TY 2018 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) THOMAS SHAFFER...................................................................... VICE CHAIR	1.0 ................. 2.0	X	X	0	0
(2) JASON TRONETTI DO...................................................................... PHYSICIAN/DIRECTOR END 09/18	40.0 ................. 2.0	X		382,131	40,723
(3) DAVID J LOPATOFSKY MD...................................................................... DIRECTOR	1.0 ................. 2.0	X		0	0
(4) DAVID BUCKLER...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0
(5) CHRISTAN CARAMIA MD...................................................................... PHYSICAN/DIRECTOR END 12/18	40.0 ................. 2.0	X		479,654	37,786
(6) CHARLES UPDEGRAFF...................................................................... CHAIR	1.0 ................. 2.0	X	X	0	0
(7) MELYNDA BUDD...................................................................... DIRECTOR	1.0 ................. 2.0	X		0	0
(8) JOHN LEETE...................................................................... DIRECTOR	1.0 ................. 2.0	X		0	0
(9) ALANNA HUCK...................................................................... SECRETARY	1.0 ................. 2.0	X	X	0	0
(10) JEANNE MIGLICIO...................................................................... TREASURER	1.0 ................. 2.0	X	X	0	0
(11) CARRIE ENNIS...................................................................... DIRECTOR	1.0 ................. 2.0	X		0	0
(12) DAVID CRANDALL...................................................................... DIRECTOR	1.0 ................. 2.0	X		0	0
(13) ELIZABETH WALLACE...................................................................... DIRECTOR	1.0 ................. 2.0	X		0	0
(14) STEVEN P JOHNSON...................................................................... DIRECTOR	1.0 ................. 2.0	X		0	0
(15) MARIBETH MCLAUGHLIN...................................................................... DIRECTOR	1.0 ................. 2.0	X		0	0
(16) MICHAEL CALLAHAN DO...................................................................... DIRECTOR	1.0 ................. 2.0	X		25,946	182
(17) ROBERT SMITH...................................................................... DIRECTOR	1.0 ................. 3.0	X		0	0

(A) Name and business address	(B) Description of services	(C) Compensation
FOOT AND ANKLE INNOVATIONS PC, 201 SOUTH MECHANIC STREET SMETHPORT,PA16749	PHYSICIAN SERVICES	416,987
ALLEGHANY HOSPITAL ASSOCIATION PLLC, 130 S UNION ST OLEAN,NY14760	PHYSICIAN SERVICES	370,500
EASTERN PA RADIATION ONCOLOGY, ONCOLOGY AUBURN,PA17922	PHYSICIAN SERVICES	330,000
SARAH SORLIEN, 1010 DYRE STREET PHILADELPHIA,PA19124	PHYSICIAN SERVICES	265,817
POLSINELLI SHUGHART, PO BOX 878681 KANSAS CITY,MO64187	LEGAL	258,450
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 9

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2018 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization CHARLES COLE MEMORIAL HOSPITAL

Part I	Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization CHARLES COLE MEMORIAL HOSPITAL		Employer identification number 24-0802108

Part II	Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization CHARLES COLE MEMORIAL HOSPITAL			Employer identification number 24-0802108
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...............................
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................
d	Other exempt purpose expenditures ........................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

4,877

Total. Add lines 1c through 1i ....................................................................................................

4,877

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1G	DIRECT CONTACT WITH LEGISLATORS: EDWARD PITCHFORD, CEO, ATTENDS MEETING WITH LEGISLATORS. THERE IS NO COST TO THE HOSPITAL ASSOCIATED WITH THESE MEETINGS. MEETING PURPOSE IS TO EDUCATE LEGISLATORS ON PERTINENT ISSUES IN THE HEALTHCARE ARENA.
SCHEDULE C, PART II-B, LINE 1I	OTHER LOBBYING ACTIVITIES: THE ORGANIZATION IS A MEMBER OF AHA AND HCWP. $4,877 OF DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2018

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c	5,156
d	Additions during the year ............................	1d	75,189
e	Distributions during the year ..........................	1e	76,082
f	Ending balance ................................	1f	4,263

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	4,220,847	4,095,589	3,891,581	4,148,803	4,420,558
b	Contributions ...
c	Net investment earnings, gains, and losses	195,396	301,199	394,894	-42,451	-36,364
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	190,951	175,941	190,886	214,771	235,391
f	Administrative expenses ....
g	End of year balance ......	4,225,292	4,220,847	4,095,589	3,891,581	4,148,803

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

Yes

(ii) related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	1,030,847		1,030,847
b	Buildings ....	51,718,539	31,928,902	19,789,637
c	Leasehold improvements
d	Equipment ....	26,639,938	21,800,341	4,839,597
e	Other .....	2,216,323	1,616,234	600,089
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				26,260,170

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1)INVESTMENT IN COLE FOUNDATION	1,259,834	C
(2)INVESTMENT IN HENDORN	602,541	C
(3)INVEST. IN HAMOTCOLE VENTURES	4,973,241	C
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	6,835,616

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DUE FROM AFFILIATES				25,814,346
(2) OTHER RECEIVABLES				1,432,122
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				27,246,468

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
DUE TO THIRD PARTY PAYERS	4,230,372
MALPRACTICE LIABILITY	998,509
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	5,228,881
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2018

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART IV, LINE 1B	ESCROW ACCOUNTS: THE CORPORATION HAS AN ESCROW ACCOUNT FOR THEIR SKILLED NURSING FACILITY PATIENTS WHO REQUEST THE USE OF THE ACCOUNT.
SCHEDULE D, PART V, LINE 4	ENDOWMENT FUND: THE ENDOWMENT FUND WAS ESTABLISHED TO ALLOW THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES TO POOR AND NEEDY PATIENTS.
SCHEDULE D, PART X, LINE 2	UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	364,324		364,324	0.400 %
b	Medicaid (from Worksheet 3, column a) . . . . .	18,554,775	15,928,803	2,625,972	2.870 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	18,919,099	15,928,803	2,990,296	3.270 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	127,211	13,972	113,239	0.120 %
f	Health professions education (from Worksheet 5) . . .	559,890		559,890	0.610 %
g	Subsidized health services (from Worksheet 6) . . . .	31,146,839	22,822,070	8,324,769	9.100 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	9,964		9,964	0.010 %
j	Total. Other Benefits . .	31,843,904	22,836,042	9,007,862	9.840 %
k	Total. Add lines 7d and 7j .	50,763,003	38,764,845	11,998,158	13.110 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	7,230	7,230	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	3,496	3,496
7	Community health improvement advocacy	2,243	2,243
8	Workforce development	1,115	1,115
9	Other
10	Total	14,084	14,084	0.010 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

4,830,522

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

714,917

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

15,332,886

Enter Medicare allowable costs of care relating to payments on line 5.....

15,181,075

Subtract line 6 from line 5. This is the surplus (or shortfall)........

151,811

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	CHARLES COLE MEMORIAL HOSPITAL 1001 EAST 2ND STREET COUDERSPORT,PA16915 WWW.COLEMEMORIAL.ORG 031801	X	X	X	X

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	CHARLES COLE MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTP://WWW.COLEMEMORIAL.ORG/ABOUT.ASPX

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTP://WWW.COLEMEMORIAL.ORG/ABOUT.ASPX

