2020-08-11T11:51:05-07:00 2019-09-30 990 2018-10-01 042103581 HENRY HEYWOOD MEMORIAL HOSPITAL HENR 9786306106 242 Green Street Gardner MA 01440 Michael Abbatiello CFO / VP of Finance 9786306157 2020-04-30 209.160.147.198 2018 2020-09-23 17:36:50Z Heywood Hospital Michael Abbatiello 242 Green Street Gardner MA 01440 158257910 0 X www.heywood.org X 1907 MA To be our community's trusted choice for exceptional patient care. 21 18 1264 142 0 0 1991817 1530476 126273610 145004554 1578974 884140 2293257 3080564 132137658 150499734 206681 256111 0 0 65832671 68580975 65407 84000 518205 63208558 77488207 129313317 146409293 2824341 4090441 93519747 95608319 40553298 42090507 52966449 53517812 To be our community's trusted choice for exceptional patient care. 0 0 92329711 73532395 Heywood offers various outpatient services such as an Emergency Room, Outpatient oncology and hematology, advanced imaging, special procedures, rehabilitation services and many others on an outpatient basis. For FY 2019, there were 284,000 outpatient visits to the Hospital. 30327409 44345568 Heywood offers Inpatient services including telemetry, intensive care, maternity, pediatrics, geriatric and adult inpatient care and inpatient adult mental health. For FY 2019 the hospital provide 22,700 days of Inpatient Care. 16404123 19311931 Heywood has eleven specialty, and one Primary Care, provider based practices. The primary care practice focuses on Pediatrics and Family Practice, and the specialty care practices focus on the areas of Cardiology, Endocrinology, Gastroenterology, Gynecology/Obstetrics, Orthopedics, Pulmonology, Urology and General Surgery. In FY 2019, there were 89,583 visits to these practices. 0 0 0 139061243 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 0 1 173 0 1 1264 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 21 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Michael Abbatiello 9786306157 242 Green Street Gardner MA 01440 Robert Chauvin Trustee 0 0 X 0 0 0 Cheney Castine Treasurer 0 0 X X 0 0 0 Craig Twohey Trustee 0 0 X 0 0 0 Daniel Asquino Trustee 0 0 X 0 0 0 Donald Mruk Trustee 0 0 X 0 0 0 Glenn Hunt Chairman 0 0 X X 0 0 0 James Garrison Trustee 0 0 X 0 0 0 James Meehan Trustee 0 0 X 0 0 0 JoAnne Parks Clerk 0 0 X X 0 0 0 Joel Shaughnessy Trustee 0 0 X 0 0 0 John Flick Trustee 0 0 X 0 0 0 John Skrzypczak Trustee 0 0 X 0 0 0 Joyce Fletcher Trustee 0 0 X 0 0 0 Kenneth Pierce Trustee 0 0 X 0 0 0 Michelle Parks Trustee 0 0 X 0 0 0 Roy Lake Trustee 0 0 X 0 0 0 Tina Sbrega Trustee 0 0 X 0 0 0 Albert Rose Trustee 0 0 X 0 0 0 Winfield Brown CEO / President 40.00 0 X X 879061 0 79628 Elizabeth Nottleson Trustee / Physician 0 28 X 0 283139 20272 Benjamin Prentiss Trustee / Physician 0 36 X 0 68103 5157 Robert Crosby Officer / CFO 40 0 X 377571 0 61396 Ellen Ray Chief of Emergency Room Medicine 40 0 X 637490 0 70415 Andrew Cocchiarella Director of Anesthesia Services 40 X 834499 0 54675 Daniel Wilson ER Physician 30 0 X 614485 0 45582 Sarah Gilbert ER Physician 30 0 X 434385 0 119615 Saleem Khanani Oncology Physician 36 0 X 493914 0 56906 4271405 351242 513646 121 0 1 0 Quartulli & Associates PO Box 423 Gardner MA 01440 Physical Therapy 2911400 Alliance Healthcare Services 18201 Von Karman Ave Ste 600 Irving CA 92612 MRI Services 1739435 New England Inpatient Specialists 47 High St Ste 101 North Andover MA 01845 Hospitalist services 1228236 Spine and Pain Care Center 242 Green Street Gardner MA 01440 Physician Services 1199704 Charles M Moran 54 Allen St Clinton MA 01510 Plumbing & Heating Services 952591 45 0 0 61085 113512 1203737 152142 0 1530476 Ancillary OP Services 622110 92826844 92826844 0 0 Anciliar and Routine IP Services 622110 44352705 44352705 0 0 HMG Patient Revenue (Net) 621111 3806201 3806201 0 0 Contracted Services Revenue 900099 3481920 3481920 0 0 Physician Hospital Service Revenue 900099 415346 415346 0 0 121538 121538 0 0 145004554 612377 0 0 612377 0 0 0 0 0 0 0 0 406401 0 0 0 406401 0 406401 0 0 406401 7895105 249 7581668 41923 313437 -41674 271763 0 0 271763 169077 61085 134585 34492 0 34492 0 0 0 0 0 0 0 0 0 0 0 0 Pharmacy 340B Contracted Revenue 900099 1304987 0 0 1304987 Meal Revenue 900099 824629 0 0 824629 Purchase Discounts 900099 210563 0 0 210563 299492 0 0 299492 2639671 150499734 145004554 0 3964704 X 255361 255361 750 750 0 0 0 0 2627762 1240983 1245674 141105 0 0 0 0 54214739 52493824 1557749 163166 963571 834632 104106 24833 6370113 5848522 479929 41662 4404790 4147885 232488 24417 0 0 0 0 342517 12066 330451 0 187899 0 187899 0 0 0 0 0 84000 84000 0 0 0 0 29524456 29320840 203616 0 204122 201003 3119 0 18749017 18585451 157487 6079 1774592 1684031 89105 1456 0 0 0 0 2709669 2573821 135848 0 99000 73410 25554 36 0 0 0 0 191354 153294 37861 199 495185 495185 0 0 0 0 0 0 3357837 3340705 16367 765 742469 618019 