2019-05-15T07:56:18-05:00 2018-06-30 440160260 BKD LLP 910 E St Louis Street Suite 200 Springfield MO 65806 990 2017-07-01 232176963 Soldiers and Sailors Memorial Hospital SOLD 5707230605 32-36 Central Avenue No Acctg Wellsboro PA 16901 Chris Stockhausen Interim CFO 4125789592 2019-05-15 1 Brian D Todd P00422601 4178658701 50.202.239.68 2019-05-15 08:55:47 ED P 1BA4CE2121576A7D46F0E86313F165324A79D8C6 CF77422DD73D8D63E416D3D1138E47F9157013E9 2017 2019-02-21 02:37:17Z Steven P Johnson 700 High Street Williamsport PA 17701 78830169 0 X upmcsusquehanna.org X 1919 PA Soldiers & Sailors Memorial Hospital (SSMH) is a 50 bed, critical access hospital, primarily serving Tioga and surrounding counties. SSMH provides a full range of outpatient, inpatient and emergency services. 13 10 0 91 0 2166 26046 6700 71932539 77632614 117624 165238 552462 698851 72628671 78503403 7675 686928 0 0 26207312 24679469 0 0 0 35013948 37835804 61228935 63202201 11399736 15301202 85842590 97443370 13713473 7489947 72129117 89953423 X Soldiers & Sailors Memorial Hospital ("SSMH") is a subsidiary of the exempt organization UPMC Susquehanna. The mission of UPMC Susquehanna and its affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our Vision is to create an integrated community health system that delivers world class care. Our values are to carefully place our patients and their families first, share ownership with all our caregivers and lead with a servant's heart. 0 0 58342208 686928 77632614 The hospital is an 50 bed critical access hospital, which provides care to patients who meet certain criteria without charge or at amounts less than its established rates. The hospital does not pursue collection of amounts determined to qualify as charity care, nor are such amounts reported as revenue. The charity care charges foregone amounted to $1,264,200 in 2018. The following is a summary of the services provided to patients in 2018;Inpatient admissions 1,707Outpatient visits 94,776Newborn deliveries 206Emergency department visits 15,677Surgeries performed 5,842Laboratory tests 256,094CAT Scans 7,357Ultrasound tests 6,598Radiology tests 17,670MRI tests 1,822Nuclear Medicine tests 742Rehab 11,186Oncology Procedures 2,420 SSMH treats all patients without regard to their ability to pay. In addition, the Hospital treats Medicare and Medical Assistance patients and maintains a Medicare/Medical Assistance policy that provides patients enrolled in such programs with access to all covered inpatient, outpatient and diagnostic services that are available to non-Medicare/Medical Assistance patients. On an annual basis, SSMH devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $13,738,000 in quantifiable community benefits reported for FY 2018. Charity care (at cost) $315,000; Bad Debt (at cost) 5,619,000; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, and other safety net programs) $7,129,000. In addition, various other programs such as Community Building, Community Wellness and recreation, Financial and InKind Contributions and Community Benefit Operations totaling $675,000. 58342208 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 PA X Gretchen Regina 5707230605 32-36 Central Avenue Wellsboro PA 16901 Lisa V Feil Psy D Director 1.00 1.00 X 0 0 0 Robert PFitzgerald Director 1.00 1.00 X 0 0 0 Harold F Hoose III Treasurer 1.00 1.00 X X 0 0 0 Michael W Lichty Director 1.00 1.00 X 0 0 0 JDennis Murray PhD Director 1.00 1.00 X 0 0 0 Thomas M Owlett Esq Chairman 1.00 1.00 X X 0 0 0 Glenn BPoirier Vice Chairman 1.00 1.00 X X 0 0 0 Wendy SSwartz CPA Director 1.00 1.00 X 0 0 0 Donna R Wilson Director 1.00 1.00 X 0 0 0 Kathy J Wright PhD Secretary 1.00 1.00 X X 0 0 0 Jill ABurns MD Director 1.00 41.00 X 0 249542 29207 Walter J Laibinis DO Director 1.00 41.00 X 0 361408 29999 Steven P Johnson President/CEO 1.00 51.00 X X 0 1434188 33810 Janie M Hilfiger VP/President 40.00 2.00 X 188935 0 18092 Eric Pohjala Executive VP/CFO 0.00 52.00 X 0 434880 31749 Jan E Fisher Executive VP/COO 1.00 41.00 X 0 480809 28165 David Lopatofsky MD Executive VP/CMO 1.00 41.00 X 0 552898 35625 Enrico Doganiero Physician 40.00 X 527891 0 35866 Candy Klotz Pharmacist 40.00 X 141877 0 6773 Stephen Bortz Supervisor Chief Pharmaci 40.00 X 147670 0 13913 Toni Burch RN Supervisor 40.00 X 146670 0 14442 1153043 3513725 277641 5 0 1 0 Aramark Healthcare 24863 Network Place Chicago IL 60673 Management Services/Environment 6086909 Oracle (People Soft) 500 Oracle Parkway Redwood Shores CA 94065 Software support 1931084 2 6700 6700 Patient service revenue 621990 75558570 75558570 Employee Pharmacy revenue 446110 830040 830040 Paramedic revenue 621910 541618 541618 Other Miscellaneous income 621990 469123 469123 Cafeteria revenue 722210 216943 216943 16320 16320 77632614 7395 7395 698851 0 698851 698851 698851 484609 326766 157843 157843 157843 78503403 77632614 0 864089 X 686928 686928 1153043 964108 188935 18805107 17064119 1740988 75013 67512 7501 3234989 2911490 323499 1411317 1270185 141132 1548232 1548232 1073 1073 3885 3885 11327263 10689505 637758 194 194 574566 506729 67837 884739 860236 24503 120845 120845 34566 34566 603478 603478 3777208 3777208 498698 498698 Medical Supplies and Dr 9597398 9588825 8573 Bad Debt Expenses 5618536 5618536 Repairs and Maintenance 2240310 2233232 7078 Laundry and Linen 216172 216172 788641 629642 158999 63202201 58342208 4859993 0 6393504 210423 34558 24622 7621953 9121333 867555 3191543 684327 368486 171922 28050 82929499 42094944 42107777 40834555 27960994 43664358 85842590 97443370 10446129 3547740 257624 173952 2349399 2231753 660321 1536502 13713473 7489947 X 71903101 89708581 226016 244842 72129117 89953423 85842590 97443370 X 15301202 2523104 X X 0 1 X 1 0 X 0 0 0 0 0 1 4221 0 0 0 4221 0 Part II-B, Line 1: The Hospital holds a membership in the American Hospital Association (AHA) which engages in lobbying as part of their mission to represent the interests of hospitals at both the Federal and State levels. For the year ended June 30, 2018, the amount of dues paid to AHA totaled $18,370, of which 22.98% or $4,221, was used for lobbying purposes. 1340122 1340122 52519034 22502147 30016887 116316 115890 426 25511639 17596665 7914974 3442388 1880242 1562146 40834555 Due from Exempt Affiliates 43664358 43664358 Estimated amounts due to third-party payers 1536502 1536502 X Part X, Line 2: UPMC has no uncertain tax positions recorded. 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. As of June 30, 2018, UPMC does not have any unrecorded tax benefits. An external audit is completed at a consolidated UPMC system level only, including UPMC and all taxable and tax-exempt subsidiaries. Central America 0 1 Program Services Captive Insurance Company 441976 0 1 0 0 0 1 441976 0 441976 0 0 0 0 0 0 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 312257 0 312257 0.00490 8254784 6913112 1341672 0.02120 8567041 6913112 1653929 0.02610 6153 6153 0.00010 1006992 1006992 0.01590 1013145 1013145 0.01600 9580186 6913112 2667074 0.04210 0 1 5618536 280927 6969670 8265879 -1296209 X 1 1 1 1 Soldiers & Sailors Memorial Hospital 32-36 Central Avenue Wellsboro PA 16901 www.upmcsusquehannahealth.org 390043 X X X Soldiers & Sailors Memorial Hospital 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X See Part V, Page 7 X 1 15 1 See Part V, Page 7 0 1 X 250.000000000000 400.000000000000 X X X 1 1 X X X 1 X WWW/UPMC.com/patients-visitors/paying-bill/services X WWW/UPMC.com/patients-visitors/paying-bill/services X WWW/UPMC.com/patients-visitors/paying-bill/services X X X X X X 1 X 0 X 1 X 0 0 Soldiers & Sailors Memorial Hospital Part V, Section B, Line 5: In conducting its CHNA, the hospital took into account input from representatives of the community served, including those with special knowledge of or expertise in public health. This was accomplished by conducting 9 Key Informant interviews with 55 people answering the key informant interview. A web-based tool was utilized to conduct the key informant interviews; however, paper questionnaires identical to the