TY 2019 Form 990

- 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

2019

Open to Public
Inspection

Name of the organization

JAMESON CARE CENTER INC

Employer identification number

23-2871396

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	310	194	220	6,007	332,865	339,596
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	9,034,476	7,205,699	7,573,916	7,651,717	8,185,598	39,651,406
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....						0
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...						0
5	The value of services or facilities furnished by a governmental unit to the organization without charge						0
6	Total. Add lines 1 through 5	9,034,786	7,205,893	7,574,136	7,657,724	8,518,463	39,991,002
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.)						39,991,002

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...	9,034,786	7,205,893	7,574,136	7,657,724	8,518,463	39,991,002
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	230	0	0	0	0	230
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.						0
c	Add lines 10a and 10b.	230	0	0	0	0	230
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.						0
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..	23,100	0	0	0		23,100
13	Total support. (Add lines 9, 10c, 11, and 12.)..	9,058,116	7,205,893	7,574,136	7,657,724	8,518,463	40,014,332

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

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

99.942 %

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

99.890 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

0.001 %

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

0.001 %

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

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

Section A. All Supporting Organizations

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

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

Yes

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

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

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

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

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 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 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, 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 2019. 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 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

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

2019

Name of the organization

JAMESON CARE CENTER INC

Employer identification number

23-2871396

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization JAMESON CARE CENTER INC

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization JAMESON CARE CENTER INC		Employer identification number 23-2871396

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization JAMESON CARE CENTER INC			Employer identification number 23-2871396
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) (2019)

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

2019

Open to Public Inspection

Name of the organization

JAMESON CARE CENTER INC

Employer identification number

23-2871396

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

(ii)

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

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under 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) 2019

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

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

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 .....	229,452		229,452
b	Buildings ....	4,235,661	600,459	3,635,202
c	Leasehold improvements	27,462	22,330	5,132
d	Equipment ....	524,638	126,208	398,430
e	Other .....	506,836		506,836
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				4,775,052

Schedule D (Form 990) 2019

Page 3

Part VII

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

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

Part VIII

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

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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	0
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	8,441,709
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) 2019

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference	Explanation

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

JAMESON CARE CENTER INC

Employer identification number

23-2871396

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

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

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

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1MARK BONDI PRESIDENT	(i) (ii)	0 ------------- 187,363	0 ------------- 101,750	0 ------------- 3,709	0 ------------- 0	0 ------------- 0	0 ------------- 292,822	0 ------------- 0
2WILLIAM NIGRO CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 146,290	0 ------------- 21,733	0 ------------- 272	0 ------------- 0	0 ------------- 0	0 ------------- 168,295	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

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

Return Reference

Explanation

SCHEDULE J, PART I, QUEST. 7

JAMESON CARE CENTER PROVIDES INCENTIVE COMPENSATION AS PART OF ITS TOTAL COMPENSATION PROGRAM FOR OFFICERS AND KEY EMPLOYEES. THE COMPONENTS ARE BASED UPON THE ACCOMPLISHMENT OF PREDETERMINED PERFORMANCE GOALS AND OBJECTIVES WHICH FOCUS ON THE ACHIEVEMENT OF MULTIPLE ANNUAL AND THREE YEAR INDIVIDUAL AND GROUP PERFORMANCE CRITERIA IN THE CONTEXT OF APPROPRIATE RISK TAKING. THESE CRITERIA DIRECTLY SUPPORT UPMC SENIOR COMMUNITIES' MISSION AND INCLUDE :PATIENT QUALITY AND SATISFACTION, COMMUNITY BENEFITS, OPERATIONAL AND FINANCIAL STRENGTH, LEADERSHIP DEVELOPMENT AND STRATEGIC BUSINESS INITIATIVES, AMONG OTHERS.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

