2020-07-15T09:50:27-05:00 2019-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2018-07-01 820844453 UPMC PINNACLE LITITZ UPMC 7172318245 PO BOX 8700 HARRISBURG PA 171058700 ALISON BERNHARDT CHIEF FINANCIAL OFFICER 7172318907 2020-07-14 1 KERRI N BOGDA CPA P00760402 7177404863 73.101.37.214 2020-07-14 10:01:18 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F58787FA80410BAE38B710EAF9FCC5760AD3BCDF 2018 2020-09-23 17:36:50Z ALISON BERNHARDT PO BOX 8700 HARRISBURG PA 171058700 84909268 0 X WWW.UPMCPINNACLE.COM X 2017 PA INPATIENT AND OUTPATIENT HEALTHCARE FOR CITIZENS OF THE LOCAL & SURROUNDING COMMUNITIES. 20 17 491 138 994 -216 0 500 61735796 83539069 29950 -18701 -84384 -381368 61681362 83139500 50 0 0 0 26712739 33745798 0 0 0 41181748 65721923 67894537 99467721 -6213175 -16328221 68903539 81864299 6393411 8371874 62510128 73492425 X UPMC PINNACLE LITITZ IS A CHARITABLE ORGANIZATION DEDICATED TO MAINTAINING AND IMPROVING THE HEALTH AND QUALITY OF LIFE FOR ALL THE PEOPLE OF CENTRAL PENNSYLVANIA. 0 0 81318564 0 83538075 UPMC PINNACLE LITITZ IS A FULL-SERVICE ACUTE CARE HOSPITAL WITH 148 LICENSED BEDS OFFERING A WIDE RANGE OF SERVICES INCLUDING CARDIAC CARE, A CERTIFIED PRIMARY STROKE CENTER, EMERGENCY CARE, IMAGING, ONCOLOGY CARE, OBSTETRICS, ORTHOPEDICS, PLASTIC AND RECONSTRUCTIVE SURGERY, AND GENERAL SURGERY.WE PRIDE OURSELVES ON PROVIDING THE HIGHEST QUALITY CARE IN ALL SERVICE AREAS. OUR INTENSE FOCUS ON CUSTOMER SERVICE AND PATIENT SAFETY HAS CREATED A UNIQUE HEALING ENVIRONMENT. WE ARE AN ACCREDITED STROKE CENTER AND AN ACCREDITED CHEST PAIN AND HEART ATTACK CENTER.WE SERVE THE GREATER LANCASTER COUNTY AREA. IN KEEPING WITH OUR MISSION OF CARING FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, UPMC PINNACLE LITITZ HOSPITAL IS A FORCE FOR STABILITY, STRENGTH, AND RELIABILITY FOR THOSE WE SERVE. IN ADDITION TO FINANCIAL SUPPORT, OUTREACH TO THE COMMUNITY IS CRUCIAL TO ACHIEVING OUR MISSION. THROUGH VOLUNTEERISM AND ENGAGEMENT, WE STRIVE TO BE A FORCE FOR HEALTH AND WELL-BEING. WE HELP THE UNDERSERVED, MENTOR STUDENTS, LEND EXPERTISE TO COMMUNITY ORGANIZATIONS, AND EDUCATE THE COMMUNITY ON DISEASE PREVENTION AND MANAGEMENT.COMMUNITY HEALTH IMPROVEMENT SERVICES:TAKING HEALTH CARE BEYOND THE DOORS OF ITS HOSPITALS, CLINICS, AND OFFICES, AND BRINGING IT INTO THE REGION'S TOWNS, SCHOOLS AND WORKPLACES, UPMC PINNACLE LITITZ IS HELPING TO CREATE HEALTHIER COMMUNITIES IN LANCASTER COUNTY. THROUGH ITS CHARITABLE GIVING AND COMMUNITY INITIATIVES, UPMC PINNACLE LITITZ IS MAKING A DIFFERENCE IN THE HEALTH AND WELL-BEING OF ITS NEIGHBORS. FROM PUBLIC HEALTH AND WELLNESS INITIATIVES TO SCHOOL HEALTH SCREENINGS, INSURANCE ENROLLMENT HELP, HOME-VISIT PROGRAMS, CHARITY CARE, AND FREE HEALTH CLASSES, UPMC PINNACLE LITITZ PROVIDES BENEFITS TO THE COMMUNITY. UPMC PINNACLE LITITZ OFFERS A VARIETY OF FREE COMMUNITY PROGRAMS THAT ARE MAKING A DIFFERENCE IN THE LIVES OF CENTRAL PENNSYLVANIANS EVERY DAY, INCLUDING:1) HEALTH EDUCATION SEMINARS ARE HELD AT VARIOUS LOCATIONS WITHIN THE COMMUNITY TO EDUCATE PEOPLE ON VARIOUS CONDITIONS. THESE SEMINARS INCLUDE: - SKIN SAFETY IN THE SUN- CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND LUNG CANCER RISK FACTORS- EXERCISE FOR ARTHRITIS- CHRONIC KNEE AND HIP PAIN SOLUTIONS- STROKE PREVENTING DISABILITY- OH MY ACHING BACK- WHY WAIT? LET'S LOSE WEIGHT- HEALTHY AGING FOR WOMEN- IS DEPRESSION A NORMAL PART OF THE AGING PROCESS?- WHEN SHOULD I CALL 911?2) WELLNESS AND SCREENING PROGRAMS ARE PROVIDED INCLUDING:- CHOLESTEROL SCREENINGS- PROSTATE SCREENINGS- INFANT DEVELOPMENT SCREENINGS- SPEECH AND HEARING SCREENINGS- DEPRESSION AND ANXIETY SCREENINGS- BONE DENSITY SCREENINGS- NUTRITION THERAPY EDUCATION PROGRAMS- LEAD POISONING SCREENINGS 81318564 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 X 0 0 491 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 20 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 PA X ALISON BERNHARDT CHIEF FINANCIAL OFFICER 7172318245 PO BOX 8700 HARRISBURG PA 171058700 PHILIP W GUARNESCHELLI PRESIDENT/CEO 1.00 39.00 X X 0 1375741 35711 LESLIE DAVIS DIRECTOR 1.00 1.00 X 0 0 0 RICHARD HAMILTON DIRECTOR 1.00 1.00 X 0 0 0 EDWARD KARLOVICH DIRECTOR 1.00 1.00 X 0 0 0 DAVID MARTIN DIRECTOR 1.00 1.00 X 0 0 0 ROBERT MONTLER DIRECTOR 1.00 1.00 X 0 0 0 STEVEN SHAPIRO MD DIRECTOR 1.00 1.00 X 0 0 0 MICHAEL L FERNANDEZ MD DIRECTOR/MEDICAL DIRECTOR 1.00 1.00 X 0 37583 0 JOHN C HICKEY CHAIR 1.00 1.00 X X 0 0 0 MARK GLESSNER DIRECTOR 1.00 1.00 X 0 0 0 YVONNE HOLLINS DIRECTOR 1.00 1.00 X 0 0 0 CAROLYN KREAMER PHD DIRECTOR 1.00 1.00 X 0 0 0 MICHAEL MURCHIE DIRECTOR 1.00 1.00 X 0 0 0 DOUG NEIDICH VICE CHAIR 1.00 1.00 X X 0 0 0 KENNETH OKEN MD DIRECTOR 1.00 1.00 X 0 119167 0 CYNTHIA TOLSMA DIRECTOR 1.00 1.00 X 0 0 0 JONATHAN VIPOND III DIRECTOR 1.00 1.00 X 0 0 0 PAUL SPEARS MD DIRECTOR 0.10 0.40 X 0 0 0 RONALD KRATZ MD DIRECTOR 0.10 0.40 X 0 0 0 JOHN KUNKLE DIRECTOR 0.10 0.40 X 0 0 0 DEBORAH WILLWERTH PRESIDENT UPMC LITITZ/SECRETARY 40.00 X 288624 0 25827 MICHAEL BROOKS TURKEL SVP & PRESIDENT, LANC DIV 20.00 20.00 X 0 604667 29197 WILLIAM H PUGH EVP-TREAS./CFO 1.00 39.00 X 0 912948 24684 ALISON BERNHARDT VP, CORP ACCT&RPT/CFO 1.00 39.00 X 0 379089 12862 CHRISTOPHER P MARKLEY ESQ ASST. SEC'Y/SR VP STAT SVC/GEN COUNS 1.00 39.00 X 0 636796 31392 CHRISTIAN CAICEDO MD SR. VP UPMC PINNACLE CUMBERLAND DIV 1.00 39.00 X 0 664138 35294 DAVID SCHMIDT REGIONAL CNO & VP NURSING OPS 40.00 X 187750 0 15219 DAVID BENNER CLINICAL STAFF PHARMACIST 40.00 X 155262 0 14976 MIKE SHERK RN, WEEKEND FLEX PRN 40.00 X 145875 0 2918 JUDITH MCCOY HOUSE SUPERVISOR-WKND 40.00 X 145393 0 16402 BRIANNA DOHM PHARMACIST SUPERVISOR 40.00 X 133421 0 18689 