4A (Expenses $ 5335679 including grants of $ 0) (Revenue $ 5154284)
Inpatient healthcare services - Providing inpatient community-based medicine and tertiary care to the surrounding region. Services are available to individuals regardless of their ability to pay. During FY16 through August 31, 2016, Baystate Mary Lane Hospital Corporation provided 1,865 patient days of inpatient services, with 728 discharges.

4B (Expenses $ 8962781 including grants of $ 0) (Revenue $ 8251431)
Outpatient healthcare services - Providing outpatient clinical services to the surrounding region. Services are available to individuals regardless of their ability to pay. During FY16 through August 31, 2016, Baystate Mary Lane Hospital Corporation had 33,988 outpatient visits.

4C (Expenses $ 6820272 including grants of $ 0) (Revenue $ 6010778)
Emergency department services - Providing emergency department services to the surrounding region. Services are available to individuals regardless of their ability to pay. During FY16 through August 31, 2016, Baystate Mary Lane Hospital Corporation had 12,970 emergency department visits.

4D (Expenses $ 216874 including grants of $ 0) (Revenue $ 1812261)

Baystate Mary Lane Hospital Corporation
Part V, Section B, Line 3j: The impact of actions taken to address the significant health needs identified in the hospital facility's prior 2013 CHNA.

Baystate Mary Lane Hospital Corporation
Part V, Section B, Line 5: A wide range of stakeholders took part in the 2016 Coalition CHNA process, including local and regional public health and health departments, other local municipal agencies, diverse community-based organizations, advocacy organizations, healthcare providers, and community residents. These stakeholders provided input through focus groups, key informant interviews and participation in the CHNA Steering Committee. Additionally, community listening sessions were conducted to vet findings with community members.The following organizations/community stakeholders were interviewed: Public Health Experts - Caulton-Harris, Helen, Commissioner of Public Health, City of Springfield - Dennis, Soloe, Western Region Director, Massachusetts Department of Public Health (MDPH) - Garcia, Luz Eneida, Care Coordinator, MDPH Division for Perinatal, Early Childhood and Special Needs, Care Coordination Unit - Hyry-Dermith, Dalila, Supervisor, MDPH Division for Perinatal, Early Childhood and Special Needs, Care Coordination Unit - Merriam, Carolyn, Public Health Nurse, Town of Ware - Metcalf, Judy, Director, Quabbin Health District - O'Leary, Meredith, Director, Northampton Health Department - Steinbock, Lisa, Public Health Nurse, City of Chicopee - Walker, Phoebe, BFMC CBAC Co-Chair, Franklin Regional Council of Governments (FRCOG) - White, Lisa, Public Health Nurse, Franklin Regional Council of Governments (FRCOG)Community Leaders or Health or Other Agencies Interviewed - Adzigirey, Liliya, Translator/ Interpreter, Baystate Noble Hospital - Azeez, Robert, Medicaid Behavioral Health Manager, Health New England - Balder, Dr. Andrew, Director, Mason Square Neighborhood Health Center and Health Care for the Homeless - Beck-Brewer, Joni, Vice President, Patient Services, Square One - Benjamin, Dr. Evan, Chief Quality Officer and Sr. VP of Quality and Population Health, Baystate Health - Blanchet, M.D., Jacques, Director of the Emergency Department, Baystate Noble Hospital - Boos, Dr. Stephen, Medical Director, Baystate Family Advocacy - Bouthillette, Marianne, Director of Child and Family Services, Parent Child Development Center, Community Action of the Franklin, Hampshire and North Quabbin Regions - Bradley, Leah, Director of Behavioral Health, Baystate Wing Hospital Griswold Center - Cardaropoli, Antonia, School Adjustment Counselor, Ware Junior/Senior High School - Cox, Jennifer, Director of Behavioral Health, Baystate Franklin Medical Center - Crowley, Kelley, Administrative Director of Behavioral Health, Baystate Noble Hospital - Cummings, Sara, Director of Community Services and Asset Development, Community Action of the Franklin, Hampshire and North Quabbin Regions - Davis, Kim, Nurse Manager, Baystate Mary Lane Hospital - Di Leo, Marlene, Superintendent, Ware Public Schools - Durkin, Dr. Louis, Director of Emergency Medicine, Mercy Medical Center - Gerard, Mary Beth, WIC Director, Community Action of the Franklin, Hampshire and North Quabbin Regions - Hettler, Dr. Joeli, Chief, Pediatric Emergency Medicine, Baystate Health - Higgins, Clare, Executive Director, Community Action of the Franklin,Hampshire and North Quabbin Regions - Jean-Guillaume, M.D., Rock, Chair of Emergency Medicine, Baystate Wing Hospital - Jock, Jacqueline, School Adjustment Counselor, Ware Middle School - Johnson, Yolanda, Executive Officer for Student Services, Springfield Public Schools - LaBounty, Kerry, Medicaid Program Manager, Health New England - Manser, Katherine, WIC Senior Nutritionist, Community Action of the Franklin, Hampshire, and North Quabbin Regions - Martoccia, Roseann, Executive Director, Franklin County Home Care Corp. - Ostiguy, Karen, Nurse Manager, Baystate Wing Hospital - Paulson, Tina, Nurse Manager, Baystate Mary Lane Hospital - Plourde, Annette, RN, Nurse, Monson Medical Center - Rathlev, Dr. Niels, Chair, Emergency Medicine, Baystate Health - Reilly, Elizabeth, Hardwick Youth Center and Food Pantry - Roose, Dr. Robert, Chief Medical Officer, Addiction Services for the Sisters of Providence Health System; Member of the Governor's Task Force on Opioid Abuse - Russo-Appel, Dr. Maria, Chief Medical Officer, Providence Behavioral Health Hospital (PBHH) - Shaver, John, Chief Financial Officer, Baystate Noble Hospital - Shendell-Falik, Nancy, President, Baystate Medical Center and Sr. VP, Hospital Operations, Baystate Health - Silva, David, Medicaid Community Leader, Health New England - Spain, M.D., Jackie, Medicaid Program Medical Director, Health New England - Talati, M.D., Rakesh, Chair of Emergency Medicine, Baystate Franklin Medical - Taylor, Charles, Reverend, United Church of Ware - Velazquez, M.D., Louis, Baystate Wing Griswold CenterThe following individuals served on the CHNA Steering Committee, which met monthly over the course of a year with the Coalition and CHNA Consultant Team. - Allard, Andrea, President/CEO, YMCA of Westfield - Amador, Ruth, President, National Association of Hispanic Nurses - Western MA Chapter - Ayres, Jim, President and CEO, United Way of Hampshire County - Barber, Tania, President/CEO, Caring Health Center - Blanchette, Mary Ellen, Nurse Leader, Palmer Public Schools - Caisse, Ed, C3/Safe Neighborhood Initiative - South Holyoke, Hampden County Sheriff's Department - Christopolis, Dave, Executive Director, Hilltown CDC - Garozzo, Salvatore, Executive Director, United Cerebral Palsy Assoc. of Berkshire County, Inc. - Graves, Marie, Program Director, Springfield Dept. Health & Human Services - Rudder, Shannon Executive Director, MotherWoman - Lee, Jennifer, Systems Advocate for Change, Stavros Center for Independent Living - Lewandowski, Sue, Representative for Worcester County, Assumption College - Lopez, Luz, Director, MetroCare of Springfield - McCafferty, Gerry, Director of Housing, City of Springfield, Office of Housing - Prullage, Beth, Clinical Social Worker, Providence Behavioral Health - Reeves, Halley, Community Health Planning And Engagement Specialist, MA Dept. of Public Health - Silverman, Risa, Coordinator, Office for Public Health Practice & Outreach, UMASS Amherst School of Public Health and Health Sciences - Simmons, Tony, Community Liaison, Hampden County District Attorney's Office - Simonds, Jane, Sr. Program Manager, Behavioral Health Network - Outpatient Services - Walker, Phoebe, BFMC CBAC Co-chair, Franklin Regional Council of Governments (FRCOG) - Wilson, Gloria, Member Western MA Black Nurses Association - Wood, Ben, Healthy Community Design Coordinator, MA Dept. of Public Health