JAMESON CARE CENTER INC

Employer identification number

23-2871396

Return Reference	Explanation
FORM 990, PART I, LINE 1	JAMESON CARE CENTER'S MISSION IS TO PROMOTE THE HEALTH AND WELL-BEING OF ELDERLY AND HANDICAPPED PERSONS IN LAWRENCE COUNTY, PENNSYLVANIA THROUGH THE PROVISION OF SKILLED NURSING AND PERSONAL CARE FACILITIES AND RELATED HEALTHCARE SERVICES.
FORM 990, PART III STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	Jameson Care Center, Inc. EIN 23-2871396 Fiscal Year Ending June 30, 2020 Form 990, Part III - Statement of Program Service Accomplishments The mission of Jameson Care Center (JCC) is to promote the health and well being of elderly and handicapped persons in Lawrence County, Pennsylvania through the provision of skilled nursing and personal care facilities and related healthcare services. Jameson Care Center is comprised of two (2) facilities: Jameson Care Center, which provides long-term skilled and intermediate nursing care and short-term rehabilitation, and Jameson Place, which is a state-licensed personal care facility that recognizes and supports the privacy, dignity, and independence of those it serves. Jameson Care Center is a 78-bed, Medicare-certified care facility with 14 private rooms and 64 semi-private rooms. During fiscal year 2020, there were 272 admissions and had an average daily census of 66.6. Jameson Care Center offers the following services to its patients: - 24-hour nursing care and supervision by professional nursing staff - Access to all services and programs offered at UPMC Jameson - Rehabilitation services focused on restorative nursing care and rehabilitation therapies, as needed - IV therapy - Enterostomal therapy - Nutritional services monitored by a registered dietician - Medical supervision and administration by skilled staff - Activity therapy program - Social services - Spiritual needs - Special consulting services available on site including psychological, dental, podiatry, ophthalmologic and others, as needed Jameson Place is located adjacent to Jameson Care Center. Residents enjoy an array of features to support their mental, physical, social, and spiritual development. A total of 36 private apartments, either studio or one-bedroom, offer a warm, homelike environment for seniors who require some assistance. The staff of Jameson Place provides supervised care under the direction of licensed administrators in addition to highly skilled staff specifically trained in personal care direct support services. Residents retain their own personal physician who oversees care. During fiscal year 2019, there were 13 admissions and 11,759 resident days. Jameson Place provides the following amenities to its residents: - Spacious, comfortable, handicapped accessible apartments with kitchenette equipped with refrigerator - Private bathrooms, individual climate controls, emergency call system in each apartment - Private phone hook-up with cable ready television hook-ups - Free Parking - Beautifully furnished glass-enclosed lounge in the main lobby - Daily meals in a central dining room featuring a scenic view - Private dining room with kitchen for social activities with family - Laundry equipment for resident's use or a small fee for laundry service - Full schedule of stimulating daily activities to promote engagement and socializing - Smoke-free facility - In-house salon available - Transportation to travel for shopping and doctor's appointments within travel distance - Weekly housekeeping included within travel distance - Weekly housekeeping included
FORM 990, PART VI, LINE 11b	A full copy of the form 990 was provided to each Board of Directors member prior to filing.
FORM 990, PART VI, LINE 12c	UPMC requires all of its key employees and non-employed personnel to comply with its conflict of interest policies when they engage in UPMC-related business. People covered by the policies include: UPMC entity board members, board committee members, and corporate officers; UPMC physicians and non-physician employees who hold a position of influence; Non-employed members of the UPMC medical staff who hold a position of influence of trust; Individuals conducting clinical research at UPMC, whether or not they are employed by UPMC. These people are required to complete a questionnaire at least annually. An electronic form has been developed to capture the data from the questionnaire and to monitor completion. The information, along with other data, is used to capture individual and institutional relationships so that potential conflicts of interest can be identified. If a potential conflict is identified regarding a specific UPMC activity the corporate compliance department, with the assistance of the legal department, evaluate the activity in relation to the potential conflict. If a perceived or actual conflict is determined to exist and a decision is made to proceed with the activity, a written plan designed to prevent the conflict from influencing decisions related to the activity is developed. The process is ultimately overseen by a conflict of interest committee of the UPMC board of directors on behalf of all UPMC subsidiaries, including Jameson Care Center, Inc.
FORM 990, PART VI, LINE 15a and 15b	UPMC has established a rigorous compensation review process for its top executives which includes review by its executive compensation committee in a process intended to satisfy the "rebuttable presumption of reasonableness" set forth in the regulations to section 4958 of the internal revenue code. UPMC gives authority to those executives to establish the compensation of executives of others subsidiaries and business units, including those of Jameson Care Center, Inc.
FORM 990, PART VI, LINE 19	Upon request, management determines public disclosure applicability.
SCHEDULE R	There are organizations included in the UPMC Group form 990 tax return for fiscal year 2020 which are related to Jameson Care Center, Inc. These organizations are not required to be listed in schedule R. These related organizations have direct and indirect control.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

