TY 2020 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) AHUJA - BALL STANLEY C...................................................................... DIRECTOR (BEGIN 12/20)	2.00 ................. 0.00	X		0	0
(2) AHUJA - DOODY RICHARD...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0
(3) AHUJA - FINE LAUREN RICH...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0
(4) AHUJA - GLICK ROBERT A...................................................................... DIRECTOR (END 08/20)	2.00 ................. 0.00	X		0	0
(5) AHUJA - HABER IRWIN G...................................................................... VICE CHAIRPERSON/DIRECTOR	2.00 ................. 0.00	X	X	0	0
(6) AHUJA - JONES M STEVEN...................................................................... DIRECTOR EX OFFICIO (BEG 5/20)	2.00 ................. 0.00	X		0	0
(7) AHUJA - JORDAN SHARON SOBOL...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0
(8) AHUJA - KLINE ANDREW L...................................................................... DIRECTOR	50.00 ................. 0.00	X		58,633	24,791
(9) AHUJA - PAPA ALAN J FACHE...................................................................... DIRECTOR EX OFFICIO/PRESIDENT	50.00 ................. 0.00	X	X	454,776	17,916
(10) AHUJA - PLUMMER DEBORAH L...................................................................... DIRECTOR (BEGIN 12/20)	2.00 ................. 0.00	X		0	0
(11) AHUJA - ROSENBERG ENID...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0
(12) AHUJA - SEITZ THOMAS W...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0
(13) AHUJA - SETHI NEIL MD...................................................................... CHAIRPERSON/DIRECTOR	2.00 ................. 0.00	X	X	0	0
(14) AHUJA - SHARPNACK PATRICIA...................................................................... DIRECTOR EX OFFICIO	2.00 ................. 0.00	X		0	0
(15) AHUJA - SIMON MD DANIEL I...................................................................... DIRECTOR EX OFFICIO (END 5/20)	2.00 ................. 0.00	X		0	0
(16) AHUJA - ZELMAN DANIEL N...................................................................... DIRECTOR	2.00 ................. 0.00	X		0	0
(17) AMHERST - YUZON FLORENCIO MD...................................................................... DIRECTOR (END 01/20)	2.00 ................. 0.00	X		0	0

