4A (Expenses $ 1988028093 including grants of $ 1989108) (Revenue $ 2208588881)
UMASS MEMORIAL MEDICAL CENTER UMASS MEMORIAL MEDICAL CENTER IS COMMITTED TO IMPROVING THE HEALTH OF THE PEOPLE OF CENTRAL NEW ENGLAND THROUGH EXCELLENCE IN CLINICAL CARE, SERVICE, TEACHING AND RESEARCH. UMASS MEMORIAL MEDICAL CENTER DOES THIS BY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE RESIDENTS OF CENTRAL NEW ENGLAND WITHOUT REGARD TO THEIR ABILITY TO PAY. FY 2022 KEY STATISTICS - TOTAL DISCHARGES: 35,939 TOTAL SURGICAL ENDOSCOPY CASES: 46,363 TOTAL ER VISITS: 123,820

4B (Expenses $ 583143473 including grants of $ 6612750) (Revenue $ 480630402)
UMASS MEMORIAL MEDICAL GROUP THE UMASS MEMORIAL MEDICAL GROUP IS A MULTISPECIALTY GROUP PRACTICE OF PHYSICIANS WHOSE MISSION AND PURPOSE IS TO SUPPORT THE CLINICAL, EDUCATIONAL, RESEARCH AND COMMUNITY SERVICE MISSIONS OF UMASS MEMORIAL HEALTH CARE AND UMASS MEMORIAL MEDICAL CENTER. UMASS MEMORIAL MEDICAL GROUP ACCOMPLISHES THIS MISSION BY PROVIDING MEDICAL CARE TO RESIDENTS OF CENTRAL NEW ENGLAND WITHOUT REGARD TO THEIR ABILITY TO PAY.

4C (Expenses $ 293212989 including grants of $ 186455) (Revenue $ 414421902)
OTHER UMASS MEMORIAL ENTITIES - UMASS MEMORIAL HAS A NUMBER OF SUBSIDIARY ENTITIES THAT FUNCTION PRIMARILY TO DELIVER HEALTH CARE TO PATIENTS OR TO SUPPORT THE DELIVERY OF HEALTH CARE TO PATIENTS OF UMASS MEMORIAL. THEY ACCOMPLISH THIS THROUGH THE DELIVERY OF HEALTH CARE SERVICES WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. THEY ALSO ACCOMPLISH THIS BY PROVIDING SUPPORT, OR PATIENT ADVOCACY SERVICES TO THE PATIENTS OF UMASS MEMORIAL, CENTRAL NEW ENGLAND, AND OTHER GEOGRAPHIES.

4D (Expenses $ 290933010 including grants of $ 8715) (Revenue $ 307746918)
UMASS MEMORIAL COMMUNITY HOSPITALS THE UMASS MEMORIAL COMMUNITY HOSPITALS (CLINTON HOSPITAL, HEALTH ALLIANCE HOSPITALS, INC., MARLBOROUGH HOSPITAL) ARE COMMITTED TO IMPROVING THE HEALTH OF THE PEOPLE OF THE COMMUNITIES THAT THEY SERVE THROUGH EXCELLENCE IN CLINICAL CARE AND SERVICE. EACH OF THESE HOSPITALS ACCOMPLISHES THIS GOAL BY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE RESIDENTS OF THEIR COMMUNITIES WITHOUT REGARD TO THEIR ABILITY TO PAY. FY 2022 KEY STATISTICS - TOTAL DISCHARGES: 10,147 TOTAL SURGICAL ENDOSCOPY CASES: 11,161 TOTAL ER VISITS: 79,852

Schedule H, Part V, Section B, Line 3E
Yes, the significant health needs identified in the CHNA are a prioritized description of the significant health needs of the community.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - UMASS MEMORIAL MEDICAL CENTER. YES, INPUT FROM DIVERSE PERSONS WHO REPRESENT THE COMMUNITY WAS TAKEN INTO ACCOUNT. UMASS MEMORIAL MEDICAL CENTER JOINED EFFORTS WITH THE WORCESTER DIVISION OF PUBLIC HEALTH (WDPH), FALLON HEALTH, THE HANOVER INSURANCE GROUP AND THE COALITION FOR A HEALTHY GREATER WORCESTER WHICH SERVED IN AN ADVISORY ROLE IN THE DEVELOPMENT OF ITS 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE DIRECTOR OF THE WDPH, UMASS MEMORIAL VICE PRESIDENT OF COMMUNITY RELATIONS, THE DIRECTOR OF COMMUNITY RELATIONS AND THE DIRECTOR OF GOVERNMENT AFFAIRS AND PUBLIC POLICY, FALLON HEALTH AND THE ASSISTANT VICE PRESIDENT OF COMMUNITY RELATIONS, HANOVER INSURANCE GROUP CO-CHAIRED THE LEADERSHIP PROCESS TO DEVELOP A CHNA AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR THE GREATER WORCESTER REGION. DURING THE ASSESSMENT PROCESS, COMMUNITY MEMBERS WERE ENGAGED IN KEY INFORMANT INTERVIEWS, FOCUS GROUPS, AND CHIP COMMUNITY CONVERSATIONS, WHICH ALLOWED FOR COMMUNITY MEMBERS TO PROVIDE THEIR FEEDBACK AND PRIORITIZATION ON COMMUNITY HEALTH-RELATED STRENGTHS, NEEDS, AND A VISION FOR THE FUTURE. THE CHNA PROCESS GATHERED EXTENSIVE QUANTITATIVE DATA FROM FEDERAL, STATE, AND LOCAL SOURCES FOR THE CITY OF WORCESTER, AND THE OUTLYING COMMUNITIES OF SHREWSBURY, GRAFTON, MILLBURY AND WEST BOYLSTON. THESE SESSIONS GATHERED CRITICAL COMMUNITY INPUT FROM SERVICE PROVIDERS, COMMUNITY LEADERS AND NEIGHBORHOOD RESIDENTS WITH AN EMPHASIS ON ENGAGING AT-RISK POPULATIONS AS WELL AS SERVICE PROVIDERS REPRESENTING FIELDS INCLUDING; BEHAVIORAL HEALTH PROVIDERS, HEALTH PROVIDERS FOR ETHNIC AND LINGUIST MINORITIES, PEOPLE WITH DISABILITIES, ELDERS AND PUBLIC HEALTH OFFICIALS. THE CHNA ENSURED THAT THE GREATER WORCESTER COMMUNITY WAS REPRESENTED IN ALL ITS DIVERSE ASPECTS: BUSINESS, EDUCATION, COMMUNICATIONS, TRANSPORTATION, HEALTH AND WELLNESS, FAITH-BASED GROUPS, PHILANTHROPIC ORGANIZATIONS, CIVIC AND GOVERNMENT, VULNERABLE POPULATIONS (DISABLED, SENIORS, ETC.), AND OTHER ORGANIZATIONS AND SPECIALIZED AREAS. COMPLETION OF THE CHNA INCLUDED INPUT FROM HUNDREDS OF INDIVIDUALS WHO PARTICIPATED IN 45 INTERVIEWS, NINE FOCUS GROUPS AND A SERIES OF CHIP COMMUNITY CONVERSATIONS IN WHICH A TOTAL OF 97 PEOPLE WERE INTERVIEWED THROUGH 35 1-ON-1 AND SMALL GROUP DISCUSSIONS (ALL OF WHICH WERE HELD VIRTUALLY DUE TO COVID). PARTICIPANTS INCLUDED REPRESENTATIVES OF HEALTH AND SOCIAL SERVICE ORGANIZATIONS, PUBLIC HEALTH DEPARTMENTS, ACADEMIC INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS AND ADVOCACY GROUPS, RESIDENTS AS WELL AS BUSINESSES LEADERS AND INDIVIDUALS WHO LIVE AND WORK IN THE COMMUNITY. IN ADDITION, A TOTAL OF 909 PEOPLE COMPLETED A WEB-BASED COMMUNITY HEALTH SURVEY THAT WAS ADMINISTERED BY THE WORCESTER DIVISION OF PUBLIC HEALTH (WDPH). THE SURVEY WAS OPEN TO ALL INDIVIDUALS WHO LIVE, WORK AND PLAY IN GREATER WORCESTER AND WAS IMPLEMENTED AS A WAY TO GATHER INFORMATION FROM POPULATIONS THAT MAY HAVE NOT BEEN CONNECTED TO OTHER ASSESSMENT ACTIVITIES. THE CHNA SPONSORS WORKED WITH WDPH STAFF TO CRAFT A SURVEY THAT WAS ACCESSIBLE AND EASY TO UNDERSTAND. IT WAS MADE AVAILABLE IN THREE LANGUAGES (ENGLISH, SPANISH, VIETNAMESE) AND DISTRIBUTED WIDELY THROUGH A RANGE OF MEANS INCLUDING: * BOARDS OF HEALTH IN THE CHNA SERVICE AREA * MONTHLY NEWSLETTERS TO TOWNS * EMPLOYEE NEWSLETTERS BY ALL PARTNER ORGANIZATIONS * POSTINGS ON PARTNER FACEBOOK PAGES AND SOCIAL MEDIA PLATFORMS * E-NEWSLETTER DISTRIBUTION BY THE COALITION FOR A HEALTHY GREATER WORCESTER TO APPROXIMATELY 850 COMMUNITY MEMBERS AND ORGANIZATIONS (SENT THREE TIMES AND POSTED ON SOCIAL MEDIA) * THE WORCESTER TOGETHER COALITION INCLUDING OVER 150 MEMBERS * OTHER EMAIL DISTRIBUTION LISTS AND AT COMMUNITY OUTREACH EVENTS, SUCH AS THE UMASS MEMORIAL COVID-19 FEET ON THE STREET, COVID TESTING, AND VACCINATION SITES. THE INFORMATION GATHERED THROUGH THESE EFFORTS ENABLED THE CHNA FACILITATORS TO ENGAGE THE COMMUNITY AND GAIN A BETTER UNDERSTANDING OF THE REGION'S CAPACITY, STRENGTHS, AND WEAKNESSES, AS WELL AS HEALTH STATUS, BARRIERS TO CARE, SERVICE GAPS AND UNDERLYING DETERMINANTS OF HEALTH. WHILE IT WAS NOT POSSIBLE FOR THIS ASSESSMENT TO INVOLVE ALL COMMUNITY STAKEHOLDERS, IT ENGAGED A COMPREHENSIVE AND INCLUSIVE SAMPLE OF THE POPULATION; THOSE INVOLVED SHOWED COMMITMENT TO STRENGTHENING THE REGION'S HEALTH SYSTEM, PARTICULARLY FOR PEOPLE MOST AT-RISK. SECONDARY AND PRIMARY DATA FROM MULTIPLE SOURCES WAS UTILIZED IN THE COMPLETION OF THE CHNA AND SPECIAL ATTENTION WAS GIVEN TO SOCIAL AND ECONOMIC INDICATORS. THE RESULTS OF THESE EFFORTS WERE SYNTHESIZED IN THE CHNA REPORT AND WERE ANNOUNCED PUBLICLY TO APPROXIMATELY 200 COMMUNITY STAKEHOLDERS AT THE COALITION FOR A HEALTHY GREATER WORCESTER'S ANNUAL MEETING HELD VIRTUALLY ON MARCH 23, 2021. TO PROVIDE A COMPREHENSIVE PORTRAIT OF THE REGION AND SET THE FOUNDATION FOR THE GREATER WORCESTER COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP).

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - UMASS MEMORIAL MEDICAL CENTER. UMASS MEMORIAL CONDUCTED THE CHNA IN COLLABORATION WITH THE WORCESTER DIVISION OF PUBLIC HEALTH, FALLON HEALTH AND THE HANOVER INSURANCE GROUP. ADDITIONAL ENGAGED STAKEHOLDERS INCLUDED: * ANSAAR OF WORCESTER * CENTRAL WEST JUSTICE CENTER * CITY OF WORCESTER ACCESSIBILITY ADVISORY COMMISSION * CITY OF WORCESTER MAYOR'S MENTAL HEALTH TASK FORCE * CLARK UNIVERSITY; COMMUNITY DEVELOPMENT AND PLANNING * COALITION FOR A HEALTHY GREATER WORCESTER * COMMUNITY LEGAL AID * EDWARD M. KENNEDY HEALTH CENTER * FAMILY HEALTH CENTER OF WORCESTER * HOPE COALITION * LATIN AMERICAN HEALTH ALLIANCE * LEGENDARY LEGACIES, INC. * MASSACHUSETTS COLLEGE OF PHARMACY * MAYOR'S MENTAL HEALTH TASK FORCE WORCESTER TOGETHER: MENTAL HEALTH COMMITTEE * MUSLIM COMMUNITY LINK * OPEN SKY COMMUNITY SERVICES * OURSTORY EDUTAINMENT * QUINSIGAMOND COMMUNITY COLLEGE * RELIANT MEDICAL GROUP * SAINT VINCENT HOSPITAL * SUMMIT ELDERCARE * THE SOUTHEAST ASIAN COALITION * TOWN OF SHREWSBURY * UMASS CHAN MEDICAL SCHOOL * UMASS MEMORIAL COMMUNITY HEALTHLINK * UMASS MEMORIAL MEDICAL CENTER: INTERPRETER SERVICES * WORCESTER COMMON GROUND * WORCESTER FAMILY RESOURCE CENTER * WORCESTER REGIONAL CHAMBER OF COMMERCE * WORCESTER REGIONAL ENVIRONMENTAL COUNCIL * WORCESTER REGIONAL RESEARCH BUREAU * WORCESTER STATE UNIVERSITY * WORCESTER TOGETHER COALITION * WORCESTER TOGETHER UNDOCUMENTED WORKING GROUP * WORCESTER TOGETHER: FOOD INSECURITY FOOD ACCESS * WORCESTER TOGETHER: LOGISTICS COMMITTEE * WORCESTER TOGETHER: MENTAL HEALTH COMMITTEE * WORCESTER TOGETHER: OLDER ADULTS WORKING GROUP * YOUTHCONNECT * YWCA OF CENTRAL MASSACHUSETTS