JAMESON CARE CENTER INC

Employer identification number

23-2871396

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)UPMC SENIOR COMMUNITIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1574736	SR LIVING	PA	501(C)(3)	10	UPMC	Yes
(2)PITTSBURGH LIFETIME CARE COMMUNITY 600 GRANT STREET PITTSBURGH,PA15219 25-1335247	CCRC	PA	501(C)(3)	10	UPMC SR COMM	Yes
(3)CANTERBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-0965334	SR LIVING	PA	501(C)(3)	10	UPMC SR COMM	Yes
(4)SENECA PLACE 600 GRANT STREET PITTSBURGH,PA15219 72-1562844	SR LIVING	PA	501(C)(3)	10	UPMC SR COMM	Yes
(5)SHADYSIDE HOSPITAL SUPPORTING FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 26-0303394	FOUNDATION	PA	501(C)(3)	12(A) I	UPMC	Yes
(6)UPMC LEE 600 GRANT STREET PITTSBURGH,PA15219 25-0613830	INACTIVE	PA	501(C)(3)	3	UPMC	Yes
(7)PITTSBURGH CARE PARTNERSHIP INC 600 GRANT STREET PITTSBURGH,PA15219 25-1753852	SR CARE MGMT	PA	501(C)(3)	10	UPMC	Yes
(8)UPMC CENTER FOR HIGH VALUE HEALTHCARE 600 GRANT STREET PITTSBURGH,PA15219 45-2178782	RESEARCH	PA	501(C)(3)	7	UPMC	Yes
(9)SHADYSIDE HOSPITAL FOUNDATION 532 SOUTH AIKEN AVENUE PITTSBURGH,PA15232 25-1290546	FOUNDATION	PA	501(C)(3)	12(C)III	UPMC PRESBY	Yes
(10)PASSAVANT HOSPITAL FOUNDATION 9100 BABCOCK BLVD PITTSBURGH,PA15237 25-1407815	FOUNDATION	PA	501(C)(3)	12(B)II	UPMC PASS	Yes
(11)NORTHWEST HOSPITAL FOUNDATION 100 FARFIELD DRIVE SENECA,PA16346 25-1483624	FOUNDATION	PA	501(C)(3)	12(D)III	UPMC NORTHWE	Yes
(12)ST MARGARET FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1520340	FOUNDATION	PA	501(C)(3)	7	UPMC ST MARG	Yes
(13)CHILDREN'S HOSPITAL OF PITTSBURGH FND 600 GRANT STREET PITTSBURGH,PA15219 25-1865744	FOUNDATION	PA	501(C)(3)	7	UPMC CHP	Yes
(14)MAGEE-WOMEN RES INST AND FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1462312	FOUNDATION	PA	501(C)(3)	7	NA		No
(15)Great Lakes Physician Practice PC 600 Grant Street 58th Floor PITTSBURGH,PA15219 46-4186362	PHYSICIAN SRV	NY	501(C)(3)	3	Regnl Health	Yes
(16)Hamot Health Foundation 302 FRENCH STREET ERIE,PA16507 25-1400999	FOUNDATION	PA	501(C)(3)	12(B)II	UPMC HAMOT	Yes
(17)UPMCJAMESON CANCER CENTER 600 GRANT STREET 58TH FL PITTSBURGH,PA15219 20-1459415	ONCOLOGY SVC	PA	501(C)(3)	10	UPMC Jameson	Yes
(18)JAMESON CARE CENTER INC 1211 WILMINGTON AVE NEW CASTLE,PA16105 23-2871396	SR SERVICES	PA	501(C)(3)	10	UPMC SR COMM	Yes
(19)UPMC SUSQUEHANNA 700 HIGH STREET WILLIAMSPORT,PA17701 23-2751183	MGMT SUPPORT	PA	501(C)(3)	3	UPMC	Yes
(20)UPMC MUNCY 215 EAST WATER STREET MUNCY,PA17756 24-0806023	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQUEH	Yes
(21)DIVINE PROVIDENCE HOSPITAL OF THE SISTE 1100 GRAMPIAN BOULEVARD WILLIAMSPORT,PA17701 24-0799343	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQUEH	Yes
(22)SUSQUEHANNA PHYSICIAN SERVICES 1201 GRAMPIAN BOULEVARD WILLIAMSPORT,PA17701 23-2449454	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC SUSQUEH	Yes
(23)SUSQUEHANNA HEALTH SYSTEM INNOVATION CT 700 HIGH STREET WILLIAMSPORT,PA17701 47-1600873	SUPPORT SRV	PA	501(C)(3)	12(a)(I)	UPMC SUSQUEH	Yes
(24)SUSQUEHANNA HEALTH FOUNDATION 1100 GRAMPIAN BOULEVARD WILLIAMSPORT,PA17701 23-2743470	FOUNDATION	PA	501(C)(3)	12(A)(I)	UPMC SUSQUEH	Yes
(25)UPMC WILLIAMSPORT 700 HIGH STREET WILLIAMSPORT,PA17701 24-0795508	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQUEH	Yes
(26)LAUREL REALTY INC 32-36 CENTRAL AVENUE WELLSBORO,PA16901 23-1403678	REAL ESTATE	PA	501(C)(2)	N/A	UPMC SUSQUEH	Yes
(27)LAUREL MANAGEMENT SERVICES INC 32-36 CENTRAL AVENUE WELLSBORO,PA16901 25-1644910	MANAGEMENT SV	PA	501(C)(3)	12(B)(II)	UPMC SUSQUEH	Yes
(28)LAUREL HEALTH SYSTEM 32-36 CENTRAL AVENUE WELLSBORO,PA16901 24-0795488	SUPPORT SRV	PA	501(C)(3)	12(B)(II)	UPMC SUSQUEH	Yes
(29)UPMC WELLSBORO 32-36 CENTRAL AVENUE WELLSBORO,PA16901 23-2176963	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQUEH	Yes
(30)THE GREEN HOME 37 CENTRAL AVENUE WELLSBORO,PA16901 24-0804365	SKILLED NURSI	PA	501(C)(3)	10	UPMC SUSQUEH	Yes
(31)TIOGA HEALTH CARE PROVIDERS 1201 GRAMPIAN BOULEVARD WILLIAMSPORT,PA17701 25-1765538	HEALTHCARE	PA	501(C)(3)	12(B)(II)	UPMC SUSQUEH	Yes
(32)WILLIAMSPORT AREA AMBULANCE SERVICE COO 700 HIGH STREET WILLIAMSPORT,PA17701 23-2416166	AMBULANCE SVC	PA	501(C)(3)	10	WILLIAM HOSP	Yes
(33)UPMC LOCK HAVEN 700 HIGH STREET WILLIAMSPORT,PA17701 82-1600494	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQUEH	Yes
(34)UPMC SUNBURY 700 HIGH STREET WILLIAMSPORT,PA17701 82-1592230	HOSPITAL	PA	501(C)(3)	3	UPMC SUSQUEH	Yes
(35)UPMC CHAUTAUQUA AT WCA 207 FOOTE AVENUE JAMESTOWN,NY14701 16-0743226	HOSPITAL	NY	501(C)(3)	3	UPMC CHAUTAU	Yes
(36)WCA GROUP INC 207 FOOTE AVENUE JAMESTOWN,NY14701 22-2392582	HOLDING CO	NY	501(C)(3)	12 (B)(II)	CHAUT AT WCA	Yes
(37)STARFLIGHT INC 135 ALLEN STREET JAMESTOWN,NY14701 16-1557878	AIR AMBULANCE	NY	501(C)(3)	7	CHAUT AT WCA	Yes
