2022-05-12T11:56:34-05:00 2021-06-30 390859910 BAKER TILLY US LLP 5700 CORPORATE SUITE 650 PITTSBURGH PA 15237 990 2020-07-01 250965570 UPMC SOMERSET UPMC 8144435221 600 GRANT STREET 58TH FLR CORP TAX PITTSBURGH PA 15219 MONICA J KLATT CFO 8144435221 2022-05-06 1 MONICA KLATT 999009999 JEFFREY J PETRELL P00138808 4126356270 X 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z ANDREW RUSH 600 GRANT STREET 58TH FLR CORP TAX PITTSBURGH PA 15219 84370283 0 X WWW.UPMC.COM X 1921 PA UPMC SOMERSET IS A NOT-FOR-PROFIT COMMUNITY ASSET COMMITTED: TO PROVIDING CARE TO THE SICK AND INJURED, PRESERVING AND SUSTAINING LIFE, AND PROMOTING HEALTH AND WELL BEING; TO THE PROMOTION AND DEVELOPMENT OF COMPLEMENTARY PROGRAMS AND SERVICES, MANPOWER AND FACILITIES; TO THE CONTINUOUS IMPROVEMENT OF QUALITY, ACCESSIBILITY AND CONTINUITY OF PATIENT CARE; TO THE WELFARE AND LIVELIHOOD OF ITS EMPLOYEES; TO ENSURING THE HOSPITAL'S FINANCIAL VIABILITY NECESSARY TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY AND REGION TODAY AND IN THE FUTURE. 9 4 857 27 678356 3287 5377127 902768 71503335 82222909 363279 170766 275423 858817 77519164 84155260 0 0 0 0 32196305 35875745 0 0 0 37393080 43379644 69589385 79255389 7929779 4899871 92368390 73632907 35584210 27529274 56784180 46103633 X OUR MISSION AS AN ORGANIZATION IS TO PRESERVE AND IMPROVE LIFE BY PROVIDING ACCESS TO QUALITY, CUSTOMER-FRIENDLY HEALTHCARE SERVICES. 0 0 67049267 82164740 ON FEBRUARY 1, 2019, UPMC SOMERSET AFFILIATED WITH THE UPMC HEALTH SYSTEM TO BECOME UPMC SOMERSET. UPMC'S MISSION IS TO SERVE OUR COMMUNITY BY PROVIDING OUTSTANDING PATIENT CARE AND TO SHAPE TOMORROW'S HEALTH SYSTEM THROUGH CLINICAL AND TECHNOLOGICAL INNOVATION, RESEARCH, AND EDUCATION. UPMC SOMERSET IS A NOT-FOR-PROFIT COMMUNITY ASSET COMMITTED: TO PROVIDING CARE TO THE SICK AND INJURED, PRESERVING AND SUSTAINING LIFE, AND PROMOTING HEALTH AND WELL BEING; TO THE PROMOTION AND DEVELOPMENT OF COMPLEMENTARY PROGRAMS AND SERVICES, MANPOWER AND FACILITIES; TO THE CONTINUOUS IMPROVEMENT OF QUALITY, ACCESSIBILITY AND CONTINUITY OF PATIENT CARE; TO THE WELFARE AND LIVELIHOOD OF ITS EMPLOYEES; TO ENSURING THE HOSPITAL'S FINANCIAL VIABILITY NECESSARY TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY AND REGION TODAY AND IN THE FUTURE.UPMC SOMERSET IS A 111-BED, NOT-FOR-PROFIT COMMUNITY HOSPITAL SERVING THE SOMERSET AREA. THE HOSPITAL ALSO PROVIDES CARE FOR MANY PATIENTS NORTH OF SOMERSET TO ROUTE 30 AND SOUTH OF SOMERSET TO THE MARYLAND STATE LINE. UPMC SOMERSET HAD 6,512 PATIENT DAYS AND 947 PATIENT DAYS OBSERVATIONS. THERE WAS A TOTAL OF 1,207 ADMISSIONS, 631 OBSERVATION VISITS, 8,502 EMERGENCY ROOM VISITS, 1,847 SURGERIES, AND 57,523 OUTPATIENT VISITS.UPMC SOMERSET, ONE OF THE TOP FIVE EMPLOYERS IN SOMERSET COUNTY, PROVIDES QUALITY HEALTH CARE IN A COMPASSIONATE MANNER REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR THE PATIENT'S ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF UPMC SOMERSET, THE HOSPITAL, UNDER ITS WRITTEN CHARITY CARE POLICY, IS COMMITTED TO PROVIDING NECESSARY HEALTH CARE SERVICES AT NO CHARGE OR AT A REDUCED CHARGE TO PATIENTS.PUBLIC POLICIESTHROUGH SIGNAGE POSTED IN THE HOSPITAL'S INFORMATION CENTER, ADMISSIONS DEPARTMENT, EMERGENCY ROOM AND CREDIT OFFICE, THE PUBLIC IS PROVIDED WITH THE ORGANIZATION'S POLICY OF PROVIDING CARE REGARDLESS OF ABILITY TO PAY. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS ALSO LOCATED ON THE UPMC SOMERSET WEBSITE. THIS INFORMATION HAS ALSO BEEN WIDELY AVAILABLE IN THE COMMUNITY, THROUGH POSINGS AT MANY COMMUNITY SERVING BUILDINGS.UPMC SOMERSET GENERALLY DESIGNATES SERVICES AS "CHARITY CARE" AFTER BILLING. BASED ON AN INDIVIDUAL'S ABILITY TO PAY, UPMC SOMERSET OFFERS PAYMENT PLANS AND ASSISTS INDIVIDUALS IN APPLYING FOR THE STATE'S MEDICAL ASSISTANCE PROGRAM. SELF-PAY PATIENTS ARE REQUESTED TO PROVIDE PARTIAL PRE-PAYMENT FOR SERVICES RENDERED BY THE HOSPITAL. HOWEVER, SERVICES BY UPMC SOMERSET ARE PROVIDED WITHOUT REGARD TO AN INDIVIDUAL'S ABILITY TO PAY.COMMUNITY SERVICE AND CONTRIBUTIONSDURING THE PAST YEAR, UPMC SOMERSET HAS PROVIDED THE FOLLOWING EVENTS TO THE COMMUNITY.DAILY AMERICAN - PEOPLE SERVED 14,000WQED - BATTLING OPIOIDS - PEOPLE SERVED 100,000INJECTION DRUG USE HELP AD - PEOPLE SERVED 14,000BOWLING-RECOVERY EVENT - PEOPLE SERVED 11SALISBURY WELLNESS FAIR - PEOPLE SERVED 225RECOVERY EVENT-AXE THROWING - PEOPLE SERVED 5STICKER SHOCK - PEOPLE SERVED 5,000HOPPING AROUND SOMERSET COUNTY - PEOPLE SERVED 1,000SALISBURY HEALTH FAIR - PEOPLE SERVED 300TOPS EXERCISE PRESENTATION - PEOPLE SERVED 25BOYS AND GIRL'S CLUB NUTRITION EDUCATION - PEOPLE SERVED 20 67049267 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 78 0 857 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 9 4 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X MONICA J KLATT 8144435221 225 SOUTH CENTER AVENUE SOMERSET PA 15501 KRISTA MATHIAS CHAIRMAN 2.00 2.00 X X 0 0 0 MARK BOWER VICE CHAIR 2.00 2.00 X X 0 0 0 TOM SKELTON SECRETARY 2.00 2.00 X X 0 0 0 JOHN CUPPS TREASURER 2.00 2.00 X X 0 0 0 JAYESH DESAI MD DIRECTOR 1.00 40.00 X 0 413150 16084 MARK YAROS MD DIRECTOR 1.00 40.00 X 0 273717 16014 DAVID MARTIN DIRECTOR 1.00 40.00 X 0 1115128 187842 DAVID RUSSELL DIRECTOR 1.00 40.00 X 0 514981 46804 DAVID BURWELL MD DIRECTOR 1.00 40.00 X 0 375076 61715 ANDREW RUSH CEO 29.00 11.00 X 345099 0 22011 MONICA J KLATT CFO 20.00 20.00 X 0 141363 24994 CHARLES TULLIS MD PHYSICIAN 40.00 X 407273 0 13565 MOKBEL MATTA MD PHYSICIAN 40.00 X 416323 0 4989 KELLY EAGLEHOUSE MD PHYSICIAN 40.00 X 224503 0 9953 JONATHAN THIELE MD PHYSICIAN 40.00 X 189221 0 20144 MARCO CANTINI MD MEDICAL DIRECTOR OF ANESTHESIOLOGY 40.00 X 440307 0 13565 2022726 2833415 437680 22 0 1 0 DIVERSIFIED CLINICAL SERVICES 28525 NETWORK PLACE CHICAGO IL 60673 MEDICAL SERVICES 610430 CHANGE HEALTHCARE 5995 WINDWARD PARKWAY ALPHARETTA GA 30005 SOFTWARE 400073 B&B CONTRACTORS 409 STOYSTOWN ROAD SOMERSET PA 15501 CONSTRUCTION 178012 FIRE DOOR SOLUTIONS LLC 7500 160TH STREET STILWELL KS 66085 FIRE COMPLIANCE 164732 4 10000 720227 172541 902768 NET PATIENT REVENUE 900099 80758050 80758050 PHARMACY SALES 900099 806258 806258 OTHER PATIENT SERVICE REVENUE 900099 658601 658601 82222909 57872 57872 440383 193630 246753 246753 246753 12108 100786 0 0 12108 100786 112894 112894 13270 10000 21393 -8123 -8123 MISCELLANEOUS REVENUE 900099 600432 600432 SUPPORT SERVICES 900099 19755 19755 