4A (Expenses $ 165645862 including grants of $ 534319) (Revenue $ 145341802)
SEE SCHEDULE O.

4B (Expenses $ 84844033 including grants of $ 0) (Revenue $ 153653229)
SEE SCHEDULE O.

4C (Expenses $ 26392443 including grants of $ 0) (Revenue $ 28029080)
SEE SCHEDULE O.

WINCHESTER HOSPITAL
PART V, SECTION B, LINE 5: FOR DISCLOSURES RELATED TO FORM 990 SCHEDULE H PART V, SECTION B PLEASE SEE SCHEDULE H PART VI SUPPLEMENTAL INFORMATION

FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS
"COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSWINCHESTER HOSPITAL AFFILIATIONWINCHESTER HOSPITAL IS A MEMBER OF BETH ISRAEL LAHEY HEALTH (BILH).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 ARE COMMITTED TO WORKING COLLABORATIVELY WITH BILH'S COMMUNITIES TO ADDRESS THE LEADING HEALTH ISSUES AND CREATE A HEALTHY FUTURE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES.WINCHESTER HOSPITAL COMMUNITY BENEFITS MISSION STATEMENT WINCHESTER HOSPITAL'S MISSION IS ""TO CARE. TO HEAL. TO EXCEL. IN SERVICE TO OUR COMMUNITY."" THIS MISSION IS SUPPORTED BY THE HOSPITAL'S COMMITMENT TO PERSONALIZED, EXCELLENT CARE FOR PATIENTS; A WORKFORCE COMMITTED TO INDIVIDUAL ACCOUNTABILITY, MUTUAL RESPECT, AND COLLABORATION; AND A COMMITMENT TO MAINTAINING FINANCIAL HEALTH. WINCHESTER HOSPITAL IS ALSO COMMITTED TO BEING ACTIVE IN THE COMMUNITY. SERVICE TO COMMUNITY IS AT THE CORE OF WINCHESTER HOSPITAL'S MISSION. THE WINCHESTER HOSPITAL FOUNDERS MADE A COVENANT TO CARE FOR THE UNDERSERVED IN THE HOSPITAL'S SERVICE AREA, ATTEND TO UNMET NEEDS, AND ADDRESS DISPARITIES IN ACCESS TO CARE AND HEALTH OUTCOMES. WINCHESTER HOSPITAL'S COMMITMENT TO THIS COVENANT AND THE PEOPLE IT SERVES REMAINS STEADFAST TODAY. WINCHESTER HOSPITAL'S COMMUNITY BENEFITS MISSION IS FULFILLED BY:- INVOLVING WINCHESTER HOSPITAL STAFF, INCLUDING ITS LEADERSHIP AND DOZENS OF COMMUNITY PARTNERS, IN THE COMMUNITY HEALTH NEEDS ASSESSMENT(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 WINCHESTER HOSPITAL'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 WINCHESTER HOSPITAL'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, WINCHESTER HOSPITAL PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFITS OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $2,224,065 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I."

COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY
MOST 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. WINCHESTER HOSPITAL COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN SEPTEMBER 2022. THAT CHNA WAS APPROVED BY THE WINCHESTER HOSPITAL BOARD OF TRUSTEES ON SEPTEMBER 13, 2022. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS ALSO ADOPTED BY THE BOARD ON SEPTEMBER 13, 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 WINCHESTER HOSPITAL'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 WINCHESTER HOSPITAL ASSESS COMMUNITY HEALTH NEEDS, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES AND CREATE A COMMUNITY HEALTH STRATEGY THAT DESCRIBES HOW WINCHESTER HOSPITAL, 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, WINCHESTER HOSPITAL COMPLETED ITS LAST ASSESSMENT IN SEPTEMBER 2022. THE GEOGRAPHICAL FOCUS, REFERRED TO AS THE COMMUNITY BENEFITS SERVICE AREA (CBSA) OF WINCHESTER HOSPITAL'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT ENCOMPASSES NINE CITIES AND TOWNS: MEDFORD, NORTH READING, READING, STONEHAM, WAKEFIELD, WILMINGTON, WINCHESTER, WOBURN, AND TEWKSBURY.COMMUNITY HEALTH ISSUES AND PRIORITY COHORTS FOR WINCHESTER HOSPITAL'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).WINCHESTER HOSPITAL'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:- YOUTH- LOW-RESOURCED POPULATIONS- OLDER ADULTS- RACIALLY, ETHNICALLY AND LINGUISTICALLY DIVERSE POPULATIONS; AND- LGBTQIA+ 2022 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSWINCHESTER HOSPITAL'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 WINCHESTER HOSPITAL'S CBSA, ESPECIALLY THE POPULATION SEGMENTS THAT ARE OFTEN DISADVANTAGED, FACE DISPARITIES IN HEALTH-RELATED OUTCOMES, AND WHO HAVE BEEN HISTORICALLY UNDERSERVED. WINCHESTER HOSPITAL'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, WINCHESTER HOSPITAL CONDUCTED 21 ONE-ON-ONE INTERVIEWS WITH KEY COLLABORATORS IN THE COMMUNITY, FACILITATED THREE FOCUS GROUPS WITH SEGMENTS OF THE POPULATION FACING THE GREATEST HEALTH-RELATED DISPARITIES, ADMINISTERED A COMMUNITY HEALTH SURVEY INVOLVING MORE THAN 800 RESIDENTS, AND ORGANIZED TWO COMMUNITY LISTENING SESSIONS. IN TOTAL, THE ASSESSMENT PROCESS COLLECTED INFORMATION FROM MORE THAN 1,000 COMMUNITY RESIDENTS, CLINICAL AND SOCIAL SERVICE PROVIDERS AND OTHER COMMUNITY PARTNERS.2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSWINCHESTER HOSPITAL RELIED ON NUMEROUS PRIMARY AND SECONDARY DATA SOURCES TO ANALYZE THE HEALTH STATUS AND NEED LEVEL THROUGHOUT THEIR CBSA. WINCHESTER HOSPITAL COLLECTED DATA FROM A NUMBER OF SOURCES INCLUDING PRIMARY QUANTITATIVE AND QUALITATIVE DATA, AS WELL AS SECONDARY DATA. EXAMPLES OF SECONDARY DATA SOURCES THAT WINCHESTER HOSPITAL 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 PROCESS - KEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS (SCHEDULE H, PART V, SECTION B, LINE 5):BETWEEN OCTOBER 2021 AND FEBRUARY 2022, WINCHESTER HOSPITAL CONDUCTED 21 KEY INFORMANT INTERVIEWS THAT ENGAGED COMMUNITY-BASED ORGANIZATIONS, CLINICAL AND SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH OFFICIALS, ELECTED/APPOINTED OFFICIALS AND OTHER KEY COLLABORATORS THROUGHOUT WINCHESTER HOSPITAL'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 WINCHESTER HOSPITAL'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 WINCHESTER HOSPITAL'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.2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS - FOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5):BETWEEN OCTOBER 2021 AND FEBRUARY 2022, WINCHESTER HOSPITAL FACILITATED THREE FOCUS GROUPS WITH SEGMENTS OF THE POPULATION FACING THE GREATEST HEALTH-RELATED DISPARITIES; STONEHAM WAKEFIELD BOYS & GIRLS CLUB, MEDFORD COUNCIL ON AGING, AND A WOBURN PARENTS GROUP. THE, IN ADDITION WINCHESTER HOSPITAL ADMINISTERED A COMMUNITY HEALTH SURVEY INVOLVING MORE THAN 800 RESIDENTS, AND ORGANIZED TWO COMMUNITY LISTENING SESSIONS. IN TOTAL, THE ASSESSMENT PROCESS COLLECTED INFORMATION FROM MORE THAN 1,000 COMMUNITY RESIDENTS, CLINICAL AND SOCIAL SERVICE PROVIDERS AND OTHER COMMUNITY PARTNERS. WINCHESTER HOSPITAL HAS BEEN INTENTIONAL IN ENSURING THAT VARIED EXPERIENCES AND PERSPECTIVES, REFLECTIVE OF WINCHESTER HOSPITAL'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 SOCIAL MEDIA, INSTITUTIONAL NEWSLETTERS, EMAILS TO LARGE NETWORKS, PUBLIC LIBRARIES, COMMUNITY EVENTS AND LARGE APARTMENT BUILDINGS TO HELP ENSURE DIVERSE REPRESENTATION IN THE CHNA.

BAD DEBTS
IN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, WINCHESTER HOSPITAL 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 $2,954,349 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, 2020 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).FINANCIAL ASSISTANCE POLICYINTERNAL REVENUE CODE SECTION 501(R)(4)FINANCIAL ASSISTANCE POLICY PURPOSE:WINCHESTER HOSPITAL 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 WINCHESTER HOSPITAL AS WELL AS PROVIDERS WHO FOLLOW WINCHESTER HOSPITAL'S FINANCIAL ASSISTANCE POLICY. A LIST OF ALL PROVIDERS WHO PROVIDE CARE WITHIN WINCHESTER HOSPITAL AS WELL AS INFORMATION INDICATING IF THE LISTED PROVIDERS FOLLOW WINCHESTER HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS INCLUDED IN APPENDIX 5 TO THE FINANCIAL ASSISTANCE POLICY. WINCHESTER HOSPITAL 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 POLICY:AS 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 PRIOR TO SEPTEMBER 30, 2017 AND THESE DOCUMENTS WERE ALL EFFECTIVE AS OF OCTOBER 1, 2017, THE FIRST DAY OF THE HOSPITAL'S FISCAL YEAR IN WHICH THE HOSPITAL WAS REQUIRED TO BE IN COMPLIANCE WITH THE REGULATIONS PROMULGATED BY THE TREASURY AND RELATED TO IRC SECTION 501(R).FINANCIAL ASSISTANCE POLICY - APPLYING 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 POLICY - ELIGIBILITY 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).FINANCIAL ASSISTANCE - PUBLIC 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 TAKING INTO ACCOUNT 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 AND CERTAIN OTHER COMMUNITY BENEFITS - RESEARCH
AS 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 OF THE FOLLOWING DISCIPLINES:- ANESTHESIA, CRITICAL CARE, AND PAIN MEDICINE - EMERGENCY MEDICINE - MEDICINE - ALLERGY AND INFLAMMATION - CARDIOVASCULAR MEDICINE - CENTER FOR VASCULAR BIOLOGY RESEARCH - CENTER FOR VIROLOGY AND VACCINE RESEARCH - CLINICAL INFORMATICS - CLINICAL NUTRITION - ENDOCRINOLOGY - EXPERIMENTAL MEDICINE - GASTROENTEROLOGY - GENERAL MEDICINE AND PRIMARY CARE - GENETICS - GERONTOLOGY - HEMATOLOGY AND ONCOLOGY - HEMOSTASIS AND THROMBOSIS - IMMUNOLOGY - INFECTIOUS DISEASE - INTERDISCIPLINARY MEDICINE AND BIOTECHNOLOGY - MOLECULAR AND VASCULAR MEDICINE - NEPHROLOGY - PULMONOLOGY - RHEUMATOLOGY - SIGNAL TRANSDUCTION - TRANSLATIONAL RESEARCH - TRANSPLANT IMMUNOLOGY- NEONATOLOGY - NEUROLOGY - OBSTETRICS AND GYNECOLOGY - ORTHOPAEDIC SURGERY - PATHOLOGY - PSYCHIATRY - RADIOLOGY - SURGERY - CARDIAC SURGERY - CENTER FOR MINIMALLY INVASIVE SURGERY - NEUROSURGERY - PLASTIC AND RECONSTRUCTIVE SURGERY - 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 CENTER:THE 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 BIDMC:BELOW 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. COVID-19 VACCINE RESEARCH:ALTHOUGH 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. DETAIL 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 MEN:IN 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 GROWTH:IN 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 THE 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 DELIRIUM:AS 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 TECHNIQUE:A 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.""QUASHING THE RESISTANCE: MICRORNA REGULATES DRUG TOLERANCE IN SUBSET OF LUNG CANCERS:RELAPSE 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 MEDICATIONS:A 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."""

