SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Holyoke Medical Center Inc
 
Employer identification number

22-2520073
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		  4,446 1,756,906 838,820 918,086 0.750 %
b Medicaid (from Worksheet 3, column a) . . . . .   74,939 36,399,154 33,289,607 3,109,547 2.530 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .   79,385 38,156,060 34,128,427 4,027,633 3.280 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 46 17,758 875,543   875,543 0.710 %
f Health professions education (from Worksheet 5) . . . 4 1,179 51,112   51,112 0.040 %
g Subsidized health services (from Worksheet 6) . . . . 4 980 10,418,927 8,584,075 1,834,852 1.490 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 1 0 1,643,000   1,643,000 1.340 %
j Total. Other Benefits . . 55 19,917 12,988,582 8,584,075 4,404,507 3.580 %
k Total. Add lines 7d and 7j . 55 99,302 51,144,642 42,712,502 8,432,140 6.860 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support 13 3,400 105,215   105,215 0.090 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building 5 456 5,198   5,198 0 %
7 Community health improvement advocacy 2 222 8,044   8,044 0.010 %
8 Workforce development 1 82 38,174   38,174 0.030 %
9 Other            
10 Total 21 4,160 156,631   156,631 0.130 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,535,664
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
34,525,057
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
29,593,156
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
4,931,901
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Holyoke Medical Center Inc
575 Beech Street
Holyoke,MA01040
www.holyokehealth.com
2145 		X X         X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Holyoke Medical Center Inc
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................. 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): see Part V, Section C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b Yes  
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Holyoke Medical Center Inc
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Holyoke Medical Center Inc
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Holyoke Medical Center, Inc. Part V, Section B, Line 5: Verite Healthcare Consulting met with community stakeholders, including 11 public health officials and experts; 16 individuals affiliated with Health Departments or Agencies; and various other community leaders and HMC-affiliated clinicians, administrators, and staff during a series of interviews and "listening sessions" to review and respond to preliminary findings.Additionally, HMC collaborated with organizations that participated in a "Design Team" established to develop the CHNA. Representatives from community organizations, regional government, and public health departments particiated in this Team.Finally, a community survey was conducted as a major element of the CHNA, garnering responses from 1,083 community members. Survey results were post-stratified to accurately reflect the community's demographics. Responses were also assessed by race, insurance status, and education status.
Holyoke Medical Center, Inc. Part V, Section B, Line 6a: Holyoke Medical Center, Inc. is a member of the Coalition of Western Massachusetts Hospitals, which also includes Baystate Medical Center, Baystate Mary Lane Hospital, Baystate Franklin Medical Center, Mercy Medical Center, Cooley Dickinson Hospital, and Wing Memorial Hospital. The Coalition hospitals collaborated in preparing their CHNAs. However, each Coalition hospital conducted their own separate CHNA.