MICHAEL A YOUNG FORMER PRESIDENT/CEO (RES. 3/17) 0.00 X 0 1035976 9539 1056325 5766105 272710 14 1 1 0 COMMUNITY ANESTHESIA ASSOCIATES 1575 HIGHLANDS DR 200B LITITZ PA 17543 CONTRACT HEALTH SVCS. 1880053 PEDIATRIX MEDICAL GROUP OF PA 111 S FRONT ST HARRISBURG PA 17101 CONTRACT HEALTH SVCS. 466453 QUEST DIAGNOSTICS PO BOX 740709 ATLANTA GA 30374 CONTRACT HEALTH SVCS. 448728 DIVERSIFIED CLINICAL SERVICES INC 5220 BELFORT RD JACKSONVILLE FL 32256 CONTRACT HEALTH SVCS. 359150 PENN STATE MILTON S HERSHEY MEDICAL CTR SPECIAL BILLING MAIL CODE CA520 HERSHEY PA 17033 CONTRACT HEALTH SVCS. 180155 9 500 500 PATIENT REVENUE, NET 621500 83232100 83231106 994 MEDICAL EDUCATION 900099 140437 140437 COMMUNITY PROGRAM INCOME 900099 88488 88488 QUALITY INCENTIVE INCOME 900099 77604 77604 WOMANCARE 621990 260 260 180 180 83539069 1 1 1185201 1670223 -485022 -485022 -485022 67405 86107 -18702 -18702 -18702 21211 13438 7773 7773 MANAGEMENT & SUPPORT 900099 37967 37967 TAX REFUNDS 900099 24985 24985 MEDICAL STAFF SERVICES 900099 23950 23950 8979 8979 95881 83139500 83538075 994 -400069 X 1072289 1072289 26417778 24526244 1891534 1026907 960472 66435 3272196 3061110 211086 1956628 1762507 194121 8805071 8805071 23794727 23072235 722492 163167 14885 148282 1181479 948625 232854 679491 554510 124981 4303639 3175119 1128520 64944 55618 9326 66996 57124 9872 6833 6833 5826418 4435044 1391374 550196 550196 MEDICAL SUPPLIES 9967309 9928078 39231 PHARMACY 7673501 7660327 13174 MEDICAID MODERNIZATION 1359153 1359153 LAB EXPENSES 464804 462302 2502 814195 644364 169831 99467721 81318564 18149157 0 1125 975 78656 1452215 7202760 15303043 2112520 1178475 1026690 1160403 71775077 9500057 58258124 62275020 223664 494168 68903539 81864299 6281858 8291106 111553 80768 6393411 8371874 X 62510128 73492425 62510128 73492425 68903539 81864299 X -16328221 27310518 X X 0 1 X 1 0 X 2400000 2400000 45152336 2389915 42762421 754029 95230 658799 23128600 7013185 16115415 340112 1727 338385 62275020 X PART X, LINE 2: TAX BENEFITS ARE RECOGNIZED WHEN IT IS MORE-LIKELY-THAN-NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION BY THE TAX AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION. SUCH TAX POSITIONS ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY TO BE REALIZED UPON ULTIMATE SETTLEMENT WITH THE TAX AUTHORITIES ASSUMING FULL KNOWLEDGE OF THE POSITION AND ALL RELEVANT FACTS. CERTAIN OF THE COMPANY'S SUBSIDIARIES ARE SUBJECT TO TAXATION IN THE UNITED STATES, VARIOUS STATES AND FOREIGN JURISDICTIONS. AS OF DECEMBER 31, 2018, THE COMPANY'S RETURN FOR THE FISCAL YEAR ENDED JUNE 30, 2017 IS OPEN FOR EXAMINATION BY THE VARIOUS TAXING AUTHORITIES. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 0 693895 693895 0.00700 13345027 4162764 9182263 0.09230 14038922 4162764 9876158 0.09930 2007912 328900 1679012 0.01690 3307698 3307698 0.03330 5315610 328900 4986710 0.05020 19354532 4491664 14862868 0.14950 1 1146954 11886777 16501958 -4615181 X 1 1 1 1 UPMC PINNACLE LITITZ 1500 HIGHLANDS DRIVE LITITZ PA 17543 WWW.UPMCPINNACLE.COM 380101 UPMC PINNACLE LITITZ 820844453 X X X X UPMC PINNACLE LITITZ 1 0 1 1 X X X X X X X X 18 1 1 0 1 X WWW.UPMCPINNACLE.COM X WWW.LANCASTERGENERALHEALTH.ORG, WWW.WELLSPAN.ORG X X 1 18 1 WWW.UPMCPINNACLE.COM 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X WWW.UPMCPINNACLE.COM X WWW.UPMCPINNACLE.COM X WWW.UPMCPINNACLE.COM X X X X X X 1 X 0 X X X X 1 X 0 0 UPMC PINNACLE LITITZ PART V, SECTION B, LINE 2: EFFECTIVE JULY 1, 2017, UPMC PINNACLE (THEN PINNACLE HEALTH SYSTEM) ACQUIRED HEART OF LANCASTER REGIONAL MEDICAL CENTER, NOW NAMED UPMC PINNACLE LITITZ. WITH THIS ACQUISITION, HEART OF LANCASTER HAS ADOPTED UPMC PINNACLE'S CHARITY CARE POLICIES AND ASSUMED UPMC PINNACLE'S NON-PROFIT STATUS, AS WELL AS ITS MISSION, VISION AND VALUES. BRINGING THIS HOSPITAL INTO THE UPMC PINNACLE NETWORK WAS A SIGNIFICANT OPPORTUNITY TO SERVE MORE COMMUNITIES, ACHIEVE OUR MISSION OF PROVIDING THE HIGHEST QUALITY CARE, AND INCREASE ACCESS TO CARE ACROSS THE REGION. TO IMPROVE THE HEALTH OF THE RESIDENTS OF THE COMMUNITIES IT SERVES, UPMC PINNACLE LITITZ PROVIDES EXTENSIVE HEALTH EDUCATION AND WELLNESS OPPORTUNITIES FOR MEMBERS OF THE COMMUNITY THROUGH, DIABETES EDUCATION, OPIOID ADDICTION EDUCATION, AND JOINT AND SPINE CARE EDUCATION. TO PROMOTE SENIOR HEALTH, COMMUNITY SEMINARS ARE CONDUCTED ON THE FLU, DEMENTIA, VASCULAR HEALTH, HEARING LOSS, BALANCE AND STABILITY. FREE HEALTH SCREENINGS ARE ALSO OFFERED. UPMC PINNACLE LITITZ PROVIDES HEALTH EDUCATION/ACTIVITIES IN SUPPORT OF THE AMERICAN HEART ASSOCIATION, MARCH OF DIMES, AMERICAN CANCER SOCIETY, ALZHEIMER'S ASSOCIATION, LOCAL SCHOOL DISTRICTS AND EXCENTIA SERVICES (SUPPORTS FOR PEOPLE WITH DEVELOPMENTAL NEEDS).UPMC PINNACLE LITITZ PARTICIPATED IN A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN PARTNERSHIP WITH PENN MEDICINE LANCASTER GENERAL HEALTH AND WELLSPAN HEALTH. THE HEALTH CARE ORGANIZATIONS PROVIDED LEADERSHIP AND OVERSIGHT IN CONDUCTING THIS COUNTY-WIDE ASSESSMENT. THIS COMMUNITY HEALTH NEEDS ASSESSMENT RELIED ON COUNTY-LEVEL DATA AND INPUT FROM INDIVIDUALS AND ORGANIZATIONS TO IDENTIFY THE MOST PRESSING COMMUNITY HEALTH NEEDS. INFORMATION WAS RECEIVED BY THE COMMUNITY AND A SURVEY WAS CONDUCTED AT COMMUNITY EVENTS IN THE SUMMER OF 2018; 258 SURVEYS WERE RECEIVED FROM MEMBERS OF THE COALITION TO END HOMELESSNESS AND LIGHTEN UP LANCASTER COUNTY COALITION, STAFF FROM COMMUNITY ACTION PARTNERSHIP AND HEALTHY BEGINNINGS PLUS, THE LANCASTER COUNTY OFFICE OF AGING, AND COMMUNITY MEMBERS WHO TOOK THE SURVEY ONLINE OR AT LANCASTER COUNTY'S PRIDE DAY CELEBRATION. THE GOAL OF THE SURVEY WAS TO SAMPLE FROM SELECTED LOCATIONS, ORGANIZATIONS, AND