Schedule H, Part V, Section B, Line 7 Facility , 1
Facility , 1 - UMASS MEMORIAL MEDICAL CENTER. THE CHNA WAS PUBLICLY ANNOUNCED TO THE COMMUNITY AT AN EVENT ATTENDED BY APPROXIMATELY 200 COMMUNITY STAKEHOLDERS AT THE COALITION FOR A HEALTHY GREATER WORCESTER'S ANNUAL MEETING HELD VIRTUALLY ON MARCH 23, 2021 TO PROVIDE A COMPREHENSIVE PORTRAIT OF THE REGION AND SET THE FOUNDATION FOR THE CHIP. THE CHNA WAS ADDITIONALLY PUBLICIZED THROUGH VARIOUS VENUES INCLUDING COMMUNICATIONS OF THE COALITION FOR A HEALTHY GREATER WORCESTER (CHNA-8), A HEALTHY COMMUNITIES COALITION.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - UMASS MEMORIAL MEDICAL CENTER. THE HOSPITAL CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT IN 2021 AND DEVELOPED ITS COMMUNITY BENEFITS STRATEGIC IMPLEMENTATION STRATEGY. THE PRIORITIZATION PROCESS OF IDENTIFIED COMMUNITY HEALTH NEEDS WAS LED BY THE WORCESTER DIVISION OF PUBLIC HEALTH, FALLON HEALTH, THE HANOVER INSURANCE GROUP AND THE HOSPITAL VICE PRESIDENT OF COMMUNITY BENEFITS AND INCLUDED INPUT FROM COMMUNITY STAKEHOLDERS. THE HOSPITAL'S COMMUNITY BENEFIT STRATEGIC IMPLEMENTATION STRATEGY ALIGNS WITH THE PRIORITY FINDINGS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND THE GREATER WORCESTER COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE OTHER NEEDS THAT ARE NOT INCLUDED IN THE CHNA/CHIP ARE NOT BEING ADDRESSED BECAUSE THEY ARE NOT A PART OF THE IDENTIFIED PRIORITY CHIP DOMAIN AREAS AND DUE TO LIMITED FUNDING. COMMUNITY BENEFITS TARGET POPULATIONS ARE IDENTIFIED THROUGH A COMMUNITY INPUT AND PLANNING PROCESS INCLUDING A RANGE OF FOCUS GROUPS, KEY STAKEHOLDER INTERVIEWS, FORUMS AND SURVEYS. THIS INCLUDES THE CHNA PROCESS AND THE DEVELOPMENT OF A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) TO ADDRESS THE PRIORITY AREAS IDENTIFIED IN THE CHNA. PRIORITY AREAS IDENTIFIED IN THE 2021 CHNA ARE: * SOCIAL DETERMINANTS OF HEALTH, INCLUDING: FOOD INSECURITY, HOUSING, TRANSPORTATION/ACCESSIBILITY, CULTURAL AND LINGUISTIC BARRIERS, SOCIOECONOMICS * MENTAL HEALTH, INCLUDING: DEPRESSION, STRESS, TRAUMA, SOCIAL ISOLATION, SERIOUS MENTAL ILLNESS * SUBSTANCE USE, INCLUDING: ALCOHOL, TOBACCO, E-CIGARETTES, OPIOIDS AND OTHER PRESCRIPTION DRUGS, MARIJUANA * CHRONIC/COMPLEX CONDITIONS AND THEIR RISK FACTORS, INCLUDING: OBESITY, PHYSICAL ACTIVITY, NUTRITION, ASTHMA, DIABETES, CARDIOVASCULAR DISEASE, NEUROLOGICAL CONDITIONS, CANCER, DISABILITIES * RACISM, DISCRIMINATION, AND HEALTH EQUITY: A CROSS-CUTTING PRIORITY THAT AFFECTS BARRIERS TO CARE, HEALTH OUTCOMES, AND HEALTH DISPARITIES IN EACH OF THE OTHER PRIORITY AREAS UMMMC ADDRESSED THESE PRIORITY AREAS THROUGH THE FOLLOWING PROGRAMS AND EFFORTS IN 2022: * UMASS MEMORIAL HAS PROVIDED ONGOING SUPPORT SINCE 2008 FOR THE COALITION FOR A HEALTHY GREATER WORCESTER, A HEALTHY COMMUNITIES COALITION, THAT PLAYS A LEADERSHIP ROLE IN ORGANIZING CHIP WORKING GROUPS FOR EACH OF THE CHNA PRIORITY AREAS AND IN SECURING SIGNIFICANT FUNDING FOR COMMUNITY HEALTH IMPROVEMENT EFFORTS SUCH AS SECURING A $3.5 MILLION CENTERS FOR DISEASE CONTROL REACH GRANT FOCUSED ON LATINO HEALTH. SOCIAL DETERMINANTS OF HEALTH: ACCESS TO CARE: UMMMC OPERATES THE RONALD MCDONALD CARE MOBILE PROGRAM: A MOBILE CLINIC ESTABLISHED IN 2000 PROVIDING MEDICAL AND PREVENTIVE DENTAL SERVICES IN 10 LOCAL LOW INCOME NEIGHBORHOODS AND 24 INNER-CITY ELEMENTARY SCHOOLS IN WORCESTER. PATIENTS ARE SERVED REGARDLESS OF INSURANCE STATUS AND ASSISTED IN ENROLLMENT INTO A MEDICAL AND DENTAL HOME AND CONNECTION TO SOCIAL SUPPORT SERVICES. THE PROGRAM PLAYS A CRITICAL ROLE IN ADDRESSING THE HIGH LEVEL OF TOOTH DECAY DUE TO A LACK OF FLUORIDE IN THE CITY'S WATER SUPPLY. DUE TO THE COVID-19 PANDEMIC, BEGINNING IN APRIL 2020 AND CONTINUING INTO 2022, THE CARE MOBILE PIVOTED TO CONDUCTING COVID-19 EDUCATION AND OUTREACH ON SAFETY PROTOCOLS, PROPER MASKING, HAND HYGIENE AND ADMINISTERED OVER 12,000 COVID-19 VACCINES IN NEIGHBORHOODS OF COLOR MOST AFFECTED BY THE VIRUS. REGULAR CARE MOBILE OPERATIONS RESUMED IN APRIL 2022. * ORAL HEALTH TASK FORCE: IS COORDINATED AND SUPPORTED BY THE UMMMC CARE MOBILE PROGRAM TO ENSURE THAT AMONG TASK FORCE PROVIDERS, PREVENTIVE DENTAL SERVICES ARE DELIVERED TO AT-RISK CHILDREN IN PUBLIC AND CHARTER SCHOOLS. COLLABORATORS INCLUDE WORCESTER PUBLIC SCHOOLS, TWO COMMUNITY HEALTH CENTERS, A COMMUNITY COLLEGE, MDPH AND A COLLEGE OF PHARMACY. * COMMUNITYHELP: AN ONLINE TECHNOLOGY PLATFORM TO IMPROVE ACCESSIBILITY OF COMMUNITY RESOURCE INFORMATION AND SOCIAL DETERMINANTS OF HEALTH. A COLLABORATIVE EFFORT WITH RELIANT MEDICAL GROUP, THE PLATFORM CAN BE VIEWED IN MULTIPLE LANGUAGES AND LINKS PATIENTS WITH NEEDED COMMUNITY RESOURCES. * MEDICAL-LEGAL PARTNERSHIP: A PARTNERSHIP WITH UMMMC'S LEGAL DEPARTMENT AND COMMUNITY LEGAL AID, INC. THAT ASSISTS MEDICAID-ELIGIBLE, SOCIALLY COMPLEX PATIENTS IN ADDRESSING A WIDE ARRAY OF SOCIAL DETERMINANTS OF HEALTH NEEDS. THE PROGRAM LEVERAGES PRO-BONO, PRIVATE LEGAL SERVICES WITH LAW FIRMS TO ADDRESS MULTIPLE SOCIAL FACTORS. DURING THE COVID PANDEMIC, THE MLP IMPLEMENTED REMOTE SERVICES. THE MLP STAFF ATTORNEY OFFERED VIRTUAL CLINIC HOURS TO EACH OF THE FOUR CLINICS. IN 2022, 182 REFERRALS TO LEGAL SERVICES WERE MADE TO PRO-BONO ATTORNEYS. * HEALTH INSURANCE ENROLLMENT ASSISTANCE: IS PROVIDED BY OUR FINANCIAL COUNSELORS TO IMPROVE ACCESS TO HEALTH CARE. ABOUT 8,500 PEOPLE RECEIVE HEALTH INSURANCE ENROLLMENT ASSISTANCE EACH YEAR. MENTAL HEALTH: * WORCESTER ADDRESSES CHILDHOOD TRAUMA (WORCESTER ACTS): A UNIQUE, COMMUNITY-WIDE COMMUNITY HEALTH WORKER (CHW) RESILIENT HOME VISITING PROGRAM FOR CHILDREN THAT HAVE EXPERIENCED OR WITNESSED ADVERSE CHILDHOOD EXPERIENCES (ACES). AS A MEANS OF REDUCING FUTURE VIOLENCE, THIS INTERVENTION INTRODUCES A CLINICAL RESPONSE AT THE POINT OF A TRAUMA, AS SOON AS POSSIBLE AFTER AN INCIDENT INVOLVING POLICE. THE EFFORT IS A PARTNERSHIP AMONG THE WORCESTER POLICE DEPARTMENT (WPD), YWCA, COMMUNITY HEALTHLINK (A UMMMC MENTAL HEALTH PROVIDER), UMASS MEDICAL SCHOOL CHILD TRAUMA CENTER, UMMHC CHILD PROTECTION PROGRAM, WDPH, AND CLARK UNIVERSITY. SUBSTANCE USE: * HEALTHY OPTIONS FOR PREVENTION AND EDUCATION (H.O.P.E.) COALITION PEER LEADERS: A YOUTH/ADULT PARTNERSHIP STARTED IN 2002 THAT ADDRESSES PUBLIC HEALTH CONCERNS AFFECTING AT-RISK YOUTH, INCLUDING TOBACCO AND ALCOHOL USE, VIOLENCE AND ACCESS TO MENTAL HEALTH. H.O.P.E. PEER LEADERS CO-CHAIR THE YOUTH SUBSTANCE ABUSE PREVENTION TASK FORCE WITH THE WDPH. * UMMMC PROVIDES MEDICAL SERVICES AT THE HECTOR REYES HOUSE: A RESIDENTIAL SUBSTANCE ABUSE TREATMENT PROGRAM FOR LATINO MEN PROVIDING ON-SITE MEDICAL CARE, COGNITIVE BEHAVIORAL THERAPY AND JOB TRAINING TO REDUCE RELAPSE. SERVES 80 MEN ANNUALLY INCLUDING RETURNING CLIENTS RECEIVING ONGOING CARE. CHRONIC/COMPLEX CONDITIONS AND THEIR RISK FACTORS: * UMMMC ESTABLISHED AND CO-CHAIRS A CITY-WIDE PEDIATRIC ASTHMA HOME VISITING INTERVENTION TO REDUCE SCHOOL ABSENTEEISM, HOSPITALIZATIONS, AND ED USE AMONG HIGH-RISK ASTHMATIC CHILDREN IN WORCESTER WHERE RATES OF PEDIATRIC ASTHMA-RELATED ED VISITS ARE DOUBLE THAT OF THE STATE. THE PARTNERSHIP INCLUDES ALL WORCESTER PUBLIC SCHOOLS (WPS)/HEAD START PROGRAMS, TWO COMMUNITY HEALTH CENTERS AND THE CITY'S HEALTHY HOMES OFFICE. THIS COMMUNITY/CLINICAL LINKAGE MODEL UTILIZES TRAINED, COMMUNITY HEALTH WORKERS (CHW) TO ADDRESS ASTHMA TRIGGERS IN THE HOME. CHWS PROVIDE EDUCATION TO ADDRESS MEDICATION ADHERENCE. REFERRALS ARE MADE TO COMMUNITY RESOURCES AND COMMUNITY LEGAL AID (CLA) TO RESOLVE HOME TRIGGERS THAT REQUIRE LANDLORD REMEDIATION ACTIONS. DUE TO THE COVID-19 PANDEMIC, BEGINNING IN MARCH OF 2020 AND CONTINUING IN 2022, THE PROGRAM DISCONTINUED IN-PERSON HOME VISITS AND ADAPTED BY CONDUCTING HOME VISITS VIA ZOOM AND FACETIME. ACCESS TO HEALTHY FOOD/HUNGER/FOOD INSECURITY: UMASS MEMORIAL PROVIDES FUNDING TO KEY COMMUNITY STAKEHOLDERS ADDRESSING FOOD INSECURITY AND ACCESS TO HEALTHY FOODS. THESE INCLUDE: * THE WORCESTER REGIONAL ENVIRONMENTAL COUNCIL'S URBAN AGRICULTURAL PROGRAM THAT PROVIDES YOUTH JOBS, LEADERSHIP DEVELOPMENT AND PRODUCE FOR A VEGGIE MOBILE THAT ADDRESSES FOOD INSECURITY ACROSS THE CITY. * UMMMC COMMUNITY BENEFITS STAFF ALSO SERVE AS A MEMBER OF THE WORCESTER FOOD POLICY COUNCIL (WFPC) STEERING COMMITTEE THAT CONVENES THE CHIP ACCESS TO HEALTHY FOODS WORK GROUP TO PROMOTE HEALTHY WEIGHT/HEALTHY EATING AND IMPROVE NUTRITION IN DISTRESSED, FOOD INSECURE NEIGHBORHOODS THROUGH POLICY. TO IMPROVE ACCESS TO HEALTHY FOOD FOR UNDERSERVED, FOOD DESERT AREAS THE COUNCIL WORKS ON A RANGE OF ISSUES INCLUDING HEALTHY FOOD RETAIL, SNAP/HEALTHY INCENTIVES PROGRAM (HIP), MINIMUM WAGE, AND EXPANDING URBAN AGRICULTURE OPPORTUNITIES. * UMMMC COMMUNITY BENEFITS STAFF IS ALSO PART OF THE FOOD IS MEDICINE MASSACHUSETTS (FIMMA) STATE PLANNING EFFORT BEING LED BY THE HARVARD UNIVERSITY CENTER FOR HEALTH LAW AND POLICY INNOVATION AND COMMUNITY SERVINGS THAT DEVELOPED A STRATEGIC PLAN TO FIND WAYS TO INCREASE ACCESS TO MEDICALLY-TAILORED FOODS AND IMPROVE THE AVAILABILITY OF PREPARED NUTRITIOUS FOOD FOR ECONOMICALLY-DISADVANTAGED PATIENTS BEING DISCHARGED FROM A HOSPITAL. IN 2022, COMMUNITY BENEFITS STAFF CONTINUED TO SERVE ON THE FIMMA STEERING, PROVIDER EDUCATION, OLDER ADULT AND OTHER FIMMA COMMITTEES.