Holyoke Medical Center, Inc. Part V, Section B, Line 11: Please see the attached Implementation Plan for details on how the Hospital is addressing the significant needs identified in its most recently conducted CHNA covered by this filing.Holyoke Medical Center, Inc. prioritized services based on resources and duplication of services from other community organizations. The following needs identified in HMC's most recently conducted community health needs assessment that have not been addressed and the reasons why are: 1. Dental health - lack of access to dental care: this service is being provided by the Holyoke Health Center; 2. Health behaviors - high rates of alcohol and drug use/high rates of unsafe sex, teen pregnancy, and chlamydia: these needs are being met by HMC's sister organization, River Valley Counseling Center, Inc.; 3. Maternal and child health - prevalent infant health risk factors: HMC has not discovered an avenue to capture pre-natal patients at this time; 4. Maternal and child health - pediatric disability: HMC does not offer in-house pediatric services; 5. Physical environment - poor community safety/poor built environment and environmental quality: these issues are already addressed by the Holyoke Safe Neighborhoods Initiative; 6. Social and economic factors - basic needs insecurity: financial hardship, housing, and food access: many of these issues are already addressed by the South Holyoke Safe Neighborhoods Initiative.7. Access to Care - Health system complexity along with regulatory and administrative burdens result in frustration for both patients and providers. Cost and an undersupply of healthcare providers in the HMC community are resulting in barriers to accessing primary care, mental health services, and dental care. The community has a variety of resources working to address access barriers. There are 15 Federally Qualified Health Centers (FQHC) and FQHC site partners located in the community. All serve medically underserved areas and populations.8. Morbidity and Mortality - The community experiences comparatively high rates of chronic disease and disease related mortality, including cancer, stroke, diseases of the circulatory system, and chronic liver disease. Racial and ethnic disparities for a variety of morbidity and mortality indicators are evident, particularly in Hampden County. Poor mental and dental health affects many in the community, particularly low-income residents, homeless residents, and children. The community also exhibits comparatively high suicide rates, particularly within the White population. Asthma and air quality are community health issues. Asthma is more prevalent in Hampden County across all age groups with Holyoke having the highest prevalence of asthma in schoolchildren.9. Mental Health - Lack of access to mental health services and poor mental health status. The Massachusetts Department of Mental Health (DMH) developed the State Mental Health Plan 2012-2014 as part of its application for a Mental Health Block Grant from the Center for Mental Health Services and the Substance Abuse and Mental Health Services Administration. Please see the attached Implementation Plan for details on how the Hospital is addressing the significant needs identified in its most recently conducted CHNA covered by this filing.
Holyoke Medical Center, Inc. Part V, Section B, Line 16i: The Hospital has had a section on their website related to financial assistance for some time; however, the Hospital did not have an official Plain Language Summary during the fiscal year covered by this return. The Hospital did have a financial assistance policy and financial assistance application that was available to our patients along with financial assistance signs in certain locations in the Hospital (such as patient registration, and the Emergency department). While the Hospital did not have a formal plain language summary, we believe that we made a reasonable and good faith effort to provide such a document because the back of each patient statement is a plain language summary of our policy. The Hospital is diligently reviewing all policies and compliance matters to ensure it will be in complete compliance with question 501(r) as addressed with Schedule H, Part V, Lines 16a through 16i by 9/30/16 including posting the updated full policy, application, and plain language summary on the organization's website at www.holyokehealth.com/Patient_Default.aspxThis is consistent with the guidance that the final regulations under section 501(r) apply to a hospital facility's taxable years beginning after December 29, 2015.
Holyoke Medical Center, Inc. Part V, Section B, Line 22d: It is the policy of Holyoke Medical Center to charge all patients with and without insurance its standard rates on file with the Commonwealth of Massachusetts Division of Heathcare and Policy. The amount ultimately collected will vary depending on the Federal or State financial assistance program for which the patient qualifies or under the terms of the contract negotiated with the patient's insurance company. The amount ultimately collected from patients without insurance is handled on a case-by-case basis. Effective July 1, 2012, Holyoke Medical Center implemented a hospital specific financial assistance program which provides a discount to qualified patients (patients that meet certain financial requirements and do not qualify for a Federal or State program) and provides a discount consistent with Medicare.
Schedule H, Part V, Section B, line 7a & 10a: The CHNA is available at the Hospital facility's website: https://www.holyokehealth.com/uploadedFiles/Content/Holyoke%20Medical%20Center%20CHNA%205%2022%2013%20Final.pdf Implementation Strategy:https://www.holyokehealth.com/uploadedFiles/Holyoke%20Implementation%20Strategy%20-%20Final.pdf
Schedule H, Part V, Section B, Line 16a & 16b: The Hospital's Financial Assistance Policy (Benevolence Program) and Financial Assistance Applications can be found at: Policy:https://www.holyokehealth.com/pdf/2015%20C_C%20Policy%20final-no%20attachments.pdf Application:https://www.holyokehealth.com/pdf/Holyoke_Medical_Center_Financial_Assistance_Application_2016.pdf
Part V, Section B, Line 16 Financial Assistance Policy Website Availability
Holyoke Medical Center, Inc. Part V, Section B, line 16a website: See Part VI, Section C
Holyoke Medical Center, Inc. Part V, Section B, line 16b website: See Part VI, Section C
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2014
Page 9
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Part I, Line 3c: Not Applicable.