(38)SOUTH CENTRAL ALPHA HOUSING & HEALTH 3410 W PITTSBURG ROAD NEW CASTLE,PA16101 25-1701701	SNF & AL	PA	501(C)(3)	10	UPMC SR COMM	Yes
(39)SOUTH WESTERN ALPHA HOUSING & HEALTH 745 GREENVILLE ROAD MERCER,PA16137 25-1701700	SNF & IL	PA	501(C)(3)	10	UPMC SR COMM	Yes
(40)KANE COMMUNITY HOSPITAL FOUNDATION 4372 ROUTE 6 KANE,PA16735 26-3906925	FOUNDATION	PA	501(C)(3)	12 (B)(II)	NA		No
(41)JUNIOR GUILD OF THE JAMESON MEMORIAL HOS 1211 WILMINGTON AVENUE NEW CASTLE,PA16105 25-6005313	SUPPORT	PA	501(C)(3)	12(D)III	NA		No
(42)LAUREL HEALTH FOUNDATION 32-36 CENTRAL AVENUE WELLSBORO,PA16901 25-1810488	FOUNDATION	PA	501(C)(3)	12(B)II	NA		No
(43)WCA FOUNDATION INC 300 FOOTE AVENUE PO BOX 840 JAMESTOWN,NY14702 22-2393584	FOUNDATION	PA	501(C)(3)	12(C)III	NA		No
(44)VENANGO VNA FOUNDATION 491 ALLEGHENY BOULEVARD FRANKLIN,PA16323 25-1472179	FOUNDATION	PA	501(C)(3)	12(D) III	NA		No
(45)UPMC PINNACLE 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778658	SUPPORTING OR	PA	501(C)(3)	12(B)II	UPMC	Yes
(46)UPMC CARLISLE 361 ALEXANDER SPRING ROAD CARLISLE,PA17105 82-0880337	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL	Yes
(47)UPMC LANCASTER 250 COLLEGE AVENUE LANCASTER,PA17603 82-0896436	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL	Yes
(48)UPMC LITITZ 1500 HIGHLANDS AVENUE LITITZ,PA17543 82-0844453	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL	Yes
(49)UPMC MEMORIAL 325 SOUTH BELMONT STREET YORK,PA17405 82-0912090	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL	Yes
(50)PINNACLE HEALTH REGIONAL PHYSICIANS 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-0947698	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC PINNACL	Yes
(51)PINNACLE HEALTH FOUNDATION 409 SOUTH SECOND STREET HARRISBURG,PA17104 22-2691718	FOUNDATION	PA	501(C)(3)	12(B)II	UPMC PINNACL	Yes
(52)COMMUNITY LIFE TEAM INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1890444	MED TRANSPORT	PA	501(C)(3)	7	UPMC PINNACL	Yes
(53)HANOVER HEALTHCARE PLUS INC 300 HIGHLAND AVENUE HANOVER,PA17331 22-2658574	SUPPORTING OR	PA	501(C)(3)	12(A)(I)	UPMC PINNACL	Yes
(54)UPMC HANOVER 300 HIGHLAND AVENUE HANOVER,PA17331 23-1360851	HOSPITAL	PA	501(C)(3)	3	HANNOVER HEA	Yes
(55)UPMC PINNACLE HOSPITALS 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778644	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL	Yes
(56)PINNACLE HEALTH MEDICAL SERVICES 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1709054	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC PINNACL	Yes
(57)CHARLES E COLE MEMORIAL HOSPITAL 1001 EAST SECOND STREET COUDERSPORT,PA16915 24-0802108	HOSPITAL	PA	501(C)(3)	3	UPMC	Yes
(58)COLE FOUNDATION INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 45-5417308	FOUNDATION	PA	501(C)(3)	12(A)(I)	C COLE MEM H	Yes
(59)HAMOT COLE VENTURES 1001 EAST SECOND STREET COUDERSPORT,PA16915 27-3172100	CLINIC SITES	PA	501(C)(3)	12(A)(I)	C COLE MEM H	Yes
(60)HENDORN INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 23-1972659	RES. CARE	PA	501(C)(3)	12(A)(I)	C COLE MEM H	Yes
(61)ASBURY HEIGHTS OF UPMC 600 GRANT STREET PITTSBURGH,PA15219 25-1555687	SUPPORTING OR	PA	501(C)(3)	12(B)(II)	UPMC SR COMM	Yes
(62)ASBURY HEALTH CENTER 600 GRANT STREET PITTSBURGH,PA15219 25-0969472	CCRC	PA	501(C)(3)	10	ASBURY HEIGH	Yes
(63)ASBURY VILLAS 600 GRANT STREET PITTSBURGH,PA15219 25-1819952	PERSONAL CARE	PA	501(C)(3)	10	ASBURY HEIGH	Yes
(64)ASBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-1729266	PERSONAL CARE	PA	501(C)(3)	10	ASBURY HEIGH	Yes
(65)WESLEY HILLS 600 GRANT STREET PITTSBURGH,PA15219 25-1507472	INDEP LIVING	PA	501(C)(3)	N/A	ASBURY HEIGH	Yes
(66)ASBURY FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1555688	FOUNDATION	PA	501(C)(3)	7	ASBURY HEIGH	Yes
(67)REGIONAL CANCER CENTER FOUNDATION 2500 WEST 12TH STREET ERIE,PA16505 25-1631855	FOUNDATION	PA	501(c)(3)	12(A)(I)	REGIONAL CAN	Yes
(68)UPMC SOMERSET 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-0965570	HOSPITAL	PA	501(C)3	3	UPMC	Yes
(69)TWIN LAKES CENTER INC 225 SOUTH CENTER AVENUE SOMERSET,PA15501 23-2910318	DRUG TREATMEN	PA	501(C)3	3	UPMC SOMERSE	Yes
(70)SOMERSET COMMUNITY HOSPITAL FOUNDATION 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-1441863	FOUNDATION	PA	501(C)3	12(C)III	UPMC SOMERSE	Yes
(71)SOMERSET HEALTH SERVICES INC 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-1441920	PHYSICIAN SRV	PA	501(C)3	3	UPMC SOMERSE	Yes
(72)UPMC WESTERN MARYLAND CORPORATION PO BOX 539 CUMBERLAND,MD21501 52-0591531	HOSPITAL	MD	501(C)3	3	UPMC
(73)WESTERN MARYLAND HEALTH SYSTEM FOUNDATIO PO BOX 539 CUMBERLAND,MD21501 35-2289841	FOUNDATION	MD	501(C)3	12(C)III	UPMC WESTERN
(74)UPMC 600 GRANT STREET PITTSBURGH,PA15219 25-1423657	SUPPORTING OR	PA	501(c)(3)	12(C)III	NA

