4A (Expenses $ 181198415 including grants of $ 38500) (Revenue $ 204628982)
Holyoke Medical Center, Inc. (HMC) strives to serve the health needs of their medical service community in a high quality and efficient manner. See Schedule O for additional information.To this end, HMC shall: (1) provide compassionate care to all of whom it serves with a commitment to developing cultural diversity and competencies in our programs and workforce so that we may better serve our patients; (2) identify and serve those needs which are prevalent and substantial in the community as a whole, or within major population groups, and which can be adequately met by the provision of basic primary and secondary health care services; (3) provide information, education, and expertise to our community in order to promote the general health of its citizens; (4) provide an environment of excellence and growth in which health care professionals can use their skills and abilities to the fullest extent possible; (5) provide competitive wages and benefits, as well as safe and dignified working conditions, for all employees; (6) ensure financial responsibility in the operation of the medical center in order to guarantee the future viability of our mission; (7) provide a formal, public, and ongoing program of community benefits, in cooperation with community individuals and organizations, to improve the health status of the public including especially the medically and economically vulnerable. Holyoke Medical Center, Inc. provided inpatient, outpatient, OB/GYN, and emergency healthcare services and certain physician services to the residents of Holyoke, Massachusetts and the surrounding communities. Inpatient healthcare services included medical, surgical, critical care, cardiac, obstetrical, psychiatric, and oncology services. During FY 2022, HMC provided 38,188 patient days of inpatient services with 6,168 discharges. Outpatient healthcare services included a full array of diagnostic, therapeutic, and behavioral health services. During FY 2022, HMC had 334,334 outpatient visits. Emergency services were provided by a 24-hour emergency department. During FY 2022, HMC had 42,165 emergency department visits.

Holyoke Medical Center, Inc.
Part V, Section B, Line 5: Holyoke Medical Center has conducted formal and informal surveys each year to look at the health needs of the people we serve. In the first half of 2021, Holyoke Medical Center conducted a year long study that entailed key stakeholder interviews, community resident interviews, workshops, a lengthy survey given in English and Spanish, and data collection, which has been brought together to create the 2022 Holyoke Medical Center Community Health Needs Assessment (CHNA). The CHNA also determines how Holyoke Medical Center will provide support, resources and education to the communities we serve. A CHNA is a federal requirement for private, nonprofit hospitals and must be done every 3 years with input from the broader community including public health experts and collection of important health data. The 2022 CHNA was published by September 30, 2022, and therefore occurred within the tax year covered by the Hospital's 2021 Form 990. The complete CHNA, as well as the supplemental narratives included on this Form 990, Schedule H, Part VI, provide additional details regarding the Hospital's processes and procedures for gathering community input for its needs assessments.

Holyoke Medical Center, Inc.
Part V, Section B, Line 11: Please see the attached Implementation Plan for details on how the Hospital is addressing the significant needs identified in its most recently conducted CHNA as well as the needs that are not being addressed. The attached Implementation Plan also describes the needs that are not being addressed.

Holyoke Medical Center, Inc.
Part V, Section B, Line 16j: The Hospital has had a section on its website related to financial assistance for several years. The Hospital has a financial assistance policy, plain language summary, and financial assistance application that was available to our patients along with financial assistance signs in certain locations in the Hospital (such as patient registration, and the Emergency department).

Schedule H, Part V, Section B, line 7a & 10a:
The Hospital's 2021 Tax Year CHNA is available at: https://dashboards.mysidewalk.com/community-health-needs-assessment-5367ef8d9744The Hospital's current CHNA Implementation Strategy is available on the Hospital's website at: https://www.holyokehealth.com/wp-content/uploads/2023/02/HMC-2023-CB-Strategic-Implementation-Plan-1.pdf

Schedule H, Part V, Section B, Line 16a & 16b:
The Hospital's Financial Assistance Policy is available on the Hospital's website at: https://www.holyokehealth.com/wp-content/uploads/2019/05/Holyoke-Medical-Center-English-Financial-Assistance-Policy-FY-2016.pdfThe Plain Language Summary can be found on the Hospital's website at: https://www.holyokehealth.com/wp-content/uploads/2019/05/Holyoke-Medical-Center-Financial-Assistance-Plain-Language-Summary-ENG.pdfThe Financial Assistance Application can be found on the Hospital's website at: https://www.holyokehealth.com/wp-content/uploads/2020/03/Holyoke-Medical-Center-Financial-Assistance-Application-2020-ENG.pdfAll of the above-linked documents and materials can be accessed from the Hospital's financial assistance home page . These documents are also available in Spanish. Financial Assistance Home Page web-link:https://www.holyokehealth.com/patients-visitors/financial-assistance/

Part I, Line 3c:
Not Applicable.

