2022-08-12T12:08:08-05:00 2021-09-30 135565207 KPMG LLP 60 SOUTH STREET BOSTON MA 02111 990 2020-10-01 043314093 BOSTON MEDICAL CENTER CORPORATION BOST 6174141628 ONE BOSTON MEDICAL CENTER PLACE BOSTON MA 02118 DAVID BECK SVP/CHIEF LEGAL COUNSEL/CLERK 6176387653 2022-08-12 1 DAVID BECK 999009999 STEPHANIE LONCZAK P01880207 6179881000 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z KATHLEEN E WALSH ONE BOSTON MEDICAL CENTER PLACE BOSTON MA 02118 1980326659 0 X WWW.BMC.ORG X 1996 MA BOSTON MEDICAL CENTER'S MISSION IS TO PROVIDE COSISTENTLY EXCELLENT AND ACCESSIBLE HEALTH SERVICES TO ALL IN NEED OF CARE REGARDLESS OF STATUS AND ABILITY TO PAY. 30 26 10051 260 12058856 5854577 133609173 150978125 1699081795 1752717825 23248318 58583174 25204705 13153610 1881143991 1975432734 26453637 28222126 0 0 666076602 754442410 0 0 7718033 1090128408 1133792944 1782658647 1916457480 98485344 58975254 2742184683 2744742937 1418261968 1324215116 1323922715 1420527821 X BOSTON MEDICAL CENTER'S MISSION IS TO PROVIDE CONSISTENTLY EXCELLENT AND ACCESSIBLE HEALTH SERVICES TO ALL IN NEED OF CARE REGARDLESS OF STATUS AND ABILITY TO PAY. 0 0 1775786795 1752717825 THE STATUTE THAT AUTHORIZED THE CREATION OF BOSTON MEDICAL CENTER REQUIRES IT TO SERVE ALL POPULATIONS. BMC IS A PRIVATE, NOT-FOR-PROFIT, 514-LICENSED BED, URBAN ACADEMIC MEDICAL CENTER WHICH EMPHASIZES COMMUNITY-BASED, ACCESSIBLE CARE AND THE MISSION TO PROVIDE CONSISTENTLY ACCESSIBLE HEALTH SERVICES TO ALL IN NEED OF CARE REGARDLESS OF STATUS AND ABILITY TO PAY. BMC IS THE LARGEST SAFETY NET HOSPITAL IN NEW ENGLAND AND PROVIDES A FULL SPECTRUM OF PEDIATRIC AND ADULT CARE SERVICES FROM PRIMARY TO FAMILY MEDICINE TO ADVANCED SPECIALTY CARE. BOSTON MEDICAL CENTER IS DEDICATED TO PROVIDING ACCESSIBLE HEALTH CARE. NEARLY 75 PERCENT OF OUR PATIENTS COME FROM UNDERSERVED POPULATIONS, SUCH AS THE LOW-INCOME AND ELDERLY, WHO RELY ON GOVERNMENT PAYERS SUCH AS MEDICAID, THE HEALTH SAFETY NET, AND MEDICARE FOR THEIR COVERAGE; 27 PERCENT DO NOT SPEAK ENGLISH AS A PRIMARY LANGUAGE. TO ADDRESS THE HEALTH NEEDS OF DIVERSE PATIENT POPULATIONS, BMC PROVIDES A WIDE RANGE OF SERVICES BEYOND THE TRADITIONAL MEDICAL MODEL. THESE PROGRAMS, INCLUDING PATIENT NAVIGATION AND A FOOD PANTRY, HELP TO REDUCE BARRIERS TO ACCESS TO HEALTH SERVICES AND ELIMINATE DISPARITIES IN HEALTH CARE AMONG VARIOUS POPULATIONS THAT BMC SERVES. 27865007 27865007 BOSTON MEDICAL CENTER PROVIDES RESEARCH SUPPORT TO ORGANIZATIONS WITHIN THE US. 357119 357119 BOSTON MEDICAL CENTER PROVIDES RESEARCH SUPPORT TO FOREIGN ORGANIZATIONS. 1804008921 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 1 1 1 0 0 1 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 X 397 0 1 10051 1 1 1 1 CJ CA UK LT EI BD 0 0 0 1 1 0 0 0 0 1 0 X 30 26 1 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X PETER THUKU 6176387494 ONE BOSTON MEDICAL CENTER PLACE BOSTON MA 02118 KATHLEEN E WALSH PRESIDENT & CEO 50.00 7.50 X X 2235565 0 35988 JENNIFER TSENG MD TRUSTEE 1.00 54.00 X 0 1040916 39753 DAVID COLEMAN MD TRUSTEE 1.00 54.00 X 0 885740 34897 DAVID AMENT TRUSTEE (UNTIL 5/11/2021) 1.00 2.00 X 0 0 0 KAREN ANTMAN MD TRUSTEE 1.00 2.00 X 0 0 0 ANITA BEKENSTEIN TRUSTEE 1.00 0.00 X 0 0 0 BARRY BOCK TRUSTEE 1.00 0.00 X 0 0 0 NADINE CHAKAR TRUSTEE 1.00 0.00 X 0 0 0 ENRIQUE COLBERT TRUSTEE 1.00 0.00 X 0 0 0 SANDRA COTTERELL TRUSTEE 1.00 1.00 X 0 0 0 PIERRE CREMIEUX TRUSTEE 1.00 1.00 X 0 0 0 RANDI CUTLER TRUSTEE 1.00 1.00 X 0 0 0 PAUL EGERMAN TRUSTEE 1.00 0.00 X 0 0 0 RUTH ELLEN FITCH TRUSTEE 1.00 0.00 X 0 0 0 MELANIE FOLEY TRUSTEE 1.00 0.00 X 0 0 0 TRICIA GLYNN TRUSTEE 1.00 0.00 X 0 0 0 EILENE GRAYKEN TRUSTEE (UNTIL 5/11/2021) 1.00 0.00 X 0 0 0 JOHN T HAILER TRUSTEE (AS OF 5/11/2021) 1.00 0.00 X 0 0 0 KAREN KAMES TRUSTEE 1.00 0.00 X 0 0 0 AZRA KANJI TRUSTEE 1.00 0.00 X 0 0 0 MANUEL LOPES TRUSTEE 1.00 2.00 X 0 0 0 FRED LOWERY TRUSTEE (AS OF 5/11/2021) 1.00 0.00 X 0 0 0 RICHARD MARKS TRUSTEE 1.00 1.00 X 0 0 0 DEVIN MCCOURTY TRUSTEE (AS OF 2/9/2021) 1.00 0.00 X 0 0 0 LAUREN NENTWICH TRUSTEE (AS OF 10/1/2021) 1.00 0.00 X 0 0 0 BISOLA OJIKUTU MD TRUSTEE (AS OF 9/1/2021) 1.00 0.00 X 0 0 0 CLAIRE PERLMAN TRUSTEE 1.00 0.00 X 0 0 0 MARTHA SAMUELSON TRUSTEE/CHAIR 1.00 1.00 X 0 0 0 REV LIZ WALKER TRUSTEE 1.00 0.00 X 0 0 0 ANDREW YOUNISS TRUSTEE 1.00 1.00 X 0 0 0 RITA NIEVES TRUSTEE (UNTIL 5/11/2021) 1.00 0.00 X 0 0 0 CYNTHIA SIERRA TRUSTEE 1.00 0.00 X 0 0 0 MAROA VELEZ TRUSTEE (AS OF 5/11/2021) 1.00 0.00 X 0 0 0 DAVID BECK SVP/CHIEF LEGAL COUNSEL/CLERK 50.00 13.50 X 633628 0 57813 TERRI NEWSOM SVP/CFO/TREASURER 50.00 3.00 X 289055 0 6385 ALASTAIR BELL SVP OPS & STRATEGY/COO 50.00 2.00 X 1320299 0 113299 RAVIN DAVIDOFF MD SVP MEDICAL AFFAIRS AND CMO 50.00 1.50 X 816858 0 65949 LISA KELLY-CROSWELL SVP/CHRO 50.00 0.00 X 696614 0 86791 NANCY GADEN SVP CHIEF NURSING OFFICER 50.00 0.00 X 649873 0 107465 BOB BIGGIO SVP FACILITY & SUPT SVCS 50.00 0.00 X 608832 0 114203 NORMAN STEIN SVP CHIEF DEVELOPMENT OFFICER 50.00 0.00 X 598570 0 66966 JOE CAMILLUS SVP AMBULATORY & PRF SVC 50.00 0.50 X 544376 0 101041 ARTHUR HARVEY VP/CIO 50.00 0.00 X 556141 0 72475 JULIE JONCAS VP FINANCE 50.00 0.00 X 514157 0 53131 CHARLES ORLANDO FORMER SVP/CFO/TREAS 0.00 0.00 X 799474 0 40493 10263442 1926656 996649 1079 1 1 0 BOSTON UNIVERSITY ONE SILBER WAY BOSTON MA 02215 RESEARCH & OTHER SHARED SERVICES 44185748 SHC SERVICES INC 1640 W REDSTONE CTR DR PARK CITY UT 84098 TEMPORARY STAFFING 15820002 PRICEWATERHOUSECOOPERS ADVISOR 4040 W BIY SCOUT BOULEVARD TAMPA FL 33607 ACCOUNTS RECEIVABLE MANAGEMENT 11882795 MORRISON HEALTH CARE INC 714 SOUTHBRIDGE ST AUBURN MA 01501 FOOD SERVICE/ CAFETERIA MANAGEMENT 6094302 CYRACOM INTERNATIONAL INC 2650 E ELVIRA SUITE 132 TUCSON AZ 85756 TRANSLATION & INTERPRETATION SERVICES 3981348 297 4700447 129331289 16946389 1347536 150978125 PATIENT SERVICE REVENUE 900099 1165411708 1165411708 PHARMACY 900099 524198274 512464456 11733818 GRANT & CONTRACT REVENUE 900099 48134376 48134376 OTHER PROGRAM REVENUE 900099 11717249 11717249 NPP & PHARMACIST REVENUE 900099 3256218 3256218 1752717825 14785977 44326 14741651 4739283 4305331 433952 433952 433952 43797197 0 43797197 43797197 280712 43516485 229164 4700447 588594 -359430 -359430 PARKING 812930 10276210 10276210 CAFETERIA 900099 2802878 2802878 13079088 1975432734 1740984007 12058856 71411746 27865007 27865007 357119 357119 7150704 7150704 248420 248420 585640875 549474352 32540647 3625876 26013938 24407435 1445443 161060 88262128 82811459 4904212 546457 47126345 44216036 2618536 291773 7848058 2429303 5403870 14885 890740 89682 800475 583 84000 84000 650840 650840 127735610 98373779 27983069 1378762 797976 723433 27474 47069 14266942 13750518 365120 151304 24130977 22640757 1340818 149402 4966500 4659792 275959 30749 32549556 30539443 1808589 201524 1171703 1109514 47181 15008 631285 587194 36999 7092 24519870 23005634 1362426 151810 99302209 93169755 5517645 614809 8399962 7881218 466737 52007 DRUGS 438382984 438382984 PHYSICIAN SERVICES 109638701 108441898 1196363 440 PATIENT RELATED SUPPLIE 104669553 104624015 40973 4565 DIRECT RESEARCH 68158732 68158732 64996746 56061442 8662446 272858 1916457480 1804008921 104730526 7718033 43051623 20037332 435188674 470196193 17799534 28217572 225678776 169608461 97973088 90547535 17336619 19427967 4202903 6414876 2107673170 1117592096 1040040940 990081074 60636054 54119501 264960518 337430094 488954 510000 534827000 558152332 2742184683 2744742937 209572605 249971153 96242885 36212006 439485579 430802607 672960899 607229350 1418261968 1324215116 X 961336552 1008436056 362586163 412091765 1323922715 1420527821 2742184683 2744742937 X 58975254 50720942 -1196871 -11894219 X 0 1 X 1 1 1 X 41186207 24563859 25615642 133609173 150978125 375953006 41186207 24563859 25615642 133609173 150978125 375953006 375953006 12553229 37639990 23179858 18969810 19480934 111823821 273343 1867255 1809363 5854577 9804538 6346770 6259300 15535712 23251865 13079088 64472735 562054100 7788994956 0.66890 0.57680 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: FUNDRAISING - 2016 AMOUNT: $ 294,793. CAFETERIA - 2016 AMOUNT: $ 3,861,417. 2017 AMOUNT: $ 3,830,150. 2018 AMOUNT: $ 4,290,813. 2019 AMOUNT: $ 3,300,767. 2020 AMOUNT: $ 2,802,878. PARKING - 2016 AMOUNT: $ 2,190,560. 2017 AMOUNT: $ 2,429,150. 2018 AMOUNT: $ 11,244,899. 2019 AMOUNT: $ 10,063,598. 2020 AMOUNT: $ 10,276,210. GAIN ON SALE OF TAX CREDITS - 2019 AMOUNT: $ 9,887,500. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 84000 0 1 84000 0 PART II-B, LINE 1: BOSTON MEDICAL CENTER PAID DEMPSEY, LUCEY & ASSOCIATES $84,000 TO REPRESENT THE ORGANIZATION. THESE FEES WERE PAID TO THE LOBBYISTS LISTED TO ADVANCE BOSTON MEDICAL CENTER'S MISSION: "TO CONSISTENTLY PROVIDE EXCELLENT AND ACCESSIBLE HEALTH CARE SERVICES TO ALL IN NEED OF CARE, REGARDLESS OF STATUS OR ABILITY TO PAY" AS SET OUT IN CHAPTER 147 OF THE ACTS AND RESOLVES OF 1996 OF THE COMMONWEALTH OF MASSACHUSETTS. 633839832 363954719 108079400 370977505 1853381 733043065 724862042 61170242 42383073 192451403 2124122 633839832 709074381 285759688 25210971 292657917 2525081 724862042 697009021 21885406 40783482 47477741 3125787 709074381 642296242 127298970 71375617 142059930 1901878 697009021 0.46590 0.05540 0.47870 0 0 18306730 18306730 1246650796 522901307 723749489 41190729 25068099 16122630 686682675 507723493 178959182 114842240 61899197 52943043 990081074 DONOR RESTRICTED INVESTMENTS 337430094 F 337430094 BOARD DESIGNATED INVESTMENTS 341493471 FUNDS HELD BY TRUSTEES 41676673 NONCURRENT ACCOUNTS RECEIVABLE 6986812 INSURANCE RECOVERY RECEIVABLES 38030610 OTHER LONG-TERM ASSETS 41595450 RIGHT OF USE ASSETS- NET 88369316 558152332 EST SETTLEMENT W/3RD PARTY PAY 146777238 CAPITAL LEASE OBLIGATIONS 81487832 OTHER LONG-TERM LIABILITIES 146369821 PROFESSIONAL LIABILITY CLAIMS 38030890 TAXABLE BONDS PAYABLE 180815888 RELATED PARTY LIABILITIES 13747681 607229350 X PART V, LINE 4: GENERAL ENDOWMENT THE GENERAL ENDOWMENT INCLUDES FUNDS FROM A NUMBER OF SOURCES WITH VARIOUS RESTRICTIONS ON USE AND TREATMENT. THE ENDOWMENT FUNDS HAVE BEEN CONTRIBUTED FOR SPECIFIC PURPOSES INCLUDING CONSTRUCTION, MAINTENANCE, RESEARCH, CLINICAL CARE, EDUCATION, DEVELOPMENT, STAFFING, SALARIES, LABORATORY EQUIPMENT AND SUPPLIES, AND CONVALESCENT CARE. PART X, LINE 2: BOSTON MEDICAL CENTER IS INCLUDED IN COMBINED FINANCIAL STATEMENTS. THE TEXT OF THE UNCERTAIN TAX POSITIONS FOOTNOTE INCLUDED IN THESE FINANCIAL STATEMENTS IS AS FOLLOWS: THE HEALTH SYSTEM CORPORATION, THE MEDICAL CENTER, BMCHP, UDF, ECMF, BUAP, FACULTY AND THE PLANS, BACO, BMCICS, AND BMCIC OF VERMONT ARE ALL NONPROFIT CORPORATIONS THAT HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CORNERSTONE HEALTH SOLUTIONS, LLC IS A TAXABLE DELAWARE LIMITED LIABILITY COMPANY. AS OF SEPTEMBER 30, 2021, ALL CONTRACTS FOR THE CORNERSTONE BUSINESS LINE ARE BETWEEN THE MEDICAL CENTER AND THE CLIENTS. ALL CONTRACT RELATED REVENUE AND EXPENSE IS RECORDED AT THE MEDICAL CENTER AND EVALUATED FOR UNRELATED BUSINESS INCOME TAX (UBIT). THE HEALTH SYSTEM RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT NEED TO BE RECORDED AS OF SEPTEMBER 30, 2021 AND 2020. THE HEALTH SYSTEM ANNUALLY ASSESSES WHETHER IT MUST RECOGNIZE AN UNRELATED BUSINESS INCOME TAX EXPENSE (UBIT). THE AMOUNTS RECOGNIZED AS UBIT EXPENSE WERE NOT MATERIAL TO THE HEALTH SYSTEM'S CONSOLIDATED OPERATIONS OR CHANGES IN NET ASSETS FOR THE YEARS ENDED SEPTEMBER 30, 2021 AND 2020. SCHEDULE D, PART V, LINE 2 PRESENTATION OF ENDOWMENT ASSETS BOSTON MEDICAL CENTER HAS ADOPTED ASU 2016-14, PRESENTATION OF THE FINANCIAL STATEMENTS FOR NOT-FOR-PROFIT ENTITIES. AS A RESULT, THE SEPTEMBER 30, 2021 AUDITED FINANCIAL STATEMENTS CLASSIFY NET ASSETS AS EITHER NET ASSETS WITHOUT DONOR RESTRICTIONS, OR NET ASSETS WITH DONOR RESTRICTIONS. FOR PURPOSES OF SCHEDULE D, LINE 2, BOSTON MEDICAL CENTER HAS REPORTED ENDOWMENT FUNDS WITHOUT DONOR RESTRICTIONS AS BOARD DESIGNATED OR QUASI-ENDOWMENT AND ENDOWMENT FUNDS WITH DONOR RESTRICTIONS AS PERMANENT ENDOWMENT OR TERM RESTRICTED ENDOWMENT, RESPECTIVELY. 1 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 230735 EAST ASIA AND THE PACIFIC 0 0 INVESTMENTS 2451332 EUROPE 0 0 INVESTMENTS 8924620 MIDDLE EAST AND NORTH AFRICA 0 0 INVESTMENTS 1027460 NORTH AMERICA 0 0 INVESTMENTS 4560574 SOUTH AMERICA 0 0 INVESTMENTS 596778 SOUTH ASIA 0 0 INVESTMENTS 192732 SUB-SAHARIAN AFRICA 0 0 INVESTMENTS 610842 EAST ASIA AND THE PACIFIC 0 0 GRANTMAKING 27450 RUSSIA 0 0 GRANTMAKING 22035 CENTRAL AMERICA AND THE CARIBBEAN 0 0 GRANTMAKING 14761 SOUTH ASIA 0 0 GRANTMAKING 58852 SUB-SAHARIAN AFRICA 2 8 GRANTMAKING 100638 NORTH AMERICA 0 0 GRANTMAKING 133383 CENTRAL AMERICA AND THE CARIBBEAN PROGRAM SERVICES PREMIUMS 9164097 0 0 2 8 2 8 18595073 9521216 28116289 EAST ASIA & PACIFIC SUBAWARD 27450 WIRE TRANSFER RUSSIA SUBAWARD 22035 WIRE TRANSFER CENTRAL AMERICA & CARIBBEAN SUBAWARD 14761 WIRE TRANSFER SOUTH ASIA SUBAWARD 58852 WIRE TRANSFER SUB-SAHARAN AFRICA SUBAWARD 100638 WIRE TRANSFER NORTH AMERICA SUBAWARD 133383 WIRE TRANSFER 6 1 0 1 1 1 0 PART I, LINE 2: THE PRINCIPAL INVESTIGATOR AND ADMINISTRATOR APPROVE ALL SUBCONTRACT INVOICES, INCLUDING THOSE FROM A FOREIGN COUNTRY. THE FOREIGN SUBCONTRACT RECIPIENT HAS A BUDGET TO WHICH INVOICES ARE MATCHED TO ENSURE THAT ALL SPENDING IS APPROPRIATE. ADDITIONALLY, THE ORGANIZATION'S PRINCIPAL INVESTIGATORS REGULARLY CONTACT THE FOREIGN SUBCONTRACT RECIPIENTS TO MONITOR THE PROGRESS OF THE RECIPIENTS' WORK. PART II, LINE 1 ACCOUNTING METHOD: FOREIGN EXPENDITURES ARE SEPARATELY IDENTIFIED ON THE ORGANIZATION'S GENERAL LEDGER. PART III ACCOUNTING METHOD: GALA 2432190 2307488 124702 357418 FOOD 4 THOUGHT 706079 676079 30000 47959 8 1791342 1716880 74462 17891 165326 4929611 4700447 229164 17891 570703 588594 -359430 1 1 X 1 X 0 1 1 0 0 80093580 32552548 47541032 0.02480 1045469250 675208825 370260425 0.19320 1125562830 707761373 417801457 0.21800 16863120 12870624 3992496 0.00210 68672568 18112714 50559854 0.02640 693 70022913 51916787 18106126 0.00940 693 155558601 82900125 72658476 0.03790 693 1281121431 790661498 490459933 0.25590 2 1375746 1375746 0.00070 2 15730000 15730000 0.00820 12 1304821 300000 1004821 0.00050 1 867750 867750 0.00050 1 144594 144594 0.00010 18 19422911 300000 19122911 0.01000 1 9174983 184236584 194024505 -9787921 X 1 1 1 1 BOSTON MEDICAL CENTER ONE BOSTON MEDICAL CENTER PLACE BOSTON MA 02118 HTTP://WWW.BMC.ORG X X X X X BOSTON MEDICAL CENTER 1 0 0 1 X X X X X X X X 18 1 1 1 1 X HTTPS://WWW.BMC.ORG/CARE-OUR-COMMUNITY X 1 18 1 HTTPS://WWW.BMC.ORG/CARE-OUR-COMMUNITY 0 1 X 200.000000000000 0.000000000000 X X 1 1 X X X X 1 X HTTPS://WWW.BMC.ORG/SERVICES/PATIENT-FINANCIAL-ASSISTANCE X HTTPS://WWW.BMC.ORG/SERVICES/PATIENT-FINANCIAL-ASSISTANCE X HTTPS://WWW.BMC.ORG/SERVICES/PATIENT-FINANCIAL-ASSISTANCE X X X X X 1 X 0 X 1 X 0 0 PART V, SECTION A: THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH HAS LICENSED BOSTON MEDICAL CENTER TO OPERATE A HOSPITAL AT ONE BOSTON MEDICAL CENTER PLACE, BOSTON, MA 02118. THIS LOCATION IS (1) A LICENSED HOSPITAL, (2) PROVIDES GENERAL MEDICAL & SURGICAL TREATMENT, (3) IS A TEACHING HOSPITAL, AND (4) OPERATES AN ER 24 HOURS. WHILE THE HOSPITAL LICENSE LISTS TWO CAMPUSES, ONLY ONE CAMPUS OPERATES:1. BOSTON MEDICAL CENTER CORPORATION, MENINO PAVILION, 830-840 HARRISONAVENUE, BOSTON MA 02118BOSTON MEDICAL CENTER ALSO OPERATES THE FOLLOWING OUTPATIENT CENTERS, WHICH ARE UNDER THE HOSPITAL'S LICENSE:CODMAN SQUARE HEALTH CENTERBRIGHTON HIGH SCHOOL STUDENT HEALTH CENTERBOSTON MEDICAL CENTER RADIOLOGY AT RYAN CENTER BOSTON UNIVERSITYEAST BOSTON NEIGHBORHOOD HEALTH CENTER (10 GOVE STREET)DOTHOUSE HEALTHMADISON PARK HIGH SCHOOL