SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/form990 for instructions and the latest informtion.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
UMass Memorial Health Care Inc & Affiliates
 
Employer identification number

91-2155626
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) . . . 		    26,782,101 12,286,925 14,495,176 0.72 %
b Medicaid (from Worksheet 3, column a) . . . . .     378,582,419 317,585,937 60,996,482 3.04 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     13,249,184 13,249,184 0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 418,613,704 343,122,046 75,491,658 3.76 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     4,929,092 2,741,134 2,187,958 0.11 %
f Health professions education (from Worksheet 5) . . .     241,159,472 134,350,711 106,808,761 5.31 %
g Subsidized health services (from Worksheet 6) . . . .     62,672,989 47,705,443 14,967,546 0.74 %
h Research (from Worksheet 7) .     153,843 49,850 103,993 0.01 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     2,622,864 2,622,864 0 0 %
j Total. Other Benefits . . 0 0 311,538,260 187,470,002 124,068,258 6.17 %
k Total. Add lines 7d and 7j . 0 0 730,151,964 530,592,048 199,559,916 9.93 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
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     0 0 0 0 %
2 Economic development     0 0 0 0 %
3 Community support     12,059 0 12,059 0 %
4 Environmental improvements     0 0 0 0 %
5 Leadership development and
training for community members		     0 0 0 0 %
6 Coalition building     29,488 0 29,488 0 %
7 Community health improvement advocacy     10,000 0 10,000 0 %
8 Workforce development     160,801 57,000 103,801 0.01 %
9 Other     0 0 0 0 %
10 Total 0 0 212,348 57,000 155,348 0.01 %
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
42,163,000
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
2,796,242
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
396,673,135
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
463,079,180
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-66,406,045
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) 2017
Schedule H (Form 990) 2017
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?3Name, 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 UMASS MEMORIAL MEDICAL CENTER INC
55 LAKE AVE 119 BELMONT STREET
WORCESTER,MA01605
www.umassmemorialhealthcare.org
V111 		X X X X   X X      
2 UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL INC
60 HOSPITAL ROAD
LEOMINSTER,MA01453
www.umassmemorialhealthcare.org/healthalliance-clinton-hospital
VWPE 		X X   X     X      
3 MARLBOROUGH HOSPITAL
157 UNION STREET
MARLBOROUGH,MA01752
www.umassmemorialhealthcare.org/marlborough-hospital
2103 		X X   X     X      
Schedule H (Form 990) 2017
Page 4
Schedule H (Form 990) 2017
Page 4
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)
UMASS MEMORIAL 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 17
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  
6 a 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 Yes  
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 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): https://www.umassmemorialhealthcare.org/about-us/community-benefits-program/umass-memor
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
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" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2017
Page 5
Schedule H (Form 990) 2017
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
UMASS MEMORIAL MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
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 Was widely publicized 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
https://www.umassmemorialhealthcare.org/umass-memorial-medical-center/patients-visitors
b
https://www.umassmemorialhealthcare.org/umass-memorial-medical-center/patients-visitors
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
Page 6
Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
UMASS MEMORIAL MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
19 Did the hospital facility or other authorized 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
e
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 19. (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
Schedule H (Form 990) 2017
Page 7
Schedule H (Form 990) 2017
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
UMASS MEMORIAL MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2017
Page 4
Schedule H (Form 990) 2017
Page 4
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)
UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL 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): 		2
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 17
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  
6 a 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 Yes  
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 17
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.umassmemorialhealthcare.org/healthalliance-clinton-hospital
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
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" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2017
Page 5
Schedule H (Form 990) 2017
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
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 Was widely publicized 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
https://www.umassmemorialhealthcare.org/healthalliance-clinton-hospital/patients-visitors
b
https://www.umassmemorialhealthcare.org/healthalliance-clinton-hospital/patients-visitors
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
Page 6
Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
19 Did the hospital facility or other authorized 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
e
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 19. (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
Schedule H (Form 990) 2017
Page 7
Schedule H (Form 990) 2017
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2017
Page 4
Schedule H (Form 990) 2017
Page 4
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)
MARLBOROUGH HOSPITAL
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): 		3
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 16
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  
6 a 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 Yes  
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 Yes  
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 16
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.umassmemorialhealthcare.org/about-us/community-benefits-program/marlborough-
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
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" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2017
Page 5
Schedule H (Form 990) 2017
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MARLBOROUGH HOSPITAL
Name of hospital facility or letter of facility reporting group  
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 Was widely publicized 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
https://www.umassmemorialhealthcare.org/marlborough-hospital/patients-visitors/patient-resources
b
https://www.umassmemorialhealthcare.org/marlborough-hospital/patients-visitors/patient-resources
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
Page 6
Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
MARLBOROUGH HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
19 Did the hospital facility or other authorized 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
e
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 19. (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
Schedule H (Form 990) 2017
Page 7
Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MARLBOROUGH HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2017
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Schedule H (Form 990) 2017
Page 8
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, 16j, 18e, 19e, 20e, 21c, 21d, 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
Schedule H, Part V, Section B, Line 3E Yes, the significant health needs identified in the CHNA are a prioritized description of the significant health needs of the community. The community engagement process for the CHNA culminated with a community meeting of service providers, stakeholders and residents held at the Worcester Public Library, where CHNA key findings were presented and a prioritization process took place. This event was attended by approximately 75 people.
Schedule H, Part V, Section B, Line 3 Facility , 1 Facility , 1 - UMass Memorial Medical Center. The most recent CHNA also includes an Impact Evaluation Summary (final Appendix) of previous CHNA.
