2022-08-15T19:28:52-05:00 2021-09-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2020-10-01 042104434 WINCHESTER HOSPITAL WINC 7817449536 41 HIGHLAND AVENUE WINCHESTER MA 018900000 MATTHEW WOODS CFO AND TREASURER 7817449536 2022-08-15 1 MATTHEW WOODS XXX-XX-XXXX CHRISTINE KAWECKI P00743140 5169187000 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MATTHEW WOODS 41 HIGHLAND AVENUE WINCHESTER MA 018900000 325309484 0 X WWW.WINCHESTERHOSPITAL.ORG X 1906 MA THE MISSION OF WINCHESTER HOSPITAL IS "TO CARE. TO HEAL. TO EXCEL." THIS ETHOS PROVIDES EACH AND EVERY STAFF MEMBER WITH CLEAR EXPECTATIONS, PROMOTING TEAMWORK AND RESPECT WHILE ENSURING SAFETY, QUALITY AND EMPATHY FOR PATIENTS. WINCHESTER HOSPITAL'S SUCCESS IS BASED ON THIS SHARED COMMITMENT TO EXCELLENCE. THE HOSPITAL AND ITS STAFF TAKE PRIDE IN OFFERING AN EXCEPTIONAL PATIENT CARE EXPERIENCE, PROVIDING SAFE, HIGH-QUALITY, COMMUNITY-BASED HEALTH CARE AND ACCESS TO TERTIARY CARE IN CLOSE COLLABORATION WITH ITS AFFILIATES IN THE BETH ISRAEL LAHEY HEALTH NETWORK WITH THE ULTIMATE GOAL OF IMPROVING THE HEALTH OF THE HOSPITAL'S PATIENTS AND THE COMMUNITIES SERVED. 22 19 2589 680 4441915 483142 21115366 257089 269304309 309409179 5148317 11533214 3130123 2985222 298698115 324184704 0 117087 0 0 137283534 143631971 0 0 0 141453093 153439136 278736627 297188194 19961488 26996510 501799446 544714719 182156768 184472245 319642678 360242474 X SEE SCHEDULE O 0 0 149315829 136077396 OUTPATIENT SERVICESWINCHESTER HOSPITAL'S TREMENDOUS PRESENCE AND COMMITMENT IN THE COMMUNITY IS EXEMPLIFIED BY THE VARIOUS OUTPATIENT FACILITIES THROUGHOUT THE NORTH-OF-BOSTON AREA, INCLUDING WOBURN, STONEHAM, WILMINGTON AND MEDFORD.THE AMBULATORY SURGERY CENTER IN WINCHESTER IS A STATE-OF-THE-ART OUTPATIENT SURGERY CENTER OFFERING ADVANCED DAY SURGERY. THE CENTER FEATURES REDUCED WAIT TIMES FOR SURGICAL CARE, EXPANDED CAPACITY AND SERVICES TO ADDRESS PATIENT NEEDS, AND A FACILITY THAT WILL ALLOW FOR FUTURE EXPANSION. THE FACILITY IS ALSO HOME TO THE HOSPITAL'S CENTER FOR CANCER CARE, WHICH WAS CREATED BASED ON THE VISION TO DEVELOP A STATE-OF-THE ART, COMMUNITY-BASED CENTER DEDICATED TO AN INTEGRATED MODEL OF CANCER CARE. WINCHESTER HOSPITAL IS PROUD TO OFFER PATIENTS DIAGNOSED WITH CANCER EASY ACCESS TO THE MOST ADVANCED CLINICAL CARE IN AN ENVIRONMENT UNIQUELY DEDICATED TO MEETING THEIR MEDICAL AND EMOTIONAL NEEDS. DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2021, WINCHESTER HOSPITAL PERFORMED 2,482 SURGERIES AND HAD APPROXIMATELY 22,000 ONCOLOGY VISITS AT THE AMBULATORY CENTER.WINCHESTER HOSPITAL IN CONJUNCTION WITH THE MEDICAL STAFF PROVIDES OUTPATIENT PRIMARY CARE AS WELL AS ENDOSCOPIC, CHEMOTHERAPEUTIC AND CANCER MANAGEMENT, CARDIAC REHABILITATION AND DIABETES MANAGEMENT SERVICES, WOUND CARE AND HYPERBARIC PROGRAMS, AND SLEEP CLINIC SERVICES. WINCHESTER HOSPITAL ALSO OFFERS OCCUPATIONAL, PHYSICAL, AND SPEECH HEALTH SERVICES AND NUTRITIONAL COUNSELING. DIAGNOSTIC FACILITIES INCLUDE CT SCANNING, ULTRASOUND, MRI, MAMMOGRAPHY AND INTERVENTIONAL RADIOLOGY. ADDITIONALLY, THROUGH THE CENTER FOR HEALTHY LIVING, WINCHESTER HOSPITAL HELPS COMMUNITY MEMBERS TAKE RESPONSIBILITY FOR THEIR HEALTH AND WELLBEING BY OFFERING EDUCATION AND RESOURCES THAT FOCUS ON HEALTHY LIVING, YOGA, WELLNESS, AND CHILDBIRTH (INCLUDING LACTATION). DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2021, WINCHESTER HOSPITAL HAD APPROXIMATELY 391,000 OUTPATIENT ENCOUNTERS. 125510539 145793219 INPATIENT SERVICESWINCHESTER HOSPITAL PROVIDES A WIDE RANGE OF INPATIENT CARE INCLUDING PEDIATRICS, OBSTETRICS AND MATERNITY INCLUDING A SPECIAL CARE NURSERY, GENERAL SURGICAL SERVICES, INTENSIVE CARE AND COMPLETE DIAGNOSTIC FACILITIES. THE HOSPITAL'S INPATIENT FACILITIES INCLUDE MEDICAL/SURGICAL BEDS, OBSTETRIC BEDS AND AN INTENSIVE CARE UNIT. SURGICAL SERVICES ARE AVAILABLE 24 HOURS A DAY FOR CRITICALLY ILL OR INJURED PATIENTS REQUIRING IMMEDIATE SURGICAL INTERVENTION, OR FOR OTHER PATIENTS ON A NON-EMERGENT OR ELECTIVE BASIS. THE HOSPITAL'S HIGHLY QUALIFIED SURGEONS PERFORM ORTHOPEDIC PROCEDURES AND IMPLANTS, PLASTIC, GENERAL SURGICAL (INCLUDING BREAST), GYNECOLOGIC, AND UROLOGICAL PROCEDURES. OTHER SURGICAL SPECIALTIES INCLUDE COLON AND RECTAL, ENT, DERMATOLOGIC, ORAL, AND THORACIC AND WEIGHT LOSS SURGERY. PATIENTS ARE UNDER THE CARE OF THE MEDICAL STAFF, HOSPITALISTS AND/OR GENERAL SURGEONS ALONG WITH NURSES WHO ARE TRAINED IN CARING FOR PATIENTS WITH COMPLEX MEDICAL NEEDS.THE HOSPITAL WAS THE FIRST COMMUNITY HOSPITAL IN EASTERN MASSACHUSETTS TO PERFORM ROBOTIC SURGERY WITH THE DA VINCI SURGICAL SYSTEM, AND THE FIRST COMMUNITY HOSPITAL IN MASSACHUSETTS TO ACHIEVE MAGNET RECOGNITION. THE MAGNET PROGRAM WAS ESTABLISHED BY THE AMERICAN NURSES CREDENTIALING CENTER TO RECOGNIZE HEALTH CARE ORGANIZATIONS THAT PROVIDE THE VERY BEST IN NURSING CARE AND UPHOLD THE TRADITION OF PROFESSIONAL NURSING PRACTICE. IT IS THEIR HIGHEST HONOR FOR NURSING EXCELLENCE.THE NURSING CARE TEAM CONSISTS OF REGISTERED NURSES, SURGICAL TECHNICIANS AND QUALIFIED ANCILLARY PERSONNEL WORKING COLLABORATIVELY WITH SURGICAL AND ANESTHESIA PHYSICIANS. THE SCOPE OF NURSING PRACTICE IN THE PERIOPERATIVE AREA INCLUDES PREOPERATIVE ASSESSMENT AND PLANNING, INTRA-OPERATIVE INTERVENTION, POSTOPERATIVE ASSESSMENT AND INTERVENTION, DISCHARGE PLANNING AND DOCUMENTATION TO ENSURE HIGH QUALITY PATIENT CARE AND SAFETY. DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2021, WINCHESTER HOSPITAL HAD 14,814 INPATIENT DISCHARGES WITH 52,868 PATIENT DAYS, 3,031 OBSERVATION PATIENTS AND PERFORMED 6,001 OUTPATIENT SURGERIES AND 1,617 INPATIENT SURGERIES AND DELIVERED 2,560 BABIES. 22361826 24243407 EMERGENCY ROOM SERVICESWINCHESTER'S HOSPITAL'S EMERGENCY DEPARTMENT OFFERS ADVANCED EMERGENCY MEDICINE SERVICES TO LOCAL COMMUNITIES NORTH OF BOSTON. THE EMERGENCY DEPARTMENT IS OPEN 24 HOURS A DAY, SEVEN DAYS A WEEK AND PROVIDES EMERGENT CARE REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE HOSPITAL IS STAFFED BY BOARD-CERTIFIED, EMERGENCY MEDICINE PHYSICIANS AND NURSES WHO ARE EXTENSIVELY TRAINED IN EMERGENCY MEDICINE AND CERTIFIED IN ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND PEDIATRIC ADVANCED LIFE SUPPORT (PALS). WINCHESTER HOSPITAL IS ALSO A PRIMARY STROKE SERVICE HOSPITAL, AS DESIGNATED BY THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, PROVIDING LEADING-EDGE STROKE CARE. THE HOSPITAL ALSO OFFERS SPECIALIZED PEDIATRIC CARE PROVIDED BY AN ON-SITE PEDIATRICIAN FROM BOSTON CHILDREN'S HOSPITAL SPECIALIZING IN EMERGENCY MEDICINE. ON-SITE PEDIATRIC EMERGENCY PHYSICIANS ARE AVAILABLE EVERY DAY FROM NOON TO MIDNIGHT AND 24-HOUR PEDIATRICIAN CONSULTATION COVERAGE IS ALSO AVAILABLE.DURING THE FISCAL YEAR COVERED BY THIS FILING, WINCHESTER HOSPITAL HAD 41,835 ADULT AND PEDIATRIC EMERGENCY DEPARTMENT VISITS. 249972599 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 2589 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 22 19 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0 0 1 1 MA X MATTHEW J WOODS 7817562926 41 HIGHLAND AVENUE WINCHESTER MA 01890 NESTO MD RICHARD BILH CMO, FORMER PRESIDENT AND TRUSTEE 1.00 65.00 X 0 1157376 92737 WEINER MD RICHARD TRUSTEE (EX-OFFICIO) 1.00 58.00 X X 0 470913 42320 SMITH KEVIN F TRUSTEE AND VICE CHAIRMAN 1.00 1.00 X X 0 0 0 TARBY III ESQ JOSEPH TRUSTEE, VICE CHAIR AND ASSISTANT CLERK 1.00 1.00 X X 0 0 0 WALSH JANE TRUSTEE, CHAIR 1.00 2.00 X X 0 0 0 ADLER MD JOHNATHAN TRUSTEE/PHSYICIAN 1.00 1.00 X 0 0 0 ANDREWS PAUL TRUSTEE 1.00 1.00 X 0 0 0 BRECKWOLDT MD WILLIAM TRUSTEE (EX OFFICIO) 1.00 1.00 X 0 0 0 DEROSA CINDY TRUSTEE (EX OFFICIO) 1.00 1.00 X 0 0 0 FORTUNATO MD ROBERT TRUSTEE 1.00 1.00 X 0 0 0 FULLER MD ARLAN TRUSTEE 1.00 1.00 X 0 0 0 HAYDEN ERIC W TRUSTEE 1.00 1.00 X 0 0 0 HOUGHTON JANICE TRUSTEE 1.00 1.00 X 0 0 0 MANGANARO PAUL TRUSTEE 1.00 1.00 X 0 0 0 MCALMAN MD KAREN TRUSTEE 1.00 1.00 X 0 0 0 MCCANCE WILLIAM TRUSTEE 1.00 1.00 X 0 0 0 MCCORMACK ROSEMARY TRUSTEE (EX OFFICIO); PRESIDENT, WINSTON CLUB 1.00 1.00 X 0 0 0 MCDONOUGH DEBORAH TRUSTEE 1.00 1.00 X 0 0 0 MUNI PHD INDU TRUSTEE 1.00 1.00 X 0 0 0 ROTOLO MD PETER J TRUSTEE 1.00 1.00 X 0 0 0 SAYRE RICHARD TRUSTEE 1.00 1.00 X 0 0 0 TAYLOR MD JOSEPH TRUSTEE 1.00 1.00 X 0 0 0 TABB MD KEVIN CHIEF EXECUTIVE OFFICER (EX-OFFICIO) 1.00 65.00 X 0 3378281 364897 FISCHER STEVEN BILH CFO, TREASURER (EX-OFFICIO) 1.00 65.00 X 0 1324600 54700 KATZ ESQ JAMIE BILH GEN. COUNSEL, CLERK (EX-OFFICIO) 1.00 65.00 X 0 1271728 32538 WOODS MATTHEW ASST. TREASURER AND CHIEF FINANCIAL OFFICER, WH 1.00 58.00 X 0 425860 63591 GEVITZ ESQ KATHRYN ASSISTANT CLERK (EX-OFFICIO) 1.00 56.00 X 0 123969 7964 KERNDL JOHN TREASURER (EX-OFFICIO) 1.00 64.00 X 0 0 0 SCHULER KATHY ANN COO & CNO WINCHESTER HOSPITAL 55.00 1.00 X 418480 0 37511 ZITKOVSKY MD DANA CHIEF MEDICAL OFFICER WH 55.00 X 355849 0 41117 CROWLEY SMITH JOANNE VP HUMAN RESOURCES 1.00 56.00 X 0 235290 38134 ROBERTSON CATHARINE VP, PHYSICIAN SERVICES 55.00 X 270970 0 24792 SACHETTI NANCY DIRECTOR, HIGHLAND HEALTH IPA 55.00 X 244609 0 35239 GREGA JOANNE ADMINISTRATIVE DIRECTOR, RADIOLOGY 55.00 X 239130 0 34217 BEYERMAN KATHLEEN ACNO NURSING STAFF DEVELOPMENT 55.00 X 208802 0 33255 LEVENSON HEATHER REGISTERED NURSE, OBSTETRICS 55.00 X 186656 0 36363 O'CONNOR TIMOTHY FORMER TREASURER, EVP & CFO 0.00 0.00 X 0 931391 34666 SPACKMAN ESQ DAVID G FORMER SVP GOV AFFAIRS, GENERAL COUNSEL & CLERK 0.00 0.00 X 0 219958 0 ISEKE MD RICHARD J FORMER CMO 0.00 0.00 X 0 296708 3740 1924496 9836074 977781 716 1 1 0 BETH ISRAEL LAHEY HEALTH INC (R) 109 BROOKLINE AVENUE BOSTON MA 02215 BETH ISRAEL LAHEY HEALTH PROFESSIONAL SE 29174537 HEALTHCARE WORKFORCE LOGISTICS LLC (HWL) 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 CONTINGENT WORKFORCE MGMT - STAFFING SER 3001804 COLUMBIA CONSTRUCTION COMPANY 100 RIVERPARK DRIVE NORTH READING MA 01864 CONSTRUCTION SERVICES 2723946 NEW ENGLAND INPATIENT SPECIALISTS 47 HIGH STREET NORTH ANDOVER MA 01845 PHYSICIAN SERVICES 1869748 SODEXO OPERATIONS LLC PO BOX 360170 PITTSBURGH PA 152516170 FOOD SERVICE 1741681 46 25000 232089 257089 INPATIENT PROGRAM 900099 145793219 145793219 OUTPATIENT PROGRAM 621400 136077396 136077396 EMERGENCY PROGRAM 900099 24243407 24243407 LABORATORY 621500 3271824 3271824 RELATED ORG. RENT 23333 23333 309409179 3330410 3330410 2369869 1112721 1257148 1257148 339431 917717 8204863 10000 0 12059 8204863 -2059 8202804 8202804 LOAN STAFF 621110 707527 707527 CAFETERIA 722514 697860 697860 322687 123133 199554 1728074 324184704 306114022 4441915 13371678 117087 117087 1924496 1794535 129961 113808922 106123408 7685514 2293743 1807010 486733 17419493 13723077 3696416 8185317 6448393 1736924 1439485 1439485 1680 1680 -35002 -35002 340150 340150 22557368 18425015 4132353 511389 511389 2780659 2190603 590056 8961473 7059849 1901624 71136 56041 15095 2758880 2173446 585434 18161685 10642338 7519347 620821 499474 121347 MEDICAL SUPPLIES 34203256 34083093 120163 PHARMACEUTICALS 21332038 21332038 BILH ASSESSMENT 16607113 13092018 3515095 ADMIN AND GENERAL 7978291 6260452 1717839 15148714 4144722 11003992 297188194 249972599 47215595 0 83253079 77283114 26012859 30999979 1594438 1825691 3744179 3859689 1275524 1338186 252674897 120106045 137310729 132568852 201629470 231193243 46979168 65645965 501799446 544714719 44355879 37286112 82452094 78487170 55348795 68698963 182156768 184472245 X 291721691 327992696 27920987 32249778 319642678 360242474 501799446 544714719 X 26996510 15794869 -2191584 X 0 1 X 0 1 1 X 0 1 1 1 1 0 1 0 1 59170 59170 0 PART II-B, LINE 1: WINCHESTER HOSPITAL ENGAGED IN SOME LOBBYING EFFORTS ON BEHALF OF ITSELF AND OTHER NETWORK AFFILIATES AND/OR PAYS DUES TO CERTAIN MEMBERSHIP ORGANIZATIONS OF WHICH A PORTION MAY BE USED BY SUCH ORGANIZATIONS FOR LOBBYING ACTIVITIES ON BEHALF OF THIS INSTITUTION AND OTHER SIMILARLY SITUATED ORGANIZATIONS. LOBBYING COSTS ASSOCIATED WITH THESE COMBINED LOBBYING ACTIVITIES WAS $59,170 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2021. TOTAL LOBBYING EXPENDITURES ARE MINIMAL AND NOT SUBSTANTIAL BASED ON REVENUES. 26551785 2852362 29404147 24968323 1583462 26551785 24701561 266762 24968323 24924879 -223318 24701561 21823910 3100969 24924879 0 0 16524129 16524129 99455159 37832869 61622290 11256887 7134911 4121976 119712882 72037808 47675074 5725840 3100457 2625383 132568852 INVESTMENTS, OTHER 457B 556901 F AWUL TEMP RESTR INVESTMENTS 16297817 F AWUL PERM RESTR INVESTMENTS 1790975 F TRUST - PERM RESTR IRREV TRUST 5367011 F LT INVESTMENTS - OTHER 207180539 F 231193243 NOTES RECEIVABLE INTERNATIONAL FAMILY CHURCH 2500000 RESERVE NOTE RECEIVABLE -2500000 SPLIT DOLLAR LIFE EQUITIES 1346497 INVESTMENT IN CAPTIVE INSURANCE 894158 BENE. INT. IN NET ASSETS 8791755 RADIATION THERAPY OF WIN 742500 RADIATION THERAPY OF WIN VAL. ADJ. 34000 INVESTMENT IN JP-SHIELDS MRI 7177800 INVESTMENT IN JP-SHIELDS MRI VAL. ADJ. -1368800 INDEPENDENT PHYSICIAN NETORK 1540000 CERTIFICATE OF NEED 7000000 CLINICAL RELATIONSHIP BCH 522207 TRADE NAME VALUATION 5700000 PROFESSIONAL INSURANCE RECEIVABLE 10764684 LEASEHOLD VALUATION 767995 RIGHT-OF-USE OPERATING LEASE ASSETS 21733169 65645965 CURRENT PORTION OF LONG TERM DEBT 3266053 ESTIMATED SETTLEMENT AMOUNT 33065996 OTHER LONG TERM LIABILITIES 4217116 PROFESSIONAL LIABILITY RESERVES 6262117 OPERATING LEASE OBLIGATIONS 21887681 68698963 X 6971280000 15192082 6632984592 6648176674 323103326 1081378 1081378 324184704 6619235000 6322790021 6322790021 296444979 743215 743215 297188194 PART V, LINE 4: WINCHESTER HOSPITAL ENDOWMENTS ARE FOR GENERAL HOSPITAL OPERATIONS. PART X, LINE 2: BETH ISRAEL LAHEY HEALTH, INC., WHICH SERVES AS THE PARENT OF THE SYSTEM, HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE AN ORGANIZATION DESCRIBED UNDER INTERNAL REVENUE CODE (THE CODE) SECTION 501(C)(3) AND, THEREFORE, IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ALSO DETERMINED THAT THE OTHER ENTITIES IN THE SYSTEM, EXCLUDING ITS FOR-PROFIT SUBSIDIARIES, QUALIFY AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE, MEET THE CODE'S REQUIREMENTS UNDER SECTION 509(A), AND THEREFORE ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN FIFTY PERCENT LIKELY TO BE REALIZED UPON SETTLEMENT. CHANGES IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE SYSTEM DID NOT RECOGNIZE THE EFFECT OF ANY INCOME TAX POSITIONS IN 2021 AND 2020, RESPECTIVELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION FOR OPERATIONS 1,172,739. TRANSFERS (TO) FROM AFFILIATES -6,752,164. CONSOLIDATED AFFILIATES NET ELIMINATIONS 6,638,564,017. PART XI, LINE 4B - OTHER ADJUSTMENTS: NON-OPERATING MANAGEMENT FEES (RECLASS) 743,215. RESTRICTED REVENUE 338,163. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED AFFILIATES NET ELIMINATIONS 6,322,790,021. PART XII, LINE 4B - OTHER ADJUSTMENTS: NON-OPERATING MANAGEMENT FEES (RECLASS) 743,215. PART X, LINE 2: BETH ISRAEL LAHEY HEALTH, INC., WHICH SERVES AS THE PARENT OF THE SYSTEM, HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE AN ORGANIZATION DESCRIBED UNDER INTERNAL REVENUE CODE (THE CODE) SECTION 501(C)(3) AND, THEREFORE, IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ALSO DETERMINED THAT THE OTHER ENTITIES IN THE SYSTEM, EXCLUDING ITS FOR-PROFIT SUBSIDIARIES, QUALIFY AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE, MEET THE CODE'S REQUIREMENTS UNDER SECTION 509(A), AND THEREFORE ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN FIFTY PERCENT LIKELY TO BE REALIZED UPON SETTLEMENT. CHANGES IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE SYSTEM DID NOT RECOGNIZE THE EFFECT OF ANY INCOME TAX POSITIONS IN 2021 AND 2020, RESPECTIVELY. 1 1 X 1 X 1 X 1 1 1 0 1 1 7041091 888468 6152623 0.02070 21830661 19429675 2400986 0.00810 28871752 20318143 8553609 0.02880 3610433 1823368 1787065 0.00600 57165649 40642774 16522875 0.05560 138686 138686 0.00050 60914768 42466142 18448626 0.06210 89786520 62784285 27002235 0.09090 1 2438389 101159768 116899231 -15739463 X 1 1 1 1 WINCHESTER HOSPITAL 41 HIGHLAND AVENUE WINCHESTER MA 01890 WWW.WINCHESTERHOSPITAL.ORG X ACUTE CARE FACILITY WINCHESTER HOSPITAL 1 0 0 1 X X X X X X X 18 1 1 0 1 X SEE PART VI X 1 18 1 SEE PART VI 0 1 X 150.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X SEE PART VI X SEE PART VI X SEE PART VI X X X X X 1 X 0 X X X X 1 X 0 0 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 15 1 - WINCHESTER HOSPITAL 1021 MAIN STREET WINCHESTER MA 02180 ADMIN OFFICES, BILLING, DOCTOR OFFICES 2 - WINCHESTER HOSPITAL 200 UNICORN DRIVE WOBURN MA 01801 COMMUNITY HEALTH, MRI, BREAST CANCER CENTER 3 - WINCHESTER HOSPITAL 620 WASHINGTON STREET WINCHESTER MA 01801 RADIOLOGY/ONCOLOGY SERVICES FACILITY 4 - WINCHESTER HOSPITAL - BALDWIN PARK I 12 ALFRED STREET WOBURN MA 01801 COMMUNITY HEALTH INST., SLEEP CARE & ADMIN OFFICES 5 - WINCHESTER HOSPITAL - BALDWIN PARK II 7 ALFRED STREET WOBURN MA 01801 BREAST CARE, IMAGING HEMOTOLOGY/ONCOLOGY LAB, PHARMACY, CHIRO 6 - FAMILY MEDICAL SERVICES 500 SALEM STREET WILMINGTON MA 01887 AUDIOLOGY, OB/GYN, CARDIO-PUL, LAB, PT, URGENT CARE, PEDI 7 - WINCHESTER HOSPITAL RUSSELL HILL BUILDINGS 955 MAIN STREET WINCHESTER MA 01890 LAB, RADIOLOGY & PHYSICAL THERAPY 8 - READING HEALTH CENTER 20 POND MEADOW DRIVE READING MA 01867 LAB 9 - WINCHESTER HOSPITAL 75 RIVERSIDE AVENUE MEDFORD MA 02155 LAB, WEIGHT MGMT, WOUND CARE CENTER 10 - WINCHESTER HOSPITAL 10P COMMERCE WAY WOBURN MA 01801 ENDOSCOPY CENTER 11 - CHOATE MEDICAL CENTER 23 WARREN AVENUE WOBURN MA 01801 PHYSICAL THERAPY 12 - WINCHESTER HOSPITAL ORTHOPEDICS 20 POND MEADOW DRIVE READING MA 01867 LAB 13 - WINCHESTER HOSPITAL 75 RIVERSIDE AVENUE MEDFORD MA 02155 LAB, WEIGHT MGMT, WOUND CARE CENTER 14 - PAIN MANAGEMENT CENTER 444 WASHINGTON STREET WOBURN MA 01801 PAIN CLINIC CENTER 15 - WINCHESTER HOSPITAL RUSSELL HILL BUILDINGS 955 MAIN STREET WINCHESTER MA 01890 LAB, RADIOLOGY & PHYSICAL THERAPY 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 IS COMMITTED TO WORKING COLLABORATIVELY WITH BILH'S COMMUNITIES TO ADDRESS THE LEADING HEALTH ISSUES AND CREATE A HEALTHY FUTURE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES.WINCHESTER HOSPITAL COMMUNITY BENEFITS MISSION STATEMENT WINCHESTER HOSPITAL'S MISSION IS TO TREAT PATIENTS COMPASSIONATELY AND EFFECTIVELY, AND TO CREATE A HEALTHY FUTURE FOR THEM AND THEIR FAMILIES. 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. IN 2013, WINCHESTER HOSPITAL'S COMMUNITY BENEFITS ADVISORY COMMITTEE AND BOARD OF TRUSTEES AGREED UPON ITS MISSION: WINCHESTER HOSPITAL IS COMMITTED 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.WINCHESTER HOSPITAL'S COMMUNITY BENEFITS MISSION IS FULFILLED BY: INVOLVING WINCHESTER HOSPITAL'S STAFF, INCLUDING ITS LEADERSHIP AND DOZENS OF COMMUNITY PARTNERS IN THE COMMUNITY HEALTH ASSESSMENT PROCESS AS WELL AS IN THE DEVELOPMENT, IMPLEMENTATION, AND OVERSIGHT OF THE HOSPITAL'S THREE-YEAR IMPLEMENTATION STRATEGY(IS); ENGAGING AND LEARNING FROM RESIDENTS THROUGHOUT WINCHESTER HOSPITAL'S SERVICE AREA IN ALL ASPECTS OF THE COMMUNITY BENEFITS PROCESS, INCLUDING ASSESSMENT, PLANNING, IMPLEMENTATION, AND EVALUATION. THE HOSPITAL PAYS SPECIAL ATTENTION TO ENGAGING THOSE COMMUNITY MEMBERS WHO ARE NOT PATIENTS OF WINCHESTER HOSPITAL AND THOSE WHO ARE OFTEN LEFT OUT OF ASSESSMENT, PLANNING, AND PROGRAM IMPLEMENTATION PROCESSES; ASSESSING UNMET COMMUNITY NEED BY COLLECTING PRIMARY AND SECONDARY DATA (BOTH QUANTITATIVE AND QUALITATIVE) IN ORDER TO CHARACTERIZE THOSE IN THE COMMUNITY WHO ARE MOST VULNERABLE AND FACE DISPARITIES IN ACCESS AND OUTCOMES; IMPLEMENTING COMMUNITY HEALTH PROGRAMS AND SERVICES IN WINCHESTER HOSPITAL'S CBSA THAT ARE GEARED TOWARD IMPROVING THE CURRENT AND FUTURE HEALTH STATUS OF INDIVIDUALS, FAMILIES, AND COMMUNITIES BY REMOVING BARRIERS TO CARE, ADDRESSING SOCIAL DETERMINANTS OF HEALTH, STRENGTHENING THE HEALTH CARE SYSTEM, AND WORKING TO DECREASE THE BURDEN OF LEADING HEALTH ISSUES; PROMOTING HEALTH EQUITY BY ADDRESSING SOCIAL AND INSTITUTIONAL INEQUITIES, RACISM, AND BIGOTRY AND ENSURING THAT ALL PATIENTS ARE WELCOMED AND RECEIVED WITH RESPECT AND HAVE ACCESS TO CULTURALLY RESPONSIVE CARE; AND FACILITATING COLLABORATION AND PARTNERSHIP WITHIN AND ACROSS SECTORS (E.G., PUBLIC HEALTH, HEALTH CARE, SOCIAL SERVICES, BUSINESS, ACADEMIC, AND COMMUNITY HEALTH) 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 $1,925,751 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY BENEFITS LEADERSHIP/TEAMTHE MEMBERSHIP OF WINCHESTER HOSPITAL'S CBAC ASPIRES TO BE REPRESENTATIVE OF THE CONSTITUENCIES AND PRIORITY POPULATIONS SERVED BY WINCHESTER HOSPITAL'S PROGRAMMATIC ENDEAVORS, INCLUDING THOSE FROM DIVERSE RACIAL AND ETHNIC BACKGROUNDS AND OF DIVERSE AGE, GENDER, SEXUAL ORIENTATION, AND GENDER IDENTITY, AS WELL AS THOSE FROM CORPORATE AND NONPROFIT COMMUNITY ORGANIZATIONS. SENIOR MANAGEMENT IS ACTIVELY ENGAGED IN THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY BENEFITS PLAN, ENSURING THAT HOSPITAL POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES. WINCHESTER HOSPITAL FY21 CBAC MEMBERS: RICHARD WEINER, PRESIDENT, WINCHESTER HOSPITAL JANE WALSH, WINCHESTER BOARD OF TRUSTEES CHAIR, MEMBER OF BILH BOARD AND COMMUNITY BENEFITS COMMITTEE PAUL ANDREWS, WINCHESTER HOSPITAL BOARD OF TRUSTEES MICHAEL BALDASARRE, ASSISTANT SUPERINTENDENT, WOBURN PUBLIC SCHOOLS CARLA BEAUDOIN, DIRECTOR OF DEVELOPMENT, METRO HOUSING BOSTON JESSIE BENCOSME, INTERIM EXECUTIVE DIRECTOR, COUNCIL OF SOCIAL CONCERN, WOBURN ANGELINE BRADY, WINCHESTER HOSPITAL CENTER FOR HEALTHY LIVING DOT BUTLER, WINCHESTER SAFER COALITION DENISE FLYNN, VICE PRESIDENT OF PHILANTHROPY, WINCHESTER HOSPITAL CHRISTINE HEALEY, DIRECTOR OF COMMUNITY BENEFITS/COMMUNITY RELATIONS, BILH KAREN KEANEY, ASSOCIATE CHIEF NURSING OFFICER, EMERGENCY DEPARTMENT, AND CASE MANAGEMENT TERRI MARCIELLO, TOWN OF WILMINGTON DEPARTMENT OF ELDERLY SERVICES DEB MCDONOUGH, WINCHESTER HOSPITAL BOARD OF TRUSTEES JENNIFER MURPHY, DIRECTOR OF HEALTH, WINCHESTER HEALTH DEPARTMENT LAUREN REID, DIRECTOR OF COMMUNITY PROGRAMS, MYSTIC VALLEY ELDER SERVICES ADAM ROGERS, EXECUTIVE DIRECTOR, BOYS & GIRLS CLUB OF STONEHAM & WAKEFIELD SHARON RON, METROPOLITAN AREA PLANNING COMMISSION KATHY SCHULER, CHIEF OPERATING OFFICER, CHIEF NURSING OFFICER, WINCHESTER HOSPITAL JOSEPH TARBY, WINCHESTER HOSPITAL BOARD OF TRUSTEES LEIGHANNE TAYLOR, REGIONAL MANAGER, COMMUNITY BENEFITS AND COMMUNITY RELATIONS, WINCHESTER HOSPITAL MATTHEW WOODS, VICE PRESIDENT OF FINANCE, WINCHESTER HOSPITALIT IS NOT ONLY THE BOARD MEMBERS AND SENIOR LEADERSHIP WHO ARE HELD ACCOUNTABLE FOR FULFILLING WINCHESTER HOSPITAL'S COMMUNITY BENEFITS MISSION. AMONG WINCHESTER HOSPITAL'S CORE VALUES IS THE RECOGNITION THAT THE MOST SUCCESSFUL COMMUNITY BENEFITS PROGRAMS ARE IMPLEMENTED ORGANIZATION-WIDE AND INTEGRATED INTO THE VERY FABRIC OF THE HOSPITAL'S CULTURE, POLICIES, AND PROCEDURES. A COMMITMENT TO COMMUNITY BENEFITS IS A FOCUS AND VALUE MANIFESTED THROUGHOUT WINCHESTER HOSPITAL'S STRUCTURE AND REFLECTED IN HOW IT PROVIDES CARE AT THE HOSPITAL AND IN AFFILIATED PRACTICES.WINCHESTER HOSPITAL IS A MEMBER OF BILH. WHILE WINCHESTER HOSPITAL OVERSEES LOCAL COMMUNITY BENEFITS PROGRAMMING AND COMMUNITY ENGAGEMENT EFFORTS, COMMUNITY BENEFITS IS UNDER THE PURVIEW OF THE BILH CHIEF DIVERSITY, EQUITY, AND INCLUSION OFFICER. THIS STRUCTURE ENSURES THAT COMMUNITY BENEFITS EFFORTS, PRIORITIZATION, PLANNING, AND STRATEGY ALIGN AND ARE INTEGRATED WITH LOCAL AND SYSTEM STRATEGIC AND REGULATORY PRIORITIES. THE WINCHESTER HOSPITAL COMMUNITY BENEFITS PROGRAM IS SPEARHEADED BY THE BILH COMMUNITY BENEFITS/COMMUNITY RELATIONS REGIONAL MANAGER. THE REGIONAL MANAGER 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 UNDERSERVED POPULATIONS ARE CONSIDERED EVERY DAY IN DISCUSSIONS ON RESOURCE ALLOCATION, POLICIES, AND PROGRAM DEVELOPMENT. THIS IS THE STRUCTURE AND METHODOLOGY EMPLOYED TO ENSURE THAT COMMUNITY BENEFITS IS NOT THE PURVIEW OF ONE OFFICE ALONE AND TO MAXIMIZE EFFORTS ACROSS THE ORGANIZATION TO FULFILL THE MISSION AND GOALS OF COMMUNITY BENEFITS. COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT INTERNAL 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 FY19. THAT CHNA WAS APPROVED BY THE WINCHESTER HOSPITAL BOARD OF TRUSTEES ON SEPTEMBER 18, 2019. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS ALSO APPROVED BY THE BOARD ON SEPTEMBER 18, 2019, 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 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.2019 COMMUNITY HEALTH NEEDS ASSESSMENT TARGETED GEOGRAPHY AND POPULATIONAS NOTED ABOVE, WINCHESTER HOSPITAL COMPLETED ITS LAST ASSESSMENT IN SEPTEMBER, 2019. THE GEOGRAPHICAL FOCUS OF WINCHESTER HOSPITAL'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT ENCOMPASSES MEDFORD, NORTH READING, READING, STONEHAM, TEWKSBURY, WAKEFIELD, WILMINGTON, WINCHESTER, AND WOBURN. TARGET POPULATIONS FOR WINCHESTER HOSPITAL'S COMMUNITY BENEFITS INITIATIVES ARE 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 FOCUS ON MEDICALLY-UNDERSERVED AND VULNERABLE GROUPS OF ALL AGES IN THE WINCHESTER HOSPITAL COMMUNITY BENEFITS CBSA, AS FOLLOWS: OLDER ADULTS YOUTH AND ADOLESCENTS LOW-RESOURCE INDIVIDUALS AND FAMILIES INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS2019 COMMUNITY HEALTH NEEDS ASSESSMENT SUMMARY OF APPROACH AND METHODSWINCHESTER HOSPITAL CONDUCTED THEIR CHNAS IN THREE PHASES, WHICH ALLOWED THEM TO: COMPILE AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA; ENGAGE AND INVOLVE KEY STAKEHOLDERS, WINCHESTER HOSPITAL CLINICAL AND ADMINISTRATIVE STAFF AND THE COMMUNITY AT-LARGE; DEVELOP A REPORT AND DETAILED STRATEGIC PLAN; AND COMPLY WITH ALL COMMONWEALTH ATTORNEY GENERAL AND FEDERAL IRS COMMUNITY BENEFITS REQUIREMENTSTHE 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 METHODSTHE 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 ENGAGEMENTPHASE 2 TARGETED ENGAGEMENTPHASE 3 STRATEGIC PLANNING AND REPORTINGHUNDREDS 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 (2018) MIDDLESEX LEAGUE YOUTH RISK BEHAVIOR SURVEY (2019) CHANGING FACES OF GREATER BOSTON, BOSTON FOUNDATION (2019) PART V, SECTION B, LINE 5: 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS KEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS TO OBTAIN TARGETED DATA AND UNDERSTAND THE CURRENT ISSUES FACING THE COMMUNITY, QUALITATIVE DATA WAS COLLECTED THROUGH A VARIETY OF SOURCES INCLUDING 48 KEY INFORMANT INTERVIEWS THAT ENGAGED INSTITUTIONAL, ORGANIZATIONAL AND COMMUNITY LEADERS AND FRONT-LINE STAFF ACROSS SECTORS. 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 H 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 IN PERSON AND ON THE PHONE USING A STANDARD INTERVIEW GUIDE. INTERVIEWS FOCUSED ON IDENTIFYING MAJOR HEALTH ISSUES, INCLUDING POSSIBLE STRATEGIES TO ADDRESS THOSE CONCERNS, AND TARGET POPULATIONS. WHILE IT WAS NOT POSSIBLE FOR THE CHNA TO INVOLVE ALL COMMUNITY STAKEHOLDERS, EVERY EFFORT WAS MADE TO BE AS INCLUSIVE AS POSSIBLE AND PROVIDE A BROAD RANGE OF OPPORTUNITIES FOR PARTICIPATION. 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 COASFOCUS 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, WAITING ROOMS, LOCAL LIBRARIES, COMMUNITY EVENTS AND LARGE APARTMENT BUILDINGS 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 DOCUMENTSAS NOTED ABOVE, THE CHNA PROCESS WAS DIVIDED INTO THREE PHASES. THE FINAL PHASE, PHASE III, INCLUDED THE FOLLOWING STEPS: REVIEW OF THE ASSESSMENT'S MAJOR FINDINGS. 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. PART V, SECTION B, LINE 5 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 CONDITIONSTHE 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. COMMUNITY HEALTH NEEDS ASSESSMENT MAKING THE CHNA AND IMPLEMENTATION STRATEGY WIDELY AVAILABLE WINCHESTER 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, 2019 (TAX YEAR 2018). THAT CHNA IS AVAILABLE ON THE WINCHESTER HOSPITAL WEBSITE AT: HTTPS://WWW.WINCHESTERHOSPITAL.ORG/FILE%20LIBRARY/UNASSIGNED/WH-2019-CHNA-091319.PDFIN ADDITION TO THE CHNA, WINCHESTER HOSPITAL COMPLETED ITS MOST RECENT IMPLEMENTATION STRATEGY DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018). THE IMPLEMENTATION STRATEGY IS AVAILABLE ON THE WINCHESTER HOSPITAL WEBSITE AT:HTTPS://WWW.WINCHESTERHOSPITAL.ORG/OUR-PROMISE/SUPPORTING-OUR-COMMUNITYIN ADDITION, AS NOTED ABOVE, WINCHESTER HOSPITAL COMPLETED ITS PREVIOUS CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2016 (TAX YEAR 2015). THAT CHNA IS AVAILABLE ON THE WINCHESTER HOSPITAL WEBSITE AT:HTTPS://WWW.WINCHESTERHOSPITAL.ORG/FILE%20LIBRARY/WINCHESTER%20HOSPITAL/OUR%20PROMISE/WINCHESTER-HOSPITAL-2016-COMMUNITY-HEALTH-ASSESSMENT.PDFFINALLY, THE IMPLEMENTATION STRATEGY ASSOCIATED WITH THE CHNA COMPLETED DURING WINCHESTER HOSPITAL'S FISCAL YEAR ENDED SEPTEMBER 30, 2016 (TAX YEAR 2015) IS AVAILABLE ON THE WINCHESTER HOSPITAL WEBSITE AT:HTTPS://WWW.WINCHESTERHOSPITAL.ORG/FILE%20LIBRARY/WINCHESTER%20HOSPITAL/OUR%20PROMISE/WINCHESTER-HOSPITAL-2016-COMMUNITY-HEALTH-ASSESSMENT.PDFEACH OF THESE DOCUMENTS IS ALSO AVAILABLE ON REQUEST (SCHEDULE H, PART V, SECTION B, LINE 7A). SCHEDULE H, PART V, SECTION B, LINE 11-COMMUNITY HEALTH NEEDS ASSESSMENT ADDRESSING COMMUNITY HEALTH NEEDSAS 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, 2019. THAT CHNA AND IMPLEMENTATION STRATEGY INFORMED THE COMMUNITY BENEFITS MISSION AND ACTIVITIES OF WINCHESTER HOSPITAL FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2020 AND WILL CONTINUE TO INFORM THE HOSPITAL'S COMMUNITY BENEFITS MISSION AND ACTIVITIES FOR THE FISCAL YEARS ENDING SEPTEMBER 30, 2021 AND SEPTEMBER 30, 2022. 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 PRIORITY AREAS 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. THE PRIORITY AREAS AND GOALS ARE LISTED BELOW:PRIORITY AREA 1: MENTAL HEALTH AND SUBSTANCE USE DISORDERGOAL: 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 FACTORSGOAL: 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 CAREGOAL: 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)THE FY19 COMMUNITY HEALTH NEEDS ASSESSMENT ALONG WITH THE ASSOCIATED FY20-22 IMPLEMENTATION STRATEGY WAS DEVELOPED OVER A 10-MONTH PERIOD FROM OCTOBER 2018 TO AUGUST 2019. THESE COMMUNITY HEALTH ASSESSMENT, PLANNING, AND IMPLEMENTATION EFFORTS FULFILL THE COMMONWEALTH OF MASSACHUSETTS ATTORNEY GENERAL'S OFFICE AND FEDERAL INTERNAL REVENUE SERVICE (IRS) REQUIREMENTS. MORE SPECIFICALLY, THESE ACTIVITIES FULFILL WINCHESTER HOSPITAL'S NEED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES, INVENTORY COMMUNITY ASSETS, ASSESS IMPACT, AND DEVELOP AN IMPLEMENTATION STRATEGY. HOWEVER, THESE ACTIVITIES ARE DRIVEN PRIMARILY BY WINCHESTER HOSPITAL'S DEDICATION TO ITS MISSION, ITS COVENANT TO CARE FOR THE UNDERSERVED, AND ITS COMMITMENT TO COMMUNITY HEALTH IMPROVEMENT. BELOW IS A SUMMARY DESCRIPTION OF THE FY19 CHNA APPROACH, METHODS, AND KEY FINDINGS. 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 ENGAGEMENTPHASE 2 TARGETED ENGAGEMENTPHASE 3 STRATEGIC PLANNING AND REPORTINGHUNDREDS 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: 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 (2018) MIDDLESEX LEAGUE YOUTH RISK BEHAVIOR SURVEY (2019) CHANGING FACES OF GREATER BOSTON, BOSTON FOUNDATION (2019)QUALITATIVE DATA SOURCES: TO OBTAIN TARGETED DATA AND UNDERSTAND THE CURRENT ISSUES FACING THE COMMUNITY, THE FOLLOWING WAS DONE: 28 INTERNAL STAKEHOLDER INTERVIEWS (BOARD MEMBERS, SENIOR LEADERS, AND SERVICE LINE LEADERS) 20 EXTERNAL STAKEHOLDER INTERVIEWS 1,022 HOUSEHOLD SURVEYS TWO COMMUNITY LISTENING SESSIONS (100 ATTENDEES)INDIVIDUALS PROVIDED INPUT THROUGH INTERVIEWS, FOCUS GROUPS, COMMUNITY LISTENING SESSIONS, AND A WIDELY DISTRIBUTED COMMUNITY HEALTH SURVEY. WHILE IT WAS NOT POSSIBLE FOR THE CHNA TO INVOLVE ALL COMMUNITY STAKEHOLDERS, EVERY EFFORT WAS MADE TO BE AS INCLUSIVE AS POSSIBLE AND PROVIDE A BROAD RANGE OF OPPORTUNITIES FOR PARTICIPATION. WINCHESTER HOSPITAL'S COMMUNITY BENEFITS PROGRAM IS BUILT ON PARTNERSHIP AND DIALOGUE WITH OUR MANY COMMUNITIES. OUR UNDERSTANDING OF THESE COMMUNITIES' NEEDS IS DERIVED FROM DISCUSSIONS WITH AND OBSERVATIONS BY HEALTH CARE AND HEALTH-RELATED WORKERS IN THE NEIGHBORHOODS AS WELL AS FROM MORE FORMAL ASSESSMENTS OF PUBLIC HEALTH DATA AND THROUGH FOCUS GROUPS, SURVEYS, ETC. THIS DATA WAS THEN AUGMENTED BY DEMOGRAPHIC AND HEALTH STATUS INFORMATION FROM A VARIETY OF SOURCES INCLUDING THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, FEDERAL RESOURCES SUCH AS THE INSTITUTE OF MEDICINE AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION, AND REVIEW OF LITERATURE RELEVANT TO A PARTICULAR COMMUNITY'S NEEDS. AN ARTICULATION OF EACH SPECIFIC COMMUNITY'S NEEDS (CRAFTED JOINTLY BY WINCHESTER HOSPITAL AND COMMUNITY PARTNERS) INFORMS WINCHESTER HOSPITAL'S DECISION-MAKING ABOUT PRIORITIES FOR COMMUNITY BENEFITS EFFORTS. WE WORK IN CONCERT WITH COMMUNITY RESIDENTS AND LEADERS TO DESIGN SPECIFIC ACTIONS TO BE UNDERTAKEN EACH YEAR. EACH COMPONENT OF THE PLAN IS WOVEN INTO THE GOALS AND AGENDA FOR WINCHESTER HOSPITAL'S COMMUNITY BENEFITS IMPLEMENTATION STRATEGY, ADOPTED BY THE BOARD OF TRUSTEES. FY20 SCHEDULE H IMPLEMENTATION STRATEGY UPDATE 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 ADULTS1.1 PROGRAMMATIC OBJECTIVE: REDUCE ISOLATION AND DEPRESSION:1.2 PROGRAMMATIC OBJECTIVE: REDUCE ENVIRONMENTAL RISK FACTORS ASSOCIATED WITH DEVELOPING MENTAL HEALTH ISSUES1.3 PROGRAMMATIC OBJECTIVE: PROMOTE COLLABORATION, SHARE KNOWLEDGE, AND COORDINATE ACTIVITIES WITH INTERNAL AND EXTERNAL PARTNERS1.4 PROGRAMMATIC OBJECTIVE: INCREASE AWARENESS OF THE IMPACTS AND RISK FACTORS FOR DEVELOPING SUBSTANCE USE DISORDERS1.5 PROGRAMMATIC OBJECTIVE: INCREASE AWARENESS OF THE SIGNS, SYMPTOMS, RISKS, AND STIGMA OF DEVELOPING MENTAL HEALTH ISSUES AND PROMOTE ACCESS TO TREATMENT1.6 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 DEPARTMENTMETRICS/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 FY21, 321 YOUTH WERE SCREENED, RESULTING IN REFERRALS TO MENTAL HEALTH TREATMENT AND WEEKLY SESSIONS WITH MENTORS. THE MYSTIC VALLEY ELDER SERVICES MOBILE MENTAL HEALTH PROGRAM PROVIDED HOME-BASED MENTAL HEALTH SERVICES TO 175 OLDER ADULTS LIVING IN MEDFORD, NORTH READING, READING, STONEHAM, AND WAKEFIELD. 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 AND STONEHAM COALITION TO SUPPORT THE INTERFACE MENTAL HEALTH REFERRAL SERVICE. IN FY21 FROM DECEMBER-MAY, 84 WINCHESTER AND 30 STONEHAM RESIDENTS WERE SERVED BY THE PROGRAM. LAHEY HEALTH 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 FY21, THERE WAS AN INCREASE IN HIRING AND TRAINING BEHAVIORAL HEALTH CLINICIANS TO EXPAND PATIENT CARE CAPACITY. SPECIFICALLY, AT WINCHESTER HOSPITAL THERE WAS AN INCREASE FROM 3 SITES, SERVING 624 PATIENTS IN FY20, TO 6 SITES, SERVING 1346 PATIENTS IN FY21.COMMUNITY PARTNERS: BOYS & GIRLS CLUB OF STONEHAM/WAKEFIELD, STONEHAM COALITION FOR A HEALTH COMMUNITY, MYSTIC VALLEY ELDER SERVICES, WINCHESTER HEALTH DEPARTMENT, WINCHESTER SAFER COALITION, MYSTIC VALLEY PUBLIC HEALTH COMMITTEEPRIORITY AREA #2 - CHRONIC/COMPLEX CONDITIONS AND RISK FACTORSTHE 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 SERVICESTARGET POPULATION: OLDER ADULTS, INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS, LOW-RESOURCE INDIVIDUALS AND FAMILIES, YOUTH AND ADOLESCENTS2.1 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 ANDPROVIDE LINKAGES TO SERVICES2.3 PROGRAMMATIC OBJECTIVE: ENGAGE INDIVIDUALS IN EVIDENCE-BASED/EVIDENCE-INFORMEDPROGRAMS THAT HELP THEM BETTER MANAGE THEIR CHRONIC DISEASE2.4 PROGRAMMATIC OBJECTIVE: EDUCATE INDIVIDUALS ABOUT ACHIEVING A HEALTHY DIET2.5 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 CONDITIONSMETRICS/STATUS UPDATE: IN FY21, WINCHESTER HOSPITAL CONDUCTED 4,217 FREE BREAST CANCER RISK ASSESSMENTS. IN FY21, 84 CHILDREN WERE ENROLLED IN CHAMP, A PEDIATRIC ASTHMA MANAGEMENT PROGRAM. 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. IN IN FY21, A TOTAL OF 49 CLASSES WERE HELD, WITH 8 PARTICIPANTS COMPLETING THE 12-WEEK PROGRAM. 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 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. IN FY21, WINCHESTER HOSPITAL PROVIDED FUNDING FOR A 20-WEEK FREE FRUIT AND VEGETABLE SHARE WITH HEALTHY RECIPE RECOMMENDATIONS AT THE WINCHESTER HOUSING AUTHORITY. 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.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: 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 CARETARGET POPULATION: OLDER ADULTS, INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS, LOW-RESOURCE INDIVIDUALS AND FAMILIES, YOUTH AND ADOLESCENTS3.1 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 HEALTH3.4 PROGRAMMATIC OBJECTIVE: EXPLORE WAYS TO REDUCE/ADDRESS HOUSING INSTABILITY3.5 PROGRAMMATIC OBJECTIVE: INCREASE ACCESS TO CLINICAL SERVICES FOR HOMEBOUND PATIENTS3.6 PROGRAMMATIC OBJECTIVE: INCREASE ACCESS TO AFFORDABLE AND NUTRITIOUS FOODS AND AFFORDABLE PHYSICAL ACTIVITY3.7 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 HEALTH3.9 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 BARRIERSMETRICS/STATUS UPDATE WINCHESTER HOSPITAL COLLABORATED WITH CHECKER CAB OF WOBURN TO PROVIDE FREE RIDES TO MEDICAL APPOINTMENTS FOR 150 PATIENTS IN FY21. THROUGH A GRANT WINCHESTER HOSPITAL PROVIDED TO METRO HOUSING BOSTON, THE CO-LOCATION PROGRAM PROVIDED FREE COUNSELING TO 166 LOW- TO MODERATE-INCOME INDIVIDUALS AND FAMILIES TO HELP PREVENT THEM FROM BEING EVICTED AND INCREASE HOUSING STABILITY IN FY21. IN FY21, WINCHESTER HOSPITAL LAB SERVICES PROVIDED 11,398 FREE IN-HOME BLOOD DRAWS. 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. IN FY21, WINCHESTER HOSPITAL INTERPRETERS ASSISTED 7,086 PATIENTS BY PROVIDING FREE INTERPRETER SERVICES SESSIONS REMOTELY. THE TOP THREE LANGUAGES REQUESTING INTERPRETER SERVICES WERE: SPANISH (1,530), ITALIAN (564), AND PORTUGUESE (562). 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.COMMUNITY PARTNERS: METRO HOUSING BOSTON, MINUTEMAN SENIOR SERVICES, WINCHESTER HOUSING AUTHORITY 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, 14.38% 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 REPORTAS PREVIOUSLY NOTED IN THIS FILING, WINCHESTER HOSPITAL 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, 2019 , 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-COMMUNITY.THERE ARE SOME DIFFERENCES BETWEEN THE MASSACHUSETTS ATTORNEY GENERAL DEFINITION OF CHARITY CARE AND COMMUNITY BENEFITS AND THE INTERNAL REVENUE SERVICE DEFINITION OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS. AS SUCH, THERE ARE VARIANCES BETWEEN THIS SCHEDULE H DISCLOSURE AND THE REPORT WINCHESTER HOSPITAL FILED WITH THE ATTORNEY GENERAL'S OFFICE. EMERGENCY CARE ACCESSIN 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 PROGRAMSFINANCIAL 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 $6,152,624 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2020 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 $71,673,934 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2020. DURING THE FISCAL YEAR COVERED BY THIS FILING, WINCHESTER HOSPITAL ADOPTED AN AMENDED WRITTEN FINANCIAL ASSISTANCE POLICY. AS REPORTED IN SCHEDULE H PART I LINE 3 AND AGAIN IN SCHEDULE H PART V SECTION B LINE 13, UNDER THAT POLICY, 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 MEDICAREIN 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 ENSURE LOW-INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, WINCHESTER HOSPITAL GENERATED $19.429,675 RELATED TO TREATING MEDICAID PATIENTS WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY WINCHESTER HOSPITAL FOR SUCH SERVICES BY $2,400,986 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 180,407 OF THE HOSPITAL'S PATIENT CASES WERE WITH MEDICARE 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 $101,159,768 RELATED TO TREATING MEDICARE PATIENTS. THE COSTS OF PROVIDING CARE TO MEDICARE PATIENTS EXCEEDED REVENUE BY $15,739,463. OF THESE AMOUNTS, REVENUE OF $40,642,774 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 $16,522,874. 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% 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 $2,438,389 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, 2021 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 POLICYAS REQUIRED BY IRC SECTION 501(R)(4) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL MAINTAINS A WRITTEN FINANCIAL ASSISTANCE POLICY (FAP) THAT APPLIES TO ALL EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED BY THE HOSPITAL FACILITY. (SCHEDULE H PART I QUESTIONS 1A AND 1B). DETAIL RELATED TO EMERGENCY AND OTHER MEDICALLY NECESSARY CARE COVERED BY THE POLICY IS INCLUDED WITHIN THE POLICY AND THE DEFINITION OF EMERGENCY CARE MEETS THE DEFINITION OF THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), SECTION 1867 OF THE SOCIAL SECURITY ACT (42 USC 1395DD). (SCHEDULE H PART V SECTION B QUESTION 21). THE FAP INCLUDES A LIST OF PROVIDERS OTHER THAN THE HOSPITAL ITSELF, WHICH ARE COVERED BY THE FAP AND SPECIFIES ELIGIBILITY CRITERIA FOR BOTH FREE AND DISCOUNTED CARE. THE FAP ALSO INCLUDES THE BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS. THE PROVIDER LIST IS UPDATED NOT LESS THAN QUARTERLY. THE HOSPITAL MAINTAINS A SEPARATE CREDIT AND COLLECTION POLICY AS PERMITTED UNDER THE TREASURY REGULATIONS AND THIS CREDIT AND COLLECTION POLICY IS REFERENCED WITHIN THE FAP AS REQUIRED, ALONG WITH INFORMATION ON HOW TO OBTAIN A FREE COPY OF THE CREDIT AND COLLECTION POLICY. (SCHEDULE H PART III SECTION C QUESTIONS 9A AND 9B AND PART V SECTION B QUESTION 17). THE HOSPITAL'S FAP AND CREDIT & COLLECTION POLICY WERE ADOPTED BY THE HOSPITAL'S BOARD 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 POLICY TRANSLATIONS 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, CAMBODIAN, FRENCH, GREEK, HAITIAN-CREOLE, HINDI, ITALIAN, JAPANESE, KOREAN, MON-KHINER, PORTUGUESE, PANJABI, RUSSIAN, SPANISH, VIETNAMESE, AND TRADITIONAL CHINESE. (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/FILE%20LIBRARY/UNASSIGNED/WH---ENGLISH-FAP--JAN.-2021_FINAL-.PDF 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 SUMMARYAS NOTED IN THIS NARRATIVE SUPPORT TO THE FORM 990 SCHEDULE H, THE HOSPITAL HAS A PLAIN LANGUAGE SUMMARY OF ITS FAP. THIS IS A WRITTEN STATEMENT DESIGNED TO NOTIFY PATIENTS AND VISITORS THAT THE HOSPITAL HAS A WRITTEN FAP AND PROVIDES FINANCIAL ASSISTANCE. THIS PLAIN LANGUAGE SUMMARY INCLUDES INFORMATION ON FREE AND DISCOUNTED CARE, HOW TO OBTAIN A COPY OF THE FAP POLICY AND APPLICATION, INCLUDING THE WEBSITE ADDRESS, THE LOCATION AND PHONE NUMBER OF THE FINANCIAL COUNSELING OFFICE. THE PLAIN LANGUAGE SUMMARY ALSO INCLUDES THE LIST OF LANGUAGES INTO WHICH THE FAP AND SUMMARY HAVE BEEN TRANSLATED AS WELL AS HOW TO ACCESS INFORMATION ON PROVIDERS NOT COVERED BY THE FAP AND TO WHICH OTHER RELATED HOSPITALS APPROVAL UNDER THE FAP WILL APPLY. LINKS TO FINANCIAL ASSISTANCE POLICY AND RELATED DOCUMENTSTHE LINK TO THE 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 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 ATHTTPS://WWW.WINCHESTERHOSPITAL.ORG/FILE%20LIBRARY/UNASSIGNED/WH---ENGLISH-FAP--JAN.-2021_FINAL-.PDFLIMITATION ON CHARGES INTERNAL REVENUE CODE SECTION 501(R)(5)LIMITATION ON CHARGESAS REQUIRED BY IRC SECTION 501(R)(5) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL LIMITS THE AMOUNTS CHARGED FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IT PROVIDES TO A FINANCIAL ASSISTANCE-ELIGIBLE PATIENT, TO NOT MORE THAN AMOUNTS GENERALLY BILLED (AGB) AND LIMITS THE AMOUNTS CHARGED TO ANY FINANCIAL ASSISTANCE ELIGIBLE PATIENT FOR ALL OTHER MEDICAL CARE TO LESS THAN GROSS CHARGES. AMOUNTS GENERALLY BILLED LOOK BACK METHODTHE HOSPITAL CALCULATES ITS AGB, USING THE LOOK BACK METHOD, DIVIDING THE TOTAL PAYMENTS RECEIVED FROM ALL COMMERCIAL PLANS AND MEDICARE BY THE TOTAL CHARGES SENT TO THOSE SAME PAYERS FOR THE PREVIOUS FISCAL YEAR. CALCULATED AGB IS INCLUDED IN THE HOSPITAL'S FAP AS REQUIRED UNDER THE REGULATIONS DETAILING THE REQUIREMENTS UNDER IRC SECTION 501(R)(5). (SCHEDULE H PART V SECTION B QUESTION 22). PATIENT REFUNDS FOR CHARGES IN EXCESS OF AMOUNTS GENERALLY BILLEDTHE HOSPITAL REGULARLY MONITORS THE FINANCIAL ACCOUNTS OF FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. WHERE A PATIENT SUBMITS A COMPLETED APPLICATION FOR FINANCIAL ASSISTANCE AND IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL REFUNDS ANY AMOUNTS PREVIOUSLY PAID FOR CARE THAN EXCEEDS THE AMOUNT THAT THE PATIENT IS PERSONALLY RESPONSIBLE FOR PAYING WHERE SUCH AMOUNTS ARE EQUAL TO OR EXCEED $5.00. BILLING AND COLLECTIONS501(R)(6) EXTRAORDINARY COLLECTION ACTIVITIESTHE HOSPITAL DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIVITIES (ECAS) FOR FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. SPECIFICALLY, THE HOSPITAL DOES NOT REPORT TO CREDIT AGENCIES, ENGAGE IN LEGAL OR JUDICIAL PROCESSES OR SELL A PATIENT'S OUTSTANDING AMOUNTS OWED FOR PATIENT CARE. IN ADDITION, THIS EXTENDS TO ANY THIRD PARTY CONTRACTED WITH THE HOSPITAL RELATED TO BILLING AND COLLECTIONS. (SCHEDULE H PART V SECTION B QUESTIONS 18 AND 19).APPLICATION PERIOD PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME UP TO TWO HUNDRED FORTY (240) DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS AVAILABLE. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS RESEARCH EXAMPLES OF THE RESEARCH ENGAGED IN AT BIDMCBELOW IS INFORMATION RELATED TO JUST A HANDFUL OF THE CUTTING-EDGE RESEARCH STUDIES AND PRINCIPAL INVESTIGATORS AT THE MEDICAL CENTER. THE DETAIL BELOW IS DESIGNED TO PROVIDE THE READER WITH A TASTE OF THE MANY CONTRIBUTIONS THE MEDICAL CENTER IS MAKING TO PATIENT CARE TODAY AND TOMORROW. EXPENSES FROM THE RESEARCH ACTIVITIES NOTED BELOW ARE INCLUDED IN FORM 990 SCHEDULE H, PART I LINE 7H COLUMN C AND MAY OR MAY NOT BE QUANTIFIED IN FORM 990 SCHEDULE H, PART I, LINE 7H COLUMN E, DEPENDING ON FUNDING SOURCE. 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 RESEARCH IN WHICH BIDMC ENGAGES SUPPORTS NOT ONLY THE MISSION AND CARE FOR BIDMC PATIENTS AND COMMUNITIES BUT ALSO HELPS TO IMPROVE PATIENT CARE FOR THE COMMUNITIES OF OTHER BILH AFFILIATES AND BEYOND. THE DETAIL BELOW PROVIDES BACKGROUND ON THE RESEARCH ACTIVITIES AT BIDMC DURING THE FISCAL PERIOD COVERED BY THIS FILING.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 1,800 ACTIVE FEDERAL, INDUSTRY AND FOUNDATION SPONSORED PROJECTS AND MORE THAN 2,400 ACTIVE EXEMPT, EXPEDITED, AND FULL BOARD-REVIEWED CLINICAL RESEARCH STUDIES. BIDMC RESEARCH IS LED BY MORE THAN 260 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 O ALLERGY AND INFLAMMATIONO CARDIOVASCULAR MEDICINEO CENTER FOR VASCULAR BIOLOGY RESEARCHO CENTER FOR VIROLOGY AND VACCINE RESEARCHO CLINICAL INFORMATICSO CLINICAL NUTRITIONO ENDOCRINOLOGYO EXPERIMENTAL MEDICINEO GASTROENTEROLOGYO GENERAL MEDICINE AND PRIMARY CAREO GENETICSO GERONTOLOGYO HEMATOLOGY AND ONCOLOGYO HEMOSTASIS AND THROMBOSISO IMMUNOLOGYO INFECTIOUS DISEASEO INTERDISCIPLINARY MEDICINE AND BIOTECHNOLOGYO MOLECULAR AND VASCULAR MEDICINEO NEPHROLOGYO PULMONOLOGYO RHEUMATOLOGYO SIGNAL TRANSDUCTIONO TRANSLATIONAL RESEARCHO TRANSPLANT IMMUNOLOGY NEONATOLOGY NEUROLOGY OBSTETRICS AND GYNECOLOGY ORTHOPAEDIC SURGERY PATHOLOGY PSYCHIATRY RADIOLOGY SURGERY O CARDIAC SURGERYO CENTER FOR MINIMALLY INVASIVE SURGERYO NEUROSURGERYO PLASTIC AND RECONSTRUCTIVE SURGERYO VASCULAR SURGERY TRANSPLANT INSTITUTEDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER REPORTED $241,917,383 OF NET INTERNALLY FUNDED RESEARCH ON THIS SCHEDULE H, PART I, LINE 7H RELATED TO RESEARCH TO FURTHER SCIENCE AND PATIENT CARE, WHICH REPRESENTED 2.99% OF THE MEDICAL CENTER'S TOTAL EXPENSES. ADDITIONALLY, THE MEDICAL CENTER REPORTED $307,298,416 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 2.21%.RESEARCH ENGAGED IN AT THE MEDICAL CENTERTHE REAL CORNERSTONES OF THE MEDICAL CENTER'S SUCCESS CAN BE DESCRIBED IN THREE KEY WORDS: INNOVATION, CULTIVATION, AND TRANSFORMATION. BEGINNING WITH SUPPORT OF BOLD AND INNOVATIVE IDEAS, EXTENDING TO CULTIVATION AND NURTURING OF PROMISING YOUNG SCIENTISTS, AND CULMINATING IN THE TRANSFORMATION OF NOVEL DISCOVERIES INTO THERAPIES AND DIAGNOSTICS, THE MEDICAL CENTER'S RESEARCH PROGRAM HAS EMERGED AS A UNIQUE AND SUCCESSFUL MODEL FOR TODAY'S RAPIDLY CHANGING HEALTH CARE LANDSCAPE.EXAMPLES OF THE RESEARCH ENGAGED IN AT BIDMCBELOW IS INFORMATION RELATED TO JUST A HANDFUL OF THE CUTTING-EDGE RESEARCH STUDIES AND PRINCIPAL INVESTIGATORS AT THE MEDICAL CENTER. THE DETAIL BELOW IS DESIGNED TO PROVIDE THE READER WITH A TASTE OF THE MANY CONTRIBUTIONS THE MEDICAL CENTER IS MAKING TO PATIENT CARE TODAY AND TOMORROW. EXPENSES FROM THE RESEARCH ACTIVITIES NOTED BELOW ARE INCLUDED IN FORM 990 SCHEDULE H, PART I LINE 7H COLUMN C AND MAY OR MAY NOT BE QUANTIFIED IN FORM 990 SCHEDULE H, PART I, LINE 7H COLUMN E, DEPENDING ON FUNDING SOURCE. COVID-19 VACCINE RESEARCH THE PERIOD COVERED BY THIS FILING IS THE FISCAL YEAR ENDED SEPTEMBER 30, 2021, DURING WHICH THE COVID-19 PANDEMIC CONTINUED TO DISRUPT LIFE IN THE UNITED STATES AND ACROSS THE GLOBE. RESEARCH CONDUCTED AT BIDMC DURING THIS FISCAL PERIOD HIGHLIGHTS BIDMC'S CONTINUING NATIONAL LEADERSHIP DURING THIS ONGOING PUBLIC HEALTH CRISIS.AS OF LATE JULY, 2021, ABOUT 48.5 PERCENT OF AMERICANS, OR ABOUT 159 MILLION PEOPLE, WERE FULLY VACCINATED AGAINST SARS-COV-2, THE VIRUS THAT CAUSES COVID-19. BIDMC IMMUNOLOGIST DAN BAROUCH, MD, PHD, PLAYED AN INSTRUMENTAL ROLE IN DESIGNING AND DEVELOPING ONE OF THE FIRST THREE COVID-19 VACCINES TO COME TO MARKET IN THE UNITED STATES. AS DIRECTOR OF BIDMC'S CENTER FOR VIROLOGY AND VACCINE RESEARCH (CVVR), DR. 