124450 0 Bad Debt 6778177 6778177 0 0 Other Outside Fees 4372665 3426243 922214 24208 Free Care 1825405 1825405 0 0 Subscriptions & Dues 1296141 418865 861502 15774 4837702 4732771 114426 -9495 146409293 139061243 6829845 518205 3978349 3637618 0 0 341313 219483 14415401 15225323 0 0 0 0 33928 0 1791744 1924145 599365 1539278 110493404 65916010 43628405 44577394 24691675 25382170 1066749 1215367 169206 180644 0 0 2803612 1706897 93519747 95608319 15374415 15956241 0 0 333889 532509 19838464 19746884 0 0 0 0 112087 2154673 0 0 4894443 3700200 40553298 42090507 X 48704695 49326832 3255251 3184372 1006503 1006608 52966449 53517812 93519747 95608319 X 4090441 -582249 0 0 0 -2956829 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 24317164 5932 780373 0 176658 0 24926811 25599932 4030 1873273 0 3160071 0 24317164 22460789 2504 2793312 0 -343327 0 25599932 20377782 0 1888246 0 -194761 0 22460789 20170666 18245 -665620 0 -854491 0 20377782 0.8894 0.0404 0.0702 0 0 0 210871 210871 0 67649820 31865961 35783859 0 0 0 0 0 37864308 32574630 5289678 0 4768405 1475419 3292986 44577394 0 Estimated Settlements with Third Party Payors 2042136 Estimated Malpractice Liability 1658064 3700200 X Schedule D, Part V, Line 4 Permanent Endowment funds are established by donor restricted gifts and maintained to provide a permanent source of income, the principal of which is kept in perpetuity. Board Designated Endowment funds are established by the governing body to fund capital projects and/or improvements of the organization. Temporary restricted funds are established by donor restricted gifts that maintain a source of income for a specific period of time. Schedule D, Part X, Line 2 Heywood Healthcare, Heywood Hospital, Athol, HMGI, Charitable Foundation, Quabbin, and NMTC have been determined to be not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the "Code"), and the Realty Corp. has been determined to be a not-for-profit corporation as described in Section 501(c)(2) of the code. All of the entities are exempt from federal income taxes on related income pursuant to Section 501(a) of the code. The Organization annually evaluates its tax status and tax positions taken with respect to its operations and financial position. Under Accounting Standards Codification ("ASC") 740, an organization must recognize the financial statement effects of a tax position taken for tax return purposes when it is more likely than not that the position will not be sustained upon examination by a taxing authority. The Organization does not believe it has taken any material uncertain tax positions, and accordingly, it has not recorded any liability for unrecognized tax benefits. Additionally, the Organization has filed IRS Form 990 information returns, as required, and all other applicable returns in jurisdictions where so required. For the years ended September 30, 2019 and 2018, there were no interest or penalties recorded or included in the consolidated statement of operations. X X X X X X X 1 JNB & Associates 21 Water St Amesbury MA 01913 Fundraising Consultant 0 0 84000 -84000 0 84000 -84000 MA Golf Classic 117125 45725 71400 0 13171 18001 25965 1550 6150 Winter Affair 73203 15120 58083 0 2546 4773 19103 4694 8099 3 54834 240 54594 510 826 3044 1864 1600 22689 245162 61085 184077 510 16543 25818 46932 7844 36938 134585 49492 1 1 X 1 X 1 X 1 1 0 1 1 1968765 888284 1080481 0.0074 27204965 24098046 3106919 0.0212 0 0 0 0 0 0 29173730 24986330 4187400 0.0286 1990430 23222 1967208 0.0135 414038 0 414038 0.0028 0 0 0 0 0 0 0 0 108922 0 108922 0.0007 0 0 2513390 23222 2490168 0.0170 0 0 31687120 25009552 6677568 0.0456 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4445 0 4445 0.00 173860 0 173860 0.0012 2000 0 2000 0.00 367065 0 367065 0.0025 0 0 0 0 0 0 547370 0 547370 0.0037 1 2710022 21409 31140814 28242772 2898042 X 1 1 1 1 Henry Heywood Memorial Hospital 242 Green Street Gardner MA 01440 www.heywood.org MA License # 2036 X Henry Heywood Memorial Hospital 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X www.heywood.org/about/community-benefit X www.chna9.com/resources.html X X 1 18 1 www.heywood.org/about/community-benefit 0 0 1 X 150 300 X 1 1 X X X X 1 X www.heywood.org/financialservices X www.heywood.org/financial services X www.heywood.org/financialservices X X X X X 1 X X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Henry Heywood Memorial Hospital In 2018, Heywood Healthcare conducted a comprehensive Community Health Needs Assessment (CHNA). A priority of the health assessment is to understand the needs of under-resourced populations and to identify and prioritize health issues and related socioeconomic determinants of health. Health disparities, health equity, and "communities within communities" received special attention during the assessment. Supplemental