2018-05-15T10:11:43-05:00 2017-06-30 440160260 BKD LLP 910 E St Louis Street Suite 200 Springfield MO 65806 990 2016-07-01 232176963 Soldiers and Sailors Memorial Hospital SOLD 5707230605 32-36 Central Avenue No Acctg Wellsboro PA 16901 Eric D Pohjala Executive Vice President / CFO 5703213175 2018-05-15 1 Brian D Todd P00422601 4178658701 2016 2022-09-23 18:48:47Z Steven P Johnson 700 High Street Williamsport PA 16901 73215758 0 X upmcsusquehanna.org X 1919 PA Soldiers & Sailors Memorial Hospital (SSMH) is a 50 bed, critical access hospital, primarily serving Tioga and surrounding counties. SSMH provides a full range of outpatient, inpatient and emergency services. 14 11 535 65 0 0 175809 26046 66821206 71932539 185871 117624 359362 552462 67542248 72628671 14845 7675 0 0 29994636 26207312 0 0 0 32494822 35013948 62504303 61228935 5037945 11399736 164178815 221856558 117731570 149727441 46447245 72129117 X Soldiers & Sailors Memorial Hospital is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna and its affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our Vision is to create an integrated community health system that delivers world class care. Our values are to carefully place our patients and their families first, share ownership with all our caregivers and lead with a servant's heart. 0 1 53426906 7675 71934116 The hospital is an 50 bed critical access hospital, which provides care to patients who meet certain criteria without charge or at amounts less than its established rates. The hospital does not pursue collection of amounts determined to qualify as charity care, nor are such amounts reported as revenue. The charity care charges foregone amounted to $964,555 in 2017. The following is a summary of the services provided to patients in 2017;Inpatient admissions 1,760Outpatient visits 98,431Newborn deliveries 215Emergency department visits 16,787Surgeries performed 7,667Laboratory tests 244,606CAT Scans 6,548Ultrasound tests 7,388Radiology tests 20,041MRI tests 1,825Nuclear Medicine tests 838Rehab 27,375Oncology Procedures 2,381During 2017 Medicare and Medical Assistance charges accounted for 68% of the hospital's total charges. SSMH treats all patients without regard to their ability to pay. In addition, the Hospital treats Medicare and Medical Assistance patients and maintains a Medicare/Medical Assistance policy that provides patients enrolled in such programs with access to all covered inpatient, outpatient and diagnostic services that are available to non-Medicare/Medical Assistance patients. On an annual basis, SSMH devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $16,296,000 in quantifiable community benefits reported for FY 2017. Charity care (at cost) $269,000; Bad Debt (at cost) $4,736,000; Government-sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, and other safety net programs) $10,726,000. In addition, various other programs such as Community Building, Community Wellness and recreation, Financial and InKind Contributions and Community Benefit Operations totaling $565,000. 53426906 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 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 0 1 0 0 0 1 0 0 1 535 1 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X Eric Pohjala 5703213175 700 High Street Williamsport PA 17701 Lisa V Feil Psy D Director 0.33 1.67 X 0 0 0 Robert PFitzgerald Director 0.33 1.67 X 0 0 0 Harold F Hoose III Director 0.33 1.67 X 0 0 0 Michael W Lichty Director 0.33 1.67 X 0 0 0 JDennis Murray PhD Director 0.33 13.67 X 0 0 0 Thomas M Owlett Esq Chairman 0.33 13.67 X X 0 0 0 Glenn BPoirier Vice Chairman 0.33 13.67 X X 0 0 0 Wendy SSwartz CPA Director 0.33 1.67 X 0 0 0 Aneurin J Williams Jr Director 0.33 1.67 X 0 0 0 Donna R Wilson Director 0.33 1.67 X 0 0 0 Kathy J Wright PhD Secretary 0.33 3.67 X X 0 0 0 Jill ABurns MD Director 0.33 49.67 X 0 259810 33044 Walter J Laibinis DO Director 0.33 43.67 X 0 414730 30151 Steven P Johnson President/CEO 0.33 49.67 X X 0 960096 33271 Janie M Hilfiger VP/President 40.00 2.00 X 186187 0 18391 Eric Pohjala Executive VP/CFO 2.00 42.00 X 0 430438 32395 Jan E Fisher Executive VP/COO 0.33 43.67 X 0 551981 31238 David Lopatofsky MD Executive VP/CMO 2.00 40.00 X 0 593514 37048 Enrico Doganiero Physician 40.00 0.00 X 494371 0 36494 Leonard Dale Physician 40.00 0.00 X 150581 0 12674 Craig Konzen Pharmacist 40.00 0.00 X 137864 0 28849 Candy Klotz Pharmacist 40.00 0.00 X 142476 0 6760 Stephen Bortz Supervisor Chief Pharmacist 40.00 0.00 X 141307 0 13937 Ronald J Butler Former Exec VP/CBO (retire 0.00 0.00 X 0 335670 0 1252786 3546239 314252 20 1 1 0 The Williamsport Hospital 700 High Street Williamsport PA 17701 Management Services 3771449 Aramark Healthcare 24863 Network Place Chicago IL 60673 Management Services/Environmental 3148043 Nightrays PA PO Box 204367 Dallas TX 75320 Interpretation services 261154 Laboratory Corp of America PO Box 12140 Burlington NC 27216 Lab testing 168557 Williamsport Pathology Associates 700 High Street Williamsport PA 17701 Medical Director services 147343 5 19944 6102 26046 Patient service revenue 621990 69714252 69714252 Employee Pharmacy revenue 446110 790331 790331 Paramedic revenue 621910 554929 554929 Electronic Health Incentives 621990 330066 330066 Other Miscellaneous income 621990 297390 297390 245571 245571 71932539 50901 50901 550885 0 550885 550885 550885 646241 7569 581511 5576 64730 1993 66723 66723 990T refund FY2014 900099 1577 1577 1577 72628671 71934116 0 668509 X 7675 7675 1252786 1066599 186187 19185795 16564762 2621033 527737 453854 73883 3781695 3252258 529437 1459299 1254997 204302 3771449 3771449 2634 2634 1850 1850 3813 3813 7386908 7260739 126169 75922 50462 25460 1357639 1324428 33211 87608 87608 804047 800682 3365 156823 151906 4917 81625 76774 4851 701688 701687 1 3991453 3991453 539551 539551 Medical Supplies and Dr 7800216 7800216 Bad Debt Expenses 4736112 4736112 Repairs and Maintenance 1712225 1675843 36382 Food services 527586 437739 89847 1274799 1191561 83238 61228935 53426906 7802029 0 1284889 6393504 53478 34558 6072693 7621953 623862 867555 1104901 684327 384786 171922 95002774 52894997 43688287 42107777 71100 0 110894819 163974962 164178815 221856558 14845740 10446129 18347079 2349399 348656 257624 84190095 136674289 117731570 149727441 X 46262929 71903101 184316 226016 46447245 72129117 164178815 221856558 X 11399736 89641 14192495 X X 0 1 X 1 0 X 0 0 0 0 0 1 4448 0 0 0 4448 0 Part II-B, Line 1 Lobbying Activities: Line 1 f: The Hospital holds a membership in the American Hospital Association (AHA) which engages in lobbying as part of their mission to represent the interests of hospitals at both the Federal and State levels. For the year ended June 30, 2017,the amount of dues paid to AHA totaled $20,422, of which 21.78% or $4,448, was used for lobbying purposes. 