(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)	(F) Estimated amount of other compensation from the organization and related organizations
(18) CCO - ANNABLE CATHY J S MD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(19) CCO - HERTZ ANDREW R MD........................................................................ DIRECTOR	50.00 .......................0.00	X					792,628	0	21,391
(20) CCO - HOYNES SEAN MD........................................................................ DIRECTOR	2.00 .......................50.00	X					0	294,949	56,146
(21) CCO - MEGERIAN CLIFF MD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(22) CCO - MONHEIM KAREN M MD........................................................................ DIRECTOR	2.00 .......................50.00	X					0	201,751	27,476
(23) CCO - PLUSH MARK J........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(24) CCO - PRONOVOST PETER MD........................................................................ DIRECTOR/VICE CHAIRPERSON	2.00 .......................0.00	X	X				0	0	0
(25) CCO - RAVICHANDRANKAMALESWARY........................................................................ DIRECTOR	2.00 .......................50.00	X					0	362,317	41,171
(26) CCO - SZUBSKI MICHAEL A........................................................................ DIRECTOR/CHAIRPERSON/TREASURER	2.00 .......................0.00	X	X				0	0	0
(27) CCO - TAIT PAUL G........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(28) CCO - TOPALSKY GEORGE MD........................................................................ DIRECTOR	2.00 .......................50.00	X					0	607,900	76,039
(29) CCO - ZELIS CYNTHIA MD........................................................................ DIRECTOR	50.00 .......................0.00	X					231,550	0	3,373
(30) CHCO - BALLINGER MARCIA PHD........................................................................ VICE CHAIR (BEG 5/20)/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(31) CHCO - BRAGG DAN A........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(32) CHCO - CORCORAN KEVIN........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(33) CHCO - KODSY MAHER MD........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(34) CHCO - LONG REV JANET........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(35) CHCO - MIGGINS LYNN........................................................................ CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(36) CHCO - REIDY JOAN........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(37) CHCO - SINK KRISTI M........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	2.00 .......................0.00	X	X				0	0	0
(38) CHCO - TAIT PAUL G........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(39) CONNEAUT - BOWLER CONNIE........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(40) CONNEAUT - BRADLEY SALLY........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(41) CONNEAUT - BRECHT CHRISTOPHER........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(42) CONNEAUT - CONWAY KESHA........................................................................ DIRECTOR (END 01/20)	2.00 .......................0.00	X					0	0	0
(43) CONNEAUT - DANA RICHARD L........................................................................ CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(44) CONNEAUT - DECK CHARLES V........................................................................ VICE CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(45) CONNEAUT - GARCIA RICHARD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(46) CONNEAUT - HOCKADAY JAMES E........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(47) CONNEAUT - JONES M STEVEN........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	2.00 .......................0.00	X	X				0	0	0
(48) CONNEAUT - KUMAR AJAY MD........................................................................ DIRECTOR EX OFFICIO	2.00 .......................50.00	X					0	300,677	25,329
(49) CONNEAUT - LEGEZA MICHAEL D........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(50) CONNEAUT - MCLAUGHLIN LORI E........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(51) CONNEAUT - NEWCOMBCHRISTOPHER........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(52) CONNEAUT - PRAUSE JACK H........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(53) CONNEAUT - SKUFCA MICHAEL DDS........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(54) CONNEAUT - SOORIYAPALAN NISH........................................................................ DIRECTOR EX-OFFICIO	2.00 .......................50.00	X					0	160,291	6,247
(55) CONNEAUT - VARCKETTE STEVE........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(56) ECC - BECK JOHN........................................................................ DIRECTOR/PRESIDENT	50.00 .......................0.00	X	X				143,324	0	34,425
(57) ECC - BOND BRADLEY C........................................................................ SECRETARY/TREASURER/DIRECTOR	50.00 .......................0.00	X	X				564,461	0	44,399
(58) ECC - VEHOVEC MICHAEL R........................................................................ DIRECTOR/CHAIRPERSON	50.00 .......................0.00	X	X				409,002	0	17,855
(59) ELYRIA - BALLINGER MARCIA PHD........................................................................ VICE CHAIR (BEG 5/20)/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(60) ELYRIA - BRAGG DAN A........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(61) ELYRIA - CORCORAN KEVIN........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(62) ELYRIA - KODSY MAHER MD........................................................................ DIRECTOR EX OFFICIO	50.00 .......................0.00	X					133,667	0	783
(63) ELYRIA - LONG REV JANET........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(64) ELYRIA - MIGGINS LYNN........................................................................ DIR/CHAIR/SECRETARY (END 6/20)	2.00 .......................0.00	X	X				0	0	0
(65) ELYRIA - REIDY JOAN........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(66) ELYRIA - SINK KRISTI M........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	2.00 .......................0.00	X	X				0	0	0
(67) ELYRIA - TAIT PAUL G........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(68) GEAUGA - ANDRES BLAKE........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(69) GEAUGA - BALOGH SCOTT........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(70) GEAUGA - BARR WILLIAM H III........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(71) GEAUGA - BEVERAGE MORRIS JR........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(72) GEAUGA - DECARLO DONALD........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	50.00 .......................0.00	X					440,610	0	41,073
(73) GEAUGA - EGLESTON INDRANI........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(74) GEAUGA - FITTS JOHN T........................................................................ CHAIR (BEGIN 01/20)/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(75) GEAUGA - HOSIER-ORVIS B PAIGE........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(76) GEAUGA - JARZEMBAK KELLIE........................................................................ DIRECTOR EX OFFICIO	50.00 .......................0.00	X					120,506	0	5,909
(77) GEAUGA - JEMISON TRACY........................................................................ VICE CHAIR (BEG 1/20)/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(78) GEAUGA - KARLOVEC JOHN D........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(79) GEAUGA - KINNEY WARD BUD L........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(80) GEAUGA - KNECHT BARBARA L........................................................................ SECRETARY/TREASURER/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(81) GEAUGA - LEININGER KIMM........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(82) GEAUGA - MARKOWITZ DALE H........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(83) GEAUGA - MILLER PETE C........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(84) GEAUGA - SPALSBURG ANGELA........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(85) GEAUGA - STEFANO GREGORY MD........................................................................ DIRECTOR EX OFFICIO	2.00 .......................50.00	X					0	727,132	36,961
(86) GEAUGA - WALDECK JOHN W........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(87) GENEVA - BOWLER CONNIE........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(88) GENEVA - BRADLEY SALLY........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(89) GENEVA - BRECHT CHRISTOPHER........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(90) GENEVA - CONWAY KESHA........................................................................ DIRECTOR (END 01/20)	2.00 .......................0.00	X					0	0	0
(91) GENEVA - DANA RICHARD L........................................................................ CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(92) GENEVA - DECK CHARLES V........................................................................ VICE CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(93) GENEVA - GARCIA RICHARD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(94) GENEVA - HOCKADAY JAMES E........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(95) GENEVA - JONES M STEVEN........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	2.00 .......................0.00	X	X				0	0	0
(96) GENEVA - KUMAR AJAY MD........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(97) GENEVA - LEGEZA MICHAEL D........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(98) GENEVA - MCLAUGHLIN LORI E........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(99) GENEVA - NEWCOMB CHRISTOPHER........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(100) GENEVA - PRAUSE JACK H........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(101) GENEVA - SKUFCA MICHAEL DDS........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(102) GENEVA - SOORIYAPALAN NISH........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(103) GENEVA - VARCKETTE STEVE........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(104) HOME CARE - BECK ERIC H DO........................................................................ DIR/CHAIR/PRES (BEG 6/20)	2.00 .......................0.00	X	X				0	0	0
(105) HOME CARE - CARPENTERJENNIFER........................................................................ DIRECTOR (BEGIN 12/20)	50.00 .......................0.00	X					342,344	0	46,272
(106) HOME CARE - CHICKERELLA D........................................................................ DIR/VC/VP (BEG 6/20)	2.00 .......................0.00	X	X				435,411	0	23,051
(107) HOME CARE - COLE MELISSA CNP........................................................................ DIR (BEG 5/20)/PRES(BEG 11/20)	50.00 .......................0.00	X	X				309,823	0	37,375
(108) HOME CARE - SILA CATHY MD........................................................................ DIRECTOR/SECRETARY/TREASURER	50.00 .......................0.00	X	X				540,401	0	20,517
(109) HOME CARE - SPARKMAN-BEIERLB........................................................................ DIR (END 5/20)/PRES (END 6/20)	50.00 .......................0.00	X	X				74,430	0	5,552
(110) HOME CARE - SYLVAN DAVID........................................................................ DIRECTOR (BEGIN 05/20)	50.00 .......................0.00	X					337,663	0	16,198
(111) HOME CARE - TOPALSKY GEORGE........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(112) PARMA - BOYKO TIMOTHY A........................................................................ CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(113) PARMA - BURMA GERALD MD PHD........................................................................ DIRECTOR EX OFFICIO	2.00 .......................50.00	X					0	805,354	315,888
(114) PARMA - CIACCIA JULIUS JR........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(115) PARMA - DESOUZA LESLEY........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(116) PARMA - EMRHEIN WILLIAM........................................................................ DIR EX OF/CHAIR (BEG 5/20)	2.00 .......................0.00	X	X				0	0	0
(117) PARMA - GISZTL RODNEY........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(118) PARMA - IMHOFF DONNA PHD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(119) PARMA - MONTER BRIAN........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	2.00 .......................0.00	X	X				0	0	0
(120) PARMA - MOORE ERIC J ESQ........................................................................ VICE CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(121) PARMA - PIMPAS ANGELO N........................................................................ DIR EX OF/CHAIR (END 05/20)	2.00 .......................0.00	X	X				0	0	0