Part I, Line 6a:
Not Applicable.

Part I, Line 7:
Holyoke Medical Center, Inc. used the cost-to-charge ratio method in determining the cost of health services provided. Holyoke Medical Center, Inc. derived this cost-to-charge ratio based on total patient care expenses, divided by gross patient service charges per the state CHIA cost report.

Part I, Line 7, Column (f):
The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 9,131,308.

Part II, Community Building Activities:
Holyoke Medical Center, Inc. provides a variety of community sponsorships and ongoing relationships with local community organizations. Our goals for those sponsorships and/or team building are to help support organizations where their programming aligns with Holyoke Medical Center's Community Health Needs Assessment. Our intended outcome is to make this a healthier community.

Part III, Line 2:
Holyoke Medical Center, Inc. utilizes a costing methodology in which the ratio of patient care cost to charges is applied to the bad debt expense attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on Line 2. Discounts and payments on patient accounts are recorded as adjustments to revenue, not bad debt expense.

Part III, Line 3:
See narrative for Part III, Line 2.

Part III, Line 4:
See Footnote 2 on Page 11 of the attached audited financial statements.

Part III, Line 8:
Holyoke Medical Center, Inc. utilizes generally accepted accounting principles in the preparation of its financial statements.Holyoke Medical Center, Inc. used the cost-to-charge ratio method in determining the cost of health services provided. Holyoke Medical Center, Inc. derived this cost-to-charge ratio based on the total patient care expenses, divided by gross patient service charges per the state CHIA cost report.

Part III, Line 9b:
Populations Exempt from Collection Action - The following individuals and patient populations are exempt from any collection actions pursuant to the Massachusetts Health Safety Net Program (HSN) regulations:a. Patients enrolled in, receiving benefits from, or participating in a public health insurance program, including but not limited to MassHealth, Emergency Aid to the Elderly, Disabled and Children (EAEDC), Healthy Start, Children's Medical Security Plan (CMSP (provided the patient's family income is equal to or less than 300% of the FPL)), and low income patients subject to the following:(1) Holyoke Medical Center, Inc. may initiate Collection Action against any patient enrolled in, receiving benefits from, or participating in MassHealth, EAEDC or Healthy Start, and any low income patient, for their required co-payments and deductibles as set forth by each specific program.(2) Holyoke Medical Center, Inc. may also initiate collection action for a patient who alleges that he or she is a participant in MassHealth, EAEDC, Health Start or CMSP but fails to provide proof of such participation. Upon receipt of satisfactory proof that a patient is a participant in such a program (including, in the case of MassHealth, EAEDC or Healthy Start, receipt or verification of a signed application), Holyoke Medical Center, Inc. shall cease billing or collection activities.(3) Low income patients are exempt from Collection Action for Eligible Services (as defined by HSN regulations from time-to-time) they receive during the period for which they have low income patient status.(4) Low income patients with family income between 150% and 300% of FPL are exempt from collection action for the portion of their Holyoke Medical Center, Inc. bill that exceeds the patient's deductible. However, Holyoke Medical Center, Inc. may initiate collection action against patients for their required co-payments and deductibles.(5) Holyoke Medical Center, Inc. may continue collection action on any low income patient for services rendered prior to the low income patient determination, provided that the patient's low income patient status has been terminated or expired. However, once a patient is determined to be eligible and enrolled in the Health Safety Net, MassHealth or certain Commonwealth Care programs, Holyoke Medical Center, Inc. will cease collection action for services rendered prior to the beginning of their eligibility.(6) Holyoke Medical Center, Inc. may pursue collection action against low income patients for services other than eligible services for which the patient has agreed to be responsible, provided Holyoke Medical Center, Inc. obtained the patient's prior written consent to be billed for the services. Holyoke Medical Center, Inc. will not bill low income patients for claims denied by the patient's primary insurer resulting from an administrative or billing error unless the error was initiated by patient/ guarantor.(7) Holyoke Medical Center, Inc. will not undertake collection action against an individual who has been approved for ER Bad Debt Medical Hardship or medical hardship under the Massachusetts Health Safety Net Program with respect to the amount of the bill that exceeds the medical hardship contribution.b. With respect to low income patients injured in motor vehicle accidents, Holyoke Medical Center, Inc. will: (1) investigate whether the patient, driver and/or vehicle owner had a motor vehicle liability policy; (2) make every effort to obtain the third party payor information from the patient; (3) if the hospital has prior knowledge and is legally able, attempt to secure assignment on a patient's right to third party coverage on services provided due to an accident; (4) advise patient of duty to notify HSN/MassHealth within 10 days of filing TPL claim/lawsuit, (5) retain documentation of those efforts; (6) where applicable, submit a claim for payment to the motor vehicle liability insurer; and (7) if any portion of the claim was previously billed to the HSN, report any recovery to the HSN.c. Holyoke Medical Center, Inc. will not garnish a low income patient's or their guarantor's wages or execute a lien on the low income patient's or their guarantor's personal residence or motor vehicle unless: (1) Holyoke Medical Center, Inc. can show that the patient or their guarantor has the ability to pay; (2) the patient/guarantor did not respond to HMC requests for information or the patient/guarantor refused to cooperate with HMC to seek an alternative financial assistance program; or (3) for purposes of a lien, it was approved by Holyoke Medical Center, Inc.'s Board of Trustees on an individual case-by-case basis.d. Holyoke Medical Center, Inc. may cease any collection or billing actions against a patient who is unable to pay Holyoke Medical Center, Inc.'s bill at any time during the billing process, if the patient is eligible for assistance under financial assistance programs that HMC may, in its discretion, make available from time-to-time. Holyoke Medical Center, Inc. will keep any and all documentation that shows a patient met the criteria for such programs.e. Holyoke Medical Center, Inc. and its agents shall not continue collection or billing on a patient who is party to bankruptcy proceedings except to secure its rights as a creditor in the appropriate order.f. Holyoke Medical Center, Inc. and its agents will not charge interest on an overdue balance for a low income patient or for patients who are eligible for financial assistance programs that HMC may in its discretion make available from time-to-time.