1331789 1331789 50263047 18914270 31348777 113336 104114 9222 40137860 32353290 7784570 3156742 1523323 1633419 42107777 Due from Affiliates 163974962 163974962 Due to Other Affiliates 136013968 Estimated amounts due to third-party payers 660321 136674289 X Part X, Line 2: UPMC has no uncertain tax positions recorded. Tax benefits are recognized when it is more likely than not that a tax position will be sustained upon examination by the tax authorities based on the technical merits of the position. Such tax positions are measured as the largest amount of tax benefit that is greater than 50% likely to be realized upon ultimate settlement with the tax authorities assuming full knowledge of the position and all relevant facts. As of June 30, 2017, UPMC does not have any unrecorded tax benefits. An external audit is completed at a consolidated UPMC system level only, including UPMC and all taxable and tax-exempt subsidiaries. 1 1 1 X 1 X 1 1 1 0 1 1 263324 0 263324 0.00470 9415985 6098674 3317311 0.05870 9679309 6098674 3580635 0.06340 9679309 6098674 3580635 0.06340 30930 30930 0.00050 533898 533898 0.00870 564828 564828 0.00920 1 4736112 236806 5032094 5662056 -629962 X 1 1 1 1 Soldiers & Sailors Memorial Hospital 32-36 Central Avenue Wellsboro PA 16901 www.upmcsusquehannahealth.org 390043 X X X Soldiers & Sailors Memorial Hospital 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X See Part V, Page 7 X 1 15 1 See Part V, Page 7 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V, Page 7 X See Part V, Page 7 X See Part V, Page 7 X X X X X X 1 X 0 1 X 0 0 Soldiers & Sailors Memorial Hospital Part V, Section B, Line 5: In conducting its CHNA, the hospital took into account input from representatives of the community served, including those with special knowledge of or expertise in public health. This was accomplished by conducting 9 Key Informant interviews with 55 people answering the key informant interview. A web-based tool was utilized to conduct the key informant interviews; however, paper questionnaires identical to the electronic version were distributed to populations who may not have had access to the internet or generally are more likely to complete a paper questionnaire. For more details concerning the Key Informant Interview Process or the Community Health Input Questionnaire process, including a list of those individuals interviewed, a copy of the Community Health Input Questionnaire, and results gathered you may view the CHNA and related Implementation Plan at www.upmcsusquehanna.org/community health. Soldiers & Sailors Memorial Hospital Part V, Section B, Line 6a: Soldiers and Sailors Memorial Hospital; located in Wellsboro, PA is one of four hospitals that comprise UPMC Susquehanna based in Williamsport, Pennsylvania. For purposes of conducting CHNA's, three of these hospitals, The Williamsport Hospital (DBA:Williamsport Regional Medical Center), Divine Providence Hospital, and Muncy Hospital, share the same definition of community served, which is Lycoming County, PA. The fourth hospital that is part of UPMC Susquehanna is Soldiers and Sailors Memorial Hospital located in Wellsboro, PA and their defined community is Tioga County, PA. The health systems' approach to providing community benefits is to leverage the assets and expertise of all four hospitals to meet the needs and improve the health status of those who reside in the communities located in Lycoming and Tioga counties. Accordingly, a certain amount of collaboration between these related hospitals occurred in the development of their CHNA's and related Implementation Plans. For more details concerning these four hospitals, as well as their definition of community served you may view the CHNA and related Implementation Plans at www.upmcsusquehanna.org/community health. Soldiers & Sailors Memorial Hospital Part V, Section B, Line 11: Health needs were identified based on information gathered and analyzed through the 2016 CHNA conducted by the Health System. For the health needs prioritization process, the Health System engaged a hospital leadership team to review the most significant health needs reported in the CHNA using the following criteria, 1) Current area of hospital focus. 2) Established relationships with community partners to address the health need. 3) Organizational capacity and existing infrastructure to address the health need. Based on the criteria outlined above, the leadership team ranked each of the health needs. As a result of the priority process, the identified priority areas that will be addressed through the Health System's Implementation Strategy for fiscal years 2017 through 2019 will be: Priority 1:Improve access to primary and specialty services.Goal 1: Work with Tioga County Partnership for Community Health on Improvement of transportation for healthcare services. Update as of 7/7/2017: Tioga County Partnership for Community Health received a block grant for transportation which SSMH is using for patients discharged from the Emergency Department and inpatient units, to transport to home at no cost to the patient.Goal 2: Explore non-traditional strategies to provide access to care. Update as of 7/7/2017: Susquehanna Health Internal Medicine office has opened same day appointments to accommodate urgent needs. Laurel Health Center administration is exploring urgent care concept at the Mansfield Laurel Health Center. Visiting specialists from Lycoming provide Cardiology and ENT at Wellsboro and Cardiology, Sports Medicine and Rheumatology at Mansfield.Goal 3: Explore telehealth opportunities and innovative ways to deliver care. Update as of 7/7/2017: the following at now available at SSMH: teleburn, telestroke, telepsychiatry, and teleneurology. A UPMC Susquehanna telehealth committee has been formed.Priority 2: Bring in addiction services and/or task forces to Tioga County.Goal 1: Authorize Implementation of prescription drug monitoring program system wide. Goal 2: Collaborate with Tioga County to share best practices. Update as of 7/7/2017:SSMH actions-Review and reduce Rx when feasible, standardize narcotic formulations, OB task force setup and add ER case managers. Physician offices- monitor of prescribing patterns. County Wide-Project Bald Eagle/Tioga Coalition first mtg 4/27/17, drug drop boxes, National Guard education programs.Priority 3: Collaborate with community organizations on health and wellness initiatives. Goal 1: Promote routine cancer screenings for breast, colon and cervical cancer. Update as of 7/7/2017: Susan G Komen grant received to cover mammograms for the uninsured. Free screening for melanoma provided by Susquehanna Surgical at Wellsboro in May and September. Expansion of mammography to the Mansfield Medical Plaza. Implementation of breast health nurse navigator program in Wellsboro.Goal 2: Collaborate with the PA Department of Health and Tioga County Partnership for Community Health to establish more health screeeings and community events. Update as of 7/7/2017: Community health programs offered throughout the year to include newborn