2020-07-14T13:15:16-05:00 2019-06-30 550486667 ARNETT CARBIS TOOTHMAN LLP 5700 CORPORATE DRIVE STE 650 PITTSBURGH PA 15237 990 2018-07-01 250965570 UPMC SOMERSET UPMC 8144435221 600 GRANT STREET 58TH FLR CORP TAX PITTSBURGH PA 15219 ANDREW RUSH CEO 8144435221 2020-07-13 1 JEFFREY J PETRELL CPA P00138808 4126356270 2020-07-13 216.12.119.47 2020-07-13 13:50:45 ED P DFB9D62A0982D1DBCA0C779E13B8D9A487E805DF 0FC7072F847C0EBCE9766DFB519F02B6179509EE 2018 2021-01-29 14:40:06Z X ANDREW RUSH 600 GRANT STREET 58TH FLR CORP TAX PITTSBURGH PA 15219 95102743 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 4 913 55 45000 31192 1628148 1507024 69222531 70984739 3242748 2766335 410267 500848 74503694 75758946 0 0 0 0 32970289 30822679 0 0 0 34996070 37020481 67966359 67843160 6537335 7915786 68415098 43680177 44017421 23211202 24397677 20468975 X OUR MISSION AS AN ORGANIZATION IS TO PRESERVE AND IMPROVE LIFE BY PROVIDING ACCESS TO QUALITY, CUSTOMER-FRIENDLY HEALTHCARE SERVICES. 0 0 56742020 71394069 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, 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.CHARITY CARE FY 2019FREE CARE $166,368PUBLIC 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. 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 SERVICES AND CONTRIBUTIONS TO THE COMMUNITY. THE SERVICES ARE PROVIDED FREE OF CHARGE OR AT A NOMINAL FEE AS INDICATED.COMMUNITY HEALTH EDUCATION (FREE OR MINIMAL FEES CHARGED TO COVER DIRECT COSTS)CPR 87 PARTICIPANTS 60 HOURSHIP AND KNEE PAIN SEMINARS 21 PARTICIPANTS 2 HOURSPAIN MANAGEMENT PROGRAM 20 PARTICIPANTS 2 HOURSGASTROENTEROLOGY PROGRAM 12 PARTICIPANTS 1 HOURGENERAL SURGERY PROGRAM 14 PARTICIPANTS 2 HOURSDIABETES PROGRAM 30/YEAR 10 HOURSTOTAL 174/YEAR 77 HOURSSUPPORT GROUPS (NO CHARGE)HOSPICE BEREAVEMENT 66/YEAR 12 HOURSSLEEP APNEA 80/YEAR 8 HOURSPARKINSON'S (WE PROVIDE SPACE) 40/YEAR 12 HOURSDIABETES SUPPORT GROUP 25/YEAR 4 HOURSTOTAL 201 PEOPLE/YEAR 36 HOURSCOMMUNITY EDUCATION INFORMATION REQUESTS (NO CHARGE)PHONE 120/YEAR 10 HOURSSCHOOL PROGRAMS (NO CHARGE)SECOND GRADE TOURS 225 STUDENTS/YEAR 10 HOURSPOISON PREVENTION PROGRAMS 500/YEAR 8 HOURSSHADOW STUDENTS 30/YEAR 240 HOURS JUNIOR ACHIEVEMENT PROGRAMS 3/YEAR 52 HOURSROCKWOOD STUDENT PRESENTATIONS 16/YEAR 4 HOURSBERLIN BROTHERSVALLEY STUDENT PRESENTATIONS 4/YEAR 4 HOURSCAREER EXPLORATION 14/YEAR 3 HOURSTOTAL 792/YEAR 321 HOURSHEALTH FAIRS OR COMMUNITY EDUCATION PROGRAMS (NO CHARGE TO THE COMMUNITY)HEALTH FAIRS/SCREENINGS 1,200/YEAR 20 HOURSSCHOOL HANDWASHING PROGRAMS 40/YEAR 2 HOURSSENIOR CENTER PROGRAMS 185/YEAR 12 HOURSABI SCREENING 4/YEAR 1 HOURCOLORECTAL SCREENING 25/YEAR 8 HOURSBONE DENSITY SCREENING 22/YEAR 2 HOURSTOTAL 1,476/YEAR 45 HOURSHOSPITAL STAFF CONTRIBUTIONS TO COMMUNITY