Baystate Mary Lane Hospital Corporation
"Part V, Section B, Line 6a: In 2016, in partnership with the Coalition of Western MA Hospitals/Insurer, the hospital facility conducted a community health needs assessments (""CHNA"") of the geographic area served by the hospital facility. The Coalition of Western Massachusetts Hospitals/Insurer (""Coalition""), a partnership between nine (9) not-for-profit hospitals and an insurer in western Massachusetts that includes: Baystate Medical Center, Baystate Franklin Medical Center, Baystate Noble Hospital, Baystate Wing Hospital, the former Baystate Mary Lane Hospital (now part of BWH and known as the Baystate Mary Lane Outpatient Center), Holyoke Medical Center, Cooley Dickinson Hospital, Mercy Medical Center (part of Sisters of Providence Health System, a member of Trinity Health - New England), Shriners Hospitals for Children - Springfield, and Health New England, a local health insurer whose service area covers the four counties of western Massachusetts."

Baystate Mary Lane Hospital Corporation
"Part V, Section B, Line 6b: The Coalition of Western MA Hospitals and Insurer engaged Partners for a Healthier Community (""PHC)"", based in Springfield, MA, as the lead consultant to conduct the CHNA's. PHC was supported by two other consultant teams; Community Health Solutions, based in Northampton, MA and Pioneer Valley Planning Commission (PVPC), based in Springfield, MA. The Coalition includes Health New England, a local health insurer whose service area covers the four counties of western Massachusetts."

Baystate Mary Lane Hospital Corporation
Part V, Section B, Line 7d: The hospital facility made its CHNA report widely available to the public via an email distribution, with links to the hospital's website, to community partners and organizations. The regional findings from the CHNA reports were shared publicly at the Western MA Health Equity Summit in November 2016 (over 300 attendees). In addition, the CHNA reports have informed the development and implementation of county wide community health improvement plans. Hospital and CHNA consultant staff have been invited to various venues and audiences to present on the CHNA process and key findings.

