2020-08-17T13:34:46-05:00 2019-09-30 263753134 CBIZ MHM LLC 500 BOYLSTON STREET BOSTON MA 02116 990 2018-10-01 042103590 THE LOWELL GENERAL HOSPITAL LOWE 9789376000 295 VARNUM AVENUE LOWELL MA 018542193 WILLIAM WYMAN SR. VP OF FINANCE 9789376000 2020-08-12 1 BRENDA L BOOTH P01342395 6177610600 2020-08-12 207.172.72.163 2020-08-12 08:22:46 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AAFE5242E44AA74A98A743050A15125E154A43A4 2018 2020-11-06 18:47:13Z JOSEPH WHITE 295 VARNUM AVENUE LOWELL MA 018542193 570431173 0 X WWW.LOWELLGENERAL.ORG X 1939 MA TO MEET THE HEALTHCARE NEEDS OF COMMUNITIES SERVED THROUGH THE PROVISION OF INPATIENT AND OUTPATIENT MEDICAL SERVICES. TO PROVIDE SERVICES, PROGRAMS AND INITIATIVES TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE CITIZENS IN THE AREA, WITH A PARTICULAR FOCUS ON PEOPLE WHO ARE MEDICALLY UNDERSERVED, AT RISK, OR FINANCIALLY DISADVANTAGED. 16 14 4442 300 -1223888 0 3162248 3877996 470427050 466976860 9172790 2409315 13986355 11887407 496748443 485151578 458789 503974 0 0 229017093 230929189 0 0 963360 226604404 227187999 456080286 458621162 40668157 26530416 488997334 455209859 328005960 317420782 160991374 137789077 X TO MEET THE HEALTHCARE NEEDS OF COMMUNITIES SERVED THROUGH THE PROVISION OF INPATIENT AND OUTPATIENT MEDICAL SERVICES. TO PROVIDE SERVICES, PROGRAMS AND INITIATIVES TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE CITIZENS IN THE AREA, WITH A PARTICULAR FOCUS ON PEOPLE WHO ARE MEDICALLY UNDERSERVED, AT RISK, OR FINANCIALLY DISADVANTAGED. 0 0 147508264 503974 216280792 LGH'S OUTPATIENT AND ANCILLARY SERVICES INCLUDE EMERGENCY DEPARTMENT (LEVEL III TRAUMA SERVICES), IMAGING/RADIOLOGY (INCLUDING MRI, CT, ULTRASOUND, MAMMOGRAPHY), LABORATORY, CARDIAC TESTING AND CATHETERIZATION, ENDOSCOPY, SURGERY, REHABILITATION THERAPIES, RADIATION ONCOLOGY AND CHEMOTHERAPY, AND A NUMBER OF OTHER SERVICES NEEDED TO SUPPORT INPATIENT AND OUTPATIENT CARE.OUTPATIENT STATISTICSEMERGENCY ROOM VISITS: 98,714OUTPATIENT VISITS: 406,799OUTPATIENT SURGERIES: 8,222RADIATION TREATMENTS: 12,199 201304441 263732149 THE LOWELL GENERAL HOSPITAL'S PRIMARY SERVICE AREA ("PSA") IS COMPRISED OF THE FOLLOWING NINE COMMUNITIES: BILLERICA, CHELMSFORD, DRACUT, DUNSTABLE, LOWELL, TEWKSBURY, TYNGSBORO AND WESTFORD, MASSACHUSETTS, AND PELHAM, NEW HAMPSHIRE, WITH A TOTAL OF APPROXIMATELY 291,000 RESIDENTS. THE HOSPITAL'S SECONDARY SERVICE AREA ("SSA") HAS A POPULATION OF ALMOST 340,000 AND INCLUDES THE SURROUNDING MUNICIPALITIES OF ANDOVER, CARLISLE, GROTON, LAWRENCE, LITTLETON, METHUEN, NORTH ANDOVER, PEPPERELL AND WILMINGTON, MASSACHUSETTS, AND HOLLIS, HUDSON AND NASHUA, NEW HAMPSHIRE. THE HOSPITAL OFFERS THE LATEST TECHNOLOGY AND A FULL RANGE OF MEDICAL, SURGICAL AND CRITICAL CARE SERVICES FOR PATIENTS, FROM NEWBORNS TO SENIORS. IT IS CURRENTLY LICENSED BY THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH TO OPERATE A TOTAL OF 434 ACUTE CARE BEDS (301 ADULT MEDICAL/SURGICAL, 29 INTENSIVE CARE, 40 PEDIATRIC, 26 OBSTETRICAL, 10 LEVEL IIB SPECIAL CARE NURSERY BASSINETS AND 28 WELL-NEWBORN BASSINETS).INPATIENT STATISTICSINPATIENT ADMISSIONS: 18,460 DELIVERIES: 2,230OBSERVATION STAYS: 4,696PATIENT DAYS: 76,980SURGERIES: 2,412 348812705 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 297 0 1 4442 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 16 14 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MA X WILLIAM WYMAN SR VP OF FINANCE 9789376034 295 VARNUM AVENUE LOWELL MA 01854 GARY CAMPBELL CHAIR 1.00 1.00 X X 0 0 0 RAYMOND ANSTISS JR VICE CHAIR 1.00 1.00 X X 0 0 0 DANIEL J MANSUR ESQ CLERK 1.00 3.00 X X 0 0 0 JOHN CARSON BOARD MEMBER 1.00 1.00 X 0 0 0 JACK CLANCY BOARD MEMBER 1.00 1.00 X 0 0 0 MARK COCHRAN BOARD MEMBER 1.00 1.00 X 0 0 0 SHAMIM DAHOD MD BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL DUBUQUE BOARD MEMBER 1.00 1.00 X 0 0 0 BOPHA MALONE BOARD MEMBER 1.00 1.00 X 0 0 0 GEORGE MELTSAKOS MD BOARD MEMBER 1.00 1.00 X 0 0 0 TUSHAR PATEL MD BOARD MEMBER 1.00 2.00 X 0 0 0 LUIS PEDROSO BOARD MEMBER (UNTIL 11/19) 1.00 1.00 X 0 0 0 NAOMI PRENDERGAST BOARD MEMBER 1.00 2.00 X 0 0 0 BRUCE ROBINSON BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID WALLACE BOARD MEMBER 1.00 1.00 X 0 0 0 JOSEPH WHITE PRESIDENT 48.00 2.00 X X 1324761 0 20921 WILLIAM WYMAN SR. VP OF FINANCE/TREAS./ASST. CLERK 46.00 4.00 X 366595 0 19990 SABRINA GRANVILLE CHO 12.00 38.00 X 119986 359956 27519 AMY HOEY CHIEF OPERATING OFFICER 50.00 0.00 X 759458 0 26414 CECELIA LYNCH CNO 50.00 0.00 X 409111 0 26914 ARTHUR LAURETANO CMO 50.00 0.00 X 400926 0 1122 MICHELLE DAVIS VP EXTERNAL AFFAIRS 49.00 1.00 X 233198 0 21509 WENDY MITCHELL MEDICAL DIR. COMMUNITY HOME 50.00 0.00 X 312213 0 24520 EMILY YOUNG DIRECTOR OF HEALTHCARE OPS 50.00 0.00 X 261055 0 22469 YISHIS REN CHIEF MEDICAL PHYSICIST 50.00 0.00 X 252271 0 20706 RAMYA PRABHAKAR PHYSICIAN 50.00 0.00 X 272947 0 25755 JAMES WOOLMAN DIRECTOR ACO PERFORMANCE MGMT 50.00 0.00 X 261532 0 23383 WILLIAM GALVIN III MD BOARD MEMBER/MEDICAL DIRECTOR 1.00 1.00 X 523540 0 26413 SUSAN GREEN FMR. SENIOR VP & CFO & TREAS. - THE LGH 0.00 50.00 X 0 731087 27467 NORMAND DESCHENE FMR. PRES. OF BOARD & CEO 0.00 50.00 X 0 1656224 20921 5497593 2747267 336023 371 1 1 0 MCKESSON CORPORATION 6555 STATE HWY 161 IRVING TX 75039 MEDICAL SUPPLIES SERVICES 29543849 CERNER CORPORATION 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY MO 64117 INFORMATION SYSTEMS PROVIDER 25166656 CLAFLIN COMPANY 455 WARWICK INDUSTRIAL DR WARWICK RI 02886 MEDICAL SUPPLIES SERVICES 13349616 SODEXO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 FOOD & FACILITIES SERVICES 4336166 MERRIMACK VALLEY EMERGENCY ASSOCIATES 1 HOSPITAL DR LOWELL MA 01852 PHYSICIAN SERVICES 4186663 296 300000 61800 237298 3278898 197667 3877996 PATIENT SVC. REVENUE 621500 466976860 468662277 -1685417 466976860 2065890 478502 1587388 2016725 2049640 -32915 -32915 -16973 -15942 82786493 81333651 1109417 1452842 -1109417 343425 343425 1356545 300000 786887 569658 569658 OTHER REVENUE 621500 11350664 11350664 11350664 485151578 480012941 -1223888 2484529 503974 503974 189254218 142115635 46957104 181479 4469592 3356326 1108980 4286 23785016 17859634 5902572 22810 13420363 10077680 3329814 12869 275073 275073 271482 271482 120000 120000 342295 342295 32113975 21121932 10978207 13836 600910 1583 596866 2461 95521877 91163832 4316727 41318 23566905 19255055 4199082 112768 9453432 5755066 3694990 3376 430281 188305 241948 28 834954 497614 337301 39 7643095 7643095 20541733 17580625 2946159 14949 1938506 5865 1932641 PHYSICIAN FEES 18989274 10601399 8387875 UNCOMPENSATED CARE POOL 7876192 7876192 PROVISION FOR BAD DEBTS 4730546 4730546 TEMP RESTRICTED MISC EX 1097536 565196 532340 839933 286792 553141 458621162 348812705 108845097 963360 46085184 21460271 19086979 2009974 1607095 66149741 63918912 7913066 7633603 2536133 3646230 483296049 267791319 226867670 215504730 76984000 93581882 41364587 47857136 488997334 455209859 92059339 79048146 142581101 138696956 16540077 14089077 76825443 85586603 328005960 317420782 X 151081636 128519297 5040949 4351581 4868789 4918199 160991374 137789077 488997334 455209859 X 26530416 -296235 -49436478 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 257940 0 0 257940 0 PART II-B, LINE 1(G), DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY: A PORTION OF THE HOSPITAL'S MASSACHUSETTS HOSPITAL ASSOCIATION (MHA) DUES SUPPORTS LOBBYING ACTIVITIES. THE MHA WORKS ON BEHALF OF THE INDUSTRY TO INFLUENCE MATTERS OF IMPORTANCE TO MASSACHUSETTS HEALTHCARE. 