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. DR. BAROUCH'S TEAM QUICKLY DESIGNED A SERIES OF VACCINE CANDIDATES, EVALUATED IN CLINICAL STUDIES LED BY PRIMARY INVESTIGATOR KATHRYN E. STEPHENSON, MD, MPH, DIRECTOR OF THE CLINICAL TRIALS UNIT AT CVVR.DR. BAROUCH'S INNOVATIVE VACCINE DESIGN NOW THE BASIS OF THE JOHNSON & JOHNSON SINGLE SHOT VACCINE 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. SHOWN TO BE SAFE AND EFFECTIVE, THE COVID-19 VACCINE WAS GRANTED EMERGENCY USE APPROVAL BY THE U.S. FDA IN FEBRUARY, 2021.SINCE THEN, BAROUCH AND COLLEAGUES HAVE CONTINUED TO STUDY THE VIRUS' IMPACT ON THE IMMUNE SYSTEM AND HOW THE VACCINES AND THERAPIES DEVELOPED TO PROTECT AGAINST THE ORIGINAL STRAIN OF SARS-COV-2 ARE HOLDING UP AGAINST THE EMERGING VARIANTS. FOLLOWING IS A SUMMARY OUTLINING RESEARCH FROM FISCAL YEAR 2021.A STUDY LED BY BAROUCH AND COLLEAGUES SHED MORE LIGHT ON HOW MOLECULES OF THE IMMUNE AND VASCULAR SYSTEMS INTERACT TO PRODUCE THE EXTENSIVE DAMAGE TO THE LUNG AND VASCULAR TISSUES SEEN IN PATIENTS WITH SEVERE DISEASE. RESEARCHERS CONDUCTED COMPREHENSIVE ANALYSES OF TISSUE AND BLOOD SAMPLES FROM HUMANS AND FROM NON-HUMAN PRIMATES INFECTED WITH COVID-19. THE TEAM'S FINDINGS, PUBLISHED IN THE JOURNAL CELL, HELP DEFINE THE PATHWAYS BY WHICH COVID-19 INDUCES VASCULAR DISEASE AND ALSO POINT TO POTENTIAL THERAPEUTIC TARGETS. "OVERALL, OUR DATA REVEAL THE KEY BIOLOGICAL PROCESSES INVOLVED IN TRIGGERING THE CLOTTING AND VASCULAR DAMAGE OBSERVED WITH SARS-COV-19 INFECTION," SAID BAROUCH. "OUR RESULTS SUGGEST A MODEL IN WHICH CRITICAL INTERACTIONS BETWEEN INFLAMMATORY AND CLOTTING PATHWAYS LEAD TO SEVERE VASCULAR INJURY SEEN IN CRITICALLY ILL PATIENTS WITH COVID-19." IN A PAPER IN THE JOURNAL NATURE, BAROUCH, AND COLLEAGUES ELUCIDATED THE ROLE OF ANTIBODIES AND IMMUNE CELLS IN PROTECTION AGAINST SARS-COV-2, THE VIRUS THAT CAUSES COVID-19, IN RHESUS MACAQUES. "IN THIS STUDY, WE DEFINE THE ROLE OF ANTIBODIES VERSUS T CELLS IN PROTECTION AGAINST COVID-19 IN MONKEYS. WE REPORTTHAT A RELATIVELY LOW ANTIBODY TITER (THE CONCENTRATION OF ANTIBODIES IN THE BLOOD) IS NEEDED FOR PROTECTION," SAID BAROUCH. "SUCH KNOWLEDGE WILL BE IMPORTANT IN THE DEVELOPMENT OF NEXT GENERATION VACCINES, ANTIBODY-BASED THERAPEUTICS, AND PUBLIC HEALTH STRATEGIES FOR COVID-19." IN ANOTHER STUDY IN NATURE, BAROUCH AND COLLEAGUES ALSO TESTED JOHNSON & JOHNSON'S COVID-19 VACCINE IN RHESUS MACAQUES CHALLENGED WITH THE VIRAL VARIANT B.1.351 AND IN RHESUS MACAQUES CHALLENGED WITH THE ORIGINAL STRAIN IDENTIFIED, DESIGNATED WA1/2020. BAROUCH AND COLLEAGUES WHO HELPED DEVELOP JOHNSON & JOHNSON'S SINGLE-SHOT VIRAL VECTOR VACCINE, CALLED AD26.COV2.S REPORT THAT THE VACCINE PRODUCES ROBUST PROTECTION AGAINST BOTH. THE FINDINGS HAVE IMPORTANT IMPLICATIONS FOR THE VACCINE CONTROL OF SARS-COV-2 VARIANTS OF CONCERN. "THE EMERGENCE OF SARS-COV-2 VARIANTS THAT PARTIALLY EVADE NEUTRALIZING ANTIBODIES POSES A THREAT TO THE EFFICACY OF CURRENT COVID-19 VACCINES," SAID BAROUCH, SENIOR AUTHOR OF THE STUDY AND DIRECTOR OF VACCINE AND VIROLOGY RESEARCH AT BIDMC. "HERE WE SHOW THAT THE AD26.COV2.S VACCINE ELICITS HUMORAL AND CELLULAR IMMUNE RESPONSES THAT CROSS-REACT WITH THE B.1.351 VARIANT AND PROTECTS AGAINST THE B.1.351 CHALLENGE IN RHESUS MACAQUES." IN FINDINGS PUBLISHED IN THE NEW ENGLAND JOURNAL OF MEDICINE, BAROUCH'S TEAM REPORTED ON THE DURABILITY OF JOHNSON & JOHNSON'S AD26.COV2.S VACCINE IN HUMANS. THE SINGLE-SHOT VIRAL VECTOR VACCINE DEVELOPED IN PART BY BAROUCH AND COLLEAGUES AT BIDMC WAS ALSO EVALUATED FOR ITS COVERAGE AGAINST THE ALPHA, BETA, GAMMA, DELTA, EPSILON AND KAPPA SARS-COV-2 VARIANTS. "OUR DATA SHOW THAT THE AD26.COV2.S VACCINE ELICITED DURABLE IMMUNE RESPONSES WITH MINIMAL DECLINE FOR AT LEAST EIGHT MONTHS, THE TIMEFRAME EXAMINED, FOLLOWING IMMUNIZATION," SAID BAROUCH, CORRESPONDING AUTHOR OF THE PAPER AND ALSO PROFESSOR OF MEDICINE AT HARVARD MEDICAL SCHOOL. "WE ALSO SHOWED GOOD NEUTRALIZATION COVERAGE OF THE DELTA VARIANT AS WELL AS OTHER VARIANTS." LAST SUMMER, BAROUCH'S TEAM WAS AWARDED $4.9 MILLION IN ANNUAL FUNDING OVER THE NEXT FIVE YEARS TO FIND A CURE FOR HIV. BAROUCH WAS ONE OF TEN PRIMARY INVESTIGATORS TO RECEIVE A 2021 NATIONAL INSTITUTES OF HEALTH (NIH) MARTIN DELANEY COLLABORATORIES FOR HIV CURE RESEARCH AWARD, WHICH AIMS TO EXPEDITE HUMAN IMMUNODEFICIENCY VIRUS (HIV) CURE RESEARCH BY BRINGING TOGETHER RESEARCH PARTNERS IN ACADEMIA, GOVERNMENT, THE PRIVATE SECTOR AND THE COMMUNITY; COORDINATING COMPLEX RESEARCH STUDIES, AND MENTORING THE NEXT GENERATION OF HIV CURE RESEARCHERS. BAROUCH AND COLLEAGUES WILL FOCUS ON UNDERSTANDING THE VIRAL RESERVOIR DORMANT HIV-INFECTED IMMUNE CELLS THAT REMAIN IN THE BODY DESPITE ANTI-RETROVIRAL THERAPY (ART) AND CAN SPRING BACK INTO ACTION IF ART IS INTERRUPTED AND ON DEVELOPING NEW IMMUNOLOGIC STRATEGIES TARGETING THE RESERVOIR TO CONTROL OR ERADICATE HIV INFECTION. WITH MORE THAN 35 MILLION PEOPLE WORLDWIDE LIVING WITH THE VIRUS AND NEARLY 2 MILLION NEW CASES EACH YEAR, HIV REMAINS A MAJOR GLOBAL EPIDEMIC. "THE LATENT VIRAL RESERVOIR IS THE CRITICAL BARRIER FOR THE DEVELOPMENT OF A CURE FOR HIV-1 INFECTION," SAID BAROUCH. "OUR OVERALL HYPOTHESIS IS THAT MULTIPLE IMMUNOLOGIC STRATEGIES WILL NEED TO BE EXPLORED AND COMBINED TO ACHIEVE LONG-TERM, ART-FREE VIROLOGIC CONTROL OR COMPLETE VIRUS ERADICATION. WE'RE VERY GRATEFUL FOR THIS GRANT AND TREMENDOUSLY EXCITED TO SEE THE PROGRESS WE CAN MAKE WITH THIS LONG-TERM SOURCE OF SUPPORT." COVID AND NON-COVID RESEARCH DETAIL ON ADDITIONAL COVID AND NON-COVID RESEARCH EFFORTS WHICH WERE UNDERTAKEN AT BIDMC DURING THE FISCAL PERIOD COVERED BY THIS FILING ARE BELOW. STUDY FINDS ENTIRE HOUSEHOLD AT INCREASED RISK WHEN POST-SURGICAL PATIENTS REFILL PRESCRIPTION OPIOIDS NEARLY THREE-QUARTERS OF PEOPLE WHO MISUSE OPIOIDS REPORT GETTING THEM WITH OR WITHOUT PERMISSION FROM A FRIEND OR FAMILY MEMBER WHO HAS A PRESCRIPTION. IN A STUDY PUBLISHED IN JAMA SURGERY, PHYSICIAN-SCIENTISTS AT BIDMC SOUGHT TO BETTER UNDERSTAND HOW PRESCRIBING OPIATES TO PATIENTS AFTER SURGERY MAY CONTRIBUTE TO SUBSEQUENT OPIOID MISUSE NOT JUST FOR THE POST-OPERATIVE PATIENT, BUT FOR HOUSEHOLD MEMBERS AS WELL. TO QUANTIFY HOW PRESCRIPTION DURATION AND REFILLS FOR A SURGICAL PATIENT IMPACTED THE RISK FOR MISUSE AND CHRONIC USE IN THEIR FAMILY MEMBERS, CORRESPONDING AUTHOR GABRIEL BRAT, MD, A TRAUMA SURGEON AT BIDMC, AND COLLEAGUES RETROSPECTIVELY EXAMINED DE-IDENTIFIED COMMERCIAL INSURANCE CLAIMS FILED BETWEEN 2008 AND EARLY 2016. AMONG THE 843,531 PATIENT-FAMILY PAIRS IDENTIFIED, THE RESEARCHERS FOUND THE RATES OF OVERALL OPIOID MISUSE (MEASURED BY SUBSEQUENT DIAGNOSTIC CODES) AND CHRONIC USE (MEASURED BY FILLED PRESCRIPTIONS) WERE BOTH LESS THAN ONE PERCENT. HOWEVER, THE RISK OF MISUSE USE ROSE IN HOUSEHOLDS WHERE THE SURGICAL PATIENT OBTAINED REFILLS. THOSE IN HOUSEHOLDS WITH ANY REFILL HAD A 33 PERCENT INCREASED HAZARD OF MISUSE, AND EACH ADDITIONAL REFILL WAS LINKED WITH A 19 PERCENT INCREASE IN HAZARD OF MISUSE BY A FAMILY MEMBER. "OUR DATA SUGGEST THAT THERE ARE SECOND VICTIMS OF OPIOID OVER-PRESCRIBING, THAT THE ADVERSE EFFECTS OF OPIOID PRESCRIPTIONS EXTEND BEYOND THE SURGICAL PATIENT WHO RECEIVED A PRESCRIPTION AND HAVE BROADER IMPLICATIONS FOR THE FAMILY," SAID, BRAT. "IT IS IMPORTANT THAT PRESCRIBERS, PATIENTS, AND THE PUBLIC UNDERSTAND THIS MULTI-FACETED PROBLEM EXTENDS BEYOND THE SURGICAL PATIENT AND HAS BROADER IMPLICATIONS FOR THE FAMILY."NATIONWIDE SPIKE IN CARDIOVASCULAR DEATHS SHOWN TO BE AN INDIRECT COST OF COVID-19 PANDEMICTWO YEARS INTO THE COVID-19 PANDEMIC, MORE THAN ONE MILLION AMERICANS HAVE DIED FROM THE VIRUS. BUT REPORTS DESCRIBE AN INCREASE IN MORTALITY DURING THE PANDEMIC THAT CANNOT BE EXPLAINED BY COVID-19 ALONE. RESEARCHERS LED BY CORRESPONDING AUTHOR RISHI K. WADHERA, MD, MPP, MPHIL, A PHYSICIAN-RESEARCHER AT THE SMITH CENTER FOR OUTCOMES RESEARCH IN CARDIOLOGY AT BIDMC, EVALUATED THE RATE OF U.S. DEATHS DUE TO CARDIOVASCULAR CAUSES DURING THE FIRST 11 WEEKS OF THE COVID-19 PANDEMIC (MID-MARCH TO JUNE, 2020) RELATIVE TO THE IMMEDIATELY PRECEDING 11 WEEKS PRE-PANDEMIC. THE TEAM ALSO COMPARED THESE TWO PERIODS OF 2020 TO THE SAME WEEKS IN 2019. THE OBSERVATIONAL STUDY, PUBLISHED IN THE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (JACC), SUGGESTS THAT PATIENTS MAY HAVE AVOIDED HOSPITALS OUT OF FEAR OF CONTRACTING THE NOVEL CORONAVIRUS AND THAT SOME DIED FROM CARDIOVASCULAR CONDITIONS WITHOUT SEEKING MEDICAL CARE. THE TEAM FOUND A MARKED NATIONWIDE RISE IN CARDIAC DEATHS AFTER THE ONSET OF THE PANDEMIC IN THE U.S. DEATHS DUE-TO ISCHEMIC HEART DISEASES (RELATED TO NARROWING OF THE ARTERIES) AND HYPERTENSIVE (RELATED TO HIGH BLOOD PRESSURE) DISEASES INCREASED BY 11 PERCENT AND 17 PERCENT, RESPECTIVELY, COMPARED TO THE PREVIOUS YEAR. IN CONTRAST, THE RESEARCHERS OBSERVED NO INCREASE IN DEATHS DUE TO OTHER CARDIOVASCULAR CONDITIONS, SUCH AS HEART FAILURE, POTENTIALLY BECAUSE THEY OFTEN DO NOT REQUIRE EMERGENT HOSPITALIZATION FOR POTENTIALLY LIFE-SAVING TREATMENT. DR. WADHERA AND COLLEAGUES SUGGEST THAT THE CANCELLATION OF SEMI-ELECTIVE PROCEDURES AND OUTPATIENT VISITS AS A RESULT OF THE PANDEMIC CONTRIBUTED TO THE INCREASE IN DEATHS BY DELAYING IMPORTANT DIAGNOSTIC TESTING AND LIMITING PATIENTS' ACCESS TO PRESCRIPTION MEDICATIONS. THE STRAIN IMPOSED BY COVID-19 ON SOME HOSPITALS MAY HAVE ALSO LED TO DELAYS IN CARE FOR HOSPITALIZED PATIENTS WITHOUT COVID-19, THE RESEARCHERS ADD. PANDEMIC-RELATED DELAYS IN EMERGENCY SERVICE RESPONSE TIMES AND A REDUCTION IN BYSTANDER CPR RATES ALSO LIKELY CONTRIBUTED TO REDUCED SURVIVAL AFTER CARDIAC ARREST. ADDITIONALLY, BEYOND HEALTHCARE SYSTEM FACTORS, GREATER PSYCHOSOCIAL, COMMUNITY, AND ENVIRONMENTAL STRESS AMID THE PANDEMIC MAY ALSO HAVE PLAYED AN IMPORTANT ROLE. "OVERALL, OUR DATA HIGHLIGHT THE URGENT NEED TO IMPROVE PUBLIC HEALTH MESSAGING TO ENSURE PATIENTS WITH EMERGENT CONDITIONS SEEK AND RECEIVE MEDICAL CARE PARTICULARLY IN REGIONS CURRENTLY EXPERIENCING A SURGE OR RESURGENCE OF COVID 19 CASES," WADHERA SAID. BIDMC RESEARCHERS REVEAL HOW GENETIC VARIATIONS ARE LINKED TO COVID-19 DISEASE SEVERITYMORE THAN 90 MILLION AMERICANS HAVE BECOME INFECTED WITH COVID-19; HOWEVER, PHYSICIANS STILL AREN'T SURE WHY SOME PEOPLE EXPERIENCE MILD TO NO SYMPTOMS WHILE OTHERS BECOME CRITICALLY ILL. RESEARCH LED BY ROBERT E. GERSZTEN, MD, CHIEF OF THE DIVISION OF CARDIOVASCULAR MEDICINE AT BIDMC SHEDS NEW LIGHT ON THE GENETIC RISK FACTORS THAT MAKE INDIVIDUALS MORE OR LESS SUSCEPTIBLE TO SEVERE COVID-19. THE FINDINGS, PUBLISHED IN A LETTER IN THE NEW ENGLAND JOURNAL OF MEDICINE (NEJM), ILLUMINATE THE MECHANISMS UNDERLYING COVID-19, AND POTENTIALLY OPEN THE DOOR TO NOVEL TREATMENTS FOR THE DISEASE. A GROWING BODY OF GENETIC EVIDENCE FROM PATIENTS IN CHINA, EUROPE AND THE UNITES STATES LINKS COVID-19 OUTCOMES TO VARIATIONS IN TWO REGIONS OF THE HUMAN GENOME, FINDINGS WHICH WERE PUBLISHED IN THE NEJM. BUT THE STATISTICAL ASSOCIATION DOESN'T EXPLAIN HOW THE DIFFERENCES MODULATE DISEASE. TO DO THAT, SCIENTISTS NEED TO UNDERSTAND WHICH PROTEINS THESE SECTIONS OF THE GENOME CODE FOR AND THE ROLE THESE PROTEINS PLAY IN THE BODY IN THE CONTEXT OF DISEASE. OVER THE LAST DECADE, GERSZTEN AND COLLEAGUES HAVE GENERATED JUST SUCH A DATABASE AN IMMENSE LIBRARY OF ALL THE PROTEINS AND METABOLITES ASSOCIATED WITH VARIOUS REGIONS OF THE HUMAN GENOME. WHEN THEY LOOKED UP ONE GENOMIC "HOT SPOT" FOUND TO BE ASSOCIATED WITH COVID-19 DISEASE SEVERITY, THEY QUICKLY REALIZED THAT THE VERY SAME REGION WAS LINKED TO A PROTEIN THAT HAS RECENTLY BEEN IMPLICATED IN THE PROCESS BY WHICH THE SARS-COV-2 VIRUS INFECTS HUMAN CELLS. "GROUPS ARE INCREASINGLY FINDING GENOMIC HOTSPOTS RELATED TO DISEASES, BUT IT'S OFTEN NOT CLEAR HOW THEY IMPACT THE MECHANISMS OF DISEASE," SAID GERSZTEN. "WE LEVERAGED OUR HUGE DATABASE IT'S MORE THAN 100 TERABYTES' WORTH OF DATA TO VERY QUICKLY DETERMINE THAT THE PROTEIN MOST HIGHLY EXPRESSED BY THAT REGION TURNED OUT TO BE A CO-RECEPTOR FOR THE VIRUS THAT CAUSES COVID-19, SUGGESTING THAT THIS MIGHT BE A TARGET FOR THERAPEUTIC INTERVENTIONS. THE SO-CALLED ANTIBODY COCKTAILS CURRENTLY AVAILABLE MOSTLY TARGET THE SPIKE PROTEINS ON THE VIRUS. IN TURN, OUR WORK IDENTIFIES WHICH PROTEINS IN THE HUMAN BODY THAT SARS-COV-2 AND OTHER CORONAVIRUSES LATCH ON TO." RESEARCHERS DEMONSTRATE HOW CHRONIC ALCOHOL CONSUMPTION CAUSES INFLAMMATION IN THE BRAINALCOHOL USE DISORDER IMPACTS MILLIONS OF PEOPLE AROUND THE WORLD, INCLUDING AT LEAST 17 MILLION AMERICANS. NEARLY 100,000 PATIENTS DIE EACH YEAR FROM THE CONSEQUENCES OF CHRONIC DRINKING, WHICH INDUCES ORGAN INJURY THROUGHOUT THE BODY, PARTICULARLY TO THE LIVER AND BRAIN. RESEARCH LED BY GYONGYI SZABO, MD, PHD, HON. SCD, CHIEF ACADEMIC OFFICER OF BIDMC AND BETH ISRAEL LAHEY HEALTH, SHED LIGHT ON THE MECHANISMS BY WHICH CHRONIC ALCOHOL CONSUMPTION CAUSES DAMAGE TO BRAIN CELLS AND CELLS OF THE CENTRAL NERVOUS SYSTEM, WHICH IN TURN POTENTIALLY TRIGGERS ADDICTIVE BEHAVIOR. THE FINDINGS, PUBLISHED IN THE JOURNAL OF NEUROINFLAMMATION, ALSO SUGGEST POSSIBLE TARGETS FOR A THERAPEUTIC APPROACH TO CHRONIC ALCOHOL USE DISORDER. "CHRONIC ALCOHOL EXPOSURE INDUCES A COMPLEX, MULTI-ORGAN RESPONSE WITH ACTIVATION OF A VARIETY OF IMMUNE RESPONSES AND INFLAMMATORY EXPRESSION," SAID SZABO. "OUR DATA IDENTIFIES THE SIGNALING PATHWAY BY WHICH CHRONIC ALCOHOL CONSUMPTION PROMOTES INFLAMMATION IN TISSUES OF THE CENTRAL NERVOUS SYSTEM AND OUR FURTHER ANALYSIS SUGGESTS A STRATEGY FOR BLOCKING THIS ALCOHOL-INDUCED NEUROINFLAMMATION." IN AN EXPERIMENT SZABO AND COLLEAGUES STUDIED THE IMPACT OF CHRONIC ALCOHOL-CONSUMPTION ON VARIOUS REGIONS OF THE BRAIN IN A MOUSE MODEL. THE SCIENTISTS OBSERVED THAT IMMUNE CELLS CALLED MACROPHAGES INVADED THE BRAIN PARENCHYMA (OR TISSUE), PARTICULARLY IN THE HIPPOCAMPUS A REGION OF THE BRAIN CRITICAL TO LEARNING AND MEMORY THAT IS WELL KNOWN TO LOSE VOLUME IN PATIENTS WITH CHRONIC ALCOHOL USE DISORDER. SZABO AND COLLEAGUES POINT OUT THAT, FOR DECADES, SCIENTIFIC DOGMA HELD THAT IMMUNE CELLS COULD NOT REACH THE TISSUES OF THE CENTRAL NERVOUS SYSTEM (CNS). RESEARCHERS SUBSEQUENTLY DEMONSTRATED THE PRESENCE OF IMMUNE CELLS IN CNS TISSUES IN THE SETTING OF DISEASE. COVID AND NON-COVID RESEARCH GENE EXPRESSION ANALYSIS REVEALED THE SIGNALING PATHWAY BY WHICH ALCOHOL CONSUMPTION PROMOTES NEUROINFLAMMATION. MOREOVER, THE RESEARCHERS ALSO DEMONSTRATED THAT BLOCKING IMMUNE CELL INVASION WITH AN INVESTIGATIONAL DRUG RESTORED SOME LOST BRAIN CELL FUNCTION; HOWEVER, ADMINISTRATION OF THE INVESTIGATIONAL DRUG DID NOT CHANGE THE ALCOHOL CONSUMPTION OR PREFERENCES OF THE LABORATORY ANIMALS. HOSPITALIZED PATIENTS WITH COVID-19 SIX TIMES MORE LIKELY TO DIE THAN PATIENTS HOSPITALIZED WITH INFLUENZA, RESEARCH FINDSCOVID-19 AND INFLUENZA ARE BOTH CONTAGIOUS RESPIRATORY VIRAL DISEASES THAT CAN LEAD TO PNEUMONIA AND ACUTE RESPIRATORY FAILURE IN SEVERE CASES. HOWEVER, DETAILED COMPARISON OF THE EPIDEMIOLOGY AND CLINICAL CHARACTERISTICS OF COVID-19 AND THOSE OF INFLUENZA ARE LACKING. IN A PAPER PUBLISHED IN THE JOURNAL OF GENERAL INTERNAL MEDICINE, PHYSICIAN-RESEARCHERS AT BIDMC ASSESSED THE RELATIVE IMPACT OF COVID-19 ON PATIENTS HOSPITALIZED WITH THE VIRAL INFECTION IN MARCH AND APRIL 2020, VERSUS PATIENTS HOSPITALIZED WITH INFLUENZA DURING THE LAST FIVE FLU SEASONS AT THE MEDICAL CENTER. OVERALL, THE TEAM DEMONSTRATED THAT COVID-19 CASES RESULTED IN SIGNIFICANTLY MORE WEEKLY HOSPITALIZATIONS, MORE USE OF MECHANICAL VENTILATION AND HIGHER MORTALITY RATES THAN INFLUENZA. CORRESPONDING AUTHOR MICHAEL DONNINO, MD, A CRITICAL CARE AND EMERGENCY MEDICINE PHYSICIAN AT BIDMC, AND COLLEAGUES INCLUDED A TOTAL OF 1,634 HOSPITALIZED PATIENTS IN THEIR STUDY, 582 OF WHOM HAD LABORATORY-CONFIRMED COVID-19 AND 1,052 OF WHOM HAD CONFIRMED INFLUENZA. WHILE 174 PATIENTS WITH COVID-19 (OR 30 PERCENT) RECEIVED MECHANICAL VENTILATION DURING THE TWO-MONTH PERIOD, JUST 84 PATIENTS WITH INFLUENZA (OR 8 PERCENT) WERE PLACED ON VENTILATION OVER ALL FIVE SEASONS OF INFLUENZA. LIKEWISE, THE PROPORTION OF PATIENTS WHO DIED WAS MUCH HIGHER FOR COVID-19 THAN FOR INFLUENZA; 20 PERCENT OF ADMITTED PATIENTS WITH COVID-19 DIED IN THE TWO-MONTH PERIOD, COMPARED TO THREE PERCENT OF PATIENTS WITH INFLUENZA OVER FIVE SEASONS. FURTHER ANALYSIS REVEALED THAT HOSPITALIZED PATIENTS WITH COVID-19 TENDED TO BE YOUNGER THAN THOSE HOSPITALIZED WITH INFLUENZA. AMONG PATIENTS REQUIRING MECHANICAL VENTILATION, PATIENTS WITH COVID-19 WERE ON VENTILATION MUCH LONGER A MEDIAN DURATION OF TWO WEEKS COMPARED TO JUST OVER THREE DAYS FOR PATIENTS WITH INFLUENZA. MOREOVER, AMONG PATIENTS REQUIRING MECHANICAL VENTILATION, PATIENTS WITH COVID-19 WERE FAR LESS LIKELY TO HAVE HAD PRE-EXISTING MEDICAL CONDITIONS. "OUR DATA ILLUSTRATE THAT 98 PERCENT OF THE DEATHS OF PATIENTS HOSPITALIZED WITH COVID-19 ARE DIRECTLY OR INDIRECTLY RELATED TO THEIR COVID-19 ILLNESS, WHICH HELPS DEBUNK THE IDEA THAT THE HIGH NUMBER OF U.S. COVID-19 DEATHS ARE AN ARTIFACT OF THE WAY CAUSES OF DEATHS ARE BEING RECORDED," SAID DONNINO. "WE ALSO SHOWED THAT COVID-19 CAUSED A SUBSTANTIAL NUMBER OF PATIENTS WITHOUT MAJOR PRE-EXISTING CONDITIONS TO REQUIRE MECHANICAL VENTILATION, WHICH HAPPENS RARELY IN PATIENTS WITH INFLUENZA," SAID DONNINO. BIDMC RESEARCHERS DEVELOP MODEL TO ESTIMATE FALSE-NEGATIVE RATE FOR COVID-19 TESTS AS OF JUNE 2020, THE U.S. FOOD AND DRUG ADMINISTRATION (FDA) HAD GRANTED EMERGENCY USE AUTHORIZATION FOR MORE THAN 85 DIFFERENT VIRAL DNA TEST KITS OR ASSAYS EACH WITH WIDELY VARYING DEGREES OF SENSITIVITY AND UNKNOWN RATES OF ACCURACY. HOWEVER, WITH NO EXISTING GOLD STANDARD TEST FOR COVID-19, THERE'S LITTLE DATA ON WHICH TO JUDGE THESE VARIOUS TESTS' USEFULNESS. RESEARCHERS AT BIDMC DEVELOPED A MATHEMATICAL MEANS OF ASSESSING TESTS' FALSE-NEGATIVE RATE. THE TEAM'S METHODOLOGY, WHICH ALLOWS AN APPLES-TO-APPLES COMPARISON OF THE VARIOUS ASSAYS' CLINICAL SENSITIVITY, IS PUBLISHED IN THE JOURNAL CLINICAL INFECTIOUS DISEASES. "WE FOUND THAT CLINICAL SENSITIVITIES VARY WIDELY, WHICH HAS CLEAR IMPLICATIONS FOR PATIENT CARE, EPIDEMIOLOGY AND THE SOCIAL AND ECONOMIC MANAGEMENT OF THE ONGOING PANDEMIC," SAID CO-CORRESPONDING AUTHOR JAMES E. KIRBY, MD, DIRECTOR OF THE CLINICAL MICROBIOLOGY LABORATORIES AT BIDMC. USING DATA FROM MORE THAN 27,000 TESTS FOR COVID-19 PERFORMED AT BETH ISRAEL LAHEY HEALTH HOSPITAL SITES FROM MARCH 26 TO MAY 2, 2020, KIRBY, AND CO-CORRESPONDING AUTHOR RAMY ARNAOUT, MD, DPHIL, ASSOCIATE DIRECTOR OF THE CLINICAL MICROBIOLOGY LABORATORIES AT BIDMC, AND COLLEAGUES FIRST DEMONSTRATED THAT VIRAL LOADS CAN BE DEPENDABLY REPORTED. "THIS HELPS DISTINGUISH POTENTIAL SUPERSPREADERS, AT ONE EXTREME, FROM CONVALESCENT PEOPLE, WITH ALMOST NO VIRUS, AND THEREFORE LOW LIKELIHOOD OF SPREADING THE INFECTION," ARNAOUT SAID. NEXT, THE RESEARCHERS ESTIMATED THE CLINICAL SENSITIVITY AND THE FALSE-NEGATIVE RATE FIRST FOR THE IN-HOUSE TEST WHICH WAS AMONG THE FIRST TO BE IMPLEMENTED NATIONWIDE AND CONSIDERED AMONG THE BEST IN CLASS. ANALYZING REPEAT TEST RESULTS FOR THE NEARLY 5,000 PATIENTS WHO TESTED POSITIVE ALLOWED THE RESEARCHERS TO DETERMINE THAT THE IN-HOUSE TEST PROVIDED A FALSE NEGATIVE IN ABOUT 10 PERCENT OF CASES, GIVING THE ASSAY A CLINICAL SENSITIVITY OF ABOUT 90 PERCENT. TO ESTIMATE THE ACCURACY OF OTHER ASSAYS, THE TEAM BASED THEIR CALCULATIONS ON EACH TESTS LIMIT OF DETECTION, OR LOD, DEFINED AS THE SMALLEST AMOUNT OF VIRAL DNA DETECTABLE THAT A TEST WILL CATCH 95 PERCENT OR MORE OF THE TIME. ARNAOUT, KIRBY, AND COLLEAGUES DEMONSTRATED THAT THE LIMIT OF DETECTION CAN BE USED AS A PROXY TO ESTIMATE A GIVEN ASSAY'S CLINICAL SENSITIVITY. BY THE TEAM'S CALCULATIONS, AN ASSAY WITH A LIMIT OF DETECTION OF 1,000 COPIES VIRAL DNA PER ML IS EXPECTED TO DETECT JUST 75 PERCENT OF PATIENTS WITH COVID-19, PROVIDING ONE OUT OF EVERY FOUR PEOPLE WITH A FALSE-NEGATIVE. THE TEAM ALSO SHOWED THAT ONE TEST AVAILABLE TODAY MISSES AS MANY AS ONE IN THREE INFECTED INDIVIDUALS, WHILE ANOTHER MAY MISS UP TO 60 PERCENT OF POSITIVE CASES. FIRST-OF-ITS-KIND STUDY FOUND INFANTS OF SOCIALLY VULNERABLE MOTHERS WERE AT HIGHEST RISK OF COVID-19 INFECTIONIN A STUDY PUBLISHED IN JAMA NETWORK OPEN, PHYSICIAN-RESEARCHERS FROM BIDMC, BRIGHAM AND WOMEN'S HOSPITAL, BOSTON CHILDREN'S HOSPITAL AND MASSACHUSETTS GENERAL HOSPITAL REVEALED THAT, WHILE MOTHER-TO-NEWBORN TRANSMISSION OF THE VIRUS IS RARE, NEWBORNS OF EXPECTANT MOTHERS WITH COVID-19 CAN SUFFER INDIRECT ADVERSE HEALTH RISKS AS A RESULT OF WORSENING MATERNAL COVID-19 ILLNESS. EXAMINING NEONATAL OUTCOMES DURING THE FIRST MONTH OF LIFE FOR BABIES BORN AT 11 HOSPITALS THAT REPRESENT APPROXIMATELY 50 PERCENT OF ALL BIRTHS IN MASSACHUSETTS, THE TEAM IDENTIFIED 255 NEONATES DELIVERED BETWEEN MARCH 1 JULY 31, 2020, TO MOTHERS WITH A RECENT POSITIVE SARS-COV-2 TEST RESULT. THE RESEARCHERS USED THE AMERICAN ACADEMY OF PEDIATRICS' NATIONAL REGISTRY FOR SURVEILLANCE AND EPIDEMIOLOGY OF PERINATAL COVID-19 INFECTION COMPLEMENTED BY A MASSACHUSETTS-SPECIFIC REGISTRY. OUT OF THE 255 NEONATES STUDIED, 88.2 PERCENT WERE TESTED FOR SARS-COV-2, AND ONLY 2.2 PERCENT HAD POSITIVE RESULTS. HOWEVER, WHILE INFECTION RATES AMONG NEWBORNS WERE RELATIVELY LOW, WORSENING MATERNAL ILLNESS ACCOUNTED FOR 73.9 PERCENT OF PRETERM BIRTHS. PREMATURE BIRTH CAN OFTEN LEAD TO ACUTE AND CHRONIC COMPLICATIONS, INCLUDING RESPIRATORY DISTRESS, CHRONIC HEALTH PROBLEMS AND DEVELOPMENTAL DISABILITIES. NEWBORNS OF SOCIALLY VULNERABLE MOTHERS, AS DETERMINED USING A TOOL CREATED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION USING RESIDENTIAL ZIP-CODES, WERE AT AN INCREASED RISK FOR TESTING POSITIVE. THE SPECIFIC PATHWAYS BY WHICH SOCIAL VULNERABILITY MIGHT AFFECT MOTHER-TO-CHILD TRANSMISSION OF COVID-19 INCLUDE DIFFERENTIAL ACCESS TO CARE AND CLINICIAN BIAS. DISCRIMINATION MAY ALSO BE A FACTOR IN CHRONIC STRESS, WHICH CAN DIMINISH ANTIVIRAL IMMUNE RESPONSES. "THIS OBSERVATION THAT NEWBORNS OF SOCIALLY VULNERABLE MOTHERS WERE FIVE TIMES MORE LIKELY TO HAVE COVID-19 HIGHLIGHTS THAT HEALTH DISPARITIES ARE VERY COMPLEX AND EXTEND BEYOND RACE, ETHNICITY AND LANGUAGE STATUS," SAID CORRESPONDING AUTHOR ASIMENIA ANGELIDOU, MD, PHD, A NEONATOLOGIST AT BIDMC. "SOCIAL VULNERABILITY LIKELY AFFECTS HEALTH AND IMMUNITY AND OUR STUDY SUPPORTS FURTHER RESEARCH IN THIS AREA. REALLOCATION OF RESOURCES TO SOCIALLY VULNERABLE COMMUNITIES COULD GO A LONG WAY IN DECREASING HUMAN SUFFERING AND ECONOMIC LOSS DURING DISEASE OUTBREAKS." COVID AND NON-COVID RESEARCH JANUARY 20, 2020SCIENTISTS CREATE FIRST-OF-ITS-KIND 3D ORGANOID MODEL OF THE HUMAN PANCREAS BECAUSE PANCREATIC CANCER IS HIDDEN DEEP WITHIN THE BODY AND OFTEN SYMPTOMLESS, IT'S FREQUENTLY DIAGNOSED AFTER THE DISEASE HAS PROGRESSED TOO FAR FOR SURGICAL INTERVENTION AND/OR HAS SPREAD THROUGHOUT THE BODY. RESEARCH INDICATES THAT EARLIER DETECTION OF PANCREATIC TUMORS COULD QUADRUPLE SURVIVAL RATES; HOWEVER, NO VALIDATED AND RELIABLE TESTS FOR EARLY DETECTION OF PANCREATIC CANCER CURRENTLY EXIST. RESEARCHERS AT THE CANCER RESEARCH INSTITUTE AT BIDMC HAVE SUCCESSFULLY CREATED THE FIRST THREE-DIMENSIONAL (3D) ORGANOID MODELS OF THE PANCREAS FROM HUMAN STEM CELLS. UNLIKE PREVIOUS PLATFORMS FOR THE STUDY OF PANCREATIC CANCER, THIS FIRST-OF-ITS-KIND ORGANOID MODEL INCLUDES BOTH THE ACINAR AND DUCTAL STRUCTURES THAT PLAY A CRITICAL ROLE IN THE MAJORITY OF PANCREATIC CANCERS. THE NEW RESEARCH PLATFORM WHICH IS NOT EXPECTED TO GUIDE PATIENT CARE AT THIS TIME WILL SHED NEW LIGHT ON THE ORIGINS AND DEVELOPMENT OF PANCREATIC CANCER, AS WELL AS REVEAL POTENTIAL MEANS FOR DISCOVERING MARKERS OF