STUDENT HEALTH CENTERJEREMIAH E. BURKE STUDENT HEALTH CENTERGREATER ROSLINDALE MEDICAL & DENTALLATIN ACADEMY STUDENT HEALTH CENTERTECHBOSTON ACADEMY SCHOOL HEALTH CENTERBOSTON MEDICAL CENTER RADIOLOGY AT WHITTIER STREET HEALTH CENTERBOSTON MEDICAL CENTER RADIOLOGY AT UPHAM'S CORNER HEALTH CENTERMURIEL SNOWDEN INTERNATIONAL HIGH SCHOOL HEALTH CENTERSOUTH BOSTON COMMUNITY HEALTH CENTER 386 WEST BROADWAYSOUTH BOSTON COMMUNITY HEALTH CENTER 409 WEST BROADWAYBOSTON MEDICAL CENTER SCHOOL-BASED HEALTH CENTER AT BOSTON COMMUNITY LEADERSHIP ACADEMYEAST BOSTON NEIGHBORHOOD HEALTH CENTER - 20 MAVERICK SQUAREBOSTON MEDICAL CENTER RADIOLOGY AT MATTAPAN COMMUNITY HEALTH CENTEREAST BOSTON NEIGHBORHOOD HEALTH CENTER (79 PARIS STREET)EBHS SCHOOL BASED HEALTH CENTERWINTHROP COMMUNITY HEALTH CENTERSOUTH BOSTON COMMUNITY HEALTH CENTER SEAPORT PRIMARY CARE BOSTON MEDICAL CENTER - DEPARTMENT OF FAMILY MEDICINEBOSTON MEDICAL CENTER - CROSSTOWN BOSTON MEDICAL CENTER PART V, SECTION B, LINE 5: FOCUS GROUPS: THIRTEEN FOCUS GROUPS WERE CONDUCTED WITH SPECIFIC POPULATIONS OF INTEREST: 12 FOCUS GROUPS WERE CONDUCTED SPECIFICALLY FOR THE COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND ONE ADDITIONAL FOCUS GROUP WAS CONDUCTED BY WORK GROUP MEMBERS WHO SUBMITTED NOTES FOR THE CHNA. FOCUS GROUPS WERE 90-MINUTE SEMI-STRUCTURED CONVERSATIONS WITH APPROXIMATELY 8-12 PARTICIPANTS PER GROUP AND AIMED TO DELVE DEEPLY INTO COMMUNITY'S NEEDS, STRENGTHS, AND OPPORTUNITIES FOR THE FUTURE. FOCUS GROUPS WERE CONDUCTED WITH THE FOLLOWING POPULATION GROUPS, INCLUDING RESIDENTS OF SPECIFIC NEIGHBORHOODS: HISTORICALLY UNDERPAID FEMALE WORKERS (E.G. HOUSEKEEPERS, CHILD CARE WORKERS, HOTEL SERVICE WORKERS, ETC.); MALE LOW-WAGE WORKERS (E.G. JANITORIAL STAFF, CONSTRUCTION, ETC.); SENIORS (AGES 65+) WITH COMPLEX, CHALLENGING ISSUES (E.G. HOMEBOUND, MEDICAL COMPLICATIONS); RESIDENTS WHO ARE HOUSING INSECURE (NO PERMANENT ADDRESS OR CLOSE TO EVICTION); LATINO RESIDENTS IN EAST BOSTON (IN SPANISH); LGBTQ+ YOUTH AND YOUNG ADULTS AT RISK OF EXPERIENCING HOMELESSNESS; IMMIGRANT PARENTS OF SCHOOL AGE CHILDREN (5-18 YEARS); SURVIVORS OF VIOLENCE; MOTHERS WHO HAVE BEEN IMPACTED BY VIOLENCE; PARENTS WHO LIVE IN PUBLIC HOUSING IN DORCHESTER; CHINESE RESIDENTS LIVING IN CHINATOWN (IN CHINESE); HAITIAN RESIDENTS LIVING IN MATTAPAN (IN HAITIAN CREOLE); AND RESIDENTS IN ACTIVE SUBSTANCE USE RECOVERY.A TOTAL OF 104 COMMUNITY RESIDENTS PARTICIPATED IN FOCUS GROUPS, REPRESENTING 13 NEIGHBORHOODS ACROSS THE CITY. NEARLY HALF OF THE FOCUS GROUP PARTICIPANTS IDENTIFIED AS BLACK OR AFRICAN AMERICAN (45%), A THIRD OF PARTICIPANTS IDENTIFIED AS HISPANIC OR LATINO (34%), AND 10% IDENTIFIED AS WHITE. THE MAJORITY OF PARTICIPANTS IDENTIFIED AS FEMALE (57%), 36% IDENTIFIED AS MALE, AND 7% IDENTIFIED AS TRANSGENDER OR GENDERQUEER. ADDITIONAL DATA ON FOCUS GROUP PARTICIPANT CHARACTERISTICS CAN BE FOUND IN APPENDIX F. 15 COMMUNITY AND SOCIAL SERVICE ORGANIZATIONS LOCATED THROUGHOUT BOSTON ASSISTED WITH RECRUITING PARTICIPANTS AND/OR HOSTING FOCUS GROUPS.KEY INFORMANT INTERVIEWSA TOTAL OF 45 KEY INFORMANT INTERVIEWS WERE COMPLETED, 6 OF WHICH WERE ADDITIONAL INTERVIEWS SUBMITTED BY WORK GROUP VOLUNTEERS. INTERVIEWS WERE 45-60-MINUTE SEMI-STRUCTURED DISCUSSIONS THAT ENGAGED INSTITUTIONAL, ORGANIZATIONAL, AND COMMUNITY LEADERS AND FRONT-LINE STAFF ACROSS SECTORS. DISCUSSIONS EXPLORED INTERVIEWEES' EXPERIENCES OF ADDRESSING COMMUNITY NEEDS AND OPPORTUNITIES FOR FUTURE ALIGNMENT, COORDINATION, AND EXPANSION OF SERVICES, INITIATIVES, AND POLICIES. SECTORS REPRESENTED IN THESE INTERVIEWS INCLUDED: PUBLIC HEALTH, HEALTH CARE, HOUSING AND HOMELESSNESS, TRANSPORTATION, COMMUNITY DEVELOPMENT, FAITH, EDUCATION, PUBLIC SAFETY, ENVIRONMENTAL JUSTICE, GOVERNMENT, WORKFORCE DEVELOPMENT, SOCIAL SERVICES, FOOD INSECURITY, AND BUSINESS ORGANIZATIONAL STAFF THAT WORK WITH SPECIFIC POPULATION SUCH AS YOUTH, SENIORS, DISABLED, LGBTQ+, AND IMMIGRANTS. BOSTON MEDICAL CENTER PART V, SECTION B, LINE 6A: BOSTON MEDICAL CENTER (BMC) CONDUCTED THE CHNA WITH THE FOLLOWING HOSPITAL FACILITIES: BETH ISRAEL DEACONESS MEDICAL CENTER, BOSTON CHILDREN'S HOSPITAL, BRIGHAM AND WOMEN'S FAULKNER HOSPITAL, BRIGHAM AND WOMEN'S HOSPITAL, DANA-FARBER CANCER INSTITUTE, MASSACHUSETTS EYE AND EAR INFIRMARY, MASSACHUSETTS GENERAL HOSPITAL, AND TUFTS MEDICAL CENTER. BOSTON MEDICAL CENTER PART V, SECTION B, LINE 6B: BOSTON MEDICAL CENTER CONDUCTED THE CHNA WITH THE FOLLOWING ORGANIZATIONS: BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, BOSTON PUBLIC HEALTH COMMISSION, JAMAICA PLAIN NEIGHBORHOOD DEVELOPMENT CORPORATION, COMMUNITY LABOR UNITED, FENWAY COMMUNITY HEALTH CENTER, HEALTH LEADS, MADISON PARK DEVELOPMENT CORPORATION, MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS, UPHAM'S CORNER HEALTH CENTER, AND URBAN EDGE. BOSTON MEDICAL CENTER PART V, SECTION B, LINE 11: UNWAVERING IN OUR COMMITMENT TO ADDRESS THE HEALTH NEEDS OF OUR COMMUNITY, BMC PROVIDES A WIDE RANGE OF PROGRAMS BEYOND THE TRADITIONAL MEDICAL MODEL. CORE TO FULFILLING OUR PUBLIC HEALTH MISSION AND CONSISTENT WITH THE CHNA FINDINGS, THE GOALS OF OUR COMMUNITY BENEFITS PROGRAM ARE TO IMPROVE ACCESS TO HEALTH SERVICES AND IMPROVE HEALTH OUTCOMES FOR UNDER-RESOURCED POPULATIONS IN OUR COMMUNITY. KEY FINDINGS THAT EMERGED FROM THE CHNA INCLUDED HEALTH CARE ACCESS AND UTILIZATION, CHRONIC DISEASES AND RISK FACTORS, MENTAL HEALTH AND SUBSTANCE USE DISORDERS, VIOLENCE, HOUSING AFFORDABILITY, ENVIRONMENTAL HEALTH. FOR DETAILED INFORMATION ABOUT EACH OF THE PROGRAMS AND INITIATIVES THAT ADDRESSED THESE NEEDS LAST YEAR, PLEASE SEE SCHEDULE H, PART VI, SUPPLEMENTAL INFORMATION, PROMOTION OF COMMUNITY HEALTH BELOW. BOSTON MEDICAL CENTER PART V, SECTION B, LINE 13H: SCHEDULE H, PART V, SECTION B, LINE 13AFOR PATIENTS WHO FALL OUTSIDE COMMONWEALTH ASSISTANCE PROGRAMS, PATIENTS ARE CHARGED AT THE SAME LEVELS AS INSURERS ARE CHARGED; HOWEVER, THEY ARE OFFERED A PROMPT-PAY DISCOUNT OF 40% (REGARDLESS OF INCOME LEVEL, ETC.) IF THE PAYMENTS ARE MADE WITHIN THE FIRST 30 DAYS FROM SERVICE.SCHEDULE H, PART V, SECTION B, LINE 13HBY THE DEFINITION OF BMC'S FINANCIAL ASSISTANCE POLICY, PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE HAVE APPLIED FOR ONE OF THE COMMONWEALTH'S FINANCIAL ASSISTANCE PROGRAMS (CONNECTORCARE, MEDICAID, OR HEALTH SAFETY NET) OR HAVE BEEN PROVIDED URGENT/EMERGENT SERVICES. IN THOSE INSTANCES, PATIENTS ARE VIEWED AS UNABLE TO PAY FOR THESE CHARGES AND THE HOSPITAL SUBMITS THE CHARGE FOR REIMBURSEMENT FROM THE HEALTH SAFETY NET. 2 1 - MARGARET M SHEA RN ADULT HEALTH PROGR RIVER STREET MATTAPAN MA 02126 ADULT DAYCARE 2 - SUPPORTING PARENTS & RESILIENT KIDS CT 225 RIVER STREET MATTAPAN MA 02126 THERAPEUTIC CENTER PART I, LINE 3C: FOR PATIENTS WHO FALL OUTSIDE COMMONWEALTH ASSISTANCE PROGRAMS, PATIENTS ARE CHARGED AT THE SAME LEVELS AS INSURERS ARE CHARGED; HOWEVER, THEY ARE OFFERED A PROMPT-PAY DISCOUNT OF 40% (REGARDLESS OF INCOME LEVEL, ETC.) IF THE PAYMENTS ARE MADE WITHIN THE FIRST 30 DAYS FROM SERVICE.INTRODUCTIONTHE STATUTE THAT CREATED BOSTON MEDICAL CENTER (BMC) REQUIRES IT TO SERVE ALL POPULATIONS. BMC IS A PRIVATE, NOT-FOR-PROFIT, 514-BED, URBAN ACADEMIC MEDICAL CENTER. IT EMPHASIZES COMMUNITY-BASED, ACCESSIBLE CARE AND IS GROUNDED BY ITS MISSION TO PROVIDE CONSISTENTLY ACCESSIBLE HEALTH SERVICES TO ALL IN NEED OF CARE, REGARDLESS OF STATUS AND ABILITY TO PAY. BMC IS THE LARGEST SAFETY-NET HOSPITAL IN NEW ENGLAND AND PROVIDES A FULL SPECTRUM OF PEDIATRIC AND ADULT CARE SERVICES FROM PRIMARY TO FAMILY MEDICINE TO ADVANCED SPECIALTY CARE. DRIVEN BY THE SOCIAL DETERMINANTS OF HEALTH THAT IMPACT HEALTH OUTCOMES AMONG OUR PATIENTS AND COMMUNITY, THE GOAL OF OUR COMMUNITY HEALTH IMPROVEMENT ACTIVITIES, OR COMMUNITY BENEFITS, IS TO IMPROVE COMMUNITY HEALTH. APPROXIMATELY 59% OF OUR PATIENTS ARE FROM UNDERSERVED POPULATIONS, SUCH AS THE LOW-INCOME AND THE ELDERLY, WHO RELY ON GOVERNMENT PAYERS SUCH AS MEDICAID, THE HEALTH SAFETY NET AND MEDICARE FOR THEIR COVERAGE, AND 32% DO NOT SPEAK ENGLISH AS A PRIMARY LANGUAGE. TO ADDRESS THE HEALTH NEEDS OF ITS DIVERSE PATIENT POPULATION, BMC PROVIDES A WIDE RANGE OF SERVICES BEYOND THE TRADITIONAL MEDICAL MODEL. THESE PROGRAMS, INCLUDING BUT NOT LIMITED TO PATIENT NAVIGATION AND A FOOD PANTRY, HELP REDUCE BARRIERS TO ACCESSING HEALTH SERVICES AND ELIMINATE INEQUITIES IN HEALTHCARE AMONG THE VARIOUS POPULATIONS BMC SERVES. WITH MORE THAN 24,367 ADMISSIONS AND 1,338,510 PATIENT VISITS PER YEAR, BMC PROVIDES A COMPREHENSIVE RANGE OF INPATIENT, CLINICAL AND DIAGNOSTIC SERVICES IN MORE THAN 70 AREAS OF MEDICAL SPECIALTIES AND SUBSPECIALTIES INCLUDING CARDIAC CARE, NEUROLOGICAL CARE, ORTHOPEDICS, GERIATRICS, WOMEN'S HEALTH, AND PEDIATRICS. THE LARGEST 24-HOUR LEVEL I TRAUMA CENTER IN NEW ENGLAND, BMC'S EMERGENCY DEPARTMENT HAD MORE THAN 120,811 PATIENT VISITS IN FY2021. BMC SERVES THE URBAN COMMUNITY OF GREATER BOSTON. THE MAJORITY OF THE COMMUNITIES THAT BMC SERVES ARE LOCATED IN BOSTON CENSUS TRACTS THAT ARE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS/POPULATIONS. ALTHOUGH MASSACHUSETTS' UNIVERSAL CARE ENABLES INDIVIDUALS TO SEEK CARE AT ANY HOSPITAL, BMC REMAINS THE LARGEST SAFETY NET PROVIDER IN BOSTON AND NEW ENGLAND. AN ESTIMATED 18% OF BOSTON RESIDENTS LIVE BELOW THE FEDERAL POVERTY LEVEL. THE IMPLEMENTATION OF UNIVERSAL CARE DID NOT REDUCE THE REAL NUMBER OR PERCENT OF UNDERSERVED COMMUNITIES SERVED BY BMC.ACCORDING TO THE MASSACHUSETTS HEALTH INSURANCE SURVEY'S 2020 RESEARCH BRIEF, AN ESTIMATE OF 2.9% OF RESIDENTS WERE UNINSURED AND 92% OF MASSACHUSETTS RESIDENTS HAD COVERAGE DURING THE SURVEY OF WHICH 55.9% REPORTED EMPLOYER-SPONSORED INSURANCE (ESI) AND 43% REPORTED OTHER NON-ESI. STILL, INSURED RESIDENTS IN FAIR OR POOR HEALTH HAVE HIGH RATES OF AFFORDABILITY ISSUES WITH 25.5% REPORTING CHALLENGES PAYING THEIR MEDICAL BILLS. OF BMC'S PATIENTS IN 2021, APPROXIMATELY 2.25% WERE UNINSURED AND COVERAGE RATES FOR PRIMARY INSURANCE WERE APPROXIMATELY: 22.74 % MEDICARE; 43.58% MEDICAID; AND 30.00% PRIVATE OR ESI. PART I, LINE 5C:THE ORGANIZATION'S CHARITY CARE DID NOT EXCEED BUDGETED AMOUNTS. THE BUDGETED AMOUNTS ARE PREDICTED CHARITY CARE AMOUNTS. THE ORGANIZATION DID NOT HAVE ANY EXCESS FUNDS. PART I, LINE 7: FOR THE CALCULATION OF COSTS OF CHARITY CARE (LINE 7A) & MEDICAID COST (LINE 7B), AN OVERALL COST TO CHARGE RATIO WAS USED. A COST TO CHARGE RATIO IS DETERMINED BY DIVIDING THE TOTAL CHARGES FOR ALL SERVICES INTO THE TOTAL COST OF PROVIDING THE SERVICES. THE RATIO IS MULTIPLIED BY THE CHARGES FOR CHARITY CARE AND MEDICAID TO OBTAIN THEIR RESPECTIVE COSTS.FOR THE CALCULATION OF COMMUNITY HEALTH IMPROVEMENT SERVICES (LINE 7E) DISCRETE COSTING WAS USED. FOR THE CALCULATION OF HEALTH PROFESSIONS EDUCATION COST (LINE 7F) THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) COST ALLOCATION METHODOLOGY (CMS FORM 2552) WAS USED. CMS FORM 2552 IS A REQUIRED ANNUAL FILING TO THE FEDERAL GOVERNMENT.PART I, LINE 7, COLUMN F:THE AMOUNT OF BAD DEBT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE WAS $0.DURING FISCAL YEAR 2021, BMC RECOGNIZED NET FAVORABLE SETTLEMENTS FROM MEDICARE, MEDICAID, BMCHP, BLUE CROSS AND OTHER PAYORS RELATED TO PRIOR YEARS OF APPORXIMATELY $1,779,000. PART II, COMMUNITY BUILDING ACTIVITIES: BMC CONTRIBUTES TO THE COMMUNITY THROUGH ITS PAYMENT OF LINKAGE FEES TO THE CITY OF BOSTON. THOSE LINKAGE FEE FUNDS SUPPORT PROGRAMS FOR AFFORDABLE HOUSING AND NEIGHBORHOOD HEALTH CARE. BMC ALSO PROVIDES SUBSIDIES TO BOSTON HEALTHNET, WHICH SUPPORTS COMMUNITY-BASED SERVICES.PHYSICAL IMPROVEMENTS AND HOUSING:ACCORDING TO THE DEVELOPMENT IMPACT PROJECT AGREEMENT FOR THE MOAKLEY CENTER ADDITION AND INPATIENT BUILDING PHASE I TRANSPORT BRIDGE PROJECT BETWEEN BOSTON MEDICAL CENTER AND THE BOSTON REDEVELOPMENT AUTHORITY, DATED MAY 5, 2014, BMC AGREES TO PAY LINKAGE FEES OF $25,746, ENDING IN 2022 TO THE NEIGHBORHOOD JOBS TRUST.MATTAPAN COMMUNITY HEALTH CENTER, A COMMUNITY HEALTH CENTER AFFILIATED WITH BOSTON MEDICAL CENTER, RECEIVED A TOTAL OF $8,200,000 FROM BOSTON MEDICAL CENTER DURING 2009 AND 2010 IN THE FORM OF A LOAN THAT WAS ORIGINATED ON SEPTEMBER 30, 2010. EFFECTIVE JUNE 30, 2009, $1,000,000 OF THE 2009 PORTION OF THE MATTAPAN LOAN WAS FORGIVEN. COMMENCING NOVEMBER 1, 2011, BOSTON MEDICAL CENTER AGREED TO FORGIVE TEN PERCENT OF THE REMAINING PRINCIPAL AMOUNT ($7,200,000) OF THE NOTE EACH YEAR, WITH THE RESULT THAT THE ENTIRE LOAN OUTSTANDING COULD BE FORGIVEN IN TEN YEARS. IN FISCAL YEAR 2018, BOSTON MEDICAL CENTER INCURRED AN EXPENSE OF $2,220,000 TO FULLY RESERVE AGAINST THE NOTE RECEIVABLE AS IT WAS DETERMINED THAT NO FUTURE PAYMENTS WERE ANTICIPATED ON THE LOAN. THE LOAN AND RESPECTIVE RESERVE IS ACCOUNTED FOR ON THE BALANCE SHEET, ANNUALLY, EACH IS REDUCED BY THE FORGIVABLE AMOUNT.EAST BOSTON NEIGHBORHOOD HEALTH CENTER, A COMMUNITY HEALTH CENTERAFFILIATED WITH BOSTON MEDICAL CENTER, RECEIVED A TOTAL OF $1,000,000 FROM BOSTON MEDICAL CENTER DURING 2013 IN THE FORM OF A LOAN THAT WAS ORIGINATED EFFECTIVE JANUARY 15, 2013. COMMENCING SEPTEMBER 30, 2013, BOSTON MEDICAL CENTER AGREED TO FORGIVE TEN PERCENT OF THE ORIGINAL PRINCIPAL AMOUNT OF THE NOTE EACH YEAR, WITH THE RESULT THAT THE ENTIRE LOAN OUTSTANDING COULD BE FORGIVEN IN TEN YEARS. IN FISCAL YEAR 2018, BOSTON MEDICAL CENTER INCURRED AN EXPENSE OF $500,000 TO FULLY RESERVE AGAINST THE NOTE RECEIVABLE AS IT WAS DETERMINED THAT NO FUTURE PAYMENTS WERE ANTICIPATED ON THE LOAN. THE LOAN AND RESPECTIVE RESERVE IS ACCOUNTED FOR ON THE BALANCE SHEET, ANNUALLY, EACH IS REDUCED BY THE FORGIVABLE AMOUNT.SOUTH BOSTON COMMUNITY HEALTH CENTER, A COMMUNITY HEALTH CENTER AFFILIATED WITH BOSTON MEDICAL CENTER, RECEIVED A TOTAL OF $600,000 FROM BOSTON MEDICAL CENTER DURING 2016 IN THE FORM OF A LOAN THAT WAS ORIGINATED EFFECTIVE JANUARY 26, 2016. COMMENCING JANUARY 26, 2017, BOSTON MEDICAL CENTER AGREED TO FORGIVE TEN PERCENT OF THE ORIGINAL PRINCIPAL AMOUNT OF THE NOTE EACH YEAR, WITH THE RESULT THAT THE ENTIRE LOAN OUTSTANDING COULD BE FORGIVEN IN TEN YEARS. IN FISCAL YEAR 2018, BOSTON MEDICAL CENTER INCURRED AN EXPENSE OF $540,000 TO FULLY RESERVE AGAINST THE NOTE RECEIVABLE AS IT WAS DETERMINED THAT NO FUTURE PAYMENTS WERE ANTICIPATED ON THE LOAN. THE LOAN AND RESPECTIVE RESERVE IS ACCOUNTED FOR ON THE BALANCE SHEET, ANNUALLY, EACH IS REDUCED BY THE FORGIVABLE AMOUNT.SOUTH END COMMUNITY HEALTH CENTER, A COMMUNITY HEALTH CENTER AFFILIATED WITH BOSTON MEDICAL CENTER, RECEIVED A TOTAL OF $200,000 FROM BOSTON MEDICAL CENTER DURING 2017 IN THE FORM OF A LOAN THAT WAS ORIGINATED EFFECTIVE JUNE 16, 2017. COMMENCING JUNE 16, 2017, BOSTON MEDICAL CENTER AGREED TO FORGIVE ONE-THIRD OF THE ORIGINAL PRINCIPAL AMOUNT AND ACCRUED INTEREST OF THE NOTE EACH YEAR, WITH THE RESULT THAT THE ENTIRE LOAN OUTSTANDING COULD BE FORGIVEN IN THREE YEARS. IN FISCAL YEAR 2018, BOSTON MEDICAL CENTER INCURRED AN EXPENSE OF $200,000 TO FULLY RESERVE AGAINST THE NOTE RECEIVABLE AS IT WAS DETERMINED THAT NO FUTURE PAYMENTS WERE ANTICIPATED ON THE LOAN. THE LOAN AND RESPECTIVE RESERVE IS ACCOUNTED FOR ON THE BALANCE SHEET, ANNUALLY, EACH IS REDUCED BY THE FORGIVABLE AMOUNT.CAPITAL INVESTMENTS IN BOSTON HEALTHNET:WHILE THE NEED FOR COMMUNITY-BASED SERVICES CONTINUES TO GROW, IT HAS BECOME INCREASINGLY DIFFICULT FOR COMMUNITY HEALTH CENTERS TO MEET THE DEMAND. REIMBURSEMENT OFTEN DOES NOT COVER THE FULL COST OF CARING FOR THE COMPLEX NEEDS OF HEALTH CENTERS' DIVERSE PATIENT POPULATION. COMPOUNDING THIS PROBLEM, IN THE MID-LATE 1990S, MANY HEALTH CENTERS FOUND THEMSELVES OPERATING IN FACILITIES THAT WERE IN DESPERATE NEED OF RESTORATION OR EXPANSION. COSTLY INFORMATION TECHNOLOGY UPGRADES WERE ALSO REQUIRED TO ENHANCE MANAGEMENT EFFICIENCIES AND PATIENT CARE. IN RESPONSE TO THE HEALTH CENTERS' NEEDS, BMC PROVIDED APPROXIMATELY $15.8 MILLION IN OPERATING SUPPORT TO THE BOSTON HEALTHNET HEALTH CENTERS EACH YEAR. OTHER NET SUBSIDIES INCLUDE MOSTLY ECONOMIC DEVELOPMENT, COMMUNITY HEALTH IMPROVEMENT AND WORKFORCE DEVELOPMENT. PART III, LINE 2: SCHEDULE H, PART III, LINE 3 REPORTS BAD DEBT EXPENSE AT COST. PATIENT PAYMENTS ON ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AND RECORDED AS A BAD DEBT RECOVERY, REDUCING THE GROSS BAD DEBT WRITE-OFF. PART III, LINE 3: THE ORGANIZATION ESTIMATED $0 OF THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST) AS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY DUE TO THE MANNER IN WHICH THE DETAIL OF THE BAD DEBT EXPENSE IS PROCESSED IN ITS SYSTEM. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE IS ADDRESSED IN FOOTNOTES 1(R)(IV) AND 1(T) FOUND ON PAGES 15 AND 16 OF ITS MOST RECENT AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF $194,024,505 WERE CALCULATED USING THE CMS FORM 2552 METHODOLOGY OF DETERMINING MEDICARE COSTS. THIS USES THE STEP DOWN METHOD OF DETERMINING FULLY-ALLOCATED COSTS BY DISTINCT CLINICAL COST CENTERS AS DEFINED BY CMS. THESE FULLY-ALLOCATED COSTS ARE APPLIED AGAINST TOTAL CHARGES TO CALCULATE A RATIO OF COST TO CHARGES. THE RATIO OF COST TO CHARGES IS APPLIED TO MEDICARE CHARGES BY DISTINCT CLINICAL COST CENTERS TO DETERMINE THE MEDICARE COSTS. PART III, LINE 9B: POPULATIONS EXEMPT FROM COLLECTION ACTIVITIESTHE HOSPITAL WILL NOT REQUIRE PRE-ADMISSION OR PRE-TREATMENT DEPOSITS FROM INDIVIDUALS REQUIRING EMERGENCY SERVICES OR DETERMINED TO BE LOW-INCOME. THE FOLLOWING INDIVIDUALS AND PATIENT POPULATIONS ARE EXEMPT FROM ANY COLLECTION OR BILLING PROCEDURES BEYOND THE INITIAL BILL PURSUANT TO STATE REGULATIONS:A. PATIENTS WITH MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN OF THE DISABLED, CHILDREN, AND FULL HEALTH SAFETY NET OR PATIENTS WITH COUNTY MEDICAL SERVICES PROGRAM OR PARTIAL HEPATOSPLENOMEGALY BELOW THE PROGRAM-DEFINED FEDERAL POVERTY LEVEL OR MODIFIED ADJUSTED GROSS INCOME GUIDELINE, OR OTHERS DETERMINED TO BE LOW-INCOME PATIENTS ARE EXEMPT FROM COLLECTION SUBJECT TO:1. THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY LOW-INCOME PATIENT FOR THEIR REQUIRED CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY EACH SPECIFIC PROGRAM.2. THE HOSPITAL MAY SEEK COLLECTION TO ALLOW A PATIENT TO MEET THE COMMONWEALTH ONE-TIME DEDUCTIBLE.3. THE HOSPITAL MAY ALSO INITIATE BILLING OR COLLECTION FOR A LOW-INCOME PATIENT WHO ALLEGES THAT HE OR SHE IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COSTS OF THE HOSPITAL SERVICES, BUT WHO FAILS TO PROVIDE PROOF OF HIS OR HER PARTICIPATION AND WHOSE INSURANCE CANNOT BE VERIFIED IN THE HOSPITAL ELIGIBILITY SYSTEM. UPON RECEIPT OF SATISFACTORY PROOF THAT A PATIENT IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM, INCLUDING RECEIPT OR VERIFICATION FROM THE INSURANCE CARRIER, THE HOSPITAL SHALL CEASE ITS BILLING OR COLLECTION ACTIVITIES.4. THE HOSPITAL MAY CONTINUE COLLECTION ACTION ON ANY LOW-INCOME PATIENT FOR SERVICES RENDERED PRIOR TO THE LOW-INCOME PATIENT DETERMINATION, PROVIDED THAT THE CURRENT LOW-INCOME PATIENT STATUS HAS BEEN TERMINATED OR EXPIRED. HOWEVER, ONCE A PATIENT IS DETERMINED ELIGIBLE AND ENROLLED IN THE HEALTH SAFETY NET, MASSHEALTH, OR CERTAIN FINANCIAL ASSISTANCE PROGRAMS, THE HOSPITAL WILL CEASE COLLECTION ACTIVITY FOR SERVICES PROVIDED PRIOR TO THE BEGINNING OF THE PATIENT'S ELIGIBILITY.5. THE HOSPITAL MAY SEEK COLLECTION ACTION AGAINST ANY OF THE PATIENTS PARTICIPATING IN THE PROGRAMS LISTED ABOVE FOR NON-COVERED SERVICES THAT THE PATIENT HAS AGREED TO BE RESPONSIBLE FOR, PROVIDED THAT THE HOSPITAL OBTAINED THE PATIENT'S PRIOR WRITTEN CONSENT TO BE BILLED FOR THE SERVICE. PART VI, LINE 2: NEEDS ASSESSMENTIN 2019, BMC CONDUCTED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN COLLABORATION WITH COMMUNITY ORGANIZATIONS, BOSTON RESIDENTS, HEALTH CENTERS, HOSPITALS AND THE BOSTON PUBLIC HEALTH COMMISSION. THE BOSTON COMMUNITY HEALTH NEEDS ASSESSMENT-COMMUNITY HEALTH IMPROVEMENT PLAN COLLABORATIVE (THE CHNA-CHIP COLLABORATIVE) FORMED TO UNDERTAKE THE FIRST BOSTON-WIDE CHNA AND CHIP. FOCUSING ON THE SOCIAL DETERMINANTS OF HEALTH AND USING A HEALTH EQUITY LENS, THE COLLABORATIVE EMPLOYED A PARTICIPATORY APPROACH THAT ENGAGED THE COMMUNITY IN EVERY STEP OF THE CHNA. THIS CHNA FOCUSES ON THE SOCIAL DETERMINANTS OF HEALTH USING A HEALTH EQUITY LENS. THE INFLUENCES OF RACE, ETHNICITY, INCOME, AND GEOGRAPHY ON HEALTH PATTERNS ARE OFTEN INTERTWINED. IN THE UNITED STATES, SOCIAL, ECONOMIC, AND POLITICAL PROCESSES ASCRIBE SOCIAL STATUS BASED ON RACE AND ETHNICITY, WHICH MAY INFLUENCE OPPORTUNITIES FOR EDUCATIONAL AND OCCUPATIONAL ADVANCEMENT AND HOUSING OPTIONS, TWO FACTORS THAT PROFOUNDLY AFFECT HEALTH. INSTITUTIONAL RACISM, ECONOMIC INEQUALITY, DISCRIMINATORY POLICIES, AND HISTORICAL OPPRESSION OF SPECIFIC GROUPS ARE MANY OF THE ROOT FACTORS THAT DRIVE THE HEALTH INEQUITIES WE SEE IN THE U.S. TODAY. THE CHNA USED A PARTICIPATORY, COLLABORATIVE APPROACH THAT ENGAGED THE COMMUNITY THROUGH DIFFERENT AVENUES. OVER 100 COLLABORATIVE MEMBERS REPRESENTING HEALTH CARE, PUBLIC HEALTH, EDUCATION, COMMUNITY DEVELOPMENT, SOCIAL SERVICE, AND COMMUNITY-BASED ORGANIZATIONS PROVIDED INPUT THROUGHOUT THE CHNA PROCESS AND PLAYED AN INTEGRAL ROLE IN DATA COLLECTION EFFORTS. DATA COLLECTION EFFORTS WERE FOCUSED ON ENGAGING HARD-TO-REACH POPULATIONS WHO ARE NOT TYPICALLY ENGAGED IN THESE PROCESSES OR REPRESENTED IN THE SECONDARY DATA. EXISTING DATA WERE DRAWN FROM NATIONAL, STATE, AND CITY SOURCES, SUCH AS THE U.S. CENSUS, MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, AND BOSTON PUBLIC HEALTH COMMISSION, INCLUDING DATASETS SUCH AS THE BOSTON BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BBRFSS). FOR NEW DATA COLLECTION, OVER 91 ORGANIZATIONS AND 2,500 INDIVIDUALS WERE ENGAGED IN A CHNA COMMUNITY SURVEY (N=2,404) ADMINISTERED ONLINE AND IN-PERSON IN SEVEN LANGUAGES, 13 FOCUS GROUPS WITH COMMUNITY RESIDENTS (N=104), AND 45 INTERVIEWS WITH ORGANIZATIONAL AND COMMUNITY LEADERS TO GAUGE THEIR PERCEPTIONS OF THE COMMUNITY'S NEEDS, STRENGTHS, AND OPPORTUNITIES. LIKE ALL DATA GATHERING EFFORTS, THERE ARE LIMITATIONS TO THE CHNA DATA. SECONDARY DATA HAVE A TIME LAG, AND VARIOUS SOURCES MAY USE DIFFERENT DEFINITIONS FOR SIMILAR TOPICS. DATA MAY BE AGGREGATED ACROSS TIME, GEOGRAPHIES, OR POPULATION GROUPS TO PROVIDE LARGE ENOUGH SAMPLE SIZES. MORE GRANULAR ANALYSIS FOR SPECIFIC NEIGHBORHOODS OR ETHNIC GROUPS WITHIN LARGER RACIAL/ETHNIC CATEGORIES IS NOT POSSIBLE. PRIMARY DATA SUCH AS THE SURVEY AND FOCUS GROUPS USE A CONVENIENCE SAMPLE WHICH MAY NOT BE REPRESENTATIVE OF THE LARGER POPULATION.THIRTEEN FOCUS GROUPS WERE CONDUCTED WITH SPECIFIC POPULATIONS OF INTEREST: 12 FOCUS GROUPS CONDUCTED SPECIFICALLY FOR THE COLLABORATIVE CHNA AND ONE ADDITIONAL FOCUS GROUP CONDUCTED BY WORK GROUP MEMBERS WHO SUBMITTED NOTES FOR THE CHNA. FOCUS GROUPS WERE 90-MINUTE SEMI-STRUCTURED CONVERSATIONS WITH APPROXIMATELY 8-12 PARTICIPANTS PER GROUP AND AIMED TO DELVE DEEPLY INTO COMMUNITY'S NEEDS, STRENGTHS, AND OPPORTUNITIES FOR THE FUTURE. FOCUS GROUPS WERE CONDUCTED WITH THE FOLLOWING POPULATION GROUPS, INCLUDING RESIDENTS OF SPECIFIC NEIGHBORHOODS: HISTORICALLY UNDERPAID FEMALE WORKERS (E.G. HOUSEKEEPERS, CHILD CARE WORKERS, HOTEL SERVICE WORKERS, ETC.); MALE LOW-WAGE WORKERS (E.G. JANITORIAL STAFF, CONSTRUCTION, ETC.); SENIORS (AGES 65+) WITH COMPLEX, CHALLENGING ISSUES (E.G. HOMEBOUND, MEDICAL COMPLICATIONS); RESIDENTS WHO ARE HOUSING INSECURE (NO PERMANENT ADDRESS OR CLOSE TO EVICTION); LATINO RESIDENTS LIVING IN EAST BOSTON (IN SPANISH); LGBTQ+ YOUTH AND YOUNG ADULTS AT RISK OF BEING HOMELESS; IMMIGRANT PARENTS OF SCHOOL AGE CHILDREN (5-18 YEARS); SURVIVORS OF VIOLENCE; MOTHERS WHO HAVE BEEN IMPACTED BY VIOLENCE; PARENTS LIVING IN PUBLIC HOUSING IN DORCHESTER; CHINESE RESIDENTS LIVING IN CHINATOWN (IN CHINESE); HAITIAN RESIDENTS LIVING IN MATTAPAN (IN HAITIAN CREOLE); AND RESIDENTS IN ACTIVE SUBSTANCE USE RECOVERY.A TOTAL OF 104 COMMUNITY RESIDENTS PARTICIPATED IN FOCUS GROUPS, REPRESENTING 13 NEIGHBORHOODS ACROSS THE CITY. NEARLY HALF OF FOCUS GROUP PARTICIPANTS IDENTIFIED AS BLACK OR AFRICAN AMERICAN (45%), A THIRD OF PARTICIPANTS IDENTIFIED AS HISPANIC OR LATINO (34%), AND 10% IDENTIFIED AS WHITE. THE MAJORITY OF PARTICIPANTS IDENTIFIED AS FEMALE (57%), 36% IDENTIFIED AS MALE, AND 7% IDENTIFIED AS TRANSGENDER OR GENDERQUEER. ADDITIONAL DATA ON FOCUS GROUP PARTICIPANT CHARACTERISTICS CAN BE FOUND IN APPENDIX F. FIFTEEN COMMUNITY AND SOCIAL SERVICE ORGANIZATIONS LOCATED THROUGHOUT BOSTON ASSISTED WITH RECRUITING PARTICIPANTS AND/OR HOSTING FOCUS GROUPS.A TOTAL OF 45 KEY INFORMANT INTERVIEWS WERE COMPLETED, SIX OF WHICH WERE ADDITIONAL INTERVIEWS SUBMITTED BY WORK GROUP VOLUNTEERS. INTERVIEWS WERE 45-60-MINUTE SEMI-STRUCTURED DISCUSSIONS THAT ENGAGED INSTITUTIONAL, ORGANIZATIONAL, AND COMMUNITY LEADERS AND FRONT-LINE STAFF ACROSS SECTORS. DISCUSSIONS EXPLORED INTERVIEWEES' EXPERIENCES OF ADDRESSING COMMUNITY NEEDS AND OPPORTUNITIES FOR FUTURE ALIGNMENT, COORDINATION, AND EXPANSION OF SERVICES, INITIATIVES, AND POLICIES. SECTORS REPRESENTED IN THESE INTERVIEWS INCLUDED: PUBLIC HEALTH, HEALTH CARE, HOUSING AND HOMELESSNESS, TRANSPORTATION, COMMUNITY DEVELOPMENT, FAITH, EDUCATION, PUBLIC SAFETY, ENVIRONMENTAL JUSTICE, GOVERNMENT, WORKFORCE DEVELOPMENT, SOCIAL SERVICES, FOOD INSECURITY, BUSINESS ORGANIZATIONAL STAFF THAT WORK WITH SPECIFIC POPULATION SUCH AS YOUTH, SENIORS, DISABLED, LGBTQ+, AND IMMIGRANTS. KEY FINDINGS THAT EMERGED FROM THE CHNA INCLUDED HEALTH CARE ACCESS AND UTILIZATION, CHRONIC DISEASES AND RISK FACTORS, MENTAL HEALTH AND SUBSTANCE USE DISORDERS, VIOLENCE, HOUSING AFFORDABILITY, AND ENVIRONMENTAL HEALTH. UNWAVERING IN OUR COMMITMENT TO ADDRESS THE HEALTH NEEDS OF OUR COMMUNITY, BMC PROVIDES A WIDE RANGE OF PROGRAMS BEYOND THE TRADITIONAL MEDICAL MODEL TO ADDRESS THESE SOCIAL DETERMINANTS OF HEALTH. CORE TO FULFILLING OUR PUBLIC HEALTH MISSION AND CONSISTENT WITH THE CHNA FINDINGS, THE GOALS OF OUR COMMUNITY BENEFITS PROGRAM ARE TO IMPROVE ACCESS TO HEALTH SERVICES AND IMPROVE HEALTH OUTCOMES FOR UNDER-RESOURCED POPULATIONS IN OUR COMMUNITY. PART VI, LINE 3: THE HOSPITAL POSTS NOTICES OF AVAILABILITY OF FINANCIAL ASSISTANCE IN: I. INPATIENT, CLINIC, AND EMERGENCY DEPARTMENT AND WAITING AREAS; II. PATIENT FINANCIAL COUNSELOR AREAS; III. CENTRAL ADMISSION/REGISTRATION AREAS; IV. BUSINESS OFFICE AREAS THAT ARE OPEN TO PATIENTS. POSTED NOTICES ARE CLEARLY VISIBLE AND LEGIBLE TO PATIENTS VISITING THESE AREAS. THE HOSPITAL ALSO INCLUDES A NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IN ALL INITIAL BILLS. WHEN THE PATIENT CONTACTS THE HOSPITAL, THE PATIENT FINANCIAL SERVICES STAFF NOTIFIES THE PATIENT IF THEY QUALIFY FOR A PAYMENT PLAN. A PATIENT WHO IS ENROLLED IN A PUBLIC FINANCIAL ASSISTANCE PROGRAM (FOR EXAMPLE, MASSHEALTH, HEALTH SAFETY NET, OR FOR MEDICAL HARDSHIP) MAY QUALIFY FOR CERTAIN PLANS. PATIENTS MAY ALSO QUALIFY FOR ADDITIONAL ASSISTANCE BASED ON THE HOSPITAL'S OWN INTERNAL CRITERIA FOR FINANCIAL ASSISTANCE. FOR CASES WHERE THE HOSPITAL IS USING THE VIRTUAL GATEWAY APPLICATION, THE HOSPITAL ASSISTS THE PATIENT IN COMPLETING THE APPLICATION FOR MASSHEALTH CONNECTORCARE, 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 ARE TRANSLATED INTO LANGUAGES OTHER THAN ENGLISH IF A LANGUAGE IS SPOKEN BY 10% OR MORE OF THE POPULATION RESIDING IN THE HOSPITAL SERVICE AREA. CURRENTLY, THE HOSPITAL TRANSLATES THE NOTICES INTO ENGLISH, PORTUGUESE, SPANISH, AND HAITIAN CREOLE. PART VI, LINE 4: COMMUNITY INFORMATIONPLEASE SEE INTRODUCTION. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHHEALTH CARE ACCESS BIRTH SISTERS: BIRTH SISTERS ARE COMMUNITY MEMBERS TRAINED BY BMC TO PROVIDE SUPPORT TO PREGNANT BMC PATIENTS FROM THEIR OWN COMMUNITIES DURING PREGNANCY, CHILDBIRTH AND EARLY PARENTHOOD. BIRTH SISTERS OFFER CHILDBIRTH AND PARENTING EDUCATION, CONNECT THEIR CLIENTS TO COMMUNITY AND HOSPITAL-BASED RESOURCES, PROVIDE CONTINUOUS LABOR SUPPORT, AND SUPPORT THEIR CLIENTS IN THE EARLY POSTPARTUM PERIOD. THE BIRTH SISTERS PROGRAM HAS BEEN LINKED TO SIGNIFICANTLY HIGHER BODY/BREASTFEEDING RATES AND FEWER CESAREAN BIRTHS. THE PANDEMIC HAS REQUIRED SHIFTS IN SERVICE PROVISION, MOST NOTABLY, THROUGH THE UTILIZATION OF VIRTUAL SUPPORT STRATEGIES TO BUILD CONNECTION BEFORE AND AFTER BIRTH. DURING THE 2021 FISCAL YEAR, BIRTH SISTERS PROVIDED SUPPORT FOR 254 PATIENTS.CATALYST CLINIC: IN MAY 2016, BOSTON MEDICAL CENTER LAUNCHED THE CATALYST CLINIC (CENTER FOR ADDICTION TREATMENT FOR ADOLESCENT/YOUNG ADULTS WHO USE SUBSTANCES), A PROGRAM DESIGNED TO TREAT YOUNG PEOPLE AGED 25 AND UNDER WHO ARE STRUGGLING WITH SUBSTANCE USE, OR WHO HAVE EXPERIMENTED WITH DRUGS AND ALCOHOL AND MAY BE AT RISK FOR DEVELOPING AN ADDICTION. THE CATALYST CLINIC TEAM WORKS TO PROVIDE INTERDISCIPLINARY, TEAM-BASED CARE THAT INCLUDES PHYSICIANS, A NURSE, TWO SOCIAL WORKERS, A RECOVERY SUPPORT NAVIGATOR AND A PROGRAM MANAGER. THE CATALYST CLINIC TEAM WORKS TOGETHER TO OFFER ASSESSMENT, DIAGNOSIS, AND TREATMENT OF VARIOUS SUBSTANCE USE DISORDERS, AS WELL AS FACILITATES THE TRANSITION FROM ADOLESCENT TO ADULT CARE WHEN APPROPRIATE. IN FISCAL YEAR 2021, THE CATALYST CLINIC RECEIVED APPROXIMATELY 88 REFERRALS TO THE CLINIC; 718 REFERRALS HAVE BEEN RECEIVED SINCE THE PROGRAM'S INCEPTION. CHILD LIFE PROGRAM (CLP): THE CHILD LIFE PROGRAM ASSISTS CHILDREN AND FAMILIES IN MANAGING THE STRESSES ASSOCIATED WITH HOSPITALIZATION AND ILLNESS. ALL CLP TEAM MEMBERS ARE TRAINED DEVELOPMENTAL SPECIALISTS, AIMING TO SUPPORT CHILDREN AND FAMILIES THROUGH THE HOSPITAL EXPERIENCE. THE GOALS OF THE CLP ARE TO: HELP CHILDREN EXPRESS THEIR FEELINGS THROUGH PLAY IN A SAFE AND SUPPORTIVE ENVIRONMENT; ADVOCATE FOR CHILDREN, OFFERING SUPPORT TO EFFECTIVELY WORK THROUGH PAIN MANAGEMENT; OFFER CHILDREN DEVELOPMENTALLY APPROPRIATE CHOICES THAT INCREASE FEELINGS OF INDEPENDENCE, SELF-ESTEEM, AND TRUST; AND ASSIST WITH IMPLEMENTATION OF COPING TECHNIQUES DURING STRESSFUL SITUATIONS. THE CLP CURRENTLY COVERS THE AREAS OF INPATIENT PEDIATRICS AND THE PEDIATRIC INTENSIVE CARE UNIT, PEDIATRIC AMBULATORY CARE CLINIC INCLUDING SPECIALTY CLINICS, PEDIATRIC EMERGENCY DEPARTMENT, PEDIATRIC OTOLARYNGOLOGY CLINIC AND OPERATING AREAS FOR PEDIATRIC SURGERY. THE TEAM REMAINS A CONSULT SERVICE FOR PEDIATRIC CASES IN THE NICU, RADIOLOGY, TRAUMA SERVICES, AND OBYGN AS WELL AS FOR BEREAVEMENT SUPPORT WORKING WITH CHILDREN OF ADULT FAMILIES.CHILD PASSENGER SAFETY PROGRAM: BMC RECOGNIZES AND USES THE CENTER FOR DISEASE CONTROL AND PREVENTION'S CHILD PASSENGER SAFETY RECOMMENDATIONS. MASSACHUSETTS STATE LAW REQUIRES THAT ALL CHILDREN UNDER AGE 8 AND LESS THAN 57 INCHES TALL BE PROPERLY FASTENED AND SECURED IN A FEDERALLY APPROVED CAR SEAT OR BOOSTER SEAT. BMC REQUIRES ALL NEWBORNS LEAVING THE HOSPITAL HAVE AN APPROPRIATE CAR SEAT PRIOR TO DISCHARGE HOME. THE DIVISION OF TRAUMA PARTNERS WITH THE PUBLIC SAFETY OFFICE TO PROVIDE CHILD SAFETY SEAT INSTALLATION AND INSPECTION FREE OF CHARGE. PUBLIC SAFETY OFFICERS ARE TRAINED CHILD PASSENGER SAFETY TECHNICIANS (CPSTS) WHO HAVE BEEN CERTIFIED IN CORRECT INSTALLATION OF CHILD SAFETY SEATS AND ARE RE-CERTIFIED EVERY 2 YEARS. BMC'S CPSTS ARE RESPONSIBLE FOR AND CAPABLE OF: SECURING CHILDREN IN APPROPRIATE CHILD RESTRAINT SYSTEMS; INSTALLING CHILD RESTRAINT SYSTEMS IN MULTIPLE TYPES OF VEHICLES; EDUCATING OTHERS ON HOW TO CORRECTLY INSTALL CHILD RESTRAINT SYSTEMS IN VEHICLES AND HOW TO PROPERLY RESTRAIN CHILDREN IN MOTOR VEHICLES; AND