COALITIONS TO GATHER FEEDBACK FROM TRADITIONALLY MARGINALIZED COMMUNITIES, INCLUDING PEOPLE OF COLOR, PEOPLE OF HISPANIC/LATINO ETHNICITY, AND INDIVIDUALS WHO IDENTIFY AS GAY, LESBIAN, BISEXUAL AND/OR TRANSGENDER. IN ADDITION TO THE COMMUNITY SURVEY, UPMC PINNACLE LITITZ, PENN MEDICINE LANCASTER GENERAL HEALTH AND WELLSPAN JOINTLY HOSTED A COMMUNITY FORUM ON DECEMBER 17, 2018. THE THREE PRIMARY GOALS OF THE FORUM WERE TO: 1. EXPLAIN THE CHNA PROCESS AND THE ROLE OF THE COMMUNITY STAKEHOLDERS2. PRESENT THE ANALYTICS FRAMEWORK AND PRELIMINARY COMMUNITY HEALTH DATA3. GATHER INPUT FROM COMMUNITY STAKEHOLDERS, PARTICULARLY THOSE WITH PUBLIC HEALTH EXPERTISE AND INDIVIDUALS AND ORGANIZATIONS SERVING MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS IN LANCASTER COUNTY ABOUT THE COMMUNITY HEALTH NEEDS AND COMMUNITY RESOURCES. BASED ON THE SCOPE, SEVERITY, AND COMMUNITY PERCEPTIONS OF SEVERITY AND POTENTIAL IMPACT, LANCASTER COUNTY'S MOST SIGNIFICANT NEEDS FOCUS ON TWO SOCIAL DETERMINANTS OF TWO BEHAVIORAL HEALTH PRIORITIES: ESTABLISHING AND MAINTAINING THE BASIC CONDITIONS THAT SUPPORT HEALTH, INCLUDING ACCESS TO CARE, FAMILY-SUSTAINING INCOMES, ACCESSIBLE TRANSPORTATION, AFFORDABLE AND QUALITY HOUSING, VIOLENCE REDUCTION, AND REDUCTION IN EXPOSURE TO ADVERSE CHILDHOOD EXPERIENCESADVOCATING FOR IMPROVEMENTS IN THE COUNTY'S PHYSICAL ENVIRONMENT, EMPHASIZING IMPROVED AIR AND WATER QUALITY, SUPPORTING IMPROVED MENTAL HEALTH INCLUDING REDUCING AND TREATING SUBSTANCE USE AND SUPPORTING ACTIVE LIVING, HEALTH EATING, AND LESS OBESITY. THESE PRIORITIES WERE ADOPTED BY THE UPMC PINNACLE LITITZ BOARD OF DIRECTORS AND AN INFRASTRUCTURE HAS BEEN PUT IN PLACE TO DEVELOP AN IMPLEMENTATION PLAN AROUND THESE PRIORITIES IN 2019. UPMC PINNACLE LITITZ PART V, SECTION B, LINE 5: THIS NEEDS ASSESSMENT USED TWO MECHANISMS TO GATHER COMMUNITY INPUT ABOUT HEALTH NEEDS. PENN MEDICINE LANCASTER GENERAL HEALTH CONDUCTED A SURVEY OF COMMUNITY MEMBERS AT SELECTED COMMUNITY EVENTS DURING SUMMER 2018 TO GATHER INPUT ABOUT PERCEIVED COMMUNITY HEALTH NEEDS AND BARRIERS TO GOOD HEALTH. PENN MEDICINE LANCASTER GENERAL HEALTH COLLECTED A TOTAL OF 258 SURVEY RESPONSES FROM MEMBERS OF THE COALITION TO END HOMELESSNESS AND LIGHTEN UP LANCASTER COUNTY COALITION, STAFF FROM COMMUNITY ACTION PARTNERSHIP AND HEALTHY BEGINNINGS PLUS, THE LANCASTER COUNTY OFFICE OF AGING, AND COMMUNITY MEMBERS WHO TOOK THE SURVEY ONLINE OR AT LANCASTER COUNTY'S PRIDE DAY CELEBRATION. THE GOAL OF THE SURVEY WAS TO SAMPLE FROM SELECTED LOCATIONS, ORGANIZATIONS, AND COALITIONS TO GATHER FEEDBACK FROM TRADITIONALLY MARGINALIZED COMMUNITIES, INCLUDING PEOPLE OF COLOR, PEOPLE OF HISPANIC/LATINO ETHNICITY, AND INDIVIDUALS WHO IDENTIFY AS GAY, LESBIAN, BISEXUAL, AND/OR TRANSGENDER.IN ADDITION TO THE COMMUNITY SURVEY, PENN MEDICINE LANCASTER GENERAL HEALTH, WELLSPAN HEALTH, AND UPMC PINNACLE LITITZ JOINTLY HOSTED A COMMUNITY STAKEHOLDER FORUM ON DECEMBER 17, 2018. THE THREE PRIMARY GOALS OF THE FORUM WERE TO: (1) EXPLAIN THE CHNA PROCESS AND THE ROLE OF COMMUNITY STAKEHOLDERS; (2) PRESENT THE ANALYTIC FRAMEWORK AND PRELIMINARY COMMUNITY HEALTH DATA INCLUDED IN THIS SUMMARY; AND (3) GATHER INPUT FROM COMMUNITY STAKEHOLDERS, PARTICULARLY THOSE WITH PUBLIC HEALTH EXPERTISE AND INDIVIDUALS AND ORGANIZATIONS SERVING MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS IN LANCASTER COUNTY, ABOUT COMMUNITY HEALTH NEEDS AND COMMUNITY RESOURCES. UPMC PINNACLE LITITZ PART V, SECTION B, LINE 6A: PENN MEDICINE LANCASTER GENERAL HOSPITAL, WELLSPAN EPHRATA COMMUNITY HOSPITAL UPMC PINNACLE LITITZ PART V, SECTION B, LINE 7D: COMMUNITY EVENTS UPMC PINNACLE LITITZ PART V, SECTION B, LINE 15E: IN INSTANCES WHEN AN UNINSURED PATIENT MAY APPEAR ELIGIBLE FOR A CHARITY CARE/FINANCIAL ASSISTANCE DISCOUNT, BUT LACKS DOCUMENTATION TO SUPPORT IT, CONSIDERATION WILL BE GIVEN BASED ON CIRCUMSTANCES PRESENTED OR CREDIT AGENCY INCOME DATA FOR PRESUMPTIVE CHARITY CARE/FINANCIAL ASSISTANCE. THIS WILL INCLUDE, BUT IS NOT LIMITED TO; HOMELESSNESS, NO INCOME, PARTICIPATION IN WOMEN INFANTS AND CHILDREN PROGRAMS (WIC), FOOD STAMP ELIGIBILITY, OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (E.G. MEDICAID SPEND-DOWN), INFORMATION FROM FAMILY OR FRIENDS, LOW INCOME HOUSING PROVIDED AS VALID ADDRESS, PATIENT DECEASED WITH NO KNOWN ESTATE, ELIGIBLE FOR STATE FUNDED PRESCRIPTION PROGRAM, AND CREDIT BUREAU SOFT CREDIT CHECKS THAT ARE ONLY SEEN BY THE PATIENT/ GUARANTOR. UPMC PINNACLE LITITZ PART V, SECTION B, LINE 20E: ANY INDIVIDUAL WHO CALLS HOSPITAL CUSTOMER SERVICE AND MENTIONS THEY CANNOT AFFORD TO PAY THE AMOUNT BILLED IS ORALLY NOTIFIED OF THE FAP AND THE FAP PROCESS. PART I, LINE 7: THE COST OF CHARITY CARE AND UNREIMBURSED MEDICAID COSTS ARE CALCULATED BY THE HOSPITAL'S COST-TO-CHARGE RATIO FOR EACH OF THE INDIVIDUAL SERVICES PROVIDED TO THE PATIENT. IT UTILIZES HOSPITAL EXPENSES FROM THE GENERAL LEDGER AND REVENUE DETAILS FROM THE PATIENT ACCOUNTING SYSTEM. EACH DEPARTMENT WITHIN THE HOSPITAL IS CLASSIFIED AS EITHER INDIRECT (OVERHEAD) OR DIRECT (PATIENT CARE AREAS). EXPENSES ARE CLASSIFIED AS FIXED OR VARIABLE AS THEY RELATE TO PATIENT VOLUME. LOGICAL STATISTICS ARE USED TO ALLOCATE OVERHEAD EXPENSES TO THE PATIENT CARE DEPARTMENTS. USING EITHER A RATIO OF COST-TO-CHARGE OR RVUS (RELATIVE VALUE UNITS), THE DIRECT AND INDIRECT COSTS FOR EACH DEPARTMENT ARE ALLOCATED TO THE SERVICES THEY PROVIDE. PART I, LINE 7G: LOSSES ATTRIBUTED TO PRIMARY CARE AND CLINICS ARE INCLUDED AS SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $1,146,954 IS INCLUDED IN NET PATIENT REVENUE ON FORM 990, PART VIII, LINE 2A, AND THEREFORE IS NOT INCLUDED FOR THE PURPOSES OF CALCULATING THE APPLICABLE