Part I, Line 6a: Not Applicable.
Part I, Line 7: Holyoke Medical Center, Inc. used the cost-to-charge ratio method in determining the cost of health services provided. Holyoke Medical Center, Inc. derived this cost-to-charge ratio based on the total patient care expense, after step-down adjustment, divided by gross patient charges per the Medicare 2552 cost report.
Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 3,316,768.
Part II, Community Building Activities: Holyoke Medical Center, Inc. provides a variety of community sponsorships and ongoing relationships with local community organizations. Our goals for those sponsorships and/or team building are to help support cultural and healthy lifestyle events, whether it be to support youth sports teams, celebrate youth academic leaders and their families and teachers, or support of a community celebration. Our intended outcome is to make this a healthier and livelier community.The majority of our community support is a result of requests from civic, social, and athletic groups within our community. As an example, working with three community partners, Holyoke Medical Center, Inc. staff help coordinate a children's grant to specifically assist speech and language screening and education for children and parents in the community for children with speech and hearing difficulties. Working with our partners, this program helps assist families with obtaining public school services for their children. Our ongoing involvement helps oversee budgets and assure flow to appropriate allocation of funds to those community services which will support those children and their families for speech, occupational and physical therapy, behavioral counseling, therapeutic play, hearing screenings, family literacy, and nutrition. In addition, HMC also partners with a variety of local community agencies to help oversee specific grants that have been awarded for the broader community for children with childhood developmental delays in their cognitive speech and hearing. Family support and teaching pre-school and grammar school educational programs for teachers are held to assist in minimizing the delays that these children would otherwise undergo without this service.
Part III, Line 2: Holyoke Medical Center, Inc. utilizes a costing methodology in which the ratio of patient care cost to charges is applied to the bad debt expense attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on Line 2. Discounts and payments on patient accounts are recorded as adjustments to revenue, not bad debt expense.
Part III, Line 3: See narrative for Part III, Line 2.
Part III, Line 4: See Page 9 of the attached audited financial statements.
Part III, Line 8: Holyoke Medical Center, Inc. utilizes generally accepted accounting principles in the preparation of its financial statements.Holyoke Medical Center, Inc. used the cost-to-charge ratio method in determining the cost of health services provided. Holyoke Medical Center, Inc. derived this cost-to-charge ratio based on the total patient care expense, after step-down adjustment, divided by gross patient charges per the Medicare 2552 Cost Report.
