2019-11-13T15:33:41-06:00 2018-12-31 454051133 FREED MAXICK CPAS PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2018-01-01 160743226 UPMC CHAUTAUQUA AT WCA UPMC 7164870141 207 FOOTE AVENUE / PO BOX 840 JAMESTOWN NY 147020840 BRIAN DURNIOK PRESIDENT 7164870141 2019-11-12 1 THOMAS DALTON P00645802 7168472651 2019-11-12 104.193.28.34 2019-11-12 13:01:44 ES P E210C69A99B6B409F535E460B7A96F986BBED713 115878043888188F8F7D76596040743C125938FF 2018 2020-04-17 16:48:07Z UPMC CHAUTAUQUA WCA BRIAN DURNIOK 207 FOOTE AVENUE / PO BOX 840 JAMESTOWN NY 147020840 116471977 0 X WWW.UPMCCHAUTAUQUAWCA.ORG X 1885 NY SEE SCHEDULE O 12 7 1157 92 -1760 0 2179603 461015 89105226 89963503 31734 5802622 11292655 8105988 102609218 104333128 0 0 0 0 53541791 57226558 0 0 0 48265780 47432031 101807571 104658589 801647 -325461 91125892 90491490 47714288 66912244 43411604 23579246 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 82302084 97994434 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. 82302084 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 94 0 1 1157 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 608262 67043 BRADLEY DINGER TREASURER 40.00 X X 0 184121 24538 CRISTIE HERBST BOARD MEMBER 2.00 X 0 0 0 CAMELLIA HERISKO CNO, VP OPS & PATIENT CARE SVCS 2.00 X 221581 0 36248 EDWARD KARLOVICH BOARD MEMBER 2.00 X 0 868512 103429 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, VP PATIENT CARE SVCS 40.00 X X 0 233689 34984 BETSY T WRIGHT PRESIDENT/CEO 40.00 X 501068 0 41290 CECIL M MILLER III SECRETARY/VP OF OPERATIONS 40.00 X 167702 0 18992 CHARLES NAZZARO CFO 40.00 X 215098 0 34648 LISA MCCHESNEY CIO 40.00 X 0 222933 37017 GALO GRIJALVA MD PHYSICIAN 40.00 X 367043 0 39095 JONATHAN BLASIUS MD MEDICAL DIRECTOR-HOSPITALI 40.00 X 335954 0 46838 SALVATORE J BUONAIUTO MD HOSPITALIST 40.00 X 303904 0 32631 PUJAN SHRESTHA MD PHYSICIAN 40.00 X 296708 0 9453 ASHOK B MOVVA MD HOSPITALIST 40.00 X 286902 0 26547 2695960 2117517 552753 25 0 1 0 LECHASE CONSTRUCTION 205 INDIGO CREEK DRIVE ROCHESTER NY 14626 CONSTRUCTION SERVICES 3091687 PREMIER ANESTHESIA OF NY PC 2655 NORTHWINDS PKWY ALPHARETTA GA 30009 ANESTHESIA PHYSICIAN SERVICES 952873 MEDICAL SOLUTIONS 1010 N 102ND ST STE 300 OMAHA NE 68114 NURSE STAFF SERVICES 726869 JAMESTOWN PSYCHIATRIC PC 305 E FAIRMOUNT AVENUE LAKEWOOD NY 14750 PSYCHIATRIC PHYSICIAN SERVICES 461498 JAMESTOWN RADIOLOGISTS 333 E FIFTH ST JAMESTOWN NY 14701 RADIOLOGY SERVICES 351621 15 18640 170000 272375 461015 HOSPITAL REVENUE 621500 89280655 89280655 TRI-STATE REGIONAL ASSOCIATES 621500 349014 349014 CHAUTAUQUA INTEGRATED DELIVERY SY 621500 287398 287398 31 SHERMAN INVESTORS 621500 48196 48196 CHAUTAUQUA REGION ASSOC. MEDICAL 