(122) PARMA - SPEAR BRENDA........................................................................ VICE CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(123) PARMA - TAIT PAUL G........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(124) PARMA - THOMAS DONNA ESQ........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(125) PARMA - WILKINSON SCOTT A........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(126) PARMA - ZANIN CLAUDIO........................................................................ SECRETARY/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(127) PORTAGE - BENOIT WILLIAM........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	50.00 .......................0.00	X	X				400,042	0	41,032
(128) PORTAGE - BROOME BARBARA ANN........................................................................ VICE CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(129) PORTAGE - CHILDERS WILLIAM........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(130) PORTAGE - COE RICHARD J........................................................................ DIRECTOR EX OFFICIO/CHAIR	2.00 .......................0.00	X	X				0	0	0
(131) PORTAGE - CONNER MARJORIE........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(132) PORTAGE - DORSEY MARLENE PHD........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(133) PORTAGE - FLYNN SCOTT ESQ........................................................................ VICE CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(134) PORTAGE - FRENCH MATTHEW C........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(135) PORTAGE - GUSZ JOHN R MD........................................................................ DIRECTOR EX OF (BEGIN 01/20)	2.00 .......................0.00	X					0	0	0
(136) PORTAGE - JONES M STEVEN........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	2.00 .......................0.00	X	X				0	0	0
(137) PORTAGE - LEWIS MICHAEL A........................................................................ CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(138) PORTAGE - SAHR MICHELLE........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(139) PORTAGE - SNOWBERGER THOMAS........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(140) PORTAGE - TREXLER THOMAS........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(141) R E - MCCOMSEY GRACE MD........................................................................ DIRECTOR	50.00 .......................0.00	X					408,730	0	43,132
(142) R E - SIMON MD DANIEL I........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(143) R E - SZUBSKI MICHAEL A........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(144) REGIONAL - BEJANISHVILI TAMAR........................................................................ DIRECTOR EX OFFICIO	2.00 .......................50.00	X					0	393,333	36,016
(145) REGIONAL - CORRENTI MARY ANN........................................................................ CHAIR (END 05/20)/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(146) REGIONAL - GREIG JUDITH C RN........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(147) REGIONAL - HANFF POLLY M........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(148) REGIONAL - JUDD JAMES O........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(149) REGIONAL - MILLER MARCIA J........................................................................ VICE CHAIR (BEG 5/20)/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(150) REGIONAL - PAUL STAMY S........................................................................ VC (END 5/20)/CR(BEG 5/20)/DIR	2.00 .......................0.00	X	X				0	0	0
(151) REGIONAL - POLITO MARIA ANN........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(152) REGIONAL - RAPKIN DAVID S MD........................................................................ DIRECTOR EX OFFICIO	2.00 .......................50.00	X					0	454,386	59,753
(153) REGIONAL - ROWELL ROBIN........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	50.00 .......................0.00	X	X				400,871	0	46,601
(154) REGIONAL - SIRACUSA ANTHONY........................................................................ VICE CHAIR (BEG5/20)/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(155) REGIONAL - SMITH GERI M........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(156) REGIONAL - ZELLER LORNA A........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(157) SAMARITAN - BEER ANNE........................................................................ CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(158) SAMARITAN - BURKHOLDER HARVEY........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(159) SAMARITAN - CHANDLER POLLY........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(160) SAMARITAN - COWEN TIMOTHY........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(161) SAMARITAN - DAWSON PATRICIA........................................................................ DIRECTOR (END 08/20)	2.00 .......................0.00	X					0	0	0
(162) SAMARITAN - GILMAN THOMAS R........................................................................ VICE CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(163) SAMARITAN - HARFORD TODD........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	50.00 .......................0.00	X	X				285,921	0	45,799
(164) SAMARITAN - HEIMANN SUSAN........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(165) SAMARITAN - HUNT JOYCE ANNE........................................................................ DIRECTOR	50.00 .......................0.00	X					23,018	0	1,100
(166) SAMARITAN - KELLY MICHAEL SR........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(167) SAMARITAN - KELSAY RALPH J........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(168) SAMARITAN - MACDONALD MARY MD........................................................................ DIRECTOR EX OFFICIO (END 5/20)	2.00 .......................50.00	X					0	345,774	40,921
(169) SAMARITAN - MCGEE THOMAS........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(170) SAMARITAN - MYERS PAUL R........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(171) SAMARITAN - ROYAL KIMBERLY S........................................................................ DIRECTOR EX OF (BEGIN 05/20)	2.00 .......................50.00	X					0	351,151	27,145
(172) SAMARITAN - SHAW ANNETTE........................................................................ DIR/TREAS/SEC (END 10/20)	2.00 .......................0.00	X	X				0	0	0
(173) SAMARITAN - STENCELMICHAEL MD........................................................................ DIRECTOR	2.00 .......................50.00	X					0	301,048	99,779
(174) SAMARITAN - ZOLTANSKI JOAN MD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(175) ST JOHN - BLOXDORFGREGORY DO........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(176) ST JOHN - CLOUGHMAYOR DENNIS........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(177) ST JOHN - DAVID ROBERT G........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	50.00 .......................0.00	X	X				550,656	0	42,471
(178) ST JOHN - DAVIE DIANE........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(179) ST JOHN - GAUGHAN HON PAT........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(180) ST JOHN - GIANFAGNA JEAN M........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(181) ST JOHN - MACKINLAY SARA ANN........................................................................ CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(182) ST JOHN - MCQUISTON EDWARD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(183) ST JOHN - SIMON MD DANIEL I........................................................................ DIRECTOR EX OFFICIO (END 5/20)	2.00 .......................0.00	X					0	0	0
(184) ST JOHN - STANO DIANE PHD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(185) ST JOHN - YATES VIVIAN........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(186) UHCMC - ADLER-RASKIND JULIE........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(187) UHCMC - AGRANOVICH CHERYL........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(188) UHCMC - CAMIENER DAVID A........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(189) UHCMC - CARR DAVID........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(190) UHCMC - CLARK JILL........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(191) UHCMC - HALLBERG CHARLES E........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(192) UHCMC - HARRINGTON JILL........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(193) UHCMC - HARRIS TIMOTHY S........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(194) UHCMC - KELSHEIMER JERRY L........................................................................ CHAIR/DIR (END 5/20)	2.00 .......................0.00	X	X				0	0	0
(195) UHCMC - KENNEDY TERRI........................................................................ DIRECTOR EX OF/PRES(END 05/20)	2.00 .......................0.00	X	X				0	0	0
(196) UHCMC - KLINE STUART F........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(197) UHCMC - KOURY LEE M........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(198) UHCMC - LAISURE COLLETTE........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(199) UHCMC - MACHTAY MD MITCHELL........................................................................ DIRECTOR EX OFFICIO	50.00 .......................0.00	X					333,882	0	24,506
(200) UHCMC - PHYFER CHERI M........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(201) UHCMC - PRIEMER WILLIAM A........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(202) UHCMC - REYNOLDS DAVID M........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(203) UHCMC - RICCI KENNETH C........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(204) UHCMC - SCHULZE-FLYNNCYNTHIA........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(205) UHCMC - SHAUGHNESSY MARIAN K........................................................................ DIRECTOR (END 02/20)	2.00 .......................0.00	X					0	0	0
(206) UHCMC - SIMON MD DANIEL I........................................................................ DIRECTOR EX OFFICIO/PRESIDENT	2.00 .......................0.00	X	X				0	0	0
(207) UHCMC - SKODA GREGORY J........................................................................ VICE CHAIR (BEG 5/20)/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(208) UHCMC - SKORY JOHN E........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(209) UHCMC - STEINHILBER JEFFREY........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(210) UHCMC - TAYLOR EDDIE JR........................................................................ CHR(BEG 5/20)/VC(END 5/20)/DIR	2.00 .......................0.00	X	X				0	0	0
(211) UHCMC - TIFFT VICTORIA........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(212) UHCMC - ZENTY THOMAS F III........................................................................ DIRECTOR EX OFFICIO/CEO	2.00 .......................0.00	X	X				0	0	0
(213) UHHS - ADELMAN JOEL E........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(214) UHHS - ANTON ARTHUR F........................................................................ CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(215) UHHS - ANTONUCCI JOHN........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(216) UHHS - ARNOLD CRAIG A........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(217) UHHS - BAUM ROBIN I........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(218) UHHS - CLARK PAUL........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(219) UHHS - CONNELL MICHELE L........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(220) UHHS - CONNOR CHRISTOPHER M........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(221) UHHS - DECKARD JENNIFER........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(222) UHHS - DELLA RATTA RALPH........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(223) UHHS - ETTINGER HEATHER R........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(224) UHHS - GORMAN CHRISTOPHER M........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(225) UHHS - HALL BRIAN E........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(226) UHHS - HARDY KENNETH D........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(227) UHHS - HARLAN M ANN........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(228) UHHS - HASLAM DEE........................................................................ VICE CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(229) UHHS - KELSHEIMER JERRY L........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(230) UHHS - LACEY WILLIAM........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(231) UHHS - MEGERIAN CLIFF MD........................................................................ DIRECTOR EX OF (BEG 1/20)/PRES	50.00 .......................0.00	X					2,486,633	0	46,750
