4A (Expenses $ 124522335 including grants of $ 115779) (Revenue $ 142454765)
SEE SCHEDULE O.

4B (Expenses $ 118180776 including grants of $ 0) (Revenue $ 157906425)
SEE SCHEDULE O.

4C (Expenses $ 32278532 including grants of $ 0) (Revenue $ 27049333)
SEE SCHEDULE O.

BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH, INC.
PART V, SECTION B, LINE 5: BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH, INC.:PART V, SECTION B, LINE 5: PART V, SECTION B, LINE 5: FOR DISCLOSURESRELATED TO FORM 990 SCHEDULE H PART V, SECTION B PLEASE SEE SCHEDULE HPART VI SUPPLEMENTAL INFORMATION

BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH, INC.
PART V, SECTION B, LINE 11: BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH, INC.:PART V, SECTION B, LINE 11: PART V, SECTION B, LINE 11: FOR DISCLOSURESRELATED TO FORM 990 SCHEDULE H PART V, SECTION B PLEASE SEE SCHEDULE HPART VI SUPPLEMENTAL INFORMATION.

PART I, LN 7 COL(F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,341,839

FORM 990 SCHEDULE H PART V, 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 GROUPSBETH ISRAEL DEACONESS HOSPITAL PLYMOUTH (BID-PLYMOUTH) AFFILIATIONBETH ISRAEL LAHEY HEALTH (BILH) IS THE SOLE MEMBER OF BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH (BID-PLYMOUTH OR HOSPITAL). 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 IS COMMITTED TO WORKING COLLABORATIVELY WITH BILH'S COMMUNITIES TO ADDRESS THE LEADING HEALTH ISSUES AND CREATE A HEALTHY FUTURE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES.BID-PLYMOUTH COMMUNITY BENEFITS MISSION STATEMENT THE MISSION OF BID-PLYMOUTH IS TO HELP IMPROVE THE HEALTH AND WELLBEING OF OUR PATIENTS AND COMMUNITY BY PROVIDING A FULL CONTINUUM OF HEALTHCARE SERVICES WITH EXCELLENCE AND COMPASSION. SERVING THE GREATER PLYMOUTH REGION, THE HOSPITAL COLLABORATES WITH COMMUNITY LEADERS, PUBLIC AND PRIVATE AGENCIES AND BUSINESSES TO PROVIDE HEALTH PROMOTION, HEALTH PROTECTION AND PREVENTIVE SERVICES. ALL ARE DESIGNED TO MEET THE BROAD RANGE OF OUR COMMUNITY'S HEALTH AND WELLBEING, AS IDENTIFIED THROUGH COMMUNITY FEEDBACK AND FORMAL COMMUNITY NEEDS ASSESSMENTS. AS PART OF IT MISSION TO SUPPORT COMMUNITY HEALTH, BID-PLYMOUTH IS COMMITTED TO ASSESSING ROOT CAUSES OF HEALTH DISPARITIES AND TO ASSISTING IN IMPROVING HEALTHCARE FOR THE DISADVANTAGED AND UNDERSERVED.BID-PLYMOUTH'S COMMUNITY BENEFITS MISSION IS FULFILLED BY: INVOLVING BID-PLYMOUTH 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 BID PLYMOUTH'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 BID-PLYMOUTH'S 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, BID-PLYMOUTH PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFITS OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $1,021,039 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY BENEFITS LEADERSHIP/TEAMTHE BID-PLYMOUTH'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. TO ACCOMPLISH THIS BY PROVIDING A FULL CONTINUUM OF HEALTHCARE SERVICES WITH EXCELLENCE AND COMPASSION ARE PRIMARY TENETS OF ITS MISSION. BID-PLYMOUTH'S COMMUNITY BENEFITS DEPARTMENT, UNDER THE DIRECT OVERSIGHT OF BID-PLYMOUTH'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 BID-PLYMOUTH'S IMPLEMENTATION STRATEGY, ENSURING THAT HOSPITAL POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES. THE BID-PLYMOUTH COMMUNITY BENEFITS PROGRAM IS SPEARHEADED BY THE MANAGER OF COMMUNITY BENEFITS & COMMUNITY RELATIONS. THE MANAGER HAS DIRECT ACCESS AND IS ACCOUNTABLE TO THE BID-PLYMOUTH 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 BID-PLYMOUTH COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) WORKS IN COLLABORATION WITH BID PLYMOUTH'S HOSPITAL LEADERSHIP, INCLUDING THE HOSPITAL'S GOVERNING BOARD AND SENIOR MANAGEMENT TO SUPPORT BID-PLYMOUTH'S COMMUNITY BENEFITS MISSION TO ASSESS ROOT CAUSES OF HEALTH DISPARITIES AND TO ASSIST IN IMPROVING HEALTHCARE FOR THE DISADVANTAGED AND UNDERSERVED. THE CBAC PROVIDES INPUT INTO THE DEVELOPMENT AND IMPLEMENTATION OF BID-PLYMOUTH'S COMMUNITY BENEFITS PROGRAMS IN FURTHERANCE OF BID-PLYMOUTH'S COMMUNITY BENEFITS MISSION. THE MEMBERSHIP OF BID-PLYMOUTH'S CBAC ASPIRES TO BE REPRESENTATIVE OF THE CONSTITUENCIES AND PRIORITY COHORTS SERVED BY BID-PLYMOUTH'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. BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH'S CBAC MEMBERS INCLUDE: MIKE BABINI, BID-PLYMOUTH BOARD OF TRUSTEES LYLE BAZZINOTTI, BID-PLYMOUTH BOARD OF TRUSTEES DENNIS CARMAN, EXECUTIVE DIRECTOR, UNITED WAY OF GREATER PLYMOUTH SARAH CLOUD, DIRECTOR OF SOCIAL WORK, BID-PLYMOUTH BETTY DEBENEDICTIS, LEGISLATIVE DIRECTOR FOR REPRESENTATIVE MATT MURATORE, COMMONWEALTH OF MASSACHUSETTS CHRISTINA DEGAZON, PRACTICE MANAGER, BID-PLYMOUTH ALISA DELAGE, CHIEF PROGRAMS OFFICER, OLD COLONY ELDER SERVICES PETER FORMAN, EXECUTIVE DIRECTOR, SOUTH SHORE CHAMBER OF COMMERCE SUE GIOVANETTI, EXECUTIVE DIRECTOR, PLYMOUTH AREA COALITION FOR THE HOMELESS VEDNA HEYWOOD, PLYMOUTH COMMUNITY MEMBER NATE HORWITZ-WILLIS, EXECUTIVE DIRECTOR OF ADVOCACY FUND AND EXECUTIVE VICE PRESIDENT OF EXTERNAL AFFAIRS, PLANNED PARENTHOOD LEAGUE OF MASSACHUSETTS ADRIENNE ING, DIRECTOR OF OPERATIONS, HARBOR HEALTH SERVICES, INC. MIKE JACKMAN, CHAIR, SOUTH SHORE COMMUNITY PARTNERS FOR PREVENTION KAREN KEANE, DIRECTOR, PLYMOUTH PUBLIC HEALTH DEPARTMENT MALISSA KENNEY, PRESIDENT/CEO, HEALTHY PLYMOUTH JOANNE LAFERRARA, DIRECTOR, CUSTOMER RELATIONS, GREATER ATTLEBORO TAUNTON REGIONAL TRANSIT AUTHORITY (GATRA) DEREK PAIVA, VICE PRESIDENT, OLD COLONY YMCA AMI TANNER, DIRECTOR OF RESIDENT SERVICES, ALGONQUIN HEIGHTS

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
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. BID-PLYMOUTH COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN SEPTEMBER 2022. THAT CHNA WAS APPROVED BY THE BID-PLYMOUTH BOARD OF TRUSTEES ON SEPTEMBER 14, 2022. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS ALSO ADOPTED BY THE BOARD ON SEPTEMBER 14, 2022, WHICH IS WITHIN THE TIMELINE REQUIRED BY THE TREASURY REGULATIONS UNDER 501(R). 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 BID-PLYMOUTH'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 BID-PLYMOUTH ASSESS COMMUNITY HEALTH NEEDS, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES AND CREATE A COMMUNITY HEALTH STRATEGY THAT DESCRIBES HOW BID-PLYMOUTH, 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, BID-PLYMOUTH COMPLETED ITS LAST ASSESSMENT IN SEPTEMBER 2022. THE GEOGRAPHICAL FOCUS OF BID-PLYMOUTH'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT ENCOMPASSES CARVER, DUXBURY, KINGSTON AND PLYMOUTH.COMMUNITY HEALTH ISSUES AND PRIORITY COHORTS FOR BID-PLYMOUTH'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).BID-PLYMOUTH'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 CARVER, DUXBURY, KINGSTON AND PLYMOUTH IN ITS CBSA, PRIORITY COHORTS AS FOLLOWS: YOUTH OLDER ADULTS LOW RESOURCED POPULATIONS INDIVIDUALS WITH DISABILITIES RACIALLY, ETHNICALLY AND LINGUISTICALLY DIVERSE POPULATIONS.AS NOTED ABOVE, THE COMMUNITY CHARACTERISTICS THAT WERE THOUGHT TO HAVE THE GREATEST IMPACT ON HEALTH STATUS AND ACCESS TO CARE IN THE CBSA WERE ISSUES RELATED TO AGE, RACE/ETHNICITY, LANGUAGE, IMMIGRATION STATUS, AND DISABILITY. WHILE THE MAJORITY OF THE RESIDENTS IN THE CBSA WERE WHITE AND BORN IN THE UNITED STATES, THERE WERE NON-WHITE, PEOPLE OF COLOR, RECENT IMMIGRANTS, NON-ENGLISH SPEAKERS, AND FOREIGN-BORN POPULATIONS IN ALL COMMUNITIES. THERE WAS CONSENSUS AMONG INTERVIEWEES AND FOCUS GROUP PARTICIPANTS THAT OLDER ADULTS, PEOPLE OF COLOR, RECENT IMMIGRANTS, AND NON-ENGLISH SPEAKERS WERE MORE LIKELY TO HAVE POOR HEALTH STATUS AND FACE SYSTEMIC CHALLENGES ACCESSING NEEDED SERVICES THAN YOUNG, WHITE, ENGLISH SPEAKERS WHO WERE BORN IN THE UNITED STATES. INTERVIEWEES, FOCUS GROUPS, AND LISTENING SESSION PARTICIPANTS ALSO IDENTIFIED BARRIERS TO CARE AND DISPARITIES FOR INDIVIDUALS WITH DISABILITIES. THESE SEGMENTS OF THE POPULATION WERE IMPACTED BY BARRIERS THAT LIMITED ACCESS TO APPROPRIATE SERVICES, POSED HEALTH LITERACY CHALLENGES, EXACERBATED ISOLATION, AND MAY HAVE LED TO DISCRIMINATION AND DISPARITIES IN ACCESS AND HEALTH OUTCOMES.2022 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSBID-PLYMOUTH'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 BID-PLYMOUTH'S CBSA, ESPECIALLY THE POPULATION SEGMENTS THAT ARE OFTEN DISADVANTAGED, FACE DISPARITIES IN HEALTH-RELATED OUTCOMES, AND WHO HAVE BEEN HISTORICALLY UNDERSERVED. BID-PLYMOUTH'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, BID-PLYMOUTH CONDUCTED 17 ONE-ON-ONE INTERVIEWS WITH KEY COLLABORATORS IN THE COMMUNITY, FACILITATED 4 FOCUS GROUPS WITH SEGMENTS OF THE POPULATION FACING THE GREATEST HEALTH-RELATED DISPARITIES, ADMINISTERED A COMMUNITY HEALTH SURVEY INVOLVING MORE THAN 460 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 600 COMMUNITY RESIDENTS, CLINICAL AND SOCIAL SERVICE PROVIDERS AND OTHER COMMUNITY PARTNERS.2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSBID-PLYMOUTH RELIED ON NUMEROUS PRIMARY AND SECONDARY DATA SOURCES TO ANALYZE THE HEALTH STATUS AND NEED LEVEL THROUGHOUT THEIR CBSA. BID-PLYMOUTH COLLECTED DATA FROM A NUMBER OF SOURCES INCLUDING PRIMARY QUANTITATIVE AND QUALITATIVE DATA, AS WELL AS SECONDARY DATA. EXAMPLES OF SECONDARY DATA SOURCES THAT BID-PLYMOUTH 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, BID-PLYMOUTH CONDUCTED 17 KEY INFORMANT INTERVIEWS THAT ENGAGED COMMUNITY-BASED ORGANIZATIONS, CLINICAL AND SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH OFFICIALS, ELECTED/APPOINTED OFFICIALS AND OTHER KEY COLLABORATORS THROUGHOUT BID-PLYMOUTH'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 BID-PLYMOUTH'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 BID-PLYMOUTH'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.