qualitative data collected from 596 Surveys, 17 Focus Groups, and 12 Healthcare Professional Interviews provided information and perceptions from under-represented racial/ethnic, socioeconomic, and geographic groups. Schedule H, Part V, Section B, Line 6a-Henry Heywood Memorial Hospital The CHNA was a collaborative effort conducted by Heywood Hospital and Athol Hospital. The assessment focuses on the 15 primary communities served by Heywood and Athol Hospitals. The data was analyzed and presented in three ways the Heywood Healthcare total service area of 15 communities, the Heywood Hospital service area of 6 towns, and the Athol Hospital service area of 9 communities. Schedule H, Part V, Section B, Line 6b-Henry Heywood Memorial Hospital A collaboration among Mont Reg Plan Comm, UMASS Mem, Health Alliance Clinton Hosp, Comm Hlth Ntwk of Nrth Cent MA and John Snow Inc. Quantitative data came from MA Comm Hlth Info Profile, MA Dpt of Pub Hlth; Youth Risk Behav Survey data; US Census data, including data from the Amer Comm Survey and other Cmmwlth and Fed Govt orgs. Staff at MRPC was responsible for conducting research. The Comm Bene Leadership Team made up of dpt heads from Athol and Heywood Hosps, Nrth Quabbin Comm Coalit, CHNA9 Grp, and other comm partners. Leadership Team members assisted with reviewing rpts. Other orgs assisting to the review include the Nrth Quabbin Recov Plan Grp; Jail to Comm Task Force; Children's Hlth and Wellness; Multicult Task Force; GAIT; Substance Abuse Task Force; GGRC; Schwartz Cntr Rnds; Greater Gardner Chamb of Comm; Heywd Sr Team; Reg Behav Hlth Collab; Gardner MENders Sup Grp; Mont Suicide Prev Task Force; North Quabbin Comm Coalit; Comm Hlth Conn Bd; Mont Public Hlth Ntwk and CHNA9 Schedule H, Part V, Section B, Line 7d-Henry Heywood Memorial Hospital Hospital staff presented the CHNA findings with community members, stakeholders, and partners and solicited input in response to the CHNA to help inform the development of a Community Health Improvement Plan (CHIP). Numerous community groups provided feedback on the assessment findings and helped to identify priority health focus areas and strategies. These groups included the Multicultural Task Force; Gardner Area Interagency Team; Substance Abuse Task Force; Greater Gardner Religious Council; Schwartz Center Rounds; Heywood Leadership Team; Regional Behavioral Health Collaborative; Athol and Heywood Hospital Medical Ethics; Athol and Heywood PFAC; Montachusett Suicide Prevention Task Force; North Quabbin Community Coalition; Heywood Charitable Foundation Community Investment Committee and CHNA-9. Schedule H, Part V, Section B, Line 11-Henry Heywood Memorial Hospital The Community Health Improvement Plan (CHIP) prioritizes health focus areas (Social Determinants, Interpersonal Violence and Injuries, Mental Health and Substance Use, and Wellness and Chronic Disease). It identifies at risk populations (racial and ethnic minorities, older adults, veterans, low socioeconomic, and youth/adolescents). The CHIP outlines the strategies and community partners the hospital will partner with to respond to the health needs. Heywoods approach to addressing the critical health needs is to collaborate with crosssector coalitions, healthcare and behavioral health providers, community, and faith-based organizations and businesses to develop and implement our plan, goals, and strategies. We engage community-based organizations, our P.F.A.C, and the Community Benefits Advisory Committee in the development of the CHIP To ensure that the CHIP has input from persons who represent the broad interests and special knowledge of the significant health needs of our community Schedule H, Part V, Section B, Line 12a-Henry Heywood Memorial Hospital LINE 11: Social Determinants of Health: Assisted 58 community members to overcome barriers and address psycho-social needs by providing information and referrals on issues related to housing, food, transportation, behavioral, and substance abuse. Provided financial and health insurance information and enrollment assistance to 4,048 individuals reducing financial barriers to accessing healthcare. Assisted and paid for legal services (such as healthcare proxy, guardianship, advanced directives) for 14 patients who did not have the means to pay. Assisted 260 patients with transportation, and as a result, they were able to follow up with their healthcare and prevented missed appointments. Provided over 30,000 hours of mentorship to 200 students pursuing careers in healthcare and subsequently hired six into permanent paid positions Schedule H, Part V, Section B, Line 12b-Henry Heywood Memorial Hospital LINE 11: Interpersonal Violence and Injuries: Convened the Regional Behavioral Health Collaborative (RBHC), a multi-sector partnership of