4A (Expenses $ 336085022 including grants of $ 0) (Revenue $ 351439795)
BROCKTON HOSPITAL IS AN ACUTE CARE HOSPITAL LICENSED BY THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH TO OPERATE 216 ACUTE CARE BEDS (COMPOSED OF 131 MEDICAL/SURGICAL, 16 INTENSIVE CARE, 8 PEDIATRIC, 20 OBSTETRIC, 22 PSYCHIATRIC), AND 19 BASSINETS (COMPOSED OF 13 WELLINFANT AND 6 SPECIAL CARE). THE HOSPITAL OFFERS A COMPREHENSIVE RANGE OF HEALTH CARE SERVICES TO MEET DIVERSE COMMUNITY NEEDS INCLUDING EMERGENCY CARE, ACUTE CARE (INCLUDING MEDICAL/SURGICAL, OBSTETRICS, PEDIATRIC, PSYCHIATRIC, CARDIAC AND CANCER CARE. THE HOSPITAL PROVIDES FREE CARE TO THOSE WHO ARE UNABLE TO PAY, SPONSORS FREE HEALTH SCREENINGS, VARIOUS SUPPORT GROUPS AND EDUCATIONAL PROGRAMS, INCLUDING PUBLIC HEALTH EDUCATION, WELLNESS PROGRAMS AND THE TRAINING OF HEALTH PROFESSIONALS SUCH AS FIRST RESPONDER EDUCATION AND TRAINING. DURING THE YEAR ENDED SEPTEMBER 30, 2021 THE HOSPITAL HAD 14,320 TOTAL DISCHARGES AND OBSERVATIONS, 53,872 TOTAL PATIENT DAYS, AND 174,273 OUTPATIENT CLINIC VISITS. THE HOSPITAL'S EMERGENCY DEPARTMENT HAD 51,451 VISITS DURING THE FISCAL YEAR AND IS OPEN 24 HOURS A DAY, EVERY DAY OF THE YEAR AND PROVIDES CARE REGARDLESS OF ONE'S ABILITY TO PAY.

SCHEDULE H, PART V, SECTION B, LINE 5:
THE 2022 SIGNATURE HEALTHCARE COMMUNITY HEALTH NEEDS ASSESSMENT SOLICITED THE INPUT OF A VARIETY OF COMMUNITIES WITHIN ITS SERVICE AREA, WITH A PARTICULAR FOCUS ON INDIVIDUALS AND GROUPS FACING SOCIAL, ENVIRONMENTAL AND FINANCIAL INEQUITIES. SUCH QUALITATIVE INPUT PROVIDED IMPORTANT CONTEXT FOR THE QUANTITATIVE DATA THAT WAS COLLECTED AND ANALYZED. SEVEN FOCUS GROUPS WERE CONDUCTED WITH SIX OF THOSE DONE VIRTUALLY. PARTICIPANTS RANGED SIGNIFICANTLY IN AGE, SOCIO-ECONOMIC STATUS, RESIDENCY, PRIMARY LANGUAGE, RACE AND ETHNICITY. ONE OF THE FOCUS GROUPS WAS CONDUCTED IN COLLABORATION WITH BETH ISRAEL DEACONNESS HOSPITAL-MILTON FOR THE COMMUNITY OF RANDOLPH. FEEDBACK FROM FOCUS GROUPS AND KEY INFORMANTS WERE CODED AND PRIORITIZED BASED ON FREQUENCY. EIGHT KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH A VARIETY OF COMMUNITY STAKEHOLDERS.

SCHEDULE H, PART V, SECTION B, LINE 7A:
HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/SIGNATUREHEALTHCARE/MEDIA/PDF/SIGNATU RE-HEALTHCARE-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-2022.PDF

SCHEDULE H, PART V, SECTION B, LINE 10A:
HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/SIGNATUREHEALTHCARE/MEDIA/PDF/2019 COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF

SCHEDULE H, PART V, SECTION B, LINE 11:
"HOUSING AND HOMELESSNESS: WE TREAT A LARGE POPULATION OF HOMELESS PATIENTS. THEY RECEIVE TREATMENT REGARDLESS OF THEIR RESIDENCY. WE ARE EXPLORING OPPORTUNITIES TO FURTHER SUPPORT THIS POPULATION WITH THEIR HOUSING NEEDS. SIGNATURE HEALTHCARE & FR. BILLS AND MAINSPRING CONTINUE TO PARTNER TO PROVIDE RESPITE FOR HOMELESS PATIENTS BEING DISCHARGED FROM THE HOSPITAL OR RELEASED FROM THE ED. BECAUSE PATIENTS REQUIRE CONTINUED REST TO PROMOTE HEALING, TWO BEDS ARE UTILIZED IN THE SHELTER FOR PATIENTS TO BE ABLE TO ""STAY IN"" FOR RECUPERATION AND AVOID BEING OUT ON THE STREETS THROUGHOUT THE DAY, POTENTIALLY EXACERBATING THE CONDITION IN WHICH THEY WERE TREATED. IN ADDITION, THIS COLLABORATION EXTENDS TO BROCKTON VNA TO PROVIDE ADDITIONAL HOME CARE SERVICES TO THE PARTICIPANTS INCLUDING NURSING AND PHYSICAL THERAPY. SIGNATURE HEALTHCARE BROCKTON HOSPITAL PARTNERS WITH FATHER BILLS AND MAINSPRING HOUSE JOB DEVELOPERS ALONG WITH OTHER SUPPORTERS OF LOCAL BUSINESSES INCLUDING BRIDGEWATER STATE UNIVERSITY, DEPARTMENT OF TRANSITIONAL ASSISTANCE, ARBELLA INSURANCE FOUNDATION, STATE STREET, UNITED WAY OF GREATER PLYMOUTH COUNTY AND CITIZENS BANK. WE RECRUIT GRADUATES FROM THE WORK EXPRESS AND WORK READY PROGRAM INTO PAYING JOBS WHERE THEY CAN WORK TO BROADEN THEIR SKILLS AND EXPERIENCE VARIOUS HEALTHCARE EMPLOYMENT OPPORTUNITIES. IN MANY CASES PARTICIPATION IN THIS PROGRAM HELPS REBUILD THEIR LIVES AND PROVIDE FOR THEIR FAMILIES SIGNATURE HEALTHCARE HAS BEEN SUCCESSFUL IN HIRING GRADUATES FROM BOTH PROGRAMS INTO VARIOUS PART TIME, PER DIEM AND FULL TIME POSITIONS WITHIN THE HOSPITAL SETTING. EDUCATION ACCESS: SIGNATURE HEALTHCARE AND ONE FAMILY LAUNCHED C2C'S FIRST EMPLOYER PARTNERSHIP IN FY 21. THIS TWO-YEAR PILOT PARTNERSHIP HAS TWO MAIN GOALS: FIRST, TO HELP CURRENT ENTRY-LEVEL, LOW-WAGE SIGNATURE HEALTHCARE EMPLOYEES ACCESS BETTER CAREER GROWTH PATHWAYS WITHIN THE HOSPITAL NETWORK. SECOND, IT EMPOWERS BROCKTON AREA RESIDENTS TO ENTER QUALITY CAREER PATHS WITH SIGNATURE HEALTHCARE AND REGIONAL EMPLOYERS. IN FY 22, THE PROGRAM SERVED 92 HOUSEHOLDS IN COLLABORATION WITH SIGNATURE HEALTHCARE. THE PROGRAM OUTCOMES ARE TREMENDOUS WITH 78% OF THE PARTICIPANTS BEING EMPLOYEES OR ENROLLED IN A CREDENTIAL BY THE END OF THE PROGRAM, AND NEW JOBS WERE SECURED THROUGH C2C WITH AN AVERAGE SALARY INCREASE OF $22,475, HELPING TO IMPROVE FINANCIAL STABILITY. HEALTH CARE ACCESS: SIGNATURE HEALTHCARE AIMS TO LINK THOSE WHO FACE BARRIERS TO HEALTHCARE ACCESS OR DISPARITIES IN HEALTH OUTCOMES DUE TO THE SOCIAL DETERMINANTS OF HEALTH TO APPROPRIATE COMMUNITY BASED SERVICES, SCHEDULE APPOINTMENTS WITH PRIMARY AND SPECIALTY CARE PROVIDERS AND OFFER FREE SCREENINGS. SIGNATURE HEALTHCARE ALSO PROVIDES PHYSICIAN OUTREACH DIRECTLY IN THE COMMUNITIES WHERE SIGNATURE HEALTHCARE CORPORATION PATIENTS RESIDE FOR ""ONE ON ONE"" INTERACTION. SAFETY: DOMESTIC VIOLENCE WAS SEEN AS AN ISSUE IN THE BROCKTON AREA. OUR CLINICIANS HAVE PROVIDED EDUCATION ON HEALTHY