Baystate Mary Lane Hospital Corporation
"Part V, Section B, Line 11: The 2016 CHNA was conducted using a determinant of health framework as it is recognized that social and economic determinants of health contribute substantially to population health. It has been estimated that less than a third of our health is influenced by our genetics or biology. Our health is largely determined by the social, economic, cultural, and physical environments that we live in and healthcare we receive.The hospital facility anticipates health needs and available resources may change, therefore, a flexible approach was adopted in the development of its implementation strategy. For example, certain community health needs may become more pronounced and require changes to the initiatives identified by the hospital in the Strategy. Other community organizations may address certain needs, indicating that the hospital's strategies should be refocused on alternative community health needs or assume a different focus on the needs identified in the 2016 CHNA.Hospital resource inputs that will help address priority health needs include, Community Benefits Investments, Community Relations Investments, Better Together Grant Program, Community Education & Training, hospital-based community benefits activities, external grants received by hospital, and other hospital-based program/services.The hospital facility views a community benefits implementation strategy as a ""LIVING"" document. Due to the evolving climate in health care, the hospital's financial health year to year remains unknown; therefore hospital resources and inputs may increase, decrease, or need to be modified. The hospital's implementation strategy work plan provides an opportunity for the hospital to be strategic and focused, yet flexible in its community health planning and improvement efforts. The hospital facility, in partnership with its Community Benefits Advisory Council will updates the work plan with annual outputs and outcomes for each input and activity.No health care system or hospital facility can address all the health needs present in its community. The hospital facility is committed to adhering to its mission and remaining financially healthy so that it can continue to enhance its clinical excellence and patient experience, as well as continue community health planning and improvement efforts. The hospital facility's implementation strategy does not explicitly address all the priority community health needs identified in the 2016 CHNA due to; 1. the hospital's limited resources (time, talent and financial), 2. other hospitals or community organizations within service area are addressing the need; 3. the need falls outside of the hospitals' mission or limited resource capacity. However, many, if not all of the CHNA priority health needs will be addressed INDIRECTLY by the hospital and/or community partners through existing community health planning and improvement efforts.Needs being addressed: - Basic needs, including housing - Cultural humility - Domestic violence - Food deserts/insecurity - Health equity - Health literacy - Insurance challenges - Maternal/infant/child health - Mental health and substance use disorders - Transportation Needs not being addressed: - Care coordination - Chronic health conditions - Limited availability of providers - Physical activity and healthy diet"

Baystate Mary Lane Hospital Corporation
Part V, Section B, Line 13b: All patients with account balances (other than balances resulting from co-payments or deductibles on insured services) are eligible to receive a prompt pay discount of 20% of the balance for claims paid in full at time of service or within 60 days of the date of the initial bill. Patients must request the discount. The discount cannot be combined with the Hospital Supplemental Financial Assistance Program. The hospital offers a co-payment discount program for patients receiving services in the emergency departments of the hospitals. This discount program is available to all hospital emergency department patients with co-payment obligations under private or government health insurance (unless prohibited by law or a BH Hospital's contract with a private insurer or government authority). These patients may reduce the otherwise applicable emergency department service co-payment by 10% if the patient elects to pay the co-payment at the conclusion of the patient's emergency department visit.

Baystate Mary Lane Hospital Corporation
Part V, Section B, Line 15e: The hospital provide patients with information about the availability of State Programs, Health Safety Net, or the Hospital Supplemental Financial Assistance Program which may cover all or some of their unpaid hospital bill as well as about hospital discount programs. For those patients who request such assistance, the hospital assists patients by screening them for eligibility in available State Program and assisting them in applying for such programs. When applicable, the hospital may also assist patients in applying for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. The hospital has contracted with the Executive Office of Health and Human Services and the Commonwealth Health Insurance Connector Authority to serve as a Certified Application Counselor Organization. As a Certified Application Counselor (CAC), appropriate staff will inform a patient of the functions and responsibility of a CAC, seek that the patient sign a Certified Application Counselor Designation Form, and assist the patient in finding applicable financial assistance.

Form 990, Part V, Line 7
7a:https://www.baystatehealth.org/about-us/community-programs/community-benefits/community-health-needs-assessment7b: http://www.cbsys.ago.state.ma.us/cbpublic/public/annual_reports_start.aspx

Form 990, Part V, Line 10
10a: https://www.baystatehealth.org/about-us/community-programs/community-benefits/community-health-needs-assessmentThe Hospital is currently in compliance with the final 501(r) regulations effective for the tax year beginning 10/1/2016. This schedule will be answered accordingly with the 2016 return. This return has been filed according to the proposed regulations which were in place at the time of the 2015 tax year.

Part I, Line 6a:
The hospital facility files an annual community benefits report electronically with the Massachusetts Office of the Attorney General's via their website at http://www.cbsys.ago.state.ma.us/cbpublic/public/annual_reports_start.aspx. The hospital facility's annual community benefits report is also published on the Baystate Health website at https://www.baystatehealth.org/about-us/community-programs/community-benefits/community-health-needs-assessment. The hospital's community benefits report provides the Office of the Attorney General and the general public important information about how the hospital partners with the community to identify and address health needs.