Part VI, Line 2:
"Holyoke Medical Center conducts a Community Health Needs Assessment (CHNA) of the community it serves every three years in conjunction with numerous agencies. As part of the CHNA, community meetings were held with numerous local agencies including Holyoke Housing Authority residents, Holyoke City Officials, Holyoke High and Dean Vocational High School students, Holyoke Medical Center (Valley Health Systems' staff members, including representatives from Holyoke Medical Center, River Valley Counseling Center and Holyoke Visiting Nurse Association), The Salvation Army Holyoke representatives, Lorraine's Soup Kitchen community members, and board members from the Chicopee Chamber of Commerce, House of Color LGBTQ+ Support Group staff and members of their group, Holyoke residents at Key Foods Grocery Store on three occasions and public school therapists. HMC Community Benefits maintains partnerships with many of these agencies throughout the year to continue to assess community needs. HMC conducted over 30 stakeholder interviews for its 2022 CHNA, which included meeting with two Council on Aging directors from Holyoke, Chicopee and South Hadley; Board of Health Directors from Holyoke, South Hadley, Chicopee and West Springfield; Holyoke's Mayor, Director of Planning and Economic Development, a City Councilor, and Chief of Police; the Holyoke Boys & Girls Club' Executive Director, Holyoke and South Hadley's Housing Authority, Holyoke Health Center's Chief Medical Officer, MA State Representative, Pat Duffy, MA State Senator, John Velis, Valley Opportunity Council, Lorraine's Soup Kitchen Executive Director, WestMass ElderCare, Action Ambulance, River Valley Counseling, OneHolyoke CDC, Holyoke Public Schools Superintendent, two of HMC's Nurse Navigation members, and the Community Benefits Advisory Committee which includes representatives from HMC, The Salvation Army, OneHolyoke CDC, Hampden County Sheriff's Department, HMC Behavioral Health, Holyoke Boys & Girls Club, Holyoke Health Center and River Valley Counseling Center, among others. In addition, as part of the CHNA process, HMC implemented a survey with over 60 questions in English and Spanish, among over 400 community members. These questions were developed with the Western Massachusetts Hospital Coalition so that all involved asked the same questions in the various communities they serve. This collaboration and consistency allows data to be shared and analyzed between the other Western Massachusetts hospitals so that solutions can be worked on regionally through the Community Health Improvement Plan (CHIP). The results help to inform the Holyoke Medical Center's Strategic Implementation Plan and the type of programming to offer in the community to help address the needs identified. In addition to the CHNA, HMC uses the Thrive survey, a tool used to screen for social determinants of health. Based on the responses, providers are able to make referrals for those showing need in areas of housing, food, paying for medication, caring for a dependent, paying for utilities, domestic violence, and transportation. In 2022, HMC provided 13,000 THRIVE screenings and referred those in need to resources. HMC Community Benefits Director also participates in a variety of boards and committees to continually assess the needs of the community and create relationships with non-profit organizations for their feedback. These include the Greater Holyoke Chamber, Girls Inc. of the Valley, The Salvation Army, Hampden County Community Health Improvement Plan committee through Pioneer Valley Planning Authority - Community Team 4 Healthy and Active Living, Holyoke Food & Resources with State Representative, Pat Duffy, Holyoke High Dean Campus Program Advisory Committee, Let's Move Hampden County, 5210 committee, McKinney-Vento Homeless Coalition for Holyoke Public Schools, McKinney-Vento Homeless Coalition for Chicopee Public Schools, Safe Routes to School - Walking School Bus, School Community Health Advisory Council for Holyoke Public Schools, Westover Job Corps Community Relations Council and Western Mass Hospital Coalition. These meetings not only serve the respective organization's specific community, they also connect the hospital to many other community based organizations who are participants. In addition, other HMC staff participate in other committees and boards including the Greater Chicopee Chamber of Commerce, Holyoke Rotary, Holyoke HUB, and the Greater Holyoke YMCA to name a few. Key Objectives:The objective of Holyoke Medical Center's 2022 Community Health Needs Assessment was to: 1. Look at the 2019 findings and identify which key health issues and concerns remain the same for the residents in Holyoke Medical Center's primary service area. 2. Identify the vulnerable populations that are experiencing health disparities. 3. Look at other contributing factors that create barriers to living healthier lives.CHNA Conclusions: Holyoke Medical Center gathered comments put forward from the community and narrowed the list down to the top common priority areas from the community input. HMC also developed a set of principles to help determine our highest priorities and guide our decision-making process regarding community benefits. Holyoke Medical Center's goals are to: 1. Increase access to care centered on the Social Determinants of Health. 2. Serve vulnerable and underserved populations especially with chronic conditions. 3. Concentrate on the greatest level of community concern and most consistent with the organization's strengths.Significant Health Needs Identified in Order of Priority Include: Social and Economic Issues that Impact Health:- Transportation- Cultural awareness- Employment training for youth- Housing Security and HomelessnessAccess to Healthcare in the following areas:- Primary Care- Mental health services- Affordable medications- Assistance with finances and insurance- Educational resources- Food security- Affordable housingCommunication Assistance Needed to Improve Health Outcomes:- Understanding of Doctor's Instructions- Simplified terminology by providers for patients understanding- Instructions provided in preferred language (written and spoken)- Promotion of educational resources and support groups- Social Interactions for Seniors- Medication managementHealth:- Pain management- Substance use of drugs and alcohol- Mental health- Upper respiratory disease- Asthma- Obesity- Dementia and Alzheimer's- DiabetesVulnerable Populations:- Low income residents who lack access to healthcare- Residents that lack transportation- People who struggle with drug addiction/overdose challenges- Older adults especially with language barriers- Residents with chronic mental illness- Children in our target area- Homeless- Veterans- Spanish speaking families- People who are overweight or obese- Youth at RiskIt is important not to overlook the substantial contribution that the hospital makes to the community through our many educational programs, and our support of community events. HMC will continue to monitor these programs for their need and effectiveness in the community, and, working with our community partners, assess for gaps in the needs of the community that are not being filled.The 2022 CHNA was conducted using a social determinant of health framework as it is recognized that social and economic determinants of health contribute substantially to population health. It has been estimated that less than a third of our health is influenced by our genetics or biology. Our health is largely determined by the social, economic, cultural, and physical environments that we live in and the healthcare we receive.Among these ""modifiable"" factors that impact health, social and economic factors are estimated to have the greatest impact. The County Health Rankings model, developed by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, estimates the extent to which these modifiable factors contribute to health based on reviews of the scientific literature and a synthesis of data from a number of national sources. It is estimated that social and economic factors account for (40%) of our health, followed by health behaviors (30%), clinical care (20%), and the physical environment (10%). Many health disparities occur as a result of inequities in these determinants of health.In addition to the community meetings, stakeholder meetings, and survey, HMC outsourced MySidewalk to help collect data from a large number of sources that include, USDA, US Census, local data and hospital data and helped HMC develop an online version of our CHNA that will be updated annually and not have to wait for three years for the next CHNA.(This narrative is continued later in the supplemental statements.)"