Part III, Line 9b: Populations Exempt from Collection Action - The following individuals and patient populations are exempt from any collection actions pursuant to the Massachusetts Health Safety Net Program (HSN) regulations:a. Patients enrolled in, receiving benefits from, or participating in a public health insurance program, including but not limited to MassHealth, Emergency Aid to the Elderly, Disabled and Children (EAEDC), Healthy Start, Children's Medical Security Plan (CMSP (provided the patient's family income is equal to or less than 400% of the FPL)), and low income patients subject to the following:(1) Holyoke Medical Center, Inc. may initiate Collection Action against any patient enrolled in, receiving benefits from, or participating in MassHealth, EAEDC or Healthy Start, and any low income patient, for their required co-payments and deductibles as set forth by each specific program.(2) Holyoke Medical Center, Inc. may also initiate collection action for a patient who alleges that he or she is a participant in MassHealth, EAEDC, Health Start or CMSP but fails to provide proof of such participation. Upon receipt of satisfactory proof that a patient is a participant in such a program (including, in the case of MassHealth, EAEDC or Healthy Start, receipt or verification of a signed application), Holyoke Medical Center, Inc. shall cease billing or collection activities.(3) Low income patients are exempt from Collection Action for Eligible Services (as defined by HSN regulations from time-to-time) they receive during the period for which they have low income patient status.(4) Low income patients with family income between 200% and 400% of FPL are exempt from collection action for the portion of their Holyoke Medical Center, Inc. bill that exceeds the patient's deductible. However, Holyoke Medical Center, Inc. may initiate collection action against patients for their required co-payments and deductibles.(5) Holyoke Medical Center, Inc. may continue collection action on any low income patient for services rendered prior to the low income patient determination, provided that the patient's low income patient status has been terminated or expired. However, once a patient is determined to be eligible and enrolled in the Health Safety Net, MassHealth or certain Commonwealth Care programs, Holyoke Medical Center, Inc. will cease collection action for services rendered prior to the beginning of their eligibility.(6) Holyoke Medical Center, Inc. may pursue collection action against low income patients for services other than eligible services for which the patient has agreed to be responsible, provided Holyoke Medical Center, Inc. obtained the patient's prior written consent to be billed for the services. Holyoke Medical Center, Inc. will not bill low income patients for claims denied by the patient's primary insurer resulting from an administrative or billing error unless the error was initiated by patient/ guarantor.(7) Holyoke Medical Center, Inc. will not undertake collection action against an individual who has been approved for ER Bad Debt Medical Hardship or medical hardship under the Massachusetts Health Safety Net Program with respect to the amount of the bill that exceeds the medical hardship contribution.b. With respect to low income patients injured in motor vehicle accidents, Holyoke Medical Center, Inc. will: (1) investigate whether the patient, driver and/or vehicle owner had a motor vehicle liability policy; (2) make every effort to obtain the third party payor information from the patient; (3) if the hospital has prior knowledge and is legally able, attempt to secure assignment on a patient's right to third party coverage on services provided due to an accident; (4) advise patient of duty to notify HSN/MassHealth within 10 days of filing TPL claim/lawsuit, (5) retain documentation of those efforts; (6) where applicable, submit a claim for payment to the motor vehicle liability insurer; and (7) if any portion of the claim was previously billed to the HSN, report any recovery to the HSN.c. Holyoke Medical Center, Inc. will not garnish a low income patient's or their guarantor's wages or execute a lien on the low income patient's or their guarantor's personal residence or motor vehicle unless: (1) Holyoke Medical Center, Inc. can show that the patient or their guarantor has the ability to pay; (2) the patient/guarantor did not respond to HMC requests for information or the patient/guarantor refused to cooperate with HMC to seek an alternative financial assistance program; or (3) for purposes of a lien, it was approved by Holyoke Medical Center, Inc.'s Board of Trustees on an individual case-by-case basis.d. Holyoke Medical Center, Inc. may cease any collection or billing actions against a patient who is unable to pay Holyoke Medical Center, Inc.'s bill at any time during the billing process, if the patient is eligible for assistance under financial assistance programs that HMC may, in its discretion, make available from time-to-time. Holyoke Medical Center, Inc. will keep any and all documentation that shows a patient met the criteria for such programs.e. Holyoke Medical Center, Inc. and its agents shall not continue collection or billing on a patient who is party to bankruptcy proceedings except to secure its rights as a creditor in the appropriate order.f. Holyoke Medical Center, Inc. and its agents will not charge interest on an overdue balance for a low income patient or for patients who are eligible for financial assistance programs that HMC may in its discretion make available from time-to-time.
