TY 2020 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) STEVEN P JOHNSON...................................................................... DIRECTOR	1.0 ................. 2.0	X					0	1,054,183	188,112
(2) TERRANCE FOUST DO...................................................................... PHYSICIAN	40.0 ................. 1.0				X		898,068	0	64,274
(3) BRADLEY GIANNOTTI MD...................................................................... PHYSICIAN	40.0 ................. 0.0				X		846,296	0	55,186
(4) DAVID J LOPATOFSKY MD...................................................................... DIRECTOR/VICE CHAIR	1.0 ................. 2.0	X	X				0	697,797	132,918
(5) SAKET PRASAD MD...................................................................... PHYSICIAN	40.0 ................. 0.0				X		627,996	0	63,608
(6) SPARSHA KUKUNOOR...................................................................... PHYSICIAN	40.0 ................. 0.0				X		551,634	0	18,325
(7) JEREMY REED...................................................................... PHYSICIAN	40.0 ................. 0.0				X		465,260	0	38,488
(8) MARIBETH MCLAUGHLIN...................................................................... DIRECTOR	1.0 ................. 2.0	X					0	414,760	50,962
(9) EDWARD PITCHFORD...................................................................... PRESIDENT/CEO	0.0 ................. 0.0					X	0	390,265	0
(10) JANIE HILFIGER...................................................................... PRESIDENT/CEO	47.0 ................. 3.0		X				0	279,060	33,507
(11) MARY ANN RIGAS MD...................................................................... DIRECTOR	1.0 ................. 2.0	X					216,115	0	40,660
(12) RON RAPP...................................................................... CHIEF FINANCIAL OFFICER	47.0 ................. 2.0		X				0	196,726	47,964
(13) TIMOTHY BROWN...................................................................... VP OF OPERATIONS	40.0 ................. 2.0			X			190,743	0	24,795
(14) CARRIE ENNIS...................................................................... DIRECTOR	1.0 ................. 2.0	X					0	174,180	27,155
(15) MICHAEL CALLAHAN DO...................................................................... DIRECTOR	1.0 ................. 2.0	X					0	17,511	1,204
(16) ALANNA HUCK...................................................................... SECRETARY	1.0 ................. 2.0	X	X				0	0	0
(17) DAVID CRANDALL...................................................................... DIRECTOR	1.0 ................. 2.0	X					0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
JAMES N RINTOUL MD, PO BOX 884 CAMP HILL,PA17001	PHYSICIAN SERVICES	435,820
ORLANDO CRUZ MD, 437 YORK STREET OLEAN,NY14760	PHYSICIAN SERVICES	440,928
WADE PORTERFIELD MD, 3887 WEST BRANCH ROAD ALLEGANY,NY14706	PHYSICIAN SERVICES	462,493
STEPHEN CARLSON MD, 413 VAN BUREN AVE OLEAN,NY14760	PHYSICIAN SERVICES	435,123
JASON MICHEAL KODAT, 5043 GREENSBURG RD MURRYSVILLE,PA15668	PHYSICIAN SERVICES	409,563
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 12

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

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

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2020

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 6, column (f) divided by line 11, column (f)) .........

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

16a

33 1/3% support test—2020. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2019. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2020

Page 3

Part III

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 8, column (f) divided by line 13, column (f)) .........

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

Section D. Computation of Investment Income Percentage

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

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

19a

331/3% support tests—2020. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2019. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2020

Page 4

Part IV

Supporting Organizations

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

Section A. All Supporting Organizations

Yes

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

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

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

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

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

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

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

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

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2020

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

Activities Test. Answer lines 2a and 2b below.

Yes

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

Did the activities described in line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

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

Schedule A (Form 990 or 990-EZ) 2020

Page 6

Part V

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

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

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

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

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

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

Schedule A (Form 990 or 990-EZ) 2020

Page 7

Part V

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2020

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2020

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2020)

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

Name of organization CHARLES COLE MEMORIAL HOSPITAL

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

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

Page 3

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

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

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

Page 4


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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
SchDMd Bullet

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

If the organization elected, as permitted under 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) 2020

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

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	9,926
d	Additions during the year ............................	1d	63,121
e	Distributions during the year ..........................	1e	61,561
f	Ending balance ................................	1f	12,532

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 ....	3,930,704	4,225,292	4,220,847	4,095,589	3,891,581
b	Contributions ...
c	Net investment earnings, gains, and losses	1,404,272	-85,227	195,396	301,199	394,894
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	176,951	209,361	190,951	175,941	190,886
f	Administrative expenses ....
g	End of year balance ......	5,158,025	3,930,704	4,225,292	4,220,847	4,095,589

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

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)

Yes

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

3a(ii)

Yes

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

Yes

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

Part VI

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

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

1a	Land .....	1,030,847		1,030,847
b	Buildings ....	24,552,974	6,361,872	18,191,102
c	Leasehold improvements
d	Equipment ....	13,807,545	6,493,583	7,313,962
e	Other .....	1,342,841	184,959	1,157,882
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				27,693,793

Schedule D (Form 990) 2020

Page 3

Part VII

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

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

Part VIII

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

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

(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
(1)DUE FROM EXEMPT AFFILIATES				24,100,070
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				24,100,070

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
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	4,575,133
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2020

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference	Explanation
SCHEDULE D, PART IV, LINE 1B	ESCROW ACCOUNTS: THE CORPORATION HAS AN ESCROW ACCOUNT FOR THEIR SKILLED NURSING FACILITY PATIENTS WHO REQUEST THE USE OF THE ACCOUNT.
SCHEDULE D, PART IV, LINE 2B	AMOUNT ON FORM 990, PART X, LINE 21 FOR ESCROW LIABILITY: THE ORGANIZATION ADDED ESCROW BALANCE TO BALANCE SHEET IN MARCH OF 2021.
SCHEDULE D, PART V, LINE 4	ENDOWMENT FUND: THE ENDOWMENT FUND WAS ESTABLISHED TO ALLOW THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES TO POOR AND NEEDY PATIENTS.
ORGANIZATIONS IN SCHEDULE R IN THE INTEREST OF TRANSPARENCY.	UNCERTAIN TAX POSITIONS: AN EXTERNAL AUDIT IS COMPLETED AT A CONSOLIDATED UPMC SYSTEM LEVEL ONLY, INCLUDING UPMC AND ALL TAXABLE AND TAX-EXEMPT SUBSIDIARIES. TAX BENEFITS ARE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINTATION BY THE TAX AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION. SUCH TAX POSITIONS ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY TO BE REALIZED UPON ULTIMATE SETTLEMENT WITH THE TAX AUTHORITIES ASSUMING FULL KNOWLEDGE OF THE POSITION AND ALL RELEVANT FACTS. AS OF JUNE 30, 2021 UPMC DOES NOT HAVE AN UNCERTAIN TAX POSITIONS RECORDED.

Schedule D (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	212,932		212,932	0.210 %
b	Medicaid (from Worksheet 3, column a) . . . . .	16,365,639	14,347,784	2,017,855	2.040 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	16,578,571	14,347,784	2,230,787	2.250 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	104,765		104,765	0.110 %
f	Health professions education (from Worksheet 5) . . .	266,780		266,780	0.270 %
g	Subsidized health services (from Worksheet 6) . . . .	32,853,259	14,758,495	18,094,764	18.250 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	163		163
j	Total. Other Benefits . .	33,224,967	14,758,495	18,466,472	18.630 %
k	Total. Add lines 7d and 7j .	49,803,538	29,106,279	20,697,259	20.880 %

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

Schedule H (Form 990) 2020

Page

Part II

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

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development	4,433	4,433
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	297,188	297,188
8	Workforce development
9	Other
10	Total	301,621	301,621

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

5,464,563

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

881,980

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

Section B. Medicare

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

14,050,311

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

13,911,199

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

139,112

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2020

Page

Part VFacility Information

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

Schedule H (Form 990) 2020

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

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

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

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

Yes

6 a

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

Yes

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

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

Yes

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

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url):

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

Other (describe in Section C)

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

Yes

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

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

Yes

If "Yes" (list url): SEE PART V, SECTION C

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100%
and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

SEE PART V, SECTION C

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

SEE PART V, SECTION C

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

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

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

Yes

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

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

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 7

Part VFacility Information (continued)