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - UMass Memorial Medical Center. Yes, input from diverse persons who represent the community was taken into account. UMass Memorial Medical Center joined efforts with the Worcester Division of Public Health (WDPH), Fallon Health and The Coalition for a Healthy Greater Worcester which served in an advisory role in the development of its CHNA. The Director of the WDPH, UMass Memorial Vice President of Community Relations, and Fallon Health co-chaired the leadership process to develop a CHNA and Community Health Improvement Plan (CHIP) for the greater Worcester region. During the assessment process, community members were engaged in Key Informant Interviews, Focus Groups, and Community Dialogues, which allowed for community members to review and discuss a profile of the region and provide their feedback and prioritization on community health-related strengths, needs, and a vision for the future. The CHNA process gathered extensive quantitative data from federal, state and local sources for the City of Worcester, and the outlying communities of Shrewsbury, Grafton, Millbury, West Boylston, Leicester, and Holden, including a community health survey of nearly 3,000 individuals who live, work and play in Greater Worcester. Qualitative information was captured through 45 key stakeholder interviews, ten focus groups, four community forums, a strategic retreat, a community health survey conducted at multiple community events and an online survey. These sessions gathered critical community input from service providers, community leaders and neighborhood residents with an emphasis on engaging at-risk populations (e.g., Focus groups included: Hispanics/Latinos, youth, South East Asians and individuals with disabilities) as well as service providers representing fields including; behavioral health providers, health providers for elders and public health officials. The process included a Steering Committee comprised of a diverse number of stakeholders that advised and informed the CHNA.
Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - UMass Memorial Medical Center. : UMass Memorial conducted the CHNA in collaboration with the Worcester Division of Public Health and Fallon Health. Additional partners included: Academic Health Collaborative, Worcester Division of Public Health Central MA Tobacco Free Partnership City of Worcester Clark University Coalition for a Healthy Greater Worcester Edward M. Kennedy Health Center Family Health Center of Worcester HOPE Coalition Latino Educational Institute Massachusetts Department of Public Health Muslim Community Link Regional Environmental Council of Worcester Reliant Medical Group UMass Medical School Women In Action Worcester Food Policy Council YouthConnect/Boys & Girls Club of Worcester YWCA Central Massachusetts Worcester Public Schools Worcester Regional Research Bureau
Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - UMass Memorial Medical Center. The CHNA was publicly announced to the community at an event attended by more than 150 community stakeholders and hosted by the Worcester City Manager, Worcester Director of Public Health (WDPH), Senior Vice President of UMass Memorial Health Care, the UMass Memorial Vice President of Community Relations and the Director of Community Relations, Fallon Health. The CHNA was additionally publicized through various venues including; in local news and communications of CHNA-8, a Healthy Communities Coalition.
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - UMass Memorial Medical Center. The hospital conducted its most recent Community Health Needs Assessment in 2018 and developed its Community Benefits Strategic Implementation Strategy. The prioritization process of identified community health needs was led by the Worcester Division of Public Health, Fallon Health and the hospital Vice President of Community Benefits and included input from 75 community stakeholders. The hospital's Community Benefit Strategic Implementation Strategy aligns with the priority findings of the Community Health Needs Assessment (CHNA) and the Greater Worcester Community Health Improvement Plan (CHIP). The other needs that are not included in the CHNA/CHIP are not being addressed because they are not a part of the identified priority CHIP Domain areas and due to limited funding.
Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - UMass Memorial Medical Center. Financial Assistance - UMassMemorial Medical Center employs a staff of Financial Counselors, Certified Application Counselors, Customer Service Representatives and Guarantor Collectors who are available by phone or by appointment to support patients in applying for financial assistance and resolving their medical bills. Financial Counselors, Certified Application Counselors, Customer Service Representatives and Guarantor Collectors provide potentially eligible patients with the appropriate methods of applying for health care coverage as listed on the Massachusetts ConnectorCare website
Schedule H, Part V, Section B, Line 16 Facility , 2 Facility , 2 - UMASS MEMORIAL MEDICAL CENTER. Sch H, Part V, Section B, Lines 16 a-c Website for FAP, its application, and its plain language summary: https://www.umassmemorialhealthcare.org/umass-memorial-medical-center/patients-visitors/patient-resources/financial-assistance
Schedule H, Part V, Section B, Line 19d Facility , 1 Facility , 1 - UMass Memorial Medical Center. UMMMC refers accounts to a credit agency when written off as bad debt for further collections. These agencies continue collections without impact to the credit rating.
Schedule H, Part V, Section B, Line 3E Yes, the significant health needs identified in the CHNA are a prioritized description of the significant health needs of the community. The community engagement activities for the CHNA culminated throughout five community, provider focus groups, and three community forums in the UMass Memorial HealthAlliance-Clinton Hospital's service area where information was gathered, and input was received from service providers, community leaders, and residents. The engagement process was held at the areas listed below where CHNA key findings were presented and a prioritization process took place. Approximately 100 people attended the focus groups and community forums.
