TY 2021 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/1099-NEC)
(1) STEVEN KILBURN...................................................................... BOARD MEMBER/CHAIR	2.00 .................	X	X		0	0	0
(2) BRENDA IRELAND...................................................................... BOARD MEMBER	2.00 .................	X			0	0	0
(3) MICHAEL SULLIVAN...................................................................... BOARD MEMBER	2.00 .................	X			0	0	0
(4) DAVID GIBBONS...................................................................... BOARD MEMBER/VICE CHAIR	40.00 .................	X	X		0	945,082	121,242
(5) BRADLEY DINGER...................................................................... BOARD MEMBER/TREASURER/CFO	40.00 .................	X	X		0	250,978	33,805
(6) CRISTIE HERBST...................................................................... BOARD MEMBER	2.00 .................	X			0	0	0
(7) CAMELLIA HERISKO...................................................................... BOARD MEMBER	40.00 .................	X			0	274,287	47,188
(8) MARK RAIMY...................................................................... BOARD MEMBER	2.00 .................	X			0	0	0
(9) ANNA DIBBLE...................................................................... BOARD MEMBER	2.00 .................	X			0	0	0
(10) WILLIAM GEARY MDPHD...................................................................... BOARD MEMBER	2.00 .................	X			0	0	0
(11) JAMES DONNELLY...................................................................... BOARD MEMBER	40.00 .................	X			0	316,536	46,064
(12) BRIAN DURNIOK...................................................................... PRESIDENT	40.00 .................		X		0	495,549	64,922
(13) CECIL M MILLER III...................................................................... SECRETARY/VP OF OPERATIONS	40.00 .................		X		202,351	0	20,931
(14) GALO GRIJALVA MD...................................................................... PHYSICIAN	40.00 .................			X	396,289	0	47,695
(15) AMARDEEP SAPPLE MD...................................................................... HOSPITALIST	40.00 .................			X	393,298	0	35,326
(16) AMIT BHOWMIK MD...................................................................... HOSPITALIST	40.00 .................			X	354,725	0	20,346
(17) SALVATORE J BUONAIUTO MD...................................................................... HOSPITALIST	40.00 .................			X	408,228	0	42,633

(A) Name and business address	(B) Description of services	(C) Compensation
PREMIER ANESTHESIA OF NY PC 2655 NORTHWINDS PKWY ALPHARETTA,GA30009	ANESTHESIA PHYSICIAN SERVICES	2,531,856
ASSOCIATED CLINICAL LAB 1526 PEACH STREET ERIE,PA16501	LAB SERVICES	1,847,390
SOUTHERN TIER SECURITY LLC 125 S UNION ST OLEAN,NY14760	SECURITY SERVICES	661,177
SUPPLEMENTAL HEALTH CARE 95 JOHN MUIR DR AMHERST,NY14228	HEALTH CARE SERVICES	534,139
NOVO HEALTH SERVICES LLC 5155 WESTPARK DR SW ATLANTA,GA30336	HEALTH CARE SERVICES	460,700
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 8

- TIN:

SCHEDULE A
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

UPMC CHAUTAUQUA AT WCA

Employer identification number

16-0743226

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

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) .

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

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 on 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 on 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) 2021

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

11a

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

11b

A 35% controlled entity of a person described on 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 on 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) 2021

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) 2021

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 2021 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-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2021

Name of the organization

UPMC CHAUTAUQUA AT WCA

Employer identification number

16-0743226

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) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization UPMC CHAUTAUQUA AT WCA

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) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization UPMC CHAUTAUQUA AT WCA		Employer identification number 16-0743226

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) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization UPMC CHAUTAUQUA AT WCA			Employer identification number 16-0743226
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) (2021)

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

2021

Open to Public Inspection

Name of the organization

UPMC CHAUTAUQUA AT WCA

Employer identification number

16-0743226

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) 2021

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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

Yes No

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

Part V

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

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

1a	Beginning of year balance ....	17,972,550	15,946,410	13,649,391	14,973,749	13,142,333
b	Contributions ...	-166,856	73,261	77,571	102,059	96,982
c	Net investment earnings, gains, and losses	3,316,332	2,657,988	2,926,269	-721,818	2,378,581
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...		705,109	706,821	704,599	644,147
f	Administrative expenses ....
g	End of year balance ......	21,122,026	17,972,550	15,946,410	13,649,391	14,973,749

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

Board designated or quasi-endowment SchDMd Bullet

77.370 %

Permanent endowment SchDMd Bullet

22.630 %

Term endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

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

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

1a	Land .....	2,016,055		2,016,055
b	Buildings ....	23,199,963	-24,531,354	47,731,317
c	Leasehold improvements	3,131,935	2,760,136	371,799
d	Equipment ....	45,218,867	33,602,066	11,616,801
e	Other .....	533,955		533,955
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				62,269,927

Schedule D (Form 990) 2021

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

Part VIII

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

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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)BENEFICIAL INTEREST IN NET ASSETS OF WCA FOUNDATION				20,728,022
(2)INVESTMENT IN WCA SERVICES CORPORATION				1,400,000
(3)INVESTMENT IN HCP CENTRAL PHARMACY				390,240
(4)DUE TO EXEMPT AFFILIATE				-7,586,605
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				14,931,657

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
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	25,736,953
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) 2021

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference

Explanation

PART V, LINE 4:

THE INCOME FROM THE ENDOWMENT FUND IS UNRESTRICTED AND ITS USES ARE DETERMINED BY THE BOARD.

PART X, LINE 2:

THE HOSPITAL IS A NOT-FOR PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C) (3) OF THE INTERNAL REVENUE CODE (THE "CODE"), AND ACCORDINGLY, IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH U.S. GAAP, WHICH REQUIRES THE RECOGNITION AND MEASUREMENT OF UNCERTAIN INCOME TAX POSITIONS THAT THE HOSPITAL HAS TAKEN OR EXPECTS TO TAKE IN THE HOSPITAL'S TAX RETURNS. THE HOSPITAL HAS NOT RECORDED ANY AMOUNTS RELATING TO UNCERTAIN TAX POSITIONS.

Schedule D (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

UPMC CHAUTAUQUA AT WCA

Employer identification number

16-0743226

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other 25000.0000000000 %

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

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

Yes

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

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

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

Yes

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

Yes

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

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) . . .	545,350		545,350	0.400 %
b	Medicaid (from Worksheet 3, column a) . . . . .	30,186,106	21,905,625	8,280,481	6.020 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	-1,007	1,108	0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	30,730,449	21,906,733	8,825,831	6.420 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	357,801		357,801	0.260 %
f	Health professions education (from Worksheet 5) . . .	289,897	121,578	168,319	0.120 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	93,040		93,040	0.070 %
j	Total. Other Benefits . .	740,738	121,578	619,160	0.450 %
k	Total. Add lines 7d and 7j .	31,471,187	22,028,311	9,444,991	6.870 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

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. ......

2,137,878

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. ......

277,924

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).....

46,999,850

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

54,534,037

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

-7,534,187

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 %
11 31 SHERMAN STREET INVESTORS LLC	REAL ESTATE PROJECTS	50.000 %	0 %	0 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

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	UPMC CHAUTAUQUA AT WCA 207 FOOTE AVENUE / PO BOX 840 JAMESTOWN,NY147020840 WWW.UPMCCHAUTAUQUAWCA.ORG 10-65-60	X	X	X

Schedule H (Form 990) 2021

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)

	UPMC CHAUTAUQUA AT WCA
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

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

Yes

6 a

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

Yes

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

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): WWW.UPMC.COM

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

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

Yes

If "Yes" (list url): WWW.UPMC.COM

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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	UPMC CHAUTAUQUA AT WCA
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

WWW.UPMC.COM

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

WWW.UPMC.COM

A plain language summary of the FAP was widely available on a website (list url):
WWW.UPMC.COM

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) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	UPMC CHAUTAUQUA AT WCA
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) 2021

Page 7

Part VFacility Information (continued)

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

	UPMC CHAUTAUQUA AT WCA
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) 2021

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
UPMC CHAUTAUQUA AT WCA	PART V, SECTION B, LINE 5: UPMC'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS INCLUDED A PARTNERSHIP WITH EXPERTS AT THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH TO CONDUCT THE CHNA USING A BEST-PRACTICE METHODOLOGY. THE ASSESSMENT BLENDED ANALYSIS OF DOCUMENTED HEALTH AND SOCIOECONOMIC FACTORS WITH A STRUCTURED, COMMUNITY INPUT SURVEY PROCESS. EFFECTIVELY ENGAGING THE COMMUNITY IN A BROAD, SYSTEMATIC WAY, THE SURVEY SOLICITED FEEDBACK FROM COMMUNITY ADVISORY PANELS COMPOSED OF LEADERS OF ORGANIZATIONS THAT REPRESENT PATIENT CONSTITUENCIES, INCLUDING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY, AND CHRONICALLY ILL POPULATIONS WITHIN THE HOSPITAL'S COMMUNITY. APPENDIX C OF EACH HOSPITAL CHNA REPORT INCLUDES A LIST OF COMMUNITY PARTICIPANTS. WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/PAGES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX
UPMC CHAUTAUQUA AT WCA	PART V, SECTION B, LINE 6A: UPMC HOSPITALS CONDUCTED JOINT CHNAS AS FOLLOWS:ERIE, MCKEAN, AND VENANGO COUNTIES IN PA AND CHAUTAUQUA COUNTY, NY HOSPITALS: UPMC HAMOT, UPMC KANE, UPMC NORTHWEST, AND UPMC CHAUTAUQUA.ALLEGHENY COUNTY HOSPITALS: UPMC CHILDREN'S HOSPITAL OF PITTSBURGH, UPMC EAST, UPMC MAGEE-WOMENS HOSPITAL, UPMC MCKEESPORT, UPMC MERCY, UPMC PASSAVANT, UPMC PRESBYTERIAN SHADYSIDE, AND UPMC ST. MARGARET.BEDFORD AND BLAIR COUNTY HOSPITALS: UPMC ALTOONA AND UPMC BEDFORD.LAWRENCE AND MERCER COUNTY HOSPITALS: UPMC JAMESON AND UPMC HORIZON.CLINTON, LYCOMING, NORTHUMBERLAND, POTTER, AND TIOGA COUNTY HOSPITALS: UPMC LOCK HAVEN, UPMC MUNCY, UPMC WILLIAMSPORT, UPMC SUNBURY, UPMC COLE, AND UPMC WELLSBORO.
UPMC CHAUTAUQUA AT WCA	PART V, SECTION B, LINE 11: THROUGH A RIGOROUS CHNA METHODOLOGY, UPMC HOSPITALS IDENTIFIED FOUR MAJOR THEMES REPRESENTING THE SIGNIFICANT HEALTH NEEDS IN THEIR COMMUNITIES: CHRONIC DISEASE MANAGEMENT; BEHAVIORAL HEALTH; ACCESS TO CARE AND NAVIGATING RESOURCES; AND PREVENTION AND COMMUNITY-WIDE HEALTHY LIVING. THE HOSPITALS DEVELOPED STRATEGIC IMPLEMENTATION PLANS TO ADDRESS THESE ISSUES, AS OUTLINED IN THEIR CHNA DOCUMENTS AND COMMUNITY HEALTH STRATEGIC PLANS - SEE SECTION IV OF EACH CHNA REPORT. WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/PAGES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX
UPMC CHAUTAUQUA AT WCA	PART V, SECTION B, LINE 13B: UPMC CHAUTAUQUA AT WCA RESERVES THE RIGHT TO REVIEW/APPROVE CASES WITH EXCESSIVE MEDICAL EXPENSES WHOSE FAMILY INCOME EXCEED 400% OF THE FPL, ON A CASE BY CASE BASIS.
UPMC CHAUTAUQUA AT WCA	PART V, SECTION B, LINE 20E: UPMC'S POLICIES DO NOT PERMIT HOSPITAL FACILITIES OR ANY OTHER AUTHORIZED PARTIES TO ENGAGE INEXTRAORDINARY COLLECTIONS ACTIONS IN ANY CIRCUMSTANCES. THEREFORE, LINE 20 HAS BEEN LEFT BLANK SINCE IT IS NOT APPLICABLE AND UPMC BELIEVES IT WOULD BE MISLEADING TO CHECK ANY OF THE BOXES.