ORGANIZING, COORDINATING OR ASSISTING AT INSPECTION STATIONS AND CHECKUP EVENTS. IN FY21, THE CHILD PASSENGER SAFETY PROGRAM INSTALLED OR PROVIDED EDUCATION ON APPROXIMATELY 100 CAR SEATS.CLOTHING BANK: BMC'S SOCIAL WORKERS ACCESS THE CLOTHING BANK IN REAL TIME WHEN A PROVIDER CONTACTS SOCIAL WORK ABOUT A BASIC CLOTHING NEED (SWEATPANTS, SHIRTS, UNDERWEAR, SOCKS, SHOES, AND WINTER COATS) FOR A LOW-INCOME PATIENT.THE CENTER FOR THE URBAN CHILD AND HEALTHY FAMILY (THE CENTER): THE CENTER, LAUNCHED IN 2016, IS CATALYZING BMC'S VISION OF MAKING BOSTON ONE OF THE HEALTHIEST CITIES IN THE WORLD BY ENSURING EVERY CHILD HAS AN EQUAL OPPORTUNITY TO BE HEALTHY AND ACHIEVE THEIR FULL POTENTIAL. AS SUCH, THE CENTER IS CREATING A SYSTEM OF PEDIATRIC HEALTH CARE THAT ACTIVELY PROMOTES HEALTH EQUITY AND ERADICATES DISPARITIES. AS AN INNOVATION HUB WITHIN THE DEPARTMENT OF PEDIATRICS, THE CENTER CREATES AND TESTS INNOVATIVE HEALTH CARE DELIVERY MODELS, WORKING IN PARTNERSHIP WITH FAMILIES, COMMUNITIES AND OTHER CHILD- AND FAMILY-SERVING SECTORS. THE CENTER HAS SET A GOAL THAT BY 2028, ALL CHILDREN CARED FOR BY BMC PEDIATRICS WILL BE HEALTHY AND READY TO LEARN WITH ADEQUATE SUPPORTS TO THRIVE BY AGE FIVE. TO ACHIEVE THIS GOAL, THE CENTER CO-DEVELOPED A NEW MODEL OF PEDIATRIC PRIMARY CARE, THE PEDIATRIC PRACTICE OF THE FUTURE, WITH FAMILIES AND PEDIATRIC PROVIDERS. THIS MODEL SUPPORTS WHOLE FAMILY DEVELOPMENT WITH ATTENTION TO FACTORS INFLUENCING WELL-BEING AND BRINGING TOGETHER CARE IN A SYSTEMATIC, EQUITABLE WAY TO PROMOTE WELLNESS THROUGHOUT THE LIFE COURSE. THE CENTER IS PILOTING THE NEW MODEL AIMED AT FAMILIES WITH NEWBORNS, AND IS COLLECTING DATA TO UNDERSTAND ITS IMPACT. THE PILOT LAUNCHED IN JANUARY 2020 AND HAS SINCE ENROLLED 100 FAMILIES. ULTIMATELY, A FINANCIALLY SUSTAINABLE MODEL WILL BE SCALED TO THE LARGER PRIMARY CARE PRACTICE. IN ADDITION, THE CENTER IS PARTNERING WITH BMC HEALTHNET PLAN, BMC'S HEALTH INSURANCE PROGRAM, TO TEST ALTERNATIVE PAYMENT MODELS TO ULTIMATELY REDEFINE VALUE IN PEDIATRIC CARE.CRIBS FOR KIDS: BMC PARTNERS WITH THE NATIONAL CRIBS FOR KIDS PROGRAM, WHERE ITS MISSION IS TO PROVIDE CRIBS TO BABIES WHOSE MOTHERS COULD NOT AFFORD THEM OTHERWISE AND EDUCATE MOTHERS ABOUT THE DANGERS OF UNSAFE SLEEP ENVIRONMENTS. BMC PROVIDES FREE PACK-AND-PLAYS AND CRIBS TO FAMILIES WHO DO NOT OTHERWISE HAVE A SAFE SPACE FOR THEIR BABY TO SLEEP. THIS PROGRAM IS FUNDED THROUGH THE INJURY PREVENTION TRAUMA DEVELOPMENT FUND. IN FY21, THE CRIBS FOR KIDS PROGRAM AT BMC PROVIDED PACK AND PLAYS TO APPROXIMATELY 50 FAMILIES.ELDERS LIVING AT HOME PROGRAM (ELAHP): THE GOAL OF ELAHP IS TO HELP OLDER ADULTS WHO ARE HOMELESS OR AT RISK FOR HOMELESSNESS SECURE AND MAINTAIN A PERMANENT RESIDENCE AND LIVE AS INDEPENDENTLY AS POSSIBLE. ELAHP SERVED 383 CLIENTS DURING FISCAL YEAR 2021. OF THESE CLIENTS, 189 RECEIVED HOUSING SEARCH AND PLACEMENT SERVICES; 169 RECEIVED HOUSING STABILIZATION SERVICES; AND 70 RECEIVED HOMELESSNESS PREVENTION ASSISTANCE. OVER THE LAST 12 YEARS, THE SUCCESS RATE OF ELAHP'S STABILIZATION SERVICES IS 98%. AN ADDITIONAL 157 CLIENTS WERE SERVED THROUGH THE LIVING WELL AT HOME PROJECT, A COMMUNITY-BASED COMPLEX CARE MANAGEMENT PILOT DESIGNED TO IMPROVE HEALTH OUTCOMES FOR FRAIL RESIDENTS OF AN ELDERLY/DISABLED HOUSING COMPLEX IN ROXBURY AND ANOTHER IN CAMBRIDGE. SOME CLIENTS RECEIVED MORE THAN ONE TYPE OF SERVICE. ALL CLIENTS SUFFER FROM AT LEAST ONE CHRONIC ILLNESS, AND 96% SUFFER FROM TWO OR MORE DISABLING MEDICAL CONDITIONS.GROW CLINIC: THE GROW CLINIC WAS FOUNDED IN 1984 WITHIN BMC'S DEPARTMENT OF PEDIATRICS. THE PRIMARY GOAL OF THE GROW CLINIC IS TO PROVIDE COMPREHENSIVE MULTIDISCIPLINARY MEDICAL, NUTRITIONAL, SOCIAL SERVICES AND DEVELOPMENTAL SUPPORT TO CHILDREN FROM THE GREATER BOSTON AREA DIAGNOSED WITH FAILURE TO THRIVE (FTT). CHILDREN WITH FTT HAVE SIGNIFICANT DIFFICULTY GROWING BECAUSE OF MALNUTRITION ASSOCIATED WITH ILLNESS, POVERTY, AND OTHER FAMILY STRESSORS. THE EFFECTS OF FTT INCLUDE SHORTENED ATTENTION SPANS, EMOTIONAL PROBLEMS, DELAYED COGNITIVE DEVELOPMENT, LASTING GROWTH FAILURE, AND FREQUENT SERIOUS ILLNESS, WHICH CAN RESULT IN HOSPITALIZATION. THE GROW CLINIC PROVIDES MEDICAL TREATMENT, NUTRITIONAL ASSESSMENT, HOME HEALTH EDUCATION, SOCIAL SERVICE ADVOCACY, DEVELOPMENTAL REFERRALS, AND ACCESS TO BMC'S THERAPEUTIC FOOD PANTRY, NUTRITIONAL SUPPLEMENTS, CHILDREN'S CLOTHES, DIAPERS, BOOKS AND EDUCATIONAL TOYS, AMONG OTHER SERVICES. APPROXIMATELY 200 CHILDREN ARE TREATED ANNUALLY BY THE GROW CLINIC. IN FY2021, THERE WERE 93 NEW PATIENTS. FORTY-EIGHT PERCENT (48%) OF CLINIC PATIENTS WERE 12 MONTHS OF AGE OR YOUNGER; THE AVERAGE AGE AT REFERRAL WAS 24 MONTHS; AND THE AVERAGE LENGTH OF TREATMENT WAS 28 MONTHS. THERE WERE 1,041 TOTAL CLINIC VISITS DURING THIS PERIOD. APPROXIMATELY 15% OF PATIENT FAMILIES WERE HOMELESS AND LIVING IN SHELTERS. CLINICIANS MADE 326 HOME VISITS IN FY21. ALL PATIENTS DEMONSTRATED IMPROVED GROWTH, AND 80% DEMONSTRATED SIGNIFICANT WEIGHT IMPROVEMENT. PART VI, LINE 6: BMC HEALTHNET PLANBMC HEALTHNET PLAN IS A NON-PROFIT HEALTH PLAN THAT PROVIDES HEALTH INSURANCE COVERAGE TO MASSACHUSETTS RESIDENTS, INCLUDING LOW INCOME, UNDERSERVED, DISABLED AND ELDERLY POPULATIONS. IT WAS ESTABLISHED IN 1997 BY BMC AND HAS MORE THAN 20 YEARS OF EXPERIENCE DELIVERING ACCESSIBLE CARE TO COMPLEX POPULATIONS. BMC HEALTHNET PLAN SERVES OVER 313,777 MEMBERS ACROSS MASSACHUSETTS. IT ALSO PROVIDES HEALTH COVERAGE TO MEDICAID MEMBERS IN NEW HAMPSHIRE, WHERE IT OPERATES AS WELL SENSE HEALTH PLAN. BOSTON HEALTHNET (BHN) THE BOSTON HEALTHNET (BHN) HEALTH CENTER NETWORK REPRESENTS A FUNDAMENTAL PARTNERSHIP BETWEEN BOSTON MEDICAL CENTER AND THE COMMUNITY HEALTH CENTERS (CHCS) TO FULFILL A SHARED COMMITMENT TO THE MOST VULNERABLE AND DIVERSE PATIENTS SERVED. ESTABLISHED IN 1995, BHN IS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM COMPRISED OF BMC, THE BOSTON UNIVERSITY SCHOOL OF MEDICINE AND 12 COMMUNITY HEALTH CENTERS. THE PARTNERSHIP HAS BECOME A NATIONAL MODEL FOR COMMUNITY HEALTH CARE NETWORKS, ESPECIALLY THOSE SERVING URBAN, UNDERSERVED AND WORKING CLASS POPULATIONS BHN'S COMMUNITY HEALTH CENTER PARTNERS PROVIDE OUTREACH, PREVENTION, PRIMARY CARE, SPECIALTY CARE AND DENTAL SERVICES AT SITES LOCATED THROUGHOUT BOSTON'S COMMUNITIES AS WELL AS ATTLEBORO, QUINCY, TAUNTON, AND WINTHROP, THEREBY EXTENDING BMC'S PRESENCE INTO THESE NEIGHBORHOODS. PHYSICIANS WORKING IN THE HEALTH CENTERS ARE CREDENTIALED MEMBERS OF BMC'S MEDICAL STAFF. HEALTH CENTER PATIENTS HAVE ACCESS TO HIGHLY TRAINED SPECIALISTS AND CUTTING-EDGE TECHNOLOGY AT BMC WHILE PROVIDING INDIVIDUALIZED AND CULTURALLY SENSITIVE CARE IN THEIR OWN NEIGHBORHOODS. THE ACCOMPLISHMENTS OF THE NETWORK ARE EVIDENCED BY: NOTABLE SHARE OF BMC VOLUME ORIGINATING FROM THE HEALTH CENTERS; COLLABORATIVE DEVELOPMENT OF QUALITY IMPROVEMENT INITIATIVES, CLINICAL PROTOCOLS, AND STANDARDS OF PRACTICE; DEGREE OF FACILITATION AND COORDINATION OF HEALTH INFORMATION TECHNOLOGY TRAINING, COMMUNICATION AND OPTIMIZATION ACROSS THE HEALTH CENTER NETWORK WITH NINE OF THE BHN HEALTH CENTERS ON THE SAME ELECTRONIC HEALTH RECORD.IN ADDITION, THE COMMUNITY HEALTH CENTER PARTNERSHIP EXTENDS INTO CLINICIAN TRAINING AND JOINT HIRING WITH NEARLY 240 BU SCHOOL OF MEDICINE STUDENTS USING HEALTH CENTER EDUCATION PROGRAMS (PRE-COVID), 78 RESIDENTS HAVING LONGITUDINAL AMBULATORY EXPERIENCE AT CHCS IN 2022 AND 38 PROVIDERS JOINTLY HIRED BY HEALTH CENTERS AND BU FAMILY MEDICINE ACROSS SIX HEALTH CENTERS.OTHER AREAS DEMONSTRATING THE LONGSTANDING AND DEEP PARTNERSHIP INCLUDE:GOVERNANCE: COMMUNITY HEALTH CENTERS ARE NOTABLY INVOLVED IN BMC GOVERNANCE WITH REPRESENTATION ON BMC'S BOARD OF TRUSTEES, TWO COMMITTEES OF THE BMC BOARD OF TRUSTEES AND THREE HOSPITAL COMMITTEES.RESEARCH: FOR OVER 15 YEARS, A RESEARCH COLLABORATIVE COMPRISED OF BHN, COMMUNITY HEALTH CENTERS AND BOSTON UNIVERSITY CLINICAL TRANSLATIONAL SCIENCE INSTITUTE HAS EXISTED IN ORDER TO ADVANCE HEALTH RELATED RESEARCH IN THE COMMUNITY, INCLUDE THE COMMUNITY VOICE IN RESEARCH PROJECTS AND FACILITATE CLINICIAN ENGAGEMENT IN THE RESEARCH PROCESS.ACO PARTICIPATION: CURRENTLY, 8 BOSTON HEALTHNET COMMUNITY HEALTH CENTERS PARTICIPATE IN BACO BACO'S PARTICIPANTS ARE COLLECTIVELY ACCOUNTABLE FOR THE QUALITY AND COST OF THE CARE THEY PROVIDE. BACO'S MOST SIGNIFICANT RISK ARRANGEMENT IS WITH THE MASSHEALTH ACO PROGRAM. WITH ITS PARTICIPATION IN THE MASSHEALTH ACO PROGRAM, BACO BECAME CLINICALLY AND FINANCIALLY INTEGRATED WITH BMC HEALTH SYSTEM, WHICH INCLUDES BMC, BOSTON UNIVERSITY MEDICAL GROUP, AND BMC HEALTHNET PLAN.COVID-19 INITIATIVES: OVER THE LAST YEAR, BHN, BMC AND THE HEALTH CENTERS CONTINUED TO COLLABORATE ON: 1. EFFORTS TO MITIGATE THE SPREAD THROUGH VACCINE SUPPLY DISTRIBUTION, WORKFLOW DEVELOPMENT AND STAFFING OF VACCINE CLINICS 2. SURGE PLANNING AND 'RETURN' TO PRIMARY CARE, ESPECIALLY FOR PATIENTS WITH CHRONIC CONDITIONS WHOSE CARE AND TREATMENT HAD BEEN DEFERRED DURING THE PANDEMIC SCHEDULE H, PART VI, LINE 5 (CONTINUATION): IMMIGRANT AND REFUGEE HEALTH CENTER (IHRC): THE IHRC CONNECTS ALL OF BMC'S EXISTING PROGRAMS AND EXPERTISE IN IMMIGRANT AND REFUGEE HEALTH CARE INTO ONE CENTRAL POINT OF ENTRY. THROUGH THE IHRC, ANY IMMIGRANT PATIENT CAN BE CONNECTED WITH ALL OF THE MEDICAL, MENTAL HEALTH AND SOCIAL SERVICES THAT THEY NEED TO HEAL, REBUILD, AND THRIVE. THIS INCLUDES SPECIALIZED PRIMARY CARE SERVICES FOR IMMIGRANT AND REFUGEE PATIENTS INCLUDING REGULAR CHECK-UPS, IMMUNIZATIONS AND SCREENINGS; SPECIALIZED, TRAUMA-INFORMED MENTAL HEALTH CARE FOR IMMIGRANT AND REFUGEE AND TAILORED OBSTETRICS AND GYNECOLOGICAL CARE FOR IMMIGRANT AND REFUGEE PATIENTS, INCLUDING PREGNANCY AND POSTPARTUM CARE, ANNUAL CHECK-UPS, GYNECOLOGIC CARE, CONTRACEPTION COUNSELING, SURGICAL CONSULTATION AND CONSULTATIONS REGARDING FEMALE GENITAL CIRCUMCISION. WE ALSO RECOGNIZE THAT NAVIGATING THE US HEALTHCARE SYSTEM CAN BE CHALLENGING. OUR CASE MANAGEMENT TEAM PARTNERS WITH OUR PATIENTS TO CONNECT THEM WITH THE MEDICAL AND SOCIAL SERVICES THEY NEED (FROM IMMIGRATION LEGAL NEEDS, TO CAREER DEVELOPMENT, TO FOOD AND HOUSING SUPPORT) IN A SUPPORTIVE ENVIRONMENT THAT IS SPECIFICALLY TAILORED TO MEET THE UNIQUE NEEDS OF OUR PATIENTS. FOREIGN AND SIGN LANGUAGE INTERPRETERS ARE AVAILABLE TO HELP PATIENTS COMMUNICATE WITH THE STAFF. THE PRACTICE PROVIDES ON-SITE INTERPRETERS AND PHONE-BASED INTERPRETERS FOR MORE THAN 250 LANGUAGES. IN THE PAST YEAR, THE IHRC SERVED FOR OVER 2,000 IMMIGRANT, REFUGEE, AND ASYLUM SEEKING PATIENTS, DELIVERING APPROXIMATELY 6,400 CLINICAL VISITS ANNUALLY. MARGARET M. SHEA RN ADULT DAY HEALTH PROGRAM: THE PROGRAM HOLDS A LICENSE UNDER THE DEPARTMENT OF PUBLIC HEALTH AND OFFERS FAMILIES PEACE OF MIND AND A SUPPORT SYSTEM TO HELP THEM CARE DAILY FOR A FAMILY MEMBER UNABLE TO FUNCTION ALONE DURING THE DAY. THE PROGRAM OFFERS INTERVENTION PROGRAMS THAT PROVIDE SERVICES IN AN AMBULATORY, HOME-LIKE SETTING FOR ADULTS WHO DO NOT REQUIRE 24-HOUR INSTITUTIONAL CARE BUT, BECAUSE OF PHYSICAL AND/OR MENTAL IMPAIRMENT, ARE NOT COMPLETELY ABLE TO LIVE INDEPENDENTLY OR REMAIN AT HOME, ALLOWING FAMILY MEMBERS THE OPPORTUNITY TO CONTINUE TO WORK WHILE THEIR LOVED ONE IS AT A PROGRAM DURING THE DAY. A REFERRED PARTICIPANT CAN LOOK FORWARD TO PROGRAM OFFERINGS SUCH AS NURSING INTERVENTIONS, SOCIAL SERVICES, THERAPEUTIC ACTIVITIES, AND TRANSPORTATION TO AND FROM THE PROGRAM.DUE TO COVID-19, THE PROGRAM CLOSED IN-PERSON PROGRAMING IN MARCH 2020, WITH STAFF MAINTAINING CLOSE CONTACT VIA TELEPHONIC REMOTE SERVICES. CLIENTS BEGAN TO RETURN TO IN-PERSON SERVICES IN OCTOBER 2020, WITH ONLY 4-6 CLIENTS PER DAY THROUGH THE WINTER OF 2020-2021. REMOTE SERVICES CONTINUED THROUGH FALL OF 2021 INCLUDING CLIENTS JOINING US FROM HOME VIA ZOOM FOR BINGO AND OTHER ACTIVITY PROGRAMS. BY THE END OF DECEMBER 2021 ALL CLIENTS RETURNED TO IN-PERSON PROGRAMING AND TO THEIR AUTHORIZED &/OR SCHEDULED PREFERENCE OF 2-5 DAYS PER WEEK. THE PROGRAM CURRENTLY HAS A ROSTER OF 32 PARTICIPANTS WITH AN AVERAGE OF 20 CLIENTS PER DAY IN ATTENDANCE. DURING THIS TIME PERIOD THE PROGRAM ALSO WELCOMED NEW STAFF INCLUDING A NEW PROGRAM DIRECTOR, SOCIAL WORKER, NURSES AND PROGRAM AIDES.PROGRAM FOR INTEGRATIVE MEDICINE AND HEALTH CARE DISPARITIES (INTEGRATIVE MEDICINE): STARTED IN 2004, THE PROGRAM FOR INTEGRATIVE MEDICINE AND HEALTH CARE DISPARITIES AT BMC COMBINES CONVENTIONAL MEDICAL TREATMENT, COMPLEMENTARY THERAPIES, AND LIFESTYLE CHANGES. THE CORE PURPOSE OF THIS PROGRAM IS TO PIONEER A WIDELY ACCESSIBLE, MULTICULTURAL, CROSS-DISCIPLINARY, NATIONAL MODEL OF INTEGRATIVE HEALTH FOR ALL THROUGH CLINICAL SERVICES, EDUCATION, RESEARCH AND ADVOCACY. COMPLEMENTARY THERAPIES INCLUDE YOGA, MASSAGE, ACUPUNCTURE, HERBAL THERAPY, DIETARY SUPPLEMENTS, MEDITATION, HYPNOSIS, CHI GUNG, TAI CHI, AND REIKI. THE PROGRAM OFFERS ALL CLINICAL SERVICES AND CLASSES AT LITTLE OR NO COST.PEDIATRIC ASSESSMENT OF COMMUNICATION CLINIC (AUTISM PROGRAM): THE AUTISM PROGRAM AT BMC IS A MULTIDISCIPLINARY, MULTI-TIERED, COMPREHENSIVE AND CULTURALLY COMPETENT PROGRAM THAT IS UNIQUELY EQUIPPED TO MEET THE COMPLEX NEEDS OF PATIENTS AND FAMILIES. OUR TEAM, COMPRISED OF A PROGRAM DIRECTOR AND ASSOCIATE DIRECTOR, AUTISM RESOURCE SPECIALISTS, TRANSITION SPECIALIST, RESEARCH COORDINATOR AND AUTISM FRIENDLY HOSPITAL PROJECT COORDINATOR, OFFERS SPECIALIZED OUTREACH, TRAINING AND ADVOCACY SERVICES. IN ADDITION, THE TEAM FORMS EFFECTIVE PARTNERSHIPS WITH SCHOOLS, COLLABORATES WITH LOCAL SUPPORT ORGANIZATIONS AND DRAWS UPON A DEEP KNOWLEDGE BASE OF SOCIAL SERVICE AGENCIES TO FACILITATE LINKAGES TO RESOURCES AND SUPPORTS WHILE DEVELOPING AND SCALING UP NOVEL INTERVENTIONS TO MEET GAPS IN SERVICES. OUR AUTISM RESOURCE SPECIALISTS WORK INTENSELY WITH PATIENT FAMILIES TO HELP ENSURE TIMELY AND APPROPRIATE TREATMENT FOR CHILDREN, WHICH OFTEN INCLUDES PROVIDING SUPPORT FOR THOSE FACING FINANCIAL BARRIERS, LINGUISTIC NEEDS AND CULTURAL ISSUES; ENHANCING PATIENT-PROVIDER COMMUNICATION; NAVIGATING HEALTH CARE SYSTEM OBSTACLES; AS WELL AS ACCESSING STATE AND GOVERNMENTAL BENEFITS. ADDITIONALLY, STAFF PROVIDE INDIVIDUALIZED BEHAVIOR CONSULTATION AND PARENT TRAINING TO STRENGTHEN CHILDREN'S COMMUNICATION AND RELATED SKILL-BUILDING AND REDUCE CHALLENGING BEHAVIORS. OUR TRANSITION SPECIALIST PROVIDES TRANSITION-AGED YOUTH (14-22 YEARS OLD) AND THEIR FAMILIES WITH INFORMATION, GUIDANCE, AND RESOURCES REGARDING THE TRANSITION FROM SCHOOL SERVICES TO ADULT LIFE AND DISCUSSES TOPICS SUCH AS GOAL SETTING, SCHOOL IEP PLANNING, ADULT SERVICES, AND LIFE SKILLS DEVELOPMENT. OUR AUTISM FRIENDLY INITIATIVE (AFI) IS RECOGNIZED AS A NATIONAL AND INTERNATIONAL LEADER IN IMPROVING THE HEALTHCARE EXPERIENCE FOR PATIENTS WITH AUTISM SPECTRUM DISORDER (ASD) AND THEIR FAMILIES. OUR AFI HAS SUCCESSFULLY DEVELOPED AND IMPLEMENTED A RANGE OF INTERVENTIONS ACROSS THE DOMAINS OF INDIVIDUALIZING PATIENT CARE, MODIFYING THE SENSORY ENVIRONMENT, STAFF TRAINING, AND PATIENT/FAMILY ACCOMMODATIONS. THE AUTISM PROGRAM ALSO HAS A WELL-ESTABLISHED SOCIAL MEDIA PRESENCE ON FACEBOOK AND INSTAGRAM - BOTH OF WHICH SERVE AS ADDITIONAL AVENUES TO PROVIDE RESOURCES, INFORMATION, AND GUIDANCE TO FAMILIES. THE AUTISM PROGRAM HAS SUPPORTED OVER 11,000 FAMILY REFERRALS SINCE ITS INCEPTION IN 2007 AND APPROXIMATELY 1,500 IN FY21. ADDITIONALLY, THE PROGRAM TRAINS OVER 1,000 INDIVIDUALS ANNUALLY. PEDIATRIC COMPREHENSIVE CARE PROGRAM (CCP): CCP SERVED A PANEL OF APPROXIMATELY 600 CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND THEIR FAMILIES IN FY21. THE CLINICAL STAFF INTEGRATES PRIMARY CARE WITH SPECIALTY CARE AND SOCIAL SERVICES FOR CHILDREN WITH NEURODEVELOPMENTAL AND EMOTIONAL/BEHAVIORAL NEEDS RELATED TO