EARLY DIAGNOSIS AND MONITORING THE DISEASE. THE TEAM'S REPORT APPEARS IN CELL STEM CELL. "WE THOUGHT, IF WE HAD A WAY TO USE HUMAN PANCREATIC CELLS TO FORWARD ENGINEER CANCER, WE COULD BEGIN TO UNDERSTAND THE EARLIEST STEPS IN THE DEVELOPMENT OF THIS DISEASE," SAID CORRESPONDING AUTHOR SENTHIL MUTHUSWAMY, PHD, DIRECTOR OF CELL BIOLOGY AT THE CANCER RESEARCH INSTITUTE AT BIDMC. "THIS MODEL COULD ALSO SERVE AS A PLATFORM TO POTENTIALLY DISCOVER BIOMARKERS MEASURABLE CHANGES LINKED TO DISEASE THAT WE HOPE TO USE IN THE CLINIC TO MONITOR CANCER DEVELOPMENT." THE PANCREAS IS A HORMONE-SECRETING ORGAN CONSISTING OF DUCTS AND ACINAR STRUCTURES, OR SACLIKE STRUCTURES THAT STORE PANCREATIC SECRETIONS. UNTIL NOW, SCIENTISTS HAVE NOT BEEN ABLE TO SUCCESSFULLY GROW AND MAINTAIN HUMAN ACINAR STRUCTURES IN THE LAB CHALLENGING THEIR ABILITY TO TEST THE HYPOTHESIS IN A MODEL. RESEARCHERS SUSPECT THAT THE MOST COMMON KIND OF PANCREATIC CANCER ARISES IN THE CELLS LINING ACINAR AND DUCTAL STRUCTURES.THE CULMINATION OF FIVE-PLUS YEARS' OF WORK, THE STUDY REPRESENTS THE FIRST TIME RESEARCHERS SUCCESSFULLY GENERATED HUMAN ACINAR CELLS IN CULTURE AND MAINTAINED THEM LONG ENOUGH TO BE ABLE TO USE THEM IN EXPERIMENTS. FINANCIAL BURDENS ASSOCIATED WITH CANCER CARE DISPROPORTIONATELY AFFECTS YOUNG, NON-WHITE PATIENTS WITH GYNECOLOGIC CANCERSTHE COST OF CANCER CARE IN UNITED STATES WAS AN ESTIMATED $183 BILLION IN 2015 AND IS PROJECTED TO RISE BY 30 PERCENT BY 2030, ACCORDING TO THE AMERICAN CANCER SOCIETY. WHILE PRIVATE AND GOVERNMENT INSURANCE MAY COVER MUCH OF THE COST OF CARE, EVEN PATIENTS WITH INSURANCE CAN STRUGGLE TO PAY FOR OFFICE VISIT CO-PAYMENTS, PRESCRIPTION MEDICATIONS OR OTHER CANCER-RELATED EXPENSES. YET LIMITED DATA DESCRIBES HOW FINANCIAL HARDSHIP IMPACTS PATIENT BEHAVIOR AND HOW THAT IN TURN MAY IMPACT PATIENTS' HEALTH. IN A STUDY DESIGNED TO PROVIDE A MORE COMPREHENSIVE PICTURE OF HOW A DIVERSE COHORT OF GYNECOLOGIC CANCER PATIENTS ARE AFFECTED BY FINANCIAL DISTRESS ALSO CALLED "FINANCIAL TOXICITY" IN ACKNOWLEDGMENT OF THE HEALTH HAZARD IT CAN POSE RESEARCHER-PHYSICIANS AT BIDMC AND THE UNIVERSITY OF ALABAMA (UAB) ANALYZED PREVIOUSLY COLLECTED SURVEY DATA OF GYNECOLOGIC ONCOLOGY PATIENTS FROM THEIR RESPECTIVE INSTITUTIONS. THEIR FINDINGS ARE REPORTED IN THE INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER. USING THE COMPREHENSIVE SCORE FOR FINANCIAL TOXICITY (COST) TO MEASURE THE ECONOMIC BURDEN EXPERIENCED BY PATIENTS WITH CANCER, CORRESPONDING AUTHOR KATHARINE M. ESSELEN, MD, MBA, OF THE DIVISION OF GYNECOLOGIC ONCOLOGY IN THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, AND COLLEAGUES ANALYZED PREVIOUSLY COLLECTED SURVEY DATA FROM 308 PATIENTS WITH GYNECOLOGIC CANCER 240 PATIENTS SURVEYED AT BIDMC AND 121 SURVEYED AT UAB. THEY FOUND THAT NEARLY HALF OF PATIENTS WITH GYNECOLOGIC CANCER REPORTED EXPERIENCING MODERATE TO SEVERE FINANCIAL TOXICITY. FURTHER ANALYSIS OF SURVEY DATA REVEALED THAT YOUNGER PATIENTS WERE AT GREATER RISK OF EXPERIENCING FINANCIAL TOXICITY FOR A VARIETY OF REASONS. YOUNGER PATIENTS ARE NOT ELIGIBLE FOR MEDICARE, AND DIAGNOSIS AND TREATMENT MAY IMPACT THEIR ABILITY TO WORK. THEY HAVE ALSO HAD FEWER EARNING YEARS TO ACCUMULATE A FINANCIAL SAFETY NET. PATIENTS REPORTING SEVERE FINANCIAL TOXICITY ACCOUNTED FOR 15 PERCENT OF THOSE SURVEYED. ESSELEN AND COLLEAGUES FOUND THIS GROUP MORE LIKELY TO REPORT CHANGING SPENDING HABITS AND BORROWING MONEY DUE TO THE COSTS OF CANCER CARE. MOST ALARMINGLY, THOSE REPORTING SEVERE FINANCIAL HARDSHIP WERE NEARLY FIVE TIMES MORE LIKELY TO ATTEMPT TO COPE WITH THE HIGH COST OF CARE THROUGH MEDICATION NON-COMPLIANCE. IMMUNOTHERAPY MAY BE EFFECTIVE FOR SUBSET OF PROSTATE CANCER IN RECENT YEARS, CANCER IMMUNOTHERAPY HAS BEEN EFFECTIVE IN TREATING PATIENTS WITH IMMUNOGENIC, OR SO-CALLED "HOT" TUMORS WITH INCREASED LEVELS OF INFLAMMATION AND THE PRESENCE OF IMMUNE CELLS IN AND AROUND THE TUMORS. PROSTATE CANCER, HOWEVER, IS CONSIDERED A "COLD" TUMOR, WITH FEW IMMUNE CELLS RECOGNIZING AND INFILTRATING PROSTATE MALIGNANCIES. ACCORDINGLY, PROSTATE CANCER HAS BEEN FOUND TO RESPOND POORLY TO THE CLASS OF IMMUNOTHERAPIES KNOWN AS IMMUNE CHECKPOINT INHIBITORS. IN PREVIOUS WORK, A TEAM LED BY MEDICAL ONCOLOGISTS AT BIDMC IDENTIFIED A SUBSET OF PROSTATE CANCERS THAT EXHIBITED CHARACTERISTICS MORE TYPICAL OF HOT CANCERS. IN A PAPER APPEARING IN THE JOURNAL CLINICAL CANCER RESEARCH, RESEARCHERS REPORT THAT ABOUT A QUARTER OF LOCALIZED PROSTATE CANCERS MAY DEMONSTRATE THESE IMMUNOLOGIC TRAITS, SUGGESTING THAT A SUBSTANTIAL NUMBER OF PATIENTS WITH PROSTATE CANCER MAY, IN FACT, BENEFIT FROM IMMUNOTHERAPIES. "WE WERE SURPRISED TO FIND ALL THE FEATURES OF MORE TRADITIONALLY IMMUNOGENIC CANCERS IN THESE PROSTATE CANCERS, AND THAT THIS IS NOT A RARE SUBTYPE, OBSERVED IN ABOUT A QUARTER OF HIGH-RISK TUMORS," SAID CO-CORRESPONDING AUTHOR DAVID J. EINSTEIN, MD, A MEDICAL ONCOLOGIST AT BIDMC. "WE'RE INTERESTED IN WHETHER THERE IS A SUBSET OF PATIENTS WITH LOCALIZED PROSTATE CANCER, ESPECIALLY MORE AGGRESSIVE ONES, WHOSE CANCERS MIGHT BE MORE RECOGNIZED BY THE IMMUNE SYSTEM AND THEREFORE MORE TREATABLE WITH IMMUNOTHERAPIES. THESE WOULD ALSO BE SOME OF THE PATIENTS AT GREATEST RISK FOR RELAPSE AND METASTATIC SPREAD." EINSTEIN AND COLLEAGUES, INCLUDING CO-CORRESPONDING AUTHOR STEVEN BALK, MD, PHD, A PHYSICIAN AT BIDMC, FOCUSED ON TWO CHARACTERISTICS THAT MAKE TRADITIONALLY IMMUNOGENIC CANCERS SUSCEPTIBLE TO IMMUNOTHERAPY: PD-L1 EXPRESSION AND T CELL INFILTRATION. PD-L1 IS A PROTEIN INVOLVED IN TUMOR EVASION OF THE IMMUNE SYSTEM. T CELLS ARE THE SENTINELS OF THE IMMUNE SYSTEM, PATROLLING THE BODY FOR POTENTIAL PATHOGENS OR DISEASE. THE RESEARCHERS IDENTIFIED PROSTATE CANCERS THAT HAD BEEN REMOVED FROM PATIENTS, LOOKING FOR THOSE THAT HAD AREAS OF HIGH PD-L1 EXPRESSION AND THEN LOOKED FOR THE PRESENCE OF INFILTRATING T CELLS. NEXT, THE TEAM COMPARED THE T CELL LANDSCAPE IN THE MORE IMMUNOGENIC PROSTATE CANCERS TO THAT OF MORE TYPICAL PROSTATE CANCERS, AS WELL AS TO KIDNEY CANCER, ONE OF THE MOST IMMUNOGENIC TUMOR TYPES. FINALLY, THE TEAM USED DNA SEQUENCING TO COMPARE THE GENETIC PROFILES FROM THESE IMMUNOLOGICALLY HOT AREAS TO THAT OF THE SO-CALLED COLD AREAS IN THE SAME TUMORS, AS WELL AS TO THE GENOMIC LANDSCAPE OF IMMUNOGENIC CANCERS IN GENERAL. THE SCIENTISTS WERE SURPRISED TO LEARN HOW MANY MORE T CELLS INFILTRATED THE IMMUNOGENIC PROSTATE CANCERS COMPARED WITH MORE TYPICAL PROSTATE CANCERS, AND TO OBSERVE ALL THE FEATURES OF MORE TRADITIONALLY IMMUNOGENIC CANCERS LIKE KIDNEY CANCER IN THESE MORE IMMUNOGENIC PROSTATE CANCERS. THEY ALSO NOTED SIGNIFICANTLY MORE LOSS OF SOME KEY TUMOR SUPPRESSOR GENES IN THESE IMMUNOGENIC PROSTATE CANCERS COMPARED WITH TYPICAL PROSTATE CANCER, A DIFFERENCE THAT COULD POTENTIALLY SERVE AS MARKERS TO FIND CANCERS MORE TREATABLE WITH IMMUNOTHERAPIES. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS GRADUATE MEDICAL 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 60 ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED CLINICAL RESIDENCY AND FELLOWSHIP PROGRAMS WITH 785 RESIDENTS AND CLINICAL FELLOWS. IN ADDITION, THE MEDICAL CENTER HAS 52 NONSTANDARD CLINICAL FELLOWSHIP PROGRAMS WITH 60 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 PROGRAMSTHE MEDICAL CENTER SPONSORS CORE CLINICAL TRAINING PROGRAMS IN THE FOLLOWING FIELDS: ANESTHESIOLOGY EMERGENCY MEDICINE EAR, NOSE AND THROAT (OTOLARYNGOLOGY) INTERNAL MEDICINE NEUROLOGY NEUROSURGERY OBSTETRICS AND GYNECOLOGY PATHOLOGY PLASTIC SURGERY PSYCHIATRY RADIOLOGY SURGERY TRANSITIONAL YEAR UROLOGYDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER HAD NET EXPENDITURES OF $68,456,175 REPORTED ON THIS SCHEDULE H, PART I, LINE 7F RELATED TO THE MEDICAL CENTER'S TEACHING FUNCTION WHICH REPRESENTED 3.13% OF THE MEDICAL CENTER'S TOTAL EXPENSES.RESIDENCY PROGRAMSTHE MEDICAL CENTER SPONSORS ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED RESIDENCY PROGRAMS IN EACH OF THE CORE CLINICAL TRAINING PROGRAMS LISTED ABOVE. FELLOWSHIP PROGRAMSIN ADDITION TO THE RESIDENT TRAINING PROGRAMS LISTED ABOVE, THE MEDICAL CENTER SPONSORS A WIDE VARIETY OF FELLOWSHIP TRAINING PROGRAMS FOR ELIGIBLE DOCTORS WHO HAVE COMPLETED THEIR RESIDENCY AND WANT TO ENGAGE IN MORE SPECIALIZED STUDY. OVER HALF OF THESE PROGRAMS (59 OF 109) ARE ACGME APPROVED OR APPROVED BY A COMPARABLE BODY RELATED TO THE PARTICULAR SUBSPECIALTY. THE MEDICAL CENTER SPONSORS THE FOLLOWING FELLOWSHIP PROGRAMS: ANESTHESIA: ADULT CARDIOTHORACIC ANESTHESIOLOGY, ADVANCED CLINICAL ANESTHESIA, ANESTHESIA FOR OUTPATIENT SURGERY, CRITICAL CARE MEDICINE, NEUROANESTHESIA, NEURO CRITICAL CARE, OBSTETRIC ANESTHESIOLOGY, PAIN MEDICINE, REGIONAL ANESTHESIA, VASCULAR ANESTHESIA, PATIENT SAFETY AND QUALITY IMPROVEMENT IN ANESTHESIA DERMATOLOGY: CUTANEOUS ONCOLOGY, DERMATOLOGY RESEARCH FELLOWSHIP IN CLINICAL TRIALS AND OUTCOMES RESEARCH (CLEARS) EMERGENCY MEDICINE: EMERGENCY MEDICAL SERVICES, EMERGENCY ULTRASOUND, DISASTER MEDICINE, ACADEMIC EMERGENCY MEDICINE INTERNAL MEDICINE: ADVANCED CARDIAC NON-INVASIVE IMAGING, ADVANCED ENDOCRINE, DIABETES AND METABOLISM, ADVANCED ENDOSCOPY, ADVANCED INFECTIOUS DISEASE, ADVANCED NEPHROLOGY, CARDIAC MAGNETIC RESONANCE IMAGING, CARDIOVASCULAR DISEASE, CELIAC DISEASE, CLINICAL CARDIAC ELECTROPHYSIOLOGY, CLINICAL INFORMATICS, ENDOCRINOLOGY, DIABETES, AND METABOLISM, GASTROENTEROLOGY, GENERAL MEDICINE, GERIATRIC MEDICINE, GERIATRIC AND DIABETES, GI MOTILITY/FUNCTIONAL BOWEL DISORDERS, GLOBAL HEALTH, HEMATOLOGY AND MEDICAL ONCOLOGY, HEPATOLOGY, HOSPICE AND PALLIATIVE CARE, INFECTIOUS DISEASE, INFLAMMATORY BOWEL DISEASE, INTERVENTIONAL CARDIOLOGY, INTERVENTIONAL PULMONOLOGY, NEPHROLOGY, PULMONARY CRITICAL CARE, RHEUMATOLOGY, SLEEP MEDICINE, SLEEP RESPIRATION, STRUCTURAL HEART DISEASE, TRANSPLANT HEPATOLOGY, TRANSPLANT NEPHROLOGY NEUROLOGY: AUTONOMIC DISORDERS, COGNITIVE BEHAVIORAL NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, EPILEPSY, MOVEMENT DISORDERS, MULTIPLE SCLEROSIS, NEUROLOGY-HIV, NEUROMUSCULAR MEDICINE, NEURO-ONCOLOGY, VASCULAR NEUROLOGY OBSTETRICS AND GYNECOLOGY: FEMALE PELVIC MEDICINE & RECONSTRUCTIVE SURGERY, GYNECOLOGIC ONCOLOGY, MATERNAL FETAL MEDICINE, REPRODUCTIVE ENDOCRINOLOGY PATHOLOGY: BLOOD BANKING/TRANSFUSION MEDICINE, CYTOPATHOLOGY, DERMATOPATHOLOGY, HEMATOPATHOLOGY, MEDICAL MICROBIOLOGY, MEDICAL MICROBIOLOGY CPEP, NEUROPATHOLOGY, SELECTIVE PATHOLOGY PSYCHIATRY RADIOLOGY-DIAGNOSTIC: ABDOMINAL RADIOLOGY, BREAST IMAGING RADIOLOGY, INTERVENTIONAL RADIOLOGY-INDEPENDENT, INTERVENTIONAL RADIOLOGY-INTEGRATED, MRI, MUSCULOSKELETAL IMAGING MSK, NEURORADIOLOGY, THORACIC IMAGING RADIOLOGY, RADIATION ONCOLOGY: BRACHYTHERAPY, STEREOTATIC SURGERY: ABDOMINAL TRANSPLANT SURGERY/KIDNEY, ACUTE CARE SURGERY, ANTERIOR SEGMENT OPHTHALMOLOGY, COLON AND RECTAL SURGERY, CORNEA AND REFRACTIVE SURGERY, CEREBROVASCULAR AND ENDOVASCULAR NEUROSURGERY, HEAD & NECK SURGICAL ONCOLOGY & RECONSTRUCTION, INTERDISCIPLINARY BREAST SURGERY, LYMPHATIC SURGERY, MINIMALLY INVASIVE BARIATRIC SURGERY, NEUROSURGERY/ORTHO SPINE, ORTHOPAEDIC HAND SURGERY, ORTHOPAEDIC SPINE SURGERY, OTOLARYNGOLOGY FELLOWSHIP, 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.INTERNSHIPTHE INTERNSHIP YEAR EMPHASIZES THE CARE OF PATIENTS IN GENERAL INPATIENT MEDICINE, INTENSIVE CARE MEDICINE, ONCOLOGY, CARDIOLOGY, EMERGENCY MEDICINE AND AMBULATORY CARE UTILIZING BOTH CAMPUSES AND SELECTED OUTSIDE SITES. WORKING AS PART OF A 2-4 PHYSICIAN TEAM WHICH INCLUDES AN OVERSEEING RESIDENT, ATTENDING STAFF AND OFTEN MEDICAL STUDENTS, INTERNS GAIN EXPERIENCE IN THE MANAGEMENT OF PATIENTS WITH A BROAD RANGE OF MEDICAL DISEASES. INTERNS HAVE PRIMARY RESPONSIBILITY FOR THE CARE OF ALL PATIENTS ADMITTED TO THE MEDICAL WARD SERVICE AND ARE CONSIDERED THEIR PATIENT'S PRIMARY INPATIENT DOCTOR FOR THE DURATION OF THE HOSPITALIZATION. THROUGHOUT INTERN YEAR, INTERNS MAINTAIN A LONGITUDINAL CONTINUITY CLINIC EXPERIENCE WHERE THEY DEVELOP A PANEL OF THEIR OWN PRIMARY CARE PATIENTS. DURING MOST OF THE YEAR, WITH THE EXCEPTION OF INTENSIVE CARE ROTATIONS, AN INTERN WILL HAVE CLINIC ONE HALF-DAY PER WEEK. DISTRIBUTED THROUGHOUT THE YEAR ARE FOUR "AMBULATORY BLOCKS" OF TWO WEEKS DURATION. DURING THIS TIME THE INTERN IS IN THEIR CONTINUITY CLINIC EVERY AFTERNOON AND ATTENDS OUTPATIENT SPECIFIC DIDACTIC LECTURES DURING THE MORNING HOURS. AS MEMBERS OF THE HARVARD FACULTY, INTERNS PLAY AN IMPORTANT ROLE IN TEACHING, BOTH OF THEIR PEERS AND OF ROTATING MEDICAL STUDENTS. WHILE ON THE MEDICAL WARDS, INTERNS PROVIDE DAILY CLINICAL GUIDANCE AND TEACHING TO THIRD AND FOURTH YEAR MEDICAL STUDENTS. AS PART OF THE AMBULATORY CARE CURRICULUM, INTERNS WILL ALSO HAVE THE OPPORTUNITY TO LEAD PRE-CLINIC CONFERENCES. DURING THE YEAR, THERE ARE SPECIAL INTERN-ONLY EDUCATIONAL ACTIVITIES INCLUDING THE TWICE-WEEKLY INTERN REPORT, MONTHLY INTERN FORUM SESSIONS AND BI-ANNUAL 24-HOUR INTERN RETREATS.JUNIOR AND SENIOR RESIDENCYRESIDENCY SOLIDIFIES CLINICAL AND TEACHING SKILLS AND ALLOWS TRAINEES TO EXPERIENCE LEADERSHIP OF A MEDICAL TEAM. JUNIOR RESIDENCY PROVIDES THE FIRST OPPORTUNITY FOR RESIDENTS TO SUPERVISE HOUSESTAFF TEAMS ON GENERAL MEDICAL SERVICES AND IN THE MEDICAL AND CARDIAC INTENSIVE CARE UNITS. SENIOR RESIDENCY PROMOTES CONSOLIDATION AND REFINEMENT OF THESE SKILLS, WITH ATTENDINGS ALLOWING INCREASING AUTONOMY. THE RESIDENT ON THE SERVICE IS LOOKED ON AS THE TEAM LEADER AND ASSUMES PRIMARY RESPONSIBILITY FOR TEACHING OF THE TEAM. RESIDENCY ALSO PROVIDES OPPORTUNITIES FOR INCREASED ELECTIVE TIME TO SAMPLE SUBSPECIALTY ROTATIONS. THIS PROVIDES ADDITIONAL SPECIALTY TRAINING IN AREAS OF INTEREST. THE ELECTIVE OPPORTUNITIES ARE DIVERSE, RANGING FROM ELECTROPHYSIOLOGY TO MUSCULOSKELETAL MEDICINE TO HEALTH POLICY. RESIDENTS ALSO HAVE THE OPPORTUNITY TO PARTICIPATE IN ONE OF SEVERAL "TRACKS" WITHIN THE RESIDENCY PROGRAM IF INTERESTED IN ADDITIONAL SPECIFIC TRAINING RESOURCES AND EXPERIENCES.TEACHING AS A RESIDENTAS MENTIONED ABOVE, RESIDENTS ARE VIEWED AS SOME OF THE PRIMARY TEACHERS WITHIN THE DEPARTMENT OF MEDICINE. SOME OF THESE TEACHING OPPORTUNITIES WILL ALSO BE OBSERVED BY DEPARTMENT FACULTY TO HELP THE RESIDENT REFINE THE STYLE AND EFFECTIVENESS OF THEIR TEACHING. TEACHING OPPORTUNITIES WILL INCLUDE:LEADING INPATIENT MEDICINE ROUNDS: RESIDENTS 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 PROGRAMOUR MISSION IS TO TRAIN LEADERS IN GLOBAL HEALTH TO BE EFFECTIVE PRACTITIONERS IN UNDERSERVED, RESOURCE-LIMITED SETTINGS AND TO DESIGN, MANAGE, IMPROVE AND EVALUATE GLOBAL PUBLIC HEALTH PROGRAMS THAT ADDRESS THE HEALTH PROBLEMS OF THE WORLD'S NEEDIEST POPULATIONS.PROGRAM OBJECTIVES INTRODUCE GLOBAL HEALTH ISSUES TO BIDMC MEDICAL RESIDENTS CONTRIBUTE TO THE HEALTH AND WELL-BEING OF UNDERSERVED POPULATIONS IN BOSTON AND AROUND THE WORLD ENRICH THE MEDICAL KNOWLEDGE AND ENHANCE THE CLINICAL SKILLS OF RESIDENTS BY PRACTICING IN UNIQUE SETTINGS WITH LIMITED RESOURCES EXPAND RESEARCH OPPORTUNITIES ADVANCE THE CAREERS OF BIDMC RESIDENTS IN THE FIELDS OF INTERNATIONAL HEALTH, PUBLIC POLICY AND RESEARCH SITE LOCATIONS BOTSWANA: THE DEPARTMENT HAS A PERMANENT PRESENCE IN BOTSWANA WITH A MEMBER OF OUR DEPARTMENT FULL-TIME AT SCOTTISH LIVINGSTONE HOSPITAL IN MOLEPOLOLE, BOTSWANA. VIETNAM: THE MEDICAL CENTER HAS A PERMANENT PRESENCE IN VIETNAM. PHYSICIAN AND NURSE TRAINING ON HIV/AIDS CARE IN VIETNAM TAKES PLACE THROUGH FUNDING FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION. ADDITIONAL LOCATIONS: THE DEPARTMENT OFFERS ROTATIONS AT THE ALBERT SCHWEITZER HOSPITAL IN GABON AND OTHER INTERNATIONAL SITES. RESIDENTS CAN ALSO DO ROTATIONS THROUGH THE INDIAN HEALTH SERVICE OR AT BIDMC-AFFILIATED COMMUNITY HEALTH CENTERS. GLOBAL HEALTH TRACK LEARNING HOW TO WORK EFFECTIVELY IN RESOURCE-LIMITED SETTINGS REQUIRES BOTH TRAINING AND EXPERIENCE. PARTICIPANTS IN THE GLOBAL HEALTH TRACK WILL PARTICIPATE WITH LEARNERS FROM AROUND THE WORLD IN THE GLOBAL HEALTH EFFECTIVENESS PROGRAM AT THE HARVARD SCHOOL OF PUBLIC HEALTH; THEY WILL ENGAGE IN OUR HOSPITAL-WIDE, YEAR-LONG GLOBAL HEALTH CURRICULUM AND JOURNAL CLUB, AND THEY WILL BE GIVEN THE OPPORTUNITY FOR TWO FIELD EXPERIENCES DURING RESIDENCY. HOSPITAL-WIDE GLOBAL HEALTH PROGRAM THE BIDMC GLOBAL HEALTH PROGRAM IS A HOSPITAL-WIDE PROGRAM AVAILABLE TO ALL BIDMC RESIDENTS. WHILE REQUIREMENTS AND TIMELINES MAY DIFFER BETWEEN DEPARTMENTS AND SPECIALTIES, THE OVERARCHING GOAL IS TO PROVIDE RESIDENTS WITH FURTHER TRAINING AND EDUCATION IN THE DISCIPLINE OF GLOBAL HEALTH. NEUROLOGY EDUCATION AT 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. 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 TRACKSCURRENTLY, SIX TRACKS ARE OFFERED: CLINICAL EDUCATION RESEARCH GLOBAL HEALTH QUALITY IMPROVEMENT HEALTH POLICY/HEALTH ECONOMICSEACH OF THESE TRACKS HAS SPECIFIC CURRICULAR OFFERINGS AND EDUCATIONAL GOALS. MOST OF THE TRACKS ARE LINKED TO SPECIFIC EDUCATIONAL ENDEAVORS. FOR EXAMPLE, A RESIDENT SELECTING THE GLOBAL HEALTH TRACK WILL ENROLL IN THE GLOBAL EFFECTIVENESS CURRICULUM OFFERED BY THE HARVARD SCHOOL OF PUBLIC HEALTH AND WILL SPEND TIME ABROAD PROVIDING CLINICAL RADIOLOGY SERVICES AND UNDERTAKING A GLOBAL HEALTH PROJECT. A RESIDENT SELECTING THE EDUCATION TRACK WILL PURSUE ADVANCED TRAINING IN EDUCATIONAL THEORY AND ADULT LEARNING BY PARTICIPATING IN THE HARVARD MACY PROGRAM FOR PHYSICIAN EDUCATORS AND UNDERTAKE AN EDUCATIONAL PROJECT BASED AT BIDMC OR HARVARD MEDICAL SCHOOL. A RESIDENT CHOOSING THE RESEARCH TRACK WILL PARTICIPATE IN GRANT WRITING WORKSHOPS AND DELVE DEEPLY INTO A RESEARCH PROJECT OF THEIR CHOICE.NO MATTER WHICH TRAINING TRACK, THE EXPECTATION IS THAT EVERY RESIDENT WILL HAVE THE OPPORTUNITY TO UNDERTAKE A SUBSTANTIAL PROJECT DURING RESIDENCY THAT WILL CULMINATE IN PRESENTATION AT A NATIONAL MEETING AND/OR PUBLICATION. SURGERY EDUCATION AT 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 TEACHINGTHE 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. WH-ADDITIONAL INFORMATION REGARDING PROMOTING THE HEALTH OF THE COMMUNITY (SCHEDULE H, PART VI, QUESTIONS 5 AND 6)OPEN MEDICAL STAFF AND COMMUNITY BOARDTHE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF AND AS NOTED IN THIS FORM 990 PARTS I AND VI, THE MAJORITY OF BOARD MEMBERS ARE INDEPENDENT COMMUNITY MEMBERS.AFFILIATED HEALTH CARE SYSTEMAS NOTED BELOW AND THROUGHOUT THIS FILING, WH IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH (BILH) NETWORK OF AFFILIATES. AS NOTED IN VARIOUS NARRATIVE DISCLOSURES THAT SUPPORT THIS FORM 990 AND RELATED SCHEDULES FOR THE PERIOD COVERED BY THIS FILING, BILH IS A MASSACHUSETTS NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. BETH ISRAEL LAHEY HEALTH'S (BILH) MISSION IS TO SUPPORT ITS AFFILIATES AND THOSE AFFILIATES' MISSIONS TO IMPROVE THE HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITIES SERVED. BILH STRIVES TO ACCOMPLISH THIS MISSION BY PROVIDING SERVICES TO ITS AFFILIATES WHICH SUPPORT THE DELIVERING THE HIGH-QUALITY HEALTH CARE THAT EVERY PATIENT DESERVES. BILH BELIEVES THAT EFFECTIVE CARE IS EASILY ACCESSIBLE AND SIMPLE TO ACCESS SO IT IS BILH'S FOCUS TO PROVIDE PATIENTS WITH CARE THAT IS IN CLOSE PROXIMITY AND CONVENIENT REGARDLESS OF WHERE PATIENTS LIVE, THEIR HEALTH HISTORY OR STAGE OF LIFE.BETH ISRAEL LAHEY HEALTH (BILH) IS THE PARENT AND A SUPPORT ORGANIZATION OF THE BILH NETWORK OF AFFILIATES. THE NETWORK COMPRISES AN INTEGRATED HEALTH CARE DELIVERY SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM INCLUDES ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS AND ADDICTION TREATMENT PROGRAMS. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES.DURING THE FISCAL PERIOD COVERED BY THIS FILING, BILH SERVED AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL -- MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL -- NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL -- PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES (LHSS), LAHEY CLINIC FOUNDATION (LCF), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC) WHICH INCLUDES BEVERLY, ADDISON GILBERT AND BAYRIDGE HOSPITALS, NORTHEAST BEHAVIORAL CORPORATION (NBHC), ANNA JAQUES HOSPITAL (AJH), THE BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK (BILHPN) AND THE BETH ISRAEL LAHEY HEALTH PHARMACY. THE LAHEY CLINIC FOUNDATION IN TURN SERVED AS THE SOLE MEMBER OF LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL & MEDICAL CENTER (LHMC). THE ENTITIES LISTED HERE MAY HAVE ALSO, IN TURN, SERVED AS MEMBER TO OTHER NETWORK AFFILIATES. AS A SUPPORT ORGANIZATION OF THESE ENTITIES, BILH PROVIDES CENTRALIZED SERVICES AND SUPPORT TO ITS AFFILIATES IN AREAS SUCH AS MANAGEMENT, STRATEGIC PLANNING, HUMAN RESOURCES AND BENEFITS, DEVELOPMENT AND FUNDRAISING, LEGAL SERVICES, FINANCE, TREASURY, INVESTMENT, INSURANCE, COMPLIANCE AND TAXATION AS WELL AS PATIENT CARE CONTRACTING AND OTHER SERVICES.BILH'S SUPPORT OF ITS AFFILIATES ENABLES THE NETWORK AS A WHOLE TO ACCOMPLISH ITS PRIMARY MISSION OF IMPROVING THE HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITIES SERVED. BILH STRIVES TO ACCOMPLISH THIS MISSION BY DELIVERING THE HIGH-QUALITY HEALTH CARE THAT EVERY PATIENT DESERVES. BILH BELIEVES THAT EFFECTIVE CARE IS EASILY ACCESSIBLE AND SIMPLE TO USE SO IT IS BILH'S FOCUS TO PROVIDE PATIENTS WITH CARE THAT IS IN CLOSE PROXIMITY AND CONVENIENT REGARDLESS OF WHERE PATIENTS LIVE, THEIR HEALTH HISTORY OR STAGE OF LIFE AND BILH IS ACCOMPLISHING THIS GOAL BY PROVIDING SUPPORT TO EACH OF ITS AFFILIATES, PROVIDING AN ORGANIZATIONAL STRUCTURE AND OPERATING MODEL WHICH IS DRIVEN BY FOUR DEEPLY INTERCONNECTED DOMAINS DESIGNED TO ADVANCE MEANINGFUL PARTNERSHIPS ACROSS ORGANIZATIONS, CARE SETTINGS, SPECIALTIES, AND GEOGRAPHIES TO ENSURE BILH PATIENTS RECEIVE THE CARE THEY NEED IN THE COMMUNITIES WHERE THEY LIVE AND WORK.BILH IS DELIVERING ON THE PROMISE TO BILH PATIENTS AND COMMUNITIES TO EXPAND ACCESS AND PROVIDE EXTRAORDINARY CARE, WHILE ALSO ADVANCING MEDICINE THROUGH DISCOVERY AND EDUCATION. BILH IS ACCOMPLISHING THIS MISSION BY PROVIDING SUPPORT TO ITS AFFILIATES WHICH INCLUDE:1. A PHYSICIAN ENTERPRISE THAT ENCOMPASSES THE SYSTEM'S NETWORK OF EMPLOYED PRIMARY CARE AND SPECIALTY PHYSICIANS LOCATED THROUGHOUT OUR REGION;2. A HOSPITAL AND AMBULATORY SERVICES GROUP THAT INCLUDES WORLD-CLASS ACADEMIC MEDICAL CENTERS AND TEACHING HOSPITALS WITH AFFILIATIONS WITH HARVARD MEDICAL SCHOOL AND TUFTS UNIVERSITY SCHOOL OF MEDICINE; LEADING COMMUNITY HOSPITALS; A RENOWNED ORTHOPEDICS HOSPITAL; AND COMPREHENSIVE AMBULATORY CENTERS;3. A POPULATION HEALTH ENTERPRISE THAT EMBRACES A NEW MODEL OF CARE TO IMPROVE THE HEALTH OF ALL THOSE SERVED BY BILH; THE POPULATION HEALTH DOMAIN INCLUDES THE SYSTEM'S CLINICALLY INTEGRATED NETWORK OF AFFILIATED PROVIDERS AND VITAL SERVICES, INCLUDING BEHAVIORAL HEALTH AND HOME CARE SERVICES;4. A ROBUST NETWORK OF ADMINISTRATIVE AND OPERATIONAL SERVICES TO ADVANCE STRATEGIC GOALS, BOTH LOCALLY AND AT THE SYSTEM LEVEL, THAT OFFERS EXPERTISE AND STANDARDIZED RESOURCES BASED ON BEST PRACTICES. BILH BEHAVIORAL HEALTH SERVICES THE BETH ISRAEL LAHEY HEALTH NETWORK (BILH) IS COMMITTED TO THE BEHAVIORAL HEALTH NEEDS OF THE PATIENTS AND COMMUNITIES SERVICED. BELOW ARE SOME OF ACTIVITIES THAT BILH BEHAVIORAL SERVICES (BILHBS) HAS PROVIDED TO THE PATIENTS AND COMMUNITIES SERVED BY BILH AND ITS AFFILIATED ENTITIES. BILHBS (WHICH INCLUDES THE ACTIVITIES OF BILH'S TAX-EXEMPT AFFILIATE NORTHEAST BEHAVIORAL HEALTH CORP) IS THE LARGEST NETWORK OF MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES IN EASTERN MASSACHUSETTS. BILHBS' NETWORK OF BEHAVIORAL HEALTH CARE INCLUDES SERVICES FOR CHILDREN AND ADULTS RANGING FROM INPATIENT TREATMENT TO COMMUNITY-BASED PROGRAMS. SERVICES INCLUDE: INPATIENT PSYCHIATRIC AND DETOXIFICATION TREATMENT; EMERGENCY PSYCHIATRIC AND MOBILE EMERGENCY SERVICES TEAMS; OUTPATIENT MENTAL HEALTH AND ADDICTION TREATMENT; INDIVIDUAL/COUPLE/FAMILY THERAPY; MEDICATION ASSISTED TREATMENT PROGRAMS FOR PERSONS WITH OPIOID USE DISORDERS; AND SCHOOL-BASED AND HOME-BASED COUNSELING FOR YOUTH AND THEIR FAMILIES.SINCE THE CREATION OF BILH IN MARCH 2019, BILH HAS INVESTED SIGNIFICANTLY IN IMPROVING ACCESS TO BEHAVIORAL HEALTH CARE THROUGH A SYSTEM-WIDE APPROACH TO CARE DELIVERY. FIRST, IT HAS MADE A MULTI-YEAR COMMITMENT TO PROVIDE BEHAVIORAL HEALTH SUPPORT TO ITS EMPLOYED PRIMARY CARE PRACTICES USING AN EVIDENCE-BASED APPROACH KNOWN AS THE IMPACT MODEL. BY THE END OF FY 2021, BILH