Community Benefit Insight - Tax-exempt hospital

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Emerson Hospital

Emerson Hospital

133 Ornc
Concord, MA 01742

Bed count	149	Medicare provider number	220084	Member of the Council of Teaching Hospitals	YES	Children's hospital	NO

EIN: 042103565

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

1.01%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 2,632,089 0.76 %
Medicaid as % of operating expenses	$ 452,637 0.13 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 406,170 0.12 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 3,182,821 0.92 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 109448649 including grants of $ 0) (Revenue $ 120340431)
EMERSON HOSPITAL IS AN 199-BED ACUTE CARE NON-PROFIT COMMUNITY HOSPITAL THAT PROVIDES SERVICES TO INPATIENTS. THE FACILITY INCLUDES THE FOLLOWING UNITS: THREE MEDICAL/SURGICAL UNITS, A LOCKED BEHAVIORAL HEALTH UNIT, A LOCKED MATERNITY/OBSTETRICS UNIT, A CRITICAL CARE UNIT, A SHORT TERM REHABILITATION TRANSITIONAL CARE UNIT, A PEDIATRICS UNIT AND A SPECIAL CARE NURSERY. EMERSON HOSPITAL SERVED 6,833 INPATIENTS AND 1,795 OBSERVATION PATIENTS FOR A TOTAL OF 36,342 PATIENT DAYS.

4B (Expenses $ 175079947 including grants of $ 0) (Revenue $ 192503026)
EMERSON HOSPITAL IS AN ACUTE CARE NON-PROFIT COMMUNITY HOSPITAL THAT PROVIDES A VARIETY OF SERVICES ON AN OUTPATIENT BASIS. EMERSON PERFORMED 1,633,301 PROCEDURES ON OUTPATIENTS DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2022 IN ADDITION, THE HOSPITAL ALSO HAD 32,340 EMERGENCY DEPARTMENT VISITS AND 87,580 REHABILITATION SERVICE VISITS.

4C (Expenses $ 2087443 including grants of $ 0) (Revenue $ 2295175)
EMERSON HOSPITAL PROVIDES HOMECARE SERVICES. HOME CARE IS AVAILABLE 24 HOURS PER DAY AND 7 DAYS PER WEEK TO HOMEBOUND PATIENTS OF ALL AGES. PRIMARY HOMECARE SERVICES INCLUDE PROFESSIONAL NURSES WHO DELIVER MEDICAL CARE AS ORDERED BY PHYSICIANS, REHABILITATION PROFESSIONALS WHO WORK WITH PATIENTS TO RESTORE FUNCTION AND INDEPENDENCE AND HOME HEALTH AIDES WHO ASSIST WITH PERSONAL CARE TASKS. FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2022 EMERSON HOSPITAL SAW 1,515 NEW HOMECARE PATIENTS.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

EMERSON HOSPITAL
PART V, SECTION B, LINE 5: IN CONDUCTING THE MOST RECENT CHNA, THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM KEY INFORMANT INTERVIEWS WITH COMMUNITY RESIDENTS AND STAKEHOLDERS. INDIVIDUALS CONSULTED INCLUDED LOCAL AND STATE PUBLIC HEALTH DEPARTMENTS, REPRESENTATIVES FROM COUNCILS ON AGING, HOUSING AUTHORITIES, SCHOOL NURSES, GUIDANCE COUNSELORS, THE UNITED WAY, LOCAL VETERAN'S AGENTS, THE DOMESTIC VIOLENCE NETWORK, EMERSON HOSPITAL'S BEHAVIORAL HEALTH SERVICES, AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS.

EMERSON HOSPITAL
PART V, SECTION B, LINE 11: EMERSON HOSPITAL IS FOCUSING PROGRAMS AND PLANNING ON THE KEY AREAS IDENTIFIED IN THE CHNA INCLUDING CANCER PREVENTION, DETECTION, AND CARE; MENTAL HEALTH AND SUBSTANCE ABUSE CARE; CARE COORDINATION FOR ELDERLY PATIENTS; DOMESTIC VIOLENCE AWARENESS AND ADVOCACY; AND HEALTH CARE SERVICES IN MAYNARD, MASSACHUSETTS. THE COMMUNITY BENEFITS ADVISORY COMMITTEE MEETS QUARTERLY TO REVIEW PROGRESS AND PROVIDE FURTHER INPUT. ALL KEY AREAS ARE IN THE PROCESS OF BEING ADDRESSED.

EMERSON HOSPITAL
PART V, SECTION B, LINE 18E: REPORTING TO CREDIT AGENCIES IS NOT PERMITTED UNDER EMERSON'S CREDIT AND COLLECTION POLICY. ALTHOUGH LIENS AND LAWSUITS ARE PERMITTED, THE HOSPITAL DID NOT EXECUTE ANY LAWSUITS OR LIENS DURING THE 2021 TAX YEAR. THE HOSPITAL DOES ENGAGE COLLECTION AGENCIES TO PURSUE UNDPAID BALANCES, BUT DOES NOT ALLOW THE COLLECTION AGENCIES TO REPORT TO CREDIT AGENCIES, FILE LAWSUITS OR PLACE LIENS.