electronic version were distributed to populations who may not have had access to the internet or generally are more likely to complete a paper questionnaire. For more details concerning the Key Informant Interview Process or the Community Health Input Questionnaire process, including a list of those individuals interviewed, a copy of the Community Health Input Questionnaire, and results gathered you may view the CHNA and related Implementation Plan at www.upmcsusquehanna.org/community health. Soldiers & Sailors Memorial Hospital Part V, Section B, Line 6a: Soldiers and Sailors Memorial Hospital; located in Wellsboro, PA is one of six hospitals that comprise UPMC Susquehanna based in Williamsport, Pennsylvania. For purposes of conducting CHNA's, three of these hospitals, The Williamsport Hospital (DBA:Williamsport Regional Medical Center), Divine Providence Hospital, and Muncy Hospital, share the same definition of community served, which is Lycoming County, PA. The fourth hospital that is part of UPMC Susquehanna is Soldiers and Sailors Memorial Hospital located in Wellsboro, PA and their defined community is Tioga County, PA. Additionally there are two recently acquired hospital entities, Lock Haven Hospital and Sunbury Hospital,whose community health needs are being evaluated. The health systems' approach to providing community benefits is to leverage the assets and expertise of all six hospitals to meet the needs and improve the health status of those who reside in the communities located in Lycoming and Tioga counties. Accordingly, a certain amount of collaboration between these related hospitals occurred in the development of their CHNA's and related Implementation Plans. For more details concerning these four hospitals, as well as their definition of community served you may view the CHNA and related Implementation Plans at www.upmcsusquehanna.org/community health. Soldiers & Sailors Memorial Hospital Part V, Section B, Line 11: Health needs were identified based on information gathered and analyzed through the 2016 CHNA conducted by the Health System. For the health needs prioritization process, the Health System engaged a hospital leadership team to review the most significant health needs reported in the CHNA using the following criteria, 1) Current area of hospital focus. 2) Established relationships with community partners to address the health need. 3) Organizational capacity and existing infrastructure to address the health need. Based on the criteria outlined above, the leadership team ranked each of the health needs. As a result of the priority process, the identified priority areas that will be addressed through the Health System's Implementation Strategy for fiscal years 2017 through 2019 will be: Priority 1:Improve access to primary and specialty services.Goal 1: Work with Tioga County Partnership for Community Health on Improvement of transportation for healthcare services. Update as of 7/7/2017: Tioga County Partnership for Community Health received a block grant for transportation which SSMH is using for patients discharged from the Emergency Department and inpatient units, to transport to home at no cost to the patient.Goal 2: Explore non-traditional strategies to provide access to care. Update as of 7/7/2017: Susquehanna Health Internal Medicine office has opened same day appointments to accommodate urgent needs. Laurel Health Center administration is exploring urgent care concept at the Mansfield Laurel Health Center. Visiting specialists from Lycoming provide Cardiology and ENT at Wellsboro and Cardiology, Sports Medicine and Rheumatology at Mansfield.Goal 3: Explore telehealth opportunities and innovative ways to deliver care. Update as of 7/7/2017: the following at now available at SSMH: teleburn, telestroke, telepsychiatry, and teleneurology. A UPMC Susquehanna telehealth committee has been formed.Priority 2: Bring in addiction services and/or task forces to Tioga County.Goal 1: Authorize Implementation of prescription drug monitoring program system wide. Goal 2: Collaborate with Tioga County to share best practices. Update as of 7/7/2017:SSMH actions-Review and reduce Rx when feasible, standardize narcotic formulations, OB task force setup and add ER case managers. Physician offices- monitor of prescribing patterns. County Wide-Project Bald Eagle/Tioga Coalition first mtg 4/27/17, drug drop boxes, National Guard education programs.Priority 3: Collaborate with community organizations on health and wellness initiatives. Goal 1: Promote routine cancer screenings for breast, colon and cervical cancer. Update as of 7/7/2017: Susan G Komen grant received to cover mammograms for the uninsured. Free screening for melanoma provided by Susquehanna Surgical at Wellsboro in May and September. Expansion of mammography to the Mansfield Medical Plaza. Implementation of breast health nurse navigator program in Wellsboro.Goal 2: Collaborate with the PA Department of Health and Tioga County Partnership for Community Health to establish more health screeeings and community events. Update as of 7/7/2017: Community health programs offered throughout the year to include newborn immunization program through SSMH and Tioga Partnership.Goal 3: Continue to partner with River Valley Regional YMCA and Wellsboro Parks and Recreation Department to support health and wellness programs for both children and adults. Update as of 7/7/2017: YMCA offers a variety of programs for youth. The UPMC Wellness program provides a multitude of activities to promote a healthy lifestyle.Goal 4: Continue to grow and expand Spirit of Women program. Update as of 7/7/2017: Multiple programs provided throughout the year by the Spirit of Women program.Priority 4: Support mental health serviceGoal 1: Increase access to behavorial health specialists. Update as of 7/7/2017: Telehealth available at SSMH and pediatric behavorial health through the Penn State telehealth program available at Wellsboro Behavorial Health Office.Priority 5: Support transportation options to healthcare for rural areas.Goal 1: Work with Tioga County Partnership for Community Health on improvement of transportation for healthcare services. Update as of 7/7/2017: Tioga County Partnership received a grant for transportaion which SSMH is using for patients discharged from the ER and inpatient units, to transport to home at no cost to the patient.Goal 2 : Bring routine wellness screenings and programs to rural Tioga areas. Update as of 7/7/2017: PA Department of health no longer employs an RN to assist with programs. UPMC SSMH and Tioga Partnership continue to offer routine Wellness screenings and programs, such as CMBA (community multi-phasic blood analysis). Soldiers & Sailors Memorial Hospital Part V, Section B, Line 20e: UPMC Soldiers and Sailors Memorial Hospital engages in no extraordinary collection actions. Part I, Line 3c: Financial Assistance or Charity care is available for eligible individuals who have health care needs and are uninsured, underinsured, inelgible for government programs or otherwise unable to pay for their own care.A patient may be determined to have financial needs based on the following:1. Indigency: if income falls at or below 250% of the Federal Poverty guidelines, the patient will have no financial responsibilty. The patient is approved for 100% free care. 2. Low income sliding scale: Assistance may be a discounted or reduced patient liability depending on the patient's income:A. If the combined family income is greater than 251% and less than or equal to 400% of the Federal poverty guidelines and uninsured, the patient is eligible for reduced charity care.There will be an 87% reduction in the patient bill. The discounted charity care scale is listed below:F/S=Family Size 2018Family Size Category 1-100% Category 2-87%1 $30,350 $48,5602 $41,150 $65,8403 $51,950 $83,1204 $62,750 $100,4005 $73,550 $117,6806 $84,350 $134,9607 $95,150 $152,2408 $105,950 $169,520Each Additional $10,800 $17,2803. Financial hardship: If a patient is approved for discounted