immunization program through SSMH and Tioga Partnership.Goal 3: Continue to partner with River Valley Regional YMCA and Wellsboro Parks and Recreation Department to support health and wellness programs for both children and adults. Update as of 7/7/2017: YMCA offers a variety of programs for youth. The UPMC Wellness program provides a multitude of activities to promote a healthy lifestyle.Goal 4: Continue to grow and expand Spirit of Women program. Update as of 7/7/2017: Multiple programs provided throughout the year by the Spirit of Women program.Priority 4: Support mental health serviceGoal 1: Increase access to behavorial health specialists. Update as of 7/7/2017: Telehealth available at SSMH and pediatric behavorial health through the Penn State telehealth program available at Wellsboro Behavorial Health Office.Priority 5: Support transportation options to healthcare for rural areas.Goal 1: Work with Tioga County Partnership for Community Health on improvement of transportation for healthcare services. Update as of 7/7/2017: Tioga County Partnership received a grant for transportaion which SSMH is using for patients discharged from the ER and inpatient units, to transport to home at no cost to the patient.Goal 2 : Bring routine wellness screenings and programs to rural Tioga areas. Update as of 7/7/2017: PA Department of health no longer employs an RN to assist with programs. UPMC SSMH and Tioga Partnership continue to offer routine Wellness screenings and programs, such as CMBA (community multi-phasic blood analysis). Soldiers & Sailors Memorial Hospital Part V, Section B, Line 16j: Other Method Brochure Part V, Line 7a https://www.susquehannahealth.org/in-the-community/community-health-nee ds- assessments Part V, line 10a https://www.susquehannahealth.org/in-the-community/community-health-nee ds- assessments Part V, line 16a FAP website https://www.susquehannahealth.org/patients-visitors/for-patients/billin g- insurance/financial-assistance-program Part V, Line 16B, FAP application website https://www.susquehannahealth.org/patients-visitors/for-patients/billin g- insurance/financial-assistance-program. Part V, line 16c, FAP plain language summary website https://www.susquehannahealth.org/patients-visitors/for-patients/billin g- insurance/financial-assistance-program. Part V, line 16i There are no groups with limited English proficiency that exceed IRC Section 501(r) thresholds. However, language translations of the financial assistance policy and related documents are available by request at the financial counseling department of the hospital. Part I, Line 6a: The community benefit report is prepared on a system wide basis under UPMC Susquehanna. Part I, Line 7: Part I Line 7 Column (F): The Bad Debt expense included on Form 990, Part IX, Line 25 (A) but subtracted for purposes of calculating the percentage in this column is $4,736,112. Part I, Line 7g: Soldiers & Sailors Memorial Hospital has various subsidized services which are included within the Medicare and Medical Assistance unreimbursed costs. Part II, Community Building Activities: Soldiers & Sailors Memorial Hospital participates in community building through various means such as making parts of the building (conference rooms cafeteria, etc) available for public meetings, blood drives, CPR classes, expectant parent classes, and EMS education among others. The hospital has a large group of volunteers from the community who donate time to assist the organization providing care and well being to the community it serves. For fiscal year 2017, SSMH had 65 volunteers donate approximately 7841 hours of their time. Part III, Line 2: Bad Debt expense consists of the actual bad debts written off, plus a reserve calculation based on a progressive percentage for self pay and other non-contract accounts receivable aging categories. This figure is the amount of bad debt in the audited financial statements. Part III, Line 3: An estimate of 5% is used based on looking at patients that were in bad debt status and eventually through the annual bad debt sale, determined they did not have the resources to pay and were really charity care costs. Part III, Line 4: The System reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The System provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the System bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Part III, Line 8: The Medicare cost report uses a cost per day for the routine service costs times the number of Medicare days. Ancillary costs are calculated based on the cost to charge ratio by department. The Medicare cost report does not capture all charges and reimbursements provided to the facility under Medicare. For the fiscal year ended June 30, 2017, the facility had approximately $5 million in Medicare charges provided at a cost of approximately $6 million. This resulted in a $1 million shortfall for the fiscal year.Serving patients with government health benefits, such as Medicare, is a component of the community benefit standard that tax-exempt hospitals are held to. This implies that serving Medicare patients is a community benefit and that the hospital operates to promote the health of the community. Part III, Line 9b: UPMC Susquehanna will provide financial assistance under the Financial Assistance Program for patients that require medically necessary services during the period in which family income and financial resources meets the defined guidelines, and after all other payment resources have been exhausted. The UPMC Susquehanna Financial Assistance Program is always the coverage of the last resort.Eligible services include inpatient and outpatient hospital services which are medically necessary and are provided directly by UPMC Susquehanna (Hospitals and Susquehanna Physician Services) or by employees of UPMC Susquehanna for the treatment of an illness or injury.All payer resources must be exhausted. Pennsylvania Medical Assistance screening must be completed for all considered individuals. All other payment arrangements must be explored. The income guidelines source is the annual poverty income published in the Federal Register by the Department of Health and Human Services. The federal poverty guidelines are used to determine three tiers of UPMC Susquehanna Financial Assistance Program eligibility. Income guidelines are updated annually according to federal poverty guideline updates. Family income must be at or below the eligibility guidelines for program consideration.It is the responsibility for the patient or guarantor to initiate the UPMC Susquehanna Financial Assistance Program by applying. Part VI, Line 2: The Health System engaged BKD, LLP to conduct a formal CHNA. BKD, LLP is one of the largest CPA and advisory firms in the United States, with approximately 2,000 partners and employees in 34 offices. BKD serves more than 900 hospitals and health care systems across the country. The CHNA was conducted from February 2016 to June 2016.The following steps were conducted as part of the Health System's CHNA 1) An evaluation of the impact of actions taken to address the significant health needs identified in the tax year 2012 CHNA was completed to understand the effectiveness of the Health System's current strategies and programs. 