Part VI, Line 3:
1) General Principles:Holyoke Medical Center, Inc. or its agents will assist uninsured and underinsured patients with the process of applying for available financial assistance programs that may pay for some or all of their hospital bills. In order to help uninsured and underinsured patients find and apply for available financial assistance, HMC will provide all patients with a general notice of the availability of programs by way of posted notices throughout HMC and by way of individual notices to patients. The goal of these notices is to inform patients regarding the availability of financial assistance, as well as assistance with the application process. Holyoke Medical Center, Inc. will assist patients with the application process for the following Massachusetts programs: MassHealth, Commonwealth Care, CMSP, Healthy Start, Health Safety Net, and Medical Hardship through the Health Safety Net. Holyoke Medical Center, Inc. will provide, upon request, specific information about: (a) the eligibility criteria to be a low income patient under the Massachusetts Health Safety Net program or (b) additional financial assistance programs that HMC may in its discretion make available to low income patients from time-to-time. Holyoke Medical Center, Inc. will also notify the patient about available payment plans that may be available to them pursuant to HSN regulations.2) Role of Hospital Patient Financial Counselors and Other Finance Staff:Holyoke Medical Center, Inc. will attempt to identify available coverage options for patients who may be uninsured or underinsured when the patient is scheduling services, while the patient is at HMC, upon discharge and for a reasonable time following discharge. Holyoke Medical Center, Inc. will direct all patients seeking available coverage options to HMC's Patient Financial Counseling office for eligibility screening and assistance with the application process, including the application process for financial assistance programs that HMC may in its discretion make available to low income patients from time-to-time.Holyoke Medical Center, Inc. will also provide information on how to contact the appropriate staff within the hospital's Finance Department to verify the accuracy of the hospital bill or to dispute certain charges.3) Notification Practices:Holyoke Medical Center, Inc. will post a notice (signs) of availability of financial assistance in the following locations: a. Service delivery areas (e.g., inpatient, clinic, emergency department admission and/or registration areas); b. Patient financial counselor areas; c. Central admission/registration areas; and/or d. Business office areas that are open to patients.Posted signs will be clearly visible and legible to patients visiting these areas. The hospital will also include a notice about the availability of financial assistance in all initial bills.When a patient contacts the hospital, the hospital finance staff will attempt to identify if a patient qualifies for a public financial assistance program or a payment plan. A patient who is enrolled in a public financial assistance program (e.g., MassHealth or the Health Safety Net) may qualify for certain plans. Patients may also qualify for additional assistance based on the hospital's own internal criteria for financial assistance or qualify for coverage of services as a medical hardship based on the patient's documented income and allowable medical expenses.For cases in which the hospital is using the Virtual Gateway application, the hospital will assist the patient in completing the application for MassHealth, Commonwealth Care, Children's Medical Security Plan, Health Start, Health Safety Net, or other forms of financial assistance programs as they become part of the Virtual Gateway program.All signs and notices shall be translated into languages other than English if such language is primarily spoken by 10% or more of the residents in the hospital service area, which is based on the hospital admissions and/or discharge information.