(232) UHHS - MORIKIS JOHN G........................................................................ VICE CHAIRPERSON/DIRECTOR	2.00 .......................0.00	X	X				0	0	0
(233) UHHS - PANDRANGI VASU MD........................................................................ DIRECTOR EX OFFICIO/CHAIR	2.00 .......................50.00	X					0	375,771	102,155
(234) UHHS - PIANALTO SANDRA........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(235) UHHS - POTASH STEVEN........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(236) UHHS - SABIK JOSEPH MD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(237) UHHS - SETHI NEIL MD........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(238) UHHS - SMITH ROBERT C........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(239) UHHS - TAYLOR EDDIE JR........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(240) UHHS - YOUNG WILLIAM A JR........................................................................ DIRECTOR EX OFFICIO	2.00 .......................0.00	X					0	0	0
(241) UHHS - ZENTY THOMAS F III........................................................................ DIRECTOR EX OFFICIO/CEO	50.00 .......................0.00	X	X				2,323,234	0	79,247
(242) UHLSF - BOND BRADLEY C........................................................................ DIRECTOR/TREASURER	2.00 .......................0.00	X	X				0	0	0
(243) UHLSF - BROWN SAM H........................................................................ DIRECTOR/PRESIDENT/SECRETARY	50.00 .......................0.00	X	X				242,643	0	36,816
(244) UHLSF - GOODELLE MICHAEL........................................................................ DIRECTOR	50.00 .......................0.00	X					181,273	0	35,221
(245) UHMG - CHICKERELLA DANIELLE........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(246) UHMG - CLARK JILL........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(247) UHMG - DEPOMPEI PATRICIA M........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(248) UHMG - HALLBERG CHARLES E........................................................................ DIRECTOR (END 05/20)	2.00 .......................0.00	X					0	0	0
(249) UHMG - JAIN MUKESH MD........................................................................ DIRECTOR (BEGIN 05/20)	50.00 .......................0.00	X					794,266	0	43,300
(250) UHMG - MEGERIAN CLIFF MD........................................................................ DIRECTOR EX OF/PRES(END 05/20)	2.00 .......................0.00	X	X				0	0	0
(251) UHMG - MILLER CHRISTOPHER MD........................................................................ DIREX OF/PRES (BEGIN 05/20)	50.00 .......................0.00	X	X				664,213	0	40,117
(252) UHMG - MILLER MARLENE MD........................................................................ DIRECTOR EX OFFICIO	50.00 .......................0.00	X					627,543	0	41,824
(253) UHMG - RAO GOUTHAM MD........................................................................ DIRECTOR	50.00 .......................0.00	X					422,519	0	40,986
(254) UHMG - SABIK JOSEPH MD........................................................................ DIRECTOR EX OFFICIO	50.00 .......................0.00	X					1,294,379	0	41,771
(255) UHMG - SALATA ROBERT A MD........................................................................ DIRECTOR EX OFFICIO	50.00 .......................0.00	X					622,363	0	36,776
(256) UHMG - SALVINO SONIA........................................................................ DIRECTOR/SECRETARY/TREASURER	2.00 .......................0.00	X	X				0	0	0
(257) UHMG - SELMAN WARREN R MD........................................................................ DIRECTOR	50.00 .......................0.00	X					1,004,991	0	48,597
(258) UHMG - SHAUGHNESSY MARIAN K........................................................................ DIRECTOR (END 02/20)	2.00 .......................0.00	X					0	0	0
(259) UHMG - SIMON MD DANIEL I........................................................................ DIRECTOR EX OFF/CHAIR	2.00 .......................0.00	X	X				0	0	0
(260) UHMG - SNOWBERGER THOMAS D........................................................................ DIRECTOR	2.00 .......................0.00	X					0	0	0
(261) UHMG - TIFFT VICTORIA........................................................................ DIRECTOR (BEGIN 05/20)	2.00 .......................0.00	X					0	0	0
(262) UHMG - VOOS JAMES........................................................................ DIRECTOR	50.00 .......................0.00	X					1,607,199	0	41,484
(263) UHMG - ZOLTANSKI JOAN MD........................................................................ DIRECTOR	50.00 .......................0.00	X					317,562	0	28,367
(264) AHUJA - BOND BRADLEY C........................................................................ SECRETARY/TREASURER (BEG 7/20)	2.00 .......................0.00		X				0	0	0
(265) CCO - HILLARD BRADLEY G DO........................................................................ PRESIDENT (END 01/20)	2.00 .......................50.00		X				0	9,948	841
(266) CCO - SCHARIO MARK E........................................................................ PRESIDENT (BEG 1/20)/SECRETARY	50.00 .......................0.00		X				314,392	0	41,397
(267) CONNEAUT - GLOWCZEWSKI JASON........................................................................ SECRETARY/TREASURER (BEG 8/20)	2.00 .......................0.00		X				0	0	0
(268) ELYRIA - BOND BRADLEY C........................................................................ SECRETARY/TREASURER (BEG 6/20)	2.00 .......................0.00		X				0	0	0
(269) GENEVA - GLOWCZEWSKI JASON........................................................................ SECRETARY/TREASURER (BEG 8/20)	50.00 .......................0.00		X				234,672	0	26,149
(270) REGIONAL - JONES M STEVEN........................................................................ SECRETARY/TREASURER	2.00 .......................0.00		X				0	0	0
(271) SAMARITAN - BOND BRADLEY C........................................................................ SECRETARY/TREASURER(BEG 11/20)	2.00 .......................0.00		X				0	0	0
(272) ST JOHN - SALVINO SONIA........................................................................ SECRETARY	2.00 .......................0.00		X				0	0	0
(273) UHCMC - ADELMAN HARLIN G ESQ........................................................................ CHIEF LEGAL OFFICER/SECRETARY	2.00 .......................0.00		X				0	0	0
(274) UHCMC - CHANG PHILLIP MD........................................................................ CMO (BEGIN 05/20)	50.00 .......................0.00		X				457,970	0	12,383
(275) UHCMC - DEPOMPEI PATRICIA M........................................................................ PRESIDENT	50.00 .......................0.00		X				659,683	0	48,077
(276) UHCMC - PIRTZ JASON M........................................................................ CHIEF NURSING OFFICER	50.00 .......................0.00		X				286,682	0	36,812
(277) UHCMC - SALVINO SONIA........................................................................ TREASURER	2.00 .......................0.00		X				0	0	0
(278) UHCMC - STROSACKER ROBYN MD........................................................................ CMO/COO	50.00 .......................0.00		X				597,539	0	33,106
(279) UHCMC - TEKNOS THEODOROS MD........................................................................ PRESIDENT	50.00 .......................0.00		X				1,116,850	0	39,778
(280) UHHS - ADELMAN HARLIN G ESQ........................................................................ CHIEF LEGAL OFFICER/SECRETARY	50.00 .......................0.00		X				1,017,185	0	174,191
(281) UHHS - BECK ERIC H DO MPH........................................................................ COO (BEGIN 02/20)	50.00 .......................0.00		X				866,401	0	28,134
(282) UHHS - BRIEN WILLIAM W MD........................................................................ CMO/CHIEF QUALITY OFFICER	50.00 .......................0.00		X				664,124	0	16,858
(283) UHHS - SIMON MD DANIEL I........................................................................ CF CLIN & SCIEN OFF (BEG 2/20)	50.00 .......................0.00		X				1,462,516	0	44,879
(284) UHHS - SNOWBERGER THOMAS D........................................................................ CHIEF HUMAN RESOURCES OFFICER	50.00 .......................0.00		X				922,145	0	31,623
(285) UHHS - STANDLEY STEVEN D........................................................................ CHIEF ADMIN OFFICER (END 3/20)	50.00 .......................0.00		X				912,446	0	176,995
(286) UHHS - SZUBSKI MICHAEL A........................................................................ CFO/TREASURER	50.00 .......................0.00		X				1,227,676	0	46,863
(287) UHHS - TAIT PAUL G........................................................................ CHIEF STRATEGY OFFICER	50.00 .......................0.00		X				832,573	0	46,425
(288) UHHS - BISHOP SHERRI L........................................................................ CHIEF DEVELOPMENT OFFICER	50.00 .......................0.00			X			594,853	0	44,944
(289) UHHS - CHRISTIAN VALDA CLARK........................................................................ CHIEF COMPLIANCE OFFICER	50.00 .......................0.00			X			398,276	0	25,616
(290) UHHS - KEEGAN ARTHUR EDWIN........................................................................ CHIEF MARKETING OFFICER	50.00 .......................0.00			X			400,845	0	18,416
(291) UHHS - PRONOVOST PETER MD........................................................................ CHIEF CLINICAL TRANSFORM. OF	50.00 .......................0.00			X			942,614	0	14,773
(292) UHHS - STAMLER JONATHAN........................................................................ PRES - HARRINGTON DISC INST	50.00 .......................0.00				X		1,672,677	0	32,291
(293) UHMG - EUBANKS JASON D........................................................................ ORTHOPEDIC SURGEON	50.00 .......................0.00				X		1,294,409	0	24,090
(294) UHMG - GLOTZBECKER MICHAEL P........................................................................ ORTHOPEDIC SURGEON	50.00 .......................0.00				X		1,243,809	0	26,199
(295) UHMG - PELLETIER MARC PATRICK........................................................................ DIVISION CHIEF, CARDIAC SURGERY - UHCMC	50.00 .......................0.00				X		1,083,593	0	26,199
(296) UHMG - BAMBAKIDIS NICHOLAS C........................................................................ DIRECTOR - UH NEUROLOGICAL INSTITUTE	50.00 .......................0.00				X		1,079,652	0	46,058
(297) CCO - HAMMACK ELIZABETH R........................................................................ FORMER SECRETARY	50.00 .......................0.00					X	237,254	0	38,308
(298) AHUJA ECC - JURIS SUSAN V........................................................................ FORMER OFFICER	50.00 .......................0.00					X	198,711	0	15,177
(299) GEAUGA - JONES M STEVEN........................................................................ FORMER OFFICER	50.00 .......................0.00					X	723,818	0	32,988
(300) PARMA - SINK KRISTI M........................................................................ FORMER OFFICER	50.00 .......................0.00					X	448,427	0	40,236
(301) REGIONAL - MONTER BRIAN........................................................................ FORMER OFFICER	50.00 .......................0.00					X	474,399	0	39,668
(302) UHLSFCMC - DZIEDZICKI RONALD........................................................................ FORMER OFFICER	50.00 .......................0.00					X	177,751	0	124,436
(303) UHLSF - SALVINO SONIA........................................................................ FORMER OFFICER	50.00 .......................0.00					X	536,803	0	46,263
(304) UHMG - ADELMAN HARLIN G ESQ........................................................................ FORMER OFFICER	2.00 .......................0.00					X	0	0	0
(305) UHMG - SZUBSKI MICHAEL A........................................................................ FORMER OFFICER	2.00 .......................0.00					X	0	0	0
(306) UHHS - GARTLAND HEIDI I........................................................................ FORMER KEY EMPLOYEE	50.00 .......................0.00					X	389,277	0	29,776
(307) UHMG - RONIS ROBERT........................................................................ FORMER KEY EMPLOYEE	50.00 .......................0.00					X	449,224	0	20,158