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSFOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5)BID-PLYMOUTH CONDUCTED 4 COMMUNITY FOCUS GROUPS AND HELD TWO COMMUNITY LISTENING SESSIONS THAT ENGAGED 226 RESIDENTS IN BID-PLYMOUTH'S COMMUNITY BENEFITS SERVICE AREA (CBSA) TO GATHER CRITICAL COMMUNITY INPUT FROM COMMUNITY RESIDENTS AND STAKEHOLDERS. THESE FOCUS GROUPS AND LISTENING SESSIONS WERE ORGANIZED IN COLLABORATION WITH THE SOUTH SHORE COMMUNITY PARTNERS IN PREVENTION (CHNA 23), ALGONQUIN HEIGHTS, NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) PLYMOUTH AND THE HEALING STUDY WORKGROUP.BID-PLYMOUTH HAS BEEN INTENTIONAL IN ENSURING THAT VARIED EXPERIENCES AND PERSPECTIVES, REFLECTIVE OF BID-PLYMOUTH'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 TWELVE LANGUAGES. FURTHERMORE, EXTENSIVE OUTREACH WAS CONDUCTED VIA SENIOR CENTERS, PARTNER NEWSLETTERS, EMAILS TO LARGE NETWORKS, PUBLIC LIBRARIES AND TARGETED OUTREACH TO POPULATIONS NEVER BEFORE ENGAGED TO HELP ENSURE DIVERSE REPRESENTATION IN THE CHNA. THE BID-PLYMOUTH 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. 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 BID-PLYMOUTH COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) AND HELD A VIRTUAL COMMUNITY FORUM PRESENTING RESULTS. IDENTIFY BID-PLYMOUTH'S COMMUNITY BENEFITS PRIORITY COHORTS, GEOGRAPHIC FOCUS, AND COMMUNITY HEALTH PRIORITIES. ANALYZE BID-PLYMOUTH'S EXISTING COMMUNITY BENEFITS ACTIVITIES WHICH WERE INFORMED BY THE 2019 CHNA AND SUBSEQUENT 2020 2022 IMPLEMENTATION STRATEGY THAT WERE COMPLETED BY BID-PLYMOUTH 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 OLDER ADULTS LOW-RESOURCED POPULATIONS INDIVIDUALS WITH DISABILITIES RACIALLY, ETHNICALLY AND LINGUISTICALLY DIVERSE POPULATIONSBID-PLYMOUTH'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 BID-PLYMOUTH'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, BID-PLYMOUTH 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 BID-PLYMOUTH 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 POPULATIONBID-PLYMOUTH COMPLETED ITS 2019 ASSESSMENT IN SEPTEMBER 2019. THE GEOGRAPHICAL FOCUS OF BID-PLYMOUTH'S 2019 CHNA ENCOMPASSES CARVER, DUXBURY, KINGSTON AND PLYMOUTH.TARGET POPULATIONS FOR BID-PLYMOUTH'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).

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
SOCIAL DETERMINANTS OF HEALTH CONTINUE TO HAVE A SUBSTANTIAL IMPACT ON MANY SEGMENTS OF THE POPULATION. ONE OF THE DOMINANT THEMES FROM THE ASSESSMENT'S FINDINGS WAS THE IMPACT THAT THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH ARE HAVING ON THOSE LIVING IN THE CBSA. THE SEGMENTS OF THE POPULATION MOST CHALLENGED BY THESE ISSUES ARE OLDER ADULTS, LOW-INCOME INDIVIDUALS/FAMILIES, RACIAL/ETHNIC MINORITIES, NON-ENGLISH SPEAKERS, AND THOSE WITH DISABILITIES OR WITH CHRONIC/COMPLEX CONDITIONS. MORE SPECIFICALLY, THESE SEGMENTS STRUGGLE WITH FINANCIAL INSECURITY, SAFE/AFFORDABLE HOUSING, TRANSPORTATION, ACCESS TO HEALTHY/AFFORDABLE FOOD, LACK OF SOCIAL SUPPORT, SOCIAL ISOLATION, AND LANGUAGE ACCESS /CULTURAL HUMILITY. THESE ISSUES IMPACT MANY PEOPLE'S AND FAMILIES' ABILITY TO ACCESS OR PAY FOR THE SERVICES, HOUSING, FOOD, OR OTHER ESSENTIAL ITEMS THEY NEED AND/OR TO LIVE A HAPPY, FULFILLING, PRODUCTIVE LIFE. THE BURDEN OF SUBSTANCE USE AND MENTAL HEALTH ISSUES. MENTAL HEALTH AND SUBSTANCE USE ISSUES CONTINUE TO BE ONE OF THE REGION'S MOST PREVALENT AND CHALLENGING ISSUES AND ARE HAVING A PROFOUND IMPACT ON INDIVIDUALS, FAMILIES, AND COMMUNITIES THROUGHOUT THE CBSA. THESE ISSUES ARE ALSO A MAJOR BURDEN ON THE HEALTH AND SOCIAL SERVICE SYSTEM. HEALTH AND SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH AGENCIES, FIRST-RESPONDERS, AND COMMUNITY-BASED ORGANIZATIONS ARE CONFRONTED DAILY WITH PEOPLE STRUGGLING WITH ACUTE OR CHRONIC CONDITIONS AND STRUGGLE TO PROVIDE OR LINK THEM TO THE CARE THEY NEED. WITH RESPECT TO MENTAL HEALTH ISSUES, DEPRESSION/ANXIETY, STRESS, SOCIAL ISOLATION, AND THE IMPACTS OF TRAUMA ARE THE LEADING ISSUES. WITH RESPECT TO SUBSTANCE USE, THE OPIOID CRISIS CONTINUES TO HAVE A TREMENDOUS IMPACT ON THE REGION, ALONG WITH ALCOHOL USE, MARIJUANA USE, AND VAPING IN YOUTH. THE FACT THAT PHYSICAL HEALTH, MENTAL HEALTH, AND SUBSTANCE ISSUES ARE SO INTERTWINED COMPOUNDS THE IMPACT OF THESE ISSUES. OF PARTICULAR CONCERN ARE THE INCREASING RATES OF OPIOID USE AND THE IMPACT OF TRAUMA. LIMITED ACCESS TO BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE USE) SERVICES. DESPITE THE PREVALENCE OF MENTAL HEALTH AND SUBSTANCE USE ISSUES AND THE IMPACT THAT THESE ISSUES ARE HAVING ON INDIVIDUALS, FAMILIES, AND COMMUNITIES, THE BEHAVIORAL HEALTH SERVICE SYSTEM IN THE REGION IS EXTREMELY LIMITED. THERE ARE MAJOR SHORTAGES OF SPECIALIZED PROVIDERS - SUCH AS PSYCHIATRISTS, THERAPISTS, ADDICTION SPECIALISTS, AND CASE MANAGERS - WHO CAN PROVIDE THE FULL BREADTH OF PREVENTIVE, SCREENING, ASSESSMENT, TREATMENT, AND RECOVERY SUPPORT SERVICES THAT THE COMMUNITY NEEDS. THIS IS PARTICULARLY TRUE FOR THOSE WHO HAVE LIMITED ENGLISH SKILLS OR DIFFERENT CULTURAL PERSPECTIVES THAT REQUIRE MORE SPECIALIZED CARE, SUCH AS RECENT IMMIGRANTS, RACIAL/ETHNIC MINORITIES, AND LGBTQ INDIVIDUALS. UNINSURED INDIVIDUALS, THOSE COVERED BY MEDICAID, AND THOSE IN LOW TO MODERATE INCOME BRACKETS ALSO STRUGGLE TO ACCESS OR PAY FOR THE SERVICES THEY NEED OR TO FIND PROVIDERS WHO ARE ABLE TO TAKE THEIR COVERAGE OR INSURANCE. HIGH RATES OF CHRONIC AND ACUTE PHYSICAL HEALTH CONDITIONS. ANOTHER MAJOR FINDING FROM THE ASSESSMENT IS THE HIGH RATES OF CHRONIC AND COMPLEX CONDITIONS THAT EXIST FOR MANY OF THE LEADING PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA) IN THE CBSA. IN SOME CASES, THE RATES OF ILLNESS AND DEATH ARE STATISTICALLY HIGHER THAN THE RATES FOR THE COMMONWEALTH, INDICATING A PARTICULARLY SIGNIFICANT PROBLEM. EVEN IN THE COMMUNITIES WHERE THE RATES ARE LOWER THAN THE COMMONWEALTH AVERAGE, CHRONIC PHYSICAL HEALTH CONDITIONS, SUCH AS HEART DISEASE, CANCER, STROKE, DIABETES, AND RESPIRATORY DISEASE, ARE STILL BY FAR THE LEADING CAUSES OF DEATH AND NEED TO BE ADDRESSED TO IMPROVE HEALTH STATUS IN THE REGION. HIGH RATES OF THE LEADING HEALTH RISK FACTORS (E.G., LACK OF NUTRITIONAL FOOD AND PHYSICAL ACTIVITY, ALCOHOL/ILLICIT DRUG USE, AND TOBACCO USE). BASED ON INFORMATION GATHERED FROM FOCUS GROUPS, INTERVIEWS, COMMUNITY MEETINGS, THE COMMUNITY HEALTH SURVEY, AND QUANTITATIVE SOURCES, THE ASSESSMENT FOUND THAT THERE WERE SUBSTANTIAL CONCERNS RELATED TO THE LEADING HEALTH RISK FACTORS, SUCH AS HEALTHY EATING, PHYSICAL ACTIVITY, OBESITY, TOBACCO USE/VAPING, ALCOHOL USE, AND STRESS. MANY OF THOSE WHO WERE INVOLVED IN THE ASSESSMENT BELIEVED THAT THERE WAS A NEED FOR MORE HEALTH EDUCATION AND A GREATER EMPHASIS ON HEALTH PROMOTION AND PREVENTION. CHALLENGES NAVIGATING THE SYSTEM AND COORDINATING NEEDED SERVICES. ANOTHER MAJOR THEME FROM THE INTERVIEWS, FOCUS GROUPS, AND COMMUNITY MEETINGS CONDUCTED FOR THE ASSESSMENT WAS THE CHALLENGES THAT MANY PEOPLE IN THE CBSA FACE NAVIGATING THE HEALTH AND SOCIAL SERVICE SYSTEM. THERE WAS A GENERAL SENSE THAT THERE WAS A BROAD RANGE OF HEALTH AND SOCIAL SERVICES AVAILABLE IN THE REGION BUT THAT MANY DID NOT KNOW WHERE TO GO FOR SERVICES OR STRUGGLED TO ACCESS THE SERVICES EVEN IF THEY KNEW WHERE TO GO. ONCE AGAIN, THE POPULATION SEGMENTS WHO STRUGGLE MOST TO NAVIGATE THE SYSTEM ARE OLDER ADULTS; LOW-INCOME INDIVIDUALS/FAMILIES, RACIAL/ETHNIC MINORITIES, NON-ENGLISH SPEAKERS, AND THOSE WITH CHRONIC/COMPLEX CONDITIONS. MANY PEOPLE SAID THAT THEY WISHED THERE WAS A RESOURCE INVENTORY THAT WOULD HELP RESIDENTS ACCESS SERVICES, ALONG WITH COUNSELORS OR CASE MANAGERS WHO COULD FURTHER ASSIST PEOPLE TO OBTAIN AND ACCESS THE SERVICES THEY NEEDED. 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 BID PLYMOUTH'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 PROHIBIT 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 BID-PLYMOUTH, 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 BID-PLYMOUTH WERE IMPACTED BY THIS UNFORESEEN HEALTH CRISIS AND IN THE ABSENCE OF REGULATORY GUIDANCE TO THE CONTRARY, BID-PLYMOUTH NEEDED TO QUICKLY REASSESS AND PIVOT TO MEET THE NEW AND PREVIOUSLY UNEXPECTED COMMUNITY NEEDS. AS SUCH, IN RESPONSE TO THE COVID-19 CRISIS BID-PLYMOUTH'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.THE ACTIONS TAKEN TOWARD ADDRESSING THESE NEEDS ARE INCLUDED FURTHER IN THIS NARRATIVE SUPPORT ALONG WITH BID-PLYMOUTH'S DETAILED DESCRIPTION OF ACTIVITIES UNDERTAKEN TO MEET THE COMMUNITY NEEDS.COMMUNITY HEALTH NEEDS ASSESSMENTMAKING THE CHNA AND IMPLEMENTATION STRATEGY WIDELY AVAILABLEBID-PLYMOUTH STRIVES TO ADDRESS THE PRIORITY AREAS IN ITS CHNA AND IMPLEMENTATION STRATEGY.