620187 84155260 82164740 678356 409396 X 367110 367110 28446623 22636052 5810571 512781 403148 109633 4461465 3524909 936556 2087766 1641402 446364 125146 125146 9294289 7300629 1993660 75363 59250 16113 434975 341977 92998 1646431 1253026 393405 147713 116132 31581 74220 58352 15868 6107 4801 1306 3313965 2605439 708526 1380281 1085177 295104 MEDICAL SUPPLIES 15746403 15746403 PHYSICIAN FEES 3750760 3750760 BAD DEBT 3272669 3272669 EQUIPMENT RENTAL & MAIN 2350817 1848212 502605 1760505 1400929 359576 79255389 67049267 12206122 0 7598061 800069 6903260 6194600 233427 834852 1754718 1777846 63528422 35526779 27706878 28001643 6263872 724058 41908174 35299839 92368390 73632907 5311508 2953890 30272702 24575384 35584210 27529274 X 56291587 45538836 492593 564797 56784180 46103633 92368390 73632907 X 4899871 -15580418 X X 0 1 X 1 0 X 0 0 0 0 0 0 1 24008 0 1 324 24332 0 PART II-B, LINE 1: A PORTION OF UPMC SOMERSET'S DUES TO THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA (HAP), HEALTHCARE COUNCIL, AND OTHER HEALTHCARE ASSOCIATIONS ARE USED FOR LOBBYING. PART II-B, LINE 1(G), DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY: UPMC SOMERSET CONTACTS VARIOUS LEGISLATORS AND GOVERMENT OFFICIALS TO FURTHER HEALTH CARE INITIATIVES IN THE COMMUNITIES IT SERVES. 2433649 2433649 44100174 25121566 18978608 106849 6288 100561 12534017 6424528 6109489 4353733 3974397 379336 28001643 UPMC CAPITAL COMMITMENT 35299839 35299839 ADVANCES FROM EXEMPT AFFILIATES 19232230 DUE TO THIRD PARTY PAYORS 5343154 24575384 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, 2021, UPMC DOES NOT HAVE ANY UNRECORDED TAX BENEFITS. AN EXTERNAL AUDIT IS COMPLETED AT CONSOLIDATED UPMC SYSTEM LEVEL ONLY, INCLUDING UPMC AND ALL TAXABLE AND TAX-EXEMPT SUBSIDIARIES. GOLF OUTING 23270 10000 13270 9627 6879 615 4272 23270 10000 13270 9627 6879 615 4272 21393 -8123 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 375435 375435 0.00490 10396479 7985261 2411218 0.03170 10771914 7985261 2786653 0.03660 195288 195288 0.00260 1890424 1255320 635104 0.00840 2085712 1255320 830392 0.01100 12857626 9240581 3617045 0.04760 0 3272669 11370076 10034516 1335560 X 1 1 1 1 UPMC SOMERSET 225 SOUTH CENTER AVENUE SOMERSET PA 15501 X X X UPMC SOMERSET 1 0 1 1 X X X X X X X X X 18 1 0 0 1 X WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 18 1 WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 250.000000000000 400.000000000000 X X X 1 1 X X X 1 X SOMERSETHOSPITAL.COM/PATIENT_INFORMATION/FINANCIAL_ASSISTANCE_POLICY.ASPX X SOMERSETHOSPITAL.COM/PATIENT_INFORMATION/FINANCIAL_ASSISTANCE_POLICY.ASPX X SOMERSETHOSPITAL.COM/PATIENT_INFORMATION/FINANCIAL_ASSISTANCE_POLICY.ASPX X X X X X X 1 X 0 1 X 0 0 UPMC SOMERSET PART V, SECTION B, LINE 2: SOMERSET HOSPITAL WAS ACQUIRED BY UPMC FEBRUARY 1, 2019. THE TAX ID AND TAX-EXEMPT STATUS DID NOT CHANGE. UPMC SOMERSET PART V, SECTION B, LINE 5: UPMC SOMERSET TOOK SEVERAL STEPS TO MAKE SURE THE INTERESTS OF THOSE WHO RESPRESENT THE COMMUNITY WERE TAKEN INTO ACCOUNT. KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH JAMES YODER, DIRECTOR OF SOMERSET COUNTY AREA AGENCY ON AGING, AMANDA WEBRECK, HOMELESS ASSISTANCE CASE MANAGER, JOSHUA