Community Benefit Insight - Tax-exempt hospital

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Henry Heywood Memorial Hospital

Henry Heywood Memorial Hospital

242 Green Street
Gardner, MA 01440

Bed count	134	Medicare provider number	220095	Member of the Council of Teaching Hospitals	YES	Children's hospital	NO

EIN: 042103581

Display data for year:

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

8.97%

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	$ 2,039,931 1.17 %
Medicaid as % of operating expenses	$ 11,092,197 6.35 %
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.	$ 2,488,742 1.43 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 45,988 0.03 %
Community building* as % of operating expenses	$ 253,901 0.15 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
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	$ 253,901 0.15 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 17,867 7.04 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 236,034 92.96 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 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	$ 3,604,428 2.06 %
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 $ 163431930 including grants of $ 131061) (Revenue $ 151237392)
Heywood offers various outpatient services such as an Emergency Room, Outpatient oncology and hematology advanced imaging, special procedures, rehabilitation services and many others on an outpatient basis. For FY 2022, there were 103,208 outpatient visits to the Hospital.Heywood offers Inpatient services including telemetry, intensive care, maternity, pediatrics, geriatric and adult inpatient care and inpatient adult mental health. For FY 2022, the Hospital provided 26,108 days of inpatient care. Heywood has eleven specialty and one Primary Care, provider based practices. The primary care practice focuses on Pediatrics and Family Practice, and the specialty care practices focus on the areas of Cardiology, Endocrinology, Gastroenterology, Gynecology/Obstetrics, Orthopedics, Pulmonology, Urology and General Surgery. In FY 2022, there were 43,633 visits to these practices.

Facility Information

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

Henry Heywood Memorial Hospital
"Part V, Section B, Line 5: In 2021, Heywood Healthcare conducted a comprehensive Community Health Needs Assessment (CHNA). A priority of the health assessment is to understand the needs of under-resourced populations and to identify and prioritize health issues and related socioeconomic determinants of health. Health disparities, health equity, and ""communities within communities"" received special attention during the assessment. Supplemental qualitative data collected from 1,341 Surveys and 18 Focus Groups with 200+ participants provided information and perceptions from under-represented racial/ethnic, socioeconomic, and geographic groups."

Henry Heywood Memorial Hospital
Part V, Section B, Line 6a: The CHNA was a collaborative effort conducted by Heywood Hospital and Athol Hospital. The assessment focuses on the 15 primary communities served by Heywood and Athol Hospitals. The data was analyzed and presented in three ways the Heywood Healthcare total service area of 15 communities, the Heywood Hospital service area of 6 towns, and the Athol Hospital service area of 9 communities.

Henry Heywood Memorial Hospital
Part V, Section B, Line 6b: The Community Health Needs Assessment was a collaboration between the Montachusett Regional Planning Commission (MRPC), UMass Memorial Health - HealthAlliance-Clinton Hospital (HealthAlliance-Clinton Hospital or HA-C), North Quabbin Community Coalition (NQCC), and the Community Health Network of North Central Massachusetts CHNA 9 Group (CHNA-9). Quantitative data sources came from Massachusetts Public Health Information Tool (Mass PHIT) data from the Massachusetts Department of Public Health (MassDPH); the Youth Risk Behavior Survey (YRBS) data; US Census data (including data from the American Community Survey); and other Commonwealth and Federal Government organizations and agencies. All data were subject to rigorous review, fact-checking, and verification processes. Staff at MRPC was responsible for conducting research and analysis efforts. Heywood Healthcare leadership assembled a CHNA Advisory Group to advise leadership on the process and the plan's strategic objectives. The advisory members are well-versed in the region's health needs. They include hospital department heads, patients, residents, community-based organizations and health service partners, community coalitions, public health officials, and local schools. Leadership Team members assisted with analyzing and reviewing the report. Other organizations and individuals also contributed to the assessment: Groups included the Gardner Community Action Team, Patient & Family Advisory Council, Clinton Area Partnership, Gardner Chamber of Commerce, North Quabbin Food Alliance, Clinton Community Stewards, Schwartz Rounds, CHNA-9 Behavioral Health Mental Health Substance Use Working Group, Youth Change Leaders, Montachusett Joint Transportation Group, North Central Homelessness Task Force, Gardner Area Interagency Team, Heywood Healthcare Care Transitions Group, CHNA 9 Racial Justice WorkGroup, Providers focused on serving LGBTQ+individuals with disabilities, and Veterans.