2) The "community" served by the Health System was defined by utilizing inpatient data regarding patient origin. This process is further described in the Community Served by the Health System. 3) Population demographics and socioeconomic characteristics of the community were gathered and reported utilizing various third parties. The health status of the community was then reviewed. Information on the leading causes of death and morbidity information was analyzed in conjunction with health outcomes and factors reported for the community by the Center for Disease Control and Prevention (Community Health Status Indicators). Health factors with significant opportunity for improvement were noted. 4) Community input was provided through nine key stakeholder meetings and a community health survey. Results and findings are described in the Community Input Key Stakeholder Interviews and Survey section of the CHNA at www.upmcsusquehanna.org/community health. 5) Information gathered in the above steps was analyzed and reviewed to identify health issues of uninsured persons, low income persons and minority groups and the community as a whole. Health needs were ranked utilizing a weighing method that weighs the size of the problem, the seriousness of the problem, the impact of the issues on vulnerable populations, the prevalence of common themes, how important the issue is to the community, and how the issue aligns with the Hospital's strategic plan. 6) An inventory of health care facilities and other community resources potentially available to address the significant health needs identified through the CHNA was prepared and collaborative efforts were identified. Health needs were then prioritized taking into account the perceived degree of influence the Health System has to impact the need and the health needs impact on overall health for the community.To help see the implementation plan come to fruition an implementation team has been formed which is comprised of various individuals from community organizations throughout Lycoming and Tioga counties. Such partnered organizations include Lycoming County Health Improvement Coalition, Tioga County Partnership for Community Health, River Valley YMCA, Project Bald Eagle, STEP, YWCA, PA Department of Health , just to name a few. Part VI, Line 3: UPMC Susquehanna will provide financial assistance under the Financial Assistance Program for patients that require medically necessary services during the period in which family income and financial resources meets the defined guidelines, and after all other payment resources have been exhausted. The UPMC Susquehanna Financial Assistance Program is always the coverage of last resort.The UPMC Susquehanna Financial Assistance Program is an income/assets based package designed to meet the healthcare financial needs of eligible individuals and households who receive medically necessary inpatient or outpatient services from TWH, DPH, MVH, or SSMH. The first hospital claim sent to guarantors of uninsured accounts will include a statement briefly explaining the availability and contacts for referral to the Financial Assistance program. Subsequent guarantor billings also reference the availability of the Financial Assistance program.It is the responsibility for the patient or guarantor to initiate the UPMC Susquehanna Financial Assistance Program by applying. It is the responsibility of the UPMC Susquehanna Finance personnel to administrate the program according to the policy. Part VI, Line 4: The organization serves Tioga County and surrounding areas. Tioga County is located in rural North Central Pennsylvania and has a population 41,981 as of the 2010 census. The median household income was $44,187 with 15.3 percent of the residents below two times the Federal Poverty level. Part VI, Line 5: The hospitals of UPMC Susquehanna all have entity specific boards that are composed of persons who reside in Lycoming and Tioga Counties.In addition to this UPMC Susquehanna extends medical staff privileges to all qualified physicians in the county in all areas of primary and specialty care according to the UPMC Susquehanna Medical Staff Bylaws. Bylaws excerpts pertaining to this area are as follows:3.1) Nature of Membership - Medical Staff membership is available to qualified physicians, dentists, maxillofacial/oral surgeons, and podiatrists and confers both responsibilities and prerogatives, but only as provided in these Bylaws. No physician, dentist, or podiatrist, including those employed by or otherwise under contract with the Hospital(s), may admit a patient or independently provide patient care services in the Hospital(s) unless he is a Medical Staff member with applicable clinical privileges pursuant to these Bylaws. A member shall have only those clinical privileges, including admitting privileges, as have been granted in accordance with these Bylaws.3.2) Qualifications - No individual shall be considered eligible for appointment or reappointment to the Medical Staff unless he meets each of the following required qualifications/criteria. If any change in personal or professional status occurs which would inhibit practitioner's ability to effectively meet the obligations for patient care and Medical Staff membership under these Bylaws, the practitioner shall immediately notify the Medical Director.3.2-1) Professional Licensure Qualification - A member must be a physician, dentist, or podiatrist and must be duly licensed to practice in the Commonwealth of Pennsylvania.3.2-2) Clinical Privileges Qualification - A Member of the Medical Staff must have clinical privileges(or in the case of a new applicant, is granted privileges at the time of the appointment), except those appointed to the Emeritus Staff or as otherwise specified in these Bylaws. 