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

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

Yes

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

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2020

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 5	COMMUNITY INPUT: THE HOSPITAL USED A 6-STEP APPROACH TO COMPLETE THE NEEDS ASSESSMENT. INCLUDED IN THIS APPROACH WERE SEVERAL DATA ANALYSES, BASED ON SECONDARY SOURCE DATA AUGMENTED WITH COMMUNITY HEALTH SURVEY DATA. SINCE THE SERVICE AREA DOES NOT COMPRISE SOME OF THE ENTIRE COUNTIES WE SERVE, UPMC COLE ASKED LOCAL RESIDENTS TO NOTE IF THEY PERCEIVED THE PROBLEMS, OR NEEDS IDENTIFIED BY SECONDARY SOURCES TO EXIST IN THEIR PORTION OF THE COUNTY THEY LIVE IN. DATA SOURCES USED INCLUDED SEVERAL WEBSITES TO ASSESS THE HEALTH NEEDS OF THE COUNTIES SERVED, ACCESS CURRENT POPULATION DATA, ASSESS CHARACTERISTICS OF CERTAIN HEALTH OBJECTIVES, ADDRESS THE PROBLEM OF ESCALATING HEALTH COSTS, AND CAPTURE DATA THAT CAN HELP UNDERSTAND HEALTH STATISTICS. TO OBTAIN DATA WITHIN THE COMMUNITIES SERVED BY THE HOSPITAL, ALL COMMUNITY MEMBERS WERE INVITED TO COMPLETE A SURVEY, WHICH WOULD REMAIN ANONYMOUS. THE ADMINISTRATION OF AN INTERNET-BASED AND PAPER SURVEY WAS PROMOTED THROUGH ADVERTISEMENTS IN LOCAL NEWSPAPERS, BLOGS, AND TELEVISION AND WAS DISTRIBUTED TO LOCAL CIVIC AND HEALTH ORGANIZATIONS. IN ADDITION, WE CONDUCTED A SURVEY TO KEY LEADERS OF THE REGION THAT ALSO INCLUDED OUR SERVICE PROVIDERS. THE TERMS OF GAINING INPUT SPECIFIED EACH RESPONDENT REMAINED ANONYMOUS. THE FEEDBACK WAS SOLICITED THROUGH THE SURVEY. PRELIMINARY CONCLUSIONS OF THE SURVEYS RESULTS WERE PRESENTED TO THE CHNA STEERING COMMITTEE, ALSO KNOWN AS THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE WHICH WERE ASKED TO VALIDATE PRIOR ASSESSMENTS AND TO ESTABLISH PRIORITY AMONG VARIOUS IDENTIFIED HEALTH NEEDS. MEMBERS OF THE COMMITTEE INCLUDE UPMC COLE STAFF AND COMMUNITY ORGANIZATIONS SUCH AS: - DICKINSON CENTER, INC. - OFFICE OF AGING - DRUG AND ALCOHOL SERVICES - LOCAL AREA SCHOOL DISTRICTS - MCKEAN AND POTTER COUNTY DISTRICT OFFICE - LOCK HAVEN PA PROGRAM - COMMUNITY BASED CARE - HOSPITAL COUNCIL OF WESTERN PENNSYLVANIA WE ALSO HAD A REPRESENTATIVE FROM ROBERT WOOD JOHNSON FOUNDATION COME AND PROVIDE INPUT REGARDING THE FINDINGS TO HELP DETERMINE OUR PRIORITIES.
SCHEDULE H, PART V, SECTION B, LINE 6A	CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED ALONG WITH THE FOLLOWING HOSPITALS: - UPMC LOCK HAVEN - UPMC MUNCY - UPMC WILLIAMSPORT - UPMC WILLIAMSPORT DIVINE PROVIDENCE - UPMC WELLSBORO
SCHEDULE, PART V, SECTION B, LINE 7A	CHNA AVAILABILITY: THE HOSPITAL POSTED THE REPORT ON THE WEBSITE UNDER ABOUT US. YOU CAN LOCATE IT AT WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDSASSESSMENT
SCHEDULE H, PART V, SECTION B, LINE 10A	IMPLEMENTATION STRATEGY AVAILABILITY: HTTPS://CDN.UPMC.COM/-/MEDIA/UPMC/ABOUT/COMMUNITY-COMMITMENT/2019- COMMUNITY-COMMITMENT/DOCUMENTS/2019-CHNA-UPMC-CLINTON-LYCOMING-NORTHUMBERL AND-POTTER-TIOGA-COUNTIES.PDF?LA=EN&REV=1651FBD663EC4B7C8CBF5C 9EFF8F6CE3&HASH=115EB8D3368E1B0A8E53C5E16EF77F3D&_GA=2.93493595.XXX-XX-XXXX. 1614111582-99937498.1614111582
SCHEDULE H, PART V, SECTION B, LINE 11	IMPLEMENTATION STRATEGY: ON JUNE 19, 2019, THE UPMC COLE BOARD OF DIRECTORS ADOPTED AN IMPLEMENTATION PLAN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED: - BEHAVIORAL HEALTH - PREVENTION AND COMMUNITY-WIDE HEALTHY LIVING BY PROVIDING A COMPREHENSIVE SUITE OF PROGRAMS, UPMC COLE PLAYS AN IMPORTANT ROLE IN ADDRESSING THE COMMUNITY HEALTH NEEDS THAT WERE IDENTIFIED IN THE RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITAL WILL SUPPORT THE PRIORITY AREAS WITH INTERNAL RESOURCES, THROUGH GRANTS, AND BY STRENGTHENING COLLABORATIONS WITH NUMEROUS COMMUNITY PARTNERS. ADDRESSING BEHAVIORAL HEALTH: UPMC COLE IS DEDICATED TO MAINTAINING AND EXPANDING ITS EFFORTS TO SUPPORT THE COMMUNITY'S NEEDS RELATING TO BEHAVIORAL HEALTH, INCLUDING SUBSTANCE USE DISORDER. UPMC COLE WORKS WITH OTHER COMMUNITY ORGANIZATIONS TO ENHANCE BEHAVIORAL HEALTH CARE IN THE AREA. ADDRESSING BEHAVIORAL HEALTH NEEDS IS BROKEN INTO TWO CATEGORIES; ACCESS TO BEHAVIORAL HEALTH SERVICES AND OPIOID ADDICTION AND SUBSTANCE ABUSE ACCESS TO BEHAVIORAL HEALTH SERVICES: INTENDED ACTIONS - TAKE A COMPREHENSIVE APPROACH TO ADDRESS BEHAVIORAL HEALTH ACCESS IN THE COMMUNITY. THIS INCLUDES THE FOLLOWING GOALS: - RAISE AWARENESS OF AND INCREASE SERVICES FOR BEHAVIORAL HEALTH ISSUES - INCREASE AWARENESS OF AND ACCESS TO EDUCATIONAL PROGRAMS ABOUT SUICIDE RISK FOR ALL COMMUNITY RESIDENTS - IMPROVE ACCESS TO MENTAL HEALTH PROVIDERS PROGRAMS: - MENTAL HEALTH FIRST AID TRAINING - MULTIMEDIA INITIATIVE TO RAISE AWARENESS OF BEHAVIORAL HEALTH (E.G. SOCIAL MEDIA, EDUCATIONAL OUTREACH EVENTS, TRAINING SESSIONS) - SUICIDE PREVENTION INITIATIVES (E.G., EDUCATIONAL CONFERENCES AND SEMINARS AT LOCAL SCHOOL DISTRICTS) - DEVELOP AND IMPLEMENT AN OUTPATIENT BEHAVIORAL HEALTH SERVICE LINE OPIOID ADDICTION AND SUBSTANCE ABUSE: INTENDED ACTIONS - CREATE PROGRAMMING TO STEM ADDICTION AND SUBSTANCE USE. THIS INCLUDES THE FOLLOWING GOALS: - PROMOTE PUBLIC EDUCATION AND AWARENESS TO HELP PREVENT PRESCRIPTION DRUG AND OPIOID MISUSE, ABUSE, AND OVERDOSE - REDUCE ACCESS TO PRESCRIPTION DRUGS FOR MISUSE AND ABUSE PROGRAMS: - ENHANCE AND EXPAND ADDICTION MEDICINE SERVICE LINE - CAMPAIGNS TO PROMOTE AWARENESS OF SUBSTANCE USE AND AVAILABLE RESOURCES (E.G., STOP CAMPAIGN PROGRAM, ROADMAP OF AVAILABLE RESOURCES) - CONTINUE TO PROMOTE NARCAN TRAINING AND PRESCRIPTION DRUG TAKE-BACK INITIATIVES ADDRESSING PREVENTION AND COMMUNITY-WIDE HEALTHY LIVING: UPMC COLE WILL ADDRESS PREVENTIVE HEALTH AND WELLNESS THROUGH CUSTOMIZED PROGRAMMING AND COMMUNITY EDUCATION. THE HOSPITAL WILL DEDICATE EFFORTS AROUND FOOD INSECURITY AND ADDRESSING TEEN PREGNANCY. UPMC COLE WILL ADVANCE PREVENTION INITIATIVES BY LEVERAGING STRONG COMMUNITY PARTNERSHIPS, SUCH AS WITH THE NORTHERN TIER COMMUNITY HEALTH COLLABORATIVE. MANY OF THESE PARTNERSHIPS HAVE BEEN INSTRUMENTAL IN HELPING TO PROMOTE HEALTHY BEHAVIORS IN THE COMMUNITY. ADDRESSING PREVENTION AND COMMUNITY-WIDE HEALTHY LIVING IS BROKEN INTO TWO CATEGORIES; COMMUNITY PREVENTION AND WELLNESS INITIATIVES AND HEALTH-RELATED SOCIAL NEEDS COMMUNITY PREVENTION AND WELLNESS INITIATIVES: INTENDED ACTIONS: ENHANCE COMMUNITY WELLBEING THROUGH EDUCATION, SCREENINGS, AND PROMOTION OF HEALTHY BEHAVIORS. DEDICATED EFFORTS INCLUDE TARGETED INTERVENTIONS TO PREVENT TEEN PREGNANCY. - TAKE A COMPREHENSIVE APPROACH TO ADDRESS THE IMPORTANCE OF ABSTINENCE AMONG FEMALE ADOLESCENTS AGES 15-19 IN THE COMMUNITY * REDUCE PREGNANCIES AMONG ADOLESCENT FEMALES AGED 15-19 * INCREASE THE PROPORTION OF ABSTINENCE AMONG OUR ADOLESCENT FEMALE POPULATION AGED 19 YEARS AND UNDER * ENGAGE RESIDENTS IN A COMMUNITY-WIDE EFFORT TO ADDRESS TEEN PREGNANCY * INCREASE YOUTH ACCESS AND AWARENESS OF REPRODUCTIVE HEALTH CARE SERVICES * INCREASE STAKEHOLDER EDUCATION - INCREASE OPPORTUNITIES FOR AND ENGAGEMENT IN PHYSICAL ACTIVITY AND HEALTHY NUTRITION - CONTINUE TO ENHANCE METHODS OF DETERMINING AND ADDRESSING HEALTH LITERACY NEEDS IN THE COMMUNITY - ADDRESS ACCESS TO CANCER EARLY DETECTION SCREENINGS AND TREATMENT PROGRAMS: ADDRESSING TEEN PREGNANCY: - PROVIDE EDUCATION AND RESOURCES TO MEDICAL SUPPLIERS TO OFFER TEEN-FRIENDLY REPRODUCTIVE HEALTH CARE SERVICES AND EDUCATION THAT ARE EASILY AVAILABLE - EDUCATE CIVIC/KEY LEADERS, PARENTS, ADOLESCENTS, AND OTHER COMMUNITY MEMBERS ABOUT EVIDENCE-BASED STRATEGIES TO ADDRESS TEEN PREGNANCY AND IMPROVE ADOLESCENT REPRODUCTIVE HEALTH. - RAISE AWARENESS AMONG COMMUNITY PARTNERS ABOUT THE LINK BETWEEN TEEN PREGNANCY AND SOCIAL DETERMINANTS OF HEALTH - CREATE A "ROADMAP" OF SERVICES AVAILABLE FOR COMMUNITY MEMBERS REGARDING AVAILABLE SERVICES, SUPPORT GROUPS, AND EDUCATIONAL CLASSES PHYSICAL INACTIVITY AND NUTRITION: - PHYSICAL ACTIVITY EFFORTS (E.G., GUIDED HIKES, EVERYBODY WALK PA, RUNNING CLUBS, 4-H CLUBS) - WORKPLACE WELLNESS - EDUCATION EFFORTS (E.G., HEALTHY COOKING CLASSES, HEALTHY HABITS FOR LIFE) - SCHOOL PARTNERSHIP INITIATIVES (E.G., SCHOOL POLICY CONSULTATION TO PROMOTE HEALTHY NUTRITION AND PHYSICAL ACTIVITY, HEALTHIER DRINK AND FOOD OPTIONS AT LOCAL SCHOOL DISTRICTS) - NUTRITION COUNSELING (COLE MEMORIAL MEDICAL GROUP) HEALTH LITERACY - DEVELOPMENT OF INNOVATIVE STRATEGIES AND INITIATIVES TO PROMOTE BASIC LITERACY IN THE COMMUNITY (E.G., COMMUNITY AND EMPLOYEE EDUCATION, HEALTH LITERACY TOOLKIT) ADDRESS ACCESS TO EARLY CANCER DETECTION SCREENINGS AND TREATMENT: - RECRUIT SPECIALIZED STAFF - EVALUATE CANCER SERVICES AND RADIATION ONCOLOGY PROGRAM HEALTH-RELATED SOCIAL NEEDS - PROMOTE HEALTHY DIETS AND WEIGHT THROUGH EDUCATION, SCREENINGS, AND CUSTOMIZED PROGRAMMING TO HELP INCREASE FOOD SECURITY IN HOUSEHOLDS. DEDICATED EFFORTS INCLUDE TARGETED INTERVENTIONS TO COMBAT FOOD INSECURITY. INTENDED ACTIONS - ADDRESS VERY LOW FOOD SECURITY AMONG CHILDREN - HELP REDUCE HOUSEHOLD FOOD INSECURITY - INCREASE ACCESS AND PROMOTE FRUITS AND VEGETABLES THROUGH A VARIETY OF OUTREACH EFFORTS, SUCH AS GARDENS, FARMS, WORK, AND SCHOOL PROGRAMS, AND LOCAL GROCERY STORES - INCREASE ACCESS TO FOOD THROUGH LOCAL AREA FOOD BANKS PROGRAMS: - CREATE A SCREENING TOOL FOR PROVIDERS TO USE TO SCREEN PATIENTS TO DETERMINE IF THEY HAVE EXPERIENCED FOOD INSECURITY - WORK WITH LOCAL AREA FOOD BANKS TO REFER PATIENTS AND/ OR VOLUNTEERS AND DONATE FOOD ITEMS - WORK WITH LOCAL SCHOOL DISTRICTS TO HELP PROVIDE FOOD TO CHILDREN ON THE WEEKENDS TO ENSURE THEY HAVE ADEQUATE FOOD - PARTNER WITH LOCAL FARMERS' MARKETS TO PROMOTE HEALTHY FOOD OPTIONS, SUCH AS VEGETABLES AND FRUIT - PARTNER WITH PENN STATE EXTENSION TO PROVIDE LOW-COST CLASSES TO COMMUNITY RESIDENTS AROUND "HOW TO MAKE A HEALTHY MEAL"HOW TO PREPARE FOOD ON A BUDGET"
SCHEDULE H, PART V, LINE 13H	OTHER FACTORS USED IN ELIGIBILITY CRITERIA: CHARLES COLE MEMORIAL HOSPITAL ALSO USES THE FOLLOWING METHODS: -EMPLOYMENT STATUS ALONG WITH FUTURE EARNINGS POTENTIAL AND ASSESS IF IT IS SUFFICIENT TO MEET THE OBLIGATION WITHIN A REASONABLE PERIOD OF TIME -FAMILY SIZE AND CONFIGURATION -AMOUNT(S) AND FREQUENCY OF HOSPITAL AND OTHER HEALTHCARE/MODIFICATION BILLS IN RELATION TO ALL OTHER FACTORS.
SCHEDULE H, PART V, LINE 16A, 16B & 16C	POLICY PUBLICATION: HTTP://WWW.COLEMEMORIAL.ORG/PATIENTS-FINANCIAL.ASPX
SCHEDULE H, PART V, LINE 16I	LEP TRANSLATIONS: THERE ARE NO GROUPS WITH LIMITED ENGLISH PROFICIENCY THAT RISE TO THE THRESHOLD REQUIRED UNDER IRC SECTION 501(R). HOWEVER, LANGUAGE TRANSLATIONS OF THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE BY REQUEST AT THE FINANCIAL COUNSELING DEPARTMENT OF THE HOSPITAL.

Schedule H (Form 990) 2020

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?13
Name and address		Type of Facility (describe)
1	PORT ALLEGANY HEALTH CENTER 45 PINE STREET PORT ALLEGANY,PA16743	DENTAL PRACTICE, RURAL HEALTH CENTER, REHABILITATION LAB SERVICES, RADIOLOGY
2	SHINGLEHOUSE HEALTH CENTER 129 PURITAN STREET SHINGLEHOUSE,PA16748	RURAL HEALTH CENTER REHABILITATION LAB SERVICES, RADIOLOGY
3	ELDRED HEALTH CENTER 139 MAIN STREET ELDRED,PA16371	RURAL HEALTH CENTER LAB SERVICES
4	EMPORIUM HEALTH CENTER 288 SIZERVILLE ROAD EMPORIUM,PA15834	RURAL HEALTH CENTER REHABILITATION LAB SERVICES
5	GALETON HEALTH CENTER 30 RIVER STREET GALETON,PA16922	RURAL HEALTH CENTER LAB SERVICES
6	WESTFIELD RURAL HEALTH CLINIC 222 CHURCH STREET WESTFIELD,PA16950	RURAL HEALTH CENTER LAB SERVICES
7	BOWMAN HEALTH CENTER 83 MARVIN STREET SMETHPORT,PA16749	RURAL HEALTH CENTER REHABILITATION LAB SERVICES
8	NORTHERN POTTER HEALTH CENTER 511 ACADEMY STREET ULYSSES,PA16948	RURAL HEALTH CENTER LAB SERVICES
9	CENTRAL POTTER HEALTH CENTER 46 ELK STREET COUDERSPORT,PA16915	RURAL HEALTH CENTER LAB SERVICES
10	HOME HEALTH AND HOSPICE 102-108 SOUTH MAIN ST COUDERSPORT,PA16915	HOME HEALTH OFFICES
11	DR VICTOR BROWN DMD 11 8TH STREET COUDERSPORT,PA16915	DENTAL PRACTICE
12	DR TOD TWICHELL DDS 438 EAST 2ND STREET COUDERSPORT,PA16915	DENTAL PRACTICE
13	BRADFORD SPECIALISTS 700 SOUTH AVENUE BRADFORD,PA167013978	SPECIALTY MEDICAL CENTER