FELLOWSHIP PROGRAMS:
"IN 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 BIDMC:THE 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. INTERNAL MEDICINE EDUCATION AT BIDMC:THE 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.INTERNSHIP:THE 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 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."

PATHOLOGY EDUCATION AT BIDMC:
"THE 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 THE 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 BIDMC:THE 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 IS 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, VIDEO-RECORDING, 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.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 TRACKS - CURRENTLY, 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."

COMMUNITY BENEFITS LEADERSHIP/TEAM
THE WINCHESTER HOSPITAL'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. WINCHESTER HOSPITAL'S COMMUNITY BENEFITS DEPARTMENT, UNDER THE DIRECT OVERSIGHT OF WINCHESTER HOSPITAL'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 WINCHESTER HOSPITAL'S IMPLEMENTATION STRATEGY, ENSURING THAT HOSPITAL POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES. WINCHESTER HOSPITAL COMMUNITY BENEFITS PROGRAM IS SPEARHEADED BY THE DIRECTOR OF COMMUNITY BENEFITS AND COMMUNITY RELATIONS. THE REGIONAL MANAGER OF COMMUNITY BENEFITS AND COMMUNITY RELATIONS HAS DIRECT ACCESS AND IS ACCOUNTABLE TO THE WINCHESTER HOSPITAL 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 WINCHESTER HOSPITAL COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) WORKS IN COLLABORATION WITH WINCHESTER HOSPITAL'S LEADERSHIP, INCLUDING THE HOSPITAL'S GOVERNING BOARD AND SENIOR MANAGEMENT TO SUPPORT WINCHESTER HOSPITAL'S COMMUNITY BENEFITS MISSION: TO BENEFIT ALL OF THE COMMUNITIES WE SERVE BY COLLABORATING WITH COMMUNITY PARTNERS TO IDENTIFY HEALTH NEEDS, IMPROVE THE HEALTH STATUS OF COMMUNITY RESIDENTS, ADDRESS HEALTH DISPARITIES, AND EDUCATE COMMUNITY MEMBERS ABOUT PREVENTION AND SELF-CARE. THE CBAC PROVIDES INPUT INTO THE DEVELOPMENT AND IMPLEMENTATION OF WINCHESTER HOSPITAL'S COMMUNITY BENEFITS PROGRAMS IN FURTHERANCE OF WINCHESTER HOSPITAL'S COMMUNITY BENEFITS MISSION. THE MEMBERSHIP OF WINCHESTER HOSPITAL'S CBAC ASPIRES TO BE REPRESENTATIVE OF THE CONSTITUENCIES AND PRIORITY COHORTS SERVED BY WINCHESTER HOSPITAL'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.WINCHESTER HOSPITAL'S CBAC MEMBERS INCLUDE:- CARLA BEAUDOIN, DIRECTOR OF DEVELOPMENT, METRO HOUSING BOSTON - JESSIE BENCOSME, EXECUTIVE DIRECTOR, COUNCIL OF SOCIAL CONCERN - ANGELINE BRADY, COMMUNITY HEALTH PROGRAMS SUPERVISOR, WINCHESTER HOSPITAL CENTER FOR HEALTHY LIVING- DOT BUTLER, WINCHESTER SAFER COALITION- DR. MARIE CONDON WALSH, MEDFORD FAMILY PRACTICE - DENISE FLYNN; VICE PRESIDENT OF PHILANTHROPY, WINCHESTER HOSPITAL - CHRISTINE HEALEY, DIRECTOR OF COMMUNITY BENEFITS/COMMUNITY RELATIONS, BETH ISRAEL LAHEY HEALTH- KAREN KEANEY, CHIEF NURSING OFFICER- DEB MCDONOUGH, WINCHESTER HOSPITAL BOARD OF TRUSTEES- TERRI MARCIELLO, DIRECTOR OF ELDERLY SERVICES, WILMINGTON- JENNIFER MURPHY, DIRECTOR OF HEALTH, WINCHESTER HEALTH DEPARTMENT - LAUREN REID, DIRECTOR OF COMMUNITY PROGRAMS, MYSTIC VALLEY ELDER SERVICES - SHARON RON, PUBLIC HEALTH PLANNER, METROPOLITAN AREA PLANNING COMMISSION - ADAM ROGERS, EXECUTIVE DIRECTOR, BOYS & GIRLS CLUB OF STONEHAM & WAKEFIELD- MAUREEN RYAN, ASSISTANT SUPERINTENDENT, WOBURN PUBLIC SCHOOLS - JOSEPH TARBY, WINCHESTER HOSPITAL BOARD OF TRUSTEES- LEIGHANNE TAYLOR, REGIONAL MANAGER, COMMUNITY BENEFITS AND COMMUNITY RELATIONS WINCHESTER HOSPITAL - DR. RICHARD WEINER, PRESIDENT, WINCHESTER HOSPITAL - MATTHEW WOODS, CHIEF FINANCIAL OFFICER, WINCHESTER HOSPITAL - JANE WALSH, WINCHESTER HOSPITAL BOARD OF TRUSTEES

THE WINCHESTER HOSPITAL 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 PROCESS - REVIEWING RESULTS AND COMPILING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY DOCUMENTS:AS 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 WINCHESTER HOSPITAL COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC) AND HELD A VIRTUAL COMMUNITY FORUM PRESENTING RESULTS.- IDENTIFY WINCHESTER HOSPITAL'S COMMUNITY BENEFITS PRIORITY COHORTS, GEOGRAPHIC FOCUS, AND COMMUNITY HEALTH PRIORITIES.- ANALYZE WINCHESTER HOSPITAL'S EXISTING COMMUNITY BENEFITS ACTIVITIES WHICH WERE INFORMED BY THE 2019 CHNA AND SUBSEQUENT 2020 2022 IMPLEMENTATION STRATEGY THAT WERE COMPLETED BY WINCHESTER HOSPITAL 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 PROCESS - KEY FINDINGS:THE KEY PRIORITY COHORTS IDENTIFIED THROUGH THE CHNA CONDUCTED DURING THE PERIOD ENDED SEPTEMBER 30, 2022, WERE:- YOUTH - OLDER ADULTS- LOW-RESOURCED POPULATIONS- RACIALLY, ETHNICALLY AND LINGUISTICALLY DIVERSE POPULATIONS- LGBTQIA+WINCHESTER HOSPITAL'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 WINCHESTER HOSPITAL'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, WINCHESTER HOSPITAL 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 IMPLEMENTATION STRATEGY WAS COMPLETED BY WINCHESTER HOSPITAL 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 ASSESSMENT - TARGET GEOGRAPHY AND POPULATION:WINCHESTER HOSPITAL COMPLETED ITS 2019 ASSESSMENT BEGINNING IN DECEMBER 2018. THE GEOGRAPHICAL FOCUS OF WINCHESTER HOSPITAL'S 2019 CHNA ENCOMPASSES NINE CITIES AND TOWNS: MEDFORD, NORTH READING, READING, STONEHAM, WAKEFIELD, WILMINGTON, WINCHESTER, WOBURN, AND TEWKSBURY.TARGET POPULATIONS FOR WINCHESTER HOSPITAL'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).WINCHESTER HOSPITAL'S TARGET POPULATIONS FOCUSED ON MEDICALLY-UNDERSERVED AND VULNERABLE GROUPS OF ALL AGES IN MEDFORD, NORTH READING, READING, STONEHAM, WAKEFIELD, WILMINGTON, WINCHESTER, WOBURN, AND TEWKSBURY AS FOLLOWS:- YOUTH AND ADOLESCENTS - OLDER ADULTS - LOW-RESOURCE INDIVIDUALS AND FAMILIES - INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS THE GEOGRAPHICAL FOCUS OF WINCHESTER HOSPITAL'S 2019 CHNA ENCOMPASSES MEDFORD, NORTH READING, READING, STONEHAM, WAKEFIELD, WILMINGTON, WINCHESTER, WOBURN, AND TEWKSBURY.2019 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODS THE CHNA USED A PARTICIPATORY, COLLABORATIVE APPROACH TO LOOK AT HEALTH IN ITS BROADEST CONTEXT. THE COLLABORATIVE PROCESS INCLUDED SYNTHESIZING EXISTING REGIONAL DATA ON SOCIAL, ECONOMIC AND HEALTH INDICATORS AS WELL AS INFORMATION FROM KEY INFORMANT INTERVIEWS, COMMUNITY SURVEYS, FOCUS GROUPS AND COMMUNITY MEETINGS CONDUCTED WITH INDIVIDUALS FROM THE NINE CITIES AND TOWNS IN WINCHESTER HOSPITAL'S CBSA, AND WITH A RANGE OF PEOPLE REPRESENTING DIFFERENT AUDIENCES, INCLUDING LEADERS IN EMERGENCY RESPONSE, EDUCATION, HEALTH CARE AND SOCIAL SERVICE ORGANIZATIONS FOCUSING ON VULNERABLE POPULATIONS (E.G., OLDER ADULTS) (SCHEDULE H, PART V, SECTION B, QUESTIONS 3 AND 5). ULTIMATELY, THE QUALITATIVE RESEARCH ENGAGED APPROXIMATELY 1,061 PEOPLE; - KEY INFORMANT INTERVIEWS WITH WINCHESTER HOSPITAL/BILH STAFF - 28 - KEY INFORMANT INTERVIEWS WITH COMMUNITY PARTNERS 20 - FOCUS GROUPS (4) - 95 ATTENDEES - COMMUNITY LISTENING SESSIONS (2) - 100 ATTENDEES - COMMUNITY SURVEYS 806 RESPONDENTS - CBAB MEETINGS (2) - 35 ATTENDEES TOTAL - PAC MEETINGS 25 ATTENDEES 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS - DETAIL OF APPROACH AND METHODS THE ASSESSMENT BEGAN IN DECEMBER 2018 AND WAS CONDUCTED IN THREE PHASES, ALLOWING FOR THE COLLECTION OF AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA: PHASE 1 PRELIMINARY ASSESSMENT AND ENGAGEMENT PHASE 2 TARGETED ENGAGEMENT PHASE 3 STRATEGIC PLANNING AND REPORTING HUNDREDS OF INDIVIDUALS FROM ACROSS WINCHESTER HOSPITAL'S SERVICE AREA WERE ENGAGED IN THE ASSESSMENT AND PLANNING PROCESS, INCLUDING HEALTH AND SOCIAL SERVICES PROVIDERS, PUBLIC HEALTH OFFICIALS, ELECTED OFFICIALS, PUBLIC SCHOOL NURSES AND ADMINISTRATORS, FIRST RESPONDERS, LEADERS OF FAITH-BASED ORGANIZATIONS, BILH SENIOR LEADERSHIP, STAFF, AND BOARD MEMBERS, AND COMMUNITY RESIDENTS.