Henry Heywood Memorial Hospital
Part V, Section B, Line 7d: The CHNA findings were reported to the hospital leadership, the Community Benefits Committee, and community members. Discussions with these groups informed the prioritization of health needs and strategy development. These priority categories continue from the previous CHNA-CHIP process, as they represent ongoing, critical needs, especially for key populations, and several initiatives are still in progress to address them. The CHIP strategies address the pandemic's broader social and economic impacts highlighted in the 2021 CHNA.

Henry Heywood Memorial Hospital
Part V, Section B, Line 11: See Part VI Ln 2, 4, 5, 6, 7.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
The costing method used to calculate the amounts reported in the table in Part I, was based on the cost to charge ratio derived from the supplied Worksheet 2, in the IRS Schedule H instructions.

Part II, Community Building Activities:
"Henry Heywood Memorial Hospital's Community Benefits Mission Statement is ""Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the specific health needs of the under-served and collaborating with others to enhance quality and contain the growth of community healthcare costs."

Part III, Line 2:
The Organization used the cost-to-charge ratio as its costing methodology to calculate bad debt expense at cost.

Part III, Line 4:
Patient accounts receivable are recorded at net realizable value based on certain assumptions determined by each payor. For third-party payors including Medicare and Medicaid, the net realizable value is based on the estimated contractual reimbursement percentage, which is based on current contract prices or historical paid claims data by payor. For self-pay accounts receivable, which include patients who are uninsured and the patient responsibility portion for patients with insurance, the net realizable value is determined using estimates of historical collection experience. These estimates are adjusted for estimated conversions of patient responsibility portions, expected recoveries, and any anticipated changes in trends.Patient accounts receivable can be impacted by the effectiveness of the Organization's collection efforts. Additionally, significant changes in payor mix, business office operations, economic conditions, or trends in federal and state governmental healthcare coverage could affect the net realizable value of accounts receivable by monitoring historical cash collections, as well as by analyzing current period net revenue and admissions by payor classification, aged accounts receivable by payor, days revenue outstanding, the composition of self-pay receivables between pure self-pay patients, and the patient responsibility portion of third-party insured receivables. Final Settlements for some payors and programs are subject to adjustment based on administrative review and audit by third parties.

Part III, Line 8:
As Henry Heywood Memorial Hospital operates at a loss from Medicare, the shortfall could be treated as community benefit as there are no other funds available to subsidize the loss. The allowable costs on line 6 were obtained from our FY 2022 Medicare Cost Report, Worksheet D schedules.

Part III, Line 9b:
Heywood Hospital provides patients with information about financial assistance programs that are available through the Commonwealth of MA or through Heywood Hospital's own financial assistance program, which may cover all or some of their unpaid hospital bills. For those patients that request such assistance, Heywood Hospital assists patients by screening them for eligibility in an available public program and assisting them in applying for the program. These programs include but are not limited to MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start, Health Safety Net and others. It is the patient's obligation to provide Heywood Hospital with accurate and timely information to determine if the patient is eligible to apply for certain health insurance programs. If the patient of guarantor is unable to provide the necessary information, Heywood Hospital may make reasonable efforts to obtain any additional information from other sources. Information the Hospital obtains will be maintained in accordance with applicable federal and state privacy and security laws. The screening and application process for public health insurance programs is done through Virtual Gateway, which is an internet portal designed by the MA Executive Office of Health and Human Services. The Virtual Gateway manages the application process from the programs listed above, which is available for children, adults, seniors, veterans, homeless and disabled individuals. Heywood specifically assists the patient in completing the application and secure the necessary documentation required by the applicable financial assistance program. Heywood Hospital will then submit this document to the Commonwealth Office of Medicaid and assist the patient in any additional documentation if such is required by the Commonwealth of MA, Office of Medicaid. Special circumstance applications are reviewed and approved by the MA Division of Health Care Finance and Policy. The Hospital has no role in determination of program eligibility made by the Commonwealth, but at the patient's request may take a direct role in appealing decisions made by the Commonwealth to ensure accurate and timely adjudication of all hospital bills. If the patient does not comply with the requests for documentation, then our standard collection procedures apply.