Schedule H (Form 990) 2020

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 7, COLUMN F	PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE OF $5,464,563.
SCHEDULE H, PART I, LINE 7G	SUBSIDIZED HEALTH SERVICES: SEVERAL RURAL HEALTH CLINICS WERE INCLUDED IN THE COMPUTATION OF SUBSIDIZED HEALTH SERVICES ON LINE 7G AMOUNTING TO $18,094,764 NET COMMUNITY BENEFIT EXPENSE. UPMC COLE PROVIDES PRIMARY CARE TO THE SURROUNDING COUNTIES AT THESE RURAL HEALTH CENTERS. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. UPMC COLE CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED.
SCHEDULE H, PART I, LINE 7	COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3, AND 6.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ALLOW UPMC COLE TO FULFILL ITS MISSION OF WORKING TOGETHER TO OPTIMIZE THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES COLE SERVES. ONE OF OUR STRATEGIC PRIORITIES IS TO CREATE A CULTURE OF HEALTH FOR THE COMMUNITIES WE SERVE. IN DOING SO, WE NEED TO ADOPT, DEVELOP, CREATE, AND IMPLEMENT THESE COMMUNITY BUILDING ACTIVITIES FOR OUR COMMUNITY RESIDENTS. OUR COMMUNITY BENEFIT ADVISORS, NORTHERN TIER COMMUNITY COLLABORATIVE, AND OUR OUTREACH EFFORTS PLAY A KEY ROLE IN CREATING A CULTURE OF HEALTH AND FULFILLING OUR MISSION.
SCHEDULE H, PART III, SECTION A, LINE 2	BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOPSITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITALS'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2020. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.
SCHEDULE H, PART III, SECTION A, LINE 3	BAD DEBT EXPENSE ATTRIBUTABLE TO FAP-ELIGIBLE PATIENTS: LINE 3 WAS DETERMINED BY MULTIPLYING THE BAD DEBT EXPENSE (LINE 2) BY THE PERCENT OF PERSONS BELOW THE POVERTY LEVEL BASED ON US CENSUS BUREAU DATA FOR 2014 - 2018.
SCHEDULE H, PART III, SECTION A, LINE 4	BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE REGARDING BAD DEBT EXPENSE. THEY DO HOWEVER CONTAIN A FOOTNOTE REGARDING NET PATIENT SERVICE REVENUE. THIS NOTE CAN BE FOUND IN THE ATTACHED AUDITED FINANCIAL STATEMENTS. $5,400,000 YEAR ENDED JUNE 30, 2020 TO APPROXIMATELY $5,460,000 FOR THE YEAR ENDED JUNE 30, 2021. THE CHANGES ARE A RESULT OF TRENDS IN THE COLLECTION OF AMOUNTS FROM SELF-PAY PATIENTS IN FISCAL YEAR 2021.
SCHEDULE H, PART III, SECTION B, LINE 8	COMMUNITY BENEFIT: MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. UPMC COLE IS CLASSIFIED AS A CRITICAL ACCESS HOSPITAL. THIS CLASSIFICATION SHOWS THAT UPMC COLE IS IN A MEDICALLY UNDERSERVED AREA AND AT A HEALTH PROFESSIONAL SHORTAGE AREA. THIS DEMONSTRATES THAT UPMC COLE IS THE ONLY REASONABLE SOURCE OF HOSPITAL CARE AVAILABLE TO MEDICARE BENEFICIARIES IN OUR SERVICE AREA, AND LIKEWISE TREATS ALL BENEFICIARIES IN OUR SERVICE AREA THAT PRESENT THEMSELVES FOR CARE, DESPITE KNOWING WE WILL GENERALLY LOSE MONEY CARING FOR MEDICARE PATIENTS. ADDITIONALLY, SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
SCHEDULE H, PART III, SECTION C, LINE 9B	COLLECTION POLICY: EFFORTS ARE MADE TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE IN ACCORDANCE WITH THE HOSPITAL'S CHARITY CARE POLICY OR THE PHYSICIAN NETWORK SLIDING FEE SCALE PRIOR TO THE STATEMENT PROCESS WHEN POSSIBLE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT: UNDERSTANDING THE HEALTH NEEDS OF THE COMMUNITY ALLOWS UPMC COLE TO DESIGN AND IMPLEMENT COST-EFFECTIVE STRATEGIES THAT IMPROVE THE HEALTH STATUS OF THE POPULATIONS WE SERVE. A COMPREHENSIVE DATA-DRIVEN ASSESSMENT PROCESS CAN IDENTIFY PRIORITY HEALTH NEEDS AND ISSUES RELATED TO PREVENTION, DIAGNOSIS, AND TREATMENT THROUGH QUANTITATIVE AND QUALITATIVE DATA. UPMC COLE'S COMMUNITY HEALTH NEEDS ASSESSMENT FOCUSES ON THE 28 ZIP CODES THAT WE SERVE. TO HELP GUIDE THE PROCESS USED FOR THE ASSESSMENT, THE NORTHERN TIRE COMMUNITY HEALTH COLLABORATIVE WAS CONVENED. THIS COLLABORATIVE'S ROLE WAS TO PROVIDE INPUT ON (A) IDENTIFICATION OF EXISTING DATA SOURCES FOR THE STUDY; (B) CONTENT OF THE COMMUNITY ONLINE SURVEY QUESTIONNAIRE; (C) INTERPRETATION OF SURVEY FINDINGS; (D) REVIEW OF RECOMMENDATIONS, AND; (E) DATA DISSEMINATION AND A FOLLOW-UP PLAN. THE COLLABORATIVE WILL CONTINUE TO MEET QUARTERLY WITH THE FOCUS LEADERS THAT HAVE BEEN IDENTIFIED TO ENSURE PROGRESS IS BEING MADE UNDER EACH IDENTIFIED PRIORITY. THE COLLABORATIVE MET TO REVIEW, CONSIDER, AND PRIORITIZE SURVEY DATA AND SECONDARY DATA COLLECTED DURING THIS PROCESS. IN ADDITION TO THE COLLABORATIVE, UPMC COLE'S COMMUNITY BENEFIT ADVISORY COMMITTEES WHICH REPRESENT PUBLIC HEALTH, GOVERNMENT, FORMER AND PRESENT BOARD MEMBERS, FOUNDATIONS, PASTORS, SCHOOL NURSES, AND VARIOUS OTHER ORGANIZATIONS, PROVIDED CRITICAL INPUT INTO THE NEEDS ASSESSMENT, FROM INITIAL CONCEPT TO HOW THE DATA WOULD BE SHARED WITH COMMUNITIES IN OUR WINTER AND SPRING MEETINGS. WE CONDUCTED SURVEYS WITHIN THE COMMUNITIES COLE SERVES FOR COMPLETION BY ANY COMMUNITY RESIDENT, KEY LEADERS OF THE REGION, AND OUR SERVICE PROVIDERS. THE TERMS OF GAINING INPUT SPECIFIED EACH RESPONDENT REMAINED ANONYMOUS. THE ADMINISTRATION OF AN INTERNET-BASED AND PAPER SURVEY WAS PROMOTED THROUGH ADVERTISEMENTS ON FACEBOOK, WEBSITE, BLOGS, AND WAS DISTRIBUTED TO LOCAL CIVIC AND HEALTH ORGANIZATIONS WITH A REQUEST FOR PARTICIPATION. PRELIMINARY CONCLUSIONS OF THE SURVEY RESULTS WERE PRESENTED TO THE COLLABORATIVE, WHICH WERE ASKED TO VALIDATE PRIOR ASSESSMENTS AND TO ESTABLISH PRIORITY AMONG VARIOUS IDENTIFIED HEALTH NEEDS. AFTER A COUPLE OF MONTHS ANALYZING THE PRECEDING DATA AND INFORMATION WE RECEIVED FROM THE SURVEYS AND SECONDARY DATA, WE PUT THE INFORMATION IN FRONT OF OUR BOARD OF DIRECTORS AND COMMUNITY BENEFIT ADVISORS. THEY WERE ASKED TO AGREE OR DISAGREE WITH OUR CURRENT SUMMARY CONCLUSIONS. THEY ALSO WERE AT LIBERTY TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL STATEMENTS. WE MADE OUR COMMUNITY HEALTH NEEDS ASSESSMENT WIDELY AVAILABLE VIA THE WEBSITE. WE ALSO HAVE PLACED HARD COPIES IN OUR ACCOUNTING DEPARTMENT AND COMMUNITY OUTREACH DEPARTMENT.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE PATIENT FINANCIAL COUNSELOR CONTACTS SELF-PAY PATIENTS/GUARANTORS TO DISCUSS PAYMENT ARRANGEMENTS. IF THEY ARE UNABLE TO PAY, SHE EXPLAINS THE PROCESS OF APPLYING FOR CHARITY WHICH INCLUDES APPLYING FOR PA MEDICAL ASSISTANCE FIRST AND IF THEY ARE DENIED OR HAVE A PORTION TO PAY, THEN THEY CAN APPLY FOR CHARITY. THE CHARITY APPLICATION IS ON THE BACK OF OUR SELF-PAY STATEMENTS. ALSO, THE HOSPITAL-OWNED PHYSICIAN PRACTICES ARE AWARE OF THIS PROGRAM AND REFER PATIENTS/GUARANTORS TO THE PATIENT FINANCIAL COUNSELOR.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION: UPMC COLE IS LOCATED IN COUDERSPORT, POTTER COUNTY, IN NORTH-CENTRAL PENNSYLVANIA. THE HOSPITAL SERVES OVER 55,000 RESIDENTS IN ITS PRIMARY AND SECONDARY SERVICE AREAS, ENCOMPASSING CAMERON, MCKEAN, POTTER, AND TIOGA COUNTIES IN PENNSYLVANIA AND PORTIONS OF NEW YORK'S SOUTHERN TIER. ALL OF THE COUNTIES THAT WE SERVE ARE CONSIDERED RURAL AND MOUNTAINOUS. ACCORDING TO THE ROBERT WOODS JOHNSON FOUNDATION COUNTY HEALTH RANKINGS, OUT OF 67 COUNTIES IN PENNSYLVANIA WITH 67 BEING RANKED THE WORST, CAMERON IS RANKED 48, POTTER RANKED 43, TIOGA RANKED 15, AND MCKEAN COUNTY RANKED 51 IN OVERALL HEALTH OUTCOMES. THIS INCLUDES LENGTH OF LIFE AND QUALITY OF LIFE. WHEN IT CAME TO BEING OVERALL RANKED FOR HEALTH FACTORS WHICH INCLUDE HEALTH BEHAVIORS, CLINICAL CARE, SOCIAL AND ECONOMIC FACTORS, AND PHYSICAL ENVIRONMENT; TIOGA RANKED 36, CAMERON RANKED 39, POTTER RANKED 63, AND MCKEAN RANKED 53. THIS IS WHY CONDUCTING A CHNA IS EXTREMELY IMPORTANT AND KNOWING THE NEEDS OF THE COMMUNITIES WE SERVE IS VITAL.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: UPMC COLE IS LARGELY DEPENDENT ON PROVIDING SERVICES AND CARE TO THOSE INDIVIDUALS WHO MAY NOT HAVE THE RESOURCES TO BE AWARE OF, ABLE TO PAY FOR, OR HAVE THE EDUCATION/KNOWLEDGE ABOUT CARE, PROGRAMS AND SERVICES THAT ARE AVAILABLE TO THEM. THROUGH VARIOUS ACTIVITIES, COLE REACHES OUT TO OUR COMMUNITIES TO EDUCATE, IMPROVE HEALTH, PREVENT AND TREAT DISEASE AND SUPPORT INDIVIDUALS AND GROUPS. IN CONJUNCTION WITH THE AREA AGENCY ON AGING, COLE PROVIDES NO-COST EDUCATION TO COUNTY SENIOR CENTERS FOR A TOTAL OF 30+ SESSIONS. TOPICS INCLUDE IMMUNIZATIONS, COPD, ADVANCE DIRECTIVES, PALLIATIVE CARE, HEART DISEASE, DIET AND NUTRITION, COLE SERVICES AND MANY MORE. ALONG WITH MANY OTHER PROGRAMS SUCH AS SUPPORT GROUPS, SPEAKER'S BUREAU, WORKFORCE DEVELOPMENT, ECONOMIC SUPPORT, COMMUNITY LEADERSHIP, PARTNERSHIPS WITH LOCAL CIVIC, GOVERNMENT, SCHOOL DISTRICTS AND COMMUNITY GROUPS, UPMC COLE CONTINUES EFFORTS TO ASSURE THAT HEALTHCARE, IN ALL FORMS, IS ACCESSIBLE AND AVAILABLE TO THOSE WHO MAY OTHERWISE GO WITHOUT. OTHER INFORMATION: UPMC COLE PROVIDES THE COMMUNITY WITH SPACE FOR EVENTS, MEETINGS AND PROGRAMS SUCH AS SUPPORT GROUPS, ANNUAL EVENTS, TRAINING SESSIONS AND YOUTH SPORTS. UPMC COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN ITS CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES IS TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY AND AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS. AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS. TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES IS TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY AND AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS. AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM: THE AFFILIATED HEALTH CARE SYSTEM INCLUDES CHARLES COLE MEMORIAL HOSPITAL (UPMC COLE), COLE CARE, INC., HENDORN, INC., HAMOTCOLE VENTURES, INC. AND COLE FOUNDATION. COLE MEMORIAL (THE HOSPITAL) PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN COUDERSPORT, PENNSYLVANIA. THE HOSPITAL ALSO OPERATES A HOME HEALTH AGENCY AND A NUMBER OF PHYSICIAN CLINICS IN THE SAME GEOGRAPHIC AREA. COLE CARE, INC., A WHOLLY OWNED SUBSIDIARY OF THE HOSPITAL, OPERATES A DURABLE MEDICAL EQUIPMENT COMPANY FOR THE SALE AND RENTAL OF EQUIPMENT. HENDORN, INC., D/B/A COLE MANOR (COLE MANOR), OF WHICH THE HOSPITAL IS THE SOLE CORPORATE MEMBER, OWNS AND OPERATES A 30-BED PERSONAL CARE RESIDENTIAL FACILITY. HAMOTCOLE VENTURES, INC., OF WHICH THE HOSPITAL IS THE SOLE CORPORATE MEMBER, PRIMARILY EARNS REVENUE THROUGH LEASE ARRANGEMENTS OF CERTAIN PROPERTIES IN WESTERN PENNSYLVANIA. COLE FOUNDATION PROVIDES SUPPORT TO THESE ORGANIZATIONS THROUGH FUNDRAISING ACTIVITIES. EFFECTIVE MARCH 1, 2018 CHARLES COLE MEMORIAL HOSPITAL WAS ENTERED INTO AN AFFILIATION AGREEMENT WITH UPMC. AS SUCH, THE HOSPITAL IS NOW PART OF THE UPMC SYSTEM WHICH INCLUDES MANY HOSPITALS AND ADDITIONAL RELATED ORGANIZATIONS SERVING THEIR COMMUNITIES. COMMUNITY BUILDING ACTIVITIES ALLOW UPMC COLE TO FULFILL ITS MISSION OF WORKING TOGETHER TO OPTIMIZE THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES COLE SERVES. ONE OF OUR STRATEGIC PRIORITIES IS TO CREATE A CULTURE OF HEALTH FOR THE COMMUNITIES WE SERVE. IN DOING SO, WE NEED TO ADOPT, DEVELOP, CREATE, AND IMPLEMENT THESE COMMUNITY BUILDING ACTIVITIES FOR OUR COMMUNITY RESIDENTS. OUR COMMUNITY BENEFIT ADVISORS, NORTHERN TIER COMMUNITY COLLABORATIVE, AND OUR OUTREACH EFFORTS PLAY A KEY ROLE IN CREATING A CULTURE OF HEALTH AND FULFILLING OUR MISSION.