Part VI, Line 2: Holyoke Medical Center, Inc. conducts a needs assessment of the communities it serves in conjunction with numerous community agencies. These include the United Way of Pioneer Valley, Holyoke Health Center, Inc., our sister organizations River Valley Counseling Center, Inc. and Holyoke Visiting Nurse Association, Inc., as well as Holyoke Community College and a wide variety of education institutions in the Holyoke/ Springfield area, including the University of Massachusetts Medical School in Worcester. Partnering with these organizations has allowed HMC to utilize our expertise and assessment of the population we serve to better formulate our community benefit initiatives. Based on the needs assessment, HMC determines which initiatives to continue and which programs to implement within our financial means. This includes a focus on community education and community outreach. It is important not to overlook the substantial contribution that the hospital makes to the community through our many educational programs, free flu shots, and our support of community events. HMC will continue to monitor these programs for their need and effectiveness in the community, and, working with our community partners, assess for gaps in the needs of the community that are not being filled. The formal needs assessment done in 2010 by the United Way of Pioneer Valley, combined with our own data and information of our patient population including what is publicly reported by the Department of Public Health - Massachusetts Community Health Information Profiles and other public sources has enabled us to focus our limited resources to better serve our community.
Part VI, Line 3: 1) General Principles:Holyoke Medical Center, Inc. or its agents will assist uninsured and underinsured patients with the process of applying for available financial assistance programs that may pay for some or all of their hospital bills. In order to help uninsured and underinsured patients find and apply for available financial assistance, HMC will provide all patients with a general notice of the availability of programs by way of posted notices throughout HMC and by way of individual notices to patients. The goal of these notices is to inform patients regarding the availability of financial assistance, as well as assistance with the application process. Holyoke Medical Center, Inc. will assist patients with the application process for the following Massachusetts programs: MassHealth, Commonwealth Care, CMSP, Healthy Start, Health Safety Net, and Medical Hardship through the Health Safety Net. Holyoke Medical Center, Inc. will provide, upon request, specific information about: (a) the eligibility criteria to be a low income patient under the Massachusetts Health Safety Net program or (b) additional financial assistance programs that HMC may in its discretion make available to low income patients from time-to-time. Holyoke Medical Center, Inc. will also notify the patient about available payment plans that may be available to them pursuant to HSN regulations.2) Role of Hospital Patient Financial Counselors and Other Finance Staff:Holyoke Medical Center, Inc. will attempt to identify available coverage options for patients who may be uninsured or underinsured when the patient is scheduling services, while the patient is at HMC, upon discharge and for a reasonable time following discharge. Holyoke Medical Center, Inc. will direct all patients seeking available coverage options to HMC's Patient Financial Counseling office for eligibility screening and assistance with the application process, including the application process for financial assistance programs that HMC may in its discretion make available to low income patients from time-to-time.Holyoke Medical Center, Inc. will also provide information on how to contact the appropriate staff within the hospital's Finance Department to verify the accuracy of the hospital bill or to dispute certain charges.3) Notification Practices:Holyoke Medical Center, Inc. will post a notice (signs) of availability of financial assistance in the following locations:a. Service delivery areas (e.g., inpatient, clinic, emergency department admission and/or registration areas);b. Patient financial counselor areas;c. Central admission/registration areas; and/ord. Business office areas that are open to patients.Posted signs will be clearly visible and legible to patients visiting these areas. The hospital will also include a notice about the availability of financial assistance in all initial bills.When a patient contacts the hospital, the hospital finance staff will attempt to identify if a patient qualifies for a public financial assistance program or a payment plan. A patient who is enrolled in a public financial assistance program (e.g., MassHealth or the Health Safety Net) may qualify for certain plans. 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.For cases in which the hospital is using the Virtual Gateway application, the hospital will assist the patient in completing the application for MassHealth, Commonwealth Care, Children's Medical Security Plan, Health Start, Health Safety Net, or other forms of financial assistance programs as they become part of the Virtual Gateway program.All signs and notices shall be translated into languages other than English if such language is primarily spoken by 10% or more of the residents in the hospital service area, which is based on the hospital admissions and/or discharge information.