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	CHARLES COLE MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	CHARLES COLE MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	CHARLES COLE MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 5	COMMUNITY INPUT: THE HOSPITAL USED A 6-STEP APPROACH TO COMPLETE THE NEEDS ASSESSMENT. INCLUDED IN THIS APPROACH WERE SEVERAL DATA ANALYSES, BASED ON SECONDARY SOURCE DATA AUGMENTED WITH COMMUNITY HEALTH SURVEY DATA. SINCE THE SERVICE AREA DOES NOT COMPRISE SOME OF THE ENTIRE COUNTIES WE SERVE, UPMC COLE ASKED LOCAL RESIDENTS TO NOTE IF THEY PERCEIVED THE PROBLEMS, OR NEEDS IDENTIFIED BY SECONDARY SOURCES TO EXIST IN THEIR PORTION OF THE COUNTY THEY LIVE IN. DATA SOURCES USED INCLUDED SEVERAL WEBSITES TO ASSESS THE HEALTH NEEDS OF THE COUNTIES SERVED, ACCESS CURRENT POPULATION DATA, ASSESS CHARACTERISTICS OF CERTAIN HEALTH OBJECTIVES, ADDRESS THE PROBLEM OF ESCALATING HEALTH COSTS, AND CAPTURE DATA THAT CAN HELP UNDERSTAND HEALTH STATISTICS. TO OBTAIN DATA WITHIN THE COMMUNITIES SERVED BY THE HOSPITAL, ALL COMMUNITY MEMBERS WERE INVITED TO COMPLETE A SURVEY, WHICH WOULD REMAIN ANONYMOUS. THE ADMINISTRATION OF AN INTERNET-BASED AND PAPER SURVEY WAS PROMOTED THROUGH ADVERTISEMENTS IN LOCAL NEWSPAPERS, BLOGS, AND TELEVISION AND WAS DISTRIBUTED TO LOCAL CIVIC AND HEALTH ORGANIZATIONS. IN ADDITION, WE CONDUCTED A SURVEY TO KEY LEADERS OF THE REGION THAT ALSO INCLUDED OUR SERVICE PROVIDERS. THE TERMS OF GAINING INPUT SPECIFIED EACH RESPONDENT REMAINED ANONYMOUS. THE FEEDBACK WAS SOLICITED THROUGH THE SURVEY. PRELIMINARY CONCLUSIONS OF THE SURVEYS RESULTS WERE PRESENTED TO THE CHNA STEERING COMMITTEE, ALSO KNOWN AS THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE WHICH WERE ASKED TO VALIDATE PRIOR ASSESSMENTS AND TO ESTABLISH PRIORITY AMONG VARIOUS IDENTIFIED HEALTH NEEDS. MEMBERS OF THE COMMITTEE INCLUDE UPMC COLE STAFF AND COMMUNITY ORGANIZATIONS SUCH AS: - DICKINSON CENTER, INC. - OFFICE OF AGING - DRUG AND ALCOHOL SERVICES - LOCAL AREA SCHOOL DISTRICTS - MCKEAN AND POTTER COUNTY DISTRICT OFFICE - LOCK HAVEN PA PROGRAM - COMMUNITY BASED CARE - HOSPITAL COUNCIL OF WESTERN PENNSYLVANIA WE ALSO HAD A REPRESENTATIVE FROM ROBERT WOOD JOHNSON FOUNDATION COME AND PROVIDE INPUT REGARDING THE FINDINGS TO HELP DETERMINE OUR PRIORITIES.
SCHEDULE H, PART V, SECTION B, LINE 6A	CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED ALONG WITH THE FOLLOWING HOSPITALS: - UPMC SUSQUEHANNA LOCK HAVEN - MUNCY VALLEY HOSPITAL - WILLIAMSPORT REGIONAL MEDICAL CENTER - UPMC SUSQUEHANNA SUNBURY - SOLDIERS + SAILORS MEMORIAL HOSPITAL
SCHEDULE H, PART V, SECTION B, LINE 7D	CHNA AVAILABILITY: THE HOSPITAL POSTED THE REPORT ON THE WEBSITE UNDER "ABOUT US." YOU CAN LOCATE IT AT WWW.COLEMEMORIAL.ORG.
SCHEDULE H, PART V, SECTION B, LINE 11	IMPLEMENTATION STRATEGY: THE HEALTH NEEDS THAT WERE ACKNOWLEDGED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT HAVE BEEN INTEGRATED INTO THE DESIGN OF A THREE-YEAR IMPLEMENTATION PLAN. AFTER REVIEWING CURRENT COMMUNITY COLLABORATIONS AND PARTNERSHIPS, AND INTERNAL RESOURCES, THE STEERING COMMITTEE WILL BE FORMING FOCUS GROUPS TO HELP IDENTIFY ITS EXISTING RESOURCES AND CREATE INNOVATIVE PROGRAMS. THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE WILL BE OVERSEEING THESE IDENTIFIED PRIORITIES. PROGRAM HIGHLIGHTS HELPING TO REDUCE OBESITY RATES OVER THE LAST THREE YEARS, UPMC COLE HAS CONTINUED ITS EFFORTS TO ADDRESS OBESITY THROUGH INITIATIVES THAT AIM TO DECREASE THE PERCENTAGE OF COMMUNITY RESIDENTS WHO ARE OVERWEIGHT OR OBESE. SINCE 2016, THE HOSPITAL HAS: -WORKED WITH THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE TO DEVELOP A RESOURCE GUIDE THAT IDENTIFIES COMMUNITY RESOURCES FOR ADULTS AND CHILDREN FOR HEALTHY EATING AND ACTIVITY CHOICES. -IMPLEMENTED PROGRAMS THAT REACH PARENTS AND CHILDREN TO IMPROVE THE NUTRITION AND/OR PHYSICAL ACTIVITY LEVELS AT HOME AS WELL AS AT SCHOOL. IN 2017, APPROXIMATELY 500 PARENTS AND CHILDREN PARTICIPATED IN THESE PROGRAMS. -CONTINUED TO HELP REVISE AND EXPAND SCHOOL POLICIES THAT HAVE A STRONG FOCUS AROUND NUTRITION AND PHYSICAL ACTIVITY. THE POLICIES WILL BE PILOTED WITH ONE SCHOOL DISTRICT AND IMPLEMENTED IN AT LEAST THREE ADDITIONAL LOCAL SCHOOL DISTRICTS. -PROVIDED NUTRITION COUNSELING IN ITS PRIMARY CARE SETTINGS THROUGH THE COLE MEMORIAL MEDICAL GROUP. IN THE FIRST SIX MONTHS, 67 PATIENTS WERE SEEN TO DEVELOP WEIGHT LOSS STRATEGIES AND MANAGE CHRONIC DISEASES. -COLLABORATED WITH SIX EMPLOYERS TO OFFER WELLNESS AND PREVENTIVE SERVICES FOR THEIR EMPLOYEES. -LINKED WITH PENN STATE EXTENSION ON PROGRAMS, SUCH AS "MEDITERRANEAN DIET", AND "EVERYBODY WALK PA.". -IMPLEMENTED HEALTHY HABITS FOR LIFE AT COLE MEMORIAL MEDICAL GROUP'S COUDERSPORT PEDIATRIC OFFICE. ENCOURAGING PEOPLE TO BE MORE ACTIVE THE HOSPITAL IS WORKING TO PROVIDE AND PROMOTE AFFORDABLE AND ACCESSIBLE OPPORTUNITIES, SUCH AS PARKS, TRAILS, FITNESS EVENTS, AND RECREATIONAL FACILITIES, TO HELP CHILDREN AND ADULTS BE PHYSICALLY ACTIVE. OVER THE LAST THREE YEARS, UPMC COLE HAS: -WORKED WITH SIX SCHOOL DISTRICTS AND COMMUNITY ORGANIZATIONS TO INCORPORATE PHYSICAL ACTIVITY INTO THE SCHOOL CULTURE. -ENCOURAGED PEOPLE TO LEARN ABOUT ALTERNATIVE TRANSPORTATION AND RECREATION OPTIONS, SUCH AS WALKING AND BICYCLING. -EXPLORED THE IDEA OF USING VIRTUAL FITNESS AT LOCAL WELLNESS CENTERS TO MAKE FITNESS MORE ACCESSIBLE FOR INDIVIDUALS. -PARTNERED WITH DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES (DCNR) TO PROMOTE OUTDOOR RECREATIONAL ACTIVITIES AND ENCOURAGE PEOPLE TO BE MORE ACTIVE AT VARIOUS LOCAL STATE PARKS, SUCH AS "WINTER OUTINGS,ECOURAGE PEOPLE TO BE MORE ACTIVE AT VARIOUS LOCAL STATE PARKS. -PROMOTED APPROXIMATELY 10 AFTER-SCHOOL PROGRAMS, INCLUDING 4-H CLUB, RUNNING CLUB, AND FAMILY FITNESS PROGRAMING - IN CONJUNCTION WITH THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE. PROMOTING HEALTHY FOOD CHOICES IN 2016, UPMC COLE SET A GOAL TO INCREASE THE PERCENTAGE OF COMMUNITY RESIDENTS WHO REPORTED EATING AT LEAST FIVE SERVINGS OF FRUITS AND/OR VEGETABLES FROM 21 PERCENT IN AUGUST 2015 TO 23 PERCENT BY JUNE 2019. THE HOSPITAL HAS MET THIS GOAL THROUGH DIVERSE EFFORTS: -PROMOTED FRUITS AND VEGETABLES THROUGH A VARIETY OF OUTREACH EFFORTS, SUCH AS COMMUNITY GARDENS, FARMS, HOME AND SCHOOL PROGRAMS, FARMER MARKETS, AND LOCAL GROCERY STORES. -OFFERED EDUCATIONAL ACTIVITIES TO LEARN MORE ABOUT HEALTHY EATING, SUCH AS THE WHOLE SHARE PROGRAM AND "HOW TO MAKE A MEAL" IN PARTNERSHIP WITH PENN STATE EXTENSION. -IMPLEMENTED HEALTHIER DRINK AND FOOD OPTIONS AT VENDING MACHINES IN NINE SCHOOLS. FIGHTING THE MENTAL HEALTH STIGMA OVER THE PAST THREE YEARS, UPMC COLE HAS REMAINED COMMITTED TO EDUCATING THE COMMUNITY ABOUT MENTAL HEALTH ISSUES THROUGH A RANGE OF COMMUNICATION OUTLETS, INCLUDING: -SOCIAL MEDIA: MENTAL HEALTH SERVICES, SUCH AS COUNSELING SERVICES, HAVE BEEN PROMOTED THROUGH SOCIAL MEDIA. -BROCHURES: IN PARTNERSHIP WITH THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE, THE HOSPITAL HELPED DEVELOP AND DISTRIBUTE A RESOURCE GUIDE THAT HIGHLIGHTS LOCAL MENTAL HEALTH SERVICES. -COMMUNITY EVENTS: IN PARTNERSHIP WITH LOCAL AGENCIES, THE HOSPITAL PROVIDED INFORMATIONAL MATERIALS AT A WIDE RANGE OF COMMUNITY EVENTS, SUCH AS 5K RUN, LIBRARY EVENTS, MOVIE NIGHT, PAPER TIGERS DOCUMENTARY, MAPLE FESTIVAL, AND FAMILY FUN FAIR. -TRAINING SESSIONS: THE HOSPITAL CONTINUES TO ENDORSE TRAINING EVENTS FOR VARIOUS COMMUNITY MEMBERS. FOR INSTANCE, THE HOSPITAL ENCOURAGES DEPARTMENT MANAGERS AND STAFF TO PARTICIPATE IN MENTAL HEALTH FIRST AID, A NATIONAL PROGRAM TO TEACH SKILLS NEEDED TO RESPOND TO THE SIGNS OF MENTAL ILLNESS AND SUBSTANCE USE. -PAPER/ON-LINE RESOURCE LIST: THE HOSPITAL DEVELOPED A RESOURCE LIST THAT INCLUDES ALL LOCAL MENTAL HEALTH SERVICES TO HELP COMMUNITY MEMBERS BETTER NAVIGATE TREATMENT AND SUPPORT SERVICES. INTEGRATING PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES COLE MEMORIAL MEDICAL GROUP AND DICKINSON CENTER, INC. EVALUATED THE NEED TO BRING PRIMARY CARE SERVICES TO THE MENTAL HEALTH SETTING. TELEPSYCHIATRY SERVICES WERE ADDED TO SUPPORT THE PRIMARY NETWORK WITH 207 ADULTS AND CHILDREN SEEN IN 2017. LICENSED SOCIAL WORKERS PROVIDED COUNSELING SERVICES IN FOUR LOCATIONS AND PROVIDED 1,844 VISITS IN 2017. RAISING AWARENESS ABOUT SUICIDE RISK FACTORS THE HOSPITAL IS WORKING WITH LOCAL PARTNERS TO HELP EDUCATE THE COMMUNITY ABOUT SUICIDE PREVENTION, FOCUSING ON ADOLESCENTS AND SENIORS. SINCE 2016, THE HOSPITAL HAS: -EXAMINED DIFFERENCES IN SUICIDE RATES BY COUNTY. -ENCOURAGED SUICIDE PREVENTION EDUCATION AT FIVE SCHOOLS, REACHING APPROXIMATELY 2,000 STUDENTS. -UTILIZED SOCIAL MEDIA AND PUBLIC SERVICE ANNOUNCEMENTS TO EDUCATE COMMUNITY MEMBERS ABOUT SUICIDE PREVENTION. -INCREASED SUICIDE PREVENTION EDUCATION AT FIVE EVENTS, SUCH AS WALKS, RUNS, AND FAIRS, REACHING APPROXIMATELY 500 INDIVIDUALS. INCREASING ACCESS TO RESOURCES AND SUPPORT FOR SUBSTANCE USE DISORDER UPMC COLE IS COMMITTED TO ENSURING THAT AREA RESIDENTS WILL HAVE ACCESS TO THE BEST PRACTICES IN SCREENING, SUPPORT, AND TREATMENT FOR SUBSTANCE USE DISORDERS IN ORDER TO ACHIEVE AND MAINTAIN OPTIMAL HEALTH OUTCOMES. HOSPITAL PROGRESS OVER THE LAST THREE YEARS INCLUDE: -DEVELOPED INFORMATIONAL RESOURCES: IN PARTNERSHIP WITH THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE, THE HOSPITAL HELPED DISTRIBUTE INFORMATION ABOUT OVERDOSE PREVENTION, EDUCATIONAL MATERIALS, AND FACT SHEETS ACROSS THE REGION - INCLUDING THE STOP CAMPAIGN INITIATIVE. THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE ALSO DEVELOPED A "ROADMAP" OF AVAILABLE SUBSTANCE ABUSE SERVICES AND SUPPORTS AND DISTRIBUTED THIS INFORMATION TO MORE THAN 30 COMMUNITY ORGANIZATIONS. -COLLABORATED WITH LAW ENFORCEMENT REGARDING SUBSTANCE USE: THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE SUBSTANCE ABUSE WORKGROUP TEAMED UP TO PROMOTE PUBLIC EDUCATION, AWARENESS, AND PREVENTION OF PRESCRIPTION DRUG AND OPIOIDS. -NALOXONE TRAINING: ONE OF THE WORKGROUP'S INITIATIVES INCLUDED PROVIDING NALOXONE TRAINING TO 17 INDIVIDUALS IN MCKEAN COUNTY, THE POTTER COUNTY BOROUGH POLICE, AND TO SCHOOL NURSES IN THE REGION. -CONCERNED LAW ENFORCEMENT AGAINST NARCOTICS C.L.E.A.N.: THE C.L.E.A.N. PROTOCOL IS BEING ENACTED IN ASSOCIATION WITH UPMC COLE AND POTTER COUNTY'S DRUG AND ALCOHOL ABUSE SERVICES AND COMES WITH OVERWHELMING SUPPORT FROM STATE AND MUNICIPAL POLICE ACROSS THE COUNTY. THIS PROTOCOL FOCUSES ON REHABILITATING DRUG ABUSERS, ALLOWING THEM TO SEEK HELP FROM POLICE BY REPORTING ADDICTION AND TO TURN OVER DRUG PARAPHERNALIA WITHOUT FEAR OF PROSECUTION. -SUPPORTED COLLABORATIVE DRUG DISPOSAL EFFORTS: THE HOSPITAL CONTINUES TO ENCOURAGE AND SUPPORT THE POTTER COUNTY DRUG AND ALCOHOL PROGRAM WITH ITS ONGOING PLACEMENT OF ADDITIONAL DRUG DISPOSAL DROP BOXES AND TO PROVIDE EDUCATIONAL TRAINING AND MATERIALS TO DISPENSERS AND PRESCRIBERS. IN 2016, A GRANT SECURED THROUGH THE PENNSYLVANIA DISTRICT ATTORNEY'S ASSOCIATION SUPPORTED "PRESCRIPTION DRUG TAKE BACK" BOXES AT FOUR LOCATIONS IN POTTER COUNTY. THIS EFFORT HELPS TO STOP PRESCRIPTION DRUG ABUSE BY REMOVING POTENTIALLY ADDICTIVE MEDICATIONS FROM HOMES THAT MIGHT BE STOLEN AND/OR MISUSED. DURING THE FIRST YEAR OF THE PROGRAM, 160 POUNDS OF MEDICATIONS WERE COLLECTED LOCALLY. -IMPLEMENTED NARCAN TRAINING ACROSS REGION: IN 2017, UPMC COLE'S PHARMACY WAS NAMED POTTER COUNTY'S CENTRALIZED COORDINATING ENTITY (CCE) TO DISTRIBUTE NALOXONE KITS TO FIRST RESPONDERS. TWENTY-FIVE KITS HAVE BEEN DISTRIBUTED TO FIRST RESPONDERS AND SCHOOL DISTRICTS, AND EIGHT TRAINING SESSIONS HAVE BEEN PROVIDED. -SUBSTANCE USE DISORDER SCREENING: THE HOSPITAL DEVELOPED A PLAN TO IMPLEMENT UNIVERSAL SUBSTANCE USE DISORDER SCREENING IN THE PRIMARY CARE NETWORK. IMPROVING HEALTH LITERACY UPMC COLE IS WORKING TO IMPROVE HEALTH LITERACY AND INCREASE COMMUNITY UNDERSTANDING OF BASIC HEALTH INFORMATION AND SERVICES T
SCHEDULE H, PART V, LINE 13H	OTHER FACTORS USED IN ELIGIBILITY CRITERIA: CHARLES COLE MEMORIAL HOSPITAL ALSO USES THE FOLLOWING METHODS: -EMPLOYMENT STATUS ALONG WITH FUTURE EARNINGS POTENTIAL AND ASSESS IF IT IS SUFFICIENT TO MEET THE OBLIGATION WITHIN A REASONABLE PERIOD OF TIME -FAMILY SIZE AND CONFIGURATION -AMOUNT(S) AND FREQUENCY OF HOSPITAL AND OTHER HEALTHCARE/MODIFICATION BILLS IN RELATION TO ALL OTHER FACTORS.
SCHEDULE H, PART V, LINES 16A, 16B & 16C	POLICY PUBLICATION: HTTP://WWW.COLEMEMORIAL.ORG/PATIENTS-FINANCIAL.ASPX
SCHEDULE H, PART V, LINE 16I	LEP TRANSLATIONS: THERE ARE NO GROUPS WITH LIMITED ENGLISH PROFICIENCY THAT RISE TO THE THRESHOLD REQUIRED UNDER IRC SECTION 501(R).