(A) Name and business address	(B) Description of services	(C) Compensation
MCKESSON CORPORATION 1 PORT STREET SUITE 3275 SAN FRANCISCO,CA94104	PHARMACEUTICALS DISTRIBUTION	360,559,236
OWENS & MINOR DIST INC 9120 LOCKWOOD BLVD MECHANICSVILLE,VA23116	MEDICAL SUPPLIES	79,748,725
CVS CAREMARK SPECIALTY PHARMACY 1 CVS DRIVE WOONSOCKET,RI02895	PHARMACEUTICALS	69,100,565
CGS ADMINISTRATORS LLC 26 CENTURY BLVD NASHVILLE,TN37214	MEDICAL BILLING SERVICES	35,723,956
SODEXO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG,MD20878	FACILITIES MANAGEMENT	33,232,994
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 866

- 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 instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

UNIVERSITY HOSPITALS HEALTH SYSTEM INC
GROUP RETURN

Employer identification number

90-0059117

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 ...............................4

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

(i) Name of supported organization	(ii) EIN	(iii) Type of organization (described on lines 1- 10 above (see instructions))	(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)
(A) UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER	341567805	3	Yes		0	0
(B) UNIVERSITY HOSPITALS ROBINSON HEALTH SYSTEM INC	461382538	3	Yes		0	0
(C) EMH REGIONAL MEDICAL CENTER	340714612	3	Yes		0	0
(D) SAMARITAN REGIONAL HEALTH SYSTEM	340714535	3	Yes		0	0
Total 4					0	0

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2020

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. 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—2019. 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—2020. 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—2019. 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) 2020

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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	2,800,000	147,000	913,000	387,000	2,061,000	6,308,000
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	2,800,000	147,000	913,000	387,000	2,061,000	6,308,000
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons						0
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.						0
c	Add lines 7a and 7b..						0
8	Public support. (Subtract line 7c from line 6.)						6,308,000

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
9	Amounts from line 6...	2,800,000	147,000	913,000	387,000	2,061,000	6,308,000
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.)..	2,800,000	147,000	913,000	387,000	2,061,000	6,308,000

First 5 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 2020 (line 8, column (f) divided by line 13, column (f)) .........

100.000 %

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

100.000 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

0 %

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. 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—2019. 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) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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.

Yes

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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) 2020

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 lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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.