76021699 8074 2930857 234264 78726366 77572133 16191 8139178 9705803 76021699 69687775 19850 978039 -6886469 77572133 63685872 10148 1050057 -4941698 69687775 65774190 10489 1015170 3113977 63685872 0.96230 0.03770 0.00000 0 0 5377764 5377764 300579445 139836022 160743423 4430938 2976937 1454001 166401160 122216530 44184630 6506742 2761830 3744912 215504730 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 1423402 F CERTIFICATES OF DEPOSIT 18895346 F MUTUAL FUNDS 73263134 F 93581882 OTHER ASSETS 33889724 DUE FROM AFFILIATES 13967412 47857136 CAPITAL LEASE OBLIGATIONS 9935056 ACCRUED PENSION EXPENSE 53070582 OTHER LONG-TERM LIABILITIES 16701927 DUE TO AFFILIATES 5879038 85586603 489971008 -296235 6477194 6180959 483790049 342295 1019234 1361529 485151578 513173302 55892532 55892532 457280770 342295 998097 1340392 458621162 PART V, LINE 4: THE HOSPITAL CLASSIFIES AS PERMANENTLY RESTRICTED NET ASSETS (A) THE ORIGINAL VALUE OF THE GIFTS DONATED TO THE PERMANENT ENDOWMENT WHEN EXPLICIT DONOR STIPULATIONS REQUIRING PERMANENT MAINTENANCE OF THE HISTORICAL FAIR VALUE ARE PRESENT, AND (B) THE ORIGINAL VALUE OF THE SUBSEQUENT GIFTS TO THE PERMANENT ENDOWMENT WHEN EXPLICIT DONOR STIPULATIONS REQUIRING PERMANENT MAINTENANCE OF THE HISTORICAL FAIR VALUE ARE PRESENT. THE REMAINING PORTION OF THE DONOR-RESTRICTED ENDOWMENT FUND COMPRISED OF ACCUMULATED GAINS NOT REQUIRED TO BE MAINTAINED IN PERPETUITY IS CLASSIFIED AS TEMPORARILY RESTRICTED NET ASSETS UNTIL THOSE AMOUNTS ARE APPROPRIATED FOR EXPENDITURE IN A MANNER CONSISTENT WITH THE DONOR'S STIPULATIONS. THE HOSPITAL CONSIDERS THE FOLLOWING FACTORS IN MAKING A DETERMINATION TO APPROPRIATE OR ACCUMULATE DONOR-RESTRICTED ENDOWMENT FUNDS: DURATION AND PRESERVATION OF THE FUND, PURPOSES OF THE DONOR-RESTRICTED ENDOWMENT FUNDS, GENERAL ECONOMIC CONDITIONS, THE POSSIBLE EFFECT OF INFLATION AND DEFLATION, THE EXPECTED TOTAL RETURN FROM INCOME AND THE APPRECIATION OF INVESTMENTS, OTHER RESOURCES OF THE HOSPITAL, AND THE INVESTMENT POLICIES OF THE HOSPITAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 2,049,640. SPECIAL EVENT EXPENSE 786,887. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS 1,728,230. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR CAPITAL 1,327,904. LOSS ON EXTINGUISHMENT OF DEBT 584,533. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 21,137. PHILANTHROPY EXPENSES NETTED WITH CONTRIBUTIONS 998,097. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 2,049,640. SPECIAL EVENTS EXPENSE 786,887. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS 1,728,230. NET ASSETS RELEASED FROM RESTRICTIONS FOR CAPITAL 1,327,904. TRANSFERS TO AFFILIATES 24,616,222. PROVISION FOR UNCOLLECTIBLE ACCOUNTS- PATIENTS 12,984,894. LOSS ON EXTINGUISHMENT OF DEBT 584,533. PENSION RELATED ADJUSTMENTS 11,814,222. PART XII, LINE 4B - OTHER ADJUSTMENTS: PHILANTHROPY EXPENSES NETTED WITH CONTRIBUTIONS 998,097. TEAM WALK FOR CANCER CARE 834277 200000 634277 2500 13193 22055 4160 28756 253881 BALL 420599 100000 320599 8075 171001 130 8025 106321 1 401669 401669 5000 868 114577 48345 1656545 300000 1356545 7500 22136 307633 4290 36781 408547 786887 569658 1 1 X 1 X 1 X 1 1 1 0 1 1 11265465 4164474 7100991 0.01550 841744 841744 0.00180 4697470 4697470 0.01020 16804679 4164474 12640205 0.02750 1116304 23822 1092482 0.00240 1269559 12100 1257459 0.00270 429817 57485 372332 0.00080 918650 100000 818650 0.00180 3734330 193407 3540923 0.00770 20539009 4357881 16181128 0.03520 328062 328062 0.00070 200000 200000 0.00040 528062 528062 0.00110 1 12984894 779094 109806087 122046572 -12240485 X 1 1 2 1 THE LOWELL GENERAL HOSPITAL 275-319 VARNUM AVENUE LOWELL MA 01854 X X X ALSO DESIGNATED AS A TRAUMA CENTER A 2 THE LOWELL GENERAL HOSPITAL 1-2 HOSPITAL DRIVE LOWELL MA 01852 X X A THE LOWELL GENERAL HOSPITAL 0 0 1 X X X X X X X X X 17 1 0 1 1 X WWW.LOWELLGENERAL.ORG 1 17 1 WWW.LOWELLGENERAL.ORG 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X X 1 X WWW.LOWELLGENERAL.ORG X WWW.LOWELLGENERAL.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: THE LOWELL GENERAL HOSPITAL, - FACILITY 2: THE LOWELL GENERAL HOSPITAL THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 3J: LOWELL GENERAL HOSPITAL COMPLETES A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED FROM MULTIPLE SOURCES, IN THREE DIFFERENT WAYS: (1) FOCUS GROUPS, (2) KEY INFORMANT INTERVIEWS, AND (3) A REVIEW OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS FROM THE MASS CHIP DATABASE. THERE WERE 16 FOCUS GROUPS WITH A TOTAL OF 167 PARTICIPANTS. THE FOCUS GROUPS WERE CONDUCTED IN ENGLISH, KHMER, SPANISH, PORTUGUESE AND OTHER LANGUAGES, AS NEEDED. THE UNIVERSITY OF MASSACHUSETTS LOWELL CONDUCTED THREE KEY INFORMANT INTERVIEWS. THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 5: INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED FROM MULTIPLE SOURCES, IN THREE DIFFERENT WAYS: (1) FOCUS GROUPS, (2) KEY INFORMANT INTERVIEWS, AND (3) A REVIEW OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS FROM THE MASSCHIP DATABASE. THERE WERE 16 FOCUS GROUPS WITH A TOTAL OF 167 PARTICIPANTS. THE FOCUS GROUPS WERE CONDUCTED IN ENGLISH, KHMER, SPANISH, PORTUGUESE AND OTHER LANGUAGES, AS NEEDED. THE UNIVERSITY OF MASSACHUSETTS LOWELL CONDUCTED THREE KEY INFORMANT INTERVIEWS.ALL PARTICIPANTS IN THE FOCUS GROUPS AND KEY INFORMANT INTERVIEWS INDICATED THAT PROVIDERS AND AGENCIES IN LOWELL COLLABORATE WELL, ESPECIALLY LOWELL GENERAL HOSPITAL AND LOWELL COMMUNITY HEALTH CENTER. THEY ALSO ACKNOWLEDGED STRONG COLLABORATION BETWEEN COMMUNITIES, AGENCIES AND PROVIDERS. SOME FELT THAT LOWELL AND LOWELL AREA SERVICES HAVE A "GOOD PUBLIC HEALTH APPROACH." THE COMMUNITY FOCUS GROUPS ALSO FELT THAT GOOD ATTENTION TO DIVERSE COMMUNITIES, OUTREACH AT COMMUNITY EVENTS, GOOD PREVENTION PROGRAMS, AND STRONG SERVICES FOR IMMIGRANTS, REFUGEES, AND THE HOMELESS AT LCHC WERE ALL STRENGTHS OF THE HEALTHCARE SYSTEM.MORE THAN 50 GREATER LOWELL PROFESSIONALS PARTICIPATED IN THE FOCUS GROUPS AND PERSONAL INTERVIEWS - INCLUDING SCHOOL NURSES, HOSPITAL EXECUTIVES, TOWN MANAGERS AND LOCAL HEALTH DEPARTMENT DIRECTORS, AS WELL AS INDIVIDUALS REPRESENTING THE COUNCILS OF AGING, SKILLED NURSING FACILITIES AND VARIOUS COMMUNITY-BASED ORGANIZATIONS. THESE INDIVIDUALS WERE ASKED TO SPEAK TO THE STRENGTHS AND WEAKNESSES OF THE AREA'S HEALTH SYSTEM AND SUGGEST CHANGES TO IMPROVE IT.THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE WITHIN THE GREATER LOWELL AREA WAS THOROUGHLY INVESTIGATED, FOCUSING SUBSTANTIALLY ON THE ISSUES OR PROBLEMS INDICATED FROM THE PERSONAL AND FOCUS GROUP INTERVIEWS, AS WELL AS THE PUBLIC HEALTH DATA AND STATISTICS. THESE DATA INDICATED THAT THE GREATER LOWELL AREA SAW A DOUBLING OF THE RATE OF MENTAL HEALTH HOSPITALIZATIONS BETWEEN 1989 AND 2006. IN ADDITION, LOWELL HAS SEEN INCREASES IN PROBLEMATIC ALCOHOL CONSUMPTION AND OPIATE-RELATED MORTALITY. THE EXPERIENCE IN THE LOWELL AREA WAS ALSO COMPARED, AS APPROPRIATE, WITH THE STATEWIDE EXPERIENCE. IN SO DOING, WE FOUND THAT THE USE OF EMERGENCY DEPARTMENT SERVICES IN LOWELL IS 39% HIGHER THAN THE STATE AVERAGE IN MOST RECENT DATA AVAILABLE, 2002 THROUGH 2005. WHEN RELIABLE INFORMATION WAS AVAILABLE, WE ADDITIONALLY EXAMINED THE COMPARATIVE EXPERIENCE OF DIFFERENT DEMOGRAPHIC SUBGROUPS. THE MORTALITY RATE AMONG ASIAN-AMERICANS IN THE GREATER LOWELL AREA, FOR EXAMPLE, WAS NEARLY TWICE AS HIGH AS THE MASSACHUSETTS AVERAGE FOR THIS GROUP. IN ADDITION TO PROVIDING SUPPLEMENTAL INFORMATION ON HEALTHCARE CONCERNS VOICED BY VARIOUS STUDY RESPONDENTS, THE DATA ANALYSIS ALSO INDICATED OTHER IMPORTANT FINDINGS, MOST IMPORTANTLY, THAT THE PROPORTION OF INDIVIDUALS IN LOWELL WITHOUT HEALTH INSURANCE INCREASED SUBSTANTIALLY