EXPENSE PERCENTAGES OF SCHEDULE H. PART III, LINE 3: FOR THE PORTION OF BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, THE HOSPITAL DETERMINED THE ZIP CODES THAT PRIMARILY INCLUDE PUBLIC HOUSING, LOW INCOME, AND/OR POVERTY. BAD DEBT WRITE-OFFS FOR THE FISCAL YEAR ARE REVIEWED TO DETERMINE THE ACCOUNTS WHERE THE PATIENT ADDRESS WAS LOCATED IN THOSE ZIP CODES. AN OVERALL COST-TO-CHARGE RATIO WAS THEN APPLIED TO THIS AMOUNT TO ARRIVE AT AN EXPENSE FIGURE. THIS METHOD CONTINUES TO BE HONED AS WE FURTHER DEVELOP OUR PRESUMPTIVE CHARITY CARE AND FINANCIAL AID APPROACH. PART III, LINE 4: THE FINANCIAL STATEMENTS DO NOT HAVE A SPECIFIC NOTE ON BAD DEBT EXPENSE; RATHER THE FINANCIAL STATEMENTS EVALUATE BAD DEBTS IN ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE FOOTNOTE RELATED TO THE ALLOWANCE IS SUMMARIZED AS FOLLOWS: ACCOUNTS RECEIVABLE ARE RECORDED AT THEIR ESTIMATED NET REALIZABLE VALUE. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS ESTIMATED BASED UPON HISTORICAL COLLECTION RATES.THE BAD DEBT EXPENSE ON PART III, LINE 2 WAS CALCULATED BY TAKING THE AMOUNT WRITTEN OFF TO BAD DEBT FOR EACH ACCOUNT AND CONVERTING IT TO CHARGES BY APPROPRIATELY ADJUSTING THE AMOUNT BY THE PAYOR REIMBURSEMENT PERCENTAGE FOR THAT ACCOUNT. THEN, THE COST-TO-CHARGE RATIO METHODOGY FOR EACH SPECIFIC ACCOUNT, UTILIZING THE COSTS FROM THE HOSPITAL COST ACCOUNTING SYSTEM (DESCRIBED IN DETAIL ABOVE), WAS APPLIED TO THIS CALCULATED PORTION OF THE TOTAL CHARGES. PART III, LINE 8: THE MEDICARE COSTS WERE DETERMINED BASED ON THE HOSPITAL'S COST-TO-CHARGE RATIO FOR THE SERVICES RENDERED. PART III, LINE 9B: PATIENTS ARE NOTIFIED OF OUR CHARITY CARE POLICY IN A VARIETY OF WAYS. THERE ARE POSTERS INFORMING PATIENTS OF OUR CHARITY CARE POLICY AND A PLAIN LANGUAGE VERSION OF THE POLICY HANDED OUT TO THE UNINSURED AT ALL THE REGISTRATION SITES. ALL OF OUR PATIENT ACCOUNT STATEMENTS CONTAIN LANGUAGE THAT INDICATES THERE IS FINANCIAL AID AVAILABLE FOR QUALIFYING INDIVIDUALS. IN ADDITION, THE POLICY AND APPLICATION ARE POSTED ON THE HOSPITAL WEBSITE IN BOTH ENGLISH AND SPANISH. PATIENTS WHO APPLY FOR FINANCIAL ASSISTANCE AND PROVIDE ALL THE NECESSARY DOCUMENTATION REQUIREMENTS ARE NOTIFIED WITHIN THIRTY DAYS OF THE HOSPITAL'S DECISION. WHEN THE APPROVAL IS DETERMINED, THE APPROPRIATE DISCOUNT IS POSTED TO THE PATIENT ACCOUNT IMMEDIATELY. THE FINANCIAL ASSISTANCE DISCOUNT WILL BE APPLIED TO SERVICE FOR THE PREVIOUS TWELVE MONTHS AND SUBSEQUENT SIX MONTHS. THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE. NO ADDITIONAL COLLECTION EFFORTS ARE MADE. APPLICANTS APPROVED FOR ONLY PARTIAL DISCOUNT WILL BE REQUIRED TO MAKE REASONABLE PAYMENT ARRANGEMENTS ON THEIR BALANCE IN ACCORDANCE WITH THE HOSPITAL'S CREDIT AND COLLECTION POLICY. THIS POLICY DOES PERMIT THE USE OF BOTH INTERNAL COLLECTION STAFF AND EXTERNAL COLLECTION AGENCIES WHO WILL ENGAGE IN STANDARD ACCEPTABLE BUSINESS PRACTICES WHICH INCLUDE PHONE CALLS, MAILING AND THE REPORTING OF UNPAID DEBT TO THE CREDIT REPORTING AGENCIES; BUT UNDER NO CIRCUMSTANCES WILL THE HOSPITALS OR ITS CONTRACTED COLLECTION AGENCY ADOPT "EXTRAORDINARY COLLECTION ACTIONS" THAT ENTAIL ANY LEGAL COURSE OF ACTION OR JUDICIAL PROCESSES SUCH AS LAWSUITS OR LIENS. PART VI, LINE 2: TO IMPROVE THE HEALTH OF THE RESIDENTS OF THE COMMUNITIES IT SERVES UPMC PINNACLE LITITZ PROVIDES EXTENSIVE HEALTH EDUCATION AND WELLNESS OPPORTUNITIES FOR MEMBERS OF THE COMMUNITY BY PROVIDING DIABETES EDUCATION, OPIOID ADDICTION EDUCATION, AND JOINT AND SPINE CARE EDUCATION. TO PROMOTE SENIOR HEALTH, COMMUNITY SEMINARS ARE CONDUCTED ON THE FLU, DEMENTIA, VASCULAR HEALTH, HEARING LOSS, BALANCE AND STABILITY AND FREE HEALTH SCREENINGS. UPMC PINNACLE LITITZ PROVIDES HEALTH EDUCATION SUPPORT TO THE AMERICAN HEART ASSOCIATION, THE LONG HOME, AMERICAN CANCER SOCIETY, THE ALZHEIMER'S ASSOCIATION, BRIGHT SIDE OPPORTUNITIES CENTER, LANCASTER SCHOOL DISTRICT AND THE YWCA OF LANCASTER.UPMC PINNACLE LITITZ PARTICIPATED IN A COMMUNITY HEALTH NEEDS ASSESSMENT IN PARTNERSHIP WITH PENN MEDICINE LANCASTER GENERAL HEALTH AND WELLSPAN HEALTH. THE HEALTH CARE ORGANIZATIONS PROVIDED LEADERSHIP AND OVERSIGHT IN CONDUCTING A COUNTY-WIDE ASSESSMENT. THIS COMMUNITY HEALTH NEEDS ASSESSMENT RELIED ON COUNTY-LEVEL DATA AND INPUT FROM INDIVIDUALS AND ORGANIZATIONS TO IDENTIFY THE MOST PRESSING COMMUNITY HEALTH NEEDS. INFORMATION WAS RECEIVED BY THE COMMUNITY ABOUT HEALTH NEEDS. A SURVEY WAS CONDUCTED AT COMMUNITY EVENTS IN THE SUMMER OF 2018; 258 SURVEYS WERE RECEIVED FROM MEMBERS OF THE COALITION TO END HOMELESSNESS AND LIGHTEN UP LANCASTER COUNTY COALITION, STAFF FROM COMMUNITY ACTION PARTNERSHIP AND HEALTHY BEGINNINGS PLUS, THE LANCASTER COUNTY OFFICE OF AGING, AND COMMUNITY MEMBERS WHO TOOK THE SURVEY ONLINE OR AT LANCASTER COUNTY'S PRIDE DAY CELEBRATION. THE GOAL OF THE SURVEY WAS TO SAMPLE FROM SELECTED LOCATIONS, ORGANIZATIONS, AND COALITIONS TO GATHER FEEDBACK FROM TRADITIONALLY MARGINALIZED COMMUNITIES, INCLUDING PEOPLE OF COLOR, PEOPLE OF HISPANIC/LATINO ETHNICITY, AND INDIVIDUALS WHO IDENTIFY AS GAY, LESBIAN, BISEXUAL AND/OR TRANSGENDER. IN ADDITION TO THE COMMUNITY SURVEY, UPMC PINNACLE LITITZ, PENN MEDICINE LANCASTER GENERAL HEALTH AND WELLSPAN JOINTLY HOSTED A COMMUNITY FORUM ON DECEMBER 17, 2018. THE THREE PRIMARY GOALS OF THE FORUM WERE TO: 1. EXPLAIN THE CHNA PROCESS AND THE ROLE OF THE COMMUNITY STAKEHOLDERS2. PRESENT THE ANALYTICS FRAMEWORK AND PRELIMINARY COMMUNITY HEALTH DATA3. GATHER INPUT FROM COMMUNITY STAKEHOLDERS, PARTICULARLY THOSE WITH PUBLIC HEALTH EXPERTISE AND INDIVIDUALS AND ORGANIZATIONS SERVING MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS IN LANCASTER COUNTY, ABOUT THE