4A (Expenses $ 57086442 including grants of $ 65933) (Revenue $ 58256172)
SEE SCHEDULE O.

4B (Expenses $ 60011747 including grants of $ 0) (Revenue $ 61241418)
SEE SCHEDULE O.

4C (Expenses $ 11889979 including grants of $ 0) (Revenue $ 12133465)
SEE SCHEDULE O.

ANNA JAQUES HOSPITAL
PART V, SECTION B, LINE 5: PART V, SECTION B, LINE 5: FOR DISCLOSURES RELATED TO FORM 990 SCHEDULE H PART V, SECTION B PLEASE SEE SCHEDULE H PART VI SUPPLEMENTAL INFORMATION.

ANNA JAQUES HOSPITAL
PART V, SECTION B, LINE 11: PART V, SECTION B, LINE 11: FOR DISCLOSURES RELATED TO FORM 990 SCHEDULE H PART V, SECTION B PLEASE SEE SCHEDULE H PART VI SUPPLEMENTAL INFORMATION.

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
FORM 990 SCHEDULE H PART V, SECTION C, SUPPLEMENTAL INFORMATION FOR SCHEDULE H PART V, SECTION BFINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITSCOMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSANNA JAQUES HOSPITAL AFFILIATIONANNA JAQUES HOSPITAL IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES. THE BILH NETWORK OF AFFILIATES IS AN INTEGRATED HEALTH CARE SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM IS COMPRISED OF ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS, ADDICTION TREATMENT PROGRAMS. THE BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES. AT THE HEART OF BILH IS THE BELIEF THAT EVERYONE DESERVES HIGH-QUALITY, AFFORDABLE HEALTH CARE AND THIS BELIEF IS WHAT DRIVES EACH AFFILIATE TO WORK WITH COMMUNITY PARTNERS ACROSS THE REGION TO PROMOTE HEALTH, EXPAND ACCESS AND DELIVER THE BEST CARE IN THE COMMUNITIES BILH SERVES. BILH'S COMMUNITY BENEFITS STAFF ARE COMMITTED TO WORKING COLLABORATIVELY WITH BILH'S COMMUNITIES TO ADDRESS THE LEADING HEALTH ISSUES AND CREATE A HEALTHY FUTURE FOR INDIVIDUALS, FAMILIES, AND COMMUNITIES.ANNA JAQUES HOSPITAL COMMUNITY BENEFITS MISSION STATEMENT THE MISSION OF ANNA JAQUES HOSPITAL IS TO PROVIDE HIGH-QUALITY, COMPASSIONATE MEDICAL CARE IN PARTNERSHIP WITH ITS MEDICAL STAFF TO IMPROVE THE HEALTH OF ITS COMMUNITIES. ESTABLISHED IN 1884 THROUGH THE VISION AND CHARITY OF MISS ANNA JAQUES, THE HOSPITAL STANDS AS A TESTAMENT TO ONE WOMAN AND HER PHYSICIAN'S COMMITMENT TO THE COMMUNITY AND ITS NEEDS. AJH PROUDLY CONTINUES THAT TRADITION TODAY BY ACTIVELY SERVING ITS COMMUNITY: BY ADDRESSING THE MOST PRESSING HEALTH NEEDS, SUPPORTING THE UNDERSERVED IN THE HOSPITAL'S SERVICE AREA, AND ADDRESSING DISPARITIES IN ACCESS TO CARE AND HEALTH OUTCOMES.ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS MISSION IS FULFILLED BY: INVOLVING ANNA JAQUES HOSPITAL STAFF, INCLUDING ITS LEADERSHIP AND DOZENS OF COMMUNITY PARTNERS, IN THE CHNA PROCESS AS WELL AS IN THE DEVELOPMENT, IMPLEMENTATION AND OVERSIGHT OF THE HOSPITAL'S THREE-YEAR IMPLEMENTATION STRATEGY. ENGAGING AND LEARNING FROM RESIDENTS THROUGHOUT ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS SERVICE AREA (CBSA) IN ALL ASPECTS OF THE COMMUNITY BENEFITS PROCESS, WITH SPECIAL ATTENTION FOCUSED ON ENGAGING DIVERSE PERSPECTIVES, FROM THOSE, PATIENTS, AND NON-PATIENTS ALIKE, WHO ARE OFTEN LEFT OUT OF SIMILAR ASSESSMENT, PLANNING AND PROGRAM IMPLEMENTATION PROCESSES. ASSESSING UNMET COMMUNITY NEED BY COLLECTING PRIMARY AND SECONDARY DATA (BOTH QUANTITATIVE AND QUALITATIVE) TO UNDERSTAND UNMET HEALTH-RELATED NEEDS AND IDENTIFY COMMUNITIES AND POPULATION SEGMENTS DISPROPORTIONATELY IMPACTED BY HEALTH ISSUES AND OTHER SOCIAL, ECONOMIC AND SYSTEMIC FACTORS. IMPLEMENTING COMMUNITY HEALTH PROGRAMS AND SERVICES IN ANNA JAQUES HOSPITAL CBSA THAT ADDRESS THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH, BARRIERS TO ACCESSING CARE, AS WELL AS PROMOTE HEALTH EQUITY TO IMPROVE THE HEALTH STATUS OF THOSE WHO ARE OFTEN DISADVANTAGED, FACE DISPARITIES IN HEALTH-RELATED OUTCOMES, EXPERIENCE POVERTY, AND HAVE BEEN HISTORICALLY UNDERSERVED. PROMOTING HEALTH EQUITY BY ADDRESSING SOCIAL AND INSTITUTIONAL INEQUITIES, RACISM AND BIGOTRY AND ENSURING THAT ALL PATIENTS ARE WELCOMED AND RECEIVE CARE THAT IS RESPECTFUL AND CULTURALLY RESPONSIVE; AND FACILITATING COLLABORATION AND PARTNERSHIP WITHIN AND ACROSS SECTORS (E.G., STATE/LOCAL PUBLIC HEALTH AGENCIES, HEALTH CARE PROVIDERS, SOCIAL SERVICE ORGANIZATIONS, BUSINESSES, ACADEMIC INSTITUTIONS, COMMUNITY HEALTH COLLABORATIVES, AND OTHER COMMUNITY HEALTH ORGANIZATIONS) TO ADVOCATE FOR, SUPPORT AND IMPLEMENT EFFECTIVE HEALTH POLICIES, COMMUNITY PROGRAMS AND SERVICES.COMMUNITY BENEFITS FINANCIAL SUMMARY DURING THE FISCAL YEAR COVERED BY THIS FILING, ANNA JAQUES HOSPITAL PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFITS OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $658,647 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY BENEFITS LEADERSHIP/TEAMTHE ANNA JAQUES HOSPITAL'S BOARD OF TRUSTEES ALONG WITH ITS CLINICAL AND ADMINISTRATIVE STAFF IS COMMITTED TO IMPROVING THE HEALTH AND WELL-BEING OF RESIDENTS THROUGHOUT ITS CBSA AND BEYOND. ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS DEPARTMENT, UNDER THE DIRECT OVERSIGHT OF ANNA JAQUES HOSPITAL'S BOARD OF TRUSTEES, IS DEDICATED TO COLLABORATING WITH COMMUNITY PARTNERS AND RESIDENTS AND WILL CONTINUE TO DO SO IN ORDER TO MEET ITS COMMUNITY BENEFITS OBLIGATIONS. HOSPITAL SENIOR LEADERSHIP IS ACTIVELY ENGAGED IN THE DEVELOPMENT AND IMPLEMENTATION OF THE ANNA JAQUES HOSPITAL'S IMPLEMENTATION STRATEGY, ENSURING THAT HOSPITAL POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES. ANNA JAQUES HOSPITAL COMMUNITY BENEFITS PROGRAM IS SPEARHEADED BY A COMMUNITY BENEFITS MANAGER. THE COMMUNITY BENEFITS MANAGER HAS DIRECT ACCESS AND IS ACCOUNTABLE TO THE ANNA JAQUES HOSPITAL PRESIDENT AND THE BILH VICE PRESIDENT OF COMMUNITY BENEFITS AND COMMUNITY RELATIONS, THE LATTER OF WHOM REPORTS DIRECTLY TO THE BILH CHIEF DIVERSITY, EQUITY AND INCLUSION OFFICER. IT IS THE RESPONSIBILITY OF THESE LEADERS TO ENSURE THAT COMMUNITY BENEFITS IS ADDRESSED BY THE ENTIRE ORGANIZATION AND THAT THE NEEDS OF COHORTS WHO HAVE BEEN HISTORICALLY UNDERSERVED ARE CONSIDERED EVERY DAY IN DISCUSSIONS ON RESOURCE ALLOCATION, POLICIES, AND PROGRAM DEVELOPMENT. THE ANNA JAQUES HOSPITAL COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) WORKS IN COLLABORATION WITH ANNA JAQUES HOSPITAL'S HOSPITAL LEADERSHIP, INCLUDING THE HOSPITAL'S GOVERNING BOARD AND SENIOR MANAGEMENT TO SUPPORT ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS MISSION TO PROVIDE HIGH-QUALITY, COMPASSIONATE MEDICAL CARE IN PARTNERSHIP WITH ITS MEDICAL STAFF TO IMPROVE THE HEALTH OF ITS COMMUNITIES. THE CBAC PROVIDES INPUT INTO THE DEVELOPMENT AND IMPLEMENTATION OF ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS PROGRAMS IN FURTHERANCE OF ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS MISSION. THE MEMBERSHIP OF ANNA JAQUES HOSPITAL'S CBAC ASPIRES TO BE REPRESENTATIVE OF THE CONSTITUENCIES AND PRIORITY COHORTS SERVED BY ANNA JAQUES HOSPITAL'S PROGRAMMATIC ENDEAVORS, INCLUDING THOSE FROM DIVERSE RACIAL AND ETHNIC BACKGROUNDS, AGE, GENDER, SEXUAL ORIENTATION AND GENDER IDENTITY, AS WELL AS THOSE FROM CORPORATE AND NON-PROFIT COMMUNITY ORGANIZATIONS. AJH'S HOSPITAL'S CBAC MEMBERS INCLUDE: MICHELLE BRASIER, PRACTICE MANAGER, BETH ISRAEL LAHEY PRIMARY CARE HAVERHILL ANDI EGMONT, DIRECTOR OF YOUTH SERVICES AND THE BEACON COALITION, CITY OF NEWBURYPORT TRACY FULLER, REGIONAL EXECUTIVE DIRECTOR, HAVERHILL YMCA ILENE HARNCH-GRADY, ENCORE PROGRAM LEADER, YWCA OF NEWBURYPORT CHRISTINE HEALEY, DIRECTOR OF COMMUNITY BENEFITS AND COMMUNITY RELATIONS, NORTH REGION, BETH ISRAEL LAHEY HEALTH TINA LOS, PROJECT COORDINATOR, ESSEX COUNTY ASSET BUILDER NETWORK TIFFANY NIGRO, EXECUTIVE DIRECTOR, THE PETTENGILL HOUSE PAM PALOMBO, PUBLIC HEALTH NURSE, CITY OF NEWBURYPORT OFFICER DANI SINCLAIR, NEWBURYPORT POLICE; ESSEX COUNTY OUTREACH JEAN TRIM, MANAGING DIRECTOR & PORTFOLIO MANAGER, VIGILANT CAPITAL MANAGEMENT, LLC; MEMBER, AJH BOARD OF TRUSTEES SHARI WILKINSON, MARKET COORDINATOR, NEWBURYPORT FARMERS MARKET COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGYMOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENTINTERNAL REVENUE CODE SECTION 501(R)INTERNAL REVENUE CODE SECTION 501(R), ENACTED AS PART OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, REQUIRES EACH HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND TO FORMALLY ADOPT AN IMPLEMENTATION STRATEGY PURSUANT TO FEDERAL GUIDELINES, IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS AS A HOSPITAL UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) OF 1986, AS AMENDED. ANNA JAQUES HOSPITAL COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN SEPTEMBER 2022. THAT CHNA WAS APPROVED BY THE ANNA JAQUES HOSPITAL BOARD OF TRUSTEES ON SEPTEMBER 1, 2022. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS ALSO ADOPTED BY THE BOARD ON SEPTEMBER 1, 2022, WHICH IS WITHIN THE TIMELINE REQUIRED BY THE TREASURY REGULATIONS UNDER 501(R).

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND THE ASSOCIATED IMPLEMENTATION STRATEGY (IS) REPRESENT THE CULMINATION OF A YEAR OF WORK AND WERE BORNE LARGELY OF ANNA JAQUES HOSPITAL'S COMMITMENT TO BETTER UNDERSTAND AND ADDRESS THE HEALTH-RELATED NEEDS OF THOSE LIVING IN ITS COMMUNITY BENEFITS SERVICE AREA WITH AN EMPHASIS ON THOSE WHO ARE MOST DISADVANTAGED. THE PROJECT ALSO FULFILLS THE COMMONWEALTH ATTORNEY GENERAL'S OFFICE AND FEDERAL INTERNAL REVENUE SERVICE (IRS) REGULATIONS THAT REQUIRE THAT ANNA JAQUES HOSPITAL ASSESS COMMUNITY HEALTH NEEDS, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES, AND CREATE A COMMUNITY HEALTH STRATEGY THAT DESCRIBES HOW ANNA JAQUES HOSPITAL, IN COLLABORATION WITH THE COMMUNITY AND LOCAL HEALTH DEPARTMENT(S), WILL ADDRESS THE NEEDS AND THE PRIORITIES IDENTIFIED BY THE CHNA.2022 COMMUNITY HEALTH NEEDS ASSESSMENTPRIORITY GEOGRAPHY AND COHORTSAS NOTED ABOVE, ANNA JAQUES HOSPITAL COMPLETED ITS LAST ASSESSMENT IN SEPTEMBER 2022. THE GEOGRAPHICAL FOCUS OF ANNA JAQUES HOSPITAL'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT ENCOMPASSES AMESBURY, HAVERHILL, MERRIMAC, NEWBURYPORT, AND SALISBURY.COMMUNITY HEALTH ISSUES AND PRIORITY COHORTS FOR ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS INITIATIVES ARE IDENTIFIED THROUGH A COLLABORATIVE COMMUNITY ENGAGEMENT AND PLANNING PROCESS FROM A CHNA THAT IS CONDUCTED EVERY THREE YEARS IN ACCORDANCE WITH THE REQUIREMENTS UNDER IRC SECTION 501(R).ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS INVESTMENTS AND RESOURCES WILL FOCUS ON IMPROVING THE HEALTH STATUS OF THOSE WHO ARE MEDICALLY-UNDERSERVED, EXPERIENCE POVERTY OR FACE THE GREATEST HEALTH DISPARITIES IN THE COMMUNITIES OF AMESBURY, HAVERHILL, MERRIMAC, NEWBURYPORT, SALISBURY IN ITS CBSA, AS FOLLOWS: YOUTH LOW-RESOURCED POPULATIONS OLDER ADULTS RACIALLY, ETHNICALLY, AND LINGUISTICALLY DIVERSE POPULATIONS INDIVIDUALS WITH DISABILITIES2022 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSANNA JAQUES HOSPITAL'S 2022 CHNA APPROACH INVOLVED EXTENSIVE DATA COLLECTION ACTIVITIES, SUBSTANTIAL EFFORTS TO ENGAGE THE HOSPITAL'S PARTNERS AND COMMUNITY RESIDENTS, AND THOUGHTFUL PRIORITIZATION, PLANNING, AND REPORTING PROCESSES. THROUGHOUT THE CHNA PROCESS, EFFORTS WERE MADE TO UNDERSTAND THE NEEDS OF THE COMMUNITIES ENCOMPASSING ANNA JAQUES HOSPITAL'S CBSA, ESPECIALLY THE POPULATION SEGMENTS THAT ARE OFTEN DISADVANTAGED, FACE DISPARITIES IN HEALTH-RELATED OUTCOMES, AND WHO HAVE BEEN HISTORICALLY UNDERSERVED. ANNA JAQUES HOSPITAL'S UNDERSTANDING OF THESE COMMUNITIES' NEEDS IS DERIVED FROM COLLECTING A WIDE RANGE OF QUANTITATIVE DATA TO IDENTIFY DISPARITIES AND CLARIFY THE NEEDS OF SPECIFIC COMMUNITIES AND COMPARING IT AGAINST DATA COLLECTED AT THE REGIONAL, STATE AND NATIONAL LEVELS WHEREVER POSSIBLE TO SUPPORT ANALYSIS AND THE PRIORITIZATION PROCESS, AS WELL AS EMPLOYING A VARIETY OF STRATEGIES TO ENSURE COMMUNITY MEMBERS WERE INFORMED, CONSULTED, INVOLVED, AND EMPOWERED THROUGHOUT THE ASSESSMENT PROCESS. THE CHNA AND IS DEVELOPMENT PROCESS WAS GUIDED BY THE FOLLOWING PRINCIPLES: EQUITY, COLLABORATION, ENGAGEMENT, CAPACITY BUILDING, AND INTENTIONALITY.BETWEEN OCTOBER 2021 AND FEBRUARY 2022, ANNA JAQUES HOSPITAL CONDUCTED 18 ONE-ON-ONE INTERVIEWS WITH KEY COLLABORATORS IN THE COMMUNITY, FACILITATED THREE FOCUS GROUPS WITH SEGMENTS OF THE POPULATION FACING THE GREATEST HEALTH-RELATED DISPARITIES, ADMINISTERED A COMMUNITY HEALTH SURVEY INVOLVING MORE THAN 750 RESIDENTS, AND ORGANIZED TWO COMMUNITY LISTENING SESSIONS. (SCHEDULE H, PART V, SECTION B, QUESTIONS 3 AND 5). ULTIMATELY, THE ASSESSMENT PROCESS COLLECTED INFORMATION FROM MORE THAN 800 COMMUNITY RESIDENTS, CLINICAL AND SOCIAL SERVICE PROVIDERS, AND OTHER COMMUNITY PARTNERS.2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSANNA JAQUES HOSPITAL RELIED ON NUMEROUS PRIMARY AND SECONDARY DATA SOURCES TO ANALYZE THE HEALTH STATUS AND NEED LEVEL THROUGHOUT THEIR CBSA. ANNA JAQUES HOSPITAL COLLECTED DATA FROM A NUMBER OF SOURCES INCLUDING PRIMARY QUANTITATIVE AND QUALITATIVE DATA, AS WELL AS SECONDARY DATA. EXAMPLES OF SECONDARY DATA SOURCES THAT ANNA JAQUES HOSPITAL LEVERAGED INCLUDED: U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2016-2020) U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY POPULATION CHANGE (2010-2020) U.S. CENSUS BUREAU, COVID-19 HOUSEHOLD PULSE SURVEY (2021) BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY, 2019 MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION: SCHOOL AND DISTRICT PROFILES (2020-2021) FBI UNIFORM CRIME REPORTS (2019) MASSACHUSETTS DEPARTMENT OF ECONOMIC RESEARCH, LABOR MARKET INFORMATION (2020-2021) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, REGISTRY OF VITAL RECORDS AND STATISTICS (2019) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, BUREAU OF SUBSTANCE ABUSE SERVICES (2015-2017) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, COVID-19 DASHBOARD (2021) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, COVID-19 COMMUNITY IMPACT SURVEY (2021) MASSACHUSETTS BUREAU OF INFECTIOUS DISEASE AND LABORATORY SCIENCES (2019) MASSACHUSETTS CENTER FOR HEALTH INFORMATION ANALYSIS (CHIA) HOSPITAL DISCHARGES (2019) MASSACHUSETTS HEALTHY AGING COLLABORATIVE, COMMUNITY PROFILES (2020) MASSACHUSETTS INSTITUTE OF TECHNOLOGY, EVICTION LAB (2018) ROBERT WOOD JOHNSON COUNTRY HEALTH RANKINGS (2019, 2020, 2021)2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS (SCHEDULE H, PART V, SECTION B, LINE 5)BETWEEN OCTOBER 2021 AND FEBRUARY 2022, ANNA JAQUES HOSPITAL CONDUCTED 18 KEY INFORMANT INTERVIEWS THAT ENGAGED COMMUNITY-BASED ORGANIZATIONS, CLINICAL AND SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH OFFICIALS, ELECTED/APPOINTED OFFICIALS AND OTHER KEY COLLABORATORS THROUGHOUT ANNA JAQUES HOSPITAL'S CBSA. DISCUSSIONS EXPLORED INTERVIEWEES' EXPERIENCES OF ADDRESSING COMMUNITY NEEDS AND OPPORTUNITIES FOR FUTURE ALIGNMENT, COORDINATION AND EXPANSION OF SERVICES, INITIATIVES AND POLICIES. A LIST OF KEY INFORMANTS IS INCLUDED IN APPENDIX A OF THE CHNA REPORT THAT IS POSTED ON ANNA JAQUES HOSPITAL'S WEBSITE. THESE INDIVIDUALS WERE CHOSEN TO AMASS A REPRESENTATIVE GROUP OF PEOPLE WHO HAD THE EXPERIENCE NECESSARY TO PROVIDE INSIGHT ON THE HEALTH OF COMMUNITIES IN ANNA JAQUES HOSPITAL'S CBSA. INTERVIEWS WERE CONDUCTED VIRTUALLY USING A STANDARD INTERVIEW GUIDE. INTERVIEWS FOCUSED ON IDENTIFYING THE BIGGEST HEALTH-RELATED CONCERNS/ISSUES, AS WELL AS THE BARRIERS AND/OR CHALLENGES FOR ACCESSING RESOURCES AND SERVICES AMONG THOSE THEY SERVE AND/OR THOSE LIVING IN THE COMMUNITY, INCLUDING POSSIBLE STRATEGIES TO ADDRESS THOSE CONCERNS.2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSFOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5)ANNA JAQUES HOSPITAL CONDUCTED 3 COMMUNITY FOCUS GROUPS AND HELD TWO COMMUNITY LISTENING SESSIONS THAT ENGAGED 800 RESIDENTS IN ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS SERVICE AREA (CBSA) TO GATHER CRITICAL COMMUNITY INPUT FROM COMMUNITY RESIDENTS AND STAKEHOLDERS. THESE SESSIONS WERE ORGANIZED IN COLLABORATION WITH THE LINK HOUSE IN AMESBURY, AMESBURY HIGH SCHOOL -LGBTQ YOUTH AND THE PETTENGILL HOUSE. ANNA JAQUES HOSPITAL HAS BEEN INTENTIONAL IN ENSURING THAT VARIED EXPERIENCES AND PERSPECTIVES, REFLECTIVE OF ANNA JAQUES HOSPITAL'S CBSA AND THE COMMUNITY AT LARGE, WERE SHARED THROUGHOUT THE CHNA AND IS PROCESS. TO REACH A BROAD RANGE OF COMMUNITY MEMBERS, ALL COMMUNITY SURVEYS, FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH A FOCUS ON COMMUNITY REPRESENTATIVENESS. FOR EXAMPLE, THE SURVEY WAS ADMINISTERED ONLINE AND VIA HARD COPY IN MULTIPLE LANGUAGES. FURTHERMORE, EXTENSIVE OUTREACH WAS CONDUCTED VIA SOCIAL MEDIA, INSTITUTIONAL NEWSLETTERS, EMAILS TO LARGE NETWORKS, PUBLIC LIBRARIES, FOOD PANTIES AND COMMUNITY EVENTS TO HELP ENSURE DIVERSE REPRESENTATION IN THE CHNA. THE ANNA JAQUES HOSPITAL COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) WAS ALSO INTEGRALLY INVOLVED IN PROVIDING INPUT ON COMMUNITY NEEDS AND PRIORITIZING THE LEADING HEALTH ISSUES. THE CBAC MET FIVE TIMES DURING THE COURSE OF THE ASSESSMENT. THEY PROVIDED INPUT REGARDING THE CHNA OVERALL AND GUIDED THE PRIORITIZATION AND PLANNING PHASE, CONDUCTING OUTREACH TO COMMUNITY VOICES THAT HAVE HISTORICALLY BEEN LEFT OUT OF SIMILAR PROCESSES.

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
COMMUNITY HEALTH NEEDS ASSESSMENTADDRESSING COMMUNITY HEALTH NEEDS(SCHEDULE H, PART V, SECTION B, LINE 11)AS NOTED ABOVE, ANNA JAQUES HOSPITAL'S MOST RECENT CHNA AND IMPLEMENTATION STRATEGY WERE CONDUCTED AND APPROVED BY THE BOARD DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, BUT IT IS THE PREVIOUS CHNA AND IMPLEMENTATION STRATEGY WHICH INFORMED THE COMMUNITY BENEFITS MISSION AND ACTIVITIES OF ANNA JAQUES HOSPITAL FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, WHICH ARE REPORTED HERE. A SUMMARY OF ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS ACTIVITIES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, AND PRIORITIZED IN THE RELATED IMPLEMENTATION STRATEGY ARE PROVIDED HERE ALONG WITH THE ENTITIES THAT THE HOSPITAL PARTNERS WITH ON THESE EFFORTS. GIVEN THE COMPLEX HEALTH ISSUES IN THE COMMUNITY, ANNA JAQUES HOSPITAL HAS BEEN STRATEGIC IN IDENTIFYING ITS COMMUNITY HEALTH PRIORITIES IN ORDER TO MAXIMIZE THE IMPACT OF ITS COMMUNITY BENEFITS PROGRAM AND WORK TO IMPROVE THE OVERALL HEALTH AND WELLNESS OF RESIDENTS IN ITS CBSA. GOALS FOR EACH HEALTH PRIORITY AREA ARE LISTED BELOW.PRIORITY AREA 1: CHRONIC DISEASE GOAL 1: INCREASE CANCER SCREENING AND PREVENTION GOAL 2: PROVIDE PATIENT SUPPORT SERVICES AND SURVIVORSHIP RESOURCES GOALS 3: INCREASE ACCESS TO PHYSICAL ACTIVITY, WELLNESS, AND HEALTHY EATING PRIORITY AREA 2: BEHAVIORAL HEALTH (SUBSTANCE USE & MENTAL HEALTH) GOAL 1: INCREASE SCREENING, ACCESS TO CARE AND SERVICES GOAL 2: PROMOTE POSITIVE YOUTH RESOURCES PRIORITY AREA 3: SOCIAL DETERMINANTS OF HEALTH GOAL 1: SUPPORT FOOD SECURITY EFFORTS GOAL 2: INCREASE AVAILABILITY OF EMERGENCY HOUSING GOAL 3: SUPPORT LOCAL ADVOCACY AND PREVENTION RESOURCES PRIORITY AREA 4: ACCESS TO CARE GOAL: DECREASE BARRIERS TO HEALTHCARECOMMUNITY HEALTH NEEDS ASSESSMENTAPPROACH TO ADDRESSING HEALTH NEEDS (SCHEDULE H, PART V, SECTION B, LINE 11)A SUMMARY OF ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS ACTIVITIES THAT ADDRESSES THE NEEDS IDENTIFIED IN THE 2019 CHNA COMPLETED DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2019, AND PRIORITIZED IN THE RELATED IMPLEMENTATION STRATEGY IS PROVIDED BELOW, ALONG WITH THE ENTITIES THAT THE HOSPITAL PARTNERS WITH ON THESE EFFORTS. THESE AREAS ARE (1) BEHAVIORAL HEALTH (SUBSTANCE USE AND MENTAL HEALTH) (2) CHRONIC DISEASE (3) ACCESS TO CARE AND (4) SOCIAL DETERMINANTS OF HEALTH.BEHAVIORAL HEALTH (SUBSTANCE USE & MENTAL HEALTH)BEHAVIORAL HEALTH CRISIS CONSULTATIONTO PROVIDE 24/7/365 BEHAVIORAL HEALTH CRISIS EVALUATION IN THE EMERGENCY DEPARTMENT (ED) AND THROUGHOUT OTHER HOSPITAL UNITS FOR INDIVIDUALS EXPERIENCING MENTAL HEALTH AND SUBSTANCE USE RELATED CRISIS. SERVICES ARE PAYER AGNOSTIC AND PROVIDED VIA IN-PERSON OR TELEHEALTH BY A MULTIDISCIPLINARY TEAM OF QUALIFIED PROFESSIONALS, INCLUDING PSYCHIATRISTS, INDEPENDENTLY LICENSED AND MASTER'S LEVEL CLINICIANS, NURSE PRACTITIONERS, REGISTERED NURSES, CERTIFIED PEER SPECIALISTS, AND FAMILY PARTNERS. THE SERVICES INCLUDE INITIAL ASSESSMENTS FOR RISKS, CLINICAL STABILIZATION, TREATMENT INITIATION, CARE COORDINATION, AND ONGOING EVALUATION TO ENSURE APPROPRIATE LEVEL OF CARE PLACEMENT. A MULTIDISCIPLINARY TEAM, COMPRISED OF QUALIFIED BEHAVIORAL HEALTH PROVIDERS, PSYCHIATRY, FAMILY PARTNERS, AND PEER SPECIALISTS, IS EMPLOYED TO PROVIDE BEHAVIORAL HEALTH CRISIS CONSULTATIONS IN THE EMERGENCY DEPARTMENT OR MEDICAL FLOORS OF THE HOSPITAL. THE TEAM SERVED 432 PATIENTS IN FY22. COLLABORATIVE CARE MODELIN ORDER TO INCREASE ACCESS TO MENTAL HEALTH SERVICES, AJH HAS IMPLEMENTED THE COLLABORATIVE CARE MODEL, A NATIONALLY RECOGNIZED PRIMARY CARELED PROGRAM THAT SPECIALIZES IN PROVIDING BEHAVIORAL HEALTH SERVICES IN THE PRIMARY CARE SETTING. THE SERVICES, PROVIDED BY A BILH LICENSED BEHAVIORAL HEALTH CLINICIAN, INCLUDE COUNSELING SESSIONS, PHONE CONSULTATIONS WITH A PSYCHIATRIST, AND COORDINATION AND FOLLOW-UP CARE. THE BEHAVIORAL HEALTH CLINICIAN WORKS CLOSELY WITH THE PRIMARY CARE PROVIDER IN AN INTEGRATIVE TEAM APPROACH TO TREAT A VARIETY OF MEDICAL AND MENTAL HEALTH CONDITIONS. AJH OFFERED THIS COLLABORATIVE CARE MODEL IN TWO LOCATIONS IN FY22: AMESBURY (2) AND HAVERHILL (1) AND SERVED A TOTAL OF 529 PATIENTS. PATIENT NAVIGATOR AT ANNA JAQUES HOSPITALTHE PATIENT CARE NAVIGATOR AT AJH SUPPORTS WOMEN WITH SUBSTANCE USE DISORDER (SUD) AND/OR NEONATAL ABSTINENCE SYNDROME (NAS), A CONDITION THAT IMPACTS ABOUT 14.5 CASES PER 1,000 BIRTHS IN MASSACHUSETTS. THE PATIENT CARE NAVIGATOR SERVES WOMEN IN RECOVERY AND SEEKING ADDITIONAL SUPPORT, WHO HAVE SUFFERED FROM TRAUMA OR ABUSE, OR WHO HAVE BEEN DIAGNOSED WITH MENTAL HEALTH DISORDERS. THE PATIENT CARE NAVIGATOR CHAMPIONS WOMEN THROUGHOUT THEIR PREGNANCY AND INTO THE FIRST YEAR OF MOTHERHOOD, WORKING IN COLLABORATION WITH WOMEN'S HEALTH CARE AND THE ANNA JAQUES BIRTH CENTER & NEONATAL CARE CENTER.IN FY22, THE NAVIGATOR SERVED 251 WOMEN EITHER IN RECOVERY AND SEEKING ADDITIONAL SUPPORT, WHO HAVE SUFFERED FROM TRAUMA OR ABUSE, OR WHO HAVE BEEN DIAGNOSED WITH MENTAL HEALTH DISORDERS. COMMUNITY EDUCATION AND SUPPORTANNA JAQUES PARTNERS WITH AREA NON-PROFITS, SOCIAL SERVICE AGENCIES AND COMMUNITY GROUPS AIMED AT PROVIDING COMMUNITY EDUCATION, SUPPORT AND TRAINING. FOR EXAMPLE, THE ESSEX COUNTY OUTREACH IS A COLLABORATIVE EFFORT INVOLVING ALL 34 POLICE DEPARTMENTS WITHIN ESSEX COUNTY, AS WELL AS THE SHERIFF'S DEPARTMENT, PARTNERING WITH SOCIAL SERVICE AGENCIES, PEER SPECIALISTS, AND OTHER COMMUNITY SUPPORTS TO ASSIST WITH: SUBSTANCE USE DISORDER (SUD) MENTAL OR BEHAVIORAL HEALTH NEEDS HIGH RISK (OF OVERDOSING) REFERRALS HARM REDUCTION STRATEGIES ADDITIONAL SUPPORTS TO FAMILIES AND CHILDREN IMPACTED BY SUD SUPPORTS FOR THOSE THAT HAVE LOST A LOVED ONE TO SUD ECO ESTABLISHED AN OFFICE SPACE IN SALISBURY WHERE MEETINGS WILL BE HELD, LANDLINE ESTABLISHED, AND POTENTIAL FOR DROP IN VISITS AS A SPACE FOR INDIVIDUALS IN NEED TO COME TO FOR SUPPORT AND RESOURCES. ESSEX COUNTY WAS DIVIDED INTO 4 MANAGEABLE REGIONS WITH IDENTIFIED COORDINATORS FOR EACH REGION TO MEET QUARTERLY AND DISCUSS SUCCESSES, OBSTACLES, AREAS FOR IMPROVEMENT, ETC. WITHIN THE COUNTY. A SIM WORKSHOP WAS COMPLETED IN MAY 2022 WITH THE ASSISTANCE OF PRA AND COMMUNITY PARTNERS AND AREAS FOR COLLABORATION WERE IDENTIFIED. AN EMPLOYEE PORTAL VIA THE ECO WEBSITE HAS BEEN ESTABLISHED FOR COMMUNICATION AMONG PARTNERS, DOCUMENT, AND EVENT SHARING. ADDITIONALLY, THE SAMARITANS OF MERRIMACK VALLEY AIMS TO REDUCE THE INCIDENCE OF SUICIDE IN NORTHEASTERN MASSACHUSETTS BY PROVIDING A HOST OF PREVENTION AND AFTER-CARE SERVICES INCLUDING COMMUNITY OUTREACH, TRAININGS, SURVIVOR SUPPORT, AND A 24-HOUR CRISIS HOTLINE. THEY EXPANDED CRISIS HELPLINES AND PROVIDED SEVERAL TRAINING SESSIONS/SUPPORT GROUPS AS WELL AS CAREGIVER TRAINING. THE PETTENGILL HOUSE THE PETTENGILL HOUSE SUBSTANCE ADDICTION/MENTAL HEALTH INITIATIVE PROVIDES PROFESSIONAL ASSESSMENTS, SUPPORT SERVICES, AND INTERVENTIONS TO GREATER NEWBURYPORT RESIDENTS IN NEED. REALIZING THE COMPLEXITY OF SUBSTANCE ADDICTION AND MENTAL HEALTH, AND KNOWING THE NEED FOR INDIVIDUALIZED TREATMENT, THE PETTENGILL HOUSE IMPLEMENTS ITS THERAPEUTIC SYSTEM OF CARE MODEL, WHICH PROVIDES COMPREHENSIVE CASE MANAGEMENT, ADVOCACY, AND INTENSIVE FOLLOW-UP ON BEHALF OF THE IDENTIFIED INDIVIDUALS IN NEED.IN FY22, THE PROGRAM SCREENED 53 INDIVIDUALS FOR MENTAL HEALTH AND SUBSTANCE MISUSE NEEDS AND CONNECTED THEM WITH EITHER INPATIENT TREATMENT, OUTPATIENT TREATMENT, OR MEDICATION ASSISTED TREATMENT. 305 CASE MANAGEMENT INTERVENTIONS WERE CONDUCTED, 391 RECOVERY COACHING AND SUPPORT, 68 COMMUNITY OUTREACH OR WELLNESS VISITS; 185 CALLS, CASE CONSULTATIONS OR REFERRALS; AND 44 HARM REDUCTION SERVICES. THE PROGRAM ALSO WORKED WITH 91 FAMILIES OVER 189 CONSULTATION SESSIONS. CHRONIC DISEASESURVIVORSHIP PROGRAMMINGANNA JAQUES HOSPITAL PARTNERS WITH COMMUNITY ORGANIZATIONS AIMED AT SUPPORTING A PERSON BEYOND THEIR CANCER DIAGNOSIS TO PROMOTE SURVIVORSHIP. FOR EXAMPLE, YMCA'S CORNERSTONE PROGRAM IS A COLLABORATIVE PROGRAM PROVIDING ESSENTIAL DAILY LIVING SUPPORT TO CANCER PATIENTS, CANCER SURVIVORS, AND THEIR FAMILIES. THE PROGRAM PROVIDES A MEMBERSHIP TO THE Y FOR PEOPLE DIAGNOSED WITHIN THE PAST FIVE YEARS, ACCESS TO SPECIALIZED PROGRAMS TO HELP THOSE WITH CANCER AND RECOVERING FROM CANCER, SPECIAL DROP-IN BABYSITTING FOR PARENTS WHO ARE CURRENTLY IN TREATMENT, WEEKS OF SUMMER CAMP IS OFFERED FOR FAMILIES WHO HAVE BEEN AFFECTED BY CANCER AND THE PROGRAM PROVIDES AN OVERALL SENSE OF COMMUNITY TO SUPPORT SURVIVORSHIP. IN FY22, THE YMCA EXTENDED 49 CORNERSTONE MEMBERSHIPS TO SUPPORT HEALTHY LIVING TO FAMILIES IMPACTED BY CANCER.