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?12
Name and address		Type of Facility (describe)
1	PORT ALLEGANY HEALTH CENTER 45 PINE STREET PORT ALLEGANY,PA16743	DENTAL PRACTICE, RURAL HEALTH CENTER, REHABILITATION LAB SERVICES, RADIOLOGY
2	SHINGLEHOUSE HEALTH CENTER 129 PURITAN STREET SHINGLEHOUSE,PA16748	RURAL HEALTH CENTER REHABILITATION LAB SERVICES, RADIOLOGY
3	ELDRED HEALTH CENTER 139 MAIN STREET ELDRED,PA16371	RURAL HEALTH CENTER LAB SERVICES
4	EMPORIUM HEALTH CENTER 288 SIZERVILLE ROAD EMPORIUM,PA15834	RURAL HEALTH CENTER REHABILITATION LAB SERVICES
5	GALETON HEALTH CENTER 30 RIVER STREET GALETON,PA16922	RURAL HEALTH CENTER LAB SERVICES
6	WESTFIELD RURAL HEALTH CLINIC 222 CHURCH STREET WESTFIELD,PA16950	RURAL HEALTH CENTER LAB SERVICES
7	BOWMAN HEALTH CENTER 83 MARVIN STREET SMETHPORT,PA16749	RURAL HEALTH CENTER REHABILITATION LAB SERVICES
8	NORTHERN POTTER HEALTH CENTER 511 ACADEMY STREET ULYSSES,PA16948	RURAL HEALTH CENTER LAB SERVICES
9	CENTRAL POTTER HEALTH CENTER 46 ELK STREET COUDERSPORT,PA16915	RURAL HEALTH CENTER LAB SERVICES
10	HOME HEALTH AND HOSPICE 102-108 SOUTH MAIN ST COUDERSPORT,PA16915	HOME HEALTH OFFICES
11	DR VICTOR BROWN DMD 11 8TH STREET COUDERSPORT,PA16915	DENTAL PRACTICE
12	DR TOD TWICHELL DDS 438 EAST 2ND STREET COUDERSPORT,PA16915	DENTAL PRACTICE

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 7, COLUMN F	PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE OF $4,830,522.
SCHEDULE H, PART I, LINE 7G	SUBSIDIZED HEALTH SERVICES: SEVERAL RURAL HEALTH CLINICS WERE INCLUDED IN THE COMPUTATION OF SUBSIDIZED HEALTH SERVICES ON LINE 7G AMOUNTING TO $8,324,769 NET COMMUNITY BENEFIT EXPENSE. UPMC COLE PROVIDES PRIMARY CARE TO THE SURROUNDING COUNTIES AT THESE RURAL HEALTH CENTERS. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. UPMC COLE CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED.
SCHEDULE H, PART I, LINE 7	COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3, AND 6.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ALLOW UPMC COLE TO FULFILL ITS MISSION OF WORKING TOGETHER TO OPTIMIZE THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES COLE SERVES. ONE OF OUR STRATEGIC PRIORITIES IS TO CREATE A CULTURE OF HEALTH FOR THE COMMUNITIES WE SERVE. IN DOING SO, WE NEED TO ADOPT, DEVELOP, CREATE, AND IMPLEMENT THESE COMMUNITY BUILDING ACTIVITIES FOR OUR COMMUNITY RESIDENTS. OUR COMMUNITY BENEFIT ADVISORS, NORTHERN TIER COMMUNITY COLLABORATIVE, AND OUR OUTREACH EFFORTS PLAY A KEY ROLE IN CREATING A CULTURE OF HEALTH AND FULFILLING OUR MISSION.
SCHEDULE H, PART III, SECTION A, LINE 2	BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOPSITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITALS'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2018. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.
SCHEDULE H, PART III, SECTION A, LINE 3	BAD DEBT EXPENSE ATTRIBUTABLE TO FAP-ELIGIBLE PATIENTS: LINE 3 WAS DETERMINED BY MULTIPLYING THE BAD DEBT EXPENSE (LINE 2) BY THE PERCENT OF PERSONS BELOW THE POVERTY LEVEL BASED ON US CENSUS BUREAU DATA FOR 2014 - 2018.
SCHEDULE H, PART III, SECTION A, LINE 4	BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE REGARDING BAD DEBT EXPENSE. THEY DO HOWEVER CONTAIN A FOOTNOTE REGARDING NET PATENT SERVICE REVENUE. THIS NOTE CAN BE FOUND ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. YEAR ENDED JUNE 30, 2018 TO APPROXIMATELY $4,830,000 FOR THE YEAR ENDED JUNE 30, 2019. THE CHANGES ARE A RESULT OF TRENDS IN THE COLLECTION OF AMOUNTS FROM SELF-PAY PATIENTS IN FISCAL YEAR 2019.
SCHEDULE H, PART III, SECTION B, LINE 8	COMMUNITY BENEFIT: MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. UPMC COLE IS CLASSIFIED AS A CRITICAL ACCESS HOSPITAL. THIS CLASSIFICATION SHOWS THAT UPMC COLE IS IN A MEDICALLY UNDERSERVED AREA AND AT A HEALTH PROFESSIONAL SHORTAGE AREA. THIS DEMONSTRATES THAT UPMC COLE IS THE ONLY REASONABLE SOURCE OF HOSPITAL CARE AVAILABLE TO MEDICARE BENEFICIARIES IN OUR SERVICE AREA, AND LIKEWISE TREATS ALL BENEFICIARIES IN OUR SERVICE AREA THAT PRESENT THEMSELVES FOR CARE, DESPITE KNOWING WE WILL GENERALLY LOSE MONEY CARING FOR MEDICARE PATIENTS. ADDITIONALLY, 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.
SCHEDULE H, PART III, SECTION C, LINE 9B	COLLECTION POLICY: EFFORTS ARE MADE TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE IN ACCORDANCE WITH THE HOSPITAL'S CHARITY CARE POLICY OR THE PHYSICIAN NETWORK SLIDING FEE SCALE PRIOR TO THE STATEMENT PROCESS WHEN POSSIBLE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT: UNDERSTANDING THE HEALTH NEEDS OF THE COMMUNITY ALLOWS UPMC COLE TO DESIGN AND IMPLEMENT COST-EFFECTIVE STRATEGIES THAT IMPROVE THE HEALTH STATUS OF THE POPULATIONS WE SERVE. A COMPREHENSIVE DATA-DRIVEN ASSESSMENT PROCESS CAN IDENTIFY PRIORITY HEALTH NEEDS AND ISSUES RELATED TO PREVENTION, DIAGNOSIS, AND TREATMENT THROUGH QUANTITATIVE AND QUALITATIVE DATA. UPMC COLE'S COMMUNITY HEALTH NEEDS ASSESSMENT FOCUSES ON THE 28 ZIP CODES THAT WE SERVE. TO HELP GUIDE THE PROCESS USED FOR THE ASSESSMENT, THE NORTHERN TIRE COMMUNITY HEALTH COLLABORATIVE WAS CONVENED. THIS COLLABORATIVE'S ROLE WAS TO PROVIDE INPUT ON (A) IDENTIFICATION OF EXISTING DATA SOURCES FOR THE STUDY; (B) CONTENT OF THE COMMUNITY ONLINE SURVEY QUESTIONNAIRE; (C) INTERPRETATION OF SURVEY FINDINGS; (D) REVIEW OF RECOMMENDATIONS, AND; (E) DATA DISSEMINATION AND A FOLLOW-UP PLAN. THE COLLABORATIVE WILL CONTINUE TO MEET QUARTERLY WITH THE FOCUS LEADERS THAT HAVE BEEN IDENTIFIED TO ENSURE PROGRESS IS BEING MADE UNDER EACH IDENTIFIED PRIORITY. THE COLLABORATIVE MET TO REVIEW, CONSIDER, AND PRIORITIZE SURVEY DATA AND SECONDARY DATA COLLECTED DURING THIS PROCESS. IN ADDITION TO THE COLLABORATIVE, UPMC COLE'S COMMUNITY BENEFIT ADVISORY COMMITTEES WHICH REPRESENT PUBLIC HEALTH, GOVERNMENT, FORMER AND PRESENT BOARD MEMBERS, FOUNDATIONS, PASTORS, SCHOOL NURSES, AND VARIOUS OTHER ORGANIZATIONS, PROVIDED CRITICAL INPUT INTO THE NEEDS ASSESSMENT, FROM INITIAL CONCEPT TO HOW THE DATA WOULD BE SHARED WITH COMMUNITIES IN OUR WINTER AND SPRING MEETINGS. WE CONDUCTED 2 SURVEYS WITHIN THE COMMUNITIES COLE SERVES FOR COMPLETION BY ANY COMMUNITY RESIDENT, KEY LEADERS OF THE REGION, AND OUR SERVICE PROVIDERS. THE TERMS OF GAINING INPUT SPECIFIED EACH RESPONDENT REMAINED ANONYMOUS. THE ADMINISTRATION OF AN INTERNET-BASED AND PAPER SURVEY WAS PROMOTED THROUGH ADVERTISEMENTS ON FACEBOOK, WEBSITE, BLOGS, AND WAS DISTRIBUTED TO LOCAL CIVIC AND HEALTH ORGANIZATIONS WITH A REQUEST FOR PARTICIPATION. PRELIMINARY CONCLUSIONS OF THE SURVEY RESULTS WERE PRESENTED TO THE COLLABORATIVE, WHICH WERE ASKED TO VALIDATE PRIOR ASSESSMENTS AND TO ESTABLISH PRIORITY AMONG VARIOUS IDENTIFIED HEALTH NEEDS. AFTER A COUPLE OF MONTHS ANALYZING THE PRECEDING DATA AND INFORMATION WE RECEIVED FROM THE SURVEYS AND SECONDARY DATA, WE PUT THE INFORMATION IN FRONT OF OUR BOARD OF DIRECTORS AND COMMUNITY BENEFIT ADVISORS. THEY WERE ASKED TO AGREE OR DISAGREE WITH OUR CURRENT SUMMARY CONCLUSIONS. THEY ALSO WERE AT LIBERTY TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL STATEMENTS. WE MADE OUR COMMUNITY HEALTH NEEDS ASSESSMENT WIDELY AVAILABLE VIA THE WEBSITE. WE ALSO HAVE PLACED HARD COPIES IN OUR ACCOUNTING DEPARTMENT AND COMMUNITY OUTREACH DEPARTMENT.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE PATIENT FINANCIAL COUNSELOR CONTACTS SELF-PAY PATIENTS/GUARANTORS TO DISCUSS PAYMENT ARRANGEMENTS. IF THEY ARE UNABLE TO PAY, SHE EXPLAINS THE PROCESS OF APPLYING FOR CHARITY WHICH INCLUDES APPLYING FOR PA MEDICAL ASSISTANCE FIRST AND IF THEY ARE DENIED OR HAVE A PORTION TO PAY, THEN THEY CAN APPLY FOR CHARITY. THE CHARITY APPLICATION IS ON THE BACK OF OUR SELF-PAY STATEMENTS. ALSO, THE HOSPITAL-OWNED PHYSICIAN PRACTICES ARE AWARE OF THIS PROGRAM AND REFER PATIENTS/GUARANTORS TO THE PATIENT FINANCIAL COUNSELOR.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION: UPMC COLE IS LOCATED IN COUDERSPORT, POTTER COUNTY, IN NORTH-CENTRAL PENNSYLVANIA. THE HOSPITAL SERVES OVER 55,000 RESIDENTS IN ITS PRIMARY AND SECONDARY SERVICE AREAS, ENCOMPASSING CAMERON, MCKEAN, POTTER, AND TIOGA COUNTIES IN PENNSYLVANIA AND PORTIONS OF NEW YORK'S SOUTHERN TIER. ALL OF THE COUNTIES THAT WE SERVE ARE CONSIDERED RURAL AND MOUNTAINOUS. ACCORDING TO THE ROBERT WOODS JOHNSON FOUNDATION COUNTY HEALTH RANKINGS, OUT OF 67 COUNTIES IN PENNSYLVANIA WITH 67 BEING RANKED THE WORST, CAMERON IS RANKED 19, POTTER RANKED 43, TIOGA RANKED 15, AND MCKEAN COUNTY RANKED 54 IN OVERALL HEALTH OUTCOMES. THIS INCLUDES LENGTH OF LIFE AND QUALITY OF LIFE. WHEN IT CAME TO BEING OVERALL RANKED FOR HEALTH FACTORS WHICH INCLUDE HEALTH BEHAVIORS, CLINICAL CARE, SOCIAL AND ECONOMIC FACTORS, AND PHYSICAL ENVIRONMENT; TIOGA RANKED 34, CAMERON RANKED 41, POTTER RANKED 64, AND MCKEAN RANKED 58. THIS IS WHY CONDUCTING A CHNA IS EXTREMELY IMPORTANT AND KNOWING THE NEEDS OF THE COMMUNITIES WE SERVE IS VITAL.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: UPMC COLE IS LARGELY DEPENDENT ON PROVIDING SERVICES AND CARE TO THOSE INDIVIDUALS WHO MAY NOT HAVE THE RESOURCES TO BE AWARE OF, ABLE TO PAY FOR, OR HAVE THE EDUCATION/KNOWLEDGE ABOUT CARE, PROGRAMS AND SERVICES THAT ARE AVAILABLE TO THEM. THROUGH VARIOUS ACTIVITIES, COLE REACHES OUT TO OUR COMMUNITIES TO EDUCATE, IMPROVE HEALTH, PREVENT AND TREAT DISEASE AND SUPPORT INDIVIDUALS AND GROUPS. IN COOPERATION WITH COMMUNITY-BASED GROUPS SUCH AS ROTARIES AND LIBRARIES, PROVIDES FIVE COMPREHENSIVE BLOOD ANALYSIS SCREENINGS ANNUALLY IN FIVE RURAL COMMUNITIES: GALETON, SMETHPORT, PORT ALLEGANY, SHINGLEHOUSE AND COUDERSPORT. CBA'S SCREEN OVER 30 OF THE MOST COMMON BLOOD TESTS THAT DETECT HEALTH ISSUES SUCH AS CORONARY HEART DISEASE, LIVER DISEASE, KIDNEY DISEASE, CANCER, THYROID DISEASE, DIABETES, ANEMIA, BONE DISEASE AND RESPIRATORY DISEASE. THIS YEAR WE INCLUDED HEP. C SCREENING. THESE SCREENINGS ARE PROVIDED AT A FRACTION OF THE COST OF HAVING THESE TESTS PERFORMED THROUGH A FAMILY PHYSICIAN. ALL PARTICIPANTS AND THEIR PRIMARY MEDICAL PROVIDER ARE SENT THE RESULTS AND PROVIDERS FOLLOW-UP WITH INDIVIDUALS WHOSE SCREENING RESULTS INDICATE ABNORMALITIES. FOR MANY INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED AND LIKELY WOULD NOT SEEK MEDICAL CARE UNTIL IT WAS EMERGENT, THESE EVENTS PROVIDE AN AVENUE TO MONITOR THEIR HEALTH AND DETECT POTENTIAL ISSUES BEFORE THEY BECOME EMERGENT. IN ADDITION, THE LOCAL CO-SPONSORS RECEIVE A PORTION OF THE PROCEEDS FROM THESE EVENTS AND UTILIZE THE FUNDS TO PROVIDE SCHOLARSHIPS AND SUPPORT TO LOCAL STUDENTS AND PROJECTS TO BENEFIT THE COMMUNITY. ALSO, IN CONJUNCTION WITH THE AREA AGENCY ON AGING, COLE PROVIDES NO-COST EDUCATION TO COUNTY SENIOR CENTERS FOR A TOTAL OF 30+ SESSIONS. TOPICS INCLUDE IMMUNIZATIONS, COPD, ADVANCE DIRECTIVES, PALLIATIVE CARE, HEART DISEASE, DIET AND NUTRITION, COLE SERVICES AND MANY MORE. ALONG WITH MANY OTHER PROGRAMS SUCH AS SUPPORT GROUPS, SPEAKERS BUREAU, WORKFORCE DEVELOPMENT, ECONOMIC SUPPORT, COMMUNITY LEADERSHIP, PARTNERSHIPS WITH LOCAL CIVIC, GOVERNMENT, SCHOOL DISTRICTS AND COMMUNITY GROUPS, UPMC COLE CONTINUES EFFORTS TO ASSURE THAT HEALTHCARE, IN ALL FORMS, IS ACCESSIBLE AND AVAILABLE TO THOSE WHO MAY OTHERWISE GO WITHOUT. OTHER INFORMATION: UPMC COLE PROVIDES THE COMMUNITY WITH SPACE FOR EVENTS, MEETINGS AND PROGRAMS SUCH AS SUPPORT GROUPS, ANNUAL EVENTS, TRAINING SESSIONS AND YOUTH SPORTS. UPMC COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, FIVE COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN ITS CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES IS TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY AND AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM: THE AFFILIATED HEALTH CARE SYSTEM INCLUDES CHARLES COLE MEMORIAL HOSPITAL (UPMC COLE), COLE CARE, INC., HENDORN, INC., HAMOTCOLE VENTURES, INC. AND COLE FOUNDATION. UPMC COLE (THE HOSPITAL) PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN COUDERSPORT, PENNSYLVANIA. THE HOSPITAL ALSO OPERATES A HOME HEALTH AGENCY AND A NUMBER OF PHYSICIAN CLINICS IN THE SAME GEOGRAPHIC AREA. COLE CARE, INC., A WHOLLY OWNED SUBSIDIARY OF THE HOSPITAL, OPERATES A DURABLE MEDICAL EQUIPMENT COMPANY FOR THE SALE AND RENTAL OF EQUIPMENT. HENDORN, INC., D/B/A COLE MANOR (COLE MANOR), OF WHICH THE HOSPITAL IS THE SOLE CORPORATE MEMBER, OWNS AND OPERATES A 30-BED PERSONAL CARE RESIDENTIAL FACILITY. HAMOTCOLE VENTURES, INC., OF WHICH THE HOSPITAL IS THE SOLE CORPORATE MEMBER, PRIMARILY EARNS REVENUE THROUGH LEASE ARRANGEMENTS OF CERTAIN PROPERTIES IN WESTERN PENNSYLVANIA. COLE FOUNDATION PROVIDES SUPPORT TO THESE ORGANIZATIONS THROUGH FUNDRAISING ACTIVITIES. EFFECTIVE MARCH 1, 2018 CHARLES COLE MEMORIAL HOSPITAL ENTERED INTO AN AFFILIATION AGREEMENT WITH UPMC. AS SUCH, THE HOSPITAL IS NOW PART OF THE UPMC SYSTEM WHICH INCLUDES MANY HOSPITALS AND ADDITIONAL RELATED ORGANIZATIONS SERVING THEIR COMMUNITIES. COMMUNITY BUILDING ACTIVITIES ALLOW UPMC COLE TO FULFILL ITS MISSION OF WORKING TOGETHER TO OPTIMIZE THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES COLE SERVES. ONE OF OUR STRATEGIC PRIORITIES IS TO CREATE A CULTURE OF HEALTH FOR THE COMMUNITIES WE SERVE. IN DOING SO, WE NEED TO ADOPT, DEVELOP, CREATE, AND IMPLEMENT THESE COMMUNITY BUILDING ACTIVITIES FOR OUR COMMUNITY RESIDENTS. OUR COMMUNITY BENEFIT ADVISORS, NORTHERN TIER COMMUNITY COLLABORATIVE, AND OUR OUTREACH EFFORTS PLAY A KEY ROLE IN CREATING A CULTURE OF HEALTH AND FULFILLING OUR MISSION.

