATIENTS WHOSE HEALTH INSURANCE COVERAGE IS PROVIDED UNDER TITLE XIX OF THE SOCIAL SECURITY ACT. THE HOSPITAL NOTES THE FOLLOWING SPECIFIC ITEMS OF COMMUNITY BENEFIT INCLUDED IN THIS LOSS: OF THE CLAIMED REIMBURSEMENT FOR MEDICARE BAD DEBTS ON THE AS - FILED FY 2022 COST REPORT, APPROXIMATELY $1.59 MILLION ARE ASSOCIATED WITH UNPAID COINSURANCE AND DEDUCTIBLES FOR SERVICES PROVIDED TO PATIENTS WHO ARE DUALLY ELIGIBLE FOR MEDICARE AND MEDICAID. OF THIS AMOUNT, APPROXIMATELY $555,000 WILL NOT BE REIMBURSED OWING TO THE STATUTORY THIRTY - FIVE PERCENT (35%) MANDATED BY THE BALANCED BUDGET ACT OF 1997. EFFECTIVELY THIS REPRESENTS A HOSPITAL SUBSIDY OF SERVICES PROVIDED TO PATIENTS WHOSE INSURANCE COVERAGE IS PARTLY THE RESPONSIBILITY OF TITLE XIX. GIVEN THE HIGH NUMBER OF DUAL ELIGIBLE PATIENTS WHO RECEIVE CARE AT LAWRENCE GENERAL HOSPITAL, VARIOUS ELEMENTS OF THE FEDERAL GOVERNMENT'S BUDGET ACTIONS AND CMS'S PAYMENT POLICIES FOR MEDICARE HAVE A DISPROPORTIONATE IMPACT ON THIS ORGANIZATION. HISTORICALLY THE MEDICARE PROGRAM RECOGNIZED THE ADDITIONAL COSTS ASSOCIATED WITH TREATING SUCH PATIENTS THROUGH THE DISPROPRORTIONATE SHARE HOSPITAL (DSH) ADJUSTMENT TO INPATIENT MS-DRG PAYMENTS. HOWEVER, CHANGES MANDATED BY VARIOUS PROVISIONS OF THE AFFORDABLE CARE ACT AND THE HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010 RESULTED IN REDUCTIONS IN REIMBURSEMENT FOR HOSPITALS IN STATES WHICH EXPANDED MEDICAID ELIGIBILITY AND BENEFITED HOSPITALS IN STATES WHICH DID NOT. IN THE HOSPITAL'S FY 2022 IT IS ESTIMATED THAT THESE CHANGES RESULTED IN A REIMBURSEMENT LOSS OF APPROXIMATELY $5 MILLION FROM PRE-2014 LEVELS."

PART III, SECTION B, LINE 6:
THE HOSPITAL USES THE SAME COST FINDING METHOD EMPLOYED IN THE MEDICARE COST REPORT, WHICH IS A BLEND OF RATIO OF COSTS TO CHARGES ('RCC') AND PER DIEM METHODOLOGIES.

PART III, SECTION C, LINE 9B:
SECTION V OF THE ORGANIZATION'S CREDIT AND COLLECTION POLICY OUTLINES THE COLLECTION PRACTICES OF THE ORGANIZATION.

PART VI, LINE 3 - Patient education of eligibility for assistance:
FOR THOSE PATIENTS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH THEM TO ASSIST WITH APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED PATIENTS FIND AVAILABLE AND APPROPRIATE FINANCIAL ASSISTANCE PROGRAMS, THE HOSPITAL PROVIDES PATIENTS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PROGRAMS IN BOTH THE INITIAL BILL THAT IS SENT TO PATIENTS AS WELL AS GENERAL NOTICES POSTED THROUGOUT THE HOSPITAL. THE GOAL OF THESE NOTICES IS TO ASSIST PATIENTS IN APPLYING FOR COVERAGE WITHIN A FINANCIAL ASSISTANCE PROGRAM, SUCH AS MASSHEALTH, CAREPLUS, MASSHEALTH STANDARD, AND HEALTH SAFETY NET. WHEN APPLICABLE, THE HOSPITAL MAY ALSO ASSIST PATIENTS IN APPLYING FOR COVERAGE OF SERVICES AS A MEDICAL HARDSHIP BASED ON THAT PATIENT'S DOCUMENTED INCOME AND ALLOWABLE MEDICAL EXPENSES. THE HOSPITAL WILL PROVIDE, UPON