COMMUNITY HEALTH NEEDS AND COMMUNITY RESOURCES. BASED ON THE SCOPE, SEVERITY, AND COMMUNITY PERCEPTIONS OF SEVERITY AND POTENTIAL IMPACT, LANCASTER COUNTY'S MOST SIGNIFICANT NEEDS FOCUS ON TWO SOCIAL DETERMINANTS: BEHAVIORAL HEALTH PRIORITIES: ESTABLISHING AND MAINTAINING THE BASIC CONDITIONS THAT SUPPORT HEALTH, INCLUDING ACCESS TO CARE, FAMILY-SUSTAINING INCOMES, ACCESSIBLE TRANSPORTATION, AFFORDABLE AND QUALITY HOUSING, VIOLENCE REDUCTION, AND REDUCTION IN EXPOSURE TO ADVERSE CHILDHOOD EXPERIENCES. ADVOCATING FOR IMPROVEMENTS IN THE COUNTY'S PHYSICAL ENVIRONMENT: EMPHASIZING IMPROVED AIR AND WATER QUALITY; SUPPORTING IMPROVED MENTAL HEALTH INCLUDING REDUCING AND TREATING SUBSTANCE USE AND SUPPORTING ACTIVE LIVING, HEALTH EATING, AND LESS OBESITY. THESE PRIORITIES WERE ADOPTED BY THE UPMC PINNACLE LITITZ BOARD OF DIRECTORS AND AN INFRASTRUCTURE HAS BEEN PUT IN PLACE TO DEVELOP AN IMPLEMENTATION PLAN AROUND THESE PRIORITIES IN 2019.THE IMPLEMENTATION PLAN IN LITITZ WILL FOCUS ON THE FOLLOWING ACTIONS TO FURTHER THE PRIORITIES LISTED ABOVE: 1. ASSESSING THE VIABILITY OF CREATING PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS TO ADDRESS FAMILY-SUSTAINING INCOMES BY CREATING A PIPELINE FOR A HEALTH CARE WORKFORCE DEVELOPMENT INITIATIVE. 2. ASSESSING CURRENT MENTAL HEALTH SERVICES AND THE GAPS IN THOSE SERVICES3. ASSESSING NUTRITIONAL SERVICES SUCH AS FOOD DESERTS. UPMC PINNACLE LITITZ WILL ASSESS CURRENT HEALTHY LIVING ACTIVITIES OFFERED BY COMMUNITY PARTNERS AND IDENTIFY FOOD INSECURITIES DUE TO LACK OF RESOURCES AND TRANSPORTATION. THE FAMILY MEDICINE RESIDENCY PROGRAM AND INFECTIOUS MEDICINE RESIDENCY PROGRAM AT UPMC LITITZ DELIVERED SIGNIFICANT BENEFITS TO THE COMMUNITY BY PROVIDING 4,273 VISITS IN 2018. THE RESIDENTS SERVE AN URBAN POPULATION AT TWO SITES. THE DEMOGRAPHICS ARE AS FOLLOWS: 7.9% BLACK; 23% HISPANIC; 63.2% WHITE; 2.6% ASIAN. THE UNEMPLOYMENT RATE IS AT 6.5% AND 16.7% LIVE BELOW THE POVERTY LEVEL. THE MAJORITY OF THE PATIENTS RECEIVE MEDICAL ASSISTANCE. THE RESIDENCY PROGRAM ALSO PROVIDES SERVICES AT THE SPANISH AMERICAN CIVIC ASSOCIATION. THE DEMOGRAPHICS ARE AS FOLLOWS: 9.7% BLACK; 27% HISPANIC; 53.8% WHITE; 2.6% ASIAN. THE UNEMPLOYMENT RATE IS 7.3% AND 20.5% LIVE BELOW THE POVERTY LEVEL. IN 2018, THE RESIDENCY PROGRAM PROVIDED 1,240 INFANTS AND CHILDREN WITH CARE. ALSO INTEGRATED INTO THE RESIDENCY PROGRAM ARE BEHAVIORAL HEALTH AND ADDICTION MEDICINE. TO PROMOTE LOWER RATES OF ADDICTION IN THE COMMUNITY, UPMC PINNACLE LITITZ OFFERS A MEDICALLY ASSISTED TREATMENT PROGRAM THAT PROVIDES BUPRENORPHINE INJECTIONS. THERE ARE 75-100 PATIENT ENCOUNTERS PER MONTH IN THIS PROGRAM. IN ADDITION TO THEIR OUTPATIENT CLINIC, THE UPMC RESIDENCY PROGRAM OFFERS A SECOND SITE ONE AND A HALF DAY A WEEK AT THE SPANISH AMERICAN CIVIC ASSOCIATION. THE PROGRAM PRESENTLY HAS 61 ACTIVE PATIENTS AND PROVIDES A MUCH NEEDED SERVICE TO THE COMMUNITY; ESPECIALLY SINCE NONE OF THESE PATIENTS ARE COMMERCIALLY INSURED AND WOULD FACE LARGE BARRIERS IN RECEIVING MEDICATION ASSISTED TREATMENT ELSEWHERE. PART VI, LINE 3: PATIENTS ARE INFORMED OF AVAILABLE ASSISTANCE IN NUMEROUS WAYS. SIGNAGE IS POSTED AND LITERATURE IS HANDED OUT TO THE UNINSURED AT ALL THE REGISTRATION SITES INDICATING TO THE PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. ALL UNINSURED PATIENTS WHO ARE SCHEDULED FOR HIGH DOLLAR TESTS AND SURGERIES ARE CONTACTED BY ONE OF THE HOSPITAL'S FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE OPTIONS AVAILABLE TO THEM. THE FINANCIAL ASSISTANCE POLICY IS ALSO DISCLOSED ON THE HOSPITAL WEBSITE, ALONG WITH THE APPLICATION, IN BOTH ENGLISH AND SPANISH. IN ADDITION, ALL INPATIENTS WHO ARE RESIDENTS OF PENNSYLVANIA ARE PROVIDED PERSONAL ASSISTANCE IN THE COMPLETION OF THE MEDICAL ASSISTANCE APPLICATION. AS PART OF THE DISCHARGE PROCESS IN THE EMERGENCY DEPARTMENT, ALL UNINSURED PATIENTS ARE SCREENED FOR CHARITY CARE ELIGIBILITY UNDER THE HOSPITAL POLICY, AND IF APPROPRIATE PROVIDED ASSISTANCE IN APPLYING FOR MEDICAID OR OBTAINING INSURANCE THROUGH HEALTHCARE.GOV. LASTLY, INFORMATION ABOUT FINANCIAL ASSISTANCE IN INCLUDED ON THE PATIENT BILLING STATEMENTS. PROGRAMS DISCUSSED INCLUDE THE PENNSYLVANIA STATE MEDICAID PROGRAM (MEDICAL ASSISTANCE), HOSPITAL CHARITY CARE PROGRAM, AND FUNDS AVAILABLE THROUGH HOSPITAL ENDOWMENT FUNDS.IN INSTANCES WHEN AN UNINSURED PATIENT MAY APPEAR ELIGIBLE FOR A CHARITY CARE/FINANCIAL ASSISTANCE DISCOUNT, BUT LACKS DOCUMENTATION TO SUPPORT IT, CONSIDERATION WILL BE GIVEN BASED ON CIRCUMSTANCES PRESENTED OR CREDIT AGENCY INCOME DATA FOR PRESUMPTIVE CHARITY CARE/FINANCIAL ASSISTANCE. THIS WILL INCLUDE, BUT IS NOT LIMITED TO; HOMELESSNESS, NO INCOME, PARTICIPATION IN WOMEN INFANTS AND CHILDREN PROGRAMS (WIC) FOOD STAMP ELIGIBILITY AND OTHER STATE OR LOCAL ASSISTANCE THAT ARE UNFUNDED (E.G. MEDICAID SPEND-DOWN), INFORMATION FROM FAMILY OR FRIENDS, LOW INCOME HOUSING PROVIDED AS A VALID ADDRESS, PATIENT DECEASED WITH NO KNOWN ESTATE, ELIGIBLE FOR STATE FUNDED PRESCRIPTION PROGRAM, AND CREDIT BUREAU SOFT CREDIT CHECKS THAT ARE ONLY SEEN BY THE PATIENT/ GUARANTOR. PART VI, LINE 4: UPMC PINNACLE LITITZ IS LOCATED IN LANCASTER COUNTY. KEY FINDINGS FROM THE CHNA INDICATE SOCIAL DETERMINANTS INDICATORS REVEAL NOTABLE CONCERNS ABOUT THE COUNTY'S ECONOMIC STABILITY AND COMMUNITY AND SOCIAL CONDITIONS INCLUDING RATES OF EDUCATIONAL ATTAINMENT. THE MAJOR SOCIAL DETERMINANTS ISSUES FACING THE COUNTY INCLUDE:- LARGE NUMBERS OF RENTERS STRUGGLING WITH HOUSING AFFORDABILITY- HIGH RATES OF POVERTY, PARTICULARLY FOR MINORITIES: IN 2016 28.3% OF LATINOS AND 28.8% OF BLACKS COMPARED TO 8% FOR WHITES - LARGE INCOME DISPARITIES BETWEEN WHITES AND NON-WHITES- HOURLY WAGE