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
"ADDITIONALLY, AJH SUPPORTS THE YWCA OF NEWBURYPORT'S ENCORE PROGRAM A FREE 12-WEEK PROGRAM OFFERED TO ANY ""THRIVER"" WHO HAS EXPERIENCED CANCER AT ANY TIME IN THEIR LIVES, WHICH HAS SERVED HUNDREDS OF WOMEN IN OUR COMMUNITY. THE YWCA ENCORE PROGRAM IS DESIGNED TO EMPOWER WOMEN TO RECLAIM THEIR PHYSICAL AND EMOTIONAL HEALTH AND WELL-BEING AFTER A CANCER DIAGNOSIS AND TREATMENT.VIRTUAL SUPPORT GROUP OFFERINGSANNA JAQUES HOSPITAL COLLABORATES WITH COMMUNITY PROGRAMS TO PROMOTE AWARENESS OF THE IMPORTANCE OF BREAST CANCER SCREENING AND TO INCREASE AWARENESS OF RESOURCES FOR PEOPLE IMPACTED BY CANCER. IN FY19 ANNA JAQUES SUPPORTED THE LAUNCH OF THE NORTH OF BOSTON CANCER RESOURCE. THE COMPREHENSIVE ONLINE GUIDE SIMPLIFIES ACCESS TO RESOURCES, EDUCATION AND SERVICES TO HELP PEOPLE WITH CANCER SURVIVE AND THRIVE THROUGH DIAGNOSIS, TREATMENT AND BEYOND. THIS RESOURCE, DEVELOPED IN COLLABORATION WITH THREE OTHER ORGANIZATIONS, BUILDS UPON THE HOSPITAL'S RELATIONSHIPS WITH COMMUNITY PARTNERS WHO PROVIDE COMPLEMENTARY SERVICES IN THE ANNA JAQUES CANCER CENTER. THE ONLINE NORTH OF BOSTON CANCER RESOURCE RECORDED 10,900 PAGE VIEWS. IN RESPONSE TO THE COVID-19 PANDEMIC, THE NORTH OF BOSTON CANCER RESOURCE SPEAKER SERIES SHIFTED VIRTUALLY TO EDUCATE AND OFFER SUPPORT TO PEOPLE AFFECTED BY CANCER. THE SESSIONS PROVIDE THE OPPORTUNITY FOR PARTICIPANTS TO LEARN ABOUT AND EXPERIENCE HEALING PRACTICES THAT CAN HELP THEM EASE THE DISTRESS OF A CANCER DIAGNOSIS AND TREATMENT AND ENHANCE THEIR WELL-BEING FROM DIAGNOSIS THROUGH TREATMENT AND BEYOND. NBCR HOSTED 10 SPEAKER SERIES EVENTS FOR A TOTAL OF 122 PARTICIPANTS. LOCAL FARMERS' MARKETSSOME 6,000 PEOPLE IN NORTHEASTERN ESSEX COUNTY ARE FOOD INSECURE. ANNA JAQUES HOSPITAL (AJH) PARTNERS WITH BOTH THE NEWBURYPORT AND HAVERHILL FARMERS' MARKETS TO ENSURE THAT COMMUNITIES HAVE ACCESS TO HEALTHY AFFORDABLE FOODS, ESPECIALLY FRUITS AND VEGETABLES. BOTH MARKETS INCLUDE FARMERS AND VENDORS WHO ACCEPT EBT/SNAP TO MAKE HEALTHY EATING MORE ACCESSIBLE TO EVERYONE.THE NEWBURYPORT MARKET 30 MARKETS HELD FROM MAY THROUGH NOVEMBER 2022. ROUGHLY 1,200 - 1,600 PEOPLE ATTENDED WEEKLY THE HAVERHILL FARMERS' MARKET PROMOTES HEALTHY EATING AND IS EASILY ACCESSIBLE BY PUBLIC TRANSPORTATION. HAVERHILL FARMERS' MARKET HOSTED MARKETS WEEKLY FROM JUNE THROUGH OCTOBER 2022 (TOTAL OF 19). THE MARKET SERVED ROUGHLY 700-800 RESIDENTS PER WEEK. FARMERS MARKETS ARE CRUCIAL IN PROVIDING FRESH LOCAL PRODUCE AND HEALTHY FOOD OPTIONS. ACCESS TO CAREBARRIER TO HEALTH CAREBARRIERS TO OBTAINING HEALTH CARE INCLUDE TRANSPORTATION, ACCESS TO AVAILABLE RESOURCES, AFFORDABILITY, INSURANCE COVERAGES, INADEQUATE SERVICES, LACK OF HEALTH CARE PROVIDERS, AND LANGUAGE BARRIERS. TRANSPORTATION WAS THE LARGEST CONCERN THROUGHOUT ALL COMMUNITIES IN THE GREATER HAVERHILL AREA. AJH PROVIDES SERVICES TO ADDRESS THESE GAPS INCLUDING PATIENT FINANCIAL COUNSELORS, TRANSPORTATION SUPPORT, AND INTERPRETER SERVICES. SOCIAL DETERMINANTS OF HEALTH FOOD SECURITYAJH SUPPORTS OUR NEIGHBORS' TABLE'S (ONT) YEAR-ROUND WEDNESDAY MEAL IS A FREE, OPEN, COMMUNITYWIDE DINING EXPERIENCE OFFERING A THREE-COURSE, NUTRITIOUS MEAL EACH WEEK. IN ADDITION TO THE MEAL ITSELF, THE PROGRAM OFFERS SOCIALIZATION AND CONNECTION TO OTHER RESOURCES AND SUPPORT FOR PEOPLE LIVING IN THE REGION, INCLUDING ONT'S GROCERY MARKETS AND SNAP.IN RESPONSE TO PUBLIC HEALTH GUIDELINES RELATED TO COVID-19, ONT CLOSED ITS DINING ROOM IN MARCH 2020 AND PIVOTED SWIFTLY TO OFFER DINNERS AS INDIVIDUAL OR FAMILY-SIZED MEALS TO-GO. ONT SAW AN 89% INCREASE IN PEOPLE COMING TO RECEIVE A TAKE-HOME MEAL EACH WEEK, WITH THE GREATEST AMONG THEM BEING FAMILIES WITH CHILDREN AND MEN AND WOMEN IN RECOVERY. SUPPORT PROVIDED BY AJH SPONSORED SIX WEEKS' WORTH OF MEALS FOR ONT GUESTS. IN 2022, ONT HAS PROVIDED 8,387 ADULTS AND 1,181 CHILDREN WITH A WEEKLY FREE MEAL AND INTRODUCED THEM TO ONT'S GROCERY PROGRAM WHERE THEY CAN ACCESS GROCERIES OF THEIR CHOICE ONCE A WEEK AT NO COST TO THEM. APPROXIMATELY 82% OF MEAL RECIPIENTS ARE RETURNING GUESTS EACH WEEK.FAMILIES WITH CHILDREN HAVE REPRESENTED THE GREATEST INCREASE IN ATTENDANCE AND HAVE HIGHLIGHTED SOME POSITIVE PROGRAMMATIC CHANGES RESULTING FROM THE PANDEMIC. ANONYMITY AND THE CONVENIENCE OF A GRAB-AND-GO, FAMILY-SIZED DINNER IS A DRAW FOR FAMILIES WHO DON'T HAVE ADEQUATE FOOD AT HOME NOR THE TIME OR ABILITY TO PREPARE DINNER WHILE JUGGLING PARENTING, HOMESCHOOLING, AND WORK. AJH'S SUPPORT WAS FOCUSED ON THE NEEDS RELATED TO OFFERING MEALS TO-GO ON A WEEKLY BASIS, YEAR-ROUND. HOUSINGAJH STRENGTHENED ITS PARTNERSHIP WITH EMMAUS THROUGH ""MITCH'S PLACE EMERGENCY SHELTER"" THAT SERVES ADULTS IMPACTED BY HOMELESSNESS IN THE GREATER HAVERHILL AREA AND EXPERIENCED A SIGNIFICANT INCREASE IN NEED DURING THE PANDEMIC. AJH SUPPORTED UNEXPECTED FINANCIAL BURDENS TO ENSURE THAT STATE SAFETY MEASURES RELATED TO COVID-19 WERE IN PLACE TO KEEP PATRONS SAFE DURING THE PANDEMIC.EMMAUS SERVED 222 INDIVIDUALS AT MITCH'S PLACE OVERNIGHT EMERGENCY SHELTER IN FY'22 JULY 2021 - JUNE 2022), UP FROM 119 IN FY'21 WHEN IT OPERATED AS A 24/7 PROGRAM DURING THE HEIGHT OF THE PANDEMIC. THE NUMBER OF INDIVIDUALS SERVED IN FY '22 APPROACHED PRE-PANDEMIC LEVELS WHEN 267 DIFFERENT INDIVIDUALS USED THE SHELTER. IN FY'22, EMMAUS CONTINUED TO PRIORITIZE GENERATING AND MAINTAINING PERMANENT HOUSING SOLUTIONS FOR THOSE IMPACTED BY HOMELESSNESS. THE AGENCY EXPANDED ITS RAPID REHOUSING PROGRAM, PLACING 56 INDIVIDUALS INTO PERMANENT HOUSING WITH ATTACHED SUPPORTIVE SERVICES IN THE 12-MONTH PERIOD. THE RAPID RE-HOUSING INITIATIVE KEPT THE LENGTH OF STAY IN SHELTER UNDER 30 DAYS FOR 71% OF THE MITCH'S PLACE SHELTER GUESTS. LESS THAN 5% OF SHELTER GUESTS REMAINED IN SHELTER FOR MORE THAN SIX MONTHS. EMMAUS CONTINUES TO MANAGE 99 UNITS OF PERMANENT AFFORDABLE HOUSING THAT IT OWNS AND OPERATES, INCLUDING 59 UNITS DESIGNATED FOR INDIVIDUAL ADULTS. RESIDENTS PAY 30% OF THEIR INCOME AND ARE RE-ASSESSED ANNUALLY. THE MAJORITY OF THESE RESIDENTS HAVE LIVED STABLY IN EMMAUS PROPERTIES FOR MANY YEARS. THERE IS VERY LITTLE TURNOVER IN THESE UNITS.FY22 SCHEDULE HIMPLEMENTATION STRATEGY UPDATEPRIORITY AREA 1: CHRONIC DISEASE CANCER IS THE LEADING CAUSE OF DEATH IN MASSACHUSETTS AND THE CAUSE OF ONE IN EVERY FOUR DEATHS IN THE UNITED STATES (CDC). IN MASSACHUSETTS, DEATHS DUE TO ALL CANCERS ARE SLIGHTLY HIGHER THAN THE STATE AVERAGE. LUNG CANCER DEATHS ARE HIGHER THAN THE STATE AVERAGE OVERALL, AND SIGNIFICANTLY HIGHER IN MERRIMAC, SALISBURY, HAVERHILL, AND AMESBURY. AJH STRIVES TO PROMOTE PREVENTION AND AWARENESS THROUGH THE ADVOCACY OF ANNUAL CANCER SCREENINGS AND EDUCATION, WHILE ALSO ADDRESSING CERTAIN HEALTH RISK FACTORS THAT MAY LEAD TO CANCER, INCLUDING OBESITY, LACK OF EXERCISE AND POOR NUTRITION.GOAL 1: INCREASE CANCER SCREENING & PREVENTIONPROGRAMMATIC OBJECTIVES1.1 PROVIDE CANCER SCREENINGS AT A LOWER (OR NO) COST COMMUNITY OBJECTIVES / STRATEGIES PROVIDE PREVENTION EDUCATION IN PARTNERSHIP WITH ANNA JAQUES CANCER PROGRAMS INCREASE ANNUAL MAMMOGRAM SCREENINGS THROUGH AWARENESS CAMPAIGNS SUPPORT LOCAL ORGANIZATIONS FOCUSED ON CANCER PREVENTIONMETRICS AND STATUS UPDATES NUMBER OF PATIENTS SCREENED FOR BREAST CANCER/MAMMOGRAPHY (FY20: 9,894; FY21: 12,448 AJH COLLABORATED WITH LOCAL BUSINESSES AND COMMUNITIES DURING BREAST CANCER AWARENESS MONTH TO INCREASE AWARENESS AND PREVENTION. (FY20 AND FY21: WORKPLACE WELLNESS AND ENGAGEMENT AROUND THE THEME ""THE BEST PREVENTION IS EARLY DETECTION"" IS SHARED THROUGHOUT SEVEN COMMUNITIES). AJH PROMOTED PREVENTION OF OVARIAN CANCER IN COLLABORATION WITH GREATER NEWBURYPORT OVARIAN CANCER AWARENESS (GNOCA), DURING OVARIAN CANCER AWARENESS MONTH. NUMBER OF EXTENDED-CARE FACILITIES AND NUMBER OF WOMEN RECEIVING OUTREACH EDUCATION (FY20: 17 FACILITIES AND 700 WOMEN; FY21: 17 FACILITIES AND 700 WOMEN).COMMUNITY PARTNERS: GREATER NEWBURYPORT OVARIAN CANCER AWARENESS (GNOCA), ANNA JAQUES HOSPITAL/GERRISH BREAST CARE CENTERGOAL 2: PROVIDE PATIENT SUPPORT SERVICES AND SURVIVORSHIP RESOURCES PROGRAMMATIC OBJECTIVES1.1 CONTINUE TO SUPPORT LOCAL AND REGIONAL EFFORTS FOR PATIENT AND SURVIVOR SUPPORTCOMMUNITY ACTIVITIES / STRATEGIES AJH BREAST CARE NAVIGATOR PROVIDES INDIVIDUALIZED SUPPORT AND ASSISTANCE TO PATIENTS AND THEIR CAREGIVERS TO HELP THEM MAKE INFORMED DECISIONS ABOUT THEIR CARE AND TO OVERCOME BARRIERS TO OPTIMAL CARE ON-GOING SUPPORT GROUPS FOR CANCER SURVIVORS, IN-PERSON AND VIRTUAL ONLINE RESOURCES AND DIRECTORIES TO CONNECT PEOPLE WITH VITAL RESOURCES AND LOCAL OFFERINGS RELATED TO CANCER"

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
"METRICS AND STATUS UPDATES NUMBER OF PATIENTS AND FAMILIES PROVIDED WITH SUPPORT SERVICES BY AJH BREAST CARE NAVIGATOR (FY20: 68 INDIVIDUAL PATIENTS AND THEIR FAMILIES OR CAREGIVERS. 61 PATIENTS WERE ALSO PROVIDED SURVIVORSHIP CARE PLANS; FY21: 275+ WOMEN SCHEDULED FOR IMAGE-GUIDED BREAST BIOPSIES AND 133 GERRISH BREAST CARE CENTER (GBCC) PATIENTS AND FAMILIES; FY22: 300 WOMEN SCHEDULED FOR IMAGE-GUIDED BREAST BIOPSIES AND 100+ GBCC PATIENTS AND FAMILIES) NUMBER OF SPEAKER SERIES SESSIONS OFFERED BY NORTH OF BOSTON CANCER RESOURCE TO EDUCATE AND OFFER SUPPORT TO PEOPLE AFFECTED BY CANCER. (FY20: 8 EVENTS AND 84 PARTICIPANTS; FY21:10 EVENTS AND 138 PARTICIPANTS; FY22: 10 EVENTS AND 122 PARTICIPANTS) NUMBER OF SURVIVORSHIP SUPPORT PROGRAM MEMBERSHIPS OFFERED IN GREATER HAVERHILL BY YMCA CORNERSTONE (FY21: 45; FY22: 49) NUMBER OF MEMBERS IN YWCA NEWBURYPORT ENCORE CANCER SURVIVOR WELLNESS PROGRAM (FY20: 80, FY21: 20; FY22: 20)COMMUNITY PARTNERS: NORTH OF BOSTON CANCER RESOURCE, YMCA HAVERHILL CORNERSTONE, YWCA ENCORE, ANNA JAQUES HOSPITAL CANCER PROGRAMSGOAL 3: INCREASE ACCESS TO PHYSICAL ACTIVITY, WELLNESS, AND HEALTHY EATING PROGRAMMATIC OBJECTIVES1.1 PROVIDE SUPPORT FOR FITNESS AND ACCESS TO FRESH, HEALTHY FOODSCOMMUNITY ACTIVITIES / STRATEGIES PROVIDE ACCESS TO FREE PHYSICAL ACTIVITY OPPORTUNITIES SUPPORT EDUCATION ON IMPORTANCE OF PHYSICAL ACTIVITY SUPPORT LOCAL FARMERS' MARKETS THAT INCREASE ACCESSIBILITY TO FRESH, NUTRITIOUS FOODMETRICS AND STATUS UPDATES ANNUAL ""ADOPT-A-TRAIL"" SPONSORSHIP AS PART OF COASTAL TRAILS COALITION, PROVIDING FUNDS TO MANAGE TRAIL SAFETY AND OPPORTUNITY FOR HEALTHY ACTIVITY IN THE COMMUNITY FY20, FY21, FY22: AJH SPONSORED A PART OF THE TRAIL THAT SUPPORTS THE OFFERING OF A 30-MILE BIKE PATH. SPONSORSHIP OF THE HAVERHILL FARMERS' MARKET DEDICATED TO PROMOTING HEALTHY EATING, AND SUPPORTING LOCAL BUSINESS, SUSTAINABILITY, AND COMMUNITY SPIRIT BY PROVIDING FRESH, LOCAL PRODUCE, BAKED AND PREPARED FOODS AS WELL AS HAND-CRAFTED GOODS. HOSTED IN DOWNTOWN HAVERHILL AND EASILY ACCESSIBLE BY PUBLIC TRANSPORTATION, THE MARKET ACCEPTS EBT/SNAP. NUMBER OF WEEKLY MARKETS HOSTED AND NUMBER OF WEEKLY ATTENDEES (FY20: 17 MARKETS JUNE THROUGH OCT 2020; FY21: 19 MARKETS JUNE THRU OCT 2021 AND 700-800 ATTENDEES; FY22: 19 MARKETS JUNE THRU OCT 2022 AND 700-800 ATTENDEES, INCREASE IN SNAP/WIC BENEFITS). SPONSORSHIP OF NEWBURYPORT FAMERS MARKET TO PROMOTE AFFORDABLE, HEALTHY FOOD CHOICES AND REDUCE RISK OF CHRONIC DISEASE. EBT/SNAP ACCEPTED. NUMBER OF WEEKLY MARKETS HOSTED AND NUMBER OF WEEKLY ATTENDEES (FY21: 24 MARKETS JUNE THRU NOV 2021 AND 1200-1500 ATTENDEES; FY22: 30 MARKETS MAY THRU NOV 2022, 1200-1600 ATTENDEES) AJH SPONSORED THE FRIENDS OF AMESBURY COUNCIL ON AGING'S ""HEALTH & WELLNESS FEST"" WHICH HOSTED FREE FITNESS AND HEALTH OPPORTUNITIES EVERY WEDNESDAY IN SEPTEMBER AS AN OPPORTUNITY FOR SENIORS TO RECONNECT AND RECEIVE DIRECT SERVICES SUCH AS FLU SHOTS, FITNESS DEMONSTRATIONS AND HEALTHY MEALS. OFFERINGS WERE HELD IN PERSON WITH MANY SAFETY MEASURES IN PLACE AND IN FULL COMPLIANCE OF STATE SAFETY GUIDELINES FY20: HOSTED 4 HEALTH AND WELLNESS DAYS OVER MONTH OF SEPTEMBER WELCOMED 40 ELDERS EACH DAY; ADMINISTERED 125 FLU SHOTS; PROVIDED 200 GRAB & GO LUNCHES.COMMUNITY PARTNERS: AMESBURY COUNCIL ON AGING, NEWBURYPORT FARMERS MARKET, HAVERHILL FARMERS MARKET, COASTAL TRAILS COALITIONPRIORITY AREA 2: BEHAVIORAL HEALTH (SUBSTANCE USE & MENTAL HEALTH) THE NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) REPORTS THAT ONE-IN-FOUR INDIVIDUALS EXPERIENCES A MENTAL ILLNESS EACH YEAR, UNDERSCORING A CRITICAL NEED FOR MENTAL HEALTHCARE ACCESS ACROSS ALL PATIENT POPULATIONS. IN THE 2019 AJH CHNA, MENTAL HEALTH INCLUDING DEPRESSION, ANXIETY, STRESS, SERIOUS MENTAL ILLNESS, AND OTHER CONDITIONS WAS OVERWHELMINGLY IDENTIFIED AS ONE OF THE LEADING HEALTH ISSUES FOR RESIDENTS OF THE SERVICE AREA. STUDENT'S GRADES 6-12 IN THE AMESBURY, GEORGETOWN, NEWBURYPORT AND TRITON SCHOOL DISTRICTS ENGAGED IN AN ATTITUDES & BEHAVIOR SURVEY WHICH SHARED: WHILE FAMILY SUPPORT IS HIGH (84%), PARENT INVOLVED IN SCHOOL IS LACKING (37%) AND THAT POSITIVE FAMILY COMMUNICATIONS IS LOWER (39%); THE SURVEY ALSO REFLECTED THE STUDENTS PERCEIVE THAT THE PERCENT OF ADULTS IN THE COMMUNITY WHO VALUE YOUTH IS LOW (30%), AS WELL THAT YOUNG PEOPLE ARE GIVEN USEFUL ROLES IN THE COMMUNITY (39%). AJH PARTNERS WITH LOCAL SOCIAL SERVICES AGENCIES TO SUPPORT ACCESS TO CASE MANAGEMENT AND INTERVENTIONS, AS WELL AS COLLABORATES LOCALLY TO PROVIDE POSITIVE RESOURCES AND SUPPORTS FOR YOUTH.GOAL 1: INCREASE SCREENING, ACCESS TO CARE AND SERVICESPROGRAMMATIC OBJECTIVES1. PROVIDE AND SUPPORT SUBSTANCE USE SERVICES AT THE HOSPITAL AND COMMUNITY.COMMUNITY OBJECTIVES / STRATEGIES IMPROVE COORDINATION OF CARE FROM INPATIENT TO OUTPATIENT BEHAVIORAL HEALTH SERVICES SUPPORT LOCAL CASE MANAGEMENT OFFERINGS AND INITIATIVES FOCUSED ON MENTAL HEALTH AND SUBSTANCE USEMETRICS AND STATUS UPDATES AJH BEGAN PROVIDING 24/7/365 BEHAVIORAL HEALTH CRISIS EVALUATION IN THE EMERGENCY DEPARTMENT (ED) AND THROUGHOUT OTHER HOSPITAL UNITS FOR INDIVIDUALS EXPERIENCING MENTAL HEALTH AND SUBSTANCE USE RELATED CRISIS. SERVICES ARE PAYER AGNOSTIC AND PROVIDED VIA IN-PERSON OR TELEHEALTH BY A MULTIDISCIPLINARY TEAM OF QUALIFIED PROFESSIONALS, INCLUDING PSYCHIATRISTS, INDEPENDENTLY LICENSED AND MASTER'S LEVEL CLINICIANS, NURSE PRACTITIONERS, REGISTERED NURSES, CERTIFIED PEER SPECIALISTS, AND FAMILY PARTNERS. THE SERVICES INCLUDE INITIAL ASSESSMENTS FOR RISKS, CLINICAL STABILIZATION, TREATMENT INITIATION, CARE COORDINATION, AND ONGOING EVALUATION TO ENSURE APPROPRIATE LEVEL OF CARE PLACEMENT. NUMBER OF PATIENTS WHO RECEIVED BEHAVIORAL HEALTH CRISIS CONSULTATION SERVICES (FY22: 432) AJH PARTNERED WITH SOCIAL SERVICE AGENCY, THE PETTENGILL HOUSE, ON ITS SUBSTANCE ADDICTION/MENTAL HEALTH INITIATIVE WHICH PROVIDES PROFESSIONAL ASSESSMENTS, SUPPORT SERVICES AND INTERVENTIONS TO GREATER NEWBURYPORT RESIDENTS IN NEED. REALIZING THE COMPLEXITY OF SUBSTANCE ADDICTION AND MENTAL HEALTH, AND KNOWING THE NEED FOR INDIVIDUALIZED TREATMENT, PETTENGILL HOUSE IMPLEMENTS ITS THERAPEUTIC SYSTEM OF CARE MODEL WHICH PROVIDES COMPREHENSIVE CASE MANAGEMENT, ADVOCACY, AND INTENSIVE FOLLOW-UP ON BEHALF OF THE IDENTIFIED INDIVIDUALS IN NEED. NUMBER OF INDIVIDUALS SCREENED AND CONNECTED TO SERVICES (FY20: 83, FY21: 53, FY22: 53) NUMBER OF INDIVIDUALS ACCESSING SUBSTANCE AND MENTAL HEALTH CARE (FY20: 67, FY21: 53, FY22: 87) AJH SUPPORTED THE SAMARITANS OF THE MERRIMACK VALLEY THAT AIMS TO REDUCE THE INCIDENTS OF SUICIDE IN NORTHEASTERN MASSACHUSETTS BY PROVIDING A HOST OF PREVENTION AND POST-VENTION SERVICES INCLUDING COMMUNITY OUTREACH, TRAININGS, SURVIVOR SUPPORT AND A 24-HOUR CRISIS HOTLINE. FY20: HOSTED THREE 8-WEEK SERIES OF THE SUICIDE ATTEMPT SURVIVOR SUPPORT GROUP; COMPLETED 16 HOURS OF SUICIDE PREVENTION TRAININGS; HOSTED 10 ""SAFE PLACE"" SUPPORT GROUPS FY21: RECRUITED AND TRAINED 14 NEW CRISIS-LINE VOLUNTEERS WHO ANSWERED 14,500+ CALLS; PROVIDED THREE 8-WEEK SERIES FOR A SUICIDE-ATTEMPT SUPPORT GROUP; ORGANIZED 40 SAFE PLACE SUPPORT GROUPS FOR SUICIDE LOSS SURVIVORS; COMPLETED 24-HOURS OF ""GATEKEEPER"" TRAINING WITH 240 GATEKEEPERS OF MIDDLE-AGED PERSONS FY22: ADDED 30 NEW STAFF AND 5 VOLUNTEERS TO PROVIDE COVERAGE FOR NEW 988 CRISIS CALL CENTERS TO ANSWER 1800 CALLS PER MONTH AND ANSWER RATE OF 92%. FOUR 8-WEEK SESSIONS OF THE SUICIDE ATTEMPT SURVIVOR SUPPORT GROUP; 28 HOURS OF ""GATEKEEPER TRAINING"" WITH 210 ""GATEKEEPERS; 10 OUTREACH TRAINING SESSIONS TO COMMUNITY GROUPS AND SCHOOLS, 48 SAFE PLACE SUPPORT GROUPS FOR SUICIDE LOSS SURVIVORS AJH CONTINUED OFFERING THE PATIENT CARE NAVIGATOR THAT SUPPORTS WOMEN WITH SUBSTANCE USE DISORDER AND/OR NEONATAL ABSTINENCE SYNDROME, A CONDITION THAT IMPACTS ABOUT 14.5 CASES PER 1,000 BIRTHS IN MASSACHUSETTS. THE PATIENT CARE NAVIGATOR SERVES WOMEN IN RECOVERY AND SEEKING ADDITIONAL SUPPORT, WHO HAVE SUFFERED FROM TRAUMA OR ABUSE, OR WHO HAVE BEEN DIAGNOSED WITH MENTAL HEALTH DISORDERS. THE PATIENT CARE NAVIGATOR CHAMPIONS WOMEN THROUGHOUT THEIR PREGNANCY AND INTO THE FIRST YEAR OF MOTHERHOOD, WORKING IN COLLABORATION WITH WOMEN'S HEALTH CARE AND THE ANNA JAQUES BIRTH CENTER & NEONATAL CARE CENTER. NUMBER OF WOMEN SERVED IN RECOVERY OR SEEKING ADDITIONAL SUPPORT (FY20: 182; FY21: 155; FY22: 251). AJH CONTINUED PARTNERING WITH ESSEX COUNTY OUTREACH, A COLLABORATIVE EFFORT INVOLVING ALL 34 POLICE DEPARTMENTS WITHIN ESSEX COUNTY, AS WELL AS THE SHERIFF'S DEPARTMENT, PARTNERING WITH SOCIAL SERVICE AGENCIES, PEER SPECIALISTS, AND OTHER COMMUNITY SUPPORTS TO INCREASE RESOURCES FOR SUBSTANCE USE AND MENTAL HEALTH. FY21: 14 COMMUNITY EVENTS, FY22: SIM WORKSHOP, EMPLOYEE PORTAL, ADDITIONAL STAFF HIRED, AND POOL OF RECOVERY COACHES CREATED"