RELATIONSHIPS TO AREA COMMUNITY GROUPS. SIGNATURE HEALTHCARE CONTINUES TO WORK CLOSELY WITH AND SUPPORT FAMILY & COMMUNITY RESOURCES, INC., HEALTH IMPERATIVES AND CAPE VERDEAN WOMEN UNITED, ALL OF WHICH PROVIDE DOMESTIC VIOLENCE SUPPORT TO THOSE LIVING IN OUR COMMUNITY. MATERNAL AND CHILD HEALTH: SIGNATURE HEALTHCARE HAS 10 OB/GYN PHYSICIANS WITHIN ALL SIGNATURE MEDICAL GROUP LOCATIONS ALONG WITH 6 PEDIATRICIANS IN BROCKTON, EASTON, AND RANDOLPH. SIGNATURE HEALTHCARE BROCKTON HOSPITAL HAS AN INPATIENT PEDIATRICS DEPT. WHICH IS STAFFED 24/7 BY TUFTS FLOATING HOSPITALISTS. SIGNATURE HEALTHCARE IS A ""BABY FRIENDLY DESIGNATED HOSPITALSTRIVES TO SUPPORT MOTHERS TO BREASTFEED BABIES FOR THE BEST START IN LIFE. SIGNATURE HEALTHCARE WROTE A BREASTFEEDING POLICY THAT IS ROUTINELY COMMUNICATED TO ALL HEALTHCARE STAFF AND PROVIDES EDUCATION AND INFORMATION TO ALL EXPECTING MOTHERS ON THE BENEFITS OF BREASTFEEDING. MATERNITY STAFF HELP MOTHERS INITIATE BREASTFEEDING WITHIN ONE HOUR OF BIRTH AND CONTINUE TO SHOW MOTHERS HOW TO BREASTFEED AND MAINTAIN LACTATION EVEN IF THEY ARE SEPARATED FROM THEIR INFANTS. SIGNATURE HEALTHCARE OFFERS BABE-E-NEWS A FREE; OPT-IN, ELECTRONIC NEWSLETTER PROVIDING EDUCATION, TOOLS AND RESOURCES FOR PREGNANCY INTO EARLY CHILDHOOD. THE INFORMATION IS TAILORED TO A MOTHER' S DUE DATE OR CHILD 'S BIRTH DATE, MAKING THE WEEKLY INFORMATION RELEVANT AND USEFUL. THIS NEWSLETTER CAN ALSO BE SHARED WITH ANY NUMBER OF FAMILY MEMBERS WHO CAN SELECT TO READ THE NEWSLETTER IN MULTIPLE LANGUAGES. COMMUNICATING TO PATIENTS IN THEIR NATIVE LANGUAGE HELPS TO PROMOTE COMPLIANCE AND UNDERSTANDING OF THEIR PERSONAL HEALTHCARE. IN FY 20, SIGNATURE HEALTHCARE PARTNERED WITH YOMINGO, AN ONLINE CHILDBIRTH EDUCATION PROGRAM. BY WORKING WITH YOMINGO, SIGNATURE HEALTHCARE WAS ABLE TO HELP OUR PATIENTS ELIMINATE THE HURDLE OF FITTING IN-PERSON CHILDBIRTH CLASSES INTO THEIR SCHEDULE AND PRACTICE SOCIAL DISTANCING AND INSTEAD BRINGS CLASSES TO THEM. THIS IS A FREE PROGRAM FOR OUR PATIENTS AND IS AVAILABLE IN 14 LANGUAGES. YOMINGO'S EVIDENCE-BASED ONLINE MATERNITY EDUCATION INCLUDES EDUCATION ON LABOR AND BIRTH AND TOPICS SUCH AS BREASTFEEDING, NEWBORN CARE, COMMUNITY HEALTH RESOURCES, SUPPORT GROUPS AMONGST VARIOUS OTHER TOOLS. STD HIV/AIDS - REFER TO FAMILY PLANNING FOR EVALUATION AND TREATMENT AND WITH THE POSSIBILITY OF BEING REFERRED TO OUR INFECTIOUS DISEASE PHYSICIAN FOR FURTHER TREATMENT AND FUTURE HEALTH CARE NEEDS. RISKY BEHAVIORS AND HEALTH SCREENINGS: SIGNATURE HEALTHCARE CONTINUES TO WORK WITH STAFF FROM HIGH POINT THE BROCKTON AREA PREVENTION COLLABORATIVE AND THE PLYMOUTH COUNTY DRUG ABUSE TASK FORCE. SIGNATURE HEALTHCARE EMERGENCY DEPARTMENT PHYSICIANS WORK WITH LOCAL POLICE AND FIRE DEPARTMENTS PROVIDING TRAINING AND MEDICAL GUIDANCE. POLICE DEPARTMENTS FROM NORFOLK, PLYMOUTH AND BRISTOL COUNTIES WERE TRAINED ON THE PROPER USE OF NASAL NARCAN. THE ED PHYSICIANS ALSO WORKED ON PROJECTS WITH THE NORFOLK PLYMOUTH AND MIDDLESEX COUNTY DISTRICT ATTORNEY'S OFFICES TO