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - UMass Memorial - HealthAlliance-Clinton Hospital. UMass Memorial HealthAlliance-Clinton Hospital conducted a comprehensive Community Health Needs Assessment (CHNA) that gathered, analyzed and documented qualitative and quantitative data. The CHNA was developed through a collaborative process involving both administrative and clinical staff at the hospital working with a diverse CHNA Advisory Group made up of health and social service providers, local public health officials, community health advocates, and other community leaders. The Advisory Committee's input and involvement was central to the CHNA and strategic plan development process informed and based on the Hospital's Community Health Improvement Plan (CHIP). Since the beginning of the assessment, more than one hundred individuals participated in key stakeholder interviews, focus groups, and community forums. Key stakeholder interviews were conducted with eighteen community leaders and staff members at UMass Memorial HealthAlliance-Clinton Hospital. Key stakeholder interviews were done to collect qualitative information from key health and social service providers, city/town officials, representatives from community organizations or advocacy groups, and other community leaders to (1) confirm and refine findings from secondary data, (2) provide community context, (3) clarify needs and priorities of the community. Five community and provider focus groups with key segments of the population and/or key types of service providers were also conducted in HealthAlliance-Clinton Hospital's service area. This activity allows for the collection of more targeted and nuanced information from segments of the population who are deemed most at-risk and the key service providers who serve these populations and are critical to community health improvement. Focus groups (1) augment findings from secondary data and key informant interviews and (2) allow for exploration of strategic and programmatic options to address identified health issues, service gaps, and/or barriers to care. Three Community Forums for the public at-large were also conducted in the towns of Fitchburg, Leominster, and Clinton. Community forums allow for the capture of information directly from community residents and, to some extent, representatives from local service providers or community organizations. Input is captured from residents on (1) community health needs and priorities, (2) service system gaps, (3) barriers to care across a wide array of health-related service and community resource domains (e.g., health, housing, transportation, safety, food access). Forums are critical to fulfilling a comprehensive community engagement plan and will support the development of a sound and objective health needs assessment that will be used to develop programs that reduce disparities and improve health status.
Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - UMass Memorial - HealthAlliance-Clinton Hospital. The Community Health Needs Assessment was conducted with input from our community partners including: Community Health Network Association 9 (CHNA9), Community Health Connections, Heywood Healthcare (Athol Hospital, Heywood Hospital), The Joint Coalition on Health and the Montachusett Public Health Network.
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - UMass Memorial - HealthAlliance-Clinton Hospital. The hospital conducted its most recent Community Health Needs Assessment (CHNA) in 2018 and developed its Community Benefits Strategic Implementation Strategy. The CHNA included a prioritization process that identified the most pressing needs that offer opportunities to partner and leverage resources. The prioritization process was led by the Steering Committee with the support of the Hospital's staff, CHNA Advisory Committee, PFAC, and other stakeholders and included input from 18 community stakeholders. The needs identified in the CHNA are 1) Health Equity, 2) Behavioral Health (mental health and substance use), 3) Chronic/Complex Conditions and Risk Factors, 4) Healthy Relationships and Domestic/Interpersonal Violence, and 5) Healthy Aging. The hospital's Community Benefit Strategic Implementation Strategy aligns with the priority findings of the Community Health Needs Assessment (CHNA) and the Community Health Improvement Plan (CHIP). The other needs that are not included in the CHNA/CHIP are not being addressed due to limited funding.
Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - UMass Memorial HealthAlliance-Clinton Hospital, Inc.. UMass Memorial HealthAlliance-Clinton Hospital, Inc. The hospital employs a staff of Financial Counselors, Certified Application Counselors, Customer Service Representatives and Guarantor Collectors who are available by phone or by appointment to support patients in applying for financial assistance and resolving their medical bills. Financial Counselors, Certified Application Counselors, Customer Service Representatives and Guarantor Collectors provide potentially eligible patients with the appropriate methods of applying for health care coverage as listed on the Massachusetts ConnectorCare website.
Schedule H, Part V, Section B, Line 3E Yes, the significant health needs identified in the CHNA are a prioritized description of the significant health needs of the community. The CHNA conducted in 2016 results were presented to the public on Friday, November 18, 2017. Over 100 MetroWest community members attended. All Marlborough Hospital focus group participants (including faith leaders, Community Benefits Advisory Council, seniors and Patient Family Advisory Council) and key informants who participated were invited with approximately 10 attended the public presentation. In addition to an online community survey that engaged over 600 residents, approximately 92 individuals from multisector organizations, residents, and community stakeholders participated in focus groups and interviews to gather feedback on community strengths, challenges, priority health concerns, and opportunities for the future.
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Marlborough Hospital. The process included gathering community input through a Community Health Survey to community members, as well as analysis of general data collected from the hospital and publicly available data sources. The process also incorporated a survey component that was available in English, Spanish and Portuguese, as well as 607 respondents in 22 metro west region communities completed a community survey and 150 individuals from multi sector organizations, community stakeholders and residents were engaged in focus groups.
Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Marlborough Hospital. The CHNA was completed in conjunction with the MetroWest Medical Center.
Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Marlborough Hospital. The CHNA was completed in conjunction with MetroWest Health Foundation, MetroWest Medical Center, Hudson Health Department, and Framingham Health Department.
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Marlborough Hospital. The hospital responds to priority health needs in many ways, and in times that are critical for patients in crisis. In addition to charity care, indigent care, a significant number of programs and services offered address the priority needs identified in the Community Health Needs Assessment (CHNA). Our hospital does not have the available resources to develop initiatives to meet every priority health need identified, which makes collaboration with community agencies critical. The hospital is not currently addressing all chronic conditions due to limited resources.
Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - Marlborough Hospital. Financial Assistance - Marlborough Hospital employs Financial Counselors who are available by phone or by appointment to support patients in applying for financial assistance and for help resolving their medical bills. Financial Counselors provide potentially eligible patients with the appropriate methods of applying for health care coverage as listed on the Massachusetts ConnectorCare website.
Schedule H, Part V, Section B, Line 19d Facility , 1 Facility , 1 - Marlborough Hospital. Marlborough engages a third party agency to assist on all self pay accounts at origination. They refer accounts to a credit agency when written off as bad debt for further collections. These agencies continue collections without impact to the credit rating.