or reduced charity care and cannot afford to pay the remaining balance, the patient may be considered for financial hardship. Assistance will be provided in the form of an adjustment of charges to prevent the patient liability from exceeding the lesser of 15% of family income or the AGB. 4. Medical Hardship/catastrophic care: If a patient is denied financial assistance and cannot afford to pay the account balance, the patient may be considered medically indigent and may be considered for medical hardship/catastrophic care. The patient will be liable to pay the lesser of 15% of their calculated household income or the AGB towards their medical bill. This is a one time financial assistance adjustment for existing account balances. The remaining balance will be adjusted to free care.Part 1 Line 4"Medically indigent" means persons who the organization has determined unable to pay some or all of their medical bills because their medical bills exceed a certain percntage of their family household's income. Part I, Line 6a: The community benefit report is prepared on a system wide basis under UPMC Susquehanna. Part I, Line 7: Part I Line 7 Column (F): The Bad Debt expense included on Form 990, Part IX, Line 25 (A) but subtracted for purposes of calculating the percentage in this column is $5,618,536. Part II, Community Building Activities: Soldiers & Sailors Memorial Hospital participates in community building through various means such as making parts of the building (conference rooms cafeteria, etc) available for public meetings, blood drives, CPR classes, expectant parent classes, and EMS education among others. The hospital has a large group of volunteers from the community who donate time to assist the organization providing care and well being to the community it serves. For fiscal year 2018, SSMH had 91 volunteers donate approximately 6,865 hours of their time. Part III, Line 2: Bad Debt expense consists of the actual bad debts written off, plus a reserve calculation based on a progressive percentage for self pay and other non-contract accounts receivable aging categories. This figure is the amount of bad debt in the audited financial statements. Part III, Line 3: Process for reallocation from Bad Debt to Charity Care UPMC reclassifies bad debt accounts as charity care by utilizing a predictive model called PARO (Payment Assistance Rank Order). PARO was built as a socio-economic score that identified those patients that are most likely to be the highest need of financial assistance. This is accomplished by analyzing comsumer data and IRS data. PARO provides a systematic approach to financial assistance: "Predictive model that encompasses health care economics and credit policies; Uniform assessment measure for every patient regardless of financial standing. "Accounts for patients that are unresponsive, illiterate, or otherwise challenged to apply, "Eliminates barrier to application and meets increased pressure to provide additional financial resources to consumers; "Identify and support those community needs efforts to provide assistance to those consumers in need." There are two data points returned to UPMC in order to make the decision whether the patient would qualify for charity care. The first is the estimated income level based on the Federal poverty level guidelines. The second is the PARO score which utilizes an algorithm based approach and returns a score based on personal attributes of the patient. Data elements were combined to create two primary indicators of need, the PARO score and the Federal poverty level. PARO analyzed our historical charity care approvals to determine our PARO threshold and the FPL threshold for historical approvals. The approved charity care accounts were compared against accounts that were inactive accounts receivable. This was done to determine if the distributions were similar or if any pattern existed based on the approved accounts and the unknown accounts. If the patient's estimated income and PARO score are within the scores identified by the calibration of UPMC exisitng charity care patients, the account is reclassified from bad debt to charity care, however, the automated strategy focuses on patients that do not complete the application process. The US Department of Education estimates that 1 in 5 consumers are functionally illiterate. This, coupled with the low levels of participation in traditional banking methods, makes the appliation process virtually impossible for consumers. Part III, Line 4: The System reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The System provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the System bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Part III, Line 8: The Medicare cost report uses a cost per day for the routine service costs times the number of Medicare days. Ancillary costs are calculated based on the cost to charge ratio by department. The Medicare cost report does not capture all charges and reimbursements provided to the facility under Medicare. For the fiscal year ended June 30, 2018, the facility had approximately $7 million in Medicare charges provided at a cost of approximately $8 million. This resulted in a $1 million shortfall for the fiscal year.Serving patients with government health benefits, such as Medicare, is a component of the community benefit standard that tax-exempt hospitals are held to. This implies that serving Medicare patients is a community benefit and that the hospital operates to promote the health of the community. Part III, Line 9b: UPMC has a debt collection policy outlining collection practices for patients. If at any time the patient expresses an inability to pay, they are sent a financial assistance application. Information regarding financial assistance is printed on all collection letters. Collections per policy do not apply to account balances known to be eligible for financial assistance. Part VI, Line 2: The Health System engaged BKD, LLP to conduct a formal CHNA. BKD, LLP is one of the largest CPA and advisory firms in the United States, with approximately 2,000 partners and employees in 34 offices. BKD serves more than 900 hospitals and health care systems across the country. The CHNA was conducted from February 2016 to June 2016.The following steps were conducted as part of the Health System's CHNA 1) An evaluation of the impact of actions taken to address the significant health needs identified in the tax year 2012 CHNA was completed to understand the effectiveness of the Health System's current strategies and programs. 2) The "community" served by the Health System was defined by utilizing inpatient data regarding patient origin. This process is further described in the Community Served by the Health System. 3) Population demographics and socioeconomic characteristics of the community were gathered and reported utilizing various third parties. The health status of the community was then reviewed. Information on the leading causes of death and morbidity information was analyzed in conjunction with health outcomes and factors reported for the community by the Center for Disease Control and Prevention (Community Health Status Indicators). Health factors with significant opportunity for improvement were noted. 4) Community input was provided through nine key stakeholder meetings and a community health survey. Results and findings are described in the Community Input Key Stakeholder Interviews and Survey section of the CHNA at www.upmcsusquehanna.org/community health. 