REQUEST, SPECIFIC INFORMATION ABOUT THE ELIGIBILITY PROCESS TO BE A LOW INCOME PATIENT UNDER EITHER THE MASSACHUSETTS HEALTH SAFETY NET PROGRAM. THE HOSPITAL WILL ALSO NOTIFY THE PATIENT ABOUT AVAILABLE PAYMENT PLANS THAT MAY BE AVAILABLE TO THEM BASED ON THEIR FAMILY SIZE AND INCOME. THE HOSPITAL MAKES A REASONABLE EFFORT TO IDENTIFY AVAILABLE COVERAGE OPTIONS FOR PATIENTS WHO MAY BE UNINSURED AND UNDERINSURED WITH THEIR CURRENT INSURANCE PROGRAM WHEN THE PATIENT IS SCHEDULING THEIR SERVICES WHILE THE PATIENT IS IN THE HOSPITAL, UPON DISCHARGE, AND FOR A REASONABLE TIME FOLLOWING DISCHARGE FROM THE HOSPITAL. THE HOSPITAL WILL DIRECT ALL PATIENTS SEEKING AVAILABLE COVERAGE OPTIONS, OR THOSE THAT THE HOSPITAL DETERMINES MAY BE ELIGIBLE, TO THE HOSPITAL'S PATIENT FINANCIAL COUNSELING SERVICES TO SCREEN FOR ELIGILBITY IN AN APPROPRIATE COVERAGE OPTION. THE HOSPITAL WILL THEN ASSIST THE PATIENT IN APPLYING FOR THE APPROPRIATE COVERAGE OPTIONS THAT ARE AVAILABLE OR NOTIFY THEM OF THE AVAILABILTY OF FINANCIAL ASSISTANCE THROUGH THE HOSPITAL'S OWN INTERNAL FINANCIAL ASSISTANCE PROGRAM. THE HOSPITAL WILL ALSO PROVIDE INFORMATION ON HOW TO CONTACT APPROPROPRIATE STAFF WITHIN THE HOSPITAL'S FINANCE OFFICE TO VERIFY THE ACCURACY OF THE HOSPITAL BILL OR TO DISPUTE CERTAIN CHARGES.

PART VI, LINE 7 - state filing of community benefit report:
THE HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF MASSACHUSETTS ONLY.

PART I, LINE 3C:
NOT APPLICABLE

PART I, LINE 7G:
NOT APPLICABLE

PART I, LN 7 COL(F):
NOT APPLICABLE

PART III, LINE 3:
NOT APPLICABLE

PART VI, LINE 2 - Needs Assessment:
LAWRENCE GENERAL HOSPITAL IDENTIFIES THE HEALTH CARE NEEDS IN OUR COMMUNITIES USING A NUMBER OF SOURCES, COMMUNITY AGENCIES, AND PARTNERS. WE USE FINDINGS AND REPORTS FROM THE MAYOR'S HEALTH TASK FORCE OF LAWRENCE, WHICH IS COMPRISED OF 100 PLUS LOCAL COMMUNITY & SOCIAL SERVICE AGENCIES; THE DEPARTMENT OF PUBLIC HEALTH; COMMUNITY NEEDS ASSESSMENT REPORTS ON HEALTH CARE ACCESS, DEMOGRAPHIC PROFILE OF ADULTS; HEALTH INDICATORS FOR LAWRENCE, MA; DEMOGRAPHIC INDICATORS; BREAST HEALTH REPORTS ON BREAST CANCER MORTALITY; BEHAVIORAL RISK FACTORS; DEMOGRAPHIC PROFILE OF ADULTS FOR THE REGION; AND CHRONIC ILLNESS REPORT FOR LAWRENCE, MA. IN ADDITION, WE CONDUCT INTERNAL PATIENT SURVEYS AND CONTINUALLY ASSESS THIS DATA, AS WELL AS DATA AVAILABLE THROUGH SOURCES SUCH AS MASSCHIP, BEHAVIORAL RISK FACTOR SURVEY DATA, QUALITY BENCHMARKING DATA, DPH REPORTS ON RACIAL AND ETHNIC HEALTH DISPARITIES OR PERIODIC BIRTH STATISTICS AND MARKET DATA. WE ALSO SOLICIT COMMUNITY INPUT THROUGH COMMUNITY SURVEYS, WEB AND SOCIAL NETWORKING SITE COMMUNICATIONS AND A LARGE NETWORK OF NEARLY 30 COMMUNITY CONTACTS VIA OUR VERY ACTIVE PATIENT-FAMILY ADVISORY COUNCIL. OTHER MEANS OF FEEDBACK AND INPUT INCLUDE COMMUNITY FOCUS GROUPS, INFORMATION SUPPLIED BY PUBLIC HEALTH PERSONNEL, LGH