Yes

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 line 2 above, 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 lines 2a and 2b 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 line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2020

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 0.015 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 0.035	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) 2020

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

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
PUBLIC CHARITY CLASSIFICATION OF EACH GROUP MEMBER IS SHOWN	AMHERST HOSPITAL ASSOCIATION, INC. - 34-0067060 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 EMH REGIONAL MEDICAL CENTER - 34-0714612 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PARMA COMMUNITY GENERAL HOSPITAL - 34-0827442 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 ROBINSON HEALTH SYSTEM, INC. - 46-1382538 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 SAMARITAN REGIONAL HEALTH SYSTEM - 34-0714535 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS AHUJA MEDICAL CENTER - 26-4827222 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER, INC. (UHCMC) - 34-1567805 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER (CMC) - 34-0714550 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS GEAUGA MEDICAL CENTER (GMC) - 34-0816492 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER (UHGMC) - 34-0714461 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UH REGIONAL HOSPITALS - 34-1924226 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER - 34-1260978 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS ACCOUNTABLE CARE ORGANIZATION - 27-3970270 509(A)(2) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS COORDINATED CARE ORGANIZATION - 90-0794903 509(A)(2) 3605 WARRENSVILLE CENTER RD. - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS HOME CARE SERVICES, INC. (HCS) - 34-1527536 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: UH CLEVELAND MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-1567805 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 170(B)(1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $30,013,000 COMPREHENSIVE HEALTH CARE OF OHIO, INC. - 34-1492733 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: EMH REGIONAL MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-0714612 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 170(B)(1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $0 HEATHER HILL INC. (HHI) - 34-0771884 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER ROAD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: UH CLEVELAND MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-1567805 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 170(B)(1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $0 UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION (UHLSF) - 34-1720429 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (II) EIN OF SUPPORTED ORGANIZATION: 34-0714775 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 509(A)(3) - TYPE II ORGANIZATION (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $0 UNIVERSITY HOSPITALS MEDICAL GROUP, INC. (UHMG) - 20-4881619 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: UH CLEVELAND MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-1567805 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 170(B)(1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $68,426,000
SCHEDULE A, PART IV, SECTION C, TYPE II ORGANIZATIONS	THE FOLLOWING GROUP SUBORDINATES RESPONDED YES: - HEATHER HILL, INC. THE FOLLOWING GROUP SUBORDINATES RESPONDED NO: - COMPREHENSIVE HEALTH CARE OF OHIO COMPREHENSIVE HEALTH CARE OF OHIO ("CHCO") IS A SUPPORTING ORGANIZATION OF EMH REGIONAL MEDICAL CENTER AS STATED IN ITS ARTICLES. UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. ("UHHS") IS THE SOLE MEMBER OF CHCO. CHCO IS SUPERVISED, DIRECTED AND CONTROLLED BY UHHS. -UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION ("UHLSF") ACTS AS A SUPPORTING ORGANIZATION TO UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. ("UHHS"). ARTICLES OF INCORPORATION PROVIDE UHHS WITH SUPERVISION, DIRECTION AND CONTROL OVER UHLSF. -UNIVERISTY HOSPITALS MEDICAL GROUP, INC. UNIVERSITY HOSPITALS MEDICAL GROUP, INC. ("UHMG") ACTS AS A SUPPORTING ORGANIZATION TO UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER ("UHCMC"). THE CONTROL AND MANAGEMENT OF UHMG IS VESTED IN THE SAME PERSONS THAT CONTROL AND MANAGE ITS SUPPORTED ORGANIZATION BECAUSE BOTH ENTITIES ARE PART OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY A COMMON PARENT, UNIVERSITY HOSPITALS HEALTH SYSTEM. -UNIVERISTY HOSPITALS HOMECARE SERVICES, INC. UNIVERSITY HOSPITALS HOMECARE SERVICES, INC. ("UHHCS") ACTS AS A SUPPORTING ORGANIZATION TO UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER ("UHCMC"). THE CONTROL AND MANAGEMENT OF UHHCS IS VESTED IN THE SAME PERSONS THAT CONTROL AND MANAGE ITS SUPPORTED ORGANIZATION BECAUSE BOTH ENTITIES ARE PART OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY A COMMON PARENT, UNIVERSITY HOSPITALS HEALTH SYSTEM.

Return Reference

Explanation

PUBLIC CHARITY CLASSIFICATION OF EACH GROUP MEMBER IS SHOWN

AMHERST HOSPITAL ASSOCIATION, INC. - 34-0067060 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 EMH REGIONAL MEDICAL CENTER - 34-0714612 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PARMA COMMUNITY GENERAL HOSPITAL - 34-0827442 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 ROBINSON HEALTH SYSTEM, INC. - 46-1382538 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 SAMARITAN REGIONAL HEALTH SYSTEM - 34-0714535 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS AHUJA MEDICAL CENTER - 26-4827222 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER, INC. (UHCMC) - 34-1567805 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER (CMC) - 34-0714550 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS GEAUGA MEDICAL CENTER (GMC) - 34-0816492 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER (UHGMC) - 34-0714461 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UH REGIONAL HOSPITALS - 34-1924226 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER - 34-1260978 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS ACCOUNTABLE CARE ORGANIZATION - 27-3970270 509(A)(2) 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS COORDINATED CARE ORGANIZATION - 90-0794903 509(A)(2) 3605 WARRENSVILLE CENTER RD. - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS HOME CARE SERVICES, INC. (HCS) - 34-1527536 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: UH CLEVELAND MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-1567805 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 170(B)(1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $30,013,000 COMPREHENSIVE HEALTH CARE OF OHIO, INC. - 34-1492733 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: EMH REGIONAL MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-0714612 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 170(B)(1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $0 HEATHER HILL INC. (HHI) - 34-0771884 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER ROAD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: UH CLEVELAND MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-1567805 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 170(B)(1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $0 UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION (UHLSF) - 34-1720429 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (II) EIN OF SUPPORTED ORGANIZATION: 34-0714775 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 509(A)(3) - TYPE II ORGANIZATION (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $0 UNIVERSITY HOSPITALS MEDICAL GROUP, INC. (UHMG) - 20-4881619 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD - MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 12G (I) NAME OF SUPPORTED ORGANIZATION: UH CLEVELAND MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-1567805 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-10 ABOVE OR IRC SECTION): 170(B)(1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS? YES (V) AMOUNT OF MONETARY SUPPORT: $68,426,000

SCHEDULE A, PART IV, SECTION C, TYPE II ORGANIZATIONS

THE FOLLOWING GROUP SUBORDINATES RESPONDED YES: - HEATHER HILL, INC. THE FOLLOWING GROUP SUBORDINATES RESPONDED NO: - COMPREHENSIVE HEALTH CARE OF OHIO COMPREHENSIVE HEALTH CARE OF OHIO ("CHCO") IS A SUPPORTING ORGANIZATION OF EMH REGIONAL MEDICAL CENTER AS STATED IN ITS ARTICLES. UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. ("UHHS") IS THE SOLE MEMBER OF CHCO. CHCO IS SUPERVISED, DIRECTED AND CONTROLLED BY UHHS. -UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION ("UHLSF") ACTS AS A SUPPORTING ORGANIZATION TO UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. ("UHHS"). ARTICLES OF INCORPORATION PROVIDE UHHS WITH SUPERVISION, DIRECTION AND CONTROL OVER UHLSF. -UNIVERISTY HOSPITALS MEDICAL GROUP, INC. UNIVERSITY HOSPITALS MEDICAL GROUP, INC. ("UHMG") ACTS AS A SUPPORTING ORGANIZATION TO UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER ("UHCMC"). THE CONTROL AND MANAGEMENT OF UHMG IS VESTED IN THE SAME PERSONS THAT CONTROL AND MANAGE ITS SUPPORTED ORGANIZATION BECAUSE BOTH ENTITIES ARE PART OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY A COMMON PARENT, UNIVERSITY HOSPITALS HEALTH SYSTEM. -UNIVERISTY HOSPITALS HOMECARE SERVICES, INC. UNIVERSITY HOSPITALS HOMECARE SERVICES, INC. ("UHHCS") ACTS AS A SUPPORTING ORGANIZATION TO UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER ("UHCMC"). THE CONTROL AND MANAGEMENT OF UHHCS IS VESTED IN THE SAME PERSONS THAT CONTROL AND MANAGE ITS SUPPORTED ORGANIZATION BECAUSE BOTH ENTITIES ARE PART OF AN INTEGRATED HEALTHCARE SYSTEM CONTROLLED BY A COMMON PARENT, UNIVERSITY HOSPITALS HEALTH SYSTEM.