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
"GOAL 2: PROMOTE POSITIVE YOUTH RESOURCES FOR HEALTH & WELL-BEINGCOMMUNITY ACTIVITIES / STRATEGIES SUPPORT COMMUNITY PROGRAMS AND OFFERINGS THAT PROVIDE YOUTH WITH HEALTHY ENGAGEMENT AND LEARNING OPPORTUNITIES METRICS AND STATUS UPDATES AJH SUPPORTED THE ESSEX COUNTY ASSET BUILDER NETWORK'S LAUNCH OF A DEDICATED COVID-19 FAMILY RESOURCE WEBSITE COMPILED OF ARTICLES, VIDEOS AND TIPS FOR FAMILIES AND CHILDREN OF ALL AGES TO FIND INFORMATION ON SELF-CARE, MENTAL HEALTH AND ACCESS TO LOCAL RESOURCES SUCH AS LOCAL FOOD PANTRY, CLOTHING OR HELP WITH GRANT APPLICATIONS FOR ASSISTANCE FUNDING. FY20: THE WEBSITE RECEIVED OVER 2,000 HITS; HOSTED 7 PARENT SPEAKER OR WEBINAR OPPORTUNITIES INCLUDING: ""TEENS, TWEENS & QUARANTINES"" (335 SIGN-UPS); ""PARENTS THROUGH A PANDEMIC"" (322 SIGN-UPS) ""GOOD NEWS ABOUT BAD BEHAVIOR"" (216 SIGN-UPS); MAILED SUPPORT MATERIALS TO 3,200 HOUSEHOLDS GIRLS INC. OF THE SEACOAST AREA IS AN AFFILIATE OF GIRLS INCORPORATED, A NATIONAL RESEARCH, EDUCATION, AND DIRECT ADVOCACY ORGANIZATION THAT INSPIRES GIRLS TO BE STRONG, SMART, AND BOLD. THE PROGRAM OFFERS RESEARCH-BASED CURRICULUMS INCLUDING STEAM (SCIENCE, TECHNOLOGY, ENGINEERING, ART, AND MATH); MEDIA LITERACY; ECONOMIC LITERACY; GROWING UP STRONG, SMART, AND BOLD (FRIENDSHIPS AND CONFLICT RESOLUTION); AND HEALTHY LIVING/SELF-CARE. PROGRAMS ARE OFFERED DURING THE ACADEMIC SCHOOL YEAR, SCHOOL VACATIONS, AND THE SUMMER. NUMBER OF GIRLS SERVED (FY20: 193, FY21: 129, FY22: 164)COMMUNITY PARTNERS: THE PETTENGILL HOUSE, FAMILY SERVICES OF THE MERRIMACK VALLEY, JEANNE GEIGER CRISIS CENTER, GIRLS., INC., ESSEX COUNTY OUTREACH, ESSEX COUNTY ASSET BUILDER NETWORK PRIORITY AREA 3: SOCIAL DETERMINANTS OF HEALTHIN THE LAST DECADE, EVIDENCE HAS MADE IT INCREASINGLY CLEAR THAT THE UTILIZATION OF MEDICAL SERVICES IS NOT THE PRIMARY DETERMINANT OF COMMUNITY HEALTH. RATHER, THE SOCIAL CONDITIONS IN WHICH PEOPLE ARE BORN, GROW, LIVE, WORK, AND AGE PLAY A KEY ROLE IN DETERMINING HEALTH OUTCOMES AND HEALTH DISPARITIES. DESPITE THE IMPRESSION OF AFFLUENCE IN THE HOSPITAL'S SERVICE AREA, MANY RESIDENTS ARE STRUGGLING WITH POVERTY, FOOD INSECURITY AND HOMELESSNESS. AJH WORKED TO ADDRESS THESE HEALTH NEEDS BY PARTNERING WITH LOCAL ORGANIZATIONS TO INCREASE ACCESS AND SUPPORT SERVICES. GOAL 1: SUPPORT FOOD SECURITY EFFORTS PROGRAMMATIC OBJECTIVES1.1 SUPPORT PROGRAMS TO INCREASE HEALTHY EATING AND CONSISTENT ACCESS TO AFFORDABLE, HEALTHY FOODS.COMMUNITY ACTIVITIES / STRATEGIES PARTNER WITH EXISTING PROGRAMS TO SUPPORT THEIR EFFORTS TO ADDRESS FOOD SECURITY COLLABORATE WITH PEDIATRICIANS AND PRIMARY CARE TO REACH FAMILIES IN NEED WITH RESOURCES PROVIDE GRANTS TO INCREASE LOW-COST FOOD ACCESSMETRICS AND STATUS UPDATES A COMMUNITY GRANT ISSUED IN FY20 TO OUR NEIGHBORS' TABLE (ONT) ENABLED THE PROGRAM TO PIVOT IN RESPONSE TO THE COVID-19 PANDEMIC TO PROVIDE TO-GO MEALS FOR INDIVIDUALS AND FAMILIES. IN RESPONSE TO PUBLIC HEALTH GUIDELINES RELATED TO COVID-19, ONT CLOSED ITS DINING ROOM IN MARCH AND PIVOTED SWIFTLY TO OFFER DINNERS AS INDIVIDUAL OR FAMILY-SIZED MEALS TO-GO. ONT SAW AN 89% INCREASE IN PEOPLE COMING TO RECEIVE A TAKE-HOME MEAL EACH WEEK, THE GREATEST AMONG THEM: FAMILIES WITH CHILDREN AND MEN AND WOMEN IN RECOVERY. FY20: ONT HOSTED 5,267 DINNER GUESTS AND PROVIDED 787 HOME DELIVERIES. BETWEEN JANUARY AUGUST 2020 ALONE, ONT SERVED 5,650 DINNER GUESTS AND DID 606 HOME DELIVERIES FY21: SUPPORT PROVIDED BY AJH SPONSORED SIX WEEKS' WORTH OF MEALS FOR ONT GUESTS, SERVING A TOTAL OF 10,269 MEALS TO 6,903 ADULTS AND 775 CHILDREN. APPROXIMATELY 82% ARE RETURNING GUESTS EACH WEEK FY22: ONT HAS PROVIDED 8,387 ADULTS AND 1,181 CHILDREN WITH A WEEKLY FREE MEAL AND INTRODUCED THEM TO ONT'S GROCERY PROGRAM WHERE THEY CAN ACCESS GROCERIES OF THEIR CHOICE ONCE A WEEK AT NO COST TO THEM. APPROXIMATELY 82% OF MEAL RECIPIENTS ARE RETURNING GUESTS EACH WEEK. ONE OF EVERY 10 NEIGHBORS IN NEWBURY FOOD PANTRY'S SERVICE AREA DO NOT HAVE A RELIABLE SOURCE OF HEALTHY FOOD, ACCORDING TO THE GREATER BOSTON FOOD BANK. THE FIRST PARISH NEWBURY FOOD PANTRY SUPPORTS NEIGHBORS IN NEED, INCLUDING RESIDENTS OF NEWBURYPORT, SALISBURY, AND OTHER SURROUNDING TOWNS WITH FREE FOOD DONATIONS EVERY FRIDAY, TYPICALLY SERVING BETWEEN 250 AND 300 PEOPLE THROUGH DELIVERIES OR FOOD PICKUP. FY21: SERVED OVER 10,200 GUESTS IN 2020-2021 AND DELIVERED 60% OF ORDERS TO SENIORS AND OTHERS LACKING TRANSPORTATION FY22: GUESTS PLACED 8,900 ORDERS IN 2022, OBTAINING FOOD TO SERVE 19,400 PEOPLE DURING THE YEAR. GUEST ROSTER IN 2022 INCLUDED 1,090 GUESTS IN 498 HOUSEHOLDS. NEARLY 60% OF THE HOUSEHOLDS INCLUDED A GUEST OVER THE AGE OF 65. OVERALL, 44% OF GUESTS WERE ADULTS UNDER THE AGE OF 65, 23% WERE CHILDREN AND 33% WERE SENIORS. NOURISHING THE NORTHSHORE'S VEGOUT PROGRAM BRINGS HEALTHY, LOCAL PRODUCE TO MEMBERS IN THE COMMUNITY THAT OFTEN DO NOT HAVE ACCESS TO THESE FOOD CHOICES. NOURISHING THE NORTH SHORE COMBINES EXCESS PRODUCE FROM LOCAL FARMS WITH FOOD THAT IS GROWN AT THEIR GARDEN AND DISTRIBUTE PRODUCE DIRECTLY THROUGH THE COMMUNITY'S FOOD ACCESS AGENCIES AS WELL AS NNS-RUN FARMERS' MARKET STYLE PRODUCE STANDS. ALL PRODUCE IS FREE TO THOSE WHO ARE VISITING THE FOOD ACCESS SITES. FY21: DISTRIBUTED 34,000 POUNDS OF LOCAL PRODUCE TO FOOD INSECURE INDIVIDUALS; PARTNERED WITH 6 AREA FOOD ACCESS AGENCIES; PROVIDED 41 BAGS OF LOCAL PRODUCE FOR THANKSGIVING TO RESIDENTS OF KELLEHER PARK, A LOWER INCOME COMMUNITY HOUSING IN NEWBURYPORT FY22: DISTRIBUTED 38,000 POUNDS OF LOCAL PRODUCE TO FOOD INSECURE INDIVIDUALS THROUGH 2 MOBILE MARKETS AND 6 AREA FOOD ACCESS AGENCIES, PROVIDING 148,000 SERVINGS OF VEGETABLES; PROVIDED 120 THANKSGIVING PRODUCE BAGS; DELIVERED CURATED BAGS OF LOCAL PRODUCE TO 33 SENIOR HOUSEHOLDS AT HERITAGE HOUSE IN NEWBURYPORT FOR 8 CONSECUTIVE WEEKS; WORKED WITH 11 PARTNER FARMS AND 6 AREA FOOD ACCESS AGENCIES. BETH ISRAEL LAHEY HEALTH (BILH) AWARDED THE YMCA OF THE NORTH SHORE/HAVERHILL YMCA A GRANT TO ADDRESS SOCIAL DETERMINANTS OF HEALTH NEEDS AND INCREASE FOOD ACCESS THROUGH THE INTRODUCTION OF A FREIGHT CONTAINER TO OPERATE A HYDROPONIC FARM. METRICS (TENTATIVE): DEMOGRAPHIC PROFILES, AVERAGE NUMBER OF UNITS DISTRIBUTED WEEKLY, VARIETY OF QUARTERLY PRODUCEGOAL 2: INCREASE AVAILABILITY OF EMERGENCY HOUSINGPROGRAMMATIC OBJECTIVES1.1 SUPPORT PROGRAMS AND INITIATIVES THAT STABILIZE OR CREATE ACCESS TO AFFORDABLE HOUSINGCOMMUNITY ACTIVITIES / STRATEGIES SUPPORT LOCAL SOCIAL SERVICE AGENCY EFFORTS TO INCREASE ACCESS TO EMERGENCY SHELTERMETRICS AND STATUS UPDATES AJH SUPPORTED EMMAUS, INC. ""MITCH'S PLACE"" EMERGENCY SHELTER THAT PROVIDES OVERNIGHT SHELTER, NUTRITIOUS MEALS, AND NEEDED SUPPORT SERVICES YEAR-ROUND, INCLUDING DURING EXTREME CONDITIONS, TO HOMELESS MEN AND WOMEN THAT MAY OTHERWISE SPEND THE NIGHT ENGAGING IN HIGH-RISK, SELF-DESTRUCTIVE, AND/OR ILLEGAL ACTIVITIES. THE PROGRAM ALSO OFFERS CASE MANAGEMENT TO SUPPORT ACCESSING NEEDED SERVICES AND JOB OPPORTUNITIES. NUMBER OF INDIVIDUALS SERVED (FY20: 267, FY21: 119, FY22: 222). NEWBURYPORT YWCA'S ROOF OVER HEAD COLLABORATIVE RENTAL HOUSING FOR LOW-INCOME WORKING FAMILIES WITH DEPENDENT CHILDREN FROM AMESBURY, NEWBURYPORT, AND SALISBURY. CASE MANAGERS ASSIST FAMILIES TO MOVE TOWARD PERMANENT HOUSING. ELIGIBLE FAMILIES MUST BE FROM AND HOMELESS OR AT-RISK OF BECOMING HOMELESS. NUMBER OF HOUSEHOLDS SUPPORTED (FY21:4, FY22: 4) LINK HOUSE'S WOMEN'S INDEPENDENT SOBER HOUSING (WISH) IS INDEPENDENT SOBER HOUSING, WHERE WOMEN SUSTAIN THEIR LONG-TERM RECOVERY IN A SUPPORTIVE, SAFE, AND SOBER. MEMBERS MUST BE FREE OF SUBSTANCE USE FOR A MINIMUM OF ONE YEAR, AND CONTRACT TO ABSTAIN FROM ALL SUBSTANCE USE AND OTHER ADDICTIVE BEHAVIORS, ATTEND APPROPRIATE AA/NA MEETINGS, PARTICIPATE IN HOUSE MEETINGS, CONSENT TO THE HOUSE RULES AND FULLY PARTICIPATE IN ALL ADDITIONAL ASPECTS OF RECOVERY. NUMBER OF WOMEN PROVIDED WITH SOBER HOUSING (FY21: 16) FY22: DONATION MADE TO SUPPORT HOUSING, ESSENTIAL PURCHASES, TRANSPORTATION ACCESSGOAL 3: SUPPORT LOCAL RESOURCES AIMED AT ADVOCACY AND PREVENTIONPROGRAMMATIC OBJECTIVES1.1 SUPPORT IMPACTFUL PROGRAMS THAT ADDRESS ISSUES ASSOCIATED WITH THE SOCIAL DETERMINANTS OF HEALTH.COMMUNITY ACTIVITIES / STRATEGIES COLLABORATE WITH COMMUNITY PARTNERS TO PROVIDE LOCAL RESOURCES AIMED AT DOMESTIC VIOLENCE ADVOCACY AND PREVENTION"

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
METRICS AND STATUS UPDATES AJH SUPPORTS JEANNE GEIGER CRISIS CENTER'S COMMUNITY-BASED SERVICES THAT PROVIDE AN INTEGRATED WEB OF SUPPORT AS SURVIVORS 'NEEDS SHIFT FROM CRISIS TO INDEPENDENCE. THE CENTER COORDINATES WITH SOCIAL SERVICE AGENCIES, SCHOOLS, HOSPITALS, LAW ENFORCEMENT, AND OTHER COMMUNITY PARTNERS TO PROVIDE SUPPORT FOR THE SURVIVORS AND THEIR FAMILIES AS THEIR NEED'S CHANGES OVER TIME. NUMBER OF SURVIVORS WHO RECEIVED ADVOCACY SERVICES (FY20: 779; FY21: 767; FY22: 955) NUMBER OF ADULT AND CHILD SURVIVORS WHO RECEIVED THERAPEUTIC SERVICES (FY20: 353; FY21: 375, FY22: 327) NUMBER OF SURVIVORS WHO RECEIVED LEGAL SERVICES (FY20: 117; FY21: 265; FY22: 409)COMMUNITY PARTNERS: NEWBURY FOOD PANTRY, NOURISHING THE NORTHSHORE, OUR NEIGHBORS' TABLE, EMMAUS, INC., LINK HOUSE, YWCA NEWBURYPORT, JEANNE GEIGER CRISIS CENTERPRIORITY AREA 4: ACCESS TO CAREAN EXTENSIVE BODY OF RESEARCH ILLUSTRATES THE HEALTH DISPARITIES AND DIFFERENCES IN HEALTH CARE ACCESS AND UTILIZATION THAT EXIST FOR DIVERSE INDIVIDUALS/COHORTS AND FOREIGN-BORN POPULATIONS. ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION, NON-HISPANIC BLACKS HAVE HIGHER RATES OF PREMATURE DEATH, INFANT MORTALITY, AND PREVENTABLE HOSPITALIZATION THAN DO NON-HISPANIC WHITES. HISPANICS HAVE THE HIGHEST UNINSURED RATES OF ANY RACIAL OR ETHNIC GROUP IN THE UNITED STATES. ASIANS ARE AT A HIGHER RISK FOR DEVELOPING DIABETES THAN ARE THOSE OF EUROPEAN ANCESTRY, DESPITE A LOWER AVERAGE BODY MASS INDEX. THESE DISPARITIES SHOW THE DISPROPORTIONATE AND OFTEN AVOIDABLE INEQUITIES THAT EXIST WITHIN COMMUNITIES AND REINFORCE THE IMPORTANCE OF UNDERSTANDING THE DEMOGRAPHIC MAKEUP OF A COMMUNITY TO IDENTIFY POPULATIONS MORE LIKELY TO EXPERIENCE ADVERSE HEALTH OUTCOMESKEY BARRIERS TO OBTAINING HEALTHCARE IN GREATER HAVERHILL INCLUDE TRANSPORTATION, ACCESS TO AVAILABLE RESOURCES, AFFORDABILITY, INSURANCE COVERAGES, INADEQUATE SERVICES, LACK OF HEALTHCARE PROVIDERS, AND LANGUAGE BARRIERS.GOAL 1: DECREASE BARRIERS TO HEALTHCARE SERVICES AT ANNA JAQUES HOSPITALPROGRAMMATIC OBJECTIVES1.1 PROVIDE EQUITABLE AND COMPREHENSIVE ACCESS TO HIGH-QUALITY HEALTH CARE SERVICES INCLUDING PRIMARY CARE AND SPECIALTY CARE, AS WELL AS URGENT AND EMERGING CARE, PARTICULARLY FOR THOSE WHO FACE CULTURAL, LINGUISTIC, AND ECONOMIC BARRIERS.COMMUNITY ACTIVITIES / STRATEGIES PROVIDE INTERPRETER SERVICES AT NO COST TO ALL ANNA JAQUES HOSPITAL PATIENTS PROVIDE PATIENT FINANCIAL ASSISTANCE TO ALL PATIENTS UTILIZE AN EMERGENCY FUND TO SUPPORT TRANSPORTATION NEEDS OF ANNA JAQUES HOSPITAL PATIENTSMETRICS AND STATUS UPDATES: AJH PROVIDES A FREE INTERPRETER/TRANSLATION SERVICE TO ALL ANNA JAQUES PATIENTS AT NO COST. WHILE SPANISH, CONTINENTAL PORTUGUESE, AND ASL ARE THE MOST COMMONLY UTILIZED SERVICES, AJH SERVICE OFFERED HUNDREDS OF LANGUAGE TRANSLATIONS AS NEEDED. NUMBER OF ENCOUNTERS PROVIDED (FY20: 900; FY21: 5,747; FY22: 5,747) TO ADDRESS FINANCIAL BARRIERS, AJH EMPLOYS TWO FULL-TIME FINANCIAL COUNSELORS WHO ARE CAC-CERTIFIED AND WHO CAN SCREEN PATIENTS AND ASSIST THEM IN APPLYING FOR STATE AID. THEY ALSO PROVIDE ESTIMATES FOR PATIENT'S FINANCIAL RESPONSIBILITY (COPAY, DEDUCTIBLE, COINSURANCE, SELF-PAY). NUMBER OF APPLICATIONS (FY20: 503, FY21: 287; FY22: 305). TO SUPPORT VULNERABLE COMMUNITIES AND LIMIT BARRIERS SO PATIENTS RECEIVE THE CARE THEY NEED, AJH CASE MANAGEMENT HAS AN EMERGENCY FUND TO PROVIDE TRANSPORTATION REIMBURSEMENT TO PATIENTS WHO HAVE LIMITED RESOURCES AND SOCIAL SUPPORTS. THIS PROGRAM IS OFFERED TO ANY PATIENT WHO MEETS THE CRITERIA OF NEED DECIDED BY A SOCIAL WORKER. AMOUNT DISTRIBUTED TO PATIENTS (FY20: $5,217; FY21: $7,233.25; FY22: $6,090.12) COMMUNITY PARTNERS: ANNA JAQUES HOSPITAL CASE MANAGEMENT AND PATIENT FINANCIAL COUNSELING COMMUNITY PARTNERSANNA JAQUES HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH AND WELLBEING OF RESIDENTS WITHIN ITS SERVICE AREA BY COLLABORATING WITH A DIVERSE GROUP OF COMMUNITY PARTNERS. THE HOSPITAL WORKS TOGETHER WITH THESE PARTNERS TO REDUCE BARRIERS TO HEALTH, INCREASE PREVENTION AND/OR SELF-MANAGEMENT OF CHRONIC DISEASE AND INCREASE THE EARLY DETECTION OF ILLNESS. THE HOSPITAL'S COMMUNITY PARTNERS INCLUDE:NOTE: PLEASE LIST THEM PARTNERS AS A BULLET LIST NOT AS A TABLE OR CUT/PASTE OF A CHART SINCE THE IRS SOFTWARE CANNOT ACCOMMODATE TABLES AND CHARTS. AMESBURY CHAMBER OF COMMERCE THE ARC OF GREATER HAVERHILL-NEWBURYPORT THE BEACON COALITION BOYS & GIRLS CLUB COASTAL TRAILS COALITION COMMUNITY ACTION, INC./WOMEN, INFANTS & CHILDREN (WIC) COUNCILS ON AGING (AMESBURY, NEWBURYPORT, MERRIMAC, SALISBURY, HAVERHILL) ELDER SERVICES OF THE MERRIMACK VALLEY/HOME HEALTH VNA EMMAUS, INC. ESSEX COUNTY ASSET BUILDER NETWORK ESSEX COUNTY OUTREACH FAMILY SERVICES OF THE MERRIMACK VALLEY GIRLS, INC. GREATER HAVERHILL CHAMBER OF COMMERCE GREATER LAWRENCE FAMILY HEALTH CENTER HAVERHILL OFFICE GREATER NEWBURYPORT CHAMBER OF COMMERCE GREATER NEWBURYPORT OVARIAN CANCER AWARENESS OVATIONS FOR THE CURE HAVERHILL FARMERS MARKET/CREATIVE HAVERHILL HOME HEALTH VNA/MERRIMACK VALLEY HOSPICE JEANNE GEIGER CRISIS CENTER LINK HOUSE, INC. MERRIMAC SENIOR CENTER & COUNCIL ON AGING MERRIMACK VALLEY BLACK & BROWN VOICES NEW ENGLAND ELDER TRANSPORTATION NEWBURY FOOD PANTRY NEWBURYPORT DEI ALLIANCE NEWBURYPORT FARMERS' MARKET NEWBURYPORT PUBLIC SCHOOLS NEWBURYPORT YANKEE HOMECOMING NEWBURYPORT YOUTH SERVICES NEWBURYPORT SOCIETY FOR THE RELIEF OF AGED WOMEN NORTH OF BOSTON CANCER RESOURCE NOURISHING THE NORTHSHORE OPPORTUNITY WORKS OUR NEIGHBORS' TABLE PARTNERSHIP OF AMESBURY COMMUNITY & TEENS (PACT) PENNIES FOR POVERTY THE PETTENGILL HOUSE REGIONAL SOCIAL SERVICES COLLABORATIVE ROTARY CLUBS (AMESBURY, HAVERHILL, NEWBURYPORT) SALISBURY PARKS & RECREATION DEPARTMENT YMCA OF NORTHSHORE/HAVERHILL YWCA OF GREATER HAVERHILL YWCA OF NEWBURYPORTAS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, ANNA JAQUES HOSPITAL IS DEEPLY DEDICATED TO ITS COMMUNITY BENEFITS OPERATIONS AND TO IMPROVING THE HEALTH OF ITS COMMUNITY. HOWEVER, IN RESPONSE TO SCHEDULE H, PART V, SECTION B, QUESTION 11, THERE WERE SOME NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT INCLUDED IN THE IS. IN THE FY 2023 - 2025 IS, WHICH WILL GUIDE THE ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS ACTIVITIES FOR THE FISCAL PERIODS SEPTEMBER 30, 2023, SEPTEMBER 30, 2024, AND SEPTEMBER 30, 2025, EXAMPLES OF IDENTIFIED NEEDS THAT WILL NOT BE MET IN THESE YEARS ARE SUPPORTING EDUCATION ACROSS THE LIFESPAN, STRENGTHENING THE BUILT ENVIRONMENT (I.E., IMPROVING ROADS/SIDEWALKS AND ENHANCING ACCESS TO SAFE RECREATIONAL SPACES/ACTIVITIES), AND DIGITAL DIVIDE/ACCESS TO TECH RESOURCES. IN ADDITION, THERE WERE SOME NEEDS IDENTIFIED IN THE 2019 CHNA THAT ARE NOT INCLUDED IN THE 2019 IS AND WHICH HAVE GUIDED THE ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS ACTIVITIES THE PERIOD FOR THE FISCAL PERIOD COVERED BY THIS FILING. ANNA JAQUES HOSPITAL WILL BE UNABLE TO ADDRESS THESE NEEDS DUE TO LIMITED FINANCIAL RESOURCES, FEASIBILITY OF AJH HAVING AN IMPACT, AND/OR BECAUSE IT WAS FELT THAT THE ISSUE WAS BEING ADDRESSED BY OTHER COMMUNITY PARTNERS. AS NOTED IN DETAIL ABOVE, THE ANNA JAQUES HOSPITAL'S PRIMARY TOOL FOR ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED IS THROUGH THE CHNA AND IS (SCHEDULE H PART VI QUESTION 2).FORM 990 SCHEDULE H PART VI SUPPLEMENTAL INFORMATIONTHE PURPOSE OF THIS FORM 990 SCHEDULE H NARRATIVE DISCLOSURE IS TO HELP THE READER UNDERSTAND IN MORE DETAIL HOW ANNA JAQUES HOSPITAL CARES FOR ITS COMMUNITY BY PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS. AS DEMONSTRATED IN THIS SCHEDULE H, [INSERT %] OF ANNA JAQUES HOSPITAL'S TOTAL EXPENSES AS REPORTED ON FORM 990 PART IX, LINE 24, ARE INCURRED IN PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. COMMUNITY BENEFITSANNUAL COMMUNITY BENEFITS REPORTAS PREVIOUSLY NOTED IN THIS FILING, ANNA JAQUES HOSPITAL'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY WERE COMPLETED AND APPROVED BY THE BOARD OF TRUSTEES DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, AS REQUIRED PURSUANT TO THE REGULATIONS UNDER INTERNAL REVENUE CODE SECTION 501(R). IN ADDITION, AS NOTED IN THIS FORM 990 SCHEDULE H, PART I, LINES 6A AND 6B, THE HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFITS REPORT THAT IS SUBMITTED TO THE MASSACHUSETTS ATTORNEY GENERAL (SCHEDULE H, PART VI, LINE 7). THAT FILING IS AVAILABLE FOR PUBLIC INSPECTION AT THE ATTORNEY GENERAL'S OFFICE, ON THE ATTORNEY GENERAL'S WEBSITE AND ON THE HOSPITAL WEBSITE AT HTTPS://WWW.AJH.ORG/COMMUNITY/OUTREACH-AND-INVOLVEMENT.