   
   
   
   
   
   
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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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?4
Name and address Type of Facility (describe)
1 UMASS MEMORIAL MED CENTER (LAB SVCS)
BIOTECH ONE 365 PLANTATION STREET
WORCESTER,MA01605 		SATELLITE - LAB SERVICES
2 UMASS MEMORIAL MED CENTER (PATHOLOGY)
BIOTECH THREE ONE INNOVATION DRIVE
WORCESTER,MA01605 		SATELLITE - PATHOLOGY
3 UMASS MEMORIAL MED CENTER AMBULANCE
23 WELLS STREET
WORCESTER,MA01604 		SATELLITE - AMBULATORY SERVICES
4 UMASS MEMORIAL MED CENTER
100 PROVIDENCE STREET
WORCESTER,MA01604 		SATELLITE - AMBULATORY SERVICES
5
6
7
8
9
10
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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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
Schedule H, Part I RESEARCH EXPENSES THE AMOUNT OF RESEARCH EXPENSES FOR FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS BEING REPORTED BY UMASS MEMORIAL HEALTH CARE IS LOW SINCE THESE COSTS ARE SUPPORTED BY THE UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL. THE MEDICAL SCHOOL IS CLOSELY ASSOCIATED WITH UMASS MEMORIAL HEALTH CARE AND PROVIDES A SIGNIFICANT NUMBER OF COMMUNITY BASED PROGRAMS.
Schedule H, Part II, Line 2 COMMUNITY BUILDING ACTIVITIES UMass Memorial Medical Center: UMass Memorial Medical Center recognizes Community Building activities as being a part of the "social determinants of health" that impact the health of the community. We invest in youth workforce development for at-risk youth. Programs are based on our Community Benefits Mission which was recommended by a Community Benefits Advisory Committee and draws inspiration from the World Health Organization's broad definition of health, as a "as state of complete, physical, mental and social well-being and not merely the absence of disease." By adopting this definition, UMass Memorial Medical Center has expanded its strategy to include the social and economic obstacles that prevent people from achieving optimal health. All of our Community Building activities are the result of an identified need and engage the community. They include collaborative efforts, advocacy activities and partnerships that engage a broad array of community stakeholders in addressing these unmet social determinants of health. Community Building activity examples include: funding and promoting workforce and health career development opportunities for inner-city youth. The hospital additionally provides community support through efforts including participation in the United Way Day of Caring and others. UMass Memorial HealthAlliance-Clinton Hospital Inc. : Workforce Development: UMass Memorial HealthAlliance-Clinton Hospital provides a paid internship program to high school seniors and first year college students who wish to pursue a career in the health care field. The hospital also awarded four scholarships to high school graduating seniors living in the service area who are pursuing a college education in a health-related field. During FY2018, twenty-eight high school students participated in the hospital's internship program. The program exposed these students to health career possibilities, role models and how health organizations operate; it is also an opportunity for practical experience to learn by doing and applying the knowledge. The students learn new skills and develop their own personal and professional interests. They also expand their educational opportunities, personal network, and establish valuable professional connections. This program was developed and implemented in response to an identified need in the community. Workforce Development is identified as a need nationally, as a critical component to social determinants of health, and in its CHNA. UMass Memorial HealthAlliance-Clinton Hospital partnered with the Clinton, Leominster, and Fitchburg Public High School and the Workforce Investment Board to implement the program. Coalition Building: UMass Memorial HealthAlliance-Clinton Hospital is a member of Community Health Network Association 9 (CHNA-9). The hospital's Community Health Director and Outreach Coordinator help to facilitate CHNA-9 meetings, Co-chair two of the priority areas (Healthy Eating and Active Living, Healthy and Safe Relationships, Mental/Behavioral and Substance Abuse) of the CHNA9 North Region Community Health Improvement. They additionally serve on the CHNA-9 Coalition, Grant Review Team and Steering Committee as part of a statewide effort to develop, implement, and integrate community projects to effectively utilize community resources to create healthier communities. UMass Memorial HealthAlliance-Clinton Hospital worked with the Community Health Network of North Central Mass (CHNA-9) and other partners in building capacity, engaging other partners and implementing strategies that advances the five priority areas working groups. Most working groups meet monthly and took significant steps towards gaining community input and creating a network that will enable sharing of resources in order to achieve the hospital's strategic plan in carrying out the North Central MA CHIP implementation. Advocacy for Community Health Improvements/Safety: UMass Memorial HealthAlliance-Clinton Hospital is working to address basic, social and personal needs as a way to improve their communities' health. The hospital joined The Democracy Collaborative, Anchor Network with 40 other healthcare institutions nationwide to address Health Equity, Social Determinants of Health, Health System Strengthening, and to engage with our local communities and institutions to help build communities' assets. The Healthcare Anchor Network was formed to support health systems collaborating nationally to accelerate learning and local implementation of economic inclusion strategies. Marlborough: Marlborough Hospital provides assistance to cognitively challenged post grad students aged 18 to 22 by helping them gain work/life skills to assist them in their transition from a school environment to a work and community setting. Additionally, disadvantaged students, including both economically or disengaged youth at risk, learn the tools to overcome barriers and move into self-sustaining employment in sectors of the economy where there is a need.
Schedule H, Part VI, Line 7 SCH H, PART VI, LINE 7 ALL THREE HOSPITAL'S FILE INDIVIDUAL COMMUNITY BENEFIT REPORTS WITH THE MASSACHUSETTS ATTORNEY GENERAL'S OFFICE.
Schedule H, Part III, Line 8 Schedule H, Part III, Line 8 UMASS BELIEVES THERE ARE SEVERAL REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. FIRST, NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES OUT-OF-LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS. SECOND, BY CONTINUING TO TREAT PATIENTS ELIGIBLE FOR MEDICARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. THIRD, IRS REVENUE RULING 69-545 STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
Schedule H, Part V, Section A Schedule H, Part V Section A Clinton Hospital 201 Highland Street, Clinton MA 01510 is the second campus of the UMass Memorial HealthAlliance-Clinton Hospital, Inc. The merger of Clinton Hospital Association with HealthAlliance Hospital became effective 10/1/2017.