3.2-3) Professional Competence - A member must demonstrate sufficient professional education, training, experience, competence, and good judgement to perform Medical Staff responsibilities and clinical privileges requested.3.2-4) Health Status - A member must have sufficient physical and mental health to perform Medical Staff responsibilities and exercise clinical privileges requested.3.2-5) Basic Responsibilities - A member must discharge the basic responsibilities of Medical Staff membership noted in 3.3-2.3.2-6) Board Certification Requirement - All practitioners who are current staff members at UPMC Susquehanna as of 7/1/10 and who have met prior qualifications for membership shall be exempt from board certification requirements.3.2-7) Standing with Federal Payors - A member must not be excluded from participation in federally funded programs such as Medicare and Medicaid.3.2-8) Waiver - The Board Certification requirement described in 3.2-6 may be waived under very special circumstances in which an applicant for Medical Staff membership is capable of providing specific unique expertise presently not available or insufficiently available on the Medical Staff which will fulfill an unmet medical need in the community. Such waiver may be granted by the Board(s) only upon recommendation of the Department Chairman, Credentials Committee, and the Medical Executive Committee (MEC).3.2-9) Prohibited Criteria - Medical Staff membership or assignment to a Medical Staff category shall not be denied, terminated, revoked, suspended, modified or otherwise restricted based upon:(a) Gender, race, creed, color, national origin, handicap, or disability, if the individual is otherwise qualified under these Bylaws, or(b) Economic considerations as the sole or primary criterion, or (c) Any criterion not set forth as a required qualification in these Bylaws, or(d) Any other criterion lacking professional or ethical justification.3.2-10) Effect of Other Affiliations - No individual shall be granted Medical Staff membership or be assigned to any Medical Staff category merely because he:(a) Holds a certain degree,(b) Is licensed to practice in the Commonwealth of Pennsylvania or any other state,(c) Is a member of any professional organization,(d) Is certified by any Clinical Board,(e) Had, or presently has, Medical Staff membership or clinical privileges at another health care facility,(f) Is employed by or is otherwise under contract with the Hospital(s) or,(g) Is employed by or otherwise practices with a group composed of one or more Medical Staff members.The volunteer program at UPMC Susquehanna supports the services at our 4 campuses, SSMH, MVH, DPH and TWH as well as our Life Center located within the River Valley Regional YMCA in Williamsport, PA. Volunteers ranging in age from 14, assist staff and patients in almost every department. The volunteers come from Tioga and surrounding counties to support our services. They provide over 65,000 hours of service in both office, customer service and patient care areas to support our service partners. They become ambassadors for the hospital, make new friends, financially support the hospital, become involved in the auxiliary, remain active members of society, often stay healthier longer, enjoy the camaraderie with staff and other volunteers, serve on hospital committees, recruit other volunteers, increase their volunteer hours and offer constructive suggestions for improvement. Volunteers are recruited through fairs, internet information and on-line applications, volunteer referrals and presentations to groups. They are a highly regarded, integral part of our operational support system. Part VI, Line 6: Soldiers and Sailors Memorial Hospital (SSMH) is one of four hospitals which are part of UPMC Susquehanna. The mission of UPMC Susquehanna is to promote health by acting as the parent of a nonprofit health system in North Central Pennsylvania and by raising funds and otherwise supporting the system.SSMH is a critical access hospital providing diagnostic and treatment facilities, educational and training programs and a rehabilitation facility.Divine Providence Hospital (DVH) is a specialty hospital that offers inpatient psychiatric services and a wide array of outpatient hospital services, as well as, home health and hospice services.Muncy Valley Hospital (MVH) is a critical access hospital, primarily serving Lycoming and surrounding counties. MVH also provides a full range of outpatient and emergency services, as well as, operates a long-term care facility. The Williamsport Hosital (TWH)is an acute care community hospital providing diagnostic and treatment facilities, educational and training programs, and a rehabilitation facility.The hospitals treat Medicare and Medical Assistance patients and maintains a Medicare/Medical Assistance policy that provides patients enrolled in such programs with access to all covered inpatient, outpatient and diagnostic services that are available to non-Medicare/Medical Assistance patients.The community benefit report is prepared on a system-wide basis under UPMC Susquehanna. On an annual basis, UPMC Susquehanna devotes a portion of its revenue and assets to community program services. The following reflects the breakout of $98,755,622 in quantifiable community benefits reported for FY 2017: Charity Care (at cost) $1,629,207; Bad Debts (at cost) $7,909,280; Government sponsored health care (unpaid cost of Medicare, Medicaid, indigent care programs, SCHIP and other safety net programs)$81,482,454. In addition, various other programs such as Research, Health Professions Education, Community Building, Financial and In-Kind contributions, and Community Benefit Operations totaling $7,734,681. Part VI, Line 7, Reports Filed With States PA 1 Form 990 Part IV There were no grants of $5,000 or more to any domestic organization or domestic government reported on Part IX Line 1. 1 0 0 1 1 1 1 1 0 Jill ABurns MD Director 0 224371 0 34600 0 839 0 9950 0 23094 0 292854 0 0 Walter J Laibinis DO Director 0 229365 0 173818 0 11547 0 9950 0 20201 0 444881 0 0 Steven P Johnson President/CEO 0 703292 0 226453 0 30351 0 13925 0 19346 0 993367 0 0 Janie M Hilfiger VP/President 160329 0 21609 0 4249 0 7416 0 10975 0 204578 0 0 0 Eric Pohjala Executive VP/CFO 0 362196 0 66436 0 1806 0 9950 0 22445 0 462833 0 0 Jan E Fisher Executive VP/COO 0 401814 0 138186 0 11981 0 9950 0 21288 0 583219 0 0 David Lopatofsky MD Executive VP/CMO 0 425773 0 141731 0 26010 0 11275 0 25773 0 630562 0 0 Enrico Doganiero Physician 492565 0 0 0 1806 0 9950 0 26544 0 530865 0 0 0 Leonard Dale Physician 150581 0 0 0 0 0 6517 0 6157 0 163255 0 0 0 Craig Konzen Pharmacist 135097 0 692 0 2075 0 6224 0 22625 0 166713 0 0 0 Candy Klotz Pharmacist 141858 0 555 0 63 0 6272 0 488 0 149236 0 0 0 Stephen Bortz Supervisor Chief Pharmacist 140728 0 475 0 104 0 6267 0 7670 0 155244 0 0 0 Ronald J Butler Former Exec VP/CBO (retire 0 0 0 0 0 335670 0 0 0 0 0 335670 0 0 Part I, Line 4a Ronald J. Butler, Former Executive VP/CBO retired on 4/15/15. His entire reportable compensation, $335,670 paid by a related organization, is a severance payment. Form 990 Part 1 Line 3 Explanation: The Williamsport Hospital EIN# 24-0795508, a related organization, uses the following resources to establish the compensation of the top management officials; compensation committee, independent compensation consultant, written employment contract, compensation survey or study and approval by the Board. Form 990 Part 1 Line 7 In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP) a minimum operating margin must be achieved for the most recently completed year on a consolidated system-wide basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. For FY 2017, the minimum threshold was