Schedule H (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2018

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JASON TRONETTI DO PHYSICIAN/DIRECTOR END 09/18	(i) (ii)	274,453 ------------- 0	107,234 ------------- 0	444 ------------- 0	6,875 ------------- 0	33,848 ------------- 0	422,854 ------------- 0	0 ------------- 0
2CHRISTAN CARAMIA MD PHYSICAN/DIRECTOR END 12/18	(i) (ii)	478,881 ------------- 0	0 ------------- 0	773 ------------- 0	6,875 ------------- 0	30,911 ------------- 0	517,440 ------------- 0	0 ------------- 0
3EDWARD PITCHFORD CEO/PRESIDENT END 01/19	(i) (ii)	482,977 ------------- 0	50,855 ------------- 0	32,165 ------------- 0	130,875 ------------- 0	35,241 ------------- 0	732,113 ------------- 0	0 ------------- 0
4RON RAPP VP OF FINANCE	(i) (ii)	163,590 ------------- 0	15,587 ------------- 0	3,838 ------------- 0	4,698 ------------- 0	31,591 ------------- 0	219,304 ------------- 0	0 ------------- 0
5TIMOTHY BROWN VP OF OPERATIONS	(i) (ii)	156,968 ------------- 0	14,414 ------------- 0	3,724 ------------- 0	4,369 ------------- 0	416 ------------- 0	179,891 ------------- 0	0 ------------- 0
6SAKET PRASAD MD PHYSICIAN	(i) (ii)	602,959 ------------- 0	57,506 ------------- 0	1,405 ------------- 0	6,875 ------------- 0	31,744 ------------- 0	700,489 ------------- 0	0 ------------- 0
7BRADLEY GIANNOTTI MD PHYSICIAN	(i) (ii)	830,999 ------------- 0	1,570 ------------- 0	1,405 ------------- 0	6,875 ------------- 0	23,940 ------------- 0	864,789 ------------- 0	0 ------------- 0
8TERRANCE FOUST DO PHYSICIAN	(i) (ii)	828,858 ------------- 0	7,476 ------------- 0	625 ------------- 0	6,875 ------------- 0	32,330 ------------- 0	876,164 ------------- 0	0 ------------- 0
9MAZEN FOUANY MD PHYSICIAN	(i) (ii)	484,769 ------------- 0	205,010 ------------- 0	500 ------------- 0	6,875 ------------- 0	31,676 ------------- 0	728,830 ------------- 0	0 ------------- 0
10AHMAD AWADA MD PHYSICIAN	(i) (ii)	523,302 ------------- 0	183,231 ------------- 0	25 ------------- 0	6,875 ------------- 0	26,103 ------------- 0	739,536 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

SCHEDULE J, PART I, LINE 4B

NONQUALIFIED RETIREMENT PLAN: UPMC COLE CONTRIBUTED $124,000 TO A 457(F) PLAN FOR EDWARD PITCHFORD, CEO. THE AMOUNT IS BASED ON EMPLOYEMENT AGREEMENT AND YEARS OF SERVICE.

SCHEDULE J, PART I, LINE 7

NON-FIXED PAYMENTS: SOME OF THOSE LISTED IN FORM 990, PART VII RECEIVED PAYOUTS OF ACCRUED BONUSES AND ACCRUED ADDITIONAL BONUSES FOR PARTICIPATING IN THE EXECUTIVE TEAM INCENTIVE COMPENSATION PROGRAM. EACH PARTICIPANT HAD AN ESTABLISHED TARGET TOTAL COMPENSATION BASED ON INDUSTRY SURVEYS AND THE INCENTIVE PROGRAM COMPRISED APPROXIMATELY 10% OF THE TARGETED TOTAL COMPENSATION. THE BONUS WAS BASED ON OVERALL PERFORMANCE.