Part VI, Line 4:
The primary service area for Holyoke Medical Center includes the five communities of Holyoke, Chicopee, South Hadley, Westfield, and West Springfield, all of which are located in Hampden County and Hampshire Counties. The secondary service area of HMC includes Belchertown, Easthampton, Granby, and Southampton. The total population of the service area is over 180,000 people. The communities served are a mix of urban, suburban and rural. The median age in Hampden County is 39.4, while the median age in Hampshire County is 36.4. In Hampden County, there is a diverse population with 18.4% identifying as Black or African American, American Indian, Asian or a race besides White and 27% identifies as Hispanic or Latino. In Hampshire County, 12.4% of the population identifies as Black or African American, American Indian, Asian, or race besides White and 12.4% identifies as Hispanic or Latino. In Holyoke, more than half of the residents identify as Hispanic or Latino at 53.3% of the population. In Holyoke, 21% of homes do not have a vehicle vs. 11% of homes within HMC's primary service area and 12% of homes in Massachusetts. Public transit access is facilitated by the Pioneer Valley Transit Authority, which provides bus service to all of HMC's service area communities. Paratransit services are offered throughout the service area for people with disabilities within 3/4 mile of a fixed route. In addition, HMC provides free transportation through two shuttles within the city of Holyoke as well as door-to-door van service from areas not serviced by the shuttle. Economically, there is significant variation between communities in the HMC service area. The median income for the service area is $66,200, which is considerably less than the state's median income of $89,026. Within HMC's primary service area, 14% of the population live in poverty vs. 10% of the population in all of Massachusetts. On a community-level, there is wide variation, with Holyoke's median household income at $45,045 and nearby South Hadley's median household income at $82,987. In the service area, the overall percentage of those who pay more than 30% of their income for housing costs is 46% of rented homes and 23% of owned homes. Again, these figures vary within the service area, where 49% of renters and 25% owners in Holyoke are cost-burdened.