school, emergency responders, social service organizations, medical, and behavioral health providers. The RBHC organized the implementation of Handle With Care (HWC)- an initiative to address and minimize the adverse effects of childhood trauma. The RBHC hosted trainings to increase the partnership's knowledge of the HWC model, adverse childhood experiences, and how to provide trauma-informed care. Subsequently, the police, school districts, and community partners in the towns of Ashburnham, Westminster, Gardner, Templeton, Petersham, and Winchendon developed the processes for identifying, communicating, and providing appropriate trauma-informed supports for the student and family exposed to trauma Schedule H, Part V, Section B, Line 13-Henry Heywood Memorial Hospital LINE 11: Mental Health/Substance Use: Spearheaded the Montachusett Suicide Prev Task Force providing ed., resources, and support groups. They trained 52 community members on Mental Health First Aid and increased ability to identify, understand, and respond to signs of mental illnesses/substance use disorders. They trained 100 community members on opioid overdose prev and Narcan administration. Offered support groups for military families, men who struggle with depression, those who have lost loved ones to suicide and for survivors of suicide, providing peer exchange and coping skills for managing symptoms associated with mental illness/substance use. Community Health Workers, located in Narragansett and Gardner School Districts, provided school based care coordination/behavioral health supports. 271 youth with mental health counseling either in person or via tele-behavioral health and helped over 140 families with accessing community-based services such as food, fuel, and housing assistance Schedule H, Part V, Section B, Line 13d-Henry Heywood Memorial Hospital LINE 11: Wellness and Chronic Disease: Partnered with the Gardner Public School District to distribute 7,600 backpacks with nutritious food for the weekend distributed weekly to 190 low- income youth and their families. Offered wellness instruction and self-care techniques to 240 individuals to manage symptoms associated with having a chronic condition. Schedule H, Part I, Line 7 The costing methodology used to calculate the amounts reported in the table in Part I, for lines 7a through 7c was based on the cost to charge ratio derived from the supplied Worksheet 2, in the IRS schedule H instructions. Schedule H, Part I, Line 7, Column f 6,778,177 Schedule H, Part I, Line 7g not applicable Schedule H, Part II The Heywood Hospital's Community Benefits Mission Statement is "Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the specific health needs of the under-served and collaborating with others to enhance quality and contain the growth of community healthcare costs." Schedule H, Part III, Section A, Line 2 The costing methodology used for line 2 was based on the cost charge ratio derived from the supplied worksheet 2 in the IRS Schedule H instructions. The methodology used for line 3 was to take the percentage of financial assistance applications that were due to inadequate documentation divided by the total applications received for FY 2019. This amounted to approximately 0.79% which was applied against the number on line 2. As a tax exempt hospital, we must provide necessary services regardless of the patient's ability to pay for the service provided. As a not for profit, patient care is provided to all, regardless of ability to pay for that care, making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as community benefit. Schedule H, Part III, Section A, Line 3 The costing methodology used for line 2 was based on the cost charge ratio derived from the supplied worksheet 2 in the IRS Schedule H instructions. The methodology used for line 3 was to take the percentage of financial assistance applications that were due to inadequate documentation divided by the total applications received for FY 2019. This amounted to approximately 0.79% which was applied against the number on line 2. As a tax exempt hospital, we must provide necessary services regardless of the patient's ability to pay for the service provided. As a not for profit, patient care is provided to all, regardless of ability to pay for that care, making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as community benefit. Schedule H, Part III, Section A, Line 4 The footnote can be found on page 17 of the financial statements. Schedule H, Part III, Section B, Line 8 There is no shortfall. The allowable costs on line 6 were obtained from our FY 2019 Medicare Cost Report, Worksheet D schedules. Schedule H, Part III, Section C, Line 9b Heywood Hospital provides patients with information about financial assistance programs that are available through the