2020-11-16T15:27:48-06:00 2019-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2019-01-01 160743226 UPMC CHAUTAUQUA AT WCA UPMC 7164870141 207 FOOTE AVENUE PO BOX 840 JAMESTOWN NY 147020840 BRIAN DURNIOK PRESIDENT 7164870141 2020-11-13 1 THOMAS DALTON P00645802 7168472651 2020-11-13 104.193.28.34 2020-11-13 11:05:27 ES P 9AD29C551C0D524BD933C6291C484BFCC5F79E48 382F0CF5B7BC547980A833C446D3B443A23B8F8F 2019 2021-01-29 14:40:06Z UPMC CHAUTAUQUA WCA BRIAN DURNIOK 207 FOOTE AVENUE / PO BOX 840 JAMESTOWN NY 147020840 101996551 0 X WWW.UPMCCHAUTAUQUAWCA.ORG X 1885 NY SEE SCHEDULE O 12 7 1120 96 0 -250 461015 1877074 89963503 98921434 5802622 24039 8105988 1174004 104333128 101996551 0 0 0 0 57226558 54926844 0 0 0 47432031 72860431 104658589 127787275 -325461 -25790724 90491490 109284839 66912244 35585126 23579246 73699713 TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE OF CHAUTAUQUA COUNTY AND THE SURROUNDING AREA IN A WAY THAT INCLUDES COMPASSION, DEDICATION, A COMMITMENT TO QUALITY AND PATIENT SAFETY WHILE MAINTAINING ECONOMIC VIABILITY AND A VISION FOR THE 21ST CENTURY. 0 0 92600067 99726302 OPERATING A HOSPITAL TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE OF CHAUTAUQUA COUNTY AND THE SURROUNDING AREA. SEE SCHEDULE O FOR ADDITIONAL DETAILS. 92600067 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 1120 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X BRIAN DURNIOK 7166648300 207 FOOTE AVE PO BOX 840 JAMESTOWN NY 147020840 STEVEN KILBURN CHAIR 2.00 X X 0 0 0 BRENDA IRELAND BOARD MEMBER 2.00 X 0 0 0 MICHAEL SULLIVAN BOARD MEMBER 2.00 X 0 0 0 DAVID GIBBONS VICE CHAIR 40.00 X X 0 786390 83982 BRADLEY DINGER TREASURER/CFO 40.00 X X 0 209527 32940 CRISTIE HERBST BOARD MEMBER 2.00 X 0 0 0 CAMELLIA HERISKO CNO, VP OPS & PATIENT CARE 2.00 X 274147 0 38974 EDWARD KARLOVICH BOARD MEMBER 2.00 X 0 1213265 126968 MARK RAIMY BOARD MEMBER 2.00 X 0 0 0 ANNA DIBBLE BOARD MEMBER 2.00 X 0 0 0 WILLIAM GEARY MDPHD BOARD MEMBER 2.00 X 0 0 0 JAMES DONNELLY CNO 40.00 X X 0 289309 37516 BRIAN DURNIOK PRESIDENT/CEO 40.00 X 0 444586 29666 CECIL M MILLER III SECRETARY/VP OF OPERATIONS 40.00 X 198291 0 19949 LISA MCCHESNEY CIO 40.00 X 0 276477 40689 GALO GRIJALVA MD PHYSICIAN 40.00 X 370238 0 42005 JONATHAN BLASIUS MD MEDICAL DIRECTOR-HOSPITALI 40.00 X 316135 0 57525 SALVATORE J BUONAIUTO MD HOSPITALIST 40.00 X 478039 0 38478 PUJAN SHRESTHA MD PHYSICIAN 40.00 X 301594 0 31164 SRINIVAS BOMMIREDDIPALLI MD HOSPITALIST 40.00 X 308337 0 23902 2246781 3219554 603758 31 0 1 0 LECHASE CONSTRUCTION 205 INDIGO CREEK DRIVE ROCHESTER NY 14626 CONSTRUCTION SERVICES 9273221 ASSOCIATED CLINICAL LAB 1526 PEACH STREET ERIE PA 16501 LAB SERVICES 1706183 PREMIER ANESTHESIA OF NY PC 2655 NORTHWINDS PKWY ALPHARETTA GA 30009 ANESTHESIA PHYSICIAN SERVICES 1429530 PERRY CONSTRUCTION GROUP INC 1440 WEST 21ST STREET ERIE PA 16502 CONSTRUCTION SERVICES 426211 JAMESTOWN AREA PATHOLOGY LLC 207 FOOTE AVENUE JAMESTOWN NY 14701 PATHOLOGY 343550 13 962225 914849 1877074 HOSPITAL REVENUE 621500 98183496 98183496 EQUITY INVESTMENTS REVENUE 621500 737938 737938 98921434 24039 24039 369136 0 369136 369136 369136 CAFETERIA REVENUE 621990 346672 346672 OTHER MISCELLANEOUS REVENUE 900099 278490 278490 EDUCATION REVENUE 621990 109381 109381 70325 70325 804868 101996551 99726302 0 393175 472438 472438 40040559 37825009 2215550 11264550 2398830 8865720 3149297 2977070 172227 263752 263752 113950 113950 259031 259031 1402 1402 5673494 4256224 1417270 1124654 1124654 HOSPITAL AND MEDICAL SU 20356901 20039701 317200 ENTERPRISE SHARED SERVI 16870663 16870663 PURCHASED SERVICES 12611615 10994606 1617009 PHYSICAN FEES 9764766 9643133 121633 5820203 2867000 2953203 127787275 92600067 35187208 0 1355672 548110 15835215 16083121 564358 651321 777754 292396 158543343 89959574 52643704 68583769 3455621 2479318 15859166 20646804 