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 P JOHNSON...................................................................... DIRECTOR	1.0 ................. 2.0	X				0	1,068,767	132,926
(2) TERRANCE FOUST DO...................................................................... PHYSICIAN	40.0 ................. 1.0			X		855,027	0	64,193
(3) BRADLEY GIANNOTTI MD...................................................................... PHYSICIAN	40.0 ................. 0.0			X		851,353	0	56,114
(4) DAVID J LOPATOFSKY MD...................................................................... DIRECTOR/VICE CHAIR END 12/21	1.0 ................. 2.0	X	X			0	718,820	124,256
(5) SAKET PRASAD MD...................................................................... PHYSICIAN	40.0 ................. 0.0			X		651,567	0	68,337
(6) JEREMY REED MD...................................................................... PHYSICIAN	40.0 ................. 0.0			X		465,644	0	39,015
(7) MARIBETH MCLAUGHLIN...................................................................... DIRECTOR	1.0 ................. 2.0	X				0	446,564	56,100
(8) ETHAN GABLE MD...................................................................... PHYSICIAN	40.0 ................. 0.0			X		433,196	0	23,565
(9) JANIE HILFIGER...................................................................... PRESIDENT/CEO	47.0 ................. 3.0		X			0	282,802	34,303
(10) PATRICIA JACKSON-GEHRIS...................................................................... PRES UPMC NCPA BEGIN 06/22	40.0 ................. 2.0		X			0	267,132	26,386
(11) EDWARD PITCHFORD...................................................................... PRESIDENT/CEO	0.0 ................. 0.0				X	0	292,699	0
(12) RON RAPP...................................................................... CHIEF FINANCIAL OFFICER	47.0 ................. 2.0		X			188,464	0	48,916
(13) MARY ANN RIGAS MD...................................................................... DIRECTOR	1.0 ................. 2.0	X				179,239	0	39,713
(14) CARRIE ENNIS...................................................................... DIRECTOR	1.0 ................. 2.0	X				0	177,777	27,582
(15) ALANNA HUCK...................................................................... SECRETARY/VICE CHAIR BEG 12/21	1.0 ................. 2.0	X	X			0	0	0
(16) MICHAEL CALLAHAN DO...................................................................... DIRECTOR	1.0 ................. 2.0	X				0	0	0
(17) MELYNDA BUDD...................................................................... DIRECTOR/TREASURER BEG 12/21	1.0 ................. 2.0	X	X			0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
MCCLURE COMPANY, 2000 CORPORATE DRIVE WEXFORD,PA15090	CONTRACTING	1,839,415
HALLSTOM CONSTRUCTION, 101 E LONG AVE DUBOIS,PA15801	CONTRACTING	572,035
JASON MICHEAL KODAT MD, 5043 GREENSBURG RD MURRYSVILLE,PA15668	PHYSICIAN SERVICES	532,985
WADE PORTERFIELD MD, 3887 WEST BRANCH ROAD ALLEGANY,NY14706	PHYSICIAN SERVICES	415,272
JAMES N RINTOUL MD, PO BOX 884 CAMP HILL,PA17001	PHYSICIAN SERVICES	449,020
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 15

- 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

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

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

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

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

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

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

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization CHARLES COLE MEMORIAL HOSPITAL

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

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

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990) (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

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 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	12,532
d	Additions during the year ............................	1d	47,568
e	Distributions during the year ..........................	1e	59,323
f	Ending balance ................................	1f	777

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 ....	5,158,025	3,930,704	4,225,292	4,220,847	4,095,589
b	Contributions ...
c	Net investment earnings, gains, and losses	268,182	1,404,272	-85,227	195,396	301,199
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	196,918	176,951	209,361	190,951	175,941
f	Administrative expenses ....
g	End of year balance ......	5,229,289	5,158,025	3,930,704	4,225,292	4,220,847

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

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

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

Yes

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

3a(i)

Yes

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

3a(ii)

Yes

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

Yes

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

Part VI

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

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

1a	Land .....	1,030,847		1,030,847
b	Buildings ....	26,185,372	8,064,700	18,120,672
c	Leasehold improvements
d	Equipment ....	14,965,641	7,830,933	7,134,708
e	Other .....	2,854,020	217,679	2,636,341
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				28,922,568