Commonwealth of MA or through Heywood Hospital's own financial assistance program, which may cover all or some of their unpaid hospital bills. For those patients that request such assistance, Heywood Hospital assists patients by screening them for eligibility in an available public program and assisting them in applying for the program. These programs include but are not limited to MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start, Health Safety Net and others. It is the patient's obligation to provide Heywood Hospital with accurate and timely information to determine if the patient is eligible to apply for certain health insurance programs. If the patient of guarantor is unable to provide the necessary information, Heywood Hospital may make reasonable efforts to obtain any additional information from other sources. Information the Hospital obtains will be maintained in accordance with applicable federal and state privacy and security laws. The screening and application process for public health insurance programs is done through Virtual Gateway, which is an internet portal designed by the MA Executive Office of Health and Human Services. The Virtual Gateway manages the application process from the programs listed above, which is available for children, adults, seniors, veterans, homeless and disabled individuals. Heywood specifically assists the patient in completing the application and secure the necessary documentation required by the applicable financial assistance program. Heywood Hospital will then submit this document to the Commonwealth Office of Medicaid and assist the patient in any additional documentation if such is required by the Commonwealth of MA, Office of Medicaid. Special circumstance applications are reviewed and approved by the MA Division of Health Care Finance and Policy. The Hospital has no role in determination of program eligibility made by the Commonwealth, but at the patient's request may take a direct role in appealing decisions made by the Commonwealth to ensure accurate and timely adjudication of all hospital bills. If the patient does not comply with the requests for documentation, then our standard collection procedures apply. Schedule H, Part VI, Line 2 Needs Assessment: In addition to conducting the CHNA, the organization monitors hospital data and actively engages with the hospital leadership team and Community Benefits Advisory Committee to continuously monitor and assess any changing or emerging community and healthcare needs. Schedule H, Part VI, Line 3 Role of Hospital Certified Financial Counselors and other Finance Staff: The hospital will try to identify available coverage options for patients who may be uninsured or underinsured with their current insurance program when the patient is scheduling their services, while the patient is in the hospital, upon discharge, and for a reasonable time following discharge from the hospital. The hospital will direct all patients seeking available coverage options, or those that the hospital determines may be eligible, to the hospital's patient financial counseling to screen for eligibility in an appropriate coverage option. The hospital will then assist the patient in applying for the appropriate coverage options that are available or notify them of availability of financial assistance through the hospital's own internal financial assistance program, if available. Notification Practices: Individual printed notices are available by contacting a Financial Counselor or through the Patient Accounts Office. Notices indicate the criteria used to determine eligibility for MassHealth and the Health Safety Net Trust Fund and where or how patients may apply. The goal of these notices is to assist patients in applying for coverage within a financial assistance program such as MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start, and Health Safety Net. When applicable, the hospital may also assist patients in applying for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. When a patient contacts the hospital, Patient Accounting, Financial Counseling or Social Service Staff will attempt to identify if a patient qualifies for a public financial assistance program or payment plan. Patients who are already enrolled in a public financial assistance program, such as MassHealth or Health Safety Net, may qualify for certain federal, state and private assistance agencies. Patients may also qualify for additional assistance based on the hospital's own internal criteria for financial assistance, or qualify for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. The following items outline more specifically the notification process, criteria, and availability of information beyond the signs that are posted in the hospital. 