5) Information gathered in the above steps was analyzed and reviewed to identify health issues of uninsured persons, low income persons and minority groups and the community as a whole. Health needs were ranked utilizing a weighing method that weighs the size of the problem, the seriousness of the problem, the impact of the issues on vulnerable populations, the prevalence of common themes, how important the issue is to the community, and how the issue aligns with the Hospital's strategic plan. 6) An inventory of health care facilities and other community resources potentially available to address the significant health needs identified through the CHNA was prepared and collaborative efforts were identified. Health needs were then prioritized taking into account the perceived degree of influence the Health System has to impact the need and the health needs impact on overall health for the community.To help see the implementation plan come to fruition an implementation team has been formed which is comprised of various individuals from community organizations throughout Lycoming and Tioga counties. Such partnered organizations include Lycoming County Health Improvement Coalition, Tioga County Partnership for Community Health, River Valley YMCA, Project Bald Eagle, STEP, YWCA, PA Department of Health , just to name a few. Part VI, Line 3: UPMC communicates the availability of financial assistance to its patients by placing signage and distributing brochures about the financial assistance program in its provider registration areas, admissions, emergency department and business office locations. In addition, UPMC includes information regarding how a patient can request financial assistance on the bills, follow-up correspondence and collection letters.Patients may also find information about financiai assistance through access to the UPMC website (WWW.UPMC.COM).Patients are encouraged to contact UPMC's trained financial counselors should they require assistance with completing applications. Contact telephone numbers are posted strategically throughout the hospital facilities so that patients have a resource for obtaining support with any financial assistance questions they may have. UPMC has created a plain language summary (PLS) to explain, in simplified terms, our financial assistance policy (FAP). This summary is printed at all same day surgery, ER and inpatient locations and given to the patient upon discharge. UPMC has also translated the PLS, FAP, collection and billing policy, and FAP application into the following languages; Arabic, Chinese, French, Italian, Nepali, Russian, Spanish, and Braille. The determination of languages for translation of documents was determined by a study of English proficiency in the communities served and review of predominant native languages in those communities as prescribed in IRC Section 501 (R). The PLS is available on the UPMC website.UPMC will notify all patients approved via presumptive eligibility if not receiving the highest level of assistance. A letter informing the patient that they may qualify for a higher level and a financial assitance application will be sent to the patient upon determination. UPMC has widely publicized our financial assistance policy. UPMC has worked with hospital leaders and community liasons to determine the most appropriate non-healthcare locations to reach the populations that will benefit from our financial assistance. UPMC has proactively reached out in these communities to widely publicize our financial assistance policy. Finally, UPMC will now only include patient balances from one year prior to the patient's financial assistance approval date. As a result, UPMC will also refund any patient payments made within that year of the patient's financial assistance approval date, approved via an application. Part VI, Line 4: The hospitals that comprise UPMC Susquehanna Lycoming county operations are: The Williamsport Hospital (TWH), Divine Providence Hospital (DPH) and Muncy Valley Hospital (MVH). The county is in the north central region of the state, about three and half hours northeast of Pittsburgh and the same distance northwest of Philadelphia. Lycoming County is designated as rural and has small towns nestled within a stunning natural landscape. The City of Williamsport, with the majestic Susquehanna River running through it, is designated as urban, and is home of the Little League World Series. Unfortunately, the City of Williamsport and the surrounding rural area are also home for many individuals and families who cannot afford the primary health and dental care services provided in the county. In addition, Soldiers and Sailors Memorial Hospital (SSMH)located in Wellsboro, PA, Tioga County, is also part of UPMC Susquehanna. Tioga County is located in rural North Central Pennsylvania and has a population of approximately 42,000 as of the 2010 census. The median household income was $44,000 with 15.3% of the residents below two times the Federal Poverty level. Also part of UPMC Susquehanna are Lock Haven Hospital (LHH) located in Clinton County and Sunbury Community Hospital located in Northumberland County. For a more detailed discussion regarding the community served, as well as associate socio-economic characteristics, you may view the CHNA and related Implementation plan at www.upmcsusquehannahealth.org. Part VI, Line 5: The hospitals of UPMC Susquehanna all have entity specific boards that are composed of persons who reside in Lycoming and Tioga Counties.In addition to this UPMC Susquehanna extends medical staff privileges to all qualified physicians in the county in all areas of primary and specialty care according to the UPMC Susquehanna Medical Staff Bylaws. Bylaws excerpts pertaining to this area are as follows:3.1) Nature of Membership - Medical Staff membership is available to qualified physicians, dentists, maxillofacial/oral surgeons, and podiatrists and confers both responsibilities and prerogatives, but only as provided in these Bylaws. No physician, dentist, or podiatrist, including those employed by or otherwise under contract with the Hospital(s), may admit a patient or independently provide patient care services in the Hospital(s) unless he is a Medical Staff member with applicable clinical privileges pursuant to these Bylaws. A member shall have only those clinical privileges, including admitting privileges, as have been granted in accordance with these Bylaws.3.2) Qualifications - No individual shall be considered eligible for appointment or reappointment to the Medical Staff unless he meets each of the following required qualifications/criteria. If any change in personal or professional status occurs which would inhibit practitioner's ability to effectively meet the obligations for patient care and Medical Staff membership under these Bylaws, the practitioner shall immediately notify the Medical Director.3.2-1) Professional Licensure Qualification - A member must be a physician, dentist, or podiatrist and must be duly licensed to practice in the Commonwealth of Pennsylvania.3.2-2) Clinical Privileges Qualification - A Member of the Medical Staff must have clinical privileges(or in the case of a new applicant, is granted privileges at the time of the appointment), except those appointed to the Emeritus Staff or as otherwise specified in these Bylaws. 