PRE-TERM BIRTH, CONGENITAL SYNDROMES AND CHRONIC HEALTH CONDITIONS, AND/OR HAVE EXPERIENCED TRAUMA AS A RESULT OF ABUSE AND/OR NEGLECT, PARENTAL ABANDONMENT, DOMESTIC VIOLENCE, AND PARENTAL SUBSTANCE USE DISORDER. MANY OF THE CHILDREN SEEN IN THE CCP HAVE COMPLEX OVERLAPPING HEALTH, DEVELOPMENT AND EMOTIONAL/BEHAVIORAL ISSUES. MANY LOW-INCOME PARENTS OF SPECIAL NEEDS CHILDREN TEND TO ENGAGE HAPHAZARDLY AND EPISODICALLY WITH THE HEALTHCARE SYSTEM AND FAIL TO RECEIVE APPROPRIATE FOLLOW-UP CARE AND INTERVENTION. THESE PARENTS OFTEN FACE ECONOMIC HARDSHIPS, EDUCATIONAL BARRIERS, PSYCHOSOCIAL STIGMA, AND SOCIAL ISOLATION AS THEY TRY TO COPE WITH THEIR CHILDREN'S NEEDS AND ATTEMPT TO MAINTAIN STABILITY FOR THEIR FAMILIES. THIS HAS BEEN ESPECIALLY TRUE DURING THE PANDEMIC, AND WE HAVE UTILIZED TELEMEDICINE AND OTHER TOOLS TO OFFSET THE DECREASED ACCESS TO CARE EXPERIENCED BY SOME FAMILIES. THE CCP, WITH ITS MULTIDISCIPLINARY APPROACH, SEES FROM 6 TO 8 PATIENTS PER PROVIDER PER SESSION, CONSIDERABLY LESS THAN THE 10-12 PATIENTS PER SESSION REGULARLY SEEN IN THE PEDIATRIC CLINIC. ADDITIONALLY, THESE TEAM PRIMARY CARE VISITS ALLOW FOR ATTENTION TO ROUTINE HEALTH MAINTENANCE AS WELL AS UPDATING COMPLEX CARE COORDINATION; PATIENTS MAY ALSO SEE A NEUROLOGIST, PULMONOLOGIST, NUTRITIONIST, GASTROENTEROLOGIST, BEHAVIORAL HEALTH CLINICIAN, AND/OR A PEDIATRIC ENDOCRINOLOGIST, WHEN INDICATED. THE PROGRAM ALSO UTILIZED A FAMILY NAVIGATOR AS MAINSTAYS OF THEIR CAPACITY TO ACHIEVE HIGH-TOUCH CARE MANAGEMENT AND ADDRESS THE SOCIAL DETERMINANTS OF HEALTH. THIS "ONE STOP SHOPPING" MODEL OF CARE PROMOTES COMMUNICATION BETWEEN ALL MEMBERS OF THE CHILD'S HEALTHCARE TEAM. SCHEDULE H, PART VI, LINE 5 (CONTINUATION): PEDIATRIC PAIN CLINIC: BMC'S PEDIATRIC PAIN CLINIC MANAGES ACUTE, COMPLEX, AND CHRONIC PAIN IN CHILDREN FROM INFANCY TO AGE 22. A TEAM OF EXPERTS WORK CLOSELY WITH EACH PATIENT'S PRIMARY CARE PHYSICIAN, STRIVING TO HELP CHILDREN REGAIN NORMAL LIVES AND PARTICIPATE IN TYPICAL AGE-APPROPRIATE ACTIVITIES. THE PEDIATRIC PAIN CLINIC IS ABLE TO TREAT A WIDE VARIETY OF CONDITIONS, AND OFFERS A VARIETY OF SPECIALIZED THERAPIES. PATIENTS ARE GIVEN A PERSONALIZED PAIN MANAGEMENT PLAN TO BEST FIT THEIR INDIVIDUAL NEEDS. STRATEGIES AND PARENTING SUPPORT ARE ALSO OFFERED FOR FAMILIES WHO MAY TRAVEL A LONG DISTANCE TO RECEIVE THIS SPECIALIZED CARE. THE TEAM COMMUNICATES WITH SCHOOLS AND OUTSIDE PROVIDERS TO ENSURE COMPREHENSIVE AND COLLABORATIVE CARE. FISCAL YEAR 2021 CONTINUED TO POSE MANY CHALLENGES AND MANY NEW OPPORTUNITIES TO THE HEALTHCARE SYSTEM, AND THE PEDIATRIC PAIN CLINIC WAS CERTAINLY NO EXCEPTION. THE TEAM MOVED INTO A NEW SPACE ON SHAPIRO 8 AND THE CLINIC HAS NEARLY RETURNED TO PRE-PANDEMIC SERVICE CAPACITY. THE CLINIC HAS RESUMED PHYSICAL THERAPY EVALUATIONS FOR ALL NEW PATIENTS ON MONDAY MORNINGS, WHICH WAS OFFERED PRE-PANDEMIC. AN ACUPUNCTURE TEAM CONTINUES TO BRING NEW INTERNS FOR ROTATIONS. A THE CLINIC OFFERED A KARATE PROGRAM TO PATIENTS, BUT THIS WAS PAUSED DURING THE OMICRON SURGE. MOST SIGNIFICANTLY, THE PEDIATRIC NURSE ASSIGNED TO OUR TEAM IS NOW A FULL TIME NURSE IN THE PEDIATRIC SPECIALTY GROUP; THIS CHANGE MEANS SHE WILL CONTRIBUTE TO PAIN CLINIC WORK IN ADDITION TO SUPPORTING OTHER SPECIALTY CLINICS. THE TEAM WAS ALSO ABLE TO PURCHASE NEW BIOFEEDBACK EQUIPMENT WITH A GENEROUS DONATION FROM A LOCAL GROUP, MUCH TO THE APPRECIATION OF OUR PATIENTS AND CLINICIANS. IN FY 2022, THE TEAM WILL LOOK TO POST A POSITION FOR A PART-TIME PRACTICE COORDINATOR, WHO WILL FURTHER SUPPORT OUT PROGRAM.PREVENTIVE FOOD PANTRY, TEACHING KITCHEN, AND ROOFTOP FARM: THE PREVENTIVE FOOD PANTRY AND TEACHING KITCHEN ADDRESS HUNGER-RELATED ILLNESS AND MALNUTRITION AMONG A LOW-INCOME, LARGELY UNDERSERVED PATIENT POPULATION WITHIN GREATER BOSTON. INDIVIDUALS AT RISK OF MALNUTRITION ARE REFERRED TO THE PROGRAM BY BMC OR BOSTON HEALTHNET PHYSICIANS OR NUTRITIONISTS WHO PROVIDE "PRESCRIPTIONS" FOR SUPPLEMENTAL FOOD THAT BEST PROMOTES PHYSICAL HEALTH, PREVENTS FUTURE ILLNESS, AND FACILITATES RECOVERY. THE PANTRY STAFF MEMBERS ARE FLUENT IN 4 LANGUAGES AND HAVE BEEN ESSENTIAL IN ASSISTING BMC'S MANY REFUGEE AND IMMIGRANT PATIENTS. DUE TO THE COVID-19 PANDEMIC, THERE HAVE BEEN DECREASED NUMBERS OF PEOPLE VISITING BMC. HOWEVER, THE FOOD PANTRY HAS CONTINUED TO PROVIDE NUTRITIONAL FOOD PRESCRIPTIONS TO APPROXIMATELY 4,948 PEOPLE EACH MONTH. IN FY21, THE FOOD PANTRY PROVIDED NUTRITIOUS FOOD TO 59,380 GREATER BOSTON RESIDENTS. APPROXIMATELY 9,500 POUNDS OF FOOD SUPPLIES ARE REQUIRED WEEKLY TO STOCK THE PANTRY SHELVES AT BMC. THIS EQUATES TO APPROXIMATELY 8 POUNDS OF GROCERIES PER PERSON. THE TEACHING KITCHEN ADAPTED TO ACCOMMODATE COVID-19 PREVENTION RECOMMENDATIONS AND PROTOCOLS. CLASSES WERE SHIFTED TO AN ENTIRELY REMOTE MODEL, INCLUDING BOTH LIVE AND PRE-RECORDED FORMATS, AND WERE OFFERED FOR FREE TO PATIENTS, STAFF, AND THE GENERAL COMMUNITY. WEEKLY INSTAGRAM STORIES AND TIKTOKS ENTITLED "THURSDAYS IN MY HOME KITCHEN" WERE LAUNCHED TO REACH THE WIDER COMMUNITY. RECIPES CONTINUED TO FOCUS ON LIMITING TOTAL CALORIES, EMPHASIZING LEAN AND PLANT BASED PROTEIN SOURCES, AND USING WHOLE FOOD INGREDIENTS. MEAL IDEAS WERE CENTERED AROUND STAPLE FOODS PROVIDED BY THE FOOD PANTRY AND NON-PERISHABLE FOODS TO HELP REDUCE TRIPS TO THE GROCERY STORE. COMPARED TO LAST YEAR, THE NUMBER OF CLASSES OFFERED INCREASED FROM AN AVERAGE OF 12 CLASSES PER MONTH TO AN AVERAGE OF 22 CLASSES PER MONTH, AND PARTICIPATION RATES REMAINED AN AVERAGE 8-15 PARTICIPANTS PER CLASS. IN AN INFORMAL QUALITY IMPROVEMENT SURVEY, PARTICIPANTS REPORTED PREFERRING REMOTE LEARNING FOR CONVENIENCE FACTORS INCLUDING CHILD CARE AND TRANSPORTATION, AS WELL AS ENJOYING THE HOME-COOK ATMOSPHERE AND FINDING IT MORE RELATABLE. IN APRIL 2017, BMC OPENED ITS ROOFTOP FARM, TO MEET OUR PATIENTS' GROWING NEED FOR FRESH PRODUCE. THE ROOFTOP FARM HAS 2,400 SQUARE FEET OF GROWING SPACE, AND IS LOCATED ON TOP OF BMC'S ALBANY STREET POWER PLANT. THE FARM PRODUCES CROPS SUCH AS SPINACH, COLLARDS, BOK CHOY, RADISHES, SWISS CHARD, KALE, TOMATOES, AND MUCH MORE. IN ADDITION TO PRODUCE, THE FARM ALSO HAS 4 BEEHIVES WHICH PROVIDE 20-100 POUNDS OF HONEY TO THE HOSPITAL EACH SEASON. THE 2021 FARMING SEASON FOUND THE FARM OPENING UP IN SOME CAPACITY TO THE PUBLIC. THE FARM HOSTED FREE EMPLOYEE GARDENING 101 CLASSES AS WELL AS YOGA ON THE FARM. THE FARM ALSO HOSTED TOURS FOR THE PUBLIC AND EMPLOYEES THROUGHOUT THE FARMING SEASON, BOTH VIRTUAL AND IN PERSON. FOR A SECOND YEAR THE FARM HOSTED AN INTERNSHIP PROGRAM FOR PEOPLE LOOKING TO LEARN THE INS AND OUTS OF ROOFTOP FARMING AND GROWING FOOD FOR A HOSPITAL. THE FARM PRODUCED AROUND 3,500 POUNDS OF FRESH PRODUCE IN THE 2021 GROWING SEASON, WITH ABOUT 75% GOING TO THE FOOD PANTRY AND THE REST TO BMC'S CAFETERIAS AND PATIENT PLATES.PEDIATRIC MOBILE SERVICES: WITH PEDIATRIC IN-PERSON VISITS DROPPING SIGNIFICANTLY DURING THE SURGE OF COVID-19 CASES, BMC PEDIATRICIANS GRAPPLED WITH HOW TO STAY CONNECTED TO THEIR MOST VULNERABLE PEDIATRIC PATIENTS AND FAMILIES WHO WERE AT-RISK NOW, MORE THAN EVER. THOUGH SWITCHING TO TELEHEALTH ALLOWED PROVIDERS TO MEET THE NEEDS OF SOME OF THEIR PATIENTS, IT STILL LEFT THEM UNABLE TO PROVIDE ESSENTIAL VACCINATIONS AND OTHER CRITICAL FOLLOW-UP CARE TO FAMILIES FEARFUL OF COMING TO THE HOSPITAL. BREWSTER AMBULANCE SERVICE STEPPED FORWARD WITH A SOLUTION, GENEROUSLY DONATING AN AMBULANCE TO THE TEAM OF PROVIDERS, NURSES AND STAFF WHO DID HOUSE CALLS FOR FAMILIES LIVING IN NEARBY BOSTON NEIGHBORHOODS. FOR FAMILIES NOT COMFORTABLE COMING INTO THE HOSPITAL DUE TO COVID-19, BMC PEDIATRICS OFFERED PHYSICAL EXAMS, VACCINES, AND BLOOD WORK IN A MOBILE UNIT IN BOSTON NEIGHBORHOODS. THE MOBILE UNIT PARTNERED WITH PROJECT REACH TO PROVIDE UNMET MATERIAL NEEDS TO FAMILIES THAT THEY VISITED. EACH FAMILY SCHEDULED FOR THE MOBILE UNIT UNDERWENT A NEEDS ASSESSMENT AND RECEIVED BAGS THAT WERE CUSTOMIZED BY PROJECT REACH STAFF TO MEET PATIENTS' NEEDS. BAGS INCLUDED DIAPERS, WIPES, HYGIENE PRODUCTS, FACE MASKS, CHILDREN'S BOOKS AND TOYS, AMONG OTHER NECESSITIES. IN FEBRUARY OF 2021, THE PEDIATRICS DEPARTMENT PARTNERED WITH COLLEAGUES IN OBSTETRICS TO LAUNCH 'CURBSIDE CARE FOR MOMS AND BABIES'. THIS INNOVATIVE PROGRAM PROVIDED DYADIC, COMPREHENSIVE, HIGH-TOUCH CARE TO BOTH MOTHERS AND THEIR NEWBORNS IN THE FIRST 6 WEEKS WEEKS OF LIFE AT THE CURB! SERVICES INCLUDE: NEWBORN ASSESSMENT, LACTATION SUPPORT, MATERNAL BLOOD PRESSURE SCREENING, POSTPARTUM DEPRESSION SCREENING AND REFERRAL, AND CONTRACEPTION COUNSELING AND PROVISION. IN SPRING, THE MOBILE UNIT TEAM BEGAN ACTIVELY OUTREACHING TO PATIENTS TO PROVIDE COVID VACCINATION TO ALL ELIGIBLE PATIENTS. FOLLOWING UP IN THE FALL, THE MOBILE UNIT DELIVERED FLU VACCINATION TO PEDIATRIC PATIENTS WITH SEVERE ASTHMA AND SICKLE CELL DISEASE--KEEPING PATIENTS AT-RISK FOR COVID OUT OF THE HOSPITAL AND PROTECTING THEM FROM THE FLU. FROM AUGUST THROUGH DECEMBER 2020 THE MOBILE PROGRAM DELIVERED 25-30 BAGS OF SUPPLIES AND FOOD PER WEEK, AND FROM JANUARY THROUGH JULY 2021, APPROXIMATELY 12-20 BAGS PER WEEK.PROJECT REACH: AN INITIATIVE CREATED AS A RESULT OF THE COVID-19 PANDEMIC WAS LAUNCHED TO ASSESS THE WELL-BEING OF ALL BMC PEDIATRIC PATIENTS WHO WERE QUARANTINING IN THEIR HOMES. DURING ASSESSMENTS, THE TEAM LEARNED THAT 15% OF PEDIATRIC FAMILIES WERE NOT ABLE TO LEAVE THEIR HOUSES DUE TO POSITIVE COVID-19 DIAGNOSES, CHILDCARE NEEDS OR RISK TO VULNERABLE FAMILY MEMBERS, LEAVING THEM IN DIRE NEED OF FOOD AND SUPPLIES. IN RESPONSE, PROJECT REACH QUICKLY PARTNERED WITH THE MOBILE TEAM TO EXPAND ON HOME VISITS TO INCLUDE DELIVERIES OF FOOD, HYGIENE ITEMS, CLEANING SUPPLIES AND OTHER SERVICES SUCH AS STRESS MANAGEMENT, FINANCIAL EDUCATION, MUSIC CLASSES AND STORY TIMES FOR CHILDREN. FROM OCTOBER 2020 THROUGH JUNE 2021, PROJECT REACH STAFF CONNECTED WITH THE FAMILIES OF OVER 1,000 PATIENTS FOR ASSESSMENT OF NEED AND SUPPORTS TO ADDRESS THEM, INCLUDING FOOD INSECURITY. SCHEDULE H, PART VI, LINE 5 (CONTINUATION): PROJECT RECOVERY, EMPOWERMENT, SOCIAL SERVICES, PRENATAL CARE, EDUCATION, COMMUNITY AND TREATMENT (PROJECT RESPECT): PROJECT RESPECT IS A HIGH RISK OBSTETRICAL AND ADDICTION RECOVERY MEDICAL HOME AT BMC AND BOSTON UNIVERSITY SCHOOL OF MEDICINE. PROJECT RESPECT PROVIDES A UNIQUE SERVICE OF COMPREHENSIVE OBSTETRIC AND SUBSTANCE USE DISORDER TREATMENT FOR PREGNANT WOMEN AND THEIR NEWBORNS IN MASSACHUSETTS. THE MAJORITY OF PROJECT RESPECT'S PATIENTS ARE IN RECOVERY FROM OPIOID ADDICTION. IN-PATIENT, MONITORED, ACUTE SUBSTANCE WITHDRAWAL TREATMENT AND INDUCTION OF OPIOID MAINTENANCE THERAPIES FOR PREGNANT WOMAN SEEKING ADDICTION TREATMENT ARE PROVIDED. INTENSIVE, INDIVIDUALIZED OUT-PATIENT TREATMENT PLANS ARE OUTLINED FOR EACH PATIENT TAILORED TO THE SEVERITY OF THEIR DISEASE AND THEIR RECOVERY PROGRESS. THE OUT-PATIENT MEDICAL HOME MODEL PROVIDES ON-SITE, COLLABORATIVE, AND MULTIDISCIPLINARY CARE FOR PREGNANT AND POST-PARTUM WOMEN IN RECOVERY. PROJECT RESPECT TREATS AN AVERAGE OF 120-150 PATIENTS PER MONTH, WITH 6-10 NEW PATIENTS PER MONTH. IN FY21, PROJECT RESPECT SUPPORTED MORE THAN 210 MOTHER/CHILD DYADS.STREETCRED: BMC'S STREETCRED PROGRAM ADDRESSES CHILD POVERTY BY LINKING LOW- TO MODERATE-INCOME (LMI) PEDIATRIC PATIENT FAMILIES TO ANTI-POVERTY SAFE-NET PROGRAMS. STREETCRED PROVIDES FREE TAX-PREPARATION SERVICES THROUGH WELL-TRAINED STAFF AND VOLUNTEERS WHO WORK WITH FAMILIES TO PREPARE THEIR TAXES AND ACCESS THE EITC AND OTHER TAX-BASED PROGRAMS, FOR EXAMPLE, SNAP OR THE FAFSA FOR WHICH THEY MAY BE ELIGIBLE. THE UNITED STATES FEDERAL EARNED INCOME TAX CREDIT (EITC) IS A REFUNDABLE TAX CREDIT FOR LMI WORKING INDIVIDUALS, PARTICULARLY THOSE WITH CHILDREN. IN FY21 THE STREETCRED PROGRAM PREPARED 283 TAX RETURNS FOR BMC FAMILIES, WHICH LED TO RETURNING $767,043 IN TAX REFUNDS. UNDER OUR MEDICAL TAX COLLABORATIVE NETWORK, STREETCRED PREPARED ABOUT 1,100 TAX RETURNS, WHICH PROVIDED $2,769,852 IN TAX REFUNDS. THESE TAX REFUNDS CAN HAVE A PROFOUND POSITIVE IMPACT ON A FAMILY'S HOUSEHOLD BUDGET AND, IN CASES OF FINANCIAL STRESS, ALLEVIATE SIGNIFICANT FINANCIAL BURDEN.SUPPORTING PARENTS AND RESILIENT KIDS CENTER (SPARK): THE SPARK CENTER HAS A LONG AND STORIED HISTORY OF PROVIDING INNOVATIVE CARE TO THOSE MOST IN NEED. THROUGH MARCH 2020, THE SPARK CENTER CARRIED OUT THIS MISSION THROUGH AN EDUCATION AND CARE PROGRAM FOR INFANTS AND TODDLERS WHOSE LIVES WERE AFFECTED BY COMPLEX OVERLAPPING HEALTH, EMOTIONAL, BEHAVIORAL, AND DEVELOPMENTAL CHALLENGES. AS A RESULT OF THE COVID-19 PANDEMIC, THE SPARK CENTER PIVOTED FROM CHILDCARE PROGRAMMING TOWARD EXPANDING CHILDHOOD OUTPATIENT BEHAVIORAL HEALTH SERVICES - A NEED THAT HAS ONLY BEEN AMPLIFIED THROUGH THE PANDEMIC. AS THESE CRITICAL BEHAVIORAL HEALTH SERVICES PROVIDED A SUPPORTIVE CONNECTION TO CARE FOR MANY FAMILIES THROUGH 2020 AND 2021, THE SPARK CENTER SIMULTANEOUSLY INITIATED A RE-ENVISIONING OF ITSELF AND ITS UNIQUE, COMMUNITY-BASED SETTING. IN AUGUST 2021, SPARK REOPENED AS THE HOME TO A NUMBER OF SPECIALTY PROGRAMS WITHIN BMC'S DEPARTMENT OF PEDIATRICS, ALL WITH THE OVERARCHING MISSION TO PROVIDE HIGH-QUALITY, EVIDENCED-BASED CARE. AT PRESENT, SPARK OFFERS NEURODEVELOPMENTAL ASSESSMENTS AND PSYCHOLOGICAL EVALUATIONS THROUGH THE DIVISION OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS (DBP) TO IDENTIFY CHILDREN'S SPECIFIC EMOTIONAL, BEHAVIORAL, AND COGNITIVE CHALLENGES. MULTIDISCIPLINARY PROVIDERS, INCLUDING PEDIATRICIANS, ADVANCED PRACTICE CLINICIANS, PSYCHOLOGISTS, AND AUTISM RESOURCE SPECIALISTS, WORK COLLABORATIVELY WITH CAREGIVERS TO ACCESS SPECIAL EDUCATION SERVICES AND OTHER VITAL THERAPEUTIC SUPPORTS AS EARLY AS POSSIBLE TO IMPROVE CHILDHOOD OUTCOMES. ADDING TO THE CONTINUUM OF SPECIALIZED CHILDREN'S SERVICES, THE SPARK CENTER IS THE HOME OF THE EARLY CHILDHOOD BEHAVIOR THERAPY PROGRAM AND THE GOOD GRIEF PROGRAM AND IS A CLINICAL SITE FOR THE CHILD WITNESS TO VIOLENCE PROJECT. THESE PROGRAMS OFFER AN ARRAY OF TRAUMA-INFORMED, EVIDENCE-BASED THERAPY INTERVENTIONS FOR CHILDREN AND FAMILIES ROOTED IN TWO-GENERATION APPROACHES THAT UTILIZE THE CAREGIVER-CHILD RELATIONSHIP TO FOSTER HEALTHY CHILD DEVELOPMENT. THE SYNERGISTIC COLOCATION OF THESE SERVICES MAKES THE SPARK CENTER A FACILITY THAT PROVIDES BEST-PRACTICE CARE TO CHILDREN AND FAMILIES IMPACTED BY COMPLEX DEVELOPMENTAL AND BEHAVIORAL CHALLENGES, GRIEF AND LOSS, AND DOMESTIC VIOLENCE AND OTHER FORMS OF INTERPERSONAL VIOLENCE. IN ADDITION, SPARK SERVES AS AN OUTLET FOR PEDIATRIC INFECTIOUS DISEASE CASE MANAGEMENT AND CONCRETE RESOURCE SUPPORT, VIA THEIR INTEGRATED FOOD PANTRY. SPARK IS ALSO THE LOCATION OF A MONTHLY CLINIC, PROJECT POSITIVE HOPE, WHICH PROVIDES COORDINATED SERVICES FROM OBSTETRICS AND GYNECOLOGY, ADULT INFECTIOUS DISEASE AND PEDIATRIC INFECTIOUS DISEASE SPECIALISTS WITH ON-SITE CASE MANAGEMENT, PHARMACIST COUNSELING, AND PEER SUPPORT. WITH THE ABOVE ABUNDANCE OF INNOVATIVE CLINICAL SERVICES, THE SPARK CENTER HAS BECOME AN EXCEPTIONAL TRAINING SITE FOR MENTAL HEALTH CLINICIANS AND DBP TRAINEES. THE CLINICAL TRAINING OFFERED THROUGH THE SPARK CENTER WORKS TO ENHANCE THE SKILLS AND EXPERTISE OF THE FIELD OF PROVIDERS SUPPORTING CHILDREN AND FAMILIES WITH COMPLEX BEHAVIORAL AND DEVELOPMENTAL CHALLENGES AND PSYCHOSOCIAL SITUATIONS.TEAM UP: THE CHILD MENTAL HEALTH INITIATIVETEAM UP IS A PARTNERSHIP BETWEEN BMC AND SEVEN REGIONAL COMMUNITY HEALTH CENTERS THAT SEEKS TO INTEGRATE MENTAL HEALTH CARE WITH PRIMARY CARE FOR CHILDREN SO THAT FAMILIES CAN RECEIVE ALL CARE IN ONE PLACE. ENGAGEMENT WITH THE TEAM UP MODEL OCCURS: WHEN A PARENT BRINGS IN A CHILD WITH BEHAVIORAL HEALTH ISSUES; WHEN A PRIMARY CARE PROVIDER REFERS A CHILD WITH BEHAVIORAL HEALTH