621500 -1760 -1760 89963503 189682 189682 379790 302973 76817 76817 76817 5612940 0 5612940 5612940 5612940 16080981 11835876 4245105 4245105 OTHER MISCELLANEOUS REVENUE 900099 3565856 3565856 MEALS ON WHEELS 621990 100918 100918 EDUCATION REVENUE 621990 96245 96245 21047 21047 3784066 104333128 97994434 -1760 5879439 1236627 1236627 42675073 37909777 4765296 1573704 1403837 169867 8680368 7743404 936964 3060786 2730403 330383 341015 341015 202284 202284 207899 207899 84347 84347 453221 441034 12187 2997334 1306754 1690580 210391 91725 118666 809 809 5003129 2882212 2120917 1424077 1424077 PURCHASED SERVICES 11646241 5386327 6259914 PHYSICAN FEES 9161273 8926502 234771 HOSPITAL AND MEDICAL SU 7780229 7252736 527493 OTHER 5052739 2031968 3020771 2867043 1325993 1541050 104658589 82302084 22356505 0 13709937 1355672 13823525 15835215 3423629 564358 2298160 777754 139112796 86469092 35467068 52643704 3006844 3455621 19396729 15859166 91125892 90491490 9007889 3894173 154270 12324048 0 82139 38552129 50611884 47714288 66912244 X 26581817 7918899 13621900 0 3207887 15660347 43411604 23579246 91125892 90491490 X -325461 -455899 -19050998 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 14973749 102059 -721818 704599 13649391 13142333 96982 2378581 644147 14973749 12729182 72452 950163 609464 13142333 13542757 33559 -336604 510530 12729182 12870802 41169 817403 186617 13542757 0.71800 0.28200 0 0 1429411 1429411 53496140 36981282 16514858 2844673 2437610 407063 61813930 47050200 14763730 19528642 19528642 52643704 BENEFICIAL INTEREST IN NET ASSETS OF WCA FOUNDATION 12921826 OTHER LONG TERM RECEIVABLE 1488000 ESTIMATED AMOUNTS DUE FROM THIRD PARTY PAYORS 49340 INVESTMENT IN WCA SERVICES CORPORATION 1400000 15859166 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 339088 OTHER LONG TERM LIABILITY 1488000 DUE TO EXEMPT PARENT 48784796 50611884 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 1 X 1 1 0 1 1 198880 650 198230 0.00190 30067897 17911366 12156531 0.11620 30266777 17912016 12354761 0.11810 126346 0 126346 0.00120 250122 89456 160666 0.00150 376468 89456 287012 0.00270 30643245 18001472 12641773 0.12080 1 2954187 220085 30274223 28663578 1610645 X 1 0 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 16 1 1 1 1 X WWW.UPMCCHAUTAUQUAWCA.ORG X WWW.UPMC.COM 1 16 1 WWW.UPMCCHAUTAUQUAWCA.ORG / WWW.UPMC.COM 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X 1 X WWW.UPMCCHAUTAUQUAWCA.ORG X WWW.UPMCCHAUTAUQUAWCA.ORG X WWW.UPMCCHAUTAUQUAWCA.ORG X X X X X X 1 X 0 X 1 X 0 0 UPMC CHAUTAUQUA AT WCA PART V, SECTION B, LINE 5: MAKING A COMPREHENSIVE ASSESSMENT OF COMMUNITY HEALTH NEEDS IN AN AREA AS LARGE AND DIVERSE AS THE EIGHT-COUNTY