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - UMASS MEMORIAL MEDICAL CENTER. FINANCIAL ASSISTANCE - UMASSMEMORIAL MEDICAL CENTER EMPLOYS A STAFF OF FINANCIAL COUNSELORS, CERTIFIED APPLICATION COUNSELORS, CUSTOMER SERVICE REPRESENTATIVES AND GUARANTOR COLLECTORS WHO ARE AVAILABLE BY PHONE OR BY APPOINTMENT TO SUPPORT PATIENTS IN APPLYING FOR FINANCIAL ASSISTANCE AND RESOLVING THEIR MEDICAL BILLS. FINANCIAL COUNSELORS, CERTIFIED APPLICATION COUNSELORS, CUSTOMER SERVICE REPRESENTATIVES AND GUARANTOR COLLECTORS PROVIDE POTENTIALLY ELIGIBLE PATIENTS WITH THE APPROPRIATE METHODS OF APPLYING FOR HEALTH CARE COVERAGE AS LISTED ON THE MASSACHUSETTS CONNECTORCARE WEBSITE

Schedule H, Part V, Section B, Line 3E
The significant health needs identified in the CHNA are a prioritized description of the significant health needs of the community.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - UMASS MEMORIAL - HEALTHALLIANCE-CLINTON HOSPITAL. HEALTHALLIANCE - CLINTON HOSPITAL COMMUNITY BENEFITS WORKED IN COLLABORATION WITH THE HEALTH EQUITY PARTNERSHIP OF NORTH CENTRAL MA (FORMERLY CHNA9), NORTH CENTRAL REGION STAKEHOLDERS, RESIDENTS, GRASSROOTS MINORITY LED ORGANIZATIONS, AND THE MONTACHUSETT PUBLIC HEALTH NETWORK TO LEAD THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (APPROVED IN OCTOBER OF 2021) AND TO IMPLEMENT THE HOSPITAL'S COMMUNITY BENEFITS IMPLEMENTATION PLAN 2019-2021. THE HOSPITAL HAS A ROBUST COMMUNITY BENEFITS IMPLEMENTATION PLAN THAT HAS BEEN WORKING TO ADDRESS MANY OF THE ISSUES IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT. HOWEVER, THIS ASSESSMENT HAS PROVIDED NEW INSIGHT INTO THE CHARACTERISTICS OF THE POPULATION, RISKY BEHAVIORS, AND DISEASE BURDEN, AS WELL AS COMMUNITY ATTITUDES AND PERCEPTIONS THAT HAVE ALLOWED REFINEMENT OF THE HOSPITAL'S COMMUNITY BENEFITS STRATEGIC IMPLEMENTATION PLAN. STAFF AT MRPC AND BOTH DIRECTORS FROM EACH HOSPITAL HELD 18 FOCUS GROUPS WITH PUBLIC/PRIVATE SECTOR LEADERS AND COMMUNITY MEMBERS ACROSS VARIOUS HEALTHALLIANCE-CLINTON COMMUNITIES. ALL FOCUS GROUPS WERE CONDUCTED VIRTUALLY VIA ZOOM TO ENSURE SAFETY OF PARTICIPANTS DURING THE PANDEMIC. AN MRPC STAFF MEMBER TYPICALLY FACILITATED QUESTIONING AND CONVERSATION FOR THE SESSION. THIS ACTIVITY ALLOWS FOR THE COLLECTION OF MORE TARGETED AND NUANCED INFORMATION FROM SEGMENTS OF THE POPULATION WHO ARE DEEMED MOST AT-RISK AND THE KEY SERVICE PROVIDERS WHO SERVE THESE POPULATIONS AND ARE CRITICAL TO COMMUNITY HEALTH IMPROVEMENT. FOCUS GROUPS (1) AUGMENT FINDINGS FROM SECONDARY DATA AND KEY INFORMANT INTERVIEWS AND (2) ALLOW FOR EXPLORATION OF STRATEGIC AND PROGRAMMATIC OPTIONS TO ADDRESS IDENTIFIED HEALTH ISSUES, SERVICE GAPS, AND/OR BARRIERS TO CARE. ONE THOUSAND- THREE HUNDRED SURVEYS WERE ALSO DISTRIBUTED IN THE HOSPITAL'S CATCHMENT AREA. THE SURVEYS ALLOWED TO CAPTURE INFORMATION DIRECTLY FROM COMMUNITY RESIDENTS AND, TO SOME EXTENT, REPRESENTATIVES FROM LOCAL SERVICE PROVIDERS OR COMMUNITY ORGANIZATIONS. INPUT IS CAPTURED FROM RESIDENTS ON (1) COMMUNITY HEALTH NEEDS AND PRIORITIES, (2) SERVICE SYSTEM GAPS, (3) BARRIERS TO CARE ACROSS A WIDE ARRAY OF HEALTH-RELATED SERVICE AND COMMUNITY RESOURCE DOMAINS (E.G., HEALTH, HOUSING, TRANSPORTATION, SAFETY, FOOD ACCESS). THE SURVEYS ARE CRITICAL TO FULFILLING A COMPREHENSIVE COMMUNITY ENGAGEMENT PLAN AND WILL SUPPORT THE DEVELOPMENT OF A SOUND AND OBJECTIVE HEALTH NEEDS ASSESSMENT THAT WILL BE USED TO DEVELOP PROGRAMS THAT REDUCE DISPARITIES AND IMPROVE HEALTH STATUS.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - UMASS MEMORIAL - HEALTHALLIANCE-CLINTON HOSPITAL. THE HOSPITAL'S 2021 CHNA WAS DEVELOPED THROUGH A COLLABORATIVE PROCESS INVOLVING HEYWOOD HEALTH CARE.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - UMASS MEMORIAL - HEALTHALLIANCE-CLINTON HOSPITAL. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH INPUT FROM OUR COMMUNITY PARTNERS INCLUDING: THE NORTH REGION HEALTH EQUITY PARTNERSHIP COALITION (FORMERLY CHNA9), COMMUNITY HEALTH CONNECTIONS, THE JOINT COALITION ON HEALTH, NORTH REGION HOMELESSNESS TASK FORCE, AND THE MONTACHUSETT PUBLIC HEALTH NETWORK.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - UMASS MEMORIAL - HEALTHALLIANCE-CLINTON HOSPITAL. THE HOSPITAL CONDUCTED IT'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2021 AND DEVELOPED ITS COMMUNITY BENEFITS STRATEGIC IMPLEMENTATION STRATEGY. THE CHNA INCLUDED A PRIORITIZATION PROCESS THAT IDENTIFIED THE MOST PRESSING NEEDS THAT OFFER OPPORTUNITIES TO PARTNER AND LEVERAGE RESOURCES. THE PRIORITIZATION PROCESS WAS LED BY A STEERING COMMITTEE WITH THE SUPPORT OF THE HOSPITAL'S STAFF, CHNA ADVISORY COMMITTEE, PATIENT AND FAMILY ADVISORY COUNCILS (PFACS) AND OTHER STAKEHOLDERS AND INCLUDED INPUT FROM OVER 200 COMMUNITY STAKEHOLDERS. THE NEEDS IDENTIFIED IN THE CHNA ARE 1) HEALTH CARE ACCESS AND QUALITY, 2) SOCIAL AND COMMUNITY CONTEXT, 3) HOUSING, NEIGHBORHOOD, AND BUILT ENVIRONMENT, 4) ECONOMIC STABILITY 5) HEALTHY FOOD AND NUTRITION, 6) BEHAVIORAL HEALTH AND SUBSTANCE USE, AND 7) CHRONIC DISEASE. THE HOSPITAL'S COMMUNITY BENEFIT STRATEGIC IMPLEMENTATION STRATEGY ALIGNS WITH THE PRIORITY FINDINGS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE FOLLOWING ARE COMMUNITY ACTIVITIES / STRATEGIES, AND DETERMINATION OF NEED (DON) FUNDED PROJECTS THAT ADDRESS THE IDENTIFIED HEALTH PRIORITIES NEEDS AND WERE IMPLEMENTED DURING FY 2021: 1) HEALTH CARE ACCESS AND QUALITY: * ANCHOR MISSION: UMASS MEMORIAL HEALTH - HEALTHALLIANCE-CLINTON HOSPITAL WORKS IN COLLABORATION WITH THE SYSTEM'S ANCHOR MISSION FOCUSING ON FOUR PILLARS: LOCAL PROCUREMENT, WORKFORCE DEVELOPMENT, INVESTMENT AND VOLUNTEERISM AS A MEANS OF IMPROVING THE ECONOMIC STATUS, HEALTH, AND WELL-BEING OF VULNERABLE, LOW-INCOME POPULATIONS IN TARGETED AREAS. FOR EXAMPLE, A DIVERSE HIRING COMMITTEE WORKS WITH COMMUNITY-BASED, WORKFORCE ORGANIZATIONS SERVING VULNERABLE POPULATIONS. THE HOSPITAL'S SR. DIRECTOR OF EXTERNAL AFFAIRS AND COMMUNITY HEALTH DIRECTOR/COORDINATOR SERVES ON SEVERAL UMASS MEMORIAL HEALTH ANCHOR MISSION TASK FORCES THAT ARE WORKING WITH DIFFERENT COMMUNITY GROUPS ON WORKFORCE DEVELOPMENT NEIGHBORHOOD REVITALIZATION/HOUSING, POVERTY, AND EMPLOYEE ENGAGEMENT. * HOSPITAL FINANCIAL COUNCILOR PROGRAM: COUNCILORS ENROLL AND EDUCATE COMMUNITY MEMBERS ABOUT EXISTING HEALTH INSURANCE PLANS, ENROLLING OVER 2,000 COMMUNITY MEMBERS IN FISCAL YEAR 2022. * NORTH REGION HEALTH EQUITY PARTNERSHIP COALITION'S (FORMERLY CHNA9): AS PART OF THIS STATEWIDE EFFORT, THE HOSPITAL PARTNERS WITH HEALTH EQUITY PARTNERSHIP TO DEVELOP, IMPLEMENT AND INTEGRATE COMMUNITY PROJECTS TO EFFECTIVELY UTILIZE COMMUNITY RESOURCES TO CREATE HEALTHIER COMMUNITIES THROUGH A HEALTH EQUITY FRAMEWORK. THE HOSPITAL'S COMMUNITY BENEFIT STAFF WORKS IN COLLABORATION WITH HEALTH EQUITY PARTNERSHIP AS AN ACTIVE STEERING COMMITTEE MEMBER, HELPS TO CONVENE COMMUNITY STAKEHOLDERS TO IMPLEMENT THE CHIP, AND REVIEW GRANT PROPOSALS SUBMITTED BY NOT-FOR-PROFIT COMMUNITY-BASED ORGANIZATIONS THAT ADDRESS THE PRIORITY AREAS. * HEALTHALLIANCE-CLINTON COMMITTEE ON EQUAL OPPORTUNITY AND DEI COMMITTEE: THE HOSPITAL COORDINATED AN ACTIVE COMMITTEE OF DIVERSE COMMUNITY MEMBERS, STAKEHOLDERS, AND HOSPITAL PERSONNEL WHO MEET MONTHLY TO DEVELOP IDEAS AND IMPLEMENT STRATEGIES ON HOW TO COMBAT INSTITUTIONAL RACISM, IDENTIFY ISSUES THAT AFFECT DISADVANTAGED, UNDERSERVED POPULATIONS IN OUR COMMUNITIES, OFFERING SOLUTIONS TO IMPROVE SOCIAL DETERMINANTS OF HEALTH (SDOH) AND HEALTH CARE EXPERIENCE AT HEALTHALLIANCE-CLINTON HOSPITAL. REPRESENTATIVES OF THE DIVERSITY EQUITY INCLUSION AND BELONGING (DEIB) COMMITTEE, HELP TO ASSIST IN DEVELOPING RECOMMENDATIONS TO HOSPITAL'S SENIOR LEADERSHIP TO: - INCREASE AWARENESS OF HEALTH AND RACIAL INEQUITIES AND IMPACTS OF SOCIAL DETERMINANTS - REDUCE BARRIERS TO HEALTH CARE SERVICES AND DISPARITIES IN HEALTH OUTCOMES - PROMOTE CULTURAL SENSITIVITY AT THE HOSPITAL, THE COMMUNITY AND OTHER CLINICAL AND NON-CLINICAL PARTNERS. DUE TO A STAFFING CHANGE IN THE COMMUNITY BENEFITS OFFICE AS WELL AS A UMMH SYSTEM EFFORT TO ADDRESS DIVERSITY, EQUITY, INCLUSION AND BELONGING, HEALTHALLIANCE-CLINTON HOSPITAL IS RESTRUCTURING THIS WORK LOCALLY. SOCIAL AND COMMUNITY CONTEXT * EXPAND THE SOCIAL DETERMINANT OF HEALTH SCREENING TOOL AND COMMUNITYHELP IN THE HEALTHALLIANCE-CLINTON HOSPITAL SERVICE AREA. EFFORTS ARE UNDERWAY TO INCREASE REFERRAL OUTCOMES AS A RESULT OF SDOH SCREENING TOOLS IN INPATIENT/OUTPATIENT SETTINGS UTILIZING MEDICAL ELECTRONIC RECORDS, COMMUNITYHELP (AN ONLINE RESOURCE INVENTORY LINKING PEOPLE TO COMMUNITY RESOURCES), AND WARM HANDOFFS TO COMMUNITY PARTNERS TO INCREASE ACCESS TO COMPREHENSIVE, HIGH-QUALITY, EQUITABLE HEALTH CARE SERVICES. SPECIFICALLY, THE FITCHBURG FAMILY PRACTICE AND SIMONDS-SINON REGIONAL CANCER CENTER ARE ENGAGED IN THIS EFFORT. * FOOD AS MEDICINE IN AUGUST OF 2022, HEALTHALLIANCE-CLINTON HOSPITAL LAUNCHED THE RX FOOD FARMACY INITIATIVE AT THE SIMONDS-SINON REGIONAL CANCER CENTER IN COLLABORATION WITH GROWING PLACES AND ITS LOCAL FOOD WORKS. THIS PILOT INITIATIVE WAS MADE POSSIBLE AS THE RESULT OF $72,000 FROM PRIVATE DONATIONS TO UMMH WITH THE EXPRESS PURPOSE OF CREATING BETTER PATHWAYS FOR PATIENTS TO ACCESS FOOD AS MEDICINE. - SOCIAL DETERMINANT OF HEALTH ASSESSMENT TOOL UTILIZED TO IDENTIFY FOOD INSECURITY AMONG CANCER CENTER PATIENTS - CONDUCTED 298 SDOH SCREENINGS (AUGUST 1-DECEMBER 25, 2022) - IDENTIFY NEEDS OF PATIENTS AND MAKE APPROPRIATE FOOD AS MEDICINE REFERRALS- OF THOSE SCREENED, 10% (36) OF PATIENTS INDICATED FOOD INSECURITIES; 100% REFERRED TO NUTRITIONIST AND GROWING PLACES - FRESH FOOD RESOURCES AND SNAP/HIP SCREENINGS: 26 PATIENTS WERE PROVIDED TOKENS TO RECEIVE MONTHLY FRESH FOOD. 100% OF THOSE PATIENTS WERE SCREENED AND/OR ENROLLED FOR SNAP AND HIP BENEFITS. ONCE ENROLLED, PATIENTS CAN SIGN UP FOR MONTHLY FRESH FOOD CSA DELIVERY UTILIZING THEIR EBT CARDS. - FRESH FOOD MARKET ACCESS FOR PATIENTS: 7 MONTHLY MOBILE MARKETS WERE HELD AT THE CANCER CENTER WITH LOCALLY GROWN FRESH FOOD BETWEEN 8/1/22-11/7/22 2) HOUSING, NEIGHBORHOOD, AND BUILT ENVIRONMENT * NORTH REGION HOMELESSNESS TASK FORCE: HOSPITAL COMMUNITY BENEFITS STAFF ENGAGED IN CROSS-SECTOR COLLABORATION AND ADVOCACY EFFORTS WITH THE MA NORTH REGIONAL HOUSING NETWORK AIMING TO REDUCE HOMELESSNESS AND INCREASE HOUSING AFFORDABILITY * DON T1 FUNDING TO HELP SUPPORT HABITAT FOR HUMANITY NORTH CENTRAL MASSACHUSETTS' (NCM) HOME OWNERSHIP AND CRITICAL REPAIR PROGRAMS ADDRESS ONE OF THE LEADING SOCIAL DETERMINANTS OF HEALTH - SAFE AND AFFORDABLE HOUSING FOR FAMILIES UNDER 60% OF THE AREA MEDIAN INCOME. IN OUR STATE, ONE IN SEVEN HOUSEHOLDS SPEND MORE THAN HALF OF THEIR INCOME ON HOUSING, LEAVING THEM UNABLE TO AFFORD DECENT SHELTER AND WITH LITTLE TO SPEND ON FOOD AND HEALTH. HABITAT FOR HUMANITY'S BUILDING AND HOME REPAIR PROGRAMS PROVIDE A ""HAND UP"" TO THESE FAMILIES IN NEED. * DON T2 FUNDED UNITED WAY OF NORTH CENTRAL MASSACHUSETTS TO HELP SUPPORT FINANCIAL COACHING, PROFESSIONAL DEVELOPMENT AND ACCREDITATION FOR UP TO 8 STAFF *IMPLEMENTATION OF COMPREHENSIVE FINANCIAL COACHING AND EDUCATION SERVICES AT UP TO 4 COMMUNITY-BASED ORGANIZATIONS IN FITCHBURG/LEOMINSTER, GARDNER, AND ATHOL *DEVELOP POLICY/PROGRAMMATIC APPROACHES TO RACIAL INEQUITY. MEASURE FINANCIAL IMPROVEMENT FOR UP TO 300 HOUSEHOLDS ANNUALLY. THIS INCLUDES INCREASES IN INCOME/SAVINGS, IMPROVED CREDIT SCORES, ASSET ATTAINMENT AND/OR CHANGES IN OVERALL NET WORTH. 3) ECONOMIC STABILITY * SCHOLARSHIP FOR COLLEGE EDUCATION IN HEALTH FIELD: UMASS MEMORIAL HEALTH - HEALTHALLIANCE-CLINTON HOSPITAL PROVIDED THREE SCHOLARSHIPS TO HIGH SCHOOL GRADUATING SENIORS LIVING IN THE SERVICE AREA WHO ARE PURSUING A COLLEGE EDUCATION IN A HEALTH-RELATED FIELD. * THE FINANCIAL EMPOWERMENT CENTER ADVISORY COUNCIL: HEALTHALLIANCE-CLINTON HOSPITAL'S SR. DIRECTOR OF EXTERNAL AFFAIRS IS A MEMBER OF THE FINANCIAL EMPOWERMENT CENTER ADVISORY COUNCIL. THE COMMITTEE, COMPRISED OF REPRESENTATIVES FROM THE FINANCIAL SERVICES INDUSTRY, NON-PROFIT ORGANIZATIONS, MUNICIPALITIES, AND LOCAL EMPLOYERS, ADVISE THROUGH EQUITABLE LENS ON: - IDENTIFYING AND LEVERAGING FINANCIAL PRODUCTS FOR PRIORITIZED POPULATIONS, AREAS FOR POTENTIAL GROWTH (NEW SERVICES, PARTNERSHIPS ETC.), RESOURCE DEVELOPMENT, PERFORMANCE MANAGEMENT AND EVALUATION. * DON FUNDS SUPPORTED THE HEALTH EQUITY PARTNERSHIP (CHNA9) TO CONVENE 6 LOCAL INSTITUTIONS, INCLUDING COMMUNITY HEALTH CONNECTIONS, FITCHBURG STATE UNIVERSITY, GARDNER PUBLIC SCHOOLS, HEYWOOD HEALTHCARE, AND LUK TO FORM THE NORTH CENTRAL MASSACHUSETTS ANCHOR COLLABORATIVE. ANCHOR INSTITUTIONS ARE LARGE PLACE-BASED EMPLOYERS THAT PLAY A VITAL ROLE INVESTING IN THEIR LOCAL COMMUNITIES AND ECONOMIES. THE GOAL OF THIS EFFORT IS TO DEVELOP A COHESIVE COLLABORATIVE OF LOCAL ANCHOR ORGANIZATIONS THAT CAN SYSTEMATICALLY HAVE DIRECT IMPACTS ON GROWING AND SUSTAINING LOCAL ECONOMIC AND SOCIAL WEALTH AS WELL AS HEALTHY COMMUNITIES."