QUANTITATIVE DATA SOURCES:
AN EXTENSIVE AMOUNT OF DEMOGRAPHIC AND SOCIOECONOMIC DATA, HEALTH STATUS, UTILIZATION RATES, AND RISK SURVEY DATA WAS COLLECTED FROM A BROAD RANGE OF SOURCES AND ANALYZED TO MEASURE HEALTH AND UNDERSTAND HEALTH ISSUES. EXAMPLES OF DATA SOURCES WINCHESTER HOSPITAL LEVERAGED INCLUDED: - U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2013-2017) - MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION: SCHOOL AND DISTRICT PROFILES - 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 DEPARTMENT OF PUBLIC HEALTH, OPIOID RELATED EMS INCIDENTS (2018) - MASSACHUSETTS BUREAU OF INFECTIOUS DISEASE AND LABORATORY SCIENCES (2017) - MASSACHUSETTS CENTER FOR HEALTH INFORMATION ANALYSIS (CHIA) HOSPITAL PROFILES (FY 2013-2017) - MASSACHUSETTS CENTER FOR HEALTH INFORMATION ANALYSIS (CHIA) HOSPITAL DISCHARGES (2017) - MASSACHUSETTS HEALTHY AGING COLLABORATIVE, COMMUNITY PROFILES (2019)- MIDDLESEX LEAGUE YOUTH RISK BEHAVIOR SURVEY (2019)- CHANGING FACES OF GREATER BOSTON, BOSTON FOUNDATION (2019) 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS - FOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5) FOCUS GROUPS: WINCHESTER HOSPITAL CONDUCTED COMMUNITY FOCUS GROUPS IN WINCHESTER HOSPITAL'S CBSA, TO GATHER CRITICAL COMMUNITY INPUT FROM COMMUNITY RESIDENTS AND STAKEHOLDERS. THE FOCUS GROUPS WERE CONDUCTED FOR THREE DIFFERENT VULNERABLE SEGMENTS OF THE POPULATION, ALONG WITH A SESSION FOR THOSE WHO SPECIALIZE IN SUBSTANCE MISUSE PREVENTION, AND WERE ORGANIZED IN COLLABORATION WITH COMMUNITY PARTNERS REPRESENTING THESE POPULATIONS. THE FOCUS GROUP SESSIONS INCLUDED: - YOUTH/ADOLESCENTS BOYS & GIRLS CLUB OF STONEHAM AND WAKEFIELD - SUBSTANCE USE DISORDER WINCHESTER SAFER COALITION - INDIVIDUALS WITH HOUSING/ECONOMIC INSECURITY WINCHESTER HOUSING AUTHORITY - OLDER ADULTS LOCAL COAS FOCUS GROUPS WERE HELD AT LOCATIONS THAT WERE CONSIDERED SAFE SPACES AND ACCESSIBLE TO PARTICIPANTS FROM ACROSS THE CBSA. JSI FACILITATED ALL THE FOCUS GROUPS EXCEPT THOSE FOCUSED ON YOUTH, WHICH WERE CONDUCTED BY THE BOYS & GIRLS CLUB OF STONEHAM & WAKEFIELD, WHO SHARED THEIR FINDINGS WITH JSI. FOCUS GROUPS ALLOWED FOR THE COLLECTION OF INFORMATION TO AUGMENT FINDINGS FROM SECONDARY DATA AND KEY INFORMANT INTERVIEWS, AND FOR THE EXPLORATION OF STRATEGIC AND PROGRAMMATIC OPTIONS TO ADDRESS IDENTIFIED HEALTH ISSUES, SERVICE GAPS, AND/OR BARRIERS TO CARE. PARTICIPANTS WERE RECRUITED BY WINCHESTER HOSPITAL, WORKING IN COLLABORATION WITH COMMUNITY PARTNERS.COMMUNITY FORUMS: WINCHESTER HOSPITAL FACILITATED TWO COMMUNITY LISTENING SESSIONS, ONE OF WHICH WAS CONDUCTED JOINTLY WITH MELROSE-WAKEFIELD HOSPITAL SINCE THERE IS OVERLAP BETWEEN WINCHESTER HOSPITAL'S AND MELROSE-WAKEFIELD HOSPITAL'S COMMUNITY BENEFITS SERVICE AREAS. THE LISTENING SESSIONS WERE PUBLICIZED AND OPEN TO THE PUBLIC. AT THE LISTENING SESSIONS, A SUMMARY OF KEY QUANTITATIVE AND QUALITATIVE DATA FINDINGS TO DATE WERE PRESENTED, AND FEEDBACK AND INPUT FROM COMMUNITY MEMBERS ON PRIORITY POPULATIONS AND HEALTH NEEDS WAS SOLICITED. THE SESSIONS WERE ALSO USED TO SHARE INFORMATION AND SOLICITED. THE SESSIONS ALLOWED FOR THE CAPTURE OF INFORMATION DIRECTLY FROM COMMUNITY RESIDENTS, REPRESENTATIVES FROM LOCAL COMMUNITY ORGANIZATIONS, AND LOCAL SERVICE PROVIDERS. TWO LOCATIONS WITH COMFORTABLE AND ACCESSIBLE SPACE WITH AMPLE PUBLIC PARKING WERE SELECTED IN WINCHESTER AND STONEHAM.COMMUNITY SURVEYS: WINCHESTER HOSPITAL HAS BEEN INTENTIONAL IN ENSURING THAT VARIED EXPERIENCES AND PERSPECTIVES, REFLECTIVE OF WINCHESTER HOSPITAL'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 COMMUNITY SURVEY WAS DISTRIBUTED THROUGH COMMUNITY PARTNERS AND WAS ADMINISTERED ONLINE AND VIA HARD COPY IN ENGLISH AS WELL AS SEVEN ADDITIONAL LANGUAGES INCLUDING TRADITIONAL CHINESE, HAITIAN CREOLE, HINDI, ITALIAN, KHMER, PORTUGUESE, AND SPANISH. FURTHERMORE, EXTENSIVE OUTREACH WAS CONDUCTED VIA SOCIAL MEDIA, INSTITUTIONAL NEWSLETTERS, EMAILS TO LARGE NETWORKS, LOCAL LIBRARIES AND COMMUNITY EVENTS TO HELP ENSURE DIVERSE REPRESENTATION IN THE CHNA.