90491490 109284839 3894173 4329191 12324048 26297365 82139 592751 50611884 4365819 66912244 35585126 X 7918899 56592491 15660347 17107222 23579246 73699713 90491490 109284839 X -25790724 75911191 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 13649391 77571 2926269 706821 15946410 14973749 102059 -721818 704599 13649391 13142333 96982 2378581 644147 14973749 12729182 72452 950163 609464 13142333 13542757 33559 -336604 510530 12729182 0.71820 0.28180 0 0 2016055 2016055 73558924 38640917 34918007 3095812 2550094 545718 77177728 48768563 28409165 2694824 2694824 68583769 BENEFICIAL INTEREST IN NET ASSETS OF WCA FOUNDATION 15176778 OTHER LONG TERM RECEIVABLE 550000 INVESTMENT IN WCA SERVICES CORPORATION 1400000 OPERATING LEASE RIGHT OF USE ASSETS 3520026 20646804 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 444080 OTHER LONG TERM LIABILITY 550000 DUE TO EXEMPT PARENT -148287 RIGHT OF USE LIABILITY 3520026 4365819 X PART V, LINE 4: THE INCOME FROM THE ENDOWMENT FUND IS UNRESTRICTED AND ITS USES ARE DETERMINED BY THE BOARD. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C) (3) OF THE INTERNAL REVENUE CODE (THE "CODE"), AND ACCORDINGLY, IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH U.S. GAAP, WHICH REQUIRES THE RECOGNITION AND MEASUREMENT OF UNCERTAIN INCOME TAX POSITIONS THAT THE HOSPITAL HAS TAKEN OR EXPECTS TO TAKE IN THE HOSPITAL'S TAX RETURNS. THE HOSPITAL HAS NOT RECORDED ANY AMOUNTS RELATING TO UNCERTAIN TAX POSITIONS. 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 456632 456632 0.00360 36537446 18841834 17695612 0.13850 12843 2993 9850 0.00010 37006921 18844827 18162094 0.14220 107994 107994 0.00080 262740 92840 169900 0.00130 20338 20338 0.00020 391072 92840 298232 0.00230 37397993 18937667 18460326 0.14450 1 3368986 437968 40250079 65897478 -25647399 X 1 1 1 WCA 31 SHERMAN LLC REAL ESTATE PROJECTS 0.50000 0.00000 0.00000 1 1 UPMC CHAUTAUQUA AT WCA 207 FOOTE AVENUE / PO BOX 840 JAMESTOWN NY 147020840 WWW.UPMCCHAUTAUQUAWCA.ORG 10-65-60 X X X UPMC CHAUTAUQUA AT WCA 1 0 0 1 X X X X X X X X X 19 1 1 0 1 X WWW.UPMC.COM X 1 19 1 WWW.UPMC.COM 0 1 X 250.000000000000 400.000000000000 X X X 1 1 X X X 1 X WWW.UPMC.COM X WWW.UPMC.COM X WWW.UPMC.COM X X X X X X 1 X 0 1 X 0 0 UPMC CHAUTAUQUA AT WCA PART V, SECTION B, LINE 5: UPMC'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS INCLUDED A PARTNERSHIP WITH EXPERTS AT THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH TO CONDUCT THE CHNA USING A BEST-PRACTICE METHODOLOGY. THE ASSESSMENT BLENDED ANALYSIS OF DOCUMENTED HEALTH AND SOCIOECONOMIC FACTORS WITH A STRUCTURED, COMMUNITY INPUT SURVEY PROCESS. EFFECTIVELY ENGAGING THE COMMUNITY IN A BROAD, SYSTEMATIC WAY, THE SURVEY SOLICITED FEEDBACK FROM COMMUNITY ADVISORY PANELS COMPOSED OF LEADERS OF ORGANIZATIONS THAT REPRESENT PATIENT CONSTITUENCIES, INCLUDING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY, AND CHRONICALLY ILL POPULATIONS WITHIN THE HOSPITAL'S COMMUNITY. APPENDIX C OF EACH HOSPITAL CHNA REPORT INCLUDES A LIST OF COMMUNITY PARTICIPANTS. WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/PAGES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX UPMC CHAUTAUQUA AT WCA PART V, SECTION B, LINE 6A: UPMC HOSPITALS CONDUCTED JOINT CHNAS AS FOLLOWS:ERIE, MCKEAN, AND VENANGO COUNTIES IN PA AND CHAUTAUQUA COUNTY, NY HOSPITALS: UPMC HAMOT, UPMC KANE, UPMC NORTHWEST, AND UPMC CHAUTAUQUA.ALLEGHENY COUNTY HOSPITALS: UPMC CHILDREN'S HOSPITAL OF PITTSBURGH, UPMC EAST, UPMC MAGEE-WOMENS HOSPITAL, UPMC MCKEESPORT, UPMC MERCY, UPMC PASSAVANT, UPMC PRESBYTERIAN SHADYSIDE, AND UPMC ST. MARGARET.BEDFORD AND BLAIR COUNTY HOSPITALS: UPMC ALTOONA AND UPMC BEDFORD.LAWRENCE AND MERCER COUNTY HOSPITALS: UPMC JAMESON AND UPMC HORIZON.CLINTON, LYCOMING, NORTHUMBERLAND, POTTER, AND TIOGA COUNTY HOSPITALS: UPMC LOCK HAVEN, UPMC MUNCY, UPMC WILLIAMSPORT, UPMC