BETWEEN 2000 AND 2008. THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 6B: LOWELL GENERAL HOSPITAL CONDUCTED THE LAST COMMUNITY HEALTH NEEDS ASSESSMENT WITH RESEARCHERS AND STUDENTS OF UNIVERSITY OF MASSACHUSETTS LOWELL (UML) AND THE GREATER LOWELL HEALTH ALLIANCE (GLHA). THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 11: THE TOP HEALTH PROBLEMS THAT WERE IDENTIFIED IN THE FOCUS GROUPS AND INTERVIEWS AND SUPPORTED BY PUBLIC HEALTH DATA INCLUDE MENTAL HEALTH, DIABETES, SUBSTANCE ABUSE AND ADDICTION, HYPERTENSION, OBESITY, AND ASTHMA AND RESPIRATORY DISEASE. THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE LATEST COMMUNITY HEALTH NEEDS ASSESSMENT BY INCORPORATING THESE INTO THE ORGANIZATION'S ANNUAL COMMUNITY BENEFIT PLAN. THE COMMUNITY BENEFIT PLAN IS AN ACTION PLAN DEVELOPED ANNUALLY BY HOSPITAL LEADERS TO ADDRESS PRIORITY HEALTH NEEDS WITHIN THE GREATER LOWELL REGION. LOWELL GENERAL HOSPITAL AND THE GREATER LOWELL HEALTH ALLIANCE ARE COMMITTED TO A COLLABORATIVE APPROACH INVOLVING OTHER COMMUNITY STAKEHOLDERS WITH THE GOAL TO IDENTIFY TOP PRIORITIES AND FORMULATE ACTION STEPS THAT WILL IMPROVE THE AREA HEALTHCARE SYSTEM AND OVERALL COMMUNITY HEALTH.THE MAJOR WEAKNESSES IDENTIFIED IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE MENTAL AND BEHAVIORAL HEALTH NEEDS THAT ARE NOT BEING MET, LACK OF SUBSTANCE ABUSE RESOURCES, DIFFICULT AND/OR LACK OF ACCESS TO CARE FOR MANY LOWELL AND GREATER LOWELL RESIDENTS, NEED FOR ADDITIONAL INTERPRETATION AND TRANSLATION SERVICES, LACK OF CASE MANAGEMENT SERVICES AND HEALTH NAVIGATORS, LACK OF COMMUNICATION BETWEEN EMERGENCY CARE AND PCPS, PERCEPTION OF FRAGMENTED CARE, LACK OF OUTREACH TO VULNERABLE POPULATIONS, AND LACK OF HEALTH EDUCATION. THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 13B: PATIENTS WHOSE HOUSEHOLD INCOME EXCEEDS 400% OF THE FEDERAL POVERTY GUIDELINES AND WHO MEET HEALTH SAFETY NET INCOME CRITERIA FOR MEDICAL HARDSHIP AND HAVE BALANCES (AFTER FREE CARE) OF $10,000 OR MORE. SPECIFICALLY, THESE PATIENTS MAY (1) BE ELIGIBLE FOR MEDICAL HARDSHIP ASSISTANCE UNDER THE HEALTH SAFETY NET BUT HAVE PATIENT CONTRIBUTION REQUIREMENTS GREATER THAN $10,000 OR (2) MEET THE MEDICAL HARDSHIP INCOME CRITERIA, BUT ARE INELIGIBLE FOR FREE CARE BECAUSE THE SERVICES RECEIVED ARE NOT HOSPITAL-LICENSED SERVICES. IN SUCH CIRCUMSTANCES:(I)FINANCIAL ASSISTANCE WILL BE DETERMINED AFTER A REVIEW OF ALL FINANCIAL INFORMATION AND CIRCUMSTANCES.(II)FINANCIAL ASSISTANCE WILL GENERALLY REDUCE AN OUTSTANDING BALANCE TO 15% OF ANNUAL INCOME ABSENT SIGNIFICANT ASSETS.(III)FINANCIAL ASSISTANCE UP TO 100% WILL BE CONSIDERED BASED ON THE PATIENT'S PARTICULAR MEDICAL AND FINANCIAL CIRCUMSTANCES AND MUST BE APPROVED BY THE LOWELL GENERAL HOSPITAL VICE PRESIDENT OF REVENUE OR VP FINANCE/CFO OR HIS/HER DESIGNEE. 17 1 - LGH - OFFICE SPACE OFF-SITE 10 RESEARCH PLACE CHELMSFORD MA 01824 SURGICAL DAY CARE, MD OFFICES, LAB & X-RAY 2 - LGH - OFFICE SPACE OFF-SITE 4 MEETINGHOUSE RD 13 CHELMSFORD MA 01824 XRAY PROCEDURES 3 - LGH - OFFICE SPACE OFF-SITE 20 RESEARCH PLACE STE 100 CHELMSFORD MA 01824 PATIENT AMBASSADOR & LAB OFFICE SPACE 4 - LGH - OFFICE SPACE OFF-SITE 20 RESEARCH PLACE 310 CHELMSFORD MA 01824 PATIENT AMBASSADOR & LAB OFFICE SPACE 5 - LGH - OFFICE SPACE OFF-SITE 14 RESEARCH PLACE CHELMSFORD MA 01824 ORTHOPAEDIC SURGICAL ASSOCIATES 6 - LGH - OFFICE SPACE OFF-SITE 203 TURNPIKE RD NORTH ANDOVER MA 01845 EMPLOYED PHYSICIAN PRACTICE 7 - LGH - OFFICE SPACE OFF-SITE 2337 VILLAGE SQUARE CHELMSFORD MA 01854 PROVIDE BLOOD DRAWING SERVICES 8 - LGH - OFFICE SPACE OFF-SITE 600 CLARK RD TEWKSBURY MA 01876 PROVIDE BLOOD DRAWING AND RADIOLOGY SERVICES. 9 - LGH - OFFICE SPACE OFF-SITE 161 JACKSON ST LOWELL MA 01852 LAB OFFICE SPACE 10 - LGH - OFFICE SPACE OFF-SITE 10 ADAMS ST CHELMSFORD MA 01824 LAB OFFICE SPACE 11 - LGH - OFFICE SPACE OFF-SITE 43 VILLAGE SQUARE CHELMSFORD MA 01824 REHABILITATION SERVICES 12 - LGH - OFFICE SPACE OFF-SITE 1595 BRIDGE ST DRACUT MA 01826 PHYSICIAN PRACTICE 13 - LGH - OFFICE SPACE OFF-SITE 1656 MAIN ST TEWKSBURY MA 01876 PHYSICIAN PRACTICE 14 - LGH - OFFICE SPACE OFF-SITE 198 LITTLETON ROAD WESTFORD MA 01886 URGENT CARE AND PATIENT SERVICE CENTER 15 - LGH - OFFICE SPACE OFF-SITE 33 BARTLETT ST LOWELL MA 01852 CIRCLE CARE BEHAVIORLAL HEALTH 16 - LGH - OFFICE SPACE OFF-SITE 199 BOSTON ROAD NO BILLERICA MA 01821 URGENT CARE AND PATIENT SERVICE CENTER 17 - LGH - OFFICE SPACE OFF-SITE 9 LOON HILL ROAD DRACUT MA 01850 URGENT CARE AND PATEINT SERVICE CENTER SCHEDULE H-PART I PART I, LINE 6A & B: THE ORGANIZATION PREPARES A COMMUNITY BENEFIT REPORT EVERY YEAR. THE COMMUNITY BENEFIT ANNUAL REPORT IS AVAILABLE TO THE PUBLIC ON THE ORGANIZATION'S WEBSITE OR UPON REQUEST.PART I, LINE 7: THE COST ALLOCATION IS BASED OFF THE FY2019 TOTAL PATIENT CARE EXPERIENCE (NOT INCLUDING BAD DEBT AND LESS THE MEDICAID PROVIDER TAX) DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS PERCENTAGE IS APPLIED TO THE SPECIFIC LINE ITEMS TO REFLECT THE MOST ACCURATE COST CALCULATION. PART II, COMMUNITY BUILDING ACTIVITIES: INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED FROM MULTIPLE SOURCES, IN THREE DIFFERENT WAYS: (1) FOCUS GROUPS, (2) KEY INFORMANT INTERVIEWS, AND (3) A REVIEW OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS FROM THE MASSCHIP DATABASE. THERE WERE 16 FOCUS GROUPS WITH A TOTAL OF 167 PARTICIPANTS. THE FOCUS GROUPS WERE CONDUCTED IN ENGLISH, KHMER, SPANISH, PORTUGUESE AND OTHER LANGUAGES, AS NEEDED. THE UNIVERSITY OF MASSACHUSETTS LOWELL CONDUCTED THREE KEY INFORMANT INTERVIEWS.THE LOWELL GENERAL HOSPITAL HAS A CLOSE WORKING RELATIONSHIP THAT INCLUDES FINANCIAL SUPPORT TO LOWELL COMMUNITY HEALTH CENTER (LCHC) WHICH SERVES THE LOW-INCOME, MEDICALLY UNDERSERVED POPULATION, MANY OF WHOM HAVE NO OTHER ACCESS TO HEALTHCARE SERVICES. THE MAJORITY OF PATIENTS SERVED BY LCHC HAVE MASSHEALTH, ANOTHER 10% HAVE PRIVATE HEALTH INSURANCE OR HMO COVERAGE, 7% HAVE MEDICARE, AND 20% ARE UNINSURED; AND 95% LIVE AT OR BELOW THE POVERTY LEVEL. ALMOST HALF OF LCHC'S PATIENT POPULATION IS UNDER 18 YEARS OF AGE, AND THE MAJORITY OF WOMEN ARE IN THEIR CHILDBEARING YEARS. IN 2007, 37% OF PATIENTS WERE WHITE/NON-HISPANIC; 28% WERE LATINO; 27% WERE ASIAN (PRIMARILY CAMBODIANS) AND 8% WERE AFRICAN IMMIGRANTS. ALMOST 60% OF PATIENTS WERE BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH. SOME OF THE MAJOR SERVICES THAT LCHC PROVIDES ARE - CARINO, WHICH PROVIDES SPECIAL CARE FOR PATIENTS WITH HIV/AIDS; PROMOTORAS PROGRAMS, WHICH ARE TRAINED COMMUNITY HEALTH WORKERS AND VOLUNTEERS WHO SPEAK SPANISH AND/OR PORTUGUESE AND GO THROUGH AN INTENSIVE TRAINING WITH LCHC STAFF ON SPECIFIC HEALTH TOPICS TO EDUCATE THE COMMUNITY; LCHC TEEN COALITION AND ADOLESCENT HEALTH PROGRAM, WHICH COVERS EVERYTHING FROM MENTAL HEALTH AND SELF-ESTEEM ISSUES AMONG GIRLS TO EDUCATING AND INVOLVING YOUTH IN SUBSTANCE ABUSE PREVENTION AND A JOURNEY TO HEALING PROGRAM FOR REFUGEE CHILDREN AND CHILDREN OF REFUGEES. WITHOUT THE LOWELL GENERAL'S FINANCIAL SUPPORT TO LCHC'S PENSION AND WORKER'S COMPENSATION PROGRAM, MANY OF THESE PROGRAMS WOULD NOT HAVE ADEQUATE FUNDING. THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE WITHIN THE GREATER LOWELL AREA WAS THOROUGHLY INVESTIGATED, FOCUSING SUBSTANTIALLY ON THE ISSUES OR PROBLEMS INDICATED FROM THE PERSONAL AND FOCUS GROUP INTERVIEWS, AS WELL AS THE PUBLIC HEALTH DATA AND STATISTICS. PART III, LINE 2: THE BAD DEBT EXPENSE AMOUNT DETAILED ON LINE 2 IS BASED ON THE COST TO CHARGE RATIO CALCULATED FROM THE MEDICARE COST REPORT. REGARDING THE RATIONALE FOR INCLUDING THE AMOUNT ON LINE 3 AS CHARITY