Part I, Line 7:
Line 7a (Charity Care) - community benefit expense was calculated by applying the ratio of patient care cost to charges, calculated on Worksheet 2, against total charity care gross patient charges from the audited financial statements. Line 7b (Unreimbursed Medicaid) - community benefit expense was derived using the organization's cost accounting system, which takes into account all hospital inpatients, outpatients and emergency room patients for whom services were provided and covered under Medicaid and Medicaid managed care plans.Line 7c (Other Means-Tested Programs) - community benefit expense was derived using the organization's cost accounting system, which takes into account all hospital inpatients, outpatients and emergency room patients for whom services were provided and covered under other means-tested government programs.Line 7e Community Health Improvement Services calculations are derived from direct and indirect costs associated with community benefit activities that are aligned with the hospital's 2013 community health needs assessment. These activities are carried out to improve community health and wellness and extend beyond patient care, beyond the walls of the hospital. Community Benefit Operations calculations are derived from costs associated with assigned staff and community health needs and/or assets assessment, as well as other costs associated with community benefit strategy and operations.

Part I, Ln 7 Col(f):
In fiscal year 2013, the organization adopted the provisions of Accounting Standards Update 2011-07, Health Care Entities (Topic 954), Presentation and disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities on October 1, 2012. The update changed how the provision for bad debts is reported on the audited financial statements. In prior years it was included with total operating expenses, and subtracted from total expenses reported in Part IX, Line 25, column (A) for the purpose of calculating the percentages in Part I, Line 7, column (f). In 2016, the provision for bad debts was reported as a deduction to net patient service revenue. The 2016 provision for bad debts totaled $686,120 and is not included in total expenses reported in Part IX, Line 25, column (A) for the purpose of calculating the percentages in Part 1, Line 7, column (f).

Part II, Community Building Activities:
"The following description is not quantified specifically in Part II of Schedule H. The hospital facility is committed to creating healthier communities and understands that many state and federally mandated community benefit programs and services are not sufficient to address ethnic, racial and economic health disparities and inequities. The hospital embraces the traditional definition of ""health"" to include economic opportunity, affordable housing, quality education, safe neighborhoods, food security, social and racial justice, and the arts/culture - all elements that are needed for individuals, families and communities to thrive. The hospital provides many valuable services, resources, programs and financial support - beyond the walls of the hospital and into the communities and homes of the people we serve; including grants and sponsorship of local community-based organizations and the involvement of Baystate leadership with various community board that align with our mission. The hospital facility paid dues to the Quaboag Hills Chamber of Commerce totaling $1,149 in 2016.The hospital participates in the Chamber as we are one of the largest local employers in our service area. The Chamber and its membership coordinate activities toward a common purpose of sustainability and economic growth for the region."

Part III, Line 4:
"The cost of bad debts reported in Part III, line 2 was calculated by applying a ratio of cost to charges (based on the organization's cost accounting system including all hospital inpatients and outpatients) against total patient bad debt net of recoveries as reported in the audited financial statements. For 2016, there was no bad debt attributable to patients who may qualify for financial assistance under the hospital's charity care program (reported in Part III line 3). As noted above, the organization adopted Accounting Standards Update 2011-07 effective October 1, 2012, which changed the way entities report and disclose certain financial information including the provision for bad debts. See footnote #2 (Significant Accounting Policies) on page 13 of the audited financial statements under the caption ""Allowance for Uncollectible Accounts"" for a description of the organization's reporting of its provision for bad debts.If a patient is determined eligible for financial assistance, the appropriate adjustment is made to the patient account based on their income level. Once the necessary approvals are obtained, it then flows to the general ledger. Patients applying for a prompt payment discount will have this allowance entered after agreed upon payment is received."

Part III, Line 8:
Line 6 - included all Medicare allowable costs as calculated in Worksheets D-1 Part II (inpatient) and D Part V (outpatient) of the hospital's 2016 Medicare cost report, based on Medicare costing principles. We believe the shortfall of $1,227,964 reported on line 20 should be treated as community benefit expense for tax reporting purposes because providing care for the elderly is a key component of our commitment to the community. The unreimbursed expenses should be treated similarly to unreimbursed Medicaid since the majority of the local elderly population is not affluent.

Part III, Line 9b:
For patients who are known to qualify for Charity Care or Financial Assistance: The patient may have requested assistance up front at time of service with a Financial Counselor or the Patient could have asked for assistance after receiving their bill by contacting our Patient Billing Services Representatives. The Financial Counselor will assist the patient in applying for the appropriate type of assistance based on their income and circumstances. Once approved for a State Medicaid or other program, all billing and collection activity will stop (except for required co-payments or deductibles).For all other patients, our statements contain information regarding how to apply for financial assistance. Notices concerning availability for assistance are also posted at patient care sites.