2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS - REVIEWING RESULTS AND
COMPILING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY DOCUMENTS AS 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.- IDENTIFY WINCHESTER HOSPITAL'S COMMUNITY BENEFITS PRIORITY POPULATIONS, GEOGRAPHIC FOCUS, AND COMMUNITY HEALTH PRIORITIES.- ANALYZE WINCHESTER HOSPITAL'S EXISTING COMMUNITY BENEFITS ACTIVITIES WHICH WERE INFORMED BY THE 2016 CHNA AND SUBSEQUENT IMPLEMENTATION STRATEGY THAT WERE COMPLETED BY WINCHESTER HOSPITAL 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).2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS - KEY FINDINGSBELOW IS A HIGH-LEVEL SUMMARY OF HEALTH-RELATED FINDINGS THAT WERE IDENTIFIED AFTER A COMPREHENSIVE REVIEW OF ALL THE QUANTITATIVE AND QUALITATIVE INFORMATION COLLECTED: - SOCIAL DETERMINANTS OF HEALTH (E.G., ECONOMIC STABILITY, TRANSPORTATION, ACCESS TO CARE, HOUSING FOOD INSECURITY) IMPACT MANY SEGMENTS OF THE POPULATION. A KEY THEME FROM THE ASSESSMENT'S KEY INFORMANT INTERVIEWS, FOCUS GROUPS, LISTENING SESSIONS, AND COMMUNITY HEALTH SURVEY WAS THE CONTINUED IMPACT THAT THE SOCIAL DETERMINANTS OF HEALTH HAVE ON RESIDENTS OF WH'S SERVICE AREA, ESPECIALLY THOSE WHO ARE LOW TO MODERATE INCOME, ARE FRAIL OR HOMEBOUND, HAVE MENTAL HEALTH OR SUBSTANCE USE ISSUES, OR LACK A CLOSE SUPPORT SYSTEM. THE INCREASING COST OF HOUSING IN AREAS OUTSIDE BOSTON WAS ALSO NOTED AS CONTRIBUTING TO HOUSING/FINANCIAL INSTABILITY.- CERTAIN POPULATIONS ARE MORE VULNERABLE TO HEALTH CARE DISPARITIES AND BARRIERS TO CARE. DESPITE THE FACTS THAT MASSACHUSETTS HAS ONE OF THE HIGHEST RATES OF HEALTH INSURANCE ENROLLMENT AND THE COMMUNITIES THAT MAKE UP WH'S CBSA ARE GENERALLY INSURED AND EMPLOYED, THERE WAS CONCERN THAT FAMILIES FACE FINANCIAL STRESS BECAUSE OF HIGH OUT-OF-POCKET COSTS FOR HEALTH CARE SERVICES AND NOT BEING ELIGIBLE FOR PUBLIC BENEFITS, OR, IF THEY ARE ELIGIBLE, THEY ARE NOT ENROLLING BECAUSE OF THE STIGMA OF ACCEPTING PUBLIC ASSISTANCE. IN ADDITION, THERE ARE GROUPS THAT FACE LANGUAGE AND CULTURAL BARRIERS TO ACCESSING SERVICES.- MENTAL HEALTH ISSUES (E.G., DEPRESSION, ANXIETY/STRESS, ACCESS TO TREATMENT, STIGMA) UNDERLIE MANY HEALTH AND SOCIAL CONCERNS. NEARLY EVERY KEY INFORMANT INTERVIEW, FOCUS GROUP, AND LISTENING SESSION INCLUDED DISCUSSIONS ON THE IMPACT OF MENTAL HEALTH ISSUES. FROM A REVIEW OF THE QUANTITATIVE AND QUALITATIVE INFORMATION, DEPRESSION, ANXIETY/STRESS, AND SOCIAL ISOLATION WERE THE LEADING CONCERNS. THERE WERE PARTICULAR CONCERNS ABOUT THE IMPACT OF DEPRESSION, ANXIETY, AND E-CIGARETTES/VAPING ON YOUTH AND OF SOCIAL ISOLATION AMONG OLDER ADULTS. ACCESS TO MENTAL HEALTH SERVICES WAS LIMITED BY THE GENERAL LACK OF PROVIDERS AND THE LOW NUMBER ACCEPTING EVEN PRIVATE HEALTH INSURANCE.- SUBSTANCE DEPENDENCY CONTINUES TO IMPACT INDIVIDUALS, FAMILIES, AND COMMUNITIES. THE OPIOID EPIDEMIC CONTINUES TO BE AN AREA OF FOCUS. BEYOND OPIOIDS, KEY INFORMANTS WERE ALSO CONCERNED WITH WINCHESTER HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT 2019 ALCOHOL MISUSE, CHANGING COMMUNITY NORMS IN LIGHT OF THE LEGALIZATION OF RECREATIONAL MARIJUANA USE, AND E-CIGARETTES/VAPING AMONG ADOLESCENTS.- CHRONIC DISEASES (E.G., CARDIOVASCULAR DISEASE, CANCER, DIABETES, ASTHMA) REQUIRE MORE EDUCATION, SCREENING/EARLY INTERVENTION, AND MANAGEMENT AND A FOCUS ON RISK FACTORS. ALTHOUGH THERE WAS MAJOR EMPHASIS ON BEHAVIORAL HEALTH ISSUES, MANY KEY INFORMANTS, FOCUS GROUP PARTICIPANTS, AND LISTENING SESSION PARTICIPANTS IDENTIFIED A NEED TO ADDRESS THE MANY RISK FACTORS ASSOCIATED WITH CHRONIC AND COMPLEX HEALTH CONDITIONS. PHYSICAL INACTIVITY AND POOR NUTRITION/LIFESTYLE WERE DISCUSSED BY MANY, WITH SOME OF THESE ISSUES BEING ASSOCIATED WITH AGE (MOBILITY ISSUES AMONG OLDER ADULTS), EDUCATION/HEALTH LITERACY (LACK OF UNDERSTANDING ABOUT HEALTHY EATING), AND EASE OF ACCESS TO HIGH CALORIE /UNHEALTHY FOOD CHOICES, AND A LACK OF WALKABLE STREETS IN NEIGHBORHOODS. ADDRESSING THE LEADING RISK FACTORS IS AT THE ROOT OF MANY CHRONIC DISEASE PREVENTION AND MANAGEMENT STRATEGIES. AN INTEGRATED ANALYSIS OF ALL ASSESSMENT ACTIVITIES FRAMED THE LEADING COMMUNITY HEALTH ISSUES INTO THE FOLLOWING PRIORITY AREAS AND TARGET POPULATIONS:PRIORITY AREAS: - MENTAL HEALTH & SUBSTANCE USE DISORDERS - CHRONIC COMPLEX CONDITIONS - SOCIAL DETERMINANTS OF HEALTH & ACCESS TO CARE TARGET POPULATIONS: - YOUTH AND ADOLESCENTS - OLDER ADULTS - LOW-RESOURCE INDIVIDUALS AND FAMILIES - INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS 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 WINCHESTER HOSPITAL'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 PROHIBITS 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 WINCHESTER HOSPITAL, 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 WINCHESTER HOSPITAL WERE IMPACTED BY THIS UNFORESEEN HEALTH CRISIS AND IN THE ABSENCE OF REGULATORY GUIDANCE TO THE CONTRARY, WINCHESTER HOSPITAL NEEDED TO QUICKLY REASSESS AND PIVOT TO MEET THE NEW AND PREVIOUSLY UNEXPECTED COMMUNITY NEEDS. AS SUCH, IN RESPONSE TO THE COVID-19 CRISIS WINCHESTER HOSPITAL'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 ADDITIONAL AND NEWLY URGENT HEALTH NEEDS IN RESPONSE TO COVID-19 WERE:- INCREASED DEMAND FOR FOOD ACCESS- INCREASED DEMAND FOR MENTAL HEALTH SERVICES- ACCESS TO PREVENTIVE MEASURES, TESTING, SCREENING AND TREATMENT FOR THOSE AT-RISK OR EXPOSED TO COVID-19- SOCIAL DETERMINANT OF HEALTH IMPACTS DUE TO THE PANDEMIC (FINANCIAL CONSTRAINTS, HOUSING, TRANSPORTATION ETC.).THE ACTIONS TAKEN TOWARD ADDRESSING THESE NEEDS ARE INCLUDED FURTHER IN THIS NARRATIVE SUPPORT ALONG WITH WINCHESTER HOSPITAL'S DETAILED DESCRIPTION OF ACTIVITIES UNDERTAKEN TO MEET THE COMMUNITY NEEDS. COMMUNITY HEALTH NEEDS ASSESSMENT - MAKING THE CHNA AND IMPLEMENTATION STRATEGY WIDELY AVAILABLEWINCHESTER HOSPITAL STRIVES TO ADDRESS THE PRIORITY AREAS IN ITS CHNA AND IMPLEMENTATION STRATEGY.AS NOTED ABOVE, WINCHESTER HOSPITAL 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 WINCHESTER HOSPITAL WEBSITE AT:HTTPS://WWW.WINCHESTERHOSPITAL.ORG/FILE%20LIBRARY/UNASSIGNED/WH-2022-COMMUNITY-HEALTH-NEEDS-093022.PDFIN ADDITION TO THE CHNA, WINCHESTER HOSPITAL COMPLETED ITS MOST RECENT IMPLEMENTATION STRATEGY DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021). THE IMPLEMENTATION STRATEGY IS AVAILABLE ON THE WINCHESTER HOSPITAL WEBSITE AT: HTTPS://WWW.WINCHESTERHOSPITAL.ORG/FILE%20LIBRARY/UNASSIGNED/WH-2022-CHNA-IMPLEMENTATION-093022.PDFIN ADDITION, AS NOTED ABOVE, WINCHESTER HOSPITAL COMPLETED ITS PREVIOUS CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018). THAT CHNA, WHICH INCLUDES THE FY20-FY22 IMPLEMENTATION STRATEGY IS AVAILABLE ON THE WINCHESTER HOSPITAL WEBSITE AT: HTTPS://WWW.WINCHESTERHOSPITAL.ORG/FILE%20LIBRARY/UNASSIGNED/WH-2019-CHNA-091319.PDFEACH OF THESE DOCUMENTS IS ALSO AVAILABLE ON REQUEST (SCHEDULE H, PART V, SECTION B, LINE 7A).

COMMUNITY HEALTH NEEDS ASSESSMENT - ADDRESSING COMMUNITY HEALTH NEEDS
"(SCHEDULE H, PART V, SECTION B, LINE 11)AS NOTED ABOVE, WINCHESTER HOSPITAL'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 WINCHESTER HOSPITAL FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 WHICH ARE REPORTED HERE. A SUMMARY OF WINCHESTER HOSPITAL'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, WINCHESTER HOSPITAL HAS BEEN STRATEGIC IN IDENTIFYING ITS COMMUNITY HEALTH PRIORITIES IN ORDER 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 DISORDER GOAL: ADDRESS THE PREVALENCE AND IMPACT, STIGMA, RISK/PROTECTIVE FACTORS, AND ACCESS ISSUES ASSOCIATED WITH MENTAL HEALTH AND SUBSTANCE USE DISORDER. PRIORITY AREA 2: CHRONIC COMPLEX CONDITIONS AND RISK FACTORS GOAL: PREVENT, DETECT, AND MANAGE CHRONIC DISEASE AND COMPLEX CONDITIONS AND ENHANCE ACCESS TO TREATMENT AND SUPPORT ACTIVITIES. PRIORITY AREA 3: SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO CARE GOAL: ADDRESS SOCIAL DETERMINANTS OF HEALTH AND BARRIERS TO CARE. COMMUNITY HEALTH NEEDS ASSESSMENT - APPROACH TO ADDRESSING HEALTH NEEDS (SCHEDULE H, PART V, SECTION B, LINE 11)WINCHESTER HOSPITAL HAS TAKEN A HOLISTIC AND STRATEGIC APPROACH IN ADDRESSING THE HEALTH PRIORITIES IDENTIFIED IN THE CHNA AND ASSOCIATED IMPLEMENTATION STRATEGY BY CREATING, SUPPORTING AND INVESTING IN HEALTH PROGRAMMING AND INITIATIVES THROUGHOUT THEIR CBSA. BELOW IS A SUMMARY OF SOME OF THE COMMUNITY BENEFITS PROGRAMS AND INITIATIVES WINCHESTER HOSPITAL OPERATES AND SUPPORTS TO IMPROVE HEALTH OUTCOMES AMONG THEIR TARGET POPULATIONS THROUGHOUT THE HOSPITAL'S COMMUNITY BENEFITS SERVICE AREA.WINCHESTER HOSPITAL SUPPORTS A MYRIAD OF COMMUNITY BENEFITS PROGRAMS THAT ADDRESS THE SOCIAL DETERMINANTS OF HEALTH. PROGRAMS INCLUDE METRO HOUSING BOSTON'S CO-LOCATION PROGRAM TO ADDRESS HOUSING STABILITY THROUGH RENTAL ASSISTANCE AND EVICTION PREVENTION SUPPORT FOR WINCHESTER HOSPITAL PATIENTS. IN FY21, FREE COUNSELING WAS PROVIDED TO 257 LOW- TO MODERATE-INCOME INDIVIDUALS AND FAMILIES TO PREVENT EVICTION, INCREASE HOUSING STABILITY AND ECONOMIC SELF-SUFFICIENCY, AND IMPROVE THEIR OVERALL QUALITY OF LIFE. COUNSELORS ALSO HELPED WITH HOUSING SEARCHES, EMERGENCY ASSISTANCE, RAPID REHOUSING, AND BENEFITS MAXIMIZATION, AND CONNECTED PARTICIPANTS TO COMMUNITY RESOURCES. TO FURTHER ADDRESS THE SOCIAL DETERMINANTS OF HEALTH, WINCHESTER HOSPITAL IS COMMITTED TO ENSURING ACCESS TO AFFORDABLE, HEALTHY FOOD FOR PEOPLE OF ALL INCOME LEVELS. THIS WORK IS ACCOMPLISHED THROUGH SUPPORT TO THE COUNCIL OF SOCIAL CONCERN. IN FY21 THE COUNCIL PROVIDE FOOD SECURITY RELIEF FOR 1,440 INDIVIDUALS LIVING IN WOBURN AND WINCHESTER. 97% OF HOUSEHOLDS SERVED REPORTED THAT THE FOOD ASSISTANCE AND INFORMATION REGARDING COMMUNITY RESOURCES THEY RECEIVED FROM THE FOOD PANTRY MADE IT EASIER FOR THEM TO MEET THEIR OTHER BASIC MONTHLY FINANCIAL NEEDS. OTHER EXAMPLES OF SUCCESS ARE LISTED IN THE SUBSEQUENT SCHEDULE H IMPLEMENTATION STRATEGY UPDATE. WINCHESTER HOSPITAL IS A PARTNER IN PROVIDING HEALTHCARE TO POPULATIONS WHO HAVE HISTORICALLY NOT HAD ADEQUATE ACCESS TO CARE. IN FY21, WINCHESTER HOSPITAL PHLEBOTOMY STAFF PROVIDED HOME BLOOD DRAWS FOR 12,234 PATIENTS WHO WERE HOMEBOUND DUE TO ILLNESS, INJURY, OR TRANSPORTATION ISSUES. TO FURTHER SUPPORT ACCESS TO AFFORDABLE CARE, THE HOSPITAL ALSO PARTNERED WITH MINUTEMAN SENIOR SERVICES TO PROVIDE MEDICARE BENEFITS COUNSELING TO 650 INDIVIDUALS IN THE CBSA.WINCHESTER HOSPITAL HAS FOCUSED ITS EFFORTS ON CREATING TARGETED PROGRAMS THAT ADDRESS CHRONIC DISEASES SUCH AS CANCER, DIABETES, AND ASTHMA. THESE PROGRAMS INCLUDE BUT ARE NOT LIMITED TO WINCHESTER HOSPITAL'S ONCOLOGY NURSE NAVIGATORS, BREAST CANCER RISK ASSESSMENT PROGRAM, CENTER FOR HEALTHY LIVING CHAMP ASTHMA PROGRAM, AND VARIOUS SUPPORT GROUPS FOR PEOPLE DIAGNOSED WITH CANCER. DETAILS OF OTHER WINCHESTER PROGRAMS ADDRESSING CHRONIC DISEASE MANAGEMENT ARE INCLUDED IN THE IMPLEMENTATION STRATEGY UPDATE BELOW.AMONG THE MANY WAYS WINCHESTER HOSPITAL AND ITS PARTNERS ADDRESS BEHAVIORAL HEALTH NEEDS IS BY EXPANDING BEHAVIORAL HEALTH INTEGRATION AT WINCHESTER HOSPITAL AFFILIATED PRIMARY CARE SITES THROUGH THE COLLABORATIVE CARE MODEL. RESULTS OF BEHAVIORAL HEALTH INTEGRATION SHOW THAT MORE HIGH-RISK PATIENTS ARE ACCESSING MENTAL HEALTH SERVICES, AN INCREASE IN APPOINTMENTS KEPT BY PATIENTS WHO RECEIVE A ""WARM-HAND OFF"" BY THEIR PROVIDER TO THERAPISTS, AND REDUCED WAIT TIME FOR MENTAL HEALTH APPOINTMENTS. WINCHESTER HOSPITAL ALSO SUPPORTS IN-COMMUNITY MENTAL HEALTH PROGRAMMING THROUGH A PARTNERSHIP WITH THE BOYS AND GIRLS CLUB OF STONEHAM AND WAKEFIELD, WHO LEAD PROGRAMS TO ADDRESS YOUTH MENTAL HEALTH, AND THROUGH SUPPORT OF MYSTIC VALLEY ELDER SERVICES'S MOBILE MENTAL HEALTH PROGRAM TO ADDRESS OLDER ADULT HEALTH NEEDS.A FULL UPDATE ON WINCHESTER HOSPITAL'S HEALTH PRIORITIES AND ASSOCIATED GOALS IS INCLUDED BELOW."