Schedule H, Part I, Line 7g Subsidized Health Services NOT APPLICABLE
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The Cost to Charge Ratio is utilized to calculate amounts reported for each line in Part 1, line 7.
Schedule H, Part II Community Building Activities UMass Memorial Medical Center recognizes Community Building activities as being a part of the "social determinants of health" that impact the health of the community. We invest in youth workforce development for at-risk youth. Programs are based on our Community Benefits Mission which was recommended by a Community Benefits Advisory Committee and draws inspiration from the World Health Organization's broad definition of health, as a "as state of complete, physical, mental and social well-being and not merely the absence of disease." By adopting this definition, UMass Memorial Medical Center has expanded its strategy to include the social and economic obstacles that prevent people from achieving optimal health. All of our Community Building activities are the result of an identified need and engage the community. They include collaborative efforts, advocacy activities and partnerships that engage a broad array of community stakeholders in addressing these unmet social determinants of health. Community Building activity examples include: funding and promoting workforce and health career development opportunities for inner-city youth. The hospital additionally provides community support through efforts including participation in the United Way Day of Caring and others.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Bad Debt is calculated utilizing an aged Bad Debt Model. Significant Analysis was reviewed by Revenue Reporting and Patient Accounting that verified the majority of what the Model considers Bad Debt will more than likely be written off as Admin Allowances. Based on the Meditech/Soarian/Ambulance Variance Summary output per payer and review of the other analysis prepared, it was determined and approved that the Provision as a result of the Model should represent only the following reserves: 1) Self Pay 2) FreeCare 3) Guarantor As such, the remaining reserves calculated on all other payers are included in Payment Systems Contractual reserves and Admin Allowance reserves. Bad Debt Recoveries (payments on accounts written off as Bad Debt) are recorded on the Financial statements as a reduction to Bad Debt Expense. Bad Debt Expense of 42,163,000 is net of these recoveries.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology Costing methodology: multiplied the gross patient service revenue by the ratio of costs to charges calculated as reported in hospitals DHCFP 403 Hospital Statement of Costs, Revenues & Statistics. Although our financial assistance policies and procedures make every effort to identify those patients who are eligible for financial assistance before the billing process begins, often it is not possible to make an appropriate determination until after the billing and collection collection cycle has commenced. The rationale for including bad debt amounts in community benefits would be to account for those patients who were classified as bad debt expense, but would have qualified for financial assistance if sufficient information had been available to make a determination of their eligibility.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Footnote 2, page 10 of Audited Financial Statements: Allowance for Doubtful Accounts Patient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of patient accounts receivable, the System analyzes its past history and identifies trends for each of its major categories of revenue (inpatient, outpatient and professional) to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major categories of revenue in evaluating the sufficiency of the allowance for doubtful accounts. Throughout the year, the System, after all reasonable collection efforts have been exhausted, will write off the difference between the standard rates (or discounted rates if negotiated) and the amounts actually collected against the allowance for doubtful accounts. In addition to the review of the categories of revenue, management monitors the write offs against established allowances as of a point in time to determine the appropriateness of the underlying assumptions used in estimating the allowance for doubtful accounts. Patient accounts receivable is presented net of an allowance for doubtful accounts of $75,039,000 and $57,869,000 as of September 30, 2018 and 2017, respectively, in the consolidated balance sheets. Management attributes this change in the allowance for doubtful accounts due to a decrease in accounts receivable and improvement in the aging where more current accounts are reflected in the current year. Bad debt expense for nonpatient related accounts receivable is reflected in operating expense on the statements of operations. Patient related bad debt expense is reflected as a reduction in patient service revenue in the statements of operations
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE MEDICARE COSTS ARE OBTAINED FROM THE COST REPORT FOR INPATIENT PSYCHIATRIC CAPITAL AND OUTPATIENT SERVICES. IN ADDITION, FEE BASED SERVICES, SUCH AS LABS, PT, OT, ETC, ARE DETERMINED THROUGH PS&R CHARGES TIMES OUTPATIENT COST TO CHARGE RATIO.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance A. Exemption From Self-Pay Billing and Collection Action- UMMHC will not initiate Self-Pay billing and collection activity in the following instances: 1. Upon sufficient proof that a patient is a recipient of Emergency Aid to the Elderly, Disabled and Children (EAEDC), or enrolled in MassHealth, Health Safety Net, the Children's Medical Security Plan whose family income is equal or less than 300% of the FPL or Low Income Patient designation with the exception of Dental-Only Low Income patients as determined by the office of Medicaid with the exception of co-pays and deductibles required under the Program of Assistance. 2. The hospital has placed the account in legal or administrative hold status and/or specific payment arrangements have been made with the patient or guarantor. 3. Medical Hardship bills that exceed the medical hardship contribution. 4. Medical Hardship contributions that remains outstanding during a patient's MassHealth or Low Income Patient eligibility period. 5. Unless UMMHC has checked the EVS system to determine if the patient has filed an application for MassHealth. 6. For Partial Health Safety Net eligible patients, with the exception of any deductibles required. 7. UMMHC may bill for Health Safety Net eligible and Medical Hardship patients for non-medically necessary services provided at the request of the patient and for which the patient has agreed by written consent. 8. UMMHC may bill a Low Income Patient at their request in order to allow the patient to meet the required CommonHealth One-Time Deductible