Schedule H (Form 990) 2020

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
Graphic Arrow

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

Attach to Form 990.
Graphic Arrow

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

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes 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? .............

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Cat. No. 50053T

Schedule J (Form 990) 2020

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)
1JANIE HILFIGER PRESIDENT/CEO	(i) (ii)	0 ------------- 175,991	0 ------------- 100,572	0 ------------- 2,497	0 ------------- 22,015	0 ------------- 11,492	0 ------------- 312,567	0 ------------- 0
2MARY ANN RIGAS MD DIRECTOR	(i) (ii)	165,343 ------------- 0	48,795 ------------- 0	1,977 ------------- 0	18,172 ------------- 0	22,488 ------------- 0	256,775 ------------- 0	0 ------------- 0
3STEVEN P JOHNSON DIRECTOR	(i) (ii)	0 ------------- 506,789	0 ------------- 460,000	0 ------------- 87,394	0 ------------- 148,874	0 ------------- 39,238	0 ------------- 1,242,295	0 ------------- 73,075
4CARRIE ENNIS DIRECTOR	(i) (ii)	0 ------------- 133,519	0 ------------- 40,260	0 ------------- 401	0 ------------- 12,011	0 ------------- 15,144	0 ------------- 201,335	0 ------------- 0
5MARIBETH MCLAUGHLIN DIRECTOR	(i) (ii)	0 ------------- 217,558	0 ------------- 193,001	0 ------------- 4,201	0 ------------- 29,873	0 ------------- 21,089	0 ------------- 465,722	0 ------------- 2,120
6DAVID J LOPATOFSKY MD DIRECTOR/VICE CHAIR	(i) (ii)	0 ------------- 355,879	0 ------------- 291,056	0 ------------- 50,862	0 ------------- 95,370	0 ------------- 37,548	0 ------------- 830,715	0 ------------- 46,006
7RON RAPP CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 156,720	0 ------------- 39,497	0 ------------- 509	0 ------------- 13,261	0 ------------- 34,703	0 ------------- 244,690	0 ------------- 0
8SAKET PRASAD MD PHYSICIAN	(i) (ii)	608,054 ------------- 0	16,706 ------------- 0	3,236 ------------- 0	20,221 ------------- 0	43,387 ------------- 0	691,604 ------------- 0	0 ------------- 0
9BRADLEY GIANNOTTI MD PHYSICIAN	(i) (ii)	837,795 ------------- 0	0 ------------- 0	8,501 ------------- 0	23,064 ------------- 0	32,122 ------------- 0	901,482 ------------- 0	0 ------------- 0
10SPARSHA KUKUNOOR PHYSICIAN	(i) (ii)	432,103 ------------- 0	118,751 ------------- 0	780 ------------- 0	15,775 ------------- 0	2,550 ------------- 0	569,959 ------------- 0	0 ------------- 0
11JEREMY REED PHYSICIAN	(i) (ii)	446,240 ------------- 0	18,000 ------------- 0	1,020 ------------- 0	14,580 ------------- 0	23,908 ------------- 0	503,748 ------------- 0	0 ------------- 0
12TERRANCE FOUST DO PHYSICIAN	(i) (ii)	839,992 ------------- 0	55,106 ------------- 0	2,970 ------------- 0	20,221 ------------- 0	44,053 ------------- 0	962,342 ------------- 0	0 ------------- 0
13TIMOTHY BROWN VP OF OPERATIONS	(i) (ii)	146,662 ------------- 0	43,380 ------------- 0	701 ------------- 0	11,987 ------------- 0	12,808 ------------- 0	215,538 ------------- 0	0 ------------- 0
14EDWARD PITCHFORD PRESIDENT/CEO	(i) (ii)	0 ------------- 390,265	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 390,265	0 ------------- 0

Schedule J (Form 990) 2020

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
SCHEDULE J, PART I, LINE 1	BENEFITSl UPMC MAY PROVIDE THE FOLLOWING BENEFITS TO CERTAIN EXECUTIVES WHEN THEY ARE NECESSARY TO ACHIEVE UPMC'S CHARITABLE MISSION OBJECTIVES: FIRST-CLASS OR CHARTER TRAVEL; TRAVEL FOR COMPANIONS; TAX INDEMNIFICATION OR GROSS UP PAYMENTS; AND/OR BUSINESS CLUB DUES OR INITIATION FEES. PROVISION OF ANY SUCH BENEFITS IS PREDICATED ON COMPLIANCE WITH THE ORGANIZATION'S POLICIES, IS SUBJECT TO REVIEW AND APPROVAL PROCESSES, AND IS TREATED AS TAXABLE INCOME TO THE EXECUTIVES WHERE REQUIRED UNDER THE INTERNAL REVENUE CODE. QUESTION 4A: CERTAIN PERSONS AS DISCLOSED IN PART II WERE PROVIDED SEVERANCE OR SEPARATION PAYMENTS AS CONTRACTUALLY PROVIDED FOR PER UPMC'S COMPENSATION POLICY. THESE PAYMENTS ARE PROPERLY REPORTED IN PART II, COLUMN (B).
SCHEDULE J, PART I, LINE 4A	SEVERANCE PAYMENTS: CERTAIN PERSONS AS DISCLOSED IN PART II WERE PROVIDED SEVERANCE OR SEPARATION PAYMENTS AS CONTRACTUALLY PROVIDED FOR PER UPMC'S COMPENSATION POLICY. THESE PAYMENTS ARE PROPERLY REPORTED IN PART II, COLUMN (B). RETIREMENT BENEFITS THROUGH A SUPPLEMENTAL RETIREMENT PROGRAM. THE SUPPLEMENTAL RETIREMENT PROGRAM IS SUBJECT TO MULTI YEAR VESTING WHICH PLACES THE OFFICERS AND KEY EMPLOYEES' RETIREMENT BENEFIT AT RISK OF FORFEITURE IF THE VESTING REQUIREMENTS ARE NOT SATISFIED. ONCE VESTED HOWEVER, PROVISIONS OF THE CODE REQUIRE THAT THE VESTED AMOUNTS BE REPORTED ON THE FORM 990 AND THE VESTED OFFICER OR KEY EMPLOYEE INCLUDE IN CURRENT INCOME THE VALUE OF HER OR HIS SUPPLEMENTAL RETIREMENT BENEFIT. NOTWITHSTANDING THE TAX REQUIREMENT TO RECOGNIZE THE VESTED AMOUNT OF THE SUPPLEMENTAL RETIREMENT BENEFIT AS CURRENT INCOME FOR FICA TAXATION AND REPORTING PURPOSES, THIS BENEFIT, WHICH GENERALLY HAS BEEN EARNED OVER HER OR HIS ENTIRE CAREER, HAS NOT AND WILL NOT BE DISTRIBUTED UNTIL THE OFFICER OR KEY EMPLOYEE RETIRES OR SEPARATES FROM SERVICE FROM UPMC AND SATISFIED THE NON-COMPETE PROVISION OF THEIR EMPLOYMENT AGREEMENT AND/OR SATISFY A POST-RETIREMENT SEPARATION AGREEMENT. THE SUPPLEMENTAL RETIREMENT PROGRAM PROVIDES FOR THE CURRENT DISTRIBUTION OF ONLY THE AMOUNT NECESSARY TO SATISFY ANY INCOME TAX LIABILITY RESULTING FROM THE VESTING DURING ACTIVE EMPLOYMENT. FINALLY, IT SHOULD BE NOTED THAT IN ACCORDANCE WITH IRS INSTRUCTIONS, A SUBSTANTIAL PORTION OF THE AMOUNT REPORTED ON THE FORM 990 ATTRIBUTABLE TO SUPPLEMENTAL RETIREMENT PROGRAM VESTING HAS BEEN REPORTED IN PREVIOUSLY FILED FORMS 990.
SCHEDULE J, PART I, LINE 4B	NONQUALIFIED RETIREMENT PLAN: ALL PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ARE DISCLOSED IN SCHEDULE J WITH CORRESPONDING AMOUNTS DISCLOSED WITHIN THE TOTAL AMOUNT IN SCHEDULE J COLUMN C "RETIREMENT AND OTHER DEFERRED COMPENSATION". DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE ("CODE"), CERTAIN OFFICERS AND KEY EMPLOYEES ARE LIMITED IN THE AMOUNT OF BENEFITS WHICH MAY BE RECEIVED UNDER A TAX QUALIFIED RETIREMENT PROGRAM. LIKE MANY EMPLOYERS, UPMC SUPPLEMENTS ITS RETIREMENT BENEFITS THROUGH A SUPPLEMENTAL RETIREMENT PROGRAM. THE SUPPLEMENTAL RETIREMENT PROGRAM IS SUBJECT TO MULTI YEAR VESTING WHICH PLACES THE OFFICERS AND KEY EMPLOYEES' RETIREMENT BENEFIT AT RISK OF FORFEITURE IF THE VESTING REQUIREMENTS ARE NOT SATISFIED. ONCE VESTED HOWEVER, PROVISIONS OF THE CODE REQUIRE THAT THE VESTED AMOUNTS BE REPORTED ON THE FORM 990 AND THE VESTED OFFICER OR KEY EMPLOYEE INCLUDE IN CURRENT INCOME THE VALUE OF HER OR HIS SUPPLEMENTAL RETIREMENT BENEFIT. NOTWITHSTANDING THE TAX REQUIREMENT TO RECOGNIZE THE VESTED AMOUNT OF THE SUPPLEMENTAL RETIREMENT BENEFIT AS CURRENT INCOME FOR FICA TAXATION AND REPORTING PURPOSES, THIS BENEFIT, WHICH GENERALLY HAS BEEN EARNED OVER HER OR HIS ENTIRE CAREER, HAS NOT AND WILL NOT BE DISTRIBUTED UNTIL THE OFFICER OR KEY EMPLOYEE RETIRES OR SEPARATES FROM SERVICE FROM UPMC AND SATISFIED THE NON-COMPETE PROVISION OF THEIR EMPLOYMENT AGREEMENT AND/OR SATISFY A POST-RETIREMENT SEPARATION AGREEMENT. THE SUPPLEMENTAL RETIREMENT PROGRAM PROVIDES FOR THE CURRENT DISTRIBUTION OF ONLY THE AMOUNT NECESSARY TO SATISFY ANY INCOME TAX LIABILITY RESULTING FROM THE VESTING DURING ACTIVE EMPLOYMENT. FINALLY, IT SHOULD BE NOTED THAT IN ACCORDANCE WITH IRS INSTRUCTIONS, A SUBSTANTIAL PORTION OF THE AMOUNT REPORTED ON THE FORM 990 ATTRIBUTABLE TO SUPPLEMENTAL RETIREMENT PROGRAM VESTING HAS BEEN REPORTED IN PREVIOUSLY FILED FORMS 990.
SCHEDULE J, PART I, LINE 7	NON-FIXED PAYMENTS: UPMC PROVIDES INCENTIVE COMPENSATION AS PART OF ITS TOTAL COMPENSATION PROGRAM FOR OFFICERS AND KEY EMPLOYEES. THIS COMPONENT IS BASED UPON THE ACCOMPLISHMENT OF PREDETERMINED PERFORMANCE GOALS AND OBJECTIVES WHICH FOCUS ON THE ACHIEVEMENT OF MULTIPLE ANNUAL AND THREE YEAR INDIVIDUAL AND GROUP PERFORMANCE CRITERIA IN THE CONTEXT OF APPROPRIATE RISK TAKING. THESE CRITERIA DIRECTLY SUPPORT UPMC'S MISSION AND INCLUDE: PATIENT QUALITY AND SATISFACTION, COMMUNITY BENEFITS, OPERATIONAL AND FINANCIAL STRENGTH, LEADERSHIP DEVELOPMENT, AND STRATEGIC BUSINESS INITIATIVES AMONG OTHERS.
SCHEDULE J, PART I, LINES 8 & 9	UPMC FOLLOWS THE REPUTABLE PRESUMPTION OF REASONABLENESS PROCEDURES DESCRIBED IN REGULATIONS SECTION 53.4958-6(C), WHERE APPLICABLE. THIS INCLUDES CONTRACTS THAT MAY QUALIFY FOR THE INITIAL CONTRACT EXCEPTION UNDER REGULATIONS SECTION 53.4958-4(A)(3).