HAD IMPLEMENTED THE IMPACT MODEL IN 67% OF ITS EMPLOYED PRIMARY CARE PRACTICES AS PART OF ITS COLLABORATIVE CARE PROGRAM IMPLEMENTATION. IN 2021, BILHBS EXPANDED ITS PRIMARY CARE BEHAVIORAL HEALTH INTEGRATION (PCBHI) SERVICES BY INCORPORATING A DSRIP PILOT PROJECT AIMED AT INTERPROFESSIONAL PSYCHIATRIC CONSULTS. THE PCBHI INTERPROFESSIONAL CONSULTATION INCLUDES AN ASSESSMENT AND MANAGEMENT SERVICE IN WHICH A PATIENT'S PRIMARY CARE PROVIDER (PCP) REQUESTS THE OPINION AND/OR TREATMENT ADVICE OF A PSYCHIATRIC CONSULTANT TO ASSIST IN THE DIAGNOSIS AND/OR MANAGEMENT OF THE PATIENT'S BEHAVIORAL HEALTH CONDITION WITHOUT THE NEED FOR THE PATIENT'S FACE-TO-FACE CONTACT WITH THE CONSULTANT. INTERPROFESSIONAL CONSULTATION ENABLES A COMPREHENSIVE ASSESSMENT, ENHANCES PATIENT CARE, REDUCES MISDIAGNOSIS, AND SUPPORTS THE INTEGRATION OF DISCIPLINES IN THE DELIVERY OF CARE. THE PCBHI INTERPROFESSIONAL PSYCHIATRIC CONSULTANTS PROVIDE PCPS WITH ANOTHER AVENUE FOR INTEGRATED CARE. THE IMPLEMENTATION OF PCBHI INTERPROFESSIONAL SERVICES WILL BE OFFERED IN PRACTICES WHERE COLLABORATIVE CARE IS NOT CURRENTLY AVAILABLE. ADDITIONALLY, IN 2021, BILHBS CONTINUED TO OVERSEE THE BILH-WIDE CENTRALIZED BEHAVIORAL HEALTH (BH) BED MANAGEMENT, WHICH SUPPORTS INPATIENT BEHAVIORAL HEALTH BED CAPACITY AND IMPROVING ACCESS TO THESE BEDS, WITH THE PARALLEL GOAL OF REDUCING BOARDING BY BEHAVIORAL HEALTH PATIENTS IN THE EMERGENCY DEPARTMENTS ("EDS"). AS PART OF THE CENTRALIZED BH BED MANAGEMENT, BILH STAFF ENGAGE IN A DAILY HUDDLE WITH REPRESENTATIVES FROM BILH HOSPITALS' EDS AND BEHAVIORAL HEALTH UNITS TO DISCUSS PATIENTS APPROPRIATE FOR TRANSFER TO THE UNIT. THE DAILY HUDDLES HAVE BECOME A FORUM FOR WHICH PARTICIPANTS DISCUSS BEHAVIORAL HEALTH PATIENT VOLUME AND BED CAPACITY ACROSS THE SYSTEM, AS WELL AS DISCHARGE PLANNING AND PLACEMENT OPPORTUNITIES FOR DIFFICULT-TO-PLACE PATIENTS.SEPARATELY, IN MARCH 2021, BILHBS LAUNCHED ITS CENTRALIZED BED FINDING TEAM. THIS TEAM IS PART OF OUR CENTRAL CALL CENTER, WHICH CENTRALIZES CALLS TO BILHBS' THREE EMERGENCY SERVICE PROGRAM (ESP) CATCHMENT AREAS REDUCING REDUNDANCIES ACROSS THE AGENCY AND STREAMLINING ALL CALLS TO ONE CENTRAL SERVICE. THIS CENTRALIZED BED FINDING TEAM IS RESPONSIBLE FOR CONDUCTING BED SEARCHES FOR PATIENTS SEEN THROUGH THE ESP AND WHO ARE AWAITING AN INPATIENT PSYCHIATRIC PLACEMENT. THIS TEAM DIRECTLY INCREASES THE AVAILABILITY OF CLINICIANS TO CONTINUE TO SEE PATIENTS IN THE ED AND THE COMMUNITY WHO ARE EXPERIENCING A BEHAVIORAL HEALTH AND/OR CO-OCCURRING SUBSTANCE USE DISORDER CRISIS WHILE OTHER TEAM MEMBERS SEARCH FOR AVAILABLE INPATIENT PLACEMENTS. THIS INITIATIVE SUPPORTS DECREASED RESPONSE TIME TO RESPONDING TO NEW PATIENTS IN CRISIS AND REDUCES ED BOARDING TIME FOR PATIENTS WHO CAN BE SAFELY MANAGED IN THE COMMUNITY.BILHBS SERVES APPROXIMATELY 35,000 UNDUPLICATED INDIVIDUALS ANNUALLY, OFFERING A FULL CONTINUUM OF CARE FOR CHILDREN AND ADULTS. SERVICES RANGE FROM INPATIENT TO HOME AND COMMUNITY-BASED SERVICES. BILHBS OPERATES OVER 250 BEDS IN 9 FACILITIES FOR CLIENTS REQUIRING ACUTE PSYCHIATRIC CARE, DETOXIFICATION AND RESIDENTIAL STEP-DOWN SERVICES. DURING THE PERIOD COVERED BY THIS FILING, COMMUNITY-BASED SERVICES INCLUDED MOBILE EMERGENCY SERVICES TEAMS IN THREE CATCHMENT AREAS AND HOME-BASED COUNSELING FOR ADULTS, YOUTH AND THEIR FAMILIES. BILHBS ALSO PROVIDED SERVICES IN 63 MIDDLE AND HIGH SCHOOLS, AS WELL AS 9 POLICE DEPARTMENTS.BILHBS ALSO CONTINUES TO IMPROVE ACCESS THROUGH THE URGENT PSYCHOPHARMACOLOGY SERVICES IN BILH'S LOWELL EMERGENCY SERVICES PROGRAM. THIS CLINIC PROVIDES URGENT ACCESS FOR PATIENTS REQUIRING A CHANGE TO THEIR MEDICATIONS. THIS SERVICE IS OFFERED 20 HOURS PER WEEK AND INCLUDES UNINSURED, MEDICAID, AND MEDICARE POPULATIONS, AS WELL AS ANY PERSON IN NEED OF THE SERVICE REGARDLESS OF THE PAYER SOURCE. BILH'S COMMUNITY CRISIS STABILIZATION ("CCS") UNITS IN LAWRENCE AND SALEM, WHICH TYPICALLY CARE FOR PATIENTS WITH MENTAL HEALTH ISSUES, INCREASED THEIR ABILITY TO TREAT PERSONS WITH CO-OCCURRING SUBSTANCE USE DISORDERS. THE CCS UNITS CONTINUE TO BE ABLE TO INDUCT PATIENTS WITH OPIOID USE DISORDER (OUD) ON BUPRENORPHINE AND ARE ALSO ABLE TO MAINTAIN PATIENTS WHO ARE ALREADY ON ANY OF THE THREE FDA APPROVED MEDICATIONS FOR THE TREATMENT OF OUD. THESE UNITS ARE SEEING AN INCREASE IN THE NUMBER OF PATIENTS WITH METHAMPHETAMINE DISORDERS AND HAVE DEVELOPED A PROTOCOL TO MANAGE WITHDRAWAL SYMPTOMS IN THIS POPULATION.BILHBS CONTINUES TO MAINTAIN AND ENHANCE ITS TELEHEALTH PLATFORM AND CLINICAL DELIVERY THROUGH THE USE OF DIGITAL APPLICATIONS ACROSS ALL OF ITS AMBULATORY PROGRAMS. SPECIAL EMPHASIS WAS PLACED ON SPANISH-LANGUAGE ACCESS TO LAWRENCE-BASED PROGRAMS TO ENSURE PATIENTS IN THIS REGION ACCESS LINGUISTICALLY-APPROPRIATE CARE. IN 2021, BILHBS IDENTIFIED IMPROVEMENT OF THE PATIENT EXPERIENCE AS A KEY STRATEGIC PRIORITY. TO THAT END, ALL PROGRAM DIRECTORS ARE EVALUATED AGAINST THIS GOAL AND ARE REQUIRED TO COMPLETE TWO PLAN-DO-STUDY-ACT (PDSA) CYCLES ANNUALLY. PDSA IS A WELL-ESTABLISHED PROCESS IMPROVEMENT FRAMEWORK USED IN HEALTHCARE. PROGRAM DIRECTORS REVIEW PATIENT FEEDBACK TO DEVELOP PILOT INTERVENTIONS, ANALYZE THE RESULTS, AND THEN MAKE ADJUSTMENTS TO THE INTERVENTION. EXAMPLES OF OUTCOMES ACHIEVED THROUGH THE PDSA APPROACH INCLUDE ENHANCING THE PATIENT ENGAGEMENT MODEL FOR THE BEHAVIORAL HEALTH COMMUNITY PARTNERS (BHCP) PROGRAM; IMPROVING PATIENT EXPERIENCES AND ENGAGEMENT IN THE USE OF TELEHEALTH PLATFORMS IN BILHBS' LAWRENCE OUTPATIENT SITE, IMPROVING THE ADMISSION PROCESS IN THE BILHBS GLOUCESTER OPIOID TREATMENT CENTER, REDUCING ADMINISTRATIVE DISCHARGES BY IMPLEMENTING A HARM REDUCTION MODEL, AND IMPROVING EXTERNAL REFERRAL EXPERIENCE AT THE BILHBS HAVERHILL OUTPATIENT AND CHILDREN'S BEHAVIORAL HEALTH INITIATIVES (CBHI) PROGRAMS. BETH ISRAEL LAHEY HEALTH'S COVID-19 PANDEMIC RESPONSE AS IN THE PRIOR YEAR, BETH ISRAEL LAHEY HEALTH'S ("BILH") HOSPITALS AND OTHER PATIENT CARE ORGANIZATIONS EXPENDED SIGNIFICANT TIME AND RESOURCES ACROSS FY 2021 IN THEIR CONTINUED EFFORTS TO RESPOND TO THE COVID-19 PANDEMIC. IN ADDITION TO PROVIDING COVID-19 TESTING AND TREATMENT, THE HEALTH SYSTEM INITIATED PATIENT AND STAFF VACCINATION EFFORTS IN FY 2021, REACHING OUT TO 1.3 MILLION PATIENTS USING A MULTICHANNEL, MULTILINGUAL APPROACH AND ULTIMATELY DELIVERING OVER 400,000 VACCINE DOSES. THE SYSTEM SUCCESSFULLY UNDERTOOK THESE EFFORTS WHILE ALSO NAVIGATING UNPRECEDENTED FINANCIAL AND OPERATIONAL CHALLENGES STEMMING FROM THE PANDEMIC, INCLUDING ONGOING WORKFORCE DISRUPTION AND A DECLINE IN PATIENT VOLUME DUE TO THE CURTAILMENT OF ELECTIVE SERVICES AND STAFFING CHALLENGES.HIGHLIGHTS OF THE SYSTEM'S PANDEMIC RESPONSE IN FY 2021 INCLUDE:STAFF TESTING, VACCINATION, AND SUPPORT IN NOVEMBER 2020, BILH IMPLEMENTED A PROGRAM TO PROVIDE ITS 36,000 EMPLOYEES WITH ACCESS TO ONSITE, VOLUNTARY, AND FREE-OF-CHARGE COVID-19 PCR TESTING, EVEN IF THEY HAD NO KNOWN EXPOSURE OR SYMPTOMS. IN ADDITION TO SERVING AS AN IMPORTANT ELEMENT TO CONTAIN COMMUNITY SPREAD OF COVID-19, THIS EFFORT BOOSTED BILH STAFF MORALE AND CONFIDENCE DURING THIS CHALLENGING PERIOD. IN DECEMBER 2020, BILH STOOD UP STAFF VACCINATION SITES AT ITS LOCAL HOSPITALS, ULTIMATELY DELIVERING 70,000 VACCINE DOSES TO ITS WORKFORCE IN FY 2021. THE SYSTEM TOOK PROGRESSIVE MEASURES AROUND EMPLOYEE PAID TIME OFF TO SUPPORT VACCINATION EFFORTS AS WELL AS FAMILY CARE NEEDS AND TIME MISSED DUE TO COVID-19 ILLNESS OR TESTING. IN THE SUMMER OF 2021, BILH COMMUNICATED THAT COVID-19 AND FLU VACCINE WOULD BE REQUIRED AS A CONDITION OF EMPLOYMENT; THE COVID-19 VACCINATION DEADLINE WAS SUCCESSFULLY COMPLETED ON OCTOBER 31, 2021. BILH OPERATIONALIZED A CENTRALIZED CALL CENTER TO SUPPORT STAFF WITH SYMPTOM REPORTING, COVID-19 TESTING, AND RETURN-TO-WORK PROCESSES. THE CALL CENTER ENSURED CONVENIENT AND ACCESSIBLE INFORMATION FOR A WORKFORCE SPREAD THROUGHOUT EASTERN MASSACHUSETTS. AT ITS PEAK, THE CENTRALIZED CALL CENTER HANDLED OVER 1,000 PHONE CALLS PER DAY.PATIENT VACCINATION NEARLY IMMEDIATELY UPON RECEIVING VACCINE SUPPLY THAT COULD BE USED FOR PATIENTS, BILH OPENED AND OPERATED 10 VACCINE ADMINISTRATION SITES ACROSS EASTERN MASSACHUSETTS. THE LOCATIONS WERE SELECTED BASED ON SEVERAL CRITERIA, INCLUDING PROXIMITY TO HARD-HIT COMMUNITIES AND EASE OF ACCESS IN TERMS OF TRANSPORTATION. THIS WAS A SIGNIFICANT LOGISTICAL FEAT IN LIGHT OF THE SHIFTING FORECASTS IN VACCINE SUPPLY AND SPECIAL HANDLING REQUIRED FOR THE PFIZER VACCINE. BILH DEVELOPED ITS OWN VACCINATION SCHEDULING TOOL, COVAX, TO SUPPORT STAFF AND PATIENT VACCINATION EFFORTS. THIS TOOL ENABLED BILH TO IDENTIFY PATIENTS ELIGIBLE FOR VACCINATION BASED ON STATE GUIDELINES, SCHEDULE APPOINTMENTS, AND TRACK VACCINATION ACTIVITY. BILH LED A TARGETED CAMPAIGN TO SUPPORT HEALTH EQUITY BY PRIORITIZING FOR VACCINATION BILH PATIENTS WHO RESIDED IN A COMMUNITY OR TOWN IDENTIFIED AS HAVING AMONG THE HIGHEST CUMULATIVE INCIDENCE OF COVID-19 WITHIN THE STATE OF MASSACHUSETTS. BILH ALSO COORDINATED WITH MULTIPLE COMMUNITY HEALTH CENTERS TO PROVIDE THEIR PATIENTS WITH PRIORITY ACCESS TO VACCINATION APPOINTMENTS. DUE TO THESE EFFORTS, BETH ISRAEL DEACONESS CARE ORGANIZATION ("BIDCO"), AN ACCOUNTABLE CARE ORGANIZATION ("ACO") WITHIN BILH, HAD THE HIGHEST COVID-19 VACCINATION RATE FOR MEDICAID MEMBERS AMONG ALL MEDICAID ACOS IN THE STATE. BILH ESTABLISHED THE COVID-19 HEALTH EQUITY ADVISORY COUNCIL ("THE COUNCIL") WITH A GOAL TO ADDRESS HEALTH DISPARITIES BROUGHT ON BY THE PANDEMIC, LANGUAGE BARRIERS, AND OTHER SOCIAL DETERMINANTS OF HEALTH. ITS MEMBERSHIP INCLUDED KEY BILH STAKEHOLDERS AND COMMUNITY HEALTH CENTER CHIEF MEDICAL OFFICERS. AS PART OF ITS RESPONSIBILITY, THE COUNCIL REVIEWED THE SYSTEM'S VACCINE ROLLOUT STRATEGY, INCLUDING THE PATIENT PRIORITIZATION AND SCHEDULING STRATEGY, CALL CENTER MODEL, VACCINE SITE LOCATION AND OPERATING MODEL, AND STAFF RESOURCES TO HELP COMMUNICATE AND ENGAGE WITH PATIENTS ABOUT VACCINE INFORMATION, CONCERNS, AND HESITANCY.TESTING IN FY 2021, BILH PERFORMED OVER 600,000 COVID-19 TESTS ACROSS ITS 10 HOSPITAL LABORATORIES FOR PATIENTS, HEALTHCARE PERSONNEL, AND OTHER PARTNERS, SUCH AS COMMUNITY HEALTH CENTERS AND CORRECTIONAL FACILITIES. IN JANUARY 2021, LAHEY HOSPITAL & MEDICAL CENTER BEGAN TESTING ON HIGH-THROUGHPUT THERMO FISHER INSTRUMENTS, GREATLY INCREASING THE SYSTEM'S CAPACITY FOR SAME-DAY TEST RESULTS. THESE INSTRUMENTS ALSO PROVIDED BACK-UP CAPACITY FOR OTHER LABS IN THE COMMUNITY, WHICH WERE EXPERIENCING HIGH VOLUME. THE THERMO FISHER INSTRUMENTS ADDED THE ABILITY TO RAPIDLY DETECT POTENTIAL COVID-19 VARIANTS (S-GENE DROPOUTS), A PROCESS PREVIOUSLY ONLY AVAILABLE THROUGH THE MASSACHUSETTS STATE LABORATORY. EVENTUALLY, BILH IMPLEMENTED SPECIFIC VARIANT PCR (POLYMERASE CHAIN REACTION) TESTING OF PATIENT SPECIMENS TO IDENTIFY SPECIFIC VARIANTS AND BETTER GUIDE DEVELOPMENT OF INFECTION PREVENTION RECOMMENDATIONS AND APPROPRIATE MONOCLONAL ANTIBODY TREATMENT SELECTION. THE SYSTEM MAINTAINED EIGHT DRIVE-THROUGH COVID-19 TESTING SITES ACROSS EASTERN MASSACHUSETTS TO ENABLE EASY ACCESS FOR PATIENTS AND STAFF, INCLUDING A STATE-SPONSORED "STOP THE SPREAD" SITE IN CHELSEA, MA. BILH PRIMARY CARE MADE POINT-OF-CARE COVID-19 TESTING AVAILABLE TO ITS PATIENTS IN APPROXIMATELY 20 PRACTICE SITES (25% OF TOTAL SITES) SPREAD THROUGHOUT BILH'S SERVICE AREA.INFECTION PREVENTION AND PERSONAL PROTECTIVE EQUIPMENT EFFORTS THROUGHOUT FY 2021, BILH INFECTION PREVENTION AND SUPPLY CHAIN STAFF CONTINUED TO PARTNER ON PROCURING PERSONAL PROTECTIVE EQUIPMENT ("PPE") AND OTHER RELATED SUPPLIES AND REPLENISHING BILH'S PANDEMIC SUPPLY WAREHOUSE. THIS ENSURED THE SYSTEM HAD AT LEAST 90 DAYS OF INVENTORY ON HAND FOR THE HIGHEST-UTILIZED PRODUCTS, SUCH AS GLOVES, GOWNS, FACEMASKS, AND EYE AND FACE SHIELDS. IN FY 2021, BILH SUPPLY CHAIN AND INFECTION PREVENTION COORDINATED A RESPIRATOR (N95 OR EQUIVALENT) FIT TESTING PROGRAM WITH A VENDOR TO FIT TEST MORE THAN 20,000 BILH EMPLOYEES TO BOTH DISPOSABLE AND REUSABLE RESPIRATORS. THIS UNIQUE PROGRAM INCORPORATING REUSABLE RESPIRATORS ENSURED THAT BILH STAFF WOULD NOT BE SUBJECT TO FLUCTUATIONS IN SUPPLY CHAIN DURING FUTURE WAVES OF COVID-19 OR OTHER RESPIRATORY VIRAL ILLNESSES AND MITIGATED WASTE RELATED TO DISPOSABLE RESPIRATORY PROTECTION. THROUGHOUT FY 2021, BILH INFECTION PREVENTION DEVELOPED AND UPDATED CLINICAL AND OPERATIONAL GUIDANCE INCLUDING POLICIES, TOOLS, AND EDUCATIONAL MATERIALS TO SUPPORT THE PREVENTION OF TRANSMISSION OF COVID-19. FOR EXAMPLE, BILH INFECTION PREVENTION DEVELOPED STAFF EDUCATION ON COVID-19 PREVENTION TO MEET THE OSHA COVID-19 EMERGENCY TEMPORARY STANDARD FOR USE BY ALL HOSPITAL/BUSINESS UNITS; CREATED SCREENING TOOLS FOR USE AT ALL POINTS OF ENTRY FOR PATIENTS AND VISITORS AND UPDATED CRITERIA AS NEEDED BASED ON LOCAL AND NATIONAL GUIDANCE; AND, UPDATED POLICIES FOR PREOPERATIVE AND PRE-PROCEDURAL TESTING AND PPE.TREATMENT BILH HOSPITALS CONTINUED TO PROVIDE TREATMENT TO ADMITTED PATIENTS WITH COVID-19, USING TREATMENTS AUTHORIZED FOR USE AT THE TIME. LEADERS ACROSS BILH HOSPITALS CONTINUED TO MEET AND SHARE INFORMATION TO ALLOW FOR APPROPRIATE RESOURCE ALLOCATION AND LOAD BALANCING TO ENSURE BILH WAS ABLE TO MEET PATIENT DEMAND. IN FY 2021, BILH BEGAN TO MAKE AVAILABLE TO AMBULATORY PATIENTS COVID-19 THERAPEUTICS (INTRAVENOUS MONOCLONAL ANTIBODIES AND REMDESEVIR) AND PROPHYLAXIS (EVUSHELD), WITH THESE EFFORTS EXPANDING ACROSS 2022.SAFETY NET AFFILIATE SUPPORT IN ORDER TO ENHANCE SITUATIONAL AWARENESS AND THE HEALTH SYSTEM'S UNDERSTANDING OF THE PANDEMIC'S IMPACT ON ITS SAFETY NET AFFILIATES ("SNAS"), BILH INCLUDED ITS SNAS IN DAILY HUDDLES AND INCIDENT COMMAND MEETINGS. THESE COLLABORATIVE FORUMS ENABLED BILH TO PROVIDE TARGETED, CONSISTENT SUPPORT, INCLUDING DISCUSSIONS ON PATIENT TRANSFER AVAILABILITY AND BED CAPACITY ACROSS BILH. THROUGH ITS COMMITMENT TO SUPPORTING LOCAL COMMUNITIES DEVASTATED BY THE PANDEMIC, BILH DONATED $410,000 TO COMMUNITY GROUPS LOCATED IN BROCKTON AND $600,000 TO THE CITY OF CHELSEA TO AID IN ADDRESSING PROBLEMS CREATED OR EXACERBATED BY THE PANDEMIC, INCLUDING TEMPORARY HOUSING FOR EVICTED PATRONS AND FOOD INSECURITY DUE TO LOSS OF INCOME.UNDERPINNING THESE MANY INITIATIVES WERE VARIOUS MULTI-ENTITY, INTERDISCIPLINARY COMMITTEES AND DATA COLLECTION EFFORTS TO ENSURE THAT BILH WAS PROACTIVELY MONITORING THE TRAJECTORY OF THE PANDEMIC AND NIMBLY PLANNING THE SYSTEM'S RESPONSE. THE HEALTH SYSTEM'S EFFORTS SPANNED THE CLINICAL CARE CONTINUUM, FROM PRIMARY CARE TO POST-ACUTE CARE, AS WELL AS BOTH CLINICAL AND ADMINISTRATIVE DEPARTMENTS, FROM INFECTIOUS DISEASE AND NURSING TO HUMAN RESOURCES AND INFORMATION SERVICES. BILH SUCCESSFULLY MARSHALLED ITS RESOURCES THROUGHOUT THE SYSTEM TO SERVE AS ONE OF THE PRIMARY HU 1 BOYS AND GIRLS CLUB OF STONEHAM AND WAKEFIELD 15 DALE COURT STONEHAM MA 02180 237025777 501(C)(3) 15000 COMMUNITY SUPPORT METRO HOUSING BOSTON 1411 TREMONT ST BOSTON MA 02120 042775991 501(C)(3) 15000 COMMUNITY SUPPORT MINUTEMAN SENIOR SERVICES 26 CROSBY DR BEDFORD MA 01730 042587212 501(C)(3) 9871 COMMUNITY SUPPORT MISSION OF DEEDS 6 CHAPIN AVE READING MA 01867 223252651 501(C)(3) 5070 COMMUNITY SUPPORT MYSTIC VALLEY ELDER SERVICES 300 COMMERCIAL ST MALDEN MA 02148 042562646 501(C)(3) 7500 COMMUNITY SUPPORT NEW ENTRY SUSTAINABLE FARMING PROGRAM 733 CABOT ST BEVERLY MA 01915 042261109 501(C)(3) 6046 COMMUNITY SUPPORT SOCIAL CAPITAL INC 165 M NEW BOSTON ST SUITE 233 WOBURN MA 01801 760703107 501(C)(3) 5000 COMMUNITY SUPPORT TOWN OF STONEHAM 35 CENTRAL STREET STONEHAM MA 02180 046001311 501(C)(6) 22250 COMMUNITY SUPPORT TOWN OF WILMINGTON 121 GLEN RD WILMINGTON MA 01887 046001369 501(C)(3) 8000 COMMUNITY SUPPORT TOWN OF WINCHESTER 71 MOUNT VERNON ST WINCHESTER MA 01890 046001371 501(C)(3) 15850 COMMUNITY SUPPORT WOBURN COUNCIL OF SOCIAL CONCERN 2 MERRIMAC ST WOBURN MA 01801 042494773 501(C)(3) 7500 COMMUNITY SUPPORT 10 1 PART I, LINE 2: AS PREVIOUSLY NOTED IN THE FILING WINCHESTER HOSPITAL, MAINTAINS STRONG RELATIONSHIP WITH MANY PARTNERS AND WINCHESTER HOSPITAL WORKS WITH THOSE PARTNERS AS PART OF ITS COMMUNITY BENEFIT MISSION AND ACTIVITIES. PURSUANT TO THOSE RELATIONSHIPS, GRANTS MAY BE DISTRIBUTED TO THESE PARTNERS. WINCHESTER HOSPITAL ENSURES THAT FUNDS GRANTED ARE USED FOR THE INTENDED PURPOSES AS PART OF ITS ON-GOING AND CLOSE CONNECTIONS WITH THESE COMMUNITY PARTNERS. X X X X X X 1 1 0 0 0 0 0 1 0 TABB MD KEVIN CHIEF EXECUTIVE OFFICER (EX-OFFICIO) 0 1607257 0 1271689 0 499335 0 321950 0 42947 0 3743178 0 0 FISCHER STEVEN BILH CFO, TREASURER (EX-OFFICIO) 0 824811 0 345240 0 154549 0 20155 0 34545 0 1379300 0 0 KATZ ESQ JAMIE BILH GEN. COUNSEL, CLERK (EX-OFFICIO 0 689655 0 463139 0 118934 0 19114 0 13424 0 1304266 0 0 NESTO MD RICHARD BILH CMO, FORMER PRESIDENT AND TRUST 0 733137 0 280922 0 143317 0 60546 0 32191 0 1250113 0 0 O'CONNOR TIMOTHY FORMER TREASURER, EVP & CFO 0 0 0 0 0 931391 0 34666 0 0 0 966057 0 0 WEINER MD RICHARD TRUSTEE (EX-OFFICIO) 0 373413 0 61440 0 36060 0 11200 0 31120 0 513233 0 0 WOODS MATTHEW ASST. TREASURER AND CHIEF FINANCIAL 0 356367 0 46285 0 23208 0 26913 0 36678 0 489451 0 0 SCHULER KATHY ANN COO & CNO WINCHESTER HOSPITAL 348224 0 67014 0 3242 0 5700 0 31811 0 455991 0 0 0 ZITKOVSKY MD DANA CHIEF MEDICAL OFFICER WH 313023 0 40550 0 2276 0 5700 0 35417 0 396966 0 0 0 ISEKE MD RICHARD J FORMER CMO 0 259996 0 32132 0 4580 0 0 0 3740 0 300448 0 0 ROBERTSON CATHARINE VP, PHYSICIAN SERVICES 227504 0 29491 0 13975 0 0 0 24792 0 295762 0 0 0 SACHETTI NANCY DIRECTOR, HIGHLAND HEALTH IPA 241160 0 0 0 3449 0 0 0 35239 0 279848 0 0 0 CROWLEY SMITH JOANNE VP HUMAN RESOURCES 0 206767 0 27648 0 875 0 0 0 38134 0 273424 0 0 GREGA JOANNE ADMINISTRATIVE DIRECTOR, RADIOLOGY 219888 0 10000 0 9242 0 0 0 34217 0 273347 0 0 0 BEYERMAN KATHLEEN ACNO NURSING STAFF DEVELOPMENT 188543 0 0 0 20259 0 4194 0 29061 0 242057 0 0 0 LEVENSON HEATHER REGISTERED NURSE, OBSTETRICS 183651 0 2234 0 771 0 0 0 36363 0 223019 0 0 0 SPACKMAN ESQ DAVID G FORMER SVP GOV AFFAIRS, GENERAL COUN 0 0 0 0 0 219958 0 0 0 0 0 219958 0 0 SCHEDULE J EXPLANATORY FOOTNOTES ADLER, M.D., JOHNATHAN TRUSTEE AND PHYSICIAN - WINCHESTER HOSPITAL TRUSTEE AND PHYSICIAN - WINCHESTER HEALTHCARE MANAGEMENT, INC. EMERGENCY MEDICINE SPECIALIST WINCHESTER HOSPITAL ANDREWS, PAUL TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. MR. ANDREWS TERM ON THE BOARD OF WINCHESTER HOSPITAL ENDED SEPTEMBER 30, 2021. BERTOCHI, MARGARET TRUSTEE (EX-OFFICIO); PRESIDENT, WINSTON CLUB WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO); PRESIDENT,WINSTON CLUB - WINCHESTER HEALTHCARE MANAGEMENT, INC. MS. BERTOCHI'S BOARD TERM ENDED ON JUNE 23, 2020 BRECKWOLDT, M.D., WILLIAM TRUSTEE (EX OFFICIO); PRESIDENT, MEDICAL STAFF, PHYSICIAN WINCHESTER HOSPITAL TRUSTEE (EX OFFICIO); PRESIDENT, MEDICAL STAFF, PHYSICIAN WINCHESTER HEALTHCARE MANAGEMENT, INC. GENERAL SURGERY WINCHESTER HOSPITAL CROWLEY SMITH, JOANNE VICE PRESIDENT OF HUMAN RESOURCES - WINCHESTER HOSPITAL VICE PRESIDENT OF HUMAN RESOURCES - WINCHESTER HEALTHCARE MANAGEMENT, INC. DEROSA, CINDY TRUSTEE (EX-OFFICIO);PRESIDENT, FRIENDS OF WINCHESTER HOSPITAL - WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO);PRESIDENT, FRIENDS OF WINCHESTER HOSPITAL - WINCHESTER HEALTHCARE MANAGEMENT, INC. AS REQUIRED BY THIS FORM 990, SCHEDULE J, COMPENSATION INFORMATION, THE COMPENSATION DETAIL INCLUDED IN WINCHESTER HOSPITAL'S (WH) FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2021 IS CALENDAR YEAR 2020 DETAIL. ADDITIONAL INFORMATION IS INCLUDED WITH THE EXPLANATORY NOTES TO SCHEDULE J BELOW. SCHEDULE J PART I QUESTION 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE 2020 CALENDAR YEAR, WINCHESTER HOSPITAL'S (WH) WAS A PARTICIPATING EMPLOYER IN THE LAHEY CLINIC 457(F) NON-QUALIFIED DEFINED CONTRIBUTION PLAN AND PURSUANT TO THIS PLAN, ELIGIBLE EMPLOYEES RECEIVE CERTAIN RETIREMENT BENEFITS. AMOUNTS RECEIVED BY PARTICIPANTS AND RELATED TO THIS PLAN ARE INCLUDED IN FORM 990 SCHEDULE J, PART II, COLUMN B(III), OTHER REPORTABLE COMPENSATION AND/OR FORM 990, SCHEDULE J, PART II, COLUMN C, DEFERRED COMPENSATION IN ACCORDANCE WITH THE INSTRUCTIONS TO THIS FORM 990. IN ADDITION, ONE OR MORE INDIVIDUALS LISTED IN THIS FORM 990 SCHEDULE J RECEIVED COMPENSATION FROM AN ENTITY RELATED TO WH. DURING THE 2019 CALENDAR YEAR, BETH ISRAEL LAHEY HEALTH AND BETH ISRAEL DEACONESS MEDICAL CENTER WERE PARTICIPATING EMPLOYERS IN THE BETH ISRAEL DEACONESS MEDICAL CENTER EXECUTIVE RETIREMENT PROGRAM WHICH IS A NON-QUALIFIED DEFERRED COMPENSATION PLAN. PURSUANT TO THE PLAN ELIGIBLE EMPLOYEES RECEIVE CERTAIN RETIREMENT BENEFITS. CONTRIBUTIONS RECEIVED BY PARTICIPANTS AND RELATED TO THESE PLANS ARE INCLUDED IN FORM 990 SCHEDULE J, PART II, COLUMN B(III), OTHER REPORTABLE COMPENSATION AND/OR FORM 990, SCHEDULE J, PART II, COLUMN C, DEFERRED COMPENSATION IN ACCORDANCE WITH THE INSTRUCTIONS TO THIS FORM 990. ADDITIONAL INFORMATION IS INCLUDED WITH THE EXPLANATORY NOTES TO SCHEDULE J BELOW. SCHEDULE J PART I QUESTION 7 NON-FIXED PAYMENTS DURING THE 2020 CALENDAR YEAR, THE FILING ORGANIZATION MAINTAINS EXECUTIVE COMPENSATION PACKAGES AND CERTAIN EMPLOYEE COMPENSATION PACKAGES WHICH INCLUDED OPPORTUNITIES TO EARN INCENTIVE COMPENSATION BASED ON A COMBINATION OF MEETING OR EXCEEDING PRE-DETERMINED GOALS. FOR THE PERIOD COVERED BY THIS FILING, THE INCENTIVE COMPENSATION FOR EACH EXECUTIVE REPORTED IN THIS FORM 990 WAS REVIEWED AND APPROVED BY THE BILH COMPENSATION COMMITTEE, WHICH AS PREVIOUSLY NOTED, WAS FULLY STAFFED BY INDEPENDENT MEMBERS. SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES: ALL DIRECTORS/TRUSTEES SERVE WITHOUT COMPENSATION OR BENEFITS. COMPENSATION PAID TO OFFICERS, DIRECTORS/TRUSTEES OR KEY EMPLOYEES WAS EARNED FOR WORK PERFORMED IN A CAPACITY OTHER THAN THAT OF DIRECTOR/TRUSTEE, AS DENOTED BY THE LISTED TITLES IN THE NOTES BELOW AND WAS PAID FOR POSITIONS HELD DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2021. AS REQUIRED BY FORM 990, COMPENSATION REPORTED FOR THIS FISCAL YEAR IS CALENDAR YEAR 2020 COMPENSATION. COMPENSATION REPORTED FOR INDIVIDUALS MAY REFLECT AN ALLOCATION OF COMPENSATION PAID BY ENTITIES RELATED TO THE FILING ORGANIZATION AND WITHIN THE WINCHESTOR HOSPITAL NETWORK OR OTHER ENTITIES, AS REQUIRED. REPORTABLE COMPENSATION LISTED IN FORM 990 PART VII INCLUDES BASE COMPENSATION, INCENTIVE COMPENSATION AND OTHER REPORTABLE COMPENSATION AS REPORTED IN FORM 990 SCHEDULE J. OTHER COMPENSATION LISTED IN FORM 990 PART VII INCLUDES DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS AS REPORTED IN FORM 990 SCHEDULE J. REPORTABLE COMPENSATION LISTED IN FORM 990 PART VII INCLUDES BASE COMPENSATION, INCENTIVE COMPENSATION AND OTHER REPORTABLE COMPENSATION AS REPORTED IN FORM 990 SCHEDULE J. OTHER COMPENSATION LISTED IN FORM 990 PART VII INCLUDES DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS AS REPORTED IN FORM 990 SCHEDULE J. BASE COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED IN THIS RETURN BUT QUANTIFIED IN BASE COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: REGULAR WAGES, EMPLOYEE DEFERRALS TO A 401(K) AND/OR 403(B) PLAN OTHER REPORTABLE COMPENSATION: AMOUNTS QUANTIFIED IN OTHER REPORTABLE COMPENSATION WHICH MAY NOT BE SEPARATELY NOTED IN THIS FILING INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: TAXABLE EMPLOYER-SUBSIDIZED PARKING; TAXABLE MOVING EXPENSES; TAXABLE LIFE, DISABILITY, OR LONG-TERM CARE INSURANCE; AMOUNTS DEFERRED BY THE EMPLOYEE (PLUS EARNINGS) UNDER FULLY VESTED 457(B) PLAN; DISTRIBUTIONS FROM A 457(B) PLAN; AMOUNTS INCLUDIBLE IN INCOME UNDER A 457(F) PLAN; INCREASE/DECREASE IN VALUE OF NONQUALIFIED RETIREMENT BENEFITS; OTHER TAXABLE RETIREMENT BENEFITS DEFERRED COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN DEFERRED COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: EMPLOYER CONTRIBUTIONS TO 401K RETIREMENT PLAN, EMPLOYER CONTRIBUTIONS TO 403B RETIREMENT PLAN, EMPLOYER CONTRIBUTION TO PENSION PLAN AND/OR THE CHANGE IN ACTUARIAL VALUE OF THE PENSION PLAN BENEFIT, UNFUNDED AND UNVESTED AMOUNTS DEFERRED UNDER 457(F) PLAN NON-TAXABLE BENEFITS: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN NON-TAXABLE BENEFITS INCLUDE AMOUNTS FROM ONE OR MORE OF THE NON-TAXABLE BENEFITS: EMPLOYEE CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYER CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYEE CONTRIBUTIONS TO FLEXIBLE