met that would trigger a VCIP payment. In September 2016, President/CEO Steven P Johnson received variable compensation award in the amount of $226,453. Form 990, Part III, line 3 On November 10, 2016, Soldiers & Sailors Memorial Hospital changed its status from a Acute Care Hospital to a Critical Access Hospital. Form 990, Part VI, Section A, line 6 UPMC Susquehanna is the sole member of the governing body. Form 990, Part VI, Section A, line 7a UPMC Susquehanna may elect or remove members of the governing body. Form 990, Part VI, Section A, line 7b All the business and affairs of the corporation shall be managed and controlled by the Board of Directors, subject to the oversight of the sole Member of the management and operation of the corporation, except that the following powers are reserved exclusively to the sole Member of the corporation, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid of any force or effort whatsoever. The sole Member shall exercise its power through its Board of Directors. The sole Member shall have the exclusive authority to exercise the following powers: A.)To approve the appointment and removal of the President of the corporation subject to all applicable provisions of the Creation agreement. B.) To elect and remove, with or without cause, a Director of the corporation. C.) To establish the overall policy and long range plans of the corporation, determine or change the mission of the corporation, approve the programs and services of the corporation and the termination of any programs or services of the corporation, monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists, subject to and in accordance with the provisions of the Creation agreement. D.) To adopt, amend or repeal the Articles of Incorporation or these Bylaws. E.) To establish requirements for a unified budget, the approval of new capital debt, any increment to any existing capital debt, and/or any change in capital debt obligations of the corporation. F.) To establish requirements for the approval of the acquisition, purchase, sale, leasing outside the ordinary course of business, transfer outside the ordinary course of business or encumbrance outside the ordinary course of business of land or buildings and the construction or demolition of buildings owned by the corporation. G.) To require a certified audit of corporate funds at any time. H.) To approve any guaranty of the indebtedness of any person, the granting of any security interest in or the creation of any encumbrance on any assets of the corporation outside the ordinary course of business, or any transfers of any assets of the corporation outside the ordinary course of business, except transfers between or among corporations. I.) To approve any merger, consolidation, organization, reorganization, joint venture or other modification of corporate structure or affiliations affecting the autonomy, governance, or operations of the corporation. J.) To dissolve or terminate the existence of the corporation and determine the distribution of assets upon such termination or dissolution, as provided in these Bylaws. K.) To appoint annually the external fiscal auditor of the corporation. L.) To approve the nominees for elected officers of the Board of Directors of the corporation, and to return the list of approved nominees to the Board of Directors for election. M.) To remove any elected officer of the corporation. N.) To approve the annual capital and operating budget of the corporation. O.) To coordinate managed care plans, including decisions concerning entry into or renewal of any contract or agreement relating thereto. Form 990, Part VI, Section B, line 11b A high-level overview of Form 990 is presented to the parent Board of Directors before filing and complete drafts of all returns are made available to all Board members through the CEO's and CFO's office. Form 990, Part VI, Section B, line 12c As required by law, Hospital policy states that all members of the Board of Directors and Managers must sign a statement each year disclosing any conflict of interest that may arise and agree to abstain when issues involving those parties with conflicting interests are called to motion. Any conflicts of interest are reviewed by the Hospital's attorneys. Form 990, Part VI, Section B, line 15 Form 990, Part VI, Lines 15a and 15b: All top management officials are paid by The Williamsport Hospital, EIN# 24-0795508. The Board of Directors, through the Executive Compensation Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption of reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey for the Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the Executive Compensation Committee takes the proper steps to educate the Board of Directors to understand all of the above-mentioned oversight and to appropriately prepare them for community or media inquiry. In addition, the Board is made aware of the Form 990 and its role in the communication of information to the public. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part IX, line 11g Other Purchased Services: Program service expenses 2,505,995. Management and general expenses 126,169. Fundraising expenses 0. Total expenses 2,632,164. Other Contracted Services: Program service expenses 3,149,062. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,149,062. Physician Services: Program service expenses 1,605,682. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,605,682. Form 990, Part XI, line 9: Pension Liability Adjustment 376,545. Postretirement benefit liability adjustment 1,162,355. Transfers from other affiliates 15,837,052. Transfers to other affiliates -3,325,776. TRNA 142,319. Form 990 Part XII Line 2c UPMC, the sole member of UPMC Susquehanna, has assumed the responsibility for oversite of the audited financial statements at a system level for FY 2017. Laurel Health System 32-36 Central Ave Wellsboro PA 16901 240795488 Healthcare PA 501(c)(3) Line 12b, II UPMC Susquehanna 1 Laurel Realty 32-36 Central Ave Wellsboro PA 16901 231403678 Rental Real Estate PA 501(c)(2) NA UPMC Susquehanna 1 Laurel Management Services 32-36 Central Ave Wellsboro PA 16901 251644910 Management Services PA 501(c)(3) Line 12b, II UPMC Susquehanna 1 The Green Home 37 Central Avenue Wellsboro PA 16901 240804365 Skilled nursing PA 501(c)(3) Line 10 UPMC Susquehanna 1 Tioga Health Care Providers 1201 Grampian Blvd Williamsport PA 17701 251765538 Physician Services PA 501(c)(3) Line 12b, II UPMC Susquehanna 1 Divine Providence Hospital of the Sister 1100 Grampian Blvd Williamsport PA 17701 240799343 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 Muncy Valley Hospital 215 East Water Street Muncy PA 17756 240806023 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 The Williamsport Hospital 700 High Street Williamsport PA 17701 240795508 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 Susquehanna Health Foundation 1100 Grampian Blvd Williamsport PA 17701 