VOLUNTEERS AND TRUSTEES, AND FEEDBACK FROM LGH STAFF. COMMUNITY HEALTH NEEDS ASSESSMENT TO VERIFY THAT LAWRENCE GENERAL IS ACHIEVING ITS MISSION AND MEETING THE NEEDS OF THE COMMUNITY, THE HOSPITAL PARTNERED WITH THE GREATER LAWRENCE FAMILY HEALTH CENTER TO COMPLETE A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN THE SPRING AND SUMMER OF 2022 (TAX YEAR 2021). THE LAWRENCE GENERAL HOSPITAL CHNA FOCUSED ON THE LARGEST COMMUNITIES WITHIN THE GREATER LAWRENCE AREA INCLUDING LAWRENCE, METHUEN, HAVERHILL, ANDOVER AND NORTH ANDOVER. THE CHNA EFFORT ENGAGED NEARLY 1000 PEOPLE FROM ACROSS THE GREATER LAWRENCE REGION. LGH AND GLFHC ENGAGED JOHN SNOW, INC. (JSI), A NON-PROFIT PUBLIC HEALTH CONSULTANCY ORGANIZATION, TO CONDUCT THE 2022 CHNA. THE CHNA INCLUDED REVIEWING EXISTING SOCIAL, ECONOMIC, AND HEALTH DATA OF THE MERRIMACK VALLEY REGION AS WELL AS CONDUCTING A PUBLIC SURVEY AND IN DEPTH DISCUSSIONS WITH PROVIDERS, COMMUNITY-BASED ORGANIZATIONAL LEADERS, AND RESIDENTS TO IDENTIFY THE PERCEIVED HEALTH NEEDS OF THE COMMUNITY, CHALLENGES TO ACCESS SERVICES, THE CURRENT STRENGTHS AND ASSETS, AND OPPORTUNITIES FOR ACTION. THE CHNA USED A PARTICIPATORY, COLLABORATIVE APPROACH TO LOOK AT HEALTH IN ITS BROADEST CONTEXT. THE ASSESSMENT PROCESS INCLUDED: SYNTHESIZING EXISTING DATA ON SOCIAL, ECONOMIC, AND HEALTH INDICATORS IN THE REGION; ADMINISTERING A PUBLIC SURVEY COMPLETED BY 750 RESPONENTS; AND CONDUCTING 4 FOCUS GROUPS, 3 COMMUNITY LISTENING SESSIONSAND 25 KEY STAKEHOLDER INTERVIEWS TO IDENTIFY THE PERCEIVED HEALTH NEEDS, CHALLENGES TO ACCESSING SERVICES, CURRENT STRENGTHS AND ASSETS, AND OPPORTUNITIES FOR IMPROVEMENT IN THE COMMUNITY. THE LAWRENCE GENERAL CHNA INCORPORATES DATA ON IMPORTANT SOCIAL, ECONOMIC, AND HEALTH INDICATORS PULLED FROM VARIOUS SOURCES, INCLUDING THE UNITED STATES CENSUS BUREAU AMERICAN COMMUNITY SURVEY 5-YEAR (2016-2020), THE UNITED STATES DEPARTMENT OF AGRICULTURE ECONOMIC RESEARCH SERVICE DATASET (2019), TAX ASSESSOR (ATTOM) PROPERTY TAX RATE DATASET (2021), EPA SMART LOCATION DATABASE (2019), HOUSING AND URBAN DEVELOPMENT COMPREHENSIVE HOUSING AFFORDABILITY STRATEGY DATA (2014-2018), EVICTION LAB DATA (2016), CENTERS FOR DISEASE CONTROL BRFSS PLACES (2019) AND LIFE EXPECTANCY DATA (2010-2015), HRSA PRIMARY CARE SERVICE AREA DATA (2010). PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND WERE PRIORITIZED BY THE CBAC ARE LISTED BELOW: . SOCIAL DETERMINANTS OF HEALTH . BEHAVIORAL HEALTH . ACCESS TO CARE . CHRONIC AND COMPLEX CONDITIONS AND THEIR RISK FACTORS . SYSTEMIC AND ORGANIZATION RACISM (IMPACTING ALL ABOVE DOMAINS) DEMOGRAPHIC AND ECONOMIC DISPARITIES PERSIST IN THE REGION AND SOCIAL DETERMINANTS OF HEALTH DISPROPORTIONALY BURDEN LOWER-INCOME COMMUNITIES OF COLOR. ANDOVER AND NORTH ANDOVER HAVE REMAINED AFFLUENT WHILE COMMUNITIES SUCH AS LAWRENCE, METHUEN AND HAVERHILL CONTINUE TO EXPERIENCE