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
"METRICS AND STATUS UPDATE: NUMBER OF MENTAL HEALTH FIRST AID TRAININGS CONDUCTED. (FY20: DID NOT TAKE PLACE DUE TO COVID-19; FY21: 1 TRAINING, FY22: DID NOT TAKE PLACE DUE TO COVID-19). BID-PLYMOUTH FUNDED PREVENTURE PROGRAM WORKSHOPS AND THE NUMBER OF MIDDLE STUDENTS PARTICIPATING. (FY20: DID NOT TAKE PLACE DUE TO COVID-19; FY21: DID NOT TAKE PLACE DUE TO COVID-19; FY22: SEVEN 90-MINUTE WORKSHOPS WITH 62 STUDENTS PARTICIPATING). NUMBER OF HOUSECALLS PROGRAMS CONDUCTED. (FY20: DID NOT TAKE PLACE DUE TO COVID-19; FY21: DID NOT TAKE PLACE DUE TO COVID-19; FY22: DID NOT TAKE PLACE DUE TO COVID-19). NUMBER OF EVENTS/ACTIVITIES TO INCREASE AWARENESS AND EDUCATE ON MENTAL HEALTH AND SUBSTANCE USE (NEW PROGRAM IN FY22: SUPPORTED THE FIRST ANNUAL RECOVERY FEST WHICH BROUGHT TOGETHER 3 ORGANIZATIONS THAT PROVIDE SUPPORT AT ALL STAGES OF ADDICTION AND RECOVERY AS WELL AS 25 RESOURCE TABLES TO PROVIDE SUPPORT AND AWARENESS TO THE COMMUNITY). NUMBER OF COMMUNITY-BASED HEALTH EDUCATIONAL EVENTS WITH COMMUNITY PARTNERS. (NEW PROGRAM IN FY22: BID-PLYMOUTH PROVIDED FUNDING FOR A MOBILE UNIT CALLED ""HIDDEN IN PLAIN SIGHT"" DESIGNED TO EDUCATE PARENTS AND GUARDIANS ABOUT POTENTIAL SIGNS OF RISKY BEHAVIOR). NUMBER OF INDIVIDUALS/FAMILIES LINKED TO SERVICES TO SUPPORT RECOVERY, INCLUDING HOUSING, MENTAL HEALTH, SUBSTANCE USE DISORDER, AND OTHER BASIC NEEDS EACH QUARTER THROUGH OUR COLLABORATION WITH THE PLYMOUTH COUNTY HUB. (FY20: 66 REFERRALS; FY21: 68 REFERRALS; FY22: 44 REFERRALS). NUMBER OF PEOPLE TRAINED ON HOW TO RECOGNIZE AN OVERDOSE AND ADMINISTER NARCAN AND NUMBER OF NARCAN KITS DISTRIBUTED THROUGHOUT THE COMMUNITY IN COLLABORATION WITH PCO HOPE: (FY20: 74 PEOPLE TRAINED & 37 NARCAN KITS DISTRIBUTED; FY21: 444 PEOPLE TRAINED & 1048 NARCAN KITS DISTRIBUTED; FY22: 837 PEOPLE TRAINED & 911 NARCAN KITS DISTRIBUTED). NUMBER OF INDIVIDUALS IN RECOVERY PROVIDED WITH FINANCIAL SUPPORT TO FURTHER THEIR RECOVERY PROCESS. (NEW PROGRAM IN FY22: 10 INDIVIDUALS IN RECOVERY RECEIVED FINANCIAL RESOURCES). NUMBER OF PROGRAMS CONDUCTED INCORPORATING MENTAL HEALTH AND SUBSTANCE USE AWARENESS AND EDUCATION. (FY20: NO PROGRAMS DUE TO COVID-19; FY21: NO PROGRAMS HELD DUE TO COVID-19; FY22: PROGRAMS HELD WITH SCHOOL-BASED GARDEN CLUBS, AT THE OLD COLONY YMCA AFTER-SCHOOL PROGRAM AND AT NAMASTE DAY IN PLYMOUTH SOUTH MIDDLE SCHOOL).COMMUNITY PARTNERS: PLYMOUTH SCHOOL SYSTEM, PLYMOUTH COUNTY OUTREACH (PCO), PCO HOPE, PLYMOUTH COUNTY HUB, PLYMOUTH RECOVERY CENTER, HEALTHY PLYMOUTH, TERRA CURA GOAL 2: ENHANCE ACCESS TO MENTAL HEALTH AND SUBSTANCE USE SCREENING, ASSESSMENT, AND TREATMENT SERVICES TARGET POPULATION: YOUTH AND FAMILIES, OLDER ADULTS, LOW TO MODERATE INCOME POPULATIONS AND INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS PROGRAMMATIC OBJECTIVES: 2.1 PROMOTE CROSS-SECTOR PARTNERSHIPS, COLLABORATION, AND INFORMATION SHARING ACROSS THE BROAD HEALTH SYSTEM TO ADDRESS ACCESS TO MENTAL HEALTH AND SUBSTANCE USE SERVICES. 2.2 INCREASE ACCESS TO CLINICAL AND NON-CLINICAL SUPPORT SERVICES FOR THOSE WITH MENTAL HEALTH AND SUBSTANCE USE ISSUES WITH AN EMPHASIS ON PRIORITY POPULATIONS. 2.3 INCREASE ACCESS TO PEER SUPPORT GROUPS FOR THOSE WITH MENTAL HEALTH AND SUBSTANCE USE AND THEIR FAMILY, FRIENDS, AND CAREGIVERS.2.4 INCREASE ACCESS TO SCREENING, EDUCATION, REFERRAL, AND PATIENT ENGAGEMENT SERVICES FOR THOSE IDENTIFIED WITH OR AT-RISK OF MENTAL HEALTH AND SUBSTANCE USE ISSUES IN CLINICAL AND NON-CLINICAL SETTINGS, WITH AN EMPHASIS ON PRIORITY POPULATIONS.2.5 INCREASE ACCESS TO INSURANCE, PATIENT NAVIGATION SUPPORT, AND OTHER ENABLING/SUPPORTIVE SERVICES FOR THOSE WITH MENTAL HEALTH AND SUBSTANCE USE ISSUES, WITH AN EMPHASIS ON PRIORITY POPULATIONS.2.6 INCREASE ACCESS TO PEER RECOVERY COACHES FOR THOSE WITH MENTAL HEALTH HEALTH/SUBSTANCE USE/MISUSE ISSUES.2.7 REDUCE ELDER HEALTH ISOLATION AND DEPRESSION. COMMUNITY ACTIVITIES/STRATEGIES: COMMUNITY BENEFITS STAFF AND OTHER HOSPITAL STAFF (E.G., SOCIAL WORKERS) PARTICIPATE IN COALITION AND OTHER COMMUNITY MEETINGS TO PROMOTE COLLABORATION, SHARE KNOWLEDGE, AND COORDINATE COMMUNITY HEALTH IMPROVEMENT ACTIVITIES. EXPLORE THE POSSIBILITY OF SUPPORTING THE PLYMOUTH INTERFACE MENTAL HEALTH HOTLINE, WHICH PROVIDES EDUCATION AND REFERRAL SERVICES FOR THOSE SEEKING MENTAL HEALTH AND COUNSELING SERVICES. SUPPORT INTEGRATED BEHAVIORAL HEALTH SERVICES (MENTAL HEALTH AND SUBSTANCE USE) IN PRIMARY CARE AND OTHER SPECIALTY CARE SETTINGS (IMPACT MODEL) FOR THOSE WITH OR AT-RISK OF MENTAL HEALTH ISSUES, INCLUDING SCREENING, ASSESSMENT, AND TREATMENT. EXPLORE PARTNERSHIPS WITH ELDER SERVICE PROVIDERS TO REDUCE ISOLATION AND REACH OUT TO AND SERVE ISOLATED OLDER ADULTS NOT CURRENTLY ENGAGED IN COUNCIL ON AGING ACTIVITIES. SUPPORT PEER SUPPORT GROUPS FOR THOSE SUFFERING FROM OR RECOVERING FROM SUBSTANCE USE AND MENTAL HEALTH ISSUES, POSSIBLY INCLUDING ACTIVITIES FOR THEIR FAMILIES, FRIENDS AND CAREGIVERS. EXPLORE PARTNERSHIPS WITH LOCAL HEALTH DEPARTMENTS, SUBSTANCE USE PROVIDERS, AND BID-PLYMOUTH DEPARTMENTS TO IMPLEMENT PEER RECOVERY COACH PROGRAMS GEARED TO LINKING THOSE WITH MENTAL HEALTH/SUBSTANCE USE/MISUSE ISSUES TO PEER RECOVERY COACHES WHO PROVIDE RECOVERY, CASE MANAGEMENT, AND NAVIGATION SUPPORT. SUPPORT THE PLYMOUTH COUNTY OUTREACH (PCO) PROGRAM, A PARTNERSHIP BETWEEN HOSPITAL EMERGENCY DEPARTMENTS, PUBLIC SAFETY OFFICIALS, AND BEHAVIORAL HEALTH PROVIDERS GEARED TOWARDS REACHING OUT TO, REFERRING, AND ENGAGING SUBSTANCE USERS/MISUSERS IN TREATMENT. METRICS AND STATUS UPDATE: BID-PLYMOUTH PARTICIPATION ON COALITIONS AND IN COMMUNITY MEETINGS, INCLUDING PCO, PCO HOPE, PCO HUB, BEHAVIORAL HEALTH INTEGRATED CARE INITIATIVE, HEALING COMMUNITIES COALITION, PLYMOUTH DA'S OFFICE DRUG TASK FORCE, DRUG ENDANGERED CHILDREN COALITION, PLYMOUTH COUNTY SUICIDE PREVENTION COALITION AND DUXBURY FACTS. (FY20: ACTIVE; FY21: ACTIVE; FY22: ACTIVE). BID-PLYMOUTH EXPLORED THE POSSIBILITY OF SUPPORTING THE PLYMOUTH INTERFACE MENTAL HEALTH HOTLINE, BUT THE TOWN OF PLYMOUTH WAS ABLE TO FUND IT FOR FY20 AND FY21 AND MOVED TO A NEW PLATFORM CALLED CARE SOLACE FOR FY22. NUMBER OF PATIENTS SERVED BY INTEGRATED BEHAVIORAL HEALTH SERVICES IN PRIMARY AND SPECIALTY CARE SETTINGS AND IMPROVEMENT IN DEPRESSION SYMPTOMS. (FY20: 623 PATIENTS SERVED WITH A 56% DECREASE IN PHQ9 SCORES; FY21: 736 PATIENTS SERVED WITH A 72% DECREASE IN PHQ9 SCORES; FY22: 1,470 PATIENTS SERVED WITH A 62% DECREASE IN PHQ9 SCORES & 65% DECREASE IN GAD7 SCORES). COMMUNITY BENEFITS AND SOCIAL WORK STAFF SUPPORTED THE SENIOR TASK FORCE AT THE CENTER FOR ACTIVE LIVING THROUGH STAFF EXPERTISE AND FINANCIAL RESOURCES (FY20: THE TASK FORCE WAS NOT YET FORMED; FY21: THE DIRECTOR OF SOCIAL WORK WAS ACTIVELY INVOLVED IN THE TASK FORCE; FY22: DIRECTOR OF SOCIAL WORK AND MANAGER OF COMMUNITY BENEFITS WERE ACTIVE ON THE TASK FORCE AND PROVIDED FUNDING TOWARDS EFFORTS TO ACHIEVE THE AGE AND DEMENTIA DESIGNATIONS FOR THE TOWN OF PLYMOUTH). INCREASED ACCESS TO SERVICES AND INCREASED REFERRALS MADE BY PLYMOUTH COUNTY OUTREACH AND PLYMOUTH COUNTY OUTREACH HOPE HAVE EXTENDED THEIR SERVICES TO COMMUNITY PROVIDERS AND EXPANDED THEIR REFERRALS TO COMMUNITY PEER SUPPORT GROUPS AND RECOVERY COACHES OVER THE LAST 3 YEARS. ALSO, GOSNOLD HAS MAINTAINED A PRESENCE IN THE EMERGENCY DEPARTMENT DURING THIS TIME TO OFFER URGENT CARE FOR ADDICTION AS WELL AS REFERRALS TO COMMUNITY PROGRAMS. NUMBER OF INDIVIDUALS OFFERED MEDICATION FOR OPIOID USE DISORDER (MOUD) THROUGH PROJECT MATTER (MEDICATED-ASSISTED TREATMENT FOR TRANSFORMATION AND EXTENDED RESULTS). (FY20: 100 PEOPLE OFFERED MOUD; FY21: 120 PEOPLE OFFERED MOUD; FY22: PROGRAM NO LONGER OFFERED DUE TO COMPLETION OF SHIFT CARE CHALLENGE GRANT FUNDING THROUGH THE MA HEALTH POLICY COMMISSION AS WELL AS STAFFING CAPACITY ISSUES FROM COVID-19). PLYMOUTH COUNTY OUTREACH SUPPORT: FY20: PROVIDED ASSISTANCE TO PLYMOUTH COUNTY OUTREACH (PCO) IN RECRUITING, HIRING AND TRAINING A PROGRAM COORDINATOR FOR BEHAVIORAL HEALTH SERVICES; FY21: SUPPORTED MOBILE MEDICATION FOR OPIOID USE DISORDER WHICH DID NOT RUN DUE TO STAFFING ISSUES; FY22: SUPPORTED MODEL FOR HOME VISITS FOR THOSE AT RISK FOR OVERDOSE WHICH RESULTED IN 696 SUCCESSFUL VISITS. COMMUNITY PARTNERS: PLYMOUTH SCHOOL SYSTEM, PLYMOUTH COUNTY OUTREACH, PLYMOUTH COUNTY HUB, PLYMOUTH COUNTY OUTREACH HOPE, AFFILIATED PHYSICIANS GROUP, JORDAN PHYSICIANS ASSOCIATES, PLYMOUTH COUNTY SUICIDE PREVENTION COALITION, PLYMOUTH COUNTY DA'S OFFICE, DUXBURY FACTS COALITION"