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) SENECA HILLS ASSISTED LIVING LP 600 GRANT STREET PITTSBURGH,PA15219 23-2873106	ASSISTED LIVI	PA	NA	N/A
(2) ST MARGARET MEDICAL ARTS ASSOCIATES 600 GRANT STREET PITTSBURGH,PA15219 25-1786655	MED OFFICE BL	PA	NA	N/A
(3) CORE NETWORK LLC 600 GRANT STREET PITTSBURGH,PA15219 25-1786209	HEALTHCARE	PA	NA	N/A
(4) LIFE HOME CARE LP 600 GRANT STREET PITTSBURGH,PA15219 25-1847839	HOMECARE	PA	NA	N/A
(5) SHADYSIDE MEDICAL CENTER ASSOCIATION 600 GRANT STREET PITTSBURGH,PA15219 25-1608318	MED OFFICE BL	PA	NA	N/A
(6) CHARTWELL PA LP 600 GRANT STREET PITTSBURGH,PA15219 25-1729714	HOMEHEALTH	PA	NA	N/A
(7) LIFE Care Home SRV OF NW PA 1647 SASSAFRAS STREET ERIE,PA16501 25-1536879	HOME HEALTH S	PA	NA	N/A
(8) HAMOT-KCH REAL ESTATE VENTURE 300 STATE STREET ERIE,PA16507 26-3691782	MEDICAL OFFIC	PA	NA	N/A
(9) HAMOT SURGERY CENTER LLC 200 STATE STREET ERIE,PA16507 25-1863661	AMBULATORY SU	PA	NA	N/A
(10) EPN-Hamot Urgent Care LLC 600 Grant Street Pittsburgh,PA15219 27-2147949	Urgent Care	PA	NA	N/A
(11) LAWRENCE COUNTY MRI & DIAGNOSTIC IMAGING 2526 WILMINGTON AVE NEW CASTLE,PA16105 27-0219891	IMAGING CENTE	PA	NA	N/A
(12) COMMUNITY BASKET LLC 1205 GRAMPIAN BOULEVARD WILLIAMSPORT,PA17701 20-1195739	REAL ESTATE R	PA	NA	N/A
(13) HANOVER SURGICENTER REAL ESTATE LP 300 HIGHLAND AVE HANOVER,PA17331 35-2342993	INACTIVE	PA	NA	N/A
(14) MEDCARE SUSQUEHANNA VALLEY LLC 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-1673688	DME	PA	NA	N/A
(15) OMICELO RE I LP 2525 LIBERTY AVENUE PITTSBURGH,PA15222 47-5603393	REAL ESTATE D	DE	NA	N/A
(16) UPMC LEADER SURGERY CENTER LLC 1703 INNOVATION DRIVE YORK,PA17408 23-3035083	SURGERY CENT	PA	NA	N/A