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
THERE ARE SOME DIFFERENCES BETWEEN THE MASSACHUSETTS ATTORNEY GENERAL DEFINITION OF CHARITY CARE AND COMMUNITY BENEFITS AND THE INTERNAL REVENUE SERVICE DEFINITION OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS. AS SUCH, THERE ARE VARIANCES BETWEEN THIS SCHEDULE H DISCLOSURE AND THE REPORT ANNA JAQUES HOSPITAL FILED WITH THE ATTORNEY GENERAL'S OFFICE. EMERGENCY CARE ACCESSIN ADDITION, AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION A, ANNA JAQUES HOSPITAL IS A GENERAL MEDICAL AND SURGICAL HOSPITAL, PROVIDING 24-HOUR EMERGENCY MEDICAL CARE TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITSCHARITY CARE AND MEANS TESTED GOVERNMENT PROGRAMSFINANCIAL ASSISTANCEANNA JAQUES HOSPITAL'S NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND INCLUDING PAYMENTS TO THE HEALTH SAFETY NET TRUST, WAS $696,435 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 AND HAS BEEN REPORTED ON THIS SCHEDULE H, PART I, LINE 7A.AS PREVIOUSLY NOTED IN THIS FORM 990, ANNA JAQUES HOSPITAL IS ONE OF TEN HOSPITALS WITHIN THE BETH ISRAEL LAHEY HEALTH NETWORK. COMBINED THESE HOSPITALS' NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND INCLUDING PAYMENTS TO THE HEALTH SAFETY NET TRUST, WAS $55,879,719 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022. AS REPORTED IN SCHEDULE H PART I LINE 3 AND AGAIN IN SCHEDULE H PART V SECTION B LINE 13, ELIGIBILITY FOR FREE CARE TO LOW-INCOME INDIVIDUALS IS DETERMINED USING FEDERAL POVERTY GUIDELINES OF 400% FOR FULL FREE CARE AND 400% FOR PARTIAL FREE CARE. ELIGIBILITY FOR DISCOUNTED CARE IS DETERMINED BY REVIEWING THE INDIVIDUAL'S EMPLOYMENT STATUS, FAMILY SIZE AND MONTHLY EXPENSES, INCLUDING MEDICAL HARDSHIP REVIEW.OTHER UNCOMPENSATED CHARITY CAREMEDICAID AND MEDICAREIN ADDITION TO THE CHARITY CARE REPORTED ABOVE, ANNA JAQUES HOSPITAL ALSO PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN OTHER PROGRAMS DESIGNED TO SUPPORT LOW-INCOME FAMILIES, INCLUDING PARTICULARLY THE MEDICAID PROGRAM, WHICH IS JOINTLY FUNDED BY FEDERAL AND STATE GOVERNMENTS. THE MASSACHUSETTS HEALTH REFORM LAW PROVIDED AN INITIATIVE FOR EXPANSION OF MEDICAID COVERAGE TO GREATER POPULATIONS AND FOR ENROLLMENT OF UNINSURED PATIENTS IN OTHER INSURANCE PROGRAMS. PAYMENTS FROM MEDICAID AND OTHER PROGRAMS THAT ENSURE LOW-INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, ANNA JAQUES HOSPITAL GENERATED $1,486,476 RELATED TO TREATING MEDICAID PATIENTS WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY ANNA JAQUES HOSPITAL FOR SUCH SERVICES BY $2,976,407 AS REPORTED ON THIS SCHEDULE H, PART I LINE 7B. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 10.9% OF 213,603 OF ANNA JAQUES HOSPITAL'S PATIENT ENCOUNTERS WERE WITH MEDICAID PATIENTS. IN ADDITION 51.3% OF 109,481 OF THE HOSPITAL'S PATIENT CASES WERE WITH MEDICAID PATIENTS. MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS, AND ANNA JAQUES HOSPITAL PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING, ANNA JAQUES HOSPITAL GENERATED $46,122,868 RELATED TO TREATING MEDICARE PATIENTS. THE COSTS OF PROVIDING CARE TO MEDICARE PATIENTS EXCEEDED REVENUE BY $5,716,373. OF THESE AMOUNTS, REVENUE OF $11,118,369 IS RELATED TO THE PROVISION OF NEONATOLOGY, WOUND CLINIC, AND CANCER CENTER, AND IS INCLUDED ON THIS SCHEDULE H, PART I, LINE 7G, AS PART OF SUBSIDIZED HEALTH SERVICES BECAUSE THE COST OF THOSE SERVICES EXCEEDED REVENUES BY $12,271,293. IN RESPONSE TO THE FORM 990, SCHEDULE H, PART III, LINE 8, ALTHOUGH ANNA JAQUES HOSPITAL CONSIDERS THE PROVISION OF CLINICAL CARE TO ALL MEDICARE PATIENTS AS PART OF ITS COMMUNITY BENEFIT, THE REMAINING CARE TO MEDICARE PATIENTS IS NOT QUANTIFIED ON PAGE 1 OF THE SCHEDULE H. INSTEAD, PER THE IRS INSTRUCTIONS TO SCHEDULE H, ANNA JAQUES HOSPITAL HAS SEPARATELY REPORTED THIS AMOUNT IN SCHEDULE H, PART III, LINE 7, AS REQUIRED. HOWEVER, IF THE MEDICARE SHORTFALL WERE INCLUDED IN THE SCHEDULE H PART I LINE 7 CALCULATION, IT WOULD INCREASE TO 11.05%.BAD DEBTSIN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, ANNA JAQUES HOSPITAL ALSO INCURS LOSSES RELATED TO SELF-PAY PATIENTS WHO FAIL TO MAKE PAYMENTS FOR SERVICES OR INSURED PATIENTS WHO FAIL TO PAY COINSURANCE OR DEDUCTIBLES FOR WHICH THEY ARE RESPONSIBLE UNDER INSURANCE CONTRACTS. BAD DEBT EXPENSE IS INCLUDED IN UNCOMPENSATED CARE EXPENSE IN THE CONSOLIDATED FINANCIAL STATEMENTS AND INCLUDES THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE. CHARGES FOR THOSE SERVICES DURING THE FISCAL PERIOD COVERED BY THIS FILING OF $2,064,119 REPORTED AS BAD DEBT ON FORM 990, SCHEDULE H, PART III, LINE 2. AS REQUIRED BY THE INSTRUCTIONS TO THIS FORM 990 SCHEDULE H, LOSSES RELATED TO BAD DEBTS HAVE NOT BEEN INCLUDED IN THE CALCULATION OF FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS IN SCHEDULE H PART I LINE 7. RATHER IT HAS BEEN SEPARATELY REPORTED IN SCHEDULE H PART III AS REQUIRED. THE PERCENTAGES CALCULATED IN PART I, LINE 7, COLUMN F WAS BASED ON EACH ITEM OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT AS A PERCENTAGE OF TOTAL EXPENSES REPORTED IN PART IX OF THIS FORM 990. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE BETH ISRAEL LAHEY HEALTH, INC. AND AFFILIATES FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 INCLUDE THE ACCOUNTS OF: BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY CLINIC FOUNDATION (LCF) , LAHEY CLINIC (LCI), LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER (LHMC), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NORTHEAST), ANNA JAQUES HOSPITAL (AJH) AND AFFILIATES. THE FINANCIAL STATEMENTS OF THE SYSTEM ALSO INCLUDE A CONTROLLED AFFILIATE, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP).FINANCIAL STATEMENT FOOTNOTESBAD DEBTSREVENUES UNDER THE TRADITIONAL FEE FOR SERVICE MEDICARE AND MEDICAID PROGRAMS ARE BASED PRIMARILY ON PROSPECTIVE PAYMENT SYSTEMS. RETROSPECTIVELY DETERMINED COST-BASED REVENUES UNDER THESE PROGRAMS, WHICH WERE MORE PREVALENT IN EARLIER PERIODS, AND CERTAIN OTHER PAYMENTS, SUCH AS DISPROPORTIONATE SHARE HOSPITAL AND BAD DEBT EXPENSE REIMBURSEMENT, WHICH ARE BASED ON OUR HOSPITALS' COST REPORTS, ARE ESTIMATED USING HISTORICAL TRENDS AND CURRENT FACTORS. COST REPORT SETTLEMENTS UNDER THESE PROGRAMS ARE SUBJECT TO AUDIT BY MEDICARE AND MEDICAID AUDITORS AND ADMINISTRATIVE AND JUDICIAL REVIEW, AND IT CAN TAKE SEVERAL YEARS UNTIL FINAL SETTLEMENT OF SUCH MATTERS IS DETERMINED AND COMPLETELY RESOLVED. THE SYSTEM RECORDS ACCRUALS TO REFLECT THE EXPECTED FINAL SETTLEMENTS ON COST REPORTS. FOR FILED COST REPORTS, THE ACCRUAL IS RECORDED BASED ON THOSE COST REPORTS AND SUBSEQUENT ACTIVITY. THE ACCRUAL FOR PERIODS FOR WHICH A COST REPORT IS YET TO BE FILED IS RECORDED BASED ON ESTIMATES OF WHAT THE SYSTEM EXPECTS TO REPORT ON THE FILED COST REPORTS. AFTER THE COST REPORT IS FILED, THE ACCRUAL MAY NEED TO BE ADJUSTED..EMERGENCY CARE ACCESSTHE ANNA JAQUES HOSPITAL DEPARTMENT OF EMERGENCY MEDICINE PROVIDES MEDICALLY NECESSARY CARE FOR ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OFFERS THIS CARE FOR ALL PATIENTS THAT COME TO THIS FACILITY 24 HOURS A DAY, 7 DAYS A WEEK, AND 365 DAYS A YEAR. FINANCIAL ASSISTANCE POLICYINTERNAL REVENUE CODE SECTION 501(R)(4)FINANCIAL ASSISTANCE POLICY PURPOSE ANNA JAQUES HOSPITAL IS DEDICATED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE HEALTH CARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. THIS FINANCIAL ASSISTANCE POLICY IS INTENDED TO BE IN COMPLIANCE WITH APPLICABLE FEDERAL AND STATE LAWS FOR OUR SERVICE AREA. PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WILL RECEIVE DISCOUNTED CARE FROM ANNA JAQUES HOSPITAL AS WELL AS PROVIDERS WHO FOLLOW ANNA JAQUES HOSPITAL'S FINANCIAL ASSISTANCE POLICY. A LIST OF ALL PROVIDERS WHO PROVIDE CARE WITHIN ANNA JAQUES HOSPITAL AS WELL AS INFORMATION INDICATING IF THE LISTED PROVIDERS FOLLOW ANNA JAQUES HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS INCLUDED IN APPENDIX 5 TO THE FINANCIAL ASSISTANCE POLICY. ANNA JAQUES HOSPITAL DOES NOT DISCRIMINATE BASED ON THE PATIENT'S AGE, GENDER, RACE, CREED, RELIGION, DISABILITY, SEXUAL ORIENTATION, GENDER IDENTITY, NATIONAL ORIGIN OR IMMIGRATION STATUS WHEN DETERMINING ELIGIBILITY.

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
FINANCIAL ASSISTANCE POLICY, CREDIT AND COLLECTION POLICY AND EMERGENCY CARE POLICYAS REQUIRED BY IRC SECTION 501(R)(4) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL MAINTAINS A WRITTEN FINANCIAL ASSISTANCE POLICY (FAP) THAT APPLIES TO ALL EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED BY THE HOSPITAL FACILITY. (SCHEDULE H PART I QUESTIONS 1A AND 1B). DETAIL RELATED TO EMERGENCY AND OTHER MEDICALLY NECESSARY CARE COVERED BY THE POLICY IS INCLUDED WITHIN THE POLICY AND THE DEFINITION OF EMERGENCY CARE MEETS THE DEFINITION OF THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), SECTION 1867 OF THE SOCIAL SECURITY ACT (42 USC 1395DD). (SCHEDULE H PART V SECTION B QUESTION 21). THE FAP INCLUDES A LIST OF PROVIDERS OTHER THAN THE HOSPITAL ITSELF, WHICH ARE COVERED BY THE FAP AND SPECIFIES ELIGIBILITY CRITERIA FOR BOTH FREE AND DISCOUNTED CARE. THE FAP ALSO INCLUDES THE BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS. THE PROVIDER LIST IS UPDATED NOT LESS THAN QUARTERLY. THE HOSPITAL MAINTAINS A SEPARATE CREDIT AND COLLECTION POLICY AS PERMITTED UNDER THE TREASURY REGULATIONS AND THIS CREDIT AND COLLECTION POLICY IS REFERENCED WITHIN THE FAP AS REQUIRED, ALONG WITH INFORMATION ON HOW TO OBTAIN A FREE COPY OF THE CREDIT AND COLLECTION POLICY. (SCHEDULE H PART III SECTION C QUESTIONS 9A AND 9B AND PART V SECTION B QUESTION 17). THE HOSPITAL'S FAP AND CREDIT & COLLECTION POLICY WERE ADOPTED BY THE HOSPITAL'S BOARD EFFECTIVE ON OR ABOUT AUGUST 15, 2020. FINANCIAL ASSISTANCE POLICYAPPLYING FOR ASSISTANCE THE HOSPITAL'S FAP INCLUDES INFORMATION ON THE METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE UNDER THE FAP. IN ADDITION, THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION INCLUDES A LIST OF INFORMATION/DOCUMENTATION REQUIRED AS PART OF A PATIENT'S APPLICATION FOR FINANCIAL ASSISTANCE. (SCHEDULE H PART V SECTION B QUESTION 15)FINANCIAL ASSISTANCE POLICYELIGIBILITY GUIDELINES THE HOSPITAL'S FAP USES THE FEDERAL POVERTY GUIDELINES IN DETERMINING ELIGIBILITY FOR FREE AND DISCOUNTED CARE. (SCHEDULE H PART I QUESTION 3A AND 3B AND PART V SECTION B QUESTION 13). IN ADDITION, THE HOSPITAL'S FAP PROVIDES FOR FINANCIAL ASSISTANCE BASED ON MEDICAL HARDSHIP AND ASSET LEVEL (SCHEDULE H PART I QUESTIONS 3C AND 4, PART V SECTION B QUESTION 13 AND PART VI QUESTION 3). FINALLY, THE HOSPITAL UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENT/GUARANTOR'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE APPLICATION FORM. OTHER INFORMATION MAY BE USED BY THE HOSPITAL TO DETERMINE WHETHER A PATIENT/GUARANTOR'S ACCOUNT IS UNCOLLECTIBLE, AND THIS INFORMATION WILL BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY AS OUTLINED IN THE HOSPITAL'S FAP. (SCHEDULE H PART I QUESTIONS 3C).FINANCIAL ASSISTANCEPUBLIC ASSISTANCE PROGRAMS (SCHEDULE H PART I QUESTION 3C)IN ADDITION TO FINANCIAL ASSISTANCE ELIGIBILITY UNDER THE HOSPITAL'S FAP, FOR THOSE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH PATIENTS TO ASSIST THEM IN APPLYING FOR PUBLIC ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED INDIVIDUALS FIND AVAILABLE AND APPROPRIATE OPTIONS, THE HOSPITAL WILL PROVIDE ALL INDIVIDUALS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PUBLIC ASSISTANCE AND FINANCIAL ASSISTANCE PROGRAMS DURING THE PATIENT'S INITIAL IN-PERSON REGISTRATION AT A HOSPITAL LOCATION FOR A SERVICE, IN ALL BILLING INVOICES THAT ARE SENT TO A PATIENT OR GUARANTOR, AND WHEN THE PROVIDER IS NOTIFIED OR THROUGH ITS OWN DUE DILIGENCE BECOMES AWARE OF A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS FOR PUBLIC OR PRIVATE INSURANCE COVERAGE.HOSPITAL PATIENTS MAY BE ELIGIBLE FOR FREE OR REDUCED COST OF HEALTH CARE SERVICES THROUGH VARIOUS STATE PUBLIC ASSISTANCE PROGRAMS AS WELL AS THE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS (INCLUDING BUT NOT LIMITED TO MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PROGRAM, THE HEALTH SAFETY NET, AND MEDICAL HARDSHIP). SUCH PROGRAMS ARE INTENDED TO ASSIST LOW-INCOME PATIENTS TAKING INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. FOR THOSE INDIVIDUALS THAT ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL, WHEN REQUESTED, HELP THEM WITH APPLYING FOR EITHER COVERAGE THROUGH PUBLIC ASSISTANCE PROGRAMS OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILLS.THE HOSPITAL IS AVAILABLE TO ASSIST PATIENTS IN ENROLLING INTO STATE HEALTH COVERAGE PROGRAMS. THESE INCLUDE MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE STATE'S HEALTH CONNECTOR, AND THE CHILDREN'S MEDICAL SECURITY PLAN. FOR THESE PROGRAMS, APPLICANTS CAN SUBMIT AN APPLICATION THROUGH AN ONLINE WEBSITE (WHICH IS CENTRALLY LOCATED ON THE STATE'S HEALTH CONNECTOR WEBSITE), A PAPER APPLICATION, OR OVER THE PHONE WITH A CUSTOMER SERVICE REPRESENTATIVE LOCATED AT EITHER MASSHEALTH OR THE CONNECTOR. INDIVIDUALS MAY ALSO ASK FOR ASSISTANCE FROM HOSPITAL FINANCIAL COUNSELORS (ALSO CALLED CERTIFIED APPLICATION COUNSELORS) WITH SUBMITTING THE APPLICATION EITHER ON THE WEBSITE OR THROUGH A PAPER APPLICATION.FINANCIAL ASSISTANCE POLICYTRANSLATIONS THE HOSPITAL'S FAP, CREDIT AND COLLECTION POLICY AND PLAIN LANGUAGE SUMMARY OF THE FAP (SEE DETAIL BELOW) HAVE ALL BEEN TRANSLATED INTO THE LANGUAGES SPOKEN BY THOSE IN THE HOSPITAL'S COMMUNITY WHO MAY COMMUNICATE IN A LANGUAGE OTHER THAN ENGLISH. THE HOSPITAL HAS TRANSLATED THESE DOCUMENTS INTO THE LANGUAGES OF LIMITED ENGLISH PROFICIENCY (LEP) OF ITS PATIENTS, 5% OF THE POPULATION OR 1000 PERSONS, WHICHEVER IS LESS, IN ACCORDANCE WITH THE REGULATIONS PROMULGATED UNDER IRC SECTION 501(R). BASED ON THE HOSPITAL'S REVIEW OF THIS SAFE HARBOR, THE HOSPITAL HAS TRANSLATED THESE DOCUMENTS INTO THE FOLLOWING LANGUAGES: SPANISH, FRENCH, ITALIAN, SIMPLIFIED CHINESE, TRADITIONAL CHINESE, PORTUGUESE, VIETNAMESE, ARABIC, HAITIAN CREOLE, GREEK, MON-KHMER, CAMBODIAN, RUSSIAN. (SCHEDULE H PART V SECTION B QUESTION 16I)FINANCIAL ASSISTANCE POLICYWIDELY PUBLICIZING AND AVAILABILITYCOPIES OF THE FAP, CREDIT AND COLLECTION POLICY, FAP SUMMARY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE IN BOTH ENGLISH AND ALL LEP LANGUAGES AT THE HOSPITAL, BY MAIL FREE OF CHARGE AND/OR ON THE HOSPITAL'S WEBSITE: (SCHEDULE H PART V SECTION B QUESTIONS 16A, 16B, 16C, 16D, 16E, 16H) AT HTTPS://WWW.AJH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE. IN ADDITION, THE FAP, CREDIT AND COLLECTION POLICY, FAP SUMMARY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE IN THE HOSPITAL'S EMERGENCY DEPARTMENT AND FINANCIAL COUNSELING OFFICE. (SCHEDULE H PART V SECTION B QUESTION 16F AND SCHEDULE H PART VI QUESTION 3).THE HOSPITAL MAINTAINS SIGNAGE AND CONSPICUOUS PUBLIC DISPLAYS ABOUT FINANCIAL ASSISTANCE AND THE FAP DESIGNED TO ATTRACT THE ATTENTION OF PATIENTS AND VISITORS, INCLUDING BOTH THE EMERGENCY DEPARTMENT AND ADMISSIONS. SUCH SIGNAGE IS POSTED BOTH IN ENGLISH AND THE LEP LANGUAGES NOTED ABOVE. IN ADDITION, FINANCIAL COUNSELING PERSONNEL ROUTINELY VISIT LOCATIONS DESIGNATED FOR SIGNAGE TO ENSURE THAT SUCH SIGNAGE REMAINS VISIBLE TO PATIENTS AND VISITORS AS ATTENDED. THE HOSPITAL PROVIDES INFORMATION ABOUT THE FAP TO PATIENTS BEFORE DISCHARGE AND CONSPICUOUSLY WITHIN BILLING STATEMENTS. INFORMATION PROVIDED TO PATIENTS IN THESE COMMUNICATIONS INCLUDE CONTACT INFORMATION FOR THOSE THAT CAN HELP PROVIDE ADDITIONAL INFORMATION ABOUT THE FAP, INFORMATION ON THE APPLICATION PROCESS AND THE WEBSITE WHERE THE FAP CAN BE OBTAINED. ADDITIONALLY, A PLAIN LANGUAGE SUMMARY OF THE FAP IS PROVIDED TO PATIENTS AS PART OF THE INTAKE PROCESS. (SCHEDULE H PART V SECTION B QUESTION 16G). FINANCIAL ASSISTANCE POLICYPLAIN LANGUAGE SUMMARYAS NOTED IN THIS NARRATIVE SUPPORT TO THE FORM 990 SCHEDULE H, THE HOSPITAL HAS A PLAIN LANGUAGE SUMMARY OF ITS FAP. THIS IS A WRITTEN STATEMENT DESIGNED TO NOTIFY PATIENTS AND VISITORS THAT THE HOSPITAL HAS A WRITTEN FAP AND PROVIDES FINANCIAL ASSISTANCE. THIS PLAIN LANGUAGE SUMMARY INCLUDES INFORMATION ON FREE AND DISCOUNTED CARE, HOW TO OBTAIN A COPY OF THE FAP POLICY AND APPLICATION, INCLUDING THE WEBSITE ADDRESS, THE LOCATION AND PHONE NUMBER OF THE FINANCIAL COUNSELING OFFICE. THE PLAIN LANGUAGE SUMMARY ALSO INCLUDES THE LIST OF LANGUAGES INTO WHICH THE FAP AND SUMMARY HAVE BEEN TRANSLATED AS WELL AS HOW TO ACCESS INFORMATION ON PROVIDERS NOT COVERED BY THE FAP AND TO WHICH OTHER RELATED HOSPITALS APPROVAL UNDER THE FAP WILL APPLY.

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
"RESEARCH ENGAGED IN AT THE MEDICAL CENTERTHE REAL CORNERSTONES OF THE MEDICAL CENTER'S SUCCESS CAN BE DESCRIBED IN THREE KEY WORDS: INNOVATION, CULTIVATION, AND TRANSFORMATION. BEGINNING WITH SUPPORT OF BOLD AND INNOVATIVE IDEAS, EXTENDING TO CULTIVATION AND NURTURING OF PROMISING YOUNG SCIENTISTS, AND CULMINATING IN THE TRANSFORMATION OF NOVEL DISCOVERIES INTO THERAPIES AND DIAGNOSTICS, THE MEDICAL CENTER'S RESEARCH PROGRAM HAS EMERGED AS A UNIQUE AND SUCCESSFUL MODEL FOR TODAY'S RAPIDLY CHANGING HEALTH CARE LANDSCAPE.EXAMPLES OF THE RESEARCH ENGAGED IN AT BIDMCBELOW IS INFORMATION RELATED TO JUST A HANDFUL OF THE CUTTING-EDGE RESEARCH STUDIES AND PRINCIPAL INVESTIGATORS AT THE MEDICAL CENTER. THE DETAIL BELOW IS DESIGNED TO PROVIDE THE READER WITH A TASTE OF THE MANY CONTRIBUTIONS THE MEDICAL CENTER IS MAKING TO PATIENT CARE TODAY AND TOMORROW. EXPENSES FROM THE RESEARCH ACTIVITIES NOTED BELOW ARE INCLUDED IN FORM 990 SCHEDULE H, PART I LINE 7H COLUMN C AND MAY OR MAY NOT BE QUANTIFIED IN FORM 990 SCHEDULE H, PART I, LINE 7H COLUMN E, DEPENDING ON FUNDING SOURCE. COVID-19 VACCINE RESEARCHALTHOUGH THE PERIOD COVERED BY THIS FILING IS THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, BIDMC IS FILING THIS RETURN ON OR BEFORE THE EXTENDED DUE DATE WHICH IS AUGUST 17, 2020. IN THE INTERVENING MONTHS SINCE THE END OF THE FISCAL PERIOD COVERED BY THIS FILING, THE COVID-19 PANDEMIC HAS CHANGED LIFE IN THE UNITED STATES AND ACROSS THE GLOBE. WHILE THE COVID-19 PANDEMIC BEGAN AFTER THE END OF FY 2019, RESEARCH CONDUCTED AT BIDMC DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, SET THE STAGE FOR BIDMC'S NATIONAL LEADERSHIP DURING THIS ONGOING PUBLIC HEALTH CRISIS. IT IS FOR THIS REASON, THAT BIDMC IS INCLUDING DETAIL IN THIS FILING RELATED TO COVID-19 RESEARCH EVEN THOUGH THIS RESEARCH COMMENCED AFTER THE END OF THE FISCAL PERIOD COVERED BY THIS FILING. AS OF LATE JULY 2020, NEARLY FOUR MILLION COVID-19 INFECTIONS HAVE BEEN REPORTED IN THE UNITED STATES. PUBLIC HEALTH LEADERS HAVE SUGGESTED THAT EFFORTS TO ENFORCE PHYSICAL DISTANCING INCLUDING MASK MANDATES AND STAY-AT-HOME ADVISORIES MAY HAVE TO REMAIN IN PLACE, IF INTERMITTENTLY, UNTIL SCIENTISTS DEVELOP A VACCINE FOR COVID-19.BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) IMMUNOLOGIST DAN BAROUCH, MD, PHD HAS BECOME A WORLD LEADER IN THE RACE TO DEVELOP A VACCINE AGAINST SARS-COV-2, THE VIRUS THAT CAUSES COVID-19. AS DIRECTOR OF BIDMC'S CENTER FOR VIROLOGY AND VACCINE RESEARCH (CVVR), BAROUCH AND HIS COLLEAGUES BEGAN WORKING ON A COVID-19 VACCINE ON JANUARY 10, 2020, THE SAME NIGHT THAT CHINESE SCIENTISTS RELEASED THE SARS-COV-2 VIRUS'S GENOME. BAROUCH'S TEAM QUICKLY DESIGNED A SERIES OF VACCINE CANDIDATES, WHICH ARE CURRENTLY BEING EVALUATED IN CLINICAL STUDIES AND LED BY PRIMARY INVESTIGATOR KATHRYN E. STEPHENSON, MD, MPH, DIRECTOR OF THE CLINICAL TRIALS UNIT AT CVVR.DR. BAROUCH'S INNOVATIVE VACCINE DESIGN USES A COMMON-COLD VIRUS, CALLED THE ADENOVIRUS, TO DELIVER A SMALL BIT OF THE COVID-19 DNA INTO HOST CELLS, WHERE IT STIMULATES THE BODY TO RAISE IMMUNE RESPONSES AGAINST THE VIRUS. IF PROVEN SAFE AND EFFECTIVE, THE COVID-19 VACCINE COULD BE AVAILABLE FOR EMERGENCY USE BY EARLY 2021, WHICH MAY BE THE SHORTEST TIME FROM VIRAL EMERGENCE TO VACCINE IN MEDICAL HISTORY.OVER THE LAST 20 YEARS, DR. BAROUCH HAS APPLIED THE ADENOVIRUS STRATEGY FOR USE AGAINST PATHOGENS SUCH AS HIV AND ZIKA. ONE SUCH CANDIDATE HIV VACCINE DEVELOPED BY DR. BAROUCH AND COLLEAGUES IS CURRENTLY IN CLINICAL EFFICACY TRIALS AT SITES AROUND THE WORLD, THE ONLY REMAINING HIV VACCINE CURRENTLY IN LARGE-SCALE CLINICAL TRIALS. DETAIL ON ADDITIONAL NON-COVID RESEARCH EFFORTS WHICH WERE UNDERTAKEN DURING THE FISCAL PERIOD COVERED BY THIS FILING ARE BELOW. LARGE INTERNATIONAL STUDY CONFIRMS MEASURING BONE MICROARCHITECTURE WITH NEW IMAGING TECHNOLOGY ACCURATELY PREDICTS RISK OF FRACTURE IN OLDER WOMEN AND MENIN THE LARGEST PROSPECTIVE STUDY OF ITS KIND, RESEARCHERS FROM BETH ISRAEL DEACONESS MEDICAL CENTER AND THE INSTITUTE FOR AGING RESEARCH AT HEBREW SENIORLIFE USED HIGH-RESOLUTION TOMOGRAPHY IMAGING TO ASSESS WHETHER OTHER BONE CHARACTERISTICS BESIDES BONE MINERAL DENSITY CAN BE USED TO DETERMINE FRACTURE RISK. EVERY YEAR MORE THAN TWO MILLION OLDER AMERICANS EXPERIENCE A FRAGILITY FRACTURE TO THE HIP, SPINE, OR WRIST. LOSS OF BONE MINERAL DENSITY (BMD) THE CONDITION KNOWN AS OSTEOPOROSIS IS ONE-WAY BONES CAN BECOME FRAGILE, AND SCREENING PATIENTS FOR OSTEOPOROSIS IS THE CURRENT STANDARD FOR DETERMINING FRACTURE RISK IN OLDER ADULTS. HOWEVER, LOW BONE MINERAL DENSITY IS NOT THE ONLY CAUSE OF BONE FRAGILITY, AND THE MAJORITY OF OLDER ADULTS WHO SUSTAIN A FRAGILITY FRACTURE DO NOT MEET THE DIAGNOSTIC CRITERIA FOR OSTEOPOROSIS.THE TEAM FOUND THAT ASSESSING THE MICROSTRUCTURE OF THE TWO DIFFERENT TYPES OF BONE TISSUES COMPACT BONE AND SPONGY BONE MAY BE USEFUL TO PREDICT THE INCIDENCE OF FRAGILITY FRACTURES IN THOSE WHO WOULD NOT OTHERWISE BE IDENTIFIED AS AT RISK. STUDY CO-LEAD AUTHOR MARY L. BOUXSEIN, PHD, DIRECTOR OF THE CENTER FOR ADVANCED ORTHOPEDIC STUDIES AT BIDMC, AND COLLEAGUES PUBLISHED THEIR FINDINGS IN THE LANCET DIABETES AND ENDOCRINOLOGY.SURGE PROTECTOR: NOVEL APPROACH TO SUPPRESSING THERAPY-INDUCED TUMOR GROWTHIN A PREVIOUS STUDY, A TEAM OF RESEARCHERS LED BY DIPAK PANIGRAHY, MD, A PATHOLOGIST AT BETH ISRAEL DEACONESS MEDICAL CENTER, DEMONSTRATED THAT DEAD AND DYING CANCER CELLS KILLED BY CONVENTIONAL CANCER TREATMENTS PARADOXICALLY TRIGGER THE INFLAMMATION THAT PROMOTES TUMOR GROWTH AND METASTASIS. NOW, IN A FOLLOW-UP STUDY PUBLISHED IN PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCE, PANIGRAHY AND COLLEAGUES ILLUMINATE THE MECHANISM BY WHICH DEBRIS GENERATED BY OVARIAN TUMOR CELLS TARGETED BY FIRST-LINE CHEMOTHERAPY ACCELERATES TUMOR PROGRESSION. ADDITIONALLY, THE RESEARCHERS DESCRIBE A NOVEL APPROACH TO SUPPRESSING THE CHEMOTHERAPY-INDUCED TUMOR GROWTH. DR. PANIGRAHY AND COLLEAGUE'S ANALYSIS REVEALED THAT CHEMOTHERAPY-KILLED OVARIAN CANCER CELLS INDUCE SURROUNDING IMMUNE CELLS CALLED MACROPHAGES TO RELEASE A SURGE OF IMMUNE-RELATED CHEMICAL COMPOUNDS CYTOKINES AND LIPID MEDIATORS THAT CREATE OPTIMAL CONDITIONS IN WHICH TUMORS CAN SURVIVE AND GROW. NEXT, THE TEAM SHOWED THAT A COMMON ANTI-INFLAMMATORY DRUG CALLED A DUAL COX-2 INHIBITOR BLOCKED THE SURGE OF TUMOR-FRIENDLY CYTOKINES AND LIPIDS. ""THE ROLE OF THESE CHEMOTHERAPY-INDUCED CYTOKINES AND LIPIDS IS UNDERAPPRECIATED AND POORLY CHARACTERIZED, AND OVARIAN CANCER PATIENTS MAY BENEFIT FROM SUPPRESSING THEIR RELEASE,"" SAID DR. PANIGRAHY. ""FURTHER RESEARCH IS NEEDED BUT, DUAL INHIBITION OF THE COX-2 PATHWAYS IS A NOVEL THERAPEUTIC MODALITY THAT MAY COMPLIMENT CONVENTIONAL CANCER THERAPIES BY ACTING AS A SURGE PROTECTOR AGAINST CELL DEBRIS-STIMULATED TUMOR GROWTH."" PREVENTING POSTOPERATIVE DELIRIUMAS MANY AS HALF OF ALL PATIENTS WHO UNDERGO CARDIAC SURGERY MAY EXPERIENCE DELIRIUM, A FORM OF ACUTE CONFUSION THAT CAN RESULT IN DISORIENTATION, IMPAIRED MEMORY, DELUSIONS, AND ABRUPT CHANGES IN MOOD AND BEHAVIOR, INCLUDING AGGRESSION. IN A STUDY PUBLISHED IN THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, PHYSICIAN-RESEARCHERS LED BY BALACHUNDHAR SUBRAMAINAM, MD, PHD, DIRECTOR OF THE CENTER FOR ANESTHESIA RESEARCH EXCELLENCE IN THE DEPARTMENT OF ANESTHESIA, CRITICAL CARE AND PAIN MEDICINE AT BETH ISRAEL DEACONESS MEDICAL CENTER FOUND THAT INTRAVENOUS ACETAMINOPHEN SIGNIFICANTLY REDUCED THE INCIDENCE OF POSTOPERATIVE DELIRIUM FOLLOWING CORONARY ARTERY BYPASS PROCEDURES IN PATIENTS OVER 60. THE FINDINGS OF THIS SINGLE-CENTER TRIAL MAY REPRESENT THE FIRST STEPS TOWARD A THERAPEUTIC INTERVENTION FOR THE PREVENTION OF POSTOPERATIVE DELIRIUM, A COMMON AND DEVASTATING COMPLICATION IN THE OFTEN HIGHLY VULNERABLE OLDER ADULTS WHO UNDERGO CARDIAC SURGERY.""CURRENTLY, IV ACETAMINOPHEN ADMINISTRATION IS CONSIDERED AN EXPENSIVE INTERVENTION, AND THERE IS SIGNIFICANT VARIATION IN PAIN MANAGEMENT FOLLOWING CARDIAC SURGERY,"" SAID DR. 2SUBRAMAINAM. ""IF OUR FINDINGS ARE REPLICATED IN A LARGER, MULTICENTER STUDY, POSTOPERATIVE INTRAVENOUS ADMINISTRATION OF ACETAMINOPHEN COULD BECOME A STANDARD OF CARE IN ALL CARDIAC SURGICAL PATIENTS AND COULD BE INCORPORATED IN CARDIAC SURGERY RECOVERY PROTOCOLS."""