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
NUMBER OF NEW HIV CLIENTS PROVIDED WITH NON-MEDICAL CASE MANAGEMENT SERVICES. (FY20: 6 CLIENTS; FY21: 5 CLIENTS; FY22:10 CLIENTS). IN FY22, BID-PLYMOUTH ATTENDED 2 COMMUNITY HEALTH FAIRS IN AN EFFORT TO PROVIDE STROKE EDUCATION TO A TOTAL OF 40 OLDER ADULTS. THE PEDIATRIC PALLIATIVE CARE PROGRAM CONTINUED TO SUPPORT FAMILIES OF CHILDREN DIAGNOSED WITH A LIFE LIMITING ILLNESS AND REFERRED BY THEIR PRIMARY CARE PROVIDER. NUMBER OF MONTHLY ARTICLES AND HANDOUTS DISTRIBUTED MONTHLY TO INCREASE NUTRITION EDUCATION INTERACTIONS IN THE COVID-19 SETTING. (FY20: PROGRAM NOT STARTED; FY21: 5,000 PER MONTH; FY22: 5,000 PER MONTH). COMMUNITY PARTNERS: OLD COLONY YMCA, ALGONQUIN HEIGHTS, HARBOR COMMUNITY HEALTH CENTER, PLYMOUTH SCHOOL SYSTEM, KINGSTON SCHOOL SYSTEM, CARVER AND DUXBURY COUNCIL'S ON AGING, PLYMOUTH CENTER FOR ACTIVE LIVING, SOUTH SHORE COMMUNITY ACTION COUNCIL, FOOD BANK, PLYMOUTH AREA COMMUNITY ACCESS TV, PLYMOUTH AREA COALITION FOR THE HOMELESS, PLYMOUTH FAMILY RECOVERY GOAL 2: SUPPORT REDUCED TOBACCO USE TARGET POPULATION: YOUTH AND FAMILIES, OLDER ADULTS, LOW TO MODERATE INCOME POPULATIONS AND INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS PROGRAMMATIC OBJECTIVES: 2.1 INCREASE THE NUMBER OF PEOPLE WHO ARE ABLE TO STOP SMOKING CIGARETTES, VAPING, OR USING E-CIGARETTES THROUGH EDUCATIONAL PROGRAMS. 2.2 INCREASE ACCESS TO TOBACCO, VAPING/E-CIGARETTE CESSATION PROGRAMS. COMMUNITY ACTIVITIES/STRATEGIES: ORGANIZE, FACILITATE, OR SUPPORT SMOKING CESSATION PROGRAMS GEARED TO REDUCING TOBACCO, VAPING AND E-CIGARETTE USE. METRICS AND STATUS UPDATE: NUMBER OF PROGRAMS AND PARTICIPANTS, NUMBER OF EDUCATIONAL MATERIALS DEVELOPED AND DISTRIBUTED. (FY20: DID NOT TAKE PLACE DUE TO COVID-19; FY21: DEVELOPED AND DISTRIBUTED 3500 SMOKING CESSATION BROCHURES THAT INCLUDE WEBSITES AND ONLINE PROGRAMS TO QUIT THROUGHOUT THE HOSPITAL AND IN PHYSICIAN OFFICES; FY22: PROGRAM WAS TAKEN OVER BY THE PHARMACY PROGRAM, SO BID-PLYMOUTH DID NOT CONTINUE TO CONDUCT COMMUNITY OUTREACH). COMMUNITY PARTNERS: AMERICAN CANCER SOCIETY PRIORITY AREA 3: SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO CARE BRIEF DESCRIPTION: A DOMINANT THEME FROM THE ASSESSMENT WAS THE TREMENDOUS IMPACT THAT UNDERLYING SOCIAL DETERMINANTS OF HEALTH, PARTICULARLY ACCESS TO AFFORDABLE HOUSING, TRANSPORTATION, POVERTY/EMPLOYMENT, AND FOOD INSECURITY HAVE ON THE ENTIRE POPULATION. THE SOCIAL DETERMINANTS OF HEALTH ARE OFTEN THE DRIVERS OR UNDERLYING FACTORS THAT CREATE OR EXACERBATE MENTAL HEALTH ISSUES, SUBSTANCE MISUSE, AND CHRONIC/COMPLEX CONDITIONS. THESE SOCIAL DETERMINANTS OF HEALTH, PARTICULAR POVERTY, UNDERLIE THE ACCESS TO CARE ISSUES THAT WERE PRIORITIZED IN THE ASSESSMENT: NAVIGATING THE HEALTH SYSTEM (INCLUDING HEALTH INSURANCE), CHRONIC DISEASE MANAGEMENT, AND ACCESS TO CULTURALLY AND LINGUISTICALLY COMPETENT CARE. GOAL 1: ENHANCE ACCESS TO CARE AND REDUCE THE IMPACT OF SOCIAL DETERMINANTS OF HEALTH TARGET POPULATION: YOUTH AND FAMILIES, OLDER ADULTS, LOW TO MODERATE INCOME POPULATIONS AND INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS PROGRAMMATIC OBJECTIVES: 1.1 INCREASE ACCESS TO PRIMARY CARE AND MEDICAL SPECIALTY CARE SERVICES. 1.2 INCREASE ACCESS TO APPROPRIATE, TIMELY URGENT AND EMERGENT SERVICES.1.3 INCREASE PARTNERSHIPS AND COLLABORATION WITH SOCIAL SERVICE AND OTHER COMMUNITY-BASED ORGANIZATIONS. 1.4 INCREASE EDUCATIONAL OPPORTUNITIES RELATED TO THE IMPORTANCE AND IMPACT OF SOCIAL DETERMINANTS1.5 INCREASE ACCESS TO LOW COST HEALTHY FOODS WITH AN EMPHASIS ON PRIORITY POPULATION SEGMENTS.1.6 INCREASE ACCESS TO AFFORDABLE, SAFE TRANSPORTATION OPTIONS WITH AN EMPHASIS ON PRIORITY POPULATION SEGMENTS.1.7 INCREASE TRAINING AND EMPLOYMENT OPPORTUNITIES FOR LOW TO MODERATE INCOME RESIDENTS WITH AN EMPHASIS ON PRIORITY POPULATION SEGMENTS.1.8 INCREASE NUMBER OF PEOPLE ASSISTED WITH INSURANCE AND OTHER PUBLIC PROGRAM ENROLLMENT, AND PATIENT NAVIGATION.1.9 INCREASE ACCESS TO SOCIAL EXPERIENCES FOR THOSE WHO ARE ISOLATED AND LACK FAMILY/CAREGIVER AND OTHER SOCIAL SUPPORTS.1.10 ENSURE ACCESS TO PREVENTATIVE MEASURES, TESTING, SCREENING AND TREATMENT FOR THOSE AT RISK OR EXPOSED TO COVID-19 AND MITIGATE THE IMPACTS OF THE PANDEMIC ON THE SOCIAL DETERMINANTS OF HEALTH. COMMUNITY ACTIVITIES/STRATEGIES: SUPPORT PRIMARY CARE AND MEDICAL SPECIALTY CARE SERVICES AT BID-PLYMOUTH'S PHYSICIAN PRACTICE SITES, OUTPATIENT CLINICS, EMERGENCY DEPARTMENT, AND OTHER HOSPITAL-BASED CLINICAL DEPARTMENTS. SUPPORT THE PROVISION OF APPROPRIATE, TIMELY URGENT AND EMERGENT SERVICES AT BID-PLYMOUTH'S EMERGENCY DEPARTMENT, INPATIENT UNITS, AND OTHER HOSPITAL-BASED CLINICAL DEPARTMENTS. COMMUNITY BENEFIT AND OTHER HOSPITAL STAFF (E.G., SOCIAL WORKERS) PARTICIPATE IN COALITION AND OTHER COMMUNITY MEETINGS TO PROMOTE COLLABORATION, SHARE KNOWLEDGE AND COORDINATE COMMUNITY HEALTH IMPROVEMENT ACTIVITIES. PROVIDE ENROLLMENT COUNSELING/ASSISTANCE AND PATIENT NAVIGATION SUPPORT TO UNINSURED AND UNDER-INSURED RESIDENTS TO ENHANCE ACCESS TO CARE. SUPPORT FOOD ACCESS AND NUTRITION PROGRAMMING TO LOW TO MODERATE INCOME POPULATIONS LIVING IN PUBLIC HOUSING, SCHOOL-BASED AFTER-SCHOOL PROGRAMS, COUNCILS ON AGING AND OTHER COMMUNITY VENUES. SUPPORT THE HEALTHY PLYMOUTH PROGRAM TO SUPPORT HEALTHY EATING AND FOOD ACCESS ISSUES WITH AN EMPHASIS ON PRIORITY POPULATION SEGMENTS. EXPLORE TRANSPORTATION ACCESS PARTNERSHIPS WITH REGIONAL TRANSPORTATION PARTNERS, AND OTHER COMMUNITY PARTNERS TO ENHANCE ACCESS TO AFFORDABLE, SAFE, ACCESSIBLE TRANSPORTATION OPTIONS. EXPLORE WORKFORCE MENTORSHIP AND TRAINING PROGRAMS FOR YOUTH AND ADULTS TO JOB TRAINING, SKILLS DEVELOPMENT, AND CAREER ADVANCEMENT WITH AN EMPHASIS ON PRIORITY POPULATIONS. EXPLORE PARTNERSHIPS AROUND HOUSING. METRICS AND STATUS UPDATE: FINANCIAL SUPPORT PROVIDED FOR PRIMARY CARE AND SPECIALTY CARE OFFICES TO ENSURE ACCESS TO CARE FOR LOCAL RESIDENTS. (FY20: PROVIDED FINANCIAL SUPPORT; FY21: PROVIDED FINANCIAL SUPPORT; FY22: PROVIDED FINANCIAL SUPPORT). NUMBER OF PATIENTS RECEIVING INTERPRETATION SUPPORT. (FY20: 3432 INTERPRETER SERVICES PROVIDED; FY21: 5235 INTERPRETER SERVICES PROVIDED; FY22: 8111 INTERPRETER SERVICES PROVIDED). THE DIRECTOR OF SOCIAL WORK FOR BID-PLYMOUTH HAS SERVED AS A BOARD MEMBER OF TAKING PEOPLE PLACES FOR FY20, FY21 & FY22. THIS 501C3 WAS CREATED TO PROVIDE TRANSPORTATION FOR PEOPLE OVER 65 YEARS OLD AS WELL AS PEOPLE WITH A DISABILITY NEEDING TRANSPORTATION FOR MEDICAL APPOINTMENTS AND OTHER SOCIAL NEEDS. NUMBER OF PATIENTS RECEIVING ASSISTANCE WITH ENROLLING IN MASS HEALTH OR TO APPLY FOR FINANCIAL ASSISTANCE PROGRAMS. (FY20: 2,205 PATIENTS; FY21: 1,233 PATIENTS; FY22: BID-PLYMOUTH CONTRACTED WITH CHANGE HEALTHCARE TO SERVE MORE PATIENTS, STREAMLINE THE PROCESS, WHILE CREATING A BETTER SYSTEM FOR DATA COLLECTION). POUNDS OF FOOD DONATED AND NUMBER OF COMMUNITY ORGANIZATIONS RECEIVING MONTHLY NUTRITION NOTES NEWSLETTERS (FY20: NO FOOD DRIVE DUE TO COVID-19 RESTRICTIONS, 10 ORGANIZATIONS RECEIVED NUTRITION NOTES NEWSLETTER TO DISTRIBUTE TO CONSTITUENTS; FY21: 700 POUNDS OF NUTRITIOUS FOOD DONATED, 10 ORGANIZATIONS RECEIVED NUTRITION NOTES NEWSLETTER TO DISTRIBUTE TO CONSTITUENTS; FY22: 113 POUNDS OF NUTRITIOUS FOOD DONATED, 10 ORGANIZATIONS RECEIVED NUTRITION NOTES NEWSLETTER TO DISTRIBUTE TO CONSTITUENTS). NUMBER OF PROGRAMS HELD IN SCHOOLS OR AFTER-SCHOOL SITES BY HEALTHY PLYMOUTH. (FY20: NO PROGRAMS HELD DUE TO COVID-19; FY21: NO PROGRAMS HELD DUE TO COVID-19; FY22: PROGRAMS HELD AT SCHOOL-BASED GARDEN CLUBS THE OLD COLONY YMCA AFTER-SCHOOL PROGRAM). NUMBER OF RIDES PROVIDED TO MEDICAL APPOINTMENTS FOR INDIVIDUALS AGES 60 OR OLDER AND/OR INDIVIDUALS WITH DISABILITIES. (FY20: 224 RIDES; FY21: 51 RIDES; FY22: 327 RIDES; NEW PROGRAM ALSO PROVIDED 700 RIDES FOR THOSE NEEDING ACCESS TO CANCER TREATMENT). FUNDING PROVIDED TO SUPPORT FEASIBILITY STUDY FOR FOOD INSECURITY AND WORKFORCE DEVELOPMENT PROJECT TO DEVELOP AN AQUAPONICS LAB WITH THE PLYMOUTH COUNTY SHERIFF'S DEPARTMENT. (FY22: NEW PROGRAM THAT WAS FUNDED TO SUPPORT FEASIBILITY STUDY). PERCENTAGE OF INDIVIDUALS/FAMILIES EXPERIENCING HOMELESSNESS MAINTAINING HOUSING, NUMBER SUPPORTED BY HOUSING CASE MANAGERS AND NUMBER PROVIDED WITH SEASONAL EMERGENCY SHELTER. (FY20: PROGRAM NOT YET STARTED; FY21: 93% OF RESIDENTS MAINTAINED HOUSING, 14 UNSHELTERED INDIVIDUALS CONNECTED WITH A CASE MANAGER VIA STREET OUTREACH AND 25 UNDUPLICATED INDIVIDUALS WERE PROVIDED SEASONAL EMERGENCY SHELTER; FY22: 97% OF RESIDENTS MAINTAINED HOUSING, 93 UNSHELTERED INDIVIDUALS CONNECTED WITH A CASE MANAGER VIA STREET OUTREACH AND 54 UNDUPLICATED INDIVIDUALS WERE PROVIDED SEASONAL EMERGENCY SHELTER). BID-PLYMOUTH ENGAGED NEIGHBORWORKS HOUSING SOLUTIONS TO PROVIDE EMERGENCY SHELTER AND THEIR FAMILY SUFFICIENCY PROGRAM TO EDUCATE AND HELP PEOPLE TO MOVE BEYOND SUBSIDIZED HOUSING AND BECOME FINANCIALLY STABLE.