1. The hospital will provide an individual notice of the availability of financial assistance programs and other programs of public assistance to a patient expected to incur charges for which he/she will be personally responsible, exclusive of personal convenience items or services that may not be paid in full by third party coverage. 2. The hospital or its agents will include a notice or statement about Eligible Services to Low Income Patients and other programs of public assistance in its initial bill and subsequent correspondence with the patient. All correspondence will direct the patient where and how they can receive more information or additional assistance and will inform the patient that they may apply or reapply for financial and public assistance before, during or after care, or after collection agency assignment if their situation changes. 3. The hospital will include a notice regarding the availability of financial assistance and other programs of public assistance to Low Income Patients in all written collection actions. The hospital will notify the patient that it offers a payment plan if the patient is determined to be eligible for MassHealth or free care/uncompensated care through the Health Safety Net Trust Fund as a low income patient or due to Medical Hardship. These payment plans are consistent with 1016 CMR 6613.08 (1)(f)(4). The hospital will also offer payment plan options for those individuals who do not qualify for Low Income Patient status. 4. Heywood Hospital will include language on its written notices that reads: "You may be eligible for assistance through our Financial Assistance Program. For eligibility information, please contact our Customer Services Department at 1-800-305-6757." Verbiage may change to accommodate changes of department information. 5. There is no primary language other than English that is spoken by 5% or more of the hospital's service area. Signage and other documentation will be provided in English. The hospital provides translator services for several other languages and this service may be accessed for those individuals whose primary language is not English or Spanish. 6. For cases where the hospital continues to determine eligibility for free care/uncompensated care through the Health Safety Net Trust Fund application, then MassHealth will provide written notice of determination that the patient is or is not eligible within 30 days of receiving a completed application and the required supporting documentation. The vast majority of patients will however be screened via the common intake process and processed through the Virtual Gateway and MA-21 system. 7. Whether the hospital is using the MassHealth application process through the Virtual Gateway or submitting a MassHealth application directly, the hospital will assist the patient in completing the application or intake process for enrollment and eligibility screening. Schedule H, Part VI, Line 4 Community Information: The primary service area served by Heywood Hospital includes Gardner, Templeton, Winchendon, Ashburnham, Westminster, and Hubbardston. The Service Area varies significantly in terms of the demographics, social, and economic factors. Due to these factors, the health disparities and inequities experienced by people in the region vary widely from community to community. The overall population of the Service Area has grown a modest 6% since 2000. This rate is less than the US overall (9.7%), but double that of the Commonwealth of MA (3.1%). It is essential to note the change in racial makeup over time and the growth of the Hispanic/Latino population between 2000 and 2016, especially in Gardner. The Service Area has a median age seven years higher than the State and Nation, including a more significant number of those aged 65 and older living alone and increased 7% between 2010 and 2016. The rural nature of Heywood Hospital's communities and the social isolation of older adults living alone make it more challenging to access basic daily needs. The Social and Economic inequities experienced by people in the region vary widely from community to community. There are lower poverty rates overall throughout the Service Area compared to the State and Nation, but pockets of poverty persist throughout. Gardner has the highest poverty rate at 19%, compared to the MA rate of 11.4%. Gardner's childhood poverty rates have increased by 6.4% and 22.6%, respectively, since the last CHNA in 2015 with data from 2013 and 2016. Overall, wages in the Service Area have increased by nearly $200 million since 2000, but wages have decreased significantly in select communities. Veterans in the Service Area are better off when compared to the State and Nation when it comes to health outcomes and financial stability. However, disparities in unemployment and disability compared to non-veterans are