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)DUE FROM EXEMPT AFFILIATES				17,529,500
(2)DUE FROM THIRD PARTY PAYORS				526,477
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				18,055,977

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	3,548,372
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
SCHEDULE D, PART IV, LINE 1B	ESCROW ACCOUNTS: THE CORPORATION HAS AN ESCROW ACCOUNT FOR THEIR SKILLED NURSING FACILITY PATIENTS WHO REQUEST THE USE OF THE ACCOUNT.
SCHEDULE D, PART IV, LINE 2B	AMOUNT ON FORM 990, PART X, LINE 21 FOR ESCROW LIABILITY: THE ORGANIZATION ADDED ESCROW BALANCE TO BALANCE SHEET IN MARCH OF 2021.
SCHEDULE D, PART V, LINE 4	ENDOWMENT FUND: THE ENDOWMENT FUND WAS ESTABLISHED TO ALLOW THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES TO POOR AND NEEDY PATIENTS.
SCHEDULE D, PART X, LINE 2	UNCERTAIN TAX POSITIONS: AN EXTERNAL AUDIT IS COMPLETED AT A CONSOLIDATED UPMC SYSTEM LEVEL ONLY, INCLUDING UPMC AND ALL TAXABLE AND TAX-EXEMPT SUBSIDIARIES. TAX BENEFITS ARE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION BY THE TAX AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION. SUCH TAX POSITIONS ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY TO BE REALIZED UPON ULTIMATE SETTLEMENT WITH THE TAX AUTHORITIES ASSUMING FULL KNOWLEDGE OF THE POSITION AND ALL RELEVANT FACTS. AS OF JUNE 30, 2022 UPMC DOES NOT HAVE AN UNCERTAIN TAX POSITIONS RECORDED.

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

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	149,045		149,045	0.150 %
b	Medicaid (from Worksheet 3, column a) . . . . .	17,752,419	15,200,080	2,552,337	2.520 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	17,901,464	15,200,080	2,701,382	2.670 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	406,074		406,074	0.400 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	30,149,861	16,256,984	13,892,877	13.700 %
h	Research (from Worksheet 7) .	6,737		6,737	0.010 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	1,663		1,663
j	Total. Other Benefits . .	30,564,335	16,256,984	14,307,351	14.110 %
k	Total. Add lines 7d and 7j .	48,465,799	31,457,064	17,008,733	16.780 %

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. ......

5,496,475

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. ......

887,131

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

Section B. Medicare

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

14,066,040

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

13,926,773

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

139,267

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 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	CHARLES COLE MEMORIAL HOSPITAL 1001 EAST 2ND STREET COUDERSPORT,PA16915 UPMC.COM/NORTHCENTRALPA 031801	X	X	X	X

Schedule H (Form 990) 2021

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Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

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

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

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

Yes

6 a

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

Yes

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

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

Yes

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

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

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

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

Yes

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

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2021

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Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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

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

Yes

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

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

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

SEE PART V, SECTION C

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

SEE PART V, SECTION C

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

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2021

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Part VFacility Information (continued)

Billing and Collections

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

Yes

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2021

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Part VFacility Information (continued)