Schedule H (Form 990) 2021

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2021

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
PART I, LINE 3C:	FINANCIAL ASSISTANCE OR CHARITY CARE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS WHO HAVE HEALTH CARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR GOVERNMENT PROGRAMS OR OTHERWISE UNABLE TO PAY FOR THEIR OWN CARE.A PATIENT MAY BE DETERMINED TO HAVE FINANCIAL NEED BASED ON THE FOLLOWING:1. INDIGENCY: IF INCOME FALLS AT OR BELOW 250% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT WILL HAVE NO FINANCIAL RESPONSIBILITY. THE PATIENT IS APPROVED FOR 100% FREE CARE. 2. LOW INCOME SLIDING SCALE: ASSISTANCE MAY BE A DISCOUNTED OR REDUCED PATIENT LIABILITY DEPENDING ON THE PATIENT'S INCOME: A. IF THE COMBINED FAMILY INCOME IS GREATER THAN 251% AND LESS THAN OR EQUAL TO 400% OF THE FEDERAL POVERTY GUIDELINES AND UNINSURED, THE PATIENT IS ELIGIBLE FOR REDUCED CHARITY CARE. THERE WILL BE AN 89% REDUCTION IN THE PATIENT BILL. THE DISCOUNTED CHARITY CARE SCALE IS BASED ON FAMILY HOUSEHOLD SIZE FOR 2021.3. FINANCIAL HARDSHIP: IF A PATIENT IS APPROVED FOR DISCOUNTED OR REDUCED CHARITY CARE AND CANNOT AFFORD TO PAY THE REMAINING BALANCE, THE PATIENT MAY BE CONSIDERED FOR FINANCIAL HARDSHIP. ASSISTANCE WILL BE PROVIDED IN THE FORM OF AN ADJUSTMENT OF CHARGES TO PREVENT THE PATIENT LIABILITY FROM EXCEEDING THE LESSER OF 15% OF FAMILY INCOME OR THE AGB.4. MEDICAL HARDSHIP/CATASTROPHIC CARE: IF A PATIENT IS DENIED FOR FINANCIAL ASSISTANCE AND CANNOT AFFORD TO PAY THE ACCOUNT BALANCE, THE PATIENT MAY BE CONSIDERED MEDICALLY INDIGENT AND MAY BE CONSIDERED FOR MEDICAL HARDSHIP / CATASTROPHIC CARE. THE PATIENT WILL BE LIABLE TO PAY THE LESSER OF 15% OF THEIR CALCULATED HOUSEHOLD INCOME OR THE AGB TOWARDS THEIR MEDICAL BILL. THIS IS A ONE-TIME FINANCIAL ASSISTANCE ADJUSTMENT FOR EXISTING ACCOUNT BALANCES. THE REMAINING BALANCE WILL BE ADJUSTED TO FREE CARE.
PART I, LINE 7:	THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I LINE 7 IS A RATIO OF COSTS TO CHARGES METHOD. THE METHOD EMPLOYED FOR DETERMINING THE RATIO OF COST TO CHARGES IS IN LINE WITH THOSE DESCRIBED IN SCHEDULE H, WORKSHEET 2, "RATIO OF PATIENT COSTS TO CHARGES".
PART I, LN 7 COL(F):	THE TOTAL EXPENSES REPORTED ON FORM 990 PART IX LINE 25 COLUMN A ARE INCLUSIVE OF ALL ENTITIES REPORTED WITHIN THE UPMC CHAUTAUQUA AT WCA 990 AND EXCLUDES BAD DEBT EXPENSE FOR THE ENTITY. THE EXPENSE USED TO CALCULATE THE PERCENT OF TOTAL EXPENSE FOR FORM 990 SCHEDULE H PART I LINE 7 COLUMN F ARE THE TOTAL EXPENSES FROM FORM 990 PART IX. THE TOTAL EXPENSE PER PART IX LINE 25 DOES NOT INCLUDE BAD DEBT EXPENSE, AND AS SUCH, IS NOT INCLUDED IN THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE. THE TOTAL EXPENSES USED FOR THIS CALCULATION, EXCLUDING BAD DEBT EXPENSE, IS $131,360,176.
PART I, LINE 6A	UPMC PREPARES AN ANNUAL COMMUNITY BENEFITS REPORT. THE REPORT ENCOMPASSES INFORMATION FOR THE ENTIRE INTEGRATED DELIVERY AND FINANCING SYSTEM (IDFS) THAT MAKES UP THE UPMC HEALTH SYSTEM. IT IS POSTED AND AVAILABLE TO THE PUBLIC VIA THE UPMC WEBSITE, WWW.UPMC.COM.
PART I, LINE 4	"MEDICALLY INDIGENT" MEANS PERSONS WHO THE ORGANIZATION HAS DETERMINED UNABLE TO PAY SOME OR ALL OF THEIR MEDICAL BILLS BECAUSE THEIR MEDICAL BILLS EXCEED A CERTAIN PERCENTAGE OF THEIR FAMILY HOUSEHOLD'S INCOME.
PART III, LINE 4:	PATIENT ACCOUNTS RECEIVABLE IS PRESENTED NET OF AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL COLLECTIONS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS. PATIENT ACCOUNTS RECEIVABLE ARE DUE 30 DAYS AFTER THE DATE OF DISCHARGE. RECEIVABLES PAST DUE MORE THAN 120 DAYS ARE GENERALLY WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD-PARTY PAYORS.
PART III, LINE 9B:	UPMC HAS A DEBT COLLECTION POLICY OUTLINING COLLECTION PRACTICES FOR PATIENTS. IF AT ANY TIME THE PATIENT EXPRESSES AN INABILITY TO PAY, THEY ARE SENT A FINANCIAL ASSISTANCE APPLICATION. INFORMATION REGARDING FINANCIAL ASSISTANCE IS PRINTED ON ALL COLLECTION LETTERS. COLLECTIONS PER POLICY DO NOT APPLY TO ACCOUNT BALANCES KNOWN TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE.
PART III, LINES 2 & 3	THE COSTING METHOD USED TO CALCULATE THE AMOUNTS IN SCHEDULE H PART III LINES 2 AND 3 IS A RATIO OF COST TO CHARGES METHOD. DISCOUNTS AND PAYMENTS IN PATIENTS' ACCOUNTS ARE DEDUCTED BEFORE THE COST OF BAD DEBT EXPENSE IS DETERMINED. THE METHOD EMPLOYED IS IN LINE WITH THOSE DESCRIBED IN SCHEDULE H, WORKSHEET 2, "RATIO OF PATIENT COSTS TO CHARGES".THE ORGANIZATION'S BAD DEBT EXPENSE CONSISTS SOLELY OF SELFPAY PATIENTS ACCOUNTS DEEMED UNCOLLECTABLE. IT IS UPMC GROUP'S CONTENTION THAT THE COST OF BAD DEBT SHOULD BE STATED IN PART I LINE 7 OF SCHEDULE H AS THEY REPRESENT THE COSTS FOR PROVISION OF SERVICES TO PATIENTS FOR WHICH THE ENTITY HAS EXHAUSTED ALL RECOURSE FOR REIMBURSEMENT. THE SERVICES PROVIDED TO PATIENTS WHO PRESENT THEMSELVES ARE PROVIDED REGARDLESS OF A PATIENT'S ABILITY TO PAY AND IS IN LINE WITH THE ORGANIZATION'S CHARITABLE MISSION AND SERVICE TO OUR COMMUNITY. THESE EXPENSES ARE INCURRED REGARDLESS OF THE EFFICIENCY OF THE PROVISION OF THE RELATED MEDICAL CARE AND ARE DEEMED TO HAVE BEEN MEDICALLY NECESSARY FOR THE PATIENT.
PART III, LINE 3	PROCESS FOR REALLOCATION FROM BAD DEBT TO CHARITY CARE UPMC RECLASSIFIES BAD DEBT ACCOUNTS AS CHARITY CARE BY UTILIZING A PREDICTIVE MODEL CALLED PARO (PAYMENT ASSISTANCE RANK ORDER). PARO WAS BUILT AS A SOCIO-ECONOMIC SCORE THAT IDENTIFIES THOSE PATIENTS THAT ARE MOST LIKELY TO BE THE HIGHEST NEED OF FINANCIAL ASSISTANCE. THIS IS ACCOMPLISHED BY ANALYZING CONSUMER DATA AND ACTIVITY, COURT RECORDS, GOVERNMENT RECORDS, PROPERTY FILES, CENSUS DATA AND IRS DATA. PARO PROVIDES A SYSTEMATIC APPROACH TO FINANCIAL ASSISTANCE: " PREDICTIVE MODEL THAT ENCOMPASSES HEALTHCARE ECONOMICS AND CREDIT POLICIES;" UNIFORM ASSESSMENT MEASURE FOR EVERY PATIENT REGARDLESS OF FINANCIAL STANDING; " ACCOUNTS FOR PATIENTS THAT ARE UNRESPONSIVE, ILLITERATE, OR OTHERWISE CHALLENGED TO APPLY; " ELIMINATES BARRIER TO APPLICATION AND MEETS INCREASED PRESSURE TO PROVIDE ADDITIONAL FINANCIAL RESOURCES TO CONSUMERS; " IDENTIFY AND SUPPORT THOSE COMMUNITY NEEDS EFFORTS TO PROVIDE ASSISTANCE TO THOSE CONSUMERS IN NEED." THERE ARE TWO DATA POINTS RETURNED TO UPMC IN ORDER TO MAKE THE DECISION WHETHER THE PATIENT WOULD QUALIFY FOR CHARITY CARE. THE FIRST IS THE ESTIMATED INCOME LEVEL BASED ON THE FEDERAL POVERTY LEVEL GUIDELINES. THE SECOND IS THE PARO SCORE WHICH UTILIZES AN ALGORITHM BASED APPROACH AND RETURNS A SCORE BASED ON PERSONAL ATTRIBUTES OF THE PATIENT. DATA ELEMENTS WERE COMBINED TO CREATE TWO PRIMARY INDICATORS OF NEED, THE PARO SCORE AND THE FEDERAL POVERTY LEVEL. PARO ANALYZED OUR HISTORICAL CHARITY CARE APPROVALS TO DETERMINE OUR PARO THRESHOLD AND THE FPL THRESHOLD FOR THE HISTORICAL APPROVALS. THE APPROVED CHARITY CARE ACCOUNTS WERE COMPARED AGAINST ACCOUNTS THAT WERE IN ACTIVE ACCOUNTS RECEIVABLE. THIS WAS DONE TO DETERMINE IF THE DISTRIBUTIONS WERE SIMILAR OR IF ANY PATTERN EXISTED BASED ON THE APPROVED ACCOUNTS AND THE UNKNOWN ACCOUNTS. IF THE PATIENT'S ESTIMATED INCOME AND PARO SCORE ARE WITHIN THE SCORES IDENTIFIED BY THE CALIBRATION OF UPMC EXISTING CHARITY CARE PATIENTS, THE ACCOUNT IS RECLASSIFIED FROM BAD DEBT TO CHARITY CARE. EVERY PATIENT IS ABLE TO APPLY FOR CHARITY CARE; HOWEVER, THE AUTOMATED STRATEGY FOCUSES ON PATIENTS THAT DO NOT COMPLETE THE APPLICATIONS PROCESS. THE US DEPARTMENT OF EDUCATION ESTIMATES THAT 1 IN 5 CONSUMERS ARE FUNCTIONALLY ILLITERATE. THIS, COUPLED WITH THE LOW LEVELS OF PARTICIPATION IN TRADITIONAL BANKING METHODS, MAKES THE APPLICATION PROCESS VIRTUALLY IMPOSSIBLE FOR SOME CONSUMERS.
PART III, LINE 8	THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS OF CARE IS A RATIO OF COSTS TO CHARGES METHOD. THE METHOD IS IN LINE WITH THOSE DESCRIBED IN SCHEDULE H, WORKSHEET 2, "RATIO OF PATIENT COSTS TO CHARGES". IT IS UPMC GROUP'S CONTENTION THAT ALL AMOUNTS CALCULATED TO BE SHORTFALLS IN REIMBURSEMENT FOR SERVICES PROVIDED TO MEDICARE PATIENTS ARE TRULY UNCOMPENSATED CARE THAT SHOULD BE STATED IN PART I LINE 7 OF SCHEDULE H OF FORM 990 AS THEY REPRESENT COSTS FOR PROVISION OF SERVICES TO PATIENTS FOR WHICH THE ENTITY IS UNABLE TO COLLECT, REGARDLESS OF THE EFFICIENCY OF PROVISION OF THE RELATED CARE COSTS.
PART VI, LINE 3:	UPMC COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE TO ITS PATIENTS BY PLACING SIGNAGE AND DISTRIBUTING BROCHURES ABOUT THE FINANCIAL ASSISTANCE PROGRAM IN ITS PROVIDER REGISTRATION AREAS, ADMISSIONS, EMERGENCY DEPARTMENT AND BUSINESS OFFICE LOCATIONS. IN ADDITION, UPMC INCLUDES INFORMATION REGARDING HOW A PATIENT CAN REQUEST FINANCIAL ASSISTANCE ON THE BILLS, FOLLOW-UP CORRESPONDENCE AND COLLECTION LETTERS. PATIENTS ALSO MAY FIND INFORMATION ABOUT FINANCIAL ASSISTANCE THROUGH ACCESS TO THE UPMC WEB SITE (WWW.UPMC.COM). PATIENTS ARE ENCOURAGED TO CONTACT UPMC'S TRAINED FINANCIAL COUNSELORS SHOULD THEY REQUIRE ASSISTANCE WITH COMPLETING APPLICATIONS. CONTACT TELEPHONE NUMBERS ARE POSTED STRATEGICALLY THROUGHOUT THE HOSPITAL FACILITIES SO THAT PATIENTS HAVE A RESOURCE FOR OBTAINING SUPPORT WITH ANY FINANCIAL ASSISTANCE QUESTIONS THEY MAY HAVE. UPMC HAS CREATED A PLAIN LANGUAGE SUMMARY (PLS) TO EXPLAIN, IN SIMPLIFIED TERMS, OUR FINANCIAL ASSISTANCE POLICY (FAP). THIS SUMMARY IS PRINTED AT ALL SAME DAY SURGERY, ER AND INPATIENT LOCATIONS AND GIVEN TO THE PATIENT UPON DISCHARGE. UPMC HAS ALSO TRANSLATED THE PLS, FAP, COLLECTION AND BILLING POLICY, AND FAP APPLICATION INTO THE FOLLOWING LANGUAGES: ARABIC, CHINESE, FRENCH, ITALIAN, NEPALI, RUSSIAN, SPANISH AND BRAILLE. THE DETERMINATION OF LANGUAGES FOR TRANSLATION OF DOCUMENTS WAS DETERMINED BY A STUDY OF ENGLISH PROFICIENCY IN THE COMMUNITIES SERVED AND REVIEW OF PREDOMINANT NATIVE LANGUAGES IN THOSE COMMUNITIES AS PRESCRIBED IN IRC SECTION 501(R). THE PLS IS AVAILABLE ON THE UPMC WEBSITE.UPMC WILL NOTIFY ALL PATIENTS APPROVED VIA PRESUMPTIVE ELIGIBILITY IF NOT RECEIVING THE HIGHEST LEVEL OF ASSISTANCE. A LETTER INFORMING THE PATIENT THAT THEY MAY QUALIFY FOR A HIGHER LEVEL AND A FINANCIAL ASSISTANCE APPLICATION WILL BE SENT TO THE PATIENT UPON DETERMINATION. UPMC HAS WIDELY PUBLICIZED OUR FINANCIAL ASSISTANCE POLICY. UPMC HAS WORKED WITH HOSPITAL LEADERS AND COMMUNITY LIAISONS TO DETERMINE THE MOST APPROPRIATE NON-HEALTHCARE LOCATIONS TO REACH THE POPULATIONS THAT WILL BENEFIT FROM OUR FINANCIAL ASSISTANCE. UPMC HAS PROACTIVELY REACHED OUT IN THESE COMMUNITIES TO WIDELY PUBLICIZE OUR FINANCIAL ASSISTANCE POLICY. FINALLY, UPMC WILL NOW ONLY INCLUDE PATIENT BALANCES FROM ONE YEAR PRIOR TO THE PATIENT'S FINANCIAL ASSISTANCE APPROVAL DATE. AS A RESULT, UPMC WILL ALSO REFUND ANY PATIENT PAYMENTS MADE WITHIN THAT YEAR OF THE PATIENT'S FINANCIAL ASSISTANCE APPROVAL DATE, APPROVED VIA AN APPLICATION.