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
"SURGEONS RETURNED TO MINIMALLY INVASIVE PROCEDURES FOR HYSTERECTOMY AFTER ABANDONING POTENTIALLY CANCER-SPREADING TECHNIQUEA STUDY BY SPECIALISTS AT BETH ISRAEL DEACONESS MEDICAL CENTER CHARACTERIZED NATIONAL TRENDS IN HYSTERECTOMY PRACTICE IN THE WAKE OF A 2014 FDA WARNING THAT A TOOL CALLED A POWER MORCELLATOR INTENDED TO ASSIST WITH MINIMALLY INVASIVE LAPAROSCOPIC HYSTERECTOMY COULD SPREAD CANCER IN SOME WOMEN. AFTER ENDING THE USE OF POWER MORCELLATION, SURGEONS INITIALLY RETURNED TO MORE INVASIVE ABDOMINAL HYSTERECTOMIES IN THE YEAR FOLLOWING THE FEDERAL WARNING, BIDMC'S RESEARCHERS REPORTED IN THE JOURNAL OBSTETRICS & GYNECOLOGY. HOWEVER, THE TEAM OBSERVED AN OVERALL INCREASE IN THE PROPORTION OF MINIMALLY INVASIVE HYSTERECTOMIES PERFORMED SINCE 2012. ""PREVIOUS STUDIES REPORTED AN INCREASE IN ABDOMINAL HYSTERECTOMY IN RESPONSE TO THE FDA SAFETY COMMUNICATION, AND OUR RESULTS ARE CONSISTENT WITHIN THE INITIAL SIX-MONTH PERIOD AFTER THE FIRST CONCERNS ABOUT POWER MORCELLATION WERE REPORTED,"" SAID LEAD AUTHOR ELISA M. JORGENSEN, MD, A MINIMALLY INVASIVE GYNECOLOGY SURGERY FELLOW AT BIDMC. ""HOWEVER, BY LOOKING AT DATA THROUGH 2016, WE FOUND A COMPLETE REVERSAL OF THE PREVIOUSLY REPORTED EFFECT. IN FACT, MINIMALLY INVASIVE HYSTERECTOMY WAS AT ITS PEAK INCIDENCE AT THE END OF OUR FIVE-YEAR STUDY PERIOD."" QUASHING THE RESISTANCE: MICRORNA REGULATES DRUG TOLERANCE IN SUBSET OF LUNG CANCERSRELAPSE OF DISEASE FOLLOWING CONVENTIONAL TREATMENTS REMAINS ONE OF THE CENTRAL PROBLEMS IN CANCER MANAGEMENT, YET FEW THERAPEUTIC AGENTS TARGETING DRUG RESISTANCE AND TOLERANCE EXIST. NEW RESEARCH CONDUCTED AT THE CANCER CENTER AT BETH ISRAEL DEACONESS MEDICAL CENTER FOUND THAT A MICRORNA A SMALL FRAGMENT OF NON-CODING GENETIC MATERIAL THAT REGULATES GENE EXPRESSION MEDIATES DRUG TOLERANCE IN LUNG CANCERS WITH A SPECIFIC MUTATION. THE FINDINGS, PUBLISHED IN NATURE METABOLISM, SUGGEST THAT THE MICRORNA COULD SERVE AS A POTENTIAL TARGET FOR REVERSING AND PREVENTING DRUG TOLERANCE IN A SUBSET OF NON-SMALL-CELL LUNG CANCERS. ""IN THIS STUDY, WE DISCOVERED THAT A MICRORNA KNOWN AS MIR-147B IS A CRITICAL MEDIATOR OF RESISTANCE AMONG A SUBPOPULATION OF TUMOR CELLS THAT ADOPT A TOLERANCE STRATEGY TO DEFEND AGAINST EGFR-BASED ANTICANCER TREATMENTS,"" SAID SENIOR AUTHOR FRANK J. SLACK, PHD, DIRECTOR OF THE HMS INITIATIVE FOR RNA MEDICINE AT THE CANCER CENTER AT BIDMC. ""WE ARE CURRENTLY TESTING THE IDEA OF TARGETING THIS NEW PATHWAY AS A THERAPY IN CLINICALLY RELEVANT MOUSE MODELS OF EGFR-MUTANT LUNG CANCER.""READING CLINICIAN VISIT NOTES CAN IMPROVE PATIENTS' ADHERENCE TO MEDICATIONSA STUDY OF PATIENTS READING THE VISIT NOTES THEIR CLINICIANS WRITE, REPORT POSITIVE EFFECTS ON THEIR USE OF PRESCRIPTION MEDICATIONS. PUBLISHED IN THE ANNALS OF INTERNAL MEDICINE, THE STUDY SHOWS THAT WHEN PATIENTS READ THEIR NOTES, THEY REPORT SIGNIFICANT BENEFITS, INCLUDING FEELING MORE COMFORTABLE WITH AND IN CONTROL OF THEIR MEDICATIONS, A GREATER UNDERSTANDING OF MEDICATION'S SIDE EFFECTS, AND BEING MORE LIKELY TO TAKE MEDICATIONS AS PRESCRIBED. THE STUDY OF APPROXIMATELY 20,000 ADULT PATIENTS AT BETH ISRAEL DEACONESS MEDICAL CENTER IN BOSTON AND TWO OTHER HEALTH SYSTEMS WAS CONDUCTED ONLINE BETWEEN JUNE AND OCTOBER OF 2017. THE THREE HEALTH SYSTEMS HAVE BEEN SHARING VISIT NOTES WRITTEN BY PRIMARY CARE DOCTORS, MEDICAL AND SURGICAL SPECIALISTS, AND OTHER CLINICIANS FOR SEVERAL YEARS. ""SHARING CLINICAL NOTES WITH PATIENTS IS A RELATIVELY LOW-COST, LOW-TOUCH INTERVENTION,"" SAID STUDY LEAD CATHERINE DESROCHES, DRPH, EXECUTIVE DIRECTOR OF OPENNOTES, OF THE DIVISION OF GENERAL MEDICINE AT BIDMC AND AN ASSOCIATE PROFESSOR OF MEDICINE AT HARVARD MEDICAL SCHOOL. ""WHILE NOTE SHARING REQUIRES A CULTURE SHIFT IN MEDICINE, IT IS NOT TECHNICALLY DIFFICULT WITH MOST ELECTRONIC HEALTH RECORD SYSTEMS (EHRS), AND COULD HAVE AN ENORMOUS PAYOFF, GIVEN THAT WE KNOW POOR ADHERENCE TO MEDICATIONS COSTS THE HEALTH CARE SYSTEM ABOUT $300 BILLION PER YEAR. ANYTHING THAT WE CAN DO TO IMPROVE ADHERENCE TO MEDICATIONS HAS SIGNIFICANT VALUE.""STUDY: LEVELS OF LIVER FAT BIOMARKER ASSOCIATED WITH METABOLIC HEALTH BENEFITS OF REGULAR EXERCISEWHILE GENETICS AND OTHER FACTORS LIKE AGE AND GENDER CONTRIBUTE TO EACH INDIVIDUAL'S RESPONSE TO EXERCISE, LITTLE IS KNOWN ABOUT THE BIOLOGICAL MECHANISMS BY WHICH PHYSICAL ACTIVITY BRINGS ABOUT BENEFICIAL CHANGES TO THE BODY. IN A STUDY LED BY CARDIOLOGISTS AT BETH ISRAEL DEACONESS MEDICAL CENTER, SCIENTISTS FOUND THAT INCREASING EXERCISE CAN LOWER LEVELS OF DIMETHYLGUANIDINO VALERIC ACID (DMVG), A MOLECULE IN THE BLOOD LINKED TO POOR HEALTH OUTCOMES. HOWEVER, THE RESEARCHERS WERE SURPRISED TO FIND THAT PEOPLE WITH HIGHER BASELINE LEVELS OF DMVG THOSE WITH ""MORE ROOM TO IMPROVE"" ACTUALLY SAW LESS BENEFIT FROM EXERCISE THAN PEOPLE WITH LOWER BASELINE LEVELS OF DMVG THOSE IN BETTER HEALTH TO BEGIN WITH.LED BY CORRESPONDING AUTHOR ROBERT GERSZTEN, MD, CHIEF OF CARDIOVASCULAR MEDICINE AT BIDMC, THE SCIENTISTS WERE INTERESTED IN STUDYING DMGV BASED ON THEIR PREVIOUS RESEARCH FINDINGS SHOWING THAT THE MOLECULE WAS A MARKER OF LIVER FAT AND THAT CIRCULATING LEVELS WERE TIED THE DEVELOPMENT OF TYPE 2 DIABETES UP TO 12 YEARS PRIOR TO DISEASE ONSET. THE STUDY WAS PUBLISHED IN JAMA CARDIOLOGY.STRUCTURE OF ENZYME THAT PRODUCES FUEL FOR THE HEART OF MUSCLE CELLS REVEALED AFTER SIXTY YEARS OF INTENSIVE INVESTIGATION BY BIOCHEMISTS AND PHYSIOLOGISTS WORLDWIDE, A TEAM OF SCIENTISTS LED BY GABRIEL BIRRANE, PHD, A STRUCTURAL BIOLOGIST AT BETH ISRAEL DEACONESS MEDICAL CENTER, PROVIDED THE FIRST DETAILED PICTURE OF THE STRUCTURE OF THE LIPOPROTEIN LIPASE (LPL) PROTEIN. THE TEAM'S FINDINGS, PUBLISHED IN THE PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES, OFFER A BETTER UNDERSTANDING OF CARDIOVASCULAR METABOLISM AND COULD OPEN THE DOOR TO TARGETED TREATMENT FOR SEVERAL RARE CARDIOVASCULAR DISORDERS. ""BECAUSE LPL ALONE IS NOT VERY STABLE, PREVIOUS EXPERIMENTERS HAD DIFFICULTY PRODUCING SUFFICIENT AMOUNTS LPL FOR STRUCTURAL ANALYSIS,"" EXPLAINED DR. BIRRANE. ""MY COLLABORATORS PROVIDED THE BREAKTHROUGH DATA, INCLUDING METHODS TO PURIFY ACTIVE LPL AND A COMPANION PROTEIN THAT WAS CRUCIAL TO STABILIZE LPL. WITH THIS KNOWLEDGE, WE CONCENTRATED OUR EFFORTS ON CRYSTALLIZING A COMPLEX OF THE TWO PROTEINS. CRYSTALS OF THE COMPLEX PRODUCED X-RAY DATA OF MUCH HIGHER QUALITY THAN WE WERE ABLE TO OBTAIN WITH LPL ALONE AND THIS ALLOWED US TO ANALYZE THE STRUCTURE AT A MOLECULAR LEVEL."" NOW THAT THE TEAM HAS REVEALED THE STRUCTURE OF THE PROTEIN COMPLEX, RESEARCHERS CAN UNDERSTAND HOW MUTATIONS IN LPL OR GPIHBP1 LEAD TO ELEVATED TRIGLYCERIDE LEVELS AND CORONARY ARTERY DISEASE. OTHER MOLECULES BIND TO AND REGULATE THE FUNCTION OF LPL. IN FOLLOW UP STUDIES, DR. BIRRANE AND HIS COLLABORATORS WOULD LIKE TO DETERMINE THESE MOLECULES' MECHANISM OF ACTION, INFORMATION THAT WILL ALLOW SCIENTISTS TO BETTER UNDERSTAND THE ROLE LPL PLAYS IN CARDIOVASCULAR DISEASE AND DIABETES. BOTSWANA STUDY OF HIV MEDICATION SAFETY IN PREGNANCY HAS LESSONS FOR THE USBABIES BORN TO WOMEN TAKING THE HIV THERAPY DOLUTEGRAVIR ARE AT A SLIGHTLY INCREASED RISK OF BIRTH DEFECTS CALLED NEURAL TUBE DEFECTS WHICH AFFECT THE BRAIN, SPINE, AND SPINAL CORD, ACCORDING TO A STUDY PUBLISHED IN THE NEW ENGLAND JOURNAL OF MEDICINE. THE FINDINGS, PRESENTED BY INFECTIOUS DISEASE SPECIALIST REBECCA ZASH, MD, AN ASSISTANT PROFESSOR OF MEDICINE AT BETH ISRAEL DEACONESS MEDICAL CENTER AND A RESEARCH FELLOW AT THE HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH, AT THE 10TH INTERNATIONAL AIDS SOCIETY CONFERENCE IN MEXICO CITY, COULD IMPACT TREATMENT GUIDELINES AROUND ANTIRETROVIRAL CHOICES FOR WOMEN OF REPRODUCTIVE AGE. ""WHEN DOLUTEGRAVIR CAME OUT, IT WAS POISED TO BECOME THE MOST WIDELY RECOMMENDED ANTIRETROVIRAL MEDICATION BECAUSE IT IS VERY EFFECTIVE AGAINST HIV AND IS PARTICULARLY WELL TOLERATED,"" SAID DR. ZASH. ""OUR STUDY SHOWS THAT DOLUTEGRAVIR IS NOT NECESSARILY A MAGIC BULLET AND CONTINUED EFFORTS ARE NEEDED TO DEVELOP NOVEL HIV TREATMENTS. WE PLAN TO CONTINUE OUR WORK IN BOTSWANA TO STUDY THE SAFETY OF CURRENT AND NEW ANTIRETROVIRAL MEDICATIONS IN PREGNANCY.""RESEARCHERS FIND WIDESPREAD ASPIRIN USE DESPITE FEW BENEFITS, HIGH RISKSASPIRIN USE IS WIDESPREAD AMONG GROUPS AT RISK FOR HARM INCLUDING OLDER ADULTS AND ADULTS WITH PEPTIC ULCERS PAINFUL SORES IN THE LINING OF THE STOMACH THAT ARE PRONE TO BLEEDING THAT AFFECT ABOUT ONE IN TEN PEOPLE. IN A RESEARCH REPORT PUBLISHED IN ANNALS OF INTERNAL MEDICINE, RESEARCHERS FROM BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) REPORT ON THE EXTENT TO WHICH AMERICANS 40 YEARS OLD AND ABOVE USE ASPIRIN FOR PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE."

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS GRADUATE MEDICAL EDUCATION AS NOTED THROUGHOUT THIS FILING AJH IS PART OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES. BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) IS A TERTIARY CARE ACADEMIC MEDICAL CENTER IN BOSTON AND A SISTER ENTITY OF AJH. AS PART OF THE SAME NETWORK, THE ACADEMIC TEACHING AND TRAINING IN WHICH BIDMC ENGAGES SUPPORTS NOT ONLY THE BIDMC MISSION, CARE FOR BIDMC PATIENTS AND COMMUNITIES BUT BIDMC'S COMMITMENT TO TRAINING THE MEDICAL PROFESSIONALS OF TOMORROW ALSO HELPS TO IMPROVE PATIENT CARE FOR THE COMMUNITIES OF OTHER BILH AFFILIATES AND BEYOND. THE DETAIL BELOW PROVIDES BACKGROUND ON THE TEACHING ACTIVITIES AT BIDMC DURING THE FISCAL PERIOD COVERED BY THIS FILING.THE MEDICAL CENTER'S DEVOTION TO TEACHING, RESPECT FOR STUDENTS/TRAINEES AND WILLINGNESS TO EMBRACE TECHNOLOGICAL AND CLINICAL PRACTICE INNOVATION MAKE THE MEDICAL CENTER A TOP CHOICE AMONG MEDICAL STUDENTS AND HEALTH CARE PROFESSIONALS. THE MEDICAL CENTER TRAINS HUNDREDS OF MEDICAL STUDENTS, INTERNS, RESIDENTS AND FELLOWS, AS WELL AS PROFESSIONALS IN NURSING, SOCIAL WORK AND THE ALLIED HEALTH SCIENCES. THE MEDICAL CENTER HAS 60 ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED CLINICAL RESIDENCY AND FELLOWSHIP PROGRAMS WITH 785 RESIDENTS AND CLINICAL FELLOWS. IN ADDITION, THE MEDICAL CENTER HAS 52 NONSTANDARD CLINICAL FELLOWSHIP PROGRAMS WITH 60 TRAINEES PER YEAR. STAFF PHYSICIANS AT THE MEDICAL CENTER WHO HOLD FACULTY APPOINTMENTS AT HARVARD MEDICAL SCHOOL INSTRUCT THE DOCTORS OF TOMORROW THROUGH SUPERVISION OF THEIR DAILY PATIENT CARE AND A RANGE OF INTERACTIVE LEARNING EXPERIENCES. CORE CLINICAL TRAINING PROGRAMSTHE MEDICAL CENTER SPONSORS CORE CLINICAL TRAINING PROGRAMS IN THE FOLLOWING FIELDS: ANESTHESIOLOGY EMERGENCY MEDICINE EAR, NOSE AND THROAT (OTOLARYNGOLOGY) INTERNAL MEDICINE NEUROLOGY NEUROSURGERY OBSTETRICS AND GYNECOLOGY PATHOLOGY PLASTIC SURGERY PSYCHIATRY RADIOLOGY SURGERY TRANSITIONAL YEAR UROLOGYDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER HAD NET EXPENDITURES OF $68,456,175 REPORTED ON THIS SCHEDULE H, PART I, LINE 7F RELATED TO THE MEDICAL CENTER'S TEACHING FUNCTION WHICH REPRESENTED 2.90% OF THE MEDICAL CENTER'S TOTAL EXPENSES.RESIDENCY PROGRAMSTHE MEDICAL CENTER SPONSORS ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED RESIDENCY PROGRAMS IN EACH OF THE CORE CLINICAL TRAINING PROGRAMS LISTED ABOVE. FELLOWSHIP PROGRAMSIN ADDITION TO THE RESIDENT TRAINING PROGRAMS LISTED ABOVE, THE MEDICAL CENTER SPONSORS A WIDE VARIETY OF FELLOWSHIP TRAINING PROGRAMS FOR ELIGIBLE DOCTORS WHO HAVE COMPLETED THEIR RESIDENCY AND WANT TO ENGAGE IN MORE SPECIALIZED STUDY. OVER HALF OF THESE PROGRAMS (59 OF 109) ARE ACGME APPROVED OR APPROVED BY A COMPARABLE BODY RELATED TO THE PARTICULAR SUBSPECIALTY. THE MEDICAL CENTER SPONSORS THE FOLLOWING FELLOWSHIP PROGRAMS: ANESTHESIA: ADULT CARDIOTHORACIC ANESTHESIOLOGY, ADVANCED CLINICAL ANESTHESIA, ANESTHESIA FOR OUTPATIENT SURGERY, CRITICAL CARE MEDICINE, NEUROANESTHESIA, NEURO CRITICAL CARE, OBSTETRIC ANESTHESIOLOGY, PAIN MEDICINE, REGIONAL ANESTHESIA, VASCULAR ANESTHESIA, PATIENT SAFETY AND QUALITY IMPROVEMENT IN ANESTHESIA DERMATOLOGY: CUTANEOUS ONCOLOGY, DERMATOLOGY RESEARCH FELLOWSHIP IN CLINICAL TRIALS AND OUTCOMES RESEARCH (CLEARS) EMERGENCY MEDICINE: EMERGENCY MEDICAL SERVICES, EMERGENCY ULTRASOUND, DISASTER MEDICINE, ACADEMIC EMERGENCY MEDICINE INTERNAL MEDICINE: ADVANCED CARDIAC NON-INVASIVE IMAGING, ADVANCED ENDOCRINE, DIABETES AND METABOLISM, ADVANCED ENDOSCOPY, ADVANCED INFECTIOUS DISEASE, ADVANCED NEPHROLOGY, CARDIAC MAGNETIC RESONANCE IMAGING, CARDIOVASCULAR DISEASE, CELIAC DISEASE, CLINICAL CARDIAC ELECTROPHYSIOLOGY, CLINICAL INFORMATICS, ENDOCRINOLOGY, DIABETES, AND METABOLISM, GASTROENTEROLOGY, GENERAL MEDICINE, GERIATRIC MEDICINE, GERIATRIC AND DIABETES, GI MOTILITY/FUNCTIONAL BOWEL DISORDERS, GLOBAL HEALTH, HEMATOLOGY AND MEDICAL ONCOLOGY, HEPATOLOGY, HOSPICE AND PALLIATIVE CARE, INFECTIOUS DISEASE, INFLAMMATORY BOWEL DISEASE, INTERVENTIONAL CARDIOLOGY, INTERVENTIONAL PULMONOLOGY, NEPHROLOGY, PULMONARY CRITICAL CARE, RHEUMATOLOGY, SLEEP MEDICINE, SLEEP RESPIRATION, STRUCTURAL HEART DISEASE, TRANSPLANT HEPATOLOGY, TRANSPLANT NEPHROLOGY NEUROLOGY: AUTONOMIC DISORDERS, COGNITIVE BEHAVIORAL NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, EPILEPSY, MOVEMENT DISORDERS, MULTIPLE SCLEROSIS, NEUROLOGY-HIV, NEUROMUSCULAR MEDICINE, NEURO-ONCOLOGY, VASCULAR NEUROLOGY OBSTETRICS AND GYNECOLOGY: FEMALE PELVIC MEDICINE & RECONSTRUCTIVE SURGERY, GYNECOLOGIC ONCOLOGY, MATERNAL FETAL MEDICINE, REPRODUCTIVE ENDOCRINOLOGY PATHOLOGY: BLOOD BANKING/TRANSFUSION MEDICINE, CYTOPATHOLOGY, DERMATOPATHOLOGY, HEMATOPATHOLOGY, MEDICAL MICROBIOLOGY, MEDICAL MICROBIOLOGY CPEP, NEUROPATHOLOGY, SELECTIVE PATHOLOGY PSYCHIATRY RADIOLOGY-DIAGNOSTIC: ABDOMINAL RADIOLOGY, BREAST IMAGING RADIOLOGY, INTERVENTIONAL RADIOLOGY-INDEPENDENT, INTERVENTIONAL RADIOLOGY-INTEGRATED, MRI, MUSCULOSKELETAL IMAGING MSK, NEURORADIOLOGY, THORACIC IMAGING RADIOLOGY, RADIATION ONCOLOGY: BRACHYTHERAPY, STEREOTATIC SURGERY: ABDOMINAL TRANSPLANT SURGERY/KIDNEY, ACUTE CARE SURGERY, ANTERIOR SEGMENT OPHTHALMOLOGY, COLON AND RECTAL SURGERY, CORNEA AND REFRACTIVE SURGERY, CEREBROVASCULAR AND ENDOVASCULAR NEUROSURGERY, HEAD & NECK SURGICAL ONCOLOGY & RECONSTRUCTION, INTERDISCIPLINARY BREAST SURGERY, MINIMALLY INVASIVE BARIATRIC SURGERY, NEUROSURGERY/ORTHO SPINE, ORTHOPAEDIC HAND SURGERY, ORTHOPAEDIC SPINE SURGERY, PLASTIC SURGERY, PLASTIC SURGERY/AESTHETIC RECONSTRUCTION, PLASTIC SURGERY/BREAST RECONSTRUCTION, PODIATRY, SURGICAL CRITICAL CARE, THORACIC SURGERY, UROLOGY, UROLOGY MALE INFERTILITY/SEXUAL DYSFUNCTION, VASCULAR SURGERY, VASCULAR SURGERY-INTEGRATEDADDITIONAL INFORMATION ON CLINICAL RESIDENCY AND FELLOWSHIPS -- EXAMPLESBELOW IS MORE DETAIL ON JUST A FEW OF THE SPECIFIC GRADUATE MEDICAL EDUCATION PROGRAMS OFFERED AT THE MEDICAL CENTER:HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY AT BIDMCTHE BETH ISRAEL DEACONESS MEDICAL CENTER HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY IS A THREE-YEAR PROGRAM (PGY-1 TO PGY-3) IS AFFILIATED WITH HARVARD MEDICAL SCHOOL AND IS BASED AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), A 57,000 VISIT PER YEAR LEVEL I TRAUMA CENTER. RESIDENTS ROTATE AT CHILDREN'S HOSPITAL BOSTON, BROCKTON HOSPITAL, CAMBRIDGE HOSPITAL, TUFTS MEDICAL CENTER, ST. VINCENT HOSPITAL, ST. LUKE'S HOSPITAL, MOUNT AUBURN HOSPITAL AND BETH ISRAEL DEACONESS HOSPITAL-NEEDHAM.THE EDUCATIONAL GOALS OF THE RESIDENCY ARE TO PROMOTE EXCELLENCE IN THE CLINICAL, ACADEMIC, AND ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE. RESIDENTS ARE TAUGHT HOW TO BE OUTSTANDING CLINICIANS. THIS IS ACCOMPLISHED THROUGH CLINICAL EXPERIENCE IN SEVERAL BUSY EMERGENCY DEPARTMENTS AS WELL AS THROUGH A HIGH-QUALITY DIDACTIC PROGRAM. DURING THE CLINICAL EXPERIENCE, THE RESIDENTS ARE CLOSELY SUPERVISED AND GIVEN GRADED RESPONSIBILITY FOR PATIENT CARE AND ULTIMATELY FOR PATIENT FLOW IN THE EMERGENCY DEPARTMENT. ADDITIONALLY, RESIDENTS ARE TAUGHT HOW TO SUPERVISE MEDICAL STUDENTS AND OTHER RESIDENTS AND HOW TO TEACH THE PRACTICE OF EMERGENCY MEDICINE. RESIDENTS TEACH MEDICAL STUDENTS AND PREHOSPITAL PERSONNEL AND CONTRIBUTE TO THE DIDACTIC PROGRAM. SENIOR RESIDENTS TAKE ON THE RESPONSIBILITY OF SUPERVISING JUNIOR RESIDENTS IN THE CLINICAL ARENA. THE FOCUS OF THE RESIDENCY PROGRAM IS ON TEACHING THE LEADERSHIP SKILLS NECESSARY TO DIRECT A BUSY EMERGENCY DEPARTMENT IN ANY SETTING.THE OTHER MAJOR EDUCATIONAL GOAL OF THE RESIDENCY IS TO DEVELOP THE RESEARCH AND ACADEMIC SKILLS REQUIRED FOR A CAREER IN ACADEMIC EMERGENCY MEDICINE. PARTICIPATION IN RESEARCH IS PROMOTED THROUGH A SYSTEM OF MENTORSHIP, JOURNAL CLUB PARTICIPATION, AND A DIDACTIC PROGRAM THAT TEACHES RESEARCH DESIGN AND STATISTICAL METHODS. RESIDENTS ARE REQUIRED TO COMPLETE A RESEARCH OR ACADEMIC PROJECT THAT RESULTS IN A PAPER SUITABLE FOR PUBLICATION. FUNDING IS AVAILABLE WITHIN THE DIVISION OF EMERGENCY MEDICINE AT HARVARD MEDICAL SCHOOL AND THE DEPARTMENT OF EMERGENCY MEDICINE AT BIDMC. PROMOTING THE ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE IS ANOTHER GOAL OF THE BIDMC HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY. THROUGH AN EMS/ADMINISTRATIVE ROTATION AND A LONGITUDINAL EXPERIENCE IN PREHOSPITAL ADMINISTRATION, RESIDENTS GAIN EXPERIENCE IN RUNNING A LOCAL PREHOSPITAL SYSTEM.THIS PROGRAM TAKES ADVANTAGE OF THE UNIQUE ACADEMIC OPPORTUNITIES AT HARVARD MEDICAL SCHOOL, THE HARVARD TEACHING HOSPITALS, AND THE HARVARD SCHOOL OF PUBLIC HEALTH. THESE OPPORTUNITIES INCLUDE THE OUTSTANDING EXPERIENCE AVAILABLE THROUGH BOSTON CHILDREN'S HOSPITAL AND THE DEPARTMENTS OF MEDICINE, SURGERY, OBSTETRICS AND GYNECOLOGY, AND ANESTHESIA AT BETH ISRAEL DEACONESS MEDICAL CENTER. *****