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

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

Yes

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

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

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Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 5	COMMUNITY INPUT: COMMUNITY INPUT ON THE PERCEIVED HEALTH NEEDS AND PRIORITIES OF THE REGION WAS USED TO COMPLEMENT ANALYSIS OF PUBLICLY AVAILABLE DATA. TO IDENTIFY AND PRIORITIZE HEALTH NEEDS OF THE COMMUNITIES SERVED, THE CHNA SOLICITED AND TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE FISCAL YEAR 2022 CHNA BUILDS ON THE SYSTEM-WIDE ASSESSMENT PROCESSES APPLIED IN FISCAL YEARS 2013, 2016, AND 2019, ENGAGING COMMUNITY ADVISORY PANELS TO PROVIDE STRUCTURED INPUT ON HEALTH NEEDS PRESENT IN EACH HOSPITAL'S SURROUNDING COMMUNITY. IN MAY-JUNE 2021, 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 SURVEY WAS EXTENDED TO A TOTAL OF 2,868 COMMUNITY PARTICIPANTS FROM 28 UPMC HOSPITAL COMMUNITIES PARTICIPANTS INCLUDED: - LEADERS OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND 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. - OTHER STAKEHOLDERS IN COMMUNITY HEALTH SUCH AS CONSUMER ADVOCATES, NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, LOCAL SCHOOL DISTRICTS, GOVERNMENT ORGANIZATIONS, AND HEALTH CARE PROVIDERS. IN ADDITION TO THE COMMUNITY SURVEY, UPMC HOSPITALS IN NORTH CENTRAL PA. MET WITH COMMUNITY BENEFIT ADVISORS AND KEY SERVICE LINE HOSPITAL LEADERS. PARTICIPANTS INCLUDED MORE THAN 150 HOSPITAL AND COMMUNITY LEADERS. THE MEETINGS WERE FOCUSED ON REVIEWING THE IDENTIFIED COMMUNITY HEALTH PRIORITIES FROM THE COMMUNITY SURVEY RESULTS AND AIDED IN THE DEVELOPMENT OF THE IMPLEMENTATION PLANS FOR THE FIVE HOSPITALS.
SCHEDULE H, PART V, SECTION B, LINE 6A	CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED ALONG WITH THE FOLLOWING HOSPITALS: - UPMC LOCK HAVEN - UPMC MUNCY - UPMC WILLIAMSPORT - UPMC WILLIAMSPORT DIVINE PROVIDENCE - UPMC WELLSBORO
SCHEDULE, PART V, SECTION B, LINE 7A	CHNA AVAILABILITY: THE HOSPITAL POSTED THE REPORT ON THE WEBSITE UNDER ABOUT US. YOU CAN LOCATE IT AT HTTPS://WWW.UPMC.COM/ABOUT/COMMUNITY-COMMITMENT/COMMUNITY-HEALTH-NEEDS-ASS ESSMENT
SCHEDULE H, PART V, SECTION B, LINE 10A	IMPLEMENTATION STRATEGY AVAILABILITY: HTTPS://CDN.UPMC.COM/-/MEDIA/UPMC/ABOUT/COMMUNITY-COMMITMENT/2022-COMMUNIT Y-COMMITMENT/NORTH-CENTRAL-CHNA-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 11	IMPLEMENTATION STRATEGY: THE SECONDARY DATA ANALYSES AND RESULTS FROM THE COMMUNITY INPUT SURVEY PROCESS WERE AGGREGATED, EVALUATED, AND SYNTHESIZED WITH THE ASSISTANCE OF PUBLIC HEALTH EXPERTS FROM PITT PUBLIC HEALTH. THROUGH THIS EFFORT, UPMC HOSPITAL LEADERSHIP IDENTIFIED A SET OF SIGNIFICANT HEALTH NEEDS AND THEIR COMPOSITE HEALTH ISSUES THAT ARE CRITICAL, ADDRESSABLE, AND HAVE HIGH LEVELS OF URGENCY IN THE COMMUNITY. THE PROCESS THEN MATCHED THOSE NEEDS TO: - BEST-PRACTICE METHODS FOR ADDRESSING THESE NEEDS. - EXISTING HOSPITAL COMMUNITY HEALTH PROGRAMS AND RESOURCES. PROGRAMS AND PARTNERS ELSEWHERE IN THE COMMUNITY THAT CAN BE SUPPORTED AND LEVERAGED. - ENHANCED DATA COLLECTION CONCERNING PROGRAMS. - A SYSTEM OF ASSESSMENT AND REASSESSMENT MEASUREMENTS TO GAUGE PROGRESS OVER REGULAR INTERVALS. UPMC ENGAGED WITH RESEARCHERS FROM