CARE, THE HOSPITAL PROVIDES AN ESTIMATE OF HOW MUCH IS ATTRIBUTABLE TO PERSONS WHO WOULD NORMALLY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICIES, BUT HAVE NOT TAKEN ADVANTAGE OF THE FINANCIAL ASSISTANCE THAT IS AVAILABLE TO THEM. CURRENTLY THROUGH MANUAL PROCESSES IT IS IMPOSSIBLE TO SCREEN EVERY PATIENT TO MAKE AN INCOME STATUS DETERMINATION FOR QUALIFICATION TO THE HOSPITAL'S CHARITY PROGRAM UNDER A PRESUMPTIVE CHARITY POLICY. THESE INDIVIDUALS THAT DO NOT SEEK OUT CHARITY PROGRAMS ARE OFTEN UNDERINSURED OR LOW INCOME AND DO NOT NECESSARILY CONSIDER THE BENEFIT OF THE PROCESS OF SUBMITTING AN APPLICATION TO THE HOSPITAL. THE HOSPITAL CONTINUES TO PROVIDE CARE TO THOSE INDIVIDUALS THAT HAVE A HISTORY OF POOR CREDIT WITH THE FACILITY AND NEED MEDICALLY NECESSARY SERVICES AS WE UNDERSTAND THAT THE ABILITY FOR THE COMMUNITY TO SEEK OUT QUALITY MEDICAL SERVICES IS OF THE UTMOST IMPORTANCE AND EXTENDS OUR CHARITABLE BENEFIT TO THE COMMUNITY. WE BELIEVE THAT HAD THE QUALIFICATION PROCESS TAKEN PLACE THIS BAD DEBT WOULD BE CLASSIFIED IN THE CHARITY CARE OF THE HOSPITAL. SINCE THE QUALIFICATION PROCESS HAS NOT BEEN PERFORMED WE PROPERLY REPORT THIS AS BAD DEBT AS THE ACTUAL COST TO OUR HOSPITAL. PART III, LINE 3: THE BAD DEBT EXPENSE AMOUNT DETAILED ON LINE 2 IS BASED ON THE COST TO CHARGE RATIO CALCULATED FROM THE MEDICARE COST REPORT. REGARDING THE RATIONALE FOR INCLUDING THE AMOUNT ON LINE 3 AS CHARITY CARE, THE HOSPITAL PROVIDES AN ESTIMATE OF HOW MUCH IS ATTRIBUTABLE TO PERSONS WHO WOULD NORMALLY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICIES, BUT HAVE NOT TAKEN ADVANTAGE OF THE FINANCIAL ASSISTANCE THAT IS AVAILABLE TO THEM. CURRENTLY THROUGH MANUAL PROCESSES IT IS IMPOSSIBLE TO SCREEN EVERY PATIENT TO MAKE AN INCOME STATUS DETERMINATION FOR QUALIFICATION TO THE HOSPITAL'S CHARITY PROGRAM UNDER A PRESUMPTIVE CHARITY POLICY. THESE INDIVIDUALS THAT DO NOT SEEK OUT CHARITY PROGRAMS ARE OFTEN UNDERINSURED OR LOW INCOME AND DO NOT NECESSARILY CONSIDER THE BENEFIT OF THE PROCESS OF SUBMITTING AN APPLICATION TO THE HOSPITAL. THE HOSPITAL CONTINUES TO PROVIDE CARE TO THOSE INDIVIDUALS THAT HAVE A HISTORY OF POOR CREDIT WITH THE FACILITY AND NEED MEDICALLY NECESSARY SERVICES AS WE UNDERSTAND THAT THE ABILITY FOR THE COMMUNITY TO SEEK OUT QUALITY MEDICAL SERVICES IS OF THE UTMOST IMPORTANCE AND EXTENDS OUR CHARITABLE BENEFIT TO THE COMMUNITY. WE BELIEVE THAT HAD THE QUALIFICATION PROCESS TAKEN PLACE THIS BAD DEBT WOULD BE CLASSIFIED IN THE CHARITY CARE OF THE HOSPITAL. SINCE THE QUALIFICATION PROCESS HAS NOT BEEN PERFORMED WE PROPERLY REPORT THIS AS BAD DEBT AS THE ACTUAL COST TO OUR HOSPITAL. PART III, LINE 4: THE ORGANIZATION'S PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS DESCRIBED ON PAGE 18 OF THE AUDITED FINANCIAL STATEMENTS ATTACHED. THE FOLLOWING IS EXCERPTED FROM THAT FOOTNOTE:ACCOUNTS RECEIVABLE ARE STATED AT ESTIMATED NET REALIZABLE AMOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND HISTORIC PAYMENT TRENDS AND RECORDS ESTIMATED CONTRACTUAL ALLOWANCES. THE SYSTEM RECORDS A SIGNFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICTATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILLS FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COVERED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.THE SYSTEM'S ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FOR ALL PATIENTS WAS 21% OF ACCOUNTS RECEIVABLE AS OF SEPTEMBER 30, 2018. IN ADDITION, THE SYSTEM'S WRITE-OFFS, NET OF RECOVERIES, WERE $44,846,000 AND $39,165,000, RESPECTIVELY, FOR THE YEAR ENDED SEPTEMBER 30, 2019 AND 2018. THE CHANGES WERE A RESULT OF MANAGEMENT'S REVIEW OF HISTORICAL TRENDS IN UNCOLLECTIBLE ACCOUNTS AND DETERMINATION OF RESERVES, INCLUDING THE IMPACT OF THE PROVISIONS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. THE SYSTEM HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2019. THE SYSTEM DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT BAD DEBT WRITE-OFFS FROM THIRD PARTY PAYORS. PART III, LINE 8: THERE WAS A DECLINE IN MEDICARE VOLUME FOR BOTH INPATIENT AND OUTPATIENT COMPARING FISCAL YEARS. ALSO CONTRIBUTING WAS A DECREASE IN THE MEDICARE INPATIENT BASE RATE WHICH WOULD EXPLAIN THE LOWER REVENUE IN FY'19. PART III, LINE 9B: THERE ARE TWO DISTINCTIONS THAT ARE MADE FOR PATIENTS THAT ARE CONSIDERED EITHER LOW INCOME BY DEFINITION OF THE STATE OF MASSACHUSETTS ELIGIBILITY PROGRAM OR UNDER THE HOSPITAL'S INTERNAL FINANCIAL ASSISTANCE PROGRAM FOR CHARITY CARE. IF THE PATIENT IS DEEMED TO BE LOW INCOME BY THE STATE OF MASSACHUSETTS, ALL COLLECTION EFFORTS ARE CEASED ON PRIOR AND CURRENT BALANCE ACCOUNTS. WHERE APPROPRIATE, ACCOUNTS WILL BE WRITTEN OFF TO HOSPITAL CHARITY FOR THOSE ACCOUNTS THAT EXCEED THE RETROACTIVE LOOK BACK PERIOD. FOR PATIENTS WHO QUALIFY FOR THE HOSPITAL'S INTERNAL FINANCIAL ASSISTANCE PROGRAM, THE PROGRAM WILL QUALIFY THE PATIENT FOR MEDICALLY NECESSARY SERVICES FOR THE PERIOD OF ONE YEAR IN WHICH THE ACCOUNT ACTIVITY OF THE PATIENT WILL BE WRITTEN OFF TO THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND REPORTED AS CHARITY CARE. ALL COLLECTION ACTIVITIES ON PRIOR BALANCE ACCOUNTS CEASES AT THE POINT OF THIS QUALIFICATION. FINANCIAL COUNSELORS WORK CLOSELY WITH PATIENTS TO MONITOR THEIR CURRENT FINANCIAL STATUS TO DETERMINE ANY CHANGES IN QUALIFICATIONS FOR BOTH THE STATE AND HOSPITAL PROGRAMS. PART VI, LINE 2: ON BEHALF OF LOWELL GENERAL HOSPITAL, UNIVERSITY OF MASSACHUSETTS LOWELL (UML) AND THE GREATER LOWELL HEALTH ALLIANCE (GLHA), A TEAM OF UMASS LOWELL RESEARCHERS AND STUDENTS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT STUDY TO DISTINGUISH THE UNMET MEDICAL AND PUBLIC HEALTH NEEDS WITHIN THE GREATER LOWELL COMMUNITY. THE GEOGRAPHIC AREA ASSESSED INCLUDED THE COMMUNITIES OF LOWELL, BILLERICA, CHELMSFORD, DRACUT, DUNSTABLE, TEWKSBURY, TYNGSBOROUGH AND WESTFORD. THE STUDY HAD SEVERAL OBJECTIVES, WHICH WERE TO: ASSESS THE OVERALL HEALTH OF AREA RESIDENTS, IDENTIFY THE STRENGTHS AND WEAKNESSES OF THE LOCAL HEALTHCARE SYSTEM, DETERMINE THE TOP HEALTH PROBLEMS FACING AREA RESIDENTS AND THE POPULATIONS AT GREATEST RISK, INVOLVE A BROAD SPECTRUM OF PROFESSIONALS AND RESIDENTS, INCLUDING NEWER IMMIGRANT COMMUNITIES, PROVIDE RECOMMENDATIONS TO IMPROVE THE HEALTHCARE SYSTEM AND ADDRESS UNMET HEALTH NEEDS, AND INFORM THE PROCESS TO IDENTIFY PRIORITY HEALTH NEEDS AND DEVELOP ACTION PLANS TO ADDRESS THESE PRIORITY NEEDS.INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED FROM MULTIPLE SOURCES, IN THREE DIFFERENT WAYS: (1) FOCUS GROUPS, (2) KEY INFORMANT INTERVIEWS, AND (3) A REVIEW OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS FROM THE MASSCHIP DATABASE. THERE WERE 14 FOCUS GROUPS WITH A TOTAL OF 113 PARTICIPANTS-MAJORITY WERE CONDUCTED IN ENGLISH, BUT CAMBODIAN COMMUNITY GROUP WAS CONDUCTED IN KHMER AND THE LATINO GROUP IN SPANISH. THE UNIVERSITY OF MASSACHUSETTS LOWELL CONDUCTED SIX KEY INFORMANT INTERVIEWS.MORE THAN 50 GREATER LOWELL PROFESSIONALS PARTICIPATED IN THE FOCUS GROUPS AND PERSONAL INTERVIEWS - INCLUDING SCHOOL NURSES, HOSPITAL EXECUTIVES, TOWN MANAGERS AND LOCAL HEALTH DEPARTMENT DIRECTORS, AS WELL AS INDIVIDUALS REPRESENTING THE COUNCILS OF AGING, SKILLED NURSING FACILITIES AND VARIOUS COMMUNITY-BASED ORGANIZATIONS. THESE INDIVIDUALS WERE ASKED TO SPEAK TO THE STRENGTHS AND WEAKNESSES OF THE AREA'S HEALTH SYSTEM AND SUGGEST CHANGES TO IMPROVE IT.THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE WITHIN THE GREATER LOWELL AREA WAS THOROUGHLY INVESTIGATED, FOCUSING SUBSTANTIALLY ON THE ISSUES OR PROBLEMS INDICATED FROM THE PERSONAL AND FOCUS GROUP INTERVIEWS, AS WELL