PROVIDE LECTURES TO STUDENTS, PARENTS TEACHERS AND OTHER HEALTHCARE PROFESSIONALS ON SUBSTANCE USE AND OTHER HEALTH CONCERNS FACING OUR AREA YOUTH. DR. MUSE SERVES AS THE EMS MEDICAL DIRECTOR FOR 14 LOCAL FIRE DEPARTMENTS, AND IS VERY ACTIVE IN OTHER MATTERS RELATED TO SUBSTANCE USE, INCLUDING THE BROCKTON MAYOR'S OPIOID COALITION INDEPENDENCE ACADEMY, AND PLYMOUTH COUNTIES SUBSTANCE ABUSE COALITION. DR. DAN MUSE, SIGNATURE HEALTHCARE ED PHYSICIAN, OF COORDINATES TEACHING ROUNDS WITH LOCAL EMS TEAMS. THESE INCLUDE EDUCATION ON VARIOUS TOPICS INCLUDING, HUMAN TRAFFICKING: LEGAL AND SOCIAL RAMIFICATIONS, DOMESTIC ABUSE, ADVERSE CHILDHOOD EVENTS, PEDIATRIC TRAUMA CARE AND NEWBORN CARE IN-FIELD DELIVERY, TO NAME A FEW. EMS PROFESSIONALS DELIVERING PATIENTS TO THE SIGNATURE HEALTHCARE EMERGENCY DEPARTMENT ARE INVITED TO WATCH LIFE-SAVING STENTING PROCEDURES IN ONE OF TWO BROCKTON HOSPITAL CARDIAC CATHETERIZATION LABS - CLOSING THE LOOP ON WHAT HAPPENS AFTER THEY DROP OFF A PATIENT IN CARDIAC ARREST. SIGNATURE HEALTHCARE AND DR. DAN MUSE HAVE ESTABLISHED A VERY CLOSE RELATIONSHIP WITH THE CITY OF BROCKTON. DR. MUSE IS THE MEDICAL DIRECTOR FOR BROCKTON POLICE AND FIRE. HE ALSO SERVES AS THE MEDICAL DIRECTOR FOR THE BROCKTON FIRE DEPARTMENT DISPATCH. FOR THE LAST FOUR YEARS, DR. MUSE HAS BEEN PART OF THE BROCKTON POLICE DEPARTMENT'S YEARLY MENTAL HEALTH TRAINING. HE ALSO WORKS CLOSELY WITH LOCAL POLICE AND FIRE ON SPECIAL PROGRAMS IN THEIR DEPARTMENTS AND TOWNS. A NEW PROGRAM ""SAVE A LIFE"" IS BEING LAUNCHED IN 2020. THIS PROGRAMS WORKS IN CONJUNCTION WITH LOCAL EMS TO TRAIN CITIZENS OF THEIR COMMUNITIES IN LIFE SAVING TECHNIQUES OF CPR AED USE NARCAN ADMINISTRATION AND ""STOP THE BLEED"" SKILLS. WITHIN THE SIGNATURE HEALTHCARE EMERGENCY DEPARTMENT OVERDOSE PATIENTS RECEIVE NASAL NARCAN, A LIST OF DETOX FACILITIES AND COUNSELING. THE ED PHYSICIANS ARE ALSO LIMITING THE NUMBER OF NARCOTICS THEY PRESCRIBE TO PATIENTS. THEY WILL NOT FILL LOST PRESCRIPTIONS AND ARE ADVANCING USE OF THE STATE'S ""PRESCRIPTION MONITORING PROGRAM."" SIGNATURE HEALTHCARE CREATED A PAIN AND OPIOID MANAGEMENT COMMITTEE WHO DEVELOPED A CHARTER TO GUIDE OUR PURPOSE AND ENSURE WE'RE MEETING THE REGULATORY REQUIREMENTS OF THE JOINT COMMISSION AS THEY RELATE TO PAIN AND OPIOID MANAGEMENT. WE STARTED BY ENSURING APPROPRIATE PAIN AND OPIOID MANAGEMENT POLICIES WERE DEVELOPED TO MEET THE NEEDS OF OUR PATIENT POPULATIONS. AT THE SAME TIME WE HAVE BEEN MONITORING THE EFFECTIVENESS OF PATIENT PAIN ASSESSMENTS AND PAIN MANAGEMENT THROUGHOUT THE ORGANIZATION. PART OF OUR EFFORT INCLUDES RAISING AWARENESS OF AVAILABLE SERVICES FOR CONSULTATION AND REFERRAL FOR PATIENTS WITH COMPLEX PAIN MANAGEMENT NEEDS AMONG STAFF AND OUR LICENSED INDEPENDENT PRACTITIONERS. THE COMMITTEE WORKS TO ENSURE EDUCATIONAL RESOURCES AND PROGRAMS ARE AVAILABLE TO IMPROVE PAIN ASSESSMENT PAIN MANAGEMENT, AND SAFE USE OF OPIOID MEDICATIONS THROUGHOUT THE ORGANIZATION IN AN ONGOING BASIS. EACH YEAR, DR. MUSE, IN CONJUNCTION WITH THE DIST"