ORGANIZATIONSSOMERSET ROTARY 8 HOURS/YEARSOMERSET COUNTY CHAMBER OF COMMERCE 24 HOURS/YEARSOMERSET EXCHANGE CLUB 41 HOURS/YEARDRUG-FREE COMMUNITIES 24 HOURS/YEARJUNIOR ACHIEVEMENT BOARD OF DIRECTORS 12 HOURS/YEARAMERICAN HEART ASSOCIATION ELT HEART BALL 8 HOURS/YEAROTHER CONTRIBUTIONS"IN TOUCH" HOSPICETHROUGH THE HOSPITAL'S IN TOUCH HOSPICE CARE DEPARTMENT, TERMINALLY ILL PATIENTS AND THEIR FAMILIES ARE PROVIDED CLINICAL AND EMOTIONAL SUPPORT. THIS SERVICE IS SUPPORTED THROUGH COMMUNITY CONTRIBUTIONS: ANNUAL OPERATING BUDGET: $1,315,634 IN FISCAL YEAR 2019.SOCIAL WORK SERVICESUPMC SOMERSET' SOCIAL WORK SERVICES DEPARTMENT, WITH AN OPERATING BUDGET IN EXCESS OF $147,414 IN FY 2019, IS RESPONSIBLE FOR MEETING BOTH INPATIENT AND OUTPATIENT SOCIAL NEEDS INCLUDING THE PLACEMENT OF PATIENTS IN AN APPROPRIATE COMMUNITY SETTING UPON DISCHARGE. THE STAFF PROVIDES EXPERTISE TO MANY COMMUNITY ORGANIZATIONS. 56742020 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 97 0 913 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 9 4 0 0 1 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X CRAIG SPROCK 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 CATHERINE POORBAUGH SECRETARY (UNTIL 2/1/19) 2.00 2.00 X X 0 0 0 BRAD COBER TREASURER (UNTIL 2/1/19) 2.00 2.00 X X 0 0 0 JAYESH DESAI MD DIRECTOR 1.00 40.00 X 0 425296 18790 MARK YAROS MD DIRECTOR 1.00 40.00 X 0 261309 17798 DAVID MARTIN DIRECTOR 1.00 1.00 X 0 944540 -137282 DAVID RUSSELL DIRECTOR 1.00 1.00 X 0 396940 49603 DAVID BURWELL MD DIRECTOR 1.00 1.00 X 0 302075 38545 NATHANIEL BARBERA DIRECTOR (UNTIL 2/1/19) 1.00 X 0 0 0 AJAY P SINGH MD DIRECTOR (UNTIL 2/1/19) 1.00 40.00 X 0 209245 16020 MICHELLE MOON DIRECTOR (UNTIL 2/1/19) 1.00 X 0 0 0 SHARON CLAPPER DIRECTOR (UNTIL 2/1/19) 1.00 X 0 0 0 FREDERICK ROSEMEYER DIRECTOR (UNTIL 2/1/19) 1.00 X 0 0 0 LINDA FETTEROLF DIRECTOR (UNTIL 2/1/19) 1.00 X 0 0 0 VINCE JACOB DIRECTOR (UNTIL 2/1/19) 1.00 X 0 0 0 RON ALDOM DIRECTOR (UNTIL 2/1/19) 1.00 X 0 0 0 SUSAN STURNI DIRECTOR (UNTIL 2/1/19) 1.00 X 0 0 0 BRUCE SHIPLEY DIRECTOR (UNTIL 2/1/19) 1.00 X 0 0 0 MATTHEW KOCIOLA CFO (UNTIL 7/9/2018) 29.00 11.00 X 151126 0 3496 ANDREW RUSH CEO 29.00 11.00 X 305647 0 21321 MONICA J KLATT CFO 20.00 20.00 X 0 72128 19531 RENEE YOUNG MD PHYSICIAN 40.00 X 363299 0 5471 MOKBEL MATTA MD PHYSICIAN 40.00 X 401417 0 5943 HAI C TSAO MD PHYSICIAN 40.00 X 306791 0 15871 NEELESH WELLING MD PHYSICIAN 40.00 X 256487 0 16824 MARCO CANTINI MD MEDICAL DIRECTOR OF ANESTHESIA 40.00 X 462762 0 15871 2247529 2611533 107802 28 0 1 0 AHN EMERGENCY GRP OF SOMERSET COUNTY LT 4535 DRESSLER ROAD CANTON OH 44718 PHYSICIAN SERVICES 2012662 K & L GATES LLP PO BOX 844255 BOSTON MA 022844255 LAW FIRM 414148 PONDER & CO 8498 SOLUTION CENTER CHICAGO IL 606678004 