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
"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. DETAILS 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 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.""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."""

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
"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. ""ALTHOUGH PRIOR AMERICAN HEART ASSOCIATION AND AMERICAN COLLEGE OF CARDIOLOGY GUIDELINES RECOMMENDED ASPIRIN ONLY IN PERSONS WITHOUT ELEVATED BLEEDING RISK, THE 2019 GUIDELINES NOW EXPLICITLY RECOMMEND AGAINST ASPIRIN USE AMONG THOSE OVER THE AGE OF 70 WHO DO NOT HAVE EXISTING HEART DISEASE OR STROKE,"" SAID SENIOR AUTHOR CHRISTINA C. WEE, MD, MPH, A GENERAL INTERNIST AND RESEARCHER AT BIDMC AND ASSOCIATE PROFESSOR OF MEDICINE AT HARVARD MEDICAL SCHOOL. ""OUR FINDINGS SUGGEST THAT A SUBSTANTIAL PORTION OF ADULTS MAY BE TAKING ASPIRIN WITHOUT THEIR PHYSICIAN'S ADVICE AND POTENTIALLY WITHOUT THEIR KNOWLEDGE."" FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS GRADUATE MEDICAL EDUCATION 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 59 ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED CLINICAL RESIDENCY AND FELLOWSHIP PROGRAMS WITH 670 RESIDENTS AND CLINICAL FELLOWS. IN ADDITION, THE MEDICAL CENTER HAS 50 NONSTANDARD CLINICAL FELLOWSHIP PROGRAMS WITH 62 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 EXPERIENC"

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
BID-PLYMOUTH'S TARGET POPULATIONS FOCUSED ON MEDICALLY UNDERSERVED AND VULNERABLE GROUPS OF ALL AGES IN THE CARVER, DUXBURY, KINGSTON AND PLYMOUTH, ARE AS FOLLOWS: YOUTH AND FAMILIES LOW TO MODERATE INCOME POPULATIONS OLDER ADULTS INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONSTHE GEOGRAPHICAL FOCUS OF BID-PLYMOUTH'S 2019 CHNA ENCOMPASSES CARVER, DUXBURY, KINGSTON AND PLYMOUTH. THESE TOWNS ARE DIVERSE WITH RESPECT TO DEMOGRAPHICS (E.G.,AGE, RACE AND ETHNICITY), SOCIOECONOMICS (E.G., INCOME, EDUCATION AND EMPLOYMENT) AND GEOGRAPHY (SUBURBAN AND SEMI-RURAL). THERE IS ALSO DIVERSITY WITH RESPECT TO COMMUNITY NEEDS. THERE ARE SEGMENTS OF THE BID PLYMOUTH'S CBSA POPULATION THAT ARE HEALTHY AND HAVE LIMITED UNMET HEALTH NEEDS AND OTHER SEGMENTS THAT FACE SIGNIFICANT DISPARITIES IN ACCESS, UNDERLYING SOCIAL DETERMINANTS AND HEALTH OUTCOMES.2019 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSTHE CHNA USED A PARTICIPATORY, COLLABORATIVE APPROACH TO LOOK AT HEALTH IN ITS BROADEST CONTEXT. BID-PLYMOUTH HIRED JOHN SNOW, INC., (JSI) TO CONDUCT AND MANAGE THE CHNA PROCESS UNDERTAKEN DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, AND JSI WORKED CLOSELY WITH BID-PLYMOUTH COMMUNITY BENEFITS STAFF THROUGHOUT THE PROCESS. THE 2019 CHNA WAS DESIGNED AS A THREE-PHASE PROCESS: PHASE ONE INVOLVED PRELIMINARY ASSESSMENT AND ENGAGEMENT ACTIVITIES, INCLUDING: COLLECTION AND ANALYSIS OF QUANTITATIVE DATA TO CHARACTERIZE COMMUNITY CHARACTERISTICS AND DISEASE BURDEN KEY INFORMANT INTERVIEWS WITH HOSPITAL LEADERSHIP, LOCAL SERVICE PROVIDERS, AND COMMUNITY STAKEHOLDERS AN EVALUATION OF BID-PLYMOUTH'S CURRENT PORTFOLIO OF COMMUNITY BENEFITS ACTIVITIES PHASE TWO INVOLVED TARGETED ENGAGEMENT ACTIVITIES, INCLUDING: FOCUS GROUPS WITH HOSPITAL LEADERSHIP, CLINICAL PROVIDERS, AND COMMUNITY STAKEHOLDERS A COMMUNITY MEETING WITH RESIDENTS, SERVICE PROVIDERS, PUBLIC HEALTH OFFICIALS, AND OTHER COMMUNITY STAKEHOLDERS FROM THE CBSA DISSEMINATION AND ANALYSIS OF A COMMUNITY HEALTH SURVEY TO CAPTURE RESIDENTS' PERCEPTIONS OF BARRIERS TO GOOD HEALTH, LEADING HEALTH ISSUES, VULNERABLE POPULATIONS, ACCESSIBILITY OF HEALTH SERVICES, AND OPPORTUNITIES FOR THE HOSPITAL TO IMPROVE THE SERVICES THEY OFFER TO THE COMMUNITY PHASE THREE INVOLVED A SERIES OF STRATEGIC PLANNING AND REPORTING ACTIVITIES, INCLUDING: MEETINGS WITH THE BID-PLYMOUTH'S CBAC (INCLUDING MEMBERS OF THE BOARD OF DIRECTORS), CBLT, AND SLT TO PRESENT CHNA FINDINGS, PRIORITIZE COMMUNITY HEALTH ISSUES, IDENTIFY VULNERABLE POPULATIONS, AND DISCUSS POTENTIAL RESPONSES CREATION OF A RESOURCE INVENTORY TO CATALOGUE LOCAL ORGANIZATIONS, SERVICE PROVIDERS, AND COMMUNITY ASSETS THAT HAVE THE POTENTIAL TO ADDRESS IDENTIFIED NEEDS LITERATURE REVIEW OF EVIDENCE-BASED STRATEGIES TO RESPOND TO IDENTIFIED HEALTH PRIORITIES DEVELOPMENT OF A FINAL CHNA REPORT AND IMPLEMENTATION STRATEGY 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSTHE ASSESSMENT PROCESS INCLUDED SYNTHESIZING EXISTING REGIONAL DATA ON SOCIAL, ECONOMIC AND HEALTH INDICATORS AS WELL AS INFORMATION FROM THE DISSEMINATION AND ANALYSIS OF A COMMUNITY HEALTH SURVEY TO CAPTURE RESIDENTS' PERCEPTIONS OF BARRIERS TO GOOD HEALTH, LEADING HEALTH ISSUES, VULNERABLE POPULATIONS, ACCESSIBILITY OF HEALTH SERVICES AND OPPORTUNITIES FOR THE HOSPITAL TO IMPROVE THE SERVICES THEY OFFER TO THE COMMUNITY. QUANTITATIVE DATA FROM A BROAD RANGE OF SOURCES WAS COLLECTED AND ANALYZED TO CHARACTERIZE COMMUNITIES IN BID-PLYMOUTH'S CBSA, MEASURE HEALTH STATUS, AND INFORM A COMPREHENSIVE UNDERSTANDING OF THE HEALTH-RELATED ISSUES. SOURCES INCLUDED: U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2013-2017) MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION: SCHOOL AND DISTRICT PROFILES (2017 AND 2018-2019) 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 BUREAU OF INFECTIOUS DISEASE AND LABORATORY SCIENCES (2017) MASSACHUSETTS CENTER FOR HEALTH INFORMATION ANALYSIS (CHIA) HOSPITAL PROFILES (FY2013-2017) MASSACHUSETTS HEALTHY AGING COLLABORATIVE, COMMUNITY PROFILES (2018) TO AUGMENT THE QUANTITATIVE DATA FROM MDPH, JSI WORKED WITH THE MASSACHUSETTS HEALTH DATA CONSORTIUM (MHDC) AND THE MASSACHUSETTS CENTER FOR HEALTH INFORMATION AND ANALYSIS (CHIA) TO OBTAIN 2018 INPATIENT HOSPITAL DISCHARGE DATA FOR ALL OF THE MUNICIPALITIES IN BID PLYMOUTH'S SERVICE AREA. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS (SCHEDULE H, PART V, SECTION B, LINE 5)THE CHNA INCLUDES INFORMATION COLLECTED FROM CBAC MEETINGS AND INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS. TWELVE KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH INDIVIDUALS FROM ACROSS PLYMOUTH, CARVER, KINGSTON AND DUXBURY WITH PEOPLE REPRESENTING DIFFERENT AUDIENCES, INCLUDING LEADERS IN EMERGENCY RESPONSE, EDUCATION, HEALTH CARE AND SOCIAL SERVICE ORGANIZATIONS FOCUSING ON VULNERABLE POPULATIONS (E.G., LOW-INCOME RESIDENTS FROM ALGONQUIN HEIGHTS IN PLYMOUTH. (SCHEDULE H, PART V, SECTION B, QUESTIONS 3 AND 5) 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSFOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5)THE CHNA PROCESS INVOLVED A PUBLIC MEETING, COMMUNITY DIALOGUES, AND AN ONLINE AND HARD COPY SURVEY TO MORE THAN 30,000 COMMUNITY MEMBERS IN THE CBSA, INCLUDING THE BRAZILIAN POPULATION AND LOCAL PUBLIC HEALTH OFFICIALS. OF THE MORE THAN 30,000 SURVEYS SENT OUT, THE HOSPITAL RECEIVED 1,200 COMPLETED SURVEYS. ULTIMATELY, THE QUALITATIVE RESEARCH ENGAGED APPROXIMATELY 33,000 PEOPLE. 2019 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: U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2013-2017) REVIEW OF THE ASSESSMENT'S MAJOR FINDINGS. IDENTIFY BID PLYMOUTH'S COMMUNITY BENEFITS PRIORITY POPULATIONS, GEOGRAPHIC FOCUS, AND COMMUNITY HEALTH PRIORITIES. ANALYZE BID-PLYMOUTH'S EXISTING COMMUNITY BENEFITS ACTIVITIES WHICH WERE INFORMED BY THE 2016 CHNA AND SUBSEQUENT IMPLEMENTATION STRATEGY THAT WERE COMPLETED BY BID PLYMOUTH DURING THE FISCAL PERIOD ENDED SEPTEMBER 30, 2016 (TAX YEAR 2015). 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, 2019 (TAX YEAR 2018). THE BID-PLYMOUTH IMPLEMENTATION STRATEGY WAS DEVELOPED BY A TEAM COMPRISED OF HOSPITAL LEADERSHIP, PATIENT ADVOCACY, MEDICAL STAFF, PUBLIC RELATIONS AND COMMUNITY REPRESENTATION. THE GROUP REVIEWED PROGRESS TOWARD GOALS AND OBJECTIVES OF THE PRIOR THREE-YEAR PERIOD, AS WELL AS THE CURRENT DATA COLLECTED THROUGH THE CHNA, TO HELP ENVISION AND DEFINE PRIORITY AREAS FOR THE FUTURE. THE IMPLEMENTATION STRATEGY IDENTIFIED PRIORITY AREAS AND DEFINED GOALS, ALONG WITH OBJECTIVES FOR EACH GOAL AND DRAFTED STRATEGIES TO OPERATIONALIZE THESE OBJECTIVES. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY FINDINGSTHE FOLLOWING ARE BRIEF SUMMARIES OF SOME OF THE ASSESSMENT'S KEY FINDINGS. A FULL REVIEW OF THE QUANTITATIVE AND QUALITATIVE INFORMATION THAT WAS COLLECTED FOR THIS ASSESSMENT AND THAT LED THE CBAC AND THE CBLT TO IDENTIFY THE ISSUES THAT WERE PRIORITIZED BY THE ASSESSMENT IS INCLUDED IN THE FULL BODY OF THE CHNA.