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL, INC.. UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL, INC. THE HOSPITAL EMPLOYS A STAFF OF FINANCIAL COUNSELORS, CERTIFIED APPLICATION COUNSELORS, CUSTOMER SERVICE REPRESENTATIVES AND GUARANTOR COLLECTORS WHO ARE AVAILABLE BY PHONE OR BY APPOINTMENT TO SUPPORT PATIENTS IN APPLYING FOR FINANCIAL ASSISTANCE AND RESOLVING THEIR MEDICAL BILLS. FINANCIAL COUNSELORS, CERTIFIED APPLICATION COUNSELORS, CUSTOMER SERVICE REPRESENTATIVES AND GUARANTOR COLLECTORS PROVIDE POTENTIALLY ELIGIBLE PATIENTS WITH THE APPROPRIATE METHODS OF APPLYING FOR HEALTH CARE COVERAGE AS LISTED ON THE MASSACHUSETTS CONNECTORCARE WEBSITE.

Schedule H, Part V, Section B, Line 3E
Yes, the significant health needs identified in the CHNA are a prioritized description of the significant health needs of the community.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - MARLBOROUGH HOSPITAL. TO UNDERSTAND PUBLIC PERCEPTIONS AROUND A RANGE OF HEALTH ISSUES IN THE METROWEST REGION, A COMMUNITY HEALTH SURVEY WAS DEVELOPED AND ADMINISTERED ONLINE AND VIA PAPER SURVEYS TO RESIDENTS THROUGHOUT THE 22 COMMUNITIES. THE SURVEY EXPLORED KEY HEALTH CONCERNS OF COMMUNITY RESIDENTS, ACCESS TO SERVICES, AND THEIR PRIMARY PRIORITIES FOR SERVICES AND PROGRAMMING. THE METROWEST COMMUNITY PARTNERS DISSEMINATED THE SURVEY LINK VIA THEIR NETWORKS AS WELL AS THROUGH LOCAL MEDIA. THE SURVEY WAS AVAILABLE IN ENGLISH, SPANISH, AND PORTUGUESE AND WAS ADVERTISED THROUGH LANGUAGE-SPECIFIC CHANNELS AS WELL. A TOTAL OF 799 RESPONDENTS WERE INCLUDED IN THE FINAL SAMPLE. THE MAJORITY (78.4%) OF SURVEY RESPONDENTS WERE FEMALE AND OVER HALF (55.5%) WERE AGE 50 YEARS OR OLDER. ONE QUARTER (25.2%) OF RESPONDENTS SELF-IDENTIFIED AS A MINORITY RACE/ETHNICITY, INCLUDING 13.1% WHO IDENTIFIED AS HISPANIC OR LATINO.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - MARLBOROUGH HOSPITAL. THE CHNA WAS COMPLETED IN CONJUNCTION WITH THE METROWEST MEDICAL CENTER.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - MARLBOROUGH HOSPITAL. THE CHNA WAS COMPLETED IN CONJUNCTION WITH METROWEST HEALTH FOUNDATION, METROWEST MEDICAL CENTER, HUDSON HEALTH DEPARTMENT, AND FRAMINGHAM HEALTH DEPARTMENT AND CHNA7

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - MARLBOROUGH HOSPITAL. UMASS MEMORIAL - MARLBOROUGH HOSPITAL, FY2022 COMMUNITY BENEFITS TARGET POPULATIONS ARE IDENTIFIED THROUGH A COMMUNITY INPUT AND PLANNING PROCESS INCLUDING A RANGEOF FOCUS GROUPS, KEY STAKEHOLDER INTERVIEWS, FORUMS AND SURVEYS. THIS INCLUDES THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHA) PROCESS AND THE DEVELOPMENT OF A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) TO ADDRESS THE PRIORITY AREAS IDENTIFIED IN THE CHA. THE MOST RECENT CHA WAS CONDUCTED IN 2019 AND PRIORITY AREAS IDENTIFIED IN THE 2019 CHA ARE: INCREASE AWARENESS OF SUBSTANCE USE DISORDER, MENTAL HEALTH, PROMOTE HEALTHY AGING, INCREASE ACCESS TO HEALTH CARE, PROMOTE HEALTH AND WELLNESS, SPECIFICALLY OBESITY. DUE TO THE COVID PANDEMIC, MANY OF THE INITIATIVES TO ADDRESS THESE ISSUES WERE PAUSED, EXCLUDING INCREASE ACCESS TO HEALTH CARE. MARLBOROUGH HOSPITAL ADDRESSED THIS PRIORITY THROUGH THE FOLLOWING PROGRAMS AND EFFORTS: ACCESS TO CARE *ASSISTED RESIDENTS OF THE COMMUNITY IN ENROLLING IN MASS HEALTH OR OTHER HEALTH INSURANCE PROGRAMS. ASSISTANCE IS OFFERED IN ENGLISH, SPANISH AND PORTUGUESE. *IMPROVED ACCESS TO CARE BY PROVIDING MEDICAL SERVICES TO ELDERS. ENROLLED 2737 PEOPLE INTO THE APPROPRIATE HEALTHPLANS. *ESTABLISHED VACCINATION CLINICS IN PARTNERSHIP WITH THE CITY OF MARLBOROUGH, THE TOWN OF HUDSON, THE MARLBOROUGH PUBLIC SCHOOLS, THE HUDSON PUBLIC SCHOOLS AND THE EDWARD M. KENNEDY COMMUNITY HEALTH CENTERS AND UMASS MEMORIAL HEALTH. THE GOAL OF THE CLINIC WAS TO PROVIDE VACCINE TO THE MOST VULNERABLE MEMBERS OF THE COMMUNITY, INCLUDING CHILDREN, SENIORS, UNDOCUMENTED INDIVIDUALS, INDIVIDUALS WITH LIMITED ENGLISH PROFICIENCY AT A LOCATION THAT WAS CLOSER TO WHERE THEY LIVE AND OFFERED AT MORE CONVENIENT TIMES. *PROVIDED FREE COVID TESTS TO RESIDENTS OF THE COMMUNITY IN PARTNERSHIP THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, THE CITY OF MARLBOROUGH, THE TOWN OF HUDSON. COVID TESTS WERE AVAILABLE BOTH AT THE HOSPITAL AND AT A CONVENIENT LOCATION AND WAS AVAILABLE TO ALL RESIDENTS. HEALTH INSURANCE AND DOCUMENTATION WAS NOT NECESSARY IN ORDER TO HAVE AN RT-PCR COVID TEST. PHONE CALLS WERE MADE AND RESULTS WERE PROVIDED IN ENGLISH, SPANISH AND PORTUGUESE. ANCHOR MISSION: UMASS MEMORIAL'S ANCHOR MISSION FOCUSES ON FOUR PILLARS: LOCAL PROCUREMENT, WORKFORCE DEVELOPMENT AND INVESTMENT AS A MEANS OF IMPROVING THE ECONOMIC STATUS, HEALTH AND WELL-BEING OF VULNERABLE, LOW-INCOME POPULATIONS IN TARGETED AREAS. FOR EXAMPLE, A DIVERSE HIRING COMMITTEE WORKS WITH COMMUNITY-BASED, WORKFORCE ORGANIZATIONS SERVING VULNERABLE POPULATIONS. WE HAVE SEVERAL ANCHOR MISSION TASK FORCES THAT ARE WORKING WITH DIFFERENT COMMUNITY GROUPS ON WORKFORCE DEVELOPMENT NEIGHBORHOOD REVITALIZATION/HOUSING, POVERTY AND EMPLOYEE ENGAGEMENT. THE HOSPITAL RESPONDS TO PRIORITY HEALTH NEEDS IN MANY WAYS, AND IN TIMES THAT ARE CRITICAL FOR PATIENTS IN CRISIS. IN ADDITION TO CHARITY CARE, INDIGENT CARE, A SIGNIFICANT NUMBER OF PROGRAMS AND SERVICES OFFERED ADDRESS THE PRIORITY NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IN ACCORDANCE WITH THE HOSPITAL'S COMMUNITY BENEFITS STRATEGIC IMPLEMENTATION PLAN. OUR HOSPITAL DOES NOT HAVE THE AVAILABLE RESOURCES TO DEVELOP INITIATIVES TO MEET EVERY HEALTH NEED IDENTIFIED, WHICH MAKES COLLABORATION WITH COMMUNITY ORGANIZATIONS AND STAKEHOLDERS CRITICAL.

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - MARLBOROUGH HOSPITAL. FINANCIAL ASSISTANCE - MARLBOROUGH HOSPITAL EMPLOYS FINANCIAL COUNSELORS WHO ARE AVAILABLE BY PHONE OR BY APPOINTMENT TO SUPPORT PATIENTS IN APPLYING FOR FINANCIAL ASSISTANCE AND FOR HELP RESOLVING THEIR MEDICAL BILLS. FINANCIAL COUNSELORS PROVIDE POTENTIALLY ELIGIBLE PATIENTS WITH THE APPROPRIATE METHODS OF APPLYING FOR HEALTH CARE COVERAGE AS LISTED ON THE MASSACHUSETTS CONNECTORCARE WEBSITE.