SPENDING ACCOUNTS FOR DEPENDENT CARE AND/OR MEDICAL REIMBURSEMENT, ADOPTION ASSISTANCE, TUITION ASSISTANCE PURSUANT TO AN EMPLOYER PLAN, GROUP TERM LIFE INSURANCE, DISABILITY INSURANCE COMPLETE TITLES AND ADDITIONAL EXPLANATORY INFORMATION FOR OFFICERS, DIRECTOR/TRUSTEES, KEY EMPLOYEES AND THE ENTITIES FIVE HIGHEST PAID EMPLOYEES OTHER THAN ODTKH ARE LISTED BELOW ALPHABETICALLY : SCHEDULE J EXPLANATORY FOOTNOTES ADLER, M.D., JOHNATHAN TRUSTEE AND PHYSICIAN - WINCHESTER HOSPITAL TRUSTEE AND PHYSICIAN - WINCHESTER HEALTHCARE MANAGEMENT, INC. EMERGENCY MEDICINE SPECIALIST WINCHESTER HOSPITAL ANDREWS, PAUL TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. MR. ANDREWS TERM ON THE BOARD OF WINCHESTER HOSPITAL ENDED SEPTEMBER 30, 2021. BERTOCHI, MARGARET TRUSTEE (EX-OFFICIO); PRESIDENT, WINSTON CLUB WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO); PRESIDENT,WINSTON CLUB - WINCHESTER HEALTHCARE MANAGEMENT, INC. MS. BERTOCHI'S BOARD TERM ENDED ON JUNE 23, 2020 BRECKWOLDT, M.D., WILLIAM TRUSTEE (EX OFFICIO); PRESIDENT, MEDICAL STAFF, PHYSICIAN WINCHESTER HOSPITAL TRUSTEE (EX OFFICIO); PRESIDENT, MEDICAL STAFF, PHYSICIAN WINCHESTER HEALTHCARE MANAGEMENT, INC. GENERAL SURGERY WINCHESTER HOSPITAL CROWLEY SMITH, JOANNE VICE PRESIDENT OF HUMAN RESOURCES - WINCHESTER HOSPITAL VICE PRESIDENT OF HUMAN RESOURCES - WINCHESTER HEALTHCARE MANAGEMENT, INC. DEROSA, CINDY TRUSTEE (EX-OFFICIO);PRESIDENT, FRIENDS OF WINCHESTER HOSPITAL - WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO);PRESIDENT, FRIENDS OF WINCHESTER HOSPITAL - WINCHESTER HEALTHCARE MANAGEMENT, INC. FISCHER, STEVEN EXECUTIVE VICE PRESIDENT, CHIEF FINANCIAL OFFICER AND TREASURER (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH, INC. MR. FISCHER RETIRED FROM HIS POSITION HELD AT BILH AS WELL AS THE POSITIONS DESCRIBED BELOW ON APRIL 2, 2021. UNLESS NOTED BELOW, MR. FISCHER HELD EACH POSITION THROUGH HIS DATE OF RETIREMENT. TREASURER (EX-OFFICIO) BETH ISRAEL DEACONESS MEDICAL CENTER, INC. TRUSTEE AND TREASURER (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH PHARMACY F/K/A BIDMC PHARMACY, INC. O MR. FISCHER HELD THE TRUSTEE POSITION THROUGH DECEMBER 31, 2020. TREASURER (EX-OFFICIO) NEW ENGLAND BAPTIST HOSPITAL TRUSTEE (EX-OFFICIO, CEO DESIGNATE) AND TREASURER (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITALMILTON TREASURER (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITALNEEDHAM TRUSTEE (EX-OFFICIO, CEO DESIGNATE) AND TREASURER (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITALPLYMOUTH TRUSTEE (EX-OFFICIO, CEO DESIGNATE) AND TREASURER (EX-OFFICIO) BID-MILTON PHYSICIAN ASSOCIATES F/K/A MILTON HOSPITAL FOUNDATION TREASURER (EX-OFFICIO) MOUNT AUBURN HOSPITAL TRUSTEE (EX-OFFICIO, CEO DESIGNATE) AND TREASURER (EX-OFFICIO) COMMUNITY PHYSICIANS ASSOCIATES TRUSTEE AND TREASURER (EX-OFFICIO) JORDAN PHYSICIAN ASSOCIATES TRUSTEE AND TREASURER (EX-OFFICIO) THE JORDAN HEALTH SYSTEMS, INC. TREASURER (EX-OFFICIO) ANNA JAQUES HOSPITAL TREASURER (EX-OFFICIO) - SEACOAST AFFILIATED GROUP PRACTICE TRUSTEE AND TREASURER (EX-OFFICIO) LAHEY HEALTH SHARED SERVICES, INC. ASSISTANT TREASURER BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC. TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) ADDISON GILBERT SOCIETY, INC. TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) NORTHEAST HEALTH SYSTEM, INC. TRUSTEE AND TREASURER (EX-OFFICIO) NORTHEAST PROFESSIONAL REGISTRY OF NURSES TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE AND TREASURER (EX-OFFICIO) SEACOAST NURSING & REHABILITATION CENTER, INC. TREASURER (EX-OFFICIO) WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) WINCHESTER HOSPITAL FOUNDATION, INC. TREASURER (EX-OFFICIO) WINCHESTER HEALTHCARE MANAGEMENT, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC FOUNDATION, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL & MEDICAL CENTER MANAGING DIRECTOR AND TREASURER (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK LLC TREASURER (EX-OFFICIO) NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) NORTHEAST MEDICAL PRACTICE, INC. TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE AND TREASURER CAB HEALTH & RECOVERY SERVICES, INC. TREASURER CAREGROUP PARMENTER HOME CARE AND HOSPICE, INC. TRUSTEE AND TREASURER HEALTH & EDUCATION HOUSING SERVICES, INC. ALTHOUGH MR. FISCHER SERVED IN THE POSITIONS ABOVE DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2021, AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2020 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. OTHER REPORTABLE COMPENSATION FOR MR. FISCHER INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $117,139. FORTUNATO, M.D., ROBERT TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. FULLER, M.D., ARLAN TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. GEVITZ, ESQ., KATHRYN ASSISTANT CLERK (EX-OFFICIO) - WINCHESTER HOSPITAL ASSISTANT CLERK (EX-OFFICIO) - WINCHESTER HEALTHCARE MANAGEMENT, INC. ASSOCIATE GENERAL COUNSEL, BILH HAYDEN, ERIC W. TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. HOUGHTON, JANICE TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. KATZ, J.D., JAMIE UNLESS OTHERWISE NOTED BELOW, MR, KATZ HELD THE FOLLOWING POSITIONS FOR THE FULL FISCAL PERIOD ENDED SEPTEMBER 30, 2021: GENERAL COUNSEL AND CLERK (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH, INC. CLERK (EX-OFFICIO) BETH ISRAEL DEACONESS MEDICAL CENTER, INC. TRUSTEE AND CLERK (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH PHARMACY F/K/A BIDMC PHARMACY, INC. O TRUSTEE TERM ENDED DECEMBER 31, 2020 CLERK (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL NEEDHAM CLERK BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK, LLC CLERK (EX-OFFICIO) MOUNT AUBURN HOSPITAL CLERK (EX-OFFICIO) NEW ENGLAND BAPTIST HOSPITAL CLERK (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITALMILTON CLERK (EX-OFFICIO) COMMUNITY PHYSICIANS ASSOCIATION, INC. CLERK (EX-OFFICIO) BID-MILTON PHYSICIAN ASSOCIATES F/K/A MILTON HOSPITAL FOUNDATION CLERK (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITALPLYMOUTH CLERK (EX-OFFICIO) JORDAN PHYSICIANS ASSOCIATES, INC. CLERK (EX-OFFICIO) THE JORDAN HEALTH SYSTEM CLERK (EX-OFFICIO) ANNA JAQUES HOSPITAL CLERK (EX-OFFICIO) SEACOAST AFFILIATED GROUP PRACTICE TRUSTEE AND CLERK (EX-OFFICIO) LAHEY HEALTH SHARED SERVICES, INC. TRUSTEE (EX-OFFICIO) AND CLERK (EX-OFFICIO) ADDISON GILBERT SOCIETY, INC. TRUSTEE (EX-OFFICIO) AND CLERK (EX-OFFICIO) NORTHEAST HEALTH SYSTEM, INC. TRUSTEE (EX-OFFICIO) AND CLERK (EX-OFFICIO) NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE (EX-OFFICIO) AND CLERK (EX-OFFICIO) - NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE AND CLERK (EX-OFFICIO) SEACOAST NURSING & REHABILITATION CENTER, INC. TRUSTEE (EX-OFFICIO) AND CLERK (EX-OFFICIO) WINCHESTER HOSPITAL FOUNDATION, INC. CLERK (EX-OFFICIO) WINCHESTER HEALTHCARE MANAGEMENT, INC. CLERK (EX-OFFICIO) LAHEY CLINIC FOUNDATION, INC. CLERK (EX-OFFICIO) LAHEY CLINIC, INC. CLERK (EX-OFFICIO) LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL &MEDICAL CENTER CLERK (EX-OFFICIO) - LAHEY CLINICAL PERFORMANCE ACCOUNTABLE CARE ORGANIZATION, LLC CLERK (EX-OFFICIO) - LAHEY CLINICAL PERFORMANCE NETWORK, LLC CLERK (EX-OFFICIO) NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO) AND CLERK (EX-OFFICIO) NORTHEAST MEDICAL PRACTICE, INC. TRUSTEE AND CLERK CAB HEALTH & RECOVERY SERVICES, INC. TRUSTEE AND CLERK HEALTH & EDUCATION HOUSING SERVICES, INC. CLERK (EX-OFFICIO) WINCHESTER HOSPITAL MR. KATZ SERVED IN THE POSITIONS ABOVE FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2021. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2020 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. INCENTIVE COMPENSATION FOR MR. KATZ INCLUDES $225,000 WHICH WAS PREVIOUSLY REPORTED AS DEFERRED COMPENSATION. OTHER REPORTABLE COMPENSATION FOR MR. KATZ INCLUDES COMBINED CONTRIBUTIONS TO, PAYMENTS FROM AND CHANGE IN VALUE OF, NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $87,861. KERNDL, JOHN KERNDL, JOHN UNLESS OTHERWISE NOTED BELOW, MR. KERNDL HELD THE FOLLOWING POSITIONS BEGINNING APRIL 5, 2021 THROUGH SEPTEMBER 30, 2021: EXECUTIVE VICE PRESIDENT, CHIEF FINANCIAL OFFICER AND TREASURER (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH, INC. TRUSTEE AND TREASURER CAB HEALTH & RECOVERY SERVICES, INC. TREASURER (EX-OFFICIO) COMMUNITY PHYSICIAN ASSOCIATES, INC. TREASURER CAREGROUP PARMENTER HOME CARE & HOSPICE, INC. TRUSTEE AND TREASURER - HEALTH AND EDUCATION HOUSING SERVICES, INC. TREASURER (EX-OFFICIO) - THE JORDAN HEALTH SYSTEM, INC. TREASURER (EX-OFFICIO) - JORDAN PHYSICIAN ASSOCIATES, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC FOUNDATION, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL & MEDICAL CENTER TRUSTEE AND TREASURER (EX-OFFICIO) - LAHEY HEALTH SHARED SERVICES, INC. TREASURER (EX-OFFICIO) MOUNT AUBURN HOSPITAL ASSISTANT TREASURER (EX-OFFICIO) - MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION D/B/A BETH ISRAEL LAHEY HEALTH PRIMARY CARE A/K/A AFFILIATED PHYSICIANS GROUP TREASURER BID MILTON PHYSICIAN ASSOCIATES, INC. TREASURER (EX-OFFICIO) - NORTHEAST PROFESSIONAL REGISTRY OF NURSES, INC. TREASURER (EX-OFFICIO) - NEW ENGLAND BAPTIST HOSPITAL TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) - NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) - NORTHEAST HEALTH SYSTEM, INC. TREASURER (EX-OFFICIO) NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) - NORTHEAST MEDICAL PRACTICE, INC. TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) - NORTHEAST SENIOR HEALTH CORPORATION TREASURER (EX-OFFICIO) - SEACOAST AFFILIATED GROUP PRACTICE, INC. TRUSTEE AND TREASURER (EX-OFFICIO) SEACOAST NURSING AND REHABILITATION CENTER, INC. TREASURER (EX-OFFICIO) WINCHESTER HEALTHCARE MANAGEMENT, INC. TREASURER (EX-OFFICIO) WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) WINCHESTER HOSPITAL FOUNDATION, INC. TRUSTEE (EX-OFFICIO) AND TREASURER (EX-OFFICIO) ADDISON GILBERT SOCIETY, INC. TREASURER (EX-OFFICIO) ANNA JAQUES HOSPITAL TREASURER (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITALMILTON, INC. TREASURER (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITALNEEDHAM, INC. TREASURER (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITALPLYMOUTH, INC. TREASURER (EX-OFFICIO) - BETH ISRAEL DEACONESS MEDICAL CENTER TREASURER (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH PHARMACY F/K/A BIDMC PHARMACY, INC. MANAGING DIRECTOR AND TRUSTEE- BETH ISRAEL DEACONESS PHYSICIAN ORGANIZATION, LLC MANAGING DIRECTOR AND TREASURER (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK, LLC TREASURER (EX-OFFICIO) LAHEY CLINICAL PERFORMANCE ACCOUNTABLE CARE ORGANIZATION, LLC TREASURER (EX-OFFICIO) LAHEY CLINICAL PERFORMANCE NETWORK, LLC ASSISTANT TREASURER (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC. AS MENTIONED ABOVE MR. KERNDL SERVED IN THE POSITIONS DETAILED ABOVE BEGINNING ON APRIL 5, 2021. ACCORDINGLY, SINCE COMPENSATION IS REQUIRED TO BE REPORTED IN THIS FORM 990 FOR CALENDAR YEAR 2020 AND MR. KERNDL RECEIVED NO COMPENSATION FROM BETH ISRAEL LAHEY HEALTH OR ITS AFFILIATES DURING CALENDAR YEAR 2020, NO COMPENSATION IS REPORTED IN THIS FILING. MANGANARO, PAUL TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. MCALMAN, M.D., KAREN TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE - WINCHESTER HOSPITAL MCCANCE, WILLIAM TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. MCCORMACK, ROSEMARY TRUSTEE (EX-OFFICIO), PRESIDENT, WINSTON CLUB - WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO), PRESIDENT, WINSTON CLUB - WINCHESTER HEALTHCARE MANAGEMENT, INC. MCDONOUGH, DEBORAH TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. MUNI, PH. D., INDU TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. NESTO, M.D., RICHARD UNLESS OTHERWISE NOTED BELOW, DR. NESTO HELD THE FOLLOWING POSITIONS FOR THE FULL FISCAL PERIOD ENDED SEPTEMBER 30, 2021: CHIEF MEDICAL OFFICER - BETH ISRAEL LAHEY HEALTH TRUSTEE (EX-OFFICIO, CEO DESIGNATE) ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATES GROUP PRACTICE TRUSTEE (EX-OFFICIO, CEO DESIGNATE) NORTHEAST HOSPITAL CORPORATION O SERVED AS CEO DESIGNATE THROUGH APRIL 1, 2021 TRUSTEE (EX-OFFICIO, CEO DESIGNATE) WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO, CEO DESIGNATE) WINCHESTER HEALTHCARE MANAGEMENT, INC. DIRECTOR - WINCHESTER PHYSICIAN ASSOCIATES (THROUGH DECEMBER 31, 2019) DIRECTOR, CONCORD SPECIALISTS, LLC PRESIDENT AND TRUSTEE NORTHEAST PROFESSIONAL REGISTRY OF NURSES O SERVED AS PRESIDENT AND TRUSTEE THROUGH DECEMBER 18, 2020 ALTHOUGH DR. NESTO SERVED IN THE POSITIONS ABOVE FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2021, AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2020 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. NESTO INCLUDES COMBINED CONTRIBUTIONS TO, AND CHANGE IN VALUE OF, NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $108,919. O'CONNOR, TIMOTHY FORMER FINANCE INTEGRATION LEAD, BETH ISRAEL LAHEY HEALTH MR. O'CONNOR RETIRED FROM HIS POSITION AS BILH FINANCE INTEGRATION LEAD EFFECTIVE DECEMBER 31, 2019 AND HAD SERVED IN THIS POSITION BEGINNING ON MARCH 1, 2019. PRIOR TO MARCH 1, 2019, MR. O'CONNOR SERVED AS THE EXECUTIVE VICE PRESIDENT, TREASURER AND CHIEF FINANCIAL OFFICER OF LAHEY HEALTH SYSTEM, INC. (LHSI) WHICH INCLUDED POSITIONS SERVING AS THE CHIEF FINANCIAL OFFICER, TREASURER AND TRUSTEE (EX-OFFICIO) FOR THE LAHEY CLINIC FOUNDATION, INC., LAHEY CLINIC, INC., LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL & MEDICAL CENTER, WINCHESTER HOSPITAL, NORTHEAST HOSPITAL CORPORATION, LAHEY HEALTH SHARED SERVICES (LHSS) AND MORE THAN FIFTEEN OTHER ENTITIES WHICH MADE UP THE LAHEY HEALTH SYSTEM OF AFFILIATES. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED FOR MR. O'CONNOR IS CALENDAR YEAR 2020 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. AS NOTED ABOVE, MR. O'CONNOR RETIRED FROM HIS LONGSTANDING RELATIONSHIP WITH BETH ISRAEL LAHEY HEALTH AND PREVIOUSLY WITH THE LAHEY HEALTH SYSTEM (LHSI) EFFECTIVE DECEMBER 31, 2019. AT THAT TIME, HE BECAME ELIGIBLE FOR CERTAIN SEVERANCE PAYMENTS WHICH BEGAN IN JANUARY 2020. OTHER REPORTABLE COMPENSATION FOR MR. O'CONNOR INCLUDES $700,000 OF SEVERANCE AND A ONE-TIME ADDITIONAL PAYMENT OF $210,000 PREVIOUSLY REPORTED AS DEFERRED COMPENSATION AND $43 RELATED TO A 457(B) PLAN. ROTOLO, M.D., PETER J. TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. SAYRE, RICHARD TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. SCHULER, KATHY ANN CHIEF OPERATING OFFICER & CHIEF NURSING OFFICER - WINCHESTER HOSPITAL SMITH, KEVIN F. TRUSTEE AND VICE CHAIR - WINCHESTER HOSPITAL TRUSTEE AND VICE CHAIR - WINCHESTER HEALTHCARE MANAGEMENT, INC. SPACKMAN, J.D., DAVID G. FORMER SENIOR VICE PRESIDENT OF GOVERNMENT AFFAIRS, GENERAL COUNSEL AND CLERK LAHEY HEALTH SYSTEM, INC. MR. SPACKMAN RETIRED AS LAHEY HEALTH SYSTEM, INC.'S SENIOR VICE PRESIDENT GOVERNMENT AFFAIRS, GENERAL COUNSEL AND CLERK ON MARCH 4, 2019. PRIOR TO THAT DATE, AND IN THE ROLE NOTED ABOVE, MR. SPACKMAN'S POSITIONS, INCLUDED SERVING AS, AMONG OTHERS, TRUSTEE, SECRETARY AND GENERAL COUNSEL OF LAHEY HEALTH SHARED SERVICES, INC., CLERK AND GENERAL COUNSEL OF LAHEY CLINIC FOUNDATION, INC., LAHEY CLINIC, INC. AND LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL AND MEDICAL CENTER, SENIOR VICE PRESIDENT OF GOVERNMENT AFFAIRS, GENERAL COUNSEL AND CLERK OF NORTHEAST HOSPITAL CORPORATION AND WINCHESTER HOSPITAL. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS FOR THE CALENDAR YEAR 2020. AS NOTED ABOVE, MR. SPACKMAN RETIRED FROM HIS LONGSTANDING RELATIONSHIP WITH BETH ISRAEL LAHEY HEALTH AND PREVIOUSLY WITH THE LAHEY HEALTH SYSTEM EFFECTIVE MARCH 4, 2019. AT THAT TIME, HE BECAME ELIGIBLE FOR CERTAIN SEVERANCE PAYMENTS WHICH CONTINUED INTO CALENDAR YEAR 2020. AS ALSO NOTED ABOVE AND AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED IN THIS RETURN IS FOR THE CALENDAR YEAR 2020. AND, AS SUCH, OTHER REPORTABLE COMPENSATION INCLUDES SEVERANCE OF $219,958 IN THIS FILING. TABB, M.D., KEVIN UNLESS OTHERWISE NOTED BELOW, DR. TABB HELD THE FOLLOWING POSITIONS FOR THE FULL FISCAL PERIOD ENDING SEPTEMBER 30, 2021: PRESIDENT, CHIEF EXECUTIVE OFFICER, AND TRUSTEE (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH, INC. (BILH) DIRECTOR (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER (EX-OFFICIO) BETH ISRAEL DEACONESS MEDICAL CENTER, INC. TRUSTEE (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER (EX-OFFICIO)- LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL & MEDICAL CENTER TRUSTEE (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER (EX-OFFICIO) -- LAHEY CLINIC, INC. TRUSTEE (EX-OFFICIO), BOARD CHAIR (EX-OFFICIO), PRESIDENT (EX-OFFICIO), AND CHIEF EXECUTIVE OFFICER (EX-OFFICIO) LAHEY HEALTH SHARED SERVICES, INC. DIRECTOR, PRESIDENT, CHIEF EXECUTIVE OFFICER (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH PHARMACY F/K/A BIDMC PHARMACY, INC. O SERVED AS DIRECTOR AND PRESIDENT THROUGH DECEMBER 31, 2020. TERM FOR CHIEF EXECUTIVE OFFICER BEGAN AS OF JANUARY 1, 2021. TRUSTEE (EX-OFFICIO) AND PRESIDENT (EX-OFFICIO) ADDISON GILBERT SOCIETY, INC. TRUSTEE (EX-OFFICIO), BOARD CHAIR (EX-OFFICIO), PRESIDENT (EX-OFFICIO) NORTHEAST HEALTH SYSTEM, INC. TRUSTEE (EX-OFFICIO) AND PRESIDENT NORTHEAST PROFESSIONAL REGISTRY OF NURSES O TRUSTEE (EX-OFFICIO) AND PRESIDENT THROUGH DECEMBER 18, 2020 TRUSTEE (EX-OFFICIO), BOARD CHAIR (EX-OFFICIO), PRESIDENT, (EX-OFFICIO) NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE, PRESIDENT (EX-OFFICIO), BOARD CHAIR (EX-OFFICIO) - SEACOAST NURSING & REHABILITATION CENTER, INC. CHIEF EXECUTIVE OFFICER WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO) AND PRESIDENT (EX-OFFICIO) WINCHESTER HOSPITAL FOUNDATION, INC. CHIEF EXECUTIVE OFFICER WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE (EX-OFFICIO), CHIEF EXECUTIVE OFFICER LAHEY CLINIC FOUNDATION, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER (EX-OFFICIO) NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE AND CHIEF EXECUTIVE OFFICER CAB HEALTH & RECOVERY SERVICES, INC. TRUSTEE AND CHIEF EXECUTIVE OFFICER HEALTH & EDUCATION HOUSING SERVICES, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL MILTON CHIEF EXECUTIVE OFFICER BID-MILTON PHYSICIAN ASSOCIATES CHIEF EXECUTIVE OFFICER COMMUNITY PHYSICIANS ASSOCIATES CHIEF EXECUTIVE OFFICER (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL NEEDHAM CHIEF EXECUTIVE OFFICER (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH CHIEF EXECUTIVE OFFICER (EX-OFFICIO) MOUNT AUBURN HOSPITAL CHIEF EXECUTIVE OFFICER (EX-OFFICIO) NEW ENGLAND BAPTIST HOSPITAL CHIEF EXECUTIVE OFFICER THE JORDAN HEALTH SYSTEMS, INC. CHIEF EXECUTIVE OFFICER JORDAN PHYSICIAN ASSOCIATES, INC. CHIEF EXECUTIVE OFFICER ANNA JAQUES HOSPITAL CHIEF EXECUTIVE OFFICER SEACOAST AFFILIATED GROUP PRACTICE PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL IN ADDITION TO THE POSITIONS NOTED ABOVE, DR. TABB HELD THE FOLLOWING POSITIONS FOR WHICH HE WAS ENTITLED TO AND DID APPOINT A DESIGNATE WHO THEN BECAME THE VOTING TRUSTEE IN HIS PLACE: TRUSTEE (EX-OFFICIO) NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL MILTON, BID-MILTON PHYSICIAN ASSOCIATES AND COMMUNITY PHYSICIANS ASSOCIATES TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL NEEDHAM TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, THE JORDAN HEALTH SYSTEMS, INC AND JORDAN PHYSICIAN ASSOCIATES, INC. TRUSTEE (EX-OFFICIO) MOUNT AUBURN HOSPITAL TRUSTEE (EX-OFFICIO) NEW ENGLAND BAPTIST HOSPITAL TRUSTEE (EX-OFFICIO) WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO) ANNA JAQUES HOSPITAL, INC. ALTHOUGH DR. TABB SERVED IN THE POSITIONS ABOVE FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2021, AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2020 COMPENSATION. INCENTIVE COMPENSATION FOR DR. TABB INCLUDES $250,000 WHICH WAS PREVIOUSLY REPORTED AS DEFERRED COMPENSATION. OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. TABB INCLUDES COMBINED CONTRIBUTIONS TO, PAYMENTS FROM AND CHANGE IN VALUE OF, NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $546,890. OF THIS AMOUNT, $62.475 IS UNVESTED AS OF SEPTEMBER 30, 2021. DEFERRED COMPENSATION IN THE AMOUNT OF $250,000 INCLUDED IN THIS FILING FOR DR. TABB RELATES TO CERTAIN MILESTONE PAYMENTS WHICH, AS OF DECEMBER 31, 2020, WERE NOT FUNDED, WERE NOT VESTED AND FOR WHICH THERE WAS NO GUARANTEE OF PAYMENT. THEY ARE INCLUDED HERE AS DEFERRED COMPENSATION AS REQUIRED BASED ON THE INSTRUCTIONS TO THE FORM 990. TARBY, J.D., JOSEPH III TRUSTEE, VICE CHAIR AND ASSISTANT CLERK - WINCHESTER HOSPITAL TRUSTEE, VICE CHAIR AND ASSISTANT CLERK - WINCHESTER HEALTHCARE MANAGEMENT, INC. MR. TARBY'S TERM AS ASSISTANT CLERK AT WINCHESTER HOSPITAL AND WINCHESTER HEALTHCARE MANAGEMENT ENDED ON SEPTEMBER 14, 2021. TAYLOR, M.D., JOSEPH TRUSTEE - WINCHESTER HOSPITAL TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. PHYSICIAN, INTERNAL MEDICINE, - WINCHESTER PHYSICIANS ASSOCIATES WALSH, JANE TRUSTEE AND BOARD CHAIR - WINCHESTER HOSPITAL TRUSTEE AND BOARD CHAIR - WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE - BETH ISRAEL LAHEY HEALTH WEINER, M.D., RICHARD UNLESS OTHERWISE NOTED BELOW, DR. WEINER HELD THE POSITIONS FOR THE FULL FISCAL PERIOD ENDED SEPTEMBER 30, 2021. PRESIDENT, TRUSTEE (EX-OFFICIO) WINCHESTER HOSPITAL PRESIDENT, TRUSTEE (EX-OFFICIO) WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE (EX-OFFICIO) WINCHESTER HOSPITAL FOUNDATION, INC. TRUSTEE - LAHEY CLINICAL PERFORMANCE ACCOUNTABLE CARE ORGANIZATION, LLC DIRECTOR, PRESIDENT WINCHESTER COMMUNITY ACCOUNTABLE CARE ORGANIZATION, INC. ALTHOUGH DR. WEINER SERVED IN THE POSITIONS ABOVE FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2021, AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2020 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. OTHER REPORTABLE COMPENSATION FOR DR. WEINER INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $25,179. WOODS, MATTHEW ASSISTANT TREASURER AND CHIEF FINANCIAL OFFICER -WINCHESTER HOSPITAL . ASSISTANT TREASURER AND VICE PRESIDENT, FINANCE - WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE (EX-OFFICIO) - WINCHESTER HOSPITAL FOUNDATION, INC. TREASURER AND DIRECTOR - WINCHESTER PHYSICIAN ASSOCIATES, INC . ZITKOVSKY, M.D., DANA CHIEF MEDICAL OFFICER - WINCHESTER HOSPITAL A MDFA - SERIES 2019K 043431814 57584YTK5 2019-07-31 211922775 SEE PART VI 0 0 0 B MDFA - SERIES 2018J-1 J-2 043431814 57584YJW0 2018-06-13 479594374 SEE PART VI 0 0 0 C MDFA - SERIES 2016I 043431814 57584XMT5 2016-05-12 257611877 SEE PART VI 0 0 0 D MDFA - LAHEY SERIES F 042323457 NONEXXXXX 2015-10-21 262828878 RETIRE BONDS & CAP ACQUISITION 0 0 0 A 13740000 211922775 2931137 208991638 2019 0 0 0 1 B 7900000 504219379 4594374 378819077 120805928 0 0 0 1 C 38265000 257618370 2515889 19006493 236095988 2016 0 1 1 1 D 28000000 262953908 4857465 3129474 94764737 160202232 2021 1 1 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 C 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 1 C 0 0 0 1 0 0 0 1 D 0 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 BOND A, ENTITY 1 PART I, ROW A, COLUMN A: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY. PART I, ROW A, COLUMN F: THE ISSUE REFUNDED ISSUES DATED 06/09/2008, 11/30/2005, 6/16/2003, AND 6/4/1998. BOND B, ENTITY 1 PART I, ROW B, COLUMN A: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY. PART I, ROW B, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE AN OUTPATIENT AMBULATORY CARE BUILDING, FACILITY UPGRADES, AND COMPUTER UPGRADES AT CERTAIN BIDMC AFFILIATES. PART II, COLUMN B, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $21,755,568 OF INVESTMENT EARNINGS. BOND C, ENTITY 1 PART I, ROW C, COLUMN A: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY. PART I, ROW C, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE CAPITAL PROJECTS AND REFUND ISSUES DATED 6/9/2008; 7/13/2004; 2/11/1998. PART II, COLUMN C, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $6,493 OF INVESTMENT EARNINGS. PART II, COLUMN C, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW. BOND D, ENTITY 1 PART I, ROW D, COLUMN A: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY. PART I, ROW D, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE CAPITAL PROJECTS AND REFUND ISSUES DATED 08/17/2007 AND 07/14/2005. PART II, COLUMN D, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $123,904 OF INVESTMENT EARNINGS. PART III, COLUMN D, LINE 9: THE MEMBERS OF THE LAHEY HEALTH SYSTEM OBLIGATED GROUP WERE LAHEY CLINIC FOUNDATION (LCF), INC., LAHEY CLINIC HOSPITAL, INC. (LCH) AND LAHEY CLINIC, INC. (LCI). ON MARCH 1, 2019, LAHEY HEALTH SYSTEM MERGED INTO LCF, AND PURSUANT TO A PLAN OF MERGER BETH ISRAEL LAHEY HEALTH (BILH) BECAME THE SOLE MEMBER OF LCF. LCF, IN TURN, SERVES AS THE SOLE MEMBER OF LCH AND LCI. IN JUNE 2020, THE BETH ISRAEL LAHEY HEALTH OBLIGATED GROUP WAS CREATED AND THE MEMBERS OF THE LAHEY OBLIGATED GROUP ARE CURRENTLY MEMBERS OF THE BILH OBLIGATED GROUP. SOME MEMBERS OF THE BILH OBLIGATED GROUP HAVE ADOPTED FORMAL WRITTEN WINCHESTER HOSPITAL PROJECTS AND REFUND ISSUES DATED 6/9/2008; 7/13/2004; 2/11/1998. 