Part VI, Line 2:
The Baystate Board Governance Committee meets twice a year and is charged with advocating for community benefits at the Board level and throughout the health system and community; aligning the system's four (4) hospital-specific community benefits implementation strategies into the health system's strategic plan; periodic review of CHNA data; approval of a community benefits mission statement and health priorities; review impacts of community benefits activities and investments; and ensure Baystate's community benefits are in compliance with guidelines established by the MA Attorney General and IRS. Annually, the Office of Public Health and Community Relations provides updates to the Baystate Health Board of Trustees, Baystate President's Cabinet, and other Baystate leadership teams, as requested. The hospital CBAC continues to bring a community lens and filter for the hospital's health priorities. The CBAC provides a community perspective on how to increase wellness and resilience opportunities for optimal health for an entire population; guidance in matching hospital resources to community resources, thus making the most of what is possible with the goal to improve health status and quality of life; and policy advocacy to assure and restore health equity by targeting resources for residents. In 2016, through the community benefits grant investments and the community health needs assessment, the hospital engaged more internal and community stakeholders in its community benefits planning efforts. Participants on the hospital CBAC represent constituencies and communities served by the hospital. CBAC members are responsible for reviewing community needs assessment data and use this analysis as a foundation for providing the hospital with input on its community benefits planning process.

Part VI, Line 3:
The hospital is committed to ensuring that patients in its community have access to quality health care services with fairness and respect without regard to the patients' ability to pay. The hospital recognizes the cost of necessary health care services can impose a significant financial burden on patients who are uninsured or underinsured and acts affirmatively to lessen that burden by offering patients in need the opportunity to apply for free or reduced cost services. The hospital not only offers free and reduced cost care to the financially needy as required by law, but has also voluntarily established discount and financial assistance programs that provide additional free and reduced cost care to more patients residing within the communities served by the hospital.The hospital recognizes the billing and collection process can be bewildering and burdensome for patients and has implemented procedures to make the process understandable for patients; to inform patients about discount and financial assistance options; and to ensure that patients are not subject to aggressive collection activities. Consistent with its patient commitment the hospital is required to maintain a credit and collection policy that reflects its patient billing and collection procedures and complies with applicable state and federal laws and regulations.The hospital has financial counselors available to help patients apply for financial assistance programs that may cover unpaid hospital bills, including a variety of federal and state programs as well as financial assistance through the hospital. Hospital financial counselors have all been trained and certified by the state as Certified Account Counselors to assist patients in applying for available state and federal programs. The hospital is committed to ensuring that patients or prospective patients in the community are aware of financial assistance programs. For uninsured or underinsured patients, the hospital with assist in applying for available financial assistance programs. The hospital notifies patients of the availability of assistance in both the initial bill sent to patients as well as in general notices posted throughout the hospital.When applicable, the hospital also assists patients in applying for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. The hospital provides, upon request, specific information about the eligibility process to be a Low Income Patient under either the Massachusetts Health Safety Net Program or additional assistance for patients who are low income through Baystate's own internal financial assistance program. The hospital also notifies patients about available payment plans based on their family size and income. Our Credit and Collection Policy is posted on the baystatehealth.org website. The goal of posting the Credit and Collection Policy is to ensure that patients or prospective patients in our community are aware of our financial assistance programs. Baystate's Credit and Collection Policy was developed in partnership with Health Care For All, a Massachusetts non-profit organization dedicated to making adequate and affordable health care accessible to everyone, regardless of income, social or economic status.Signs are posted around the hospital to notify patients of the availability of financial assistance programs. Signs are clearly visible in the hospital's service area: they are 8.5 x 11 inches and the Header print font is 32 pts. Notice of availability of financial assistance programs are posted in the following locations; emergency department and/or registration areas, patient financial counselor areas and business office areas that are open to patients.

Part VI, Line 4:
Baystate Mary Lane served, prior to its merger with BWH, the residents of Ware and surrounding communities offering a variety of primary and specialty health care including cancer, cardiology, surgery, and imaging services. The Satellite Emergency Facility at Baystate Mary Lane provides care for emergency injuries or illness, with highly skilled emergency medicine physicians, nurses and staff. The service area for the Baystate Eastern Region is situated halfway between the cities of Worcester and Springfield, MA, and straddles three counties - Worcester, Hampden and Hampshire. The hospital serves approximately 120,000 residents in seventeen towns, with over half this population living in the towns of Belchertown, Ludlow, Palmer, Wilbraham and Ware. Other towns in the service area range in size from 1,000 to 8,500 residents, and are fairly rural in character. There is a mix of rural and urban populations as defined by the U.S. Census Bureau. Urban areas consist of census tracts and/or blocks that meet the minimum population density requirement (2,500-49,999 for urban clusters and over 50,000 for urbanized areas) or is adjacent and meet additional criteria. While the median age across the three counties is in the mid-to-upper 30's, the median ages in the service area's largest towns are over 40, ranging from Belchertown at 42 to Wilbraham at 48 years old. Fewer than 6% of residents in these service areas identify as Black or African American, Asian, Native Hawaiian, American Indian, or Hispanic or Latino.In the Baystate Eastern Region service area, per capita income exceeds the averages in Hampden and Hampshire counties at $31,761. Housing costs are relatively low, and the proportion of housing cost burdened households where people pay more than 30% of their income towards housing is lower than the state (37%) and county rates, though still impacting nearly a third of the population (31%). Poverty rates throughout the service area are also comparatively low at about 8% for the overall population and 9% for children. These rates are well below both the state and county rates. Over 90% of the population in the service area has a high school diploma -- comparable to the statewide rate. Unemployment is somewhat higher than the state rate at 6%. The unemployment rate is based on the number of people who are either working or actively seeking work. A large portion of existing jobs are within the service, transportation, utility and wholesale-retail industries.