BOLAND, SOMERSET ECONOMIC DEVELOPMENT COUNCIL, RON ALDOM, SOMERSET COUNTY CHAMBER OF COMMERCE, KIRBY BRUGH, PENNSYLVANIA DEPARTMENT OF HEALTH AND REVERAND J. MATTHEW DEAL, ST. PAUL'S UNITED CHURCH OF CHRIST. THE STEERING COMMITTEE, IN ADDITION TO HOSPITAL EMPLOYEES, INCLUDED DOUGLAS WALTERS, CHILDREN AND YOUTH SERVICES, ERIN HOWSARE, SINGLE COUNTY AUTHORITY, JESPER NIELSEN, CRYOLE-NIELSEN THERAPEUTICS, KIRBY BRUGH, PENNSYLVANIA DEPARTMENT OF HEALTH, KRISTA MATHIAS, SOMERSET AREA SCHOOL DISTRICT, AND RON ALDOM, SOMERSET COUNTY CHAMBER OF COMMERCE. A SURVEY WAS ALSO SENT OUT TO COMMUNITY MEMBERS VIA SURVEY MONKEY AND 678 SURVEYS WERE COLLECTED. UPMC SOMERSET PART V, SECTION B, LINE 11: UPMC SOMERSET IS ADDRESSING CHRONIC DISEASES (DIABETES, HEART DISEASE, AND CANCER) THROUGH INCREASED COMMUNITY EDUCATION, FOCUSING ON SERVICES SUCH AS INTERVENTIONAL CARDIOLOGY AND PRIMARY STROKE CENTER AND INCREASED COMMUNITY SCREENINGS. BEHAVIORAL HEALTH (DRUG AND ALCOHOL, BEHAVIORAL HEALTH) IS BEING ADDRESSED THROUGH DEVELOPING A COMPREHENSIVE WARM HAND OFF PROGRAM, ADDITIONAL TRAINING FOR PROVIDERS AND HEALTH CARE WORKERS IN BOTH THE RECOGNITION OF DRUG AND ALCOHOL ISSUES, AS WELL AS BEHAVIORAL HEALTH, PREVENTION EDUCATION, RECOVERY TO WORK PROGRAMMING, AND EXPLORING PROGRAMMING FOR TELE-PSYCH. ACCESS TO CARE (BOTH PRIMARY AND SECONDARY CARE) IS BEING ADDRESSED BY RECRUITMENT OF ADDITIONAL PROVIDERS, EXPANDED PRIMARY CARE LOCATIONS AND DEVELOPMENT OF TELEMEDICINE PROGRAMS. OF THE TOP 10 IDENTIFIED HEALTH ISSUES, THE CURRENT IMPLEMENTATION PLAN ADDRESSES EACH OF THESE NEEDS EITHER DIRECTLY OR INDIRECTLY, SUCH AS OBESITY. SPECIFIC NEEDS NOT BEING ADDRESSED INCLUDE TRANSPORTATION TO AND FROM MEDICAL APPOINTMENTS, ACCESS TO HEALTHY FOODS, ACCESS TO DENTAL CARE, TEENAGE PREGNANCY, SEXUALLY TRANSMITTED INFECTIONS, MOTOR VEHICLE ACCIDENTS, UNEMPLOYEMENT RATES/POVERTY, CRIME/VIOLENCE, ADOLESCENT CRIME AND ENVIRONMENTAL HEALTH. EACH OF THESE ISSUES WERE RANKED AND RATED IN TERMS OF HOW SERIOUS THE ISSUE IS IN OUR COMMUNITY, THE CAPACITY FOR THE HOSPITAL TO ADDRESS THE NEED AND THE DEGREE TO WHICH THE HOSPITAL IS RESPONSIBLE FOR ADDRESSING THESE NEEDS. MANY OF THESE ISSUES ARE NOT BEING ADDRESS BECAUSE WHILE THEY WERE IDENTIFIED AS BEING AN ISSUE, THE DATA DOES NOT SUPPORT THIS, SUCH AS TEENAGE PREGNANCY, SEXUALLY TRANSMITTED INVECTIONS, AND ENVIRONMENTAL HEALTH, WHERE THE NUMBERS FOR OUR COMMUNITY ARE BETTER THAN THE STATE AVERAGE. OTHER ISSUES SUCH AS CRIME/VIOLENCE, AND POVERTY WERE DETERMINED TO BE OUT OF OUR CAPACITY TO CORRECT. UPMC SOMERSET PART V, SECTION B, LINE 16J: UNINSURED PATIENTS ARE PROVIDED A PLAIN LANGUAGE SUMMARY AND FAP APPLICATION FORM. BILLING STATEMENTS INCLUDE A NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN INFORMATION. PART V, SECTION B, LINE 2 PART V, SECTION B, LINE 2: THE CHNA WAS LAST CONDUCTED DURING THE ORGANIZATION'S 2018 TAX YEAR, WHICH IS EQUVIALENT TO ITS FISCAL YEAR ENDED JUNE 30, 2019. THE IMPLEMENTATION STRATEGY WAS ALSO ADOPTED DURING THAT SAME FISCAL YEAR. 3 1 - THE WHEELER CENTER 126 EAST CHURCH STREET SOMERSET PA 15501 OUTPATIENT REHABILITATION 2 - SOMERSET HOSPICE 1474 NORTH CENTER AVENUE SOMERSET PA 15501 INPATIENT HOSPICE 3 - BERLIN MEDICAL CENTER 426 MAIN STREET BERLIN PA 15530 OUTPATIENT PHYSICAL THERAPY PART I, LINE 7: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART I, LINE 7. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDED IN FISCAL YEAR 2021 WERE OUTPATIENT BEHAVIORAL HEALTH, COUMADIN CLINIC, AND INPATIENT HOSPICE. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE OF 3,272,669 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. PART III, LINE 9B: UPMC SOMERSET GENERALLY DESIGNATES SERVICES AS "CHARITY CARE" BASED ON AN INDIVIDUAL'S ABILITY TO PAY. UPMC SOMERSET OFFERS PAYMENT PLANS AND ASSISTS INDIVIDUALS IN APPLYING FOR THE STATE'S MEDICAL ASSISTANCE PROGRAM. PART VI, LINE 2: DURING FISCAL YEAR 2019, UPMC SOMERSET CONDUCTED A COUNTY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE STUDY WAS CONDUCTED TO IDENTIFY THE MOST IMPORTANT HEALTH ISSUES WHICH NEED TO BE ADDRESSED. THE CHNA LOOKS AT HEALTH STATUS, BARRIERS TO CARE, AND OTHER DEMOGRAPHIC AND SOCIAL ISSUES AFFECTING PEOPLE AND ORGANIZATIONS THROUGHOUT SOMERSET COUNTY. THE REPORT IS AIMED AT ASSISTING SOMERSET HOSPITAL IN MAKING DECISIONS ABOUT THE FUTURE OF HEALTHCARE AND PREVENTION. PART VI, LINE 3: THE PLAIN LANGUAGE SUMMARY OF THE FAP AND FAP APPLICATION ARE AVAILABLE ON SOMERSET HOSPITAL'S WEBSITE. PAPER COPIES OF THE FAP, PLAIN LANGUAGE SUMMARY OF THE FAP, AND FAP APPLICATION ARE AVAILABLE ON SOMERSET HOSPITAL'S WEBSITE, UPON REQUEST AND COPIES ARE IN THE EMERGENCY ROOM AND ADMISSIONS AREA. THE HOSPITAL HAS SIGNS THAT NOTIFY THE PATIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IN THE EMERGENCY ROOM AND ADMISSIONS AREA. UNINSURED PATIENTS ARE PROVIDED A PLAIN LANGUAGE SUMMARY AND FAP APPLICATION FORM. BILLING STATEMENTS INCLUDE A NOTICE ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN INFORMATION. PART VI, LINE 4: UPMC SOMERSET SERVES RESIDENTS IN SOMERSET COUNTY, PENNSYLVANIA. SOMERSET COUNTY IS A RURAL AREA WITH A POPULATION OF APPROXIMATELY 76,000 AND LAND AREA OF 1075 SQUARE MILES. THE COST OF LIVING IS BELOW THE NATIONAL AVERAGE AND THE ESTIMATED MEDIAN HOUSEHOLD INCOME IS $44,255 WHICH IS ALSO BELOW THE PENNSYLVANIA AVERAGE. APPROXIMATELY 14% OF SOMERSET RESIDENTS LIVE IN POVERTY. PART VI, LINE 5: UPMC SOMERSET IS A NOT-FOR-PROFIT COMMUNITY ASSET COMMITTED: TO PROVIDING CARE TO THE SICK AND INJURED, PRESERVING AND SUSTAINING LIFE, AND PROMOTING HEALTH AND WELL BEING; TO THE PROMOTION AND DEVELOPMENT OF COMPLEMENTARY PROGRAMS AND SERVICES, MANPOWER AND FACILITIES; TO THE CONTINUOUS IMPROVEMENT OF QUALITY, ACCESSIBILITY AND CONTINUITY OF PATIENT CARE; TO THE WELFARE AND LIVELIHOOD OF ITS EMPLOYEES; TO ENSURING THE HOSPITAL'S FINANCIAL VIABILITY NECESSARY TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY AND REGION TODAY AND IN THE FUTURE. SOMERSET HOSPITAL PROVIDES QUALITY HEALTH CARE IN A COMPASSIONATE MANNER REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR THE PATIENT'S ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF SOMERSET HOSPITAL, THE HOSPITAL, UNDER ITS WRITTEN CHARITY CARE POLICY, IS COMMITTED TO PROVIDING NECESSARY HEALTH CARE SERVICES AT NO CHARGE OR AT A REDUCED CHARGE TO PATIENTS. THE HOSPITAL USES ANY EXCESS IN REVENUES OVER EXPENSES TO FUND IMPROVEMENTS IN PATIENT CARE IN ORDER TO PROVIDE THE COMMUNITY WITH STATE OF THE ART EQUIPMENT AND FACILITIES. THE HOSPITAL RECRUITS THE BEST AND THE BRIGHTEST TO PROVIDE SERVICES TO THE COMMUNITY WHERE THERE IS A NEED AND A SHORTAGE OF PHYSICIANS. THE HOSPITAL EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE GOVERNING BODY IS COMPRISED OF LOCAL RESIDENTS WHO HAVE THE BEST INTEREST OF THE COMMUNITY. 