Schedule J (Form 990) 2020

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

2020

Open to Public
Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Return Reference	Explanation
FORM 990, PART I, LINE 1	ORGANIZATION'S MISSION: UPMC COLE IS A FULL SERVICE, COMPREHENSIVE HEALTH SYSTEM, SERVING POTTER, MCKEAN, CAMERON, AND TIOGA COUNTIES IN RURAL, NORTH CENTRAL PA AND PORTIONS OF NEW YORK STATE AND IS THE ONLY HOSPITAL IN POTTER COUNTY (COUDERSPORT, PA). UPMC COLE IS A CRITICAL ACCESS HOSPITAL PROVIDING PRIMARY, EMERGENCY, AND SPECIALTY CARE, AS WELL AS REHABILITATION AND WELLNESS SERVICES TO PATIENTS WITHIN A 50-MILE RADIUS. UPMC COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, FIVE COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN OUR CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES ARE TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY, AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS AND ACTIVITIES, AND PROMOTE IMPROVED COMMUNICATIONS BETWEEN THE HOSPITAL AND THE COMMUNITY. THE HOSPITAL PROVIDES DEDICATED ADMINISTRATIVE TIME TO PLANNING AND CONDUCTING FIVE CBAC MEETINGS IN THE COMMUNITIES WE SERVE THREE TIMES PER YEAR.
FORM 990, PART III, LINE 3	CEASE CONDUCTING OF A PROGRAM SERVICE: DURING THE FISCAL YEAR, THE ORGANIZATION MADE THE DECISION TO DISCONTINUE ITS RADIATION ONCOLOGY PROGRAM.
FORM 990, PART III, LINE 4	PROGRAM SERVICE ACCOMPLISHMENTS: LINE 4A UPMC COLE'S HOME HEALTH AND HOSPICE SERVICES ASSIST PATIENTS THROUGHOUT THE REGION, WITH A GROWING NUMBER OF REFERRALS AND LOWER INFECTION RATES AMONG STATE AND NATIONAL AVERAGES. LINE 4B TWO OUTLYING CENTERS OFFER IMAGING SERVICES, WHILE ALL RHCS PROVIDE LAB DRAWS SO PATIENTS DON'T HAVE TO DRIVE TO RECEIVE NECESSARY TESTING. IN ADDITION TO THE FAMILY AND INTERNAL MEDICINE SERVICES AT RHCS, PHYSICIAN PRACTICES ALSO PROVIDE SPECIALTY CARE INCLUDING PEDIATRICS, GASTROENTEROLOGY, ORTHOPEDICS, PHYSIATRY, SURGERY, PODIATRY, OBSTETRICS/GYNECOLOGY AND ONCOLOGY. LINE 4C IN ADDITION TO THE HOSPITAL'S ACUTE CARE FLOORS, UPMC COLE CARES FOR PATIENTS IN ITS 44-BED SKILLED NURSING AND REHABILITATION UNIT. LINE 4D THE ORGANIZATION ALSO OFFERS CLINICAL SERVICES, CLINICS, CORPORATE AND HOMEMAKERS SERVICES.
FORM 990, PART VI, LINE 1A	VOTING RIGHTS: VOTING RIGHTS OF EXECUTIVE COMMITTEE PER CCMH BYLAWS EFFECTIVE 3/1/2018: SECTION 6.5 EXECUTIVE COMMITTEE. THERE MAY BE AN EXECUTIVE COMMITTEE OF THE BOARD CONSISTING OF DIRECTORS WITH REPRESENTATION SIMILAR TO THE FULL BOARD OF DIRECTORS. ANY EXECUTIVE COMMITTEE OF THE BOARD SHALL BE COMPRISED ONE-THIRD (1/3) OF UPMC DESIGNATED DIRECTORS SELECTED BY UPMC AND TWO-THIRDS (2/3) OF COLE DESIGNATED DIRECTORS SELECTED BY THE COLE DESIGNATED DIRECTORS. THE CHAIR, THE VICE CHAIR AND THE MEMBER'S REPRESENTATIVE SHALL BE MEMBERS OF ANY SUCH EXECUTIVE COMMITTEE EX OFFICIO; PROVIDED, THAT THE MEMBER'S REPRESENTATIVE SHALL HAVE A VOTE ON SUCH EXECUTIVE COMMITTEE ONLY IF HE OR SHE IS A DIRECTOR. UNLESS OTHERWISE DETERMINED BY THE BOARD AND THE MEMBER, AN EXECUTIVE COMMITTEE OF THE BOARD SHALL HAVE THE AUTHORITY TO FULFILL ALL OF THE DUTIES OF THE BOARD OF DIRECTORS EXCEPT AS TO THOSE MATTERS RESERVED TO THE MEMBER BY THESE BYLAWS, OR TO THE FULL BOARD BY ANY APPLICABLE PROVISION OF THE NON-PROFIT CORPORATION LAW OF PENNSYLVANIA. A MAJORITY OF THE ACTUAL THEN-CURRENT MEMBERSHIP OF ANY EXECUTIVE COMMITTEE OF THE BOARD AND THE PRESENCE OF THE MEMBER'S REPRESENTATIVE SHALL CONSTITUTE A QUORUM AND THE VOTE OF A MAJORITY OF THE VOTING EXECUTIVE COMMITTEE MEMBERS PRESENT WHERE A QUORUM EXISTS SHALL CONSTITUTE ACTION BY THE EXECUTIVE COMMITTEE.
FORM 990, PART VI, SECTION A, LINE 4	SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS: THE CHARLES COLE MEMORIAL HOSPITAL BYLAWS WERE AMENDED DURING THE FISCAL YEAR. A NEW SECTION OUTLINING THE DUTIES OF THE FAST TRACK CREDENTIALING COMMITTEE WAS ADDED. THE FAST TRACK CREDENTIALING COMMITTEE WILL CONSIST OF THE PRESIDENT, CHIEF OF THE MEDICAL STAFF, AND ONE DIRECTOR OF THE CORPORATION. THE COMMITTEE WILL MEET AT THE CALL OF THE CHIEF OF THE MEDICAL STAFF. THE COMMITTEE HAS POWER AND AUTHORITY OF THE BOARD OF DIRECTORS WITH RESPECT TO APPROVAL OF MEDICAL STAFF MEMBERSHIP AND CREDENTIALS ON A FAST TRACK BASIS IN ACCORDANCE WITH POLICIES AND PROCEDURES ESTABLISHED BY THE BOARD OF DIRECTORS. THESE ACTIONS WILL BE RATIFIED BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINES 6,7A, & 7B	MEMBERS: UPMC IS THE SOLE MEMBER OF CHARLES COLE MEMORIAL HOSPITAL D/B/A UPMC COLE. COLE SHALL BE GOVERNED BY A BOARD OF DIRECTORS CONSISTING AS OF THE EFFECTIVE TIME OF SEVENTEEN (17) VOTING DIRECTORS. OVER TIME, AS SET FORTH IN THE BYLAWS, THE BOARD SHALL BE DECREASED TO THIRTEEN (13) TOTAL DIRECTORS. THE DIRECTORS SHALL BE DESIGNATED AS FOLLOWS: AS OF THE EFFECTIVE TIME, THE BOARD WILL BE COMPRISED OF THIRTEEN (13) COLE DESIGNATED DIRECTORS AND FOUR (4) UPMC DESIGNATED DIRECTORS. THE THIRTEEN (13) COLE DESIGNATED DIRECTORS WILL REFLECT THE MEMBERS ON THE CHARLES COLE MEMORIAL HOSPITAL BOARD IMMEDIATELY PRIOR TO CLOSING. THEREAFTER, THE BOARD SHALL DECREASE, OVER TIME, TO THIRTEEN (13) TOTAL DIRECTORS WHICH SHALL CONSIST OF NINE (9) COLE DESIGNATED DIRECTORS AND FOUR (4) UPMC DESIGNATED DIRECTORS. THE COLE DESIGNATED DIRECTORS SHALL DECREASE TO NINE (9) PERSONS WHEN A COLE DESIGNATED DIRECTOR IS NO LONGER ELIGIBLE TO SERVE, OR UPON HIS OR HER VOLUNTARY OR INVOLUNTARY RESIGNATION UNTIL THE NUMBER OF COLE DESIGNEES IS REDUCED TO NINE (9). THIS COMPOSITION OF NINE (9) COLE DESIGNATED DIRECTORS AND FOUR (4) UPMC DESIGNATED DIRECTORS SHALL CONTINUE THROUGH AT LEAST THE PARTICIPATION PERIOD. THE UPMC DESIGNATED DIRECTORS AND THEIR SUCCESSORS WILL BE APPOINTED BY UPMC. THE MEMBER SHALL HAVE THE FOLLOWING RIGHTS AND POWERS: UMPC IS THE PARENT OF CHARLES COLE MEMORIAL HOSPITAL, INC. UPMC HAS THE RIGHTS TO DO ALL OF THE FOLLOWING: (I) APPROVAL OF OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (II) ENTERING INTO NEW OR MATERIALLY CHANGING EXISTING JOINT VENTURE ARRANGEMENTS OF THE CORPORATION; (III) APPROVAL OF THE TERMS OF ANY MANAGEMENT ARRANGEMENTS WITH AN UNRELATED THIRD PARTY; (IV) ANY CHANGE IN THE CORPORATE STRUCTURE OF THE CORPORATION; (V) THE SALE, LEASE, TRANSFER OR JOINT VENTURE, WHETHER WITHIN THE SYSTEM OR EXTERNAL THERETO, INVOLVING SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (VI) THE MERGER, CONSOLIDATION, DIVESTITURE OR DISSOLUTION OF THE CORPORATION; (VII) ANY AMENDMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION; (VIII) SALE OF ANY REAL ESTATE OF THE CORPORATION; THE MEMBER AND UPMC MAY LOOK TO THE BOARD OF DIRECTORS TO PROVIDE GOVERNANCE AND OVERSIGHT WITH RESPECT TO MATTERS WHICH MAY INCLUDE DEVELOPING AND IMPLEMENTING THE GOALS AND OBJECTIVES OF THE CORPORATION IN THE FOUR KEY AREAS OF (1) QUALITY PERFORMANCE; (2) FINANCIAL PERFORMANCE; (3) PLANNING PERFORMANCE; AND (4) GOVERNANCE PERFORMANCE.
FORM 990, PART VI, SECTION B, LINE 11B	FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON INFORMATION SUPPLIED BY CHARLES COLE MEMORIAL HOSPITAL. THE DRAFT 990 IS REVIEWED BY THE FINANCE DEPARTMENT. IT IS THEN POSTED TO AN ONLINE PORTAL FOR THE BOARD OF DIRECTORS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: MEMBERS OF THE BOARD OF DIRECTORS; BOARD COMMITTEES; SENIOR LEADERS; MIDDLE MANAGEMENT EMPLOYEES; AND MEDICAL STAFF WITH ADMINISTRATIVE RESPONSIBILITIES ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY (CALENDAR YEAR). PURSUANT TO THE AMENDED BYLAWS EFFECTIVE MARCH 1, 2018, SECTION 11.6, "THE BOARD SHALL ADOPT AND MAINTAIN A POLICY CONSISTENT WITH THE POLICY OF THE MEMBER WITH RESPECT TO CONFLICTS OF INTEREST ON THE PART OF THE DIRECTORS, OFFICERS, SENIOR MANAGEMENT, PHYSICIANS, AND OTHER STAFF, AS APPLICABLE, WHICH SHALL INCLUDE A PROCEDURE WITH RESPECT TO DISCLOSURE AND REVIEW OF ACTUAL OR POTENTIAL CONFLICTS AND RELATED INFORMATION. THE CONFLICTS OF INTEREST POLICY OF COLE IN EFFECT AT THE EFFECTIVE TIME SHALL REMAIN IN EFFECT UNTIL SUCH TIME AS THE BOARD ADOPTS A POLICY CONSISTENT WITH THE POLICY OF THE MEMBER." FOR 2020, THE CONFLICT OF INTEREST POLICY AND CONFLICT OF INTEREST STATEMENT WERE REVIEWED 06/03/2020 AND, THEREAFTER, THE CONFLICT OF INTEREST STATEMENTS DISTRIBUTED TO THE NOTED PARTIES FOR COMPLETION. THE LEVELS AT WHICH CONFLICT OF INTEREST STATEMENTS WERE REVIEWED, FOR THE PERIOD 07/01/20 - 06/30/21, WERE THE COMPLIANCE OFFICER AND, THEREAFTER, THE THEN EXISTING GOVERNANCE OVERSIGHT COMMITTEE OF THE BOARD OF DIRECTORS ON 06/17/2020. AS TO RESTRICTIONS A MEMBER OF THE BOARD OR BOARD COMMITTEE MUST DISCLOSE THE EXISTENCE OF HIS/HER FINANCIAL INTEREST AFTER WHICH A DETERMINATION OF CONFLICT OF INTEREST WILL BE MADE. A VOTING MEMBER OF THE BOARD OF DIRECTORS WHO RECEIVES COMPENSATION DIRECTLY OR INDIRECTLY, AND A VOTING MEMBER OF ANY COMMITTEE WHOSE SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS AND WHO RECEIVE COMPENSATION, DIRECTLY OR INDIRECTLY, ARE PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION; PHYSICIANS WHO RECEIVE COMPENSATION, DIRECTLY OR INDIRECTLY, ARE PRECLUDED FROM MEMBERSHIP ON ANY COMMITTEE WHOSE PRIMARY SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS; AND A MANAGEMENT EMPLOYEE OR A MEDICAL STAFF MEMBER WITH ADMINISTRATIVE RESPONSIBILITIES MUST DISCLOSE TO THE SENIOR LEADER THE EXISTENCE OF THE FINANCIAL INTEREST AND ALL RELATED MATERIAL FACTS. ALSO, THE CONTRACTING POLICY CONTAINS A PROVISION FOR DISCLOSURE OF A FINANCIAL INTEREST ON THE CONTRACT ROUTING FORM.
FORM 990, PART VI, SECTION B, LINES 15A & 15B	COMPENSATION DETERMINATION: THE SENIOR DIRECTOR OF COMPENSATION FOR UPMC PARTNERS WITH E&Y AND KORN FERRY ANNUALLY TO CONDUCT A MARKET ANALYSIS FOR CEO'S & TOP 10 EXECUTIVE VP'S. THE MARKET REVIEW IS THEN PRESENTED TO THEIR EXECUTIVE COMPENSATION COMMITTEE FOR REVIEW AND APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19	DOCUMENT AVAILABILITY: THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS CAN BE VIEWED ONSITE THROUGH A WRITTEN REQUEST TO THE ORGANIZATION'S CORPORATE COMPLIANCE OFFICER. REQUESTS FOR FINANCIAL STATEMENTS AND 990'S ARE FORWARDED TO THE FINANCE / ACCOUNTING DEPARTMENT AND ARE OPEN FOR PUBLIC INSPECTION.
FORM 990, PART VII, SECTION A	BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE ANY COMPENSATION FOR THEIR DIRECTOR DUTIES. STEVEN JOHNSON, DAVID LOPATOFSKY, MARIBETH MCLAUGHLIN, AND CARRIE ENNIS ARE COMPENSATED BY A RELATED ORGANIZATION FOR THEIR OPERATIONAL ROLES. MARY ANN RIGAS AND MICHAEL CALLAHAN ARE COMPENSATED FOR THEIR ROLES AS PHYSICIANS.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS: $ ( 4,518,312) TRANSFER TO RELATED PARTY ( 176,951) NET ASSETS RELEASED FROM PERMANENTLY RESTRICTION ( 396,084) NET ASSETS RELEASED FROM TEMPORARY RESTRICTION -------------- $ ( 5,091,347)
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:3618456
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES TOTAL FEES:3610564
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER FEES AND SERVICES TOTAL FEES:1333284
FORM 990 PART IX LINE 11G	DESCRIPTION:LAB SERVICES TOTAL FEES:1090795
FORM 990 PART IX LINE 11G	DESCRIPTION:MAINTENANCE CONTRACTS TOTAL FEES:965747
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:761546
FORM 990 PART IX LINE 11G	DESCRIPTION:HOUSEKEEPING SERVICES TOTAL FEES:235131
FORM 990 PART IX LINE 11G	DESCRIPTION:CONSULTING SERVICES TOTAL FEES:74378