Part VI, Line 5:
"The impact of Holyoke Medical Center, Inc.'s (HMC) outreach efforts are evidenced by the fact that countless service agencies rely on HMC to ensure their own success. HMC conducts a triennial Community Health Needs Assessment which not only helps to guide the Strategic Implementation Plan and Community Benefits programming, it is also used by internal departments and community partners as a resource for grant writing. Key accomplishments from 2022 include: 1. CHNA Completion: Holyoke Medical Center completed the triennial Community Health Needs Assessment, which provided key data and information about the challenges and opportunities heard through community engagement with residents and community leaders. This information will help guide the hospital's Strategic Implementation Plan for the next three years and help us to serve those most in need. 2. Continued to strengthen overdose prevention strategies and provide treatment for substance use disorder: Holyoke Medical Center's Comprehensive Care Center provided outpatient treatment for individuals looking to reduce or stop substance use. Recovery coaches help to support individuals coming through the Emergency Department (ED) for substance misuse. Harm reduction also continued to be a priority. In 2022, the Addiction Consult Services at HMC treated over 1200 patients, with 75% of those patients being seen through the Emergency Department (ED), and 9% due to overdose. That same year, nearly 300 doses of Take Home Naloxone were dispensed to overdose patients in the ED at no cost to them. Dispensing Naloxone, along with safer injection syringes and strips that test for fentanyl in drugs, helps to provide support for any associated negative consequences to using. 3. Implementation of Thrive Screening - Using this social determinants of health screening tool, Holyoke Medical Group providers are able to make referrals for those showing need in areas of housing, food, paying for medication, caring for a dependent, paying for utilities, domestic violence, and transportation. In 2022, more than 13,000 patients were screened. Those needing assistance are provided with referrals for area resources through 413CARES.org. 4. Education on site and in the community continued to be a priority for HMC. Internships and clinical opportunities returned after Covid-19, however job shadowing with high school students did not. HMC welcomed back the MassHire Holyoke YouthWorks summer internship program in 2022 after a two year hiatus due to Covid-19. Holyoke Medical Center, like many hospitals across the country, is facing a nurse staffing shortage.Health education continued in the community both remote and in-person towards the end of the year. HMC staff provided educational health workshops to area residents at senior centers, the public library, schools and non-profit organizations. In addition, HMC continued quarterly distribution of its printed newsletter to 50,000 area residents which included topics such as chronic disease management and prevention. Holyoke Medical Center also continued to support agencies that focus on educational needs for disadvantaged youth. 5. Holyoke Medical Center continued to address food insecurity and proper nutrition with its community dinner distributions twice per month, providing more than 2800 meals in the community. HMC also participated in Let's Move Hampden County 5210 to educate the community on nutrition, the benefits of SNAP and HIP, and the distribution of farmers' market vouchers to patients in need. Through the 5210 group, HMC participates in planning for the local farmers' market to continually try and help bring fresh and healthy foods to those that need it. Community Benefits also facilitated an Adopt-a-Family employee- driven program which provided Christmas gifts and grocery gift cards to families through the Holyoke Boys & Girls Club. 6. HMC also works with numerous non-profit organizations to partner on events and to provide many with financial support and other materials or food. This included The Salvation Army so they were able to provide turkeys at Thanksgiving, school supplies for Holyoke Safe Neighborhood Initiative, hiring youth through MassHire YouthWorks program, collaborating with the YMCA on their Healthy Kids Day, as well as sponsorships through OneHolyoke CDC, NAMI Western MA, New England Minority Nurses Conference, Providence Ministries for the Needy, and more. 7. Transportation to access care remains a significant and high priority for the communities that Holyoke Medical Center serves. 11% of homes in HMC's primary service area and 21% of homes in Holyoke do not have a vehicle. HMC continues to provide free transportation services allowing riders access to hospital services, doctor's appointments, and our neighboring medical practices. There are two shuttles that travel throughout the community and stop at various public transportation routes, senior high rise apartments, and a local health center. In 2022, more than 14,000 people used HMC's shuttle service; over 4,000 used the door-to-door van service to get to their appointments; and more than 12,000 were assisted with valet service from the hospital's main entrance. In addition to these transportation efforts, LYFT services are often provided. 8. For patients whose preferred language is not English, there are many resources available. Over 90% of such patients use Spanish as their preferred language. American Sign Language and Polish are the second and third most frequently used language after Spanish at our campus. HMC's Interpreter Services in-house Spanish speaking Medical Interpreters are available seven days a week. Additionally we have Language Mediators who are staff members with interpretive capabilities serving primarily in their home department in a number of languages. HMC also has service contracts with two local interpretive companies. If an interpreter for a particular language is not available in person, we rely on an appropriate interpreter through several nationally-recognized remote telephonic and video interpreting language company services. Further, the Community Outreach staff is readily available to offer bilingual information about our health services. Support groups and information sessions are usually bilingual in Spanish and English. We have the ability to support other languages. When someone is discharged from the hospital, there is also a Community Navigation team in the Call Center that follows up with the patient to make sure they understand the doctor's instructions and see if they need any additional help or resources. They routinely use the telephonic interpreting services when they do not have the ability to communicate in the preferred language of the patient. For FY22, Interpretive Services performed about 40,000 encounters in 43 languages.In 2022, other Community Benefits included the following: Public School Events: HMC provides services for various school systems in the community including education, volunteerism, sponsorship and internships. The need is based on improving quality of health, workforce development, and health career education, as well as providing health related information. HMC has many partnerships within the schools and respond to their needs as they arise. Currently we work with Holyoke Public Schools and Chicopee Public Schools McKinney Vento homeless coalitions, Holyoke's School Community Health Advisory Council, Safe Routes to School / Walking School Bus, Holyoke High Dean Campus Program Advisory Committee, as well as provide internships and job shadowing opportunities. HMC also partnered with sister Valley Health Systems organization, and River Valley Counseling, to provide behavioral health support and education for teachers and workshops on trauma informed care. Fill the Back Pack Program: Holyoke Medical Center participates on the committee which provides a Back to School event for impoverished children that includes activities, services to go back to school, haircuts, and school supplies through Holyoke Safe Neighborhood's ""Fill the Back Pack Program"". There are about 2500 students served within the Flats section of the city, a low income neighborhood in Holyoke. HMC provides Nurse Navigators and Community Health Workers to offer education and screenings at this major summer event. In 2022, the Nurse Navigators and Community Health Workers provided nutrition education and passed out healthy portion plates to 2,500 students. We also provided 12,000 pencils to be put in the 2500 backpacks. (This narrative is continued later in the supplemental statements.)"