PITT PUBLIC HEALTH TO DEVELOP EVALUATION METRICS TO MEASURE AND TRACK PROGRESS RELATED TO THE IMPLEMENTATION PLANS. THE METRICS VARY BY HOSPITAL, ACCORDING TO HEALTH OUTCOMES, CURRENT HOSPITAL EFFORTS, AND HOSPITAL RESOURCES. THE IMPLEMENTATION PLANS WERE DEVELOPED WITH THE EXPECTATION THAT FUTURE PROGRESS WOULD BE REVIEWED BY THE HOSPITALS, AS WELL AS POTENTIALLY BY PUBLIC HEALTH AGENCIES. THEREFORE, TWO TYPES OF OUTCOMES ARE CONSIDERED: PROCESS OUTCOMES (DIRECTLY RELATING TO HOSPITAL/PARTNER DELIVERY OF SERVICES): - PROCESS OUTCOMES INDICATE EFFORTS HOSPITALS AND COMMUNITY PARTNERS CAN UNDERTAKE TO INCREASE DELIVERY OF A SERVICE DESIGNED TO CHANGE A HEALTH IMPACT INDICATOR. THESE MOSTLY INVOLVE INCREASES (OR BETTER TARGETING) IN PROGRAMMING, OUTREACH, PUBLICITY, OR RELATED EFFORTS. PROCESS OUTCOMES CAN BE MEASURED BY INCREASES IN INVESTMENT (DOLLARS OR PERSONNEL), OUTREACH (MEDIA MESSAGES, PUBLIC SERVICE ANNOUNCEMENTS), SERVICE UNITS DELIVERED (CLASSES, SCREENINGS), PEOPLE ATTENDING OR COMPLETING PROGRAMS, AND NUMBER OF SITES FOR DELIVERY OF PROGRAMS. - HEALTH IMPACT OUTCOMES (APPLIES TO CHANGES IN POPULATION HEALTH FOR WHICH THE HOSPITAL'S EFFORTS ARE ONLY INDIRECTLY RESPONSIBLE): HEALTH IMPACT OUTCOMES ARE CHANGES IN POPULATION HEALTH RELATED TO A BROAD ARRAY OF FACTORS, OF WHICH HOSPITAL AND COMMUNITY PARTNER EFFORTS ARE ONLY ONE CONTRIBUTING PART. THESE OUTCOMES INCLUDE REDUCTIONS IN THE PREVALENCE OF DISEASE, RISK FACTORS, AND HEALTH BEHAVIORS ASSOCIATED WITH DISEASE. BENCHMARKS FOR PROGRESS IN POPULATION INDICATORS ARE AVAILABLE FROM HEALTHY PEOPLE 2020, HEALTHY PEOPLE 2030, AND ROBERT WOOD JOHNSON COUNTY HEALTH RANKINGS & ROADMAPS. ALTHOUGH THE COMMUNITY HEALTH NEEDS ASSESSMENTS FOCUS ON THREE-YEAR PLANS AND PROGRESS REPORTS, SOME EVALUATION IS CONDUCTED TO MONITOR LONGER-TERM HEALTH OUTCOMES. INITIAL REVIEW OF MEASURES FROM THE ROBERT WOOD JOHNSON COUNTY HEALTH RANKINGS & ROADMAPS TRENDED FROM 2013 THROUGH 2020 SUGGESTS IMPROVEMENTS ACROSS SOME, BUT NOT ALL METRICS. FOR EXAMPLE, HEALTH INSURANCE COVERAGE AND THE RATE OF PREVENTABLE HOSPITAL STAYS, WHICH CAN BE USED AS A PROXY FOR ACCESS TO CARE AND NAVIGATING RESOURCES, IMPROVED IN CLINTON, LYCOMING, POTTER, AND TIOGA COUNTIES OVER THIS PERIOD. YET OUTCOME-ORIENTED METRICS INCLUDING OBESITY AND DIABETES PREVALENCE DO NOT NECESSARILY DEMONSTRATE IMPROVEMENTS OVER THIS PERIOD NATIONWIDE OR IN THE FOUR-COUNTY REGION. UPMC WILL CONTINUE TO MONITOR THESE MEASURES FROM A LONGER TERM TREND PERSPECTIVE.
SCHEDULE H, PART V, LINE 13H	OTHER FACTORS USED IN ELIGIBILITY CRITERIA: CHARLES COLE MEMORIAL HOSPITAL ALSO USES THE FOLLOWING METHODS: -EMPLOYMENT STATUS ALONG WITH FUTURE EARNINGS POTENTIAL AND ASSESS IF IT IS SUFFICIENT TO MEET THE OBLIGATION WITHIN A REASONABLE PERIOD OF TIME -FAMILY SIZE AND CONFIGURATION -AMOUNT(S) AND FREQUENCY OF HOSPITAL AND OTHER HEALTHCARE/MODIFICATION BILLS IN RELATION TO ALL OTHER FACTORS.
SCHEDULE H, PART V, LINE 16A, 16B & 16C	POLICY PUBLICATION: HTTP://WWW.COLEMEMORIAL.ORG/PATIENTS-FINANCIAL.ASPX
SCHEDULE H, PART V, LINE 16I	LEP TRANSLATIONS: THERE ARE NO GROUPS WITH LIMITED ENGLISH PROFICIENCY THAT RISE TO THE THRESHOLD REQUIRED UNDER IRC SECTION 501(R). HOWEVER, LANGUAGE TRANSLATIONS OF THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE BY REQUEST AT THE FINANCIAL COUNSELING DEPARTMENT OF THE HOSPITAL.