Schedule H, Part V, Section B, Line 2
EFFECTIVE JULY 1, 2021 UMASS MEMORIAL COMMUNITY HOSPITALS, INC. BECAME THE SOLE CORPORATE MEMBER OF UMASS MEMORIAL HEALTH - HARRINGTON, (HARRINGTON) (FORMERLY KNOWN AS HARRINGTON HEALTHCARE SYSTEM) THROUGH AN AFFILIATION AGREEMENT. THIS TRANSACTION ALIGNS WITH OUR REGIONAL STRATEGY TO PROVIDE HIGH QUALITY, COST-EFFECTIVE CARE TO ALL OF CENTRAL MASSACHUSETTS. HARRINGTON IS A NOT-FOR-PROFIT ORGANIZATION PROVIDING INPATIENT, OUTPATIENT AND EXTENDED CARE SERVICES TO RESIDENT IN ITS SERVICE AREA.

Schedule H, Part V, Section B, Line 3E
YES, THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - HARRINGTON MEMORIAL HOSPITAL. INPUT FROM DIVERSE PERSONS WHO REPRESENT THE COMMUNITY WAS TAKEN INTO ACCOUNT. UMASS MEMORIAL HARRINGTON HOSPITAL. THE HOSPITAL CONDUCTED KEY STAKEHOLDER INTERVIEWS AND A COMMUNITY HEALTH SURVEY WHICH ALLOWED FOR COMMUNITY MEMBERS TO PROVIDE THEIR FEEDBACK AND PRIORITIZATION ON COMMUNITY HEALTH-RELATED STRENGTHS, NEEDS, AND A VISION FOR THE FUTURE. THE CHNA PROCESS GATHERED EXTENSIVE QUANTITATIVE DATA FROM FEDERAL, STATE, AND LOCAL SOURCES FOR THE HOSPITAL'S SERVICE AREA. THESE EFFORTS GATHERED CRITICAL COMMUNITY INPUT FROM SERVICE PROVIDERS, COMMUNITY LEADERS AND NEIGHBORHOOD RESIDENTS WITH AN EMPHASIS ON ENGAGING AT-RISK POPULATIONS AS WELL AS SERVICE PROVIDERS. IN JUNE OF 2022, HARRINGTON ADMINISTERED A WEB-BASED COMMUNITY HEALTH SURVEY, OPEN TO ALL INDIVIDUALS WHO LIVE AND WORK IN THE HOSPITAL'S SERVICE AREA. HOSPITAL STAFF WORKED TO CRAFT A SURVEY THAT WAS ACCESSIBLE AND EASY TO UNDERSTAND. IT WAS DISTRIBUTED WIDELY, FROM JUNE 23RD-AUGUST 22ND, 2022. THE INFORMATION GATHERED THROUGH THESE EFFORTS ENABLED THE HOSPITAL TO ENGAGE THE COMMUNITY AND GAIN A BETTER UNDERSTANDING OF THE REGION'S CAPACITY, STRENGTHS AND WEAKNESSES, AS WELL AS HEALTH STATUS, BARRIERS TO CARE, SERVICE GAPS AND UNDERLYING DETERMINANTS OF HEALTH. WHILE IT WAS NOT POSSIBLE FOR THIS ASSESSMENT TO INVOLVE ALL COMMUNITY STAKEHOLDERS, ENGAGED A COMPREHENSIVE AND INCLUSIVE SAMPLE OF THE POPULATION; THOSE INVOLVED SHOWED COMMITMENT TO STRENGTHENING THE REGION'S HEALTH SYSTEM, PARTICULARLY FOR PEOPLE MOST AT-RISK.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - Harrington Memorial Hospital. THE HOSPITAL CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT IN 2021 AND DEVELOPED ITS COMMUNITY BENEFITS STRATEGIC IMPLEMENTATION STRATEGY. THE PRIORITIZATION PROCESS OF IDENTIFIED COMMUNITY HEALTH NEEDS WAS LED BY CHRIS CANNIFF, VP, ADMINISTRATION AND SUE FAFARD-DESROSIERS, COMMUNITY OUTREACH HEALTH EDUCATOR/ MANAGER BASED ON INPUT FROM COMMUNITY STAKEHOLDERS. A TOTAL OF OVER 1,500 PARTICIPATED IN THE CHNA PROCESS THROUGH KEY INFORMANT INTERVIEWS AND A COMMUNITY HEALTH SURVEY. THE HOSPITAL'S COMMUNITY BENEFIT STRATEGIC IMPLEMENTATION STRATEGY ALIGNS WITH THE PRIORITY FINDINGS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE OTHER NEEDS THAT ARE NOT INCLUDED IN THE CHNA/CHIP ARE NOT BEING ADDRESSED BECAUSE THEY ARE NOT A PART OF THE IDENTIFIED PRIORITY CHIP DOMAIN AREAS AND DUE TO LIMITED FUNDING. COMMUNITY BENEFITS TARGET POPULATIONS ARE IDENTIFIED THROUGH A COMMUNITY INPUT AND PLANNING PROCESS INCLUDING ROBUST INPUT THROUGH FOCUS GROUPS, KEY STAKEHOLDER INTERVIEWS AND A ROBUST COMMUNITY HEALTH SURVEY. THIS INCLUDES THE CHNA PROCESS AND THE DEVELOPMENT OF THE HOSPITAL'S COMMUNITY BENEFITS STRATEGIC IMPLEMENTATION PLAN TO ADDRESS THE PRIORITY AREAS IDENTIFIED IN THE CHNA. PRIORITY AREAS IDENTIFIED IN THE 2021 CHNA ARE: * SOCIAL DETERMINANTS OF HEALTH, INCLUDING: ECONOMIC INSECURITY, TRANSPORTATION, HOUSING, FOOD INSECURITY, CULTURAL AND LINGUISTIC BARRIERS * BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE USE, INCLUDING: DEPRESSION, STRESS, ANXIETY, TRAUMA, SOCIAL ISOLATION, SERIOUS MENTAL ILLNESS, INTERPERSONAL VIOLENCE; OPIOIDS, ALCOHOL, TOBACCO, AND MARIJUANA USE * ACCESS TO CARE, INCLUDING: AFFORDABILITY, ACCESS TO PRIMARY CARE AND BEHAVIORAL HEALTH CARE, CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE * CHRONIC/COMPLEX CONDITIONS AND THEIR RISK FACTORS, INCLUDING: HEART DISEASE AND STROKE, OBESITY, CANCER, DIABETES, AND NEUROLOGICAL CONDITIONS (E.G., ALZHEIMER'S, DEMENTIA) * HEALTH EQUITY: A CROSS-CUTTING PRIORITY THAT AFFECTS BARRIERS TO CARE, HEALTH OUTCOMES, AND HEALTH DISPARITIES IN EACH OF THE OTHER PRIORITY AREAS THE FOLLOWING CROSS-CUTTING ISSUES THAT UNDERLIE THE LEADING HEALTH PRIORITIES WERE ALSO IDENTIFIED AS NECESSARY TO ADDRESS TO IMPROVE OVERALL HEALTH STATUS AND REDUCE EXISTING DISPARITIES: * RACISM, DISCRIMINATION, AND HEALTH EQUITY * HEALTH SYSTEM ISSUES (E.G., WORKFORCE ISSUES, HEALTH LITERACY, CARE COORDINATION, HEALTH INFORMATION TECHNOLOGY, AND HEALTH INFORMATION EXCHANGE) UMASS MEMORIAL HARRINGTON HOSPITAL ADDRESSED THESE PRIORITY AREAS THROUGH THE FOLLOWING PROGRAMS AND EFFORTS IN 2022: * AT-RISK YOUTH - HARRINGTON TEEN SELF WELLNESS PROGRAM: SUPPORTED TEENS AND YOUNG ADULTS AGES 13-26 WITH WELLNESS INFORMATION INCLUDING ANTI BULLYING, HEALTHY RELATIONSHIPS, DOMESTIC VIOLENCE AND ABSTINENCE. UTILIZATION OF MOBILE UNIT ""HARRINGTON ON WHEELS"" TO PROVIDE GENERAL OUTREACH. EDUCATION IS ALSO DISTRIBUTED TO PARENTS OF TEENS AND YOUNG ADULTS. THE PROGRAM PROVIDES OUTREACH TO ADULTS AGES 13-26 ON BUILDING HEALTHY RELATIONSHIPS, SAFE SEX, ANTI-BULLYING AND OTHER WELLNESS PREVENTION EDUCATION. IN 2022, THIS PROGRAM WAS ABLE TO REACH 1150 TEENS AND YOUNG ADULTS. THIS PROGRAM WAS DPH GRANT FUNDED AND ENDED 6/30/22. NUMBERS ARE STILL IMPACTED BY COVID - 19. * NUTRITION EDUCATION: PROVIDED NUTRITION INFORMATION INCLUDING SUGAR, SALT AND FAT CONTENTS OF POPULAR FOODS AND DRINKS AS A MEANS OF IMPROVING HEALTH AND ADDRESSING CHRONIC CONDITIONS AMONG VULNERABLE POPULATIONS. PARTNERED WITH COMPLIMENTARY BODY COMPOSITION ANALYSIS SCREENING. APPROXIMATELY 480 COMMUNITY MEMBERS RECEIVED EDUCATION ON HEALTHY EATING AND HEALTHY FOOD RESOURCES IN 2022. NUMBERS ARE STILL BEING IMPACTED BY COVID - 19. * OPIOID AWARENESS EDUCATION: PROVIDED INFORMATION AND EDUCATION ON THE RISING OPIOID EPIDEMIC IN HARRINGTON'S FOOTPRINT AND HOW IT RELATES TO THE STATEWIDE DISPARITIES AND PRIORITY AREAS. PROVIDED FOCUSED EDUCATION TO THE COMMUNITY AND REFERRING AGENCIES, LAW ENFORCEMENT AND MUNICIPAL LEADERS. IN NOVEMBER 2020, HARRINGTON HOSPITAL INTRODUCED THE OPENING OF OUR NEW AIC (ADDICTION IMMEDIATE CARE) UNIT IN WEBSTER, MA. THERE WERE SEVERAL INFORMATIONAL FORUMS AND PRESENTATIONS ON HOW TO ADDRESS THE OPIOID EPIDEMIC IN OUR COMMUNITY. APPROXIMATELY 1075 INDIVIDUALS ATTENDED THE FORUMS IN 2022. NUMBERS ARE STILL BEING IMPACTED BY COVID - 19. * HEALTH EDUCATION: HANDS ONLY CPR TRAINING AND HEART DISEASE EDUCATION: PROVIDE FREE DEMONSTRATIONS AND TRAINING FOR HANDS-ONLY CPR TO COMMUNITY MEMBERS IN COLLABORATION WITH EDUCATION ABOUT HEART DISEASE AND CARDIAC ARREST SO MORE COMMUNITY MEMBERS ARE EQUIPPED TO SAVE LIVES. IN 2022, A TOTAL OF 34 COMMUNITY EVENTS WERE HELD AND 825 INDIVIDUALS WERE TRAINED IN HANDS ONLY CPR. NUMBERS ARE STILL IMPACTED BY COVID -19. * STROKE EDUCATION AND CARDIOVASCULAR HEALTH EDUCATION: EDUCATED COMMUNITY ON SYMPTOMS OF STROKE AND LIFESTYLE MODIFICATIONS TO INCREASE CARDIOVASCULAR HEALTH. OUR COMMUNITY OUTREACH TEAM WAS ABLE TO REACH 610 COMMUNITY MEMBERS IN 2022. NUMBERS ARE STILL BEING IMPACTED BY COVID - 19. * CANCER CARE SUPPORT; PROGRAMS/STRATEGIES TO ADDRESS HEALTH NEED: PROVIDED ONGOING CANCER SUPPORT TO PATIENTS AND CAREGIVERS AS WELL AS FAMILY MEMBERS IN THE SOUTH-CENTRAL MA AREA. IN 2022, EXTERNAL AND MULTIPLE INTERNAL SUPPORT GROUPS FOR PATIENTS ONLY WERE HELD AND ATTENDED BY 40-50 INDIVIDUALS. THEIR CAREGIVERS WERE ALSO OFFERED THE SAME, AND 60 PLUS INDIVIDUALS ATTENDED THESE VIRTUAL SESSIONS. THESE SESSIONS WERE HELD VIRTUALLY ONCE A MONTH FOR THE PATIENTS AND CAREGIVERS. * CANCER SURVIVORS NIGHT HARRINGTON HOSPITAL'S CANCER CENTER PROVIDED A CELEBRATORY AND INFORMATIVE DINNER AND/OR BREAKFAST TO CELEBRATE CANCER SURVIVORS OF ALL STAGES WITHIN OUR COMMUNITY. IN 2022, DUE TO SOME COVID-19 PROTOCOLS THERE HAS BEEN NO CELEBRATION SCHEDULED. * HEALTH SCREENINGS: PROVIDED FREE SKIN ANALYSIS AND SUN DAMAGE SCREENING UTILIZING A UV MACHINE LIGHT BOX. COLLABORATE EDUCATION ON SUNSCREEN LOTIONS AND SKIN CANCER. IN 2022, OUR EDUCATORS WERE ABLE TO REACH 280 INDIVIDUALS AND EDUCATE THEM REGARDING SUN DAMAGE. NUMBERS WERE STILL BEING IMPACTED BY COVID - 19."

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - HARRINGTON MEMORIAL HOSPITAL. UMASS MEMORIAL HARRINGTON HOSPITAL EMPLOYS A STAFF OF FINANCIAL COUNSELORS, CERTIFIED APPLICATION COUNSELORS, CUSTOMER SERVICE REPRESENTATIVES AND GUARANTOR COLLECTORS WHO ARE AVAILABLE BY PHONE OR BY APPOINTMENT TO SUPPORT PATIENTS IN APPLYING FOR FINANCIAL ASSISTANCE AND RESOLVING THEIR MEDICAL BILLS. FINANCIAL COUNSELORS, CERTIFIED APPLICATION COUNSELORS, CUSTOMER SERVICE REPRESENTATIVES AND GUARANTOR COLLECTORS PROVIDE POTENTIALLY ELIGIBLE PATIENTS WITH THE APPROPRIATE METHODS OF APPLYING FOR HEALTH CARE COVERAGE AS LISTED ON THE MASSACHUSETTS CONNECTORCARE WEBSITE.