Schedule H, Part V, Section B, Line 16a FAP website - UMASS MEMORIAL MEDICAL CENTER, INC: Line 16a URL: https://www.umassmemorialhealthcare.org/umass-memorial-medical-center/patients-visitors; - UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL, INC.: Line 16a URL: https://www.umassmemorialhealthcare.org/healthalliance-clinton-hospital/patients-visitors; - MARLBOROUGH HOSPITAL: Line 16a URL: https://www.umassmemorialhealthcare.org/marlborough-hospital/patients-visitors/patient-resources;
Schedule H, Part V, Section B, Line 16b FAP Application website - UMASS MEMORIAL MEDICAL CENTER, INC: Line 16b URL: https://www.umassmemorialhealthcare.org/umass-memorial-medical-center/patients-visitors; - UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL, INC.: Line 16b URL: https://www.umassmemorialhealthcare.org/healthalliance-clinton-hospital/patients-visitors; - MARLBOROUGH HOSPITAL: Line 16b URL: https://www.umassmemorialhealthcare.org/marlborough-hospital/patients-visitors/patient-resources;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - UMASS MEMORIAL MEDICAL CENTER, INC: Line 16c URL: https://www.umassmemorialhealthcare.org/umass-memorial-medical-center/patients-visitors; - UMASS MEMORIAL HEALTHALLIANCE-CLINTON HOSPITAL, INC.: Line 16c URL: https://www.umassmemorialhealthcare.org/healthalliance-clinton-hospital/patients-visitors; - MARLBOROUGH HOSPITAL: Line 16c URL: https://www.umassmemorialhealthcare.org/marlborough-hospital/patients-visitors/patient-resources;
Schedule H, Part VI, Line 2 Needs assessment UMass Memorial Medical Center: In addition to conducting the Community Health Needs Assessment (CHNA), UMass Memorial Medical Center assesses the health care needs of the community it serves by working closely with the Worcester Division of Public Health on an on-going basis. Community Benefits staff hold leadership roles and/or participate in multiple coalitions and efforts focused on addressing priority areas identified in the CHNA and aligned with strategies of the Community Health Improvement Plan (CHIP). In 2018, the Vice President of Community Relations and the Community Health Manager continued to serve as members of the Steering Committee of the Coalition for a Healthy Greater Worcester, a healthy communities coalition that coordinates and provides accountability for CHIP Priority Area Working Groups, participates in the CHIP Access to Care group and a subcommittee for oversight of UMass Memorial Medical Center Determination of Needs (DoN) funds distribution. The hospital also works closely with the Worcester Division of Public Health, Worcester Public Schools and two community health centers (Family Health Center of Worcester and the Edward M. Kennedy Community Health Center) on an ongoing basis through its Ronald McDonald Care Mobile program and the Worcester Pediatric Asthma Task Force/Intervention. UMass Memorial Medical Center completed its CHNA by assembling a diverse group of community stakeholders that include, but are not limited to, members of health and human service organizations, philanthropy, communities of color, neighborhood residents and the Worcester Division of Public Health as part of the group that assisted and guided the assessment process. The hospital's Community Benefits Strategic Implementation Plan is aligned with the CHIP. The other needs that are not included in the CHNA/CHIP are not being addressed because they are not a part of the nine, identified priority CHIP Domain areas and due to limited funding. The following strategies were conducted to complete the assessment: * Conducted key informant interviews and focus groups with community-based organizations and residents * Conducted outreach efforts to medically-underserved populations and convene meetings with neighborhood/community groups * Reviewed primary and secondary data * Conducted online community survey * Organized community forums to share findings and release of final report * Organized task forces for further action to identify priority areas The following sources inform and enhance our efforts to identify priorities and unmet needs: * U.S. Census 2010 * U.S. Census American Fact Finder * Massachusetts Department of Education Reports including local enrollment and language data * Massachusetts Department of Employment and Training * Hospital utilization data * Massachusetts Department of Public Health * Data from various City of Worcester departments including, but not limited to, the local Division of Public Health, Neighborhood Services and Police. * Information collected from health care providers, community groups/underserved populations and individuals and organizations who have expertise on community health issues. UMass Memorial HealthAlliance-Clinton Hospital Inc. : In addition to the CHNA, UMass Memorial HealthAlliance-Clinton Hospital Management Team plays an active role in the Community Benefit Program by sharing information regarding needed programs, services and support. Members of the Community Benefits Team and the Management Team also participate in various community agency boards, coalitions, committees, community events, and health fairs. These groups and events play a significant role in defining needs, generating program ideas and creating services, programs, and support groups. Community Benefits activities and goals are also shared with the Board of Trustees for their feedback. UMass Memorial HealthAlliance-Clinton Hospital works closely with the CHNA9 which is comprised of representatives from a diverse group of agencies, providers, schools, community organizations and community members. The hospital also works with CHNA9 members: A.E.D. Foundation, Inc. Arc of Opportunity Central Mass Agency on Aging, Clinton Adult Learning Center, Community Health Connections, Community Health link, Fitchburg Board of Health, Fitchburg Department of Community Development, Fitchburg Police Department, Fitchburg Public Schools, Fitchburg State University, GAAMHA Inc., Gardner Community Action Team, Gardner Public Schools, Gardner Visiting Nurses Association, Growing Places Inc., Health Care for All Health Disparities Collaborative, Health Foundation of Central Mass, Heywood Healthcare, Joint Coalition on Health, Leominster Public Schools, LUK, Inc., MA Department of Corrections, MA Department of Public Health, Massachusetts Public Health Association, Montachusett Community Branch YMCA, Montachusett Home Care, Montachusett Opportunity Council, Montachusett Veterans Outreach Center Inc., Montachusett Public Health Network, Mount Wachusett Community College, NAMI of North Central Mass, Nashoba Regional School District, Nashoba Valley Medical Center, North Central Mass Coalition for Healthy Relationships, North Central Mass Minority Coalition, North Central WIC, The SHINE Initiative, South Bay Mental Health, Spanish American Center, Suicide Prevention Task Force, Sunrise Senior Living, Three Pyramids Training Resources of America, Transportation for Massachusetts, UMass Medical School Center for Tobacco Treatment, United Neighbors of Fitchburg, United Way of Tri-County/Wheat