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
AS NOTED ABOVE, BID-PLYMOUTH 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 BID-PLYMOUTH WEBSITE AT:HTTPS://WWW.BIDPLYMOUTH.ORG/SITES/DEFAULT/FILES/WORKFILES/BID-PLYMOUTH-2022-CHNA-093022.PDFIN ADDITION TO THE CHNA, BID-PLYMOUTH COMPLETED ITS MOST RECENT IMPLEMENTATION STRATEGY DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021). THE IMPLEMENTATION STRATEGY IS AVAILABLE ON THE BID-PLYMOUTH WEBSITE AT: HTTPS://WWW.BIDPLYMOUTH.ORG/SITES/DEFAULT/FILES/WORKFILES/BID-PLYMOUTH-2022-CHNA-IMPLEMENTATION-093022.PDFIN ADDITION, AS NOTED ABOVE, BID-PLYMOUTH COMPLETED ITS PREVIOUS CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018). THAT CHNA IS AVAILABLE ON THE BID-PLYMOUTH WEBSITE AT: HTTPS://WWW.BIDPLYMOUTH.ORG/SITES/DEFAULT/FILES/WORKFILES/BID-PLYMOUTH%202019%20CHNA%20REPORT%20FINAL%209.25.19.PDF FINALLY, THE IMPLEMENTATION STRATEGY ASSOCIATED WITH THE CHNA COMPLETED DURING BID-PLYMOUTH'S FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018) IS AVAILABLE ON THE BID-PLYMOUTH WEBSITE AT: HTTPS://WWW.BIDPLYMOUTH.ORG/SITES/DEFAULT/FILES/WORKFILES/REVISEDBIDPLYMOUTHFY20202022IMPLENTATIONSTRATEGY.PDF EACH OF THESE DOCUMENTS IS ALSO AVAILABLE ON REQUEST (SCHEDULE H, PART V, SECTION B, LINE 7A).COMMUNITY HEALTH NEEDS ASSESSMENTADDRESSING COMMUNITY HEALTH NEEDS(SCHEDULE H, PART V, SECTION B, LINE 11)AS NOTED ABOVE, BID-PLYMOUTH'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 BID-PLYMOUTH FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, WHICH ARE REPORTED HERE. A SUMMARY OF BID-PLYMOUTH'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, BID-PLYMOUTH HAS BEEN STRATEGIC IN IDENTIFYING ITS COMMUNITY HEALTH PRIORITIES 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 PRIORITY AREA ARE LISTED BELOW.PRIORITY AREA 1: MENTAL HEALTH AND SUBSTANCE USE GOAL 1: EDUCATE ABOUT AND REDUCE THE STIGMA ASSOCIATED WITH MENTAL HEALTH AND SUBSTANCE USE ISSUES GOAL 2: ENHANCE ACCESS TO MENTAL HEALTH AND SUBSTANCE USE SCREENING, ASSESSMENT, AND TREATMENT SERVICES GOAL 3: REMOVE PRESCRIPTION DRUGS AND OTHER HARMFUL DRUGS FROM THE COMMUNITY PRIORITY AREA 2: CHRONIC AND COMPLEX CONDITIONS AND THEIR RISK FACTORS GOAL 1: ENHANCE ACCESS TO HEALTH EDUCATION, SCREENING, REFERRAL AND CHRONIC DISEASE MANAGEMENT SERVICES IN CLINICAL AND NON-CLINICAL SETTINGS GOAL 2: REDUCE THE PREVALENCE OF TOBACCO USE PRIORITY AREA 3: SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO CARE GOAL 1: ENHANCE ACCESS TO CARE AND REDUCE THE IMPACT OF SOCIAL DETERMINANTS GOAL 2: REDUCE ELDER FALLS AND PROMOTE AGING IN PLACE COMMUNITY HEALTH NEEDS ASSESSMENTAPPROACH TO ADDRESSING HEALTH NEEDS (SCHEDULE H, PART V, SECTION B, LINE 11)A FULL UPDATE ON BID PLYMOUTH'S HEALTH PRIORITIES AND ASSOCIATED GOALS IS INCLUDED BELOW. FY22 SCHEDULE HIMPLEMENTATION STRATEGY UPDATE PRIORITY AREA 1: MENTAL HEALTH AND SUBSTANCE USE AS IT IS THROUGHOUT THE COMMONWEALTH AND THE NATION, THE BURDEN OF MENTAL HEALTH AND SUBSTANCE USE ON INDIVIDUALS, FAMILIES, COMMUNITIES AND SERVICE PROVIDERS IN BID PLYMOUTH'S SERVICE AREA IS OVERWHELMING. NEARLY EVERY KEY INFORMANT INTERVIEW, FOCUS GROUP, AND COMMUNITY MEETING INCLUDED DISCUSSIONS ON THESE TOPICS. FROM A REVIEW OF THE QUANTITATIVE AND QUALITATIVE INFORMATION, DEPRESSION, ANXIETY/STRESS, SOCIAL ISOLATION, OPIOIDS, ALCOHOL, AND E-CIGARETTE/VAPING WERE THE LEADING ISSUES IN THIS DOMAIN. DESPITE INCREASED COMMUNITY AWARENESS AND SENSITIVITY ABOUT THE UNDERLYING ISSUES AND ORIGINS OF MENTAL HEALTH AND SUBSTANCE USE ISSUES, THERE IS STILL A GREAT DEAL OF STIGMA RELATED TO THESE CONDITIONS. THERE IS A GENERAL LACK OF APPRECIATION FOR THE FACT THAT THESE ISSUES ARE OFTEN ROOTED IN GENETICS, PHYSIOLOGY AND THE ENVIRONMENT, RATHER THAN AN INHERENT, CONTROLLABLE CHARACTER FLAW. THERE IS, HOWEVER, A DEEP APPRECIATION AND A GROWING UNDERSTANDING FOR THE ROLE THAT TRAUMA PLAYS FOR MANY OF THOSE WITH MENTAL HEALTH AND/OR SUBSTANCE USE ISSUES, WITH MANY PEOPLE USING ILLICIT OR CONTROLLED SUBSTANCES TO SELF-MEDICATE AND COPE WITH LOSS, STRESS, ABUSE, PAIN, AND OTHER UNRESOLVED TRAUMATIC EVENTS. GOAL 1: EDUCATE ABOUT AND REDUCE THE STIGMA ASSOCIATED WITH MENTAL HEALTH AND SUBSTANCE USE TARGET POPULATION: YOUTH AND FAMILIES, OLDER ADULTS, LOW TO MODERATE INCOME POPULATIONS, INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS PROGRAMMATIC OBJECTIVES: 1.1 INCREASE COMMUNITY EDUCATION AND AWARENESS OF SUBSTANCE USE/MISUSE, AND HEALTHY MENTAL, EMOTIONAL, AND SOCIAL HEALTH. 1.2 REDUCE THE STIGMA ASSOCIATED WITH MENTAL ILLNESS/MENTAL HEALTH AND SUBSTANCE USE/MISUSE, AND ADDICTION. COMMUNITY ACTIVITIES/STRATEGIES: SUPPORT MENTAL HEALTH FIRST AID TRAININGS IN TARGETED COMMUNITY-BASED SETTINGS TO RAISE AWARENESS, REDUCE STIGMA, AND EDUCATE RESIDENTS AND SERVICE PROVIDERS ABOUT MENTAL HEALTH AND SUBSTANCE USE. EXPLORE THE POSSIBILITY OF PROVIDING COMMUNITY HEALTH MINI GRANTS TO COMMUNITY-BASED PARTNERS TO SUPPORT EVIDENCE-BASED PROGRAMS THAT PROMOTE MENTAL HEALTH AND SUBSTANCE USE EDUCATION AND PREVENTION. ORGANIZE BID-PLYMOUTH HOUSECALLS PROGRAM. FREE COMMUNITY HEALTH LECTURES CONDUCTED BY HOSPITAL CLINICAL AND NON-CLINICAL STAFF TO RAISE AWARENESS AND EDUCATION RELATED TO MENTAL HEALTH AND SUBSTANCE USE ISSUES IN TARGETED COMMUNITY-BASED SETTINGS TO RAISE AWARENESS, REDUCE STIGMA AND EDUCATE RESIDENTS. SUPPORT COMMUNITY-BASED HEALTH EDUCATIONAL EVENTS WITH COMMUNITY PARTNERS TO RAISE AWARENESS AND EDUCATE ON RISK/PROTECTIVE FACTORS, AND SERVICES AVAILABLE IN THE COMMUNITY. SUPPORT MENTAL HEALTH AND SUBSTANCE USE SUPPORT GROUPS FOR THOSE WITH OR RECOVERING FROM MENTAL HEALTH OR SUBSTANCE USE AND THEIR FAMILIES/FRIENDS/CAREGIVERS TO RAISE AWARENESS, REDUCE STIGMA, EDUCATE, AND PROMOTE COPING/RECOVERY. CONTINUE TO SUPPORT THE HEALTHY PLYMOUTH PROGRAM AND EXPLORE HOW TO INCORPORATE MENTAL HEALTH AND SUBSTANCE USE AWARENESS AND EDUCATION EVENTS/ACTIVITIES.