3.2-3) Professional Competence - A member must demonstrate sufficient professional education, training, experience, competence, and good judgement to perform Medical Staff responsibilities and clinical privileges requested.3.2-4) Health Status - A member must have sufficient physical and mental health to perform Medical Staff responsibilities and exercise clinical privileges requested.3.2-5) Basic Responsibilities - A member must discharge the basic responsibilities of Medical Staff membership noted in 3.3-2.3.2-6) Board Certification Requirement - All practitioners who are current staff members at UPMC Susquehanna as of 7/1/10 and who have met prior qualifications for membership shall be exempt from board certification requirements.3.2-7) Standing with Federal Payors - A member must not be excluded from participation in federally funded programs such as Medicare and Medicaid.3.2-8) Waiver - The Board Certification requirement described in 3.2-6 may be waived under very special circumstances in which an applicant for Medical Staff membership is capable of providing specific unique expertise presently not available or insufficiently available on the Medical Staff which will fulfill an unmet medical need in the community. Such waiver may be granted by the Board(s) only upon recommendation of the Department Chairman, Credentials Committee, and the Medical Executive Committee (MEC).3.2-9) Prohibited Criteria - Medical Staff membership or assignment to a Medical Staff category shall not be denied, terminated, revoked, suspended, modified or otherwise restricted based upon:(a) Gender, race, creed, color, national origin, handicap, or disability, if the individual is otherwise qualified under these Bylaws, or(b) Economic considerations as the sole or primary criterion, or (c) Any criterion not set forth as a required qualification in these Bylaws, or(d) Any other criterion lacking professional or ethical justification.3.2-10) Effect of Other Affiliations - No individual shall be granted Medical Staff membership or be assigned to any Medical Staff category merely because he:(a) Holds a certain degree,(b) Is licensed to practice in the Commonwealth of Pennsylvania or any other state,(c) Is a member of any professional organization,(d) Is certified by any Clinical Board,(e) Had, or presently has, Medical Staff membership or clinical privileges at another health care facility,(f) Is employed by or is otherwise under contract with the Hospital(s) or,(g) Is employed by or otherwise practices with a group composed of one or more Medical Staff members.The volunteer program at UPMC Susquehanna supports the services at our 6 campuses, SSMH, MVH, DPH, TWH, LHH and SCH as well as our Life Center located within the River Valley Regional YMCA in Williamsport, PA. Volunteers ranging in age from 14, assist staff and patients in almost every department. The volunteers come from Tioga and surrounding counties to support our services. They provide over 65,000 hours of service in both office, customer service and patient care areas to support our service partners. They become ambassadors for the hospital, make new friends, financially support the hospital, become involved in the auxiliary, remain active members of society, often stay healthier longer, enjoy the camaraderie with staff and other volunteers, serve on hospital committees, recruit other volunteers, increase their volunteer hours and offer constructive suggestions for improvement. Volunteers are recruited through fairs, internet information and on-line applications, volunteer referrals and presentations to groups. They are a highly regarded, integral part of our operational support system. Part VI, Line 6: Soldiers and Sailors Memorial Hospital (SSMH) is one of six hospitals which are part of UPMC Susquehanna. The mission of UPMC Susquehanna is to promote health by acting as the parent of a nonprofit health system in North Central Pennsylvania and by raising funds and otherwise supporting the system.SSMH is a critical access hospital providing diagnostic and treatment facilities, educational and training programs and a rehabilitation facility.Divine Providence Hospital (DVH) is a specialty hospital that offers inpatient psychiatric services and a wide array of outpatient hospital services, as well as, home health and hospice services.Muncy Valley Hospital (MVH) is a critical access hospital, primarily serving Lycoming and surrounding counties. MVH also provides a full range of outpatient and emergency services, as well as, operates a long-term care facility. The Williamsport Hosital (TWH)is an acute care community hospital providing diagnostic and treatment facilities, educational and training programs, and a rehabilitation facility.Sunbury (SCH) is an acute care community hospital as well as offers inpatient psychiatric services.Lock Haven (LHH)is an acute care community hospital providing diagnostic and treatment facilities. LHH also operates a long-term care facility.The hospitals treat Medicare and Medical Assistance patients and maintains a Medicare/Medical Assistance policy that provides patients enrolled in such programs with access to all covered inpatient, outpatient and diagnostic services that are available to non-Medicare/Medical Assistance patients.The community benefit report is prepared on a system-wide basis under UPMC Susquehanna. On an annual basis, UPMC Susquehanna devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $108,814,429 in quantifiable community benefits reported for FY 2018: Charity Care (at cost) $1,975,767; Bad Debts (at cost) $10,179,193; Government sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs)$90,988,959. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind contributions, and Community Benefit Operations totaling $5,670,510. 1 Penn College of Technology 1 College Avenue Williamsport PA 17701 111111111 Government 670000 Appraisal Donation of Building Donated a building to be used for educational purposes by expanding its nursing program in Wellsboro Pa. 0 0 0 0 0 0 0 1 0 Jill ABurns MD Director 0 225123 0 23580 0 839 0 9668 0 19539 0 278749 0 0 Walter J Laibinis DO Director 0 228709 0 103398 0 29301 0 10100 0 19899 0 391407 0 0 Steven P Johnson President/CEO 0 727745 0 665835 0 40608 0 14150 0 19660 0 1467998 0 0 Janie M Hilfiger VP/President 163771 0 15107 0 10057 0 7651 0 10441 0 207027 0 0 0 Eric Pohjala Executive VP/CFO 0 375558 0 46874 0 12448 0 10100 0 21649 0 466629 0 0 Jan E Fisher Executive VP/COO 0 410810 0 54316 0 15683 0 10100 0 18065 0 508974 0 0 David Lopatofsky MD Executive VP/CMO 0 440444 0 75201 0 37253 0 11450 0 24175 0 588523 0 0 Enrico Doganiero Physician 515989 0 0 0 11902 0 10100 0 25766 0 563757 0 0 0 Stephen Bortz Supervisor Chief Pharmaci 142383 0 5181 0 106 0 6462 0 7451 0 161583 0 0 0 Toni Burch RN Supervisor 143859 0 2468 0 343 0 6437 0 8005 0 161112 0 0 0 Part I, Line 3 UPMC Susquehanna EIN# 23-2751183, a related organization, uses the following resources to establish the compensation of the top management officials: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board. Part I, Line 7 In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP) a minimum operating margin must be achieved for the most recently completed year on a consolidated system-wide basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. For FY 2018, the minimum threshold was met that would trigger a VCIP payment. In October 2017, CEO Steven P Johnson received a variable compensation award in the amount of $665,835. Form 990, Part VI, Section A, line 6 UPMC Susquehanna, EIN #23-2751183, is the sole member of the governing body. Form 990, Part VI, Section A, line 7a UPMC Susquehanna may elect or remove members of the governing body. Form 990, Part VI, Section A, line 7b All the business and affairs of the corporation shall be managed and controlled by the Board of Directors, subject to the oversight of the sole Member of the management and operation of the corporation, except that the following powers are reserved exclusively to the sole Member of the corporation, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid of any force or effort whatsoever. The sole Member shall exercise its power through its Board of Directors. The sole Member shall have the exclusive authority to exercise the following powers: A.)To approve the appointment and removal of the President of the corporation subject to all applicable provisions of the Creation agreement. B.) To elect and remove, with or without cause, a Director of the corporation. C.) To establish the overall policy and long range plans of the corporation, determine or change the mission of the corporation, approve the programs and services of the corporation and the termination of any programs or services of the corporation, monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists, subject to and in accordance with the provisions of the Creation agreement. D.) To adopt, amend or repeal the Articles of Incorporation or these Bylaws. E.) To establish requirements for a unified budget, the approval of new capital debt, any increment to any existing capital debt, and/or any change in capital debt obligations of the corporation. F.) To establish requirements for the approval