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

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

2020

Open to Public Inspection

Name of the organization

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)HENDORN INC DBA COLE MANOR 1001 EAST SECOND STREET COUDERSPORT,PA16915 23-1972659	RESIDENT CARE	PA	501(C)(3)	12A I	C COLE MEM H	Yes
(2)HAMOTCOLE VENTURES INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 27-3172100	REAL ESTATE	PA	501(C)(3)	12A I	C COLE MEM H	Yes
(3)COLE FOUNDATION 1001 EAST SECOND STREET COUDERSPORT,PA16915 45-5417308	SUPPORT	PA	501(C)(3)	12A I	C COLE MEM H	Yes
(4)LAUREL REALTY 32-36 CENTRAL AVENUE WELLSBORO,PA16901 23-1403678	REAL ESTATE	PA	501(C)(2)		UPMC SUSQUEH		No
(5)THE GREEN HOME 32-36 CENTRAL AVENUE WELLSBORO,PA16901 24-0804365	SKILLED NURSI	PA	501(C)(3)	10	UPMC SUSQUEH		No
(6)WILLIAMSPORT AREA AMBULANCE SERVICES 700 HIGH ST WILLIAMSPORT,PA17701 23-2416166	AMBULANCE SVC	PA	501(C)(3)	10	UPMC WILLIAM		No
(7)UPMC SENIOR COMMUNITIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1574736	SR. LIVING	PA	501(C)(3)	10	UPMC		No
(8)PITTSBURGH LIFETIME CARE COMMUNITY 600 GRANT STREET PITTSBURGH,PA15219 25-1335247	CCRC	PA	501(C)(3)	10	UPMC SR COMM		No
(9)CANTERBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-0965334	SR LIVING	PA	501(C)(3)	10	UPMC SR COMM		No
(10)SENECA PLACE 600 GRANT STREET PITTSBURGH,PA15219 72-1562844	SR. LIVING	PA	501(C)(3)	10	UPMC SR COMM		No
(11)SHADYSIDE HOSPITAL SUPPORTING FND 600 GRANT STREET PITTSBURGH,PA15219 26-0303394	FOUNDATION	PA	501(C)(3)	12A I	UPMC		No
(12)UPMC LEE 600 GRANT STREET PITTSBURGH,PA15219 25-0613830	INACTIVE	PA	501(C)(3)	3	UPMC		No
(13)PITTSBURGH CARE PARTNERSHIP INC 600 GRANT STREET PITTSBURGH,PA15219 25-1753852	SR CARE MGMT	PA	501(C)(3)	10	UPMC		No
(14)UPMC CENTER FOR HIGH VALUE HEALTHCARE 600 GRANT STREET PITTSBURGH,PA15219 45-2178782	RESEARCH	PA	501(C)(3)	7	UPMC		No
(15)SHADYSIDE HOSPITAL FOUNDATION 532 SOUTH AIKEN AVE PITTSBURGH,PA15232 25-1290546	FOUNDATION	PA	501(C)(3)	12C III	UPMC PRESBY		No
(16)PASSAVANT HOSPITAL FOUNDATION 9100 BABCOCK BLVD PITTSBURGH,PA15237 25-1407815	FOUNDATION	PA	501(C)(3)	12B II	UPMC PASS		No
(17)NORTHWEST HOSPITAL FOUNDATION 100 FAIRFIELD DRIVE SENECA,PA16346 25-1483624	FOUNDATION	PA	501(C)(3)	12D III	UPMC NORTHWE		No
(18)ST MARGARET FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1520340	FOUNDATION	PA	501(C)(3)	7	UPMC ST MARG		No
(19)MAGEE-WOMEN RES INST AND FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1462312	FOUNDATION	PA	501(C)(3)	7	NA		No
(20)GREAT LAKES PHYSICIAN PRACTICE 600 GRANT STREET PITTSBURGH,PA15219 46-4186362	PHYSICIAN SRV	NY	501(C)(3)	3	REGNL HEALTH		No
(21)HAMOT HEALTH FOUNDATION 302 FRENCH STREET ERIE,PA16507 25-1400999	FOUNDATION	PA	501(C)(3)	12B II	UPMC HAMOT		No
(22)CHILDREN'S HOSPITAL OF PITTSBURGH FND 600 GRANT STREET PITTSBURGH,PA15219 25-1865744	FOUNDATION	PA	501(C)(3)	7	UPMC CHP		No
(23)UPMCJAMESON CANCER CENTER 1211 WILMINGTON AVE NEW CASTLE,PA16105 20-1459415	ONCOLOGY SVC	PA	501(C)(3)	10	UPMC JAMESON		No
(24)VENANGO VNA FOUNDATION 491 ALLEGHENY BLVD FRANKLIN,PA16323 25-1472179	FOUNDATION	PA	501(C)(3)	12D III	NA		No
(25)UPMC CHAUTAUQUA AT WCA 207 FOOTE AVE JAMESTOWN,NY14701 16-0743226	HOSPITAL	NY	501(C)(3)	3	UPMC CHAUTAU		No
(26)WCA GROUP INC 207 FOOTE AVE JAMESTON,NY14701 22-2392582	HOLDING CO	NY	501(C)(3)	12B II	CHAUT AT WCA		No
(27)STARFLIGHT INC 135 ALLEN STREET JAMESTOWN,NY14701 16-1557878	AIR AMBULANCE	NY	501(C)(3)	7	CHAUT AT WCA		No
(28)SOUTH CENTRAL ALPHA HOUSING AND HEALTH 3410 W PITTSBURGH RD NEW CASTLE,PA16101 25-1701701	SNF & AL	PA	501(C)(3)	10	UPMC SR COMM		No
(29)SOUTH WESTERN ALPHA HOUSING AND HEALTH 745 GREENVILLE RD MERCER,PA16137 25-1701700	SNF & IL	PA	501(C)(3)	10	UPMC SR COMM		No
(30)KANE COMMUNITY HOSPITAL FOUNDATION 4372 ROUTE 6 KANE,PA16735 26-3906925	FOUNDATION	PA	501(C)(3)	12B II	NA		No
(31)JUNIOR GUILD OF JAMESON MEMORIAL HOS 1211 WILMINGTON AVE NEW CASTLE,PA16105 25-6005313	SUPPORT	PA	501(C)(3)	12D III	NA		No
(32)WCA FOUNDATION INC 300 FOOTE AVE JAMESTOWN,NY14702 22-2393584	FOUNDATION	PA	501(C)(3)	12C III	NA		No
(33)LAUREL HEALTH FOUNDATION 32-36 CENTRAL AVENUE WELLSBORO,PA16101 25-1810488	FOUNDATION	PA	501(C)(3)	12B II	NA		No
(34)UPMC PINNACLE 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778658	SUPPORTNG ORG	PA	501(C)(3)	12B II	UPMC		No
(35)UPMC CARLISLE 361 ALEXANDER SPRING ROAD CARLISLE,PA17105 82-0880337	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(36)UPMC LANCASTER 250 COLLEGE AVENUE LANCASTER,PA17603 82-0896436	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(37)UPMC LITITZ 1500 HIGHLANDS AVENUE LITITZ,PA17543 82-0844453	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(38)UPMC MEMORIAL 325 SOUTH BELMONT STREET YORK,PA17405 82-0912090	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(39)PINNACLE HEALTH REGIONAL PHYSICIANS 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-0947698	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC PINNACL		No
(40)PINNACLE HEALTH FOUNDATION 409 SOUTH SECOND STREET HARRISBURG,PA17104 22-2691718	FOUNDATION	PA	501(C)(3)	12B II	UPMC PINNACL		No
(41)COMMUNITY LIFE TEAM INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1890444	MED TRANSPORT	PA	501(C)(3)	7	UPMC PINNACL		No
(42)HANOVER HEALTHCARE PLUS INC 300 HIGHLAND AVENUE HANOVER,PA17331 22-2658574	SUPPORTNG ORG	PA	501(C)(3)	12A I	UPMC PINNACL		No
(43)UPMC HANOVER 300 HIGHLAND AVENUE HANOVER,PA17331 23-1360851	HOSPITAL	PA	501(C)(3)	3	HANOVER HEAL		No
(44)PINNACLE HEALTH MEDICAL SERVICES 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1709054	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC PINNACL		No
(45)UPMC PINNACLE HOSPITALS 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778644	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(46)ASBURY HEIGHTS OF UPMC 600 GRANT STREET PITTSBURGH,PA15219 25-1555687	SUPPORTNG ORG	PA	501(C)(3)	12B II	UPMC SR COMM		No
(47)ASBURY HEALTH CENTER 600 GRANT STREET PITTSBURGH,PA15219 25-0969472	CCRC	PA	501(C)(3)	10	ASBURY HEIGH		No
(48)ASBURY VILLAS 600 GRANT STREET PITTSBURGH,PA15219 25-1819952	PERSONAL CARE	PA	501(C)(3)	10	ASBURY HEIGH		No
(49)ASBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-1729266	PERSONAL CARE	PA	501(C)(3)	10	ASBURY HEIGH		No
(50)WESLEY HILLS 600 GRANT STREET PITTSBURGH,PA15129 25-1507472	INDEP LIVING	PA	501(C)(3)		ASBURY HEIGH		No
(51)ASBURY FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1555688	FOUNDATION	PA	501(C)(3)	7	ASBURY HEIGH		No
(52)JAMESON CARE CENTER INC 1211 WILMINGTON AVE NEW CASTLE,PA16105 23-2871396	SR SERVICES	PA	501(C)(3)	10	UPMC SR COMM		No
(53)UPMC SOMERSET 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-0965570	HOSPITAL	PA	501(C)(3)	3	UPMC		No
(54)TWIN LAKES CENTER INC 225 SOUTH CENTER AVENUE SOMERSET,PA15501 23-2910318	DRUG TREATMEN	PA	501(C)(3)	3	UPMC SOMERSE		No
(55)SOMERSET COMMUNITY HOSPITAL FOUNDATION 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-1441863	FOUNDATION	PA	501(C)(3)	12C III	UMPC SOMERSE		No
(56)SOMERSET HEALTH SERVICES INC 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-1441920	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC SOMERSE		No
(57)UPMC WESTERN MARYLAND CORPORATION PO BOX 539 CUMERLAND,MD21501 52-0591531	HOSPITAL	PA	501(C)(3)	3	UPMC		No
(58)WESTERN MARYLAND HEALTH SYSTEM FND PO BOX 539 CUMBERLAND,MD21501 35-2289841	FOUNDATION	PA	501(C)(3)	12C III	UPMC WESTERN		No
(59)HANOVER HOSPITAL FOUNDATION 300 HIGHLAND AVENUE HANOVER,PA17331 82-2553293	FOUNDATION	PA	501(C)(3)	12C III	UPMC PINNACL		No
(60)PENNSYLVANIA PSYCHIATRIC MEDICAL SERVIC 2501 NORTH THIRD STREET HARRISBURG,PA17110 82-2969322	MED SERV PROV	PA	501(C)(3)	3	PENNSYLVANIA		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2020