Schedule H, Part V, Section B, Line 24 Facility , 1
Facility , 1 - HARRINGTON MEMORIAL HOSPITAL. ALL HOSPITAL PATIENTS ARE CHARGED ACCORDING TO THE HOSPITAL'S ESTABLISHED CHARGES FOR SERVICES. IT IS INCUMBENT UPON THE PATIENT TO AVIAL HIMSELF/HERSELF OF RELIEF THROUGH THE HOSPITAL'S UNINSURED RELIEF PROGRAM.

Schedule H, Part I RESEARCH EXPENSES
NO RESEARCH EXPENSES HAVE BEEN REPORTED ON PART I, LINE 7B

Schedule H, Part VI, Line 7 SCH H, PART VI, LINE 7
ALL FOUR HOSPITALS FILE INDIVIDUAL COMMUNITY BENEFIT REPORTS WITH THE MASSACHUSETTS ATTORNEY GENERAL'S OFFICE.

Schedule H, Part III, Line 8 Schedule H, Part III, Line 8
UMASS BELIEVES THERE ARE SEVERAL REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. FIRST, NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES OUT-OF-LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS. SECOND, BY CONTINUING TO TREAT PATIENTS ELIGIBLE FOR MEDICARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. THIRD, IRS REVENUE RULING 69-545 STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.

Schedule H, Part I, Line 7 Bad Debt Expense
Bad Debt Expense has been excluded from Financial Assistance.

Schedule H, Part V, Section B, Line 11 cont. 1: UMass Memorial HealthAlliance-Clinton hospital
4) Healthy Food and Nutrition Don Tier 3 funded Northeast Organic Association of Massachusetts which is a first-ever Germinemos and SproutChange Academy. Germinemos and SproutChange Academy offers a Train-the-Trainer program in Fitchburg, MA that helps to empower, train, and develop a new workforce in North Central MA with the knowledge, tools, and resources they need to teach Germinemos and SproutChange's philosophy and methodology on using food as medicine, natural remedies, and herbs as well as growing their own organic healing foods sustainably. (*This is part of a stewardship program that New Vue/Marc Dohan's org created) * Hospital staff works with CHNA 9's Healthy Eating and Active Living Workgroup to expand access to healthy foods and recreational opportunities in partnership with area food banks, farmers markets, community garden organizations, recreational facilities, and other community organizations 5) Behavioral Health and Substance Use * Opioid Task Force: HealthAlliance-Clinton Hospital formed an Opioid Task Force in response to the growing problem of opioids/substance use in the North Central MA region (Leominster, Fitchburg, Clinton, and surrounding towns). The Task Force aims to bring together healthcare providers, community leaders, patient advocates and community stakeholders to tackle the problem of substance and prescription drug abuse in the area by reducing opioid and addiction, preventing overdose deaths, and improving the well-being of our community. 6) Chronic/Complex Conditions and Risk Factors * WHEAT Community Cafe: Hospital supports over 700 community members access a warm nutritional meal through a feeding program at the WHEAT Community Cafe for populations living in poverty. * Determination of Need Funding: UMass Memorial Health - HealthAlliance-Clinton Hospital Community Benefits distributed Determination of Needs (DoN) funding from the hospital's emergency department capital project funds to community organizations addressing priority needs identified in the hospital's 2018 CHNA through an RPF process. These funds represent 5% of the total cost of the ED renovation as approved by the Department of Public Health on January 17, 2017. Since 2020, the Hospital has been distributing $2,350,000 in community benefits through the Determination of Needs (DoN) funding from our emergency department capital project. To date, over $1.3 million dollars has been distributed to support eligible community projects, including $511,996 during this fiscal year. This year 19 projects were funded to Health Care Access and Quality, Social and Community Context, Housing, Neighborhood and Built Environment, Economic Stability, Healthy Food and Nutrition, Behavioral Health and Chronic Disease. The remaining $1 million will be distributed over the next two years to projects that address the priority areas recently identified in the 2021-2024 Community Health Needs Assessment. DoN funds supported Community Based Organizations: Habitat for Humanity, RFK, Spanish American Center, Northeast Organic Association, JUMP, Growing Places, MOC, United Way, Boys and Girls Club, Community Foundation Central Massachusetts, Fitchburg Housing Authority, Littleton Community Farm, Literacy Volunteers of Montachusett, Clinton Public Schools, Mount Wachusett Community College, Salvation Army.

Schedule H, Part V, Section B, Line 16a Line 16c - FAP Website - UMASS MEMORIAL MEDICAL CENTER, INC
The FAP, the FAP application form, and a plain language summary of the FAP were widely available on the following website for UMASS MEMORIAL MEDICAL CENTER, INC: https://www.ummhealth.org/umass-memorial-medical-center/patients-visitors/patient-resources/financial-assistance-and-credit-and-collection-policy

Schedule H, Part V, Section B, Line 16a Line 16c - UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL
The FAP, the FAP application form, and a plain language summary of the FAP were widely available on the following website for UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL, INC: https://www.ummhealth.org/healthalliance-clinton-hospital/patients-visitors/patient-resources/financial-assistance-and-credit-and-collection-policy

Schedule H, Part V, Section B, Line 16a Line 16c - FAP Website - MARLBOROUGH HOSPITAL
The FAP, the FAP application form, and a plain language summary of the FAP were widely available on the following website for MARLBOROUGH HOSPITAL: https://www.ummhealth.org/marlborough-hospital/patients-visitors/patient-resources/financial-assistance-and-credit-and-collection-policy

Schedule H, Part V, Section B, Line 22 HARRINGTON MEMORIAL HOSPITAL
PATIENT RESPONSIBLE AMOUNTS ARE BASED ON FAMILY SIZE AND RELATIONSHIP OF THE FAMILY'S INCOME TO THE FEDERAL POVERTY GUIDELINES, PER THE HOSPITAL'S UNINSURED RELIEF POLICY. RELIEF IS AVAILABLE FOR INDIVIDUALS WHOSE FAMILY INCOME IS 400% OR LESS OF THE FEDERAL POVERTY GUIDELINES. RELIEF PROVIDED TO THE PATIENT RANGES FROM 100% RELIEF TO 20% RELIEF OF OUTSTANDING AMOUNTS DEPENDING ON FAMILITY SIZE AND INCOME LEVEL.

Schedule H, Part I, Line 7g Subsidized Health Services
NO COSTS ASSOCIATED WITH STAND-ALONE PHYSICIAN CLINICS ARE INCLUDED ON PART I, LINE 7G

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
THE COST TO CHARGE RATIO IS THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN EACH LINE IN PART 1. LINE 7.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
For patient accounts receivable after adoption of ASU 2014-09 on October 1, 2018, the estimated uncollectible amounts are generally considered implicit price concessions that are a direct reduction to patient accounts receivable rather than allowance for doubtful accounts.

Schedule H, Part III, Line 8 Community benefit methodology for determining medicare costs
THE MEDICARE COSTS ARE OBTAINED FROM THE COST REPORT FOR INPATIENT PSYCHIATRIC CAPITAL AND OUTPATIENT SERVICES. IN ADDITION, FEE BASED SERVICES, SUCH AS LABS, PT, OT, ETC, ARE DETERMINED THROUGH PSR CHARGES TIMES OUTPATIENT COST TO CHARGE RATIO.

Schedule H, Part V, Section B, Line 11 cont. 1: UMass Memorial Medical Center
"* UMMMC's Maternal-Fetal Medicine and Community Relations departments partner with the Worcester Division of Public Health in a Community Health Worker (CHW) intervention in Maternal-Fetal Medicine to address at-risk pregnancies among Latino women and vulnerable populations. The funding for this intervention was provided by the Centers for Disease Control and Prevention (CDC) REACH Grant, to support a CHW to address breastfeeding and linkages to community supports for social determinants of health and nutrition among at-risk pregnant and lactating women. Due to the COVID-19 pandemic, beginning in March of 2020 and continuing in 2021, the program discontinued in-person home visits and adapted by conducting home visits via Zoom and Facetime. Anchor Mission: UMass Memorial Health Care system-wide Anchor Mission was formally adopted in 2018 and continued with a strong focus in 2021 to leverage the assets of the organization to address social determinants of health. UMass Memorial's Anchor Mission focuses on four pillars: Local Procurement, Workforce Development, Investment and Employee Volunteerism as a means of improving the economic status, health and well-being of vulnerable, low-income populations in targeted areas. For example, a diverse Hiring Committee works with community-based, workforce organizations serving vulnerable populations. These include unemployed adults and youth, English as a Second Language (ESL) learners, teen mothers, those seeking General Education Development (GED) and newly arrived immigrants/refugees to identify barriers to viable employment and growth opportunities to formalize a hiring pipeline. In FY2022, the Anchor Mission hiring effort included adding new hires in supporting roles at the UMass Memorial COVID community testing and vaccination sites. The Anchor Mission Procurement Committee is working on local purchasing processes and identifying local vendor contract opportunities and the Investment Committee has allocated $4.0 Million in hospital investment funds to address community issues such as housing needs for chronically-homeless through a collaborative with bankers, philanthropic organizations and City Government/Housing Authority. Community Benefits staff are highly engaged in each of the four Anchor Mission pillar areas as well as a targeted effort identifying and establishing an Anchor District in the City of Worcester in one of the city's most economically-distressed areas with high Social Vulnerability Index (SVI), a census tract level composite measure, used for determining communities that will likely be in need of support before, during, and after emergency events. SVI calculations are based on measures associated with socioeconomic status, household composition, minority and language status, housing, and transportation. An Anchor Mission Food is Medicine effort has also been implemented to provide connectivity to healthy foods to patients identified as being food insecure in the Cancer Center initially with plans to broaden to other Medical Center and system level efforts in the future. In FY2022, the Anchor Mission Food is Medicine effort launched a voucher program providing free purchases of fresh produce for patients identified in the Cancer Center as being food insecure in partnership with community-based food prescription program, Fresh Connect. Racism/Discrimination/ Health Equity * COVID Health Equity Task Force: UMass Memorial Health established the Health Equity Task Force to support partnerships that address community-based health equity; incorporate and apply critical knowledge and learning gained through the multi-pronged community-COVID outreach and response into addressing not just COVID, but health equity and community health improvement programming and intervention development through targeted efforts. Community Benefits staff serve as a member of the Worcester COVID Health Equity Task Force co-chaired by UMass Memorial SVP/Chief of Staff and the Commissioner for the City of Worcester Division of Health and Human Services. * COVID-19: In response to the onset of the COVID-19 pandemic, UMass Memorial developed and implemented a multi-pronged, community-based approach to combat COVID-19 within neighborhoods targeting populations most at-risk. Beginning with the COVID-19 ""Feet on the Street"" outreach, the hospital's Care Mobile staff were swiftly redeployed to provide education and demonstration on handwashing, proper mask use, answers to COVID-19 questions in Spanish and English and written materials provided in six languages. The intervention distributed face masks, sanitizer and information on critical resources including food, housing and evictions, access to flu shots, voter registration and U.S. Census. * In August 2020, UMass Memorial was asked to lead the Massachusetts' 'Stop the Spread' COVID-19 testing in Worcester's in high positivity areas. The hospital developed and implemented a COVID-19 testing operation able to; function effectively out- or indoors as weather changed, rotate events into various hot-spot neighborhoods of color and vulnerability based on data, provide same-day set up and break down and function with minimal or no WiFi or access to power, successfully manage unpredictable volumes while meeting the language needs of Worcester's diverse populations. Strategies included utilizing neighborhood hot-spot/positivity data, PDSAs focused on efficiency, and a robust partnership effort with multiple community organizations including public health. In November 2020, the program moved indoors into a central location with easy access to minimize transportation barriers. Most importantly, our COVID-19 neighborhood-based intervention was led by our Health Equity initiative, which has community stakeholders and our partner the Worcester Division of Health and human Services analyzing the data and providing input on direction."

Schedule H, Part V, Section B, Line 16a FAP website
- UMASS MEMORIAL MEDICAL CENTER, INC: Line 16a URL: See Part VI; - UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL, INC.: Line 16a URL: See Part VI; - MARLBOROUGH HOSPITAL: Line 16a URL: See Part VI; - Harrington Memorial Hospital: Line 16a URL: https://www.harringtonhospital.org/for-patients/patient-financial-services/billing-faqs/;

Schedule H, Part V, Section B, Line 16b FAP Application website
- UMASS MEMORIAL MEDICAL CENTER, INC: Line 16b URL: See Part VI; - UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL, INC.: Line 16b URL: See Part VI; - MARLBOROUGH HOSPITAL: Line 16b URL: See Part VI; - Harrington Memorial Hospital: Line 16b URL: https://www.harringtonhospital.org/for-patients/patient-financial-services/billing-faqs/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- UMASS MEMORIAL MEDICAL CENTER, INC: Line 16c URL: See Part VI; - UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL, INC.: Line 16c URL: See Part VI; - MARLBOROUGH HOSPITAL: Line 16c URL: See Part VI; - Harrington Memorial Hospital: Line 16c URL: https://www.harringtonhospital.org/for-patients/patient-financial-services/billing-faqs/;