LOWER MEDIAN INCOMES AND HIGHER RATES OF POVERTY AND UNEMPLOYMENT. SOCIAL DETERMINANTS SUCH AS THE LACK OF AFFORDABLE HOUSING, TRANSPORTATION, HEALTHY FOOD, CHILDCARE OPTIONS, HIGH RATES OF COMMUNITY AND DOMESTIC VIOLENCE, AND LOW RATES OF EDUCATIONAL ATTAINMENT ARE ALL LINKED TO RESIDENTS' ABILITY TO ACCESS AND MAINTAIN HIGHER-PAYING JOBS WITH BENEFITS AND ENJOY ECONOMIC SECURITY. AND LOW HEALTH LITERACY RELATED TO LOWER EDUCATIONAL ATTAINMENT ALL HAVE A NEGATIVE IMPACT ON OVERALL RESIDENT HEALTH. CHNA PARTICIPANTS NOTED AN INCREASED AWARENESS THAT RACSIM AND DISCRIMINATION ARE ALSO POWERFUL SOCIAL DETERMINANTS OF HEALTH, EXACERBATING THOSE ALREADY LISTED ABOVE, AND HOW THIS DISPROPORTIONATELY IMPACTS THE HEALTH AND WELLNESS OF RESIDENTS OF COLOR. BEHAVIORAL HEALTH CONTINUES TO BE A TOP CONCERN. BEHAVIORAL HEALTH CHALLENGES SUCH AS ANXIETY, DEPRESSION, AND SUICIDAL IDEATION HAVE INCREASED OVERALL, BUT ESPECIALLY AMONG YOUTH, EXACERBATED BY TRAUMA AS THE RESULT OF EXPOSURE TO VIOLENCE, ADVERSE CHILDHOOD EXPERIENCES, AND POVERTY. SUBSTANCE USE DISORDER, PARTICULARLY OPIOID AND ALCOHOL ABUSE, ALSO CONTINUE TO BE TOP CONCERNS. SURVEY RESPONDENTS ALSO NOTED THE NEED FOR MORE CRISIS OUTREACH AND BETTER CARE COORDINATION AND TRANSITIONS BETWEEN BEHAVIORAL HEALTH CARE SETTINGS SUCH AS THE EMERGENCY DEPARTMENT, INPATIENT FACILITIES, AND COMMUNITY PROVIDERS. ACCESS TO CARE CONTINUES TO BE A CONCERN ALONGSIDE NEW CONCERNS FOR HEALTHCARE SYSTEM CAPACITY IN THE WAKE OF THE COVID-19 PANDEMIC. WHILE THE COST OF CARE AND LACK OF INSURANCE CONTINUE TO PRESENT BARRIERS TO THOSE SEEKING HEALTHCARE, RESPONDENTS SHARED NEW BARRIERS TO ACCESS INCLUDING MISTRUST OF HEALTHCARE SYSTEMS AND PROVIDERS (ESPECIALLY AMONG PATIENTS OF COLOR), ONGOING LINGUISTIC AND CULTURAL BARRIERS, AND DIFFICULTY NAVIGATING THE HEALTHCARE SYSTEM ITSELF. ADDITIONALLY, RESPONDENTS IDENTIFIED NEW CONCERNS AROUND THE CAPACITY OF THE HEALTHCARE SYSTEM ITSELF IN THE WAKE OF HEALTHCARE WORKERS LEAVING THE PROFESSION AND HEALTHCARE FACILITIES STRUGGLING TO FILL VACANCIES, LEADING TO LONGER WAIT TIMES AND LACK OF CAPACITY TO TAKE ON NEW PATIENTS. CHRONIC AND COMPLEX CONDITIONS AND THEIR RISK FACTORS CONTINUE TO BE A CONCERN FOR RESIDENTS, WITH NEW CONCERNS ABOUT INFECTIOUS DISEASES HIGH RATES OF OBESITY, LIMITED OPPORTUNITIES FOR PHYSICAL EXERCISE, LOW ACCESS TO HEALTHY FOODS, AND BARRIERS NOTED ABOVE THAT KEEP LOWER-INCOME RESIDENTS FROM OBTAINING TIMELY PREVENTATIVE CARE ALL CONTRIBUTE TO HIGH RATES OF DIABETES, CARDIOVASCULAR DISEASE, AND CANCER. NOTED BY CHNA PARTICIPANTS WAS THE NEED FOR MORE CULTURALLY APPROPRIATE EDUCATION ABOUT AND SUPPORT FOR PREVENTING AND MANAGING CHRONIC DISEASES. PUBLIC HEALTH NURSES IN PARTICULAR NOTED A RISE IN INFECTIOUS DISEASES (BEYOND COVID-19) AS COMMUNITY HEALTH THREATS, INCLUDING TUBERCOLUSIS, HIV, STDS, AND LOW INFLUENZA VACCINATION RATES.