Part VI, Line 5:
The hospital facility has a responsibility to respond to health care needs unsupported by government programs. In exchange for this responsibility, the hospital qualifies for tax-exempt status under 501(c)(3). However, providing hospital care alone is not enough to qualify for tax-exempt status. Hospitals also must operate in the public interest and provide programs that benefit the community. The hospital is fully committed to its role in the community and serves with pride and compassion for people in need.The charitable mission of the hospital facility, a member hospital of Baystate Health (BH), is to improve the health of the people in our communities every day, with quality and compassion. The hospital's Community Benefits Mission is to reduce health disparities, promote community wellness and improve access to care for vulnerable populations. The hospital is committed to meeting the identified health and wellness needs of constituencies and communities served through the combined efforts of Baystate Health's member organizations, affiliated providers, and community partners.The hospital facility meets all of the factors required of medical facilities in order to maintain tax exemption, as first described in Revenue Ruling 69-545. In support of patient care and the medical needs of the communities served by the hospital, medical staff membership and privileges are extended to all qualified physicians and practitioners in western Massachusetts who meet the requirements for credentialing and clinical privileges, whether employed by a related Baystate entity or community-based. The hospital's emergency department is open to all in need of care and services; no one requiring emergency care is denied treatment. In addition, surplus funds from operations are generally applied, as permitted, to the following; improvements in patient care, expansion and renovation of existing facilities, purchase and replacement of equipment, debt service, expenses associated with training of physicians and other health care professionals, professional development of medical and other clinical staff, and the support of scientific, translational, and clinical research.Baystate Health's volunteer Board of Trustees, the governing body of the organization and its affiliates, is comprised of the President and Chief Executive Officer of Baystate Health and up to twenty-two (22) other elected Trustees who are representative of the broad range of interests which exist in the communities served by Baystate Health and its affiliates. The Governance Committee oversees the nomination of Trustees and submits recommendations to the Board of Trustees for membership on the various Board committees. In considering nominations or recommendations for trustees, directors, committee members or officers the Governance Committee select nominees who are representative of the various and diverse constituencies served by Baystate Health and its affiliates. In particular the Committee nominates persons who are representative of the community consumer interests of the various neighborhoods and localities which are served by Baystate Health and its affiliates in the carrying out of and pursuant to the charitable mission of the Baystate Health and its affiliates.The hospital's Patient and Family Advisory Council facilitate patients and families to share information and advise the hospital regarding policies and programs. Information from the Council provides hospital leadership with an enhanced understanding of how to improve quality, program development, service excellence, communications, patient safety, facility design, patient and family education, patient and family satisfaction, and loyalty.Please refer to the section above in line 2 for additional examples of the hospital's responsiveness to the community and opportunities for community involvement; including the Board of Trustees' Governance Committee, Community Benefits Advisory Council, and Community Health Needs Assessment. For additional information, please see Line 6 below.