Part VI, Line 4: While the geographic boundary includes cities and towns in Hampden and Hampshire counties, our organization focuses its resources on the eight cities and towns in our primary service area: Holyoke, Chicopee, South Hadley, Granby, Easthampton, Belchertown, West Springfield, and Southampton, with a total population of about 185,000 people. Within this population are subsets of individuals with specific needs such as elderly, poor, and those who exhibit a health profile with higher-than-average morbidity.For example, statistics from the 2013 Massachusetts Department of Public Health Massachusetts Community Health Information Profile show that for the city of Holyoke, where the majority of our patients reside, indicate that:- per capita income is 61% of the state average;- Adults over 65-years-old are 103% of the state average;- AFDC Medicaid recipients are 383% of the state average;- Hispanic persons are 504% of the state average;- Births to adolescent mothers are 394% of the state average;- Asthma is 262% of the state average;- Gonorrhea is 173% of the state average;- Chlamydia is 378% of the state average;- AIDS/HIV-related deaths are 278% of the state average;- Cardiovascular disease deaths are 124% of the state average;- Alcohol and other drug related hospital discharge rate is 273% of the state average.Prioritizing the needs is an ongoing process and is dependent upon a multitude of factors such as the Mission of the organization, the scope and depth of the specific need, and available resources. As the sole acute care provider in this area, we attempt to include the needs of all residents in our decisions, without regard to demographic or health status.
Part VI, Line 5: The impact of Holyoke Medical Center, Inc.'s outreach efforts are evidenced by the fact that countless service agencies rely on HMC to ensure their own success. Among the key accomplishments this year was:- Oversaw emergency ambulance services for the City of Holyoke in conjunction with American Medical Response;- Operated the only Emergency Department in the City of Holyoke, providing emergency medical and behavioral health services to the community 24 hours a day, 7 days a week, 365 days per year;- Provided a variety of behavioral health services, including community liaison work with agencies in the mental health community in order to improve the provision of behavioral health/psychiatric services for community members, education lectures and provided transportation to members of the community who do not have their own transportation and are in need of partial hospitalization or intensive outpatient levels of care for mental health treatment;- Provided numerous outreach classes and services, through the Medical Center's Speech and Hearing department, to members of the community with hearing and speech difficulties. The department has also worked with a variety of long-term care facilities and elder communities to educate elders on hearing loss, hearing aids, medical conditions, speech, and swallowing issues.- Promoted health care career education throughout the community, such as hosting site visits to high school students to expand their knowledge of community hospitals and encourage youth to enter healthcare professions;- Provided numerous educational programs to promote healthy behaviors, encourage routine medical screenings to prevent a variety of common diseases in our community. For example, conducted diabetes education classes, conducted programs that provided information regarding the recognition, treatment, and prevention of stroke, and conducted CPR classes for the community;- Provided education on infectious disease and flu vaccine clinics which administered free flu vaccines to the general public;- Educated and implemented programs to promote access to primary and preventative care, utilizing medical and professional staff to educate the community to encourage routine medical screenings, education on speech and hearing issues, preventing pulmonary disease, and behavioral health issues;- Provided birthing, lactation and parenting skill education classes.
Part VI, Line 6: Holyoke Medical Center, Inc. (HMC) is an affiliate of Valley Health Systems, Inc. (VHS). The mission of VHS is to enhance the delivery of broadly diverse, high-quality and coordinated healthcare services and products to consumers in a fiscally-sound, efficient and effective manner. To this end, VHS maintains a network of systems, facilities, services, and products that provide compassionate care consistent with its philanthropic purposes. This will be achieved in an environment of growth, dignity, and respect for its employees.VHS is a tax-exempt organization which, through its affiliated organizations, operates a healthcare delivery system in the greater Holyoke/Chicopee area. The services provided by the system include:- Acute inpatient and outpatient services- Inpatient and Outpatient psychiatric services- Home health services- Occupational health services- Primary care services- Hospice services
Part VI, Line 7, Reports Filed With States MA
Schedule H (Form 990) 2014
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