WESTERN NEW YORK REGION REQUIRED THE INTEGRATION OF A WIDE ARRAY OF INFORMATION AND DATA TYPES, INCLUDING MULTIPLE SOURCES OF COMMUNITY ENGAGEMENT. QUANTITATIVE DATA SOURCES INCLUDED BASIC DEMOGRAPHICS, INDICATORS OF "COMMUNITY STRUCTURE OR SOCIAL DETERMINANTS OF HEALTH NEED, AND DETAILED HEALTH CARE DATA DESCRIBING SYSTEM-WIDE PERFORMANCE, QUALITY OF CARE AND POPULATION HEALTH STATUS. TOGETHER, USING COMPOSITE INDICES, THESE PROVIDE A POWERFUL SET OF MEASURES TO UNDERSTAND IN CONCRETE TERMS THE HEALTH OF THE REGION, HOW HEALTH CARE IS BEING DELIVERED, AND WHAT ARE THE GAPS IN THE HEALTH SYSTEM AND COMMUNITY RESOURCES.THREE COMMUNITY ENGAGEMENT APPROACHES WERE USED TO GATHER EXTENSIVE QUALITATIVE DATA THAT PROVIDED DIMENSION AND HUMAN CONTEXT TO THE NUMBERS, PROVIDING US WITH THE MEANS TO EXPLAIN SOME OF THE DYNAMICS AT PLAY IN OUR HEALTH CARE SYSTEM TODAY: 1. REGIONAL HEALTH NEEDS SURVEY-COMPLETED BY MORE THAN 7,000 PEOPLE 2. FOCUS GROUPS-16 "COMMUNITY CONVERSATIONS" ENGAGING PEOPLE SERVED BY THE SYSTEM TO BETTER UNDERSTAND THOSE PATIENT PERSPECTIVES. 3. KEY INFORMANT PROVIDER INTERVIEWS-A SERIES OF 42 INTERVIEWS WITH PROVIDERS FROM EVERY PART OF THE REGION AND EVERY PHASE OF THE HEALTH CARE SYSTEM. INCLUDING BUT NOT LIMITED TO PHYSICIANS, MEDICAID PROVIDERS AND COUNTY HEALTH COMMISSIONERS. UPMC CHAUTAUQUA AT WCA PART V, SECTION B, LINE 6A: THE WESTERN NEW YORK COMMUNITY NEEDS ASSESSMENT HAS BEEN JOINTLY CONDUCTED AND LED BY TWO "PERFORMING PROVIDER SYSTEMS"-COMMUNITY PARTNERS OF WNY (WHICH INCLUDES UPMC CHAUTAUQUA AT WCA, BROOKS MEMORIAL HOSPITAL, WESTFIELD HOSPITAL AND MOUNT ST MARY'S HOSPITAL) AND MILLENNIUM COLLABORATIVE CARE (COMPRISING ERIE COUNTY MEDICAL CENTER, KALEIDA HEALTH, NIAGARA FALLS MEMORIAL MEDICAL CENTER, THE MCGUIRE GROUP AND THE SAFETY NET ASSOCIATION OF PRIMARY CARE AFFILIATED PROVIDERS). THEY HAVE COLLABORATED ON THE PRODUCTION OF THIS CHNA TO INFORM THEIR SELECTION OF PROJECTS AND PROVIDE DATA, ANALYSIS AND INSIGHTS NEEDED TO FURTHER DEVELOP PROJECT PLANS. UPMC CHAUTAUQUA AT WCA PART V, SECTION B, LINE 6B: THE WESTERN NEW YORK COMMUNITY NEEDS ASSESSMENT HAS BEEN JOINTLY CONDUCTED AND LED BY TWO "PERFORMING PROVIDER SYSTEMS"-COMMUNITY PARTNERS OF WNY (WHICH INCLUDES UPMC CHAUTAUQUA AT WCA, BROOKS MEMORIAL HOSPITAL, WESTFIELD HOSPITAL AND MOUNT ST MARY'S HOSPITAL) AND MILLENNIUM COLLABORATIVE CARE (COMPRISING ERIE COUNTY MEDICAL CENTER, KALEIDA HEALTH, NIAGARA FALLS MEMORIAL MEDICAL CENTER, THE MCGUIRE GROUP AND THE SAFETY NET ASSOCIATION OF PRIMARY CARE AFFILIATED PROVIDERS). THEY HAVE COLLABORATED ON THE PRODUCTION OF THIS CHNA TO INFORM THEIR SELECTION OF PROJECTS AND PROVIDE DATA, ANALYSIS AND INSIGHTS NEEDED TO FURTHER DEVELOP