PART VI, LINE 5:	IN 2019, IN KEEPING WITH IRS 501(R) GUIDELINES, UPMC CHAUTAUQUA COLLABORATED WITH OTHER UPMC HOSPITALS IN THE FOUR-COUNTY REGION THAT INCLUDES CHAUTAUQUA COUNTY IN NEW YORK, AND ERIE, MCKEAN, AND VENANGO COUNTIES IN PENNSYLVANIA. THROUGH THE ASSESSMENT PROCESS, UPMC'S HOSPITALS IDENTIFIED THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, PRIORITIZED THOSE HEALTH NEEDS, ESTABLISHED ACTION PLANS, AND IDENTIFIED RESOURCES TO ADDRESS THOSE NEEDS. THE 2019 DOCUMENT BUILDS UPON PRIOR ASSESSMENTS AND IMPLEMENTATION PLANS DEVELOPED IN 2013 AND 2016. UPMC APPROACHED THE CHNA REQUIREMENT AS AN OPPORTUNITY TO EVALUATE AND ASSESS NEEDS THROUGH A FORMALIZED, RIGOROUS, AND STRUCTURED PROCESS TO ENSURE THAT HEALTH IMPROVEMENT EFFORTS AND RESOURCES ARE ALIGNED WITH THE MOST SIGNIFICANT COMMUNITY HEALTH NEEDS.UPMC ACTIVELY ENGAGED ITS HOSPITAL BOARDS, COMMUNITY STAKEHOLDERS, AND PUBLIC HEALTH EXPERTS TO IDENTIFY COMMUNITY HEALTH NEEDS AND DETERMINE HOW TO COLLABORATE MOST EFFECTIVELY TO ADDRESS THOSE NEEDS. THE ORGANIZATION SOLICITED AND TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. IN MAY THROUGH JUNE 2018, PITT PUBLIC HEALTH SURVEYED COMMUNITY LEADERS AND STAKEHOLDERS SPECIFIC TO EACH HOSPITAL'S LOCAL COMMUNITY, AS WELL AS A SYSTEM-WIDE PANEL OF REGIONAL STAKEHOLDERS. A TOTAL OF 2,074 COMMUNITY PARTICIPANTS FROM 22 UPMC HOSPITAL COMMUNITIES WERE SURVEYED. PARTICIPANTS INCLUDED: LEADERS OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASE; REPRESENTATIVES FROM PUBLIC HEALTH DEPARTMENTS OR GOVERNMENTAL AGENCIES SERVING COMMUNITY HEALTH; MEDICAL STAFF LEADERS WHO HAVE A UNIQUE PERSPECTIVE AND VIEW OF THE COMMUNITY; AND OTHER STAKEHOLDERS IN COMMUNITY HEALTH, SUCH AS CONSUMER ADVOCATES, NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, LOCAL SCHOOL DISTRICTS, GOVERNMENT ORGANIZATIONS, AND HEALTH CARE PROVIDERS. MORE THAN 800 INDIVIDUALS COMPLETED THE SURVEY, AND GREATER THAN 70 PERCENT OF THOSE PARTICIPANTS SELF-IDENTIFIED AS BEING A REPRESENTATIVE OR MEMBER OF A MEDICALLY UNDERSERVED, MINORITY, OR LOW-INCOME POPULATION.UPMC USED THE COMMUNITY INPUT TO DEVELOP STRATEGIC PLANS FOR EACH OF ITS LICENSED HOSPITALS TO ADDRESS SIGNIFICANT COMMUNITY HEALTH NEEDS. IMPORTANTLY, THESE PLANS ADDRESS LOCAL COMMUNITY NEEDS NOT ONLY AT THE HOSPITAL LEVEL, BUT ALSO INCLUDE EFFORTS UNDERTAKEN IN PARTNERSHIP WITH OTHER UPMC HOSPITALS, EXTERNAL ORGANIZATIONS, AND THE LARGER UPMC SYSTEM. KEY THEMES THAT EMERGED AT UPMC HOSPITALS CAN BE GROUPED INTO FOUR BROAD CATEGORIES - CHRONIC DISEASE MANAGEMENT, BEHAVIORAL HEALTH, ACCESS TO CARE AND NAVIGATING RESOURCES, AND PREVENTION AND COMMUNITY-WIDE HEALTHY LIVING. THE 2019 CHNA REPORTS AND 2019-2022 STRATEGIC PLANS FOR EACH UPMC HOSPITAL CAN BE FOUND ON UPMC'S WEBSITE: HTTPS://WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.UPMC HOSPITALS CONTINUE TO BUILD AN EXTENSIVE SUITE OF PROGRAMS AND SERVICES TO ADDRESS THE FOUR SIGNIFICANT HEALTH NEEDS. UPMC HOSPITALS LEVERAGE COMMUNITY-BASED PARTNERSHIPS AND SYSTEM-WIDE RESOURCES TO SUPPORT RESIDENTS IN NEED. UPMC CHAUTAUQUA'S 2019-2022 STRATEGIC PLAN TO IMPROVE COMMUNITY HEALTH INCLUDES THE FOLLOWING:ADDRESSING CHRONIC DISEASE MANAGEMENT: UPMC CHAUTAUQUA IS WORKING TO INCREASE AWARENESS, PREVENTION, AND MANAGEMENT OF CHRONIC DISEASES IN THE COMMUNITY THROUGH INTERVENTIONS TARGETING HEART DISEASE, CANCER, AND DIABETES. THE HOSPITAL CONTINUES TO PROMOTE COMMUNITY EDUCATION AND OUTREACH AND TO OFFER PROGRAMS THAT SUPPORT AND EMPOWER PATIENTS TO MANAGE THEIR HEALTH CONDITIONS.ADDRESSING BEHAVIORAL HEALTH: UPMC CHAUTAUQUA CONTINUES TO ENHANCE EFFORTS TO ADDRESS BEHAVIORAL HEALTH NEEDS IN THE COMMUNITY THROUGH MULTIPLE CHANNELS AND COMMUNITY-BASED PARTNERSHIPS. THE HOSPITAL IS CREATING PROGRAMS TO ADDRESS OPIOID ADDICTION AND SUBSTANCE ABUSE AND CONTINUING TO ENSURE RESIDENTS HAVE ACCESS TO INPATIENT BEHAVIORAL HEALTH SERVICES.ADDRESSING ACCESS TO CARE AND NAVIGATING RESOURCES: UPMC CHAUTAUQUA IS COLLABORATING WITH LOCAL COMMUNITY ORGANIZATIONS, AS WELL AS PIONEERING INNOVATIVE CARE MODELS. THE HOSPITAL IS WORKING TO EXTEND ACCESS TO SPECIALTY CARE THROUGH PHYSICIAN RECRUITMENT AND IS EVALUATING TELEHEALTH CAPABILITIES.ADDRESSING PREVENTION AND COMMUNITY-WIDE HEALTHY LIVING: UPMC CHAUTAUQUA IS PARTNERING WITH LOCAL ORGANIZATIONS TO ENHANCE AND DEVELOP PROGRAMS THAT PROMOTE A HEALTHY AND SAFE ENVIRONMENT FOR THE COMMUNITY. EXAMPLES OF TARGETED INITIATIVES INCLUDE PROMOTING PHYSICAL EXERCISE, PRENATAL EDUCATION, AND BREASTFEEDING EDUCATION.THE BOARD OF DIRECTORS AT EACH UPMC HOSPITAL REGULARLY MONITORS THE PROGRESS OF THE COMMUNITY HEALTH IMPROVEMENT PLANS. UPMC CHAUTAUQUA IS MAKING MEASURABLE PROGRESS IN AREAS IDENTIFIED THROUGH THE CHNA PROCESS, INCLUDING IMPROVING AND EXPANDING EXISTING PROGRAMS - REACHING OUT AND TARGETING PEOPLE WHO COULD BENEFIT MOST.
PART VI, LINE 7, REPORTS FILED WITH STATES	NY
PART VI, LINE 5	PART VI, LINE 5 (CONTINUED)BEGINNING IN MARCH 2020, THE COVID-19 PANDEMIC DISRUPTED NEW YORK'S COMMUNITIES, ECONOMY, AND HEALTH CARE ORGANIZATIONS. TO HELP SLOW THE SPREAD OF COVID-19 THROUGHOUT THE REGION, STATE AND LOCAL GOVERNMENTS ISSUED COMMUNITY MITIGATION AND SOCIAL DISTANCING MEASURES, IMPACTING UPMC CHAUTAUQUA'S ABILITY TO IMPLEMENT PLANNED COMMUNITY HEALTH IMPROVEMENT INITIATIVES. AS A RESULT, UPMC CHAUTAUQUA TEMPORARILY SUSPENDED OR MODIFIED IN-PERSON PROGRAMS TO PROMOTE SOCIAL DISTANCING, EDUCATED THE COMMUNITY ABOUT THE HEALTH RISKS OF COVID-19, INCREASED ACCESS TO TELEHEALTH SERVICES, ESTABLISHED COVID-19 TESTING AND VACCINE SITES, AND WORKED WITH STATE AND LOCAL LEADERS TO DELIVER COVID-19 VACCINES. WHILE UPMC CHAUTAUQUA NAVIGATED THE COMPLEXITIES OF THE PANDEMIC, THE HOSPITAL CONTINUED TO ADDRESS IDENTIFIED HEALTH NEEDS BY DEVELOPING INNOVATIVE APPROACHES AND STRATEGIES TO ENGAGE WITH ITS COMMUNITIES. EXAMPLES OF PROGRESS OVER THE PAST THREE YEARS INCLUDES:ADDRESSING CHRONIC DISEASE MANAGEMENT:UPMC CHAUTAUQUA IS WORKING TO ADDRESS HEART DISEASE, DIABETES, AND CANCER. TO PROMOTE HEART HEALTH AND TO HELP REDUCE READMISSIONS FOR PATIENTS WITH HEART DISEASE, UPMC CHAUTAUQUA'S CARDIAC NURSE NAVIGATOR HELPS TO SUPPORT AND GUIDE PATIENTS THROUGH THEIR INPATIENT OR OUTPATIENT HEART CARE, SERVING AS A LIAISON BETWEEN PATIENTS, THEIR CAREGIVERS, AND HEALTH CARE PROVIDERS. THE CARDIAC NURSE NAVIGATOR COUNSELS CARDIOVASCULAR AND CONGESTIVE HEART FAILURE (CHF) PATIENTS ABOUT RISK FACTORS AND EDUCATES PATIENTS ABOUT SELF-MANAGEMENT OF THEIR DISEASE TO HELP REDUCE READMISSIONS TO THE HOSPITAL. IN 2020, THE HOSPITAL BEGAN OFFERING LOW-INCOME PATIENTS WITH UNCONTROLLED HEART DISEASE DIGITAL SCALES AND BLOOD PRESSURE CUFFS TO HELP WITH SELF-MANAGEMENT OF THEIR DISEASE. IN 2021, THE HOSPITAL STARTED PROVIDING CHF KITS TO PATIENTS AS NEEDED INCLUDING A BLOOD PRESSURE CUFF, A SCALE, A DAILY WEIGHT LOG, A WATER BOTTLE FOR FLUID MANAGEMENT, A PILL ORGANIZER, AND CHF EDUCATIONAL MATERIALS. THE HOSPITAL ALSO DEVELOPED A LEARNING MODULE FOR USE ON INPATIENT TELEVISIONS AND ADOPTED A QUESTIONNAIRE FOR USE WITH PATIENTS WHO WERE READMITTED WITHIN 7-30 DAYS. TO HELP PREVENT AND MANAGE DIABETES, UPMC CHAUTAUQUA CONTINUES TO ENCOURAGE HEALTHY EATING - OFFERING A GRAB AND GO HEALTHY FOOD OPTION IN THE CAFETERIA, WHICH INCORPORATES LOCAL, SEASONAL, FRESH FRUITS AND VEGETABLES IN 300-500 CALORIE MEALS, AS WELL AS WATER, LOW SUGAR, AND LOW CALORIE BEVERAGE CHOICES. UPMC CHAUTAUQUA ALSO REMAINS COMMITTED TO CANCER SUPPORT AND TREATMENT. TO SUPPORT THOSE NEWLY DIAGNOSED WITH BREAST CANCER, THE HOSPITAL PROVIDES A NURSE NAVIGATOR, WHO HELPS PATIENTS SCHEDULE APPOINTMENTS AND CONNECTS PATIENTS WITH RESOURCES AND SUPPORT GROUPS. TO INCREASE LOCAL ACCESS TO TREATMENT, THE UPMC HILLMAN CANCER CENTER AT UPMC CHAUTAUQUA ADDED ONE MEDICAL ONCOLOGIST AND ONE HEMATOLOGIST IN 2020, AND IN 2021 A NEW PHYSICIAN ASSISTANT JOINED THE TEAM. THESE SPECIALISTS ARE AVAILABLE FIVE DAYS PER WEEK - UP FROM ONE DAY PER WEEK WHEN THE CANCER CENTER FIRST OPENED.FILLING A GAP FOR RESIDENTIAL ADDICTION SERVICES:UPMC CHAUTAUQUA OFFERS ACCESS TO INPATIENT BEHAVIORAL HEALTH SERVICES, WITH 65 BEDS DEDICATED TO MENTAL HEALTH AND SUBSTANCE USE DISORDER. IN SEPTEMBER 2019, UPMC CHAUTAUQUA OPENED A 20-BED, LONG-TERM RESIDENTIAL ADDICTION SERVICES PROGRAM AT UPMC CHAUTAUQUA'S JONES MEMORIAL HEALTH CENTER CAMPUS. THIS FACILITY IS THE FIRST LONG-TERM RESIDENTIAL ADDICTION SERVICES PROGRAM IN CHAUTAUQUA COUNTY - INCREASING LOCAL ACCESS TO BEHAVIORAL HEALTH CARE. THE PROGRAM OFFERS THREE LEVELS OF CARE: STABILIZATION, REHABILITATION, AND COMMUNITY REINTEGRATION. THESE PHASES ALLOW INDIVIDUALS WHO MAY RELAPSE WHILE IN TREATMENT TO REMAIN IN THE RESIDENCE, RATHER THAN CHANGE LOCATIONS. THIS MODEL OF CARE OFFERS THE ABILITY TO ADAPT TREATMENT PLANS AND PROGRAMMING AROUND A PATIENT, INCREASING SUPPORTS AND SERVICES AS NEEDED. IN ADDITION, UPMC CHAUTAUQUA'S ADOLESCENT AND ADULT MENTAL HEALTH INPATIENT UNITS OFFER TEN BEDS DEDICATED FOR CHILDREN AND ADOLESCENTS AND 20 BEDS DEDICATED FOR ADULTS. THESE NEW UNITS PROVIDE A RECOVERY-ORIENTED ENVIRONMENT - WITH PRIVATE ROOMS AND A GYM FOR RECREATION THERAPY - AND IMMEDIATE ACCESS TO HOSPITAL SERVICES THROUGH A DIRECT CONNECTION FROM THE EMERGENCY DEPARTMENT. SINCE JULY 2019, MORE THAN 2,000 PATIENTS WERE SERVED THROUGH THE INPATIENT BEHAVIORAL HEALTH UNITS.INCREASING ACCESS TO CARE THROUGH PHYSICIAN RECRUITMENT:UPMC CHAUTAUQUA CONTINUES EFFORTS TO RECRUIT NEW PHYSICIANS - HELPING TO INCREASE ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS. OVER THE PAST THREE YEARS, THE HOSPITAL RECRUITED 12 SPECIALISTS TO THE REGION INCLUDING AN ENT SPECIALIST, AN ORTHOPEDIC SURGEON, AND A FAMILY MEDICINE PHYSICIAN. IN ADDITION, UPMC CHAUTAUQUA PARTNERS WITH UPMC HAMOT TO INCREASE LOCAL ACCESS TO SPECIALTY PROVIDERS. WHEN A SPECIALIST IS NOT AVAILABLE IN CHAUTAUQUA COUNTY, UPMC CHAUTAUQUA OFFERS TELEMEDICINE TO INCREASE LOCAL ACCESS TO CARE. MORE THAN 24,000 VIRTUAL VISITS WERE CONDUCTED SINCE JULY 2019.CARING FOR NEW MOMS AND INFANTS:UPMC CHAUTAUQUA CONTINUES TO OFFER EXCELLENT MATERNITY CARE TO THE COMMUNITY. IN 2019, THE HOSPITAL EXPANDED ITS WOMENS AND MATERNITY CARE CENTER - ADDING LABOR AND DELIVERY SUITES, TRIAGE ROOMS, AND POSTPARTUM PRIVATE ROOMS. THE HOSPITAL ALSO CONTINUES TO OFFER INDIVIDUALIZED BREASTFEEDING SUPPORT TO ALL MOMS, WITH FOUR NURSES SERVING AS LACTATION COUNSELORS. OVER THE LAST THREE YEARS, UPMC CHAUTAUQUA HAS CONTINUED TO OFFER EDUCATION AND SUPPORT TO PREGNANT WOMEN AND HAS DELIVERED MORE THAN 1200 BABIES.PROMOTING EMPLOYEE WORKSITE WELLNESS:UPMC CHAUTAUQUA CONTINUES TO PROMOTE HEALTH AND WELLNESS AMONG EMPLOYEES. THE HOSPITAL OFFERS EMPLOYEES THE OPPORTUNITY TO SPEAK WITH A HEALTH COACH FROM UPMC HEALTH PLAN FOR INDIVIDUALIZED HEALTH ADVICE AND SUPPORT. THESE COACHES HELP EMPLOYEES SET GOALS, CREATE WORK OUT PLANS, LEARN ABOUT NUTRITION, DECREASE STRESS, AND MOTIVATE EMPLOYEES TO ADOPT HEALTHY HABITS. TO CONTINUE TO SUPPORT EMPLOYEES DURING THE COVID-19 PANDEMIC, HEALTH COACHES ADAPTED THEIR CONSULTATIONS TO A VIRTUAL PLATFORM. SINCE JULY 2019, THE HOSPITAL'S THREE EMPLOYEE EXERCISE ROOMS LOGGED MORE THAN 550 VISITS, EVEN THOUGH THE FACILITIES WERE TEMPORARILY CLOSED DUE TO COVID-19.FOR MORE DETAILED INFORMATION ON UPMC'S COMMUNITY BENEFITS EFFORT, SEE THE ORGANIZATION'S COMMUNITY BENEFITS REPORT, AVAILABLE AT:HTTPS://WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/BENEFITS-REPORT