ISSUES; WHEN A PRIMARY CARE PROVIDER EXPRESSES CONCERNS ABOUT A FAMILY; WHEN A CHILD OR FAMILY EXPERIENCES A NEW MAJOR STRESSOR (E.G., PARENTAL SEPARATION, DIAGNOSIS OF A SERIOUS ILLNESS); AND AFTER A COMPREHENSIVE PSYCHOSOCIAL AND BEHAVIORAL HEALTH ASSESSMENT DURING A WELL-CHILD VISIT IN THE PRIMARY CARE SETTING. THE GOAL OF TEAM UP IS TO PROMOTE POSITIVE CHILD HEALTH AND WELL-BEING THROUGH INNOVATION AND CONSISTENT DELIVERY OF EVIDENCE-BASED INTEGRATED CARE. BMC SUPPORTS IMPLEMENTATION OF THE TEAM UP MODEL THROUGH A LEARNING COMMUNITY THAT PROVIDES PRACTICE TRANSFORMATION SUPPORT AND CLINICAL TRAINING. BMC IS ALSO UNDERTAKING AN EVALUATION OF THE MODEL; DATA ARE USED TO GUIDE IMPLEMENTATION AND ASSESS THE IMPACT OF THE MODEL.GOOD GRIEF: THE GOOD GRIEF PROGRAM PROVIDES TRAUMA-INFORMED, CULTURALLY RESPONSIVE THERAPEUTIC SERVICES TO CHILDREN (AGE 0-18) IMPACTED BY DEATH AND ACUTE LOSS. AS ONE OF THE ONLY CHILDREN'S GRIEF AND LOSS PROGRAMS WITHIN THE CITY OF BOSTON, GOOD GRIEF WORKS TIRELESSLY TO BEST SERVE URBAN CHILDREN AND YOUTH WHO HAVE SUFFERED MULTIPLE, TRAUMATIC LOSSES. GOOD GRIEF SERVES CHILDREN AND THEIR FAMILIES IN A HOLISTIC WAY, RECOGNIZING THAT SIGNIFICANT LOSS IS ALWAYS ACCOMPANIED BY SECONDARY LOSSES THAT ARE DESTABILIZING, DISORIENTING, AND DAUNTING. OUR SMALL CLINICAL TEAM WORKS WITH FAMILIES TO SUPPORT THEIR MENTAL AND EMOTIONAL HEALTH NEEDS WHILE ALSO MITIGATING OTHER LOSS-RELATED STRESSORS AND STRUCTURAL DETERMINANTS OF HEALTH THEY MAY EXPERIENCE AND WHICH AFFECT OVERALL HEALTH (E.G., CHALLENGES AT SCHOOL, HOUSING/FOOD/FINANCIAL INSECURITY, IMMIGRATION-RELATED NEEDS, ETC.).IN 2017, THE GOOD GRIEF PROGRAM SHIFTED ITS PRIMARY FOCUS FROM TRAINING AND CONSULTATION WITH COMMUNITY-BASED ORGANIZATIONS TO PROVIDING DIRECT CLINICAL SERVICES TO CHILDREN IMPACTED BY SIGNIFICANT LOSS. IN THE FOUR YEARS PROCEEDING, THE NUMBER OF CHILDREN REFERRED TO AND SERVED BY THE PROGRAM HAS GROWN QUICKLY. WHEN CLINICAL SERVICES WERE OPENED IN AUGUST 2017, 26 CHILDREN WERE REFERRED IN A FIVE MONTH PERIOD. IN 2021, 220 CHILDREN WERE REFERRED TO GOOD GRIEF. THE EXPONENTIAL GROWTH OF THE PROGRAM HAS BEEN FUELED BY MANY FACTORS INCLUDING THE DEARTH OF HIGH-QUALITY CHILDREN'S GRIEF SERVICES IN BOSTON AND GOOD GRIEF'S RELIABLE REPUTATION AMONG MEMBERS OF THE COMMUNITY AND OTHER SERVICE ORGANIZATIONS. MOREOVER, THE COVID-19 PANDEMIC HAS RESULTED IN DISPROPORTIONATELY HIGH RATES OF HOSPITALIZATION AND DEATH AMONG BLACK AND AFRICAN AMERICAN AND HISPANIC AND LATINO PERSONS, AND CHILDREN FROM THESE RACIAL AND ETHNIC GROUPS COMPRISED 76% OF GOOD GRIEF'S PATIENTS IN 2021.HOUSINGIN FISCAL YEAR 2018 BMC LAUNCHED A MULTI-YEAR INVESTMENT IN A SUPPORTIVE HOUSING STRATEGY AS PART OF OUR DETERMINATION OF NEED (DON) COMMUNITY HEALTH INITIATIVE (CHI). THIS PROJECT WAS DESIGNED WITH AS A MULTI-PRONGED APPROACH TO IMPACT AFFORDABLE HOUSING AND AFFORDABLE HOUSING WITH SUPPORTS IN BOSTON. THIS PORTFOLIO INCLUDES NEW FUNDING FOR INTERNAL HOUSING NAVIGATION SUPPORT IN THE PEDIATRIC AND COMPLEX CARE MANAGEMENT, EXPANSION OF THE ELDERS LIVING AT HOME PROGRAM AND AND DEEPER COLLABORATION WITH BOSTON AND CAMBRIDGE HOUSING AUTHORITY ON SUPPORTIVE HOUSING PROGRAMS. THE FOLLOWING ADDRESSES THE SECOND OF THESE MULTI-YEAR COMMITMENTS. SCHEDULE H, PART VI, LINE 5 (CONTINUATION): BMC INVESTED $1.35M IN A LOAN TO THE COMMUNITY ECONOMIC DEVELOPMENT ASSISTANCE CORPORATION (CEDAC). THE PURPOSE OF THIS LOAN IS TO PARTIALLY CAPITALIZE LOANS UNDER THE ACCELERATING INVESTMENTS IN HEALTH COMMUNITIES (AIHC) INITIATIVE. THROUGH THIS, CEDAC WILL PROVIDE SUBORDINATE LOANS TO THREE AFFORDABLE HOUSING DEVELOPMENTS. THIS INVESTMENT SERVES AS CRITICAL "GAP" FINANCING TO ALLOW ALL THE DIFFERENT FINANCING TO BE EXECUTED AT THE SAME TIME AND THEREFORE FOR CONSTRUCTION ON NEW AFFORDABLE HOUSING TO BEGIN BEFORE HOUSING COSTS WENT US FURTHER. THE LOANS ARE LONG TERM, 20+ YEARS COMMITMENTS TO MATCH AND LEVERAGE THE CITY AND STATE INVESTMENTS IN THESE PROJECTS.BMC INVESTED $69,012 IN THE CAMBRIDGE HEALTH ALLIANCE (CHA) TOWARDS A COMMUNITY WELLNESS ADVOCATE AT THE MANNING APARTMENT COMPLEX. THE COMMUNITY WELLNESS ADVOCATE PROVIDED INDIVIDUALIZED CASE MANAGEMENT AND SUPPORT TO RESIDENTS OF MANNING HOUSE TO IMPROVE HEALTH OUTCOMES FOR THESE RESIDENTS. BMC ALSO INVESTED $65,219 IN A COMMUNITY WELLNESS REGISTERED NURSE (RN) AS PART OF THE ELDERS LIVING AT HOME PROGRAM. THE RN WORKED WITH THE CHA AND MANNING HOUSE STAFF TO IMPROVE RESIDENTS' ACCESS TO SERVICES AND SUPPORT, AND SERVED AS THE PRIMARY LIAISON BETWEEN BMC AND OTHER HEALTH CARE PROVIDERS.BMC PROVIDED A THREE-MONTH EXTENSION TO THE COMMUNITY BUILDERS (TCB) TO CONTINUE THE PARTNERSHIP WHICH ALLOWS FOR BMC TO SUPPORT SERVICE PROVISION AT THE NEW FRANKLIN APARTMENTS. TCB IMPLEMENTS A PLACE-BASED MODEL THAT USES STABLE HOUSING AS A PLATFORM FOR RESIDENTS AND NEIGHBORHOODS TO ACHIEVE SUCCESS. THIS ON-SITE HOUSING WORKER DOES ANNUAL ASSESSMENTS OF RESIDENTS' NEEDS IN THE COMMUNITY, AND DEVELOPS PERSONALIZED PLANS TO CONNECTING RESIDENTS TO THOSE RESOURCES. IN ADDITION, WHEN RESOURCES GAPS EXIST, THE ONSITE HOUSING WORKER WILL DEVELOP NEW RESOURCES. EXAMPLES INCLUDE AN ONSITE FOOD PANTRY WHERE RESIDENTS STAFF THE PANTRY TO ASSIST OTHER RESIDENTS, AND USING COMMUNITY ROOMS IN THE HOUSING DEVELOPMENT FOR AFTER SCHOOL PROGRAMMING, EXERCISE CLASSES AND EVEN COVID-TESTING.BMC INVESTED $330,431 IN THE INNOVATIVE STABLE HOUSING INITIATIVE, LED BY HEALTH RESOURCES IN ACTION (HRIA). THROUGH THIS PARTNERSHIP, HRIA HAS SUCCESSFULLY FACILITATED A COMMUNITY ENGAGEMENT PROCESS THAT HAS BROUGHT TOGETHER HOUSING ADVOCATES, HEALTHCARE PROVIDERS, AND COMMUNITY RESIDENTS TO DESIGN AND IMPLEMENT A PARTICIPATORY GRANTMAKING PROCESS FOCUSED ON HOUSING STABILITY AND ECONOMIC MOBILITY. BMC INVESTED IN THE HEALTHY NEIGHBORHOOD EQUITY FUND, A $22.35 MILLION PRIVATE EQUITY FUND LED BY THE CONSERVATION LAW FOUNDATION AND THE MASSACHUSETTS HOUSING INVESTMENT CORPORATION. IT IS BASED ON A SOCIALLY RESPONSIBLE INVESTMENT MODEL THAT CONSIDERS THE COMMUNITY, ENVIRONMENTAL, AND HEALTH BENEFITS AS WELL AS THE FINANCIAL RISKS AND RETURNS. BOSTON PROJECTS INCLUDE TREADMARK, ASHMONT, DORCHESTER AND BARTLETT STATION, DUDLEY SQUARE, ROXBURY.BMC INVESTED IN THE BOSTON HOUSING AUTHORITY (BHA) TO SUPPORT THEIR REASONABLE ACCOMMODATIONS FUND, THROUGH WHICH BHA INVESTS FUNDS TO IMPROVE THE HEALTH, SAFETY, AND COMFORT OF THEIR RESIDENTS. FURTHER, BMC ALSO PROVIDED SUPPORT TO COVER SOME STAFFING TIME FOR ONE OF BHA'S STAFF MEMBERS. BMC ALSO INVESTED IN THE METROPOLITAN AREA PLANNING COUNCIL (MAPC), THE EVALUATOR FOR BMC'S DON. IN THIS ROLE, MAPC DEVELOPS AND IMPLEMENTS AN EVALUATION PLAN TO ASSESS THE IMPACTS AND EFFECTS OF BMC'S MULTI-YEAR DON FOCUSED ON IMPROVING HOUSING STABILITY. THE EVALUATION WILL SEEK TO ASCERTAIN HOW THE VARIOUS INVESTMENTS IN HOUSING STABILITY INDIVIDUALLY AND COLLECTIVELY ADDRESS CONDITIONS ASSOCIATED WITH HEALTH OUTCOMES AND WITH PERFORMANCE OF THE ORGANIZATIONS INVOLVED IN THE PROCESS.THE HOUSING TO HEALTH PROGRAM IN THE DEPARTMENT OF PEDIATRICS AT BOSTON MEDICAL CENTER HAS SUCCESSFULLY DEPLOYED A MULTIDIMENSIONAL STRATEGY FOR RESPONDING TO A RANGE OF HOUSING AND HOMELESSNESS ISSUES AMONG PATIENT FAMILIES. IN 2021, THIS MODEL INCLUDED TWO FULL-TIME HOUSING NAVIGATORS WITH DEEP EXPERTISE IN SUPPORTING FAMILIES TO ACCESS HOUSING-RELATED PROGRAMS AND SOLUTIONS. THESE NAVIGATORS WORK CLOSELY WITH FAMILIES TO ENTER SHELTER, RESOLVE HOUSING QUALITY ISSUES, APPLY FOR RENTAL ASSISTANCE AND SUBSIDIZING HOUSING, AND CONNECT WITH LEGAL AND COMMUNITY-BASED SERVICES (IN ADDITION TO OTHER WRAPAROUND SUPPORTS). THE WORK OF THE NAVIGATORS WAS BOLSTERED IN 2021 BY KEY EXTERNAL PARTNERSHIPS WITHIN HOUSING TO HEALTH. SPECIFICALLY, FUNDED PARTNERSHIPS WITH METRO HOUSING BOSTON, FAMILYAID BOSTON AND MEDICAL-LEGAL PARTNERSHIP BOSTON (MLPB) SERVED TO ADDRESS A RANGE OF PATIENT FAMILY NEEDS. FOR EXAMPLE, METRO HOUSING CONNECTED BMC FAMILIES WITH RENTAL ASSISTANCE FOR ARREARAGES. FAMILYAID BOSTON WORKED WITH BMC FAMILIES TO ACCESS PRIORITY HOUSING VOUCHERS AND PROVIDE STABILIZATION SERVICES; THEY RECENTLY WORKED WITH BMC AND BOSTON CHILDREN'S HOSPITAL TO ESTABLISH THE HOSPITAL EMERGENCY HOUSING PROGRAM, WHICH OFFERS RAPID RESPONSE SHELTER OPTIONS FOR FAMILIES WITH NO SAFE SHELTERING OPTIONS WHO WOULD OTHERWISE BE FORCED TO STAY OVERNIGHT IN A LOCAL EMERGENCY ROOM. FINALLY, MLPB PROVIDED REGULAR LEGAL PROBLEM-SOLVING TRAININGS TO FRONTLINE STAFF WORKING WITH FAMILIES AS WELL AS CASE-SPECIFIC LEGAL CONSULTATION. CHRONIC DISEASES AND RISK FACTORSCANCER SUPPORT GROUPS: THROUGHOUT FY 2021, PROGRAM OFFERINGS TO PATIENTS/SURVIVORS WERE DELIVERED ALMOST ENTIRELY VIA ZOOM. OFFERINGS INCLUDED AN ARRAY OF SIXTEEN (16) MONTHLY SUPPORT GROUPS BY CANCER TYPE (E.G., BREAST, GI, HEAD & NECK); POPULATION TYPE (E.G., MEN, SPANISH-SPEAKING), OTHER DISEASE (E.G., SICKLE CELL, AMYLOIDOSIS); AND RELATED SUPPORT (E.G., OSTOMY, CAREGIVER, BEREAVEMENT). ALSO PROVIDED TO ALL CLIENTS WERE FIVE (5) ONGOING SUPPORT ACTIVITIES FOR MIND/HAND/BODY/NUTRITION THAT MET WEEKLY TO MONTHLY. ADDITIONALLY, EACH QUARTER SAW A VARIETY OF FOUR TO SIX (4-6) FEATURED PROGRAMS IN ART/THEATER/MUSIC. ONE OF THESE FEATURED PROGRAMS SPANNED FIVE MONTHS AND PRODUCED A PROFESSIONALLY-SHOT VIDEO AND A HARDCOVER BOOK SAMPLING PARTICIPANTS' ARTWORK AND CULMINATED WITH A PUBLIC CELEBRATION. THE CANCER & SICKLE CELL SUPPORT PROGRAMS ALSO PROVIDED A FREE WEEKLY ACUPUNCTURE CLINIC FOR PATIENTS CURRENTLY OR RECENTLY IN TREATMENT.ALL PROGRAMS WERE MANAGED AND IMPLEMENTED BY THE PROGRAM MANAGER AND ONE PROGRAM ASSISTANT; TWO IN-HOUSE SOCIAL WORKERS WHO EACH FACILITATED ONE OF THE REGULAR MONTHLY GROUPS; A HIGHLY EXPERIENCED LICENSED ACUPUNCTURIST; BMC REGISTERED DIETITIANS FOR A MONTHLY CLASS; AND SEVERAL OUTSIDE VENDORS CONTRACTED FOR THE FEATURED ART PROGRAMS. BECAUSE OF INCREASED REFERRALS OF PATIENTS TO THE PROGRAM, NUMBERS IN TERMS OF PARTICIPATION LEVEL REMAINED CONSISTENT WITH PREVIOUS YEARS DESPITE SOME EFFECT OF ZOOM FATIGUE AND ZOOM AVERSION. BECAUSE THE PROGRAMS RAN ALMOST ENTIRELY BY ZOOM, SECONDARY COSTS SUCH AS FOR FOOD AND SUPPLIES WERE VERY MINIMAL COMPARED TO THE YEARS BEFORE THE COVID PANDEMIC, WHEN MEETINGS WERE ALL HELD IN PERSON.PATIENT NAVIGATION (PN): BMC'S PN PROGRAM WAS LAUNCHED IN 2005. THE MAIN FOCUS OF THIS PROGRAM IS TO IDENTIFY AND OVERCOME BARRIERS THAT PLAY A KEY ROLE IN A PATIENT'S TREATMENT COMPLIANCE AND COMPLETION. PATIENT NAVIGATORS DO THIS BY PROVIDING ADVOCACY AND CASE MANAGEMENT TO ONCOLOGY PATIENTS WHO HAVE AT LEAST ONE IDENTIFIED BARRIER TO CARE AND ARE UNDERGOING ACTIVE CANCER TREATMENT. PNS WORK TO EMPOWER PATIENTS BY LINKING THEM TO A BROAD RANGE OF SERVICES INCLUDING, BUT NOT LIMITED TO, ONCOLOGY SUPPORT SERVICES, TRANSPORTATION, FINANCIAL ASSISTANCE, AND APPROPRIATE COMMUNITY RESOURCES.VIOLENCECHILD WITNESS TO VIOLENCE PROJECT (CWVP): CWVP IS A NATIONALLY-RECOGNIZED AND AWARD-WINNING MENTAL HEALTH COUNSELING, OUTREACH, AND CONSULTATION PROGRAM. CWVP SPECIALIZES IN INTERVENTION WITH VERY YOUNG CHILDREN EXPOSED TO DOMESTIC OR COMMUNITY VIOLENCE. THE PROGRAM OFFERS BOTH SHORT- AND LONG-TERM EVIDENCE-BASED TREATMENTS THAT REPRESENT BEST PRACTICE IN SERVING THE NEEDS OF TRAUMATIZED CHILDREN AND THEIR FAMILIES. THE PROGRAM PROVIDES A FLEXIBLE COMBINATION OF SERVICES, INCLUDING RESOURCE ADVOCACY, AND IT LINKS FAMILIES TO BASIC SERVICES SUCH AS HEALTH CARE, CHILDCARE, HOUSING, AND AFTER-SCHOOL PROGRAMS. THE CWVP PROVIDED REFERRALS, ADVOCACY, ASSESSMENT, SHORT-TERM, AND/OR LONGER-TERM CLINICAL CARE TO APPROXIMATELY 400 FAMILIES IN FY21. IN ADDITION TO ITS CLINICAL SERVICES, CWVP IS ENGAGED IN EXTENSIVE LOCAL, STATEWIDE, AND NATIONAL TRAINING EFFORTS TO RAISE THE STANDARD OF CARE FOR YOUNG CHILDREN EXPERIENCING THE TRAUMATIC EFFECTS OF VIOLENCE. THE STAFF HAVE DELIVERED NUMEROUS TRAININGS ACROSS MULTIPLE STATES AND ABROAD TO MENTAL HEALTH AND OTHER PROVIDERS ACROSS SERVICE SECTORS AND SETTINGS. SCHEDULE H, PART VI, LINE 5 (CONTINUATION): COMMUNITY VIOLENCE RESPONSE TEAM (CVRT): THE CVRT ADDRESSES THE GREAT NEED FOR SERVICES FOR VICTIMS OF COMMUNITY VIOLENCE AND THEIR FAMILIES, AS WELL AS FAMILY SURVIVORS OF HOMICIDE VICTIMS FROM THE GREATER BOSTON AREA. FREE, CULTURALLY SENSITIVE, FAMILY-FOCUSED CLINICAL SERVICES PROVIDED BY THE CVRT INCLUDE CRISIS INTERVENTION, ADVOCACY, CASE MANAGEMENT, AND TRAUMA-FOCUSED COUNSELING FOR ADULTS, ADOLESCENTS, AND CHILDREN (WITH A FOCUS ON AGE EIGHT AND OVER). CVRT SEEKS TO REDUCE THE EFFECTS OF TRAUMA BY PROVIDING THERAPEUTIC SUPPORT THROUGHOUT THE RECOVERY PROCESS AND ULTIMATELY MINIMIZING MENTAL HEALTH TRAUMA. CVRT STAFF REFLECTS THE DIVERSITY OF BMC'S PATIENT POPULATION. IN FY21 THE CVRT SERVED 1,146 PEOPLE.DOMESTIC VIOLENCE PROGRAM (DVP): THE DVP PROVIDES DIRECT ADVOCACY SERVICES FOR VICTIMS OF DOMESTIC VIOLENCE, AS WELL AS TRAINING AND EDUCATION FOR STAFF, STUDENTS, AND COMMUNITY GROUPS INTERESTED IN LEARNING MORE ABOUT DOMESTIC VIOLENCE, ITS IMPACT ON HEALTH ACROSS THE LIFESPAN, AND THE ROLE WE ALL CAN PLAY IN ADDRESSING IT. IN FY21 THE MULTI-LINGUAL TEAM OF 4 SAFETY AND SUPPORT ADVOCATES ASSISTED 384 VICTIMS AND SURVIVORS WITH A RANGE OF SERVICES INCLUDING CRISIS INTERVENTION/COUNSELING; RISK ASSESSMENT AND SAFETY PLANNING; ASSISTANCE WITH ACCESSING PROTECTIVE ORDERS AND VICTIM COMPENSATION; ACCOMPANIMENT TO COURT, LEGAL, MEDICAL, HOUSING AND OTHER APPOINTMENTS; REFERRAL TO COMMUNITY-BASED DV ADVOCACY/RAPE CRISIS COUNSELING, MEDICAL/MENTAL HEALTH SERVICES; EMERGENCY FINANCIAL ASSISTANCE; AND OTHER SUPPORT AS NEEDED. OF THOSE SERVED, 71% WERE PATIENTS REFERRED BY BMC PROVIDERS, 4% WERE BMC EMPLOYEES, AND 25% WERE SELF-REFERRALS OR REFERRED BY COMMUNITY AND GOVERNMENT PROGRAMS THAT ASSIST DV SURVIVORS.DURING FY21 THE DV PROGRAM MAINTAINED AN ON-SITE PRESENCE, WITH A HYBRID MODEL OF STAFFING ALLOWING FOR ADVOCATES TO MAINTAIN ADEQUATE AND COMFORTABLE SPACING IN THE OFFICE WHEN MEETING WITH CLIENTS, AS WELL AS TO MAINTAIN THE CAPACITY TO WORK FROM HOME. WE ALSO BEGAN OFFERING SUPPORT GROUPS IN ENGLISH AND SPANISH VIA ZOOM, WHICH HAVE BEEN WELL ATTENDED AND WELL RECEIVED. THE PROGRAM SAW AN INCREASE IN COVID-RELATED NEEDS FOR BASIC ASSISTANCE WITH FOOD, HOUSING, TRANSPORTATION, AND MANY OTHER FORMS OF EMERGENCY FINANCIAL ASSISTANCE. THE DV PROGRAM MANAGER CONTINUED PROVIDING ROUTINE ORIENTATION SESSIONS WITH NEW STAFF AND INTERNS FROM SEVERAL DISCIPLINES/DEPARTMENTS THROUGHOUT THE YEAR, SOME IN PERSON AND SOME CONTINUING VIA ZOOM FORMAT. VIOLENCE INTERVENTION ADVOCACY PROGRAM (VIAP): CONCEIVED IN 2006 TO HELP STEM THE TIDE OF BOSTON'S GUN AND KNIFE VIOLENCE, VIAP HAS BECOME A VITAL COMPONENT OF VIOLENCE INTERVENTION IN THE CITY AND BEYOND. VIAP'S PURPOSE IS TO HELP VICTIMS HEAL SO THEY CAN AVOID FUTURE VIOLENCE AND BUILD A POSITIVE FUTURE. TO ACCOMPLISH THIS, PATIENT VICTIMS AND THEIR FAMILIES ARE PAIRED WITH A TEAM COMPRISED OF A CASE MANAGER, A MENTAL HEALTH CLINICIAN, AND A FAMILY SUPPORT ADVOCATE TO HELP THEM OVERCOME BARRIERS AND TURN THEIR LIVES AROUND. A POWERFUL VIAP INNOVATION IS THAT THE INTERVENTION WITH THE PATIENT BEGINS IN THE SAFETY OF THE HOSPITAL, WHERE THEY ARE VISITED BY A VIOLENCE INTERVENTION ADVOCATE WITHIN 48 HOURS OF ADMISSION TO INITIATE CASE MANAGEMENT, TAKING ADVANTAGE OF THE "TEACHABLE MOMENT" ASSOCIATED WITH VIOLENT INJURY. AS THE VICTIM HEALS, THE VIAP TEAM CONTINUES A COMPREHENSIVE TREATMENT PROGRAM THAT INCLUDES SAFETY PLANNING, COUNSELING, JOB AND EDUCATIONAL TRAINING, MENTAL HEALTH, AND FAMILY SUPPORT SERVICES. VIAP HAS SEEN A SHARP INCREASE IN THE DEMAND FOR SERVICES DURING FY21. (IT IS SIGNIFICANT TO NOTE THAT BMC RECEIVES 70% OF THE CITY'S GUNSHOT AND STABBING