AS THE PUBLIC HEALTH DATA AND STATISTICS. THESE DATA INDICATED THAT THE GREATER LOWELL AREA SAW A DOUBLING OF THE RATE OF MENTAL HEALTH HOSPITALIZATIONS BETWEEN 1989 AND 2006. IN ADDITION, LOWELL HAS SEEN INCREASES IN PROBLEMATIC ALCOHOL CONSUMPTION AND OPIATE-RELATED MORTALITY. THE EXPERIENCE IN THE LOWELL AREA WAS ALSO COMPARED, AS APPROPRIATE, WITH THE STATEWIDE EXPERIENCE. IN SO DOING, WE FOUND THAT THE USE OF EMERGENCY DEPARTMENT SERVICES IN LOWELL IS 39% HIGHER THAN THE STATE AVERAGE IN MOST RECENT DATA AVAILABLE, 2002 THROUGH 2005. WHEN RELIABLE INFORMATION WAS AVAILABLE, WE ADDITIONALLY EXAMINED THE COMPARATIVE EXPERIENCE OF DIFFERENT DEMOGRAPHIC SUBGROUPS. THE MORTALITY RATE AMONG ASIAN-AMERICANS IN THE GREATER LOWELL AREA, FOR EXAMPLE, WAS NEARLY TWICE AS HIGH AS THE MASSACHUSETTS AVERAGE FOR THIS GROUP. IN ADDITION TO PROVIDING SUPPLEMENTAL INFORMATION ON HEALTHCARE CONCERNS VOICED BY VARIOUS STUDY RESPONDENTS, THE DATA ANALYSIS ALSO INDICATED OTHER IMPORTANT FINDINGS, MOST IMPORTANTLY, THAT THE PROPORTION OF INDIVIDUALS IN LOWELL WITHOUT HEALTH INSURANCE INCREASED SUBSTANTIALLY BETWEEN 2000 AND 2008. THE NEXT COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE COMPLETED IN 2019. PART VI, LINE 3: FOR THOSE PATIENTS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WORKS WITH THEM TO ASSIST WITH APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED PATIENTS FIND AVAILABLE AND APPROPRIATE FINANCIAL ASSISTANCE PROGRAMS, THE HOSPITAL PROVIDES ALL PATIENTS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PROGRAMS IN BOTH THE BILLS THAT ARE SENT TO PATIENTS AS WELL AS IN GENERAL NOTICES THAT ARE POSTED THROUGHOUT THE HOSPITAL. IN ADDITION TO GENERAL NOTICES, THERE ARE INFORMATIONAL BROCHURES AVAILABLE IN ACCESS AREAS AND DURING THE PROCESS OF REGISTRATION ANYONE THAT INDICATES THEY ARE HAVING TROUBLE PAYING THEIR BILLS OR WHO ARE UNINSURED ARE PROVIDED WITH A BUSINESS CARD THAT IDENTIFIES HOW TO CONTACT A PATIENT FINANCIAL COUNSELOR. ALL SIGNS AND NOTICES ARE TRANSLATED INTO LANGUAGES OTHER THAN ENGLISH IF SUCH LANGUAGE IS SPOKEN BY 10% OR MORE OF THE POPULATION RESIDING IN THE HOSPITAL SERVICE AREA. CURRENTLY, THE HOSPITAL TRANSLATES THE NOTICES INTO THE FOLLOWING LANGUAGES - SPANISH, PORTUGUESE, AND KHMER.THE HOSPITAL TRIES 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 PATIENT ACCESS STAFF DIRECTS ALL PATIENTS SEEKING AVAILABLE COVERAGE OPTIONS OR FINANCIAL ASSISTANCE TO THE HOSPITAL'S PATIENT FINANCIAL COUNSELING OFFICE TO DETERMINE IF THEY ARE ELIGIBLE AND THEN TO SCREEN FOR ELIGIBILITY IN AN APPROPRIATE COVERAGE OPTION. THE HOSPITAL ASSISTS THE PATIENT IN APPLYING FOR THE APPROPRIATE COVERAGE OPTIONS THAT ARE AVAILABLE OR NOTIFY THEM OF THE AVAILABILITY OF FINANCIAL ASSISTANCE THROUGH THE HOSPITAL'S OWN INTERNAL FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4: THE CITY OF LOWELL WAS FOUNDED IN 1820 AS A PLANNED INDUSTRIAL COMMUNITY ALONG THE BANKS OF THE MERRIMACK RIVER WHOSE ECONOMY WAS BASED ON TEXTILE MANUFACTURING. BY THE 1850'S, IT HAD BECOME THE LARGEST INDUSTRIAL CENTER IN THE UNITED STATES AND THE SECOND LARGEST CITY IN NEW ENGLAND. MUCH OF THE POPULATION GROWTH IN LOWELL WAS ATTRIBUTABLE TO IMMIGRATION, WHICH NEW RESIDENTS COMING FROM MANY PARTS OF EUROPE AND FRENCH-SPEAKING CANADA, CREATING AN ETHNICALLY DIVERSE COMMUNITY. DURING THIS PERIOD, LOWELL SERVED AS A REGIONAL ECONOMIC ENGINE, PROVIDING GOODS AND SERVICES TO THE SURROUNDING COMMUNITIES, WHICH RETAINED A LARGELY AGRICULTURAL ECONOMY INTO THE EARLY 1900'S. BY THE 1920'S, HOWEVER, LOWELL HAD GONE INTO ECONOMIC DECLINE AS THE U.S. TEXTILE INDUSTRY MOVED SOUTH, AND BY THE END OF THE 1950'S ALL OF THE TEXTILE MILLS HAD CLOSED. IN THE 1970'S, WANG LABORATORIES LOCATED ITS HEADQUARTERS IN THE CITY AND SPURRED A TEMPORARY ECONOMIC REVIVAL, WHICH COLLAPSED WHEN THE COMPANY FILED FOR BANKRUPTCY IN 1992. WHILE THE URBAN CORE HAS BEEN REDEVELOPED AS A RESIDENTIAL COMMUNITY, WITH FORMER TEXTILE MILLS BEING REHABILITATED AS CONDOMINIUMS AND APARTMENTS, LOWELL LACKS A STRONG INDUSTRIAL BASE. IN A LARGE MEASURE, THE EMERGENCE OF A HIGH TECHNOLOGY AND BIOMEDICAL ECONOMIC BASE IN EASTERN MASSACHUSETTS COINCIDED WITH A DECENTRALIZATION OF DEVELOPMENT AND URBAN PLANNING, WITH MANY NEW BUSINESSES LOCATING OUTSIDE CITY CENTERS, ALONG TRANSPORTATION CORRIDORS (E.G., ROUTES 128 AND 495). WHILE LOWELL STILL PROVIDES REGIONAL SERVICES NOT AVAILABLE IN THE SMALLER COMMUNITIES - HEALTHCARE, EDUCATION AND ENTERTAINMENT - MUCH OF THE AREA'S RECENT JOB GROWTH HAS COME FROM THE HIGH TECHNOLOGY SECTOR IN NEARBY TOWNS SUCH AS BILLERICA, CHELMSFORD, TEWKSBURY AND WESTFORD.IN THE 1980'S, THE CITY OF LOWELL WAS DESIGNATED AS A REFUGEE AND RESETTLEMENT AREA FOR CAMBODIANS IN THE WAKE OF THE ATROCITIES COMMITTED BY THE KHMER ROUGE REGIME. TODAY, LOWELL IS HOME TO THE SECOND LARGEST CAMBODIAN POPULATION WITHIN THE U.S. IN ADDITION, MANY OF THE AMENITIES THAT HAD SERVED PREVIOUS GENERATIONS OF LOWELL IMMIGRANTS, SUCH AS PLENTIFUL RENTAL HOUSING AND A HIGH GEOGRAPHIC DENSITY OF RETAIL BUSINESSES AND SERVICES CONTINUE TO ATTRACT IMMIGRANTS. IN THE 2000 CENSUS, MORE THAN ONE IN FIVE LOWELL RESIDENTS WAS FOREIGN BORN. CONTRASTED WITH THE PREDOMINANTLY NORTHERN AND WESTERN EUROPEAN IMMIGRATION DURING THE CITY'S MANUFACTURING HEYDAY, RECENT FIGURES SHOW THAT THE FOREIGN BORN IN LOWELL TODAY HAVE MORE DIVERSE ORIGINS. IN 2000, APPROXIMATELY HALF OF ALL LOWELL IMMIGRANTS WERE ASIAN, NEARLY A QUARTER FROM LATIN AMERICA, 16 PERCENT FROM EUROPE (WITH MANY ARRIVING FROM PORTUGAL), AND APPROXIMATELY SIX PERCENT FROM AFRICA. WITH THEIR ARRIVAL, THESE IMMIGRANTS HAVE ALSO ALTERED THE SERVICE ENVIRONMENT, WITH SOME HEALTHCARE FACILITIES, NOTABLY THE LOWELL COMMUNITY HEALTH CENTER, ADAPTING THEIR SERVICES TO ACCOMMODATE INDIVIDUALS WITH IDIOSYNCRATIC CULTURAL AND HEALTH NEEDS, AS WELL AS PROVIDING SERVICES IN AN INCREASING NUMBER OF LANGUAGES.IMMIGRANTS ARRIVING IN LOWELL TODAY ARE GREETED WITH A STARKLY DIFFERENT ECONOMIC REALITY THAN THOSE ARRIVING DURING THE INDUSTRIAL REVOLUTION. THERE ARE ESSENTIALLY NO MANUFACTURING JOBS REMAINING IN LOWELL, AND THE MAJORITY OF JOBS IN THE NEW HIGH TECHNOLOGY SECTOR REQUIRE A COLLEGE EDUCATION. AS A RESULT, MOST JOBS AVAILABLE TO NEW IMMIGRANTS WITHOUT AN ADVANCED EDUCATION ARE SERVICE JOBS, MANY OF WHICH DO NOT PAY A LIVING WAGE. GREATER LOWELL'S DEMOGRAPHIC PROFILE FROM THE MASSACHUSETTS EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT, AS OF DECEMBER 2016 INDICATES A 4.2% UNEMPLOYMENT RATE COMPARED TO 3.8% FOR THE STATE OF MASSACHUSETTS. HOWEVER, IT IS WORTH NOTING THAT LOWELL, MASSACHUSETTS, WHICH REPRESENTS APPROXIMATELY 39% OF THE POPULATION IN LOWELL GENERAL HOSPITAL'S SERVICE AREA, HAS 19% OF THE POPULATION LIVING BELOW POVERTY AND AN EMPLOYMENT RATE THAT HAS BEEN AT OR ABOVE 8% FOR THE PAST 12 MONTHS. THE COMMUNITIES SURROUNDING LOWELL HAVE ATTRACTED FAR FEWER IMMIGRANTS, WITH IMMIGRANTS ACCOUNTING FOR JUST THREE TO SEVEN PERCENT OF THEIR POPULATIONS. OF THE SUBURBAN COMMUNITIES IN THE GREATER LOWELL AREA, ONLY WESTFORD HAS A HIGHER PROPORTION FOREIGN BORN (12.6%), BUT THESE IMMIGRANTS ARE PREDOMINANTLY WELL EDUCATED AND DRAWN TO THE TOWN'S HIGH TECHNOLOGY JOBS.WHILE LOWELL IS NO LONGER THE ECONOMIC CENTER THAT IT ONCE WAS, LOWELL IS STILL A CULTURAL AND INSTITUTIONAL CENTER FOR THE REGION. IT IS HOME TO THE UNIVERSITY OF MASSACHUSETTS LOWELL, MIDDLESEX COMMUNITY COLLEGE AND THE LOWELL NATIONAL HISTORICAL PARK, AS WELL AS LOWELL GENERAL HOSPITAL, SUPERIOR AND DISTRICT COURTS, THE MERRIMACK REPERTORY THEATER, THE LOWELL MEMORIAL AUDITORIUM, THE TSONGAS CENTER AND LALACHEUR