PART VI, LINE 4 - Community information:
LAWRENCE GENERAL HOSPITAL IS LOCATED IN LAWRENCE, MASSACHUSETTS, BUT SERVES THE ENTIRE MERRIMACK VALLEY REGION. THE VALLEY IS A BI-STATE REGION ALONG THE MERRIMACK RIVER IN THE STATES OF NEW HAMPSHIRE AND MASSACHUSETTS, WITH LAWRENCE GENERAL SERVING THE SOUTHERN TIP OF THE NH VALLEY, AND ALL OF THE MA VALLEY AREA. THE MERRIMACK RIVER IS ONE OF THE LARGER WATERWAYS IN THE NEW ENGLAND REGION AND HAS HELPED DEFINE THE LIVELIHOOD AND CULTURE OF THOSE LIVING ALONG IT SINCE NATIVE TIMES. MAJOR CITIES IN THE MERRIMACK VALLEY INCLUDE LOWELL, LAWRENCE, HAVERHILL, METHUEN AND NEWBURYPORT IN MASSACHUSETTS. THE MERRIMACK VALLEY WAS A MAJOR CENTER OF THE TEXTILE INDUSTRY IN AMERICA DURING THE 19TH CENTURY. LAWRENCE HAS ALWAYS BEEN A MULTI-ETHNIC AND MULTICULTURAL GATEWAY CITY WITH A HIGH PERCENTAGE OF FOREIGN-BORN RESIDENTS. THE SUCCESSIVE WAVES OF IMMIGRANTS COMING TO LAWRENCE TO WORK IN THE MILLS BEGAN WITH THE IRISH, FOLLOWED BY THE FRENCH CANADIANS, ENGLISHMEN, AND GERMANS IN THE LATE 1800'S. AROUND THE TURN OF THE CENTURY AND EARLY 1900'S, ITALIANS, POLES, LITHUANIANS, AND SYRIANS BEGAN ARRIVING. THE WAVE OF PUERTO RICANS AND DOMINICANS STARTED IN THE MID TO LATE 1900'S, AND THE NEWEST ARRIVALS HAVE ORIGINATED FROM VIETNAM AND CAMBODIA. THE CURRENT POPULATION IS LARGELY HISPANIC AND HAS GIVEN A LATINO SLANT TO THE LOCAL ECONOMY AND CULTURE. CURRENTLY, LAWRENCE'S TOTAL POPULATION IS APPROXIMATELY 89,000 (CENSUS BUREAU APRIL 1, 2020 ESTIMATE), OF WHICH ROUGHLY 81% ARE OF LATINO DESCENT, MAINLY FROM THE DOMINICAN REPUBLIC AND PUERTO RICO. TODAY, LAWRENCE REMAINS AN URBAN CENTER WITH A SIGNIFICANT PART OF ITS ECONOMY STILL MANUFACTURING-BASED. DESPITE GLOBAL TRENDS THAT HAVE SEEN MANUFACTURING INDUSTRIES MOVE SOUTH AND OVERSEAS, THE CITY IS STILL A HUB OF TEXTILE, APPAREL AND SHOE COMPANIES SUCH AS MALDEN MILLS, KGR INC., GRIECO BROTHERS, NEW BALANCE AND CARDINAL SHOE. WITH THE AFFORDABLE SPACE AND CLOSE PROXIMITY TO I-93 AND I-95, NEWER COMPANIES IN TECHNOLOGY, HEALTH CARE AND MANUFACTURING SUCH AS NEW ENGLAND AFFILIATED TECHNOLOGY, THE ROBERT ABLE COMPANY AND THE GEM GROUP, HAVE CHOSEN TO LOCATE IN LAWRENCE. LAWRENCE, MA IS A COLORFUL CITY WITH SIGNIFICANT CHALLENGES. ONCE A THRIVING CITY AND THE HUB OF THE U.S. TEXTILE INDUSTRY, THE CITY OF LAWRENCE IS STILL STRUGGLING TO RECOVER FROM THE DEVASTATING ECONOMIC DECLINE IT SUFFERED WHEN THE MILLS BEGAN TO CLOSE IN THE 1960'S. TODAY, THE CITY IS A DENSELY POPULATED, IMPOVERISHED AREA WITH HIGH LEVELS OF UNEMPLOYMENT, HIGH RATES OF CRIME, ILLITERACY, AND AGING HOUSING, AS WELL AS DRUG USE AND ITS RELATED VIOLENCE. NEARLY ONE HALF OF THE HOUSEHOLDS IN LAWRENCE CAN BE CLASSIFIED AS POOR, BASED ON THE FEDERAL POVERTY LEVEL. IN 2017 THE MA DEPARTMENT OF PUBLIC HEALTH IDENTIFIED LAWRENCE PUBLIC SCHOOLS AS HAVING ONE OF THE HIGHEST STUDENT RATES OF OBESITY IN THE STATE, AT 45%. AT THE TIME OF THIS REPORT, THE MA DEPARTMENT OF PUBLIC HEALTH HAS NOT UPDATED THIS