RATES THAT ARE DECREASING FOR PERSONS ON THE LOWER HALF OF THE EARNINGS SCALE- LOW RATES OF POST-SECONDARY EDUCATIONAL ATTAINMENT- AN AGING POPULATION- POOR AIR QUALITY; LANCASTER IS RANKED 13TH NATIONALLY FOR PEOPLE AT RISK BY SHORT-TERM PARTICLE POLLUTION AND IS RANKED 8TH NATIONALLY FOR PEOPLE AT RISK BY YEAR-ROUND PARTICLE POLLUTION- A POLLUTED PHYSICAL ENVIRONMENT; INDICATORS OF AIR AND WATER QUALITY PLACE LANCASTER'S PHYSICAL ENVIRONMENT 64TH OUT OF THE STATE'S 67 COUNTIES. PART VI, LINE 5: THE ORGANIZATION DEVELOPED AN IMPLEMENTATION PLAN BASED ON THE CHNA PERFORMED IN 2018 WHICH WAS APPROVED BY THE BOARD IN MAY 2019. IMPLEMENTATION AS OUTLINED IN LINE 2 HAS BEGUN. PART VI, LINE 6: UPMC PINNACLE LITITZ IS PART OF UPMC PINNACLE, A FULLY INTEGRATED, AFFILIATED HEALTH CARE SYSTEM. THE SYSTEM IS COMPRISED OF TEN WHOLLY OWNED ENTITIES AS WELL AS A VARIETY OF AFFILIATED JOINT VENTURES. THE ORGANIZATION'S MISSION IS TO MAINTAIN AND IMPROVE THE HEALTH AND QUALITY OF LIFE FOR EVERYONE IN CENTRAL PENNSYLVANIA. UPMC PINNACLE IS ENGAGED IN AND CONDUCTS CHARITABLE, EDUCATIONAL, AND SCIENTIFIC ACTIVITIES THROUGH THE SUPPORT AND BENEFIT OF PINNACLE HEALTH FOUNDATION, AND PROVIDES MANAGEMENT AND CONSULTATIVE SERVICES TO AFFILIATED ENTITIES. UPMC PINNACLE MEDICAL SERVICES AND REGIONAL PHYSICIANS ARE PRIMARILY ENGAGED IN THE PROVISION OF PHYSICIAN SERVICES TO SUPPORT AND ENHANCE THE SERVICES WITHIN UPMC PINNACLE. THE UPMC PINNACLE CARDIOVASCULAR INSTITUTE IS ENGAGED IN PROVIDING COMPREHENSIVE CARDIAC CARE, INCLUDING TECHNOLOGICAL ADVANCES IN ORDER TO PROVIDE THE BEST CLINICAL OUTCOMES TO THE COMMUNITY. COMMUNITY LIFE TEAM IS ENGAGED IN PROVIDING COMMUNITY BASED, EFFICIENT AND COST EFFECTIVE MEDICAL TRANSPORT SERVICES, PRE-HOSPITAL EMERGENCY MEDICAL SERVICES FOR THE RESIDENTS AND COMMUNITIES OF THE CENTRAL PENNSYLVANIA YORK REGIONS.PINNACLE HEALTH VENTURES, INC. WAS FORMED IN 2012 TO CONSOLIDATE VARIOUS ENTITIES THAT FUNCTION IN SUPPORT OF THE UPMC PINNACLE NETWORK. CURRENTLY INCLUDED IN VENTURES ARE PINNACLE HEALTH IMAGING, MEDCARE SUSQUEHANNA VALLEY, PINNACLE HEALTH ALLBETTERCARE, AND MEDICAL ARTS BUILDING. UNITED HEALTH RISK IS A WHOLLY-OWNED, FOR-PROFIT, OFFSHORE CAPTIVE INSURANCE COMPANY, AND UNITED CENTRAL PENNSYLVANIA RECIPROCAL RISK RETENTION GROUP IS A WHOLLY-OWNED, FOR-PROFIT, VERMONT CAPTIVE INSURANCE COMPANY. BOTH INSURANCE ENTITIES OPERATE FOR THE BENEFIT OF UPMC PINNACLE.UPMC PINNACLE AND ITS AFFILIATES ARE ACTIVELY INVOLVED IN THE CENTRAL PENNSYLVANIA REGION THROUGH VARIOUS CHARITY AND COMMUNITY BENEFIT ACTIVITIES. THE SYSTEM PROVIDED $42 MILLION OF CHARITY CARE RECORDED AT CHARGES WITH UPMC PINNACLE LITITZ PROVIDING $2.6 MILLION. PART VI, LINE 7, REPORTS FILED WITH STATES PA 1 1 0 0 0 0 0 0 0 PHILIP W GUARNESCHELLI PRESIDENT/CEO 0 828825 0 348731 0 198185 0 16500 0 19211 0 1411452 0 0 DEBORAH WILLWERTH PRESIDENT UPMC LITITZ/SECRETARY 214528 0 43316 0 30780 0 12872 0 12955 0 314451 0 0 0 MICHAEL BROOKS TURKEL SVP & PRESIDENT, LANC DIV 0 458069 0 92495 0 54103 0 16500 0 12697 0 633864 0 0 WILLIAM H PUGH EVP-TREAS./CFO 0 603418 0 222089 0 87441 0 16500 0 8184 0 937632 0 0 ALISON BERNHARDT VP, CORP ACCT&RPT/CFO 0 258421 0 86065 0 34603 0 4854 0 8008 0 391951 0 0 CHRISTOPHER P MARKLEY ESQ ASST. SEC'Y/SR VP STAT SVC/GEN COUNS 0 416046 0 154502 0 66248 0 16500 0 14892 0 668188 0 0 CHRISTIAN CAICEDO MD SR. VP UPMC PINNACLE CUMBERLAND DIV 0 437562 0 162224 0 64352 0 16500 0 18794 0 699432 0 0 DAVID SCHMIDT REGIONAL CNO & VP NURSING OPS 150282 0 33269 0 4199 0 7514 0 7705 0 202969 0 0 0 DAVID BENNER CLINICAL STAFF PHARMACIST 145953 0 1957 0 7352 0 7388 0 7588 0 170238 0 0 0 JUDITH MCCOY HOUSE SUPERVISOR-WKND 137274 0 4821 0 3298 0 8236 0 8166 0 161795 0 0 0 BRIANNA DOHM PHARMACIST SUPERVISOR 130174 0 0 0 3247 0 6509 0 12180 0 152110 0 0 0 MICHAEL A YOUNG FORMER PRESIDENT/CEO (RES. 3/17) 0 0 0 0 0 1035976 0 0 0 9539 0 1045515 0 0 PART I, LINE 3 UPMC PINNACLE LITITZ RELIES ON UPMC PINNACLE, A RELATED ORGANIZATION, TO ESTABLISH THE COMPENSATION FOR THE ORGANIZATION'S CEO. METHODS USED TO ESTABLISH COMPENSATION BY THE RELATED ORGANIZATION INCLUDE: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE COMPENSATION COMMITTEE OF THE BOARD PART I, LINES 4A-B MICHAEL A. YOUNG, THE FORMER CEO, RECEIVED A SEVERANCE PAYMENT OF $1,035,976 DURING THE YEAR. UPMC PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO ITS FORMER CHIEF EXECUTIVE OFFICER (THE "FORMER CEO") THROUGH AN ALTERNATIVE FUNDING ARRANGEMENT THE IRS CALLS "LOAN-REGIME SPLIT-DOLLAR" ("LRSD"). ALTHOUGH THE IRS REQUIRES LRSD TO COMPLY WITH THE TAX PRINCIPLES OF A LOAN FOR FEDERAL INCOME TAX PURPOSES (IRC 7872), LRSD IS NOT AN ACTUAL LOANNO FUNDS ARE TRANSFERRED TO THE EXECUTIVE. RATHER, THE "LOAN" TREATMENT APPLIES BECAUSE AFTER THE EXECUTIVE HAS RECEIVED RETIREMENT BENEFITS (SUBJECT TO VESTING REQUIREMENTS AND POLICY INVESTMENT PERFORMANCE), UPMC RECOVERS ALL ITS OUTLAYS PLUS A MARKET RATE OF INTEREST. AS WITH AN EMPLOYER-EMPLOYEE LOAN, AND CONSISTENT WITH THE 2003 FINAL REGULATIONS AND IRC 7872, THE PLAN IS NON-COMPENSATORY TO THE PARTICIPATING EXECUTIVE, AS THE LOAN IS REPAID PLUS INTEREST UPON THE DEATH OF THE EXECUTIVE. UNDER THE REGULATIONS, THERE IS NO COMPENSATION IMPUTED TO THE EXECUTIVE. THE UPMC LRSD PLAN WORKS AS FOLLOWS. UPMC DEPOSITED FUNDS DIRECTLY INTO CASH VALUE LIFE INSURANCE POLICIES ON THE FORMER CEO'S LIFE. DURING LIFE, TO THE EXTENT THE FORMER CEO FULFILLED SERVICE AND VESTING REQUIREMENTS, THE FORMER CEO CAN BORROW AGAINST VALUES IN THE POLICIES TO SUPPLEMENT RETIREMENT INCOME. POLICY PERFORMANCE IS CLOSELY MONITORED. IF POLICY PERFORMANCE LAGS, THE FORMER CEO'S BORROWING RIGHTS COULD BE REDUCED TO PROTECT UPMC'S RECOVERY RIGHTS. AT THE FORMER CEO'S DEATH, THE POLICY DEATH PROCEEDS ARE FIRST USED TO REPAY UPMC ITS DEPOSITS PLUS COMPOUNDED INTEREST (AT THE IRS LONG-TERM APPLICABLE FEDERAL RATE). THE FORMER CEO'S BENEFICIARY THEN RECEIVES ANY PROJECTED RETIREMENT BORROWING NOT ACCESSED DURING LIFE. CHRISTIAN CAICEDO MD OWNER OF CIS PA LLC 1828113 AS THE OWNER OF CIS PA LLC, MR. CAICEDO PROVIDES SOFTWARE SUPPORT FOR UPMC PINNACLE ENTITIES. ALL TRANSACTIONS ARE NEGOTIATED AT ARM'S LENGTH RATES. 