CONSULTANT 366087 CHANGE HEALTHCARE 5995 WINDWARD PARKWAY ALPHARETTA GA 30005 SOFTWARE 179212 4 20000 1487024 1507024 NET PATIENT REVENUE 900099 69508016 69508016 PHARMACY SALES 900099 1180122 1180122 MISC PATIENT REVENUE 900099 296473 296473 MEDICAL RECORDS 900099 128 128 70984739 607212 607212 417857 392937 24920 24920 24920 21008449 73872 18923198 0 2085251 73872 2159123 2159123 49260 20000 27662 21598 21598 GAIN ON INVESTMENTS IN EQUITY INV 900099 217553 217553 OTHER OPERATING REVENUE 900099 191777 191777 MANAGEMENT FEE 900099 45000 45000 454330 75758946 71394069 45000 2812853 X 481590 481590 25376585 20310563 5066022 3071565 2434421 637144 1892939 1488256 404683 534544 534544 98684 98684 7557699 5941973 1615726 142972 112407 30565 549047 431669 117378 927042 728854 198188 99698 78384 21314 11517 9055 2462 391993 308191 83802 3795359 2983967 811392 1045296 821827 223469 MEDICAL SUPPLIES 12998475 12998475 PHYSICIAN FEES 2666550 2666550 BAD DEBT 2580377 2580377 EQUIPMENT RENTAL & MAIN 1733247 1362704 370543 1887981 1484347 403634 67843160 56742020 11101140 0 1953846 3626270 750000 7380453 7420877 252210 261915 1568944 1626748 1094643 933081 111283576 82676192 31058438 28607384 22945654 379611 1410910 824291 68415098 43680177 9110006 4373426 20625782 396470 508865 13885163 18328911 44017421 23211202 X 23768229 19974199 609448 474776 20000 20000 24397677 20468975 68415098 43680177 X 7915786 -3093325 -8751163 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 32217 0 1 28434 60651 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. 2655588 2655588 34101363 31386550 2714813 55725995 51289642 4436353 18800630 18800630 28607384 SELF INSURANCE 3323028 ADVANCES FROM EXEMPT AFFILIATES 15005883 18328911 GOLF OUTING 69260 20000 49260 13328 12003 2331 69260 20000 49260 13328 12003 2331 27662 21598 1 1 X 1 X 1 X 1 1 1 0 1 1 1010143 1010143 0.01550 10873530 9131697 1741833 0.02670 11883673 9131697 2751976 0.04220 231135 231135 0.00350 1258681 590354 668327 0.01020 59655 59655 0.00090 1549471 590354 959117 0.01460 13433144 9722051 3711093 0.05680 0 2580377 166368 15002382 15788495 -786113 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 200.000000000000 200.000000000000 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 2019 WERE OUTPATIENT BEHAVIORAL HEALTH, COUMADIN CLINIC, AND INPATIENT HOSPICE. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE OF 2,580,377 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. 