FY20 SCHEDULE HIMPLEMENTATION STRATEGY UPDATE
WINCHESTER HOSPITAL'S FY20-22 IMPLEMENTATION STRATEGY FOCUSES ON THE FOLLOWING THREE PRIORITY AREAS IDENTIFIED IN THE CHNA THAT ADDRESS THE BROAD RANGE OF HEALTH AND SOCIAL ISSUES FACING RESIDENTS WHO HAVE THE GREATEST HEALTH DISPARITIES: BASELINE-2019, YEAR 1-2020, YEAR 2-2021, YEAR 3 - 2022 PRIORITY AREA #1 - MENTAL HEALTH AND SUBSTANCE USE DISORDERSMENTAL HEALTH ISSUES (E.G., DEPRESSION, ANXIETY, STRESS, STIGMA, AND ACCESS TO TREATMENT) UNDERLIE MANY HEALTH AND SOCIAL CONCERNS. CONCERNS INCLUDE DEPRESSION, ANXIETY/STRESS, SOCIAL ISOLATION AMONG OLDER ADULTS, SUBSTANCE DEPENDENCY (PARTICULARLY USE OF E-CIGARETTES/VAPING AND ALCOHOL BY YOUTH), AND THE OPIOID EPIDEMIC, WHICH CONTINUES TO IMPACT INDIVIDUALS, FAMILIES, AND COMMUNITIES. GOAL: ADDRESS THE PREVALENCE AND IMPACT, STIGMA, RISK/PROTECTIVE FACTORS, AND ACCESS ISSUES ASSOCIATED WITH MENTAL HEALTH AND SUBSTANCE USE DISORDER. TARGET POPULATION: CHILDREN, YOUTH, ADULTS, OLDER ADULTS PROGRAM OBJECTIVES:1.1 PROGRAMMATIC OBJECTIVE: REDUCE ISOLATION AND DEPRESSION: 1.2 PROGRAMMATIC OBJECTIVE: REDUCE ENVIRONMENTAL RISK FACTORS ASSOCIATED WITH DEVELOPING MENTAL HEALTH ISSUES 1.3 PROGRAMMATIC OBJECTIVE: PROMOTE COLLABORATION, SHARE KNOWLEDGE, AND COORDINATE ACTIVITIES WITH INTERNAL AND EXTERNAL PARTNERS 1.4 PROGRAMMATIC OBJECTIVE: INCREASE AWARENESS OF THE IMPACTS AND RISK FACTORS FOR DEVELOPING SUBSTANCE USE DISORDERS 1.5 PROGRAMMATIC OBJECTIVE: INCREASE AWARENESS OF THE SIGNS, SYMPTOMS, RISKS, AND STIGMA OF DEVELOPING MENTAL HEALTH ISSUES AND PROMOTE ACCESS TO TREATMENT 1.6 INCREASE ACCESS TO APPROPRIATE MENTAL HEALTH AND SUBSTANCE USE TREATMENT AND SUPPORT SERVICES: COMMUNITY ACTIVITIES/STRATEGIES: - ORGANIZE AND/OR SUPPORT INITIATIVES THAT INCREASE OPPORTUNITIES FOR SOCIAL ENGAGEMENT - ORGANIZE AND/OR SUPPORT COMMUNITY BASED INITIATIVES THAT INCREASE AWARENESS, PREVENT, AND/OR IDENTIFY INDIVIDUALS AT RISK FOR DEVELOPING SUBSTANCE USE DISORDERS, INCLUDING VAPING. (E.G. BOYS & GIRLS CLUB SBIRT) - ORGANIZE AND/OR SUPPORT INITIATIVES THAT REDUCE ENVIRONMENTAL RISK FACTORS ASSOCIATED WITH DEVELOPING MENTAL HEALTH ISSUES SUCH AS HOARDING, ETC. (E.G. MOBILE MENTAL HEALTH CLINIC) - SUPPORT AND/OR PARTICIPATE IN TASK FORCES AND COMMUNITY COLLABORATIVES THAT DISCUSS STRATEGIES TO ADDRESS MENTAL HEALTH/SUBSTANCE USE ISSUES (E.G. MYSTIC VALLEY PUBLIC HEALTH COMMITTEE) - ENHANCE ACCESS TO INTEGRATED BEHAVIORAL HEALTH SERVICES (E.G. INTERFACE HELPLINES) - PROVIDE SUPPORT/REFERRALS TO INDIVIDUALS WITH MENTAL HEALTH AND/OR SUBSTANCE USE ISSUES WITHIN THE EMERGENCY DEPARTMENT METRICS/STATUS UPDATE: - WINCHESTER HOSPITAL PROVIDED A GRANT TO THE BOYS & GIRLS CLUB OF STONEHAM & WAKEFIELD TO CONTINUE PROVIDING THE SBIRT PROGRAM ONSITE AT THE CLUB. IN FY20, 220 YOUTH WERE SCREENED. IN FY21, 321 YOUTH WERE SCREENED, RESULTING IN REFERRALS TO MENTAL HEALTH TREATMENT AND WEEKLY SESSIONS WITH MENTORS. IN FY22, 275 YOUTH WERE SCREENED, RESULTING IN 22 REFERRALS TO TREATMENT. OF ALL THE CHILDREN SCREENED OVER THE THREE YEARS, OVER 90% AGREED TO JOIN WEEKLY MENTORING PROGRAMS, NEARLY 80% REPORTED THEY WERE LESS LIKELY TO PARTICIPATE IN RISKY BEHAVIORS, NEARLY 95% IDENTIFIED AN ADULT TO TALK TO IF THEY FELT DEPRESSED OR HAD THOUGHTS OF SELF-HARM, AND OVER 65% OF ALL PARTICIPANTS IMPROVED THEIR ACCURACY IN ESTIMATING PEER MARIJUANA AND TOBACCO USE.- THE MYSTIC VALLEY ELDER SERVICES MOBILE MENTAL HEALTH PROGRAM PROVIDED HOME-BASED MENTAL HEALTH SERVICES TO OLDER ADULTS LIVING IN MEDFORD, NORTH READING, READING, STONEHAM, AND WAKEFIELD. NUMBERS SERVED BY YEAR ARE AS FOLLOWS: FY20: 329, FY21: 175, FY22: 264. THE PROGRAM ADDRESSED A VARIETY OF ISSUES AFFECTING OLDER ADULTS' EMOTIONAL WELL-BEING AND QUALITY OF LIFE THROUGH HOME-BASED MENTAL HEALTH COUNSELING AND DIRECT CARE SERVICES. - WINCHESTER HOSPITAL PROVIDED GRANTS TO THE WINCHESTER HEALTH DEPARTMENT (FY20-22) AND STONEHAM COALITION (FY21-22) TO SUPPORT THE INTERFACE MENTAL HEALTH REFERRAL SERVICE. IN FY20, 85 WINCHESTER RESIDENTS WERE SERVED BY INTERFACE. IN FY21 FROM DECEMBER-MAY, 84 WINCHESTER AND 30 STONEHAM RESIDENTS WERE SERVED BY THE PROGRAM. IN WINCHESTER IN FY22, 107 CALLERS UTILIZED INTERFACE. THE TOP REFERRAL CONCERNS INCLUDED SUICIDAL IDEATION, SELF-HARM, ANXIETY, AND DEPRESSION. IN STONEHAM IN FY22, 91 STONEHAM RESIDENTS WERE SERVED BY INTERFACE. THE TOP CALL CONCERNS FOR ALL THREE YEARS WERE ANXIETY AND DEPRESSION, INCLUDING SUICIDAL IDEATION AND SELF-INJURY. - BILH PRIMARY CARE CONTINUED TO IMPLEMENT THE COLLABORATIVE CARE MODEL (COCM) AND INTEGRATED BEHAVIORAL HEALTH SERVICES INTO PRIMARY CARE OFFICES IN WINCHESTER HOSPITAL'S CBSA. IN FY20, 624 PATIENTS RECEIVED THE SERVICE AT THREE DIFFERENT PRIMARY CARE SITES: STONEHAM (248 PATIENTS), TEWKSBURY (206 PATIENTS), AND WINCHESTER (170 PATIENTS).IN FY21, THERE WAS AN INCREASE IN HIRING AND TRAINING BEHAVIORAL HEALTH CLINICIANS TO EXPAND PATIENT CARET CAPACITY. AT WINCHESTER HOSPITAL THERE WAS AN INCREASE FROM 3 TO 6 SITES, SERVING 624 SERVING 1346 PATIENTS. IN FY22 THE SERVICE WAS INTEGRATED INTO 7 PRIMARY CARE SITES IN WINCHESTER HOSPITAL'S CBSA, REACHING 1,918 PEOPLE.