04-2104434 POLICIES AND PROCEDURES TO REVIEW AND MONITOR ARRANGEMENTS WHICH COULD GENERATE PRIVATE USE OF BOND FINANCED FACILITIES AND COMPLIANCE RELATED TO INTERNAL REVENUE CODE (IRC) SECTION 141 AND ARBITRAGE RULES UNDER IRC SECTION 148. ALTHOUGH LCF, LCH AND LCI HAVE NOT FORMALLY ADOPTED THESE WRITTEN POLICIES AND PROCEDURE, THESE THREE ENTITIES FOLLOW THE POLICIES AND PROCEDURES ADOPTED BY OTHER MEMBERS OF THE BILH OBLIGATED GROUP TO ENSURE COMPLIANCE WITH THESE SECTIONS OF THE IRC AND THE REGULATIONS PROMULGATED THEREUNDER. SUCH POLICIES AND PROCEDURES INCLUDE, AMONG OTHER THINGS, THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS, IF ANY, ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION ISN'T AVAILABLE UNDER APPLICABLE REGULATIONS. BOND A, ENTITY 2 PART I, ROW A, COLUMN A: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY. PART I, ROW A, COLUMN F: THE ISSUE'S PURPOSE WAS TO REFINANCE SEVERAL DIFFERENT ISSUES (DATED 06/09/2008; 11/30/2005; 07/16/2003; AND 06/03/1998), FUND TERMINATION PAYMENTS, AND FUND BUILDING IMPROVEMENTS, EQUIPMENT AND LAND IMPROVEMENTS. PART IV, COLUMN A, LINE 2(C): ARBITRAGE REBATE & YIELD RESTRICTION LIABILITY CALCULATION PERFORMED ON OCTOBER 29, 2019. BOND B, ENTITY 2 PART I, ROW B, COLUMN A: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY. PART I, ROW B, COLUMN F: DESCRIPTION OF PURPOSE CONSTRUCTION & EQUIPPING OF A POWER PLANT AND ACQUISITION OF CAPITAL ASSETS. PART I, ROW B, COLUMN F: DESCRIPTION OF PURPOSE REFUND ISSUE DATED 02/11/1998. PART III, COLUMN B, LINE 9: THE MEMBERS OF THE LAHEY HEALTH SYSTEM OBLIGATED GROUP WERE LAHEY CLINIC FOUNDATION (LCF), INC., LAHEY CLINIC HOSPITAL, INC. (LCH) AND LAHEY CLINIC, INC. (LCI). ON MARCH 1, 2019, LAHEY HEALTH SYSTEM MERGED INTO LCF, AND PURSUANT TO A PLAN OF MERGER BETH ISRAEL LAHEY HEALTH (BILH) BECAME THE SOLE MEMBER OF LCF. LCF, IN TURN, SERVES AS THE SOLE MEMBER OF LCH AND LCI. IN JUNE 2020, THE BETH ISRAEL LAHEY HEALTH OBLIGATED GROUP WAS CREATED AND THE MEMBERS OF THE LAHEY OBLIGATED GROUP ARE CURRENTLY MEMBERS OF THE BILH OBLIGATED GROUP. SOME MEMBERS OF THE BILH OBLIGATED GROUP HAVE ADOPTED FORMAL WRITTEN POLICIES AND PROCEDURES TO REVIEW AND MONITOR ARRANGEMENTS WHICH COULD GENERATE PRIVATE USE OF BOND FINANCED FACILITIES AND COMPLIANCE RELATED TO INTERNAL REVENUE CODE (IRC) SECTION 141 AND ARBITRAGE RULES UNDER IRC SECTION 148. ALTHOUGH LCF, LCH AND LCI HAVE NOT FORMALLY ADOPTED THESE WRITTEN POLICIES AND PROCEDURE, THESE THREE ENTITIES FOLLOW THE POLICIES AND PROCEDURES ADOPTED BY OTHER MEMBERS OF THE BILH OBLIGATED GROUP TO ENSURE COMPLIANCE WITH THESE SECTIONS OF THE IRC AND THE REGULATIONS PROMULGATED THEREUNDER. SUCH POLICIES AND PROCEDURES INCLUDE, AMONG OTHER THINGS, THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS, IF ANY, ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION ISN'T AVAILABLE UNDER APPLICABLE REGULATIONS. PART V, COLUMN B: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. BOND C, ENTITY 2 PART I, ROW C, COLUMN A: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY. PART II, COLUMN C, LINE 11: 8,993,760 OF THE PROCEEDS LISTED WERE USED FOR TERMINATION OF THE HEDGE AGREEMENT, WITH THE REMAINDER BEING REFUNDING PROCEEDS THAT ARE NO LONGER IN ESCROW. PART III, COLUMN D: BOTH THE 2012 AND 2011 ISSUES ARE EXEMPT FROM COMPLETING PART ILL AS BOTH ISSUE WERE REFUNDINGS OF BONDS ISSUED PRIOR TO 12/31/2002. BOND D, ENTITY 2 PART I, ROW D, COLUMN A: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY. PART II, COLUMN D, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW. PART III, COLUMN D: BOTH THE 2012 AND 2011 ISSUES ARE EXEMPT FROM COMPLETING PART ILL AS BOTH ISSUE WERE REFUNDINGS OF BONDS ISSUED PRIOR TO 12/31/2002. BOND A, ENTITY 3 PART I, ROW A, COLUMN A: MASSACHUSETTS HEALTH AND EDUCATIONAL FACILITIES AUTHORITY. PART I, ROW A, COLUMN F: DESCRIPTION OF PURPOSE - REFUND ISSUE DATED 06/28/2000. PART III, COLUMN A, LINE 9: WINCHESTER HOSPITAL (WINCHESTER) IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH OBLIGATED GROUP. SOME MEMBERS OF THE BILH OBLIGATED GROUP HAVE ADOPTED FORMAL WRITTEN POLICIES AND PROCEDURES TO REVIEW AND MONITOR ARRANGEMENTS WHICH COULD GENERATE PRIVATE USE OF BOND FINANCED FACILITIES AND COMPLIANCE RELATED TO INTERNAL REVENUE CODE (IRC) SECTION 141 AND ARBITRAGE RULES UNDER IRC SECTION 148. ALTHOUGH WINCHESTER HAS NOT FORMALLY ADOPTED THESE WRITTEN POLICIES AND PROCEDURE, WINCHESTER FOLLOWS THE POLICIES AND PROCEDURES ADOPTED BY OTHER MEMBERS OF THE BILH OBLIGATED GROUP TO ENSURE COMPLIANCE WITH THESE SECTIONS OF THE IRC AND THE REGULATIONS PROMULGATED THEREUNDER. SUCH POLICIES AND PROCEDURES INCLUDE, AMONG OTHER THINGS, THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS, IF ANY, ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION ISN'T AVAILABLE UNDER APPLICABLE REGULATIONS. PART IV, ROW 2C, COLUMN A: ARBITRAGE REBATE & YIELD RESTRICTION LIABILITY CALCULATION PERFORMED ON OCTOBER 10, 2009. A MDFA - SERIES 2015 H-1 043431814 57584XDH1 2015-09-02 203702204 SEE PART VI 0 0 0 B MDFA - LAHEY SERIES E 043431814 NONEXXXXX 2013-03-07 130000000 POWER PLANT & CAPITAL ACQUISITION 0 0 0 C MDFA - SERIES 2012G 043431814 NONEXXXXX 2012-07-11 49910000 REFUND ISSUE DATED 02/11/1998 0 0 0 D MDFA - SERIES 2011F-1 F-2 F-3 043431814 NONEXXXXX 2011-09-15 120280000 REFUND ISSUE DATED 02/11/1998 0 0 0 A 57565000 203702204 2348479 201353725 2015 1 1 1 1 B 103365000 130050301 500000 129550301 2015 0 0 1 1 C 49910000 368094 49541906 2012 1 0 1 1 D 105250000 120280000 290672 119989328 2011 1 0 1 1 A 0 1 1 1 0 0.00100 0.00000 0.00100 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 1 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 1 C 0 0 1 0 0 0 0 1 D 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 A MHEFA - WINCHESTER SERIES F 042456011 57586CDD4 2004-07-08 30340000 SERIAL BOND SERIES F - ADV REFUND 0 0 0 A 5510000 30340000 412448 29927552 2004 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 1 1 MORGAN STANLEY 20.000000000000 0 0 0 1 A 1 WOODS MATTHEW LEAHY, JANET 89673 FAMILY MEMBER COMP 0 SAYRE RICHARD HAMILTON, ELLEN 169189 FAMILY MEMBER COMP 0 SCHEDULE L, PART IV, COLUMN D MATTHEW J. WOODS, THE VP OF FINANCE AT WINCHESTER HOSPITAL (WH), IS THE BROTHER OF JANET LEAHY WHO IS A REGISTERED NURSE AT WH. HER SALARY AND OTHER INCOME FOR THE CALENDAR YEAR 2020 INCLUDE:BASE COMPENSATION: $59,425INCENTIVE COMPENSATION: $0OTHER REPORTABLE COMPENSATION: $789DEFERRED COMPENSATION: $1,474NON-TAXABLE BENEFITS: $27,986RICHARD SAYRE, AT TRUSTEE AT WH, IS THE FATHER OF ELLEN SAYRE HAMILTON WHO IS A REGISTERED NURSE AT WH. HER SALARY AND OTHER INCOME FOR THE CALENDAR YEAR 2020 INCLUDE:BASE COMPENSATION: $130,424 INCENTIVE COMPENSATION: $0OTHER REPORTABLE COMPENSATION: $758DEFERRED COMPENSATION: $2,814NON-TAXABLE BENEFITS: $35,192VARIOUS CURRENT AND FORMER OFFICERS, DIRECTORS/TRUSTEES AND KEY EMPLOYEES OF WH MAY ALSO HOLD POSITIONS WITH OTHER ENTITIES WHICH MAKE CHARITABLE CONTRIBUTIONS TO WH. SUCH CONTRIBUTIONS HAVE NOT BEEN INCLUDED IN THE DISCLOSURES ABOVE. WH MAINTAINS AN ACCOUNTABLE BUSINESS EXPENSE REIMBURSEMENT PLAN. FROM TIME TO TIME, WH MAY REIMBURSE ITS OFFICERS, DIRECTORS/TRUSTEES AND/OR KEY EMPLOYEES FOR EXPENSES THEY INCURRED AND WHICH ARE PROPERLY ORDINARY AND NECESSARY BUSINESS EXPENSES OF THE REPORTING ENTITY. THE POLICIES AND PROCEDURES REQUIRED BY THE ACCOUNTABLE BUSINESS PLAN MUST BE FOLLOWED IN ORDER TO RECEIVE REIMBURSEMENT FOR SUCH EXPENSES AND IT IS POSSIBLE THAT ONE OR MORE INDIVIDUALS RECEIVED NON-TAXABLE REIMBURSEMENTS WHICH TOTALED $10,000 OR MORE DURING THE FISCAL PERIOD COVERED BY THIS FILING. ALL OF THE ABOVE TRANSACTIONS WERE NEGOTIATED AT ARMS-LENGTH AND IN ACCORDANCE WITH THE WH CONFLICT OF INTEREST POLICIES. PART III, LINE I THE MISSION OF WINCHESTER HOSPITAL IS "TO CARE. TO HEAL. TO EXCEL." THIS ETHOS PROVIDES EACH AND EVERY STAFF MEMBER WITH CLEAR EXPECTATIONS, PROMOTING TEAMWORK AND RESPECT WHILE ENSURING SAFETY, QUALITY AND EMPATHY FOR PATIENTS. WINCHESTER HOSPITAL'S SUCCESS IS BASED ON THIS SHARED COMMITMENT TO EXCELLENCE. THE HOSPITAL AND ITS STAFF TAKE PRIDE IN OFFERING AN EXCEPTIONAL PATIENT CARE EXPERIENCE, PROVIDING SAFE, HIGH-QUALITY, COMMUNITY-BASED HEALTH CARE AND ACCESS TO TERTIARY CARE IN CLOSE COLLABORATION WITH ITS AFFILIATES IN THE BETH ISRAEL LAHEY HEALTH NETWORK WITH THE ULTIMATE GOAL OF IMPROVING THE HEALTH OF THE HOSPITAL'S PATIENTS AND THE COMMUNITIES SERVED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH (BILH) SERVED AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL -- MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL -- NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL -- PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES (LHSS), LAHEY CLINIC FOUNDATION (LCF), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC) WHICH INCLUDES BEVERLY, ADDISON GILBERT AND BAYRIDGE HOSPITALS, NORTHEAST BEHAVIORAL CORPORATION (NBHC), ANNA JAQUES HOSPITAL (AJH) AND THE BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK (BILHPN). THE LAHEY CLINIC FOUNDATION IN TURN SERVED AS THE SOLE MEMBER OF LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER (LHMC). THE ENTITIES LISTED HERE MAY HAVE ALSO, IN TURN, SERVED AS MEMBER TO OTHER NETWORK AFFILIATES. 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 AND ADDICTION TREATMENT PROGRAMS. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING WINCHESTER HOSPITAL OFFICERS, DIRECTOR/TRUSTEES, AND KEY EMPLOYEES HAVE BUSINESS AND/OR FAMILY RELATIONSHIPS: DEBORAH MCDONOUGH AND BILL MCCANCE HAVE A BUSINESS RELATIONSHIP FOR THE PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH, INC. SERVED AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES, LAHEY CLINIC FOUNDATION, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL HEALTH CORPORATION (NBHC) AND ANNA JAQUES HOSPITAL). EACH OF THESE AFFILIATES MAY HAVE, IN TURN, SERVED AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE BILH NETWORK OF AFFILIATES. IN ADDITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP) IS THE DEDICATED PHYSICIAN PRACTICE OF BIDMC AND AN ENTITY INTEGRALLY RELATED TO HELPING BIDMC AND OTHER AFFILIATES IN THE BILH NETWORK ACCOMPLISH THEIR CHARITABLE PURPOSES. FOR THIS SAME PERIOD HMFP SERVED AS THE SOLE MEMBER OF AFFILIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (APHMFP) AS WELL AS SEVERAL ADDITIONAL ENTITIES. TWO OR MORE OF THE PERSONS LISTED IN THIS FORM 990 PART VII HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER BY VIRTUE OF SITTING ON ONE OR MORE BOARDS OF DIRECTORS/TRUSTEES OR BY SERVING IN AN EMPLOYMENT RELATIONSHIP WITH ONE OR MORE ENTITIES WITHIN THE NETWORK OF THE AFFILIATED ORGANIZATIONS NOTED ABOVE. ADDITIONAL DETAIL IS PROVIDED IN THE EXPLANATORY NOTES TO THIS FORM 990 SCHEDULE J. FORM 990, PART VI, SECTION A, LINE 4 DURING THE PERIOD COVERED BY THIS FILING, WINCHESTER HOSPITAL, AMENDED ITS BY-LAWS. AS REQUIRED BY THIS FORM 990, WINCHESTER HOSPITAL, HAS SUMMARIZED THOSE CHANGES BELOW: THE GOAL OF THE BYLAW AMENDMENTS WAS TO PROVIDE CLARIFICATION AND TO ALIGN THE LANGUAGE WITH CURRENT/BEST GOVERNANCE PRACTICES. AS A REMINDER TO THE READER AND AS NOTED THROUGHOUT THIS FORM 990, BETH ISRAEL LAHEY HEALTH (BILH) SERVES AS THE SOLE MEMBER OF WINCHESTER HOSPITAL. THE AMENDMENTS INCLUDE: 1. TECHNICAL CHANGES AMENDS PURPOSES OF THE CORPORATION TO INCORPORATE DEEPER ARTICULATION OF THE BILH SYSTEM'S CORE VALUES. CLARIFIES HOW THE BILH BOARD MAY FUNCTIONALLY TAKE ACTION IN ITS CAPACITY AS THE DIRECT SOLE CORPORATE MEMBER OF WINCHESTER HOSPITAL. 2. CLARIFICATIONS REGARDING BOARD OF TRUSTEES AND COMMITTEES CLARIFIES THAT ANY TRUSTEES OR COMMITTEE MEMBERS WITH A TERM FEWER THAN OR MORE THAN THREE YEARS WILL BE CONSIDERED A FULL, THREE-YEAR TERM IF: (A) IT WAS TO ACHIEVE STAGGERING OR (B) DUE TO A TERM COMMENCING AT ANY TIME OTHER THAN OCTOBER 1 OF A GIVEN YEAR. CLARIFIES THAT TRUSTEES AND COMMITTEE MEMBERS APPOINTED TO FILL VACANCIES WILL SERVE THE REMAINDER OF THE THREE-YEAR TERM VACATED AND WILL BE ELIGIBLE FOR UP TO TWO CONSECUTIVE THREE-YEAR TERMS FOLLOWING THE END OF SUCH VACATED TERM. ALIGNS WINCHESTER HOSPITAL'S BOARD'S ANNUAL MEETING WITH THE BILH BOARD'S ANNUAL MEETING IN SEPTEMBER. GIVES WINCHESTER HOSPITAL'S BOARD FLEXIBILITY TO ESTABLISH THE OPTIONAL STANDING COMMITTEES LISTED IN THE BYLAWS WITHOUT BILH BOARD APPROVAL. CLARIFIES THAT AD HOC COMMITTEES MAY BE ESTABLISHED NOT ONLY BY A MAJORITY OF THE TRUSTEES, BUT ALSO BY THE BOARD CHAIR (OR A COMMITTEE CHAIR IN CONSULTATION WITH THE BOARD CHAIR), AND THAT THESE COMMITTEES ARE INTENDED TO BE ESTABLISHED FOR SPECIFIC TASKS ON A SHORT-TERM BASIS. CONFIRMS THAT WINCHESTER HOSPITAL'S COMMUNITY BENEFITS COMMITTEE HAS BEEN DISBANDED AT WINCHESTER HOSPITAL. THE COMMUNITY BENEFITS COMMITTEE WILL BE AT THE BILH BOARD LEVEL AND WINCHESTER HOSPITAL WILL HAVE A COMMUNITY BENEFITS ADVISORY COMMITTEE AS STATUTORILY REQUIRED BY THE COMMONWEALTH OF MASSACHUSETTS WHICH IS NOT A BOARD COMMITTEE. ADDS THE BOARD CHAIR AND PRESIDENT (OR THEIR RESPECTIVE DESIGNEES) EX OFFICIO TO ALL MANDATORY OR OPTIONAL STANDING COMMITTEES. ADDS (1) VICE-CHAIR(S) AS EX OFFICIO MEMBER(S) OF GOVERNANCE/NOMINATING COMMITTEE AND (2) MEDICAL STAFF PRESIDENT AS EX OFFICIO MEMBER OF MEDICAL STAFF APPOINTMENT COMMITTEE. CLARIFIES THAT THE CHAIRS OF THE FINANCE, QUALITY, AND GOVERNANCE/NOMINATING COMMITTEES WILL ACT AS THE PRINCIPAL LIAISON TO THE CORRESPONDING BILH COMMITTEE. GRANTS FLEXIBILITY TO THE GOVERNANCE/NOMINATING COMMITTEE TO OPERATE THROUGH ONE OR MORE SUBCOMMITTEES AND/OR GOVERNANCE/NOMINATING COMMITTEES. MAKES THE PHILANTHROPY COMMITTEE A MANDATORY RATHER THAN AN OPTIONAL STANDING COMMITTEE OF THE BOARD. PERMITS WINCHESTER HOSPITAL'S BOARD TO DELEGATE THE APPROVAL/REMOVAL OF DEPARTMENT/DIVISIONAL CHAIRS TO THE MEDICAL APPOINTMENT COMMITTEE (TO THE EXTENT SUCH APPROVAL IS REQUIRED BY HOSPITAL'S MEDICAL STAFF BYLAWS). 3. CLARIFICATIONS REGARDING OFFICERS CREATES TWO EX OFFICIO OFFICER POSITIONS: (1) ASSISTANT TREASURER (WINCHESTER HOSPITAL'S CFO) AND (2) ASSISTANT CLERK (ATTORNEY ASSIGNED TO WINCHESTER HOSPITAL BY BILH'S OFFICE OF GENERAL COUNSEL). LIMITS OFFICERS TO THOSE ENUMERATED IN THE BYLAWS (CHAIR, VICE-CHAIR(S), PRESIDENT, TREASURER, CLERK, ASSISTANT TREASURER, ASSISTANT CLERK). REQUIRES CHAIR AND VICE CHAIR TO BE INDEPENDENT TRUSTEES. FORM 990, PART VI, SECTION A, LINE 6 EFFECTIVE MARCH 1, 2019, BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS THE SOLE MEMBER OF WINCHESTER HOSPITAL. LAHEY HEALTH SYSTEM, INC. WHICH MERGED INTO LAHEY CLINIC FOUNDATION EFFECTIVE MARCH 1, 2019, PREVIOUSLY SERVED AS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE EXCLUSIVE AUTHORITY TO (A) APPOINT AND REAPPOINT TRUSTEES, (B) FILL ANY VACANCIES IN THE OFFICES OF TRUSTEES, AND (C) ACTING BY VOTE OF NOT LESS THAN THREE QUARTERS (3/4) OF THE MEMBER'S TRUSTEES THEN IN OFFICE, REMOVE, WITH OR WITHOUT CAUSE, A TRUSTEE. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER OF WINCHESTER HOSPITAL HAS THE FOLLOWING RIGHTS, AS DESIGNATED IN WINCHESTER HOSPITAL'S BY-LAWS: SUBJECT TO THE PROVISIONS OF THE ARTICLES OF ORGANIZATION AND THESE BYLAWS, THE MEMBER SHALL HAVE THE RIGHT TO EXERCISE ALL POWERS, BOTH POSITIVE AND NEGATIVE, CONFERRED BY MASSACHUSETTS GENERAL LAWS ("M.G.L.") CHAPTER 180, AS AMENDED, ON MEMBERS OF CORPORATIONS ORGANIZED UNDER M.G.L. CHAPTER 180. IN ADDITION, EXCEPT AS ARE EXPRESSLY GRANTED TO THE BOARD OF TRUSTEES OF THE CORPORATION ("BOARD") IN THESE BYLAWS, THE MEMBER SHALL HAVE THE RIGHT TO EXERCISE ALL POWERS, POSITIVE AND NEGATIVE, CONFERRED BY M.G.L. CHAPTER 180 ON BOARDS OF CORPORATIONS ORGANIZED UNDER M.G.L. CHAPTER 180. NOTWITHSTANDING THE FOREGOING, THE MEMBER MAY NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT THE APPROVAL OF THE BOARD: (A) APPROVE OR REQUIRE ANY CHANGE IN, OR CONSOLIDATION OF PHILANTHROPIC GIFTS, ASSETS, AND PROGRAMS OF THE CORPORATION, WHICH SHALL REMAIN UNDER THE CORPORATION'S CONTROL AND BE USED FOR THE BENEFIT OF THE CORPORATION AND NOT FOR OTHER COMPONENTS OF THE MEMBER'S SYSTEM, EXCEPT TO THE EXTENT THAT SUCH CHANGES INVOLVE BACK-OFFICE CONSOLIDATION WITH OTHER DIRECT OR INDIRECT SUBSIDIARIES OF THE MEMBER; (B) APPROVE OR REQUIRE ANY CHANGE IN THE NAME, BRAND, OR TRADEMARK OF THE CORPORATION OR ANY OF ITS SUBSIDIARIES, EXCEPT SUCH COMPLEMENTARY CHANGES AS THE MEMBER MAY DETERMINE ARE REASONABLY APPROPRIATE IN ESTABLISHING A SYSTEM-WIDE IDENTITY FOR THE AFFILIATED ENTITIES; OR (C) AMEND OR RESTATE THESE BYLAWS TO CHANGE OR ELIMINATE EITHER OF THE FOREGOING LIMITATIONS ON ITS POWERS. FOR THE PERIOD ENDING ON THE THIRD ANNIVERSARY OF THE DATE THE MEMBER BECOMES THE SOLE CORPORATE MEMBER OF THE CORPORATION, THE MEMBER'S AUTHORITY TO CHANGE THE MEDICAL SCHOOL AFFILIATION OF THE CORPORATION OR ANY OF ITS SUBSIDIARIES IS SUBJECT TO THE REQUIREMENT THAT IT OBTAIN THE UNANIMOUS CONSENT OF THE CORPORATION'S DESIGNATED TRUSTEES (AS DEFINED IN THE BYLAWS OF THE MEMBER) AND THE APPROVAL OF THE MEMBER'S BOARD OF TRUSTEES (THE "MEMBER'S BOARD"). THE MEMBER MAY NOT CAUSE THE CORPORATION TO CEASE OPERATING A SEPARATELY LICENSED HOSPITAL FACILITY, OR CLOSE ANY ESSENTIAL SERVICE OF SUCH HOSPITAL FACILITY, WITHOUT CONSULTING WITH THE BOARD PRIOR TO TAKING SUCH ACTION. THE POWERS AND RESPONSIBILITIES OF THE BOARD INCLUDE THE FOLLOWING: (A) PROVIDING RECOMMENDATIONS TO THE MEMBER REGARDING (I) APPOINTMENT, REAPPOINTMENT AND REMOVAL OF TRUSTEES, (II) THE ESTABLISHMENT OF THE CORPORATION'S POLICIES, (III) THE MAINTENANCE OF PATIENT CARE QUALITY, AND (IV) THE PROVISION OF CLINICAL SERVICES AND COMMUNITY SERVICE PLANNING IN A MANNER RESPONSIVE TO LOCAL COMMUNITY NEEDS; (B) ENSURING COMPLIANCE WITH ALL LICENSURE AND ACCREDITATION REQUIREMENTS, INCLUDING CREDENTIALING AND OTHER MEDICAL STAFF MATTERS; (C) PROVIDING OVERSIGHT FOR INSTITUTIONAL PLANNING, MAKING RECOMMENDATIONS FOR NEW CLINICAL SERVICES, AND PARTICIPATING IN AN ANNUAL REVIEW OF THE CORPORATION'S STRATEGIC AND FINANCIAL PLAN AND GOALS; (D) REVIEWING AND RECOMMENDING APPROVAL OF OPERATING AND CAPITAL BUDGETS AS WELL AS MAKING RECOMMENDATIONS WITH RESPECT TO CAPITAL EXPENDITURES; (E) MAKING RECOMMENDATIONS WITH RESPECT TO QUALITY ASSESSMENT AND IMPROVEMENT PROGRAMS; (F) PROVIDING OVERSIGHT OF RISK MANAGEMENT PROGRAMS RELATING TO PATIENT CARE AND SAFETY; (G) REVIEWING DISASTER PLANS THAT DEAL WITH BOTH INTERNAL (E.G., FIRE) AND EXTERNAL DISASTERS; AND (H) EVALUATING RECRUITMENT NEEDS TO ENSURE ADEQUATE MEDICAL STAFF CAPACITY TO CONTINUE TO MEET COMMUNITY NEEDS. EXCEPT AS OTHERWISE PROVIDED IN THESE BYLAWS, THE BOARD SHALL ACT IN AN ADVISORY CAPACITY AND CONSISTENT THEREWITH SHALL HAVE ONLY THE FOLLOWING POWERS: (A) POWERS EXPRESSLY GRANTED BY THE MEMBER FROM TIME TO TIME; (B) POWER TO EXERCISE ITS AUTHORITY AS A MEMBER OF OTHER CORPORATIONS; (C) POWER TO ENFORCE ANY RIGHTS VESTED IN THE CORPORATION UNDER THE BYLAWS OF THE MEMBER (AS DEFINED UNDER THE BYLAWS OF THE MEMBER) OR UNDER THESE BYLAWS WITH RESPECT TO THE MEMBER; AND (D) POWERS TO ENFORCE ANY RIGHTS VESTED IN THE CORPORATION UNDER THAT AGREEMENT DATED JUNE 30, 2017 BY AND AMONG LAHEY HEALTH SYSTEM, INC., BETH ISRAEL DEACONESS MEDICAL CENTER, INC., NEW ENGLAND BAPTIST HOSPITAL, INC., MOUNT AUBURN HOSPITAL, CAREGROUP, INC., AND SEACOAST REGIONAL HEALTH SYSTEMS, INC. THE POWERS OF THE BOARD IN CLAUSES (A) AND (B) OF THE PRECEDING SENTENCE SHALL BE SUBJECT TO THE RESERVED POWERS OF THE MEMBER AS NOTED ABOVE. THE POWERS OF THE BOARD IN CLAUSE (C) AND (D) OF THE FIRST SENTENCE OF THIS PARAGRAPH SHALL BE INDEPENDENT OF THE MEMBER AND NOT SUBJECT TO THE RESERVED POWERS OF THE MEMBER AS NOTED ABOVE. NOTWITHSTANDING CLAUSE (B) ABOVE, THE POWER OF THE CORPORATION TO EXERCISE ITS AUTHORITY AS A MEMBER OF ANOTHER CORPORATION SHALL BE SUBJECT TO THE FOLLOWING LIMITATIONS: (X) ALL STATUTORY POWERS THAT RESIDE IN THE CORPORATION AS A MEMBER OF ANOTHER CORPORATION UNDER MASSACHUSETTS LAW MAY BE EXERCISED BY THE CORPORATION ONLY AT THE EXPRESS AND EXPLICIT DIRECTION OF, AND WITH THE APPROVAL OF, THE MEMBER; (Y) ALL STATUTORY POWERS THAT RESIDE IN THE CORPORATION AS A MEMBER OF ANOTHER CORPORATION UNDER MASSACHUSETTS LAW MAY BE EXERCISED DIRECTLY BY THE MEMBER AFTER CONSULTATION WITH THE CHAIR BUT OTHERWISE WITHOUT THE APPROVAL OR PARTICIPATION OF THE CORPORATION; AND (Z) OTHER THAN STATUTORY POWERS, THE CORPORATION SHALL HAVE ONLY THOSE POWERS AND AUTHORITIES OVER AND WITH RESPECT TO THE CORPORATIONS OF WHICH IT IS A MEMBER AS ARE EXPRESSLY AND EXPLICITLY DELEGATED OR DIRECTED TO THE CORPORATION BY ACTION OF THE MEMBER'S BOARD. FORM 990, PART VI, SECTION B, LINE 11B AS NOTED IN VARIOUS DISCLOSURES THROUGHOUT THIS FILING, BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS THE SOLE MEMBER OF LAHEY HEALTH SHARED SERVICES (LHSS), WHICH IS IN TURN, THE SOLE MEMBER OF WINCHESTER HOSPITAL . THIS FORM 990 IS PREPARED IN CONJUNCTION WITH THE LHSS FINANCE STAFF. IN ADDITION, THE BILH TAX DEPARTMENT WORKS WITH OTHER DISCIPLINES AND DEPARTMENTS WITHIN BILH, WINCHESTER HOSPITAL AND OTHER AFFILIATES TO ENSURE THAT OTHER FINANCIAL AND NON-FINANCIAL DISCLOSURES ARE COMPLETE AND ACCURATE. EXAMPLES OF SUCH DEPARTMENTS MAY INCLUDE: FINANCIAL ASSISTANCE AND REIMBURSEMENT, COMPLIANCE, GRADUATE MEDICAL EDUCATION, LEGAL, COMMUNITY BENEFITS, GOVERNANCE, DEVELOPMENT, HUMAN RESOURCES AND PAYROLL, GOVERNMENT RELATIONS, RESEARCH AND/OR RESEARCH FINANCE. THE TAX RETURNS REVIEWED BY THE BILH EXECUTIVE DIRECTOR, TAXATION WINCHESTER HOSPITAL 'S CHIEF FINANCIAL OFFICER AND DELOITTE TAX, LLP. FORM 990, PART VI, SECTION B, LINE 12C WINCHESTER HOSPITAL IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH (BILH) SYSTEM OF AFFILIATES. ALL ENTITIES IN THE BILH NETWORK ADHERE TO THE BILH CONFLICT OF INTEREST POLICY AND MAINTAIN A WRITTEN, COMPREHENSIVE CONFLICT OF INTEREST POLICY AT THE ENTITY LEVEL. PURSUANT TO THESE POLICIES, ALL OF WINCHESTER HOSPITAL OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE THE ANNUAL CONFLICT OF INTEREST AND TAX QUESTIONNAIRE WHICH IS DESIGNED TO REQUIRE DISCLOSURE OF ANY BUSINESS RELATIONSHIPS AND AFFILIATIONS MAINTAINED BY OFFICERS, TRUSTEES, OR KEY EMPLOYEES AND THEIR FAMILY MEMBERS AND WHICH MAY RESULT IN A REAL OR PERCEIVED CONFLICT OF INTEREST. THE BILH OFFICE OF INTEGRITY AND COMPLIANCE, IN CONJUNCTION WITH THE BILH TAX DEPARTMENT, ADMINISTERS THE CONFLICT OF INTEREST AND TAX QUESTIONNAIRE PROCESS ANNUALLY. BILH INTEGRITY AND COMPLIANCE COLLECTS AND REVIEWS ALL DISCLOSURES. DISCLOSURES FOR BILH EXECUTIVES AND KEY EMPLOYEES ARE ASSIGNED APPROPRIATE FOLLOW-UP ACTION IN ACCORDANCE WITH THE BILH POLICY. A SUMMARY OF POSITIVE RESPONSES OF WINCHESTER HOSPITAL IS PROVIDED TO THE WINCHESTER HOSPITAL 'S COMPLIANCE OFFICER FOR REVIEW FINAL DETERMINATION OF ANY POTENTIAL OR ACTUAL CONFLICT. ANY ACTIVITY THAT REQUIRES ACTION UNDER THE CONFLICT OF INTEREST POLICIES IS SUBJECT TO ONGOING REVIEW BY WINCHESTER HOSPITAL AS WELL AS THE BILH INTEGRITY AND COMPLIANCE OFFICE. PURSUANT TO THE BILH CONFLICT OF INTEREST POLICY, CERTAIN ACTIVITIES WHICH COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED WHILE OTHER TYPES OF RELATIONSHIPS ARE PERMITTED, SUBJECT TO COMPLIANCE WITH A MANAGEMENT PLAN TO REQUIRE DISCLOSURE AND RECUSAL, INCLUDING APPROPRIATE DOCUMENTATION IN THE MINUTES. IN ADDITION AS NOTED ABOVE, THE ANNUAL CONFLICT OF INTEREST PROCESS OUTLINE ABOVE IS JOINTLY ISSUED BY THE BILH TAX DEPARTMENT, TO ENSURE THAT THE QUESTIONNAIRE IS DISTRIBUTED TO ALL CURRENT AND FORMER MEMBERS OF THE WINCHESTER HOSPITAL BOARD OF