of the acquisition, purchase, sale, leasing outside the ordinary course of business, transfer outside the ordinary course of business or encumbrance outside the ordinary course of business of land or buildings and the construction or demolition of buildings owned by the corporation. G.) To require a certified audit of corporate funds at any time. H.) To approve any guaranty of the indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any assets of the corporation outside the ordinary course of business, or any transfers of any assets of the corporation outside the ordinary course of business, except transfers between or among corporations. I.) To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting the autonomy, governance, or operations of the corporation. J.) To dissolve or terminate the existence of the corporation and determine the distribution of assets upon such termination or dissolution, as provided in these Bylaws. K.) To appoint annually the external fiscal auditor of the corporation. L.) To approve the nominees for elected officers of the Board of Directors of the corporation, and to return the list of approved nominees to the Board of Directors for election. M.) To remove any elected officer of the corporation. N.) To approve the annual capital and operating budget of the corporation. O.) To coordinate managed care plans, including decisions concerning entry into or renewal of any contract or agreement relating thereto. Form 990, Part VI, Section B, line 11b A copy of the full IRS Form 990 is available for all board members to review prior to filing. Form 990, Part VI, Section B, line 12c UPMC, as a system-wide practice, requires key employed and non-employed personnel to comply with its conflict of interest policies when they engage in UPMC-related business. Individuals covered by the policies include: UPMC Board Members, Corporate Officers, and key employees. UPMC Physicians and non-physician employees who hold a position of influence, identified non-employed members of the UPMC medical staff who hold a position of influence, and individuals conducting clinical research at UPMC, whether or not they are employed by UPMC. These individuals are required to complete a questionnaire at least annually, which along with other data is used to identify possible individual and institutional conflicts of interest. If a potential conflict is identified regarding a specific UPMC activity, the corporate compliance department, with the assistance of the legal department, either develops a written plan designed to prevent the conflict from influencing decisions related to that activity, or requires that the conflicting relationship be divested, as appropriate. For employed personnel and non-board members, non-employed personnel, the conflict of interest identification and management process is ultimately overseen by an ethics and compliance committee of the UPMC Board of Directors on behalf of UPMC and all of its subsidiaries. Potential conflicts of interest transactions involving UPMC entity Board members and entities with which they are affiliated are monitored and subject to pre-approval by the governance and nominating committee of the UPMC Board of Directors. Form 990, Part VI, Section B, line 15 All top management officials are paid by UPMC Susquehanna, EIN #23-2751183. The Board of Directors, through the Executive Compensation Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey for Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the Executive Compensation Committee takes the proper steps to educate the Board of Directors to understand all of the above mentioned oversight and to appropriately prepare them for the community or media inquiry. In addition, the Board is made aware of the Form 990 and its role in the communication of information to the public. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policies and financial statements available upon request from the person listed as possessor of the information on line 20. Form 990, Part IX, line 11g Other Purchased Services: Program service expenses 5,699,844. Management and general expenses 637,758. Fundraising expenses 0. Total expenses 6,337,602. Housekeeping: Program service expenses 3,353,558. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,353,558. Physician Services: Program service expenses 920,404. Management and general expenses 0. Fundraising expenses 0. Total expenses 920,404. Catering and Food Services: Program service expenses 83,584. Management and general expenses 0. Fundraising expenses 0. Total expenses 83,584. Contracted Medical: Program service expenses 632,115. Management and general expenses 0. Fundraising expenses 0. Total expenses 632,115. Form 990, Part XI, line 9: Transfers between related entities 2,523,104. Form 990 Part XII Line 2c UPMC, the sole member of UPMC Susquehanna, has assumed the responsibility for oversite of the audited financials at a system-wide level for FY 2018. Laurel Health System 32-36 Central Ave Wellsboro PA 16901 240795488 Healthcare PA 501(c)(3) Line 12b, II UPMC Susquehanna 1 Laurel Realty 32-36 Central Ave Wellsboro PA 16901 231403678 Rental Real Estate PA 501(c)(2) NA UPMC Susquehanna 1 Laurel Management Services 32-36 Central Ave Wellsboro PA 16901 251644910 Inactive PA 501(c)(3) Line 12b, II UPMC Susquehanna 1 The Green Home 37 Central Avenue Wellsboro PA 16901 240804365 Skilled nursing PA 501(c)(3) Line 10 UPMC Susquehanna 1 Tioga Health Care Providers 1201 Grampian Blvd Williamsport PA 17701 251765538 Physician Services PA 501(c)(3) Line 12b, II UPMC Susquehanna 1 Divine Providence Hospital of the Sister 1100 Grampian Blvd Williamsport PA 17701 240799343 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 Muncy Valley Hospital 215 East Water Street Muncy PA 17756 240806023 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 The Williamsport Hospital 700 High Street Williamsport PA 17701 240795508 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 Susquehanna Health Foundation 1100 Grampian Blvd Williamsport PA 17701 232743470 Fundraising PA 501(c)(3) Line 12a, I UPMC Susquehanna 1 Susquehanna Physician Services 1201 Grampian Blvd Williamsport PA 17701 232449454 Physician Services PA 501(c)(3) Line 3 UPMC Susquehanna 1 Williamsport Area Ambulance Services 700 High Street Williamsport PA 17701 232416166 Ambulance transport PA 501(c)(3) Line 10 Williamsport Hospital 1 Laurel Health Foundation 32-36 Central Ave Wellsboro PA 16901 251810488 Foundation PA 501(c)(3) Line 12b, II Laurel Health System 0 Susquehanna Health Innovation Center Inc 700 High Street Williamsport PA 17701 471600873 Fundraising PA 501(c)(3) Line 12a, I UPMC Susquehanna 1 UPMC Susquehanna 1205 Grampian Blvd Williamsport PA 17701 232751183 management Services PA 501(c)(3) Line 3 UPMC 1 UPMC Senior Communities Inc 600 Grant Street Pittsburgh PA 15219 251574736 Senior Living PA 501(c)(3) Line 10 UPMC 1 Pittsburgh Lifetime Care Community 600 Grant Street Pittsburgh PA 15219 251335247 CCRC PA 501(c)(3) Line 10 UPMC SR Comm 1 Canterbury Place 600 Grant Street Pittsburgh PA 15219 250965334 Senior Living PA 501(c)(3) Line 10 UPMC SR Comm 1 Seneca Place 600 Grant Street Pittsburgh PA 15219 721562844 Senior Living PA 501(c)(3) Line 10 UPMC SR Comm 1 Shadyside Hospital Supporting Foundation 600 Grant Street Pittsburgh PA 15219 260303394 Foundation PA 501(c)(3) Line 12a, I UPMC 1 UPMC Lee 600 Grant Street Pittsburgh PA 15219 250613830 Inactive PA 501(c)(3) Line 3 UPMC 1 Pittsburgh Care Partnership Inc 600 Grant Street Pittsburgh PA 15219 251753852 Adult Daycare PA 501(c)(3) Line 10 UPMC 1 UPMC Center for High Value Healthcare 600 Grant Street Pittsburgh PA 15219 452178782 Research PA 501(c)(3) Line 7 UPMC 1 Shadyside Hospital Foundation 532 South Aiken Avenue Pittsburgh PA 15232 251290546 Foundation PA 501(c)(3) Line 12c, III-FI UPMC Presby 1 Passavant Hospital Foundation 9100 Babcock Blvd Pittsburgh PA 15237 251407815 Foundation PA 501(c)(3) Line 12b, II UPMC Pass 1 UPMC Northwest Foundation 100 Farfield Drive Seneca