Schedule A (Form 990 or 990-EZ) 2020

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

2020

Name of the organization

UNIVERSITY HOSPITALS HEALTH SYSTEM INC
GROUP RETURN

Employer identification number

90-0059117

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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization UNIVERSITY HOSPITALS HEALTH SYSTEM INC GROUP RETURN

Part I Contributors	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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization UNIVERSITY HOSPITALS HEALTH SYSTEM INC GROUP RETURN		Employer identification number 90-0059117

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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization UNIVERSITY HOSPITALS HEALTH SYSTEM INC GROUP RETURN			Employer identification number 90-0059117
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) (2020)

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

2020

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

UNIVERSITY HOSPITALS HEALTH SYSTEM INC
GROUP RETURN

Employer identification number

90-0059117

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) 2020

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). Click to see attachment

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.)		(a) Filing organization's totals	(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................	8,811	16,853
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................	271,144	518,613
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................	279,955	535,466
d	Other exempt purpose expenditures ...............................................................................	1,220,287,405	3,922,546,038
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................	1,220,567,360	3,923,081,504
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.	1,000,000	1,000,000
	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) .................................................	250,000	250,000
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................	0	0
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................	0	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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) Total

2a	Lobbying nontaxable amount	1,000,000	1,000,000	1,000,000	1,000,000	4,000,000

b	Lobbying ceiling amount (150% of line 2a, column(e))					6,000,000

c	Total lobbying expenditures	627,175	423,303	507,309	535,466	2,093,253

d	Grassroots nontaxable amount	250,000	250,000	250,000	250,000	1,000,000

e	Grassroots ceiling amount (150% of line 2d, column (e))					1,500,000

f	Grassroots lobbying expenditures	17,170	17,431	16,057	16,853	67,511

Schedule C (Form 990 or 990-EZ) 2020

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|No

(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? .......................

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

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

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

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
FORM 990, SCHEDULE C, PART IV	UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. GROUP RETURN DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENTS), ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE.
FORM 990, SCHEDULE C, PART II-B	SOFTWARE WOULD NOT ALLOW THE COMPLETION OF PART II-B: 1A - NO 1B - YES 1C - NO 1D - YES $158,543 1E - NO 1F - YES $131,447 1G - YES $116,036 1H - NO 1I - NO 1J - $406,036 2A NO

Schedule C (Form 990 or 990EZ) 2020

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 instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

UNIVERSITY HOSPITALS HEALTH SYSTEM INC
GROUP RETURN

Employer identification number

90-0059117

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 FASB 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 FASB 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

$ 377,569

(ii)

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

$ 7,853,567

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 FASB 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) 2020

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 SEE SUPPLEMENTAL INFORMATION

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
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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 ....	211,303,000	179,723,000	187,557,000	159,046,000	149,283,000
b	Contributions ...	10,211,000	9,871,000	5,345,000	8,523,000	7,136,000
c	Net investment earnings, gains, and losses	24,607,000	32,087,000	-5,466,000	28,790,000	10,239,000
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	4,217,000	10,378,000	7,713,000	8,802,000	7,612,000
f	Administrative expenses ....
g	End of year balance ......	241,904,000	211,303,000	179,723,000	187,557,000	159,046,000

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

Board designated or quasi-endowment SchDMd Bullet

5.570 %

Permanent endowment SchDMd Bullet

64.620 %

Term endowment SchDMd Bullet

29.810 %

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)

(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 .....	147,494,000		147,494,000
b	Buildings ....	2,106,197,000	957,833,000	1,148,364,000
c	Leasehold improvements	33,924,000	24,039,000	9,885,000
d	Equipment ....	1,763,295,000	1,298,708,000	464,587,000
e	Other .....	60,696,000	44,087,000	16,609,000
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				1,786,939,000

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program 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)BENEFICIAL INT. IN FOUNDATION	176,605,000	F
(2)INVESTMENT IN AFFILIATES	153,688,000	C
(3)INVESTMENTS - PROGRAM RELATED	227,950,000	F
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	558,243,000

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

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
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,391,761,000
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) 2020

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
PART III, LINE 4:	THE UH ART COLLECTION INCLUDES APPROXIMATELY 3,045 ORIGINAL WORKS OF ART, MANY DONATED OVER THE YEARS. ARTWORK INCLUDES PAINTINGS, PHOTOS, SCULPTURES AND THE LIKE. THE UH ART COLLECTION HAS BEEN ESTABLISHED TO ENCOURAGE REFLECTION, AND TO DELIGHT, UPLIFT AND COMFORT OUR PATIENTS, VISITORS, AND EMPLOYEES.
PART V, LINE 4:	THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUND VARIES DEPENDING ON DONOR STIPULATIONS. ALL SPENDING OF ENDOWMENT EARNINGS ARE DONE SO IN ACCORDANCE WITH DONOR INTENT AND APPLICABLE LAW. ENDOWMENTS ARE HELD ON THE BOOKS OF THE PARENT ORGANIZATION OF THE GROUP MEMBERS. SPENDING ALLOCATIONS ARE MADE TO THE PROPER UH ENTITY BY THE PARENT TO COMPLY WITH DONOR WISHES.
PART X, LINE 2:	UNIVERISTY HOSPITALS HEALTH SYSTEM, INC. MUST RECONGIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. AS OF DECEMBER 31, 2020 AND 2019, UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS.
FORM 990, SCHEDULE D, PART V	IN 2016 THE HEALTH SYSTEM ADOPTED FINANCIAL ACCOUNTING STANDARDS BOARD CODIFICATION TOPIC 820 ("FASB"). AS A RESULT THE HEALTH SYSTEM'S ENDOWMENT FUNDS FOR 2016-2020 HAVE BEEN PRESENTED TO CONFORM TO THE STANDARD.