SUNBURY, UPMC COLE, AND UPMC WELLSBORO. UPMC CHAUTAUQUA AT WCA PART V, SECTION B, LINE 11: THROUGH A RIGOROUS CHNA METHODOLOGY, UPMC HOSPITALS IDENTIFIED FOUR MAJOR THEMES REPRESENTING THE SIGNIFICANT HEALTH NEEDS IN THEIR COMMUNITIES: CHRONIC DISEASE MANAGEMENT; BEHAVIORAL HEALTH; ACCESS TO CARE AND NAVIGATING RESOURCES; AND PREVENTION AND COMMUNITY-WIDE HEALTHY LIVING. THE HOSPITALS DEVELOPED STRATEGIC IMPLEMENTATION PLANS TO ADDRESS THESE ISSUES, AS OUTLINED IN THEIR CHNA DOCUMENTS AND COMMUNITY HEALTH STRATEGIC PLANS - SEE SECTION IV OF EACH CHNA REPORT. WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/PAGES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX UPMC CHAUTAUQUA AT WCA PART V, SECTION B, LINE 13B: UPMC CHAUTAUQUA AT WCA RESERVES THE RIGHT TO REVIEW/APPROVE CASES WITH EXCESSIVE MEDICAL EXPENSES WHOSE FAMILY INCOME EXCEED 400% OF THE FPL, ON A CASE BY CASE BASIS. UPMC CHAUTAUQUA AT WCA PART V, SECTION B, LINE 20E: UPMC'S POLICIES DO NOT PERMIT HOSPITAL FACILITIES OR ANY OTHER AUTHORIZED PARTIES TO ENGAGE INEXTRAORDINARY COLLECTIONS ACTIONS IN ANY CIRCUMSTANCES. THEREFORE, LINE 20 HAS BEEN LEFT BLANK SINCE IT IS NOT APPLICABLE AND UPMC BELIEVES IT WOULD BE MISLEADING TO CHECK ANY OF THE BOXES. PART I, LINE 3C: FINANCIAL ASSISTANCE OR CHARITY CARE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS WHO HAVE HEALTH CARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR GOVERNMENT PROGRAMS OR OTHERWISE UNABLE TO PAY FOR THEIR OWN CARE.A PATIENT MAY BE DETERMINED TO HAVE FINANCIAL NEED BASED ON THE FOLLOWING:1. INDIGENCY: IF INCOME FALLS AT OR BELOW 250% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT WILL HAVE NO FINANCIAL RESPONSIBILITY. 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 88% REDUCTION IN THE PATIENT BILL.THE DISCOUNTED CHARITY CARE SCALE IS BASED ON FAMILY HOUSEHOLD SIZE FOR 2019.3. 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 FOR 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 I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I LINE 7 IS A RATIO OF COSTS TO CHARGES METHOD. THE METHOD EMPLOYED FOR DETERMINING THE RATIO OF COST TO CHARGES IS IN LINE WITH THOSE DESCRIBED IN SCHEDULE H, WORKSHEET 2, "RATIO OF PATIENT COSTS TO CHARGES". PART I, LN 7 COL(F): THE TOTAL EXPENSES REPORTED ON FORM 990 PART IX LINE 25 COLUMN A ARE INCLUSIVE OF ALL ENTITIES REPORTED WITHIN THE UPMC CHAUTAUQUA AT WCA 990 AND EXCLUDES BAD DEBT EXPENSE FOR THE ENTITY. THE EXPENSE USED TO CALCULATE THE PERCENT OF TOTAL EXPENSE FOR FORM 990 SCHEDULE H PART I LINE 7 COLUMN F ARE THE TOTAL EXPENSES FROM FORM 990 PART IX. THE TOTAL EXPENSE PER PART IX LINE 25 DOES NOT INCLUDE BAD DEBT EXPENSE, AND AS SUCH, IS NOT INCLUDED IN THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE. THE TOTAL EXPENSES USED FOR THIS CALCULATION, EXCLUDING BAD DEBT EXPENSE, IS $127,787,275. PART I, LINE 6A UPMC PREPARES AN ANNUAL COMMUNITY BENEFITS REPORT. THE REPORT ENCOMPASSES INFORMATION FOR THE ENTIRE INTEGRATED DELIVERY AND FINANCING SYSTEM (IDFS) THAT MAKES UP THE UPMC HEALTH SYSTEM. IT IS POSTED AND AVAILABLE TO THE PUBLIC VIA THE UPMC WEBSITE, WWW.UPMC.COM. PART I, 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 PERCENTAGE OF THEIR FAMILY HOUSEHOLD'S INCOME. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE IS PRESENTED NET OF AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL COLLECTIONS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS. PATIENT ACCOUNTS RECEIVABLE ARE DUE 30 DAYS AFTER THE DATE OF DISCHARGE. RECEIVABLES PAST DUE MORE THAN 120 DAYS ARE GENERALLY WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD-PARTY PAYORS. 