PROJECT PLANS. UPMC CHAUTAUQUA AT WCA PART V, SECTION B, LINE 11: IN ADDITION TO THE EXTENSIVE QUALITATIVE DATA SOURCES LISTED ABOVE, THE FOLLOW QUANTITATIVE DATA SOURCES WERE USED TO CONDUCT THIS COMMUNITY NEEDS ASSESSMENT: DSRIP PERFORMANCE DATA DASHBOARD (ZIP AND COUNTY LEVEL) NEW YORK STATE PREVENTION AGENDA DATA DASHBOARD (COUNTY LEVEL) SPARCS DATA (COUNTY LEVEL) CDC MORTALITY DATA (COUNTY LEVEL) US CENSUS (COUNTY, ZIP AND TRACT LEVEL) STATEWIDE PERINATAL DATA SYSTEM (COUNTY AND ZIP LEVEL)THE TEN PROJECTS IDENTIFIED BY THE CHNA ARE AS FOLLOWS: CREATE INTEGRATED DELIVERY SYSTEMS THAT ARE FOCUSED ON EVIDENCE BASED MEDICINE/POPULATION HEALTH MANAGEMENT. ED TRIAGE FOR AT-RISK PATIENTS. HOSPITAL-HOME CARE COLLABORATION SOLUTIONS. EXPAND USAGE OF TELEMEDICINE IN UNDERSERVED AREAS TO PROVIDE ACCESS TO OTHERWISE SCARCE SERVICES. INTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES. CARDIOVASCULAR HEALTH: EVIDENCE BASED STRATEGIES FOR DISEASE MANAGEMENT IN HIGH RISK/AFFECTED POPULATIONS. INCREASE SUPPORT PROGRAMS FOR MATERNAL AND CHILD HEALTH. INTEGRATION OF PALLIATIVE CARE INTO THE PCMH MODEL. PROMOTE MENTAL, EMOTIONAL AND BEHAVIORAL WELL-BEING IN COMMUNITIES. PROMOTE TOBACCO USE CESSATION, ESPECIALLY AMONG LOW SES POPULATIONS AND THOSE WITH POOR MENTAL HEALTH. 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 300% OF THE FPL, ON A CASE BY CASE BASIS. PART I, LINE 3C: UPMC CHAUTAUQUA AT WCA USES A SLIDING FEE SCALE FOR PATIENTS WHO ARE ABOVE 200% OF THE FPL UP TO 300% ABOVE THE FPL. UPMC CHAUTAUQUA AT WCA USES A SLIDING FEE SCALE RANGING FROM 20%, 40%, 60%, 80% UP TO 100% TO DETERMINE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. UPMC CHAUTAUQUA AT WCA RESERVES THE RIGHT TO REVIEW/APPROVE CASES WITH EXCESSIVE MEDICAL EXPENSES WHOSE FAMILY INCOME EXCEEDS 300% OF THE FPL, ON A CASE BY CASE BASIS. PART I, LINE 7: PATIENT CHARGE AND REIMBURSEMENT INFORMATION WAS OBTAINED FROM THE NYS ICR EXHIBIT 46 WHICH INCORPORATES ALL PATIENT SEGMENTS AND FINANCIAL CLASSES.THE RATIO OF PATIENT CARE COST TO CHARGES RATIO WAS DEVELOPED USING WORKSHEET 2. TOTAL AUDITED OPERATING EXPENSES EXCLUDED BAD DEBT AND WERE OFFSET BY NON-PATIENT CARE ACTIVITY REVENUE AND COMMUNITY BENEFIT EXPENSE. GROSS PATIENT CHARGES WERE OBTAINED FROM NYS ICR EXHIBIT 46. PART I, LINE 7G: THERE WERE NO SUBSIDIZED HEALTH SERVICES REPORTED FOR 2018 REPORTED ON LINE 7G. PART I, LINE 6A THE COMMUNITY SERVICE BENEFIT REPORT IS PREPARED INTERNALLY BY UPMC CHAUTAUQUA AT WCA. THIS REPORT IS FILED WITH NEW YORK STATE ON A PERIODIC BASIS. IT IS ALSO AVAILABLE ON THE UPMC CHAUTAUQUA AT WCA WEBSITE. 