Schedule D (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization
UNIVERSITY HOSPITALS HEALTH SYSTEM INC
GROUP RETURN

Employer identification number

90-0059117

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

AL, FL, GA, HI, IL, KS, KY, MD, MA, MI, MN, MS, NH, NJ, NM, NY, NC, ND, OK, OR, PA, SC, TN, UT, VA, WI

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2020

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 GOLF OUTING (event type)	(b) Event #2 REMOTE WINE TASTING (event type)	(c) Other events 1 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	167,619	122,961	58,703	349,283
2	Less: Contributions . . . .	145,354	100,542	50,690	296,586
3	Gross income (line 1 minus line 2) . . . . . .	22,265	22,419	8,013	52,697

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .
7	Food and beverages . . .	16,390	6,306	4,119	26,815
8	Entertainment . . . .
9	Other direct expenses . . .	5,377	30,463	11,109	46,949
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				73,764
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				-21,067

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2020

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2020

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

2020

Open to Public Inspection

Name of the organization

UNIVERSITY HOSPITALS HEALTH SYSTEM INC
GROUP RETURN

Employer identification number

90-0059117

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 25000.0000000000 %

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? . . . . . .

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) . . .	50,934,447		50,934,447	1.260 %
b	Medicaid (from Worksheet 3, column a) . . . . .	854,948,363	599,154,942	255,793,421	6.330 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	905,882,810	599,154,942	306,727,868	7.590 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	11,174,558	1,237,947	9,936,611	0.250 %
f	Health professions education (from Worksheet 5) . . .	122,084,130	29,524,249	92,559,881	2.290 %
g	Subsidized health services (from Worksheet 6) . . . .	49,062,178	33,144,433	15,917,745	0.390 %
h	Research (from Worksheet 7) .	94,063,525	36,944,656	57,118,869	1.410 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	488,882		488,882	0.010 %
j	Total. Other Benefits . .	276,873,273	100,851,285	176,021,988	4.350 %
k	Total. Add lines 7d and 7j .	1,182,756,083	700,006,227	482,749,856	11.940 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

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	42,785	42,785	0 %
3	Community support
4	Environmental improvements
5	Leadership development and training for community members	34,228	34,228	0 %
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other	5,827	5,827	0 %
10	Total	82,840	82,840	0 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

112,000,000

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. ......

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).....

496,475,984

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

595,693,113

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

-99,217,129

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 %	(e) Physicians' profit % or stock ownership %
11 EMH SHEFFIELD MEDICAL BUILDING CONDOMINIUM ASSOCIATION	CONDO MANAGEMENT	56.000 %	44.000 %
22 GATES MEDICAL CENTER INC	CONDO MANAGEMENT	40.000 %	60.000 %
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

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?14Name, 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)									Other (describe)	Facility reporting group
1	UH CLEVELAND MEDICAL CENTER 11100 EUCLID AVENUE CLEVELAND,OH44106 WWW.UHHOSPITALS.ORG 1142 UH CLEVELAND MEDICAL CENTER 341567805	X	X		X		X	X	IP PSYCH./IP REHAB./SKILLED NURSING LVL 1 TRAUMA CNTR	A
2	UH RAINBOW BABIES & CHILDREN'S HOSPITAL 11100 EUCLID AVENUE CLEVELAND,OH44106 WWW.UHHOSPITALS.ORG 1142 UH CLEVELAND MEDICAL CENTER 341567805	X	X	X	X		X	X	LVL 1 TRAUMA CTR	A
3	UH GEAUGA MEDICAL CENTER 13207 RAVENNA ROAD CHARDON,OH44024 WWW.UHHOSPITALS.ORG 1001 UH GEAUGA MEDICAL CENTER 340816492	X	X					X	IP PSYCHIATRIC UNIT	B
4	UH AHUJA MEDICAL CENTER 3999 RICHMOND ROAD BEACHWOOD,OH44122 WWW.UHHOSPITALS.ORG 1497 UH AHUJA MEDICAL CENTER 264827222	X	X					X		A
5	UH REGIONAL HOSPITALS 27100 CHARDON ROAD RICHMOND HEIGHTS,OH44143 WWW.UHHOSPITALS.ORG 1141&1008 UH REGIONAL HOSPITALS 341924226	X	X		X			X		A
6	UH GENEVA MEDICAL CENTER 870 WEST MAIN STREET GENEVA,OH44041 WWW.UHHOSPITALS.ORG 1108 UH GENEVA MEDICAL CENTER 340714461	X				X		X		A
7	UH CONNEAUT MEDICAL CENTER 158 WEST MAIN ROAD CONNEAUT,OH44030 WWW.UHHOSPITALS.ORG 1107 UH CONNEAUT MEDICAL CENTER 340714550	X				X		X		A
8	UH PARMA MEDICAL CENTER 7007 POWERS BLVD PARMA,OH44129 WWW.UHHOSPITALS.ORG 1007 UH PARMA MEDICAL CENTER 311827442	X	X					X		A
9	UH ELYRIA MEDICAL CENTER 630 EAST RIVER STREET ELYRIA,OH44035 WWW.UHHOSPITALS.ORG 1217 UH ELYRIA MEDICAL CENTER 340827442	X	X					X		A
10	UH ST JOHN MEDICAL CENTER 29000 CENTER RIDGE ROAD WESTLAKE,OH441455275 WWW.UHHOSPITALS.ORG 1034 UH ST JOHN MEDICAL CENTER 341260978	X	X		X			X		A
11	UH PORTAGE MEDICAL CENTER 6847 NORTH CHESTNUT STREET RAVENNA,OH44266 WWW.UHHOSPITALS.ORG 1255 UH PORTAGE MEDICAL CENTER 461382538	X	X		X			X		A
12	UH SAMARITAN MEDICAL CENTER 1025 CENTER STREET ASHLAND,OH44805 WWW.SAMARITANHOSPITAL.ORG 1104 UH SAMARITAN MEDICAL CENTER 340714535	X	X					X		B
13	UNIVERSITY HOSPITALS REHABILITATION HOSPITAL 23333 HARVARD ROAD BEACHWOOD,OH44122 WWW.UHHOSPITALS.ORG 1509 UH CLEVELAND MEDICAL CENTER 341567805	X							REHABILATION	A
14	UH AVON REHABILITATION HOSPITAL 37900 CHESTER ROAD AVON,OH44011 WWW.UHHOSPITALS.ORG 1523 UNIVERSITY HOSPITALS HEALTH SYSTEM INC 340714775	X							REHABILATION	A

Schedule H (Form 990) 2020

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)

	REPORTING GROUP A
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 19

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. ............................

Yes

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): SEE PART VI

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 19

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

Yes

If "Yes" (list url): SEE PART VI

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) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	REPORTING GROUP A
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 250.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

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):

HTTPS://WWW.UHHOSPITALS.ORG/MYUHCARE/PAY-MY-BILL/FINANCIAL-ASSISTANCE

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

HTTPS://WWW.UHHOSPITALS.ORG/MYUHCARE/PAY-MY-BILL/FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://WWW.UHHOSPITALS.ORG/MYUHCARE/PAY-MY-BILL/FINANCIAL-ASSISTANCE

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) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	REPORTING GROUP A
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 (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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) 2020

Page 7

Part VFacility Information (continued)

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

	REPORTING GROUP A
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) 2020

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)

	REPORTING GROUP B
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?........................

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 19

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..................................

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. ............................

Yes

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): SEE PART VI

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 19

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

Yes

If "Yes" (list url): SEE PART VI

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

10b

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) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	REPORTING GROUP B
Name of hospital facility or letter of facility reporting group