TRUSTEES AS WELL AS FORMER OFFICERS AND KEY EMPLOYEES. THE TAX QUESTIONNAIRE PROCESS IS DESIGNED TO GATHER THE INFORMATION NECESSARY FOR WINCHESTER HOSPITAL TO COMPLETELY AND ACCURATELY COMPLETE FORM 990 SCHEDULE L, TRANSACTIONS WITH INTERESTED PERSONS AND FORM 990, PART VI, QUESTION 2, FAMILY AND BUSINESS RELATIONSHIPS BETWEEN OFFICERS, DIRECTORS/TRUSTEES AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 WINCHESTER HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST AT THE FOLLOWING LOCATION: BETH ISRAEL LAHEY HEALTH TAX DEPARTMENT 109 BROOKLINE AVENUE, SUITE 300 BOSTON, MA 02215 FORM 990, PART XI, LINE 9: TRANSFERS TO/FROM AFFILIATES -6,752,164. NET ASSETS RELEASED FROM RESTRICTION FROM AFFILIATES NA RELEASED FROM REST-OPS 355,447. NA RELEASED FROM REST-PPE 83,769. CHANGE IN INTEREST OF FOUNDATION - TEMP 1,649,087. CHANGE IN INTEREST OF FOUNDATION - PERM 398,254. CHANGE IN VALUATION OF SWAPS (NET ASSETS) 1,256,412. OTHER CHANGES IN TRUST 817,611. BETH ISRAEL LAHEY HEALTH'S COVID-19 PANDEMIC RESPONSE IN ADDITION TO THE PROGRAM SERVICE ACCOMPLISHMENTS NOTED ABOVE, THE BILH NETWORK HAD SIGNIFICANT ACTIVITIES ACROSS ENTITIES RELATED TO BOTH BEHAVIORAL HEALTH AND ITS RESPONSE TO THE ONGOING COVID-19 PANDEMIC. SEE THE NARRATIVE SUPPORT FOR SCHEDULE H FOR ADDITIONAL DETAILS. FORM 990, PART IV, LINE 12 AND 12A: THE BOSTON, MA OFFICE OF KPMG ISSUED AN UNQUALIFIED OPINION ON THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE BETH ISRAEL LAHEY HEALTH, INC. AND AFFILIATES FOR FISCAL PERIOD ENDED SEPTEMBER 30, 2020 THESE STATEMENTS WERE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND INCLUDED THE ACCOUNTS OF THE BETH ISRAEL LAHEY HEALTH, INC. (BILH), AND THE ENTITIES FOR WHICH BETH ISRAEL LAHEY HEALTH, INC. (BILH) SERVED AS SOLE MEMBER DURING THE FISCAL PERIOD COVERED BY THIS FILING, (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). EACH OF THESE AFFILIATES MAY IN TURN SERVE AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE NETWORK OF AFFILIATES, AND WHOSE ACCOUNTS ARE INCLUDED IN THE BILH AUDITED FINANCIAL STATEMENTS. THE FINANCIAL STATEMENTS ALSO INCLUDE THE ACCOUNTS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP), THE DEDICATED PHYSICIAN PRACTICE OF BETH ISRAEL DEACONESS MEDICAL CENTER AND AN ENTITY INTEGRALLY RELATED TO HELPING BIDMC AND OTHER AFFILIATES IN THE BILH NETWORK ACCOMPLISH THEIR CHARITABLE PURPOSES. FORM 990, PART V, QUESTION 7G WINCHESTER HOSPITAL DID NOT RECEIVE ANY CONTRIBUTIONS OF INTELLECTUAL PROPERTY AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 8899. FORM 990, PART V, QUESTION 7H: WINCHESTER HOSPITAL DID NOT RECEIVE ANY CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 1098-C. FORM 990, PART IV, LINE 24A AS DESCRIBED IN THIS FORM 990, BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS AN ENTITY EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND SERVED AS A SUPPORT ORGANIZATION OF AND SOLE MEMBER OF WINCHESTER HOSPITAL DURING THIS SAME PERIOD, WINCHESTER HOSPITAL WAS A MEMBER OF THE BILH OBLIGATED GROUP AND ITS TAX EXEMPT BOND FINANCING WAS ISSUED THROUGH BILH OR THROUGH A PREVIOUS OBLIGATED GROUP WHICH IS NOW A PART OF THE BILH OBLIGATED GROUP. THE SCHEDULE K AS INCLUDED IN THIS FORM 990 INCLUDES ALL OF THE BILH OBLIGATED GROUP OUTSTANDING TAX EXEMPT DEBT FOR BONDS ISSUED AFTER DECEMBER 31, 2002, ONLY A PORTION OF WHICH IS ALLOCABLE TO AND REPORTED ON WINCHESTER HOSPITAL'S BALANCE SHEET. FORM 990, PART IV, LINE 24B: AS REPORTED ON THE FORM 990 SCHEDULE K, THE LAHEY HEALTH SYSTEM INC. (LHSI) SERIES F BONDS WHICH WERE ISSUED IN 2015 ARE NOW PART OF THE BETH ISRAEL LAHEY HEALTH (BILH) OBLIGATED GROUP DEBT. THE BONDS WERE ISSUED IN 2015 AND AS OF SEPTEMBER 30, 2020 THERE WAS A BALANCE REMAINING IN THE CONSTRUCTION FUND. PROCEEDS IN THE CONSTRUCTION FUND WERE UNEXPECTEDLY HELD BEYOND THE THREE-YEAR TEMPORARY PERIOD, AND WERE YIELD RESTRICTED IN COMPLIANCE WITH FEDERAL TAX REQUIREMENTS. ALTHOUGH THESE BONDS ARE NOT ON THE WINCHESTER HOSPITAL BALANCE SHEET, WINCHESTER HOSPITAL IS INCLUDING THIS DISCLOSURE IN ITS FORM 990 BECAUSE WINCHESTER HOSPITAL IS A MEMBER OF THE BILH OBLIGATED GROUP. FORM 990, PART III, LINE 4D: OTHER PROGRAM SERVICES AS IN THE PRIOR YEAR, BETH ISRAEL LAHEY HEALTH'S ("BILH") HOSPITALS AND OTHER PATIENT CARE ORGANIZATIONS EXPENDED SIGNIFICANT TIME AND RESOURCES ACROSS FY 2021 IN THEIR CONTINUED EFFORTS TO RESPOND TO THE COVID-19 PANDEMIC. IN ADDITION TO PROVIDING COVID-19 TESTING AND TREATMENT, THE HEALTH SYSTEM INITIATED PATIENT AND STAFF VACCINATION EFFORTS IN FY 2021, REACHING OUT TO 1.3 MILLION PATIENTS USING A MULTICHANNEL, MULTILINGUAL APPROACH AND ULTIMATELY DELIVERING OVER 400,000 VACCINE DOSES. THE SYSTEM SUCCESSFULLY UNDERTOOK THESE EFFORTS WHILE ALSO NAVIGATING UNPRECEDENTED FINANCIAL AND OPERATIONAL CHALLENGES STEMMING FROM THE PANDEMIC, INCLUDING ONGOING WORKFORCE DISRUPTION AND A DECLINE IN PATIENT VOLUME DUE TO THE CURTAILMENT OF ELECTIVE SERVICES AND STAFFING CHALLENGES. HIGHLIGHTS OF THE SYSTEM'S PANDEMIC RESPONSE IN FY 2021 INCLUDE: STAFF TESTING, VACCINATION, AND SUPPORT IN NOVEMBER 2020, BILH IMPLEMENTED A PROGRAM TO PROVIDE ITS 36,000 EMPLOYEES WITH ACCESS TO ONSITE, VOLUNTARY, AND FREE-OF-CHARGE COVID-19 PCR TESTING, EVEN IF THEY HAD NO KNOWN EXPOSURE OR SYMPTOMS. IN ADDITION TO SERVING AS AN IMPORTANT ELEMENT TO CONTAIN COMMUNITY SPREAD OF COVID-19, THIS EFFORT BOOSTED BILH STAFF MORALE AND CONFIDENCE DURING THIS CHALLENGING PERIOD. IN DECEMBER 2020, BILH STOOD UP STAFF VACCINATION SITES AT ITS LOCAL HOSPITALS, ULTIMATELY DELIVERING 70,000 VACCINE DOSES TO ITS WORKFORCE IN FY 2021. THE SYSTEM TOOK PROGRESSIVE MEASURES AROUND EMPLOYEE PAID TIME OFF TO SUPPORT VACCINATION EFFORTS AS WELL AS FAMILY CARE NEEDS AND TIME MISSED DUE TO COVID-19 ILLNESS OR TESTING. IN THE SUMMER OF 2021, BILH COMMUNICATED THAT COVID-19 AND FLU VACCINE WOULD BE REQUIRED AS A CONDITION OF EMPLOYMENT; THE COVID-19 VACCINATION DEADLINE WAS SUCCESSFULLY COMPLETED ON OCTOBER 31, 2021. BILH OPERATIONALIZED A CENTRALIZED CALL CENTER TO SUPPORT STAFF WITH SYMPTOM REPORTING, COVID-19 TESTING, AND RETURN-TO-WORK PROCESSES. THE CALL CENTER ENSURED CONVENIENT AND ACCESSIBLE INFORMATION FOR A WORKFORCE SPREAD THROUGHOUT EASTERN MASSACHUSETTS. AT ITS PEAK, THE CENTRALIZED CALL CENTER HANDLED OVER 1,000 PHONE CALLS PER DAY. PATIENT VACCINATION NEARLY IMMEDIATELY UPON RECEIVING VACCINE SUPPLY THAT COULD BE USED FOR PATIENTS, BILH OPENED AND OPERATED 10 VACCINE ADMINISTRATION SITES ACROSS EASTERN MASSACHUSETTS. THE LOCATIONS WERE SELECTED BASED ON SEVERAL CRITERIA, INCLUDING PROXIMITY TO HARD-HIT COMMUNITIES AND EASE OF ACCESS IN TERMS OF TRANSPORTATION. THIS WAS A SIGNIFICANT LOGISTICAL FEAT IN LIGHT OF THE SHIFTING FORECASTS IN VACCINE SUPPLY AND SPECIAL HANDLING REQUIRED FOR THE PFIZER VACCINE. BILH DEVELOPED ITS OWN VACCINATION SCHEDULING TOOL, COVAX, TO SUPPORT STAFF AND PATIENT VACCINATION EFFORTS. THIS TOOL ENABLED BILH TO IDENTIFY PATIENTS ELIGIBLE FOR VACCINATION BASED ON STATE GUIDELINES, SCHEDULE APPOINTMENTS, AND TRACK VACCINATION ACTIVITY. BILH LED A TARGETED CAMPAIGN TO SUPPORT HEALTH EQUITY BY PRIORITIZING FOR VACCINATION BILH PATIENTS WHO RESIDED IN A COMMUNITY OR TOWN IDENTIFIED AS HAVING AMONG THE HIGHEST CUMULATIVE INCIDENCE OF COVID-19 WITHIN THE STATE OF MASSACHUSETTS. BILH ALSO COORDINATED WITH MULTIPLE COMMUNITY HEALTH CENTERS TO PROVIDE THEIR PATIENTS WITH PRIORITY ACCESS TO VACCINATION APPOINTMENTS. DUE TO THESE EFFORTS, BETH ISRAEL DEACONESS CARE ORGANIZATION ("BIDCO"), AN ACCOUNTABLE CARE ORGANIZATION ("ACO") WITHIN BILH, HAD THE HIGHEST COVID-19 VACCINATION RATE FOR MEDICAID MEMBERS AMONG ALL MEDICAID ACOS IN THE STATE. BILH ESTABLISHED THE COVID-19 HEALTH EQUITY ADVISORY COUNCIL ("THE COUNCIL") WITH A GOAL TO ADDRESS HEALTH DISPARITIES BROUGHT ON BY THE PANDEMIC, LANGUAGE BARRIERS, AND OTHER SOCIAL DETERMINANTS OF HEALTH. ITS MEMBERSHIP INCLUDED KEY BILH STAKEHOLDERS AND COMMUNITY HEALTH CENTER CHIEF MEDICAL OFFICERS. AS PART OF ITS RESPONSIBILITY, THE COUNCIL REVIEWED THE SYSTEM'S VACCINE ROLLOUT STRATEGY, INCLUDING THE PATIENT PRIORITIZATION AND SCHEDULING STRATEGY, CALL CENTER MODEL, VACCINE SITE LOCATION AND OPERATING MODEL, AND STAFF RESOURCES TO HELP COMMUNICATE AND ENGAGE WITH PATIENTS ABOUT VACCINE INFORMATION, CONCERNS, AND HESITANCY. TESTING IN FY 2021, BILH PERFORMED OVER 600,000 COVID-19 TESTS ACROSS ITS 10 HOSPITAL LABORATORIES FOR PATIENTS, HEALTHCARE PERSONNEL, AND OTHER PARTNERS, SUCH AS COMMUNITY HEALTH CENTERS AND CORRECTIONAL FACILITIES. IN JANUARY 2021, LAHEY HOSPITAL & MEDICAL CENTER BEGAN TESTING ON HIGH-THROUGHPUT THERMO FISHER INSTRUMENTS, GREATLY INCREASING THE SYSTEM'S CAPACITY FOR SAME-DAY TEST RESULTS. THESE INSTRUMENTS ALSO PROVIDED BACK-UP CAPACITY FOR OTHER LABS IN THE COMMUNITY, WHICH WERE EXPERIENCING HIGH VOLUME. THE THERMO FISHER INSTRUMENTS ADDED THE ABILITY TO RAPIDLY DETECT POTENTIAL COVID-19 VARIANTS (S-GENE DROPOUTS), A PROCESS PREVIOUSLY ONLY AVAILABLE THROUGH THE MASSACHUSETTS STATE LABORATORY. EVENTUALLY, BILH IMPLEMENTED SPECIFIC VARIANT PCR (POLYMERASE CHAIN REACTION) TESTING OF PATIENT SPECIMENS TO IDENTIFY SPECIFIC VARIANTS AND BETTER GUIDE DEVELOPMENT OF INFECTION PREVENTION RECOMMENDATIONS AND APPROPRIATE MONOCLONAL ANTIBODY TREATMENT SELECTION. THE SYSTEM MAINTAINED EIGHT DRIVE-THROUGH COVID-19 TESTING SITES ACROSS EASTERN MASSACHUSETTS TO ENABLE EASY ACCESS FOR PATIENTS AND STAFF, INCLUDING A STATE-SPONSORED "STOP THE SPREAD" SITE IN CHELSEA, MA. BILH PRIMARY CARE MADE POINT-OF-CARE COVID-19 TESTING AVAILABLE TO ITS PATIENTS IN APPROXIMATELY 20 PRACTICE SITES (25% OF TOTAL SITES) SPREAD THROUGHOUT BILH'S SERVICE AREA. INFECTION PREVENTION AND PERSONAL PROTECTIVE EQUIPMENT EFFORTS THROUGHOUT FY 2021, BILH INFECTION PREVENTION AND SUPPLY CHAIN STAFF CONTINUED TO PARTNER ON PROCURING PERSONAL PROTECTIVE EQUIPMENT ("PPE") AND OTHER RELATED SUPPLIES AND REPLENISHING BILH'S PANDEMIC SUPPLY WAREHOUSE. THIS ENSURED THE SYSTEM HAD AT LEAST 90 DAYS OF INVENTORY ON HAND FOR THE HIGHEST-UTILIZED PRODUCTS, SUCH AS GLOVES, GOWNS, FACEMASKS, AND EYE AND FACE SHIELDS. IN FY 2021, BILH SUPPLY CHAIN AND INFECTION PREVENTION COORDINATED A RESPIRATOR (N95 OR EQUIVALENT) FIT TESTING PROGRAM WITH A VENDOR TO FIT TEST MORE THAN 20,000 BILH EMPLOYEES TO BOTH DISPOSABLE AND REUSABLE RESPIRATORS. THIS UNIQUE PROGRAM INCORPORATING REUSABLE RESPIRATORS ENSURED THAT BILH STAFF WOULD NOT BE SUBJECT TO FLUCTUATIONS IN SUPPLY CHAIN DURING FUTURE WAVES OF COVID-19 OR OTHER RESPIRATORY VIRAL ILLNESSES AND MITIGATED WASTE RELATED TO DISPOSABLE RESPIRATORY PROTECTION. THROUGHOUT FY 2021, BILH INFECTION PREVENTION DEVELOPED AND UPDATED CLINICAL AND OPERATIONAL GUIDANCE INCLUDING POLICIES, TOOLS, AND EDUCATIONAL MATERIALS TO SUPPORT THE PREVENTION OF TRANSMISSION OF COVID-19. FOR EXAMPLE, BILH INFECTION PREVENTION DEVELOPED STAFF EDUCATION ON COVID-19 PREVENTION TO MEET THE OSHA COVID-19 EMERGENCY TEMPORARY STANDARD FOR USE BY ALL HOSPITAL/BUSINESS UNITS; CREATED SCREENING TOOLS FOR USE AT ALL POINTS OF ENTRY FOR PATIENTS AND VISITORS AND UPDATED CRITERIA AS NEEDED BASED ON LOCAL AND NATIONAL GUIDANCE; AND, UPDATED POLICIES FOR PREOPERATIVE AND PRE-PROCEDURAL TESTING AND PPE. TREATMENT BILH HOSPITALS CONTINUED TO PROVIDE TREATMENT TO ADMITTED PATIENTS WITH COVID-19, USING TREATMENTS AUTHORIZED FOR USE AT THE TIME. LEADERS ACROSS BILH HOSPITALS CONTINUED TO MEET AND SHARE INFORMATION TO ALLOW FOR APPROPRIATE RESOURCE ALLOCATION AND LOAD BALANCING TO ENSURE BILH WAS ABLE TO MEET PATIENT DEMAND. IN FY 2021, BILH BEGAN TO MAKE AVAILABLE TO AMBULATORY PATIENTS COVID-19 THERAPEUTICS (INTRAVENOUS MONOCLONAL ANTIBODIES AND REMDESEVIR) AND PROPHYLAXIS (EVUSHELD), WITH THESE EFFORTS EXPANDING ACROSS 2022. SAFETY NET AFFILIATE SUPPORT IN ORDER TO ENHANCE SITUATIONAL AWARENESS AND THE HEALTH SYSTEM'S UNDERSTANDING OF THE PANDEMIC'S IMPACT ON ITS SAFETY NET AFFILIATES ("SNAS"), BILH INCLUDED ITS SNAS IN DAILY HUDDLES AND INCIDENT COMMAND MEETINGS. THESE COLLABORATIVE FORUMS ENABLED BILH TO PROVIDE TARGETED, CONSISTENT SUPPORT, INCLUDING DISCUSSIONS ON PATIENT TRANSFER AVAILABILITY AND BED CAPACITY ACROSS BILH. THROUGH ITS COMMITMENT TO SUPPORTING LOCAL COMMUNITIES DEVASTATED BY THE PANDEMIC, BILH DONATED $410,000 TO COMMUNITY GROUPS LOCATED IN BROCKTON AND $600,000 TO THE CITY OF CHELSEA TO AID IN ADDRESSING PROBLEMS CREATED OR EXACERBATED BY THE PANDEMIC, INCLUDING TEMPORARY HOUSING FOR EVICTED PATRONS AND FOOD INSECURITY DUE TO LOSS OF INCOME. FORM 990, PART III, LINE 4D: OTHER PROGRAM SERVICES UNDERPINNING THESE MANY INITIATIVES WERE VARIOUS MULTI-ENTITY, INTERDISCIPLINARY COMMITTEES AND DATA COLLECTION EFFORTS TO ENSURE THAT BILH WAS PROACTIVELY MONITORING THE TRAJECTORY OF THE PANDEMIC AND NIMBLY PLANNING THE SYSTEM'S RESPONSE. THE HEALTH SYSTEM'S EFFORTS SPANNED THE CLINICAL CARE CONTINUUM, FROM PRIMARY CARE TO POST-ACUTE CARE, AS WELL AS BOTH CLINICAL AND ADMINISTRATIVE DEPARTMENTS, FROM INFECTIOUS DISEASE AND NURSING TO HUMAN RESOURCES AND INFORMATION SERVICES. BILH SUCCESSFULLY MARSHALLED ITS RESOURCES THROUGHOUT THE SYSTEM TO SERVE AS ONE OF THE PRIMARY HUBS FOR COVID-19 RELATED CARE IN MASSACHUSETTS. ADDISON GILBERT SOCIETY INC 41 MALL ROAD BURLINGTON MA 01805 464371382 SUPPORT MA 501(C)(3) 7 LAHEY HEALTH SHARED SERVICES INC 1 ANNA JAQUES HOSPITAL 25 HIGHLAND AVENUE NEWBURYPORT MA 01950 042104338 HEALTHCARE MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 ASSOCIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL 375 LONGWOOD AVENUE BOSTON MA 02215 320058309 TO PROVIDE EMERGENCY MEDICAL SERVICES MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BAIM INSTITUTE FOR CLINICAL RESEARCH INC DBA BAIM INSTITUTE 930 COMMONWEALTH AVENUE BOSTON MA 02215 043521077 SCIENTIFIC & MEDICAL RESEARCH MA 501(C)(3) 7 BETH ISRAEL DEACONESS MEDICAL CENTER (50) AND HARVARD MEDICAL FACULTY PHYSI 1 BETH ISRAEL ANAESTHESIA FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 042997215 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL COMMUNITY FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 042776678 INACTIVE CORPORATION MA 501(C)(3) 7 N/A 1 BETH ISRAEL DEACONESS DEPARTMENT OF EMERGENCY MEDICINE FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 364803234 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF MEDICINE FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 043079630 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF NEONATOLOGY FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 208253452 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF NEUROLOGY FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 043030397 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF ORTHOPAEDIC SURGERY FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 204974585 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF SURGERY FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 020671240 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS HOSPITAL MILTON INC 199 REEDSDALE RD MILTON MA 02186 042103604 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS. MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS HOSPITAL NEEDHAM INC 148 CHESTNUT STREET NEEDHAM MA 02492 043229679 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS. MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC 275 SANDWICH STREET PLYMOUTH MA 02360 222667354 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS. MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL MEDICAL CARE C 300 LONGWOOD AVENUE BOSTON MA 02215 043200113 SUPPORT MA 501(C)(3) 12A, I N/A 0 BETH ISRAEL DEACONESS MEDICAL CENTER OBSTETRICS AND GYNECOLOGY FOUNDATION I 330 BROOKLINE AVENUE BOSTON MA 02215 042794855 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS MEDICAL CENTER INC 330 BROOKLINE AVENUE BOSTON MA 02215 042103881 THE OPERATION OF A WORLD CLASS ACADEMIC MEDICAL CENTER IN BOSTON, MA MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS PHYSICIAN ORGANIZATION LLC DBA BETH ISRAEL DEACONES 247 STATION DRIVE NW 1 WESTWOOD MA 02186 043426253 PROMOTE HEALTHCARE MA 501(C)(3) 12A, I BETH ISRAEL DEACONESS HOSPITAL - MILTON 1 BETH ISRAEL DERMATOLOGY FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 043117601 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL LAHEY HEALTH PHARMACY INC 80 WILSON WAY WESTWOOD MA 02090 822526816 TO OPERATE A SPECIALTY PHARMACY AND 340B PROGRAM FOR BIDMC MA 501(C)(3) 12A, I BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL LAHEY HEALTH INC 20 UNIVERSITY ROAD CAMBRIDGE MA 02138 832671600 SUPPORT MA 501(C)(3) 12A, I N/A 1 BETH ISRAEL LAHEY HEALTH PRIMARY CARE 41 MALL ROAD BURLINGTON MA 01805 472248298 HEALTHCARE MA 501(C)(3) 10 LAHEY HEALTH SHARED SERVICES INC 1 BID-MILTON PHYSICIAN ASSOCIATES INC FKA MILTON HOSPITAL FOUNDATION INC 199 REEDSDALE ROAD MILTON MA 02186 222566792 MA BETH ISRAEL DEACONESS HOSPITAL - MILTON 0 BIH PATHOLOGY FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 222548374 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BIH RADIOLOGIC FOUNDATION INC 330 BROOKLINE AVENUE BOSTON MA 02215 042571853 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 CAB HEALTH AND RECOVERY SERVICES INC 199 ROSEWOOD DRIVE DANVERS MA 01923 042400270 SUBSTANCE ABUSE MA 501(C)(3) 10 NORTHEAST BEHAVIORAL HEALTH CORPORATION 1 CAREGROUP PARMENTER HOME CARE & HOSPICE INC DBA BILH AT HOME - WATERTOW 330 MOUNT AUBURN STREET CAMBRIDGE MA 02138 473111453 ALL ASSET AND LIABILITIES OF CPHCH WERE TRANSFERRED TO NPRN ON 9/30/2020. GO MA 501(C)(3) 12A, I NORTHEAST PROFESSIONAL REGISTRY OF NURSES INC DBA LAHEY HEALTH AT HOME 1 COMMUNITY PHYSICIANS ASSOCIATES INC 199 REEDSDALE RD MILTON MA 02186 043243146 OUTPATIENT AND PRIMARY CARE SERVICES MA 501(C)(3) 3 BETH ISRAEL DEACONESS HOSPITAL - MILTON 1 CONTINUING EDUCATION PROGRAM INC DBA BETH ISRAEL DEACONESS DEPARTMENT OF 330 BROOKLINE AVENUE BOSTON MA 02215 043242952 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 375 LONGWOOD AVENUE BOSTON MA 02215 222768204 GENERAL AND SPECIALIZED MEDICAL SERVICES TO THE PATIENTS OF BIDMC AND OTHERS MA 501(C)(3) 10 BETH ISRAEL DEACONESS MEDICAL CENTER 1 HEALTH & EDUCATION HOUSING SERVICES INC 199 ROSEWOOD DRIVE DANVERS MA 01923 223232914 HUD HOUSING MA 501(C)(3) 10 NORTHEAST BEHAVIORAL HEALTH CORPORATION 1 JORDAN PHYSICIAN ASSOCIATES INC 275 SANDWICH STREET PLYMOUTH MA 02360 043228556 OUTPATIENT AND PRIMARY CARE SERVICES MA 501(C)(3) 10 BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH INC 1 LAHEY CLINIC CANADIAN FOUNDATION 130 KING STREET WEST TORONTO CA FUNDRSG ORG CA NON-US N/A 0 LAHEY CLINIC FOUNDATION INC 41 MALL ROAD BURLINGTON MA 01805 042323457 SUPPORT MA 501(C)(3) 7 BETH ISRAEL LAHEY HEALTH INC 1 LAHEY CLINIC HOSPITAL INC (LAHEY HOSPITAL & MEDICAL CENTER) 41 MALL ROAD BURLINGTON MA 018050001 042704686 HEALTHCARE MA 501(C)(3) 3 LAHEY CLINIC FOUNDATION INC 1 LAHEY CLINIC INC 41 MALL ROAD BURLINGTON MA 018050001 042704683 HEALTHCARE MA 501(C)(3) 10 LAHEY CLINIC FOUNDATION INC 1 LAHEY HEALTH SHARED SERVICES INC 41 MALL ROAD BURLINGTON MA 01805 043178972 ADMINISTRATION MA 501(C)(3) 10 BETH ISRAEL LAHEY HEALTH INC 1 LONGWOOD MEDICAL INTERNATIONAL FOUNDATION INC 375 LONGWOOD AVENUE BOSTON MA 02215 043208878 INACTIVE CORPORATION MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 MEDICAL CARE OF BOSTON MANAGEMENT CORP DBA BETH ISRAEL DEACONESS HEALTHC 464 HILLSIDE AVENUE NEEDHAM MA 02492 042810972 OUTPATIENT, PRIMARY CARE AND SPECIALTY SERVICES MA 501(C)(3) 10 BETH ISRAEL LAHEY HEALTH PRIMARY CARE INC 1 MOUNT AUBURN HOSPITAL 330 MOUNT AUBURN STREET CAMBRIDGE MA 02138 042103606 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 MOUNT AUBURN PROFESSIONAL SERVICES INC 330 MOUNT AUBURN STREET CAMBRIDGE MA 02138 043026897 OFFERING MEDICAL CARE IN GENERAL AND SPECIALIZED PRACTICES MA 501(C)(3) 12A, I MOUNT AUBURN HOSPITAL 1 NEW ENGLAND BAPTIST HOSPITAL 125 PARKER HILL AVENUE BOSTON MA 02120 042103612 ORTHOPEDIC SPECIALTY HOSPITAL MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 NEW ENGLAND BAPTIST MEDICAL ASSOCIATES INC 125 PARKER HILL AVENUE BOSTON MA 02120 043235796 OUTPATIENT MEDICAL SERVICES TO THE VARIOUS COMMUNITIES SERVICED BY NEBH MA 501(C)(3) 3 NEW ENGLAND BAPTIST HOSPITAL 1 NORTHEAST BEHAVIORAL HEALTH CORPORATION 199 ROSEWOOD DRIVE DANVERS MA 01923 042777145 HEALTHCARE MA 501(C)(3) 10 BETH ISRAEL LAHEY HEALTH INC 1 NORTHEAST HEALTH SYSTEM INC 85 HERRICK STREET BEVERLY MA 01915 043240453 SUPPORT MA 501(C)(3) 12A, I LAHEY HEALTH SHARED SERVICES INC 1 NORTHEAST HOSPITAL CORPORATION 85 HERRICK STREET BEVERLY MA 01915 042121317 HEALTHCARE MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 NORTHEAST MEDICAL PRACTICE INC 85 HERRICK STREET BEVERLY MA 01915 043201853 HEALTHCARE MA 501(C)(3) 10 NORTHEAST HOSPITAL CORPORATION 1 NORTHEAST PROFESSIONAL REGISTRY OF NURSES INC DBA LAHEY HEALTH AT HOME 600 CUMMINGS CENTER BEVERLY MA 01915 201287349 HEALTHCARE MA 501(C)(3) 10 NORTHEAST SENIOR HEALTH CORPORATION 1 NORTHEAST SENIOR HEALTH CORPORATION 600 CUMMINGS CENTER BEVERLY MA 01915 042731137 HEALTHCARE MA 501(C)(3) LAHEY HEALTH SHARED SERVICES INC 1 SEACOAST AFFILIATED GROUP PRACTICE INC 25 HIGHLAND AVENUE NEWBURYPORT MA 01915 043485648 PHYSICIAN GROUP MA 501(C)(3) 10 ANNA JAQUES HOSPITAL INC 1 SEACOAST NURSING AND REHABILITATION CENTER INC 302 WASHINGTON STREET GLOUCESTER MA 01930 041305001 HEALTHCARE MA 501(C)(3) 10 LAHEY HEALTH SHARED SERVICES INC 1 THE ANNA JAQUES COMMUNITY HEALTH FOUNDATION INC 25 HIGHLAND AVENUE NEWBURYPORT MA 01950 043318952 FUNDRSG ORG MA 501(C)(3) 12A, I ANNA JAQUES HOSPITAL INC 1 THE JORDAN HEALTH SYSTEMS INC 275 SANDWICH STREET PLYMOUTH MA 02360 042103805 PROMOTE HEALTHCARE MA 501(C)(3) 7 BETH ISRAEL DEACONESS MEDICAL CENTER 1 WINCHESTER COMMUNITY ACCOUNTABLE CARE ORGANIZATION INC 41 HIGHLAND AVENUE WINCHESTER MA 01890 223137856 ACO MA 501(C)(3) 12A, I WINCHESTER HEALTHCARE MANAGEMENT INC 1 WINCHESTER HEALTHCARE MANAGEMENT INC 41 HIGHLAND AVENUE WINCHESTER MA 01890 222701817 MANAGEMENT MA 501(C)(3) 12A, I LAHEY HEALTH SHARED SERVICES INC 1 WINCHESTER HOSPITAL 41 HIGHLAND AVENUE WINCHESTER MA 018900000 042104434 HEALTHCARE MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 WINCHESTER HOSPITAL FOUNDATION INC 39 DOUBLET HILL ROAD WESTON MA 02493 043399570 SUPPORT MA 501(C)(3) 12A, I WINCHESTER HEALTHCARE MANAGEMENT INC 1 RADIATION THERAPY OF WINCHESTER LLC 700 CONGRESS ST SUITE 204 QUINCY MA 02169 205330549 MRI SERVICES MA WINCHESTER HOSPITAL EXCLUDED -168689 1706659 0 0 0.50000 GREATER NEWBURYPORT MANAGEMENT SERVICES ORGANIZATION INC 25 HIGHLAND AVE NEWBURYPORT MA 01950 161744477 MANAGEMENT SERVICES MA N/A C 0 HUNTINGFIELD CORPORATION C/O LAHEY CLINIC FOUNDATION INC 41 BURLINGTON MA 01805 TO HOLD OWNERSHIP OF SUBTERRANEAN RIGHTS. DE N/A C 0 JORDAN COMMUNITY ACO INC 275 SANDWICH STREET PLYMOUTH MA 02360 454047430 COORDINATED, SAFE AND COST EFFECTIVE PATIENT CARE AT BID-PLYMOUTH MA N/A C 0 LEDGEWOOD HEALTH CARE CORPORATION 87 HERRICK STREET BEVERLY MA 01915 042855189 NURSING HOME KY N/A C 0 NORTHEAST PROPRIETARY CORP 100 POWERS STREET BEVERLY MA 01915 042855191 MEDICAL SERVICES MA N/A C 0 WINCHESTER HEALTHCARE ENTERPRISES INC 611 MAIN STREET WINCHESTER MA 01890 042932059 MANAGEMENT SERVICES MA N/A C 0 WINCHESTER PHYSICIAN ASSOCIATES INC 41 HIGHLAND AVE WINCHESTER MA 01890 043262963 MANAGEMENT SERVICES MA N/A C 0 1 0 0 1 1 0 0 0 0 1 0 1 1 1 1 1 1 1 1 ACCOUNTABLE CARE ORGANIZATION Q 116219 FMV BETH ISRAEL LAHEY HEALTH INC P 18021879 FMV BETH ISRAEL DEACONESS MEDICAL CENTER P 154524 FMV LAHEY CLINIC INC P 1393691 FMV LAHEY CLINIC HOSPITAL P 159189 FMV LAHEY HEALTH SHARED SERVICES P 302669 FMV LAHEY HEALTH SHARED SERVICES P 328626 FMV LAHEY HEALTH SHARED SERVICES P 8007978 FMV LAHEY HEALTH SHARED SERVICES P 147231649 FMV LAHEY HEALTH SHARED SERVICES P 16565009 FMV NORTHEAST BEHAVIORAL HEALTH P 278004 FMV NORTHEAST HEALTH CORPORATION Q 938544 FMV WINCHESTER HEALTHCARE FOUNDATION Q 1680000 FMV WINCHESTER HEALTHCARE FOUNDATION Q 439216 FMV WINCHESTER PHYSICIAN ASSOCIATES INC Q 149712 FMV WINCHESTER PHYSICIAN ASSOCIATES INC Q 145229 FMV WINCHESTER PHYSICIAN ASSOCIATES INC Q 1094016 FMV WINCHESTER PHYSICIAN ASSOCIATES INC Q 4281653 FMV WINCHESTER PHYSICIAN ASSOCIATES INC Q 379854 FMV WINCHESTER PHYSICIAN ASSOCIATES INC Q 275559 FMV WINCHESTER PHYSICIAN ASSOCIATES INC Q 1038423 FMV LAHEY HEALTH SHARED SERVICES S 18582365 FMV