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 8: MEDICARE REVENUE (INCLUDING DSH) WAS OBTAINED FROM THE ORGANIZATION'S MEDICARE PS&R. MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE ORGANIZATION'S MEDICARE COST REPORT. THERE WAS A SURPLUS REPORTED: $30,274,223 - $28,663,578 = $1,610,645 SURPLUS. PART III, LINE 9B: UPMC CHAUTAUQUA AT WCA 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, LINE 2 THE BAD DEBT EXPENSE (AT COST) WAS CALCULATED BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO THE GROSS BAD DEBT. PART III, LINE 3 THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS CALCULATED BY DEVELOPING AN AVERAGE COST PER CLAIM AND THEN MULTIPLYING THAT AVERAGE COST BY THE NUMBER OF INCOMPLETE OR DENIED CLAIMS. PART VI, LINE 3: COMMUNICATION OF THE FINANCIAL ASSISTANCE TO PATIENTS AND WITHIN THE COMMUNITY - THE AVAILABILITY OF CHARITY CARE IS MADE KNOWN TO ALL PATIENTS VIA APPLICATIONS AVAILABLE IN ADMISSIONS, THE CASE MANAGEMENT DEPARTMENT, EMERGENCY DEPARTMENT, CUSTOMER SERVICE, WELLNESS/OUTREACH CENTERS, OUTPATIENT REGISTRATION WHERE PATIENTS ACCESS OR INQUIRE ABOUT HOSPITAL SERVICES, PATIENT STATEMENTS, FINANCIAL COUNSELORS, HOSPITAL/PATIENT ACCESS PERSONNEL AND OTHER LOCATIONS DEEMED APPROPRIATE. IN ADDITION, INFORMATION IS ALSO MADE AVAILABLE ON THE UPMC CHAUTAUQUA AT WCA WEBSITE AND AT OTHER PUBLIC PLACES AS UPMC CHAUTAUQUA AT WCA MAY ELECT. UPMC CHAUTAUQUA AT WCA ALSO PUBLISHED AND WIDELY PUBLICIZED A SUMMARY OF THIS CHARITY CARE POLICY ON FACILITY WEBSITES, IN BROCHURES AVAILABLE IN-PATIENT ACCESS SITES AND AT OTHER PLACES WITHIN THE COMMUNITY SERVED BY THE HOSPITAL. 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. SUCH NOTICES AND SUMMARY INFORMATION WILL BE PROVIDED IN THE PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY UPMC CHAUTAUQUA AT WCA. REFERRAL OF PATIENTS FOR CHARITY MAY BE MADE BY ANY MEMBER OF THE UPMC CHAUTAUQUA AT WCA STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS AND CASE MANAGERS. PART VI, LINE 5: UPMC CHAUTAUQUA AT WCA IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL LOCATED IN JAMESTOWN, NY. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES, AND MENTAL HEALTH AND CHEMICAL DEPENDENCY REHABILITATION FOR RESIDENTS OF THE LOCAL GEOGRAPHIC REGION. THE MISSION OF UPMC CHAUTAUQUA AT WCA IS TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE OF CHAUTAUQUA COUNTY AND THE SURROUNDING AREA IN A WAY THAT INCLUDES COMPASSION, DEDICATION, AND A COMMITMENT TO QUALITY, WHILE MAINTAINING ECONOMIC VIABILITY AND A VISION FOR THE FUTURE. NO PATIENT IS DENIED SERVICES BECAUSE HE OR SHE CANNOT AFFORD THEM. UPMC CHAUTAUQUA AT WCA ADMITS AND SERVES PATIENT EQUALLY WITHOUT REGARD TO AGE, RACE, COLOR OR NATIONAL ORIGIN, DISABILITY, SEX, RELIGION OR ABILITY TO PAY.THE