Schedule H (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

UPMC CHAUTAUQUA AT WCA

Employer identification number

16-0743226

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1DAVID GIBBONS BOARD MEMBER/VICE CHAIR	(i) (ii)	0 ------------- 461,727	0 ------------- 420,000	0 ------------- 63,355	0 ------------- 110,833	0 ------------- 10,409	0 ------------- 1,066,324	0 ------------- 58,667
2BRIAN DURNIOK PRESIDENT	(i) (ii)	0 ------------- 274,060	0 ------------- 194,000	0 ------------- 27,489	0 ------------- 59,424	0 ------------- 5,498	0 ------------- 560,471	0 ------------- 24,039
3SALVATORE J BUONAIUTO MD HOSPITALIST	(i) (ii)	407,047 ------------- 0	500 ------------- 0	681 ------------- 0	21,065 ------------- 0	21,568 ------------- 0	450,861 ------------- 0	0 ------------- 0
4GALO GRIJALVA MD PHYSICIAN	(i) (ii)	393,998 ------------- 0	500 ------------- 0	1,791 ------------- 0	21,330 ------------- 0	26,365 ------------- 0	443,984 ------------- 0	0 ------------- 0
5AMARDEEP SAPPLE MD HOSPITALIST	(i) (ii)	352,919 ------------- 0	40,205 ------------- 0	174 ------------- 0	16,214 ------------- 0	19,112 ------------- 0	428,624 ------------- 0	0 ------------- 0
6AMIT BHOWMIK MD HOSPITALIST	(i) (ii)	318,802 ------------- 0	35,686 ------------- 0	237 ------------- 0	14,985 ------------- 0	5,361 ------------- 0	375,071 ------------- 0	0 ------------- 0
7SRINIVAS BOMMIREDDIPALLI MD HOSPITALIST	(i) (ii)	335,804 ------------- 0	500 ------------- 0	720 ------------- 0	21,268 ------------- 0	14,388 ------------- 0	372,680 ------------- 0	0 ------------- 0
8JAMES DONNELLY BOARD MEMBER	(i) (ii)	0 ------------- 186,883	0 ------------- 127,000	0 ------------- 2,653	0 ------------- 23,018	0 ------------- 23,046	0 ------------- 362,600	0 ------------- 0
9CAMELLIA HERISKO BOARD MEMBER	(i) (ii)	0 ------------- 166,853	0 ------------- 105,000	0 ------------- 2,434	0 ------------- 22,724	0 ------------- 24,464	0 ------------- 321,475	0 ------------- 0
10BRADLEY DINGER BOARD MEMBER/TREASURER/CFO	(i) (ii)	0 ------------- 173,409	0 ------------- 76,000	0 ------------- 1,569	0 ------------- 19,424	0 ------------- 14,381	0 ------------- 284,783	0 ------------- 0
11CECIL M MILLER III SECRETARY/VP OF OPERATIONS	(i) (ii)	144,536 ------------- 0	56,566 ------------- 0	1,249 ------------- 0	15,489 ------------- 0	5,442 ------------- 0	223,282 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

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

PART I, LINES 4A-B

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).