Schedule H (Form 990) 2021

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?13
Name and address		Type of Facility (describe)
1	PORT ALLEGANY HEALTH CENTER 45 PINE STREET PORT ALLEGANY,PA16743	DENTAL PRACTICE, RURAL HEALTH CENTER, REHABILITATION LAB SERVICES, RADIOLOGY
2	SHINGLEHOUSE HEALTH CENTER 129 PURITAN STREET SHINGLEHOUSE,PA16748	RURAL HEALTH CENTER REHABILITATION LAB SERVICES, RADIOLOGY
3	ELDRED HEALTH CENTER 139 MAIN STREET ELDRED,PA16371	RURAL HEALTH CENTER LAB SERVICES
4	EMPORIUM HEALTH CENTER 288 SIZERVILLE ROAD EMPORIUM,PA15834	RURAL HEALTH CENTER REHABILITATION LAB SERVICES
5	GALETON HEALTH CENTER 30 RIVER STREET GALETON,PA16922	RURAL HEALTH CENTER LAB SERVICES
6	WESTFIELD RURAL HEALTH CLINIC 222 CHURCH STREET WESTFIELD,PA16950	RURAL HEALTH CENTER LAB SERVICES
7	BOWMAN HEALTH CENTER 83 MARVIN STREET SMETHPORT,PA16749	RURAL HEALTH CENTER REHABILITATION LAB SERVICES
8	NORTHERN POTTER HEALTH CENTER 511 ACADEMY STREET ULYSSES,PA16948	RURAL HEALTH CENTER LAB SERVICES
9	CENTRAL POTTER HEALTH CENTER 46 ELK STREET COUDERSPORT,PA16915	RURAL HEALTH CENTER LAB SERVICES
10	HOME HEALTH AND HOSPICE 102-108 SOUTH MAIN ST COUDERSPORT,PA16915	HOME HEALTH OFFICES
11	BEHAVIORAL HEALTH-TELEMD 11 8TH STREET COUDERSPORT,PA16915	TELEMED LOCATION
12	COVID COLLECTION SIGHT 438 EAST 2ND STREET COUDERSPORT,PA16915	COVID COLLECTION SIGHT
13	BRADFORD SPECIALISTS 1001 EAST MAIN STREET BRADFORD,PA167013978	SPECIALTY MEDICAL CENTER