232743470 Fundraising PA 501(c)(3) Line 12a, I UPMC Susquehanna 1 Susquehanna Physician Services 1201 Grampian Blvd Williamsport PA 17701 232449454 Physician Services PA 501(c)(3) Line 3 UPMC Susquehanna 1 Williamsport Area Ambulance Services 700 High Street Williamsport PA 17701 232416166 Ambulance transport PA 501(c)(3) Line 10 Williamsport Hospital 1 Laurel Health Foundation 32-36 Central Ave Wellsboro PA 16901 251810488 Foundation PA 501(c)(3) Line 12b, II UPMC Susquehanna 0 Susquehanna Health Innovation Center Inc 700 High Street Williamsport PA 17701 471600873 Fundraising PA 501(c)(3) Line 12a, I UPMC Susquehanna 1 UPMC Susquehanna 1205 Grampian Blvd Williamsport PA 17701 232751183 Healthcare PA 501(c)(3) Line 12b, II UPMC 1 UPMC Senior Communities Inc 600 Grant Street Pittsburgh PA 15219 251574736 Senior Living PA 501(c)(3) Line 10 UPMC 1 Pittsburgh Lifetime Care Community 600 Grant Street Pittsburgh PA 15219 251335247 CCRC PA 501(c)(3) Line 10 UPMC SR Comm 1 Canterbury Place 600 Grant Street Pittsburgh PA 15219 250965334 Senior Living PA 501(c)(3) Line 10 UPMC SR Comm 1 Seneca Place 600 Grant Street Pittsburgh PA 15219 721562844 Senior Living PA 501(c)(3) Line 10 UPMC SR Comm 1 Shadyside Hospital Supporting Foundation 600 Grant Street Pittsburgh PA 15219 260303394 Foundation PA 501(c)(3) Line 12a, I UPMC 1 UPMC Lee 600 Grant Street Pittsburgh PA 15219 250613830 Inactive PA 501(c)(3) Line 3 UPMC 1 Pittsburgh Care Partnership Inc 600 Grant Street Pittsburgh PA 15219 251753852 Adult Daycare PA 501(c)(3) Line 10 UPMC 1 UPMC Center for High Value Healthcare 600 Grant Street Pittsburgh PA 15219 452178782 Research PA 501(c)(3) Line 7 UPMC 1 Shadyside Hospital Foundation 532 South Aiken Avenue Pittsburgh PA 15232 251290546 Foundation PA 501(c)(3) Line 12c, III-FI UPMC Presby 1 Passavant Hospital Foundation 9100 Babcock Blvd Pittsburgh PA 15237 251407815 Foundation PA 501(c)(3) Line 12b, II UPMC Pass 1 UPMC Northwest Foundation 100 Farfield Drive Seneca PA 16346 251483624 Foundation PA 501(c)(3) Line 12d, III-O UPMC Northwe 1 St Margaret Foundation 600 Grant Street Pittsburgh PA 15219 251520340 Foundation PA 501(c)(3) Line 7 UPMC St Marg 1 Children's Hospital of Pittburgh Fnd 600 Grant Street Pittsburgh PA 15219 251865744 Foundation PA 501(c)(3) Line 7 UPMC CHP 1 Magee-Women Res Inst and Foundation 600 Grant Street Pittsburgh PA 15219 251462311 Foundation PA 501(c)(3) Line 7 N/A 0 UPMC Kane 4372 Route 6 Kane PA 16735 250998168 Hospital PA 501(c)(3) Line 3 UPMC HAMOT 0 Great Lakes Physician Practice 600 Grant Street 58th Floor Pittsburgh PA 15219 464186362 Physician Services NY 501(c)(3) Line 3 Regnl Health 1 HAMOT Health Foundation 302 French Street Erie PA 16507 251400999 Foundation PA 501(c)(3) Line 12b, II UPMC HAMOT 1 Safe Harbor Behavorial Health of UPMC HA 1330 W 26TH Street Erie PA 16508 251317492 Behavorial PA 501(c)(3) Line 7 UPMC HAMOT 1 UPMC Jameson 1211 Wilmington Avenue New Castle PA 16105 250965406 Healthcare PA 501(c)(3) Line 3 UPMC 1 Jameson Healthcare Foundation 1211 Wilmington Avenue New Castle PA 16105 251536037 Foundation PA 501(c)(3) Line 12b, II UPMC Jameson 1 Jameson Health Services Inc 1211 Wilmington Avenue New Castle PA 16105 030486993 Healthcare PA 501(c)(3) Line 12b, II UPMC Jameson 1 Children's Advocacy Center of Lawrence 1107 Wilmington Avenue New Castle PA 16105 251581304 Support Sys PA 501(c)(3) Line 7 UPMC Jameson 1 UPMCJameson Cancer Center 600 Grant Street 58th Floor Pittsburgh PA 15219 201459415 Oncology Svc PA 501(c)(3) Line 10 UPMC Jameson 1 Jameson Medical Care Inc 1211 Wilmington Avenue New Castle PA 16105 260462696 Healthcare PA 501(c)(3) Line 10 UPMC Jameson 1 Jameson Care Center Inc 1211 Wilmington Avenue New Castle PA 16105 232871396 Healthcare PA 501(c)(3) Line 10 UPMC SR Comm 1 Venango VNA Foundation 491 Alleghany Boulevard Franklin PA 16323 251472179 Foundation PA 501(c)(3) Line 12d, III-O UPMC Visitin 1 UPMC Susquehanna Lock Haven 700 High Street Williamsport PA 17701 821600494 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 UPMC Susquehanna Sunbury 700 High Street Williamsport PA 17701 821592230 Hospital PA 501(c)(3) Line 3 UPMC Susquehanna 1 UPMC Chautauqua at WCA 207 Foote Avenue Jamestown NY 14701 160743226 Hospital NY 501(c)(3) Line 3 UPMC Chautau 1 WCA Group Inc 207 Foote Avenue Jamestown NY 14701 222392582 Holding Company NY 501(c)(3) Line 12b, II UPMC Chautau 1 Starflight Inc 135 Allen Street Jamestown NY 14701 161557878 Stat Medvac NY 501(c)(3) Line 7 UPMC Chautau 1 South Central Alpha Housing and Healthcare 3410 West Pittsburg Road New Castle PA 16101 251701701 Skilled Nursing PA 501(c)(3) Line 10 UPMC Sr Comm 1 South Western Alpha Housing and Health Care 745 Greenville Road Mercer PA 16137 251701700 Skilled Nursing PA 501(c)(3) Line 10 UPMC Sr Comm 1 Kane Community Hospital Foundation 4372 Route 6 Kane PA 16735 263906925 Foundation PA 501(c)(3) Line 7 UPMC Kane 1 Junior Guild of the Jameson Memorial Hospital 1211 Wilmington Avenue New Castle PA 16105 256005313 Support Sys PA 501(c)(3) Line 12d, III-O UPMC Jameson 1 WCA Foundation Inc 300 Foote Avenue PO Box 840 Jamestown NY 14702 222393584 Foundation PA 501(c)(3) Line 12c, III-FI UPMC Chautau 1 UPMC 600 Grant Street Pittsburgh PA 15219 251423657 Supporting Organization PA 501(c)(3) Line 12c, III-FI N/A 1 Community Basket LLC 1205 Grampian Blvd Williamsport PA 17701 201195739 Rents real estate PA N/A N/A 0 0 Seneca Hills Assisted Living 600 Grant Street Pittsburgh PA 15219 232873106 Assisted Living PA N/A N/A 0 0 St Margaret Medical Arts Association 600 Grant Street Pittsburgh PA 15219 251786655 Med Office BL PA N/A N/A 0 0 Core Network LLC 600 Grant Street Pittsburgh PA 15219 251786209 Healthcare PA N/A N/A 0 0 Life Home Care LP 600 Grant Street Pittsburgh PA 15219 251847839 Homecare PA N/A N/A 0 0 Shadyside Medical Center Association 600 Grant Street Pittsburgh PA 15219 251608318 Med Office BL PA N/A N/A 0 0 Chartwell PA LP 600 Grant Street Pittsburgh PA 15219 251729714 Homehealth PA N/A N/A 0 0 Life Care Home Srv of NW PA 1647 Sassafras Street Erie PA 16507 251536879 Homehealth PA N/A N/A 0 0 HAMOT-KCH Real Estate Venture 300 State Street Erie PA 16507 263691782 Med Office BL PA N/A N/A 0 0 HAMOT Surgery Center LLC 200 State Street Erie PA 16507 251863661 Ambulatory Srv PA N/A N/A 0 0 EPN-HAMOT Urgent Care LLC 600 Grant Street Pittsburgh PA 15219 272147949 Urgent Care PA N/A N/A 0 0 Mountain View Medical Oncology 600 Grant Street 58th Floor Pittsburgh PA 15219 461449241 Healthcare PA N/A N/A 0 0 Lawrence County MRI & Diagnostic 2526 Wilmington Avenue New Castle PA 16105 270219891 Imaging Center PA N/A N/A 0 0 Tyoga Carenet 32-36 Central Avenue Wellsboro PA 16901 251810967 Integrate Healthcare Regionally PA N/A C 0 Susquehanna Ventures Inc 1201 Grampian Blvd Williamsport PA 17701 232470263 Pharmacy PA N/A C 0 Susquehanna Health System Insurance Network LTD PO Box 1159 Grand Caymans CJ 980458722 Insurance CJ N/A 0 HC Pharmacy