VICTIMS.) DURING THIS PERIOD 382 VICTIMS WERE SERVED, INCLUDING 185 GUNSHOT AND 197 STABBING VICTIMS. THERE WERE 286 FAMILY MEMBERS SERVED THROUGH OUR FAMILY SUPPORT COMPONENT, AS WELL AS 27 FAMILIES OF HOMICIDE VICTIMS. SURVIVORS RECEIVED A SPECTRUM OF SERVICES, INCLUDING EMPLOYMENT HELP (330 SERVICES PROVIDED AND 21 NEW JOBS OBTAINED); BEHAVIORAL AND MENTAL HEALTH CARE (80% IN SHORT-TERM THERAPY AND 40% IN LONG TERM); AND LEGAL ASSISTANCE. VIAP ASSISTED WITH HOUSING APPLICATIONS; EDUCATION (4 OBTAINED THEIR HISET AND 5 COMPLETED JOB TRAINING). MEDICAL ASSISTANCE INCLUDED ACCESSING PRIMARY CARE, PT, REHABILITATION, NURSING SERVICES (FOR 117 VICTIMS), SUBSTANCE USE AND MEDICATION MANAGEMENT. ADDITIONAL ASSISTANCE INCLUDED HELP WITH FOOD INSECURITY, TRANSPORTATION, OBTAINING A DRIVER'S LICENSE, SOCIAL SECURITY CARD, AND REGISTERING TO VOTE. VIAP'S STAFF WELLNESS PROGRAM HAS INCLUDED TRAININGS, TEAM BUILDING, AND OTHER ESSENTIAL SUPPORTIVE RESOURCES. MENTAL HEALTH AND SUBSTANCE USE DISORDERMENTAL HEALTH DIVERSION INITIATIVE (MHDI) OR CRIMINAL JUSTICE DIVERSION PROGRAM (DMH): OVER THE COURSE OF FY21, BOSTON MEDICAL CENTER'S MENTAL HEALTH COURT PROGRAM SERVED CLIENTS IN THREE BOSTON MUNICIPAL COURTS, BMC CENTRAL DIVISION, WEST ROXBURY DISTRICT COURT AND ROXBURY DISTRICT COURT. OVER THAT TIME, WITHIN BMC CENTRAL THERE WERE 125 CLIENTS SERVED, 65 OF WHOM WERE NEW REFERRALS AND 60 OF WHOM WERE CARRIED OVER FROM FY20. A TOTAL OF THIRTY SIX CLIENTS MET ALL REQUIREMENTS AND GRADUATED FROM THE PROGRAM. ON AVERAGE, BMC CENTRAL RECEIVES THREE NEW REFERRALS EACH WEEK.IN WEST ROXBURY THERE WERE A TOTAL OF TWENTY NINE NEW REFERRALS, BRINGING THE TOTAL NUMBER OF CLIENTS SERVED UP TO SIXTY NINE, WITH FORTY CLIENTS BEING CARRIED OVER FROM FY20. A TOTAL OF TWENTY THREE CLIENTS GRADUATED. THE WEST ROXBURY DIVISION RECEIVES ON AVERAGE FIVE NEW REFERRALS A MONTH. IN ROXBURY, A TOTAL OF NINE CLIENTS GRADUATED. OF NOTE, A FULLTIME CLINICIAN WAS HIRED FOR THE ROXBURY COURT AND SINCE THAT TIME, REFERRALS HAVE INCREASED EXPONENTIALLY WHICH WILL BE REFLECTIVE IN THE FY22 DATA. CUMULATIVELY, AT THE END OF THE FISCAL YEAR THERE WERE APPROXIMATELY 15 PENDING REFERRALS. ON AVERAGE, MENTAL HEALTH COURT CLIENTS ARE SEEN IN SESSION ONCE MONTHLY, THOUGH EACH CLIENT'S ACUITY IS TAKEN INTO CONSIDERATION WHEN SCHEDULING THEIR FOLLOWING APPEARANCE AND CLIENTS CAN BE SEEN SOONER IF APPROPRIATE. IN BMC CENTRAL AND WEST ROXBURY THIS MEANS THAT THERE MIGHT BE UPWARDS OF 12-15 CLIENTS APPEARING BEFORE THE JUDGE AT EACH WEEKLY SESSION.*OVERALL NUMBERS (REFERRALS AND TOTAL PARTICIPANTS) MAY BE LOWER THAN PREVIOUS YEARS, DUE TO THE COVID-19 PANDEMIC, WHICH OCCURRED MID-MARCH THROUGH THE END OF THIS FISCAL YEAR.FASTER PATHS: FASTER PATHS RAPIDLY EVALUATES, MOTIVATES, AND REFERS PATIENTS WITH SUBSTANCE USE DISORDERS TO A COMPREHENSIVE CARE NETWORK OF INPATIENT AND OUTPATIENT DETOXIFICATION, TREATMENT, AND AFTERCARE SERVICES INTEGRATED WITH MENTAL HEALTH AND MEDICAL CARE. THE GOAL OF FASTER PATHS IS TO INCORPORATE AND BUILD UPON THE EXISTING SUBSTANCE USE SERVICES PROVIDED BY BMC, FILLING THE GAPS IN CARE TO CREATE A SEAMLESS CONTINUUM. BACKED BY 24/7 ACCESS VIA THE BMC EMERGENCY DEPARTMENT (ED), FASTER PATHS ENHANCES EXISTING CAPACITY TO: TRIAGE PATIENTS INTO MEDICAL CARE; PROVIDE MEDICAL AND PSYCHIATRIC EXAMINATIONS TO MATCH PATIENTS WITH THE RIGHT LEVEL OF CARE; AND ENSURE ACCESS TO MEDICATION THERAPY. LICENSED ALCOHOL AND DRUG COUNSELORS FROM BMC'S PROJECT ASSERT FROM 8 AM TO 12 AM DAILY PROVIDE INTAKE, PSYCHO-SOCIAL ASSESSMENTS, AND REFERRALS TO AN ARRAY OF ADDICTION TREATMENT SERVICES AND SHELTERS, OVERDOSE PREVENTION EDUCATION AND NALOXONE, HARM REDUCTION SERVICES, AND TRANSPORTATION. THE RAPID ACCESS PROGRAM'S TEAM OF RECOVERY COACHES AND ADDICTION COUNSELORS PROVIDE SAME-DAY ACCESS AND SUPPORT TO HELP PATIENTS ACCESS EVIDENCE-BASED TREATMENT. A KEY FEATURE OF THE CENTER IS WEEKDAY ACCESS TO MEDICATION FOR ADDICTION TREATMENT (MAT) IN THE FASTER PATHS OUTPATIENT CLINIC. ADDICTION NURSES OVERSEE THE OFFICE INITIATION OF MAT, INCLUDING BUPRENORPHINE/NALOXONE INDUCTION AND INJECTABLE NALTREXONE, WITH MONDAY-FRIDAY BUPRENORPHINE/NALOXONE ADMINISTRATION AVAILABLE FOR PATIENTS WHO NEED MAT AND ARE AWAITING PLACEMENT IN AN OBAT OR A METHADONE MAINTENANCE PROGRAM. BOSTON PUBLIC HEALTH COMMISSION'S (BPHC'S) PAATHS (PROVIDING ACCESS TO ADDICTION TREATMENT, HOPE, AND SUPPORT) RECOVERY NAVIGATOR ASSIST WITH LINKAGES TO EXTERNAL MAT PROGRAMS AND OTHER COMMUNITY SERVICES. 95 PATIENTS WERE INITIATED ON MEDICATIONS/ MAT AND OF THESE, 117 WERE TRANSFERRED TO MAINTENANCE PROGRAMS, AND 207 WERE PLACED AND TRANSPORTED TO ACUTE TREATMENT PROGRAMS/DETOX. IN FY2021, FASTER PATHS SERVED 1227 UNIQUE PATIENTS FOR 4008 CLINICAL VISITS. THE SUCCESS OF THE FASTER PATHS MODEL HAS INSPIRED REPLICATION IN OTHER BRIDGE CLINICS, INCLUDING THE TRANSITIONAL CARE CENTER AT 891 MASSACHUSETTS AVENUE IN CONJUNCTION WITH LOW-THRESHOLD HOUSING. SCHEDULE H, PART VI, LINE 5 (CONTINUATION): ALCOHOL & SUBSTANCE ABUSE SERVICES, EDUCATION, AND REFERRAL TO TREATMENT (PROJECT ASSERT): PROJECT ASSERT WAS ESTABLISHED IN 1994 TO PROVIDE GREATER ACCESS TO SUBSTANCE USE TREATMENT IN THE EMERGENCY DEPARTMENT (ED) SETTING AND HAS EXPANDED TO INCLUDE A VARIETY OF SOCIAL AND COMMUNITY HEALTHCARE SUPPORT SERVICES. BASED IN THE ED, PROJECT ASSERT COUNSELS PATIENTS WHOSE ALCOHOL AND/OR DRUG USE WAS DIRECTLY AND INDIRECTLY IMPLICATED IN THEIR NEED FOR EMERGENCY SERVICES. LICENSED ALCOHOL AND DRUG COUNSELORS (LADCS) CONSULT AND COLLABORATE WITH HOSPITAL STAFF TO OFFER ED PATIENTS ALCOHOL AND DRUG SCREENING, BRIEF INTERVENTION, COUNSELING ON TREATMENT OPTIONS AND REFERRALS TO HEALTH AND SOCIAL RESOURCES SUCH AS SUD TREATMENT AND PRIMARY CARE SERVICES. DURING THE BMC FY21, PROJECT ASSERT SERVED 1712 WHOM HAD 3289 LADC VISITS. BASED ON SCREENING AND PATIENT PREFERENCE FOR TREATMENT, THE FOLLOWING SERVICES WERE PROVIDED: 713 UNIQUE PATIENTS WERE PLACED IN DETOX/ACUTE TREATMENT SERVICES AND BECAUSE OF MULTIPLE VISITS THERE WERE A TOTAL OF 1204 DETOX PLACEMENT AMONG THESE PATIENTS); 1029 UNIQUE PATIENTS WERE REFERRED TO NA/AA; 774 WERE PROVIDED WITH TRANSPORTATION SERVICES. SHELTER SERVICES WERE PROVIDED DURING 242 VISITS. PROJECT ASSERT LADCS ALSO EDUCATED PATIENTS AT RISK FOR OPIOID OVERDOSE AND DISTRIBUTED 1007 NALOXONE RESCUE KITS TO PATIENTS AND 671 WERE OFFERED AND REFUSED. A TOTAL OF 1552 PATIENTS RECEIVED OVERDOSE EDUCATION ON HOW TO RECOGNIZE AND PREVENT AN OPIOID OVERDOSE. IN ADDITION, 175 PATIENTS WERE REFERRED AND SEEN IN OUR MAT MEDICATION FOR ADDICTION TREATMENT CLINIC. SUPPORTING OUR FAMILIES THROUGH ADDICTION AND RECOVERY (SOFAR): THE GOAL OF SOFAR IS TO CREATE A MEDICAL HOME IN THE PEDIATRIC PRIMARY CARE CLINIC FOR MOTHERS IN RECOVERY AND THEIR CHILDREN. SOFAR HOUSES A MULTIDISCIPLINARY TEAM OF PHYSICIANS, SOCIAL WORKERS, PATIENT NAVIGATORS, NURSE PRACTITIONERS, AND COORDINATORS WHO PROVIDE HIGH-QUALITY, COORDINATED MEDICAL AND PSYCHOSOCIAL CARE FOR FAMILIES TO MAXIMIZE THEIR ABILITY TO SUCCESSFULLY NAVIGATE PARENTING AND SUBSTANCE USE RECOVERY. SOFAR EXPANDS ON THE MULTIDISCIPLINARY PRENATAL CARE PROVIDED BY PROJECT RESPECT FOR PREGNANT WOMEN WITH OPIOID USE DISORDER. SOFAR PROVIDES ONGOING SUPPORT FOR FAMILIES TO ENHANCE CHILD DEVELOPMENT AS WELL AS ONGOING SUPPORT FOR RECOVERY, WITH ACCESS TO SPECIALTY CARE AND SOCIAL SERVICES. IN FY21, SOFAR SERVED 196 FAMILIES, WITH 266 MOTHER-CHILD DYADS. VACCINATION UPTAKE: EARLY IN ITS TRAJECTORY, THE COVID-19 PANDEMIC REVEALED GROSS INEQUITIES IN THE UPTAKE OF VACCINATIONS BY BLACK AND LATINX PEOPLE ACROSS THE US, WITH DEADLY CONSEQUENCES. BETWEEN DECEMBER 2020 AND NOVEMBER 2021, BMC LED LOCAL EFFORTS TO CLOSE THESE DISPARITIES IN BOSTON BY IMPLEMENTING COMMUNITY-BASED VACCINATION SITES IN CHURCHES AND COMMUNITY CENTERS, ORGANIZING MOBILE VACCINATION EVENTS AT SCHOOLS, GROCERY STORES AND COMMUNITY EVENTS, AND PROVIDING VACCINE ACCESS AS WELL AS HEALTH EDUCATION TO RESIDENTS OF THE CITY'S MOST IMPOVERISHED NEIGHBORHOODS. BMC ESTABLISHED SEVEN COMMUNITY-BASED VACCINATION CLINICS AND CONDUCTED 99 INDIVIDUAL MOBILE VACCINATION EVENTS IN ADDITION TO VACCINATION OPPORTUNITIES ON THE MEDICAL CAMPUS TO REACH THE HEALTH EQUITY GOALS IN HISTORICALLY DISINVESTED COMMUNITIES. THE VACCINATION PROGRAM ADMINISTERED OVER 100,000 FIRST DOSES. THESE EVENTS WERE CRITICAL IN PROVIDING ACCESS TO VACCINES IN LOCATIONS WITH THE HIGHEST SOCIAL VULNERABILITY INDEX (SVI), IDENTIFIED USING THE US CENSUS DATA INCLUDING SOCIOECONOMIC STATUS, HOUSEHOLD COMPOSITION AND DISABILITY, SOCIAL/ECONOMIC MINORITY STATUS, LANGUAGE, UNEMPLOYMENT, AND OTHER FACTORS AFFECTING COMMUNITY HEALTH. TO BUILD CONFIDENCE IN COVID-19 VACCINES AND IN THE HEALTHCARE SYSTEM, BMC PARTNERED WITH AFFILIATED HEALTH CENTERS, COMMUNITY PARTNERS, STATE AND LOCAL HEALTH DEPARTMENTS, AND THE COMMONWEALTH OF MASSACHUSETTS. BOSTON MEDICAL CENTER (BMC) SUCCESSFULLY IMPLEMENTED A ROBUST MOBILE COVID-19 VACCINATION ACCESS AND OUTREACH PROGRAM FOCUSED ON ENSURING EQUITABLE ACCESS TO THE VACCINE AND THAT COMMUNITIES COULD BE VACCINATED IN PLACES THAT THEY KNOW AND TRUST. IN ORDER TO MAXIMIZE THE IMPACT OF OUR OUTREACH RESOURCES, BMC MAPPED ADDRESSES OF UNVACCINATED BMC PATIENTS TO IDENTIFY "HOTSPOTS" OF VACCINE HESITANCY. BMC LEVERAGED RELATIONSHIPS WITH EXISTING COMMUNITY PARTNERS AND FORMED PARTNERSHIPS WITH NEW ONES. THESE COLLABORATIONS ENABLED INCREASED ACCESS TO VACCINES FOR COMMUNITIES IN NEED AND THE SUCCESSFUL IMPLEMENTATION OF HIGH-TOUCH OUTREACH, EDUCATION, AND VACCINATION "POP UP" EVENTS. THE BMC MOBILE COVID-19 VACCINATION TEAM BROUGHT VACCINATION APPOINTMENTS DIRECTLY TO PATIENTS' NEIGHBORHOODS THROUGH "POP UP" EVENTS, CURBSIDE VACCINATIONS, AND HOME-BASED VACCINATIONS.BMC RAN MORE THAN 175 MOBILE, "POP-UP" VACCINATION EVENTS FROM JULY THROUGH DECEMBER 2021 IN BROCKTON AND BOSTON. EVENTS IN BROCKTON INCLUDED PARTNERSHIPS WITH CHURCHES, COMMUNITY HEALTH CENTERS, AND NUMEROUS AMBULANCE CURBSIDE VACCINATIONS. AS THESE EVENTS WERE HELD IN CONVENIENT LOCATIONS WITHIN THE RESPECTIVE COMMUNITIES, INCLUDING COMMUNITY ORGANIZATIONS, CHURCHES, AND SCHOOLS, AND WITH THE SUPPORT OF BMC'S COMMUNITY VACCINE NETWORK WHICH HELPED PATIENTS TO SECURE VACCINE APPOINTMENTS, OUR EFFORTS WERE HIGHLY EFFECTIVE IN REMOVING BARRIERS TO VACCINATION. VACCINE UPTAKE IN COMMUNITIES DISPROPORTIONALLY IMPACTED BY THE PANDEMIC IMPROVED FOLLOWING THE VACCINATION PROGRAM. BETWEEN JULY 15TH AND DECEMBER 4TH, BMC'S MOBILE VACCINATION EFFORTS ADMINISTERED 4,337 DOSES OF THE COVID-19 VACCINE. OF THE 1,844 FIRST DOSE VACCINES ADMINISTERED, 68% WERE GIVEN TO PEOPLE IN THE TOP THREE SOCIAL VULNERABILITY INDEX (SVI) DECILES AND 55% WERE ADMINISTERED TO BLACK (32%) AND LATINX (23%) PATIENTS. BMC'S MOBILE VACCINATION TEAM WAS COMPRISED OF MULTILINGUAL AND MULTICULTURAL REGISTERED NURSES FROM THE LOCAL COMMUNITY WHO WERE ABLE TO COMMUNICATE WITH PATIENTS IN THEIR PREFERRED LANGUAGES AND EFFECTIVELY ADDRESS VACCINE HESITANCY, PROVIDE CULTURALLY COMPETENT EDUCATION, AND NAVIGATE PATIENTS TO THE POP-UP EVENTS AND VACCINATION SITES. THESE NURSES WERE ABLE TO FACILITATE PATIENT-CENTERED CONVERSATIONS AND DEVELOP RAPPORT, CREATING SPACE FOR PATIENTS TO OPEN UP ABOUT THEIR CONCERNS AND PAST HEALTHCARE TRAUMAS. AS FEATURED IN A SCHOLARLY ARTICLE IN MAY OF 2022 IN THE ANNALS OF INTERNAL MEDICINE, THE BMC VACCINATION INITIATIVE HAS SHOWN THE IMPORTANCE OF HAVING LEADERSHIP AND WORKFORCE COMMITMENT TO HEALTH EQUITY AND COMMUNITY ENGAGEMENT. AS A RESULT, BMC IS NOW PART OF THE COMMUNITY ENGAGED ALLIANCE OF THE NATIONAL INSTITUTES OF HEALTH, AIMED AT INCREASING VACCINE CONFIDENCE AND ENGAGEMENT IN RESEARCH. HOUSING AND ADDICTION TREATMENT: THE COLLIDING EPIDEMICS AND PANDEMICS OF HOMELESSNESS, OPIOID USE DISORDER (OUD), AND COVID-19 ALONGSIDE UPSTREAM HEALTH ISSUES AND CURRENT AND HISTORIC FLAWS IN HOUSING MODELSHAVE LED TO A PUBLIC HEALTH CRISIS AT MASS AND CASS (MASSACHUSETTS AVENUE AND MELNEA CASS BOULEVARD), A FEW BLOCKS FROM BOSTON MEDICAL CENTER. UNLIKE PRIOR ATTEMPTS TO DISPERSE THE ENCAMPMENTS OF PEOPLE EXPERIENCING HOMELESSNESS FINDING SUITABLE HOUSING AND ADDICTION TREATMENT OPTIONS WERE KEY PARTS OF THE LATEST STRATEGY.PART OF ADDRESSING THIS COMPLEX PUBLIC HEALTH CRISIS IS IDENTIFYING THE NEEDS OF THE PEOPLE WHO ARE EXPERIENCING HOMELESSNESS. THE PEOPLE WHO WERE SLEEPING AT MASS AND CASS WERE TYPICALLY PEOPLE WITH VERY HIGH RATES OF SUBSTANCE USE DISORDER AND CO-OCCURRING MENTAL HEALTH CONDITIONS, INCLUDING PSYCHOTIC DISORDERS AND HIGH RATES OF TRAUMA.BMC AND THE CITY OF BOSTON IMPLEMENTED AN ACTION-ORIENTED APPROACH TO ADDRESSING THE COMPLEX CRISIS AT MASS AND CASS. THE INITIATIVE INCLUDED TWO CLINICAL PROGRAMS AS WELL AS CRISIS HOUSING, CREATING A THREE-PRONGED APPROACH: TRANSITIONAL CARE CENTER (TCC), ALSO KNOWN AS A BRIDGE CLINIC; STABILIZATION CARE CENTER (SCC); AND LOW-THRESHOLD CRISIS HOUSING BEDS. THESE INITIATIVES FUNCTIONED IN CONJUNCTION OR INDIVIDUALLY, DEPENDING ON A PERSON'S NEEDS.THE TCC OPERATED AS AN URGENT CARE CENTER TO TREAT SUDINCLUDING STARTING MEDICATIONS FOR ADDICTIONMANAGING WITHDRAWAL, AND TREATING CO-OCCURRING ISSUES, SUCH AS ACUTE MENTAL HEALTH SYMPTOMS AND INCREASED RISK OF HIV AND HEPATITIS C.THE SCC FUNCTIONED AS A SORT OF TRIAGE CENTER FOR ACUTE NEEDS, SO THAT CLINICIANS COULD DETERMINE THE BEST PATH FOR THAT PERSON EXPERIENCING HOMELESSNESS. VISITS TO THE SCC WERE INTENDED TO BE SHORT-STAY, LESS THAN 24 HOURS, WHERE PEOPLE WERE STABILIZED AND OBSERVED IF THEY CAME IN WITH SYMPTOMS. BOTH THE TRANSITIONAL CARE AND STABILIZATION CARE CENTERS WERE CO-LOCATED WITH THE LOW-THRESHOLD HOUSING PROGRAM WITH APPROXIMATELY 60 BEDS. THE FACILITY OPERATED AS HOUSING, BUT UNLIKE TRADITIONAL SHELTER OPTIONS, IT PROVIDED STABILIZATION SERVICES TO SUPPORT ADDICTION RECOVERY. ULTIMATELY, PEOPLE WHO FOUND SHELTER AT THE FACILITY WERE TRANSITIONED INTO PERMANENT HOUSING. 