2019-05-09T15:37:05-07:00 2018-09-30 990 2017-10-01 042103581 HENRY HEYWOOD MEMORIAL HOSPITAL HENR 9786323420 242 Green Street Gardner MA 01440 Robert Crosby Sr VP of Finance, Treasurer, CFO 9786323420 2019-04-10 209.160.147.198 2017 2019-02-21 02:37:17Z Heywood Hospital Henry Heywood Memorial Hospital 242 Green Street Gardner MA 01440 138532457 0 X www.heywood.org X 1907 MA To be our community's trusted choice for exceptional patient centered care. 21 18 1197 128 0 0 1783646 1991817 116121685 126273610 943308 1578974 1433260 2293257 120281899 132137658 156414 206681 0 0 61677293 65832671 56000 65407 473316 55787633 63208558 117677340 129313317 2604559 2824341 96090126 93519747 41756567 40553298 54333559 52966449 To be our community's trusted choice for exceptional patient centered care. 0 0 122053314 206681 130145841 Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the specific health care needs of the under-served and collaborating with others to enhance quality and contain the growth of the community health care costs. Details to this are published in Heywood Hospital's "Community Benefit Report - FY 2018" filed with the MA Attorney General's Office. 0 0 0 122053314 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 0 0 0 0 0 0 1 0 0 0 1 195 0 1 1197 1 0 0 0 0 0 1 1 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 Robert Crosby 9786306157 242 Green Street Gardner MA 01440 X Daniel Asquino Trustee 0.2 0 X 0 0 0 Winfield Brown President/CEO 40 0 X X 894266 0 72206 Cheney Castine Treasurer 0.20 0 X 0 0 0 Robert Chauvin Trustee 0.2 0 X 0 0 0 Joyce Fletcher Trustee 0.2 0 X 0 0 0 John Flick Trustee 0.2 0 X 0 0 0 James Garrison Trustee 0.2 0 X 0 0 0 Glenn Hunt Chairman 0.2 0 X 0 0 0 Roy Lake Trustee 0.2 0 X 0 0 0 James Meehan Trustee 0.2 0 X 0 0 0 Don Mruk Trustee 0.2 0 X 0 0 0 Elizabeth Nottleson Trustee 0.2 28 X 0 279752 19337 Michele Parker Trustee 0.2 0 X 0 0 0 JoAnne Parks Trustee, Clerk 0.2 0 X 0 0 0 Kenneth Pierce Trustee 0.2 0 X 0 0 0 Benjamin Prentiss Trustee 0.2 36 X 0 393972 41565 Tina Sbrega Trustee 0.2 0 X 0 0 0 Joel Shaughnessy Trustee 0.2 0 X 0 0 0 John Skrzypczak Trustee 0.2 0 X 0 0 0 Craig Twohey Trustee 0.2 0 X 0 0 0 Albert Rose Trustee 0.2 0 X 0 0 0 Robert Crosby Sr VP of Finance / CFO 40 0 X 394327 0 60454 Tina Santos VP of Patient Care Services 40 0 X 296769 0 34654 Carol Roosa Chief Info Officer / VP of Info Services 40 0 X 218744 0 48708 Dawn Casavant VP of External Affairs 40 0 X 201795 0 52371 Rose Kavalchuck VP of Prof. Services 40 0 X 213869 0 47679 Andrew Cocchiarella Director of Anesthesia Services 50 0 X 738101 0 41973 Ellen Ray Chief of ER Medicine 40 0 X 509312 0 57597 Sarah Gilbert ER Physician 30 0 X 368799 0 51790 Marc DeBell ER Physician 30 0 X 263938 0 29118 Daniel Wilson ER Physician 30 0 X 391078 0 32377 Rebecca Bialecki VP of Community Health Relations 40 0 X 168794 0 47096 Bruce Bertrand Chief Medical Officer 40 0 X 311696 0 37762 Michael Grimmer VP of Support Services 0 0 X 234587 0 40741 5206075 673724 715428 111 1 1 0 Quartulli & Associates PO Box 423 Gardner MA 01440 Physical Therapy 2799420 Alliance Healthcare Services 18201 Von Karman Ave Suite 600 Irvine CA 92612 MRI 1587921 Quest Diagnostics 5763 Collection Center Dr Chicago IL 60693 Lab contracted services 1199801 New England Inpatient Specialists 47 High Street Suite 101 North Andover MA 01845 Hospitalists 960933 Diversified Clinical Services 28525 Network Place Chicago IL 60673 Wound management services 821394 31 0 0 56405 157826 1386860 390726 0 1991817 Ancillary O/P Services 622110 75566170 75566170 0 0 Ancillary I/P & Routine Services 622110 43448932 43448932 0 0 HMG Patient Revenue (net) 621111 3728986 3728986 0 0 Contracted Services Revenue 900099 3459094 3459094 0 0 Lifeline Service Revenue 624120 28831 28831 0 0 41597 41597 0 0 126273610 435885 0 0 435885 0 0 0 0 0 0 0 0 369868 0 0 0 369868 0 369868 0 0 369868 7362952 26355 6243227 2991 1119725 23364 1143089 0 0 1143089 149787 56405 148581 1206 0 1206 0 0 0 0 0 0 0 0 0 0 0 0 Meal Revenue 900099 