WESTERN NEW YORK COMMUNITY NEEDS ASSESSMENT HAS BEEN JOINTLY CONDUCTED AND LED BY TWO "PERFORMING PROVIDER SYSTEMS"- COMMUNITY PARTNERS OF WNY (WHICH INCLUDES UPMC CHAUTAUQUA AT WCA, BROOKS MEMORIAL HOSPITAL, WESTFIELD HOSPITAL AND MOUNT ST MARY'S HOSPITAL) AND MILLENNIUM COLLABORATIVE CARE (COMPRISING ERIE COUNTY MEDICAL CENTER, KALEIDA HEALTH, NIAGARA FALLS MEMORIAL MEDICAL CENTER, THE MCGUIRE GROUP AND THE SAFETY NET ASSOCIATION OF PRIMARY CARE AFFILIATED PROVIDERS). THEY HAVE COLLABORATED ON THE PRODUCTION OF THIS CHNA TO INFORM THEIR SELECTION OF PROJECTS AND PROVIDE DATA, ANALYSIS AND INSIGHTS NEEDED TO FURTHER DEVELOP PROJECT PLANS.MAKING A COMPREHENSIVE ASSESSMENT OF COMMUNITY HEALTH NEEDS IN AN AREA AS LARGE AND DIVERSE AS THE EIGHT-COUNTY WESTERN NEW YORK REGION REQUIRED THE INTEGRATION OF A WIDE ARRAY OF INFORMATION AND DATA TYPES, INCLUDING MULTIPLE SOURCES OF COMMUNITY ENGAGEMENT. QUANTITATIVE DATA SOURCES INCLUDED BASIC DEMOGRAPHICS, INDICATORS OF "COMMUNITY STRUCTURE OR SOCIAL DETERMINANTS OF HEALTH NEED, AND DETAILED HEALTH CARE DATA DESCRIBING SYSTEM-WIDE PERFORMANCE, QUALITY OF CARE AND POPULATION HEALTH STATUS. TOGETHER, USING COMPOSITE INDICES, THESE PROVIDE A POWERFUL SET OF MEASURES TO UNDERSTAND IN CONCRETE TERMS THE HEALTH OF THE REGION, HOW HEALTH CARE IS BEING DELIVERED, AND WHAT ARE THE GAPS IN THE HEALTH SYSTEM AND COMMUNITY RESOURCES.THREE COMMUNITY ENGAGEMENT APPROACHES WERE USED TO GATHER EXTENSIVE QUALITATIVE DATA THAT PROVIDED DIMENSION AND HUMAN CONTEXT TO THE NUMBERS, PROVIDING US WITH THE MEANS TO EXPLAIN SOME OF THE DYNAMICS AT PLAY IN OUR HEALTH CARE SYSTEM TODAY: 1. REGIONAL HEALTH NEEDS SURVEY-COMPLETED BY MORE THAN 7,000 PEOPLE 2. FOCUS GROUPS-16 "COMMUNITY CONVERSATIONS" ENGAGING PEOPLE SERVED BY THE SYSTEM TO BETTER UNDERSTAND THOSE PATIENT PERSPECTIVES. 3. KEY INFORMANT PROVIDER INTERVIEWS-A SERIES OF 42 INTERVIEWS WITH PROVIDERS FROM EVERY PART OF THE REGION AND EVERY PHASE OF THE HEALTH CARE SYSTEM. INCLUDING BUT NOT LIMITED TO PHYSICIANS, MEDICAID PROVIDERS AND COUNTY HEALTH COMMISSIONERS.IN ADDITION TO THE EXTENSIVE QUALITATIVE DATA SOURCES LISTED ABOVE, THE FOLLOWING QUANTITATIVE DATA SOURCES WERE USED TO CONDUCT THIS COMMUNITY NEEDS ASSESSMENT: DSRIP PERFORMANCE DATA DASHBOARD (ZIP AND COUNTY LEVEL) NEW YORK STATE PREVENTION AGENDA DATA DASHBOARD (COUNTY LEVEL) SPARCS DATA (COUNTY LEVEL) CDC MORTALITY DATA (COUNTY LEVEL) US CENSUS (COUNTY, ZIP AND TRACT LEVEL) STATEWIDE PERINATAL DATA SYSTEM (COUNTY AND ZIP LEVEL) NEW YORK STATE EXTENDED BRFFS SURVEY (FOR CHRONIC DISEASE PREVALENCE ESTIMATES, COUNTY LEVEL). MULTIPLE SOURCES FOR PROVIDER AND RESOURCE INVENTORIES (DSRIP, NPO DATABASE, D&B, 211 