Part VI, Line 7, Reports Filed With States
MA

Part VI, Line 6:
Holyoke Medical Center (HMC) is a 219-bed independent community hospital with over 1,600 employees serving individuals and families throughout the cities and towns of the Pioneer Valley. The medical staff includes more than 375 physicians and consulting staff. Holyoke Medical Center is a nationally-accredited hospital and is the first and only hospital in Western Massachusetts to obtain the prestigious accomplishment of becoming certified in the ISO 9001:2015 Quality Management System. Among some of the top-rated services at Holyoke Medical Center is the award winning Holyoke Medical Center Stroke Service which has been consistently rated as one of the best in the state. HMC received the Top Hospital Award in 2020, 2016, and 2014 from the Leapfrog Group for excellence in quality of care and patient safety. Areas of clinical emphasis also include behavioral health, critical care, emergency care, orthopedics, oncology, rehabilitation, women's health services, speech and hearing, bariatric, and wound care services.Holyoke Medical Center is a member of Valley Health Systems in Holyoke, which also includes the affiliates Holyoke Medical Group, Holyoke Visiting Nurse Association & Hospice Life Care, and River Valley Counseling Center. Our Mission at Holyoke Medical Center is to improve the health of all people in our community. We do that with honesty, respect and dignity for our patients, visitors and staff. We do that through expert and compassionate care, education and knowledge sharing, community partnerships, fostering innovation and growth and by inspiring hope in all we touch. We do that by being good stewards of our resources and providing efficient and cost effective care to all.The Community Benefit Mission Statement is to collaborate with community partners to assess and improve the health needs of our residents. We will do this by providing resources, education, and services to address the needs of our most vulnerable community members