0 1 0 0 0 0 0 0 0 DAVID MARTIN DIRECTOR 0 493787 0 530000 0 91341 0 164735 0 23107 0 1302970 0 78350 DAVID RUSSELL DIRECTOR 0 276530 0 217500 0 20951 0 42298 0 4506 0 561785 0 8170 MARCO CANTINI MD MEDICAL DIRECTOR OF ANESTHESIOLOGY 421307 0 0 0 19000 0 0 0 13565 0 453872 0 0 0 DAVID BURWELL MD DIRECTOR 0 354316 0 0 0 20760 0 40430 0 21285 0 436791 0 1584 JAYESH DESAI MD DIRECTOR 0 393650 0 0 0 19500 0 0 0 16084 0 429234 0 0 MOKBEL MATTA MD PHYSICIAN 397323 0 0 0 19000 0 0 0 4989 0 421312 0 0 0 CHARLES TULLIS MD PHYSICIAN 388273 0 0 0 19000 0 0 0 13565 0 420838 0 0 0 ANDREW RUSH CEO 325662 0 0 0 19437 0 5446 0 16565 0 367110 0 0 0 MARK YAROS MD DIRECTOR 0 254217 0 0 0 19500 0 0 0 16014 0 289731 0 0 KELLY EAGLEHOUSE MD PHYSICIAN 224503 0 0 0 0 0 4291 0 5662 0 234456 0 0 0 JONATHAN THIELE MD PHYSICIAN 189221 0 0 0 0 0 3780 0 16364 0 209365 0 0 0 MONICA J KLATT CFO 0 141127 0 0 0 236 0 10561 0 14433 0 166357 0 0 PART I, LINE 3 UPMC HAS ESTABLISHED A RIGOROUS COMPENSATION REVIEW PROCESS FOR ITS TOP EXECUTIVES WHICH INCLUDES REVIEW BY ITS EXECUTIVE COMPENSATION COMMITTEE IN A PROCESS INTENDED TO SATISFY THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" SET FORTH IN THE REGULATIONS TO SECTIONS 4958 OF THE INTERNAL REVENUE CODE. UPMC GIVES AUTHORITY TO THOSE EXECUTIVES TO ESTABLISH THE COMPENSATION OF EXECUTIVES OF OTHER SUBSIDIARIES AND BUSINESS UNITS, INCLUDING THOSE OF UPMC SOMERSET. PART I, LINE 4B ALL PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ARE DISCLOSED IN SCHEDULE J WITH CORRESPONDING AMOUNTS IN SCHEDULE J COLUMN C "RETIREMENT AND OTHER DEFERRED COMPENSATION." DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE ("CODE"), CERTAIN OFFICERS AND KEY EMPLOYEES ARE LIMITED IN THE AMOUNT OF BENEFITS WHICH MAY BE RECEIVED UNDER A TAX QUALIFIED RETIREMENT PROGRAM. LIKE MANY EMPLOYERS, UPMC SUPPLEMENTS ITS RETIREMENT BENEFITS THROUGH A SUPPLEMENTAL RETIREMENT PROGRAM. THE SUPPLEMENTAL RETIREMENT PROGRAM IS SUBJECT TO MULTIYEAR VESTING WHICH PLACES THE OFFICERS AND KEY EMPLOYEES' RETIREMENT BENEFIT AT RISK OF FORFEITURE IF THE VESTING REQUIREMENTS ARE NOT SATISFIED. ONCE VESTED HOWEVER, PROVISIONS OF THE CODE REQUIRE THAT THE VESTED AMOUNTS BE REPORTED ON FORM 990 AND THE VESTED OFFICER OR KEY EMPLOYEE INCLUDE IN CURRENT INCOME THE VALUE OF HER OR HIS SUPPLEMENTAL RETIREMENT BENEFIT. NOTWITHSTANDING THE TAX REQUIREMENT TO RECOGNIZE THE VESTED AMOUNT OF THE SUPPLEMENTAL RETIREMENT BENEFIT AS INCOME, THIS BENEFIT, WHICH HAS BEEN EARNED OVER HER OR HIS ENTIRE CAREER, HAS NOT AND WILL NOT BE DISTRIBUTED UNTIL THE OFFICER OR KEY EMPLOYEE RETIRES OR SEPARATES FROM SERVICE FROM UPMC. THE SUPPLEMENTAL RETIREMENT PROGRAM PROVIDES FOR THE CURRENT DISTRIBUTION OF ONLY THE AMOUNT NECESSARY TO SATISFY ANY INCOME TAX LIABILITY RESULTING FROM THE VESTING DURING ACTIVE EMPLOYMENT. FINALLY, IT SHOULD BE NOTED THAT IN ACCORDANCE WITH IRS INSTRUCTIONS, A SUBSTANTIAL PORTION OF THE AMOUNT REPORTED ON THE FORM 990 ATTRIBUTABLE TO SUPPLEMENTAL RETIREMENT PROGRAM VESTING HAS BEEN REPORTED IN PREVIOUSLY FILED FORMS 990. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER IS THE EXEMPT ENTITY UPMC. FORM 990, PART VI, SECTION A, LINE 7B DURING THE INTEGRATION PERIOD WHICH ENDED FEBRUARY 1, 2021, OR SUCH LONGER PERIOD AS SPECIFICALLY INDICATED BELOW, THE FOLLOWING ACTIONS WILL REQUIRE APPROVAL OF THE SOMERSET BOARD AND UPMC, AND NEITHER UPMC NOR THE SOMERSET BOARD SHALL HAVE THE AUTHORITY INDIVIDUALLY TO UNDERTAKE ANY OF THE FOLLOWING ACTIONS WITHOUT SUCH JOINT APPROVAL: (A) APPROVAL OF OPERATING AND CAPITAL BUDGETS OF SOMERSET AND THE SOMERSET ENTITIES. (B) APPROVAL OF PLANS FOR APPLICATION AND USE OF THE CAPITAL EXPENDITURES AND PROGRAMMATIC ENHANCEMENT COMMITMENT IN ACCORDANCE WITH SECTIONS 3.3.1 THROUGH 3.3.3 OF THE INTEGRATION AGREEMENT. (C) APPROVAL OF STRATEGIC PLANS FOR SOMERSET. (D) ENTERING INTO NEW, OR MATERIALLY CHANGING ANY EXISTING, JOINT VENTURE ARRANGEMENTS SPECIFICALLY OF SOMERSET OR THE SOMERSET ENTITIES. (E) APPROVAL OF SELECTION OF THE SOMERSET PRESIDENT/SENIOR EXECUTIVE, AND APPROVAL OF REMOVAL AND COMPENSATION TERMS. (F) APPROVAL OF THE TERMS OF ANY MANAGEMENT ARRANGEMENTS OF ANY SOMERSET ENTITY WITH AN UNRELATED THIRD PARTY. (G) DURING THE FIVE-YEAR PERIOD FOLLOWING THE CLOSING. ANY MATERIAL CHANGES TO SOMERSETS CLINICAL PROGRAMS. (H) ANY CHANGE IN THE CORPORATE STRUCTURE OF SOMERSET OR ANY SOMERSET ENTITY. (I) THE SALE, LEASE, TRANSFER OR JOINT VENTURE, WHETHER WITHIN THE SYSTEM OR EXTERNAL THERETO, INVOLVING SUBSTANTIALLY ALL OF THE ASSETS OR BUSINESS OR SIGNIFICANT PRODUCT LINES OF SOMERSET OR ANY SOMERSET ENTITY, EXCEPT FOR UPMC SOMERSETS OUTPATIENT REHABILITATION, HOME HEALTH, HOSPICE, AND DURABLE MEDICAL EQUIPMENT LINES OF SERVICE AND BUSINESSES THAT WILL BE INTEGRATED INTO THE UPMC SYSTEMS OPERATIONS AS SET FORTH IN SECTIONS 12.4 THROUGH 12.7 OF THE INTEGRATION AGREEMENT. (J) THE MERGER, CONSOLIDATION, DIVESTITURE OR DISSOLUTION OF SOMERSET OR ANY OF ITS SUBSIDIARIES. (K) DURING THE FIVE-YEAR PERIOD FOLLOWING THE CLOSING, THE DETERMINATION THAT SOMERSET OR ANY SOMERSET ENTITY WILL NO LONGER BE LICENSED OR OPERATED AS CURRENTLY LICENSED OR OPERATED. (L) ANY AMENDMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF SOMERSET OR ANY SOMERSET ENTITY. (M) SALE OF ANY REAL ESTATE OF OR BY SOMERSET OR ANY SOMERSET ENTITY. FORM 990, PART VI, SECTION B, LINE 11B UPMC SOMERSET HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. THE RETURN IS THEN FINALIZED AND THE BOARD IS PROVIDED A COPY OF THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C UPMC REQUIRES ALL OF ITS KEY EMPLOYEES AND NON-EMPLOYED PERSONNEL TO COMPLY WITH ITS CONFLICT OF INTEREST POLICIES WHEN THEY ENGAGE IN UPMC-RELATED BUSINESS. PEOPLE COVERED BY THE POLICIES INCLUDE: -UPMC ENTITY BOARD MEMBERS, BOARD COMMITTEE MEMBERS, AND CORPORATE OFFICERS -UPMC PHYSICIANS AND NON-PHYSICIAN EMPLOYEES WHO HOLD A POSITION OF INFLUENCE -NON-EMPLOYED MEMBERS OF THE UPMC MEDICAL STAFF WHO HOLD A