INFORMATION REFERRAL AND OTHER MISCELLANEOUS SOURCES)THE TEN PROJECTS IDENTIFIED BY THE CHNA ARE AS FOLLOWS: CREATE INTEGRATED DELIVERY SYSTEMS THAT ARE FOCUSED ON EVIDENCE BASED MEDICINE/POPULATION HEALTH MANAGEMENT ED TRIAGE FOR AT-RISK PATIENTS HOSPITAL-HOME CARE COLLABORATION SOLUTIONS. EXPAND USAGE OF TELEMEDICINE IN UNDERSERVED AREAS TO PROVIDE ACCESS TO OTHERWISE SCARCE SERVICES INTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES CARDIOVASCULAR HEALTH: EVIDENCE BASED STRATEGIES FOR DISEASE MANAGEMENT IN HIGH RISK AFFECTED POPULATIONS. INCREASE SUPPORT PROGRAMS FOR MATERNAL AND CHILD HEALTH. INTEGRATION OF PALLIATIVE CARE INTO THE PCMH MODEL PROMOTE MENTAL, EMOTIONAL AND BEHAVIORAL WELL-BEING IN COMMUNITIES. PROMOTE TOBACCO USE CESSATION, ESPECIALLY AMONG LOW SES POPULATIONS AND THOSE WITH POOR MENTAL HEALTHTHE PREVENTION AGENDA 2013-17 IS THE BLUEPRINT FOR STATE AND LOCAL ACTION TO IMPROVE THE HEALTH OF NEW YORKERS IN FIVE PRIORITY AREAS AND TO REDUCE HEALTH DISPARITIES FOR RACIAL, ETHNIC, DISABILITY, SOCIOECONOMIC AND OTHER GROUPS WHO EXPERIENCE THEM. COMMUNITY HOSPITAL AND LOCAL HEALTH DEPARTMENTS WORK COLLABORATIVELY TO ASSESS THE NEEDS OF THEIR COMMUNITIES AND TO IMPLEMENT PLANS THAT FOCUS ON IMPROVING POPULATION HEALTH. THERE WERE FIVE ITEMS THAT WERE SELECTED FOR UPMC CHAUTAUQUA AT WCA'S COMMUNITY SERVICE PLAN 2017-2018 PREVENT CHRONIC DISEASE-OBESITY-DIABETES PROMOTE HEALTH AND SAFE ENVIRONMENT PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE PREVENT HIV/STDS, VACCINE-PREVENTABLE DISEASE AND HEALTHCARE ASSOCIATED INFECTIONSEVIDENCE BASED EDUCATION, AWARENESS AND OUTREACH PROGRAMS FOR 2017: NATIONAL DIABETES PREVENTION PROGRAM BABY AND ME TOBACCO FREE PROGRAM NATIONAL CANCER INSTITUTE-MAXIMIZING MAMMOGRAPHY PARTICIPATION AMERICAN CANCER SOCIETY LOOK GOOD FEEL BETTER "RETHINK YOUR DRINK" DECREASE CONSUMPTION OF SUGARY BEVERAGES PATIENT NAVIGATION IN CANCER CARE MILLION HEARTS PROGRAM PART VI, LINE 7, REPORTS FILED WITH STATES NY X X 0 0 0 0 0 0 0 1 0 DAVID GIBBONS VICE CHAIR 0 383124 0 173125 0 52013 0 58460 0 8583 0 675305 0 17873 BRADLEY DINGER TREASURER 0 173967 0 9000 0 1154 0 8305 0 16233 0 208659 0 0 CAMELLIA HERISKO CNO, VP OPS & PATIENT CARE SVCS 167778 0 52250 0 1553 0 16081 0 20167 0 257829 0 0 0 EDWARD KARLOVICH BOARD MEMBER 0 425526 0 337500 0 105486 0 80600 0 22829 0 971941 0 18500 JAMES DONNELLY CNO, VP PATIENT CARE SVCS 0 183412 0 42624 0 7653 0 16579 0 18405 0 268673 0 0 BETSY T WRIGHT PRESIDENT/CEO 369233 0 104199 0 27636 0 22000 0 19290 0 542358 0 3458 0 CECIL M MILLER III SECRETARY/VP OF OPERATIONS 155303 0 11731 0 668 0 12966 0 6026 0 186694 0 0 0 CHARLES NAZZARO CFO 198569 0 13931 0 2598 0 16585 0 18063 0 