STADIUM.IN 2010, THE GREATER LOWELL AREA, AS DEFINED HEREIN, HAD A POPULATION OF 275,000 RESIDENTS, INCLUDING AN ESTIMATED 106,000 PEOPLE IN THE CITY OF LOWELL ALONE. THUS, THE CITY OF LOWELL ITSELF ACCOUNTS FOR LESS THAN 50 PERCENT OF THE AREA'S POPULATION. FOUR OTHER COMMUNITIES - BILLERICA, CHELMSFORD, DRACUT AND TEWKSBURY - EACH HAVE A POPULATION OF NEARLY 30,000 OR MORE. WE ALSO SEE THAT THE CITY OF LOWELL DIFFERS FROM ITS SUBURBAN NEIGHBORS IN IMPORTANT RESPECTS - A GREATER PERCENTAGE NON-HISPANIC WHITE, A GREATER PERCENTAGE FOREIGN BORN AND A HIGHER POVERTY RATE.LOWELL GENERAL HOSPITAL'S PRIMARY SERVICE AREA (PSA) IS COMPRISED OF APPROXIMATELY 300,000 RESIDENTS FROM THE FOLLOWING NINE COMMUNITIES: BILLERICA, CHELMSFORD, DRACUT, DUNSTABLE, LOWELL, TEWKSBURY, TYNGSBOROUGH, WESTFORD, AND PELHAM, NEW HAMPSHIRE. THE HOSPITAL'S SECONDARY SERVICE AREA (SSA) HAS A POPULATION OF APPROXIMATELY 371,000 AND INCLUDES THE SURROUNDING TOWNS OF ANDOVER, CARLISLE, GROTON, LAWRENCE, LITTLETON, METHUEN, NORTH ANDOVER, PEPPERELL, WILMINGTON, AND HOLLIS, HUDSON AND NASHUA, NEW HAMPSHIRE. PART VI, LINE 5: LOWELL GENERAL HOSPITAL PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES IN MANY WAYS. TO HELP IMPROVE THE HEALTH STATUS OF OUR COMMUNITY WE RECOGNIZE THE IMPORTANCE OF ACCESS TO CARE. TO HELP MEET THIS NEED, LOWELL GENERAL HOSPITAL EVALUATES THE AVAILABILITY OF PRIMARY CARE AND SPECIALISTS TO OUR COMMUNITY MEMBERS AND ACTIVELY RECRUITS PHYSICIANS TO FILL GAPS. THESE GAPS OFTEN INCLUDE RECRUITMENT OF MULTI-LINGUAL PHYSICIANS AND THOSE WHO HAVE SPECIALTIES IN IDENTIFIED HEALTH NEEDS FOR OUR COMMUNITY. LOWELL GENERAL PROVIDES BOTH FINANCIAL AND PRACTICE MANAGEMENT SUPPORT TO THESE PHYSICIANS. THIS ENHANCES THE COMMUNITIES' ABILITY TO ACCESS EXCELLENT PRIMARY AND SPECIALTY CARE IN A LOCAL SETTING.LOWELL GENERAL HOSPITAL HAS A CLOSE WORKING RELATIONSHIP THAT INCLUDES FINANCIAL SUPPORT TO LOWELL COMMUNITY HEALTH CENTER (LCHC) WHICH SERVES THE LOW-INCOME, MEDICALLY UNDERSERVED POPULATION, MANY OF WHOM HAVE NO OTHER ACCESS TO HEALTHCARE SERVICES. THE MAJORITY OF PATIENTS SERVED BY LCHC HAVE MASSHEALTH, ANOTHER 10% HAVE PRIVATE HEALTH INSURANCE OR HMO COVERAGE, 7% HAVE MEDICARE, AND 20% ARE UNINSURED; AND 95% LIVE AT OR BELOW THE POVERTY LEVEL. ALMOST HALF OF LCHC'S PATIENT POPULATION IS UNDER 18 YEARS OF AGE, AND THE MAJORITY OF WOMEN ARE IN THEIR CHILDBEARING YEARS. IN 2007, 37% OF PATIENTS WERE WHITE/NON-HISPANIC; 28% WERE LATINO; 27% WERE ASIAN (PRIMARILY CAMBODIANS) AND 8% WERE AFRICAN IMMIGRANTS. ALMOST 60% OF PATIENTS WERE BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH. SOME OF THE MAJOR SERVICES THAT LCHC PROVIDES ARE - CARINO, WHICH PROVIDES SPECIAL CARE FOR PATIENTS WITH HIV/AIDS; PROMOTORAS PROGRAMS, WHICH ARE TRAINED COMMUNITY HEALTH WORKERS AND VOLUNTEERS WHO SPEAK SPANISH AND/OR PORTUGUESE AND GO THROUGH AN INTENSIVE TRAINING WITH LCHC STAFF ON SPECIFIC HEALTH TOPICS TO EDUCATE THE COMMUNITY; LCHC TEEN COALITION AND ADOLESCENT HEALTH PROGRAM, WHICH COVERS EVERYTHING FROM MENTAL HEALTH AND SELF-ESTEEM ISSUES AMONG GIRLS TO EDUCATING AND INVOLVING YOUTH IN SUBSTANCE ABUSE PREVENTION AND A JOURNEY TO HEALING PROGRAM FOR REFUGEE CHILDREN AND CHILDREN OF REFUGEES. WITHOUT LOWELL GENERAL'S FINANCIAL SUPPORT TO LCHC'S PENSION AND WORKER'S COMPENSATION PROGRAM, MANY OF THESE PROGRAMS WOULD NOT HAVE ADEQUATE FUNDING.THE HOSPITAL DEDICATES EXTENSIVE RESOURCES THROUGHOUT THE ORGANIZATION IN ITS COMMITMENT TO THE COMMUNITY BENEFIT PROGRAM. THE BOARD OF DIRECTORS, IN PARTNERSHIP WITH THE SENIOR MANAGEMENT TEAM AND THE PLANNING AND RESEARCH DEPARTMENT, CREATED A FORMAL STRUCTURE TO SUPPORT THE HOSPITAL'S OUTREACH INTO THE COMMUNITY, DEDICATING RESOURCES AND INVESTING IN A THREE-PRONGED APPROACH THROUGH THE CREATION OF THREE MAJOR INITIATIVES: THE CENTER FOR COMMUNITY HEALTH & WELLNESS, THE GREATER LOWELL HEALTH ALLIANCE, AND THE LGH BALL FOR COMMUNITY HEALTH INITIATIVES, WHICH IS NOW KNOWN AS THE CIRCLE HEALTH BALL FOR COMMUNITY HEALTH INITIATIVES. CENTER FOR COMMUNITY HEALTH & WELLNESSTHE CENTER FOR COMMUNITY HEALTH & WELLNESS (CCHW) WAS CREATED IN 2006 TO MEET THE EVER-CHANGING HEALTHCARE NEEDS THROUGHOUT GREATER LOWELL. PROGRAMS AND EVENTS ARE CREATED BY THE STAFF TO ADDRESS UNMET PUBLIC HEALTH NEEDS INCLUDING, PHYSICAL ACTIVITY, NUTRITION, MENTAL HEALTH, PREVENTION, AND OVERALL HEALTH AND WELLNESS. MANY OF THESE PROGRAMS TARGET OUR COMMUNITY'S UNDERSERVED AND VULNERABLE POPULATIONS, INCLUDING CHILDREN, ELDERLY, AND IMMIGRANTS.TODAY, OUR CENTER FOR COMMUNITY HEALTH AND WELLNESS PLANS AND SUPPORTS MORE THAN 50 EVENTS ANNUALLY, INCLUDING HEALTH FAIRS AND COMMUNITY SCREENINGS, AND PROVIDES MORE THAN 15 SUPPORT GROUPS. IN ADDITION, WE PARTICIPATE IN 15-20 COMMITTEES AND COALITIONS IN THE GREATER LOWELL AREA, SUCH AS THE ASTHMA COALITION OF GREATER LOWELL, CITY MANAGER'S DOMESTIC VIOLENCE TASK FORCE, THE SUBSTANCE USE AND PREVENTION TASK FORCE, LOWELL'S EARLY CHILDHOOD ADVISORY COUNCIL, AND THE MENTAL HEALTH TASK FORCE. OUR LEADERSHIP ROLE IN THESE INITIATIVES ENABLES US TO INCREASE COMMUNITY BUILDING AND CAPACITY, BROADENING THE IMPACT OF OUR REACH. RESPONDING TO THE NEEDS AND FEEDBACK OF OUR COMMUNITY, WE ALSO IMPLEMENTED A CORPORATE WELLNESS PROGRAM, WHICH PROVIDES OUTSIDE CORPORATIONS WITH SCREENINGS, INNOVATIVE PROGRAMS AND HEALTH INFORMATION TO IMPROVE THEIR EMPLOYEES' HEALTH AND WELLBEING.IN 2008, THE HOSPITAL'S CHILDBIRTH EDUCATION DEPARTMENT MOVED UNDER THE LEADERSHIP OF THE CENTER FOR COMMUNITY HEALTH & WELLNESS, CENTRALIZING ALL PREVENTION AND WELLNESS PROGRAMMING FOR THE COMMUNITY. UNDER THE DIRECTION OF CCHW, THE CHILDBIRTH EDUCATION DEPARTMENT HAS GROWN IN NUMBER OF ATTENDEES AND PROGRAMS OFFERED. GREATER LOWELL HEALTH ALLIANCEAS THE CENTER FOR COMMUNITY HEALTH & WELLNESS THRIVED, OUR RESEARCH INDICATED THAT THE SCOPE OF THE REGION'S HEALTHCARE NEEDS REQUIRED RESOURCES AND COLLABORATION BEYOND THOSE THAT COULD BE PROVIDED BY A SINGLE INSTITUTION. THIS FINDING LED LOWELL GENERAL HOSPITAL TO CREATE THE GREATER LOWELL HEALTH ALLIANCE (GLHA), AN INDEPENDENT NON-PROFIT ALLIANCE WITH A MISSION TO SUSTAIN A STRATEGIC ALLIANCE OF COMMUNITY ORGANIZATIONS THAT IMPROVES THE OVERALL HEALTH AND WELLNESS OF THOSE LIVING IN THE GREATER LOWELL REGION. BY RAISING AWARENESS AND PROVIDING RESOURCES FOR OUR HEALTH CARE PROVIDERS, COMMUNITIES, SCHOOLS AND CIVIC AND BUSINESS LEADERS, WE EMPOWER THEM TO MAKE DECISIONS AND TAKE ACTIONS THAT WILL LEAD TO AN IMPROVEMENT IN THE OVERALL HEALTH OF OUR COMMUNITIES.A MAJOR GOAL OF THE GLHA IS TO REDUCE DUPLICATION OF EFFORTS. THEREFORE, IN 2008 GLHA MERGED WITH THE COMMUNITY HEALTH NETWORK AREA (CHNA) 10, A COALITION OF PUBLIC, NON-PROFIT AND PRIVATE SECTORS CREATED BY THE DEPARTMENT OF PUBLIC HEALTH IN 1992. THE UNIFICATION OF THE TWO ORGANIZATIONS STRENGTHENED OUR ABILITY TO WORK WITH OTHERS TO ENRICH THE GREATER LOWELL COMMUNITY; NETWORK AND SHARE IDEAS WITH PEOPLE OF SIMILAR INTEREST IN BUILDING A HEALTHIER GREATER LOWELL COMMUNITY; GAIN MORE KNOWLEDGE ABOUT HEALTH-RELATED ISSUES AND TOPICS; AND INCREASE CULTURAL COMPETENCY OF THE SERVICES PROVIDED TO THE COMMUNITY. SINCE 2006, GLHA HAS GROWN FROM 13 PARTICIPATING ORGANIZATIONS TO MORE THAN 100, AND FROM ONE TASK FORCE (HEALTHY WEIGHT) TO FIVE (SUBSTANCE USE & PREVENTION, MENTAL HEALTH, CULTURAL COMPETENCE, HEALTHY EATING & LIVING, AND MATERNAL CHILD HEALTH). LOWELL GENERAL HOSPITAL CONTINUES TO PROVIDE LEADERSHIP AND FINANCIAL SUPPORT TO THE GLHA.CIRCLE HEALTH BALL FOR COMMUNITY HEALTH INITIATIVESWITH THE GROWING NEED FOR COMMUNITY HEALTH PROGRAMS AND SUPPORT CAME THE NEED FOR ADDITIONAL