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
"GOAL 3: REMOVE PRESCRIPTION DRUGS AND OTHER HARMFUL DRUGS FROM THE COMMUNITY TARGET POPULATION: YOUTH AND FAMILIES, OLDER ADULTS, LOW-TO-MODERATE INCOME POPULATIONS AND INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS PROGRAMMATIC OBJECTIVES: 3.1 DECREASE THE AVAILABILITY OF UNUSED PRESCRIPTION DRUGS. 3.2 INCREASE THE NUMBER OF OPPORTUNITIES THAT RESIDENTS OF THE SERVICE AREA GIVE BACK UNUSED PRESCRIPTIONS. COMMUNITY ACTIVITIES/STRATEGIES: ORGANIZE ""DRUG TAKE BACK DAYS"" WITH LOCAL LAW ENFORCEMENT AND OTHER COMMUNITY-BASED PARTNERS (E.G., SCHOOLS, YMCA, COUNCILS ON AGING). METRICS AND STATUS UPDATE: NUMBER OF GALLONS OF UNUSED PRESCRIPTION DRUGS DEPOSITED INTO THE HOSPITAL'S MEDSAFE BOX AND REMOVED FROM THE COMMUNITY. (FY20: 155 GALLONS REMOVED; FY21: 490 GALLONS REMOVED; FY22: 384 GALLONS REMOVED). COMMUNITY PARTNERS: LAW ENFORCEMENT AGENCIES, COUNCILS ON AGING IN PLYMOUTH, KINGSTON, CARVER AND DUXBURY, PLYMOUTH COUNTY OUTREACH HOPE, PLYMOUTH COUNTY SCHOOLS PRIORITY AREA 2: CHRONIC AND COMPLEX CONDITIONS AND THEIR RISK FACTORS BRIEF DESCRIPTION: WHILE MENTAL HEALTH AND SUBSTANCE USE WERE PERCEIVED TO BE THE LEADING ISSUES IN BID PLYMOUTH'S SERVICE AREA, ONE CANNOT LOSE SIGHT OF THE FACT THAT HEART DISEASE, STROKE AND CANCER ARE THE LEADING CAUSES OF DEATH IN THE NATION AND THE COMMONWEALTH. ROUGHLY, 6 IN 10 DEATHS MAY BE ATTRIBUTED TO THESE THREE CONDITIONS COMBINED. IF YOU INCLUDE RESPIRATORY DISEASE (E.G., ASTHMA, COPD) AND DIABETES, WHICH ARE IN THE TOP 10 LEADING CAUSES ACROSS ALL GEOGRAPHIES, THEN ONE CAN ACCOUNT FOR THE VAST MAJORITY OF CAUSES OF DEATH. ALL THESE CONDITIONS ARE TYPICALLY CONSIDERED TO BE CHRONIC AND COMPLEX AND CAN OFTEN STRIKE EARLY IN ONE'S LIFE, QUITE OFTEN ENDING IN PREMATURE DEATH. WITHIN THIS PRIORITY AREA, ACCORDING TO THOSE WHO PARTICIPATED IN INTERVIEWS, FOCUS GROUPS, THE COMMUNITY MEETING, AND THE COMMUNITY HEALTH SURVEY, CARDIOVASCULAR DISEASE, CANCER, DIABETES, AND ALZHEIMER'S DISEASE AND OTHER DEMENTIAS WERE THOUGHT TO BE OF THE HIGHEST PRIORITY. IT IS ALSO IMPORTANT TO NOTE THAT THE RISK FACTORS FOR NEARLY ALL CHRONIC/COMPLEX CONDITIONS ARE MUCH THE SAME, INCLUDING LACK OF PHYSICAL ACTIVITY, POOR NUTRITION, OBESITY, TOBACCO USE, AND ALCOHOL USE. GOAL 1: ENHANCE ACCESS TO HEALTH EDUCATION, SCREENING, REFERRAL AND CHRONIC DISEASE MANAGEMENT SERVICES IN CLINICAL AND NON-CLINICAL SETTINGS TARGET POPULATION: YOUTH AND FAMILIES, OLDER ADULTS, LOW-TO-MODERATE INCOME POPULATIONS AND INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS PROGRAMMATIC OBJECTIVES: 1.1 INCREASE THE NUMBER OF PEOPLE WHO ARE EDUCATED ABOUT CHRONIC DISEASE RISK FACTORS AND PROTECTIVE BEHAVIORS. 1.2 INCREASE THE NUMBER OF RESIDENTS WITH CHRONIC AND COMPLEX CONDITIONS WHO RECEIVE EDUCATION, CASE MANAGEMENT AND PATIENT NAVIGATION SUPPORT. 1.3 INCREASE THE NUMBER OF RESIDENTS WITH HIV/AIDS WHO RECEIVE CARE/CASE MANAGEMENT AND PATIENT NAVIGATION SERVICES. COMMUNITY ACTIVITIES/STRATEGIES: COMMUNITY BENEFIT AND OTHER HOSPITAL STAFF (E.G., SOCIAL WORKERS) PARTICIPATE IN COALITION AND OTHER COMMUNITY MEETINGS TO PROMOTE COLLABORATION, SHARE KNOWLEDGE AND COORDINATE COMMUNITY HEALTH IMPROVEMENT ACTIVITIES. ORGANIZE BID-PLYMOUTH HOUSECALLS, FREE COMMUNITY HEALTH LECTURES CONDUCTED BY HOSPITAL CLINICAL AND NON-CLINICAL STAFF TO RAISE AWARENESS, EDUCATION AND THE MANAGEMENT OF CHRONIC AND COMPLEX CONDITIONS IN TARGETED COMMUNITY-BASED SETTINGS. PROVIDE EVIDENCE-BASED HEALTH EDUCATION ON RISK/PROTECTIVE FACTORS, AND SELF-MANAGEMENT SUPPORT PROGRAMS THROUGH PARTNERSHIPS WITH COMMUNITY-BASED ORGANIZATIONS. SUPPORT SCREENING, EDUCATION, AND REFERRAL PROGRAMS IN CLINICAL AND NON-CLINICAL SETTINGS THAT SCREEN, EDUCATE, AND REFER PATIENTS IN NEED OF FURTHER ASSESSMENT AND CHRONIC DISEASE MANAGEMENT SUPPORTS (E.G., BLOOD PRESSURE, STROKE, CANCER). CONTINUE WITH THE CANCER PATIENT SUPPORT PROGRAM GEARED TO PROVIDING EDUCATION, CASE MANAGEMENT, AND PATIENT NAVIGATION SUPPORT TO THOSE WITH CANCER WITH AN EMPHASIS ON THOSE FROM PRIORITY POPULATION SEGMENTS. CONTINUE THE PEDIATRIC PALLIATIVE CARE PROGRAM GEARED TO PROVIDE EDUCATION, CARE/CASE MANAGEMENT, PATIENT NAVIGATION AND SPECIALTY CARE ACCESS SUPPORT TO CHILDREN WITH COMPLEX CONDITIONS AND THEIR FAMILIES/CAREGIVERS. CONTINUE THE HIV ACCESS PROGRAM GEARED TO PROVIDING CARE/CASE MANAGEMENT AND CARE NAVIGATION SERVICES TO THOSE SCREENED POSITIVE FOR HIV/AIDS. METRICS AND STATUS UPDATE: THE BID-PLYMOUTH REGISTERED DIETICIAN (RD) PLAYED AN ACTIVE ROLE ON THE WELLNESS COMMITTEE THROUGH THE PLYMOUTH PUBLIC SCHOOLS (FY20: ACTIVE MEMBER; FY21: ACTIVE MEMBER; FY22: ACTIVE MEMBER) NUMBER OF HOUSECALLS COMMUNITY EDUCATION EVENTS OFFERED AND NUMBER OF PARTICIPANTS AT EACH. (FY20: DID NOT TAKE PLACE DUE TO COVID-19; FY21: 1 COMMUNITY EVENT WITH 24 PARTICIPANTS; FY22: 3 INTERNAL EVENTS, WITH AN AVERAGE OF 40 PARTICIPANTS PER SESSION). NUMBER OF NUTRITION EVENTS FOCUSED ON CHRONIC DISEASE PREVENTION AND MANAGEMENT AND NUMBER OF PARTICIPANTS. (FY20: 7 PROGRAMS WITH 600 YOUTH AND FAMILIES; FY21: 17 PROGRAMS WITH 388 YOUTH AND FAMILIES; FY22; 31 PROGRAMS WITH 508 YOUTH AND FAMILIES, WITH AN ADDITIONAL 364 VIEWS OF YOUTUBE PUBLIC ACCESS CHANNEL DELICIOUS & NUTRITIOUS SHOWS). NUMBER OF PATIENTS WITH HIV/AIDS COMPLETING THE ""MANAGING OUR BLOOD PRESSURE"" PROGRAM. (FY20: 5 CLIENTS; FY21: 5 CLIENTS; FY22: PROGRAM NO LONGER ACTIVE DUE TO LACK OF STAFF AND RESOURCES AS AN IMPACT FROM COVID-19.). NUMBER OF PATIENTS PROVIDED WITH SCHOLARSHIPS TO POST-CARDIAC REHAB PROGRAM ""KEEP THE BEAT."". (FY20: NOT OFFERED DUE TO COVID-19, WHICH DELAYED THE START OF THE PROGRAM TO FY21; FY21: 7 SCHOLARSHIPS PROVIDED; FY22: 11 SCHOLARSHIPS PROVIDED). EDUCATION, CASE MANAGEMENT AND PATIENT NAVIGATION PROVIDED BY CANCER PATIENT SUPPORT PROGRAM; NUMBER OF CANCER SCREENINGS PROVIDED AND NUMBER OF PARTICIPANTS. FY20: 37 PATIENTS ATTENDED THE GENERAL SUPPORT GROUP, 12 ATTENDED THE STAGE 4 SUPPORT GROUP AND 23 ATTENDED THE CAREGIVER SUPPORT GROUP; FUNDING WAS PROVIDED FOR 12 CANCER SURVIVORS TO ATTEND PLYMOUTH FITNESS' BRIDGE TO WELLNESS PROGRAM BUT WAS PUT ON-HOLD DUE TO COVID-19; 374 CANCER PATIENTS WERE SCREENED FOR BARRIERS TO CARE AND PROVIDED RESOURCES TO 36 IDENTIFIED PATIENTS. FY21: ONE BREAST CANCER AWARENESS EVENT WITH EDUCATION ON MAMMOGRAMS FOR 35 PARTICIPANTS. FY22 UPDATE: NUMBER OF CANCER SURVIVORS TRAINED AS MENTORS WAS 5, NUMBER OF GIFT CARDS GIVEN OUT WAS 76, 700 RIDES PROVIDED TO MEDICAL APPOINTMENTS AND 40 WIGS PROVIDED WITH ACCESS TO A WIG SPECIALIST 2 DAYS PER MONTH FOR ASSISTANCE. NUMBER OF CANCER SCREENINGS/AWARENESS CONDUCTED IN THE COMMUNITY AND NUMBER OF INDIVIDUALS SCREENED. (FY20: 1 LUNG CANCER SCREENING EVENT HELD WITH 10 PARTICIPANTS, SKIN SCREENING AND BREAST CANCER AWARENESS EVENTS WERE CANCELLED DUE TO COVID-19 BUT EDUCATION PROVIDED USING SOCIAL MEDIA; FY21: MAMMOGRAM EDUCATIONAL VISIT CONDUCTED WITH 35 PARTICIPANTS AND SKIN AND BREAST CANCER PROGRAMS WERE CANCELLED DUE TO COVID-19 BUT EDUCATION PROVIDED USING SOCIAL MEDIA; FY22: NO SCREENING PROGRAMS WERE HELD DUE TO COVID-19). NUMBER OF NEW HIV CLIENTS ENROLLED INTO THE ACCESS PROGRAM, BID PLYMOUTH'S HIV/AIDS PROGRAM THAT PROVIDES MEDICAL CARE, EDUCATION, SUPPORT, MEDICAL CASE MANAGEMENT, AND MEDICAL TRANSPORTATION SERVICES TO ITS CLIENTS. (FY20: 10 CLIENTS; FY21: 10 CLIENTS; FY22:10 CLIENTS)."

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
NUMBER OF GRANT WRITERS HIRED TO SUPPORT COMMUNITY-BASED ORGANIZATIONS IN SECURING FUNDING FOR HOUSING, FOOD ACCESS AND OTHER PRIORITY NEED AREAS AND FUNDING PROVIDED TO SUPPORT HOUSING AND FINANCIAL SECURITY PROGRAMS WITH LOW-RESOURCED INDIVIDUALS AND FAMILIES IN HOSPITAL'S SERVICE AREA (FY22: FOUR GRANT WRITERS WERE ENGAGED TO PROVIDE CAPACITY BUILDING AND GRANT WRITING SERVICES TO CBOS IN THE CBSA AND FUNDING WAS PROVIDED TO SUPPORT HOUSING AND FINANCIAL SECURITY PROGRAMS WITH LOW-RESOURCED INDIVIDUALS AND FAMILIES). COMMUNITY BENEFITS AND SOCIAL WORK STAFF SUPPORTED THE SENIOR TASK FORCE AT THE CENTER FOR ACTIVE LIVING THROUGH STAFF EXPERTISE AND FINANCIAL RESOURCES (FY20: THE TASK FORCE WAS NOT YET IN EXISTENCE; FY21: THE DIRECTOR OF SOCIAL WORK WAS ACTIVELY INVOLVED IN THE TASK FORCE; FY22: DIRECTOR OF SOCIAL WORK AND MANAGER OF COMMUNITY BENEFITS WERE ACTIVE ON THE TASK FORCE AND PROVIDED FUNDING TOWARDS EFFORTS TO ACHIEVE THE AGE AND DEMENTIA DESIGNATIONS FOR THE TOWN OF PLYMOUTH). COMMUNITY PARTNERS: GREATER PLYMOUTH AREA TRANSPORTATION CONSORTIUM, ATRIUS HEALTH, PLYMOUTH CENTER FOR ACTIVE LIVING, PLYMOUTH FAMILY NETWORK, PLYMOUTH BAY MEDICAL GROUP, HARBOR COMMUNITY HEALTH CENTER, BETH ISRAEL DEACONESS HEALTHCARE, PLYMOUTH COALITION FOR THE HOMELESS, ALGONQUIN HEIGHTS, KINGSTON COUNCIL ON AGING, CARVER COUNCIL ON AGING, DUXBURY COUNCIL ON AGING, PLYMOUTH CENTER FOR ACTIVE LIVING, FATHER BILL'S & MAINSPRING, SOUTH SHORE COMMUNITY ACTION COUNCIL, GRANT WRITING SERVICES, NEIGHBORWORKS, PLYMOUTH COUNTY SHERIFF'S DEPARTMENT, TOWN OF PLYMOUTH. GOAL 2: REDUCE ELDER FALLS AND PROMOTE AGING IN PLACE TARGET POPULATION: OLDER ADULTS PROGRAMMATIC OBJECTIVES: 2.1 REDUCE FEAR OF FALLING 2.2 INCREASE ACTIVITY LEVELS 2.3 REDUCE PREVENTABLE EMERGENCY DEPARTMENT AND INPATIENT VISITS2.4 INCREASE THE NUMBER OF OLDER ADULTS LIVING INDEPENDENTLY IN THEIR HOMES COMMUNITY ACTIVITIES/STRATEGIES: EXPLORE OPPORTUNITIES WITH LOCAL AGENCIES (MATTER OF BALANCE WORKSHOPS) FOR PRIORITY POPULATIONS. METRICS AND STATUS UPDATE: NUMBER OF MATTER OF BALANCE PROGRAMS AT LOCAL COMMUNITY-BASED ORGANIZATIONS AND NUMBER OF PARTICIPANTS. (FY20: NO PROGRAMS WERE HELD DUE TO COVID-19; FY21: NO PROGRAMS WERE HELD DUE TO COVID-19; FY22: NO PROGRAMS WERE HELD DUE TO COVID-19).COMMUNITY PARTNERS: COUNCILS ON AGING IN THE CBSA, OLD COLONY ELDER SERVICESCOMMUNITY PARTNERSBID-PLYMOUTH 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: ALGONQUIN HEIGHTS AMERICAN HEART ASSOCIATION ANCHOR HOUSE, INC. BAT STATE COMMUNITY SERVICES, INC. BETH ISRAEL LAHEY HEALTH BID-PLYMOUTH COMMUNITY BUSINESS PARTNERS (APPROXIMATELY 69 BUSINESSES) BOSTON PUBLIC HEALTH COMMISSION-RYAN WHITE PART A BOSTON MEDICAL CENTER BOURNE SUBSTANCE USE COALITION BOYS AND GIRLS CLUB OF PLYMOUTH BRAZILIAN CHURCH BRAZILIAN POINT STORE BRAZILIAN SILVA STORE BRAZILIAN STEAKHOUSE BRAZILIAN MARKET (UAI BRAZIL) CAPE COD CANAL REGION CHAMBER OF COMMERCE CARVER COUNCIL ON AGING CARVER PUBLIC LIBRARY CLEANSLATE CENTERS COMMUNITY HEALTH NETWORK AREA (CHNA 23) COUNCILS ON AGING IN THE CBSA COMMUNITY SERVINGS DUXBURY COUNCIL ON AGING DUXBURY FREE LIBRARY EMS PROVIDERS IN THE CBSA FATHER BILLS & MAINSPRING FRANCIS KEVILLE MEMORIAL TRUST FUND FOOD PANTRIES IN THE CBSA GOSNOLD BEHAVIORAL HEALTH GREAT ISLAND SOCIAL CLUB GREATER ATTLEBORO TAUNTON REGIONAL TRANSIT AUTHORITY (GATRA) GREATER PLYMOUTH FOOD WAREHOUSE HADASSAH HARBOR HEALTH SERVICES, INC. HEALTH IMPERATIVES HEALTHY PLYMOUTH HEALTH RESOURCE & SERVICES ADMINISTRATION (HRSA)-RYAN WHITE PART C HERRING POND WAMPANOAG TRIBE HIGH POINT TREATMENT CENTER JETT FOUNDATION KINGSTON COUNCIL ON AGING KINGSTON PUBLIC LIBRARY LAURELWOOD AT THE PINEHILLS LIBRARIES IN THE CBSA MARSHFIELD COUNCIL ON AGING MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH MCLEAN HOSPITAL NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) - PLYMOUTH NATIONAL INSTITUTES OF HEALTH, HEAL INITIATIVE PLYMOUTH NEIGHBORWORKS NEW HOPE CHAPEL OFFICE OF ADOLESCENT HEALTH AND YOUTH DEVELOPMENT OLD COLONY ELDER SERVICES OLD COLONY YMCA PAC TV PEER GROUP ADVISORS, INC. DBA TAB-PLYMOUTH PILGRIMS HOPE PLYMOUTH AREA CHAMBER OF COMMERCE PLYMOUTH AREA COALITION FOR THE HOMELESS PLYMOUTH AREA COMMUNITY ACCESS TELEVISION (PACTV) PLYMOUTH BAY HOUSE PLYMOUTH BOYS & GIRLS CLUB PLYMOUTH CENTER FOR ACTIVE LIVING PLYMOUTH COUNTY DA'S OFFICE PLYMOUTH COUNTY SHERIFF'S OFFICE PLYMOUTH COUNTY SUICIDE PREVENTION COALITION PLYMOUTH COUNTY HUB PLYMOUTH COUNTY OUTREACH PLYMOUTH COUNTY OUTREACH HOPE PLYMOUTH DEPARTMENT OF DEVELOPMENTAL SERVICES PLYMOUTH DEPARTMENT OF PUBLIC HEALTH PLYMOUTH FAMILY NETWORK PLYMOUTH FAMILY RESOURCE CENTER PLYMOUTH FITNESS CENTER PLYMOUTH HOUSING AUTHORITY PLYMOUTH LIONS CLUB PLYMOUTH POLICE DEPARTMENT PLYMOUTH PRIDE PLYMOUTH PUBLIC LIBRARY PLYMOUTH RECOVERY CENTER PLYMOUTH RECREATION DEPARTMENT PLYMOUTH PUBLIC SCHOOLS PLYMOUTH YOUTH DEVELOPMENT COLLABORATIVE (PYDC) POLICE DEPARTMENTS IN THE CBSA PUBLIC HEALTH DEPARTMENTS IN THE CBSA RED CROSS BLOOD DRIVE ROTARY CLUB OF PLYMOUTH SALVATION ARMY SCHWARTZ CENTER ROUNDS SIGNATURE HEALTHCARE / BROCKTON HOSPITAL SCHOOLS IN THE CBSA SENIOR HOUSING IN THE CBSA SOUTH SHORE ALLIANCE OF LGBTQ+ YOUTH (SSHAGLY) SOUTH SHORE CHAMBER OF COMMERCE SOUTH SHORE COMMUNITY PARTNERS IN PREVENTION SOUTH SHORE COMMUNITY ACTION COUNCIL SOUTH SHORE CONTINUUM OF CARE SOUTH SHORE PARTNERS IN PREVENTION (CHNA 23) TAKING PEOPLE PLACES/THE ALTERNATIVE BOARD TERRA CURA, INC. TO THE MOON AND BACK TOWN OF PLYMOUTH QUINCY ASIAN RESOURCES, INC. (QARI) U-MASS EXTENSION UNITED WAY GREATER PLYMOUTH ZION LUTHERAN CHURCH ASSOCIATES