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	(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?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) SENECA HILLS ASSISTED LIVING 600 GRANT STREET PITTSBURGH,PA15219 23-2873106	ASSISTED LIVING	PA	NA				No			No
(2) ST MARGARET MEDICAL ARTS ASSOC 600 GRANT STREET PITTSBURGH,PA15219 25-1786655	MED OFFICE BL	PA	NA				No			No
(3) CORE NETWORK LLC 600 GRANT STREET PITTSBURGH,PA15219 25-1786209	HEALTHCARE	PA	UPMC COMM PROVI				No			No
(4) SHADYSIDE MEDICAL CENTER ASSOC 600 GRANT STREET PITTSBURGH,PA15219 25-1608318	MED OFFICE BL	PA	NA				No			No
(5) CHARTWELL PA LP 600 GRANT STREET PITTSBURGH,PA15219 25-1729714	HOME HEALTH	PA	UPMC COMM PROV				No			No
(6) LIFE CARE HOME SRV OF NW PA 1647 SASSAFRAS ST ERIE,PA16507 25-1536879	HOME HEALTH	PA	UPMC HAMOT				No			No
(7) HAMOT-KCH REAL ESTATE VENTURE 300 STATE ST ERIE,PA16507 26-3691782	MEDICAL OFFIC	PA	UPMC HAMOT				No			No
(8) HAMOT SURGERY CENTER LLC 200 STATE STREET ERIE,PA16507 25-1863661	AMBULATORY SU	PA	UPMC HAMOT				No			No
(9) EPN-HAMOT URGENT CARE LLC 600 GRANT STREET PITTSBURGH,PA15219 27-2147949	URGENT CARE	PA	NA				No			No
(10) HANOVER SURGICENTER REAL ESTATE 300 HIGHLAND AVE HANOVER,PA17331 35-2342993	INACTIVE	PA	HANOVER HEALTH				No			No
(11) MEDCARE SUSQUEHANNA VALLEY LLC 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-1673688	DME	PA	PINNACLE HEALTH				No			No
(12) OMICELO RE I LP 2525 LIBERTY AVENUE PITTSBURGH,PA15222 47-5603393	REAL ESTATE D	DE	UPMC FOR YOU				No			No
(13) UPMC LEADER SURGERY CENTER LLC 1703 INNOVATION DRIVE YORK,PA17408 23-3035083	SURGERY CENTER	PA	UPMC MEMORIAL				No			No
(14) BAYFRONT BUILDING PROFESSIONAL LLC 3645 WEST LAKE ROAD ERIE,PA16505 25-1480837	REAL ESTATE	PA	UPMC HAMOT				No			No
(15) CHAUTAUQUA INTEGRATED DELIVERY SYSTEM 200 HARRISON STREET 2ND FLOOR JAMESTOWN,NY14701 16-1542139	INTEGRATED DELIV	NY	UPMC CHAUTAUQUA				No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) COLE CARE INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 25-1497347	DURABLE MED EQUIP	PA	COLE MEMORIAL	C CORP	5,009,277	467,844	100.000 %	Yes
(2) SUSQUEHANNA VENTURES INC 1201 GRAMPIAN BLVD WILLIAMSPORT,PA17701 23-2470623	PHARMACY	PA	NA	C CORP					No
(3) SUSQUEHANNA HEALTH SYS INS NETWORK LTD PO BOX 1159 KY1-1102 GRAND CAYMANS,CAYMAND ISLANDS CJ	INSURANCE	CJ	NA	C CORP					No
(4) HC PHARMACY CENTRAL INC 600 GRANT STREET PITTSBURGH,PA15219 25-1364192	PHARMACY CO-OP	PA	NA	C CORP					No
(5) CHILDREN'S COMMUNITY CARE 600 GRANT STREET PITTSBURGH,PA15219 25-1781887	PHYSICIAN SERV	PA	NA	C CORP					No
(6) UPMC PHYSICIAN SERVICES HOLDING COMPANY 600 GRANT STREET PITTSBURGH,PA15219 25-1877017	HOLDING CO	PA	NA	C CORP					No
(7) ONCOLOGY HEMATOLOGY ASSOCIATION INC 600 GRANT STREET PITTSBURGH,PA15219 25-1762980	PHYSICIAN SERV	PA	NA	C CORP					No
(8) TRI-STATE NEUROSURGICAL ASSOCIATES - UPM 600 GRANT STREET PITTSBURGH,PA15219 25-1458655	PHYSICIAN SERV	PA	NA	C CORP					No
(9) RENAISSANCE FAMILY PRACTICE-UPMC INC 600 GRANT STREET PITTSBURGH,PA15219 26-2942406	PHYSICIAN SERV	PA	NA	C CORP					No
(10) UPMC HOLDING COMPANY INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777713	HOLDING CO	PA	NA	C CORP					No
(11) UPMC COVERAGE PRODUCTS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777710	HOLDING CO	PA	NA	C CORP					No
(12) FREEDOM INSURANCE COMPANY 600 GRANT STREET PITTSBURGH,PA15219 03-0308944	INSURANCE	VT	NA	C CORP					No
(13) TRI-CENTURY INSURANCE CO 600 GRANT STREET PITTSBURGH,PA15219 25-1500739	INSURANCE	PA	NA	C CORP					No
(14) UPMC DNA INC 600 GRANT STREET PITTSBURGH,PA15219 25-1883237	INSURANCE	PA	NA	C CORP					No
(15) UPMC HEALTH BENEFITS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1844144	HEALTH INSURANCE	PA	NA	C CORP					No
(16) UPMC HEALTH NETWORK INC 600 GRANT STREET PITTSBURGH,PA15219 72-1527566	HEALTH INSURANCE	PA	NA	C CORP					No
(17) UPMC HEALTH PLAN INC 600 GRANT STREET PITTSBURGH,PA15219 23-2813536	HEALTH INSURANCE	PA	NA	C CORP					No
(18) UPMC BENEFIT MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1769564	WORKER'S COMP	PA	NA	C CORP					No
(19) UPMC DIVERSIFIED SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1778454	HOLDING CO	PA	NA	C CORP					No
(20) MONROEVILLE SPECIALTY CLINIC 600 GRANT STREET PITTSBURGH,PA15219 25-1666087	AMB SURG	PA	NA	C CORP					No
(21) MEDICAL ARCHIVAL SYSTEMS INC 600 GRANT STREET PITTSBURGH,PA15219 23-2912501	SOFTWARE DEVE	DE	NA	C CORP					No
(22) RX PARTNERS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1801966	PHARMACY	PA	NA	C CORP					No
(23) BIOTRONICS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1843500	EQUIP MAINTENANCE	PA	NA	C CORP					No
(24) MEDICAL CENTER PROPERTIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1796940	REAL ESTATE	PA	NA	C CORP					No
(25) ASKESIS DEVELOPMENT GROUP INC 600 GRANT STREET PITTSBURGH,PA15219 54-1625585	SOFTWARE DEVE	DE	NA	C CORP					No
(26) PANTHER REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN CJ 98-1402742	INSURANCE	CJ	NA	C CORP					No
(27) FORBES REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN,CAYMAN ISLANDS CJ 98-1400710	INSURANCE	CJ	NA	C CORP					No
(28) CATHEDRAL (RE) INSURANCE CO PO BOX 1109 GRAND CAYMAN,CAYMAN ISLANDS CJ 98-1400837	INSURANCE	CJ	NA	C CORP					No
(29) UPMC IRELAND LIMITED 6TH FLOOR BEACON HOSPITAL SANDYFORD,DUBLIN EI	HEALTHCARE SU	EI	UPMC INT'L HOLD	C CORP					No
(30) UPMC UNITED KINGDOM LTD C/O NAIRCO 11TH FLOOR WHITEFRIARS LEWINS MEAD,BRISTOL UK 98-0571026	SOFTWARE LICENCE	UK	UPMC INT'L HOLD	C CORP					No
(31) BAYFRONT REGIONAL DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401388	RE HOLDING CO	PA	NA	C CORP					No
(32) BAYSIDE DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401386	REAL ESTATE	PA	NA	C CORP					No
(33) UPMC WORK ALLIANCE INC 600 GRANT STREET PITTSBURGH,PA15219 45-2825053	INSURANCE	PA	NA	C CORP					No
(34) UPMC CANADA TECHNOLOGIES LIMITED 600 GRANT STREET PITTSBURGH,PA15219	SOFTWARE	CA	UPMC INT'L HOLD	C CORP					No
(35) UPMC HEALTH COVERAGE INC 600 GRANT STREET PITTSBURGH,PA15219 46-2824537	INSURANCE	PA	NA	C CORP					No
(36) UPMC COMPLETE CARE INC 5215 CENTRE AVE PITTSBURGH,PA15232 46-3605753	PHYSICIAN SERV	PA	NA	C CORP					No
(37) AMERICAN HOME HEALTH SERVICES 868 CORPORATE WAY WESTLAKE,OH44145 31-1521422	HOME HEALTH	OH	QUALITY FIRST	C CORP					No
(38) HEALTH FIDELITY INC 210 S B ST SAN MATEO,CA94401 45-2538963	TECHNOLOGY	CA	NA	C CORP					No
(39) CURAVI HEALTH INC 6425 PENN AVE PITTSBURGH,PA15206 81-1217377	HEALTHCARE	DE	NA	C CORP					No
(40) PENSIAMO INC 600 GRANT STREET PITTSBURGH,PA15219 81-2069236	SUPPLY CHAIN	DE	NA	C CORP					No
(41) ALTOONA FAMILY INC 620 HOWARD AVE ALTOONA,PA16601 25-1444935	MGMT SVCS	PA	UPMC ALTOONA	C CORP					No
(42) LEXINGTON HOLDINGS INC 620 HOWARD AVE ALTOONA,PA16601 25-1794386	HOLDING CO	PA	CTRL PA MED FND	C CORP					No
(43) LEXINGTON ONE INC 620 HOWARD AVE ALTOONA,PA16601 25-1468889	RENTAL	PA	LEXINGTON HOLD	C CORP					No
(44) LEXINGTON TWO INC HOWARD AVE AND 7TH ST ALTOONA,PA16601 25-1555689	DURABLE MED EQUIP	PA	LEXINGTON HOLD	C CORP					No
(45) LEXINGTON FOUR INC 620 HOWARD AVE ALTOONA,PA16601 25-1793736	HOLDING CO	PA	LEXINGTON HOLD	C CORP					No
(46) UPMC ALTOONA REGIONAL HEALTH SERVICES 1414 9TH AVE ALTOONA,PA16602 25-1219302	PHYSICIAN SERV	PA	LEXINGTON FOUR	C CORP					No
(47) LEXINGTON ANESTHESIA ASSOCIATES INC 620 HOWARD AVE ALTOONA,PA16601 25-1897765	PHYSICIAN SERV	PA	LEXINGTON FOUR	C CORP					No
(48) UPMC EXCESS PL TR 600 GRANT STREET PITTSBURGH,PA15219 82-6254351	TRUST	PA	NA	TRUST					No
(49) RXANTE INC 511 CONGRESS STREET PORTLAND,ME04101 45-4040219	MEDICATION MG	DE	NA	C CORP					No
(50) WCA SERVICE CORPORATION INC 207 FOOTE AVE JAMESTOWN,NY14701 16-1151438	SUPPORT	NY	CHAUT AT WCA	C CORP					No
(51) HEMATOLOGY ONCOLOGY ASSOCIATION INC 600 GRANT STREET PITTSBURGH,PA12519 42-1648357	PHYSICIAN SERV	PA	NA	C CORP					No
(52) UPMC HEALTH OPTIONS INC 600 GRANT STREET PITTSBURGH,PA15219 46-2824626	INSURANCE	PA	NA	C CORP					No
(53) PINNACLE HEALTH CARDIOVASCULAR INSTITUT 409 SOUTH SECOND STREET HARRISBURG,PA17104 32-0321362	PHYSICIAN SERV	PA	NA	C CORP					No
(54) HANOVER HEALTH CORPORATION 300 HIGHLAND AVENUE HANOVER,PA17331 90-0498067	HOLDING CO	PA	NA	C CORP					No
(55) HANOVER APOTHECARY INC 310 STOCK STREET SUITE 1 HANOVER,PA17331 03-0594526	PHARMACY	PA	NA	C CORP					No
(56) UNITED CENTRAL PA RECIPROCAL RISK RETEN 76 SAINT PAUL STREET SUITE 500 BURLINGTON,VT05401 13-4224033	INSURANCE	VT	NA	C CORP					No
(57) PINNACLE HEALTH VENTURES INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 61-1677624	HOLDING CO	PA	NA	C CORP					No
(58) PINNACLE HEALTH IMAGING INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1718571	IMAGING SRV	PA	NA	C CORP					No
(59) UPMC ITALY HEALTH SERVICES SRL VIA DISCESA DEI GIUDICI 4 PALERMO 90133 IT	HEALTH SVC	IT	UPMC ITALY SRL	C CORP					No
(60) UPMC INVESTMENTS LTD C/O UPMC WHITEFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	HOLDING CO	EI	UPMC IRELAND LT	C CORP					No
(61) UPMC PROPERTY LTD C/O UPMC WHITEFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY	EI	UPMC INVEST LTD	C CORP					No
(62) EURO CARE INFRASTRUCTURE LTD C/O UPMC WHITEFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY MGMT	EI	UPMC INVEST LTD	C CORP					No
(63) EURO CARE PROPERTY MANAGEMENT LTD C/O UPMC WHITEFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY MGMT	EI	UPMC INVEST LTD	C CORP					No
(64) BLUESPHERE BIO 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 82-4979766	IMMUNOTHERAPY	DE	NA	C CORP					No
(65) INFECTIOUS DISEASE CONNECT INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 83-3311071	TELEMEDICINE	DE	NA	C CORP					No
(66) HUMONIC INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 83-4005420	BIOPHARM	DE	NA	C CORP					No
(67) UPMC HILLMAN CANCER CENTER - PINNACLE 101 ERFORD ROAD CAMP HILL,PA17701 83-3640945	CANCER TREATMENT	PA	NA	C CORP					No
(68) SHANGHAI UPMC CO LTD 288 SHIMEN 1ST ROAD JINGAN DIST SHANGHAI 200041 CH	HEALTHCARE MG	CH	UPMC INT'L HOLD	C CORP					No
(69) SALVATOR MUNDI INTERNATIONAL HOSPITAL ROMA VIALE DELLE MURA GIANICOLENSI CAP 00152 IT	HOSPITAL	IT	UPMC ITALY SRL	C CORP					No
(70) SOMERSET ANESTHESIA INC 600 GRANT STREET PITTSBURGH,PA15219 45-5135437	PHYSICIAN SERV	PA	NA	C CORP					No
(71) SOMERSET MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1512960	MOB OWNERSHIP	PA	NA	C CORP					No
(72) GENERIAN PHARMACEUTICALS INC 2425 SIDNEY STREET PITTSBURGH,PA15203 83-3340453	PHARMACY	PA	NA	C CORP					No
(73) ASTRATA INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-4804493	SOFTWARE	DE	NA	C CORP					No
(74) VEGAVECT 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-4280784	GENE THERAPY	DE	NA	C CORP					No
(75) NOVIMAB 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-1494905	CLINICAL RESEARCH	DE	NA	C CORP					No
(76) HAYSTACK CONSOLIDATED SERVICES INC 12500 WILLOWBROOK ROAD CUMBERLAND,MD21502 52-1335895	INACTIVE	PA	NA	C CORP					No
(77) WESTERN MARYLAND INSURANCE COMPANY LTD PO BOX 10233 GRAND CAYMAN,CAYMAN ISLANDS CJ	INSURANCE	CJ	NA	C CORP					No
(78) WILLOWBROOK HEALTHCARE CONDO 12401 WILLOWBROOKE ROAD CUMBERLAND,MD21502 37-1538510	REAL ESTATE	DE	NA	C CORP					No
(79) CLANE HOSPITAL DEVELOPMENT ASSOCIATES C/O UPMC WHITFIELD CORK ROAD BUTLERSTOWN NORTH,WATERFORDX91 DH9W EI	MANAGEMENT	EI	UPMC IRELAND LT	C CORP					No
(80) GENERIAN PHARMACEUTICALS AUSTRALIA PTY LEVEL 5 63 PIRIE STREET ADELAIDE 5001 AS	PHARMACY	AS	GENERIAN PHARM	C CORP					No
(81) NOVASENTA INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 82-5443222	IMMUNOTHERAPY	DE	NA	C CORP					No
(82) RXANTE PHARMACY SERVICES INC 511 CONGRESS STREET 803 PORTLAND,ME04101 83-3402761	PHARMACY	DE	NA	C CORP					No
(83) UPMC AUT EVEN HOSPITAL LTD FRESHFORD ROAD COUNTY KILKENNY R95 D3760 EI	HOSPITAL	EI	UPMC INVEST LTD	C CORP					No
(84) UPMC GLOBAL OPERATIONS CENTER LTD 6TH FLOOR BEACON HOSPITAL SANDYFORD DUBLIN 18 EI	CANCER TREATMENT	EI	UPMC IRELAND LT	C CORP					No
(85) UPMC KILDARE HOSPITAL LTD PROSPEROUS ROAD CLANE W91 W535 EI	HOSPITAL	EI	CLANE HOSPITAL	C CORP					No
(86) UPMC WHITFIELD HOSPITAL LTD C/O UPMC WHITFIELD CORK ROAD BUTLER,WATERFORD EI	HOSPITAL	EI	UPMC INVEST LTD						No