FUNDING TO SUPPORT THEM. LOWELL GENERAL HOSPITAL DEVELOPED THE ANNUAL "LGH BALL FOR COMMUNITY HEALTH INITIATIVES", NOW KNOWN AS THE CIRCLE HEALTH BALL, TO RAISE AWARENESS AND FUNDS FOR COMMUNITY OUTREACH AND EDUCATION. IN THE PAST SEVEN YEARS, LOWELL GENERAL HOSPITAL HAS RAISED MORE THAN $600,000 FOR COMMUNITY INITIATIVES, INCLUDING THE HEALTHY BABIES INITIATIVE, A BREASTFEEDING EDUCATION AND SUPPORT PROGRAMS FOR NEW MOMS; THE "BEDS FOR KIDS" PROGRAM OF THE LOWELL WISH PROJECT, WHICH PROVIDES NEW BEDS AND BEDDING FOR AT-RISK CHILDREN IN THE CITY; A PUBLIC SERVICE CAMPAIGN TO PROMOTE MENTAL HEALTH AWARENESS AND RESOURCES; THE "HEART AND SOLES" MALL WALKING PROGRAM; AN OUTDOOR RIVER PATH WALKING PROGRAM; A CHILDREN'S LITERACY PROGRAM; A SMOKING PREVENTION PROGRAM IN THE LOWELL PUBLIC SCHOOLS; AND A COMPREHENSIVE HEALTH RISK ASSESSMENT PROGRAM.IN 2017, THE CIRCLE HEALTH BALL RAISED MORE THAN $97,000 TO HELP FUND VITAL HEALTH AND WELLNESS PROGRAMS WHICH BENEFIT RESIDENTS OF THE GREATER LOWELL COMMUNITY. FIVE LOCAL NON-PROFITS WERE AWARDED COMMUNITY HEALTH INITIATIVE GRANTS FOR 2017. THEY WERE THE LOWELL TRANSITIONAL LIVING CENTER, PHEASANT LANE WALKING POGRAM, UNITED TEAM EQUALITY CENTER, HABITAT FOR HUMANITY AND THE INTERNATIONAL INSTITUTE OF BOSTON.LOWELL GENERAL HOSPITAL IS DEDICATED TO THE PROMOTION OF THE HEALTH IN THE COMMUNITY BY PROVIDING EDUCATIONAL OPPORTUNITIES FOR LOCAL SENIOR CENTERS, HOSTING QUARTERLY BLOOD DRIVES IN PARTNERSHIP WITH THE AMERICAN RED CROSS, RUNNING ANNUAL FOOD DRIVES TO BENEFIT THE LOCAL FOOD BANKS, AND PARTICIPATING IN COUNTLESS HEALTH FAIRS WHERE WE PROVIDE VALUABLE HEALTH PROMOTION INFORMATION AND OFTEN PROVIDE FREE HEALTH SCREENINGS. PART VI, LINE 6: MEMBERS AND OFFICERS OF LOWELL GENERAL HOSPITAL ARE ACTIVELY SERVING ON THE BOARDS OF MANY LOCAL COMMUNITY AREA AGENCIES AND AS HEADS OF THE GREATER LOWELL HEALTH ALLIANCE. IN 2012, LOWELL GENERAL HOSPITAL OFFICIALLY BECAME A MEMBER OF CIRCLE HEALTH. CIRCLE HEALTH IS A PROGRESSIVE COLLABORATION OF PHYSICIANS, HOSPITALS, OTHER HEALTH PROVIDERS, AND OTHER COMMUNITY-BASED ORGANIZATIONS WITH A SHARED VISION FOR EMPOWERING PEOPLE AND COMMUNITIES TO BE THE HEALTHIEST THEY CAN BE. WITH OUR INNOVATIVE PROGRAMS AND APPROACH TO CARE MANAGEMENT, OUR PROMISE TO YOU IS AN EXPERIENCE OF COMPLETE CONNECTED CARESM. CIRCLE HEALTH IS ABOUT SUPPORTING COMMUNITIES WITH A COMPREHENSIVE RANGE OF SERVICES SO THAT INDIVIDUALS HAVE EASY ACCESS TO THE EXPERTISE AND RESOURCES THEY NEED IN ORDER TO ACHIEVE THE BEST POSSIBLE HEALTH THROUGHOUT THEIR LIVES.CIRCLE HEALTH IS A MASSACHUSETTS NONPROFIT CORPORATION AND MEMBER OF THE WELLFORCE SYSTEM THAT OVERSEES AND COORDINATES A SERIES OF AFFILIATED CORPORATIONS THAT PROVIDE A BROAD RANGE OF HEALTH CARE AND RELATED SERVICES IN LOWELL, MASSACHUSETTS. THE CONSOLIDATED AFFILIATED ENTITIES OF CIRCLE HEALTH INCLUDE THE LOWELL GENERAL HOSPITAL, A NONPROFIT GENERAL ACUTE CARE HOSPITAL; LGH SERVICES, INC. AND CONSOLIDATED AFFILIATES, A FOR-PROFIT ENTITY AND SOLE SHAREHOLDER OF LGH MANAGEMENT SERVICE, INC., LGH MEDICAL BUILDING SERVICES ("LGH MEDICAL BUILDING"), AND LGH MEDICAL SERVICES, INC.; CIRCLE HEALTH PHYSICIANS, A NONPROFIT ENTITY AND SOLE SHAREHOLDER OF A NUMBER OF PHYSICIAN PRACTICES AND CIRCLE HEALTH PHARMACY LLC; AND CIRCLE HEALTH ALLIANCE, LLC ("ALLIANCE"), AN ACCOUNTABLE CARE ORGANIZATION. PART VI, LINE 7, REPORTS FILED WITH STATES MA 1 BOYS & GIRLS CLUB OF GREATER LOWELL INC 657 MIDDLESEX STREET LOWELL MA 01851 042014396 501(C)(3) 9500 SPONSOR VARIOUS EVENTS CHELMSFORD POP WARNER FOOTBALL INC PO BOX 101 NO CHELMSFORD MA 01863 521656310 501(C)(3) 5000 DONATION CHINMAYA MISSION BOSTON 1 UNION STREET ANDOVER MA 01810 043491406 501(C)(3) 5000 SPONSOR VARIOUS EVENTS CIRCLE HOME INC 847 ROGERS STREET LOWELL MA 01852 042103812 501(C)(3) 5000 SPONSORSHIP CITY OF LOWELL 375 MERRIMACK STREET LOWELL MA 01852 046001396 GOV'T ENTITY 8800 DONATION D'YOUVILLE SENIOR CARE 981 VARNUM AVENUE LOWELL MA 01854 912055004 501(C)(3) 12700 SPONSORSHIP FRESH START FOOD GARDENS LLC 41 WEST STREET WESTFORD MA 01886 811481646 9000 DONATION GIRLS INCORPORATED 220 WORTHERN STREET LOWELL MA 01852 042104401 501(C)(3) 5750 SPONSOR VARIOUS EVENTS GREATER LOWELL COMMUNITY FOUNDATION 100 MERRIMACK STREET LOWELL MA 01852 043401997 501(C)(3) 7100 SPONSOR VARIOUS EVENTS GREATER LOWELL YMCA 35 YMCA DRIVE LOWELL MA 01852 042104398 501(C)(3) 16015 DONATION/SPONSOR VARIOUS EVENTS GREATER MERRIMACK VALLEY CONVENTION & VISITORS BUREAU 40 FRENCH STREET 2ND FL LOWELL MA 01852 043158302 501(C)(6) 7500 SPONSORSHIP IMMACULATE CONCEPTION CHURCH 3 FAYETTE STREET LOWELL MA 01852 042106189 501(C)(3) 5200 SPONSOR VARIOUS EVENTS LOWELL FESTIVAL FOUNDATION PO BOX 217 LOWELL MA 01852 042578293 501(C)(3) 6000 DONATION LOWELL HOUSE INC 555 MERRIMACK STREET WESTFORD MA 01854 237110106 501(C)(3) 10900 DONATION/SPONSOR VARIOUS EVENTS LOWELL SUMMER MUSIC SERIES 67 KIRK STREET LOWELL MA 01852 042578293 501(C)(3) 25000 SPONSORSHIP LOWELL COMMUNITY HEALTH CENTER 161 JACKSON STREET LOWELL MA 01852 042881348 501(C)(3) 5000 SPONSORSHIP MASSACHUSETTS MEDICAL SOCIETY 860 WINTER STREET WALTHAM MA 02451 042050773 501(C)(3) 5000 SPONSORSHIP MERRIMACK REPERTORY THEATRE 132 WARREN STREET LOWELL MA 01852 042664784 501(C)(3) 26481 DONATION/SPONSOR VARIOUS EVENTS MERRIMACK VALLEY FOOD BANK INC 735 BROADWAY STREET LOWELL MA 01854 223241609 501(C)(3) 5000 SPONSORSHIP MIDDLESEX COMMUNITY COLLEGE FOUNDATION PO BOX 716 BEDFORD MA 01730 042973384 501(C)(3) 6500 SPONSORSHIP THE LOWELL PLAN 600 SUFFOLK STREET SUITE 120 LOWELL MA 01854 042693109 501(C)(3) 10500 DONATION/SPONSOR VARIOUS EVENTS THE MEGAN HOUSE FOUNDATION 31 KIRK STREET LOWELL MA 01852 473503719 501(C)(3) 10000 SPONSOR VARIOUS EVENTS TOWN OF TYNGSBOROUGH 25 BRYANT LANE TYNGSBOROUGH MA 01879 046001328 GOV'T ENTITY 12500 DONATION UNIVERSITY OF MASSACHUSETTS LOWELL 225 FRANKLIN STREET FL 33 BOSTON MA 02110 043167352 501(C)(3) 39000 DONATION/SPONSOR VARIOUS EVENTS UNITED TEEN EQUALITY CENTER INC 35 WARREN STREET LOWELL MA 01852 383669532 501(C)(3) 10000 DONATION WILLIAM JAMES COLLEGE INC FREEDMAN CENTER NEWTON MA 02459 042620216 501(C)(3) 5000 DONATION 24 2 PART I, LINE 2: THE LOWELL GENERAL HOSPITAL RESPONDS TO SPECIFIC REQUESTS FOR FUNDING TO LOCAL AGENCIES AND ORGANIZATIONS RELATED TO COMMUNITY BENEFIT EVENTS AND NEEDS. THE HOSPITAL REQUIRES THAT THE ORGANIZATION STATE THE NATURE OF THEIR NEED PRIOR TO THEM MAKING THE CONTRIBUTION AND, IN THE CASE OF MAJOR DONATIONS AN ANNUAL REPORT IS REQUESTED WHICH DETAILS HOW SUCH DONATED FUNDS WERE SPENT. X X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 JOSEPH WHITE PRESIDENT 679599 0 157248 0 487914 0 8250 0 12671 0 1345682 0 0 0 WILLIAM WYMAN SR. VP OF FINANCE/TREAS./ASST. CLERK 317072 0 46365 0 3158 0 6320 0 13670 0 386585 0 0 0 SABRINA GRANVILLE CHO 87142 261425 26042 78125 6802 20406 2063 6188 4817 14451 126866 380595 0 0 AMY HOEY CHIEF OPERATING OFFICER 424449 0 117212 0 217797 0 8250 0 18164 0 785872 0 0 0 CECELIA LYNCH CNO 342989 0 59098 0 7024 0 8250 0 18664 0 436025 0 0 0 ARTHUR LAURETANO CMO 367616 0 32334 0 976 0 0 0 1122 0 402048 0 0 0 MICHELLE DAVIS VP EXTERNAL AFFAIRS 233000 0 0 0 198 0 2581 0 18928 0 254707 0 0 0 WENDY MITCHELL MEDICAL DIR. COMMUNITY HOME 284411 0 26780 0 1022 0 0 0 24520 0 336733 0 0 0 EMILY YOUNG DIRECTOR OF HEALTHCARE OPS 218312 0 41867 0 876 0 0 0 22469 0 283524 0 0 0 YISHIS REN CHIEF MEDICAL PHYSICIST 248530 0 0 0 3741 0 0 0 20706 0 272977 0 0 0 RAMYA PRABHAKAR PHYSICIAN 272204 0 0 0 743 0 0 0 25755 0 298702 0 0 0 JAMES WOOLMAN DIRECTOR ACO PERFORMANCE MGMT 212922 0 48038 0 572 0 0 0 23383 0 284915 0 0 0 WILLIAM GALVIN