prevalent throughout the Service Area. Schedule H, Part VI, Line 5 Promotion of Community Health: Heywood Hospital's approach to addressing the critical health needs identified by the CHNA is to participate on cross-sector coalitions actively and collaborate with healthcare and behavioral health providers, community, and faith-based organizations and businesses. These collaborations help to develop and implement our plan, goals, and strategies. Partners include CHNA9; Gardner Area Interagency Team (GAIT); Suicide Prevention Task Force; Regional Behavioral Health Collaborative; North Central MA Minority Coalition; Health Disparities Collaborative; Community Health Connections FQHC; GVNA Healthcare; Community Health Link; LUK, Inc.; AED Foundation; SHINE Initiative; Gardner Community Action Team (GCAT); Montachusett Opioid Prevention Coalition (MOPC); Greater Gardner Religious Council; Unitarian Church; Gardner CAC; HOPE House; Gardner, Ashburnham, Narragansett, Winchendon, and Westminster Public School Districts; Montachusett Vocational Technical High School; The Winchendon School; Mount Wachusett Community College; Fitchburg State University; Framingham State University; Bates College; Gardner Rotary Club; Greater Gardner and North Central MA Chamber of Commerce; Fitchburg and Gardner Housing Authority; United Way of North Central MA; Hannaford Supermarkets; Gardner News. Schedule H, Part VI, Line 6 Heywood Hospital is part of Heywood Healthcare, an independent, community-owned healthcare system serving north-central Massachusetts and southern New Hampshire. It is comprised of Heywood Hospital, Athol Hospital, a 25-bed not-for-profit, Critical Access Hospital in Athol, MA; Heywood Medical Group, with primary care physicians and specialists located throughout the region; and the Quabbin Retreat, our premier destination for treatment of mental health and substance misuse. The organization includes six satellite facilities in MA; Heywood Rehabilitation Center, Heywood Family Medicine and Urgent Care in Gardner; Winchendon Health Center and Murdock School-based Health Center in Winchendon; Tully Family Medicine and Walk-in in Athol; and West River Health Center in Orange. The organization also includes the Heywood Healthcare Charitable Foundation. Schedule H, Part VI, Line 7 Community Benefit Report is filed with the Attorney General's Office, State of Massachusetts. https://www.heywood.org/about/community-benefit 1 Montachusett Home Care Corp 680 Mechanic St Leominster MA 01453 042551175 501(c)(3) 36414 0 cash home care-elderly & disabled Boys and Girls Club of Fitchburg 365 Lindell Ave Leominster MA 01453 135562976 501(c)(3) 10000 0 cash general support of youths United Way of North Central MA 649 John Fitch Highway Fitchburg MA 01420 042233021 501(c)(3) 10000 0 cash general support Heywood Healthcare Charitable Foundation Inc 242 Green Street Gardner MA 01440 222720562 501(c)(3) 120000 cash support local organizations 0 4 Schedule I, Part I, Line 2 Heywood Hospital has reporting systems in place to monitor grantee expenditures within each budget period and within the overall project period. This includes the requirements that grantees submit mid-year and end of year grant reports, to include a detailed report on the project budget expenditures. Heywood Hospital's Community Investment Committee reviews mid and end of year reports for financial and operational compliance to assure that use of funds are consistent with the approved project and budget. Montachusett Home Care Corp files an annual report with the Office of Healthy Communities that contains a summary of how funds are allocated. X 0 1 X X X X X X 0 0 0 0 0 1 0 0 0 Winfield Brown CEO / President 527347 0 71091 0 280623 0 24000 0 55628 0 958689 0 0 0 Elizabeth Nottleson Trustee / Physician 0 271951 0 0 0 11189 0 5487 0 14785 0 303412 0 0 Robert Crosby Officer / CFO 305215 0 29856 0 42500 0 24000 0 37396 0 438967 0 0 0 Andrew Cocchiarella Director of Anesthesia Services 704549 0 68250 0 61700 0 4274 0 50401 0 889174 0 0 0 Ellen Ray Chief of Emergency Room Medicine 546095 0 68095 0 23300 0 24000 0 46415 0 707905 0 0 0 Daniel Wilson ER Physician 505753 0 55720 0 53012 0 0 0 45582 0 660067 0 0 0 Sarah Gilbert ER Physician 377505 0 55680 0 1200 0 21959 0 40956 0 497300 0 0 0 Saleem Khanani Oncology Physician 493914 0 0 0 0 0 13773 0 43133 0 550820 0 0 0 Schedule J, Part I, Line 1a Social Club membership dues were paid for Winfield Brown, CEO, per his employment contract. Schedule J, Part I, Line 1b There is no written policy for payment of Social Club Membership dues, this is paid based off an employment contract with the CEO/President. Schedule J, Part I, Line 3 Other Reportable Compensation - Mr. Winfield Brown, CEO, and Mr. Robert Crosby, CFO received deferred compensation payments, which