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 III, LINES 2 & 3 THE COSTING METHOD USED TO CALCULATE THE AMOUNTS IN SCHEDULE H PART III LINES 2 AND 3 IS A RATIO OF COST TO CHARGES METHOD. DISCOUNTS AND PAYMENTS IN PATIENTS' ACCOUNTS ARE DEDUCTED BEFORE THE COST OF BAD DEBT EXPENSE IS DETERMINED. THE METHOD EMPLOYED IS IN LINE WITH THOSE DESCRIBED IN SCHEDULE H, WORKSHEET 2, "RATIO OF PATIENT COSTS TO CHARGES".THE ORGANIZATION'S BAD DEBT EXPENSE CONSISTS SOLELY OF SELFPAY PATIENTS ACCOUNTS DEEMED UNCOLLECTABLE. IT IS UPMC GROUP'S CONTENTION THAT THE COST OF BAD DEBT SHOULD BE STATED IN PART I LINE 7 OF SCHEDULE H AS THEY REPRESENT THE COSTS FOR PROVISION OF SERVICES TO PATIENTS FOR WHICH THE ENTITY HAS EXHAUSTED ALL RECOURSE FOR REIMBURSEMENT. THE SERVICES PROVIDED TO PATIENTS WHO PRESENT THEMSELVES ARE PROVIDED REGARDLESS OF A PATIENT'S ABILITY TO PAY AND IS IN LINE WITH THE ORGANIZATION'S CHARITABLE MISSION AND SERVICE TO OUR COMMUNITY. THESE EXPENSES ARE INCURRED REGARDLESS OF THE EFFICIENCY OF THE PROVISION OF THE RELATED MEDICAL CARE AND ARE DEEMED TO HAVE BEEN MEDICALLY NECESSARY FOR THE PATIENT. 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 IDENTIFIES THOSE PATIENTS THAT ARE MOST LIKELY TO BE THE HIGHEST NEED OF FINANCIAL ASSISTANCE. THIS IS ACCOMPLISHED BY ANALYZING CONSUMER DATA AND ACTIVITY, COURT RECORDS, GOVERNMENT RECORDS, PROPERTY FILES, CENSUS DATA AND IRS DATA. PARO PROVIDES A SYSTEMATIC APPROACH TO FINANCIAL ASSISTANCE: "PREDICTIVE MODEL THAT ENCOMPASSES HEALTHCARE 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 THE HISTORICAL APPROVALS. THE APPROVED CHARITY CARE ACCOUNTS WERE COMPARED AGAINST ACCOUNTS THAT WERE IN ACTIVE 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 EXISTING CHARITY CARE PATIENTS, THE ACCOUNT IS RECLASSIFIED FROM BAD DEBT TO CHARITY CARE. EVERY PATIENT IS ABLE TO APPLY FOR CHARITY CARE; HOWEVER, THE AUTOMATED STRATEGY FOCUSES ON PATIENTS THAT DO NOT COMPLETE THE APPLICATIONS 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 APPLICATION PROCESS VIRTUALLY IMPOSSIBLE FOR SOME CONSUMERS. PART III, LINE 8 THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS OF CARE IS A RATIO OF COSTS TO CHARGES METHOD. THE METHOD IS IN LINE WITH THOSE DESCRIBED IN SCHEDULE H, WORKSHEET 2, "RATIO OF PATIENT COSTS TO CHARGES". IT IS UPMC GROUP'S CONTENTION THAT ALL AMOUNTS CALCULATED TO BE SHORTFALLS IN REIMBURSEMENT FOR SERVICES PROVIDED TO MEDICARE PATIENTS ARE TRULY UNCOMPENSATED CARE THAT SHOULD BE STATED IN PART I LINE 7 OF SCHEDULE H OF FORM 990 AS THEY REPRESENT COSTS FOR PROVISION OF SERVICES TO PATIENTS FOR WHICH THE ENTITY IS UNABLE TO COLLECT, REGARDLESS OF THE EFFICIENCY OF PROVISION OF THE RELATED CARE COSTS. 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 ALSO MAY FIND INFORMATION ABOUT FINANCIAL ASSISTANCE THROUGH ACCESS TO THE UPMC WEB SITE (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 ASSISTANCE 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 LIAISONS 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 5: IN 2019, IN KEEPING WITH IRS 501(R) GUIDELINES, UPMC CHAUTAUQUA COLLABORATED WITH OTHER UPMC HOSPITALS IN THE FOUR-COUNTY REGION THAT INCLUDES CHAUTAUQUA COUNTY IN NEW YORK, AND ERIE, MCKEAN, AND VENANGO COUNTIES IN PENNSYLVANIA. THROUGH THE ASSESSMENT PROCESS, UPMC'S HOSPITALS IDENTIFIED THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, PRIORITIZED THOSE HEALTH NEEDS, ESTABLISHED ACTION PLANS, AND IDENTIFIED RESOURCES TO ADDRESS THOSE NEEDS. THE 2019 DOCUMENT BUILDS UPON PRIOR ASSESSMENTS AND IMPLEMENTATION PLANS DEVELOPED IN 2013 AND 2016. UPMC APPROACHED THE CHNA REQUIREMENT AS AN OPPORTUNITY TO EVALUATE AND ASSESS NEEDS THROUGH A FORMALIZED, RIGOROUS, AND STRUCTURED PROCESS TO ENSURE THAT HEALTH IMPROVEMENT EFFORTS AND RESOURCES ARE ALIGNED WITH THE MOST SIGNIFICANT COMMUNITY HEALTH NEEDS.UPMC ACTIVELY ENGAGED ITS HOSPITAL BOARDS, COMMUNITY STAKEHOLDERS, AND PUBLIC HEALTH EXPERTS TO IDENTIFY COMMUNITY HEALTH NEEDS AND DETERMINE HOW TO COLLABORATE MOST EFFECTIVELY TO ADDRESS THOSE NEEDS. THE