Schedule J (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) NANCY RUDOLPH	SISTER OF J. MIGLICIO	51,567	EMPLOYEE OF HOSPITAL		No
(2) VICTORIA COPP	SISTER OF J. MIGLICIO	81,627	EMPLOYEE OF HOSPITAL		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Return Reference	Explanation
FORM 990, PART I, LINE 1	ORGANIZATION'S MISSION: UPMC COLE IS A FULL SERVICE, COMPREHENSIVE HEALTH SYSTEM, SERVING POTTER, MCKEAN, CAMERON, AND TIOGA COUNTIES IN RURAL, NORTH CENTRAL PA AND PORTIONS OF NEW YORK STATE AND IS THE ONLY HOSPITAL IN POTTER COUNTY (COUDERSPORT, PA). UPMC COLE IS A CRITICAL ACCESS HOSPITAL PROVIDING PRIMARY, EMERGENCY, AND SPECIALTY CARE, AS WELL AS REHABILITATION AND WELLNESS SERVICES TO PATIENTS WITHIN A 50-MILE RADIUS. UPMC COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, FIVE COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN OUR CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES ARE TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY, AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS AND ACTIVITIES, AND PROMOTE IMPROVED COMMUNICATIONS BETWEEN THE HOSPITAL AND THE COMMUNITY. THE HOSPITAL PROVIDES DEDICATED ADMINISTRATIVE TIME TO PLANNING AND CONDUCTING FIVE CBAC MEETINGS IN THE COMMUNITIES WE SERVE THREE TIMES PER YEAR.
FORM 990, PART III, LINE 4	PROGRAM SERVICE ACCOMPLISHMENTS: LINE 4A UPMC COLES HOME HEALTH AND HOSPICE SERVICES ASSIST PATIENTS THROUGHOUT THE REGION, WITH A GROWING NUMBER OF REFERRALS AND LOWER INFECTION RATES AMONG STATE AND NATIONAL AVERAGES. THIS PAST YEAR WE PROVIDED OVER 22,000 VISITS. LINE 4B TWO OUTLYING CENTERS OFFER IMAGING SERVICES, WHILE ALL RHCS PROVIDE LAB DRAWS SO PATIENTS DON'T HAVE TO DRIVE TO RECEIVE NECESSARY TESTING. IN ADDITION TO THE FAMILY AND INTERNAL MEDICINE SERVICES AT RHCS, PHYSICIAN PRACTICES ALSO PROVIDE SPECIALTY CARE INCLUDING PEDIATRICS, GASTROENTEROLOGY, ORTHOPEDICS, PHYSIATRY, SURGERY, PODIATRY, OBSTETRICS/GYNECOLOGY AND ONCOLOGY. COLE PROVIDED 109,200 PATIENT VISITS THIS PAST YEAR (INCLUDING DENTAL). TOTAL VISITS THIS YEAR WERE 124,300. LINE 4C IN ADDITION TO THE HOSPITAL'S ACUTE CARE FLOORS, UPMC COLE CARES FOR PATIENTS IN ITS 44-BED SKILLED NURSING AND REHABILITATION UNIT WHICH REPORTED 15,075 DAYS LAST YEAR. LINE 4D THE ORGANIZATION ALSO OFFERS CLINICAL SERVICES, CLINICS, AND CORPORATE SERVICES.
FORM 990, PART VI, LINE 1A	VOTING RIGHTS: VOTING RIGHTS OF EXECUTIVE COMMITTEE PER CCMH BYLAWS EFFECTIVE 3/1/2018: SECTION 6.5 EXECUTIVE COMMITTEE. THERE MAY BE AN EXECUTIVE COMMITTEE OF THE BOARD CONSISTING OF DIRECTORS WITH REPRESENTATION SIMILAR TO THE FULL BOARD OF DIRECTORS. ANY EXECUTIVE COMMITTEE OF THE BOARD SHALL BE COMPRISED ONE-THIRD (1/3) OF UPMC DESIGNATED DIRECTORS SELECTED BY UPMC AND TWO-THIRDS (2/3) OF COLE DESIGNATED DIRECTORS SELECTED BY THE COLE DESIGNATED DIRECTORS. THE CHAIR, THE VICE CHAIR AND THE MEMBERS REPRESENTATIVE SHALL BE MEMBERS OF ANY SUCH EXECUTIVE COMMITTEE EX OFFICIO; PROVIDED, THAT THE MEMBERS REPRESENTATIVE SHALL HAVE A VOTE ON SUCH EXECUTIVE COMMITTEE ONLY IF HE OR SHE IS A DIRECTOR. UNLESS OTHERWISE DETERMINED BY THE BOARD AND THE MEMBER, AN EXECUTIVE COMMITTEE OF THE BOARD SHALL HAVE THE AUTHORITY TO FULFILL ALL OF THE DUTIES OF THE BOARD OF DIRECTORS EXCEPT AS TO THOSE MATTERS RESERVED TO THE MEMBER BY THESE BYLAWS, OR TO THE FULL BOARD BY ANY APPLICABLE PROVISION OF THE NON-PROFIT CORPORATION LAW OF PENNSYLVANIA. A MAJORITY OF THE ACTUAL THEN-CURRENT MEMBERSHIP OF ANY EXECUTIVE COMMITTEE OF THE BOARD AND THE PRESENCE OF THE MEMBERS REPRESENTATIVE SHALL CONSTITUTE A QUORUM AND THE VOTE OF A MAJORITY OF THE VOTING EXECUTIVE COMMITTEE MEMBERS PRESENT WHERE A QUORUM EXISTS SHALL CONSTITUTE ACTION BY THE EXECUTIVE COMMITTEE.
FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B	MEMBERS: UPMC IS THE SOLE MEMBER OF CHARLES COLE MEMORIAL HOSPITAL D/B/A UPMC COLE. COLE SHALL BE GOVERNED BY A BOARD OF DIRECTORS CONSISTING AS OF THE EFFECTIVE TIME OF SEVENTEEN (17) VOTING DIRECTORS. OVER TIME, AS SET FORTH IN THE BYLAWS, THE BOARD SHALL BE DECREASED TO THIRTEEN (13) TOTAL DIRECTORS. THE DIRECTORS SHALL BE DESIGNATED AS FOLLOWS: AS OF THE EFFECTIVE TIME, THE BOARD WILL BE COMPRISED OF THIRTEEN (13) COLE DESIGNATED DIRECTORS AND FOUR (4) UPMC DESIGNATED DIRECTORS. THE THIRTEEN (13) COLE DESIGNATED DIRECTORS WILL REFLECT THE MEMBERS ON THE CHARLES COLE MEMORIAL HOSPITAL BOARD IMMEDIATELY PRIOR TO CLOSING. THEREAFTER, THE BOARD SHALL DECREASE, OVER TIME, TO THIRTEEN (13) TOTAL DIRECTORS WHICH SHALL CONSIST OF NINE (9) COLE DESIGNATED DIRECTORS AND FOUR (4) UPMC DESIGNATED DIRECTORS. THE COLE DESIGNATED DIRECTORS SHALL DECREASE TO NINE (9) PERSONS WHEN A COLE DESIGNATED DIRECTOR IS NO LONGER ELIGIBLE TO SERVE, OR UPON HIS OR HER VOLUNTARY OR INVOLUNTARY RESIGNATION UNTIL THE NUMBER OF COLE DESIGNEES IS REDUCED TO NINE (9). THIS COMPOSITION OF NINE (9) COLE DESIGNATED DIRECTORS AND FOUR (4) UPMC DESIGNATED DIRECTORS SHALL CONTINUE THROUGH AT LEAST THE PARTICIPATION PERIOD. THE UPMC DESIGNATED DIRECTORS AND THEIR SUCCESSORS WILL BE APPOINTED BY UPMC. THE MEMBER SHALL HAVE THE FOLLOWING RIGHTS AND POWERS: DURING THE INTEGRATION PERIOD, THE FOLLOWING ACTIONS WILL REQUIRE APPROVAL OF THE COLE BOARD AND UPMC, AND NEITHER UPMC NOR THE COLE 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 COLE AND THE COLE 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, OR MATERIAL CHANGES TO, ANY NEW OR EXISTING AFFILIATIONS OR CONTRACTUAL ARRANGEMENTS OF COLE WITH ANY HOSPITALS, HEALTH SYSTEMS, OR PHYSICIAN GROUPS INCLUDING ANY CUSTOMARY RENEWALS OR EXTENSIONS OF CLINICAL AFFILIATION OR SERVICE AGREEMENTS. (D) APPROVAL OF STRATEGIC PLANS FOR COLE. (E) MATERIAL CHANGES TO EXISTING CONTRACTUAL ARRANGEMENTS OF COLE AND THE COLE ENTITIES WITH PHYSICIANS, AND APPROVAL OF ANY NEW PHYSICIAN CONTRACT PROVIDING FOR ANY EXCLUSIVE PRIVILEGES AT COLE. (F) ENTERING INTO NEW, OR MATERIALLY CHANGING ANY EXISTING, JOINT VENTURE ARRANGEMENTS SPECIFICALLY OF COLE OR THE COLE ENTITIES. (G) APPROVAL OF SELECTION OF THE PRESIDENT OF COLE, AND APPROVAL OF REMOVAL AND COMPENSATION TERMS. (H) APPROVAL OF THE TERMS OF ANY MANAGEMENT ARRANGEMENTS OF ANY COLE ENTITY WITH AN UNRELATED THIRD PARTY. (I) ANY MATERIAL CHANGES TO COLE'S CLINICAL PROGRAMS. (J) ANY CHANGE IN THE CORPORATE STRUCTURE OF COLE OR ANY COLE ENTITY. (K) 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 COLE OR ANY COLE ENTITY. (L) THE MERGER, CONSOLIDATION, DIVESTITURE OR DISSOLUTION OF COLE OR ANY OF ITS SUBSIDIARIES. (M) THE DETERMINATION THAT COLE OR ANY COLE ENTITY WILL NO LONGER BE LICENSED OR OPERATED AS CURRENTLY LICENSED OR OPERATED. (N) ANY AMENDMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF COLE OR ANY COLE ENTITY. (O) SALE OF ANY REAL ESTATE OF OR BY COLE OR ANY COLE ENTITY. AT THE CONCLUSION OF THE INTEGRATION PERIOD, THE POWER TO MAKE DECISIONS WITH RESPECT TO THOSE MATTERS DESCRIBED ABOVE, SHALL REST SOLELY WITH UPMC.
FORM 990, PART VI, SECTION B, LINE 11B	FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON INFORMATION SUPPLIED BY CHARLES COLE MEMORIAL HOSPITAL. THE DRAFT 990 IS REVIEWED BY THE FINANCE DEPARTMENT. IT IS THEN POSTED TO AN ONLINE PORTAL FOR THE BOARD OF DIRECTORS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: MEMBERS OF THE BOARD OF DIRECTORS; BOARD COMMITTEES; SENIOR LEADERS; MIDDLE MANAGEMENT EMPLOYEES; AND MEDICAL STAFF WITH ADMINISTRATIVE RESPONSIBILITIES ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY (CALENDAR YEAR). PURSUANT TO THE AMENDED BYLAWS EFFECTIVE MARCH 1, 2018, SECTION 11.6, "THE BOARD SHALL ADOPT AND MAINTAIN A POLICY CONSISTENT WITH THE POLICY OF THE MEMBER WITH RESPECT TO CONFLICTS OF INTEREST ON THE PART OF THE DIRECTORS, OFFICERS, SENIOR MANAGEMENT, PHYSICIANS, AND OTHER STAFF, AS APPLICABLE, WHICH SHALL INCLUDE A PROCEDURE WITH RESPECT TO DISCLOSURE AND REVIEW OF ACTUAL OR POTENTIAL CONFLICTS AND RELATED INFORMATION. THE CONFLICTS OF INTEREST POLICY OF COLE IN EFFECT AT THE EFFECTIVE TIME SHALL REMAIN IN EFFECT UNTIL SUCH TIME AS THE BOARD ADOPTS A POLICY CONSISTENT WITH THE POLICY OF THE MEMBER." FOR 2018, THE CONFLICT OF INTEREST POLICY AND CONFLICT OF INTEREST STATEMENT WERE REVIEWED 05/09/18 AND, THEREAFTER, THE CONFLICT OF INTEREST STATEMENTS DISTRIBUTED TO THE NOTED PARTIES FOR COMPLETION. THE LEVELS AT WHICH CONFLICT OF INTEREST STATEMENTS WERE REVIEWED, FOR THE PERIOD 07/01/18 - 06/30/19, WERE THE COMPLIANCE OFFICER AND, THEREAFTER, THE THEN EXISTING GOVERNANCE OVERSIGHT COMMITTEE OF THE BOARD OF DIRECTORS ON 08/02/18. AS TO RESTRICTIONS A MEMBER OF THE BOARD OR BOARD COMMITTEE MUST DISCLOSE THE EXISTENCE OF HIS/HER FINANCIAL INTEREST AFTER WHICH A DETERMINATION OF CONFLICT OF INTEREST WILL BE MADE. A VOTING MEMBER OF THE BOARD OF DIRECTORS WHO RECEIVES COMPENSATION DIRECTLY OR INDIRECTLY, AND A VOTING MEMBER OF ANY COMMITTEE WHOSE SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS AND WHO RECEIVE COMPENSATION, DIRECTLY OR INDIRECTLY, ARE PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION; PHYSICIANS WHO RECEIVE COMPENSATION, DIRECTLY OR INDIRECTLY, ARE PRECLUDED FROM MEMBERSHIP ON ANY COMMITTEE WHOSE PRIMARY SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS; AND A MANAGEMENT EMPLOYEE OR A MEDICAL STAFF MEMBER WITH ADMINISTRATIVE RESPONSIBILITIES MUST DISCLOSE TO THE SENIOR LEADER THE EXISTENCE OF THE FINANCIAL INTEREST AND ALL RELATED MATERIAL FACTS. ALSO, THE CONTRACTING POLICY CONTAINS A PROVISION FOR DISCLOSURE OF A FINANCIAL INTEREST ON THE CONTRACT ROUTING FORM.
FORM 990, PART VI, SECTION B, LINES 15A & 15B	COMPENSATION DETERMINATION: ER MATTHEW DEAN, SR DIRECTOR OF COMPENSATION UPMC PARTNERS WITH E&Y AND KORN FERRY ANNUALLY TO CONDUCT A MARKET ANALYSIS FOR CEO'S & TOP 10 EXECUTIVE VP'S. THE MARKET REVIEW IS THEN PRESENTED TO THEIR EXECUTIVE COMPENSATION COMMITTEE FOR REVIEW AND APPROVAL
FORM 990, PART VI, SECTION C, LINE 19	DOCUMENT AVAILABILITY: THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS CAN BE VIEWED ONSITE THROUGH A WRITTEN REQUEST TO THE ORGANIZATION'S CORPORATE COMPLIANCE OFFICER. REQUESTS FOR FINANCIAL STATEMENTS AND 990'S ARE FORWARDED TO THE FINANCE / ACCOUNTING DEPARTMENT AND ARE OPEN FOR PUBLIC INSPECTION.
FORM 990, PART VII, SECTION A	BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE ANY COMPENSATION FOR THEIR DIRECTOR DUTIES. MICHAEL CALLAHAN, DO, IS COMPENSATED BY COLE MEMORIAL AS A PHYSICIAN. JASON TRONETTI, DO, IS COMPENSATED BY COLE MEMORIAL AS A PHYSICIAN. CHRISTAN CARAMIA, MD, IS COMPENSATED BY COLE MEMORIAL AS A PHYSICIAN.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS: $37,258,470 TRANSFER FROM RELATED PARTY 462,316 DEFERRED REVENUE 356,953 MALPRACTICE LIABILITY ------------ $38,077,739
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:7137573
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES TOTAL FEES:6657386
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:5824542
FORM 990 PART IX LINE 11G	DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:1272286
FORM 990 PART IX LINE 11G	DESCRIPTION:DIRECTOR FEES TOTAL FEES:367700

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
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- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) NORTHERN TIER COMM HEALTH COLLABORATIVE 1001 EAST SECOND STREET COUDERSPORT,PA16915 82-0819418	CHNA IMPLEM	PA	0	0	UPMC COLE