PART I, LINE 7

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 (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

UPMC CHAUTAUQUA AT WCA

Employer identification number

16-0743226

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 1A	ALL BOARD MEMBERS HAVE A VOTE EXCEPT THE PRESIDENT ELECT OF THE MEDICAL STAFF WHO IS A BOARD MEMBER WITHOUT VOTING RIGHTS.
FORM 990, PART VI, SECTION A, LINE 6	UPMC CHAUTAUQUA SERVICES INC. A NY STATE NON-PROFIT, FEDERALLY TAX EXEMPT ENTITY, IS AN ACTIVE PARENT HOLDING COMPANY AND IS THE SOLE MEMBER OF THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	UPMC CHAUTAUQUA SERVICES, INC., THE PARENT ENTITY, ELECTS DIRECTORS OF THE GOVERNING BODY. UPMC HAMOT, A RELATED FEDERALLY TAX-EXEMPT ENTITY, APPOINTS 6 OF THE 12 BOARD MEMBERS FROM AMONG REPRESENTATIVES OF UPMC AND UPMC HAMOT.
FORM 990, PART VI, SECTION A, LINE 7B	DECISIONS OF THE GOVERNING BODY RELATIVE TO A MAJOR TRANSFER OF ASSETS ARE SUBJECT TO APPROVAL BY THE PARENT ENTITY, UPMC CHAUTAUQUA SERVICES, INC.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. THE 990 IS REVIEWED BY MANAGEMENT AND IS MADE AVAILABLE TO THE FULL BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	UPMC CHAUTAUQUA AT WCA REQUIRES KEY EMPLOYED AND NON-EMPLOYED PERSONNEL TO COMPLY WITH ITS CONFLICT OF INTEREST POLICIES WHEN THEY ENGAGE IN UPMC CHAUTAUQUA AT WCA-RELATED BUSINESS. PERSONS COVERED BY THE POLICIES INCLUDE: - UPMC CHAUTAUQUA AT WCA BOARD MEMBERS, BOARD COMMITTEE MEMBERS, CORPORATE OFFICERS, AND KEY EMPLOYEES - UPMC CHAUTAUQUA AT WCA PHYSICIANS AND NON-PHYSICIAN EMPLOYEES WHO HOLD A POSITION OF INFLUENCE IDENTIFIED NON-EMPLOYED MEMBERS OF THE UPMC CHAUTAUQUA AT WCA MEDICAL STAFF WHO HOLD A POSITION OF INFLUENCE OR TRUST-INDIVIDUALS CONDUCTING CLINICAL RESEARCH AT THE UPMC CHAUTAUQUA AT WCA, WHETHER OR NOT THEY ARE EMPLOYED BY UPMC CHAUTAUQUA AT WCA. THESE PEOPLE ARE REQUIRED TO COMPLETE A QUESTIONNAIRE AT LEAST ANNUALLY, WHICH ALONG WITH OTHER DATA IS USED TO IDENTIFY POSSIBLE INDIVIDUAL AND INSTITUTIONAL CONFLICTS OF INTEREST. IF A POTENTIAL CONFLICT IS IDENTIFIED REGARDING A SPECIFIC UPMC CHAUTAUQUA AT WCA ACTIVITY, THE CORPORATE COMPLIANCE DEPARTMENT, WITH THE ASSISTANCE OF THE LEGAL DEPARTMENT, EITHER DEVELOPS A WRITTEN PLAN DESIGNED TO PREVENT THE CONFLICT FROM INFLUENCING DECISIONS RELATED TO THAT ACTIVITY, OR REQUIRES THAT THE CONFLICTING RELATIONSHIP BE DIVESTED, AS APPROPRIATE. FOR EMPLOYED PERSONNEL AND NON-BOARD MEMBER, NON-EMPLOYED PERSONNEL, THE CONFLICT OF INTEREST IDENTIFICATION AND MANAGEMENT PROCESS IS ULTIMATELY OVERSEEN BY AN ETHICS AND COMPLIANCE COMMITTEE OF THE UPMC CHAUTAUQUA AT WCA BOARD OF DIRECTORS ON BEHALF OF UPMC CHAUTAUQUA AT WCA AND ALL OF ITS RELATED ENTITES. POTENTIAL CONFLICT OF INTEREST TRANSACTIONS INVOLVING UPMC CHAUTAUQUA AT WCA BOARD MEMBERS AND ENTITIES WITH WHICH THEY ARE AFFILIATED ARE MONITORED AND SUBJECT TO PRE-APPROVAL BY THE GOVERNANCE AND NOMINATING COMMITTEE OF THE UPMC CHAUTAUQUA AT WCA BOARD OF DIRECTORS. IN ADDITION TO THE GENERAL CORPORATE AND BOARD POLICIES DESCRIBED ABOVE, UPMC CHAUTAUQUA AT WCA HAS ALSO DEVELOPED AND IMPLEMENTED A SEPARATE TAX QUESTIONNAIRE DISTRIBUTED TO OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ANNUALLY THAT SPECIFICALLY ADDRESSES DISCLOSURE REQUIREMENTS OF FORM 990.
FORM 990, PART VI, SECTION B, LINE 15	TO SUPPORT UPMC'S AND ITS SUBSIDIARIES MISSION AND ASSET FORTH IN THE UPMC BYLAWS, THE BOARD OF DIRECTORS HAS FORMED AN EXECUTIVE COMPENSATION COMMITTEE ("COMMITTEE") AND DELEGATED TO IT THE RESPONSIBILITY FOR ESTABLISHMENT AND IMPLEMENTATION OF OFFICER AND KEY EMPLOYEE TOTAL COMPENSATION PROGRAMS. AS PART OF THIS RESPONSIBILITY THE COMMITTEE REPORTS REGULARLY TO THE BOARD OF DIRECTORS. WITH BOARD OF DIRECTORS APPROVAL, THE COMMITTEE HAS ADOPTED A FORMAL CHARTER, WHICH INCLUDES THE ESTABLISHMENT OF A COMPENSATION PHILOSOPHY AND RELATED POLICIES WITH RESPECT TO THE TOTAL COMPENSATION PAID BY UPMC TO ITS OFFICERS AND KEY EMPLOYEES. THE UPMC TOTAL COMPENSATION PROGRAM FOR OFFICERS AND KEY EMPLOYEES IS PREDICATED UPON AN INCENTIVE COMPENSATION COMPONENT. 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. THE TOTAL COMPENSATION PROGRAM IS INTEGRATED WITH AND REINFORCES THE UPMC BUSINESS PLANNING CYCLE AS WELL AS MANAGEMENT DEVELOPMENT AND SUCCESSION PLANNING PROCESSES. IT IS THE COMMITTEE'S JUDGMENT THAT THE STRUCTURE OF THE TOTAL COMPENSATION PROGRAM IS VITAL TO, AND STRONGLY SUPPORTIVE OF, THE HIGH LEVEL OF ONGOING SUCCESS OF UPMC AND FOSTERS THE RETENTION OF CRITICAL OFFICER AND KEY EMPLOYEE TALENT. THE TOTAL COMPENSATION DETERMINATION PROCESS UTILIZED BY THE COMMITTEE IS INTENDED TO SATISFY THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" AS SET FORTH IN THE REGULATIONS TO SECTION 4958 OF THE INTERNAL REVENUE CODE ("CODE"). THIS MEANS THAT COMPENSATION PROGRAMS AND LEVELS ARE APPROVED IN ADVANCE BY THE COMMITTEE WHICH IS COMPOSED ENTIRELY OF OUTSIDE DIRECTORS WHO DO NOT HAVE A CONFLICT OF INTEREST, AS DEFINED BY THE RELEVANT REGULATIONS, WITH RESPECT TO THE COMPENSATION PROGRAM AND LEVELS. THE COMMITTEE OBTAINS AND RELIES UPON A BROAD RANGE OF APPROPRIATE DATA AS TO COMPARABILITY PRIOR TO MAKING ITS DETERMINATIONS. THE COMMITTEE THEN CONTEMPORANEOUSLY DOCUMENTS, IN FORMAL MEETING MINUTES, THE BASIS AND REASONS FOR ITS DETERMINATIONS. THE TOTAL COMPENSATION PROGRAM IS DESIGNED AND ADMINISTERED IN ACCORDANCE WITH THE UPMC BYLAWS, SOUND BUSINESS PRACTICES, THE TENETS OF COMMON LAW BUSINESS JUDGMENT AND FIDUCIARY RESPONSIBILITY AS WELL AS ADHERENCE TO ALL RELEVANT FEDERAL, STATE AND LOCAL LAWS. IN ADDITION TO CODE SECTION 4958, AS SET FORTH ABOVE, THIS INCLUDES BUT IS NOT LIMITED TO CODE SECTION 501(C)(3) AND THE APPLICABLE REGULATIONS THEREUNDER AS WELL AS ALL LAWS AND REGULATIONS PROHIBITING PRIVATE INUREMENT, PRIVATE BENEFIT TRANSACTIONS AND DISCRIMINATION. FURTHER, THE COMMITTEE HAS IDENTIFIED AND ADOPTED, AS APPROPRIATELY MODIFIED FOR UPMC, COMPENSATION PROGRAM "BEST PRACTICES" FROM THE BUSINESS WORLD (E.G. SARBANES OXLEY, SEC, ETC.). THE COMMITTEE BELIEVES THAT WHILE THESE PRACTICES ARE NOT REQUIRED IN THE TAX-EXEMPT SECTOR, THEY ARE IN THE BEST INTERESTS OF THE ORGANIZATION AND FURTHER SUPPORT UPMC'S NONPROFIT MISSION. IN ACCORDANCE WITH THE ABOVE, DETERMINATION OF TOTAL COMPENSATION FOR THE CEO IS MADE EXCLUSIVELY BY THE COMMITTEE. DETERMINATION OF TOTAL COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS RECOMMENDED BY THE CEO AND SUBJECT TO REVIEW AND APPROVAL BY THE COMMITTEE. THE COMMITTEE, WHICH MEETS AT LEAST FOUR TIMES A YEAR, OBTAINS PROFESSIONAL ADVICE FROM ITS OWN EXPERTS, INCLUDING ACCOUNTANTS, EXECUTIVE COMPENSATION CONSULTANTS AND LEGAL COUNSEL.
FORM 990, PART VI, SECTION C, LINE 19	UPMC (THE ULTIMATE PARENT COMPANY OF ALL UPMC SYSTEM ENTITIES) PUBLIC WEBSITE (WWW.UPMC.COM) MAKES ITS FINANCIAL RESULTS, CONFLICT OF INTEREST PROCESS, AND VARIOUS INFORMATION ABOUT THE GOVERNANCE AND OVERSIGHT AVAILABLE TO THE PUBLIC. ADDITIONAL INFORMATION MAY BE SUPPLIED UPON SPECIFIC REQUEST FOR DATA NO POSTED TO THE WEB SITE.
FORM 990, PART VI, SECTION B, LINE 16B:	UPMC CHAUTAUQUA AT WCA HAS A FORMAL WRITTEN POLICY PERTAINING TO JOINT VENTURES BETWEEN UPMC CHAUTAUQUA AT WCA TAX-EXEMPT ENTITIES AND TAXABLE ENTITIES. THE POLICY EMPLOYS AN INTERNAL PROCEDURE FOR REVIEW OF ALL TRANSACTIONS INVOLVING POTENTIAL PARTICIPATION IN JOINT VENTURES AND SIMILAR ARRANGEMENTS TO ENSURE THAT SUCH ENTITIES OPERATE IN ACCORDANCE WITH APPLICABLE IRS POLICIES AND WITHIN UPMC CHAUTAUQUA AT WCA'S CHARITABLE PURPOSES.
FORM 990, PART XI, LINE 9:	BOOK TO TAX ADJUSTMENT - PARTNERSHIP INTERESTS -793,907. TRANSFER FROM RELATED EXEMPT ENTITY 16,201,066.
FORM 990, PART XII, LINE 2C:	UPMC CHAUTAUQUA AT WCA'S FINANCIAL STATEMENTS ARE AUDITED ON A CONSOLIDATED BASIS ONLY. THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED AUDIT OF UPMC AND SUBSIDIARIES WHICH INCLUDES ALL UMPC TAXABLE AND TAX-EXEMPT SUBSIDIARIES OF THE SYSTEM. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART IV, LINE 12A & 12B	AN EXTERNAL AUDIT IS COMPLETED AT A CONSOLIDATED UPMC SYSTEM LEVEL ONLY, WHICH INCLUDES UPMC AND ALL SUBSIDIARIES.
FORM 990, PART V, LINE 15	PART V STATEMENTS REGARDING OTHER IRS FILINGS AND TAX COMPLANCE UPMC ENTITES DO NOT HAVE A SECTION 4960 EXCISE TAX LIABILITY TO REPORT ON FORM 4720 RELATED TO PAYMENTS OF $1 MILLION OR MORE IN REMUNERATION OR EXCESS PARACHUTE PAYMENTS DURING THE TAX YEAR ENDED DECEMBER 31, 2021. REMUNERATION IS NOT TAKEN INTO ACCOUNT FOR THE PURPOSES OF THE EXCISE TAX IF NO DEDUCTION FOR THE REMUNERATION IS ALLOWED BY REASON OF SECTION 162(M). SECTION 162(M)(6) IMPOSES A COMPENSATION DEDUCTION LIMITATION ON CONTROLLED GROUPS, SUCH AS THE UPMC CONTROLLED GROUP, THAT INCLUDE ONE ORE MORE COVERED HEALTH INSURANCE PROVIDERS.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