PRIORITY AREA #2 - CHRONIC/COMPLEX CONDITIONS AND RISK FACTORS
THE CHNA FINDINGS REVEALED A NEED TO ADDRESS THE MANY RISK FACTORS ASSOCIATED WITH CHRONIC AND COMPLEX HEALTH CONDITIONS, INCLUDING PHYSICAL INACTIVITY AND POOR NUTRITION/LIFESTYLE, PARTICULARLY FOR OLDER ADULTS, PEOPLE WITH LOWER LEVELS OF EDUCATION/HEALTH LITERACY, AND THOSE WITH ACCESS ISSUES. ADDRESSING THE LEADING RISK FACTORS IS THE KEY TO MANY CHRONIC DISEASE PREVENTION AND MANAGEMENT STRATEGIES. GOAL: PREVENT, DETECT AND MANAGE CHRONIC DISEASE AND COMPLEX CONDITIONS AND ENHANCE ACCESS TO TREATMENT AND SUPPORT SERVICES TARGET POPULATION: OLDER ADULTS, INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS, LOW-RESOURCE INDIVIDUALS AND FAMILIES, YOUTH AND ADOLESCENTS PROGRAM OBJECTIVES:2.1 PROGRAMMATIC OBJECTIVE: CREATE AWARENESS OF/EDUCATE COMMUNITY MEMBERS ABOUT THE PREVENTABLE RISK FACTORS ASSOCIATED WITH CHRONIC AND COMPLEX HEALTH CONDITIONS. 2.2 PROGRAMMATIC OBJECTIVE: HELP COMMUNITY MEMBERS DETECT CHRONIC DISEASE AND PROVIDE LINKAGES TO SERVICES.2.3 PROGRAMMATIC OBJECTIVE: ENGAGE INDIVIDUALS IN EVIDENCE-BASED/EVIDENCE-INFORMED PROGRAM THAT HELP THEM BETTER MANAGE THEIR CHRONIC DISEASE.2.4 PROGRAMMATIC OBJECTIVE: EDUCATE INDIVIDUALS ABOUT ACHIEVING A HEALTHY DIET.2.5 PROGRAMMATIC OBJECTIVE: INCREASE ACCESS TO SUPPORTIVE SERVICES THAT REDUCE THE STRESS AND ANXIETY ASSOCIATED WITH CHRONIC ILLNESS.COMMUNITY ACTIVITIES/STRATEGIES:- ORGANIZE AND/OR SUPPORT PROGRAMS AND ACTIVITIES IN CLINICAL OR COMMUNITY BASED SETTINGS TO PROVIDE EDUCATION (E.G. BREAST CANCER EDUCATION & OUTREACH, STROKE AWARENESS, BACK TO SCHOOL EVENT). - ORGANIZE AND/OR SUPPORT HEALTH SCREENINGS IN CLINICAL OR NON-CLINICAL SETTINGS TO DETECT CHRONIC/COMPLEX CONDITIONS AND REFER TO AND/OR COORDINATE CARE (E.G. BREAST CANCER RISK ASSESSMENT, HOME BLOOD DRAW PROGRAM) - ORGANIZE AND/OR SUPPORT PROGRAMS AND ACTIVITIES THAT REFER, EDUCATE AND SUPPORT INDIVIDUALS IN BETTER MANAGING THEIR CHRONIC/COMPLEX CONDITIONS (E.G. CHRONIC DISEASE MANAGEMENT PROGRAM, CHAMP PEDIATRIC ASTHMA PROGRAM, FIGHTING FATIGUE, ETC.) - ORGANIZE AND/OR SUPPORT PROGRAMS IN CLINICAL AND NON-CLINICAL SETTINGS THAT EDUCATE ON HOW TO CHOOSE AND/OR PREPARE HEALTHY FOODS - PROVIDE OR SUPPORT PROGRAMS AND SERVICES THAT HELP INDIVIDUALS AND FAMILY MEMBERS ALLEVIATE THE BURDEN(S) ASSOCIATED WITH CHRONIC/COMPLEX CONDITIONS METRICS/STATUS UPDATE: - IN FY20, WINCHESTER HOSPITAL CONDUCTED 3,342 FREE BREAST CANCER RISK ASSESSMENTS, 4,217 ASSESSMENTS IN FY21, AND 4,027 ASSESSMENTS IN FY22.- IN FY20 AND FY21, 84 CHILDREN WERE ENROLLED IN CHAMP, A PEDIATRIC ASTHMA MANAGEMENT PROGRAM EACH YEAR. IN FY22 PROGRAM ENROLLMENT GREW TO 104 CHILDREN. THIS PROGRAM RESULTED IN FEWER MISSED SCHOOL DAYS AND EMERGENCY ROOM VISITS AND IMPROVED OVERALL QUALITY OF LIFE FOR PARTICIPANTS. - PHYSICAL THERAPISTS FROM WINCHESTER HOSPITAL CONTINUED THE FIGHTING FATIGUE PROGRAM FOR TWO YEARS, FY20 AND FY21. IN FY20, A TOTAL OF 94 CLASSES WERE HELD, WITH 13 PARTICIPANTS COMPLETING THE 12-WEEK PROGRAM. THEIR DIAGNOSES INCLUDED GYNECOLOGICAL, BREAST, AND BLOOD CANCERS. IN FY21, A TOTAL OF 49 CLASSES WERE HELD, WITH 8 PARTICIPANTS COMPLETING THE 12-WEEK PROGRAM. THE PROGRAM ENDED IN FY22.- IN FY20, WINCHESTER HOSPITAL PROVIDED 584 FREE INTEGRATIVE THERAPY SESSIONS TO MORE THAN 500 PATIENTS UNDERGOING CANCER TREATMENT. IN FY21, WINCHESTER HOSPITAL PROVIDED 613 FREE INTEGRATIVE THERAPY SESSIONS TO MORE THAN 600 PATIENTS UNDERGOING CANCER TREATMENT. IN ADDITION, 15 YOGA CLASSES WERE OFFERED TO CANCER PATIENTS IN TREATMENT OR RECOVERY, REACHING APPROXIMATELY 40 PARTICIPANTS. IN FY22, WINCHESTER HOSPITAL PROVIDED 540 FREE INTEGRATIVE THERAPY SESSIONS TO MORE THAN 500 PATIENTS.- IN FY21, WINCHESTER HOSPITAL PROVIDED FUNDING TO SUPPORT THE WINCHESTER COUNCIL ON AGING JENKS CENTER MOBILE CHOLESTEROL AND ANEMIA CLINIC TO TARGET HOUSEHOLDS WITH LIMITED INCOMES TO ADDRESS THESE SERIOUS HEALTH CONCERNS AMONG LOWER INCOME OLDER ADULTS. 44 INDIVIDUALS PARTICIPATED BETWEEN THE CLINIC'S HOUSING AUTHORITY SITES AND JENKS CLINIC SITE. THIS WAS A ONE YEAR PROGRAM.- IN FY20-FY22, WINCHESTER HOSPITAL PROVIDED FUNDING FOR A 20-WEEK FREE FRUIT AND VEGETABLE SHARE WITH HEALTHY RECIPE RECOMMENDATIONS AT THE WINCHESTER HOUSING AUTHORITY. IN FY20, 112 RESIDENTS PARTICIPATED IN THE PROGRAM, AND MORE THAN 4,000 POUNDS OF PRODUCE WERE DELIVERED. IN FY21, MORE THAN 3,430 POUNDS OF FRESH PRODUCE, INCLUDING MORE THAN SIX VARIETIES OF FRUITS AND VEGETABLES, WERE DELIVERED TO THE TWO WINCHESTER HOUSING LOCATIONS. THIS PROGRAM CONTINUED IN FY22, DELIVERING MORE THAN 2,560 POUNDS OF PRODUCE. PER A POST-PROGRAM SURVEY, PROGRAM PARTICIPANTS REPORTED: 80% ATE A GREATER VARIETY OF FRUITS AND/OR VEGETABLES, 92% INCREASED THEIR DAILY INTAKE OF FRUITS AND VEGETABLES, AND 73% LEARNED MORE ABOUT LOCALLY GROWN FRUITS AND VEGETABLES. COMMUNITY PARTNERS: AMERICAN CANCER SOCIETY, THE JENKS CENTER, WINCHESTER HOUSING AUTHORITY, NEW ENTRY SUSTAINABLE FARMING INITIATIVE.