Part VI, Line 2:
Needs Assessment: In addition to conducting the CHNA, the organization monitors hospital data and actively engages with the hospital leadership team and Community Benefits Advisory Committee to continuously monitor and assess any changing or emerging community and healthcare needs.

Line 7:
Community Benefit Report is filed with the Attorney General's Office, State of Massachusetts.

Part VI, Line 3:
"Role of Hospital Certified Financial Counselors and other Finance Staff: The hospital will try to identify available coverage options for patients who may be uninsured or underinsured with their current insurance program when the patient is scheduling their services, while the patient is in the hospital, upon discharge, and for a reasonable time following discharge from the hospital. The hospital will direct all patients seeking available coverage options, or those that the hospital determines may be eligible, to the hospital's patient financial counseling to screen for eligibility in an appropriate coverage option. The hospital will then assist the patient in applying for the appropriate coverage options that are available or notify them of availability of financial assistance through the hospital's own internal financial assistance program, if available. Notification Practices: Individual printed notices are available by contacting a Financial Counselor or through the Patient Accounts Office. Notices indicate the criteria used to determine eligibility for MassHealth and the Health Safety Net Trust Fund and where or how patients may apply. The goal of these notices is to assist patients in applying for coverage within a financial assistance program such as MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start, and Health Safety Net. When applicable, the hospital may also assist patients in applying for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. When a patient contacts the hospital, Patient Accounting, Financial Counseling or Social Service Staff will attempt to identify if a patient qualifies for a public financial assistance program or payment plan. Patients who are already enrolled in a public financial assistance program, such as MassHealth or Health Safety Net, may qualify for certain federal, state and private assistance agencies. Patients may also qualify for additional assistance based on the hospital's own internal criteria for financial assistance, or qualify for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. The following items outline more specifically the notification process, criteria, and availability of information beyond the signs that are posted in the hospital. 1. The hospital will provide an individual notice of the availability of financial assistance programs and other programs of public assistance to a patient expected to incur charges for which he/she will be personally responsible, exclusive of personal convenience items or services that may not be paid in full by third party coverage. 2. The hospital or its agents will include a notice or statement about Eligible Services to Low Income Patients and other programs of public assistance in its initial bill and subsequent correspondence with the patient. All correspondence will direct the patient where and how they can receive more information or additional assistance and will inform the patient that they may apply or reapply for financial and public assistance before, during or after care, or after collection agency assignment if their situation changes. 3. The hospital will include a notice regarding the availability of financial assistance and other programs of public assistance to Low Income Patients in all written collection actions. The hospital will notify the patient that it offers a payment plan if the patient is determined to be eligible for MassHealth or free care/uncompensated care through the Health Safety Net Trust Fund as a low income patient or due to Medical Hardship. These payment plans are consistent with 1016 CMR 6613.08 (1)(f)(4). The hospital will also offer payment plan options for those individuals who do not qualify for Low Income Patient status. 4. Heywood Hospital will include language on its written notices that reads: ""You may be eligible for assistance through our Financial Assistance Program. For eligibility information, please contact our Customer Services Department at 1-800-305-6757."" Verbiage may change to accommodate changes of department information. 5. There is no primary language other than English that is spoken by 5% or more of the hospital's service area. Signage and other documentation will be provided in English. The hospital provides translator services for several other languages and this service may be accessed for those individuals whose primary language is not English or Spanish. 6. For cases where the hospital continues to determine eligibility for free care/uncompensated care through the Health Safety Net Trust Fund application, then MassHealth will provide written notice of determination that the patient is or is not eligible within 30 days of receiving a completed application and the required supporting documentation. The vast majority of patients will however be screened via the common intake process and processed through the Virtual Gateway and MA-21 system. 7. Whether the hospital is using the MassHealth application process through the Virtual Gateway or submitting a MassHealth application directly, the hospital will assist the patient in completing the application or intake process for enrollment and eligibility screening."