DATASET. AS THE PREVALENCE OF OBESITY HAS BEEN LINKED TO THE ECONOMIC HARDSHIP OF A COMMUNITY, THE CITY OF LAWRENCE CONTINUES TO BE AT RISK. THESE FINDINGS INDICATE THAT LAWRENCE'S CONSIDERABLE POPULATION OF LOW-INCOME, LATINO CHILDREN ARE MORE LIKELY TO SUFFER FROM OBESITY BECAUSE OF THE MANY BARRIERS TO HEALTHY EATING AND ACTIVE LIFESTYLES. FOR INSTANCE, URBAN RESIDENTS OFTEN LACK CONSISTENT ACCESS TO HEALTHY FOOD CHOICES AND SAFE PLACES FOR PHYSICAL ACTIVITY IN THEIR NEIGHBORHOODS. ADDITIONALLY, MANY LAWRENCE PUBLIC SCHOOLS HAVE LIMITED SPACE AND NO DESIGNATED GYMNASIUM, AND THEREFORE, NO FORMAL PHYSICAL EDUCATION PROGRAMS FOR THEIR STUDENTS. APPROXIMATELY 40% OF THE PATIENTS THAT LAWRENCE GENERAL TREATS ARE ON SOME TYPE OF GOVERNMENT ASSISTANCE PROGRAM OR NEED FINANCIAL ASSISTANCE WITH THEIR MEDICAL COSTS. AS A RESULT, LAWRENCE GENERAL PROVIDED OVER $9.6M IN CHARITABLE CARE AND COMMUNITY BENEFITS TO PERSONS WHO WOULD NOT OTHERWISE BE ABLE TO AFFORD QUALITY HEALTHCARE IN FY2022. OTHERWISE BE ABLE TO AFFORD QUALITY HEALTHCARE IN FY2022.

PART VI, LINE 6 - affiliated health care system:
"LAWRENCE GENERAL HOSPITAL IS PART OF LAWRENCE GENERAL HOSPITAL & AFFILIATES. THERE ARE EIGHT AFFILIATES WITHIN THIS SYSTEM AS OF 9-30-2022, INCLUDING: LGH HEALTH ENTERRISES, INC. THIS ENTITY IS A FOR-PROFIT HEALTHCARE MANAGEMENT COMPANY LOCATED IN LAWRENCE, MASSACHUSETTS. THIS ENTITY PROVIDES HEALTHCARE MANAGEMENT SERVICES. COMMUNITY MEDICAL ASSOCIATES, INC. THIS ENTITY IS A NOT-FOR-PROFIT MULTI-SPECIALITY CARE PHYSICIAN PRACTICE GROUP LOCATED IN LAWRENCE, MASSACHUSETTS. LGH PHYSICIAN ASSOCIATES, P.C. THIS ENTITY IS A FOR-PROFIT MANAGEMENT COMPANY LOCATED IN LAWRENCE, MASSACHUSETTS. THIS ENTITY PROVIDES MANAGEMENT SERVICES TO LOCAL AREA PHYSICIAN GROUPS. LGH CHARITABLE TRUST, INC. THIS ENTITY IS A NOT-FOR-PROFIT CHARITABLE FOUNDATION LOCATED IN LAWRENCE, MASSACHUSETTS. THIS ENTITY ACTS ON BEHALF OF THE HOSPITAL FOR ALL OF ITS' FUNDRAISING INITIATIVES. LGH ADMINISTRATIVE SERVICES, INC. THIS ENTITY IS A NOT-FOR PROFIT QUALIFED ACTIVE LOW INCOME COMMUNITY BUSINESS (""QALICB"") LOCATED IN LAWRENCE, MASSACHUSETTS. THIS ENTITY WAS CREATED FOR PURPOSES OF NEW MARKET TAX CREDIT TRANSACTION THAT FUNDED THE CONSTRUCTION OF A SURGICAL BUILDING. MERRIMACK VALLEY HEALTH SERVICES, INC. THIS ENTITY IS A NOT-FOR PROFIT PROVIDES MEDICAL IMAGING SERVICES AT AN OFFSITE LOCATION IN ANDOVER AND ALSO AT LAWRENCE GENERAL HOSPITAL IN LAWRENCE, MASSACHUSETTS. MERRIMACK VALLEY IN MOTION, LLC THIS ENTITY IS A FOR-PROFIT LIMITED LIABILITY COMPANY (LLC) LOCATED IN LAWRENCE, MASSACHUSETTS. THIS ENITY PROVIDES MANAGEMENT AND PROFESSIONAL SERVICES TO LGH IN CONNECTION WITH CERTAIN OUTPATIENT REHABILITATION CLINICS. LAWRENCE INTEGRATED HEALTH PROVIDER NETWORK, LLC (""LIHPN"") THIS ENTITY IS A DISREGARDED LIMITED LIABILITY COMPANY (LLC) LOCATED IN LAWRENCE, MASSACHUSETTS. LIHPN IS A CLINICALLY INTEGRATED NETWORK FOR PROVIDER MEMBERS AND PROVIDES CARE COORDINATION FOR PATIENTS."