EMERSON HOSPITAL
PART V, SECTION B, LINE 24: ALL PATIENTS REGARDLESS OF INSURANCE OR FINANCIAL MEANS ARE CHARGED THE SAME STANDARD RATE AS DETERMINED BY EMERSON HOSPITAL ON A PERIODIC BASIS. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE OR PARTIAL FREE CARE, DISCOUNTS ARE THEN APPLIED TO CHARGES.

PART I, 7F
EMERSON HOSPITAL IS A NON-PROFIT ACUTE CARE COMMUNITY HOSPITAL THAT SERVES APPROXIMATELY 300,000 RESIDENTS IN 25 TOWNS. EMERSON WAS INCORPORATED AS TAX-EXEMPT INSTITUTION IN 1911 AND, SINCE THAT TIME HAS BEEN COMMITTED TO PROVIDING BOTH EMERGENCY AND NON-EMERGENCY CARE TO ALL IN NEED, REGARDLESS OF THEIR ABILITY TO PAY.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
EMERSON HOSPITAL USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE.

PART I, LINE 6A:
THE ANNUAL COMMUNITY BENEFIT'S REPORT IS DISTRIBUTED TO THE HOSPITAL BOARD OF DIRECTORS AND TO THE COMMUNITIES SERVED BY THE HOSPITAL. THE REPORT IS ALSO AVAILABLE WITHIN THE HOSPITAL, ON THE WEBSITE, AND AT LOCAL LIBRARIES. IN ADDITION, INFORMATION REGARDING COMMUNITY BENEFITS PLAN ACTIVITIES IS DISSEMINATED THROUGH THE HOSPITAL'S INFORMATIONAL MATERIALS, INCLUDING HEALTHWORKS MAGAZINE, WHICH IS MAILED TO AREA RESIDENTS. THE REPORT IS ALSO FILED WITH THE STATE OF MASSACHUSETTS AND IS AVAILABLE THROUGH THE STATE.

PART I, LINE 7:
FINANCIAL ASSISTANCE AT COST IS DETERMINED USING THE MASSACHUSETTS HEALTHCARE SAFETY NET ASSESSMENT INCLUDING ANY SHORTFALL FUNDING TO THE HEALTHCARE SAFETY NET POOL.

PART III, LINE 4:
IN ANALYZING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS OF COLLECTION TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. AFTER ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE HOSPITAL WILL WRITE OFF THE DIFFERENCE BETWEEN STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED.BELOW IS THE PORTION OF THE FOOTNOTE FROM THE AUDITED FINANCIAL STATEMENTS OF EMERSON HEALTH SYSTEM, INC (OF WHICH EMERSON HOSPITAL IS PART OF THE CONSOLIDATION) WHICH CONCERNS BAD DEBT EXPENSE:CONCENTRATION OF CREDIT RISKTHE HEALTH SYSTEM GRANTS CREDIT WITHOUT COLLATERAL TO ITS PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD PARTY PAYOR AGREEMENTS. THE HEALTH SYSTEM RECEIVES A SIGNIFICANT PORTION OF ITS PAYMENTS FOR SERVICES RENDERED FROM A LIMITED NUMBER OF GOVERNMENT AND COMMERCIAL THIRD PARTY PAYORS, INCLUDING MEDICARE, MEDICAID, BLUE CROSS OF MASSACHUSETTS, HARVARD PILGRIM HEALTH CARE, AND TUFTS ASSOCIATED HEALTH PLAN. THE HEALTH SYSTEM HAS NOT HISTORICALLY INCURRED ANY SIGNIFICANT CREDIT LOSSES OUTSIDE THE NORMAL COURSE OF BUSINESS. LINE 2 BAD DEBT EXPENSE AT COST WAS CALCULATED USING THE RATIO OF PATIENT CARE COST TO CHARGES MULTIPLIED BY THE ACTUAL BAD DEBT EXPENSE.

PART III, LINE 8:
THE COSTING METHODOLOGY USED IN DETERMINING ALLOWABLE COSTS OF CARE FOR MEDICARE IS THE COST TO CHARGE RATIO. MEDICARE COSTS ARE OBTAINED FROM THE COST REPORT FOR ALL SERVICES PROVIDED.

PART III, LINE 9B:
EMERSON HOSPITAL MAINTAINS VERIFICATION OF A PATIENT'S INSURANCE DATA AND CHARITY CARE ELIGIBLITY PERMANENTLY WITHIN THE HOSPITAL'S MEDITECH DATABASE. AT EACH SERVICE DATE, VERIFICATION OF CHARITY CARE APPROVAL THROUGH THE STATE PROGRAM (HSNO) IS PERFORMED BY THE PATIENT ACCOUNTS DEPARTMENT. PATIENTS WHO ARE NOT ENROLLED ARE SCREENED FOR OTHER HEALTH INSURANCE ENROLLMENT BY REGISTRATION AND PATIENT ACCOUNTS DEPARTMENT.ONCE CHARITY CARE APPROVAL HAS BEEN VERIFIED, ALL BILLING AND COLLECTION ATTEMPTS ARE CEASED. COPAYMENTS AND SOME HOSPITAL SERVICES, I.E. HOME CARE, ARE EXCLUDED FROM THE STATE'S CHARITY CARE PROGRAM.