Part VI, Line 5, Continued:
"Let's Move 5-2-1-0: Holyoke Medical Center is a partner in Let's Move Hampden County 5-2- 1-0 with the Holyoke Health Center as the lead, along with other community based organizations and local schools. This initiative provides educational outreach, supporting materials and training on healthy eating and physical activity with children and their families, as well as supporting a large, diverse group of Holyoke agencies and organizations. Holyoke Medical Center is taking more of a lead this year and has written this initiative into the Implementation Plan to include more community outreach with the 5210 partners and provide a farmers' market to increase access to healthy food and provide education about SNAP and HIP. Ambulance Community Events: Provide ambulance coverage for area community events. Stand by services to provide first aid care if required. Chronic Disease Education: HMC continues to provide chronic disease education within the surrounding communities, including medical topics about high rates of diet and exercise related diseases (obesity, diabetes, stroke, heart disease). - Nutrition for the Cancer Patient. HMC ensures access to care for all oncology patients with lack of food access or financial hardship. Upon admission, patients are evaluated to assess needs and follow-up services are provided. - Survivorship and Support Group. A survivorship care plan is started for all cancer patients. Patients are considered survivors from the beginning of their journey to the end. - Diabetes Community Education Program: Community diabetic education provided to include the understanding of Type 2 diabetes, planning meals, dietary requirements, and management of medications. This is ongoing education that is held regularly at Senior Centers, public libraries, housing authorities and at other locations in the community as requested. - Stroke Community Education, Lectures & Health Fairs: Community stroke education lectures and health fairs that provide information to the public regarding prevention of stroke, recognition of stroke symptoms and/or treatment of stroke. In 2022, HMC's Stroke Services department also provided education in the community by working with nursing students at STCC and made an appearance on local NBC affiliate lifestyle channel, MassAppeal, reaching thousands of viewers. - Smoking Cessation: Ready, Set Quit! Smoking Cessation Workshop is made up of four classes designed to give residents the information and support they need get through one of most important changes of their life. Offering both one on one sessions as well as workshops in the community.Wayfinders Steering Committee: HMC provides social determents of health screening and consults with Wayfinders when someone screens housing insecure. They work on referrals and communication and get case updates at weekly meetings. At monthly meetings, direction and concerns with the program are discussed so that every patient is followed and supported. In 2022, HMC's Community Navigation referred 86 patients to the Wayfinders program that were either ""At Risk of Homelessness or ""Experiencing Homelessness"". Community dinners: Food security is a priority to support lower income residents. Holyoke Medical Center provides two meals on a monthly basis to members of our community identified as having food insecurity. One dinner is held on site and distributed curbside and the other is at a non-profit community organization such as Kate's Kitchen, The Salvation Army, and Holyoke Veterans' Lunch Group. Tickets for the dinners are distributed at the non-profit organization for their community while tickets for the onsite curbside dinners are distributed at numerous non-profit organizations such as Enlace de Familias, and Lorraine's Soup Kitchen as well as through HMC's Community Navigation Department to their patients. Prepared meals are pre-cooked, individually bagged, served to-go style and include a balanced meal with a protein entree, vegetable, fruit, milk, water, and dessert. A health screening such as for blood pressure or anxiety is often provided at the offsite dinner. In 2022, HMC served 2800 meals to community members in need. Behavioral Health, Inpatient- Civil Commitments: Uncompensated legal proceedings to commit patients to inpatient psychiatric treatment when they are assessed to be a danger to themselves or members of the community based on psychiatric symptoms, as well as to enforce compliance with said treatment. In 2022, there were 197 uncompensated legal services provided to patients.Community Health Fairs and Workshops: Participation in health fairs in Holyoke and surrounding communities to provide education and preventative information. Provide health screenings. Various health matters are addressed such as nutrition, stroke, cardiology, pulmonary, cancer, etc. In 2022, HMC worked with the Holyoke Public Library to share programs/ workshops via Zoom due to Covid-19. Health fairs at area Senior Centers were held in person. Community Health Education: Educated and implemented programs at area schools and senior centers to promote access to primary and preventative care, utilizing medical and professional staff to educate the community to encourage routine medical screenings, prevent pulmonary disease, and help address behavioral health issues. Emergency Services: HMC operated the only Emergency Department in the City of Holyoke, providing emergency medical and behavioral health services to the community 24 hours a day, 7 days a week, 365 days per year.Healthcare Student Internships and Clinicals: HMC offered internships and clinicals in partnership with colleges and universities. Students in programs to become Nurse Practitioners and Physician Assistants participate in clinical rotations with various HMC providers to gain the experience they need to make informed decisions about what to practice. In 2022, HMC physicians and advanced practice providers spent nearly 3,000 hours training nurse practitioner and physician assistant students. Over 2,500 hours were invested in nursing student internships. MassHire YouthWorks: HMC partners with MassHire Youth Works on their summer program and hosts students interested in a career in healthcare throughout the school year. The goal of the Summer YouthWorks program is to give youth the opportunity to have a meaningful work experience, obtain training, and acquire useful work habits and skills to prepare youth for future meaningful, unsubsidized employment. In 2022, participating departments included Purchasing, Dietary, Specialty Offices, Lab, Physical Therapy, Human Resources, Orthopedics, Vascular, Oncology, Emergency Department, Med Tele and the ICU. In 2022, HMC professional staff and physicians invested over 1,000 hours in high school student internships."