Central Inc 600 Grant Street Pittsburgh PA 15219 251364192 Pharmacy co-op PA N/A C 0 Children's Community Care 600 Grant Street Pittsburgh PA 15219 251781887 Pediatric Svc PA N/A C 0 UPMC Cancer Centers Ireland Limited 6th Floor Beacon Hospital Sandyford Dublin EI Cancer Treatment EI N/A C 0 UPMC Physician Services Holding Company 600 Grant Street Pittsburgh PA 15219 251877017 Holding Company PA N/A C 0 Hematology Oncology Association 600 Grant Street Pittsburgh PA 15219 421648357 Healthcare PA N/A C 0 Oncology Hematology Association 600 Grant Street Pittsburgh PA 15219 251762980 Healthcare PA N/A C 0 Tri-State Neurosurgical Associates 600 Grant Street Pittsburgh PA 15219 251458655 Healthcare PA N/A C 0 Renaissance Family Practice - UPMC Inc 600 Grant Street Pittsburgh PA 15219 262942406 Healthcare PA N/A C 0 UPMC Holding Company Inc 600 Grant Street Pittsburgh PA 15219 251777713 Holding Company PA N/A C 0 UPMC Coverage Products Inc 600 Grant Street Pittsburgh PA 15219 251777710 Holding Company PA N/A C 0 Freedom Insurance Company 600 Grant Street Pittsburgh PA 15219 030308944 Insurance VT N/A C 0 Tri-Century Insurance Comp 600 Grant Street Pittsburgh PA 15219 251500739 Insurance PA N/A C 0 UPMC DNA Inc 600 Grant Street Pittsburgh PA 15219 251883237 Insurance PA N/A C 0 UPMC Health Benefits Inc 600 Grant Street Pittsburgh PA 15219 251844144 Health Insurance PA N/A C 0 UPMC Health Network Inc 600 Grant Street Pittsburgh PA 15219 721527566 Health Insurance PA N/A C 0 UPMC Health Plan Inc 600 Grant Street Pittsburgh PA 15219 232813536 Health Insurance PA N/A C 0 UPMC Benefit Management Services Inc 600 Grant Street Pittsburgh PA 15219 251769564 Worker's Comp PA N/A C 0 UPMC Diversified Services Inc 600 Grant Street Pittsburgh PA 15219 251778454 Holding Company PA N/A C 0 Monroeville Specialty Clinic 600 Grant Street Pittsburgh PA 15219 251666087 Healthcare PA N/A C 0 Medical Archival Systems Inc 600 Grant Street Pittsburgh PA 15219 232912501 Software Dev DE N/A C 0 Presby Health Resource Mgnt 600 Grant Street Pittsburgh PA 15219 251422155 Healthcare PA N/A C 0 RX Partners Inc 600 Grant Street Pittsburgh PA 15219 251801966 Retail Pharmacy PA N/A C 0 Biotronics Inc 600 Grant Street Pittsburgh PA 15219 251843500 Equip Maint PA N/A C 0 Medical Center Properties Inc 600 Grant Street Pittsburgh PA 15219 251796940 Real Estate PA N/A C 0 Askesis Development Group Inc 600 Grant Street Pittsburgh PA 15219 541625585 Software Dev DE N/A C 0 Panther Reinsurance Company Inc PO Box 1109 Grand Cayman Cayman Islands CJ Insurance CJ N/A C 0 Forbes Reinsurance Compnay LTD PO Box 1109 Grand Cayman Cayman Islands CJ Insurance CJ N/A C 0 Cathedral (RE) Insurance Co PO Box 1109 Grand Cayman Cayman Islands CJ Insurance CJ N/A C 0 UPMC International Health Initiatives 600 Grant Street Pittsburgh PA 15219 841706741 Inactive PA N/A C 0 UPMC Ireland Limited 6th Floor Beacon Hospital Sandyford Dublin EI Healthcare Srv EI N/A C 0 UPMC United Kingdom LTD C/O Nair Co 11th Floor Whitefriar Lewins Mead Bristol UK 980571026 Software LICE UK N/A C 0 Bayfront Regional Development Corp 300 State Street Erie PA 16507 251401388 Holding Company PA N/A C 0 Bayside Development Corp 300 State Street Erie PA 16507 251401386 Real Estate PA N/A C 0 UPMC Work Alliance Inc 600 Grant Street Pittsburgh PA 15219 452825053 Insurance PA N/A C 0 UPMC Canada Technologies Limited 600 Grant Street Pittsburgh PA 15219 Software CA N/A C 0 Allied Orthopedics Appliances Inc 335 East 3rd Street Jamestown NY 14701 161092951 Med Appliance PA N/A C 0 UPMC Health Coverage Inc 600 Grant Street Pittsburgh PA 15219 462824537 Insurance PA N/A C 0 UPMC Health Options Inc 600 Grant Street Pittsburgh PA 15219 462824626 Insurance PA N/A C 0 UPMC Complete Care Inc 5215 Centre Avenue Pittsburgh PA 15232 463605753 Healthcare PA N/A C 0 American Home Health Services 868 Corporate Way Westlake OH 44145 311521422 Home Health C OH N/A C 0 Health Fidelity Inc 210 South B Street San Mateo CA 94401 452538963 Technology Sv CA N/A C 0 Fluence Health Inc 6425 Penn Avenue Pittsburgh PA 15206 472684174 Software DE N/A C 0 Curavi Health Inc 6425 Penn Avenue Pittsburgh PA 15206 811217377 Healthcare DE N/A C 0 Pensiamo Inc 600 Grant Street 59th Floor Pittsburgh PA 15219 812069236 Supply Chain DE N/A C 0 Altoona Family Inc 620 Howard Avenue Altoona PA 16601 251444935 Mgmt Serv PA N/A C 0 Lexington Holdings Inc 620 Howard Avenue Altoona PA 16601 251794386 Medical Srvs PA N/A C 0 Lexington One Inc 620 Howard Avenue Altoona PA 16601 251468889 Rental PA N/A C 0 Lexington Two Inc Howard Avenue 7th Street Altoona PA 16601 251555689 Rental Equip PA N/A C 0 Lexington Four Inc 620 Howard Avenue Altoona PA 16601 251793736 Holding Company PA N/A C 0 Allegheny Healthcare Staffing Inc 620 Howard Avenue Altoona PA 16601 271657362 Employment Sv PA N/A C 0 UPMC Altoona Regional Health Services 1414 9th Avenue Altoona PA 16602 251219302 Medical Srvs PA N/A C 0 Lexington Anesthesia Associates Inc 620 Howard Avenue Altoona PA 16601 251897765 Medical Srvs PA N/A C 0 Northern Cambria Medical Center Inc 620 Howard Avenue Altoona PA 16601 251530860 Medical Srvs PA N/A C 0 Patton Family Medical Center Inc 620 Howard Avenue Altoona PA 16601 251793735 Medical Srvs PA N/A C 0 MEDCPU 100 Wall Street Suite 2202 New York NY 10005 383805381 Software Dev DE N/A C 0 UPMC Excess PL TR 600 Grant Street Pittsburgh PA 15219 826254351 Trust PA N/A T 0 RXANTE Inc 511 Congress Street 803 Portland ME 04101 454040219 Medication Mgnt DE N/A C 0 Vincent Payment Solutions Inc Bakery Square 6425 Penn Avenue Suit pittsburgh PA 15219 821101143 Payment System DE N/A C 0 J Health Ventures Inc 1211 Wilmington Avenue New Castle PA 16105 251607893 Inactive PA N/A C 0 JER Medical Associates Inc 1211 Wilmington Avenue New Castle PA 16105 251609398 Inactive PA N/A C 0 WCA Service Corporation Inc 207 Foote Avenue Jamestown NY 14701 161151438 NY N/A C 0 Friends of Altoona Hospital 620 Howard Avenue Altoona PA 16601 861140504 Fundraising PA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Schedule R Part II to IV The entities marked with an asterick are not technically "related parties", as defined by the IRS Form 990 instructions, of the filing organization. However, they are listed on Schedule R to reflect that they are part of the UPMC system of entities, as they all share UPMC as their ultimate parent corporation. Form 990 Part IV Susquehanna Health System Insurance Network, LTD (SHSIN) EIN# 98-0458722, is a foreign corporation, incorporated under the laws of the Cayman Islands. There are no income, capital, or premium taxes levied in the Cayman Islands and SHSIN has been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder is Susquehanna Health System EIN#23-2751183, is a 501 (c) (3) organization exempt from Federal Income Taxes. SHSIN conducts no business in the United States. It files an 1120F protective filing which implies that its income is not subject to US Federal income taxes.