PART VI, LINE 5 - promotion for community health:
"LAWRENCE GENERAL HOSPITAL HAS A STRONG HISTORY OF ASSISTING CHILDREN AND FAMILIES IN NEED. PROUDLY RECOGNIZED AS THE ONLY NOT-FOR-PROFIT COMMUNITY HOSPITAL SERVING THIS REGION, THE INSTITUTION REMAINS TRUE TO ITS ORIGINAL MISSION. FOR MORE THAN 140 YEARS, LGH HAS CARED FOR AND IMPROVED THE HEALTH STATUS OF THE RESIDENTS OF THE MERRIMACK VALLEY REGION, PARTICULARLY LAWRENCE, ONE OF THE POOREST CITIES IN MASSACHUSETTS. IN A CITY WITH SO MUCH NEED, LGH HAS BUILT AN IMPRESSIVE TRADITION OF QUALITY AND EXCELLENCE IN HEALTH CARE WHILE CONTINUING ITS COMMITMENT TO PROVIDE CARE TO EVERYONE WHO ENTERS ITS DOORS IN SPITE DECLINING REIMBURSEMENTS. IN THE PAST 5 YEARS, LGH HAS INCREASED THE QUALITY OF ITS CARE AND EXPANDED ITS BREADTH OF SERVICES AVAILABLE LOCALLY, WHILE ENSURING THE AFFORDABILITY OF THAT CARE. EVEN DURING A YEAR IN WHICH COVID NEGATIVELY IMPACTED VOLUME WITH THE SUSPENSION OF ELECTIVE PROCEDURES AND SOME OUTPATIENT SERVICES, THE HOSPITAL PROVIDED 361,631, INPATIENT ADMISSIONS, OBSERVATION STAYS AND OUTPATIENT VISITS, EXCLUSIVE OF COVID TESTING AND VACCINATION SERVICES. LGH IS NOW THE ONLY LOCALLY-CONTROLLED, NOT-FOR-PROFIT HOSPITAL IN THE CENTRAL MERRIMACK VALLEY WITH A BOARD OF TRUSTEES FROM OUR REGION. AS THE LARGEST PRIVATE EMPLOYER IN LAWRENCE, LGH IS LICENSED FOR 186 BEDS AND IS STAFFED BY NEARLY 2000 EMPLOYEES AND MORE THAN 500 PHYSICIANS REPRESENTING OVER 40 SPECIALTIES. THE HOSPITAL'S CLINICAL STRENGTHS INCLUDE A 24-HOUR EMERGENCY DEPARTMENT AND LEVEL III TRAUMA CENTER; A DEDICATED INTENSIVE CARE UNIT; ADVANCED SURGICAL CENTER; INPATIENT PEDIATRIC CENTER; WOMEN'S HEALTH SERVICES; IMAGING CENTER; CARDIAC SERVICES; SLEEP CENTER; BIRTHING CENTER; DAY SURGERY CENTER; BARIATRIC CENTER; COMMUNITY CANCER PROGRAM; OUTPATIENT PHYSICAL THERAPY CENTER; AND AN ADVANCED LIFE SUPPORT EMS PROGRAM. ALL OF THESE SERVICES CREATE A HEALTH SAFETY NET FOR THE CITY OF LAWRENCE AND THE SURROUNDING COMMUNITIES. LGH AFFILIATED WITH STEWARD HEALTH CARE. THIS CLINICAL AFFILIATION WAS DEVELOPED TO ENHANCE PROGRAMS AND SERVICES AVAILABLE IN THE GREATER MERRIMACK VALLEY, INCREASE LOCAL ACCESS TO SPECIALTIES OF STEWARD MEDICAL GROUP, AND IMPROVE THE COORDINATION OF CARE. IN RECENT YEARS, THE HOSPITAL HAS ADDED MANY NEW SPECIALISTS AND/OR SPECIALTY CLINICS TO BETTER SERVE THE MERRIMACK VALLEY REGION. THE HOSPITAL WORKS CLOSELY WITH PRIVATE PRACTICE PHYSICIANS AND GREATER LAWRENCE FAMILY HEALTH CENTER TO INCREASE THE BREADTH OF SERVICES AVAILABLE LOCALLY, WHILE DECREASING OVERALL HEALTH CARE COSTS. IN ORDER TO FACILITATE BETTER ACCESS TO CHILDREN'S MEDICAL SERVICES, WE HAVE A CLINICAL AFFILIATION WITH Floating Hospital for Children at Tufts Medical Center. IN AN EFFORT TO EASE THE STRESS AND HARDSHIP OF FAMILIES WITH SICK CHILDREN AND TO PROVIDE THE BEST IN PEDIATRIC CARE, OUR PEDIATRIC CARE CENTER IS STAFFED BY FLOATING HOSPITAL ""HOSPITALISTS"" WHO OVERSEE INPATIENT PEDIATRIC CARE. HIGHLY-TRAINED PEDIATRIC SPECIALISTS FROM Floating Hospital for Children at Tufts Medical Center ARE ALSO AVAILABLE AT A PEDIATRIC SPECIALTY CLINIC IN LAWRENCE THROUGH OUR AFFILIATION AGREEMENT. LAWRENCE GENERAL MAINTAINS AN ACTIVE AND ENTHUSIASTIC PATIENT FAMILY ADVISORY COMMITTEE TO FURTHER INCORPORATE THE COMMUNITY VOICE INTO OUR HOSPITAL OPERATIONS. THE HOSPITAL BOARD OF TRUSTEES, WHO LIVE AND WORK IN THE LOCAL COMMUNITY ALSO PARTICIPATE, AND THE SENIOR MANAGEMENT OF THE HOSPITAL ENSURES