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
"THE COMBINED FACULTY CONSISTS OF MORE THAN 80 NEUROLOGISTS AT THE TWO PARTICIPATING HOSPITALS, AND PROVIDES CORE EXPERIENCES IN INPATIENT AND OUTPATIENT NEUROLOGY, AS WELL AS TRAINING IN ELECTROPHYSIOLOGY (INCLUDING EEG, EMG, AND SLEEP POLYSOMNOGRAPHY) AND NEUROPATHOLOGY. THE KEY DISTINGUISHING FEATURE OF THE PROGRAM IS THE CLOSE RELATIONSHIP BETWEEN THE CLINICAL FACULTY, NEARLY ALL OF WHOM ARE FULL-TIME ACADEMIC NEUROLOGISTS ENGAGED IN SUBSTANTIVE RESEARCH AND TEACHING EFFORTS, AND A SELECT GROUP OF RESIDENTS WHO ARE KEENLY INTERESTED IN FORGING ACADEMIC CAREERS IN NEUROLOGY. VIRTUALLY ALL OF THE CLINICAL TRAINING TAKES PLACE WITHIN A 2-BLOCK RADIUS ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS. A CRITICAL COMPONENT OF THE PROGRAM IS THE OPPORTUNITY FOR RESIDENTS TO HAVE A MENTORED TEACHING EXPERIENCE AS WELL AS THE OPPORTUNITY TO UNDERTAKE A MENTORED PROJECT, WHICH MAY ENTAIL EITHER CLINICAL OR LABORATORY-BASED INVESTIGATION OR PREPARATION OF INNOVATIVE TEACHING MATERIALS OR METHODS. *****PATHOLOGY EDUCATION AT BIDMCTHE DEPARTMENT OF PATHOLOGY AT BETH ISRAEL DEACONESS MEDICAL CENTER IS COMMITTED TO PROVIDING STATE-OF-THE-ART TRAINING TO PREPARE PHYSICIANS FOR LEADERSHIP ROLES IN PATHOLOGY AND ACADEMIC MEDICINE. THE PROGRAM OFFERS THREE RESIDENT TRAINING PATHWAYS: FIRST, A COMBINED ANATOMIC PATHOLOGY/CLINICAL PATHOLOGY (AP/CP) PATHWAY PROVIDES COMPREHENSIVE TRAINING IN ALL AREAS OF TISSUE DIAGNOSTICS AND LABORATORY MEDICINE. SECOND, THE AP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS ACADEMIC SURGICAL PATHOLOGISTS. THIRD, THE CP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS FUTURE LEADERS IN LABORATORY MEDICINE. ALL PATHWAYS INCLUDE EXTENSIVE OPPORTUNITIES TO PARTICIPATE IN RESEARCH PROJECTS WITH WORLD-RENOWNED EXPERTS IN PATHOLOGY OR RELATED DISCIPLINES. KNOWLEDGE COMES THROUGH EXPERIENCE AND EXTENSIVE INTERACTION WITH FACULTY. IN ANATOMIC PATHOLOGY SIGN OUT, RESIDENTS PREPARE THEIR OWN DIAGNOSES AND ARE THEN IN A POSITION TO TAKE FULL ADVANTAGE OF SIGN OUT WITH STAFF MEMBERS. IN CLINICAL PATHOLOGY, RESIDENTS GAIN EXPERIENCE DURING DAILY ROUNDS WITH ATTENDINGS, SOCRATIC TUTORIALS, AND THROUGH POSITIONING OF RESIDENTS AS AN INTERMEDIARY BETWEEN CLINICIAN AND LABORATORY. THERE ARE DAILY TEACHING AND CASE MANAGEMENT CONFERENCES COVERING THE DIFFERENT PATHOLOGY SPECIALTIES. GIVEN THE IMPORTANT ROLE PATHOLOGISTS PLAY IN TEACHING MEDICAL STUDENTS AND COLLEAGUES IN OTHER SPECIALTIES, THE PROGRAM PROVIDES GUIDANCE FOR RESIDENTS AS THEY HONE THEIR TEACHING SKILLS. SUCH ""RESIDENT-AS-TEACHER"" PROGRAMS ARE COMMON IN OTHER SPECIALTIES BUT NOT AS WELL-DEVELOPED IN PATHOLOGY. THE CURRICULUM INCLUDES SESSIONS DESIGNED TO IMPROVE SKILLS RELATED TO GIVING FEEDBACK AND SMALL GROUP TEACHING. THERE IS A SESSION ON DEVELOPING PRESENTATION SKILLS WITH CLOSE MENTORING OF FIRST YEAR RESIDENTS, BY SPECIFIC FACULTY WHO HAVE ALSO BEEN THROUGH THE CURRICULUM, AS THEY PREPARE FOR THEIR FIRST PRESENTATION. THERE ARE ALSO OPPORTUNITIES FOR RESIDENTS TO TEACH MEDICAL STUDENTS BOTH WITHIN OUR DEPARTMENT AND AT HARVARD MEDICAL SCHOOL, AS WELL AS TO RECEIVE FEEDBACK ON THEIR TEACHING SKILLS. RECOGNIZING THE NEED TO INTEGRATE TECHNOLOGY INTO RESIDENCY TRAINING, ALL FIRST-YEAR RESIDENTS ARE PROVIDED WITH IPADS. THESE TABLETS ALLOW RESIDENTS TO MORE EASILY PREVIEW THE SLIDES THAT ARE ROUTINELY SCANNED FOR OUR SURGICAL SLIDE CONFERENCE. GENOMIC TECHNOLOGY WILL AFFECT THE PRACTICE OF ALL MEDICAL PRACTITIONERS. AS THE PHYSICIANS WHO MANAGE THE HOSPITAL LABORATORIES, PATHOLOGISTS MUST UNDERSTAND NEXT-GENERATION SEQUENCING TECHNOLOGY AND ITS APPLICATION TO PATIENT CARE. IN 2009, THE PROGRAM CREATED, TO OUR KNOWLEDGE, THE FIRST GENOMIC PATHOLOGY CURRICULUM IN THE COUNTRY. THE CURRICULUM HAS BEEN PUBLISHED AND HAS SERVED AS THE BASIS FOR A COLLABORATIVE EFFORT TO DEVELOP A NATIONAL GENOMICS CURRICULUM (WWW.ASCP.ORG/TRIG).TRAINING IN EVIDENCE-BASED MEDICINE IS CRITICAL. A FIRST-YEAR RESIDENT JOURNAL CLUB ALLOWS AN INTRODUCTION TO CRITICAL REVIEW OF THE MEDICAL LITERATURE. IN LATER YEARS, RESIDENTS LEAD SMALL-GROUP DISCUSSIONS IN MONTHLY JOURNAL CLUBS. THERE IS ALSO AN EVIDENCE-BASED TRANSFUSION MEDICINE CURRICULUM TO HONE THESE SKILLS DURING CP TRAINING. *****RADIOLOGY EDUCATION AT BIDMCTHE RADIOLOGY RESIDENCY PROVIDES FOUR YEARS OF TRAINING IN DIAGNOSTIC IMAGING. APPOINTMENTS ARE HELD JOINTLY AS A RESIDENT AT THE MEDICAL CENTER AND AS A CLINICAL FELLOW AT HARVARD MEDICAL SCHOOL. WITH A CENTRAL ROLE IN CLINICAL SERVICE, TEACHING, AND RESEARCH, THE RADIOLOGY DEPARTMENT PERFORMS OVER 400,000 RADIOLOGIC EXAMINATIONS EACH YEAR. THE DEPARTMENT PROVIDES RADIOGRAPHY, CT, ULTRASOUND, MRI, NUCLEAR MEDICINE, MAMMOGRAPHY, ANGIOGRAPHY, AND INTERVENTIONAL RADIOLOGY SERVICES TO BOTH THE MEDICAL CENTER AS WELL AS OUR AFFILIATED HEALTH CARE FACILITIES. A RADIOLOGY RESEARCH AND ANIMAL LABORATORY IS HOUSED ADJACENT TO THE RADIOLOGY DEPARTMENT. ALL RESIDENTS, FELLOWS, AND FACULTY HAVE APPOINTMENTS AT HARVARD MEDICAL SCHOOL. ALL RADIOLOGIC STUDIES ARE INTERPRETED UNDER THE SUPERVISION OF STAFF RADIOLOGISTS. THE NUCLEAR MEDICINE PROGRAM IS A PART OF THE JOINT PROGRAM IN NUCLEAR MEDICINE AT HARVARD MEDICAL SCHOOL. THE DEPARTMENT PLACES STRONG EMPHASIS ON THE QUALITY OF TEACHING-BOTH IN DIDACTIC LECTURES AND IN INDIVIDUAL CASE-BASED TEACHING.WITH THE ADVENT OF RECENT CHANGES IN RESIDENCY TRAINING, THE CURRICULUM HAS RECENTLY BEEN REVISED SO THAT RESIDENTS UNDERTAKE A COURSE OF STUDY WHICH WILL PERMIT THEM TO OBTAIN EXPERTISE NOT JUST IN CLINICAL SUBSPECIALTIES BUT ALSO IN OTHER KEY AREAS SUCH AS RESEARCH, EDUCATION, GLOBAL HEALTH, QUALITY IMPROVEMENT, AND HEALTH POLICY. RADIOLOGIC PHYSICS HAS BEEN INTEGRATED INTO DAILY DIDACTIC SESSIONS. IN ADDITION, MANY DIDACTIC SESSIONS UTILIZE AUDIENCE RESPONSE TECHNOLOGY, VIDEORECORDING, AND IPAD2 TECHNOLOGY.THERE ARE NINE FORMAL SECTIONS IN THE DEPARTMENT: ABDOMINAL IMAGING, BREAST IMAGING, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY (CVIR), MRI, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, ULTRASOUND, AND THORACIC IMAGING. MOST NON-ANGIOGRAPHIC INTERVENTIONAL PROCEDURES ARE PERFORMED BY THE RESPECTIVE SERVICES. RESIDENTS ROTATING THROUGH THESE SECTIONS ARE PROVIDED WITH READING SUGGESTIONS AND MATERIAL. ACADEMIC ROTATIONS ARE MADE UP OF THIRTEEN 4-WEEK BLOCKS ANNUALLY. AT THE END OF EACH ROTATION RESIDENTS RECEIVE WRITTEN EVALUATIONS AND HAVE THE OPPORTUNITY TO EVALUATE THE STAFF.FIRST YEAR ROTATIONS EMPHASIZE FUNDAMENTALS AND COMMON RADIOLOGIC EXAMINATIONS IN PREPARATION FOR INPATIENT AND EMERGENCY DEPARTMENT RESPONSIBILITIES. PRIOR TO TAKING CALL, ALL FIRST-YEAR RESIDENTS ROTATE THROUGH ABDOMINAL IMAGING, BREAST IMAGING, EMERGENCY RADIOLOGY, FLUOROSCOPY, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, THORACIC IMAGING, AND ULTRASOUND.DURING THE SECOND YEAR, RESIDENTS CONTINUE TO GAIN EXPERIENCE IN THESE SECTIONS, PERFORMING AND INTERPRETING MORE ADVANCED EXAMINATIONS AND INTERVENTIONS AS THEIR LEVELS OF EXPERTISE INCREASE. ADDITIONAL ROTATIONS IN MORE SPECIALIZED TOPICS OCCUR THROUGHOUT THE SECOND THROUGH FOURTH YEARS, INCLUDING INTERVENTIONAL RADIOLOGY, MRI, HEAD AND NECK IMAGING, AND PEDIATRIC RADIOLOGY. IN ADDITION, ALL RESIDENTS PARTICIPATE IN A TWO-WEEK ROTATION IN QUALITY ASSURANCE WHICH PROVIDES THEM WITH ESSENTIAL SKILLS FOR EVENTUAL BOARD RE-CERTIFICATION.ROTATIONS AT OTHER TRAINING LOCATIONS DURING THE SECOND AND THIRD YEARS OF TRAINING INCLUDE: THREE MONTHS OF TRAINING IN PEDIATRIC RADIOLOGY AT THE BOSTON CHILDREN'S HOSPITAL DURING THE SECOND YEAR. FOUR-WEEK PROGRAM IN RADIOLOGIC-PATHOLOGIC CORRELATION AT THE ARMED FORCES INSTITUTE OF PATHOLOGY (AIRP) SPONSORED BY THE AMERICAN COLLEGE OF RADIOLOGY IN SILVER SPRINGS, MARYLAND DURING THE THIRD YEAR. ONE MONTH ROTATION AT THE MASSACHUSETTS EYE AND EAR INFIRMARY IN HEAD-AND-NECK RADIOLOGY DURING THE THIRD YEAR.UPON COMPLETION OF THE SECOND YEAR OF RESIDENCY TRAINING, RESIDENTS SELECT AN AREA OF ACADEMIC FOCUS FOR THEIR FOURTH YEAR WHICH WILL GUIDE CHOICES FOR THE 3-MONTH MINI-FELLOWSHIPS AND THE OTHER TWO MONTHS OF ELECTIVE TIME.OUR UNIQUE EDUCATIONAL TRACKSCURRENTLY, SIX TRACKS ARE OFFERED: CLINICAL EDUCATION RESEARCH GLOBAL HEALTH QUALITY IMPROVEMENT HEALTH POLICY/HEALTH ECONOMICS"

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
EACH OF THESE TRACKS HAS SPECIFIC CURRICULAR OFFERINGS AND EDUCATIONAL GOALS. MOST OF THE TRACKS ARE LINKED TO SPECIFIC EDUCATIONAL ENDEAVORS. FOR EXAMPLE, A RESIDENT SELECTING THE GLOBAL HEALTH TRACK WILL ENROLL IN THE GLOBAL EFFECTIVENESS CURRICULUM OFFERED BY THE HARVARD SCHOOL OF PUBLIC HEALTH AND WILL SPEND TIME ABROAD PROVIDING CLINICAL RADIOLOGY SERVICES AND UNDERTAKING A GLOBAL HEALTH PROJECT. A RESIDENT SELECTING THE EDUCATION TRACK WILL PURSUE ADVANCED TRAINING IN EDUCATIONAL THEORY AND ADULT LEARNING BY PARTICIPATING IN THE HARVARD MACY PROGRAM FOR PHYSICIAN EDUCATORS AND UNDERTAKE AN EDUCATIONAL PROJECT BASED AT BIDMC OR HARVARD MEDICAL SCHOOL. A RESIDENT CHOOSING THE RESEARCH TRACK WILL PARTICIPATE IN GRANT WRITING WORKSHOPS AND DELVE DEEPLY INTO A RESEARCH PROJECT OF THEIR CHOICE.NO MATTER WHICH TRAINING TRACK, THE EXPECTATION IS THAT EVERY RESIDENT WILL HAVE THE OPPORTUNITY TO UNDERTAKE A SUBSTANTIAL PROJECT DURING RESIDENCY THAT WILL CULMINATE IN PRESENTATION AT A NATIONAL MEETING AND/OR PUBLICATION.*****SURGERY EDUCATION AT BIDMCTHE ROBERTA AND STEPHEN R. WEINER DEPARTMENT OF SURGERY OFFERS EDUCATION OPPORTUNITIES FOR RESIDENTS, FELLOWS AND MEDICAL STUDENTS IN CARDIAC SURGERY, GENERAL SURGERY, NEUROSURGERY, PLASTIC AND RECONSTRUCTIVE SURGERY, PODIATRY, TRAUMA SURGERY, MINIMALLY INVASIVE SURGERY, UROLOGY, AND VASCULAR SURGERY. STUDENTS LEARN THE MOST ADVANCED TECHNIQUES IN A STATE-OF-THE-FACILITY. STUDENTS ALSO HAVE THE OPPORTUNITY TO LEARN MINIMALLY INVASIVE TECHNIQUES AT THE CARL J. SHAPIRO SIMULATION AND SKILLS CENTER, THE FIRST OF ITS KIND TO BE ACCREDITED IN THE COUNTRY AND LOCATED WITHIN THE MEDICAL CENTER.THE MEDICAL CENTER'S DEPARTMENT OF SURGERY IS ONE OF THREE MAJOR TEACHING AND RESEARCH UNITS OF HARVARD MEDICAL SCHOOL'S DEPARTMENT OF SURGERY. AT ALL LEVELS, THE HOUSE STAFF GAIN TRAINING AND PRACTICAL EXPERIENCE IN THE PREOPERATIVE, OPERATIVE, AND POST-OPERATIVE CARE OF PATIENTS. THE PROGRAM EMPHASIZES RESIDENT-FACULTY INTERACTION FOR EDUCATIONAL PURPOSES. TEACHING CONFERENCES AND SEMINARS FOR THE HOUSE STAFF CAPITALIZE ON WORKING RELATIONSHIPS DEVELOPED WITH THE ATTENDING STAFF. UPON COMPLETION OF FIVE YEARS OF SURGICAL TRAINING, RESIDENTS ARE ELIGIBLE FOR THE AMERICAN BOARD OF SURGERY EXAMINATION. DIDACTIC TEACHINGTHE PROGRAM HAS DEDICATED EDUCATION TIME, INCLUDING A STRONG DIDACTIC CONFERENCE SCHEDULE, TO PROVIDE A BASIC FOUNDATION OF SURGICAL KNOWLEDGE AND SKILLS. REQUIRED WEEKLY CONFERENCES INCLUDE: RESIDENT CURRICULUM CONFERENCE / MIS SKILLS LAB SURGICAL SERVICE MORBIDITY/MORTALITY & SURGICAL GRAND ROUNDS COMBINED GI CONFERENCETHROUGHOUT TRAINING, A PRIMARY RESPONSIBILITY OF SENIOR RESIDENTS IS TEACHING MORE JUNIOR RESIDENTS AND THE STUDENTS ON THEIR SERVICE. THEY ARE ALSO RESPONSIBLE FOR THE ASSIGNMENT OF CASES, CLINICAL SUPERVISION OF MEDICAL STUDENTS AND RESIDENTS, AND PREPARING MATERIAL FOR SERVICE AND TEACHING CONFERENCES.ADDITIONAL INFORMATION REGARDING PROMOTING THE HEALTH OF THE COMMUNITY (SCHEDULE H, PART VI, QUESTIONS 5 AND 6)OPEN STAFF THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF AND AS NOTED IN THIS FORM 990 PARTS I AND VI, THE MAJORITY OF BOARD MEMBERS ARE INDEPENDENT COMMUNITY MEMBERS. AFFILIATED HEALTH CARE SYSTEMAS NOTED BELOW AND THROUGHOUT THIS FILING, ANNA JAQUES HOSPITAL IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH (BILH) NETWORK OF AFFILIATES. AS NOTED IN VARIOUS NARRATIVE DISCLOSURES THAT SUPPORT THIS FORM 990 AND RELATED SCHEDULES FOR THE PERIOD COVERED BY THIS FILING, BILH IS A MASSACHUSETTS NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. BETH ISRAEL LAHEY HEALTH'S (BILH) MISSION IS TO SUPPORT ITS AFFILIATES AND THOSE AFFILIATES' MISSIONS TO IMPROVE THE HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITIES SERVED. BILH STRIVES TO ACCOMPLISH THIS MISSION BY PROVIDING SERVICES TO ITS AFFILIATES WHICH SUPPORT THE DELIVERING THE HIGH-QUALITY HEALTH CARE THAT EVERY PATIENT DESERVES. BILH BELIEVES THAT EFFECTIVE CARE IS EASILY ACCESSIBLE AND SIMPLE TO ACCESS SO IT IS BILH'S FOCUS TO PROVIDE PATIENTS WITH CARE THAT IS IN CLOSE PROXIMITY AND CONVENIENT REGARDLESS OF WHERE PATIENTS LIVE, THEIR HEALTH HISTORY OR STAGE OF LIFE.BETH ISRAEL LAHEY HEALTH (BILH) IS THE PARENT AND A SUPPORT ORGANIZATION OF THE BILH NETWORK OF AFFILIATES. THE NETWORK COMPRISES AN INTEGRATED HEALTH CARE DELIVERY SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM INCLUDES ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS AND ADDICTION TREATMENT PROGRAMS. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES.DURING THE FISCAL PERIOD COVERED BY THIS FILING, BILH SERVED AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL -- MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL -- NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL -- PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES (LHSS), LAHEY CLINIC FOUNDATION (LCF), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC) WHICH INCLUDES BEVERLY, ADDISON GILBERT AND BAYRIDGE HOSPITALS, NORTHEAST BEHAVIORAL CORPORATION (NBHC), ANNA JAQUES HOSPITAL (AJH), THE BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK (BILHPN), JOSLIN DIABETES CENTER AND THE BETH ISRAEL LAHEY HEALTH PHARMACY. THE LAHEY CLINIC FOUNDATION IN TURN SERVED AS THE SOLE MEMBER OF LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL & MEDICAL CENTER (LHMC). THE ENTITIES LISTED HERE MAY HAVE ALSO, IN TURN, SERVED AS MEMBER TO OTHER NETWORK AFFILIATES. AS A SUPPORT ORGANIZATION OF THESE ENTITIES, BILH PROVIDES CENTRALIZED SERVICES AND SUPPORT TO ITS AFFILIATES IN AREAS SUCH AS MANAGEMENT, STRATEGIC PLANNING, HUMAN RESOURCES AND BENEFITS, DEVELOPMENT AND FUNDRAISING, LEGAL SERVICES, FINANCE, TREASURY, INVESTMENT, INSURANCE, COMPLIANCE AND TAXATION AS WELL AS PATIENT CARE CONTRACTING AND OTHER SERVICES.BILH'S SUPPORT OF ITS AFFILIATES ENABLES THE NETWORK AS A WHOLE TO ACCOMPLISH ITS PRIMARY MISSION OF IMPROVING THE HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITIES SERVED. BILH STRIVES TO ACCOMPLISH THIS MISSION BY DELIVERING THE HIGH-QUALITY HEALTH CARE THAT EVERY PATIENT DESERVES. BILH BELIEVES THAT EFFECTIVE CARE IS EASILY ACCESSIBLE AND SIMPLE TO USE SO IT IS BILH'S FOCUS TO PROVIDE PATIENTS WITH CARE THAT IS IN CLOSE PROXIMITY AND CONVENIENT REGARDLESS OF WHERE PATIENTS LIVE, THEIR HEALTH HISTORY OR STAGE OF LIFE AND BILH IS ACCOMPLISHING THIS GOAL BY PROVIDING SUPPORT TO EACH OF ITS AFFILIATES, PROVIDING AN ORGANIZATIONAL STRUCTURE AND OPERATING MODEL WHICH IS DRIVEN BY FOUR DEEPLY INTERCONNECTED DOMAINS DESIGNED TO ADVANCE MEANINGFUL PARTNERSHIPS ACROSS ORGANIZATIONS, CARE SETTINGS, SPECIALTIES, AND GEOGRAPHIES TO ENSURE BILH PATIENTS RECEIVE THE CARE THEY NEED IN THE COMMUNITIES WHERE THEY LIVE AND WORK.BILH IS DELIVERING ON THE PROMISE TO BILH PATIENTS AND COMMUNITIES TO EXPAND ACCESS AND PROVIDE EXTRAORDINARY CARE, WHILE ALSO ADVANCING MEDICINE THROUGH DISCOVERY AND EDUCATION. BILH IS ACCOMPLISHING THIS MISSION BY PROVIDING SUPPORT TO ITS AFFILIATES WHICH INCLUDE:1. A PHYSICIAN ENTERPRISE THAT ENCOMPASSES THE SYSTEM'S NETWORK OF EMPLOYED PRIMARY CARE AND SPECIALTY PHYSICIANS LOCATED THROUGHOUT OUR REGION.2. A HOSPITAL AND AMBULATORY SERVICES GROUP THAT INCLUDES WORLD-CLASS ACADEMIC MEDICAL CENTERS AND TEACHING HOSPITALS WITH AFFILIATIONS WITH HARVARD MEDICAL SCHOOL AND TUFTS UNIVERSITY SCHOOL OF MEDICINE; LEADING COMMUNITY HOSPITALS; A RENOWNED ORTHOPEDICS HOSPITAL; AND COMPREHENSIVE AMBULATORY CENTERS.3. A POPULATION HEALTH ENTERPRISE THAT EMBRACES A NEW MODEL OF CARE TO IMPROVE THE HEALTH OF ALL THOSE SERVED BY BILH; THE POPULATION HEALTH DOMAIN INCLUDES THE SYSTEM'S CLINICALLY INTEGRATED NETWORK OF AFFILIATED PROVIDERS AND VITAL SERVICES, INCLUDING BEHAVIORAL HEALTH AND HOME CARE SERVICES.4. A ROBUST NETWORK OF ADMINISTRATIVE AND OPERATIONAL SERVICES TO ADVANCE STRATEGIC GOALS, BOTH LOCALLY AND AT THE SYSTEM LEVEL, THAT OFFERS EXPERTISE AND STANDARDIZED RESOURCES BASED ON BEST PRACTICES.

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
"BILH NETWORK ACCOMPLISHMENTS AND ACTIVITIES FISCAL YEAR ENDED SEPTEMBER 30, 2022SINCE COMING TOGETHER AS A HEALTH SYSTEM, BETH ISRAEL LAHEY HEALTH (""BILH"") HAS CONTINUED TO MAKE SIGNIFICANT INVESTMENTS AND UNDERTAKE INITIATIVES TO IMPROVE ACCESS FOR PATIENTS AND SUPPORT ITS SURROUNDING COMMUNITIES. IN FY 2022 ALONE, BILH INVESTED OVER $8 MILLION IN ITS COMMUNITY HEALTH CENTER PARTNERS AND SAFETY NET AFFILIATES, DEVELOPED ACCESSIBLE PATIENT MESSAGING AND EDUCATION, AND INVESTED OVER $5 MILLION IN SEVERAL BEHAVIORAL HEALTH-FOCUSED INITIATIVES. BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK (""BILHPN"") CONTINUES TO OPTIMIZE ITS POPULATION HEALTH-FOCUSED INITIATIVES, INCLUDING THOSE FOCUSED ON ADDRESSING HEALTH DISPARITIES. HIGHLIGHTS OF THE SYSTEM'S EFFORTS INCLUDE: ENHANCED ACCESS FOR MASSHEALTH PATIENTS TO MITIGATE BARRIERS IN ACCESS TO CARE AND INCREASE THE NUMBER OF MASSHEALTH PATIENTS THAT BILH SERVES, THE SYSTEM COMMITTED TO UNIVERSAL NETWORK-WIDE PROVIDER PARTICIPATION IN MASSHEALTH. SPECIFICALLY, AS OF OCTOBER 2020, ALL BILH HOSPITALS AND PROVIDERS EMPLOYED BY BILH OR ON WHOSE BEHALF BILH JOINTLY CONTRACTS HAVE APPLIED TO PARTICIPATE IN SOME FORM OF MASSHEALTH. IN FY 2022, BILH SIGNED A NEW MASSHEALTH ACO CONTRACT WITH BMC HEALTHNET PLAN / WELLSENSE HEALTH PLAN THAT WILL GO INTO EFFECT IN APRIL 2023. AS PART OF THIS CONTRACT, BILHPN WILL EXTEND PARTICIPATION TO ALL ELIGIBLE PRIMARY CARE PROVIDERS (""PCPS"") WHO WERE NOT OTHERWISE PARTICIPATING IN A MASSHEALTH ACO. WHILE ALL ELIGIBLE BILHPN PCPS WERE PARTICIPANTS IN A FORM OF MASSHEALTH, SOME PCPS HAVE PREVIOUSLY NOT PARTICIPATED IN A MASSHEALTH ACO. DURING FY 2022, BILH DEVELOPED AND REFINED A MULTICULTURAL MARKETING, ADVERTISING, AND OUTREACH PLAN WITH THE PURPOSE OF EXPANDING ACCESS FOR UNDERSERVED POPULATIONS, INCLUDING MASSHEALTH PATIENTS, IN TARGETED BILH SERVICE AREAS. IMPLEMENTATION OF THAT PLAN WILL OCCUR IN FY 2023. INVESTMENTS IN UNDERSERVED COMMUNITIES BILH HOSPITALS HAVE CREATED STRONG CONNECTIONS TO A NETWORK OF AFFILIATED HOSPITALS AND HEALTH CENTERS THAT PROVIDE COMMUNITY-BASED CARE TO HISTORICALLY UNDERSERVED POPULATIONS. IN THE REGIONS THAT THEY SERVE, THE SAFETY NET AFFILIATES (""SNAS"") AND COMMUNITY CARE ALLIANCE (""CCA"") COMMUNITY HEALTH CENTERS (""CHCS"") ARE THE CORNERSTONE OF BILH'S DELIVERY SYSTEM REGARDING COMMUNITY-BASED CARE FOR MASSHEALTH AND HISTORICALLY UNDERSERVED PATIENTS.O CCA CHCS INCLUDE BOWDOIN STREET HEALTH CENTER, CHARLES RIVER COMMUNITY HEALTH, THE DIMOCK CENTER, FENWAY HEALTH, AND SOUTH COVE COMMUNITY HEALTH CENTER. O SNAS INCLUDE CAMBRIDGE HEALTH ALLIANCE AND SIGNATURE HEALTHCARE BROCKTON HOSPITAL. BILH CONTINUES TO INVEST IN THE CCA CHCS AND SNAS, ENABLING THEM TO EXPAND THEIR CAPABILITIES AND CARE FOR MORE HISTORICALLY UNDERSERVED PATIENTS. IN FY 2022, BILH INVESTED OVER $8 MILLION IN ITS CHCS AND SNAS, IN ADDITION TO ENGAGING IN REGIONAL PLANNING AND COLLABORATIVE PROGRAM DEVELOPMENT. THESE INVESTMENTS REPRESENT ONLY A PORTION OF A MUCH LARGER COMMUNITY BENEFITS INVESTMENT PORTFOLIO THAT IS DESCRIBED IN GREATER DETAIL IN THIS AND OTHER BILH NETWORK TAX FILINGS. BILH IS EXPLORING OPPORTUNITIES WITH CHCS IN ESSEX AND MIDDLESEX COUNTIES. FOR EXAMPLE, BILH HAS ESTABLISHED A TELEHEALTH PILOT PROGRAM BETWEEN PHYSICIANS AT ADDISON GILBERT AND BEVERLY HOSPITALS AND PATIENTS AT NORTH SHORE COMMUNITY HEALTH CENTER. COMMITMENT TO BEHAVIORAL HEALTH CARE BETH ISRAEL LAHEY HEALTH BEHAVIORAL SERVICES IS THE LARGEST MENTAL HEALTH AND SUBSTANCE USE DISORDER NETWORK IN EASTERN MASSACHUSETTS. WITH A FOCUS ON COMMUNITY HEALTH, BILH BEHAVIORAL SERVICES SUPPORTS THE NEEDS OF CHILDREN, TEENS, AND ADULTS THROUGH A RANGE OF OPTIONS, FROM INPATIENT CARE TO COMMUNITY-BASED PROGRAMS. IN FY 2022, BILH INVESTED OVER $5 MILLION IN THE FOLLOWING BEHAVIORAL HEALTH INITIATIVES: THE COLLABORATIVE CARE MODEL, CENTRALIZED BED MANAGEMENT PROGRAM, AND MEDICATION ASSISTED THERAPY (""MAT"") AS OF SEPTEMBER 30, 2022, 60 OF 78 EMPLOYED PRIMARY CARE PRACTICES2 ARE PARTICIPATING IN THE IMPACT MODEL, WITH 12 NEW SITES ADDED FROM THE PREVIOUS YEAR. THE IMPACT MODEL (ALSO REFERRED TO AS THE ""COLLABORATIVE CARE"" MODEL) IS A BEHAVIORAL HEALTH INTEGRATION MODEL, WHICH INVOLVES INTRODUCING PRIMARY CARE PATIENTS WHO ARE IDENTIFIED THROUGH SCREENINGS AND DIRECT REFERRALS TO AN EMBEDDED BEHAVIORAL HEALTH CLINICIAN. BILH HAS CONTINUED TO EXPAND ITS BRIDGE CLINICS AT ADDISON GILBERT AND BEVERLY HOSPITALS, INCREASING SAME-DAY ADMISSION FOR MAT PATIENTS FROM 24 TO 40 HOURS PER WEEK, OBTAINING ADDITIONAL STAFF, AND EXPANDING ITS INDUCTION PROGRAM. BILH HAS EXPANDED ITS SYSTEM-WIDE SUBSTANCE USE DISORDER TASKFORCE, DEFINING NEW PATHWAYS FOR CONNECTING BILH PRIMARY CARE TEAMS WITH COMMUNITY ACUTE DETOX AND OTHER ADDICTION-BASED SERVICES, INCREASING THE CAPACITY OF BILH PCPS TO PRESCRIBE MEDICATIONS IN SUPPORT OF OFFICE-BASED ADDICTION TREATMENT, AND PROVIDING EDUCATIONAL TRAININGS TO PCPS TO SCREEN AND TREAT SUBSTANCE USE DISORDERS. THE PRACTICE OF MAT INDUCTION AND REFERRAL IN THE ED AT BID-PLYMOUTH CONTINUED IN FY 2022, WITH RECOVERY NAVIGATORS, AN ADDICTION LPN NURSE, AND A PSYCHIATRIC NP AS AVAILABLE RESOURCES TO PATIENTS. BID-PLYMOUTH ALSO CONTINUED ITS PARTNERSHIP WITH AREA COALITIONS TO HAND OUT SUPPLIES AND RESOURCES, INCLUDING NARCAN, TO THOSE PATIENTS WHO ARE RESIDENTS OF THE AREA AND WHO PRESENT TO THE BID-PLYMOUTH EMERGENCY ROOM WITH AN OPIOID OVERDOSE. ADDITIONAL INFORMATION ON BEHAVIORAL HEALTH IS BELOW.POPULATION HEALTH INITIATIVES BILHPN SUPPORTS AND IMPROVES ACCESS, QUALITY AND EFFICIENCY OF PATIENT-CENTERED CARE BY LEVERAGING BEST PRACTICES IN CLINICAL EXCELLENCE AND DATA ANALYTICS TO HELP PROVIDERS IMPROVE PATIENT HEALTH OUTCOMES. FOR EXAMPLE, BILHPN'S CARE MANAGEMENT TEAM WORKS WITH THE HIGHEST-RISK PATIENTS IN AN EFFORT TO EDUCATE THEM ON THEIR DISEASE, IMPROVE MEDICATION COMPLIANCE, AND HELP THEM NAVIGATE THE COMPLEXITIES OF THE HEALTHCARE SYSTEM. THE GOAL OF BILHPN'S CARE MANAGERS IS TO IMPROVE OUTCOMES FOR PATIENTS WHILE AVOIDING UNNECESSARY EMERGENCY ROOM VISITS OR HOSPITAL STAYS. DURING FY 2022, BILH UNDERTOOK SEVERAL INITIATIVES TO IMPROVE POPULATION HEALTH AND PATIENT CARE, INCLUDING: O BILHPN'S QUALITY TEAM DEVELOPED AND IMPLEMENTED EIGHT TEXT-BASED OUTREACH CAMPAIGNS FOR PATIENTS, ADDRESSING CANCER SCREENINGS, IMMUNIZATIONS, AND DIABETES CARE TO IMPROVE POPULATION HEALTH METRICS.O BILHPN CONTINUED TO OPTIMIZE ITS ENTERPRISE-WIDE POPULATION HEALTH DATA WAREHOUSE TO IDENTIFY PATIENTS WITH CARE GAPS. THROUGH COLLABORATION WITH BILH PHYSICIAN LEADERS, BILHPN MODIFIED PRACTICE WORKFLOWS AND CREATED OUTREACH PROGRAMS TO CLOSE IDENTIFIED GAPS. THESE EFFORTS RESULTED IN BILH REACHING MORE PATIENTS.O DURING FY 2022, BILHPN AND THE BILH OFFICE FOR DIVERSITY, EQUITY AND INCLUSION CO-LED EFFORTS TO INCREASE ACCESS AND IMPROVE OUTCOMES FOR UNDERSERVED POPULATIONS, WITH A FOCUS ON CLOSING DISPARITIES IN DIABETES CARE FOR BLACK AND HISPANIC PATIENTS. ONE AREA OF COLLABORATION CENTERED AROUND A $1.8 MILLION GRANT FROM THE INSTITUTE OF HEALTHCARE IMPROVEMENT / BLUE CROSS BLUE SHIELD OF MASSACHUSETTS THAT ALLOWED THE SYSTEM TO HIRE AND EMBED PATIENT NAVIGATORS WITHIN ITS MOST DIVERSE PRACTICES TO ASSIST PATIENTS ALONG THE CONTINUUM OF CARE. BILH BEHAVIORAL HEALTH SERVICESTHE BETH ISRAEL LAHEY HEALTH NETWORK (BILH) IS COMMITTED TO THE BEHAVIORAL HEALTH NEEDS OF THE PATIENTS AND COMMUNITIES SERVICED. BELOW ARE SOME OF ACTIVITIES THAT BILH BEHAVIORAL SERVICES (BILHBS) HAS PROVIDED TO THE PATIENTS AND COMMUNITIES SERVED BY BILH AND ITS AFFILIATED ENTITIES. BILHBS (WHICH INCLUDES THE ACTIVITIES OF BILH'S TAX-EXEMPT AFFILIATE NORTHEAST BEHAVIORAL HEALTH CORP) IS THE LARGEST NETWORK OF MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES IN EASTERN MASSACHUSETTS. BILHBS' NETWORK OF BEHAVIORAL HEALTH CARE INCLUDES SERVICES FOR CHILDREN AND ADULTS RANGING FROM INPATIENT TREATMENT TO COMMUNITY-BASED PROGRAMS. SERVICES INCLUDE: INPATIENT PSYCHIATRIC AND DETOXIFICATION TREATMENT; EMERGENCY PSYCHIATRIC AND MOBILE EMERGENCY SERVICES TEAMS; OUTPATIENT MENTAL HEALTH AND ADDICTION TREATMENT; INDIVIDUAL/COUPLE/FAMILY THERAPY; MEDICATION ASSISTED TREATMENT PROGRAMS; AND SCHOOL-BASED AND HOME-BASED COUNSELING FOR YOUTH AND THEIR FAMILIES.AS NOTED PREVIOUSLY, SINCE ITS CREATION IN MARCH 2019, BILH HAS CONTINUED TO INVEST SIGNIFICANTLY IN IMPROVING ACCESS TO BEHAVIORAL HEALTH CARE THROUGH A SYSTEM-WIDE APPROACH TO CARE DELIVERY. AS ONE OF SEVERAL ONGOING INITIATIVES, BILH HAS MADE A MULTI-YEAR COMMITMENT TO PROVIDE BEHAVIORAL HEALTH SUPPORT TO ITS EMPLOYED PRIMARY CARE PRACTICES USING AN EVIDENCE-BASED APPROACH KNOWN AS THE IMPACT MODEL. BY THE END OF FY 2022, BILH HAD IMPLEMENTED THE IMPACT MODEL IN 74.36% OF ITS EMPLOYED PRIMARY CARE PRACTICES AS PART OF ITS COLLABORATIVE CARE PROGRAM IMPLEMENTATION."