Community Connections, Winchendon Board of Health, Winchendon Public Schools, Worcester County Food Bank/Feeding America, You Inc., and YWCA of North Central Marlborough: The CHNA is comprised of qualitative and quantitative data collected through a community engagement process. In addition, the Community Benefits Advisory Council, comprised of members of different agencies and businesses in the area, helps to identify programs in support of the community priorities. In addition to conducting the CHNA, Marlborough Hospital assesses the health care needs of the community it serves by working closely with its Community Benefits Advisory Committee (CBAC). Other CBAC members include representatives from the Hudson and Marlborough Public Schools and the Boards of Health, agencies that focus on addiction and recovery services, the Council on Aging, the Marlborough Community Development Corporation, Wellness Council members and residents of the community. The CBAC helps to identify programs in support of the community priorities, provides feedback on an on-going basis and focuses on addressing priority areas identified in the CHNA and aligned with strategies of the Community Health Improvement Plan. Marlborough: The CHNA is comprised of qualitative and quantitative data collected through a community engagement process. In addition, the Community Benefits Advisory Council, comprised of members of different agencies and businesses in the area, helps to identify programs in support of the community priorities. In addition to conducting the CHNA, Marlborough Hospital assesses the health care needs of the community it serves by working closely with its Community Benefits Advisory Committee (CBAC). Other CBAC members include representatives from the Hudson and Marlborough Public Schools and the Boards of Health, agencies that focus on addiction and recovery services, the Council on Aging, the Marlborough Community Development Corporation, Wellness Council members and residents of the community. The CBAC helps to identify programs in support of the community priorities, provides feedback on an on-going basis and focuses on addressing priority areas identified in the CHNA and aligned with strategies of the Community Health Improvement Plan.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Financial Counselors, also referred to as Certified Application Counselors (CAC's) are state certified and located on all campus locations. CAC's are available to assist underinsured and uninsured patients navigate the medical benefit application process. CAC's will take the steps necessary to help patients submit applications to obtain coverage, resolve eligibility issues, upgrade their coverage to coverage that provides more benefits, choose and enroll in a MassHealth or Connector Care Health insurance plan and change these plans when necessary.
Schedule H, Part VI, Line 4 Community information UMass Memorial Medical Center: Geographical Reach: The 2018 Community Health Assessment (CHNA) and Greater Worcester Community Health Improvement Plan (CHIP) focuses on the City of Worcester and the outlying communities of Shrewsbury, Millbury, West Boylston, Leicester, Grafton and Holden, a sub-section of its primary service area. This specific geographic area is the focus for the City of Worcester Division of Public Health regionalization initiative, and overlaps with the service area of many other local organizations. Focusing UMass Memorial's CHNA on this geographic area facilitates the alignment of the hospital's efforts with community and governmental partners, specifically the city health department, the area Federally Qualified Health Centers, and community-based organizations. This focus also facilitates collaboration with the CHIP Advisory Committee (The Coalition for a Healthy Greater Worcester) that implements key strategies of the CHIP so that future initiatives can be developed in a more coordinated approach. Regional Description: The City of Worcester is very ethnically-diverse. The number of Hispanics living in the city has grown by 35% over the past 10 years. Refugees from Iraq currently account for the greatest percentage of new immigrants (51%) followed by refugees from Bhutan, Burma, Liberia and other African nations. Health Resources and Services Administration (HRSA) has designated the City of Worcester a health professional shortage area (HPSA) in primary care, mental health and dental services due to its low income population. The City of Worcester has several neighborhoods with a shortage of health providers and HRSA has determined that many census tracts in the city are medically-underserved areas (MUAs). Economic Characteristics: The U.S. Census American Fact Finder population estimates for 2013-2017 indicated that the median household income for the City of Worcester was $45,869 and for Worcester County region was $69,313. According to the Worcester Regional Research Bureau, of the city's total 184,743 residents, 22% are living below the poverty level. The number of children under the age of 18 living below the poverty level rose to 30% in 2010 from 25% in 2005-2009. These factors have resulted in a strong need for food assistance services. For example, according to the Massachusetts Department of Education, 64% of students in the Worcester Public School system receive free school lunch. Demographics: Worcester is a Federal Resettlement Site, as a result, the City of Worcester's foreign born population is significantly higher than Worcester County as a whole, accounting for the majority of this population in the region. According to U.S. Census 2010 figures, the Hispanic population and other non-Hispanic, non-White ethnic groups in the city have notably increased while the white, non-Hispanic population has decreased. Reflecting this diversity, ninety percent of all medical interpretations provided by UMMHC are conducted in: Spanish, Portuguese, Vietnamese, Arabic, Albanian and American Sign Language. The remaining ten percent are conducted in other "non-primary" languages, the pool of which consists of 81 different languages. The senior population in the region also continues to grow as baby boomers reach the age of 65. According to the U.S. Census, residents between the ages of 20-64 account for the majority of the population in Worcester County at 61%. UMass Memorial HealthAlliance-Clinton Hospital Inc. UMass Memorial HealthAlliance-Clinton Hospital's primary service area includes the quasi-urban municipalities of Clinton, Fitchburg, and Leominster, and the more rural towns of Ashburnham, Ashby, Gardner, Lunenburg, Townsend, Sterling, and Westminster. The Hospital's secondary service area includes an additional twelve towns: Ayer, Bolton, Groton, Harvard, Hubbardston, Lancaster, Pepperell, Princeton, Shirley, Sterling, Templeton and Winchendon. While great efforts are made to improve the health status, provide diagnostic screening, and address access barriers of all residents within these communities, special