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)HENDORN INC DBA COLE MANOR 1001 EAST SECOND STREET COUDERSPORT,PA16915 23-1972659	RESIDENT CARE	PA	501(C)(3)	12A I	UPMC COLE	Yes
(2)HAMOTCOLE VENTURES INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 27-3172100	REAL ESTATE	PA	501(C)(3)	12A I	UPMC COLE	Yes
(3)COLE FOUNDATION 1001 EAST SECOND STREET COUDERSPORT,PA16915 45-5417308	SUPPORT	PA	501(C)(3)	12A I	UPMC COLE	Yes
(4)UPMC 600 GRANT STREET PITTSBURGH,PA15219 25-1423657	SUPPORTNG ORG	PA	501(C)(3)	12C III-FI	NA		No
(5)LAUREL REALTY INC 15 MEADE STREET NO U-6 WELLSBORO,PA16901 23-1403678	REAL ESTATE	PA	501(C)(2)		UPMC SUSQ		No
(6)LAUREL MANAGEMENT SERVICES INC 32-36 CENTRAL AVENUE WELLSBORO,PA16901 25-1644910	MANAGEMENT SV	PA	501(C)(3)	12B II	UPMC SUSQ		No
(7)THE GREEN HOME 37 CENTRAL AVENUE WELLSBORO,PA16901 24-0804365	ASST LIVING	PA	501(C)(3)	10	UPMC SUSQ		No
(8)SOLDIERS AND SAILORS MEMORIAL HOSPITAL 32-36 CENTRAL AVENUE WELLSBORO,PA16901 23-2176963	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQ		No
(9)TIOGA HEALTH CARE PROVIDERS 1705 WARREN AVE STE 302 WILLIAMSPORT,PA17701 25-1765538	HEALTHCARE	PA	501(C)(3)	12B II	UPMC SUSQ		No
(10)UPMC SUSQUEHANNA 1205 GRAMPIAN BLVD WILLIAMSPORT,PA17701 23-2751183	MGMT SUPPORT	PA	501(C)(3)	12B II	UPMC		No
(11)DIVINE PROVIDENCE HOSP OF THE SISTER 1100 GRAMPIAN BLVD WILLIAMSPORT,PA17701 24-0799343	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQ		No
(12)MUNCY VALLEY HOSPITAL 215 E WATER ST MUNCY,PA17756 24-0806023	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQ		No
(13)THE WILLIAMSPORT HOSPITAL 700 HIGH ST WILLIAMSPORT,PA17701 24-0795508	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQ		No
(14)SUSQUEHANNA HEALTH FOUNDATION 1100 GRAMPIAN BLVD WILLIAMSPORT,PA17701 23-2743470	FOUNDATION	PA	501(C)(3)	12A I	UPMC SUSQ		No
(15)SUSQUEHANNA PHYSICIAN SERVICES 1201 GRAMPIAN BLVD WILLIAMSPORT,PA17701 23-2449454	PHYSICIAN SVC	PA	501(C)(3)	3	UPMC SUSQ		No
(16)WILLIAMSPORT AREA AMBULANCE SERVICES 700 HIGH ST WILLIAMSPORT,PA17701 23-2416166	AMBULANCE SVC	PA	501(C)(3)	10	WILLIAM HOSP		No
(17)LAUREL HEALTH SYSTEM 32-36 CENTRAL AVE WELLSBORO,PA16901 24-0795488	SUPPORT SVC	PA	501(C)(3)	12B II	UPMC SUSQ		No
(18)SUSQUEHANNA HEALTH INNOVATION CENTER 700 HIGH STREET WILLIAMSPORT,PA17701 47-1600873	SUPPORT SVC	PA	501(C)(3)	12A I	UPMC SUSQ		No
(19)UPMC SENIOR COMMUNITIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1574736	SR. LIVING	PA	501(C)(3)	10	UPMC		No
(20)PITTSBURGH LIFETIME CARE COMMUNITY 600 GRANT STREET PITTSBURGH,PA15219 25-1335247	CCRC	PA	501(C)(3)	10	UPMC SR COMM		No
(21)CANTERBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-0965334	SR LIVING	PA	501(C)(3)	10	UPMC SR COMM		No
(22)SENECA PLACE 600 GRANT STREET PITTSBURGH,PA15219 72-1562844	SR. LIVING	PA	501(C)(3)	10	UPMC SR COMM		No
(23)SHADYSIDE HOSPITAL SUPPORTING FND 600 GRANT STREET PITTSBURGH,PA15219 26-0303394	FOUNDATION	PA	501(C)(3)	12A I	UPMC		No
(24)UPMC LEE 600 GRANT STREET PITTSBURGH,PA15219 25-0613830	INACTIVE	PA	501(C)(3)	3	UPMC		No
(25)PITTSBURGH CARE PARTNERSHIP INC 600 GRANT STREET PITTSBURGH,PA15219 25-1753852	SR CARE MGMT	PA	501(C)(3)	10	UPMC		No
(26)UPMC CENTER FOR HIGH VALUE HEALTHCARE 600 GRANT STREET PITTSBURGH,PA15219 45-2178782	RESEARCH	PA	501(C)(3)	7	UPMC		No
(27)SHADYSIDE HOSPITAL FOUNDATION 532 SOUTH AIKEN AVE PITTSBURGH,PA15232 25-1290546	FOUNDATION	PA	501(C)(3)	12C III-FI	UPMC PRESBY		No
(28)PASSAVANT HOSPITAL FOUNDATION 9100 BABCOCK BLVD PITTSBURGH,PA15237 25-1407815	FOUNDATION	PA	501(C)(3)	12B II	UPMC PASS		No
(29)UPMC NORTHWEST FOUNDATION 100 FAIRFIELD DRIVE SENECA,PA16346 25-1483624	FOUNDATION	PA	501(C)(3)	12D III-O	UPMC NORTHWE		No
(30)ST MARGARET FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1520340	FOUNDATION	PA	501(C)(3)	7	UPMC ST MARG		No
(31)MAGEE-WOMEN RES INST AND FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1462312	FOUNDATION	PA	501(C)(3)	7	UPMC ST MARG		No
(32)UPMC KANE 4372 ROUTE 6 KANE,PA16735 25-0998168	HOSPITAL	PA	501(C)(3)	3	UPMC HAMOT		No
(33)GREAT LAKES PHYSICIAN PRACTICE 600 GRANT STREET 58TH FLOOR PITTSBURGH,PA15219 46-4186362	PHYSICIAN SRV	NY	501(C)(3)	3	REGNL HEALTH		No
(34)CHILDREN'S HOSPITAL OF PITTSBURGH FND 600 GRANT STREET PITTSBURGH,PA15219 25-1865744	FOUNDATION	PA	501(C)(3)	7	UPMC CHP		No
(35)HAMOT HEALTH FOUNDATION 302 FRENCH STREET ERIE,PA16507 25-1400999	FOUNDATION	PA	501(C)(3)	12B II	UPMC HAMOT		No
(36)SAFE HARBOR BEHAVIORAL HLTH OF UPMC HA 1330 W 26TH STREET ERIE,PA16508 25-1317492	BEHAVIOR HLTH	PA	501(C)(3)	7	UPMC HAMOT		No
(37)UPMC JAMESON 1211 WILMINGTON AVE NEW CASTLE,PA16105 25-0965406	HEALTHCARE	PA	501(C)(3)	3	UPMC		No
(38)JAMESON HEALTHCARE FOUNDATION 1211 WILMINGTON AVE NEW CASTLE,PA16105 25-1536037	FOUNDATION	PA	501(C)(3)	12B II	UPMC JAMESON		No
(39)JAMESON HEALTH SERVICES INC 1211 WILMINGTON AVE NEW CASTLE,PA16105 03-0486993	SUPPORTNG ORG	PA	501(C)(3)	12B II	UPMC JAMESON		No
(40)CHILDREN'S ADVOCACY CENTER OF LAWRENCE 1107 WILMINGTON AVE NEW CASTLE,PA16105 25-1581304	COORD SRVS	PA	501(C)(3)	7	UPMC JAMESON		No
(41)UPMCJAMESON CANCER CENTER 600 GRANT ST PITTSBURGH,PA15219 20-1459415	ONCOLOGY SVC	PA	501(C)(3)	10	UPMC JAMESON		No
(42)JAMESON MEDICAL CARE INC 1211 WILMINGTON AVE NEW CASTLE,PA16105 26-0462696	PHYSICIAN SRV	PA	501(C)(3)	10	UPMC JAMESON		No
(43)JAMESON CARE CENTER INC 1211 WILMINGTON AVE NEW CASTLE,PA16105 23-2871396	SR SERVICES	PA	501(C)(3)	10	UPMC SR COMM		No
(44)VENANGO VNA FOUNDATION 491 ALLEGHENY BLVD FRANKLIN,PA16323 25-1472179	FOUNDATION	PA	501(C)(3)	12D III-O	UPMC VISITIN		No
(45)UPMC CHAUTAUQUA AT WCA 207 FOOTE AVE JAMESTOWN,NY14701 16-0743226	HOSPITAL	NY	501(C)(3)	3	UPMC CHAUTAU		No
(46)WCA GROUP INC 207 FOOTE AVE JAMESTON,NY14701 22-2392582	HOLDING CO	NY	501(C)(3)	12B II	UPMC CHAUTAU		No
(47)STARFLIGHT INC 135 ALLEN STREET JAMESTOWN,NY14701 16-1557878	AIR AMBULANCE	NY	501(C)(3)	7	UPMC CHAUTAU		No
(48)SOUTH CENTRAL ALPHA HOUSING AND HEALTH 3410 W PITTSBURGH RD NEW CASTLE,PA16101 25-1701701	SNF AND AL	PA	501(C)(3)	10	UPMC SR COMM		No
(49)SOUTH WESTERN ALPHA HOUSING AND HEALTH 745 GREENVILLE RD MERCER,PA16137 25-1701700	SNF AND IL	PA	501(C)(3)	10	UPMC SR COMM		No
(50)KANE COMMUNITY HOSPITAL FOUNDATION 4372 ROUTE 6 KANE,PA16735 26-3906925	FOUNDATION	PA	501(C)(3)	12B II	UPMC KANE		No
(51)JUNIOR GUILD OF JAMESON MEMORIAL HOS 1211 WILMINGTON AVE NEW CASTLE,PA16105 25-6005313	SUPPORT	PA	501(C)(3)	12D III-O	UPMC JAMESON		No
(52)WCA FOUNDATION INC 300 FOOTE AVE PO BOX 840 JAMESTOWN,NY14702 22-2393584	FOUNDATION	PA	501(C)(3)	12C III-FI	UPMC CHAUTAU		No
(53)LAUREL HEALTH FOUNDATION 15 MEADE STREET U-6 WELLSBORO,PA16101 25-1810488	FOUNDATION	PA	501(C)(3)	12B II	LAUR H SYSTM		No
(54)UPMC HAMOT 201 STATE STREET ERIE,PA16550 25-0965387	HOSPITAL	PA	501(C)(3)	3	UPMC		No
(55)UPMC PINNACLE 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778658	SUPPORTNG ORG	PA	501(C)(3)	12B II	UPMC		No
(56)UPMC PINNACLE CARLISLE 361 ALEXANDER SPRING ROAD CARLISLE,PA17105 82-0880337	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(57)UPMC PINNACLE LANCASTER 250 COLLEGE AVENUE LANCASTER,PA17603 82-0896436	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(58)UPMC PINNACLE LITITZ 1500 HIGHLANDS AVENUE LITITZ,PA17543 82-0844453	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(59)UPMC PINNACLE MEMORIAL 325 SOUTH BELMONT STREET YORK,PA17405 82-0912090	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(60)PINNACLE HEALTH REGIONAL PHYSICIANS 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-0947698	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC PINNACL		No
(61)PINNACLE HEALTH FOUNDATION 409 SOUTH SECOND STREET HARRISBURG,PA17104 22-2691718	FOUNDATION	PA	501(C)(3)	12B II	UPMC PINNACL		No
(62)COMMUNITY LIFE TEAM INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1890444	MED TRANSPORT	PA	501(C)(3)	7	UPMC PINNACL		No
(63)HANOVER HEALTHCARE PLUS INC 300 HIGHLAND AVENUE HANOVER,PA17331 22-2658574	SUPPORTNG ORG	PA	501(C)(3)	12A I	NA		No
(64)UPMC PINNACLE HANOVER 300 HIGHLAND AVENUE HANOVER,PA17331 23-1360851	HOSPITAL	PA	501(C)(3)	3	HANOVER HEAL		No
(65)PINNACLE HEALTH MEDICAL SERVICES 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1709054	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC PINNACL		No
(66)UPMC PINNACLE HOSPITALS 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778644	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(67)ASBURY HEIGHTS OF UPMC 600 GRANT STREET PITTSBURGH,PA15219 25-1555687	SUPPORTNG ORG	PA	501(C)(3)	12B II	UPMC SR COMM		No
(68)ASBURY HEALTH CENTER 600 GRANT STREET PITTSBURGH,PA15219 25-0969472	CCRC	PA	501(C)(3)	10	ASBURY HEIGH		No
(69)ASBURY VILLAS 600 GRANT STREET PITTSBURGH,PA15219 25-1819952	PERSONAL CARE	PA	501(C)(3)	10	ASBURY HEIGH		No
(70)ASBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-1729266	PERSONAL CARE	PA	501(C)(3)	10	ASBURY HEIGH		No
(71)WESLEY HILLS 600 GRANT STREET PITTSBURGH,PA15129 25-1507472	INDEP LIVING	PA	501(C)(3)	PF	ASBURY HEIGH		No
(72)ASBURY FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1555688	FOUNDATION	PA	501(C)(3)	7	ASBURY HEIGH		No
(73)UPMC HOME CARE MANAGEMENT SERVICES 600 GRANT STREET PITTSBURGH,PA15219 83-0857507	HOME HEALTH	PA	501(C)(3)	10	UPMC COMM PR		No
(74)UPMC SUSQUEHANNA LOCK HAVEN 700 HIGH STREET WILLIAMSPORT,PA17701 82-1600494	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQUEH		No
(75)UPMC SUSQUEHANNA SUNBURY 700 HIGH STREET WILLIAMSPORT,PA17701 82-1592230	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQUEH		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) COMMUNITY BASKET 1205 GRAMPIAN BLVD WILLIAMSPORT,PA17701 20-1195739	REAL ESTATE	PA	NA	N/A				No			No
(2) SENECA HILLS ASSISTED LIVING 600 GRANT STREET PITTSBURGH,PA15219 23-2873106	ASSISTED LIVING	PA	NA	N/A				No			No
(3) ST MARGARET MEDICAL ARTS ASSOC 600 GRANT STREET PITTSBURGH,PA15219 25-1786655	MED OFFICE BL	PA	NA	N/A				No			No
(4) CORE NETWORK LLC 600 GRANT STREET PITTSBURGH,PA15219 25-1786209	HEALTHCARE	PA	NA	N/A				No			No
(5) LIFE HOME CARE LP 600 GRANT STREET PITTSBURGH,PA15219 25-1847839	HOMECARE	PA	NA	N/A				No			No
(6) SHADYSIDE MEDICAL CENTER ASSOC 600 GRANT STREET PITTSBURGH,PA15219 25-1608318	MED OFFICE BL	PA	NA	N/A				No			No