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
AS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, BID-PLYMOUTH 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 BID-PLYMOUTH'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 AND STRENGTHENING THE BUILT ENVIRONMENT (IE. IMPROVING ROADS/SIDEWALKS AND ENHANCING ACCESS TO SAFE RECREATIONAL SPACES/ACTIVITIES). IN ADDITION, THERE WERE SOME NEEDS IDENTIFIED IN THE 2019 CHNA THAT ARE NOT INCLUDED IN THE 2019 IS AND WHICH HAVE GUIDED THE BID-PLYMOUTH'S COMMUNITY BENEFITS ACTIVITIES THE PERIOD FOR THE FISCAL PERIOD COVERED BY THIS FILING DUE TO LIMITED FINANCIAL RESOURCES COMMUNITY NEEDS DEEMED BY THE CBAC AND SLT TO BE OUTSIDE OF BID-PLYMOUTH'S PRIMARY SPHERE OF INFLUENCE AND HAVE OPTED TO ALLOW OTHERS IN ITS CBSA AND THE COMMONWEALTH TO FOCUS ON THESE ISSUES. AS NOTED IN DETAIL ABOVE, THE BID-PLYMOUTH'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 BID-PLYMOUTH CARES FOR ITS COMMUNITY BY PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS. AS DEMONSTRATED IN THIS SCHEDULE H, 14.75% OF BID-PLYMOUTH'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, BID-PLYMOUTH 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.BIDPLYMOUTH.ORG/ABOUT-US/COMMUNITY-BENEFITS 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 BID-PLYMOUTH FILED WITH THE ATTORNEY GENERAL'S OFFICE. EMERGENCY CARE ACCESSIN ADDITION, AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION A, BID-PLYMOUTH 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 ASSISTANCEBID-PLYMOUTH'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 $$1,183,670 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, BID-PLYMOUTH 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, BID-PLYMOUTH 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, BID-PLYMOUTH GENERATED $5,098,862 RELATED TO TREATING MEDICAID PATIENTS WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY BID-PLYMOUTH FOR SUCH SERVICES BY $1,830,239 AS REPORTED ON THIS SCHEDULE H, PART I LINE 7B. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 10.8%] OR39,147 OF BID-PLYMOUTH'S PATIENT ENCOUNTERS WERE WITH MEDICAID PATIENTS. IN ADDITION 56.0%] OR 202,158 OF THE HOSPITAL'S PATIENT CASES WERE WITH MEDICAID PATIENTS. MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS, AND BID-PLYMOUTH PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING, BID-PLYMOUTH GENERATED $137,056,569 RELATED TO TREATING MEDICARE PATIENTS. THE COSTS OF PROVIDING CARE TO MEDICARE PATIENTS EXCEEDED REVENUE BY $3,575,970. OF THESE AMOUNTS, REVENUE OF $68,671,919 IS RELATED TO THE PROVISION OF PSYCH/SBH, EMERGENCY DEPARTMENT, MEDICAL ONCOLOGY, AND INFUSION THERAPY 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 $46,550,460. IN RESPONSE TO THE FORM 990, SCHEDULE H, PART III, LINE 8, ALTHOUGH BID-PLYMOUTH 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, BID-PLYMOUTH 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 0.88%].

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
BAD DEBTSIN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, BID-PLYMOUTH 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 $3,341,839 AND ARE 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 WERE 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).THE BETH ISRAEL LAHEY HEALTH INC. CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE REGARDING BAD DEBT EXPENSE.PATIENT ACCOUNTS RECEIVABLE AND RELATED ALLOWANCE FOR DOUBTFUL ACCOUNTSTHE SYSTEM'S PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE SYSTEM EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING MANAGED CARE PAYERS AND GOVERNMENT PROGRAMS), AND OTHERS AND INCLUDE AN ESTIMATE OF VARIABLE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS, REVIEWS, AND INVESTIGATIONS. GENERALLY, THE SYSTEM BILLS THE PATIENTS AND THIRD-PARTY PAYORS SEVERAL DAYS AFTER THE SERVICES ARE PERFORMED AND/OR THE PATIENT IS DISCHARGED FROM THE SYSTEM'S FACILITY.EMERGENCY CARE ACCESSAS PREVIOUSLY NOTED IN THIS FILING, FOR THE PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH SERVED AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH AND BETH ISRAEL DEACONESS MEDICAL CENTER (MEDICAL CENTER OR BIDMC) IS A SISTER ENTITY TO BID-PLYMOUTH. THE MEDICAL CENTER IS A NATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER AND TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL. ASSOCIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (APHMFP) IS AN INTEGRALLY RELATED PHYSICIAN PRACTICE OF BIDMC AND IS ALSO EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. APHMFP PHYSICIANS PROVIDE AROUND THE CLOCK PHYSICIAN PATIENT CARE COVERAGE AND MEDICAL DIRECTION OF THE BID-PLYMOUTH EMERGENCY DEPARTMENT. THESE PHYSICIANS ARE ALL CERTIFIED OR BOARD-ELIGIBLE IN LEVEL 1 TRAUMA. THE BID-PLYMOUTH 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 BID-PLYMOUTH 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 BID-PLYMOUTH AS WELL AS PROVIDERS WHO FOLLOW BID-PLYMOUTH'S FINANCIAL ASSISTANCE POLICY. A LIST OF ALL PROVIDERS WHO PROVIDE CARE WITHIN BID-PLYMOUTH AS WELL AS INFORMATION INDICATING IF THE LISTED PROVIDERS FOLLOW BID-PLYMOUTH'S FINANCIAL ASSISTANCE POLICY IS INCLUDED IN APPENDIX 5 TO THE FINANCIAL ASSISTANCE POLICY. BID-PLYMOUTH 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.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).

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
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 CONSIDERING 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: ENGLISH, SPANISH (ESPAOL), PORTUGUESE (PORTUGUS) ANDVIETNAMESE (TIENG VIET). (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.BIDPLYMOUTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE 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 INCLUDES 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. LINKS TO FINANCIAL ASSISTANCE POLICY AND RELATED DOCUMENTSTHE LINK TO THE BID-PLYMOUTH'S 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, ALL IN ENGLISH, SPANISH, PORTUGUESE, VIETNAMESE, CAN BE FOUND ON THE BID-PLYMOUTH WEBSITE AT: HTTPS://WWW.BIDPLYMOUTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE LIMITATION 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.

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
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 PREVIOUSLY NOTED IN THIS FORM 990, PART III, PART OF THE MEDICAL CENTER'S MISSION IS TO BE A WORLD-CLASS RESEARCH INSTITUTION WHERE OUTSTANDING SCIENTISTS WORK TO DEVELOP NEW KNOWLEDGE FOR THE BETTERMENT OF THE HEALTH OF OUR LOCAL AND EXTENDED COMMUNITIES. THE RESEARCH PROGRAM STRIVES TO BE RENOWNED FOR ITS BENCH-TO-BEDSIDE MODEL OF TRANSLATIONAL RESEARCH AND FOR ITS COLLABORATION WITH INDUSTRY AS A PATHWAY FOR TRANSFERRING THE FRUITS OF RESEARCH INTO PRODUCTS THAT IMPROVE THE QUALITY OF LIFE.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 1,220 ACTIVE FEDERAL, INDUSTRY AND FOUNDATION SPONSORED PROJECTS AND MORE THAN 2,500 ACTIVE EXEMPT, EXPEDITED, AND FULL BOARD-REVIEWED CLINICAL RESEARCH STUDIES. BIDMC RESEARCH IS LED BY MORE THAN 280 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 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%.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.

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
CORE CLINICAL TRAINING PROGRAMSTHE MEDICAL CENTER SPONSORS CORE CLINICAL TRAINING PROGRAMS IN THE FOLLOWING FIELDS: ANESTHESIOLOGY EMERGENCY MEDICINE INTERNAL MEDICINE NEUROLOGY NEUROSURGERY OBSTETRICS AND GYNECOLOGY PATHOLOGY PSYCHIATRY RADIOLOGY SURGERY TRANSITIONAL YEARDURING THE FISCAL YEAR COVERED BY THIS FILING, BID-PLYMOUTH HAD NET EXPENDITURES OF [KAREN TO INSERT $] REPORTED ON THIS SCHEDULE H, PART I, LINE 7F RELATED TO BID-PLYMOUTH'S TEACHING FUNCTION WHICH REPRESENTED [KAREN TO ADD %] OF BID-PLYMOUTH'S TOTAL EXPENSES.KAREN TO PROVIDE[THIS TEXT IS AN EXAMPLE.]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 PART V, 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 THE 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 HOUSESTAFF 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 OVERSEE 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 RESIDENTS' 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."

FORM 990 SCHEDULE H PART V, 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 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 ARE 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."

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
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 ECONOMICSEACH 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 EDUCATIONAL 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)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, BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH 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.

FORM 990 SCHEDULE H PART V, SUPPLEMENTAL INFORMATION
"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.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. 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 PART V, 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."