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) HC PHARMACY CENTRAL INC 600 GRANT STREET PITTSBURGH,PA15219 25-1364192	PHARMACY CO-O	PA	NA	C
(2) CHILDREN'S COMMUNITY CARE 600 GRANT STREET PITTSBURGH,PA15219 25-1781887	PHYSICIAN SRV	PA	NA	C
(3) UPMC PHYSICIAN SERVICES HOLDING COMPANY 600 GRANT STREET PITTSBURGH,PA15219 25-1877017	HOLDING CO	PA	NA	C
(4) HEMATOLOGY ONCOLOGY ASSOCIATION INC 600 GRANT STREET PITTSBURGH,PA15219 42-1648357	PHYSICIAN SRV	PA	NA	C
(5) ONCOLOGY HEMATOLOGY ASSOCATION INC 600 GRANT STREET PITTSBURGH,PA15219 25-1762980	PHYSICIAN SRV	PA	NA	C
(6) TRI-STATE NEUROSURGICAL ASSOCIATES - UPM 600 GRANT STREET PITTSBURGH,PA15219 25-1458655	PHYSICIAN SRV	PA	NA	C
(7) RENAISSANCE FAMILY PRACTICE - UPMC INC 600 GRANT STREET PITTSBURGH,PA15219 26-2942406	PHYSICIAN SRV	PA	NA	C
(8) UPMC HOLDING COMPANY INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777713	HOLDING CO	PA	NA	C
(9) UPMC COVERAGE PRODUCTS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777710	HOLDING CO	PA	NA	C
(10) FREEDOM INSURANCE COMPANY 600 GRANT STREET PITTSBURGH,PA15219 03-0308944	INSURANCE	VT	NA	C
(11) TRI-CENTURY INSURANCE CO 600 GRANT STREET PITTSBURGH,PA15219 25-1500739	INSURANCE	PA	NA	C
(12) UPMC DnA INC 600 GRANT STREET PITTSBURGH,PA15219 25-1883237	INSURANCE	PA	NA	C
(13) UPMC HEALTH BENEFITS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1844144	HEALTH INSUR	PA	NA	C
(14) UPMC HEALTH NETWORK INC 600 GRANT STREET PITTSBURGH,PA15219 72-1527566	HEALTH INSUR	PA	NA	C
(15) UPMC HEALTH PLAN INC 600 GRANT STREET PITTSBURGH,PA15219 23-2813536	HEALTH INSUR	PA	NA	C
(16) UPMC BENEFIT MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1769564	WORKERS' COMP	PA	NA	C
(17) UPMC DIVERSIFIED SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1778454	HOLDING CO	PA	NA	C
(18) MONROEVILLE SPECIALTY CLINIC 600 GRANT STREET PITTSBURGH,PA15219 25-1666087	AMB SURG	PA	NA	C
(19) MEDICAL ARCHIVAL SYSTEMS INC 600 GRANT STREET PITTSBURGH,PA15219 23-2912501	SOFTWARE DEVE	DE	NA	C
(20) RX PARTNERS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1801966	PHARMACY	PA	NA	C
(21) BIOTRONICS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1843500	EQUIP MAINTEN	PA	NA	C
(22) MEDICAL CENTER PROPERTIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1796940	REAL ESTATE	PA	NA	C
(23) ASKESIS DEVELOPMENT GROUP INC 600 GRANT STREET PITTSBURGH,PA15219 54-1625585	SOFTWARE DEVE	DE	NA	C
(24) BAYFRONT REGIONAL DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401388	RE HOLDING CO	PA	NA	C
(25) BAYSIDE DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401386	REAL ESTATE	PA	NA	C
(26) UPMC WORK ALLIANCE INC 600 GRANT STREET PITTSBURGH,PA15219 45-2825053	INSURANCE	PA	NA	C
(27) UPMC HEALTH COVERAGE INC 600 GRANT STREET 58TH FLOOR PITTSBURGH,PA15219 46-2824537	INSURANCE	PA	NA	C
(28) UPMC HEALTH OPTIONS INC 600 GRANT STREET PITTSBURGH,PA15219 46-2824626	INSURANCE	PA	NA	C
(29) UPMC COMPLETE CARE INC 5215 CENTRE AVENUE Pittsburgh,PA15232 46-3605753	PHYSICIAN SRV	PA	NA	C
(30) AMERICAN HOME HEALTH SERVICES 868 CORPORATE WAY WESTLAKE,OH44145 31-1521422	HOME HEALTH C	OH	NA	C
(31) HEALTH FIDELITY INC 210 S B STREET SAN MATEO,CA94401 45-2538963	TECHNOLOGY SV	CA	NA	C
(32) FLUENCE HEALTH INC 6425 PENN AVENUE PITTSBURGH,PA15206 47-2684174	SOFTWARE	DE	NA	C
(33) CURAVI HEALTH INC 6425 PENN AVENUE PITTSBURGH,PA15206 81-1217377	HEALTHCARE	DE	NA	C
(34) PENSIAMO INC 600 GRANT STREET 59TH FL PITTSBURGH,PA15219 81-2069236	SUPPLY CHAIN	DE	NA	C
(35) ALTOONA FAMILY INC 620 HOWARD AVE ALTOONA,PA16601 25-1444935	MGMT SVCS	PA	NA	C
(36) LEXINGTON HOLDINGS INC 620 HOWARD AVE ALTOONA,PA16601 25-1794386	HOLDING CO	PA	NA	C
(37) LEXINGTON ONE INC 620 HOWARD AVE ALTOONA,PA16601 25-1468889	RENTAL	PA	NA	C
(38) LEXINGTON TWO INC HOWARD AVE 7TH ST ALTOONA,PA16601 25-1555689	DME	PA	NA	C
(39) LEXINGTON FOUR INC 620 HOWARD AVE ALTOONA,PA16601 25-1793736	HOLDING CO	DE	NA	C
(40) UPMC ALTOONA REGIONAL HEALTH SERVICES 1414 9TH AVENUE ALTOONA,PA16602 25-1219302	PHYSICIAN SRV	PA	NA	C
(41) LEXINGTON ANESTHESIA ASSOCIATES INC 620 HOWARD AVE ALTOONA,PA16601 25-1897765	PHYSICIAN SRV	PA	NA	C
(42) MEDCPU INC 100 WALL STREET SUITE 2202 NEW YORK,NY10005 38-3805381	SOFTWARE DEVE	DE	NA	C
(43) UPMC EXCESS PL TRUST 600 GRANT STREET PITTSBURGH,PA15219 82-6254351	TRUST	PA	NA	TRUST
(44) RXANTE INC 511 CONGRESS STREET 803 PORTLAND,ME04101 45-4040219	MEDICATION MG	DE	NA	C
(45) J HEALTH VENTURES INC 1211 WILIMINGTON AVENUE NEW CASTLE,PA16105 25-1607893	INACTIVE	PA	NA	C
(46) SUSQUEHANNA VENTURES INC 1201 GRAMPIAN BOULEVARD WILLIAMSPORT,PA17701 23-2470623	PHARMACY	PA	NA	C
(47) TYOGA CARENET 114 EAST AVENUE WELLSBORO,PA16901 25-1810967	INACTIVE	PA	NA	C