Schedule H, Part VI, Line 2 Needs assessment
UMass Memorial Medical Center: In addition to conducting the Community Health Needs Assessment (CHNA), UMass Memorial Medical Center assesses the health care needs of the community it serves by working closely with the Worcester Division of Public Health on an on-going basis. Community Benefits staff hold leadership roles and/or participate in multiple coalitions and efforts focused on addressing priority areas identified in the CHNA and aligned with strategies of the Community Health Improvement Plan (CHIP). In 2022, the Community Relations staff continued to serve as members of the Steering Committee of the Coalition for a Healthy Greater Worcester, a healthy communities coalition that coordinates and provides accountability for CHIP Priority Area Working Groups, participates in the CHIP Access to Care group, the CHIP Data Committee and a subcommittee for oversight of UMass Memorial Medical Center Determination of Needs (DoN) funds distribution. UMass Memorial Medical Center completed its CHNA by assembling a diverse group of community stakeholders that include, but are not limited to, members of health and human service organizations, philanthropy, communities of color, neighborhood residents and the Worcester Division of Public Health as part of the group that assisted and guided the assessment process. The hospital's Community Benefits Strategic Implementation Plan is aligned with the CHIP. The other needs that are not included in the CHNA/CHIP are not being addressed because they are not a part of the nine, identified priority CHIP Domain areas and due to limited funding. The following strategies were conducted to complete the assessment: * Conducted key informant interviews and focus groups with community-based organizations and residents * Conducted outreach efforts to medically-underserved populations and convene meetings with neighborhood/community groups * Reviewed primary and secondary data * Conducted an online community survey * Organized community forums held virtually due to COVID to share findings and release of final report * Organized task forces for further action to identify priority areas The following sources inform and enhance our efforts to identify priorities and unmet needs: * U.S. Census 2020 * U.S. Census American Fact Finder * Massachusetts Department of Education Reports including local enrollment and language data * Massachusetts Department of Employment and Training * Hospital utilization data * Massachusetts Department of Public Health * Data from various City of Worcester departments including, but not limited to, the local Division of Public Health, Neighborhood Services and Police. * Information collected from health care providers, community groups/underserved populations and individuals and organizations who have expertise on community health issues. UMass Memorial HealthAlliance-Clinton Hospital Inc. : In addition to the CHNA, UMass Memorial HealthAlliance-Clinton Hospital Management Team plays an active role in the Community Benefit Program by sharing information regarding needed programs, services, and support. Members of the Community Benefits Team and the Management Team also participate in various community agency boards, coalitions, committees, community events, and health fairs. These groups and events play a significant role in defining needs, generating program ideas, and creating services, programs, and support groups. Community Benefits activities and goals are also shared with the Board of Trustees for their feedback. UMass Memorial HealthAlliance-Clinton Hospital works closely with the Health Equity Partnership which is comprised of representatives from a diverse group of agencies, providers, schools, community organizations and community members. The hospital also works with Health Equity Partnership members: A.E.D. Foundation, Inc. Arc of Opportunity Central Mass Agency on Aging, Clinton Adult Learning Center, Community Health Connections, Community Health link, Fitchburg Board of Health, Fitchburg Department of Community Development, Fitchburg Police Department, Fitchburg Public Schools, Fitchburg State University, GAAMHA Inc., Gardner Community Action Team, Gardner Public Schools, Gardner Visiting Nurses Association, Growing Places Inc., Health Care for All Health Disparities Collaborative, Health Foundation of Central Mass, Heywood Healthcare, Joint Coalition on Health, Leominster Public Schools, LUK, Inc., MA Department of Corrections, MA Department of Public Health, Massachusetts Public Health Association, Montachusett Community Branch YMCA, Montachusett Home Care, Montachusett Opportunity Council, Montachusett Veterans Outreach Center Inc., Montachusett Public Health Network, Mount Wachusett Community College, NAMI of North Central Mass, Nashoba Regional School District, Nashoba Valley Medical Center, North Central Mass Coalition for Healthy Relationships, North Central Mass Minority Coalition, North Central WIC, The SHINE Initiative, South Bay Mental Health, Spanish American Center, Suicide Prevention Task Force, Sunrise Senior Living, Three Pyramids, Training Resources of America, Transportation for Massachusetts, UMass Chan Medical School Center for Tobacco Treatment, Human Rights Commission, United Neighbors of Fitchburg, United Way of Tri-County/Wheat Community Connections, Winchendon Board of Health, Winchendon Public Schools, Worcester County Food Bank/Feeding America, You Inc., and YWCA of North Central. Marlborough Hospital: The CHNA is comprised of qualitative and quantitative data collected through a community engagement process. In addition, the Community Benefits Advisory Council, comprised of members of different agencies and businesses in the area, helps to identify programs in support of the community priorities. and assesses the health care needs of the community it serves by working closely with community partners. CBAC members include representatives from the Hudson and Marlborough Public Schools and the Boards of Health, agencies that focus on addiction and recovery services, the Council on Aging, the Marlborough Community Development Corporation, Wellness Council members and residents of the community. The CBAC helps to identify programs in support of the community priorities, provides feedback on an on-going basis and focuses on addressing priority areas identified in the CHNA and aligned with strategies of the Community Health Improvement Plan. Harrington Memorial Hospital: UMass Memorial Harrington Hospital completed its CHNA by conducting interviews and a Community Health Survey. A total of over 1,500 individuals participated in the CHNA. The information gathered through these efforts enabled the CHA to engage the community and gain a better understanding of the region's capacity, strengths and weaknesses, as well as health status, barriers to care, service gaps and underlying determinants of health. While it was not possible for this assessment to involve all community stakeholders, it engaged a comprehensive and inclusive sample of the population; those involved showed commitment to strengthening the region's health system, particularly for people most at-risk. This work was supported by John Snow, Inc. (JSI), a public health research and consulting organization dedicated to improving the health of individuals and communities. In June of 2022, Harrington administered a web-based community health survey, open to all individuals who live and work in the hospital's service area. Hospital staff worked to craft a survey that was accessible and easy to understand. It was distributed widely, from June 23rd-August 22nd, 2022. Methods of distribution included: * Postings on Facebook pages and social media platforms * Email distribution lists * Promotion at various community events * Discussions with community stakeholders The hospital's Community Benefits Strategic Implementation Plan is aligned with the CHNA. The other needs that are not included in the CHNA are not being addressed because they are not a part of the identified priority areas and due to limited funding. The following strategies were conducted to complete the assessment: * Conducted key informant interviews and focus groups with community-based organizations and residents * Conducted outreach efforts to medically-underserved populations and convene meetings with neighborhood/community groups * Reviewed primary and secondary data * Conducted an online community survey The following sources inform and enhance our efforts to identify priorities and unmet needs: * U.S. Census 2020 * U.S. Census American Fact Finder * Massachusetts Department of Education Reports including local enrollment and language data * Massachusetts Department of Employment and Training. * Hospital utilization data * Massachusetts Department of Public Health

Schedule H, Part VI, Line 4 Community information
"UMass Memorial Medical Center: Geographical Reach: The 2021 Community Health Assessment (CHNA) and Greater Worcester Community Health Improvement Plan (CHIP) focuses on the City of Worcester and the outlying communities of Grafton, Millbury, Shrewsbury, and West Boylston, a sub-section of its primary service area. This specific geographic area is the focus for the City of Worcester Division of Public Health regionalization initiative and overlaps with the service area of many other local organizations. Focusing UMass Memorial's CHNA on this geographic area facilitates the alignment of the hospital's efforts with community and governmental partners, specifically the city health department, the area Federally Qualified Health Centers, and community-based organizations. This focus also facilitates collaboration with the Coalition for a Healthy Greater Worcester that implements key strategies of the CHIP so that future initiatives can be developed in a more coordinated approach. Our focus is on vulnerable populations living in this geographical area. Regional Description: With a total population of 206,518 according to the 2020 U.S. Census, the City of Worcester, is the second largest city in New England and is highly diverse. The number of Hispanics living in the city has continued to grow over the past 10 years and represents 23.9% of the total population. According to the American Immigration Council, one in six Massachusetts residents is an immigrant, while one in seven residents is a native-born U.S. citizen with at least one immigrant parent. The federal Health Resources and Services Administration (HRSA) has designated the City of Worcester a health professional shortage area (HPSA) in primary care, mental health and dental services due to its low-income population. The City of Worcester has several neighborhoods with a shortage of health providers and HRSA has determined that many census tracts in the city are medically-underserved areas (MUAs). Economic Characteristics: The average unemployment rate in the City of Worcester in October 2022 was 3.2%. According to the U.S. Census population estimates, 19.3% of the City of Worcester's total population lives in poverty. Additionally, 25.5% of children under the age of 18 live in households for who poverty status is determined and 42.9% live in households receiving Supplemental Security Income (SSI), cash public assistance income, or Food Stamp/SNAP benefits, according to the US Census Bureau, 5-Year American Community Survey Estimates. Poverty is highly correlated to poor health outcomes and barriers to accessing needed care and services and other factors impacting health. Lack of access to affordable and nutritious food has a negative impact on the health of children and families. High rates of unemployment and underemployment in the region have created a high risk of homelessness and a strong need for food assistance services for families and children. All Worcester Public School system students are eligible for the free school lunch program. According to the 2020 U.S. Census, the population of the City of Worcester grew from 181,045 in 2010 to 206,518 in 2020. The median household income in the City of Worcester according to U.S. Census Bureau, 2020 5-year American Community Survey Estimates was $51,647, compared to the state Median Household Income of $84,385. Demographics: Worcester is a Federal Resettlement Site, as a result, the City of Worcester's foreign born population is significantly higher than Worcester County as a whole, accounting for the majority of this population in the region. According to U.S. Census 2020 figures, the Hispanic population and other non-Hispanic, non-White ethnic groups in the city have notably increased while the white, non-Hispanic population has decreased. Reflecting this diversity, ninety percent of all medical interpretations provided by UMMHC are conducted in: Spanish, Portuguese, Vietnamese, Arabic, Albanian and American Sign Language. The remaining ten percent are conducted in other ""non-primary"" languages, the pool of which consists of 81 different languages. The senior population in the region also continues to grow as baby boomers reach the age of 65. According to the U.S. Census, residents between the ages of 18-64 account for the majority of the population in Worcester County at 67.4%. According to the Massachusetts Office for Refugees and Immigrants, in 2018, Central Massachusetts welcomed individuals from more than 49 countries. The largest populations came from The Democratic Republic of the Congo, Haiti, Afghanistan, Ukraine, and El Salvador. Health Alliance Clinton: UMass Memorial Health - HealthAlliance-Clinton Hospital's primary service area includes the quasi-urban municipalities of Clinton, Fitchburg, and Leominster, and the more rural towns of Ashburnham, Ashby, Gardner, Lunenburg, Townsend, Sterling, and Westminster. The Hospital's secondary service area includes an additional twelve towns: Ayer, Bolton, Groton, Harvard, Hubbardston, Lancaster, Pepperell, Princeton, Shirley, Sterling, Templeton and Winchendon. While great efforts are made to improve the health status, provide diagnostic screening, and address access barriers of all residents within these communities, special attention is given to address the needs of diverse and/or low income, vulnerable segments of the population. The challenges that these cohorts face with respect to social determinants of health and access to care are often intense and are at the root of the challenges and poorer health outcomes faced in these communities. Special attention was paid to ""communities within communities"", health disparities and health equity, as well as housing and homelessness. More specifically, the hospital's 2021 CHNA identified racial ethnic minorities, recent immigrants non-English speakers, low-income individuals and families, older Adults, veterans, homeless, children adolescents, LGBTQIA+ as priority populations that deserve exclusive consideration. 211222Final HA CHNA_v2_dec2021.pdf (ummhealth.org) Demographics * The overall population of the service area has grown by only 3.0 percent from 2010 to 2019. * The service area median age (41.2) is 1.5 years higher than the state (39.7) and 2.7 years higher than the nation (38.5). * Those identified as age 45 to 54 reported as higher rates than the state or nation. This indicates that HealthAlliance-Clinton Hospital has a rapidly aging population. * From 2015 to 2019 the pop. over 65 yrs. in state increased 2%. Considerable increase in Westminster 12% to 17.5% and Sterling 14% to 18.9%. * The Hispanic/Latino population is higher than the state percentage (12.4%) in Fitchburg (28.8%), Leominster (18.4%), and Clinton (17.3) Workforce * Education/Health/Social Services ranks number one with 23,376 employees compared to other industries in the region * Healthcare is a growing industry in the area and there is a need for workforce pathways to educate and train new workers. Especially during COVID, the industry lost employees and struggled to keep up with the staffing needed to fully manage the pandemic and its outcomes. * In addition, the growing Hispanic population in the region requires there to be a more diverse workforce reflective of the Service Area populations * Poverty rates are highest in Fitchburg (14.6%), Gardner (14.1%), Leominster (7.9%), and Clinton (5%). * Poverty rates are concerning for the populations >65 yrs. in half of the service area communities. * Compared to December 2021, the labor market rates were down in twenty-four labor market areas. According to mass.gov, Labor Markets of the fifteen areas for which employment estimates are published, three NECTA areas gained jobs compared to the previous months from October 2021 to October 2022, fourteen areas gained jobs with the largest percentage increase Leominster-Gardner (+3.9%) areas. Income Poverty * Gardner has the lowest per capita income at $30,506 and Fitchburg next at $30,300. * Highest income Bolton at $66,748. * Poverty rates are highest in Fitchburg (14.6%), Gardner (14.1%), Leominster (7.9%), and Clinton (5%). * Poverty rates are concerning for the populations >65 yrs. in half of the service area communities. * Compared to December 2021, the labor market rates were down in twenty-four labor market areas. According to mass.gov, Labor Markets of the fifteen areas for which employment estimates are published, three NECTA areas gained jobs compared to the previous months from October 2021 to October 2022, fourteen areas gained jobs with the largest percentage increase Leominster-Gardner (+3.9%) areas."

Schedule H, Part VI, Line 4 Marlborough Hospital
The City of Marlborough, with a population of 39,825 (July 2018) grew 3.4% from 2010. Marlborough's population is predominately White (80%) followed by Hispanic or Latino (10%), other race is 7%, Asian 5%, Black or African American 2% and 3% identify themselves as 2 or more races. Hudson has a population of 14,603 with 90% who identify themselves as White, 4% Hispanic or Latino, 2% other, 2% Asian, 1% Black or African American and 2% indicate two or more races. Quantitative data from U.S Department of Commerce, Bureau of the Census, American Community Survey 5 year estimates, 2010-2014 illustrates that just over threefourths of the Massachusetts population is White (76.9%) which was largely consistent with Marlborough (80%). Both at the state level and in Marlborough, the Hispanic population was the next largest racial/ethnic group. Hudson's population followed a similar pattern, the proportion of its population that identified as white was even larger (90%) followed by Hispanic and Latino. English, Portuguese and Spanish are the predominant language for the communities the hospital serves.

Schedule H, Part VI, Line 4 Harrington Memorial Hosptial
Geographical Reach: The hospital's CHNA's Community Benefits Service Area (CBSA) includes the municipalities of Brimfield, Brookfield, Charlton, Dudley, East Brookfield, Holland, North Brookfield, Oxford, Palmer, Southbridge, Spencer, Sturbridge, Wales, Warren, Webster, and West Brookfield. Data tables in this report include data for Hampden County, Worcester County, and the Commonwealth of Massachusetts when possible. As a population-based assessment, the CHA considers the needs of the entire population - regardless of demographics, socioeconomics, health status, and if/where people receive health care services. Special attention is given to addressing the needs of populations that face disparities in health-related outcomes, have been disenfranchised, and those who are more likely to experience barriers to care. Regional Description: Harrington Hospital's service are in south central Massachusetts, and spans communities in both Hampden and Worcester Counties. Webster (17,776) and Southbridge (17,740) have the largest populations of all of the communities, while Wales has the smallest (1,832). The service area overall can be described as rural or semi-rural. The median age was higher than the Commonwealth (39.6 years) in all CBSA communities, with the exceptions of Oxford (38.7 years) and Warren (37.5 years). The highest median age is in West Brookfield (51.6 years). In Brimfield, Brookfield, Spencer, Sturbridge, and West Brookfield, over a fifth of community residents are over the age of 65. Economic Characteristics: The percentage of the total population living below the federal poverty level in Southbridge (19.6%) was nearly double than the Commonwealth overall (9.8%). Over a fourth of children in Southbridge live below the federal poverty level (26.6%) compared to 12.2% for the Commonwealth overall. Demographics: In all of Harrington Hospital's CBSA communities, the majority of community residents identified as non-Hispanic white. However, it should be noted that the percentage of Hispanic/Latino residents in Hampden County (26%), and many of the CBSA communities, was significantly high compared to the Commonwealth overall. Looking across all CBSA communities, percentages were particularly high in Southbridge (36%), Webster (14%), and Dudley (12%). In these communities, the most common nation of origin was Puerto Rico. Interviewees expressed concern about issues of discrimination, language and cultural barriers to care, and racial equity in the community. In all CBSA communities, the majority of community residents identified as non-Hispanic white. However, it should be noted that the percentage of Hispanic/Latino residents in Hampden County (26%), and many of the CBSA communities, are significantly high compared to the Commonwealth overall. Looking across all CBSA communities, percentages are particularly high in Southbridge (36%), Webster(14% ), and Dudley (12%). In these communities, the most common nation of origin was Puerto Rico.