249746 0 0 0 LISA MCCHESNEY CIO 0 175018 0 46290 0 1625 0 16411 0 20606 0 259950 0 0 GALO GRIJALVA MD PHYSICIAN 366154 0 0 0 889 0 19250 0 19845 0 406138 0 0 0 JONATHAN BLASIUS MD MEDICAL DIRECTOR-HOSPITALI 327350 0 7538 0 1066 0 22000 0 24838 0 382792 0 0 0 SALVATORE J BUONAIUTO MD HOSPITALIST 303569 0 0 0 335 0 15797 0 16834 0 336535 0 0 0 PUJAN SHRESTHA MD PHYSICIAN 271460 0 25000 0 248 0 0 0 9453 0 306161 0 0 0 ASHOK B MOVVA MD HOSPITALIST 286720 0 0 0 182 0 16320 0 10227 0 313449 0 0 0 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 THE CONFLICT ON INTEREST POLICY IS MADE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE PUBLISHED AND MADE AVAILABLE UPON REQUEST. IN ADDITION THE HOSPITAL PUBLISHES AN INFORMATIONAL BOOKLET CONTAINING AUDITED DATA THAT IS DISTRIBUTED THROUGH THE LOCAL NEWSPAPER AND IS AVAILABLE ON THE HOSPITAL WEBSITE. 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 -1,549,803. BOOK TO TAX ADJUSTMENT - PARTNERSHIP INTERESTS -684,052. EQUITY TRANSFER FROM RELATED PARTY -16,817,143. 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. WCA 31 SHERMAN LLC 4 CENTRE DRIVE ORCHARD PARK NY 14127 454867695 REAL ESTATE NY 0 0 UPMC CHAUTAUQUA AT WCA WCA GROUP INC PO BOX 840 JAMESTOWN NY 147020840 222393582 INACTIVE SUBSIDIARY NY 501(C)(3) 10 UPMC CHAUTAUQUA AT WCA 0 WCA FOUNDATION INC PO BOX 214 JAMESTOWN NY 147020214 222393584 PROMOTE/SUPPORT COMMUNITY HEALTH THROUGH SUPPORT OF WCA HOSP & AFFILIATE NY 501(C)(3) 7 UPMC CHAUTAUQUA AT WCA 0 STARFLIGHT INC PO BOX 840 JAMESTOWN NY 147020840 161557878 MEDICAL AVIATION SERVICE SUBSIDIARY NY 501(C)(3) 7 UPMC CHAUTAUQUA AT WCA 0 UPMC SENIOR COMMUNITIES INC 600 GRANT STREET PITTSBURGH PA 15219 251574736 SR. 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MGMT EI C 0 EURO CARE HEALTHCARE LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI X91 DH9W HOLDING CO EI C 0 WATERFORD ONCOLOGY ASSOCIATES LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI X91 DH9W ONCOLOGY SVC EI C 0 UNITED HEALTH RISK LTD PO BOX HM 2450 HAMILTON BD INSURANCE BD C 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 WCA FOUNDATION INC C 545728 WCA SERVICES CORPORATION O 1802 WCA SERVICES CORPORATION P 683705 WCA SERVICES CORPORATION Q 6750 WCA FOUNDATION INC L 7283 WCA SERVICES CORPORATION C 10650 FORM 990 - SCHEDULE R - PART II THROUGH PART IV THE ENTITIES MARKED WITH AN ASTERISK ARE NOT TECHNICALLY, "RELATED PARTIES", AS DEFINED BY THE IRS FORM 990 INSTRUCTION, OF THE FILING ORGANIZATION. HOWEVER, THEY ARE LISTED ON SCHEDULE R TO REFLECT THAT THEY ARE PART OF THE UPMC SYSTEM OF ENTITIES, AS THEY ALL SHARE UPMC AS THEIR ULTIMATE PARENT CORPORATION. LATE FILED RETURN DUE TO CCH SOFTWARE OUTAGE