are subject to multi-year vesting upon fulfilling ongoing contractual obligations. Schedule J, Part I, Line 6 Heywood Hospital accrued bonuses for the executive teams salary and 25% of the CEO's salary as part of an incentive compensation program and service goals set by the Hospital. A MA Health and Educ Facility 042456011 57586EGT2 2019-03-21 17785000 Funds used for new inpatient building 0 0 0 B MA Health and Educ Facility 042456011 57586C7E9 2008-06-19 6715000 Refinancing used for new IP Building 0 0 0 A 0 0 66235 0 0 0 281690 0 0 17569545 0 0 2010 0 0 1 1 B 0 0 19154 0 0 0 329467 0 3597891 2806796 0 0 2008 1 0 1 1 A 0 0 0 0 0 0 0 1 0 1 B 0 0 0 0 0 0 0 1 0 1 A 0 0 0 1 1 1 Td Bank 18.7 0 0 0 0 1 B 0 0 0 1 1 1 Piper Jaffery 18.7 0 0 0 0 1 A 0 B 0 Schedule K, Part IV, Line 2c-03/21/2019 17,785,000 MA Health and Educ Facility The rebate computation was performed on 10/31/2018 Schedule K, Part IV, Line 2c-06/19/2008 6,715,000 MA Health and Educ Facility The rebate computation was performed on 10/31/2018 Eliot Nottleson spouse of trustee - E.Nottleson 151692 salary as a physician assistant 0 Kaitlin Fletcher family member of trustee 85764 salary as RN 0 Form 990, Part VI, Section B, Line 11b The Accounting Department at Heywood Hospital prepares the Form 990 and provides to the Controller for review. The form is then sent to the CFO for final review. Once reviewed, the 990 is received by the Board of Trustees. The 990 is then submitted to the IRS by the Accounting Department. Form 990, Part VI, Section B, Line 12c Annually, a Conflict of Interest form is sent out to the managers, trustees and employees with broad discretionary authority. These forms are required to be signed and are monitored by the Corporate Compliance office for completion. Form 990, Part VI, Section B, Line 15 * The Board of Directors holds the sole responsibility for establishing the compensation of Heywood Healthcare's CEO. The Compensation Committee is responsible for the review and recommendation of the CEO's compensation. The Compensation Committee engages an independent compensation consultant who prepares an evaluation of compensation of CEO's of comparable institutions. The compensation committee also reviews and approves the CEO's recommendation of compensation for the Senior Leadership team. This analysis includes information from the independent compensation consultant's evaluation of compensation of key employees on our Senior Leadership team compared to similar institution's. The types of comparable data that were used to determine the fair market value for our CEO and key employees of our Senior Leadership team includes services and the nature of any decisions made so as to establish a rebuttable presumption of reasonableness for compensation for a disqualified individual. Form 990, Part VI, Section C, Line 19 The Organization makes the governing documents, conflict of interest policy and financial statements available to the public by providing completed copies to the Administrative Assistant, who provides copies upon request. Form 990, Part IX, Line 11g Other Non-Employee Fees for Services consist of the following: Outside Physician Fees $12,437,983 / Outside Clinical Fees $ 5,666,379 / Temp Employees $ 70,030 / Medical Staff $19,439 / Other Fees for Services $11,323,625 Form 990, Part XI, Line 9 The amount that makes up the other changes in net assets or fund balance is from discounts on pledge receivables, $11,419, and transfers to related organizations to support their operations, $2,968,248 Heywood Healthcare Inc (HHI) 242 Green St Gardner MA 01440 222720658 Parent Corp MA 501(c)(3) 12b N/A 0 Athol Memorial Hospital 2033 Main St Athol MA 01331 042126583 Critical Access Hospital MA 501(C)(3) 3 Heywood Healthcare Inc 0 Herywood Medical Group 242 Green St Gardner MA 01440 043136589 Multi Specialty Physicians MA 501(c)(3) 10 Heywood Helathcare Inc 0 Quabbin Healthcare Inc 242 Green St Gardner MA 01440 812053488 Behavioral Health MA 501(C)(3) 12b Heywood Healthcare Inc 0 Heywood Realty Corp 242 Green St Gardner MA 01440 043327447 Property Holding Corp MA 501(c)(2) Heywood Healthcare Inc 0 Heywood Healthcare Charitable Foundation Inc 242 Green St Gardner MA 01440 222720562 Charitable Foundation MA 501(c)(3) 7 Heywood Healthcare Inc 0 Athol Memorial Hospital NMTC Holdings Inc 2033 Main St Athol MA 01331 822171549 Supports Athol Hospital MA 501(c)(3) 12a Heywood Healthcare inc 0 HHMH Aid Association 242 Green St Gardner MA 01440 042198019 raising funds for hospital MA 501(c)(3) 10 N/A 0 Winchendon Health Foundation 87 Central St Winchendon MA 01475 042113276 supports organization MA 501(c)(3) PF N/A 0 0 1 1 0 0 0 1 0 0 1 1 1 1 1 1 1 1 1 1 Heywood Realty Corp k 290186 cost per square foot Heywood Realty Corp m 208500 contract Filed extension and received approval