Part VI, Line 6:
"Baystate Health, Inc. is the parent entity of a multi-institutional integrated delivery system composed of four hospitals and other 501(c)(3) organizations. The four hospitals include Baystate Medical Center, Baystate Franklin Medical Center, Baystate Noble Hospital, and Baystate Wing Hospital (and Baystate Mary Lane Outpatient Center) and the other 501(c)(3) organizations include Baystate Medical Practices, Visiting Nurse Association and Hospice of Western New England, Inc., and Baystate Health Foundation Inc. In September 2016, the Massachusetts Public Health Council approved Baystate Wing Hospital's application to merge Baystate Mary Lane Hospital and Baystate Wing Hospital and their respective satellite facilities under one hospital license. The facility previously operated by the filing organization, Baystate Mary Lane Hospital, now referred to Baystate Mary Lane Outpatient Center, is a satellite of Baystate Wing. Inpatient care at Baystate Mary Lane transitioned to Baystate Wing, while all outpatient services continue at Baystate Mary Lane Outpatient Center. The Emergency Department at Baystate Mary Lane Outpatient Center operates as a satellite emergency facility of Baystate Wing Hospital. In July 2015, Baystate Noble Hospital became part of the Baystate Health System. In addition to its nearly 12,000 employees, Baystate Health has medical staff, nurses and residents and fellows, medical students, nursing students, and allied health students who gain comprehensive medical education during the year. Volunteers enhance the work of our employees and interactions with our patients and families. In 2016, more than 1,200 volunteers donated over 104,000 hours showing their belief in the care we provide to our community.Baystate Medical Center (BMC), the flagship 716-bed hospital (including Baystate Children's Hospital) based in Springfield, Massachusetts is Western New England's only tertiary care referral medical center, Level 1 trauma center and neonatal and pediatric intensive care units. BMC serves as a regional resource for specialty medical care and research, while providing comprehensive primary medical services to the community. Baystate Franklin Medical Center (BFMC), a 90-bed facility located in Greenfield, Massachusetts (40 miles north of Springfield near the Vermont border) provides high quality inpatient and outpatient services to residents of rural Franklin county and the North Quabbin region. Inpatient services include behavioral health, intensive care, medical-surgical care, and obstetrics/midwifery. Outpatient services include cardiology, emergency medicine, gastroenterology, general surgery, neurology, oncology, ophthalmology, orthopedics, pediatrics, physical medicine & rehabilitation, pulmonology & sleep medicine, sports medicine, vascular surgery, wound care & hyperbaric medicine.Baystate Wing Hospital (BWH), a 74-bed facility located in Palmer, Massachusetts (18 miles east of Springfield) provides a broad range of emergency, medical, surgical and psychiatric services. Our five medical centers in Belchertown, Ludlow, Monson, Palmer and Wilbraham offer extensive outpatient services to meet the needs of our communities. BWH also includes the Griswold Behavioral Health Center, providing comprehensive behavioral health and addiction recovery services and the Wing VNA and Hospice. We are fully accredited by the Joint Commission and are a designated Primary Stroke Service by the Massachusetts Department of Public Health. Baystate Mary Lane serves the residents of Ware and surrounding communities offering a variety of primary and specialty health care including cancer, cardiology, surgery, and imaging services. The Satellite Emergency Facility at Baystate Mary Lane provides care for emergency injuries or illness, with highly skilled emergency medicine physicians, nurses and staff. Baystate Noble Hospital (BNH) is a 97-bed acute care community hospital providing a broad range of services to the Greater Westfield community. BNH is able to offer direct access to world-class technology, diagnostics, and specialists as a proud member of Baystate Health. Together, we passionately work to ensure that our patients have access to exceptional health care, close to home. An ideal combination of ""high tech and ""high touch,"" a staff of highly trained and compassionate nurses and medical support personnel complements an outstanding medical staff. Services include intensive care, diagnostic imaging, emergency services, cardiopulmonary services and rehab, cancer services, lab and behavioral health. Baystate Medical Practices (BMP) is a tax-exempt, not-for-profit corporation organized to support and assist Baystate Health and its affiliate hospitals, including BMC, BFMC, BWH and BNH, each of which is a Massachusetts not-for-profit corporation, in achieving the fulfillment of their clinical, teaching, research, and other missions related to health care. Baystate Medical Practices, Inc. provides physician services, medical education and research programs to people in the community within its geographic location. BMP's policy is to provide care to any patient in need of medical care, regardless of the patient's ability to pay for such care. Dependent upon the patient's financial capability to pay and consistent with BH and BMP policy, BMP may provide such care free of charge or at amounts below its normal charges. In FY 2016 BMP provided $2,782,513 in charity care. In addition to the charity care provided to patients, BMP's physicians participate in many and varied ongoing community outreach initiatives in the areas of education, employment, safety and health. BMP has also taken a leadership role in strengthening the health of disadvantaged citizens in surrounding communities including specific focus on AIDS and HIV and by providing physician staffing for three community-based health centers through Baystate Medical Center.Visiting Nurse Association and Hospice of Western New England, Inc. provides high quality care, expressly tailored to meet each patients' needs. Our home health team works together to ensure a safe and swift recovery from illness, accident, or surgery in the comfort of home. Baystate Hospice offers medical expertise through our extensive network of caregivers to support patients facing a serious or life limiting illness. Each patient and family is cared for by our certified and experienced nurses, therapists, social workers, hospice aides, spiritual and bereavement counselors, and volunteers. This care team works together, with both the patient and family, to bring understanding, comfort, dignity and a sense of peace, as each patient journey towards the final stage of life.The Baystate Health Foundation's Keeping Care Local campaign raised$5 million for Baystate Franklin Medical Center's new$26 million, 55,000 square-foot surgical facility which proudly opened its doors in the Spring of 2016, helping to enhance surgical services to the people in Franklin County. In addition, the Baystate Health Foundation actively engaged in annual fund, major gift, and event fundraising to ensure ongoing annual support for education, research, programs and capital needs throughout the health system that impact patient care throughout western Massachusetts.In addition to the brief descriptions of the affiliated entities above, this further information speaks to activities of Baystate Health and its affiliates regarding promotion of community health.Over 195,000 language interpreter sessions helped patients and families better understand their care in person, over the phone or via video. Staff interpreted in about 70 languages such as Spanish, American Sign Language, Arabic, Mandarin Chinese, Nepali, Portuguese, Russian, Somali, Ukrainian, and Vietnamese. New languages interpreted this year were Gujarati (India), Fukienese (China), and Mon - an ancient language spoken in Burma and Thailand.UMass Medical School (UMMS) established a regional medical school campus in Springfield, UMMS-Baystate. The new medical school will enroll 25 students in its first class beginning in 2017 in a unique tract called PURCH (Population-based Urban and Rural Community Health). The goals of the program are to increase access to students in Massachusetts seeking an affordable medical education; to respond to the health care needs of the Commonwealth by increasing the number of Massachusetts physicians trained in urban and rural primary care; and to apply proven academic research methods to improve population health, reduce health disparities, and make health care better integrated, more efficient, and more effective."