PA 16346 251483624 Foundation PA 501(c)(3) Line 12d, III-O UPMC Northwe 1 St Margaret Foundation 600 Grant Street Pittsburgh PA 15219 251520340 Foundation PA 501(c)(3) Line 7 UPMC St Marg 1 Children's Hospital of Pittburgh Fnd 600 Grant Street Pittsburgh PA 15219 251865744 Foundation PA 501(c)(3) Line 7 UPMC CHP 1 Magee-Women Res Inst and Foundation 600 Grant Street Pittsburgh PA 15219 251462312 Foundation PA 501(c)(3) Line 7 N/A 0 Great Lakes Physician Practice 600 Grant Street 58th Floor Pittsburgh PA 15219 464186362 Physician Services NY 501(c)(3) Line 3 Regnl Health 1 HAMOT Health Foundation 302 French Street Erie PA 16507 251400999 Foundation PA 501(c)(3) Line 12b, II UPMC HAMOT 1 Safe Harbor Behavorial Health of UPMC HA 1330 W 26TH Street Erie PA 16508 251317492 Behavorial PA 501(c)(3) Line 7 UPMC HAMOT 1 UPMC Jameson 1211 Wilmington Avenue New Castle PA 16105 250965406 Healthcare PA 501(c)(3) Line 3 UPMC 1 Jameson Healthcare Foundation 1211 Wilmington Avenue New Castle PA 16105 251536037 Foundation PA 501(c)(3) Line 12b, II UPMC Jameson 1 Jameson Health Services Inc 1211 Wilmington Avenue New Castle PA 16105 030486993 Supporting Organization PA 501(c)(3) Line 12b, II UPMC Jameson 1 Children's Advocacy Center of Lawrence 1107 Wilmington Avenue New Castle PA 16105 251581304 Support Sys PA 501(c)(3) Line 7 UPMC Jameson 1 UPMCJameson Cancer Center 600 Grant Street 58th Floor Pittsburgh PA 15219 201459415 Oncology Svc PA 501(c)(3) Line 10 UPMC Jameson 1 Jameson Medical Care Inc 1211 Wilmington Avenue New Castle PA 16105 260462696 Healthcare PA 501(c)(3) Line 10 UPMC Jameson 1 Jameson Care Center Inc 1211 Wilmington Avenue New Castle PA 16105 232871396 Healthcare PA 501(c)(3) Line 10 UPMC SR Comm 1 Venango VNA Foundation 491 Alleghany Boulevard Franklin PA 16323 251472179 Foundation PA 501(c)(3) Line 12d, III-O N/A 0 UPMC Susquehanna Lock Haven 700 High Street Williamsport PA 17701 821600494 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 UPMC Susquehanna Sunbury 700 High Street Williamsport PA 17701 821592230 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 UPMC Chautauqua at WCA 207 Foote Avenue Jamestown NY 14701 160743226 Hospital NY 501(c)(3) Line 3 UPMC Chautau 1 WCA Group Inc 207 Foote Avenue Jamestown NY 14701 222392582 Holding Company NY 501(c)(3) Line 12b, II UPMC Chautau 1 Starflight Inc 135 Allen Street Jamestown NY 14701 161557878 Air Ambulance NY 501(c)(3) Line 7 UPMC Chautau 1 South Central Alpha Housing and Healthcare 3410 West Pittsburg Road New Castle PA 16101 251701701 Skilled Nursing PA 501(c)(3) Line 10 UPMC Sr Comm 1 South Western Alpha Housing and Health Care 745 Greenville Road Mercer PA 16137 251701700 Skilled Nursing PA 501(c)(3) Line 10 UPMC Sr Comm 1 Kane Community Hospital Foundation 4372 Route 6 Kane PA 16735 263906925 Foundation PA 501(c)(3) Line 12b, II N/A 0 Junior Guild of the Jameson Memorial Hospital 1211 Wilmington Avenue New Castle PA 16105 256005313 Support Sys PA 501(c)(3) Line 12d, III-O N/A 0 WCA Foundation Inc 300 Foote Avenue PO Box 840 Jamestown NY 14702 222393584 Foundation PA 501(c)(3) Line 12c, III-FI N/A 0 UPMC 600 Grant Street Pittsburgh PA 15219 251423657 Supporting Organization PA 501(c)(3) Line 12c, III-FI N/A 0 UPMC Pinnacle 409 South Second Street Harrisburg PA 17104 251778658 Supporting Organization PA 501(c)(3) Line 12b, II UPMC 1 UPMC Pinnacle Carlisle 361 Alexander Spring Road Carlisle PA 17105 820880337 hospital PA 501(c)(3) Line 3 UPMC Pinnacle 1 UPMC Pinnacle Lancaster 250 College Avenue Lancaster PA 17603 820896436 hospital PA 501(c)(3) Line 3 UPMC Pinnacle 1 UPMC Pinnacle Lititz 1500 Highlands Avenue Lititz PA 17543 820844453 hospital PA 501(c)(3) Line 3 UPMC Pinnacle 1 UPMC Pinnacle Memorial 325 South Belmont Street York PA 17405 820912090 hospital PA 501(c)(3) Line 3 UPMC Pinnacle 1 Pinnacle Health Regional Physicians 409 South Second Street Harrisburg PA 17104 820947698 Physician Services PA 501(c)(3) Line 3 UPMC Pinnacle 1 Pinnacle Health Foundation 409 South Second Street Harrisburg PA 17104 222691718 Foundation PA 501(c)(3) Line 12b, II UPMC Pinnacle 1 Community Life Team Inc 409 South Second Street Harrisburg PA 17104 231890444 Ambulance transport PA 501(c)(3) Line 7 UPMC Pinnacle 1 Hanover Healthcare Plus Inc 300 Highland Avenue Hanover PA 17331 222658574 supporting Organization PA 501(c)(3) Line 12a, I UPMC PInnacle 1 UPMC Pinnacle Hanover 300 Highland Avenue Hanover PA 17331 231360851 hospital PA 501(c)(3) Line 3 Hanover Health 1 UPMC Pinnacle Hospitals 409 South Second Street Harrisburg PA 17104 251778644 hospital PA 501(c)(3) Line 3 UPMC Pinnacle 1 Pinnacle Health Medical Services 409 South Second Street HArrisburg PA 17104 251709054 Physician Services PA 501(c)(3) Line 3 UPMC Pinnacle 1 Charles E Cole Memorial Hospital 1001 East Second Street Coudersport PA 16915 240802108 hospital PA 501(c)(3) Line 3 UPMC 1 Cole Foundation Inc 1001 East Second Street Coudersport PA 16915 455417308 foundation PA 501(c)(3) Line 12a, I Charles Cole Memorial Hospital 1 Hamot Cole Ventures 1001 East Second Street Coudersport PA 16915 273172100 offsite Clinics PA 501(c)(3) Line 12a, I Charles Cole Memorial Hospital 1 Hendorn Inc 1001 East Second Street Coudersport PA 16915 231972659 Respite Care PA 501(c)(3) Line 12a, I Charles Cole Memorial Hospital 1 Asbury Heights of UPMC 600 Grant Street Pittsburgh PA 15219 251555687 Supporting Organization PA 501(c)(3) Line 12b, II UPMC Sr Comm 1 Asbury Health Center 600 Grant Street Pittsburgh PA 15219 250969472 CCRC PA 501(c)(3) Line 10 Asbury Heights 1 Asbury Villas 600 Grant Street Pittsburgh PA 15219 251819952 Personal Care PA 501(c)(3) Line 10 Asbury Heights 1 Asbury Place 600 Grant Street Pittsburgh PA 15219 251729266 Personal Care PA 501(c)(3) Line 10 Asbury Heights 1 Wesley Hills 600 Grant Street Pittsburgh PA 15219 251507472 Independent Living PA 501(c)(1) PF Asbury Heights 1 Asbury Foundation 600 Grant Street Pittsburgh PA 15219 251555688 Foundation PA 501(c)(3) Line 7 Asbury Heights 1 UPMC Home Care Management Services 600 Grant Street Pittsburgh PA 15219 830857507 Home Health PA 501(c)(3) Line 10 UPMC Comm Prov 1 Community Basket LLC 1205 Grampian Blvd Williamsport PA 17701 201195739 Rents real estate PA N/A N/A 0 0 Seneca Hills Assisted Living 600 Grant Street Pittsburgh PA 15219 232873106 Assisted Living PA N/A N/A 0 0 St Margaret Medical Arts Association 600 Grant Street Pittsburgh PA 15219 251786655 Med Office BL PA N/A N/A 0 0 Core Network LLC 600 Grant Street Pittsburgh PA 15219 251786209 Healthcare PA N/A N/A 0 0 Life Home Care LP 600 Grant Street Pittsburgh PA 15219 251847839 Homecare PA N/A N/A 0 0 Shadyside Medical Center Association 600 Grant Street Pittsburgh PA 15219 251608318 Med Office BL PA N/A N/A 0 0 Chartwell PA LP 600 Grant Street Pittsburgh PA 15219 251729714 Homehealth PA N/A N/A 0 0 Life Care Home Srv of NW PA 1647 Sassafras Street Erie PA 16507 251536879 Homehealth PA N/A N/A 0 0 HAMOT-KCH Real Estate Venture 300 State Street Erie PA 16507 263691782 Med Office BL PA N/A N/A 0 0 HAMOT Surgery Center LLC 200 State Street Erie PA 16507 251863661 Ambulatory Srv PA N/A N/A 0 0 EPN-HAMOT Urgent Care LLC 600 Grant Street Pittsburgh PA 15219 272147949 Urgent Care PA N/A N/A 0 0 Mountain View Medical Oncology 600 Grant Street 58th Floor Pittsburgh PA 15219 461449241 Healthcare PA N/A N/A 0 0 Lawrence County MRI & Diagnostic 2526 Wilmington Avenue New Castle PA 16105 270219891 Imaging Center PA N/A N/A 0 0 Hanover Surgicenter Real Estate LP 300 Highland Avenue Hanover PA 17331 352342993 Inactive PA N/A N/A 0 0 Medcare Susquehanna Valley LLC 409 South Second Street Harrisburg PA 17104 821673688 DME PA N/A N/A 0 0 Tyoga Carenet 32-36 Central Avenue Wellsboro PA 16901 251810967 Inactive PA N/A C 0 Susquehanna Ventures Inc 1201 Grampian Blvd Williamsport PA 17701 232470263 Pharmacy PA N/A C 0 Susquehanna Health System Insurance Network LTD PO Box 1159 Grand Caymans CJ Insurance CJ N/A C 0 HC Pharmacy Central Inc 600 Grant Street Pittsburgh PA 15219 251364192 Pharmacy co-op PA N/A C 0 Children's