Part VI, Line 4:
Community Information: The primary service area served by Heywood Hospital includes Gardner, Templeton, Winchendon, Ashburnham, Westminster, and Hubbardston. The Service Area varies significantly in terms of the demographics, social, and economic factors. Due to these factors, the health disparities and inequities experienced by people in the region vary widely from community to community. The overall population of the Service Area 58,336 has grown a modest 3.7% since 2010. This rate is less than the US overall (5.9%) and the Commonwealth of MA (5.0%). The region's population is predominately white (94.5%), but it is essential to note the change in racial makeup over time and the Hispanic/Latino population's growth since 2000. The growing diversity is reflected in the public-school student population. The Hispanic student population in the Service Area has increased by 45.1% vs. the 29.9% Statewide. The Narragansett (Templeton, Royalston) School Districts and Gardner School District had the most significant increase (200% and 188.9%, respectively) vs. State 50%. The increasing population numbers of non-white racial groups and the diverse mix of languages spoken among patients are reflected in the multicultural and language interpreter services at Heywood Hospital. The Service Area has a notably higher percentage population with veteran status (9.2%) than the State (5.0%) and Nation (6.9%), with Templeton having the most significant veteran status at 11.9%.There are wide-ranging disparities in incomes and poverty rates across the Service Area. The average median household income in 2019 for the area is $77,253 is lower than the State's $81,215. Westminster has the highest MHI ($100,972 per yr), and Gardner has the lowest ($49,679). The poverty rates also vary significantly by town. Perhaps most disheartening is the incredibly higher rates of poverty of those less than five years of age in Hubbardston (19.8%) and Winchendon (40.1%) when compared to the State (14.4%).

Part VI, Line 5:
Promotion of Community Health: Heywood Hospital's approach to addressing the critical health needs identified by the CHNA is to participate in cross-sector coalitions actively and collaborate with healthcare and behavioral health providers, community and faith-based organizations, and businesses. These collaborations help to develop and implement our plan, goals, and strategies. Partners include Health Equity Partnership of North Central (CHNA9); Gardner Area Interagency Team (GAIT); Montachusett Suicide Prevention Task Force; North Central MA Minority Coalition; Community Health Connections FQHC; GVNA Healthcare; LUK, Inc.; GAAMHA; Gardner Community Action Team (GCAT); Growing Places; Templeton Food Pantry; Worcester County Food Bank; Three Pyramid's; Gardner, Ashburnham, Narragansett, Winchendon, and Westminster Public School Districts, Police Departments, Boards of Health, Senior Centers, and City/Town officials; Winchendon and Gardner Community Action Center; The Winchendon School; Mount Wachusett Community College; Fitchburg State University; North Central Correctional Institution; Worcester County District Attorney; MOC Early Childcare; Aids Project Worcester; Spanish American Center; Montachusett Recovery Club; Open Sky; YOU Inc; Hope of Peace and Education; Gardner Rotary Club; Greater Gardner and North Central MA Chamber of Commerce; United Way of North Central MA; Community Foundation North Central MA.

Part VI, Line 6:
Heywood Hospital is part of Heywood Healthcare, an independent, community-owned healthcare system serving north-central Massachusetts and southern New Hampshire. It is comprised of Heywood Hospital, Athol Hospital, a 25-bed not-for-profit Critical Access Hospital in Athol, MA; Heywood Medical Group, with primary care physicians and specialists located throughout the region; and the Quabbin Retreat, our premier destination for treatment of mental health and substance misuse. The organization includes six satellite facilities in MA; Heywood Rehabilitation Center, Heywood Family Medicine and Urgent Care in Gardner; Winchendon Health Center and Murdock School-based Health Center in Winchendon; Tully Family Medicine and Walk-in and ACES School-based Health Center in Athol. The organization also includes the Heywood Healthcare Charitable Foundation.

Operating expenses	$ 174,626,360
Total amount spent on community benefits as % of operating expenses	$ 15,666,858 8.97 %