(48) WCA SERVICE CORPORATION INC 207 FOOTE AVENUE JAMESTOWN,NY14701 16-1151438	SUPPORT	NY	NA	C
(49) ITTCCO I INC 600 GRANT STREET PITTSBURGH,PA15219 82-2590699	INACTIVE	DE	NA	C
(50) ITTCCO II INC 600 GRANT STREET PITTSBURGH,PA15219 82-2597388	INACTIVE	DE	NA	C
(51) PINNACLE HEALTH CARDIOVASCULAR INSTITUT 409 SOUTH SECOND STREET HARRISBURG,PA17104 32-0321362	PHYSICIAN SRV	PA	NA	C
(52) HANOVER HEALTH CORPORATION 300 HIGHLAND AVENUE HANOVER,PA17331 90-0498067	HOLDING CO	PA	NA	C
(53) HANOVER APOTHECARY INC 310 STOCK STREET SUITE 1 HANOVER,PA17331 03-0594526	PHARMACY	PA	NA	C
(54) UNITED CENTRAL PA RECIPROCAL RISK RETEN 76 SAINT PAUL STREET SUITE 500 BURLINGTON,VT05401 13-4224033	INSURANCE	VT	NA	C
(55) PINNACLE HEALTH VENTURES INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 61-1677624	HOLDING CO	PA	NA	C
(56) PINNACLE HEALTH IMAGING INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1718571	IMAGING SVC	PA	NA	C
(57) COLE CARE INC 1001 EAST 2ND STREET COUDERSPORT,PA16915 25-1497347	DME	PA	NA	C
(58) UPMC ITALY HEALTH SERVICES SRL VIA DISCESA DEI GIUDICI 4 PALERMO 90133 IT	HEALTH SVC	IT	NA	C
(59) UPMC INVESTMENTS LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI	HOLDING CO	EI	NA	C
(60) UPMC PROPERTY LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI	PROPERTY	EI	NA	C
(61) UPMC PROPERTY II LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI	PROPERTY	EI	NA	C
(62) EURO CARE INFRASTRUCTURE LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI	PROPERTY MGMT	EI	NA	C
(63) EURO CARE PROPERTY MANAGEMENT LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI	PROPERTY MGMT	EI	NA	C
(64) EURO CARE HEALTHCARE LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI	HOSPITAL	EI	NA	C
(65) WATERFORD ONCOLOGY ASSOCIATES LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI	ONCOLOGY SVC	EI	NA	C
(66) UPMC CANCER CENTERS IRELAND LIMITED 6TH FLOOR BEACON HOSPITAL SANDYFORD DUBLIN 18 EI	CANCER TREATM	EI	NA	C
(67) PANTHER REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN,CAYMAN ISLANDS CJ 98-1402742	INSURANCE	CJ	NA	C
(68) FORBES REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN,CAYMAN ISLANDS CJ 98-1400710	INSURANCE	CJ	NA	C
(69) CATHEDRAL (RE) INSURANCE CO PO BOX 1109 GRAND CAYMAN,CAYMAN ISLANDS CJ 98-1400837	INSURANCE	CJ	NA	C
(70) UPMC IRELAND LIMITED 6TH FLOOR BEACON HOSPITAL SANDYFORD DUBLIN 18 EI	HEALTHCARE SU	EI	NA	C
(71) UPMC CANADA TECHNOLOGIES LIMITED 600 GRANT STREET PITTSBURGH,PA15219	SOFTWARE	CA	NA	C
(72) SUSQUEHANNA HEALTH SYSTEM INSURANCE NET PO BOX 1159 CAYMAN ISLANDS CJ	INSURANCE	CJ	NA	C
(73) UNITED HEALTH RISK LTD PO BOX HM 2450 HAMILTON BD	INSURANCE	BD	NA	C
(74) UPMC UNITED KINGDOM LTD C/O NAIRCO 11TH FLOOR WHITEFRIARS LEWINS MEAD,BRISTOLBS1 2NT UK 98-0571026	SOFTWARE LICE	UK	NA	C
(75) BLUESPHERE BIO 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 82-4979766	IMMUNOTHERAPY	DE	NA	C
(76) INFECTIOUS DISEASE CONNECT INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 83-3311071	TELEMEDICINE	DE	NA	C
(77) HUMONIC INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 83-4005420	BIOPHARM	DE	NA	C
(78) TTMS INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 82-5443222	IMMUNOTHERAPY	DE	NA	C
(79) UPMC HILLMAN CANCER CENTER - PINNACLE 101 ERFORD ROAD CAMP HILL,PA17701 83-3640945	CANCER TREATM	PA	NA	C
(80) SHANGHAI UPMC CO LTD 288 Shimen 1st Road Jingan Distric Shanghai 200041 CH	HEALTHCARE MG	CH	NA	C
(81) SALVATOR MUNDI INTERNATIONAL HOSPITAL ROMA VIALE DELLE MURA GIANICOLENSI CAP 00152 IT	HOSPITAL	IT	NA	C
(82) SOMERSET ANESTHESIA INC 600 GRANT STREET PITTSBURGH,PA15219 45-5135437	PHYSICIAN SRV	PA	NA	C
(83) SOMERSET MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1512960	MOB OWNERSHIP	PA	NA	C
(84) GENERIAN PHARMACEUTICALS INC 2425 SIDNEY STREET PITTSBURGH,PA15203 83-3340453	PHARMACY	DE	NA	C
(85) WORK PARTNERS NATIONAL INC 600 GRANT STREET PITTSBURGH,PA15219 84-3141950	INSURANCE	PA	NA	C
(86) ASTRATA INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-4804493	SOFTWARE	DE	NA	C
(87) VEGAVECT 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-4280784	GENE THERAPY	DE	NA	C
(88) NOVIMAB 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-1494905	CLINICAL RESEARCH	DE	NA	C
(89) PENNSYLVANIA PSYCHIATRIC MEDICAL SERVICE 2501 N THIRD STREET HARRISBURG,PA17110 82-2969322	MED SRV	PA	NA	C
(90) HAYSTACK CONSOLIDATED SERVICES INC 12500 WILLOWBROOK ROAD CUMBERLAND,MD21502 52-1335895	INACTIVE	PA	NA	C
(91) WESTERN MARYLAND INSURANCE COMPANY LTD PO BOX 10233 GRAND CAYMAN,CAYMAN ISLANDS CJ	INSURANCE	CJ	NA	C
(92) WILLOWBROOK HEALTHCARE CONDO 12401 WILLOWBROOK ROAD CUMBERLAND,MD21502 37-1538510		DE	NA	C