Schedule R (Form 990) 2020

Page 3

Part V

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

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

Yes

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

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

Yes

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

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

Yes

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

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

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

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

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

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

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) COLE CARE INC	A	205,648	FMV
(2) COLE FOUNDATION	C	73,251	FMV
(3) HAMOTCOLE VENTURES INC	K	591,500	FMV

Schedule R (Form 990) 2020

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2020

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation
SCHEDULE R, PARTS II, III, AND IV

Schedule R (Form 990) 2020

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: WE'RE COMMITTED TO BRINGING ALL THE LATEST TECHNOLOGIES RIGHT TO OUR NORTH CENTRAL PA. COMMUNITIES. IT'S TOMORROW'S HEALTH CARE, FOR YOUR HEALTHIEST LIFE NOW.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	593
6	Total number of volunteers (estimate if necessary) .............	6	16
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	122,808
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	121,062

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,874,568	656,685
9	Program service revenue (Part VIII, line 2g) .........	98,604,174	103,907,312
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	60,054	387,461
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-556,907	17,619
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	103,981,889	104,969,077
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,500	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)	44,256,984	52,542,013
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)....	53,838,450	52,042,609
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	98,097,934	104,584,622
19	Revenue less expenses. Subtract line 18 from line 12.......	5,883,955	384,455
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	72,649,035	66,801,913
21	Total liabilities (Part X, line 26).............	8,214,668	13,530,294
22	Net assets or fund balances. Subtract line 21 from line 20.....	64,434,367	53,271,619

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 29,985,773 including grants of $ ) (Revenue $ 56,505,486 )
	UPMC COLE OFFERS OUTPATIENT SERVICES, EXCEEDING 373,000 TESTS/TREATMENTS ANNUALLY THROUGHOUT THE HOSPITAL'S FOUR-COUNTY AREA AND INCLUDING IMAGING, LAB, CARDIO-PULMONARY, ONCOLOGY, HOME HEALTH, WOUND CARE AND REHABILITATION SERVICES. OUTPATIENT SURGERIES EXCEED 5,200 ANNUALLY. THE PATTERSON CANCER CARE CENTER OFFERS MEDICAL ONCOLOGY SERVICES AND HOUSES AN AMERICAN CANCER SOCIETY PATIENT RESOURCE CENTER ONSITE. THE CANCER CENTER IS HOME TO A VARIETY OF SUPPORT GROUPS, AS WELL AS FREQUENT FREE CANCER SCREENINGS FOR THE PUBLIC. SEE SCHEDULE O FOR DETAIL.

4b	(Code: ) (Expenses $ 26,417,813 including grants of $ ) (Revenue $ 16,007,869 )
	UPMC COLE PROVIDES PRIMARY CARE TO ITS SURROUNDING COMMUNITIES. THE HOSPITAL PROVIDES PRIMARY CARE TO THE SURROUNDING COMMUNITIES IN FOUR COUNTIES AT RURAL HEALTH CENTERS(RHCS), LOCATED IN COUDERSPORT, GALETON, ULYSSES, WESTFIELD, SHINGLEHOUSE, PORT ALLEGANY, ELDRED, SMETHPORT, AND EMPORIUM. COLLECTIVELY, 110,700 PATIENT VISITS WERE REPORTED LAST YEAR IN ADDITION TO 11,800 DENTAL VISITS. FOUR OF THOSE LOCATIONS ALSO INCLUDE WELLNESS AND REHABILITATION CENTERS, MAKING IT MORE CONVENIENT FOR PATIENTS TO RECEIVE THE SERVICES AND CARE THEY NEED CLOSE TO HOME. SEE SCHEDULE O FOR DETAIL.

4c	(Code: ) (Expenses $ 14,915,915 including grants of $ ) (Revenue $ 19,688,374 )
	UPMC COLE OFFERS VARIOUS INPATIENT SERVICES. UPMC COLE ADMITTED 1,180 ACUTE PATIENTS LAST YEAR (3,700 ACUTE CARE DAYS) TO INPATIENT SERVICES INCLUDING MEDICAL/SURGICAL, INTENSIVE CARE AND OBSTETRICS UNITS. UPMC COLE'S 24-HOUR EMERGENCY DEPARTMENT ADMITTED 700 PATIENTS LAST YEAR AND HAD 8,500 VISITS LAST YEAR. THE HOSPITAL'S MATERNITY UNIT WELCOMED 144 BABIES INTO THE WORLD LAST YEAR AND ALSO SUPPORTS MOTHERS-TO-BE WITH BREASTFEEDING SUPPORT PROGRAMS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 24,156,094 including grants of $ ) (Revenue $ 11,705,583 )
4e	Total program service expenses95,475,595

(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
(18) MELYNDA BUDD........................................................................ DIRECTOR	1.0 .......................2.0	X		0	0	0
(19) PATRICK LARSEN........................................................................ DIRECTOR	1.0 .......................2.0	X		0	0	0
(20) CHARLES UPDEGRAFF........................................................................ CHAIR	1.0 .......................2.0	X	X	0	0	0
(21) JOHN LEETE........................................................................ DIRECTOR/TREASURER	1.0 .......................2.0	X	X	0	0	0
(22) ELIZABETH WALLACE........................................................................ DIRECTOR	1.0 .......................2.0	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,796,112	3,224,482	787,158

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	73,251
e	Government grants (contributions)		1e	196,110

f	All other contributions, gifts, grants, and similar amounts not included above		1f	387,324

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

h Total. Add lines 1a-1f.......		656,685

		Business Code
2a	NET PATIENT SERVICE REVENUE	621990	97,660,402	97,660,402
b	PHARMACY	621990	5,823,506	5,823,506
c	CAFETERIA	722514	161,999	161,999
d	OTHER	621990	261,405	261,405
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		103,907,312

3 Investment income (including dividends, interest, and othersimilar amounts) ......			54,618			54,618
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			5,951		812	5,139
		(ii) Personal	(i) Real
6a	Gross rents		240,638	6a
b	Less: rental expenses		417,992	6b
c	Rental income or (loss)	0	-177,354	6c
d	Net rental income or (loss).......			-177,354			-177,354
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		710,766	7a
b	Less: cost or other basis and sales expenses	22,540	355,383	7b
c	Gain or (loss)	-22,540	355,383	7c
d	Net gain or (loss).........			332,843			332,843
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	GAIN ON INVESTMENT IN EQUITY INVESTEE		900099	189,022		121,996	67,026
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			189,022
12	Total revenue. See instructions.....			104,969,077	103,907,312	122,808	282,272

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 ...........	735,718	275,490	460,228
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........	40,605,720	34,950,706	5,655,014
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	378,881	342,083	36,798
9	Other employee benefits .......	8,137,568	6,983,850	1,153,718
10	Payroll taxes ...........	2,684,126	2,290,773	393,353
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	43,253		43,253
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	26,805		26,805
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	11,689,901	11,689,901
12	Advertising and promotion ....	137,890	137,890
13	Office expenses .......	11,151,479	10,147,683	1,003,796
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	1,833,467	1,833,467
17	Travel ............	272,885	272,885
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	3,008	3,008
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	3,296,551	2,960,489	336,062
23	Insurance ...	1,158,894	1,158,894
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES & DRUGS	15,629,634	15,629,634
b	BAD DEBT	5,464,563	5,464,563
c	REPAIRS & MAINTENANCE	1,101,642	1,101,642
d	LICENSES, DUES, SUBSCRIPTIONS	179,759	179,759
e	All other expenses	52,878	52,878
25	Total functional expenses. Add lines 1 through 24e	104,584,622	95,475,595	9,109,027	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 ........			1,448,616	1	1,024,271
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			65,336	3	5,034
4	Accounts receivable, net .............			2,676,519	4	5,238,315
5	Loans and other receivables from 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 ......			533,776	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	40,734,207
b	Less: accumulated depreciation	10b	13,040,414	29,088,021	10c	27,693,793
11	Investments—publicly traded securities .			5,111,827	11	6,506,432
12	Investments—other securities. See Part IV, line 11 .....			2,103,115	12	2,233,998
13	Investments—program-related. See Part IV, line 11 ..			7,956,811	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			23,665,014	15	24,100,070
16	Total assets. Add lines 1 through 15 (must equal line 33)...			72,649,035	16	66,801,913

17	Accounts payable and accrued expenses .....	2,250,933	17	1,510,474
18	Grants payable ...	0	18	0
19	Deferred revenue .........	1,977,052	19	7,432,155
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	12,532
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	3,986,683	25	4,575,133
26	Total liabilities. Add lines 17 through 25..	8,214,668	26	13,530,294

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	60,412,106	27	47,782,858
28	Net assets with donor restrictions ...........	4,022,261	28	5,488,761
	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 ...........	64,434,367	32	53,271,619
33	Total liabilities and net assets/fund balances ........	72,649,035	33	66,801,913