UPMC CHAUTAUQUA AT WCA

Employer identification number

16-0743226

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) WCA 31 SHERMAN LLC 4 CENTRE DRIVE ORCHARD PARK,NY14127 45-4867695	REAL ESTATE	NY	0	0	UPMC CHAUTAUQUA AT WCA

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)COMMUNITY LIFE TEAM INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1890444	MEDICAL TRANSPORT	PA	501 (C) 3	7	UPMC PINNACLE		No
(2)HANOVER HEALTHCARE PLUS INC 300 HIGHLAND AVENUE HANOVER,PA17331 22-2658574	SUPPORT	PA	501 (C) 3	12 (A)(I)	UPMC PINNACLE		No
(3)HANOVER HOSPITAL FOUNDATION 300 HIGHLAND AVENUE HANOVER,PA17331 82-2553293	FOUNDATION	PA	501 (C) 3	12 (C) III	UPMC PINNACLE		No
(4)KANE COMMUNITY HOSPITAL FOUNDATION 4372 ROUTE 6 KANE,PA16735 26-3906925	FOUNDATION	PA	501 (C) 3	7	N/A		No
(5)LAUREL HEALTH FOUNDATION 15 MEADE STREET NO U-6 WELLSBORO,PA16901 25-1810488	FOUNDATION	PA	501 (C) 3	12 (B) II	N/A		No
(6)LAUREL REALTY INC 32-36 CENTRAL AVENUE WELLSBORO,PA16901 23-1403678	REAL ESTATE	PA	501 (C) 2	N/A	UPMC SUSQUEH		No
(7)PINNACLE HEALTH FOUNDATION 409 SOUTH SECOND STREET HARRISBURG,PA17104 22-2691718	FOUNDATION	PA	501 (C) 3	12 (B) II	UPMC PINNACLE		No
(8)PINNACLE HEALTH MEDICAL SERVICES 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1709054	PHYSICIAN SVC	PA	501 (C) 3	3	UPMC PINNACLE		No
(9)PINNACLE HEALTH REGIONAL PHYSICIANS 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-0947698	PHYSICIAN SVC	PA	501 (C) 3	3	UPMC PINNACLE		No
(10)STARFLIGHT INC 135 ALLEN STREET JAMESTOWN,NY14701 16-1557878	MEDICAL AVIATION SERVICE SUBSIDIARY	NY	501(C)(3)	7	UPMC CHAUTAUQUA AT WCA	Yes
(11)THE GREEN HOME 37 CENTRAL AVENUE WELLSBORO,PA16901 24-0804365	SKILLED NURSING	PA	501 (C) 3	10	UPMC SUSQUEH		No
(12)UPMC CARLISLE 361 ALEXANDER SPRING ROAD CARLISLE,PA17105 82-0880337	HOSPITAL	PA	501 (C) 3	3	UPMC PINNACLE		No
(13)UPMC HANOVER 300 HIGHLAND AVENUE HANOVER,PA17331 23-1360851	HOSPITAL	PA	501 (C) 3	3	HANNOVER HEALTH		No
(14)UPMC LANCASTER 250 COLLEGE AVENUE LANCASTER,PA17603 82-0896436	HOSPITAL	PA	501 (C) 3	3	UPMC PINNACLE		No
(15)UPMC LITITZ 1500 HIGHLANDS AVENUE LITITZ,PA17543 82-0844453	HOSPITAL	PA	501 (C) 3	3	UPMC PINNACLE		No
(16)UPMC MEMORIAL 325 SOUTH BELMONT STREET YORK,PA17405 82-0912090	HOSPITAL	PA	501 (C) 3	3	UPMC PINNACLE		No
(17)UPMC PINNACLE 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778658	SUPPORT	PA	501 (C) 3	12 (B) II	UPMC		No
(18)UPMC PINNACLE HOSPITALS 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778644	HOSPITAL	PA	501 (C) 3	3	UPMC PINNACLE		No
(19)UPMC WESTERN MARYLAND CORPORATION PO BOX 539 CUMBERLAND,MD21501 52-0591531	HOSPITAL	MD	501 (C) 3	3	UPMC		No
(20)WCA GROUP INC 207 FOOTE AVENUE JAMESTOWN,NY14701 22-2392582	HOLDING CO.	NY	501 (C) 3	12 (B) II	UPMC CHAUTAUQUA AT WCA		No
(21)WESTERN MARYLAND HEALTH SYSTEM FOUNDATIO PO BOX 539 CUMBERLAND,MD21501 35-2289841	FOUNDATION	MD	501 (C) 3	12 (C) III	UPMC WESTERN		No
(22)WILLIAMSPORT AREA AMBULANCE SERVICE COOP 700 HIGH STREET WILLIAMSPORT,PA17701 23-2416166	AMBULANCE SVC	PA	501 (C) 3	10	WILLIAM HOSP		No
(23)ASBURY FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1555688	FOUNDATION	PA	501 (C) 3	7	ASBURY HEIGH		No
(24)ASBURY HEALTH CENTER 600 GRANT STREET PITTSBURGH,PA15219 25-0969472	CCRC	PA	501 (C) 3	10	ASBURY HEIGH		No
(25)ASBURY HEIGHTS OF UPMC 600 GRANT STREET PITTSBURGH,PA15219 25-1555687	SUPPORT	PA	501 (C) 3	12 (B) II	UPMC SR COMM		No
(26)ASBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-1729266	PERSONAL CARE	PA	501 (C) 3	10	ASBURY HEIGH		No
(27)ASBURY VILLAS 600 GRANT STREET PITTSBURGH,PA15219 25-1819952	PERSONAL CARE	PA	501 (C) 3	10	ASBURY HEIGH		No
(28)CANTERBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-0965334	SR. LIVING	PA	501 (C) 3	10	UPMC SR COMM		No
(29)CHARLES E COLE MEMORIAL HOSPITAL 1001 EAST SECOND STREET COUDERSPORT,PA16915 24-0802108	HOSPITAL	PA	501 (C) 3	3	UPMC		No
(30)CHILDREN'S HOSPITAL OF PITTSBURGH FND 600 GRANT STREET PITTSBURGH,PA15219 25-1865744	FOUNDATION	PA	501 (C) 3	7	UPMC CHP		No
(31)COLE FOUNDATION INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 45-5417308	FOUNDATION	PA	501 (C) 3	12 (A)(I)	C COLE MEM H		No
(32)GREAT LAKES PHYSICIAN PRACTICE PC 600 GRANT STREET 58TH FLOOR PITTSBURGH,PA15219 46-4186362	PHYSICIANS	NY	501 (C) 3	3	REGNL HEALTH		No
(33)HAMOT COLE VENTURES 1001 EAST SECOND STREET COUDERSPORT,PA16915 27-3172100	CLINIC SITES	PA	501 (C) 3	12 (A)(I)	C COLE MEM H		No
(34)HAMOT HEALTH FOUNDATION 302 FRENCH ST ERIE,PA16507 25-1400999	FOUNDATION	PA	501 (C) 3	12 (B) II	UPMC HAMOT		No
(35)HENDORN INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 23-1972659	RESIDENTIAL CARE	PA	501 (C) 3	12 (A)(I)	C COLE MEM H		No
(36)JAMESON CARE CENTER INC 1211 WILMINGTON AVE NEW CASTLE,PA16105 23-2871396	HEALTHCARE	PA	501 (C) 3	10	UPMC SR COMM		No
(37)JUNIOR GUILD OF THE JAMESON MEMORIAL HOS 1211 WILMINGTON AVENUE NEW CASTLE,PA16105 25-6005313	SUPPORT	PA	501 (C) 3	12 (D) III	N/A		No
(38)MAGEE-WOMEN RES INST AND FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1462312	FOUNDATION	PA	501 (C) 3	7	N/A		No
(39)NORTHWEST HOSPITAL FOUNDATION 100 FARFIELD DRIVE SENECA,PA16346 25-1483624	FOUNDATION	PA	501 (C) 3	12 (D) III	UPMC NORTHWEST		No
(40)PASSAVANT HOSPITAL FOUNDATION 9100 BABCOCK BLVD PITTSBURGH,PA15237 25-1407815	FOUNDATION	PA	501 (C) 3	12 (B) II	UPMC PASSAVANT		No
(41)PITTSBURGH CARE PARTNERSHIP INC 600 GRANT STREET PITTSBURGH,PA15219 25-1753852	SR CARE MGMT	PA	501 (C) 3	10	UPMC		No
(42)PITTSBURGH LIFETIME CARE COMMUNITY 600 GRANT STREET PITTSBURGH,PA15219 25-1335247	CCRC	PA	501(C)(3)	10	UPMC SR COMM		No
(43)SENECA PLACE 600 GRANT STREET PITTSBURGH,PA15219 72-1562844	SR. LIVING	PA	501 (C) 3	10	UPMC SR COMM		No
(44)SHADYSIDE HOSPITAL FOUNDATION 532 SOUTH AIKEN AVENUE PITTSBURGH,PA15232 25-1290546	FOUNDATION	PA	501 (C) 3	12 (C) III	UPMC PRESBY		No
(45)SHADYSIDE HOSPITAL SUPPORTING FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 26-0303394	FOUNDATION	PA	501 (C) 3	12(A) I	UPMC		No
(46)SOMERSET COMMUNITY HOSPITAL FOUNDATION 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-1441863	FOUNDATION	PA	501 (C) 3	12(C)III	UPMC SOMERSET		No
(47)SOMERSET HEALTH SERVICES INC 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-1441920	PHYSICIAN SRV	PA	501 (C) 3	3	UPMC SOMERSET		No
(48)SOUTH CENTRAL ALPHA HOUSING AND HEALTH 3410 W PITTSBURG ROAD NEW CASTLE,PA16101 25-1701701	SKILLED NURSING	PA	501 (C) 3	10	UPMC SR COMM		No
(49)SOUTH WESTERN ALPHA HOUSING AND HEALTH 745 GREENVILLE ROAD MERCER,PA16137 25-1701700	SKILLED NURSING	PA	501 (C) 3	10	UPMC SR COMM		No
(50)ST MARGARET FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1520340	FOUNDATION	PA	501 (C) 3	7	UPMC ST MARGARET		No
(51)TWIN LAKES CENTER INC 225 SOUTH CENTER AVENUE SOMERSET,PA15501 23-2910318	DRUG TREATMENT	PA	501 (C) 3	3	UPMC SOMERSET		No
(52)UPMC 600 GRANT STREET PITTSBURGH,PA15219 25-1423657	SUPPORTING ORG	PA	501 (C) 3	12 (C) III	N/A		No
(53)UPMC CENTER FOR HIGH VALUE HEALTHCARE 600 GRANT STREET PITTSBURGH,PA15219 45-2178782	RESEARCH	PA	501 (C) 3	7	UPMC		No
(54)UPMC LEE 600 GRANT STREET PITTSBURGH,PA15219 25-0613830	INACTIVE	PA	501 (C) 3	3	UPMC		No
(55)UPMC SENIOR COMMUNITIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1574736	SR. LIVING	PA	501(C)(3)	10	UPMC		No
(56)UPMC SOMERSET 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-0965570	HOSPITAL	PA	501 (C) 3	3	UPMC		No
(57)UPMC JAMESON CANCER CENTER 600 GRANT STREET 58TH FLOOR PITTSBURGH,PA15219 20-1459415	ONCOLOGY SVC	PA	501 (C) 3	10	UPMC JAMESON		No
(58)VENANGO VNA FOUNDATION 491 ALLEGHENY BOULEVARD FRANKLIN,PA16323 25-1472179	FOUNDATION	PA	501 (C) 3	12 (D) III	N/A		No
(59)WCA FOUNDATION INC PO BOX 214 JAMESTOWN,NY147020214 22-2393584	PROMOTE/SUPPORT COMMUNITY HEALTH THROUGH SUPPORT OF WCA HOSP & AFFILIATE	NY	501(C)(3)	7	UPMC CHAUTAUQUA AT WCA		No
(60)WESLEY HILLS 600 GRANT STREET PITTSBURGH,PA15219 25-1507472	INDEPENDENT LIVING	PA	501 (C) 3	N/A	UPMC HAMOT		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(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) 31 SHERMAN STREET INVESTORS LLC 4 CENTRE DRIVE ORCHARD PARK,NY14127 26-4629631	REAL ESTATE	NY	31 SHERMAN STREET LLC	RELATED	118,866	1,328,517		No		Yes		50.000 %
(2) CHAUTAUQUA INTEGRATED DELIVERY SYSTEM IPA LLC 200 HARRISON STREET 2ND FLOOR JAMESTOWN,NY14701 16-1542139	INTEGRATED DELIVERY SYSTEM	NY	STAND ALONE	RELATED	906,646	1,412,066	Yes				No	33.700 %
(3) SENECA HILLS ASSISTED LIVING LP 600 GRANT STREET PITTSBURGH,PA15219 23-2873106	ASSISTED LIVING	PA	N/A					No			No
(4) ST MARGARET MEDICAL ARTS ASSOCIATION 600 GRANT STREET PITTSBURGH,PA15219 25-1786655	MED OFFICE BL	PA	N/A					No			No
(5) CORE NETWORK LLC 600 GRANT STREET PITTSBURGH,PA15219 25-1786209	HEALTHCARE	PA	N/A					No			No
(6) SHADYSIDE MEDICAL CENTER ASSOCIATES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1608318	MED OFFICE BL	PA	N/A					No			No
(7) CHARTWELL PA LP 600 GRANT STREET PITTSBURGH,PA15219 25-1729714	HOME HEALTH	PA	N/A					No			No
(8) LIFE CARE HOME SRV OF NW PA 1647 SASSAFRAS STREET ERIE,PA16501 25-1536879	HOME HEALTH	PA	N/A					No			No
(9) HAMOT-KCH REAL ESTATE VENTURE 300 STATE STREET ERIE,PA16507 26-3691782	MEDICAL OFFICE	PA	N/A					No			No
(10) HAMOT SURGERY CENTER LLC 200 STATE STREET ERIE,PA16507 25-1863661	AMBULATORY	PA	N/A					No			No
(11) EPN-HAMOT URGENT CARE LLC 600 GRANT STREET PITTSBURGH,PA15219 27-2147949	URGENT CARE	PA	N/A					No			No
(12) COMMUNITY BASKET LLC 1205 GRAMPAIN BOULEVARD WILLIAMSPORT,PA17701 20-1195736	REAL ESTATE RENTAL	PA	N/A					No			No
(13) HANOVER SURGICENTER REAL ESTATE LP 300 HIGHLAND AVE HANOVER,PA17331 35-2342993	INACTIVE	PA	N/A					No			No
(14) MEDCARE SUSQUEHANNA VALLEY LLC 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-1673688	DME	PA	N/A					No			No
(15) OMICELO RE I LP 2525 LIBERITY AVENUE PITTSBURGH,PA15222 47-5603393	REAL ESTATE	DE	N/A					No			No
(16) UPMC LEADER SURGERY CENTER LLC 1703 INNOVATION DRIVE YORK,PA17408 23-3035083	SURGERY CENTER	PA	N/A					No			No