IMPLEMENTATION OF PLANS AND MONITORS PROGRESS. THE HOSPITAL'S CONTINUOUS AND ENHANCED QUALITY IMPROVEMENT PROCESS ALSO PROVIDES ANOTHER SOURCE FOR THE IDENTIFICATION OF NEEDS. OPPORTUNITIES FOR IMPROVEMENT ARE IDENTIFIED THROUGHOUT THE ORGANIZATION, AND THE BOARD OF TRUSTEES HELPS DETERMINE ANNUAL PRIORITIES. LAWRENCE GENERAL HAS MANY ENGAGED AND ENTHUSIASTIC PARTNERS IN THE COMMUNITY, AND BY WORKING WITH THE ONES LISTED BELOW (AS WELL AS OTHERS), LAWRENCE GENERAL HOSPITAL IS ABLE TO PROMOTE, FOSTER AND DELIVER IMPROVED HEALTH AND WELLNESS TO THE ENTIRE MERRIMACK VALLEY REGION: ACT Lawrence Agespan (formerly Elder Services of the Merrimack Valley) American Cancer Society American College of Radiology (ACR) American Heart Association American Red Cross American Training Andover Coalition for Public Education Andover Public Schools Asthma & Allergy Foundation Baldpate Hospital: Detox/Residential/Outpatient Substance Abuse Services Boys & Girls Club of Greater Lawrence Children's Hospital of Boston City of Lawrence Column Health Community Cancer Program Dana Farber Cancer Institute/Commonwealth Hematology & Oncology Danvers Treatment Center/Lahey Behavioral Health Clinical Stabilization Services Daybreak Shelter Diabetes Today Coalition Edgewood Retirement Community Essex County Community Foundation Family Services of the Merrimack Valley Floating Hospital for Children at Tufts Medical Center Foster Kids of Merrimack Valley Genesis Healthcare Corporation Greater Lawrence Family Health Center (GLFHC) Greater Lawrence Family Residency Groundwork Lawrence Habit OPCO Hampstead Hospital: Detox/Residential/Outpatient Substance Abuse Services Health Care For All Tufts Medicine at Home Housing Families Jackson Lumber Work Health Initiative Kiwanis Club of Lawrence L&M Radiology Lawrence Community Works Lawrence Council on Aging Lawrence Family Development Charter School Lawrence Fire Department Lawrence High School Lawrence History Center Lawrence Public Schools Lawrence Rotary Club Lawrence Senior Center Lazarus House Lynn Transitional Support Services/Lahey Behavioral Health March of Dimes Mary Immaculate Health Care Services Massachusetts Department of Public Health Mass General Hospital (Pediatric Cardiology) MassCONNECT Collaborators Mayor's Health Task Force The Office of Mayor Brian A. De Pea, City of Lawrence Merrimack College Merrimack Valley Assisted Living Facilities Merrimack Valley Chamber of Commerce Merrimack Valley Community Development Committee Merrimack Valley Food Bank Merrimack Valley Habitat for Humanity Merrimack Valley Health Services Merrimack Valley Senior Centers Merrimack Valley Skilled Nursing Facilities Merrimack Valley YMCA Methuen Health and Rehab Center Nevins Family Services Northern Essex Community College Notre Dame High School Notre Dame Adult Learning Center North Andover Athletic Association North Andover Public Schools Northeast Center for Healthy Communities Northeast Independent Living Northeast Rehabilitation NeuroCare Option Care/ Walgreens Patient Family Advisory Council Penacook Place Pentucket Medical Associates Professional Center for Child Development Psychological Center Schwartz Center for Compassionate Healthcare Tobacco Free Community Partnership Top Notch Scholars Transitions Program/Lahey Behavioral Health Post Detox/Pre-Recovery/Tewksbury Tufts Medical Center United Way of the Merrimack Valley Whittier Rehab Hospital Wingate Healthcare Services YWCA of Lawrence"