ORGANIZATION SOLICITED AND TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. IN MAY THROUGH JUNE 2018, PITT PUBLIC HEALTH SURVEYED COMMUNITY LEADERS AND STAKEHOLDERS SPECIFIC TO EACH HOSPITAL'S LOCAL COMMUNITY, AS WELL AS A SYSTEM-WIDE PANEL OF REGIONAL STAKEHOLDERS. A TOTAL OF 2,074 COMMUNITY PARTICIPANTS FROM 22 UPMC HOSPITAL COMMUNITIES WERE SURVEYED. PARTICIPANTS INCLUDED: LEADERS OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASE; REPRESENTATIVES FROM PUBLIC HEALTH DEPARTMENTS OR GOVERNMENTAL AGENCIES SERVING COMMUNITY HEALTH; MEDICAL STAFF LEADERS WHO HAVE A UNIQUE PERSPECTIVE AND VIEW OF THE COMMUNITY; AND OTHER STAKEHOLDERS IN COMMUNITY HEALTH, SUCH AS CONSUMER ADVOCATES, NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, LOCAL SCHOOL DISTRICTS, GOVERNMENT ORGANIZATIONS, AND HEALTH CARE PROVIDERS. MORE THAN 800 INDIVIDUALS COMPLETED THE SURVEY, AND GREATER THAN 70 PERCENT OF THOSE PARTICIPANTS SELF-IDENTIFIED AS BEING A REPRESENTATIVE OR MEMBER OF A MEDICALLY UNDERSERVED, MINORITY, OR LOW-INCOME POPULATION.UPMC USED THE COMMUNITY INPUT TO DEVELOP STRATEGIC PLANS FOR EACH OF ITS LICENSED HOSPITALS TO ADDRESS SIGNIFICANT COMMUNITY HEALTH NEEDS. IMPORTANTLY, THESE PLANS ADDRESS LOCAL COMMUNITY NEEDS NOT ONLY AT THE HOSPITAL LEVEL, BUT ALSO INCLUDE EFFORTS UNDERTAKEN IN PARTNERSHIP WITH OTHER UPMC HOSPITALS, EXTERNAL ORGANIZATIONS, AND THE LARGER UPMC SYSTEM. KEY THEMES THAT EMERGED AT UPMC HOSPITALS CAN BE GROUPED INTO FOUR BROAD CATEGORIES - CHRONIC DISEASE MANAGEMENT, BEHAVIORAL HEALTH, ACCESS TO CARE AND NAVIGATING RESOURCES, AND PREVENTION AND COMMUNITY-WIDE HEALTHY LIVING. THE 2019 CHNA REPORTS AND 2019-2022 STRATEGIC PLANS FOR EACH UPMC HOSPITAL CAN BE FOUND ON UPMC'S WEBSITE: HTTPS://WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.UPMC HOSPITALS CONTINUE TO BUILD AN EXTENSIVE SUITE OF PROGRAMS AND SERVICES TO ADDRESS THE FOUR SIGNIFICANT HEALTH NEEDS. UPMC HOSPITALS LEVERAGE COMMUNITY-BASED PARTNERSHIPS AND SYSTEM-WIDE RESOURCES TO SUPPORT RESIDENTS IN NEED. UPMC CHAUTAUQUA'S 2019-2022 STRATEGIC PLAN TO IMPROVE COMMUNITY HEALTH INCLUDES THE FOLLOWING:ADDRESSING CHRONIC DISEASE MANAGEMENT: UPMC CHAUTAUQUA IS WORKING TO INCREASE AWARENESS, PREVENTION, AND MANAGEMENT OF CHRONIC DISEASES IN THE COMMUNITY THROUGH INTERVENTIONS TARGETING HEART DISEASE, CANCER, AND DIABETES. THE HOSPITAL CONTINUES TO PROMOTE COMMUNITY EDUCATION AND OUTREACH AND TO OFFER PROGRAMS THAT SUPPORT AND EMPOWER PATIENTS TO MANAGE THEIR HEALTH CONDITIONS.ADDRESSING BEHAVIORAL HEALTH: UPMC CHAUTAUQUA CONTINUES TO ENHANCE EFFORTS TO ADDRESS BEHAVIORAL HEALTH NEEDS IN THE COMMUNITY THROUGH MULTIPLE CHANNELS AND COMMUNITY-BASED PARTNERSHIPS. THE HOSPITAL IS CREATING PROGRAMS TO ADDRESS OPIOID ADDICTION AND SUBSTANCE ABUSE AND CONTINUING TO ENSURE RESIDENTS HAVE ACCESS TO INPATIENT BEHAVIORAL HEALTH SERVICES.ADDRESSING ACCESS TO CARE AND NAVIGATING RESOURCES: UPMC CHAUTAUQUA IS COLLABORATING WITH LOCAL COMMUNITY ORGANIZATIONS, AS WELL AS PIONEERING INNOVATIVE CARE MODELS. THE HOSPITAL IS WORKING TO EXTEND ACCESS TO SPECIALTY CARE THROUGH PHYSICIAN RECRUITMENT AND IS EVALUATING TELEHEALTH CAPABILITIES.ADDRESSING PREVENTION AND COMMUNITY-WIDE HEALTHY LIVING: UPMC CHAUTAUQUA IS PARTNERING WITH LOCAL ORGANIZATIONS TO ENHANCE AND DEVELOP PROGRAMS THAT PROMOTE A HEALTHY AND SAFE ENVIRONMENT FOR THE COMMUNITY. EXAMPLES OF TARGETED INITIATIVES INCLUDE PROMOTING PHYSICAL EXERCISE, PRENATAL EDUCATION, AND BREASTFEEDING EDUCATION.THE BOARD OF DIRECTORS AT EACH UPMC HOSPITAL REGULARLY MONITORS THE PROGRESS OF THE COMMUNITY HEALTH IMPROVEMENT PLANS. UPMC CHAUTAUQUA IS MAKING MEASURABLE PROGRESS IN AREAS IDENTIFIED THROUGH THE CHNA PROCESS, INCLUDING IMPROVING AND EXPANDING EXISTING PROGRAMS - REACHING OUT AND TARGETING PEOPLE WHO COULD BENEFIT MOST. UPMC CHAUTAUQUA ALSO DEVELOPED NEW PROGRAMS