(17) BAYFRONT BUILDING PROFESSIONAL LLC 3645 WEST LAKE ROAD ERIE,PA16505 25-1480837	REAL ESTATE	PA	N/A					No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) WCA SERVICES CORPORATION 207 FOOTE AVENUE JAMESTOWN,NY14701 16-1151438	SUPPORT	NY	UPMC CHAUTAUQUA AT WCA	C	5,932,247	4,358,690	100.000 %	Yes
(2) HC PHARMACY CENTRAL INC 600 GRANT STREET PITTSBURGH,PA15219 25-1364192	PHARMACY CO-O	PA	N/A	C					No
(3) CHILDREN'S COMMUNITY CARE 600 GRANT STREET PITTSBURGH,PA15219 25-1781887	PEDIATRIC SVC	PA	N/A	C					No
(4) UPMC PHYSICIAN SERVICES HOLDING COMPANY 600 GRANT STREET PITTSBURGH,PA15219 25-1877017	HOLDINGS CO	PA	N/A	C					No
(5) HEMATOLOGY ONCOLOGY ASSOCIATION INC 600 GRANT STREET PITTSBURGH,PA15219 42-1648357	PHYSICIAN SERVICES	PA	N/A	C					No
(6) ONCOLOGY HEMATOLOGY ASSOCIATION INC 600 GRANT STREET PITTSBURGH,PA15219 25-1762980	PHYSICIAN SERVICES	PA	N/A	C					No
(7) TRI-STATE NEUROSURGICAL ASSOCIATES 600 GRANT STREET PITTSBURGH,PA15219 25-1458655	PHYSICIAN SERVICES	PA	N/A	C					No
(8) RENAISSANCE FAMILY PRACTICE - UPMC INC 600 GRANT STREET PITTSBURGH,PA15219 26-2942406	PHYSICIAN SERVICES	PA	N/A	C					No
(9) UPMC HOLDING COMPANY INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777713	HOLDING CORP	PA	N/A	C					No
(10) UPMC COVERAGE PRODUCTS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777710	HOLDING CORP	PA	N/A	C					No
(11) FREEDOM INSURANCE COMPANY 600 GRANT STREET PITTSBURGH,PA15219 03-0308944	INSURANCE	VT	N/A	C					No
(12) TRI-CENTURY INSURANCE CO 600 GRANT STREET PITTSBURGH,PA15219 25-1500739	INSURANCE	PA	N/A	C					No
(13) UPMC DNA INC 600 GRANT STREET PITTSBURGH,PA15219 25-1883237	INSURANCE	PA	N/A	C					No
(14) UPMC HEALTH BENEFITS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1844144	HEALTH INSUR	PA	N/A	C					No
(15) UPMC HEALTH NETWORK INC 600 GRANT STREET PITTSBURGH,PA15219 72-1527566	HEALTH INSUR	PA	N/A	C					No
(16) UPMC HEALTH PLAN INC 600 GRANT STREET PITTSBURGH,PA15219 23-2813536	HEALTH INSUR	PA	N/A	C					No
(17) UPMC BENEFIT MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1769564	WORKERS' COMP	PA	N/A	C					No
(18) UPMC DIVERSIFIED SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1778454	HOLDING CORP	PA	N/A	C					No
(19) MONROEVILLE SPECIALTY CLINIC 600 GRANT STREET PITTSBURGH,PA15219 25-1666087	AMB SURG	PA	N/A	C					No
(20) MEDICAL ARCHIVAL SYSTEMS INC 600 GRANT STREET PITTSBURGH,PA15219 23-2912501	SOFTWARE DEVE	DE	N/A	C					No
(21) RX PARTNERS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1801966	RETAIL PHARM	PA	N/A	C					No
(22) BIOTRONICS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1843500	EQUIP MAINTEN	PA	N/A	C					No
(23) MEDICAL CENTER PROPERTIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1796940	REAL ESTATE	PA	N/A	C					No
(24) ASKESIS DEVELOPMENT GROUP INC 600 GRANT STREET PITTSBURGH,PA15219 54-1625585	SOFTWARE DEVE	DE	N/A	C					No
(25) PANTHER REINSURANCE COMPANY LTD PO BOX 1109 CAYMAN ISLANDS CJ 98-1402742	INSURANCE	CJ	N/A	C					No
(26) FORBES REINSURANCE COMPANY LTD PO BOX 1109 CAYMAN ISLANDS CJ 98-1700710	INSURANCE	CJ	N/A	C					No
(27) CATHEDRAL (RE) INSUANCE CO PO BOX 1109 CAYMAN ISLANDS CJ 98-1400837	INSURANCE	CJ	N/A	C					No
(28) UPMC IRELAND LIMITED 6TH FLOOR BEACON HOSPITAL SANDYFORD DUBLIN EI	HEALTHCARE SU	EI	N/A	C					No
(29) UPMC UNITED KINGDOM LTD C/O NAIRCO 11TH FLOOR BRISTOL UK 98-0571026	SOFTWARE LICE	UK	N/A	C					No
(30) BAYFRONT REGIONAL DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401388	RE HOLDING CO	PA	N/A	C					No
(31) BAYSIDE DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401386	REAL ESTATE	PA	N/A	C					No
(32) UPMC WORK ALLIANCE INC 600 GRANT STREET PITTSBURGH,PA15219 45-2825053	INSURANCE	PA	N/A	C					No
(33) UPMC CANADA TECHNOLOGIES LIMITED 600 GRANT STREET PITTSBURGH,PA15219	SOFTWARE	CA	N/A	C					No
(34) UPMC HEALTH COVERAGE INC 600 GRANT STREET PITTSBURGH,PA15219 46-2824537	INSURANCE	PA	N/A	C					No
(35) UPMC HEALTH OPTIONS INC 600 GRANT STREET PITTSBURGH,PA15219 46-2824626	INSURANCE	PA	N/A	C					No
(36) UPMC COMPLETE CARE INC 5215 CENTRE AVENUE PITTSBURGH,PA15232 46-3605753	PHYSICIAN SERVICES	PA	N/A	C					No
(37) AMERICAN HOME HEALTH SERVICES 868 CORPORATE WAY WESTLAKE,OH44145 31-1521422	HOME HEALTH CARE	OH	N/A	C					No
(38) HEALTH FIDELITY INC 210 S B ST SAN MATEO,CA94401 45-2538963	TECHNOLOGY SV	CA	N/A	C					No
(39) CURAVI HEALTH INC 6425 PENN AVENUE PITTSBURGH,PA15206 81-1217377	HEALTHCARE	DE	N/A	C					No
(40) PENSIAMO INC 600 GRANT STREET PITTSBURGH,PA15219 81-2069236	SUPPLY CHAIN	DE	N/A	C					No
(41) ALTOONA FAMILY INC 620 HOWARD AVENUE ALTOONA,PA16601 25-1444935	MGMT SVCS	PA	N/A	C					No
(42) LEXINGTON HOLDINGS INC 620 HOWARD AVENUE ALTOONA,PA16601 25-1794386	HOLDING CO	PA	N/A	C					No
(43) LEXINGTON ONE INC 620 HOWARD AVENUE ALTOONA,PA16601 25-1468889	RENTAL	PA	N/A	C					No
(44) LEXINGTON TWO INC HOWARD AVENUE AND 7TH STREET ALTOONA,PA16601 25-1555689	DME	PA	N/A	C					No
(45) LEXINGTON FOUR INC 620 HOWARD AVENUE ALTOONA,PA16601 25-1793736	HOLDING CO	DE	N/A	C					No
(46) UPMC ALTOONA REGIONAL HEALTH SERVICES 1414 9TH AVENUE ALTOONA,PA16602 25-1219302	MEDICAL SVCS	PA	N/A	C					No
(47) LEXINGTON ANESTHESIA ASSOCIATES INC 620 HOWARD AVENUE ALTOONA,PA16601 25-1897765	MEDICAL SVCS	PA	N/A	C					No
(48) UPMC EXCESS PL TRUST 600 GRANT STREET PITTSBURGH,PA15219 82-6254351	TRUST	PA	N/A	T					No
(49) RXANTE INC 511 CONGRESS STREET 803 PORTLAND,ME04101 45-4040219	MEDICATION MGT	DE	N/A	C					No
(50) SUSQUEHANNA HEALTH SYSTEM INSURANCE NET PO BOX 1159 CAYMAN ISLANDS CJ	INSURANCE	CJ	N/A	C					No
(51) SUSQUEHANNA VENTURES INC 1201 GRAMPAIN BOULEVARD WILLIAMSPORT,PA17701 23-2470623	PHARMACY	PA	N/A	C					No
(52) PINNACLE HEALTH CARDIOVASCULAR INSTITUT 409 SOUTH SECOND STREET HARRISBURG,PA17104 32-0321362	PHYSICIAN SERVICES	PA	N/A	C					No
(53) HANOVER HEALTH CORPORATION 300 HIGHLAND AVENUE HANOVER,PA17331 90-0498067	HOLDING CO	PA	N/A	C					No
(54) HANOVER APOTHECARY INC 310 STOCK STREET SUITE 1 HANOVER,PA17331 03-0594526	PHARMACY	PA	N/A	C					No
(55) UNITED CENTRAL PA RECIPROCAL RISK RETEN 76 SAINT PAUL STREET SUITE 500 BURLINGTON,VT05401 13-4224033	INSURANCE	VT	N/A	C					No
(56) PINNACLE HEALTH VENTURES INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 61-1677624	HOLDING CO	PA	N/A	C					No
(57) PINNACLE HEALTH IMAGING INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1718571	IMAGING SVC	PA	N/A	C					No
(58) COLE CARE INC 1001 EAST 2ND STREET COUDERSPORT,PA16915 25-1497347	DME	PA	N/A	C					No
(59) UPMC ITALY HEALTH SERVICES SRL VIA DISCESA DEI GIUDICI 4 PALERMO 90133 IT	HEALTH SVC	IT	N/A	C					No
(60) UPMC INVESTMENTS LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD X91 DH9W EI	HOLDING CO	EI	N/A	C					No
(61) UPMC PROPERTY LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD X91 DH9W EI	PROPERTY	EI	N/A	C					No
(62) EURO CARE INFRASTRUCTURE LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD X91 DH9W EI	PROPERTY MGMT	EI	N/A	C					No
(63) EURO CARE PROPERTY MANAGEMENT LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD X91 DH9W EI	PROPERTY MGMT	EI	N/A	C					No
(64) EURO CARE HEALTHCARE LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD X91 DH9W EI	HOLDING CO	EI	N/A	C					No
(65) BLUESPHERE BIO 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 82-4979766	IMMUNOTHERAPY	PA	N/A	C					No
(66) INFECTIOUS DISEASE CONNECT INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 83-3311071	TELEMEDICINE	PA	N/A	C					No
(67) HUMONIC INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 83-4005420	BIOPHARM	PA	N/A	C					No
(68) NOVASENTA INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 82-5443222	IMMUNOTHERAPY	PA	N/A	C					No
(69) UPMC HILLMAN CANCER CENTER - PINNACLE 101 ERFORD ROAD CAMP HILL,PA17701 83-3640945	CANCER TREATMENT	PA	N/A	C					No
(70) SHANGHAI UPMC CO LTD 288 SHIMEN 1ST ROAD JINGAN DISTRIC SHANGHAI CH	HEALTHCARE MGMT	CH	N/A	C					No
(71) SALVADOR MUNDI INTERNATIONAL HOSPITAL ROMA VIALE DELLE MURA GIANICOLENSI IT	HOSPITAL	IT	N/A	C					No
(72) SOMERSET ANESTHESIA INC 600 GRANT STREET PITTSBURGH,PA15219 45-5135437	PHYSICIAN SRV	PA	N/A	C					No
(73) SOMERSET MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1512960	MOB OWNERSHIP	PA	N/A	C					No
(74) GENERIAN PHARMACEUTICALS INC 2425 SIDNEY STREET PITTSBURGH,PA15203 83-3340453	PHARMACY	DE	N/A	C					No
(75) WORK PARTNERS NATIONAL INC 600 GRANT STREET PITTSBURGH,PA15219 84-3141950	INSURANCE	PA	N/A	C					No
(76) ASTRATA INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-4804493	SOFTWARE	DE	N/A	C					No
(77) VEGAVECT 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-4280784	GENE THERAPY	DE	N/A	C					No
(78) NOVIMAB 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-1494905	CLINICAL RESEARCH	DE	N/A	C					No
(79) HAYSTACK CONSOLIDATED SERVICES INC 12500 WILLOWBROOK ROAD CUMBERLAND,MD21502 52-1335895	INACTIVE	PA	N/A	C					No
(80) WESTERN MARYLAND INSURANCE COMPANY LTD PO BOX 10233 GRAND CAYMAN CJ	INSURANCE	CJ	N/A	C					No
(81) WILLOWBROOK HEALTHCARE CONDO 12401 WILLOWBROOK ROAD CUMBERLAND,MA21502 37-1538510	REAL ESTATE	DE	N/A	C					No
(82) UPMC WHITFIELD HOSPITAL LTD C/O UPMC WHITFIELD CORK ROAD BUTLER WATERFORD EI	HOSPITAL	EI	N/A	C					No
(83) UPMC GLOBAL OPERATIONS CENTER LTD 6TH FLOOR BEACON HOSPITAL SANDYFORD EI	CANCER TREATMENT	EI	N/A	C					No
(84) REALYZE INTELLEGENCE INC 6425 PENN AVENUE PITTSBURGH,PA15206 85-0873923	SOFTWARE	DE	N/A	C					No
(85) GENERIAN PHARMACEUTICALS AUSTRALIA PTY L LEVEL 5 63 PIRIE STREET ADELAIDE AU	PHARMACY	AU	N/A	C					No
(86) RXANTE PHARMACY SERVICES INC 511 CONGRESS STREET 803 PORTLAND,ME04101 83-3402761	PHARMACY	DE	N/A	C					No
(87) CLANE HOSPITAL DEVELOPMENT ASSOCIATES L C/O UPMC WHITFIELD CORK ROAD BUTLERSTOWN NORTH WATERFORD EI	MANAGEMENT	EI	N/A	C					No
(88) UPMC KILDARE HOSPITAL LTD PROSPEROUS ROAD CLANE COUNTY KILDARE EI	HOSPITAL	EI	N/A	C					No
(89) UPMC AUT EVEN HOSPITAL LTD FRESHFORD ROAD COUNTY KILKENNY EI	HOSPITAL	EI	N/A	C					No