Form 990, Part VI, Line 6
"The Nurse Residency Program expanded to all Baystate Health hospitals. In partnership with Vizient and American Association of Colleges of Nursing, Baystate welcomed 57 nurse residents this year, providing both advanced curricular activities and fellowship activities to ease the transition from school to practice. Baystate's Nurse Residency Program is a one-year curriculum for newly graduated registered nurses, offering hands-on clinical experience, in-depth learning through monthly seminars, participation in evidence-based projects, and ongoing professional development.Baystate Health is committed to continuing education programs in 30 different professional areas through partnerships with Elms College, Springfield College, Western New England University, STCC, Greenfield Community College, Holyoke Community College, Westfield State University, and many others. Our post graduate programs expanded to 10 medical residencies and 20 fellowships, including new fellowship training programs in hospital medicine and gastroenterology. In addition, Baystate Medical Center welcomed 1,770 new residents, fellows, medical students, nursing students, and allied health students.Research at Baystate Health continued to grow. Baystate Medical Practice faculty members received $7.41M in external funding. Baystate Health researchers received 41 new research awards valued at over $4.4M. Noteworthy new grant activity occurred in the following areas: - Assessing the impact of early pulmonary rehabilitation for chronic obstructive pulmonary disease - Improving antibiotic prescribing for patients with community-acquired pneumonia - Studying the environmental determinants of breast cancer - Advancing the care of neonates born with opioid dependency - Training primary care providers in principles of geriatric medicine - Using evidence-based psychotherapy in the care of pediatric victims of psychological trauma - Coordinating the care of complex illness in pediatricsBaystate Health and its affiliates are committed to providing the communities they serve throughout western Massachusetts with the resources necessary to stay informed and healthy by providing both basic and extensive educational opportunities such as parent education classes, including ""Baystate's New Beginnings"". Also offered are breastfeeding classes, a ""Just for Dads"" class, Prenatal/Postnatal Yoga and infant/toddler safety classes. We also offer Babysitter's Academy, which provides a full day class for teens. Some classes are free while others are offered at a reasonable fee. No one is turned away due to inability to pay. Baystate Health offers many free parenting support groups including breastfeeding gatherings, new parents groups, toddler groups, parents of multiples groups, and a MotherWoman support group. Most of these groups meet weekly. In addition, Baystate Health has a health science library staffed by professionals who help patients, families and the general public access reliable health information.The Mini-Medical School program is an eight-part health education series offered at Baystate Medical Center featuring a different aspect of medicine each week. Designed for an adult audience, each course is taught by an energetic faculty member who will explain the science of medicine without resorting to complex terms. Mini-Medical School gives Baystate Health the opportunity to open our doors to the public and share our knowledge of medicine in a comfortable and friendly environment. Many of the students participate due to a general interest and later find that many of the things they learned over the semester are relevant to their own lives. The goal of this program is to help members of the public make more informed decisions about all aspects of their health care while receiving insight on what it's like to be a medical student. Tuition is $95 per person, $80 for Senior Class and Spirit of Women members. Baystate Health offers 50+ free programs to seniors and women. Baystate Health Senior Class is a loyalty program dedicated to health and wellness for men and women ages 55 and over. The 23,000 Senior Class members receive a quarterly newsletter with valuable health information, benefits and invitations to special events designed with their interests in mind. Baystate Spirit of Women Loyalty Program offers its 15,000 members 50+ monthly seminars with direct access to physicians, nurses and other medical professionals and the latest women's health information. The program is designed to increase knowledge of women's health issues so they are well prepared to make the best decisions regarding their health.The Mark R. Tolosky Baystate Neighbors Program, named in honor of our past President and CEO, provides forgivable loans to Baystate Health employees purchasing their first homes in the communities surrounding our hospitals. Qualified employees are granted a forgivable loan up to $7,500 that may be used towards a down payment or closing costs. In 2016, Baystate Health granted 50 loans to employees. Since 1999, Baystate Health has invested over $1.6 million in the futures of more than 220 employees and their families.Since its inception in 1994, Rays of Hope has been helping women and men in the fight against breast cancer by walking alongside them on their cancer journey. Through the Baystate Health Breast Network, Rays of Hope cares for the whole person from diagnosis and beyond by supporting research at the Rays of Hope Center for Breast Cancer Research, providing funding for state-of-the-art equipment, breast health programs and outreach and education throughout Baystate Health as well as providing grants for complementary therapies and cancer programs to our community partners throughout western Massachusetts. Now in its 24th year, Rays of Hope has raised over $13.7 million - all of which has been awarded locally throughout western Massachusetts.The United Way develops and supports programs that directly improve the lives of people in our communities, a mission proudly shared by Baystate Health. Baystate Health is a strong supporter of the United Way, and a major contributor to the organization with workforce campaigns and thousands of employee donors and volunteers. Baystate Health's contributions help the United Way serve our families, friends, colleagues and others who seek help in different ways and at different times in their lives. Three community campaigns are held annually: Springfield, Westfield, and Palmer workplace to support the United Way of Pioneer Valley, Greenfield workplace to support the United Way of Franklin County and Ware workplace to support the United Way of Hampshire County. Employees can direct their donations to one or all of the United Way's action areas: Education, Income and Health or designate to a qualified agency with a minimum contribution. See also additional information regarding Baystate Health, Inc. and its affiliates promotion of community health above in Line 5."

Form 990, Part VI, Line 6

Form 990, Part VI, Line 6

Form 990, Part VI, Line 7
List of States receiving community benefit report: MA.