0 DANIEL PUGH RELATIVE OF OFFICER WILLIAM PUGH 115455 DANIEL PUGH IS A RELATIVE OF WILLIAM PUGH AND IS COMPENSATED BY UPMC PINNACLE AS AN EMPLOYEE. WILLIAM PUGH DOES NOT SUPERVISE DANIEL PUGH NOR DOES HE PARTICIPATE IN DISCUSSIONS ON DANIEL PUGH'S COMPENSATION. 0 MICHAEL HESS RELATIVE OF OFFICER PHILIP GUARNESCHELLI 70071 MICHAEL HESS IS A RELATIVE OF PHILIP GUARNESCHELLI AND IS COMPENSATED BY UPMC PINNACLE AS AN EMPLOYEE. PHILIP GUARNESCHELLI DOES NOT SUPERVISE MICHAEL HESS NOR DOES HE PARTICIPATE IN DISCUSSIONS ON MICHAEL HESS' COMPENSATION. 0 FORM 990, PART V, LINE 1: UPMC PINNACLE, THE PARENT ENTITY OF A GROUP OF TAX-EXEMPT ORGANIZATIONS, IS THE COMMON REPORTING AGENT FOR THE GROUP AND FILES ALL 1099 FORMS FOR UPMC PINNACLE LITITZ. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS UPMC PINNACLE, A FEDERALLY TAX EXEMPT, STATE NONPROFIT ENTITY (EIN 25-1778658). FORM 990, PART VI, SECTION A, LINE 7A AS SOLE MEMBER OF THE ORGANIZATION, UPMC PINNACLE SHALL ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN GOVERNANCE DECISIONS OF THE ORGANIZATION REQUIRE THE APPROVAL OF BOTH THE UPMC PINNACLE BOARD AND THE UPMC BOARD, AS THE SOLE MEMBER OF UPMC PINNACLE. FORM 990, PART VI, SECTION B, LINE 11B THE AUTHORITY AND RESPONSIBILITY FOR REVIEW OF THE FORM 990 FOR UPMC PINNACLE AND SUBSIDIARIES IS DELEGATED TO THE FINANCE COMMITTEE OF THE UPMC BOARD. IN ORDER TO ACCOMPLISH THIS, ALL MEMBERS OF THE FINANCE COMMITTEE ARE PROVIDED WITH A REASONABLE OPPORTUNITY TO REVIEW AND COMMENT TO EXECUTIVE LEADERSHIP ON THE IRS FORMS 990 OF UPMC PINNACLE AND ITS SUBSIDIARIES. IN ADDITION, EACH MEMBER OF EACH RESPECTIVE BOARD OF DIRECTORS WILL BE GIVEN ACCESS TO VIEW THEIR INDIVIDUAL FORM 990 VIA A SHARED, PASSWORD-PROTECTED WEBSITE BEFORE THE RETURNS ARE FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C IN THE PERFORMANCE OF THEIR DUTIES TO UPMC PINNACLE, COVERED PERSONS SHALL SEEK TO ACT IN THE BEST INTERESTS OF UPMC PINNACLE, AND SHALL EXERCISE GOOD FAITH, LOYALTY, DILIGENCE AND HONESTY. A COVERED PERSON IS ANY INDIVIDUAL WHO SERVES IN A FIDUCIARY CAPACITY TO, OR WHO HAS LEGAL AUTHORITY TO REPRESENT OR OBLIGATE, UPMC PINNACLE OR ANY OF ITS AFFILIATED ORGANIZATIONS INCLUDING, BUT NOT LIMITED TO, DIRECTORS, OFFICERS, EMPLOYEES, AND AGENTS. COVERED PERSONS ALSO INCLUDE A) IMMEDIATE FAMILIES (SPOUSES, CHILDREN, SIBLINGS, PARENTS, OR SPOUSE'S PARENTS), B) ANY ORGANIZATION IN WHICH THEY OR THEIR IMMEDIATE FAMILIES DIRECTLY OR INDIRECTLY I) HAVE A MATERIAL FINANCIAL OR BENEFICIAL INTEREST, OR II) SERVE AS A DIRECTOR, OFFICER, EMPLOYEE, AGENT, ATTORNEY OR SIMILAR CAPACITY. A COVERED PERSON SHALL DISCLOSE ANY BUSINESS OR PERSONAL INTERESTS OR RELATIONSHIPS WHICH MAY BE IN CONFLICT WITH THE INTERESTS OF UPMC PINNACLE, INCLUDING, BUT NOT LIMITED TO (A) ENGAGING IN OR SEEKING TO BE ENGAGED IN (I) THE DELIVERY OF HEALTH CARE SERVICES OR (II) THE DELIVERY OF GOODS OR SERVICES TO UPMC PINNACLE, OR (B) ANY TRANSACTION OR ARRANGEMENT WITH UPMC PINNACLE WHICH WOULD RESULT IN BENEFIT TO COVERED PERSONS. THE GOVERNANCE COMMITTEE OF THE UPMC PINNACLE BOARD REVIEWS ALL CONFLICT OF INTEREST STATEMENTS AND DETERMINES WHETHER EACH DIRECTOR ON THE BOARD IS INDEPENDENT. COVERED PERSONS WHO ARE DIRECTORS MUST COMPLY WITH UPMC PINNACLE GUIDELINES FOR DETERMINING DIRECTOR INDEPENDENCE AND APPLYING DIRECTOR INDEPENDENCE REQUIREMENTS. COVERED PERSONS WITH A CONFLICT OF INTEREST SHALL NOT VOTE ON THE MATTER, AND THE UPMC PINNACLE BOARD OR COMMITTEE MUST APPROVE, AUTHORIZE, OR RATIFY THE TRANSACTION OR ARRANGEMENT BY A MAJORITY VOTE OF THE NON-INTERESTED DIRECTORS OR COMMITTEE MEMBERS PRESENT AT A MEETING THAT HAS A QUORUM. VIOLATIONS OF THIS STATEMENT OF POLICY MAY SUBJECT COVERED PERSONS TO APPROPRIATE SANCTIONS, INCLUDING REMOVAL FROM THEIR POSITIONS WITH UPMC PINNACLE. FORM 990, PART VI, SECTION B, LINE 15A THE COMPENSATION COMMITTEE OF THE UPMC PINNACLE BOARD OF DIRECTORS HAS THE AUTHORITY TO DEVELOP AND MAINTAIN EXECUTIVE AND PHYSICIAN COMPENSATION TO BE APPROVED BY THE UPMC PINNACLE BOARD. THE COMPENSATION COMMITTEE WILL FOLLOW A DILIGENT PROCESS THAT MEETS REGULATORY REQUIREMENTS FOR A REBUTTABLE PRESUMPTION OF REASONABLENESS AND PROMOTES EFFECTIVE GOVERNANCE OF EXECUTIVE COMPENSATION, CONSISTENT WITH THE UPMC PINNACLE COMPENSATION PHILOSOPHY. 1) FOLLOW A PROCESS THAT ESTABLISHES AND MAINTAINS A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL EXECUTIVES AND PHYSICIANS POTENTIALLY SUBJECT TO INTERMEDIATE SANCTIONS. 2) PREPARE MINUTES FOR EACH MEETING TO RECORD THE TERMS OF THE COMMITTEE'S DECISIONS AND THE PROCESS FOLLOWED IN REACHING THOSE DECISIONS. THESE MINUTES MUST INCLUDE INDICATIONS THAT THE COMMITTEE IS FOLLOWING GOOD PRACTICES IN DEALING WITH CONFLICTS OF INTEREST AND IN OBTAINING AND RELYING ON APPROPRIATE COMPARABILITY DATA ON TOTAL COMPENSATION. 3) SELECT AND DIRECTLY ENGAGE AND SUPERVISE ANY CONSULTANT HIRED BY UPMC PINNACLE TO ADVISE THE COMMITTEE ON EXECUTIVE AND PHYSICIAN COMPENSATION. 4) PERIODICALLY EVALUATE THE APPROPRIATENESS OF THIS CHARTER AND THE EFFECTIVENESS OF THE PROCESS THE COMMITTEE USES IN GOVERNING EXECUTIVE AND PHYSICIAN COMPENSATION AND REPORT THIS EVALUATION TO THE BOARD. 