PRIORITY AREA # 3: SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO CARE:
A DOMINANT THEME FROM THE ASSESSMENT WAS THE TREMENDOUS IMPACT THAT THE SOCIAL DETERMINANTS OF HEALTH, PARTICULARLY FINANCIAL INSECURITY, ADEQUATE HEALTH INSURANCE COVERAGE, HOUSING, TRANSPORTATION, AND ACCESS TO HEALTHY FOODS HAVE ON RESIDENTS WITHIN WH'S CBSA. 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 FINANCIAL INSECURITY, ALSO UNDERLIE MANY OF THE ACCESS TO CARE ISSUES THAT WERE PRIORITIZED IN THE ASSESSMENT: NAVIGATING THE HEALTH SYSTEM (INCLUDING HEALTH INSURANCE), CHRONIC DISEASE MANAGEMENT, AND AFFORDING CARE. A KEY FINDING WAS THE CONTINUED IMPACT THAT THE SOCIAL DETERMINANTS OF HEALTH (E.G., ECONOMIC STABILITY, TRANSPORTATION, ACCESS TO CARE, HOUSING, FOOD SECURITY) HAVE ON RESIDENTS OF WINCHESTER HOSPITAL'S SERVICE AREA, ESPECIALLY THOSE WITH LOW TO MODERATE INCOME AND THOSE WHO ARE FRAIL OR HOMEBOUND, HAVE MENTAL HEALTH OR SUBSTANCE USE ISSUES, OR LACK A CLOSE SUPPORT SYSTEM. DESPITE THE FACT THAT PEOPLE IN WINCHESTER HOSPITAL'S SERVICE AREA ARE GENERALLY INSURED AND EMPLOYED, THE CHNA INDICATED CONCERN THAT FAMILIES FACE FINANCIAL STRESS BECAUSE OF HIGH OUT-OF-POCKET COSTS FOR HEALTH CARE SERVICES AND INELIGIBILITY FOR PUBLIC BENEFITS. IF ELIGIBLE, FAMILIES IN NEED OFTEN DON'T ENROLL BECAUSE OF THE STIGMA OF ACCEPTING PUBLIC ASSISTANCE. IN ADDITION, SOME GROUPS FACE LANGUAGE AND CULTURAL BARRIERS TO SERVICES. GOAL: ADDRESS SOCIAL DETERMINANTS OF HEALTH AND BARRIERS TO CARE. TARGET POPULATION: OLDER ADULTS, INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS, LOW-RESOURCE INDIVIDUALS AND FAMILIES, YOUTH AND ADOLESCENTS.PROGRAM OBJECTIVES 3.1 PROGRAMMATIC OBJECTIVE: INCREASE ACCESS TO AFFORDABLE AND SAFE TRANSPORTATION OPTIONS3.2 PROGRAMMATIC OBJECTIVE: EDUCATE PROVIDERS AND COMMUNITY MEMBERS ABOUT HOSPITAL AND/OR PUBLIC ASSISTANCE PROGRAMS THAT CAN HELP THEM IDENTIFY AND ENROLL IN APPROPRIATE HEALTH INSURANCE PLANS AND/OR REDUCE THEIR FINANCIAL BURDEN3.3 PROGRAMMATIC OBJECTIVE: ENHANCE AWARENESS ABOUT HOSPITAL/COMMUNITY RESOURCES THAT ADDRESS HEALTH ISSUES AND SOCIAL DETERMINANTS OF HEALTH 3.4 PROGRAMMATIC OBJECTIVE: EXPLORE WAYS TO REDUCE/ADDRESS HOUSING INSTABILITY 3.5 PROGRAMMATIC OBJECTIVE: INCREASE ACCESS TO CLINICAL SERVICES FOR HOMEBOUND PATIENTS 3.6 PROGRAMMATIC OBJECTIVE: INCREASE ACCESS TO AFFORDABLE AND NUTRITIOUS FOODS AND AFFORDABLE PHYSICAL ACTIVITY 3.7 PROGRAMMATIC OBJECTIVE: INCREASE AWARENESS ABOUT HOW TO CREATE A HEALTHY AND SAFE ENVIRONMENT FOR BABIES AND FAMILIES, AND PROMOTE HEALTHY CHILD DEVELOPMENT: 3.8 PROGRAMMATIC OBJECTIVE: ENSURE ACCESS TO PREVENTIVE 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 3.9 PROGRAMMATIC OBJECTIVE: PROMOTE EQUITABLE CARE AND SUPPORT FOR THOSE WHO FACE CULTURAL AND LINGUISTIC BARRIERSCOMMUNITY ACTIVITIES/STRATEGIES: - PROVIDE SUPPORT FOR PROGRAMS/INITIATIVES THAT ADDRESS ISSUES ASSOCIATED WITH TRANSPORTATION - PROVIDE COUNSELING, SUPPORT, AND REFERRAL SERVICES TO COMMUNITY MEMBERS TO ENROLL AND REMAIN IN APPROPRIATE - DISTRIBUTE INFORMATION AT COMMUNITY EVENTS AND TO PHYSICIANS, CLINICAL STAFF, AND COMMUNITY PARTNERS. - DEVELOP RELATIONSHIPS WITH COMMUNITY PARTNERS AND ORGANIZATIONS THAT ADDRESS ISSUES ASSOCIATED WITH HOUSING INSTABILITY - PROVIDE OR SUPPORT PROGRAMS/INITIATIVES THAT ENHANCE ACCESS TO CLINICAL SERVICES - ORGANIZE AND/OR SUPPORT PROGRAMS THAT PROVIDE ACCESS TO FREE OR LOW-COST HEALTHY FOODS AND PHYSICAL - ORGANIZE AND/OR SUPPORT PROGRAMS THAT PROMOTE A HEALTHY AND SAFE ENVIRONMENT AND/OR FOSTER HEALTHY GROWTH AND DEVELOPMENT FOR INFANTS AND BABIES - ORGANIZE AND/OR SUPPORT PROGRAMS/INITIATIVES THAT HELP PREVENT THE SPREAD OF COVID AND/OR INCREASE ACCESS TO SCREENING AND TREATMENT. - PROVIDE LINGUISTICALLY AND CULTURALLY APPROPRIATE HEALTH EDUCATION AND CARE MANAGEMENT - SUPPORT COMMUNITY-BASED INITIATIVES THAT ADDRESS LANGUAGE BARRIERS METRICS/STATUS UPDATE:- WINCHESTER HOSPITAL COLLABORATED WITH CHECKER CAB OF WOBURN TO PROVIDE FREE RIDES TO MEDICAL APPOINTMENTS FOR 90 PATIENTS IN FY20, 150 PATIENTS IN FY21, AND 260 PATIENTS IN FY22.IN FY22 THE WINCHESTER CENTER FOR CANCER CARE PROVIDED VOUCHERS FOR 277 ONE-WAY RIDES, SERVING 19 PATIENTS THROUGH A GRANT PARTNERSHIP WITH THE AMERICAN CANCER SOCIETY. - THROUGH A GRANT WINCHESTER HOSPITAL PROVIDED TO METRO HOUSING BOSTON, THE CO-LOCATION PROGRAM PROVIDED FREE COUNSELING TO 107 LOW- TO MODERATE-INCOME INDIVIDUALS AND FAMILIES TO HELP PREVENT THEM FROM BEING EVICTED AND INCREASE HOUSING STABILITY IN FY20, 166 INDIVIDUALS AND FAMILIES IN FY21, AND 257 INDIVIDUALS AND FAMILIES IN FY22. COUNSELORS ALSO HELPED WITH HOUSING SEARCHES, EMERGENCY ASSISTANCE, RAPID REHOUSING, AND BENEFITS MAXIMIZATION, AND CONNECTED PARTICIPANTS TO COMMUNITY RESOURCES. - WINCHESTER HOSPITAL PHLEBOTOMY STAFF PROVIDED HOME BLOOD DRAWS FOR 10,293 PATIENTS WHO WERE HOMEBOUND DUE TO ILLNESS, INJURY, OR TRANSPORTATION ISSUES. IN FY21, WINCHESTER HOSPITAL LAB SERVICES PROVIDED 11,398 FREE IN-HOME BLOOD DRAWS, AND 12,234 DRAWS IN FY22.- IN FY21, WINCHESTER HOSPITAL SUPPORTED THE WOBURN COUNCIL OF SOCIAL CONCERN FOOD PANTRY PROGRAM. 762 INDIVIDUALS WERE SERVED AND 109,720 POUNDS OF FOOD WERE DISTRIBUTED. THE COUNCIL ALSO STARTED A BACKPACK FOOD PROGRAM IN PARTNERSHIP WITH WOBURN PUBLIC SCHOOLS, WHICH SERVED 50 FOOD INSECURE STUDENTS WEEKLY THROUGHOUT THE SCHOOL YEAR. IN FY22, 1,440 INDIVIDUALS WERE SERVED BY THE COUNCIL OF SOCIAL CONCERN FOOD PANTRY PROGRAM. APPROXIMATELY 116,000 POUNDS OF FOOD WERE DISTRIBUTED. 93% OF HOUSEHOLDS REPORTED THAT THE FOOD ASSISTANCE THEY RECEIVED FROM THE FOOD PANTRY, ALONG WITH THE FOOD THEY PURCHASE ON THEIR OWN, WAS ENOUGH FOR EACH MEMBER OF THE HOUSEHOLD TO EAT AT LEAST TWO COMPLETE MEALS PER DAY OVER A ONE-MONTH PERIOD.- IN FY20, WINCHESTER HOSPITAL INTERPRETERS ASSISTED 1620 PATIENTS BY PROVIDING FREE INTERPRETER SERVICES SESSIONS. THE TOP THREE LANGUAGES REQUESTING INTERPRETER SERVICES WERE: SPANISH (324), PORTUGUESE (168), CHINESE-MANDARIN (72) LANGUAGES. IN FY21, WINCHESTER HOSPITAL INTERPRETERS ASSISTED 7,086 PATIENTS. THE TOP THREE LANGUAGES REQUESTING INTERPRETER SERVICES WERE:SPANISH (1,530), ITALIAN (564), AND PORTUGUESE (562). IN FY22, WINCHESTER HOSPITAL PROVIDED 6,350 INTERPRETER ENCOUNTERS. THE TOP THREE LANGUAGE REQUESTS WERE: SPANISH (1,171), PORTUGUESE (870), AND CHINESE MANDARIN (472).- IN FY21, WINCHESTER HOSPITAL PROVIDED FUNDING TO LOCAL COUNCILS ON AGING TO PURCHASE THE EQUIPMENT NECESSARY TO KEEP OLDER ADULTS CONNECTED SOCIALLY AND TO TELEHEALTH SERVICES. THE MEDFORD, STONEHAM, AND WOBURN COUNCILS ON AGING REQUESTED SUPPORT IN PURCHASING 10 IPADS EACH, AND OFFERED TRAINING OPPORTUNITIES TO TEACH THE OLDER ADULTS WHO RECEIVED THE DEVICES HOW TO USE THEM EFFECTIVELY. THIS WAS A ONE YEAR PROGRAM.- FROM FY20-22 WINCHESTER HOSPITAL PARTNERED WITH MINUTE MAN SENIOR SERVICES TO ADMINISTER THE SHINE PROGRAM TO HELP ADDRESS HEALTH CARE COSTS MEDICARE BENEFICIARIES STRUGGLE WITH BY CONNECTING PEOPLE WITH HEALTH INSURANCE THAT MEETS THEIR HEALTH CARE NEEDS, LIFESTYLE, AND BUDGET. IN FY20, SHINE COUNSELORS CONDUCTED A TOTAL OF 254 FREE CONFIDENTIAL, UNBIASED COUNSELING SESSIONS FOR COMMUNITY MEMBERS AT TWO LOCATIONS: THE JENKS CENTER IN WINCHESTER AND THE WINCHESTER HOSPITAL CENTER FOR CANCER CARE. IN FY21, SHINE COUNSELORS CONDUCTED A TOTAL OF 211 COUNSELING SESSIONS FOR COMMUNITY MEMBERS AND 201 SESSIONS IN FY22.COMMUNITY PARTNERS: METRO HOUSING BOSTON, MINUTEMAN SENIOR SERVICES, WINCHESTER HOUSING AUTHORITY, AMERICAN CANCER SOCIETY, WOBURN CHECKER CAB