attention is given to address the needs of diverse and/or low income, vulnerable segments of the population. The challenges that these cohorts face with respect to social determinants of health and access to care are often intense and are at the root of the challenges and poorer health outcomes faced in these communities. More specifically, the hospital's 2018 CHNA identified low-income populations, African Americans and other racial/ethnic minority populations, recent immigrants, non-English speakers, and older adults as priority populations that deserve special attention. According to the US Census Bureau: * In Fitchburg (6%), a significantly greater percentage of residents speak Spanish at home and English "less than very well" compared to the Commonwealth overall (4%) * Compared to the Commonwealth (11%), the percentage of Hispanic/Latino residents is significantly high in Fitchburg (24%), Clinton (14%), and Leominster (15%). * The percentage of residents identifying as "some other race" besides White, Black or African American, Asian, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander is significantly high in Fitchburg (8%) and Leominster (7%) compared to the Commonwealth overall (4%). Employment, income, and poverty is another area where there was significant variation within the service area. According to the US Census Bureau: * Compared to the Commonwealth overall ($68,563), the median household income was significantly lower in Clinton, Fitchburg, Gardner, and Leominster, yet significantly higher in all other municipalities in the service area. * The percentage of residents that live below the federal poverty line is significantly high in Fitchburg (19%) and Gardner (19%) compared to the Commonwealth (12%). * Compared to the Commonwealth (24%), a significantly high percentage of residents live below 200% of the federal poverty line in Gardner (38%) and Leominster (28%). The percentage of families, individuals under 18, individuals over the age of 65, and female-headed households living in poverty was significantly high in Fitchburg compared to the Commonwealth overall. Marlborough Hospital: The City of Marlborough, with a population of 39,873 (July 2017) grew 3.4% from 2010. Marlborough's population is predominately White (80%) followed by Hispanic or Latino (10%), other race is 7%, Asian 5%, Black or African American 2% and 3% identify themselves as 2 or more races. Hudson has a population of 14,907 with 90% who identify themselves as White, 4% Hispanic or Latino, 2% other, 2% Asian, 1% Black or African American and 2% indicate two or more races. Quantitative data from U.S Department of Commerce, Bureau of the Census, American Community Survey 5 year estimates, 2010-2014 illustrates that just over threefourths of the Massachusetts population is White (76.9%) which was largely consistent with Marlborough (80%). Both at the state level and in Marlborough, the Hispanic population was the next largest racial/ethnic group. Hudson's population followed a similar pattern, the proportion of its population that identified as white was even larger (90%) followed by Hispanic and Latino. English, Portuguese and Spanish are the predominant language for the communities the hospital serves.
Schedule H, Part VI, Line 5 Promotion of community health UMass Memorial Medical Center: UMass Memorial has a designated Community Benefits department housed within Community Relations that is wholly dedicated to promoting the Community Benefit agenda with a special focus on Community Health Improvement. Our Community Benefits staff works very closely with multiple community organizations forging partnerships. The hospital has a strong and longstanding partnership with the Worcester Division of Public Health which has resulted in significant opportunities that have leveraged funding and implementation of preventive community-clinical linkages. In addition, we work closely with the two Federally Qualified Community Health Centers and leverage internal resources within the system to increase program capacity whenever possible. The Community Relations/Community Benefits Department works closely with Pedi-Primary Care, Family and Community Medicine and Pedi-Pulmonology. We also provide medical and dental services to the underserved at 11 neighborhood sites and 20 schools through the UMass Memorial Care Mobile. Most recently, we have adopted an Anchor Mission as a strategy to specifically address social determinants of health. UMass Memorial HealthAlliance-Clinton Hospital Inc.: The hospital has a Community Benefit program that is responsible for promoting the Community Benefit Implementation Strategy focusing on Community Health Improvement. Hospital staff, leaders, and medical providers work very closely with multiple community organizations forging partnerships. In addition, we leverage internal resources within the system to increase program capacity whenever possible. We continue to support health education and screenings related to chronic diseases and prevalent health conditions in the community including mental/behavioral health, lung cancer/smoking cessation, chronic occlusive pulmonary disease (COPD), heart health, depression and nutrition/diabetes. We particularly focus on diverse populations and and social determinants of health. UMass Memorial HealthAlliance-Clinton Hospital continued working with the Community Health Network of North Central Mass (CHNA9) and other partners in implementing the North Central Mass Community Health Improvement Plan (CHIP). Most CHIP working groups meet monthly and took significant steps toward reviewing baseline information and creating more partnerships that will enable sharing of resources throughout the CHIP implementation and beyond. MarlboroughHospital: Marlborough Hospital participates in area events and provides facilities for support groups. In addition, whenever possible we leverage internal resources to build capacity in our programming and we have staff that supports Community Benefits activities.
Schedule H, Part VI, Line 6 Affiliated health care system UMass Memorial Medical Center: Our clinical system is comprised of three hospitals which each site having a dedicated Community Benefits staff that works closely with their respective communities in conducting a CHNA, a CHIP and an Implementation Strategy. UMass Memorial HealthAlliance-Clinton Hospital Inc. : Our clinical system is comprised of three hospitals WITH each site having a dedicated Community Benefits staff that works closely with their respective communities in conducting a CHNA, a CHIP and an Implementation Strategy. Marlborough Hospital : Our clinical system is comprised of three hospitals with each site having a dedicated Community Benefits staff that works with their respective communities in conducting a CHNA, a CHIP and an Implementation Strategy.
Schedule H, Part VI, Line 7 State filing of community benefit report MA
Schedule H (Form 990) 2017
Additional Data


Software ID: 17005876
Software Version: 2017v2.2