Community Care 600 Grant Street Pittsburgh PA 15219 251781887 Pediatric Svc PA N/A C 0 UPMC Cancer Centers Ireland Limited 6th Floor Beacon Hospital Sandyford Dublin EI Cancer Treatment EI N/A C 0 UPMC Physician Services Holding Company 600 Grant Street Pittsburgh PA 15219 251877017 Holding Company PA N/A C 0 Hematology Oncology Associates 600 Grant Street Pittsburgh PA 15219 421648357 Physician Services PA N/A C 0 Oncology Hematology Associates 600 Grant Street Pittsburgh PA 15219 251762980 Physician Services PA N/A C 0 Tri-State Neurosurgical Associates 600 Grant Street Pittsburgh PA 15219 251458655 Physician Services PA N/A C 0 Renaissance Family Practice - UPMC Inc 600 Grant Street Pittsburgh PA 15219 262942406 Physician Services PA N/A C 0 UPMC Holding Company Inc 600 Grant Street Pittsburgh PA 15219 251777713 Holding Company PA N/A C 0 UPMC Coverage Products Inc 600 Grant Street Pittsburgh PA 15219 251777710 Holding Company PA N/A C 0 Freedom Insurance Company 600 Grant Street Pittsburgh PA 15219 030308944 Insurance VT N/A C 0 Tri-Century Insurance Comp 600 Grant Street Pittsburgh PA 15219 251500739 Insurance PA N/A C 0 UPMC DNA Inc 600 Grant Street Pittsburgh PA 15219 251883237 Insurance PA N/A C 0 UPMC Health Benefits Inc 600 Grant Street Pittsburgh PA 15219 251844144 Health Insurance PA N/A C 0 UPMC Health Network Inc 600 Grant Street Pittsburgh PA 15219 721527566 Health Insurance PA N/A C 0 UPMC Health Plan Inc 600 Grant Street Pittsburgh PA 15219 232813536 Health Insurance PA N/A C 0 UPMC Benefit Management Services Inc 600 Grant Street Pittsburgh PA 15219 251769564 Worker's Comp PA N/A C 0 UPMC Diversified Services Inc 600 Grant Street Pittsburgh PA 15219 251778454 Holding Company PA N/A C 0 Monroeville Specialty Clinic 600 Grant Street Pittsburgh PA 15219 251666087 Amb Surgery PA N/A C 0 Medical Archival Systems Inc 600 Grant Street Pittsburgh PA 15219 232912501 Software Dev DE N/A C 0 Presby Health Resource Mgnt 600 Grant Street Pittsburgh PA 15219 251422155 Inactive PA N/A C 0 RX Partners Inc 600 Grant Street Pittsburgh PA 15219 251801966 Retail Pharmacy PA N/A C 0 Biotronics Inc 600 Grant Street Pittsburgh PA 15219 251843500 Equip Maint PA N/A C 0 Medical Center Properties Inc 600 Grant Street Pittsburgh PA 15219 251796940 Real Estate PA N/A C 0 Askesis Development Group Inc 600 Grant Street Pittsburgh PA 15219 541625585 Software Dev DE N/A C 0 Panther Reinsurance Company Inc PO Box 1109 Grand Cayman Cayman Islands CJ 981402742 Insurance CJ N/A C 0 Forbes Reinsurance Compnay LTD PO Box 1109 Grand Cayman Cayman Islands CJ 981400710 Insurance CJ N/A C 0 Cathedral (RE) Insurance Co PO Box 1109 Grand Cayman Cayman Islands CJ 981400837 Insurance CJ N/A C 0 UPMC International Health Initiatives 600 Grant Street Pittsburgh PA 15219 841706741 Inactive PA N/A C 0 UPMC Ireland Limited 6th Floor Beacon Hospital Sandyford Dublin EI Healthcare Srv EI N/A C 0 UPMC United Kingdom LTD C/O Nair Co 11th Floor Whitefriar Lewins Mead Bristol UK 980571026 Software LICE UK N/A C 0 Bayfront Regional Development Corp 300 State Street Erie PA 16507 251401388 Holding Company PA N/A C 0 Bayside Development Corp 300 State Street Erie PA 16507 251401386 Real Estate PA N/A C 0 UPMC Work Alliance Inc 600 Grant Street Pittsburgh PA 15219 452825053 Insurance PA N/A C 0 UPMC Canada Technologies Limited 600 Grant Street Pittsburgh PA 15219 Software CA N/A C 0 Allied Orthopedics Appliances Inc 335 East 3rd Street Jamestown NY 14701 161092951 Inactive PA N/A C 0 UPMC Health Coverage Inc 600 Grant Street Pittsburgh PA 15219 462824537 Insurance PA N/A C 0 UPMC Health Options Inc 600 Grant Street Pittsburgh PA 15219 462824626 Insurance PA N/A C 0 UPMC Complete Care Inc 5215 Centre Avenue Pittsburgh PA 15232 463605753 Physician Services PA N/A C 0 American Home Health Services 868 Corporate Way Westlake OH 44145 311521422 Home Health C OH N/A C 0 Health Fidelity Inc 210 South B Street San Mateo CA 94401 452538963 Technology Sv CA N/A C 0 Fluence Health Inc 6425 Penn Avenue Pittsburgh PA 15206 472684174 Software DE N/A C 0 Curavi Health Inc 6425 Penn Avenue Pittsburgh PA 15206 811217377 Healthcare DE N/A C 0 Pensiamo Inc 600 Grant Street 59th Floor Pittsburgh PA 15219 812069236 Supply Chain DE N/A C 0 Altoona Family Inc 620 Howard Avenue Altoona PA 16601 251444935 Mgmt Serv PA N/A C 0 Lexington Holdings Inc 620 Howard Avenue Altoona PA 16601 251794386 Holding Company PA N/A C 0 Lexington One Inc 620 Howard Avenue Altoona PA 16601 251468889 Rental PA N/A C 0 Lexington Two Inc Howard Avenue 7th Street Altoona PA 16601 251555689 DME PA N/A C 0 Lexington Four Inc 620 Howard Avenue Altoona PA 16601 251793736 Holding Company DE N/A C 0 Allegheny Healthcare Staffing Inc 620 Howard Avenue Altoona PA 16601 271657362 Inactive PA N/A C 0 UPMC Altoona Regional Health Services 1414 9th Avenue Altoona PA 16602 251219302 Physician Services PA N/A C 0 Lexington Anesthesia Associates Inc 620 Howard Avenue Altoona PA 16601 251897765 Physician Services PA N/A C 0 Northern Cambria Medical Center Inc 620 Howard Avenue Altoona PA 16601 251530860 Inactive PA N/A C 0 Patton Family Medical Center Inc 620 Howard Avenue Altoona PA 16601 251793735 Inactive PA N/A C 0 MEDCPU 100 Wall Street Suite 2202 New York NY 10005 383805381 Software Dev DE N/A C 0 UPMC Excess PL TR 600 Grant Street Pittsburgh PA 15219 826254351 Trust PA N/A T 0 RXANTE Inc 511 Congress Street 803 Portland ME 04101 454040219 Medication Mgnt DE N/A C 0 Vincent Payment Solutions Inc Bakery Square 6425 Penn Avenue Suit pittsburgh PA 15219 821101143 Payment System DE N/A C 0 J Health Ventures Inc 1211 Wilmington Avenue New Castle PA 16105 251607893 Inactive PA N/A C 0 JER Medical Associates Inc 1211 Wilmington Avenue New Castle PA 16105 251609398 Inactive PA N/A C 0 WCA Service Corporation Inc 207 Foote Avenue Jamestown NY 14701 161151438 Support Services NY N/A C 0 ITTCCO I Inc 600 Grant Street Pittsburgh PA 15219 822590699 Inactive DE N/A C 0 ITTCCO II Inc 600 Grant Street Pittsburgh PA 15219 822597388 Inactive DE N/A C 0 Pinnacle Health Cardiovascular Institute Inc 409 South Second Street Harrisburg PA 17104 320321362 Physician Services PA N/A C 0 Hanover Health Corporation 300 Highland Avenue Hanover PA 17331 900498067 Holding Company PA N/A C 0 Hanover Apothecary Inc 310 Stock Street Suite 1 Hanover PA 17331 900498067 Pharmacy PA N/A C 0 United Central PA Reciprocal Risk Retention Group 76 Saint Paul Street Suite 500 Burlington VT 05401 134224033 Insurance VT N/A C 0 Pinnacle Health Ventures Inc 409 South Second Street Harrisburg PA 17104 611677624 Holding Company PA N/A C 0 Pinnacle Health Imaging Inc 409 South Second Street Harrisburg PA 17104 231718571 Imaging Services PA N/A C 0 Cole Care Inc 1001 East 2nd Street Coudersport PA 16915 251497347 DME PA N/A C 0 UPMC Italy Health Services SR L VIA Discesa DEI Giudici 4 Palermo IT Health Services IT N/A C 0 UPMC Investments LTD C/O UPMC Whitfield Cork Road Butler Waterford EI Holding Company EI N/A C 0 UPMC Property LTD C/O UPMC Whitfield Cork Road Butler Waterford EI Property EI N/A C 0 UPMC Property II LTD C/O UPMC Whitfield Cork Road Butler Waterford EI Property EI N/A C 0 Euro Care Infrastructure LTD C/O UPMC Whitfield Cork Road Butler Waterford EI Property Management EI N/A C 0 Euro Care Property Managment LTD C/O UPMC Whitfield Cork Road Butler Waterford EI Property Management EI N/A C 0 Euro Care Healthcare LTD C/O UPMC Whitfield Cork Road Butler Waterford EI Hospital EI N/A C 0 Waterford Oncology Associates LTD C/O UPMC Whitfield Cork Road Butler Waterford EI Oncology Services EI N/A C 0 United Health Risk LTD PO Box HM 2450 Hamilton BD Insurance BD N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Form 990 Schedule R Part II to Part IV The entities marked with an asterick are not technically "related parties", as defined by the IRS Form 990 instructions, of the filing organization. However, they are listed on Schedule R to reflect that they are part of the UPMC system of entities, as they all share UPMC as their ultimate parent corporation.