SCHEDULE H, PART V, LINE 16A, FAP WEBSITE:
HTTPS://WWW. SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT FORMS/FINANCIAL-ASSISTANCE

SCHEDULE H, PART V, LINE 16B, FAP APPLICATION WEBSITE:
HTTPS://WWW.SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT FORMS/FINANCIAL-ASSISTANCE

SCHEDULE H, PART V, LINE 16C, FAP PLAN LANGUAGE SUMMARY WEBSITE:
HTTPS://WWW. SIGNATURE-HEALTHCARE.ORG/PATIENTS-VISITORS/PATIENT- FORMS/FINANCIAL-ASSISTANCE

SCHEDULE H, PART V, SECTION B, LINE 16H:
THE HOSPITAL, IN COLLABORATION WITH LOCAL NOT FOR PROFIT ORGANIZATIONS SUCH AS THE UNITED WAY AND MASSASOIT COMMUNITY COLLEGE, MAINTAINS COPIES OF ITS ONE PAGE PLAIN LANGUAGE SUMMARY FINANCIAL ASSISTANCE POLICY ON-SITE AT THESE ORGANIZATIONS IN AN EFFORT TO NOTIFY MEMBERS OF ITS COMMUNITIES WHO ARE MOST LIKELY IN NEED OF FINANCIAL ASSISTANCE ABOUT THE AVAILABILITY OF SUCH ASSISTANCE.

SCHEDULE H, PART V, SECTION B, LINE 16J:
"WHEN REGISTERING FOR SERVICES OR IF RECEIVING A BILL, THE HOSPITAL ENCOURAGES PATIENTS TO CONTACT STAFF TO DETERMINE IF THEY AND/OR A FAMILY MEMBER ARE IN NEED OF AND ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL POSTS GENERAL NOTICES AT SERVICE DELIVERY AREAS WHERE THERE IS REGISTRATION OR A CHECK-IN AREA (INCLUDING, BUT NOT LIMITED TO INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENTS AND AFFILIATED HEALTH CENTER LOCATIONS, CERTIFIED APPLICATION COUNSELORS (""CAC"") OFFICES AND IN GENERAL BUSINESS OFFICE AREAS CUSTOMARILY USED BY PATIENTS THAT INFORM PATIENTS ABOUT THE AVAILABILITY OF PUBLIC ASSISTANCE AND HOSPITAL FINANCIAL ASSISTANCE AS WELL AS THE LOCATIONS WITHIN THE HOSPITAL AND/OR THE PHONE NUMBERS TO CALL TO SCHEDULE AN APPOINTMENT WITH A CAC."