Schedule R (Form 990) 2021

Page 3

Part V

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

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

Yes

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

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

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

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

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) .......................

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

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

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

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

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

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

Yes

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

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

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) WCA FOUNDATION INC	C	522,346	ACCOUNTING RECORDS
(2) WCA SERVICES CORPORATION	P	89,302	ACCOUNTING RECORDS

Schedule R (Form 990) 2021

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) 2021

Page 5

Part VII

Supplemental Information

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

Return Reference

Explanation

FORM 990 - SCHEDULE R - PART II THROUGH PART IV

ENTITIES REPORTED IN PARTS I THROUGH IV THAT ARE MARKED WITH AN * ARE NOT TECHNICALLY "RELATED ORGANIZATIONS", AS DEFINED IN THE FORM 990 INSTRUCTIONS AS THE REQUISITE "CONTROL" DID NOT EXIST DURING THE FISCAL YEAR ENDED JUNE 30, 2022. HOWEVER, BECAUSE THESE ENTITIES ARE AFFILIATED WITH UPMC AND THE UPMC PARENT ORGANIZATION HOLDS CERTAIN POWERS WITH RESPECT TO SUCH ENTITIES WE ARE ELECTING TO DISCLOSE THE ENTITIES AS RELATED ORGANIZATIONS IN SCHEDULE R IN THE INTEREST OF TRANSPARENCY. RELATED ORGANIZATIONS AN UNRELATED PARTNERSHIPS - THERE ARE ORGANIZATIONS INCLUDED IN THE UPMC GROUP FORM 990 TAX RETURN FOR CALENDAR YEAR 2021 WHICH ARE "RELATED" TO UPMC CHAUTAUQUA AT WCA (SEE PRIOR NOTE). THESE ORGANIZATIONS ARE NOT REQUIRED TO BE LISTED IN SCHEDULE R.

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE OF CHAUTAUQUA COUNTY AND THE SURROUNDING AREA IN A WAY THAT INCLUDES COMPASSION, DEDICATION, A COMMITMENT TO QUALITY AND PATIENT SAFETY WHILE MAINTAINING ECONOMIC VIABILITY AND A VISION FOR THE 21ST CENTURY, WITHOUT REGARD FOR THE PATIENTS ABILITY TO PAY FOR THESE HEALTH SERVICES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
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 2021 (Part V, line 2a) ......	5	1,041
6	Total number of volunteers (estimate if necessary) .............	6	22
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	10,093,262	4,321,214
9	Program service revenue (Part VIII, line 2g) .........	102,312,020	116,750,072
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	250,412	-13,745
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,750,668	3,923,282
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	114,406,362	124,980,823
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	52,819,306	64,267,181
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)....	71,710,507	73,228,579
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	124,529,813	137,495,760
19	Revenue less expenses. Subtract line 18 from line 12.......	-10,123,451	-12,514,937
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	84,859,370	106,691,665
21	Total liabilities (Part X, line 26).............	34,449,937	53,390,010
22	Net assets or fund balances. Subtract line 21 from line 20.....	50,409,433	53,301,655

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 111,651,413 including grants of $ ) (Revenue $ 119,303,851 )
	OPERATED A HOSPITAL TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE OF CHAUTAUQUA COUNTY AND THE SURROUNDING AREA. SEE SCHEDULE O FOR ADDITIONAL DETAILS.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses111,651,413

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,091,915	2,282,432	515,808

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) SRINIVAS BOMMIREDDIPALLI MD........................................................................ HOSPITALIST	40.00 .......................	X	337,024	0	35,656

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	522,346
e	Government grants (contributions)		1e	3,562,216

f	All other contributions, gifts, grants, and similar amounts not included above		1f	236,652

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

h Total. Add lines 1a-1f.......		4,321,214

		Business Code
2a	PATIENT REVENUE	621500	115,245,407	115,245,407
b	EQUITY INVESTMENTS REVENUE	621500	1,504,665	1,504,665
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		116,750,072

3 Investment income (including dividends, interest, and othersimilar amounts) ......			10,335			10,335
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents	1,369,503		6a
b	Less: rental expenses	0		6b
c	Rental income or (loss)	1,369,503		6c
d	Net rental income or (loss).......			1,369,503			1,369,503
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses	24,080		7b
c	Gain or (loss)	-24,080		7c
d	Net gain or (loss).........			-24,080			-24,080
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	OTHER MISCELLANEOUS REVENUE		900099	2,203,783	2,203,783
b	CAFETERIA REVENUE		621990	201,798	201,798
c	EDUCATION REVENUE		621990	125,729	125,729
d	All other revenue ....			22,469	22,469
e	Total. Add lines 11a–11d ......			2,553,779
12	Total revenue. See instructions.....			124,980,823	119,303,851	0	1,355,758

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	202,351	202,351
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	52,905,113	50,967,855	1,937,258
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	8,133,252	7,836,388	296,864
10	Payroll taxes ...........	3,026,465	2,915,999	110,466
11	Fees for services (non-employees):
a	Management ......	24,530		24,530
b	Legal .........	201,340	176,760	24,580
c	Accounting ...........	97,300		97,300
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	3,840,133		3,840,133
12	Advertising and promotion ....	77,284	77,284
13	Office expenses .......	367,782	318,028	49,754
14	Information technology ......	824,234	812,706	11,528
15	Royalties ..
16	Occupancy ...........	3,942,462	2,708,600	1,233,862
17	Travel ............	77,070	63,887	13,183
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	5,334	5,334
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	6,521,087	6,521,087
23	Insurance ...	1,058,290	919,436	138,854
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	ENTERPRISE SHARED SERVI	16,428,012		16,428,012
b	HOSPITAL AND MEDICAL SU	12,242,094	12,242,094
c	OTHER	11,953,844	10,315,821	1,638,023
d	DRUGS	10,003,292	10,003,292
e	All other expenses	5,564,491	5,564,491
25	Total functional expenses. Add lines 1 through 24e	137,495,760	111,651,413	25,844,347	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 ........			582,096	1	510,511
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			16,974,865	4	19,833,713
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 .......
					5
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) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			889,592	8	1,062,506
9	Prepaid expenses and deferred charges ......			582,539	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	74,100,775
b	Less: accumulated depreciation	10b	11,830,848	40,314,924	10c	62,269,927
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			3,064,192	12	1,080,454
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			0	14	7,002,897
15	Other assets. See Part IV, line 11 ...........			22,451,162	15	14,931,657
16	Total assets. Add lines 1 through 15 (must equal line 33)...			84,859,370	16	106,691,665

17	Accounts payable and accrued expenses .....	3,252,293	17	2,134,637
18	Grants payable ...		18
19	Deferred revenue .........	971,256	19	25,187,346
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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 .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	542,617	23	331,074
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	29,683,771	25	25,736,953
26	Total liabilities. Add lines 17 through 25..	34,449,937	26	53,390,010

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	31,495,855	27	32,179,630
28	Net assets with donor restrictions ...........	18,913,578	28	21,122,025
	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 ...........	50,409,433	32	53,301,655
33	Total liabilities and net assets/fund balances ........	84,859,370	33	106,691,665