849383 0 0 849383 Purchase Discounts 900099 226722 0 0 226722 340B revenue-contract pharmacy 900099 740604 0 0 740604 105474 0 0 105474 1922183 132137658 126273610 0 3872231 X 206681 206681 0 0 0 0 0 0 2246547 1063736 1057403 125408 0 0 0 0 52220958 50182077 1900381 138500 945083 819444 101732 23907 6104038 5624476 439863 39699 4316045 4064931 227621 23493 0 0 0 0 119859 5914 113945 0 117876 0 117876 0 0 0 0 0 65407 65407 0 0 0 0 16393128 16288314 104814 0 276755 273360 3395 0 18495403 18305701 182461 7241 1701192 1545922 143204 12066 0 0 0 0 2766533 2630100 136433 0 100149 81812 18207 130 0 0 0 0 162772 128304 34468 0 1423 1423 0 0 0 0 0 0 3751854 3734061 17028 765 491658 387908 103750 0 Other Outside Fees 6160320 4958136 1166781 35403 Bad Debt 6409544 6409544 0 0 Free Care 1785636 1785636 0 0 Outside Lab 1446401 1446401 0 0 3028055 2109433 917325 1297 129313317 122053314 6786687 473316 4104361 3978349 0 0 579630 341313 14299711 14415401 0 0 0 0 4000 33928 1583424 1791744 741878 599365 109431067 65802662 45513130 43628405 25904430 24691675 675397 1066749 158908 169206 0 0 2525257 2803612 96090126 93519747 14536533 15374415 0 0 228863 333889 20989321 19838464 0 0 0 0 237595 112087 0 0 5764255 4894443 41756567 40553298 X 50289068 48704695 3038068 3255251 1006423 1006503 54333559 52966449 96090126 93519747 X 2824341 941403 0 0 0 -5132854 X 0 1 X 1 0 X 25599932 4030 1873273 0 -3160071 0 30637306 22460789 2504 2793312 0 -343327 0 25599932 20377782 0 1888246 0 -194761 0 22460789 20170666 18245 -665620 0 -854491 0 20377782 18078764 100 1729112 0 -362690 0 20170666 0.883 0.041 0.076 0 0 0 210871 210871 0 67587416 30172244 37415172 0 0 0 0 0 39815333 34241791 5573542 0 1817447 1388627 428820 43628405 0 Estimated settlements with third party payors 2137495 Estimated malpractice liability 1420000 Deferred Compensation 1336948 4894443 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 Tax Status footnote per Audited Financials: 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 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, 2018 and 2017, 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 Consultant 0 0 65407 -65407 0 65407 -65407 MA Golf Classic 109845 35900 73945 0 11820 13067 26775 4114 10565 Winter Affair 65790 19765 46025 0 5851 765 19022 3206 12554 4 30557 740 29817 0 864 1978 8939 447 28614 206192 56405 149787 0 18535 15810 54736 7767 51733 148581 1206 1 1 X 1 X 1 X 1 1 0 1 1 0 0 2065125 878162 1186963 0.0097 0 0 26251128 22806678 3444450 0.028 0 0 0 0 0 0 0 0 28316253 23684840 4631413 0.0377 0 0 1587601 353827 1233774 0.01 0 0 344572 88 344484 0.0028 0 0 0 0 0 0 0 0 0 0 0 0 0 0 221956 0 221956 0.0018 0 0 2154129 353915 1800214 0.0146 0 0 30470382 24038755 6431627 0.0523 0 0 1322 0 1322 0.00 0 0 0 0 0 0 0 0 23141 0 23141 0.0002 0 0 0 0 0 0 0 0 1162 0 1162 0 0 0 91123 0 91123 0.0007 0 0 8208 0 8208 0 0 0 362208 0 362208 0.0031 0 0 0 0 0 0 0 0 487164 0 487164 0.0040 1 2870301 9185 28095879 26914226 1181653 X 1 1 1 1 Henry Heywood Memorial Hospital 242 Green St 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 X www.nqcc.org 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/financialservices X www.heywood.org/financialservices X X X X X 1 X X 0 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 socio-economic determinants of health. Throughout the assessment, special attention was paid to "communities within communities", health disparities and health equity. Information and perceptions from under-represented racial/ethnic, socioeconomic and geographic groups were collected from 596 Surveys, 17 Focus Groups, and 12 Healthcare Professional Interviews to supplement the quantitative data gathered. 