SCHEDULE H, PART I, LINE 6A:
THE COMMUNITY BENEFIT REPORT IS MADE AVAILABLE AT https://www.signature-healthcare.org/about/community-benefits.

SCHEDULE H, PART I, LINE 7:
COSTS FOR FIGURES USED IN THE LINE 7 TABLE ARE DERIVED USING WORKSHEET 2 FOR 7 A-D. DIRECT COSTS FOR 7E AND 7I, AND THE HOSPITAL'S COST ACCOUNTING SYSTEM FOR 7F-G.

SCHEDULE H, PART II, COMMUNITY BUILDING ACTIVITIES:
SIGNATURE HEALTHCARE COLLABORATES WITH AND SUPPORTS AREA ORGANIZATIONS BOTH FINANCIALLY AND WITH OUR CLINICAL EXPERTISE. WE BELIEVE THAT BY SUPPORTING AND WORKING WITH COMMUNITY PARTNERS, WE ARE ABLE TO MAKE A LARGER IMPACT ON THE OVERALL HEALTH OF OUR COMMUNITY.

SCHEDULE H, PART III, LINE 2:
THE HOSPITAL USED THE RATIO OF ITS TOTAL COSTS TO CHARGES FROM WORKSHEET 2 TO CALCULATE THE AMOUNT OF BAD DEBT EXPENSE.

SCHEDULE H, PART III, LINE 3:
THE HOSPITAL USED THE RATIO OF ITS TOTAL COSTS TO CHARGES FROM WORKSHEET 2 TO CALCULATE THE AMOUNT OF BAD DEBT EXPENSE FOR THOSE PATIENTS ELIGIBLE FOR CHARITY CARE.

SCHEDULE H, PART III, LINE 4:
THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS EQUAL TO ESTIMATED BAD DEBT LOSSES. THE ESTIMATED LOSSES ARE BASED ON HISTORICAL COLLECTION EXPERIENCE TOGETHER WITH A REVIEW OF THE CURRENT STATUS OF EXISTING RECEIVABLES. THIS FOOTNOTE IS FOUND ON PAGE 36 OF THE AUDITED FINANCIAL STATEMENTS.

SCHEDULE H, PART III, LINE 8:
THE HOSPITAL CONTINUES TO SERVE ITS VULNERABLE INDIGENT POPULATION AMIDST RISING COSTS WHILE MANY AREAS OF REIMBURSEMENT CONTINUE TO ERODE. THE CHANGE IN DSH PAYMENT METHODOLOGY, AS ONE SIGNIFICANT EXAMPLE, HAS REDUCED THE HOSPITAL'S DSH PAYMENT BY NEARLY HALF OF WHAT IT WAS UNDER THE FORMER METHODOLOGY. THE HOSPITAL USES THE MEDICARE COST REPORT AS THE COST ACCOUNTING SYSTEM TO CALCULATE ITS MEDICARE COSTS.