(7) CHARTWELL PA LP 600 GRANT STREET PITTSBURGH,PA15219 25-1729714	HOME HEALTH	PA	NA	N/A				No			No
(8) LIFE CARE HOME SRV OF NW PA 1647 SASSAFRAS ST ERIE,PA16507 25-1536879	HOME HEALTH	PA	NA	N/A				No			No
(9) HAMOT-KCH REAL ESTATE VENTURE 300 STATE ST ERIE,PA16507 26-3691782	MEDICAL OFFICE	PA	NA	N/A				No			No
(10) HAMOT SURGERY CENTER LLC 200 STATE STREET ERIE,PA16507 25-1863661	AMBULATORY SURG	PA	NA	N/A				No			No
(11) EPN-HAMOT URGENT CARE LLC 600 GRANT STREET PITTSBURGH,PA15219 27-2147949	URGENT CARE	PA	NA	N/A				No			No
(12) MOUNTAIN VIEW MEDICAL ONCOLOGY 600 GRANT STREET PITTSBURGH,PA15219 46-1449241	HEALTHCARE	PA	NA	N/A				No			No
(13) LAWRENCE COUNTY MRI AND DIAGNOST 2526 WILMINGTON AVE NEW CASTLE,PA16105 27-0219891	IMAGING CENTER	PA	NA	N/A				No			No
(14) HANOVER SURGICENTER REAL ESTATE 300 HIGHLAND AVE HANOVER,PA17331 35-2342993	INACTIVE	PA	NA	N/A				No			No
(15) MEDCARE SUSQUEHANNA VALLEY LLC 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-1673688	DME	PA	NA	N/A				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) COLE CARE INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 25-1497347	DURABLE MED EQUIP	PA	UPMC COLE	C CORP	8,874,663	1,437,719	100.000 %	Yes
(2) TYOGA CARENET 114 EAST AVE WELLSBORO,PA16901 25-1810967	INTEGRATION HC	PA	NA	C CORP					No
(3) SUSQUEHANNA VENTURES INC 1201 GRAMPIAN BLVD WILLIAMSPORT,PA17701 23-2470263	PHARMACY	PA	NA	N/A					No
(4) SUSQUEHANNA HEALTH SYS INS NETWORK LTD PO BOX 1159 KY1-1102 GRAND CAYMANS,CAYMAN ISLANDS CJ 98-0458722	CAPTIVE INSURANCE	CJ	NA	C CORP					No
(5) HC PHARMACY CENTRAL INC 600 GRANT STREET PITTSBURGH,PA15219 25-1364192	PHARMACY CO-OP	PA	NA	C CORP					No
(6) CHILDREN'S COMMUNITY CARE 600 GRANT STREET PITTSBURGH,PA15219 25-1781887	PEDIATRIC SVC	PA	NA	C CORP					No
(7) UPMC CANCER CENTERS IRELAND LIMITED 6TH FLOOR BEACON HOSPITAL SANDYFORD,DUBLIN EI	CANCER TREATMENT	EI	NA	C CORP					No
(8) UPMC PHYSICIAN SERVICES HOLDING COMPANY 600 GRANT STREET PITTSBURGH,PA15219 25-1877017	HOLDING CO	PA	NA	C CORP					No
(9) ONCOLOGY HEMATOLOGY ASSOC 600 GRANT STREET PITTSBURGH,PA15219 25-1762980	HEALTHCARE	PA	NA	C CORP					No
(10) TRI-STATE NEUROSURGICAL ASSOC 600 GRANT STREET PITTSBURGH,PA15219 25-1458655	HEALTHCARE	PA	NA	C CORP					No
(11) RENAISSANCE FAMILY PRACTICE-UPMC INC 600 GRANT STREET PITTSBURGH,PA15219 26-2942206	HEALTHCARE	PA	NA	C CORP					No
(12) UPMC HOLDING COMPANY INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777713	HOLDING CO	PA	NA	C CORP					No
(13) UPMC COVERAGE PRODUCTS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777710	HOLDING CO	PA	NA	C CORP					No
(14) FREEDOM INSURANCE COMPANY 600 GRANT STREET PITTSBURGH,PA15219 03-0308944	INSURANCE	VT	NA	C CORP					No
(15) TRI-CENTURY INSURANCE CO 600 GRANT STREET PITTSBURGH,PA15219 25-1500739	INSURANCE	PA	NA	C CORP					No
(16) UPMC DNA INC 600 GRANT STREET PITTSBURGH,PA15219 25-1883237	INSURANCE	PA	NA	C CORP					No
(17) UPMC HEALTH BENEFITS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1844144	HEALTH INSURANCE	PA	NA	C CORP					No
(18) UPMC HEALTH NETWORK INC 600 GRANT STREET PITTSBURGH,PA15219 72-1527566	HEALTH INSURANCE	PA	NA	C CORP					No
(19) UPMC HEALTH PLAN INC 600 GRANT STREET PITTSBURGH,PA15219 23-2813536	HEALTH INSURANCE	PA	NA	C CORP					No
(20) UPMC BENEFIT MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1769564	WORKER'S COMP	PA	NA	C CORP					No
(21) UPMC DIVERSIFIED SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1778454	HOLDING CO	PA	NA	C CORP					No
(22) MONROEVILLE SPECIALTY CLINIC 600 GRANT STREET PITTSBURGH,PA15219 25-1666087	HEALTHCARE	PA	NA	C CORP					No
(23) MEDICAL ARCHIVAL SYSTEMS INC 600 GRANT STREET PITTSBURGH,PA15219 23-2912501	SOFTWARE DEVELOP	DE	NA	C CORP					No
(24) PRESBY HEALTH RESOURCE MGMT 600 GRANT STREET PITTSBURGH,PA15219 25-1422155	HEALTHCARE	PA	NA	C CORP					No
(25) RX PARTNERS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1801966	RETAIL PHARMACY	PA	NA	C CORP					No
(26) BIOTRONICS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1843500	EQUIP MAINTENANCE	PA	NA	C CORP					No
(27) MEDICAL CENTER PROPERTIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1796940	REAL ESTATE	PA	NA	C CORP					No
(28) ASKESIS DEVELOPMENT GROUP INC 600 GRANT STREET PITTSBURGH,PA15219 54-1625585	SOFTWARE DEVELOP	DE	NA	C CORP					No
(29) PANTER REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN CJ	INSURANCE	CJ	NA	C CORP					No
(30) FORBES REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN CJ	INSURANCE	CJ	NA	C CORP					No
(31) CATHEDRAL (RE) INSURANCE CO PO BOX 1109 GRAND CAYMAN CJ	INSURANCE	CJ	NA	C CORP					No
(32) UPMC INTERNATIONAL HEALTH INITIATIVES 600 GRANT STREET PITTSBURGH,PA15219 84-1706741	INACTIVE	PA	NA	C CORP					No
(33) UPMC IRELAND LIMITED 6TH FLOOR BEACON HOSPITAL SANDYFORD,DUBLIN EI	HEALTHCARE SU	EI	NA	C CORP					No
(34) UPMC UNITED KINGDOM LTD C/O NAIRCO 11TH FLOOR WHITEFRIARS LEWINS MEAD,BRISTOL UK 98-0571026	SOFTWARE LICENSE	UK	NA	C CORP					No
(35) BAYFRONT REGIONAL DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401388	RE HOLDING CO	PA	NA	C CORP					No
(36) BAYSIDE DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401386	REAL ESTATE	PA	NA	C CORP					No
(37) UPMC WORK ALLIANCE INC 600 GRANT STREET PITTSBURGH,PA15219 45-2825053	INSURANCE	PA	NA	C CORP					No
(38) UPMC CANADA TECHNOLOGIES LIMITED 600 GRANT STREET PITTSBURGH,PA15219	SOFTWARE	CA	NA	C CORP					No
(39) ALLIED ORTHOPEDICS APPLIANCES INC 335 E 3RD ST JAMESTOWN,NY14701 16-1092951	MED APPLIANCE	PA	NA	C CORP					No
(40) UPMC HEALTH COVERAGE INC 600 GRANT STREET PITTSBURGH,PA15219 46-2824537	INSURANCE	PA	NA	C CORP					No
(41) UPMC COMPLETE CARE INC 5215 CENTRE AVE PITTSBURGH,PA15232 46-3605753	HEALTHCARE	PA	NA	C CORP					No
(42) AMERICAN HOME HEALTH SERVICES 868 CORPORATE WAY WESTLAKE,OH44145 31-1521422	HOME HEALTH	OH	NA	C CORP					No
(43) HEALTH FIDELITY INC 210 S B ST SAN MATEO,CA94401 45-2538963	TECHNOLOGY	CA	NA	C CORP					No
(44) FLUENCE HEALTH INC 6425 PENN AVE PITTSBURGH,PA15206 47-2684174	SOFTWARE	DE	NA	C CORP					No
(45) CURAVI HEALTH INC 6425 PENN AVE PITTSBURGH,PA15206 81-1217377	HEALTHCARE	DE	NA	C CORP					No
(46) PENSIAMO INC 600 GRANT STREET PITTSBURGH,PA15219 81-2069236	SUPPLY CHAIN	DE	NA	C CORP					No
(47) ALTOONA FAMILY INC 620 HOWARD AVE ALTOONA,PA16601 25-1444935	MGMT SVCS	PA	NA	C CORP					No
(48) LEXINGTON HOLDINGS INC 620 HOWARD AVE ALTOONA,PA16601 25-1794386	MEDICAL SVCS	PA	NA	C CORP					No
(49) LEXINGTON ONE INC 620 HOWARD AVE ALTOONA,PA16601 25-1468889	RENTAL	PA	NA	C CORP					No
(50) LEXINGTON TWO INC HOWARD AVE 7TH ST ALTOONA,PA16601 25-1555689	RENTAL EQPT	PA	NA	C CORP					No
(51) LEXINGTON FOUR INC 620 HOWARD AVE ALTOONA,PA16601 25-1793736	HOLDING CO	PA	NA	C CORP					No
(52) ALLEGHENY HEALTHCARE STAFFING INC 620 HOWARD AVE ALTOONA,PA16601 27-1657362	EMPLOYMENT SVCS	PA	NA	C CORP					No
(53) UPMC ALTOONA REGIONAL HEALTH SERVICES 1414 9TH AVE ALTOONA,PA16602 25-1219302	MEDICAL SVCS	PA	NA	C CORP					No
(54) LEXINGTON ANESTHESIA ASSOCIATES INC 620 HOWARD AVE ALTOONA,PA16601 25-1897765	MEDICAL SVCS	PA	NA	C CORP					No
(55) NORTHERN CAMBRIA MEDICAL CENTER INC 620 HOWARD AVE ALTOONA,PA16601 25-1530860	MEDICAL SVCS	PA	NA	C CORP					No
(56) PATTON FAMILY MEDICAL CENTER INC 620 HOWARD AVE ALTOONA,PA16601 25-1793735	MEDICAL SVCS	PA	NA	C CORP					No
(57) MEDCPU 100 WALL STREET NEW YORK,NY10005 38-3805381	SOFTWARE DEVELOP	DE	NA	C CORP					No
(58) UPMC ECESS PL TR 600 GRANT STREET PITTSBURGH,PA15219 82-6254351	TRUST	PA	NA	TRUST					No
(59) RXANTE INC 511 CONGRESS STREET PORTLAND,ME04101 45-4040219	MEDICATION MGT	DE	NA	C CORP					No
(60) VINCENT PAYMENT SOLUTIONS INC 6425 PENN AVE PITTSBURGH,PA15219 82-1101143	PAYMENT SYSTEM	DE	NA	C CORP					No
(61) J HEALTH VENTURES INC 1211 WILMINGTON AVE NEW CASTLE,PA16105 25-1607893	INACTIVE	PA	NA	C CORP					No
(62) JER MEDICAL ASSOCIATES INC 1211 WILMINGTON AVE NEW CASTLE,PA16105 25-1609398	INACTIVE	PA	NA	C CORP					No
(63) WCA SERVICE CORPORATION INC 207 FOOTE AVE JAMESTOWN,NY14701 16-1151438	SUPPORT	NY	NA	C CORP					No
(64) HEMATOLOGY ONCOLOGY ASSOC 600 GRANT STREET PITTSBURGH,PA12519 42-1648357	HEALTHCARE	PA	NA	C CORP					No
(65) UPMC HEALTH OPTIONS INC 600 GRANT STREET PITTSBURGH,PA15219 46-2824626	INSURANCE	PA	NA	C CORP					No
(66) ITTCCO I INC 600 GRANT STREET PITTSBURGH,PA15219 82-2590699	INACTIVE	DE	NA	C CORP					No
(67) ITTCCO II INC 600 GRANT STREET PITTSBURGH,PA15219 82-2597388	INACTIVE	DE	NA	C CORP					No
(68) PINNACLE HEALTH CARDIOVASCULAR INSTITUT 409 SOUTH SECOND STREET HARRISBURG,PA17104 32-0321362	PHYSICIAN SRV	PA	NA	C CORP					No
(69) HANOVER HEALTH CORPORATION 300 HIGHLAND AVENUE HANOVER,PA17331 90-0498067	HOLDING CO	PA	NA	C CORP					No
(70) HANOVER APOTHECARY INC 310 STOCK STREET SUITE 1 HANOVER,PA17331 03-0594526	PHARMACY	PA	NA	C CORP					No
(71) UNITED CENTRAL PA RECIPROCAL RISK RETEN 76 SAINT PAUL STREET SUITE 500 BURLINGTON,VT05401 13-4224033	INSURANCE	VT	NA	C CORP					No
(72) PINNACLE HEALTH VENTURES INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 61-1677624	HOLDING CO	PA	NA	C CORP					No
(73) PINNACLE HEALTH IMAGING INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1718571	IMAGING SVC	PA	NA	C CORP					No
(74) UPMC ITALY HEALTH SERVICES SRL VIA DISCESA DEI GIUDICI 4 PALERMO 90133 IT	HEALTH SVC	IT	NA	C CORP					No
(75) UPMC INVESTMENTS LTD C/O UPMC WHITFIELD CORK ROAD BUTLER,WATERFORDX91 DH IT	HOLDING CO	EI	NA	C CORP					No
(76) UPMC PROPERTY LTD C/O UPMC WHITFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY	EI	NA	C CORP					No
(77) UPMC PROPERTY II LTD C/O UPMC WHITFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY	EI	NA	C CORP					No
(78) EURO CARE INFRASTRUCTURE LTD C/O UPMC WHITFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY MGMT	EI	NA	C CORP					No
(79) EURO CARE PROPERTY MANAGEMENT LTD C/O UPMC WHITFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY MGMT	EI	NA	C CORP					No
(80) EURO CARE HEALTHCARE LTD C/O UPMC WHITFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	HOSPITAL	EI	NA	C CORP					No
(81) WATERFORD ONCOLOGY ASSOCIATES LTD C/O UPMC WHITFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	ONCOLOGY SVC	EI	NA	C CORP					No
(82) UNITED HEALTH RISK LTD PO BOX HM 2450 HAMILTON BD	INSURANCE	BD	NA	C CORP					No