III MD BOARD MEMBER/MEDICAL DIRECTOR 432780 0 88666 0 2094 0 8250 0 18163 0 549953 0 0 0 SUSAN GREEN FMR. SENIOR VP & CFO & TREAS. - THE 0 540301 0 155461 0 35325 0 8250 0 19217 0 758554 0 0 NORMAND DESCHENE FMR. PRES. OF BOARD & CEO 0 1092300 0 366053 0 197871 0 8250 0 12671 0 1677145 0 0 PART I, LINE 1A THE HOSPITAL HAS ENTERED INTO RESTRICTIVE ENDORSEMENT BONUS ARRANGEMENTS ("REBA'S") WITH THE FOLLOWING EMPLOYEES AS PART OF A RETIREMENT RETENTION PROGRAM: JOSEPH WHITE - PRESIDENT - THE LOWELL GENERAL HOSPITAL AMY HOEY - CHIEF OPERATING OFFICER - THE LOWELL GENERAL HOSPITAL AMOUNTS PAID BY THE HOSPITAL UNDER THE ARRANGEMENT ARE REQUIRED TO BE REPAID TO THE HOSPITAL IF LENGTH OF SERVICE REQUIREMENTS ARE NOT MET. AMOUNTS PAID UNDER THE REBA ARRANGEMENTS ARE TREATED AS TAXABLE COMPENSATION IN THE YEAR PAID BY THE HOSPITAL. THIS ARRANGEMENT WAS APPROVED BY THE HOSPITAL'S COMPENSATION COMMITTEE AS DOCUMENTED IN THE COMMITTEE MINUTES. THE W-2 COMPENSATION REPORTED FOR MR. WHITE - PRESIDENT - THE LOWELL GENERAL HOSPITAL ON FORM 990, SCHEDULE J, PART II, COLUMN B(III) INCLUDES $426,404 PAID IN 2018 IN CONNECTION WITH THE REBA ARRANGEMENT. THE W-2 COMPENSATION REPORTED FOR MS. HOEY - CHIEF OPERATING OFFICER - THE LOWELL GENERAL HOSPITAL ON FORM 990, SCHEDULE J, PART II, COLUMN B(III) INCLUDES $180,018 PAID IN 2018 IN CONNECTION WITH THE REBA ARRANGEMENT. SOCIAL CLUB DUES ARE PROVIDED TO JOSEPH WHITE AND AMY HOEY. SOCIAL CLUB DUES ARE TREATED AS TAXABLE COMPENSATION TO THE EXTENT CONSIDERED PERSONAL USEAGE. PART I, LINES 4A-B THE HOSPITAL HAS ENTERED INTO A SPLIT-DOLLAR LIFE INSURANCE AGREEMENT WITH NORMAND DESCHENE - FMR. PRESIDENT OF BOARD & CEO - THE LOWELL GENERAL HOSPITAL. PREMIUMS PAID IN CALENDAR 2018 WERE $125,648. ALL PREMIUMS WILL BE REPAID TO THE HOSPITAL. PART I, LINE 7 BONUSES ARE PAID AS INDICATED ON SCHEDULE J, PART II. BONUS PAID TO OFFICERS ARE APPROVED BY THE BOARD OF TRUSTEES. OTHER BONUSES ARE APPROVED BY THE OFFICERS OF THE HOSPITAL. A MASS HEALTH AND ED FACILITIES AUTHORITY SERIES C 042456011 57586EXB2 2010-09-29 109152040 CONSTRUCTION OF NEW BUILDING, EQUIP. ACQUISITIONS, PAY OFF COMMERCIAL DEBT 0 0 0 B MASS DEVELOPMENT FINANCE AGENCY SERIES G 043431814 57583UVQ8 2013-05-01 65688217 NEW CAPITAL PROJECTS AND EQUIPMENT COSTS AND REFUND/TERMINATE SERIES D BONDS 0 0 0 C MASSACHUSETTS DEVELOPMENT FINANCE AGENCY SERIES A 043431814 57583UBK3 2019-02-20 23765000 SEE SUPPLEMENTAL INFORMATION 0 0 1 A 12525000 109975336 7292496 1755029 92469 74150946 26684396 2013 0 0 1 1 B 65689334 1009853 15585808 49093673 2013 1 0 1 1 C 24730490 25565023 250000 25315023 2019 1 0 1 1 A 0 1 1 1 0 0.02530 0.00000 0.02530 0 0 1 B 0 1 1 1 0 0.02190 0.00000 0.02190 0 0 1 C 0 1 1 1 0 0.02600 0.00000 0.02600 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: MASS. HEALTH AND ED. FACILITIES AUTHORITY SERIES C DATE THE REBATE COMPUTATION WAS PERFORMED: 09/30/2017 PART II: MASS. HEALTH AND ED. FACILITIES AUTHORITY SERIES C LINE 3A: TOTAL PROCEEDS OF ISSUE CONSISTS OF $109,152,040 ORIGINAL PROCEEDS PLUS INVESTMENT INCOME OF $823,296 FOR TOTAL OF $109,975,336. LINE 5A: CAPITALIZED INTEREST FROM PROCEEDS TOTALED $7,292,496. LINE 11A: OTHER SPENT PROCEEDS CONSISTING OF REPAYMENT OF PRIOR BONDS SERIES B BONDS OF $11,042,852 PLUS $10,357,512 OF CAPITALIZED INTEREST AND VARIOUS LOANS PAID OFF OF $5,284,032 FOR TOTAL AMOUNT OF $26,684,396. MASS. DEVELOPMENT FINANCE AGENCY SERIES G LINE 3C: TOTAL PROCEEDS OF ISSUE CONSISTS OF $65,688,217 ORGINAL PROCEEDS PLUS INVESTMENT INCOME OF $1,117 FOR TOTAL OF $65,689,334. MASS. DEVELOPMENT FINANCE AGENCY SERIES A DESCRIPTION OF BOND PURPOSE: A. THE ISSUANCE OF BONDS AND THE LOAN OF THE PROCEEDS THEREOF IS TO (1) REFINANCE CERTAIN OUTSTANDING INDEBTEDNESS OF OR ISSUED FOR THE BENEFIT OF THE INSTITUTION, AS FUTHER IDENTIFIED BELOW, (2) FINANCE CONSTRUCTION, RENOVATION AND IMPROVEMENTS AT AND ACQUISTIONS AND EQUIPMENT FOR THE ACUTE CARE HOSPITAL AND RELATED FACILITIES OWNED AND/OR OPERATED BY TUFTS MEDICAL CENTER, (3) FUND A DEBT SERVICE RESERVE FUND, AND (4) PAY CERTAIN COSTS OF ISSUANCE OF THE BONDS. FURTHER IDENTIFICATION OF BOND PURPOSE - REFINANCINGS: SERIES E & F BONDS ISSUED 9/27/12 SERIES A BONDS WERE ISSUED FOR THE WELLFORCE OBLIGATED GROUP, WHICH INCLUDES TUFTS MEDICAL CENTER, INC., THE LOWELL GENERAL HOSPITAL, AND MELROSEWAKEFIELD HEALTHCARE. X 1 10166 FMV X FUNDRAISING EVENT ITEMS 397 187501 FMV 0 0 1 0 PART I, COLUMN (B): THE AMOUNT IN COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE LOWELL GENERAL HOSPITAL IS CIRCLE HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A CIRCLE HEALTH, INC., AS SOLE MEMBER OF THE LOWELL GENERAL HOSPITAL, ELECTS THE MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CIRCLE HEALTH, INC. APPROVES BUDGETS FOR THE LOWELL GENERAL HOSPITAL. CIRCLE HEALTH, INC. ALSO DETERMINES THE NUMBER OF LOWELL GENERAL HOSPITAL TRUSTEES AT AN ANNUAL MEETING. CIRCLE HEALTH, INC. MAY ALSO ELECT NEW TRUSTEES OR REMOVE TRUSTEES TO ACHIEVE THE NUMBER OF TRUSTEES SO FIXED. FORM 990, PART VI, SECTION B, LINE 11B CBIZ MHM, LLC A PROFESSIONAL ACCOUNTING/TAX FIRM, WILL PREPARE THE ANNUAL FORM 990 IN ASSOCIATION WITH THE FINANCE DEPARTMENT OF THE LOWELL GENERAL HOSPITAL WHO WILL SUPPLY RELEVANT INFORMATION. THE BOARD OF DIRECTORS WILL BE PROVIDED WITH A COMPLETED DRAFT OF THE FORM 990 PRIOR TO ITS FILING. ALL MEMBERS OF THE BOARD OF DIRECTORS WILL BE INVITED TO REVIEW THE COMPLETED 990 IN ADVANCE OF THE FILING DEADLINE. COPIES OF THE DRAFT FORM 990 WILL BE MADE AVAILABLE TO ALL MEMBERS OF THE BOARD OF DIRECTORS, AS NEEDED, AND IN AN APPROPRIATE FORMAT (ELECTRONIC OR PAPER.) THE BOARD OF DIRECTORS WILL RECEIVE THE FINANCE COMMITTEE REPORT AND ITS RECOMMENDATIONS FOR THE 990 AND WILL VOTE TO APPROVE IT FOR FILING. THE FINALIZED FORM, AFTER COORRECTIONS AND MODIFICATIONS, IF ANY, WILL THEN BE SIGNED BY EITHER THE CEO OR CFO AND FILED AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. ANY ACTUAL OR POTENTIAL CONFLICTS ARE FORWARDED TO THE COMPLIANCE COMMITTEE FOR CONSIDERATION. IN THE EVENT OF AN ACTUAL OR POTENTIAL CONFLICT, THE CONFLICTED INDIVIDUAL IS PROHIBITED FROM PARTICIPATING IN DELIBERATIONS OR DECISIONS RELATING TO THE MATTER. A COMPLIANCE COMMITTEE MEETING IS HELD EVERY OTHER MONTH TO ADDRESS CONCERNS. FORM 990, PART VI, SECTION B, LINE 15 A THIRD PARTY CONSULTANT IS HIRED FOR AN INDEPENDENT ASSESSMENT OF APPROPRIATE SALARY RANGES FOR THE OFFICERS OF THE ORGANIZATION SUCH AS THE CEO, PRESIDENT, COO, AND CFO. THIS ASSESSMENT IS REVIEWED BY THE COMPENSATION COMMITTEE AND A RECOMMENDATION IS GIVEN TO THE BOARD OF TRUSTEES ON SALARY INCREASES AND BONUSES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE PROVIDED TO AND MADE AVAILABLE ON THE SECRETARY OF STATE WEBSITE AND MADE AVAILABLE UPON REQUEST ALONG WITH CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION B., LINE 16A: THE LOWELL GENERAL HOSPITAL OWNS 16.67% INTEREST IN YANKEE ALLIANCE, LLC. FORM 990, PART VI, SECTION B., LINE 16B: THE ORGANIZATION ROUTINELY CONSULTS WITH INTERNAL AND OUTSIDE COUNSEL PRIOR TO ENTERING INTO JOINT VENTURE ARRANGEMENTS. THE ORGANIZATION IS CURRENTLY CONSIDERING IMPLEMENTATION OF WRITTEN POLICIES AND PROCEDURES TO EVALUATE PARTICIPATION OF JOINT VENTURE ARRANGEMENTS TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS WITH RESPECT TO SUCH ARRANGEMENTS. FORM 990, PART XI, LINE 9: PROVISION FOR UNCOLLECTIBLE ACCOUNTS -12,984,894. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS -21,137. TRANSFERS TO AFFILIATES -24,616,222. PENSION RELATED ADJUSTMENTS -11,814,222. ROUNDING -3. 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