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 are of 6 communities and the Athol Hospital service area of 9 communities. Schedule H, Part V, Section B, Line 6b-Henry Heywood Memorial Hospital It was a collaborative between the Montachusett Regional Planning Commission (MRPC); UMASS Memorial Health Alliance Clinton Hospital; The Community Health Network of North Central MA (CHNA 9) Group; and John Snow, Inc. Quantitative data sources came from Massachusetts Community Health Information Profile (MassCHIP) data from the Massachusetts Department of Public Health (MassDPH); the Youth Risk Behavior Survey (YRBS) data; U.S. Census data (including data from the American Community Survey); and other Commonwealth and Federal Government organizations and agencies. Staff at MRPC was responsible for conducting research and analysis efforts. The Community Benefits Leadership Team made up of department heads from Athol and Heywood Hospitals, the North Quabbin Community Coalition, the CHNA-9 Group and other relevant community partners provided input into the process and assisted with analyzing and reviewing the report. Other organizations and individuals also contributed to the assessment, including: North Quabbin Recovery Planning Group; Jail to Community Task Force; Children's Health and Wellness; Multicultural Task Force; Gardner Area Interagency Team; Substance Abuse Task Force; Greater Gardner Religious Council; Schwartz Center Rounds; Greater Gardner Chamber of Commerce; Heywood Senior Team ; Regional Behavioral Health Collaborative; Gardner MENders Support Group; Montachusett Suicide Prevention Task Force; North Quabbin Community Coalition; Community Health Connections Board; Montachusett Public Health Network; and CHNA-9 CHIP Breakfast . 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). A link to the assessment and a summary of the findings was presented at the following committee meetings: 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) developed from the Community Health Needs Assessment, prioritizes significant health focus areas, targets at risk populations, and outlines the strategies and resources within the community that the hospital will partner with to respond to the health needs. Heywood Healthcare's approach to addressing the critical health needs identified by the CHNA is to actively participate in and collaborate with cross-sector coalitions, healthcare and behavioral health providers, community, and faith-based organizations and businesses to develop and implement our plan, goals, and strategies. Through our engagement with community-based organizations, our Patient and Family Advisory Committee, and the Community Benefits Advisory Committee we can ensure that our CHIP has input from persons who represent the broad interests and special knowledge of the significant health needs of our community. Key Accomplishments of Reporting Year: * Provided nutrition education and health information to over 400 individuals to promote wellness and managing chronic disease through cooking classes and interactive presentations and participating in community health fairs. * Partnership with the Gardner Public School District to offer nutrition education and physical activities to 80 elementary students and provided 6400 backpacks filled with food for the weekend to 200 low- income youth and their families. * Offered wellness instruction and self-care techniques to 700 individuals to manage symptoms associated with having a mental health and/or substance use disorder. * Provided training on Opioid Overdose Prevention and Narcan Administration to 329 community members. * Offered QPR Gatekeeper training or Mental Health First Aid Training to 280 community members increasing knowledge on identifying, understanding, and responding to a mental health or suicide crisis. * Provided health and financial insurance information and enrollment assistance to 4,048 individuals reducing financial barriers to accessing healthcare. * Offered free psychosocial support to 58 community members looking for information and referrals on issues related to housing, food, transportation, behavioral and substance abuse. * 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 202 patients with transportation and as a result, was able to follow up with their healthcare and prevented missed appointments. * Provided 4,564 hours of