5) PROVIDE THE BOARD WITH AN ANNUAL REPORT ON THE COMMITTEE'S ACTIONS. 6) MONITOR CHANGES IN LAWS AND REGULATIONS PERTAINING TO EXECUTIVE COMPENSATION AND BENEFITS TO SEE THAT UPMC PINNACLE COMPLIES WITH THEM. 7) SEEK OUTSIDE REVIEW OF COMMITTEE OPERATIONS TO ENSURE COMPLIANCE WITH THE IRS REBUTTABLE PRESUMPTION OF REASONABLENESS. 8) REVIEW ACTUAL EXECUTIVE COMPENSATION AND BENEFITS PROVIDED TO CONFIRM CONSISTENCY WITH COMPENSATION AND BENEFITS APPROVED BY THE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION INCLUDES A COPY OF ITS FINANCIAL STATEMENTS WITH THE STATE REGISTRATION FILED WITH THE PENNSYLVANIA DEPARTMENT OF STATE, BUREAU OF CHARITABLE ORGANIZATIONS. THESE DOCUMENTS ARE A MATTER OF PUBLIC RECORD AND CAN BE VIEWED AT THE BUREAU OFFICE. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 272,080. MANAGEMENT AND GENERAL EXPENSES 107,133. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 379,213. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 3,862,765. MANAGEMENT AND GENERAL EXPENSES 42,839. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,905,604. CONSULTING: PROGRAM SERVICE EXPENSES 379. MANAGEMENT AND GENERAL EXPENSES 95. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 474. PROF FEES I/C LOSS TRANSFERS: PROGRAM SERVICE EXPENSES 1,394,608. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,394,608. COLLECTION FEES: PROGRAM SERVICE EXPENSES 31. MANAGEMENT AND GENERAL EXPENSES 160,599. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 160,630. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 57,626. MANAGEMENT AND GENERAL EXPENSES 10,136. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,762. OUTSOURCING: PROGRAM SERVICE EXPENSES 1,543,236. MANAGEMENT AND GENERAL EXPENSES 368,405. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,911,641. CLEANING SERVICES: PROGRAM SERVICE EXPENSES 13,535. MANAGEMENT AND GENERAL EXPENSES 31,780. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,315. LAB SERVICES: PROGRAM SERVICE EXPENSES 517,867. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 517,867. RADIOLOGY FEES: PROGRAM SERVICE EXPENSES 28,279. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,279. MEDICAL VISITS: PROGRAM SERVICE EXPENSES 42,500. MANAGEMENT AND GENERAL EXPENSES 315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,815. OTHER FEES: PROGRAM SERVICE EXPENSES 92,774. MANAGEMENT AND GENERAL EXPENSES 1,190. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 93,964. PHYSICIAN PRACTICE LOSS TRANSFERS: PROGRAM SERVICE EXPENSES 15,246,555. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,246,555. FORM 990, PART XI, LINE 9: CONTRIBUTED NET ASSETS 27,310,518. PART XII, LINE 2C: UPMC IS AUDITED ON A CONSOLIDATED BASIS. THEREFORE, THERE ARE NO SEPARATE AUDITED FINANCIAL STATEMENTS FOR UPMC PINNACLE AND ITS SUBSIDIARIES. UPMC SENIOR COMMUNITIES INC 600 GRANT STREET PITTSBURGH PA 15219 251574736 SR LIVING PA 501(C)(3) LINE 10 UPMC 0 PITTSBURGH LIFETIME CARE COMMUNITY 600 GRANT STREET PITTSBURGH PA 15219 251335247 CCRC PA 501(C)(3) LINE 10 UPMC SR COMM 0 CANTERBURY PLACE 600 GRANT STREET PITTSBURGH PA 15219 250965334 SR LIVING PA 501(C)(3) LINE 10 UPMC SR COMM 0 SENECA PLACE 600 GRANT STREET PITTSBURGH PA 15219 721562844 SR LIVING PA 501(C)(3) LINE 10 UPMC SR COMM 0 SHADYSIDE HOSPITAL SUPPORTING FOUNDATION 600 GRANT STREET PITTSBURGH PA 15219 260303394 FOUNDATION PA 501(C)(3) LINE 12A, I UPMC 0 UPMC LEE 600 GRANT STREET PITTSBURGH PA 15219 250613830 INACTIVE PA 501(C)(3) LINE 3 UPMC 0 PITTSBURGH CARE PARTNERSHIP INC 600 GRANT STREET PITTSBURGH PA 15219 251753852 SR CARE MGMT PA 501(C)(3) LINE 10 UPMC 0 UPMC CENTER FOR HIGH VALUE HEALTHCARE 600 GRANT STREET PITTSBURGH PA 15219 452178782 RESEARCH PA 501(C)(3) LINE 7 UPMC 0 SHADYSIDE HOSPITAL FOUNDATION 532 SOUTH AIKEN AVENUE PITTSBURGH PA 15232 251290546 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INFRASTRUCTURE LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI X91 DH9W PROPERTY MGMT EI N/A C 0 EURO CARE PROPERTY MANAGEMENT LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI X91 DH9W PROPERTY MGMT EI N/A C 0 EURO CARE HEALTHCARE LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI X91 DH9W HOSPITAL EI N/A C 0 WATERFORD ONCOLOGY ASSOCIATES LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI X91 DH9W ONCOLOGY SVC EI N/A C 0 UPMC CANCER CENTERS IRELAND LIMITED 6TH FLOOR BEACON HOSPITAL SANDYFORD EI DUBLIN 18 CANCER TREATM EI N/A C 0 PANTHER REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN CJ N/A 981402742 INSURANCE CJ N/A C 0 FORBES REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN CJ N/A 981400710 INSURANCE CJ N/A C 0 CATHEDRAL (RE) INSURANCE CO PO BOX 1109 GRAND CAYMAN CJ N/A 981400837 INSURANCE CJ N/A C 0 UPMC IRELAND LIMITED 6TH FLOOR BEACON HOSPITAL SANDYFORD EI DUBLIN 18 HEALTHCARE SU EI N/A C 0 UPMC CANADA TECHNOLOGIES LIMITED 600 GRANT STREET PITTSBURGH CA 15219 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GRANT STREET PITTSBURGH PA 15219 455135437 PHYSICIAN SRV PA N/A C 0 SOMERSET MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH PA 15219 251512960 MOB OWNERSHIP PA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 FORM 990, SCHEDULE R, PARTS I THROUGH IV: ENTITIES REPORTED IN PARTS I THROUGH IV THAT ARE MARKED WITH AN * ARE NOT TECHNICALLY "RELATED ORGANIZATIONS", AS DEFINED IN THE FORM 990 INSTRUCTIONS AS THE REQUISITE "CONTROL" DID NOT EXIST DURING THE FISCAL YEAR ENDED JUNE 30, 2019. HOWEVER, BECAUSE THESE ENTITIES ARE AFFILIATED WITH UPMC AND THE UPMC PARENT ORGANIZATION HOLDS CERTAIN POWERS WITH RESPECT TO SUCH ENTITIES WE ARE ELECTING TO DISCLOSE THE ENTITIES AS RELATED ORGANIZATIONS IN SCHEDULE R IN THE INTEREST OF TRANSPARENCY.