SCHEDULE H, PART III, LINE 9B:
THE FOLLOWING PATIENT POPULATIONS ARE EXEMPT FROM ANY COLLECTION OR BILLING PROCEDURES PURSUANT TO STATE REGULATIONS AND POLICIES: PATIENTS ENROLLED IN A PUBLIC HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN (EAEDC), CHILDREN'S MEDICAL SECURITY PLAN (CMSP), IF MAGI INCOME IS EQUAL TO OR LESS THAN 300% OF THE FPL; LOW INCOME PATIENTS AS DETERMINED BY MASSHEALTH AND SAFETY NET, INCLUDING THOSE WITH MAGI HOUSEHOLD INCOME OR MEDICAL HARDSHIP FAMILY COUNTABLE INCOME BETWEEN 150.1% TO 300% OF THE FPL; AND MEDICAL HARDSHIP, SUBJECT TO THE FOLLOWING EXCEPTIONS: (A) THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY PATIENT ENROLLED IN THE ABOVE MENTIONED PROGRAMS FOR THEIR REQUIRED CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY EACH SPECIFIC PROGRAM; (B) THE HOSPITAL MAY ALSO INITIATE BILLING OR COLLECTION FOR A PATIENT WHO ALLEGES THAT HE OR SHE IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COSTS OF THE HOSPITAL SERVICES, BUT FAILS TO PROVIDE PROOF OF SUCH PARTICIPATION. UPON RECEIPT OF SATISFACTORY PROOF THAT A PATIENT IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM (INCLUDING RECEIPT OR VERIFICATION OF SIGNED APPLICATION) THE HOSPITAL SHALL CEASE ITS BILLING OR COLLECTION ACTIVITIES; (C) THE HOSPITAL MAY CONTINUE COLLECTION ACTION ON ANY LOW INCOME PATIENT FOR SERVICES RENDERED PRIOR TO THE LOW INCOME PATIENT DETERMINATION, PROVIDED THAT THE CURRENT LOW INCOME PATIENT STATUS HAS BEEN TERMINATED EXPIRED OR NOT OTHERWISE IDENTIFIED ON THE STATE ELIGIBILITY VERIFICATION SYSTEM OR MEDICAID MANAGEMENT INFORMATION SYSTEM. HOWEVER, ONCE A PATIENT IS DETERMINED ELIGIBLE ANO ENROLLED IN MASSHEALTH THE PREMIUM ASSISTANCE PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PLAN OR MEDICAL HARDSHIP, THE HOSPITAL WILL CEASE COLLECTION ACTIVITY FOR SERVICES (WITH THE EXCEPTION OF ANY COPAYMENTS ANO DEDUCTIBLES) PROVIDED PRIOR TO THE BEGINNING OF THEIR ELIGIBILITY. (D) THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY OF THE PATIENTS PARTICIPATING IN THE PROGRAMS LISTED ABOVE FOR NON-COVERED SERVICES THAT THE PATIENT HAS AGREED TO BE RESPONSIBLE FOR, PROVIDED THAT THE HOSPITAL OBTAINED THE PATIENT'S PRIOR WRITTEN CONSENT TO BE BILLED FOR SUCH SERVICE(S). HOWEVER, EVEN IN THESE CIRCUMSTANCES THE HOSPITAL MAY NOT BILL THE PATIENT FOR CLAIMS RELATED TO MEDICAL ERRORS OR CLAIMS DENIED BY THE PATIENT'S PRIMARY INSURER DUE TO AN ADMINISTRATIVE OR BILLING ERROR.

SCHEDULE H, PART VI, LINE 2:
SIGNATURE HEALTHCARE WORKS COLLABORATIVELY WITH THE BROCKTON DEPARTMENT OF PUBLIC HEALTH THE BROCKTON AREA NEIGHBORHOOD HEALTH CENTER AND NUMEROUS COMMUNITY SOCIAL SERVICE AGENCIES TO COORDINATE PUBLIC HEALTH INITIATIVES TO ADDRESS THE NEEDS OF THE AT-RISK POPULATION. SIGNATURE HEALTHCARE FOLLOWS THE GUIDELINES BY PARTICIPATING IN A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. WE USE A FOUR PRONGED APPROACH TO THESE ASSESSMENTS THAT INCLUDES: CONDUCTING KEY INFORMANT INTERVIEWS WITH PEOPLE WHO WORK WITHIN OUR SERVICE AREA TO DETERMINE HOW THE NEEDS OF THE RESIDENTS ARE MET, BY REVIEWING EXISTING PROGRAMS/STRATEGIES AND SERVICES IN THE AREA, BY ANALYZING DATA TO DETERMINE HOW HEALTH OUTCOMES IN THE CITY AND SURROUNDING TOWNS COMPARED TO THE STATE AVERAGE AND LASTLY BY PARTICIPATING IN FOCUS GROUPS TO EXAMINE PERCEPTIONS ON HOW PARTICULAR ISSUES IMPACT THOSE INDIVIDUALS.

SCHEDULE H, PART VI, LINE 6:
BROCKTON HOSPITAL (BH) IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. UNDER THE CONTROL OF ITS PARENT ORGANIZATION, SIGNATURE HEALTHCARE CORPORATION, INC. (SHC) AFFILIATES BH AND SIGNATURE HEALTHCARE MEDICAL GROUP, INC. (SMG) COORDINATE THE PROVISION OF HEALTH CARE AND RELATED SERVICES TO THE RESIDENTS OF BROCKTON AND ITS SURROUNDING CITIES AND TOWNS