mentorship to 28 students pursuing careers in healthcare. * Lead several multi-sector coalitions and actively participated on community boards and committees to collaboratively address community health needs and gaps in services. * Distributed $124,000 grants to 14 local organizations that provide programs in line with the hospital's community benefit areas of focus and reach the targeted population. Schedule H, Part I, Line 6a Heywood's approach to Community Benefits has been to collaborate with others through the Joint Coalition on Health and other coalitions to develop our plan, goals and strategies. Partners include the Joint Coalition on Health, Gardner Interagency Team, the CHNA, The Minority Coalition, Montachusett Opportunity Council, Mount Wachusett Community College, the Community Health Connections Health Centers, North Central Human Services, Luc, Inc., Community Health Link, Gardner, VNA, the Gardner Public Schools, the Winchendon Public Schools, the Health Foundation of Central MA, Kresge Foundation, the Department of Public Health, AHEC, and others. At this time we continue to focus our efforts on mental health and substance abuse, insuring those without jobs and/or insurance, addressing the needs of under-served populations, focusing on the needs of youth and children, and targeting adults and children with overweight and obesity issues which lead to chronic diseases and diabetes. 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 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 4 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 2018. This amounted to approximately .3% 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. The footnote can be found on Page 11 of the financial statements - footnote #2 under "Allowance of Doubtful Accounts". Schedule H, Part III, Section B, Line 8 There is no shortfall. The allowable costs on line 6 were obtained from our FY 2018 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 of 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 Heywood obtains will be maintained in accordance with applicable federal and state privacy and security laws. The screening and application process for public health insurance program 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 after completing the application. All Virtual Gateway applications are reviewed and processed 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. Hospitals have 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 request for documentation, then our standard collection procedures apply. Schedule H, Part VI, Line 2 In addition to conducting the CHNA, the organization monitors hospital data and actively engages with the Community Benefits 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 The communities served by Heywood Hospital include Gardner, Templeton, Winchendon, Ashburnham, Westminster and Hubbardston. Communities in the Service Area vary greatly in terms of their demographic, social and economic factors. Some communities are more rural while others are more urban; others are considered more affluent while others are considered to be economically disadvantaged, and some are more racially/ethnically diverse while others are considered more homogenous. 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 important 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 nearly 7 years higher than the State and Nation including a greater number of those age 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 difficult 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 MA rate of 11.4%. Gardner's childhood poverty rates have increased 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 Heywood Hospital's approach to addressing the critical health needs identified by the CHNA is to actively participate on and collaborate with cross-sector coalitions, healthcare and behavioral health providers, community, and faith-based organizations and businesses 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 works closely with the