1 WEILL MEDICAL COLLEGE OF RESEARCH ACCOUNTING DEPT 100 BROADWAY 8TH FL FL NEW YORK NY 10005 131623978 501(C)(3) 126335 SUBAWARD INSTITUTE FOR HEALTH &RECOVERY 349 BROADWAY CAMBRIDGE MA 02139 043086647 501(C)(3) 7940 SUBAWARD CAMBRIDGE HEALTH ALLIANCE MYSTIC CENTER 10 PRESIDENTS LANDING 5TH FLOOR MEDFORD MA 02155 043320571 501(C)(3) 149327 SUBAWARD HENNEPIN HEALTHCARE RESEARCH INSTITUTE 701 PARK AVENUE SUITE PP7700 MINNEAPOLIS MN 55415 411677920 501(C)(3) 68495 SUBAWARD BROCKTON AREA MULTI-SERVICES INC 10 CHRISTYS DR BROCKTON MA 02301 042562377 501(C)(3) 102645 SUBAWARD AMERICAN ACADEMY OF PEDIATRICS 141 NORTHWEST POINT BLVD ELK GROVE VILLAGE IL 600070747 362275597 501(C)(3) 143944 SUBAWARD RAND CORPORATION 1776 MAIN ST PO BOX 2138 SANTA MONICA CA 904072138 951958142 501(C)(3) 86005 SUBAWARD HARBOR HEALTH SERVICE INC 398 NEPONSET AVE DORCHESTER MA 02122 237100550 501(C)(3) 139010 SUBAWARD 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SUBAWARD THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON 700 FANNIN STREET HOUSTON TX 77030 741761309 115 71532 SUBAWARD REGENTS OF THE UNIV OF CALIFORNIA DBA U OF CALIFORNIA SAN DIEGO 9500 GILMAN DRIVE LA JOLLA CA 920930953 956006144 501(C)(3) 100352 SUBAWARD RHODE ISLAND HOSPITAL 593 EDDY STREET PROVIDENCE RI 029034926 050258954 501(C)(3) 53703 SUBAWARD EMORY UNIVERSITY OFFICE OF GRANTS CONTRACTS 1599 CLIFTON ROAD 4TH FL ATLANTA GA 30322 580566256 501(C)(3) 39928 SUBAWARD MCLEAN HOSPITAL CORPORATION 115 MILL ST BELMONT MA 024789106 042697981 501(C)(3) 201038 SUBAWARD ACADEMIC PEDIATRIC ASSOCIATION 6728 OLD MCLEAN VILLAGE DRIVE MCLEAN VA 22101 510202446 501(C)(3) 20698 SUBAWARD BROWN UNIVERSITY OFFICE OF CONTROLLER BOX J PROVIDENCE RI 02912 050258809 501(C)(3) 13276 SUBAWARD UNIVERSITY OF N CAROLINA OFFICE OF CONTRACTS GRANTS CB 1350 104 AIRPORT DRIVE SUITE 2200 CHAPEL HILL NC 275991350 566001393 501(C)(3) 390883 SUBAWARD MASS INSTITUTE OF TECHNOLOGY DBA DIVISION OF 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CHAUNCY STREET 7TH FLOOR BOSTON MA 02111 046001907 501(C)(3) 22232 SUBAWARD NORTHWESTERN UNIVERSITY 3-707 MAIL CODE S207 CHICAGO IL 606113008 362167817 501(C)(3) 26176 SUBAWARD BRANDEIS UNIVERSITY OFFICE OF GRANTS ADMIN MAILSTOP 116 WALTHAM MA 022549110 042103552 501(C)(3) 172200 SUBAWARD UNIVERSITY OF WISCONSIN SYSTEM 21 NORTH PARK STREET ROOM 6234 MADISON WI 537151218 391805963 170(C)(1) 33606 SUBAWARD NORTHEAST BEHAVIORAL HEALTH CO 199 ROSEWOOD DRIVE SUITE 250 DANVERS MA 01923 042777145 501(C)(3) 6790 SUBAWARD CODMAN SQUARE HEALTH CTR 637 WASHINGTON STREET DORCHESTER MA 02124 042678774 501(C)(3) 13223 SUBAWARD COMMONWEALTH OF MA DEPARTMENT OF PUBLIC HEALTH DIVISION OF FOOD & DRUGS 305 SOUTH STREET JAMAICA PLAIN MA 02130 046002284 115 725270 SUBAWARD THIRD SECTOR NEW ENGLAND INC 89 SOUTH STREET 7TH FLOOR BOSTON MA 02111 042261109 501(C)(3) 40358 SUBAWARD TUFTS UNIVERSITY 169 HOLLAND STREET SOMERVILLE MA 02144 042103634 501(C)(3) 384676 SUBAWARD ARKANSAS CHILDREN'S HOSPITAL RESEARCH 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IL 60607 262264895 501(C)(3) 9100 SUBAWARD STANFORD UNIVERSITY WELLMD CENTER 1520 PAGE MILL ROAD PALO ALTO CA 943045156 941156365 501(C)(3) 50618 SUBAWARD FLORIDA INTERNATIONAL UNIVERSITY 11200 SW 8TH STREET CSC319 MIAMI FL 33199 650177616 501(C)(3) 572217 SUBAWARD JEWISH VOCATIONAL SERVICES 105 CHAUNCY ST BOSTON MA 02111 042104357 501(C)(3) 40506 SUBAWARD PLYMOUTH COUNTY OUTREACH HOPE INC PO BOX 401 BRIDGEWATER MA 02333 460970650 501(C)(3) 622399 SUBAWARD WESTERN MASSACHUSETTS TRAINING 187 HIGH STREET SUITE 202 HOLYOKE MA 01040 237450656 501(C)(3) 370349 SUBAWARD CITY OF SALEM 93 WASHINGTON STREET SALEM MA 01970 046001413 501(C)(3) 350382 SUBAWARD SPANISH AMERICAN CENTER INC 112 SPRUCE STREET LEOMINSTER MA 01453 042761759 501(C)(3) 486264 SUBAWARD UNIVERSITY OF KENTUCKY RESEARCH FOUNDATION 109 KINKEAD HALL LEXINGTON KY 405060057 616033693 501(C)(3) 7618 SUBAWARD BERKSHIRE REGIONAL PLANNING COMMISSION 1 FENN STREET PITTSFIELD MA 01201 042430187 115 41800 SUBAWARD ACTION FOR EQUITY INC 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INC ACP DECISIONA 195 CARLTON ROAD WABAN MA 02468 271871373 501(C)(3) 153775 SUBAWARD NORTH SHORE HEALTH PROJECT 5 CENTER STREET GLOUCESTER MA 01930 222978638 501(C)(3) 50000 SUBAWARD GANDARA MENTAL HEALTH CENTER INC 147 NORMAN STREER WEST SPRINGFIELD MA 01089 042622756 501(C)(3) 21000 SUBAWARD AIDS SUPPORT GROUP OF CAPE COD 96-98 BRADFORD STREET PROVINCETOWN MA 02657 042908722 501(C)(3) 58742 SUBAWARD WAKE FOREST UNIV HEALTH SCIENCES MEDICAL CENTER BOULEVARD WINSTONSALEM NC 27157 223849199 501(C)(3) 55341 SUBAWARD BRIDGEWATER STATE UNIVERSITY 131 SUMMER STREET BRIDGEWATER MA 02325 043010428 501(C)(3) 31998 SUBAWARD TEEN CHALLENGE NEW ENGLAND 1311 MAIN STREET BROCKTON MA 02301 042401399 501(C)(3) 59513 SUBAWARD KULA NO NA PO'E HAWAII 2150 TANTALUS DRIVE HONOLULU HI 96813 990305781 501(C)(3) 45646 SUBAWARD 108 PART I, LINE 2: RESEARCH ADMINISTRATION USES INFOR CLOUSUITE FINANCIALS AND DASH BOARD GEAR REPORTING SYSTEMS TO MONITOR ALL GRANT FUNDING. IN ADDITION, PRINCIPLE INVESTIGATORS AND DEPARTMENT ADMINISTRATORS HAVE SYSTEM ACCESS SO THEY ARE ABLE TO REVIEW THEIR FUNDING AND EXPENDITURES REGULARLY. X X X X X X 0 1 0 0 0 0 0 1 0 KATHLEEN E WALSH PRESIDENT & CEO 1225640 0 788400 0 221525 0 19000 0 16988 0 2271553 0 0 0 ALASTAIR BELL SVP OPS & STRATEGY/COO 738680 0 483250 0 98369 0 102000 0 11299 0 1433598 0 60600 0 JENNIFER TSENG MD TRUSTEE 0 1005433 0 32970 0 2513 0 32970 0 6783 0 1080669 0 0 DAVID COLEMAN MD TRUSTEE 0 842931 0 32970 0 9839 0 32970 0 1927 0 920637 0 0 RAVIN DAVIDOFF MD SVP MEDICAL AFFAIRS AND CMO 515387 0 229950 0 71521 0 19950 0 45999 0 882807 0 0 0 CHARLES ORLANDO FORMER SVP/CFO/TREAS 491974 0 300000 0 7500 0 5864 0 34629 0 839967 0 0 0 LISA KELLY-CROSWELL SVP/CHRO 472813 0 171550 0 52251 0 69240 0 17551 0 783405 0 32130 0 NANCY GADEN SVP CHIEF NURSING OFFICER 443342 0 160600 0 45931 0 65730 0 41735 0 757338 0 28800 0 BOB BIGGIO SVP FACILITY & SUPT SVCS 422174 0 155125 0 31533 0 63975 0 50228 0 723035 0 16000 0 DAVID BECK SVP/CHIEF LEGAL COUNSEL/CLERK 418099 0 156950 0 58579 0 19950 0 37863 0 691441 0 0 0 NORMAN STEIN SVP CHIEF DEVELOPMENT OFFICER 398078 0 146000 0 54492 0 22800 0 44166 0 665536 0 0 0 JOE CAMILLUS SVP AMBULATORY & PRF SVC 371089 0 135050 0 38237 0 57538 0 43503 0 645417 0 22500 0 ARTHUR HARVEY VP/CIO 416151 0 119720 0 20270 0 49080 0 23395 0 628616 0 9200 0 JULIE JONCAS VP FINANCE 377444 0 102200 0 34513 0 35511 0 17620 0 567288 0 26067 0 TERRI NEWSOM SVP/CFO/TREASURER 206555 0 75000 0 7500 0 0 0 6385 0 295440 0 0 0 PART I, LINE 4B BOSTON MEDICAL CENTER PROVIDES A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO CERTAIN EXECUTIVES. AMOUNTS ARE CREDITED TO PARTICIPANTS' ACCOUNTS EACH YEAR. PLAN AMOUNTS ARE SUBJECT TO FORFEITURE AND PAYMENT ONLY IF CERTAIN CONDITIONS ARE MET, AS OUTLINED IN THE PLAN AGREEMENT. AMOUNTS VEST ON SPECIFIED DATES BASED ON CONTINUED EMPLOYMENT BUT NO LATER THAN THE EXECUTIVE'S SIXTY-SECOND BIRTHDAY. AMOUNTS ACCRUED IN THE PLAN ARE REPORTED IN SCHEDULE J, PART II, COLUMN C. THE FOLLOWING AMOUNTS BECAME VESTED AND WERE PAID TO THE FOLLOWING EXECUTIVES IN CALENDAR YEAR 2020: WALSH - $195,563 BECK - $50,310 BIGGIO - $23,359 BELL - $83,946 DAVIDOFF - $61,425 KELLY-CROSSWELL - $43,213 GADEN - $37,470 STEIN - $46,800 HARVEY - $12,385 CAMILLUS - $31,122 JONCAS - $27,109 BOSTON MEDICAL CENTER PROVIDED A 457(F) NONQUALIFIED DEFERRED COMPENSATION PLAN TO DAVID BECK, SENIOR VICE PRESIDENT, CHIEF LEGAL COUNSEL, AND CLERK OF BOSTON MEDICAL CENTER. DAVID BECK REACHED THE PLAN RETIREMENT AGE IN 2019 AND VESTED 100% IN THE PLAN. IN ADDITION, PURSUANT TO THE TERMS OF THE PLAN, ONCE THE PLAN PARTICIPANT REACHES THE PLAN RETIREMENT AGE, ALL FUTURE CONTRIBUTIONS ARE MADE IN CASH. ACCORDINGLY, THE REMAINING $50,310 WAS PAID TO DAVID BECK IN CASH IN 2020. BOSTON MEDICAL CENTER PROVIDED A SEPARATE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO KATHLEEN E. WALSH, PRESIDENT AND CEO AS OF MARCH 1, 2010. PURSUANT TO THE TERMS OF THE AGREEMENT, CERTAIN AMOUNTS WERE CREDITED TO THE PRESIDENT AND CEO'S ACCOUNT IN PRIOR YEARS. THESE AMOUNTS ARE SUBJECT TO FORFEITURE AND PAYMENT WILL BE MADE ONLY IF CERTAIN CONDITIONS ARE MET, AS OUTLINED IN THE AGREEMENT. FOR CALENDAR YEAR 2020 $195,563 WAS VESTED AND IS REFLECTED IN SCHEDULE J, PART II, COLUMN B(III). PART I, LINE 7 BMC HAS AN ANNUAL EXECUTIVE PERFORMANCE INCENTIVE PLAN. PERFORMANCE TARGETS AND PAYOUT METRICS ARE ESTABLISHED AND APPROVED BY THE COMPENSATION COMMITTEE AT THE BEGINNING OF EACH PERFORMANCE CYCLE. FISCAL YEAR 2020 PERFORMANCE BONUS PAYOUTS WERE APPROVED BY THE COMMITTEE AFTER IT REVIEWED THE 2020 PERFORMANCE RESULTS AGAINST PRE ESTABLISHED PERFORMANCE TARGETS, AND APPROVED THE FORMULA-BASED PAYOUTS ACCORDINGLY. A MDFA 2012 SERIES C 043431814 57583URP5 2012-06-04 117490498 REFUNDING OF 1998 BONDS 1 0 0 B MDFA 2015 SERIES D 043431814 57583U6Q6 2015-04-08 167471151 FINANCE CAPITAL PROJECTS 0 0 0 C MDFA 2016 SERIES E 043431814 57584XWT4 2016-09-22 203977951 FINANCE NEW PROJECTS 0 0 0 D MDFA 2017 SERIES F 043431814 57584X6Z9 2017-12-20 45272849 FINANCE CAPITAL PROJECTS 0 0 0 A 51830000 29775000 117498730 4416013 1684889 115813841 1 0 1 1 B 168001143 16313245 226325 2007935 150355290 201311 2016 0 0 1 1 C 3785000 206393981 1673571 29046728 175673681 2017 0 1 1 1 D 5435000 45971835 9238 272257 45690339 2019 0 0 0 1 B 0 1 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 C 0 1 1 1 1 1 0.00600 0.00600 0 0 1 D 0 1 1 1 1 1 0 0 1 A 1 0 0 1 AIG MATCHED FUNDING 27.190000000000 1 1 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 1 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 COLUMN A PART I(F): THE PRIOR BONDS WERE ISSUES ON JULY 8, 1998, BY THE MASSACHUSETTS HEALTH AND EDUCATIONAL FACILITIES AUTHORITY. PART II, LINE 3: THE DIFFERENCE BETWEEN TOTAL PROCEEDS IN PART II, LINE 3 AND THE ISSUE PRICE OF THE BOND ISSUE IS DUE TO INTEREST EARNED ON BOND PROCEEDS. PART II, LINE 4: DEBT SERVICE RESERVE FUND WAS FUNDED BY PROCEEDS OF THE PRIOR BONDS. PART II, LINE 13: SINCE THE PROCEEDS OF THE 2012 BONDS WERE USED FOR REFUNDING PURPOSES, THE YEAR OF SUBSTANTIAL COMPLETION IS NOT APPLICABLE. PART III: BECAUSE PROCEEDS OF THE BONDS WERE USED TO REFUND BONDS ISSUED BEFORE JANUARY 1, 2003, THE ISSUER IS NOT REQUIRED TO COMPLETE PART III. PART IV, LINE 1: THE MOST RECENT FIVE YEAR REBATE REPORT, DATED JULY 25, 2017, WAS PREPARED BY BLX GROUP, LLC. COLUMN B PART II, LINE 3: THE DIFFERENCE BETWEEN TOTAL PROCEEDS IN PART II, LINE 3 AND THE ISSUE PRICE OF THE BOND ISSUE IS DUE TO INTEREST EARNED ON BOND PROCEEDS. PART IV, LINE 2(C): THE MOST RECENT FIVE YEAR REBATE REPORT, DATED APRIL 27, 2020, WAS PREPARED BY BLX GROUP, LLC. COLUMN C: PART I(F): THE PRIOR BONDS WERE ISSUED ON JULY 1, 2008, BY THE MASSACHUSETTS HEALTH AND EDUCATIONAL FACILITIES AUTHORITY. PART II, LINE 3: THE DIFFERENCE BETWEEN TOTAL PROCEEDS IN PART II, LINE 3 AND THE ISSUE PRICE OF THE BOND ISSUE IS DUE TO INTEREST EARNED ON BOND PROCEEDS. PART IV, LINE 2(C): THE MOST RECENT FIVE YEAR REBATE REPORT, DATED OCTOBER 21, 2021, WAS PREPARED BY BLX GROUP, LLC. COLUMN D PART II, LINE 3: THE DIFFERENCE BETWEEN TOTAL PROCEEDS IN PART II, LINE 3 AND THE ISSUE PRICE OF THE BOND ISSUE IS DUE TO INTEREST EARNED ON BOND PROCEEDS. COLUMN A, PAGE 2 THE BONDS ARE PART OF A POOLED FINANCING (TOTAL PAR $101,485,000) AND THUS, EXCEPT FOR PART I, ONLY THE BORROWER'S ALLOCABLE PORTION OF $13,688,734 IS REPRESENTED. PART I(F): THE BORROWER'S PORTION OF THE BONDS REFINANCED THE PORTION OF THE ISSUER'S SERIES M3-B (2005) BONDS (ISSUES ON OCTOBER 3, 2005) ALLOCABLE TO THE BORROWER. PART II, LINE 4: THE RESERVE HAS BEEN FUNDED BY THE PROCEEDS OF THE PRIOR BONDS. PART II, LINE 13: SINCE THE PROCEEDS OF THE BONDS WERE USED FOR REFUNDING PURPOSES, THE YEAR OF SUBSTANTIAL COMPLETION IS NOT APPLICABLE. PART IV, LINE 2(B): BOND PROCEEDS WERE EXPENDED TO FINANCE A CURRENT REFUNDING, WHICH HAS MET AN EXCEPTION TO THE REBATE REQUIREMENT. THE BOND PROCEEDS WERE SPENT WITHIN SIX MONTHS OF THE ISSUE DATE. A MHEFA 2009 SERIES O-1 042456011 57586ELD1 2009-08-04 101485000 REFUNDING OF SERIES M3-B 0 0 0 A 7969185 13688734 56948 13688734 1 0 1 1 A 0 0 1 1 0 0 0 1 A 0 0 1 1 1 0 0 0 1 A 1 HANNAH LEAVER DAUGHTER OF TRUSTEE 248420 EMPLOYMENT 0 SCHEDULE L, PART IV: BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS:HANNAH LEAVER, DAUGHTER OF TRUSTEE MARKS, IS EMPLOYED BY BMC. LEAVER HAS BEEN EMPLOYED BY BMC SINCE BEFORE TRUSTEE MARKS JOINED THE BMC BOARD IN 2016. X 53019 DONOR ESTIMATE X 29 1040198 DONOR ESTIMATE X 3 164156 DONOR ESTIMATE X MISCELLANEOUS 3 81745 DONOR ESTIMATE X GIFT CERTIFICATE 5 8418 DONOR ESTIMATE 0 1 0 SCHEDULE M, PART I, COLUMN B: THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS CONTRIBUTED. FORM 990, PART IV, LINE 12 BOSTON MEDICAL CENTER IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR BMC HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 2 RITA NIEVES KATHLEEN E. WALSH BISOLA OJIKUTU, M.D. BUSINESS RELATIONSHIP - THE OFFICERS AND/OR TRUSTEES ABOVE ARE ALSO TRUSTEES AND/OR EMPLOYEES OF THE BOSTON PUBLIC HEALTH COMMISSION. DAVID COLEMAN, M.D. MELANIE FOLEY JENNIFER TSENG, M.D. KATHLEEN E. WALSH BUSINESS RELATIONSHIP - THE OFFICERS AND/OR TRUSTEES ABOVE ARE ALSO TRUSTEES OF BOSTON MEDICAL CENTER INSURANCE COMPANY, LTD. MARTHA SAMUELSON PIERRE CREMIEUX BUSINESS RELATIONSHIP - THE TRUSTEES ABOVE ARE ALSO TRUSTEES, OFFICERS, AND/OR EMPLOYEES OF ANALYSIS GROUP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS BMC HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7B BMC HEALTH SYSTEM HAS THE RIGHT TO TAKE CERTAIN ACTIONS INCLUDING, BUT NOT LIMITED TO, THE APPROVAL OF BUDGETS, MERGERS, ACQUISITIONS, AND INDEBTEDNESS. FORM 990, PART VI, SECTION B, LINE 11B BOSTON MEDICAL CENTER'S FORM 990 IS PREPARED BY KPMG LLP AND REVIEWED BY BMC'S INTERNAL MANAGEMENT. FOLLOWING THAT REVIEW, BMC'S INTERNAL MANAGEMENT AND KPMG PRESENT THE FORM 990 TO THE AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW AND COMMENT. THE COMPLETED FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO THE FORM BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST QUESTIONNAIRES FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2021 WERE DISTRIBUTED BY BMC'S CORPORATE COMPLIANCE DEPARTMENT. THE CHIEF COMPLIANCE OFFICER OF BMC OR THE CHIEF COMPLIANCE OFFICER'S DESIGNEE QUERIES TRUSTEES, OFFICERS, AND DIRECTORS ON AT LEAST AN ANNUAL BASIS REGARDING RELATIONSHIPS THAT MAY CREATE POTENTIAL CONFLICTS OF INTEREST. THE CHIEF COMPLIANCE OFFICER OR THE CHIEF COMPLIANCE OFFICER'S DESIGNEE REVIEWS ALL DISCLOSURES AND DETERMINES WHETHER THERE ARE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. THE CHIEF COMPLIANCE OFFICER OR THE CHIEF COMPLIANCE OFFICER'S DESIGNEE INFORMS THE CHIEF LEGAL COUNSEL OF ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. THE CHIEF LEGAL COUNSEL ADVISES THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION ACCORDINGLY. FORM 990, PART VI, SECTION B, LINE 15 AN INDEPENDENT COMMITTEE, FORMED OF INDIVIDUALS WHOSE COMPENSATION IS NOT IN ISSUE, DETERMINES THE COMPENSATION OF OFFICERS, KEY EMPLOYEES, AND THE HIGHEST COMPENSATED EMPLOYEES. THE COMMITTEE MEMBERS ARE NOT UNDER THE CONTROL OR DIRECTION OF ANY BMC EXECUTIVE SEEKING COMPENSATION. THE COMPENSATION PLAN IS SUPPORTED BY COMPARABLE DATA, WHICH INCLUDES COMPENSATION PAID FOR COMPARABLE POSITIONS BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, COMPENSATION SURVEYS COMPILED INDEPENDENTLY, AND ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS COMPETING FOR THE SERVICES OF THE BMC EXECUTIVE. THE INDEPENDENT COMMITTEE'S ASSESSMENT OF THESE CONSIDERATIONS ARE CONTAINED IN THE MINUTES OF THE COMMITTEE MEETING. THE REVIEW PROCESS INCLUDES - AND MINUTES INDICATE - DISCUSSIONS AND EVALUATIONS OF EACH EXECUTIVE'S PRIOR PERFORMANCE, QUALIFICATION, AND EXPERIENCE. EXECUTIVES ARE NOT PRESENT FOR THE INDEPENDENT COMMITTEE'S DISCUSSIONS AND VOTE ON COMPENSATION. THE MINUTES REFLECT THE FACT THAT NO EXECUTIVE WAS PRESENT. FORM 990, PART VI, SECTION C, LINE 19 BOSTON MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS PUBLICLY AVAILABLE. HOWEVER, THE RESTATED ARTICLES OF THE ORGANIZATION ARE POSTED ON THE SECRETARY OF THE COMMONWEALTH'S CORPORATIONS WEBSITE. FORM 990, PART XI, LINE 9: PENSION BENEFITS, NON-SERVICE 1,725,684. TRANSFER TO AFFILIATES -28,000,000. PERIODIC PENSION COSTS 14,380,613. ROUNDING -516. BMC HEALTH SYSTEM INC ONE BOSTON MEDICAL CENTER PL BOSTON MA 02118 463556853 SUPPORT SVCS. 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MA 503 (C) (3) 12 B-II N/A 0 UNIVER DEVELOPMENT FOUNDATION INC ONE BOSTON MEDICAL CENTER PL BOSTON MA 02118 043101957 REAL ESTATE MA 504 (C) (3) 12 A-I BMC 1 FACULTY PRACTICE FOUNDATION INC ONE BOSTON MEDICAL CENTER PL BOSTON MA 02118 043289381 MEDICAL SVCS MA 501 (C) (3) 12 B-II N/A 0 BMC INSURANCE COMPANY LTD FIRST CARRIBEAN HOUSE 10 MAIN STRE GRAND CAYMAN CJ 980375219 INSURANCE CJ BMC C 841043 100916080 0.70000 1 CHARITABLE REMAINDER TRUST - MA (3) SUPPORT MA BMC T 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 BMC HEALTH SYSTEMS INC R 28000000 FMV BOSTON UNIVERSITY AFFILIATED PHYSICIANS INC Q 347000 FMV BMC INSURANCE COMPANY LTD P 6314000 FMV BMC HEALTH SYSTEM INC D 17592000 FMV BMC INTEGRATED CARE SERVICES Q 2630909 FMV UNIVER DEVELOPMENT FOUNDATION INC S 1835758 FMV