AND SERVICES, WHICH REQUIRED THE CREATION OF OPERATING INFRASTRUCTURE AND ESTABLISHMENT OF GOALS AND ASSESSMENT TOOLS. THE HOSPTAL ALSO DEVELOPED AND ENHANCED PARTNERSHIPS WITH OTHER COMMUNITY ORGANIZATIONS TO BETTER COORDINATE RESOURCES. EXAMPLES OF PROGRESS OVER THE PAST THREE YEARS INCLUDES: ADDRESSING CHRONIC DISEASE MANAGEMENT:UPMC CHAUTAUQUA IS WORKING TO ADDRESS HEART DISEASE, DIABETES, AND CANCER. TO PROMOTE HEART HEALTH AND TO HELP REDUCE THE MORTALITY RATES OF CARDIOVASCULAR DISEASE IN THE COUNTY, UPMC CHAUTAUQUA OFFERS COMMUNITY OUTREACH EDUCATION, INCLUDING HEART ATTACK, STROKE, AND HANDS ONLY CPR PRESENTATIONS. IN ADDITION, THE HOSPITAL'S CARDIAC NURSE NAVIGATOR SUPPORTS CARDIOVASCULAR AND CONGESTIVE HEART FAILURE (CHF) PATIENTS BY EDUCATING THEM ABOUT RISK FACTORS OF READMISSION TO THE HOSPITAL. TO HELP PREVENT AND MANAGE DIABETES, UPMC CHAUTAUQUA CONTINUES TO ENCOURAGE HEALTHY EATING - OFFERING A GRAB AND GO HEALTHY FOOD INITIATIVE, PROMOTING HEALTHY SNACKS, AND MAKING LOCAL, SEASONAL FRESH FRUITS AND VEGETABLES AVAILABLE IN THE CAFETERIA. UPMC CHAUTAUQUA ALSO REMAINS COMMITTED TO CANCER AWARENESS, SUPPORT, AND TREATMENT. TO PROMOTE AWARENESS, THE HOSPITAL HOSTED BREAST CANCER PRESENTATIONS IN OCTOBER 2019 - 375 COMMUNITY MEMBERS PARTICIPATED. TO SUPPORT THOSE NEWLY DIAGNOSED WITH BREAST CANCER, THE HOSPITAL PROVIDES A NURSE NAVIGATOR, WHO HELPS PATIENTS SCHEDULE APPOINTMENTS AND CONNECTS PATIENTS WITH RESOURCES AND SUPPORT GROUPS. TO INCREASE LOCAL ACCESS TO TREATMENT, UPMC CHAUTAUQUA EXPANDED ITS CHEMOTHERAPY INFUSION SERVICES WITH A NEW INFUSION CENTER, WHICH INCREASES PATIENTS' ABILITY TO STAY CLOSE TO HOME FOR CARE. EXPANDING SERVICES TO MEET BEHAVIORAL HEALTH NEEDS:IN 2019, UPMC CHAUTAUQUA ENHANCED ITS ABILITY TO MEET THE COMMUNITY'S BEHAVIORAL HEALTH NEEDS. UPMC CHAUTAUQUA COMPLETED CONSTRUCTION ON NEW ADOLESCENT AND ADULT MENTAL HEALTH INPATIENT UNITS, WHICH PROVIDE RECOVERY-ORIENTED ENVIRONMENTS AND IMMEDIATE ACCESS TO HOSPITAL SERVICES. IN ADDITION, THE HOSPITAL OPENED A RESIDENTIAL SUBSTANCE USE SERVICE, WHICH OFFERS THREE LEVELS OF CARE: STABILIZATION, REHABILITATION, AND COMMUNITY REINTEGRATION.INCREASING ACCESS TO CARE THROUGH PHYSICIAN RECRUITMENT:UPMC CHAUTAUQUA CONTINUES EFFORTS TO RECRUIT NEW PHYSICIANS - HELPING TO INCREASE ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS. IN 2019, THE HOSPITAL RECRUITED AN EAR, NOSE, AND THROAT (ENT) SPECIALIST, ONE ORTHOPEDIC SURGEON, AND ONE PRIMARY CARE PROVIDER.CARING FOR NEW MOMS AND INFANTS:UPMC CHAUTAUQUA CONTINUES TO OFFER EXCELLENT MATERNITY CARE TO THE COMMUNITY. IN 2019, THE HOSPITAL EXPANDED ITS WOMENS AND MATERNITY CARE CENTER - ADDING LABOR AND DELIVERY SUITES, TRIAGE ROOMS, AND POSTPARTUM PRIVATE ROOMS. THE HOSPITAL ALSO CONTINUES TO OFFER GREAT BEGINNINGS NY, AN INITIATIVE FOCUSED ON INCREASING THE PROPORTION OF BABIES WHO ARE BREASTFED BY INCREASING EXCLUSIVITY AND IMPROVING RACIAL, ETHNIC, AND ECONOMIC DISPARITIES IN BREASTFEEDING RATES.FOR MORE DETAILED INFORMATION ON UPMC'S COMMUNITY BENEFITS EFFORT, SEE THE ORGANIZATION'S COMMUNITY BENEFITS REPORT, AVAILABLE AT:HTTPS://WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/BENEFITS-REPORT PART VI, LINE 7, REPORTS FILED WITH STATES NY X X 0 1 0 0 0 0 0 1 0 DAVID GIBBONS VICE CHAIR 0 386075 0 355000 0 45315 0 75210 0 8772 0 870372 0 41882 BRADLEY DINGER TREASURER/CFO 0 173958 0 34000 0 1569 0 16860 0 16080 0 242467 0 0 CAMELLIA HERISKO CNO, VP OPS & PATIENT CARE 167543 0 105000 0 1604 0 17413 0 21561 0 313121 0 0 0 EDWARD KARLOVICH BOARD MEMBER 0 440960 0 688000 0 84305 0 102612 0 24356 0 1340233 0 77600 JAMES DONNELLY CNO 0 187506 0 99150 0 2653 0 17585 0 19931 0 326825 0 0 BRIAN DURNIOK PRESIDENT/CEO 0 264731 0 164000 0 15855 0 22400 0 7266 0 474252 0 13364 CECIL M MILLER III SECRETARY/VP OF OPERATIONS 144503 0 53120 0 668 0 13973 0 5976 