community to promote health in areas identified by the 2015 Community Health Needs Assessment (CHNA) through a variety of means. The hospital works with area school systems to address childhood obesity and onset of adult diabetes through nutrition/fitness programs targeting young students K-2, in order to help develop healthy habits which may result in a reduction of chronic illness and obesity as indicated in the 2015 CNHA. Financial counselors help uninsured populations, including those recently unemployed and those experiencing financial hardship to enroll in appropriate programs to ensure healthcare coverage, an identified barrier to obtaining health care, as indicated in the 2015 CHNA. Community programs targeting nutrition and fitness are offered free and at reduced rates focusing on nutrition, healthy cooking and consistent exercise, focusing on the reduction of chronic disease including diabetes and cardiovascular disease in adults as indicated in the 2015 CHNA. Operation of a school-based health center which enrolls an average of 79% of all students in the school, providing nearly 1,000 behavioral health visits annually, addressing higher than normal suicide and substance abuse rate, as indicated in the 2015 CHNA. The Suicide Prevention Taskforce, which partners with approximately 100 area social service agencies, provides educational tools, and raises community and legislative awareness of significant area mental health and substance abuse issues, resulting in a Gardner suicide rate approximately twice the state average. Continue to work with the Minority Coalition, Joint Coalition of Health and other community agencies to raise awareness and skills among health providers to reduce disparities and strive for equal health. Schedule H, Part VI, Line 7 Community Benefit Report is filed with Attorney General's Office, State of Massachusetts. 1 Montachusett Home Care Corp 680 Mechanic St Leominster MA 01453 042551175 501(c)(3) 36414 0 cash home care-elderly & disabled Heywood Healthcare Charitable Foundation 242 Green St Gardner MA 01440 222720562 501(c)(3) 120000 0 cash support local organizations 2 0 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 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 the funds are allocated. X X 0 1 X X X X X X 1 0 0 0 0 1 0 0 0 Winfield Brown President/CEO 501777 0 110549 0 281940 0 23400 0 48806 0 966472 0 0 0 Elizabeth Nottleson Trustee 0 262126 0 0 0 17626 0 5404 0 13933 0 299089 0 0 Benjamin Prentiss Trustee 0 373267 0 20108 0 598 0 7837 0 33727 0 435537 0 Robert Crosby Sr VP of Finance / CFO 291843 0 57133 0 45351 0 23281 0 37173 0 454781 0 0 0 Michael Grimmer VP of Support Services 230848 0 0 0 3740 0 11418 0 29322 0 275328 0 0 0 Bruce Bertrand Chief Medical Officer 271766 0 35978 0 3952 0 23400 0 14362 0 349458 0 0 0 Rose Kavalchuck VP of Prof. Services 208093 0 0 0 5776 0 21101 0 26578 0 261548 0 0 0 Rebecca Bialecki VP of Community Health Relations 167261 0 0 0 1533 0 21496 0 25600 0 215890 0 0 0 Tina Santos VP of Patient Care Services 271359 0 24519 0 891 0 18105 0 16549 0 331423 0 0 0 Carol Roosa Chief Info Officer / VP of Info Services 193314 0 25188 0 242 0 22014 0 26694 0 267452 0 0 0 Dawn Casavant VP of External Affairs 177371 0 23843 0 581 0 21735 0 30636 0 254166 0 0 0 Andrew Cocchiarella Director of Anesthesia Services 641511 0 65000 0 31590 0 4206 0 37767 0 780074 0 0 0 Ellen Ray Chief of ER Medicine 379255 0 36660 0 93397 0 23400 0 34197 0 566909 0 0 0 Daniel Wilson ER Physician 324547 0 41612 0 24919 0 0 0 32377 0 423455 0 0 0 Sarah Gilbert ER Physician 315056 0 50540 0 3203 0 19754 0 32036 0 420589 0 0 0 Marc DeBell ER Physician 228625 0 34916 0 398 0 11305 0 17812 0 293056 0 0 0 Schedule J, Part I, Line 1a Part 1, Line 1a: Travel expenses for the CEO's wife were paid through the hospital. Additionally, Social Club Membership dues provided to Winfield Brown, CEO, per his employment contract. Schedule J, Part I, Line 1b There was no written policy for the Social Club Membership dues; it was part