COMMUNITY PARTNERS
WINCHESTER HOSPITAL 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:- BOYS & GIRLS CLUB OF STONEHAM & WAKEFIELD- BURBANK YMCA- CHNA15 - CITY OF MEDFORD- CITY OF WOBURN- COUNCIL OF SOCIAL CONCERN - METRO HOUSING BOSTON - MINUTEMAN SENIOR SERVICES- MYSTIC VALLEY ELDER SERVICES - MYSTIC VALLEY PUBLIC HEALTH COALITION- NETWORK FOR SOCIAL JUSTICE- SOCIAL CAPITAL INC.- STONEHAM COALITION FOR A HEALTHY COMMUNITY- TOWN OF READING- TOWN OF STONEHAM- TOWN OF WAKEFIELD- TOWN OF WILMINGTON- TOWN OF WINCHESTER- WINCHESTER HOUSING AUTHORITY- WINCHESTER SAFER COALITIONAS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, WINCHESTER HOSPITAL 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 WINCHESTER HOSPITAL'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 STRENGTHENINGTHE BUILT ENVIRONMENT (I.E., 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 WINCHESTER HOSPITAL'S COMMUNITY BENEFITS ACTIVITIES THE PERIOD FOR THE FISCAL PERIOD COVERED BY THIS FILING. WINCHESTER HOSPITAL WILL BE UNABLE TO ADDRESS THESE NEEDS DUE TO LIMITED FINANCIAL RESOURCES AND WHILE THESE ISSUES ARE IMPORTANT, WH'S CBAC AND SENIOR LEADERSHIP TEAM DECIDED THAT THESE ISSUES WERE OUTSIDE OF THE ORGANIZATION'S SPHERE OF INFLUENCE AND INVESTMENTS IN OTHERS AREAS WERE BOTH MORE FEASIBLE AND LIKELY TO HAVE GREATER IMPACT. AS A RESULT, WH RECOGNIZED THAT OTHER PUBLIC AND PRIVATE ORGANIZATIONS IN ITS CBSA AND THE COMMONWEALTH WERE BETTER POSITIONED TO FOCUS ON THESE ISSUES. WH REMAINS OPEN AND WILLING TO WORK WITH COMMUNITY RESIDENTS, OTHER HOSPITALS, AND OTHER PUBLIC AND PRIVATE PARTNERS TO ADDRESS THESE ISSUES, PARTICULARLY AS PART OF A BROAD, STRONG COLLABORATIVE.AS NOTED IN DETAIL ABOVE, THE WINCHESTER HOSPITAL'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 INFORMATION:THE PURPOSE OF THIS FORM 990 SCHEDULE H NARRATIVE DISCLOSURE IS TO HELP THE READER UNDERSTAND IN MORE DETAIL HOW WINCHESTER HOSPITAL CARES FOR ITS COMMUNITY BY PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS. AS DEMONSTRATED IN THIS SCHEDULE H, 0.07% OF WINCHESTER HOSPITAL'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 BENEFITS - ANNUAL COMMUNITY BENEFITS REPORT:AS PREVIOUSLY NOTED IN THIS FILING, WINCHESTER HOSPITAL'S 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.WINCHESTERHOSPITAL.ORG/OUR-PROMISE/SUPPORTING-OUR-COMMUNITYTHERE 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 WINCHESTER HOSPITAL FILED WITH THE ATTORNEY GENERAL'S OFFICE.

EMERGENCY CARE ACCESS
IN ADDITION, AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION A, WINCHESTER HOSPITAL 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 BENEFITS - CHARITY CARE AND MEANS TESTED GOVERNMENT PROGRAMS:FINANCIAL ASSISTANCEWINCHESTER HOSPITAL'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 $2,981,447 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, WINCHESTER HOSPITAL 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 CARE - MEDICAID AND MEDICARE:IN ADDITION TO THE CHARITY CARE REPORTED ABOVE, WINCHESTER HOSPITAL 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 INSURE LOW-INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, WINCHESTER HOSPITAL GENERATED $7,260,224 RELATED TO TREATING MEDICAID PATIENTS WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY WINCHESTER HOSPITAL FOR SUCH SERVICES BY $2,667,209 AS REPORTED ON THIS SCHEDULE H, PART I LINE 7B. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 7.5% OR 32,924 OF WINCHESTER HOSPITAL'S PATIENT ENCOUNTERS WERE WITH MEDICAID PATIENTS. IN ADDITION. 40.9% OR 190,407 OF THE HOSPITAL'S PATIENT CASES WERE WITH MEDICAID PATIENTS. MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS, AND WINCHESTER HOSPITAL PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING, WINCHESTER HOSPITAL GENERATED $326,110,471 RELATED TO TREATING MEDICARE PATIENTS. THE COSTS OF PROVIDING CARE TO MEDICARE PATIENTS EXCEEDED REVENUE BY $23,184,973. OF THESE AMOUNTS, REVENUE OF $52,040,848 IS RELATED TO THE PROVISION OF HEMATOLOGY & ONCOLOGY, HAND SURGERY, CARDIOLOGY, RHEUMATOLOGY, GYNECOLOGY, PULMONARY DISEASES, PLASTIC SURGERY, NEONATOLOGY, NEPHROLOGY, ENDOCRINOLOGY 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 $28,506,613. IN RESPONSE TO THE FORM 990, SCHEDULE H, PART III, LINE 8, ALTHOUGH WINCHESTER HOSPITAL 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, WINCHESTER HOSPITAL 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 2.88%.

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, ARABIC, ARMENIAN, FRENCH, GREEK, GUJARATI, HAITIAN CREOLE, HINDI, ITALIAN, JAPANESE, KOREAN, MON-KHMER, CAMBODIAN, PUNJABI, PORTUGUESE, RUSSIAN, SIMPLIFIED CHINESE, SPANISH, TRADITIONAL CHINESE, VIETNAMESE (SCHEDULE H PART V SECTION B QUESTION 16I)FINANCIAL ASSISTANCE POLICY - WIDELY PUBLICIZING AND AVAILABILITY:COPIES 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.WINCHESTERHOSPITAL.ORG/MY-VISIT/INSURANCE-BILLING--RECORDS/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 INCLUDE 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 POLICY - PLAIN LANGUAGE SUMMARY:AS 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 DOCUMENTS:THE LINK TO THE WINCHESTER HOSPITAL 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, ARABIC, ARMENIAN, CAMBODIAN, FRENCH, GREEK, HAITIAN-CREOLE,HINDI, ITALIAN, JAPANESE, KOREAN, MON-KHINER, PORTUGUESE, PANJABI,RUSSIAN, SPANISH, VIETNAMESE, SIMPLIFIED AND TRADITIONAL CHINESE, CAN BE FOUND ON THE WINCHESTER HOSPITAL WEBSITE AT: HTTPS://WWW.WINCHESTERHOSPITAL.ORG/MY-VISIT/INSURANCE-BILLING--RECORDS/FINANCIAL-ASSISTANCELIMITATION ON CHARGESINTERNAL REVENUE CODE SECTION 501(R)(5):LIMITATION ON CHARGES:AS 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 METHOD:THE 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 BILLED:THE 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.BILLING AND COLLECTIONS - 501(R)(6):EXTRAORDINARY COLLECTION ACTIVITIES:THE 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.

STUDY: LEVELS OF LIVER FAT BIOMARKER ASSOCIATED WITH METABOLIC HEALTH
"BENEFITS OF REGULAR EXERCISE:WHILE 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 US:BABIES 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 RISKS:ASPIRIN 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:AS NOTED THROUGHOUT THIS FILING WH IS PART OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES. BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) IS A TERTIARY CARE ACADEMIC MEDICAL CENTER IN BOSTON AND A SISTER ENTITY OF WH. AS PART OF THE SAME NETWORK, THE ACADEMIC TEACHING AND TRAINING IN WHICH BIDMC ENGAGES SUPPORTS NOT ONLY THE BIDMC MISSION, CARE FOR BIDMC PATIENTS AND COMMUNITIES BUT BIDMC'S COMMITMENT TO TRAINING THE MEDICAL PROFESSIONALS OF TOMORROW ALSO HELPS TO IMPROVE PATIENT CARE FOR THE COMMUNITIES OF OTHER BILH AFFILIATES AND BEYOND. THE DETAIL BELOW PROVIDES BACKGROUND ON THE TEACHING ACTIVITIES AT BIDMC DURING THE FISCAL PERIOD COVERED BY THIS FILING.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 EXPERIENCES. CORE CLINICAL TRAINING PROGRAMS:THE 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, THE WINCHESTER HOSPITAL HAD NET EXPENDITURES OF $68,456,175 REPORTED ON THIS SCHEDULE H, PART I, LINE 7F RELATED TO THE WINCHESTER HOSPITAL'S TEACHING FUNCTION WHICH REPRESENTED WINCHESTER HOSPITAL 2.90% OF WINCHESTER HOSPITAL'S TOTAL EXPENSES.RESIDENCY PROGRAMS:THE MEDICAL CENTER SPONSORS ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED RESIDENCY PROGRAMS IN EACH OF THE CORE CLINICAL TRAINING PROGRAMS LISTED ABOVE."

JUNIOR AND SENIOR RESIDENCY:
"RESIDENCY 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 RESIDENT:AS 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 ARE IN CHARGE OF 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 RESIDENT'S 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 PROGRAM:OUR 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 BIDMC:THE 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.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."

SURGERY EDUCATION AT BIDMC:
THE 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 HOUSESTAFF 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 HOUSESTAFF 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 TEACHING:THE PROGRAM HAS DEDICATED EDUCATION 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.BIDMC - 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. ON MARCH 1, 2019, THE BETH ISRAEL LAHEY HEALTH SYSTEM WAS FORMED THROUGH THE COMBINATION OF THE HOSPITALS AND OTHER AFFILIATES OF THREE LEGACY HEALTH CARE SYSTEMS BASED PRIMARILY IN EASTERN MASSACHUSETTS, INCLUDING THE FORMER CAREGROUP HEALTH SYSTEM, THE FORMER LAHEY HEALTH SYSTEM, AND THE SEACOAST HEALTH SYSTEM. BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS NOW THE SOLE MEMBER OF THE HOSPITAL AND NINE ADDITIONAL AFFILIATED HOSPITALS. EACH OF THESE ENTITIES MAY HAVE, IN TURN, SERVED AS THE SOLE MEMBER OF ADDITIONAL AFFILIATES. THE BILH HEALTH SYSTEM IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES. AFFILIATED HEALTH CARE SYSTEM: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. BILH 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. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES. BILH SERVES AS SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER (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, LAHEY HEALTH SHARED SERVICES, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL HEALTH CORPORATION (NBHC) AND ANNA JAQUES HOSPITAL). LAHEY CLINIC FOUNDATION SERVES AS THE SOLE MEMBER OF LAHEY CLINIC, INC. AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER. EACH OF THESE AFFILIATES MAY IN TURN SERVE AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE NETWORK OF AFFILIATES.