SCHEDULE H, PART VI, LINE 7, LIST OF STATES REC. COMMUNITY BENEFIT REPORT:
MA

SCHEDULE H, PART VI, LINE 3:
"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. IN ADDITION, THE HOSPITAL ALSO POSTS GENERAL NOTICES AND MAKES PAPER COPIES OF THE FAP DOCUMENTS AVAILABLE UPON REQUEST AND WITHOUT CHARGE BOTH BY MAIL AND AT SERVICE DELIVERY AREAS WHERE THERE IS A REGISTRATION OR CHECK-IN AREA (INCLUDING, BUT NOT LIMITED TO, INPATIENT, OUTPATIENT EMERGENCY DEPARTMENTS, AND AFFILIATED COMMUNITY HEALTH CENTER LOCATIONS), IN CERTIFIED APPLICATION COUNSELOR (""CAC"") OFFICES AND IN GENERAL BUSINESS OFFICE AREAS THAT ARE CUSTOMARILY USED BY PATIENTS (E.G., ADMISSIONS AND REGISTRATION AREAS OR PATIENT FINANCIAL SERVICES OFFICES THAT ARE ACTIVELY OPEN TO THE PUBLIC). IN ADDITION, THE HOSPITAL POSTS NOTICES IN LOCAL COMMUNITY HEALTH CENTERS, SENIOR AND EDUCATION FACILITIES. THE GENERAL NOTICE WILL INFORM THE PATIENT ABOUT THE AVAILABILITY OF PUBLIC ASSISTANCE AND HOSPITAL FINANCIAL ASSISTANCE (INCLUDING MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PROGRAM, THE HEALTH SAFETY NET AND MEDICAL HARDSHIP) AS WELL AS THE LOCATION (S) WITHIN THE HOSPITAL AND/OR THE PHONE NUMBERS TO CALL TO SCHEDULE AN APPOINTMENT WITH A CAC. INFORMATION ABOUT APPLYING FOR FINANCIAL ASSISTANCE IS ALSO AVAILABLE ONLINE AT WWW.SIGNATURE-HEALTHCARE.ORG. THE GOAL OF THESE NOTICES IS TO ASSIST INDIVIDUALS IN APPLYING FOR COVERAGE WITHIN ONE OR MORE OF THESE PROGRAMS."

SCHEDULE H, PART VI, LINE 4:
SHBH SERVES OVER 100,000 PATIENTS ON AN ANNUAL BASIS. AS A DISPROPORTIONATE SHARE HOSPITAL AND THE HUB AND SOLE HOSPITAL OF SIGNATURE HEALTHCARE, WE PROVIDE A FULL RANGE OF PRIMARY AND SPECIALTY CARE SERVICES FOR ECONOMICALLY DISADVANTAGED AND AT-RISK INDIVIDUALS. THE POVERTY IN OUR SERVICE AREA IS SO SEVERE (72% OF PATIENTS QUALIFY FOR GOVERNMENT INSURANCE) AND RESIDENTS LACK RESOURCES FOR BASIC LIVING EXPENSES. ADD TO THAT THE FEAR OF NAVIGATING A CANCER DIAGNOSIS. OUR SERVICE AREA ALSO INCLUDES LARGE NUMBERS OF IMMIGRANT AND FIRST-GENERATION FAMILIES FROM HAITI AND CAPE VERDE AMONG OTHERS FOR WHOM ENGLISH IS A STRUGGLE. MASSACHUSETTS HAS THE HIGHEST CAPE VERDEAN POPULATION - 53,174 - IN THE UNITED STATES. THE MAJORITY - 11,709 - RESIDE IN BROCKTON, MASSACHUSETTS. *MASSACHUSETTS IS ALSO A TOP STATE IN THE UNITED STATES FOR HAITIAN POPULATION AT NEARLY 37,000 OF LEGAL RESIDENCE. THE BROCKTON AREA IS IN FACT HOME TO THE LARGEST HAITIAN COMMUNITY IN THE UNITED STATES. (*SOURCE: CENTER FOR IMMIGRATION STUDIES) WITH EXTENSIVE TRANSLATION SERVICES, A HIGH PERCENTAGE OF STAFF WHO SPEAK MORE THAN ONE LANGUAGE AND A FULL UNDERSTANDING OF THE MULTICULTURAL POPULATION IN OUR COMMUNITIES, SHBH IS UNIQUELY ABLE TO ASSIST PATIENTS AND THEIR FAMILIES THROUGHOUT THE COMMUNITIES WE SERVE. THE IMPORTANCE OF CLEAR COMMUNICATION, SUPPORT AND ACCESS TO QUALITY CARE WHEN FACING A MEDICAL CHALLENGE CANNOT BE OVERSTATED.