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
"IN MARCH 2021, BILHBS LAUNCHED ITS CENTRALIZED BED FINDING TEAM. THIS TEAM IS PART OF A BILHBS CENTRAL CALL CENTER, WHICH CENTRALIZES CALLS TO BILHBS' THREE EMERGENCY SERVICE PROGRAM (ESP) CATCHMENT AREAS REDUCING REDUNDANCIES ACROSS THE AGENCY AND STREAMLINING ALL CALLS TO ONE CENTRAL SERVICE. THIS CENTRALIZED BED FINDING TEAM IS RESPONSIBLE FOR CONDUCTING BED SEARCHES FOR PATIENTS SEEN THROUGH THE ESP AND WHO ARE AWAITING AN INPATIENT PSYCHIATRIC PLACEMENT. THIS TEAM DIRECTLY INCREASES THE AVAILABILITY OF CLINICIANS TO CONTINUE TO SEE PATIENTS IN THE EMERGENCY DEPARTMENT (ED) AND THE COMMUNITY WHO ARE EXPERIENCING A BEHAVIORAL HEALTH AND/OR CO-OCCURRING SUBSTANCE USE DISORDER CRISIS WHILE OTHER TEAM MEMBERS SEARCH FOR AVAILABLE INPATIENT PLACEMENTS. THIS INITIATIVE SUPPORTS DECREASED RESPONSE TIME TO RESPONDING TO NEW PATIENTS IN CRISIS AND REDUCES ED BOARDING TIME FOR PATIENTS WHO CAN BE SAFELY MANAGED IN THE COMMUNITY.IN FY2022, THE STATE OF MASSACHUSETTS SET FORTH THE MASSACHUSETTS BEHAVIORAL HEALTH ROADMAP TO INCLUDE FOUR PRIMARY OUTCOMES IN EFFORTS TO ADVANCE HEALTH EQUITY: (1) THE DEVELOPMENT OF COMMUNITY BEHAVIORAL HEALTH CENTERS (CBHCS); (2) SHIFTING BEHAVIORAL HEALTH EMERGENCY SERVICES TO THE COMMUNITY FROM THE EMERGENCY DEPARTMENTS; (3) TREATMENT ON DEMAND (OUTPATIENT EVALUATION AND TREATMENT); AND (4) BEHAVIORAL HEALTH HELP LINE. IN RESPONSE TO THIS MOVEMENT, BILHBS RECEIVED AN AWARD TO OPERATE A CBHC IN THE LAWRENCE LOCATION AND BEGAN THE PLANNING TO PIVOT EMERGENCY SERVICES TEAMS TO SERVE THE BILH SYSTEM EMERGENCY DEPARTMENTS. BILHBS SERVES APPROXIMATELY 35,000 UNDUPLICATED INDIVIDUALS ANNUALLY, OFFERING A FULL CONTINUUM OF CARE FOR CHILDREN AND ADULTS. SERVICES RANGE FROM INPATIENT TO HOME AND COMMUNITY-BASED SERVICES. BILHBS OPERATES OVER 250 BEDS IN 9 FACILITIES FOR CLIENTS REQUIRING ACUTE PSYCHIATRIC CARE, DETOXIFICATION AND RESIDENTIAL STEP-DOWN SERVICES. DURING THE PERIOD COVERED BY THIS FILING, COMMUNITY-BASED SERVICES INCLUDED MOBILE EMERGENCY SERVICES TEAMS IN THREE CATCHMENT AREAS AND HOME-BASED COUNSELING FOR ADULTS, YOUTH AND THEIR FAMILIES. BILHBS ALSO PROVIDED SERVICES IN 63 MIDDLE AND HIGH SCHOOLS, AS WELL AS 9 POLICE DEPARTMENTS. IN ADDITION, BILH'S COMMUNITY CRISIS STABILIZATION (""CCS"") UNITS IN LAWRENCE AND SALEM, WHICH TYPICALLY CARE FOR PATIENTS WITH MENTAL HEALTH ISSUES, INCREASED THEIR ABILITY TO TREAT PERSONS WITH CO-OCCURRING SUBSTANCE USE DISORDERS. THE CCS UNITS CONTINUE TO BE ABLE TO INDUCT PATIENTS WITH OPIOID USE DISORDER (OUD) ON BUPRENORPHINE AND ARE ALSO ABLE TO MAINTAIN PATIENTS WHO ARE ALREADY ON ANY OF THE THREE FDA APPROVED MEDICATIONS FOR THE TREATMENT OF OUD. THESE UNITS ARE SEEING AN INCREASE IN THE NUMBER OF PATIENTS WITH METHAMPHETAMINE DISORDERS AND HAVE DEVELOPED A PROTOCOL TO MANAGE WITHDRAWAL SYMPTOMS IN THIS POPULATION."

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSREVIEWING RESULTS AND COMPILING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY DOCUMENTSAS NOTED ABOVE, THE CHNA PROCESS WAS DIVIDED INTO THREE PHASES. THE FINAL PHASE, PHASE III, INCLUDED THE FOLLOWING STEPS: REVIEW OF THE ASSESSMENT'S MAJOR FINDINGS WITH THE ANNA JAQUES HOSPITAL COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) AND HELD A VIRTUAL COMMUNITY FORUM PRESENTING RESULTS. IDENTIFY ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS PRIORITY COHORTS, GEOGRAPHIC FOCUS, AND COMMUNITY HEALTH PRIORITIES. ANALYZE ANNA JAQUES HOSPITAL'S EXISTING COMMUNITY BENEFITS ACTIVITIES WHICH WERE INFORMED BY THE 2019 CHNA AND SUBSEQUENT 2020 2022 IMPLEMENTATION STRATEGY THAT WERE COMPLETED BY ANNA JAQUES HOSPITAL DURING THE FISCAL PERIOD ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018). DETERMINE IF THE RANGE OF COMMUNITY BENEFITS ACTIVITIES ESTABLISHED DURING THE PREVIOUS CHNA AND IMPLEMENTATION STRATEGY PROCESS NEEDED TO BE AUGMENTED OR CHANGED TO RESPOND TO THE ASSESSMENT COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021).2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY FINDINGSTHE KEY PRIORITY COHORTS IDENTIFIED THROUGH THE CHNA CONDUCTED DURING THE PERIOD ENDED SEPTEMBER 30, 2022, WERE: YOUTH LOW-RESOURCED POPULATIONS OLDER ADULTS RACIALLY, ETHNICALLY, AND LINGUISTICALLY DIVERSE POPULATIONS INDIVIDUALS WITH DISABILITIESANNA JAQUES HOSPITAL'S CHNA RESULTED IN KEY FINDINGS IN THE FOLLOWING AREAS: EQUITABLE ACCESS TO CARE: INDIVIDUALS IDENTIFIED A NUMBER OF BARRIERS TO ACCESSING AND NAVIGATING THE HEALTH CARE SYSTEM. MANY OF THESE BARRIERS WERE AT THE SYSTEM LEVEL, MEANING THAT THE ISSUES STEM FROM THE WAY IN WHICH THE SYSTEM DOES OR DOES NOT FUNCTION. SYSTEM LEVEL ISSUES INCLUDED PROVIDERS NOT ACCEPTING NEW PATIENTS, LONG WAIT LISTS, AND AN INHERENTLY COMPLICATED HEALTHCARE SYSTEM THAT IS DIFFICULT FOR MANY TO NAVIGATE. THERE WERE ALSO INDIVIDUAL LEVEL BARRIERS TO ACCESS AND NAVIGATION. INDIVIDUALS MAY BE UNINSURED OR UNDERINSURED, WHICH MAY LEAD THEM TO FOREGO OR DELAY CARE. INDIVIDUALS MAY ALSO EXPERIENCE LANGUAGE OR CULTURAL BARRIERS - RESEARCH SHOWS THAT THESE BARRIERS CONTRIBUTE TO HEALTH DISPARITIES, MISTRUST BETWEEN PROVIDERS AND PATIENTS, INEFFECTIVE COMMUNICATION, AND ISSUES OF PATIENT SAFETY. SOCIAL DETERMINANTS OF HEALTH (E.G., ECONOMIC STABILITY, EDUCATION, AND COMMUNITY/SOCIAL CONTEXT) CONTINUE TO HAVE A MASSIVE IMPACT ON MANY SEGMENTS OF THE POPULATION. THE SOCIAL DETERMINANTS OF HEALTH ARE THE CONDITIONS IN THE ENVIRONMENTS WHERE PEOPLE ARE BORN, LIVE, LEARN, WORK, PLAY, WORSHIP, AND AGE THAT AFFECT A WIDE RANGE OF HEALTH, FUNCTIONING, AND QUALITY-OF-LIFE OUTCOMES AND RISKS. THESE CONDITIONS INFLUENCE AND DEFINE QUALITY OF LIFE FOR MANY SEGMENTS OF THE POPULATION IN THE CBSA. RESEARCH SHOWS THAT SUSTAINED SUCCESS IN COMMUNITY HEALTH IMPROVEMENT AND ADDRESSING HEALTH DISPARITIES RELIES ON ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH THAT LEAD TO POOR HEALTH OUTCOMES AND DRIVE HEALTH INEQUITIES. THE ASSESSMENT GATHERED A RANGE OF INFORMATION RELATED TO ECONOMIC INSECURITY, EDUCATION, FOOD INSECURITY, ACCESS TO CARE/NAVIGATION ISSUES, AND OTHER IMPORTANT SOCIAL FACTORS. THERE IS LIMITED QUANTITATIVE DATA IN THE AREA OF SOCIAL DETERMINANTS OF HEALTH. DESPITE THIS, INFORMATION GATHERED THROUGH INTERVIEWS, FOCUS GROUPS, SURVEY, AND LISTENING SESSIONS SUGGESTED THAT THESE ISSUES HAVE THE GREATEST IMPACT ON HEALTH STATUS AND ACCESS TO CARE IN THE REGION - ESPECIALLY ISSUES RELATED TO HOUSING, FOOD SECURITY/NUTRITION, AND ECONOMIC STABILITY. HIGH RATES OF SUBSTANCE USE (E.G., ALCOHOL, PRESCRIPTION DRUG/OPIOIDS, MARIJUANA) AND MENTAL HEALTH ISSUES (E.G., DEPRESSION, ANXIETY, AND STRESS). ANXIETY, CHRONIC STRESS, DEPRESSION, AND SOCIAL ISOLATION WERE LEADING COMMUNITY HEALTH CONCERNS. THE ASSESSMENT IDENTIFIED SPECIFIC CONCERNS ABOUT THE IMPACT OF MENTAL HEALTH ISSUES FOR YOUTH AND YOUNG ADULTS, THE MENTAL HEALTH IMPACTS OF RACISM, DISCRIMINATION, AND TRAUMA, AND SOCIAL ISOLATION AMONG OLDER ADULTS. THESE DIFFICULTIES WERE EXACERBATED BY COVID-19. IN ADDITION TO THE OVERALL BURDEN AND PREVALENCE OF MENTAL HEALTH ISSUES, RESIDENTS IDENTIFIED A NEED FOR MORE PROVIDERS AND TREATMENT OPTIONS, ESPECIALLY INPATIENT AND OUTPATIENT TREATMENT, CHILD PSYCHIATRISTS, PEER SUPPORT GROUPS, AND MENTAL HEALTH SERVICES. SUBSTANCE USE CONTINUED TO HAVE A MAJOR IMPACT ON THE CBSA; THE OPIOID EPIDEMIC CONTINUED TO BE AN AREA OF FOCUS AND CONCERN, AND THERE WAS RECOGNITION OF THE LINKS AND IMPACTS ON OTHER COMMUNITY HEALTH PRIORITIES, INCLUDING MENTAL HEALTH, HOUSING, AND HOMELESSNESS. INDIVIDUALS ENGAGED IN THE ASSESSMENT IDENTIFIED STIGMA AS A BARRIER TO TREATMENT AND REPORTED A NEED FOR PROGRAMS THAT ADDRESS COMMON CO-OCCURRING ISSUES (E.G., MENTAL HEALTH ISSUES, HOMELESSNESS). HIGH RATES OF CHRONIC AND ACUTE PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). CHRONIC CONDITIONS SUCH AS CANCER, DIABETES, CHRONIC LOWER RESPIRATORY DISEASE, STROKE, AND CARDIOVASCULAR DISEASE CONTRIBUTE TO 56% OF ALL MORTALITY IN THE COMMONWEALTH AND OVER 53% OF ALL HEALTH CARE EXPENDITURES ($30.9 BILLION A YEAR). PERHAPS MOST SIGNIFICANTLY, CHRONIC DISEASES ARE LARGELY PREVENTABLE DESPITE THEIR HIGH PREVALENCE AND DRAMATIC IMPACT ON INDIVIDUALS AND SOCIETY.THE CHNA THAT WAS COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, AND THE ASSOCIATED IMPLEMENTATION STRATEGY ADOPTED FROM THIS PROCESS WERE DESIGNED TO INFORM ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS INITIATIVES DURING THE FISCAL YEARS ENDED SEPTEMBER 30, 2023; SEPTEMBER 30, 2024; AND SEPTEMBER 30, 2025. PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFITS ACTIVITIES REPORTED IN THIS FORM 990 SCHEDULE HAS NOTED THROUGHOUT THIS FORM 990 SCHEDULE H, ANNA JAQUES HOSPITAL MOST RECENTLY COMPLETED CHNA WAS COMPLETED DURING THE FISCAL YEAR ENDED 2022 AND THE FIRST YEAR OF ACCOMPLISHMENTS UNDER THAT CHNA AND IMPLEMENTATION STRATEGY (IS) WILL BE REPORTED IN THE FORM 990 FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2023. THE PRIOR CHNA AND CHIP PROCESS WHICH WAS COMPLETED BY ANNA JAQUES HOSPITAL IN 2019 INFORMED THE COMMUNITY BENEFITS OPERATIONS AND ACCOMPLISHMENTS REPORTED IN THIS FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, AS DESCRIBED IN DETAIL BELOW. 2019 COMMUNITY HEALTH NEEDS ASSESSMENTTARGETED GEOGRAPHY AND POPULATIONANNA JAQUES HOSPITAL COMPLETED ITS 2019 ASSESSMENT IN SEPTEMBER 2019. THE GEOGRAPHICAL FOCUS OF ANNA JAQUES HOSPITAL'S 2019 CHNA ENCOMPASSES HAVERHILL, NEWBURYPORT, AMESBURY, SALISBURY, GEORGETOWN, NEWBURY, MERRIMAC, GROVELAND, WEST NEWBURY, AND ROWLEY.TARGET POPULATIONS FOR ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS INITIATIVES WERE IDENTIFIED THROUGH A COMMUNITY INPUT AND PLANNING PROCESS, COLLABORATIVE EFFORTS AND A CHNA THAT IS CONDUCTED EVERY THREE YEARS IN ACCORDANCE WITH THE REQUIREMENTS UNDER IRC SECTION 501(R).ANNA JAQUES HOSPITAL'S TARGET POPULATIONS FOCUSED ON MEDICALLY UNDERSERVED AND VULNERABLE GROUPS OF ALL AGES IN THE TOWNS ABOVE, AS FOLLOWS: YOUTH AND ADOLESCENTS OLDER ADULTS INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS2019 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSTHE ASSESSMENT BEGAN IN DECEMBER 2018 AND WAS CONDUCTED IN THREE PHASES, ALLOWING FOR THE COLLECTION OF AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA:PHASE 1 PRELIMINARY ASSESSMENT AND ENGAGEMENTPHASE 2 TARGETED ENGAGEMENTPHASE 3 STRATEGIC PLANNING AND REPORTINGINDIVIDUALS FROM ACROSS ANNA JAQUES HOSPITAL'S SERVICE AREA WERE ENGAGED IN THE ASSESSMENT AND PLANNING PROCESS, INCLUDING HEALTH AND SOCIAL SERVICES PROVIDERS, PUBLIC HEALTH OFFICIALS, PUBLIC SCHOOL NURSES AND ADMINISTRATORS, FIRST RESPONDERS, LEADERS OF FAITH-BASED ORGANIZATIONS, BILH SENIOR LEADERSHIP, STAFF, BOARD MEMBERS, AND COMMUNITY RESIDENTS. MEMBERS OF THE COMMUNITY BENEFITS ADVISORY COMMITTEE PROVIDED LEADERSHIP, DIRECTION, AND INPUT, AS WELL AS CONNECTED AJH TO AVAILABLE COMMUNITY DATA AND RESOURCES THAT REPRESENTS THE BROAD INTERESTS OF THE COMMUNITY TO DRIVE THE CONTENT OF THE CHNA.

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSQUANTITATIVE DATA SOURCES: THE QUANTITATIVE ASSESSMENT INCLUDED AN EXTENSIVE ANALYSIS OF DEMOGRAPHIC AND SOCIOECONOMIC DATA, HEALTH STATUS, UTILIZATION RATES, AND BEHAVIORAL RISK SURVEY DATA. DATA FROM A BROAD RANGE OF SOURCES WAS COLLECTED AND ANALYZED TO CHARACTERIZE COMMUNITIES IN ANNA JAQUES HOSPITAL'S CBSA, MEASURE HEALTH STATUS, AND INFORM A COMPREHENSIVE UNDERSTANDING OF HEALTH-RELATED ISSUES. U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2013-2017) MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION: SCHOOL AND DISTRICT PROFILES FBI UNIFORM CRIME REPORTS (2017) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, REGISTRY OF VITAL RECORDS AND STATISTICS (2015) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, BUREAU OF SUBSTANCE ABUSE SERVICES (2017) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, ANNUAL REPORTS ON BIRTHS (2016) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, OPIOID RELATED EMS INCIDENTS (2018) QUALITATIVE DATA SOURCES: TO OBTAIN TARGETED DATA AND UNDERSTAND THE CURRENT ISSUES FACING THE COMMUNITY: INTERNAL STAKEHOLDER INTERVIEWS (BOARD MEMBERS, SENIOR LEADERS, AND SERVICE LINE LEADERS) EXTERNAL STAKEHOLDER INTERVIEWS2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS (SCHEDULE H, PART V, SECTION B, LINE 5)WHILE IT WAS NOT POSSIBLE FOR THIS ASSESSMENT TO INVOLVE ALL COMMUNITY STAKEHOLDERS, WE MADE AN EFFORT TO BE INCLUSIVE AND TO PROVIDE A BROAD RANGE OF OPPORTUNITIES FOR PARTICIPATION OVER THE COURSE OF SEVERAL MONTHS. ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS PROGRAM IS BUILT ON PARTNERSHIP AND DIALOGUE WITH OUR MANY COMMUNITIES. OUR UNDERSTANDING OF THESE COMMUNITIES' NEEDS IS DERIVED FROM DISCUSSIONS WITH AND OBSERVATIONS BY HEALTHCARE AND HEALTH-RELATED WORKERS IN THE NEIGHBORHOODS. THIS DATA WAS THEN AUGMENTED BY DEMOGRAPHIC AND HEALTH STATUS INFORMATION FROM A VARIETY OF SOURCES INCLUDING THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, FEDERAL RESOURCES SUCH AS THE INSTITUTE OF MEDICINE, AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION. AN ARTICULATION OF EACH SPECIFIC COMMUNITY'S NEEDS (CRAFTED JOINTLY BY ANNA JAQUES AND COMMUNITY PARTNERS) INFORMS ANNA JAQUES HOSPITAL'S DECISION-MAKING ABOUT PRIORITIES FOR COMMUNITY BENEFITS EFFORTS. WE WORK IN CONCERT WITH COMMUNITY RESIDENTS AND LEADERS TO DESIGN SPECIFIC ACTIONS TO BE UNDERTAKEN EACH YEAR. EACH COMPONENT OF THE PLAN IS EVENTUALLY WOVEN INTO THE ANNUAL GOALS AND THE AGENDA FOR THE ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS IMPLEMENTATION STRATEGY, ADOPTED BY THE BOARD OF TRUSTEES. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSREVIEWING RESULTS AND COMPILING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY DOCUMENTSPRIMARY DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT IS DERIVED FROM SHARED RESOURCES AND AVAILABLE DATA FROM COMMUNITY PARTNERSHIPS AND ORGANIZATIONS. MEMBERS OF THE CBAC COLLABORATED WITH THE CB MANAGER, THROUGH MEETINGS AND CONVERSATIONS BETWEEN 2018 - 2019, TO CONNECT AJH WITH USEFUL RESOURCES AND REPORTS, BOTH FROM MEMBERS' OWN ORGANIZATIONS AS WELL AS PUBLICLY REPORTED DATA THAT REFLECTS THE SIGNIFICANT HEALTH NEEDS FACING COMMUNITIES SERVED BY ANNA JAQUES HOSPITAL. THE MEMBERS OF THE CBAC REPRESENT THE INTERESTS OF AJH'S MOST VULNERABLE POPULATIONS, INCLUDING LOW-COME, MINORITY, HOMELESS, AND OTHER UNDERSERVED OR HIGH- RISK POPULATIONS. ADDITIONALLY, PAM PALOMBO, A MEMBER OF THE CBAC, SERVES AS NEWBURYPORT PUBLIC HEALTH NURSE, AND PROVIDED INSIGHT AND SUGGESTIONS TO THE CBAC REGARDING THE HEALTH NEEDS OF THAT COMMUNITY. DEMOGRAPHIC DATA WAS COLLECTED USING PUBLICLY AVAILABLE DATA FROM THE U.S. CENSUS BUREAU, HEALTH INDICATORS FROM THE MA DEPARTMENT OF HEALTH, AND THE CENTER FOR DISEASE CONTROL AND PREVENTION (CDC). HEALTH INDICATOR DATA SUCH AS MORTALITY, INCIDENCE, PREVALENCE, AND HOSPITALIZATION RATES WERE PROVIDED BY THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, AND BY USING OTHER STATE, REGIONAL AND NATIONAL INFORMATION SOURCES ON CANCER INCIDENCE AND OPIOID USE TRENDS. SUMMARIES OF THE ORGANIZATIONS THAT PROVIDED PRIMARY DATA AND THE COMMUNITIES AND POPULATIONS THEY SERVE, INCLUDE: YWCA OF NEWBURYPORT IS DEDICATED TO ELIMINATING RACISM, EMPOWERING WOMEN, AND PROMOTING PEACE, JUSTICE, FREEDOM, AND DIGNITY FOR ALL. FOR OVER 135 YEARS OF SERVICE TO THE COMMUNITY, IT HAS PROVIDED FOR COMMUNITY MEMBERS REGARDLESS OF RACE, GENDER, OR ECONOMIC REALITY. SUPPORT IS OFFERED TO WOMEN AND THEIR FAMILIES THROUGH PROGRAMMING THAT ADDRESSES THEIR HEALTH AND WELLNESS, AIDS IN THE DEVELOPMENT OF JOB SKILLS AND PROVIDES ACCESS TO AFFORDABLE HOUSING AND CHILDCARE PROGRAMS. O COMMUNITIES SERVED: NEWBURYPORT, AMESBURY, SALISBURY O STATE-WIDE PRIORITIES & SOCIAL DETERMINANTS OF HEALTH YWCA SUPPORTS: HOMELESSNESS; HOUSING; BUILT ENVIRONMENT; EMPLOYMENT; VIOLENCE; CHRONIC DISEASE (YWCA OFFERS AFFORDABLE GYM); SOCIAL ENVIRONMENT PENNIES FOR POVERTY: MISSION IS TO EASE THE IMPACT OF POVERTY ON THE PEOPLE OF GREATER NEWBURYPORT BY ENDORSING MODELS OF ASSISTANCE THAT PROMOTE DIGNITY, SUPPORTING ALLIED ORGANIZATIONS BOTH FINANCIALLY AND COLLABORATIVELY, INCREASING COMMUNITY AWARENESS OF POVERTY THROUGH CITIZEN EDUCATION, AND INSPIRING AND ENCOURAGING VOLUNTEERISM. O COMMUNITIES SERVED: GREATER NEWBURYPORT O STATE-WIDE PRIORITIES & SOCIAL DETERMINANTS OF HEALTH YWCA SUPPORTS: EDUCATION; BUILT ENVIRONMENT; SOCIAL ENVIRONMENT; PREVENTION; MENTAL HEALTH OUR NEIGHBOR'S TABLE: ONT'S INNOVATIVE APPROACH TO FOOD ASSISTANCE IS AIMED AT PROVIDING FLEXIBLE, PERSONALIZED PROGRAMS TO INDIVIDUALS AND FAMILIES LIVING IN NORTHEASTERN ESSEX COUNTY. ONT PROVIDES 2019 COMMUNITY HEALTH NEEDS ASSESSMENT 12 GROCERIES, FRESH FOODS, AND TOILETRIES TO MORE THAN 500 HOUSEHOLDS FROM 12 CITIES AND TOWNS A WEEK ACROSS 4 MARKET LOCATIONS AND DELIVER GROCERIES AND HOT MEALS TO HOME-BOUND INDIVIDUALS IN 3 TOWNS. EACH HOLIDAY SEASON, WE DISTRIBUTE SPECIAL GROCERIES AND TURKEYS TO MORE THAN 700 FAMILIES. WITH 24/7 EMERGENCY HOTLINE FOR FOOD. O COMMUNITIES SERVED: AMESBURY, BOXFORD, BYFIELD, GEORGETOWN, GROVELAND, MERRIMAC, NEWBURY, NEWBURYPORT, ROWLEY, SALISBURY, SOUTH HAMPTON, AND WEST NEWBURY. O STATE-WIDE PRIORITIES & SOCIAL DETERMINANTS OF HEALTH YWCA SUPPORTS: SOCIAL ENVIRONMENT; HOMELESSNESS; CHRONIC DISEASE; PREVENTION ESSEX COUNTY ASSET BUILDER NETWORK (ECAB): CREATES REGIONAL CONNECTIONS AND SUPPORTS FOR INDIVIDUALS, FAMILIES AND ORGANIZATIONS USING A POSITIVE YOUTH DEVELOPMENT APPROACH TO HELP YOUTH THRIVE. LINK TO DATA IN CHNA REPORT.O COMMUNITIES SERVED: AMESBURY, GEORGETOWN, NEWBURY, ROWLEY, SALISBURY, NEWBURYPORT O STATE-WIDE PRIORITIES & SOCIAL DETERMINANTS OF HEALTH YWCA SUPPORTS: SUBSTANCE USE; EDUCATION; SOCIAL ENVIRONMENT; MENTAL HEALTH; PREVENTION 2019 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSTHE ASSESSMENT BEGAN IN DECEMBER 2018 AND WAS CONDUCTED IN THREE PHASES, ALLOWING FOR THE COLLECTION OF AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA:PHASE 1 PRELIMINARY ASSESSMENT AND ENGAGEMENTPHASE 2 TARGETED ENGAGEMENTPHASE 3 STRATEGIC PLANNING AND REPORTINGINDIVIDUALS FROM ACROSS ANNA JAQUES HOSPITAL'S SERVICE AREA WERE ENGAGED IN THE ASSESSMENT AND PLANNING PROCESS, INCLUDING HEALTH AND SOCIAL SERVICES PROVIDERS, PUBLIC HEALTH OFFICIALS, PUBLIC SCHOOL NURSES AND ADMINISTRATORS, FIRST RESPONDERS, LEADERS OF FAITH-BASED ORGANIZATIONS, BILH SENIOR LEADERSHIP, STAFF, BOARD MEMBERS, AND COMMUNITY RESIDENTS. MEMBERS OF THE COMMUNITY BENEFITS ADVISORY COMMITTEE PROVIDED LEADERSHIP, DIRECTION, AND INPUT, AS WELL AS CONNECTED AJH TO AVAILABLE COMMUNITY DATA AND RESOURCES THAT REPRESENTS THE BROAD INTERESTS OF THE COMMUNITY TO DRIVE THE CONTENT OF THE CHNA. QUALITATIVE DATA SOURCES: TO OBTAIN TARGETED DATA AND UNDERSTAND THE CURRENT ISSUES FACING THE COMMUNITY: INTERNAL STAKEHOLDER INTERVIEWS (BOARD MEMBERS, SENIOR LEADERS, AND SERVICE LINE LEADERS) EXTERNAL STAKEHOLDER INTERVIEWS