of his employment contract. Schedule J, Part I, Line 4 Michael Grimmer, VP of Support Services, received a severance package when he terminated employment in April 2017 for 1 year severance. Schedule J, Part I, Line 6 Heywood Hospital accrues 15% of the executive team's salary as part of an incentive compensation program, and service goals are set by the Hospital's Trustees. A MA Health & Educ Facility 042456011 57586EGT2 2009-03-31 17785000 Funds used for new Watkins Building project 0 0 0 B MA Health & Educ Facility 042456011 57586C7E9 2008-06-19 6715000 Refunding used for new Watkins Building project 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 Jaffrey 18.7 0 0 0 0 1 A 0 B 0 Schedule K, Part IV, Line 2c-03/31/2009 17,785,000 MA Health & Educ Facility For both Bond Issues, the rebate computation was performed on October 31, 2018. Schedule K, Part IV, Line 2c-06/19/2008 6,715,000 MA Health & Educ Facility For both Bond Issues, the rebate computation was performed on October 31, 2018. Heather Bialecki-Canning daughter of Officer-RB 72676 Salary as NQCC Director 0 Kaitlin Fletcher family member of Trustee 83833 Salary as RN 0 Eliot Nottleson spouse of Trustee - EN 149883 Salary as Physician Assistant 0 Form 990, Part VI, Section B, Line 11b The accountant at Heywood Hospital prepares the Form 990 and provides to the controller for review. The form is then sent to the CFO for a final review. Once reviewed, the 990 is received by the Board of Trustees. The 990 is then approved by the board and 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 CEO and Executive Staff's compensation is determined by market data and analysis provided to the Hospital's Compensation Committee and Board of Trustees by an independent compensation consultant engaged by the Board of Trustees annually. Winfield Brown, CEO and Robert Crosby, CFO, receive deferred compensation payments, which are subject to multi-year vesting incumbent upon fulfilling ongoing contractual obligations. 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 VII, Section A, Line 1a Elizabeth Nottleson, Trustee to the Organization, received compensation from the organization as Medical Director and not for serving on the Board. Additionally, she received wages from a related organization for her employment as Family Practice Physician. Benjamin Prentiss, Trustee to the Organization, received compensation from the organization as Medical Staff President and not for serving on the Board. Additionally, he received wages from a related organization for his employment as Cardiology Physician. Form 990, Part IX, Line 11g Other Non-Employee Fees for Services consist of the following: Outside Physician Fees 10,198,650 Outside Clinical Fees 5,681,562 Temporary Employees 5,058 Medical Staff 416,428 Other Fees for Services 91,430 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, $6,492, and transfers to related organizations to support their operations, $5,139,346. 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 Hospital MA 501(c)(3) 3 HHI 0 Heywood Medical Group 242 Green St Gardner MA 01440 043136589 Employ Physicians MA 501(c)(3) 10 HHI 0 Quabbin Healthcare Inc 242 Green St Gardner MA 01440 812053488 Behavioral Health Services MA 501(c)(3) 12b HHI 0 Heywood Realty Corp 242 Green St Gardner MA 01440 043327447 Property Holding Co MA 501(c)(2) HHI 0 Heywood Healthcare Charitable Foundation 242 Green St Gardner MA 01440 222720562 Charitable Foundation MA 501(c)(3) 7 HHI 0 HHMH Aid Association 242 Green St Gardner MA 01440 042198019 Raising funds for Hospital MA 501(c)(3) 10 HHI 0 Winchendon Health Foundation 87 Central St Winchendon MA 01475 042113276 supports organization MA 501(c)(3) PF N/A 0 Athol Memorial Hospital NMTC Holdings Inc 242 Green St Gardner MA 01440 822171549 Support operations of Athol Memorial Hospital MA 501(c)(3) 12a HHI 0 0 1 1 0 0 0 1 0 1 1 1 1 1 1 1 1 1 1 1 Heywood Realty Corp k 122650 cost per square foot Heywood Realty Corp l 191125 contract Heywood Realty Corp o 71645 actual cost