Schedule R (Form 990) 2019

Page 3

Part V

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) RX PARTNERS	P	446,222	COST
(2) SENIOR COMMUNITIES	P	484,506	COST
(3) CURAVI HEALTH TELEMEDICINE	P	50,514	COST

Schedule R (Form 990) 2019

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation
Form 990, Schedule R, Part II, III, & IV	The entities marked with an asterisk are not technically "related parties", as defined by the IRS Form 990 instructions of the filing organization. However, they are listed on Schedule R to reflect that they are part of the UPMC system of entities, as they all share UPMC as the ultimate parent.

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	6
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	121
6	Total number of volunteers (estimate if necessary) .............	6	6
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	6,007	332,865
9	Program service revenue (Part VIII, line 2g) .........	7,651,717	8,185,598
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	0	0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	7,657,724	8,518,463
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	4,849,675	5,012,956
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	3,802,146	4,131,262
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	8,651,821	9,144,218
19	Revenue less expenses. Subtract line 18 from line 12.......	-994,097	-625,755
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	5,074,063	5,293,411
21	Total liabilities (Part X, line 26).............	8,134,467	8,979,570
22	Net assets or fund balances. Subtract line 21 from line 20.....	-3,060,404	-3,686,159

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 6,857,808 including grants of $ ) (Revenue $ 8,185,598 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses6,857,808

(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)			(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) MARK BONDI...................................................................... PRESIDENT	5.0 ................. 40.0	X	X		0	292,822	48,244
(2) WILLIAM NIGRO...................................................................... CHIEF FINANCIAL OFFICER	5.0 ................. 40.0			X	0	168,295	22,110
(3) ROBERT WUSHINSKE...................................................................... CHAIRMAN (R 8/31/2019)	1.0 ................. 0.0	X	X		0	0	0
(4) ELIZABETH SANT...................................................................... VICE CHAIRMAN	1.0 ................. 0.0	X	X		0	0	0
(5) DANIEL J VOGLER...................................................................... SECRETARY/ TREASURER	1.0 ................. 0.0	X	X		0	0	0
(6) RICHARD MARTIN...................................................................... BOARD MEMBER	1.0 ................. 0.0	X			0	0	0
(7) J CHRISTOPHER MILLER...................................................................... BOARD MEMBER	1.0 ................. 0.0	X			0	0	0
(8) MICHAEL BOYD...................................................................... BOARD MEMBER (R 11/20/2019)	1.0 ................. 0.0	X			0	0	0
(9) RANDALL SUMNER...................................................................... BOARD MEMBER	1.0 ................. 0.0	X			0	0	0
(10) DAN GRANT...................................................................... COO	1.0 ................. 40.0		X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	461,117	70,354

(A) Name and business address	(B) Description of services	(C) Compensation
ALLIANCE REHAB HVA LLC, 28100 TORCH PARKWAY SUITE 600 WARRENVILLE,IL60555	THERAPY SERVICES	507,693




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 1

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	332,845

f	All other contributions, gifts, grants, and similar amounts not included above		1f	20

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		332,865

		Business Code
2a	NET PATIENT SERVICE REVENUE	623000	6,980,492	6,980,492
b	OTHER PROGRAM SERVICE REVENUE	621990	1,205,106	1,205,106
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		8,185,598

3 Investment income (including dividends, interest, and othersimilar amounts) ......			0
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	0	6c
d	Net rental income or (loss).......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See instructions.....			8,518,463	8,185,598

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	3,965,079	3,259,180	705,899
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	757,051		757,051
10	Payroll taxes ...........	290,826	239,922	50,904
11	Fees for services (non-employees):
a	Management ......	484,506		484,506
b	Legal .........	3,009		3,009
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	909,892	909,892
12	Advertising and promotion ....	0
13	Office expenses .......	95,753	79,181	16,572
14	Information technology ......	24,870	24,811	59
15	Royalties ..	0
16	Occupancy ...........	423,974	265,237	158,737
17	Travel ............	11,458	7,124	4,334
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	325,107	325,107
23	Insurance ...	57,338	57,338
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PURCHASED SERVICES	168,678	93,039	75,639
b	DIETARY SUPPLIES	416,098	415,137	961
c	MEDICAL/PATIENT SUPPLIES	131,626	130,133	1,493
d	DRUGS	408,389	408,389
e	All other expenses	670,564	643,318	27,246
25	Total functional expenses. Add lines 1 through 24e	9,144,218	6,857,808	2,286,410	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			9,080	1	13,340
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			629,425	4	505,019
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			0	8	0
9	Prepaid expenses and deferred charges ......			0	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	5,524,049
b	Less: accumulated depreciation	10b	748,997	4,435,558	10c	4,775,052
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 33)...			5,074,063	16	5,293,411

17	Accounts payable and accrued expenses .....	216,522	17	537,861
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	7,917,945	25	8,441,709
26	Total liabilities. Add lines 17 through 25..	8,134,467	26	8,979,570

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-3,060,404	27	-3,686,159
28	Net assets with donor restrictions ...........	0	28	0
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-3,060,404	32	-3,686,159
33	Total liabilities and net assets/fund balances ........	5,074,063	33	5,293,411