Schedule H, Part II Community Building Activities
"UMASS MEMORIAL MEDICAL CENTER RECOGNIZES COMMUNITY BUILDING ACTIVITIES AS BEING A PART OF THE ""SOCIAL DETERMINANTS OF HEALTH"" THAT IMPACT THE HEALTH OF THE COMMUNITY. WE INVEST IN YOUTH WORKFORCE DEVELOPMENT FOR AT-RISK YOUTH. PROGRAMS ARE BASED ON OUR COMMUNITY BENEFITS MISSION WHICH WAS RECOMMENDED BY A COMMUNITY BENEFITS ADVISORY COMMITTEE AND DRAWS INSPIRATION FROM THE WORLD HEALTH ORGANIZATION'S BROAD DEFINITION OF HEALTH, AS ""A STATE OF COMPLETE, PHYSICAL, MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE."" BY ADOPTING THIS DEFINITION, UMASS MEMORIAL MEDICAL CENTER HAS EXPANDED ITS STRATEGY TO INCLUDE THE SOCIAL AND ECONOMIC OBSTACLES THAT PREVENT PEOPLE FROM ACHIEVING OPTIMAL HEALTH. ALL OF OUR COMMUNITY BUILDING ACTIVITIES ARE THE RESULT OF AN IDENTIFIED NEED AND ENGAGE THE COMMUNITY. THEY INCLUDE COLLABORATIVE EFFORTS, ADVOCACY ACTIVITIES AND PARTNERSHIPS THAT ENGAGE A BROAD ARRAY OF COMMUNITY STAKEHOLDERS IN ADDRESSING THESE UNMET SOCIAL DETERMINANTS OF HEALTH. COMMUNITY BUILDING ACTIVITY EXAMPLES INCLUDE: FUNDING AND PROMOTING WORKFORCE AND HEALTH CAREER DEVELOPMENT OPPORTUNITIES FOR INNER-CITY YOUTH. THE HOSPITAL ADDITIONALLY PROVIDES COMMUNITY SUPPORT THROUGH EFFORTS INCLUDING PARTICIPATION IN THE UNITED WAY ACTIVITIES AND OTHERS."

Schedule H, Part VI, Line 7 State filing of community benefit report
MA

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
"On October 1, 2018 , the System adopted ASU 2014-09 Revenue from Contracts with Customers and all subsequent amendments to the ASU (collectively, ""ASC 606"") which outlines a five-step framework that supersedes the principles for recognizing revenue (previously ""ASC 605"") and eliminated industry-specific guidance. This framework ensures that entities appropriately reflect the consideration to which they expect to be entitled in exchange for goods and services by allocating transaction price to identified performance obligations and recognizing revenue as performance obligations are satisfied. Qualitative and quantitative disclosures are required to enable users of the financial statements to understand the nature, amount, timing and uncertainty of revenue and cash flows arising from contracts with customers. The System adopted ASC 606 using a modified retrospective approach. The presentation and disclosure of revenue primarily related to uninsured or underinsured patients changed because of the adoption of ASC 606. Under the provisions of ASC 606, the estimated uncollectible amounts due from self-pay patients, as well as co-pays and co-insurance obligations of patients with insurance, generally considered implicit price concessions, are required to be reflected as a direct reduction to patient service revenue as opposed to the previous reporting as a provision for doubtful accounts. As a result, for the year ended September 30, 2022, the System recorded approximately $58,920,000 of implicit price concessions as a direct reduction of patient service revenue that would have previously been recorded as provision for doubtful accounts and $65,146,000 as a direct reduction of accounts receivable."

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
Based on historical experience, a significant portion of the System's uninsured patients will likely be unable or unwilling to pay for the services provided and are considered an implicit price concession. Estimates of implicit price concessions are determined based on historical collection experience with these classes of patients using a portfolio approach as a practical expedient to account for patient contracts as collective groups rather than individually. The financial statement effects of using this practical expedient are not materially different from an individual contract approach. Changes in the economy, unemployment rates, the number of uninsured and underinsured patients, the volume of patients through emergency departments, the increased burden of co-pays, co-insurance amounts and deductibles to be made by patients with insurance, and business practices related to collection efforts are some of the factors that can impact collection trends and the estimation process. Although our financial assistance policies and procedures make every effort to identify those patients who are eligible for financial assistance before the billing process begins, often it is not possible to make an appropriate determination until after the billing and collection collection cycle has commenced. The rationale for including implicit price concession amounts amounts in community benefits would be to account for those patients who were classified as an implicit price concession, but would have qualified for financial assistance if sufficient information had been available to make a determination of their eligibility.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Exemption From Self-Pay Billing and Collection Action- UMMHC will not initiate Self-Pay billing and collection activity in the following instances: 1. Upon sufficient proof that a patient is a recipient of Emergency Aid to the Elderly, Disabled and Children (EAEDC), or enrolled in MassHealth, Health Safety Net, the Children's Medical Security Plan whose family income is equal or less than 300% of the FPL or Low Income Patient designation with the exception of Dental-Only Low Income patients as determined by the office of Medicaid with the exception of co-pays and deductibles required under the Program of Assistance. 2. The hospital has placed the account in legal or administrative hold status and/or specific payment arrangements have been made with the patient or guarantor. 3. Medical Hardship bills that exceed the medical hardship contribution. 4. Medical Hardship contributions that remains outstanding during a patient's MassHealth or Low Income Patient eligibility period. 5. Unless UMMHC has checked the EVS system to determine if the patient has filed an application for MassHealth. 6. For Partial Health Safety Net eligible patients, with the exception of any deductibles required. 7. UMMHC may bill for Health Safety Net eligible and Medical Hardship patients for non-medically necessary services provided at the request of the patient and for which the patient has agreed by written consent. 8. UMMHC may bill a Low Income Patient at their request in order to allow the patient to meet the required CommonHealth One-Time Deductible

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
UMass Memorial Medical Center: UMass Memorial Medical Center employs 24 Financial Counselors, also referred to as Certified Application Counselors (CAC's). All Financial Counselors are state certified and located on all campus locations. The Patient Financial Counseling department has a dedicated call center line that is available to patients and any member in the community that requires assistance. Patient's are referred to the Financial Counselors from many community organizations, such as the local community actions councils and area Health Centers. Financial Counseling assistance is provided at several area free clinics to assist patients in the application process. The Patient Financial Counseling department assists patient's at bedside on inpatient units and patients in the emergency department setting. CAC's are available to assist underinsured and uninsured patients navigate the medical benefit application process. CAC's will take the steps necessary to help patients submit applications to obtain coverage, apply for Financial Assistance, resolve eligibility issues, upgrade their coverage to coverage that provides more benefits, choose and enroll in a MassHealth or Connector Care Health insurance plan and change these plans when necessary. UMass Memorial HealthAlliance-Clinton Hospital Inc. UMass Memorial HealthAlliance Clinton Hospital Inc. employs 4 Financial Counselors, also referred to as Certified Application Counselors (CAC's). All Financial Counselors are state certified and located on all campus locations. The Patient Financial Counseling department has a dedicated call center line that is available to patients and any member in the community that requires assistance. Patient's are referred to the Financial Counselors from many community organizations, such as the local community actions councils and area Health Centers. Financial Counseling assistance is provided at several area free clinics to assist patients in the application process. The Patient Financial Counseling department assists patient's at bedside on inpatient units and patients in the emergency department setting. CAC's are available to assist underinsured and uninsured patients navigate the medical benefit application process. CAC's will take the steps necessary to help patients submit applications to obtain coverage, apply for Financial Assistance, resolve eligibility issues, upgrade their coverage to coverage that provides more benefits, choose and enroll in a MassHealth or Connector Care Health insurance plan and change these plans when necessary. Marlborough Hospital: Marlborough Hospital employs 4 Financial Counselors, also referred to as Certified Application Counselors (CAC's). All Financial Counselors are state certified and located on all campus locations. The Patient Financial Counseling department has a dedicated call center line that is available to patients and any member in the community that requires assistance. Patient's are referred to the Financial Counselors from many community organizations, such as the local community actions councils and area Health Centers. Financial Counseling assistance is provided at several area free clinics to assist patients in the application process. The Patient Financial Counseling department assists patient's at bedside on inpatient units and patients in the emergency department setting. CAC's are available to assist underinsured and uninsured patients navigate the medical benefit application process. CAC's will take the steps necessary to help patients submit applications to obtain coverage, apply for Financial Assistance, resolve eligibility issues, upgrade their coverage to coverage that provides more benefits, choose and enroll in a MassHealth or Connector Care Health insurance plan and change these plans when necessary. Harrington Memorial Hospital: UMass Memorial Harrington Hospital employs 5 Financial Counselors, also referred to as Certified Application Counselors (CAC's). All Financial Counselors are state certified and located on all campus locations. The Patient Financial Counseling department has a dedicated call center line that is available to patients and any member in the community that requires assistance. Patients are referred to the Financial Counselors from many community organizations, such as the local community actions councils and area Health Centers. The Patient Financial Counseling department assists patients at bedside on inpatient units and patients in the emergency department setting. CAC's are available to assist underinsured and uninsured patients navigate the medical benefit application process. CAC's will take the steps necessary to help patients submit applications to obtain coverage, apply for Financial Assistance, resolve eligibility issues, upgrade their coverage to coverage that provides more benefits, choose and enroll in a MassHealth or Connector Care Health insurance plan and change these plans when necessary.

Schedule H, Part VI, Line 5 Promotion of community health
The majority of the governing bodies of all our boards overseeing our hospital facilities -community hospitals, inc., and the member hospitals are comprised of persons who reside in the organization's primary service area who are neither employees nor independent contractors of the organization nor family members thereof. All hospital facilities extend medical staff privileges to all qualified physicians in its respective community for some (or all) of its departments or specialties and are also eligible to become part of the faculty of UMass Chan Medical School - University of Massachusetts. UMass Memorial Medical Center: UMass Memorial has a designated Community Benefits department housed within Community Relations that is wholly dedicated to promoting the Community Benefit agenda with a special focus on Community Health Improvement. Our Community Benefits staff works very closely with multiple community organizations forging partnerships. The hospital has a strong and longstanding partnership with the Worcester Division of Public Health which has resulted in significant opportunities that have leveraged funding and implementation of preventive community-clinical linkages. In addition, we work closely with the two Federally Qualified Community Health Centers and leverage internal resources within the system to increase program capacity whenever possible. The Community Relations/Community Benefits Department works closely with Pedi-Primary Care, Family and Community Medicine, Pedi-Pulmonology, UMass Memorial Cancer Center of Excellence and the Emergency Department. We also provide medical and dental services to the underserved at 10 local neighborhood sites and 24 schools through the UMass Memorial Care Mobile (this function was on hold beginning in March 2020 due to the COVID-19 pandemic but resumed operations in April 2022). Most recently, we have adopted an Anchor Mission as a strategy to specifically address social determinants of health. UMass Memorial HealthAlliance-Clinton Hospital Inc: The hospital has a Community Benefit program that is responsible for promoting the Community Benefit Implementation Strategy focusing on Community Health Improvement. Hospital staff, leaders, and medical providers work very closely with multiple community organizations forging partnerships. In addition, we leverage internal resources within the system to increase program capacity whenever possible. We continue to support health education and screenings related to chronic diseases and prevalent health conditions in the community including mental/behavioral health, lung cancer/smoking cessation, chronic occlusive pulmonary disease (COPD), heart health, depression, and nutrition/diabetes. We particularly focus on diverse populations and social determinants of health. UMass Memorial Health - HealthAlliance-Clinton Hospital continued working with the Community Health Network of North Central Mass (CHNA9) and other partners in implementing the North Central Mass Community Health Improvement Plan (CHIP). Most CHIP working groups meet monthly and took significant steps toward reviewing baseline information and creating more partnerships that will enable sharing of resources throughout the CHIP implementation and beyond. Marlborough Hospital: Marlborough Hospital participates in area events and provides facilities for support groups. In addition, whenever possible we leverage internal resources to build capacity in our programming and we have staff that supports Community Benefits activities. HARRINGTON MEMORIAL HOSPITAL: PLEASE REFER TO THE HARRINGTON CHNA AND HOSPITAL WEBSITE FOR FURTHUR DETAILS

Schedule H, Part VI, Line 6 Affiliated health care system
"UMass Memorial Health Care is the largest not-for-profit health care system in Central Mass and the largest provider of care for the uninsured outside of Boston; and the only Safety Net provider in Central New England. Our health care system is comprised of UMass Memorial Medical Center as well as the Community Hospitals Health Alliance Clinton, Marlborough and Harrington Memorial Hospitals. We have a reporting parent board and a medical group and affiliate with Community Healthlink which is the largest provider of mental health for vulnerable populations. Each hospital in our system, has a dedicated Community Benefits staff and department that works closely with their respective communities in conducting a the Community Health Needs Assessment, a Community Health Improvement Plan and a Community Benefits Implementation Strategy. In addition, we also share best practices and knowledge and adopt when appropriate. We have been one of the few hospital systems in the country that has adopted an ""anchor mission"" for our organization. This involves leveraging all of the assets of our organization in order to address pervasive inequality and social disadvantage in our community. We do so by strategically focusing our investment practices, hiring practices and purchasing practices in a manner that addresses the social determinants of health in the community. For example, we have pledged to devote 1% of our investment portfolio ($4 Million) and invest it into the community. We have already deployed almost half of that $4 Million by making four specific investments in the areas of housing and the arts in vulnerable areas of our community."