0 218240 0 0 0 LISA MCCHESNEY CIO 0 174852 0 100000 0 1625 0 18560 0 22129 0 317166 0 0 GALO GRIJALVA MD PHYSICIAN 369349 0 0 0 889 0 19600 0 22405 0 412243 0 0 0 JONATHAN BLASIUS MD MEDICAL DIRECTOR-HOSPITALI 297375 0 17643 0 1117 0 22400 0 35125 0 373660 0 0 0 SALVATORE J BUONAIUTO MD HOSPITALIST 477536 0 0 0 503 0 19600 0 18878 0 516517 0 0 0 PUJAN SHRESTHA MD PHYSICIAN 296156 0 5000 0 438 0 16800 0 14364 0 332758 0 0 0 SRINIVAS BOMMIREDDIPALLI MD HOSPITALIST 303620 0 4375 0 342 0 12621 0 11281 0 332239 0 0 0 PART I, LINE 4B ALL PERSONS PARTICIPATING IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE DISCLOSED IN SCHEDULE J WITH CORRESPONDING AMOUNTS DISCLOSED WITHIN THE TOTAL AMOUNT 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 CHAUTAUQUA AT WCA SUPPLEMENTS ITS RETIREMENT BENEFITS THROUGH A SUPPLEMENTAL RETIREMENT PROGRAM. THE SUPPLEMENTAL RETIREMENT PROGRAM IS SUBJECT TO MULTI YEAR VESTING WHICH PLACES THE OFFICERS AND KEY EMPLOYEES' RETIREMENT BENEFIT AT RISK OF FORFEITURE OF THE VESTING REQUIREMENTS ARE NOT SATISFIED. ONCE VESTED HOWEVER, PROVISIONS OF THE CODE REQUIRE THAT THE VESTED AMOUNTS BE REPORTED ON THE FORM 990 AND THE VESTED OFFICER OR KEY EMPLOYEE INCLUDE IN CURRENT INCOME THE VALUE OF HER OR HIS SUPPLEMENTAL RETIREMENTS BENEFIT. NOTWITHSTANDING, THE TAX REQUIREMENT TO RECOGNIZE THE VESTED AMOUNT OF THE SUPPLEMENTAL RETIREMENT BENEFIT AS CURRENT INCOME FOR FICA TAXATION AND REPORTING PURPOSES, THIS BENEFIT, WHICH GENERALLY HAS BEEN EARNED OVER HER OF HIS ENTIRE CAREER, HAS NOT AND WILL NOT BE DISTRIBUTED UNTIL THE OFFICER OR KEY EMPLOYEE RETIRES OR SEPARATES FROM SERVICE FROM THE ORGANIZATION. THE SUPPLEMENTAL RETIREMENT PROGRAM PROVIDES FOR THE CURRENT LIABILITY RESULTING FROM THE VESTING CURING 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. PART I, LINE 7 UPMC PROVIDES INCENTIVE COMPENSATION AS PART OF ITS TOTAL COMPENSATION PROGRAM FOR OFFICERS AND KEY EMPLOYEES. THIS COMPONENT IS BASED UPON THE ACCOMPLISHMENT OF PREDETERMINED PERFORMANCE GOALS AND OBJECTIVES WHICH FOCUS ON THE ACHIEVEMENT OF MULTIPLE ANNUAL AND THREE YEAR INDIVIDUAL AND GROUP PERFORMANCE CRITERIA IN THE CONTEXT OF APPROPRIATE RISK TAKING. THESE CRITERIA DIRECTLY SUPPORT UPMC'S MISSION AND INCLUDE: PATIENT QUALITY AND SATISFACTION, COMMUNITY BENEFITS, OPERATIONAL AND FINANCIAL STRENGTH, LEADERSHIP DEVELOPMENT, AND STRATEGIC BUSINESS INITIATIVES AMONG OTHERS. FORM 990, PART VI, SECTION A, LINE 1 ALL BOARD MEMBERS HAVE A VOTE EXCEPT THE PRESIDENT ELECT OF THE MEDICAL STAFF WHO IS A BOARD MEMBER WITHOUT VOTING RIGHTS. FORM 990, PART VI, SECTION A, LINE 6 UPMC CHAUTAUQUA SERVICES INC. A NY STATE NON-PROFIT, FEDERALLY TAX EXEMPT ENTITY, IS AN ACTIVE PARENT HOLDING COMPANY WHICH IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A UPMC CHAUTAUQUA SERVICES, INC., THE PARENT ENTITY, ELECTS DIRECTORS OF THE GOVERNING BODY. UPMC HAMOT APPOINTS 6 OF THE 12 BOARD MEMBERS FROM AMONG REPRESENTATIVES OF UPMC AND UPMC HAMOT. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY RELATIVE TO A MAJOR TRANSFER OF ASSETS ARE SUBJECT TO APPROVAL BY THE PARENT ENTITY, UPMC CHAUTAUQUA SERVICES, INC. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. THE 990 IS REVIEWED BY MANAGEMENT AND IS MADE AVAILABLE TO THE FULL BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C UPMC CHAUTAUQUA AT WCA REQUIRES KEY EMPLOYED AND NON-EMPLOYED PERSONNEL TO COMPLY WITH ITS CONFLICT OF INTEREST POLICIES WHEN THEY ENGAGE IN UPMC CHAUTAUQUA AT WCA-RELATED BUSINESS. PERSONS COVERED BY THE POLICIES INCLUDE: - UPMC CHAUTAUQUA AT WCA BOARD MEMBERS, BOARD COMMITTEE MEMBERS, CORPORATE OFFICERS, AND KEY EMPLOYEES - UPMC CHAUTAUQUA AT WCA PHYSICIANS AND NON-PHYSICIAN EMPLOYEES WHO HOLD A POSITION OF INFLUENCE IDENTIFIED NON-EMPLOYED MEMBERS OF THE UPMC CHAUTAUQUA AT WCA MEDICAL STAFF WHO HOLD A POSITION OF INFLUENCE