PART VI, LINE 2:
EVERY THREE YEARS EMERSON HOSPITAL CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO BETTER UNDERSTAND AND ADDRESS THE HEALTH NEEDS OF THE EMERSON HOSPITAL COMMUNITY AND TO MEET ALL PROVISIONS OF SECTION 501(R) OF THE AFFORDABLE CARE ACT. THE MOST RECENT ASSESSMENT WAS CONDUCTED IN 2016-2018. THE CHNA REPORT CONTAINS SECONDARY DATA FROM EXISTING SOURCES SUCH AS THE U.S. CENSUS, THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, THE CDC BEHAVIOR RISK FACTOR SURVEILLANCE SURVEY DATA, YOUTH RISK BEHAVIOUR SURVEY, AMONG OTHERS IN THE PUBLIC DOMAIN AS WELL AS INPUT FROM INTERVIEWS WITH COMMUNITY RESIDENTS AN STAKEHOLDERS.

PART VI, LINE 3:
ALL PATIENTS ARE PROVIDED FINANCIAL ASSISTANCE LITERATURE THROUGH THE STATE ON ALL BILLING STATEMENTS AND SIGNS ARE POSTED AT ALL PATIENT REGISTRATION LOCATIONS. WE PROVIDE THE CURRENT YEAR FEDERAL POVERTY GUIDLINES ON ALL BILLING STATEMENTS. IN ADDITION, THESE GUIDELINES ARE POSTED IN OUR INPATIENT AREA, OUTPATIENT AREA AND AT OFFSITE LOCATIONS. FINANCIAL ASSISTANCE CONTACT INFORMATION BROCHURES ARE PROVIDED IN OUR SURGICAL DAY SERVICE PACKETS AND ALL ADMISSION PACKETS.

PART VI, LINE 4:
EMERSON HOSPITAL IS A FULL SERVICE NON-PROFIT ACUTE CARE REGIONAL HOSPITAL THAT SERVES A 25 TOWN SUBURBAN COMMUNITY WITH A GROWING POPULATION OF APPROXIMATELY 300,000. EMERSON IS THE ONLY HOSPITAL LOCATED WITHIN THE PRIMARY TWELVE TOWNS THAT THE HOSPITAL SERVES. THE MEDIAN HOUSEHOLD INCOME FOR THE TOWNS SERVED BY EMERSON RANGE FROM APPROXIMATELY 75,000 TO 272,000 AND APPROXIMATELY 2% OF THE HOUSEHOLDS CURRENTLY HAVE INCOME LEVELS BELOW THE FEDERAL POVERTY GUIDELINE. THERE ARE NO FEDERALLY DESIGNATED MEDICALLY UNDERSERVED POPULATIONS IN THE COMMUNITIES SERVED BY EMERSON AND APPROXIMATELY 9% OF THE COMMUNITY'S PATIENTS ARE MEDICAID RECIPIENTS.

PART VI, LINE 6:
N/A

PART VI, LINE 7, REPORTS FILED WITH STATES
MA

PART VI, LINE 5:
EMERSON PROVIDES MANY COMMUNITY SERVICES SOME OF WHICH ARE DESCRIBED BELOW:-EMERGENCY RESPONSE AND DISASTER PLANNING IN CONJUNCTION WITH LOCAL AGENCIES, THE HOSPITAL PLANS AND COORDINATES EMERGENCY PREPAREDNESS AND HAS PROVIDED AND AT TIMES SUBSIDIZED AN ADVANCED LIFE SUPPORT SERVICE.-PREVENTATIVE CARE PROGRAMS SUCH AS FLU VACCINES, CANCER AWARENESS DAY, FREE HEALTH SCREENINGS INCLUDING CHOLETEROL, THYROID, DIABETES, BLOOD PRESSURE, SKIN CANCER AND PULMONARY.-YOUTH PROGRAMS WHICH INCLUDE THE YOUTH RISK BEHAVIOUR SURVEY, JOB SHADOWING AND VOLUNTEER OPPORTUNITIES FOR YOUTH.-SENIOR SERVICES WHICH INCLUDE HOME CARE HEALTH SCREENINGS AND MONTHLY WELLNESS PROGRAMS.-HEALTH EDUCATION WHICH INVOLVES EMERSON STAFF PRESENTING FREE LECTURES TO THE COMMUNITY ON VARIOUS HEALTH CARE ISSUES SUCH AS BREAST CANCER, CARDIAC HEALTH, SPORTS MEDICINE, PRENATAL CARE AND OTHERS.

Operating expenses	$ 347,108,419
Total amount spent on community benefits as % of operating expenses	$ 3,490,896 1.01 %