1 1 0 0 0 0 0 0 0 JAYESH DESAI MD DIRECTOR 0 406796 0 18500 0 0 0 0 0 18790 0 444086 0 0 MARK YAROS MD DIRECTOR 0 248309 0 13000 0 0 0 0 0 17798 0 279107 0 0 DAVID MARTIN DIRECTOR 0 479916 0 384000 0 80624 0 -163814 0 26532 0 807258 0 70700 DAVID RUSSELL DIRECTOR 0 287680 0 105310 0 3950 0 44042 0 5561 0 446543 0 3068 DAVID BURWELL MD DIRECTOR 0 282910 0 0 0 19165 0 21177 0 17368 0 340620 0 2219 AJAY P SINGH MD DIRECTOR (UNTIL 2/1/19) 0 209245 0 0 0 0 0 0 0 16020 0 225265 0 0 MATTHEW KOCIOLA CFO (UNTIL 7/9/2018) 151126 0 0 0 0 0 3025 0 471 0 154622 0 0 0 ANDREW RUSH CEO 287147 0 18500 0 0 0 5612 0 15709 0 326968 0 0 0 RENEE YOUNG MD PHYSICIAN 363299 0 0 0 0 0 0 0 5471 0 368770 0 0 0 MOKBEL MATTA MD PHYSICIAN 382917 0 18500 0 0 0 0 0 5943 0 407360 0 0 0 HAI C TSAO MD PHYSICIAN 306791 0 0 0 0 0 0 0 15871 0 322662 0 0 0 NEELESH WELLING MD PHYSICIAN 256487 0 0 0 0 0 0 0 16824 0 273311 0 0 0 MARCO CANTINI MD MEDICAL DIRECTOR OF ANESTHESIA 462762 0 0 0 0 0 0 0 15871 0 478633 0 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, LINES 4A-B 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. CRAIG SAYLOR WAS PAID $135,002 IN SEVERANCE PAY DURING THE YEAR. ANN COBER BRAD COBER, DIRECTOR - FAMILY MEMBER 12399 EMPLOYEE OF UPMC SOMERSET 0 MIKE PETROSKY MICHELLE MOON, DIRECTOR - FAMILY MEMBER 90539 EMPLOYEE OF UPMC SOMERSET 0 FORM 990, PART VI, SECTION A, LINE 4 ON FEBRUARY 1, 2019, UPMC SOMERSET AFFILIATED WITH THE UPMC HEALTH SYSTEM. THE BYLAWS WERE UPDATED TO MAKE UPMC THE SOLE MEMBER. 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 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 18 UPMC SOMERSET MAKES ITS FORM 990 AND CONSOLIDATED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION C, LINE 19 AT THIS TIME, UPMC SOMERSET DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICY AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 5,941,973. MANAGEMENT AND GENERAL EXPENSES 1,615,726. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,557,699. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -118,347. CHANGE IN DEFINED BENEFIT PENSION COSTS -1,021,089. TRANSFERS TO EXEMPT AFFILIATES -7,655,469. CHANGE IN INTEREST OF TEMP RESTRICTED NET ASSETS OF FOUNDATION -134,672. CUMULATIVE EFFECT OF CHANGE IN ACCOUNTING -178,386. NET ASSETS RELEASED FROM RESTRICTION 356,800. FORM 990, PART XII, LINE 2: THE ORGANIZATION'S FINANCIAL STATEMENTS ARE PART OF A CONSOLIDATED FINANCIAL STATEMENT AUDIT PERFORMED BY EY FOR UPMC AND ALL SUBSIDIARIES. THE ENTIRE SYSTEM'S FINANCIAL STATEMENTS, OF WHICH THIS ORGANIZATIONS IS PART OF, 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, 2018. 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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 THE ULTIMATE PARENT. SCHEDULE R - RELATED ORGANIZATIONS AND UNRELATED PARTNERSHIPS THERE ARE ORGANIZATIONS INCLUDED IN THE UPMC GROUP FORM 990 TAX RETURN FOR FISCAL YEAR 2019 WHICH ARE RELATED TO UPMC SOMERSET (SEE PRIOR NOTE). THESE ORGANIZATIONS ARE REQUIRED TO BE LISTED IN SCHEDULE R.