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS-KEY FINDINGSAFTER A COMPREHENSIVE REVIEW OF ALL THE QUANTITATIVE AND QUALITATIVE INFORMATION COLLECTED IN THE ANNA JAQUES HOSPITAL CHNA, THE KEY HEALTH-RELATED FINDINGS IDENTIFIED WERE: IN JANUARY 2019, THE CBAC DETERMINED THAT AFTER THREE YEARS OF FOCUSING ON OBESITY, CANCER AND SUBSTANCE USE AS ITS SIGNIFICANT HEALTH PRIORITIES, THAT THE DATA AND AVAILABLE RESOURCES CONSULTED REFLECTED POSITIVE CHANGES FOR OBESITY, BUT THAT CANCER AND SUBSTANCE USE SHOULD REMAIN THE PROGRAM'S CORE FOCUS. THE CBAC VOTED THAT, IN ORDER TO ADDRESS THE MOST PRESSING HEALTH NEEDS IN OUR COMMUNITY AND INCORPORATE STATE-WIDE GOALS/SOCIAL DETERMINANTS OF HEALTH IN THE MOST IMPACTFUL AND REALISTIC WAY, TO PRIORITIZE CANCER AND SUBSTANCE USE (NOTING CONNECTION WITH MENTAL HEALTH) AS THE MOST SIGNIFICANT HEALTH NEEDS FACING ITS COMMUNITY FOR FY19-FY21. WHILE OBESITY IS NOT A PRIMARY FOCUS, THE WORLD CANCER RESEARCH FUND ESTIMATES THAT ABOUT 20% OF ALL CANCERS DIAGNOSED IN THE US ARE RELATED TO BODY FATNESS, PHYSICAL INACTIVITY, EXCESS ALCOHOL CONSUMPTION, AND/OR POOR NUTRITION. THUS, ACCESS TO HEALTHY FOODS AS WELL AS OPPORTUNITIES FOR EXERCISE WILL HELP US ADDRESS FACTORS IMPACTING BOTH CANCER AND SUBSTANCE USE. THE CHNA THAT WAS COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, AND THE ASSOCIATED IMPLEMENTATION STRATEGY ADOPTED FROM THIS PROCESS WERE DESIGNED TO INFORM ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS INITIATIVES DURING THE FISCAL YEARS ENDED SEPTEMBER 30, 2020; SEPTEMBER 30, 2021; AND SEPTEMBER 30, 2022. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY FINDINGSAFTER A COMPREHENSIVE REVIEW OF ALL THE QUANTITATIVE AND QUALITATIVE INFORMATION COLLECTED IN THE ANNA JAQUES HOSPITAL CHNA, THE KEY HEALTH-RELATED FINDINGS IDENTIFIED WERE: IN JANUARY 2019, THE CBAC DETERMINED THAT AFTER THREE YEARS OF FOCUSING ON OBESITY, CANCER AND SUBSTANCE USE AS ITS SIGNIFICANT HEALTH PRIORITIES, THAT THE DATA AND AVAILABLE RESOURCES CONSULTED REFLECTED POSITIVE CHANGES FOR OBESITY, BUT THAT CANCER AND SUBSTANCE USE SHOULD REMAIN THE PROGRAM'S CORE FOCUS. THE CBAC VOTED THAT, IN ORDER TO ADDRESS THE MOST PRESSING HEALTH NEEDS IN OUR COMMUNITY AND INCORPORATE STATE-WIDE GOALS/SOCIAL DETERMINANTS OF HEALTH IN THE MOST IMPACTFUL AND REALISTIC WAY, TO PRIORITIZE CANCER AND SUBSTANCE USE (NOTING CONNECTION WITH MENTAL HEALTH) AS THE MOST SIGNIFICANT HEALTH NEEDS FACING ITS COMMUNITY FOR FY19-FY21. WHILE OBESITY IS NOT A PRIMARY FOCUS, THE WORLD CANCER RESEARCH FUND ESTIMATES THAT ABOUT 20% OF ALL CANCERS DIAGNOSED IN THE US ARE RELATED TO BODY FATNESS, PHYSICAL INACTIVITY, EXCESS ALCOHOL CONSUMPTION, AND/OR POOR NUTRITION. THUS, ACCESS TO HEALTHY FOODS AS WELL AS OPPORTUNITIES FOR EXERCISE WILL HELP US ADDRESS FACTORS IMPACTING BOTH CANCER AND SUBSTANCE USE. THE CHNA THAT WAS COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, AND THE ASSOCIATED IMPLEMENTATION STRATEGY ADOPTED FROM THIS PROCESS WERE DESIGNED TO INFORM ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS INITIATIVES DURING THE FISCAL YEARS ENDED SEPTEMBER 30, 2020; SEPTEMBER 30, 2021; AND SEPTEMBER 30, 2022. INTERIM CHANGES AND UPDATES TO 2019 IMPLEMENTATION STRATEGY BASED ON NEWLY IDENTIFIED COMMUNITY NEEDS COVID PANDEMICAS PREVIOUSLY NOTED IN THIS FILING, IRC SECTION 501(R)(3) AND THE PROMULGATED REGULATIONS REQUIRE THAT A TAX-EXEMPT HOSPITAL CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND ADOPT AN IMPLEMENTATION STRATEGY ADDRESSING COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA AT LEAST ONCE EVERY THREE YEARS. THE PREAMBLE TO THE REGULATIONS PROMULGATED UNDER IRC SECTION 501(R)(3) NOTES THAT THE TREASURY AND THE IRS INTENDED FOR THE CHNA AND IMPLEMENTATION STRATEGY REQUIREMENT TO ESTABLISH CONTINUAL FEEDBACK ON CHNA REPORTS AND A HOSPITAL IS REQUIRED TO CONSIDER COMMENTS RECEIVED RELATED TO THE EXISTING CHNA AND IMPLEMENTATION STRATEGY WHEN ENGAGING IN THE NEXT CHNA PROCESS NOT MORE THAN THREE YEARS AFTER ADOPTION. IN ADDITION, FINAL REGULATIONS DO NOT PROHIBIT IMPLEMENTATION STRATEGIES FROM DISCUSSING HEALTH NEEDS IDENTIFIED THROUGH MEANS OTHER THAN A CHNA, PROVIDED THAT THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA ARE ALSO DISCUSSED. FINALLY, THERE IS NOTHING IN THE REGULATIONS THAT PROHIBITS A HOSPITAL FROM UPDATING ITS IMPLEMENTATION STRATEGY BASED ON AN OFF CYCLE CHANGE TO THE COMMUNITY HEALTH NEEDS THAT ARISE. DURING THE FISCAL PERIOD, OCTOBER 1, 2019, TO SEPTEMBER 30, 2020, THE HEALTH NEEDS OF THE COMMUNITIES SERVED BY ANNA JAQUES HOSPITAL, WERE IMPACTED BY AN UNEXPECTED GLOBAL PANDEMIC. ON JANUARY 9, 2020, THE WORLD HEALTH ORGANIZATION (WHO) ANNOUNCED THE IDENTIFICATION OF A NEW AND NOVEL CORONAVIRUS-RELATED PNEUMONIA IN WUHAN, CHINA. ON JANUARY 21, 2020, THE UNITED STATES CENTER FOR DISEASE CONTROL CONFIRMED THE FIRST CASE OF THIS NEW CORONA VIRUS IN THE UNITED STATES. ON JANUARY 31, 2020, THE WHO ISSUED A GLOBAL HEALTH EMERGENCY AND ON FEBRUARY 3 THE UNITED STATES DECLARED A PUBLIC HEALTH EMERGENCY BECAUSE OF THE COVID-19 VIRUS. ON MARCH 11, 2020, THE WHO DECLARED COVID-19 A PANDEMIC AND TWO DAYS LATER, THE PRESIDENT OF THE UNITED STATES DECLARED COVID-19 A NATIONAL EMERGENCY.THE HEALTH OF THE COMMUNITIES SERVED BY ANNA JAQUES HOSPITAL WERE IMPACTED BY THIS UNFORESEEN HEALTH CRISIS AND IN THE ABSENCE OF REGULATORY GUIDANCE TO THE CONTRARY, ANNA JAQUES HOSPITAL NEEDED TO QUICKLY REASSESS AND PIVOT TO MEET THE NEW AND PREVIOUSLY UNEXPECTED COMMUNITY NEEDS. AS SUCH, IN RESPONSE TO THE COVID-19 CRISIS ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS STAFF ALONG WITH THE HOSPITAL'S COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) AND IN RESPONSE TO COVID, EXPANDED GOALS RELATED TO ACCESS TO CARE AND SOCIAL DETERMINANTS OF HEALTH TARGETED PRIMARILY AT LOW INCOME AND MINORITY POPULATIONS WHO HAVE BEEN DISPROPORTIONATELY IMPACTED BY COVID-19.COMMUNITY HEALTH NEEDS ASSESSMENTMAKING THE CHNA AND IMPLEMENTATION STRATEGY WIDELY AVAILABLEANNA JAQUES HOSPITAL STRIVES TO ADDRESS THE PRIORITY AREAS IN ITS CHNA AND IMPLEMENTATION STRATEGY.AS NOTED ABOVE, ANNA JAQUES HOSPITAL COMPLETED ITS MOST RECENT CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021). THAT CHNA AND APPENDIX WITH DETAILED INFORMATION IS AVAILABLE ON THE ANNA JAQUES HOSPITAL WEBSITE AT:HTTPS://WWW.AJH.ORG/WRITABLE/FILES/AJH-2022-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-093022.PDFIN ADDITION TO THE CHNA, ANNA JAQUES HOSPITAL COMPLETED ITS MOST RECENT IMPLEMENTATION STRATEGY DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021). THE IMPLEMENTATION STRATEGY IS AVAILABLE ON THE ANNA JAQUES HOSPITAL WEBSITE AT: HTTPS://WWW.AJH.ORG/WRITABLE/FILES/AJH-2023-2025-IMPLEMENTATION-STRATEGY-101122.PDFIN ADDITION, AS NOTED ABOVE, ANNA JAQUES HOSPITAL COMPLETED ITS PREVIOUS CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018). THAT CHNA IS AVAILABLE ON THE ANNA JAQUES HOSPITAL WEBSITE AT: HTTPS://WWW.AJH.ORG/WRITABLE/APPLICATIONS/CHNA-2019-FOR-WEBSITE-FINAL.PDFFINALLY, THE IMPLEMENTATION STRATEGY ASSOCIATED WITH THE CHNA COMPLETED DURING ANNA JAQUES HOSPITAL'S FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018) IS AVAILABLE ON THE ANNA JAQUES HOSPITAL WEBSITE AT: HTTPS://WWW.AJH.ORG/WRITABLE/APPLICATIONS/CHNA-2019-FOR-WEBSITE-FINAL.PDFEACH OF THESE DOCUMENTS IS ALSO AVAILABLE ON REQUEST (SCHEDULE H, PART V, SECTION B, LINE 7A).

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
LINKS TO FINANCIAL ASSISTANCE POLICY AND RELATED DOCUMENTSTHE LINK TO THE ANNA JAQUES HOSPITAL FINANCIAL ASSISTANCE POLICY (FAP) AND THE FOLLOWING RELATED DOCUMENTS CAN BE FOUND ON THE HOSPITAL'S WEBSITE. CREDIT AND COLLECTION POLICY APPLICATION FOR FINANCIAL ASSISTANCE MEDICAL HARDSHIP APPLICATION FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARY ADDITIONAL INFORMATION ON PATIENT FINANCIAL ASSISTANCE AND BILLING, CAN BE FOUND ON THE ANNA JAQUES HOSPITAL WEBSITE AT: HTTPS://WWW.AJH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCELIMITATION ON CHARGESINTERNAL REVENUE CODE SECTION 501(R)(5)LIMITATION ON CHARGESAS REQUIRED BY IRC SECTION 501(R)(5) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL LIMITS THE AMOUNTS CHARGED FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IT PROVIDES TO A FINANCIAL ASSISTANCE-ELIGIBLE PATIENT, TO NOT MORE THAN AMOUNTS GENERALLY BILLED (AGB) AND LIMITS THE AMOUNTS CHARGED TO ANY FINANCIAL ASSISTANCE ELIGIBLE PATIENT FOR ALL OTHER MEDICAL CARE TO LESS THAN GROSS CHARGES. AMOUNTS GENERALLY BILLEDLOOK BACK METHODTHE HOSPITAL CALCULATES ITS AGB, USING THE LOOK BACK METHOD, DIVIDING THE TOTAL PAYMENTS RECEIVED FROM ALL COMMERCIAL PLANS AND MEDICARE BY THE TOTAL CHARGES SENT TO THOSE SAME PAYERS FOR THE PREVIOUS FISCAL YEAR. CALCULATED AGB IS INCLUDED IN THE HOSPITAL'S FAP AS REQUIRED UNDER THE REGULATIONS DETAILING THE REQUIREMENTS UNDER IRC SECTION 501(R)(5). (SCHEDULE H PART V SECTION B QUESTION 22). PATIENT REFUNDS FOR CHARGES IN EXCESS OF AMOUNTS GENERALLY BILLEDTHE HOSPITAL REGULARLY MONITORS THE FINANCIAL ACCOUNTS OF FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. WHERE A PATIENT SUBMITS A COMPLETED APPLICATION FOR FINANCIAL ASSISTANCE AND IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL REFUNDS ANY AMOUNTS PREVIOUSLY PAID FOR CARE THAN EXCEEDS THE AMOUNT THAT THE PATIENT IS PERSONALLY RESPONSIBLE FOR PAYING WHERE SUCH AMOUNTS ARE EQUAL TO OR EXCEED $5.00. BILLING AND COLLECTIONS501(R)(6)EXTRAORDINARY COLLECTION ACTIVITIESTHE HOSPITAL DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIVITIES (ECAS) FOR FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. SPECIFICALLY, THE HOSPITAL DOES NOT REPORT TO CREDIT AGENCIES, ENGAGE IN LEGAL OR JUDICIAL PROCESSES OR SELL A PATIENT'S OUTSTANDING AMOUNTS OWED FOR PATIENT CARE. IN ADDITION, THIS EXTENDS TO ANY THIRD PARTY CONTRACTED WITH THE HOSPITAL RELATED TO BILLING AND COLLECTIONS. (SCHEDULE H PART V SECTION B QUESTIONS 18 AND 19).APPLICATION PERIOD PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME UP TO TWO HUNDRED FORTY (240) DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS AVAILABLE. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS RESEARCHAS NOTED THROUGHOUT THIS FILING AJH IS PART OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES. BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) IS A TERTIARY CARE ACADEMIC MEDICAL CENTER IN BOSTON AND A SISTER ENTITY OF AJH. AS PART OF THE SAME NETWORK, THE RESEARCH IN WHICH BIDMC ENGAGES SUPPORTS NOT ONLY THE MISSION AND CARE FOR BIDMC PATIENTS AND COMMUNITIES BUT ALSO HELPS TO IMPROVE PATIENT CARE FOR THE COMMUNITIES OF OTHER BILH AFFILIATES AND BEYOND. THE DETAIL BELOW PROVIDES BACKGROUND ON THE RESEARCH ACTIVITIES AT BIDMC DURING THE FISCAL PERIOD COVERED BY THIS FILING.THE MEDICAL CENTER'S NOTABLE RESEARCH ACCOMPLISHMENTS INCLUDE CONSISTENTLY BEING RANKED IN THE TOP TIER OF INDEPENDENT HOSPITALS IN NATIONAL INSTITUTES OF HEALTH (NIH) FUNDING. THE MEDICAL CENTER SCIENTISTS CONTINUE TO SEARCH FOR IMPROVED UNDERSTANDING OF DISEASES AND BETTER TREATMENTS FOR PATIENTS, WHICH IN TURN DIRECTLY IMPACT THE LIVES OF OUR PATIENTS AND IMPROVE THE MEDICAL CENTER'S PATIENT CARE. DURING THE FISCAL PERIOD COVERED BY THIS FILING, MORE THAN 1,800 ACTIVE FEDERAL, INDUSTRY AND FOUNDATION SPONSORED PROJECTS AND MORE THAN 2,400 ACTIVE EXEMPT, EXPEDITED, AND FULL BOARD-REVIEWED CLINICAL RESEARCH STUDIES. BIDMC RESEARCH IS LED BY MORE THAN 260 PRINCIPAL INVESTIGATORS, THE MAJORITY OF WHOM ARE HARVARD MEDICAL SCHOOL FACULTY. THE KEY AREAS OF RESEARCH INCLUDE VASCULAR BIOLOGY, MOLECULAR IMAGING, TRANSPLANTATION, SIGNAL TRANSDUCTION, CANCER BIOLOGY, METABOLIC DISEASE, NEUROBIOLOGY, AIDS, VACCINE DEVELOPMENT AND VIROLOGY, INFECTION CONTROL AND INFECTIOUS DISEASES AND CARDIOLOGY/CARDIAC SURGERY. AS NOTED IN THIS FILING, THE MEDICAL CENTER IS A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL AND IS COMMITTED TO MAINTAINING A COLLABORATIVE CULTURE; TO MAINTAINING MODERN, HIGH-QUALITY FACILITIES, AND TO TAKING FULL ADVANTAGE OF THE UNIQUE RELATIONSHIPS THAT EXIST AMONG THE HARVARD MEDICAL SCHOOL AND THE HARVARD TEACHING HOSPITALS. THE MEDICAL CENTER DESIGNS AND IMPLEMENTS MANY INTERDEPARTMENTAL AND INTERDISCIPLINARY RESEARCH PROGRAMS WITHIN THE INSTITUTION. THE MEDICAL CENTER ALSO COLLABORATES WITH OTHER NATIONALLY RECOGNIZED AND WORLD RENOWNED EXPERTS IN VARIOUS FIELDS IN AN EFFORT TO TRANSLATE NEW KNOWLEDGE INTO NOVEL MEDICAL TREATMENTS AND PATIENT CARE. THE MEDICAL CENTER PARTICIPATES IN HARVARD CATALYST, THE HARVARD CLINICAL AND TRANSLATIONAL SCIENCE CENTER, WHICH BRINGS TOGETHER THE INTELLECTUAL FORCE, TECHNOLOGIES, AND CLINICAL EXPERTISE AT HARVARD UNIVERSITY AND ITS ACADEMIC, HEALTH CARE, AND COMMUNITY PARTNERS TO CREATE CONNECTIONS, ENABLE RESEARCH AT THE CUTTING EDGE OF DISCOVERY, AND NURTURE CLINICAL AND TRANSLATIONAL RESEARCHERS WITH THE GOAL OF IMPROVING HUMAN HEALTH.STUDIES BY MEDICAL CENTER RESEARCHERS ARE ROUTINELY PUBLISHED IN THE WORLD'S LEADING SCIENTIFIC JOURNALS, INCLUDING NATURE, SCIENCE, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION AND THE NEW ENGLAND JOURNAL OF MEDICINE, WHICH HELPS TO BRING THE RESEARCH FINDINGS TO CLINICIANS AND PATIENTS BEYOND THE MEDICAL CENTER. THE MEDICAL CENTER ENGAGES IN RESEARCH IN ALL OF THE FOLLOWING DISCIPLINES: ANESTHESIA, CRITICAL CARE, AND PAIN MEDICINE EMERGENCY MEDICINE MEDICINE O ALLERGY AND INFLAMMATIONO CARDIOVASCULAR MEDICINEO CENTER FOR VASCULAR BIOLOGY RESEARCHO CENTER FOR VIROLOGY AND VACCINE RESEARCHO CLINICAL INFORMATICSO CLINICAL NUTRITIONO ENDOCRINOLOGYO EXPERIMENTAL MEDICINEO GASTROENTEROLOGYO GENERAL MEDICINE AND PRIMARY CAREO GENETICSO GERONTOLOGYO HEMATOLOGY AND ONCOLOGYO HEMOSTASIS AND THROMBOSISO IMMUNOLOGYO INFECTIOUS DISEASEO INTERDISCIPLINARY MEDICINE AND BIOTECHNOLOGYO MOLECULAR AND VASCULAR MEDICINEO NEPHROLOGYO PULMONOLOGYO RHEUMATOLOGYO SIGNAL TRANSDUCTIONO TRANSLATIONAL RESEARCHO TRANSPLANT IMMUNOLOGY NEONATOLOGY NEUROLOGY OBSTETRICS AND GYNECOLOGY ORTHOPAEDIC SURGERY PATHOLOGY PSYCHIATRY RADIOLOGY SURGERY O CARDIAC SURGERYO CENTER FOR MINIMALLY INVASIVE SURGERYO NEUROSURGERYO PLASTIC AND RECONSTRUCTIVE SURGERYO VASCULAR SURGERY TRANSPLANT INSTITUTEDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER REPORTED $88,164,361 OF NET INTERNALLY FUNDED RESEARCH ON THIS SCHEDULE H, PART I, LINE 7H RELATED TO RESEARCH TO FURTHER SCIENCE AND PATIENT CARE, WHICH REPRESENTED 4.70% OF THE MEDICAL CENTER'S TOTAL EXPENSES. ADDITIONALLY, THE MEDICAL CENTER REPORTED $203,874,650 OF RESEARCH EXPENSES FUNDED BY GOVERNMENTS AND OTHER TAX-EXEMPT ENTITIES INCLUDING OTHER HOSPITALS, UNIVERSITIES AND FOUNDATIONS ON SCHEDULE H, PART I LINE 7H COLUMN D, WHICH, IF INCLUDED IN SCHEDULE H, PART I, LINE 7H COLUMN E CALCULATION, WOULD INCREASE THE NET COMMUNITY BENEFIT REPORTED FROM RESEARCH ACTIVITIES ON THIS SCHEDULE H, PART I, LINE 7H TO 15.56%.

FORM 990, SCHEDULE H, SUPPLEMENTAL INFORMATION
"INTERNAL MEDICINE EDUCATION AT BIDMCTHE GOAL OF THIS PROGRAM IS TO DEVELOP EACH RESIDENT'S JUDGMENT AND SKILLS TO PROVIDE THE HIGHEST QUALITY MEDICAL CARE. THE MEDICAL CENTER TRAINS RESIDENTS AS ACADEMIC INTERNISTS AND PROVIDES THE FOUNDATION FOR THE PRACTICE OF INTERNAL MEDICINE OR FOR SUBSEQUENT CLINICAL AND RESEARCH TRAINING IN MEDICAL SUBSPECIALTIES. RESIDENTS ARE EXPOSED TO A WIDE ARRAY OF PATIENTS IN VARIOUS INPATIENT AND OUTPATIENT SETTINGS, INCLUDING DIFFERENT UNITS WITHIN BIDMC, DANA FARBER CANCER INSTITUTE, AND WEST ROXBURY VETERANS AFFAIRS MEDICAL CENTER. CLINICAL TEACHING IS A FOCUS AT BIDMC AND IS COMPRISED OF FORMAL AND INFORMAL DAILY ROUNDS AND NOONTIME CONFERENCES. THIS TEACHING PROVIDES THE BASIS OF AN ORGANIZED CURRICULUM FOR ALL MEDICAL INTERNS AND RESIDENTS AT BIDMC.INTERNSHIPTHE INTERNSHIP YEAR EMPHASIZES THE CARE OF PATIENTS IN GENERAL INPATIENT MEDICINE, INTENSIVE CARE MEDICINE, ONCOLOGY, CARDIOLOGY, EMERGENCY MEDICINE AND AMBULATORY CARE UTILIZING BOTH CAMPUSES AND SELECTED OUTSIDE SITES. WORKING AS PART OF A 2-4 PHYSICIAN TEAM WHICH INCLUDES AN OVERSEEING RESIDENT, ATTENDING STAFF AND OFTEN MEDICAL STUDENTS, INTERNS GAIN EXPERIENCE IN THE MANAGEMENT OF PATIENTS WITH A BROAD RANGE OF MEDICAL DISEASES. INTERNS HAVE PRIMARY RESPONSIBILITY FOR THE CARE OF ALL PATIENTS ADMITTED TO THE MEDICAL WARD SERVICE AND ARE CONSIDERED THEIR PATIENT'S PRIMARY INPATIENT DOCTOR FOR THE DURATION OF THE HOSPITALIZATION. THROUGHOUT INTERN YEAR, INTERNS MAINTAIN A LONGITUDINAL CONTINUITY CLINIC EXPERIENCE WHERE THEY DEVELOP A PANEL OF THEIR OWN PRIMARY CARE PATIENTS. DURING MOST OF THE YEAR, WITH THE EXCEPTION OF INTENSIVE CARE ROTATIONS, AN INTERN WILL HAVE CLINIC ONE HALF-DAY PER WEEK. DISTRIBUTED THROUGHOUT THE YEAR ARE FOUR ""AMBULATORY BLOCKS"" OF TWO WEEKS DURATION. DURING THIS TIME THE INTERN IS IN THEIR CONTINUITY CLINIC EVERY AFTERNOON AND ATTENDS OUTPATIENT SPECIFIC DIDACTIC LECTURES DURING THE MORNING HOURS. AS MEMBERS OF THE HARVARD FACULTY, INTERNS PLAY AN IMPORTANT ROLE IN TEACHING, BOTH OF THEIR PEERS AND OF ROTATING MEDICAL STUDENTS. WHILE ON THE MEDICAL WARDS, INTERNS PROVIDE DAILY CLINICAL GUIDANCE AND TEACHING TO THIRD- AND FOURTH-YEAR MEDICAL STUDENTS. AS PART OF THE AMBULATORY CARE CURRICULUM, INTERNS WILL ALSO HAVE THE OPPORTUNITY TO LEAD PRE-CLINIC CONFERENCES. DURING THE YEAR, THERE ARE SPECIAL INTERN-ONLY EDUCATIONAL ACTIVITIES INCLUDING THE TWICE-WEEKLY INTERN REPORT, MONTHLY INTERN FORUM SESSIONS AND BI-ANNUAL 24-HOUR INTERN RETREATS.JUNIOR AND SENIOR RESIDENCYRESIDENCY SOLIDIFIES CLINICAL AND TEACHING SKILLS AND ALLOWS TRAINEES TO EXPERIENCE LEADERSHIP OF A MEDICAL TEAM. JUNIOR RESIDENCY PROVIDES THE FIRST OPPORTUNITY FOR RESIDENTS TO SUPERVISE HOUSE STAFF TEAMS ON GENERAL MEDICAL SERVICES AND IN THE MEDICAL AND CARDIAC INTENSIVE CARE UNITS. SENIOR RESIDENCY PROMOTES CONSOLIDATION AND REFINEMENT OF THESE SKILLS, WITH ATTENDINGS ALLOWING INCREASING AUTONOMY. THE RESIDENT ON THE SERVICE IS LOOKED ON AS THE TEAM LEADER AND ASSUMES PRIMARY RESPONSIBILITY FOR TEACHING OF THE TEAM. RESIDENCY ALSO PROVIDES OPPORTUNITIES FOR INCREASED ELECTIVE TIME TO SAMPLE SUBSPECIALTY ROTATIONS. THIS PROVIDES ADDITIONAL SPECIALTY TRAINING IN AREAS OF INTEREST. THE ELECTIVE OPPORTUNITIES ARE DIVERSE, RANGING FROM ELECTROPHYSIOLOGY TO MUSCULOSKELETAL MEDICINE TO HEALTH POLICY. RESIDENTS ALSO HAVE THE OPPORTUNITY TO PARTICIPATE IN ONE OF SEVERAL ""TRACKS"" WITHIN THE RESIDENCY PROGRAM IF INTERESTED IN ADDITIONAL SPECIFIC TRAINING RESOURCES AND EXPERIENCES.TEACHING AS A RESIDENTAS MENTIONED ABOVE, RESIDENTS ARE VIEWED AS SOME OF THE PRIMARY TEACHERS WITHIN THE DEPARTMENT OF MEDICINE. SOME OF THESE TEACHING OPPORTUNITIES WILL ALSO BE OBSERVED BY DEPARTMENT FACULTY TO HELP THE RESIDENT REFINE THE STYLE AND EFFECTIVENESS OF THEIR TEACHING. TEACHING OPPORTUNITIES WILL INCLUDE:LEADING INPATIENT MEDICINE ROUNDS: RESIDENTS ARE IN CHARGE OF RUNNING WARD ROUNDS. MEDICAL STUDENTS AND INTERNS PRESENT TO THE RESIDENT DURING ROUNDS. THE ATTENDING HOSPITALIST IS CONSIDERED THE RESIDENT'S CONSULTANT, WITH THE RESIDENT RETAINING THE PRIMARY DECISION-MAKING ROLE FOR THE PATIENTS ON THEIR SERVICE. DURING THE MONTHS ON MEDICAL WARDS, THE CHIEF RESIDENTS AND FIRM CHIEFS ARE ASSIGNED TO DO WALK ROUND ONCE EACH WEEK WITH ONE OF THE RESIDENTS ON THEIR FIRM. THEY WILL OBSERVE THE RESIDENT RUNNING THE WARD ROUNDS AND PROVIDE FEEDBACK ON THE TEACHING SKILLS OBSERVED DURING ROUNDS.LEADING TEACHING ATTENDING ROUNDS: DURING EVERY ROTATION ON THE MEDICAL WARDS, EACH RESIDENT WILL LEAD ONE TO THREE ATTENDING ROUNDS SESSIONS. THE TWO TEACHING ATTENDINGS HELP PROVIDE FEEDBACK ON THE RESIDENT'S SMALL GROUP DISCUSSION AND TEACHING SKILLS. SMALL GROUP PRESENTATIONS: DURING AMBULATORY WEEKS, RESIDENTS WILL LEAD A MAJORITY OF THE PRE-CLINIC CONFERENCES, TYPICALLY PRESENTING EITHER A CHALLENGING AMBULATORY CASE OR AMBULATORY-BASED TOPIC. ONCE DURING RESIDENCY, EACH JUNIOR RESIDENT WILL ALSO PRESENT A JOURNAL ARTICLE OF AMBULATORY CARE SIGNIFICANCE AT AMBULATORY JOURNAL CLUB TO A SMALL GROUP OF THEIR PEERS. INTERNAL MEDICINE GLOBAL HEALTH PROGRAMOUR MISSION IS TO TRAIN LEADERS IN GLOBAL HEALTH TO BE EFFECTIVE PRACTITIONERS IN UNDERSERVED, RESOURCE-LIMITED SETTINGS AND TO DESIGN, MANAGE, IMPROVE AND EVALUATE GLOBAL PUBLIC HEALTH PROGRAMS THAT ADDRESS THE HEALTH PROBLEMS OF THE WORLD'S NEEDIEST POPULATIONS.PROGRAM OBJECTIVES INTRODUCE GLOBAL HEALTH ISSUES TO BIDMC MEDICAL RESIDENTS CONTRIBUTE TO THE HEALTH AND WELL-BEING OF UNDERSERVED POPULATIONS IN BOSTON AND AROUND THE WORLD ENRICH THE MEDICAL KNOWLEDGE AND ENHANCE THE CLINICAL SKILLS OF RESIDENTS BY PRACTICING IN UNIQUE SETTINGS WITH LIMITED RESOURCES EXPAND RESEARCH OPPORTUNITIES ADVANCE THE CAREERS OF BIDMC RESIDENTS IN THE FIELDS OF INTERNATIONAL HEALTH, PUBLIC POLICY AND RESEARCH SITE LOCATIONS BOTSWANA: THE DEPARTMENT HAS A PERMANENT PRESENCE IN BOTSWANA WITH A MEMBER OF OUR DEPARTMENT FULL-TIME AT SCOTTISH LIVINGSTONE HOSPITAL IN MOLEPOLOLE, BOTSWANA. VIETNAM: THE MEDICAL CENTER HAS A PERMANENT PRESENCE IN VIETNAM. PHYSICIAN AND NURSE TRAINING ON HIV/AIDS CARE IN VIETNAM TAKES PLACE THROUGH FUNDING FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION. ADDITIONAL LOCATIONS: THE DEPARTMENT OFFERS ROTATIONS AT THE ALBERT SCHWEITZER HOSPITAL IN GABON AND OTHER INTERNATIONAL SITES. RESIDENTS CAN ALSO DO ROTATIONS THROUGH THE INDIAN HEALTH SERVICE OR AT BIDMC-AFFILIATED COMMUNITY HEALTH CENTERS. GLOBAL HEALTH TRACK LEARNING HOW TO WORK EFFECTIVELY IN RESOURCE-LIMITED SETTINGS REQUIRES BOTH TRAINING AND EXPERIENCE. PARTICIPANTS IN THE GLOBAL HEALTH TRACK WILL PARTICIPATE WITH LEARNERS FROM AROUND THE WORLD IN THE GLOBAL HEALTH EFFECTIVENESS PROGRAM AT THE HARVARD SCHOOL OF PUBLIC HEALTH; THEY WILL ENGAGE IN OUR HOSPITAL-WIDE, YEAR-LONG GLOBAL HEALTH CURRICULUM AND JOURNAL CLUB, AND THEY WILL BE GIVEN THE OPPORTUNITY FOR TWO FIELD EXPERIENCES DURING RESIDENCY. HOSPITAL-WIDE GLOBAL HEALTH PROGRAM THE BIDMC GLOBAL HEALTH PROGRAM IS A HOSPITAL-WIDE PROGRAM AVAILABLE TO ALL BIDMC RESIDENTS. WHILE REQUIREMENTS AND TIMELINES MAY DIFFER BETWEEN DEPARTMENTS AND SPECIALTIES, THE OVERARCHING GOAL IS TO PROVIDE RESIDENTS WITH FURTHER TRAINING AND EDUCATION IN THE DISCIPLINE OF GLOBAL HEALTH. *****NEUROLOGY EDUCATION AT BIDMCTHE HARVARD MEDICAL SCHOOL NEUROLOGY PROGRAM AT BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL IN BOSTON, MASSACHUSETTS WAS FOUNDED IN 1996 AS THE SUCCESSOR TO THE HARVARD-LONGWOOD NEUROLOGY PROGRAM. THE PROGRAM CONCENTRATES ON THE TRAINING AND RESEARCH OPPORTUNITIES AVAILABLE ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS, BY COMBINING THE RESOURCES OF TWO MAJOR HARVARD TEACHING HOSPITALS, BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL. THESE COMBINED HOSPITALS, WITH OVER 800 INPATIENT BEDS AND EXTENSIVE OUTPATIENT CLINICS, PROVIDE THE SETTING FOR TRAINING PHYSICIANS IN THE ART AND SCIENCE OF CLINICAL NEUROLOGY."