Schedule R (Form 990) 2018

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) COLE CARE INC	A/J	195,571	FMV
(2) COLE FOUNDATION	C	72,657	FMV
(3) COLE CARE INC	L	217,296	FMV
(4) HENDORN INC	L	42,720	FMV
(5) HENDORN INC	M	414,774	FMV
(6) COLE CARE INC	O	12,367,304	FMV
(7) COLE CARE INC	P	76,278	FMV
(8) HAMOTCOLE VENTURES INC	K	424,200	FMV
(9) HENDORN INC	R	150,000	FMV
(10) HAMOTCOLE VENTURES INC	R	400,000	FMV
(11) COLE FOUNDATION	R	184,120	FMV
(12) HAMOTCOLE VENTURES INC	S	651,771	FMV

Schedule R (Form 990) 2018

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation
SCHEDULE R, PARTS II, III, AND IV	UPMC SYSTEM ENTITIES: THE ENTITIES MARKED WITH AN ASTERISK 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.

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE HOSPITAL IS COMMITTED TO PROVIDING COMPREHENSIVE, COMMUNITY BASED HEALTH CARE. OUR ULTIMATE GOAL IS TO KEEP INDIVIDUALS IN OUR COMMUNITIES SAFE AND HEALTHY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	679
6	Total number of volunteers (estimate if necessary) .............	6	64
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	91,350
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	84,782

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	614,225	393,300
9	Program service revenue (Part VIII, line 2g) .........	96,715,102	99,579,526
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,449,836	127,406
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	462,933	-287,841
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	99,242,096	99,812,391
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	41,053,677	40,574,922
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	55,596,775	55,746,220
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	96,650,452	96,321,142
19	Revenue less expenses. Subtract line 18 from line 12.......	2,591,644	3,491,249
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	45,615,938	79,772,691
21	Total liabilities (Part X, line 26).............	18,514,260	11,000,802
22	Net assets or fund balances. Subtract line 21 from line 20.....	27,101,678	68,771,889

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 28,112,950 including grants of $ ) (Revenue $ 45,190,642 )
	UPMC COLE OFFERS OUTPATIENT SERVICES, EXCEEDING 411,000 TESTS/TREATMENTS ANNUALLY THROUGHOUT THE HOSPITAL'S FOUR-COUNTY AREA AND INCLUDING IMAGING, LAB, CARDIO-PULMONARY, ONCOLOGY, HOME HEALTH, WOUND CARE AND REHABILITATION SERVICES. OUTPATIENT SURGERIES EXCEED 5,000 ANNUALLY. THE PATTERSON CANCER CARE CENTER OFFERS FULL SERVICE RADIATION AND MEDICAL ONCOLOGY SERVICES AND HOUSES AN AMERICAN CANCER SOCIETY PATIENT RESOURCE CENTER ONSITE. THE CANCER CENTER IS HOME TO A VARIETY OF SUPPORT GROUPS, AS WELL AS FREQUENT FREE CANCER SCREENINGS FOR THE PUBLIC. SEE SCHEDULE O FOR DETAIL.

4b	(Code: ) (Expenses $ 26,322,300 including grants of $ ) (Revenue $ 21,726,436 )
	UPMC COLE PROVIDES PRIMARY CARE TO ITS SURROUNDING COMMUNITIES. THE HOSPITAL PROVIDES PRIMARY CARE TO THE SURROUNDING COMMUNITIES IN FOUR COUNTIES AT RURAL HEALTH CENTERS(RHCS), LOCATED IN COUDERSPORT, GALETON, ULYSSES, WESTFIELD, SHINGLEHOUSE, PORT ALLEGANY, ELDRED, SMETHPORT, AND EMPORIUM. COLLECTIVELY, 114,600 PATIENT VISITS WERE REPORTED LAST YEAR IN ADDITION TO 9,700 DENTAL VISITS. FOUR OF THOSE LOCATIONS ALSO INCLUDE WELLNESS AND REHABILITATION CENTERS, MAKING IT MORE CONVENIENT FOR PATIENTS TO RECEIVE THE SERVICES AND CARE THEY NEED CLOSE TO HOME. SEE SCHEDULE O FOR DETAIL.

4c	(Code: ) (Expenses $ 18,483,684 including grants of $ ) (Revenue $ 20,125,760 )
	UPMC COLE OFFERS VARIOUS INPATIENT SERVICES. UPMC COLE ADMITTED 1,500 ACUTE PATIENTS LAST YEAR (4,500 ACUTE CARE DAYS) TO INPATIENT SERVICES INCLUDING MEDICAL/SURGICAL, INTENSIVE CARE AND OBSTETRICS UNITS. UPMC COLE'S 24-HOUR EMERGENCY DEPARTMENT ADMITTED 940 PATIENTS LAST YEAR AND HAD 9,500 VISITS LAST YEAR. THE HOSPITAL'S MATERNITY UNIT WELCOMED 140 BABIES INTO THE WORLD LAST YEAR AND ALSO SUPPORTS MOTHERS-TO-BE WITH REGULAR LAMAZE AND BREASTFEEDING SUPPORT PROGRAMS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 11,990,069 including grants of $ ) (Revenue $ 12,536,688 )
4e	Total program service expenses84,909,003

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) EDWARD PITCHFORD........................................................................ CEO/PRESIDENT END 01/19	47.0 .......................3.0	X			565,997	0	166,116
(19) RON RAPP........................................................................ VP OF FINANCE	47.0 .......................2.0	X			183,015	0	36,289
(20) JANIE HILFIGER........................................................................ PRESIDENT/CEO BEGIN 01/19	20.0 .......................3.0	X			0	0	0
(21) TIMOTHY BROWN........................................................................ VP OF OPERATIONS	40.0 .......................1.0		X		175,106	0	4,785
(22) SAKET PRASAD MD........................................................................ PHYSICIAN	40.0 .......................0.0			X	661,870	0	38,619
(23) BRADLEY GIANNOTTI MD........................................................................ PHYSICIAN	40.0 .......................0.0			X	833,974	0	30,815
(24) TERRANCE FOUST DO........................................................................ PHYSICIAN	40.0 .......................1.0			X	836,959	0	39,205
(25) MAZEN FOUANY MD........................................................................ PHYSICIAN	40.0 .......................0.0			X	690,279	0	38,551
(26) AHMAD AWADA MD........................................................................ PHYSICIAN	40.0 .......................0.0			X	706,558	0	32,978

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	5,541,489	0	466,049

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	72,657
e	Government grants (contributions)		1e	108,942

f	All other contributions, gifts, grants, and similar amounts not included above		1f	211,701

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		393,300

		Business Code
2a	NET PATIENT SERVICE REVENUE	621990	91,923,361	91,923,361
b	PHARMACY	621990	6,742,250	6,742,250
c	CAFETERIA	722514	389,771	389,771
d	OTHER	621990	524,144	524,144
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		99,579,526

3 Investment income (including dividends, interest, and othersimilar amounts) ......			61,910			61,910
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			34,123		5,596	28,527
		(ii) Personal	(i) Real
6a	Gross rents		240,386
b	Less: rental expenses		234,695
c	Rental income or (loss)	0	5,691
d	Net rental income or (loss)......			5,691			5,691
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	291,049	211,877
b	Less: cost or other basis and sales expenses	280,921	156,509
c	Gain or (loss)	10,128	55,368
d	Net gain or (loss).....			65,496			65,496
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		0
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	GAIN ON INVESTMENT IN EQUITY INVESTEE		900099	57,580		85,754	-28,174
b	INCOME FROM INVESTMENT IN SUBSIDIARIES		900099	-385,235			-385,235
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			-327,655
12	Total revenue. See Instructions......			99,812,391	99,579,526	91,350	-251,785

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	2,097,730	966,422	1,131,308
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	133,194	133,194
7	Other salaries and wages	30,533,737	26,398,789	4,134,948
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	32,729	32,729
9	Other employee benefits .......	5,660,325	4,733,666	926,659
10	Payroll taxes ...........	2,117,207	1,723,082	394,125
11	Fees for services (non-employees):
a	Management ......	1,722,484	1,722,484
b	Legal .........	33,009		33,009
c	Accounting ...........	57,428		57,428
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	18,256		18,256
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	21,259,487	20,052,095	1,207,392
12	Advertising and promotion ....	131,583	18,350	113,233
13	Office expenses .......	6,143,491	4,521,991	1,621,500
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	2,027,541	1,877,693	149,848
17	Travel ............	468,576	431,802	36,774
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	269,548	197,902	71,646
20	Interest ...........	1,855	1,681	174
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	3,131,935	2,838,753	293,182
23	Insurance ...	1,159,559	452,760	706,799
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES & DRUGS	13,784,277	13,784,277
b	BAD DEBT	4,830,522	4,830,522
c	LICENSES, DUES, SUBSCRIPTIONS	401,439	190,811	210,628
d	RECRUITING & RETENTION	305,230		305,230
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	96,321,142	84,909,003	11,412,139	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			3,761,182	1	4,413,388
2	Savings and temporary cash investments .........			85,996	2	0
3	Pledges and grants receivable, net ......			201,597	3	235,468
4	Accounts receivable, net .............			9,634,766	4	9,329,153
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			1,181,473	8	1,160,266
9	Prepaid expenses and deferred charges ......			1,266,129	9	523,936
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	81,605,647
b	Less: accumulated depreciation	10b	55,345,477	28,232,606	10c	26,260,170
11	Investments—publicly traded securities .			5,236,577	11	5,408,427
12	Investments—other securities. See Part IV, line 11 .....			-12,870,486	12	-1,640,201
13	Investments—program-related. See Part IV, line 11 ..			6,934,798	13	6,835,616
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			1,951,300	15	27,246,468
16	Total assets. Add lines 1 through 15 (must equal line 34)...			45,615,938	16	79,772,691

17	Accounts payable and accrued expenses .....	13,874,441	17	5,771,921
18	Grants payable ...	0	18	0
19	Deferred revenue .........	462,316	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	258,059	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	3,919,444	25	5,228,881
26	Total liabilities. Add lines 17 through 25..	18,514,260	26	11,000,802

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	22,671,204	27	64,276,129
28	Temporarily restricted net assets ...........	209,627	28	270,468
29	Permanently restricted net assets	4,220,847	29	4,225,292
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	27,101,678	33	68,771,889
34	Total liabilities and net assets/fund balances ........	45,615,938	34	79,772,691