POSITION OF INFLUENCE OF TRUST -INDIVIDUALS CONDUCTING CLINICAL RESEARCH AT UPMC, WHETHER OR NOT THEY ARE EMPLOYED BY UPMC. THESE PEOPLE ARE REQUIRED TO COMPLETE A QUESTIONNAIRE AT LEAST ANNUALLY. AN ELECTRONIC FORM HAS BEEN DEVELOPED TO CAPTURE THE DATA FROM THE QUESTIONNAIRE AND TO MONITOR COMPLETION. THE INFORMATION, ALONG WITH OTHER DATA, IS USED TO CAPTURE INDIVIDUAL AND INSTITUTIONAL RELATIONSHIPS SO THAT POTENTIAL CONFLICTS OF INTEREST CAN BE IDENTIFIED. IF A POTENTIAL CONFLICT IS IDENTIFIED REGARDING A SPECIFIC UPMC ACTIVITY THE CORPORATE COMPLIANCE DEPARTMENT, WITH THE ASSISTANCE OF THE LEGAL DEPARTMENT, EVALUATE THE ACTIVITY IN RELATION TO THE POTENTIAL CONFLICT. IF A PERCEIVED OR ACTUAL CONFLICT IS DETERMINED TO EXIST AND A DECISION IS MADE TO PROCEED WITH THE ACTIVITY, A WRITTEN PLAN DESIGNED TO PREVENT THE CONFLICT FROM INFLUENCING DECISIONS RELATED TO THE ACTIVITY IS DEVELOPED. THE PROCESS IS ULTIMATELY OVERSEEN BY A CONFLICT OF INTEREST COMMITTEE OF THE UPMC BOARD OF DIRECTORS ON BEHALF OF ALL UPMC SUBSIDIARIES, INCLUDING UPMC SOMERSET. FORM 990, PART VI, SECTION B, LINE 15 UPMC HAS ESTABLISHED A RIGOROUS COMPENSATION REVIEW PROCESS FOR ITS TOP EXECUTIVES WHICH INCLUDES REVIEW BY ITS EXECUTIVE COMPENSATION COMMITTEE IN A PROCESS INTENDED TO SATISFY THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" SET FORTH IN THE REGULATIONS TO SECTIONS 4958 OF THE INTERNAL REVENUE CODE. UPMC GIVES AUTHORITY TO THOSE EXECUTIVES TO ESTABLISH THE COMPENSATION OF EXECUTIVES OF OTHER SUBSIDIARIES AND BUSINESS UNITS, INCLUDING THOSE OF UPMC SOMERSET. FORM 990, PART VI, SECTION C, LINE 19 UPMC'S PUBLIC WEBSITE (WWW.UPMC.COM) MAKES ITS FINANCIAL RESULTS, CONFLICT OF INTEREST PROCESS, AND VARIOUS INFORMATION ABOUT GOVERNANCE AND OVERSIGHT AVAILABLE TO THE PUBLIC. ADDITIONAL INFORMATION MAY BE SUPPLIED UPON SPECIFIC REQUEST FOR DATA NOT POSTED TO THE WEBSITE. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 7,300,629. MANAGEMENT AND GENERAL EXPENSES 1,993,660. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,294,289. FORM 990, PART XI, LINE 9: TRANSFERS TO EXEMPT AFFILIATES -7,273,387. OTHER CHANGES -3,021,550. NET ASSETS RELEASED FROM RESTRICTION -5,285,481. FORM 990, PART XII, LINE 2: AN EXTERNAL AUDIT IS COMPLETED AT A CONSOLIDATED UPMC SYSTEM LEVEL ONLY, INCLUDING UPMC AND ALL TAXABLE AND TAX-EXEMPT SUBSIDIARIES. THE ENTIRE SYSTEM'S FINANCIAL STATEMENTS, WHICH INCLUDES ALL SUBORDINATE MEMBERS OF THE UPMC GROUP, ARE POSTED ON THE UPMC WEBSITE. (WWW.UPMC.COM) THE FINANCIAL STATEMENT AUDIT DURING THE 990 FILING PERIOD IS FOR THE CALENDAR YEAR ENDED DECEMBER 31, 2020. UPMC HAS AN AUDIT COMMITTEE THAT IS ESTABLISHED TO ASSIST THE BOARD OF DIRECTORS IN FULFILLING ITS OVERSIGHT RESPONSIBILITIES BY MONITORING UPMC CONSOLIDATED FINANCIAL REPORTS AND OTHER FINANCIAL INFORMATION PROVIDED BY UPMC TO GOVERNMENTAL BODIES, THE PUBLIC OR OTHER EXTERNAL ENTITIES. THE UPMC'S SYSTEM OF INTERNAL CONTROLS REGARDING FINANCE, ACCOUNTING, LEGAL COMPLIANCE AND ETHICS THAT MANAGEMENT AND THE BOARD HAVE ESTABLISHED AND UPMC'S INTERNAL AUDITING, ACCOUNTING AND FINANCIAL REPORTING PROCESSES ALSO PROVIDED OVERSIGHT. 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