OR TRUST-INDIVIDUALS CONDUCTING CLINICAL RESEARCH AT THE UPMC CHAUTAUQUA AT WCA, WHETHER OR NOT THEY ARE EMPLOYED BY UPMC CHAUTAUQUA AT WCA. THESE PEOPLE 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 CHAUTAUQUA AT WCA 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 MEMBER, NON-EMPLOYED PERSONNEL, THE CONFLICT OF INTEREST IDENTIFICATION AND MANAGEMENT PROCESS IS ULTIMATELY OVERSEEN BY AN ETHICS AND COMPLIANCE COMMITTEE OF THE UPMC CHAUTAUQUA AT WCA BOARD OF DIRECTORS ON BEHALF OF UPMC CHAUTAUQUA AT WCA AND ALL OF ITS RELATED ENTITES. POTENTIAL CONFLICT OF INTEREST TRANSACTIONS INVOLVING UPMC CHAUTAUQUA AT WCA 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 CHAUTAUQUA AT WCA BOARD OF DIRECTORS. IN ADDITION TO THE GENERAL CORPORATE AND BOARD POLICIES DESCRIBED ABOVE, UPMC CHAUTAUQUA AT WCA HAS ALSO DEVELOPED AND IMPLEMENTED A SEPARATE TAX QUESTIONNAIRE DISTRIBUTED TO OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ANNUALLY THAT SPECIFICALLY ADDRESSES DISCLOSURE REQUIREMENTS OF FORM 990. FORM 990, PART VI, SECTION B, LINE 15 UPMC CHAUTAUQUA ENGAGES AN INDEPENDENT FIRM TO EVALUATE THE COMPENSATION OF THE CEO AND THE CFO. FORM 990, PART VI, SECTION C, LINE 19 UPMC (THE PARENT COMPANY OF UPMC CHATAUQUA AT WCA) PUBLIC WEBSITE (WWW.UPMC.COM) MAKES ITS FINANCIAL RESULTS, CONFLICT OF INTEREST PROCESS, AND VARIOUS INFORMATION ABOUT THE GOVERNANCE AND OVERSIGHT AVAILABLE TO THE PUBLIC. ADDITIONAL INFORMATION MAY BE SUPPLIED UPON SPECIFIC REQUEST FOR DATA NO POSTED TO THE WEB SITE. FORM 990, PART VI, SECTION B, LINE 16B: UPMC CHAUTAUQUA AT WCA HAS A FORMAL WRITTEN POLICY PERTAINING TO JOINT VENTURES BETWEEN UPMC CHAUTAUQUA AT WCA TAX-EXEMPT ENTITIES AND TAXABLE ENTITIES. THE POLICY EMPLOYS AN INTERNAL PROCEDURE FOR REVIEW OF ALL TRANSACTIONS INVOLVING POTENTIAL PARTICIPATION IN JOINT VENTURES AND SIMILAR ARRANGEMENTS TO ENSURE THAT SUCH ENTITIES OPERATE IN ACCORDANCE WITH APPLICABLE IRS POLICIES AND WITHIN UPMC CHAUTAUQUA AT WCA'S CHARITABLE PURPOSES. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF W.C.A. FOUNDATION 2,254,952. BOOK TO TAX ADJUSTMENT - PARTNERSHIP INTERESTS -495,361. EQUITY TRANSFER FROM EXEMPT RELATED PARTY 74,151,600. FORM 990, PART XII, LINE 2C: UPMC CHAUTAUQUA AT WCA'S FINANCIAL STATEMENTS ARE AUDITED ON BOTH A CONSOLIDATED AND SEPARATE BASIS. THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED AUDIT OF UPMC CHAUTAUQUA SERVICES INC. AND SUBSIDIARIES AS WELL AS THE CONSOLIDATED UPMC SYSTEM LEVEL AUDIT WHICH INCLUDES ALL UMPC TAXABLE AND TAX-EXEMPT SUBSIDIARIES OF UPMC. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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SALVADOR MUNDI INTERNATIONAL HOSPITAL ROMA VIALE DELLE MURA GIANICOLENSI IT HOSPITAL IT C 0 SOMERSET ANESTHESIA INC 600 GRANT STREET PITTSBURGH PA 15219 455135437 PHYSICIAN SRV PA C 0 SOMERSET MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH PA 15219 251512960 MOB OWNERSHIP PA C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 WCA FOUNDATION INC C 962225 WCA SERVICES CORPORATION P 417401 FORM 990 - SCHEDULE R - PART II THROUGH PART IV ENTITIES REPORTED IN PARTS I THROUGH IV THAT ARE MARKED WITH AN * ARE NOT TECHNICALLY "RELATED ORGANIZATIONS", AS DEFINED IN THE FORM 990 INSTRUCTIONS AS THE REQUISITE "CONTROL" DID NOT EXIST DURING THE FISCAL YEAR ENDED JUNE 30, 2019. HOWEVER, BECAUSE THESE ENTITIES ARE AFFILIATED WITH UPMC AND THE UPMC PARENT ORGANIZATION HOLDS CERTAIN POWERS WITH RESPECT TO SUCH ENTITIES WE ARE ELECTING TO DISCLOSE THE ENTITIES AS RELATED ORGANIZATIONS IN SCHEDULE R IN THE INTEREST OF TRANSPARENCY. RELATED ORGANIZATIONS AN UNRELATED PARTNERSHIPS - THERE ARE ORGANIZATIONS INCLUDED IN THE UPMC GROUP FORM 990 TAX RETURN WHICH ARE RELATED TO UPMC CHAUTAUQUA AT WCA (SEE PRIOR NOTE). THESE ORGANIZATIONS ARE NOT REQUIRED TO BE LISTED IN SCHEDULE R.