Schedule H (Form 990) 2021

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Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 7, COLUMN F	PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE OF $5,496,475.
SCHEDULE H, PART I, LINE 7G	SUBSIDIZED HEALTH SERVICES: SEVERAL RURAL HEALTH CLINICS WERE INCLUDED IN THE COMPUTATION OF SUBSIDIZED HEALTH SERVICES ON LINE 7G AMOUNTING TO $13,892,877 NET COMMUNITY BENEFIT EXPENSE. UPMC COLE PROVIDES PRIMARY CARE TO THE SURROUNDING COUNTIES AT THESE RURAL HEALTH CENTERS. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. UPMC COLE CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED.
SCHEDULE H, PART I, LINE 7	COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3, AND 6.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ALLOW UPMC COLE TO FULFILL ITS MISSION OF WORKING TOGETHER TO OPTIMIZE THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES COLE SERVES. ONE OF OUR STRATEGIC PRIORITIES IS TO CREATE A CULTURE OF HEALTH FOR THE COMMUNITIES WE SERVE. IN DOING SO, WE NEED TO ADOPT, DEVELOP, CREATE, AND IMPLEMENT THESE COMMUNITY BUILDING ACTIVITIES FOR OUR COMMUNITY RESIDENTS. OUR COMMUNITY BENEFIT ADVISORS, NORTHERN TIER COMMUNITY COLLABORATIVE, AND OUR OUTREACH EFFORTS PLAY A KEY ROLE IN CREATING A CULTURE OF HEALTH AND FULFILLING OUR MISSION.
SCHEDULE H, PART III, SECTION A, LINE 2	BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOPSITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITALS'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.
SCHEDULE H, PART III, SECTION A, LINE 3	BAD DEBT EXPENSE ATTRIBUTABLE TO FAP-ELIGIBLE PATIENTS: LINE 3 WAS DETERMINED BY MULTIPLYING THE BAD DEBT EXPENSE (LINE 2) BY THE PERCENT OF PERSONS BELOW THE POVERTY LEVEL BASED ON US CENSUS BUREAU DATA FOR 2014 - 2018.
SCHEDULE H, PART III, SECTION A, LINE 4	BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE REGARDING BAD DEBT EXPENSE. THEY DO HOWEVER CONTAIN A FOOTNOTE REGARDING NET PATIENT SERVICE REVENUE. THIS NOTE CAN BE FOUND IN THE ATTACHED AUDITED FINANCIAL STATEMENTS. $5,460,000 YEAR ENDED JUNE 30, 2021 TO APPROXIMATELY $5,490,000 FOR THE YEAR ENDED JUNE 30, 2022. THE CHANGES ARE A RESULT OF TRENDS IN THE COLLECTION OF AMOUNTS FROM SELF-PAY PATIENTS IN FISCAL YEAR 2022.
SCHEDULE H, PART III, SECTION B, LINE 8	COMMUNITY BENEFIT: MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. UPMC COLE IS CLASSIFIED AS A CRITICAL ACCESS HOSPITAL. THIS CLASSIFICATION SHOWS THAT UPMC COLE IS IN A MEDICALLY UNDERSERVED AREA AND AT A HEALTH PROFESSIONAL SHORTAGE AREA. THIS DEMONSTRATES THAT UPMC COLE IS THE ONLY REASONABLE SOURCE OF HOSPITAL CARE AVAILABLE TO MEDICARE BENEFICIARIES IN OUR SERVICE AREA, AND LIKEWISE TREATS ALL BENEFICIARIES IN OUR SERVICE AREA THAT PRESENT THEMSELVES FOR CARE, DESPITE KNOWING WE WILL GENERALLY LOSE MONEY CARING FOR MEDICARE PATIENTS. ADDITIONALLY, SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
SCHEDULE H, PART III, SECTION C, LINE 9B	COLLECTION POLICY: EFFORTS ARE MADE TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE IN ACCORDANCE WITH THE HOSPITAL'S CHARITY CARE POLICY OR THE PHYSICIAN NETWORK SLIDING FEE SCALE PRIOR TO THE STATEMENT PROCESS WHEN POSSIBLE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT: SYNTHESIZING DATA FROM THE COMMUNITY INPUT PROCESS AND SECONDARY DATA ANALYSES FOR CLINTON, LYCOMING, POTTER, AND TIOGA COUNTIES YIELDED FOUR SIGNIFICANT HEALTH NEEDS FOR THE COMMUNITY: CHRONIC DISEASE MANAGEMENT, BEHAVIORAL HEALTH, ACCESS TO CARE, AND NAVIGATING RESOURCES, PREVENTION, AND COMMUNITY-WIDE HEALTHY LIVING THESE FOUR SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED BASED ON DATA FROM THE COMMUNITY INPUT PROCESS, THE EARLIER CONCEPT MAPPING EFFORTS CONDUCTED WITH COMMUNITY PARTICIPANTS, PUBLIC HEALTH LITERATURE, AND CONSULTATION WITH PUBLIC HEALTH EXPERTS. EACH NEED REPRESENTS AN AREA THAT IS CORRELATED WITH, AND OFTEN DRIVES, HEALTH OUTCOMES, INCLUDING MORTALITY, QUALITY OF LIFE, RISK OF HOSPITALIZATION, AND DISEASE BURDEN. ALL FOUR SIGNIFICANT HEALTH NEEDS ARE RATED AS A HIGH PRIORITY ON IMPORTANCE ACROSS THE COMMUNITY LEADER SURVEYS ADMINISTERED IN CLINTON, LYCOMING, POTTER, AND TIOGA COUNTIES (SCORED ABOVE 3.9 ON A SCALE OF 1 TO 5). THE ASSESSMENT ALSO IDENTIFIED FIVE COMPOSITE HEALTH TOPICS WITHIN THE OVERARCHING HEALTH PRIORITIES.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE PATIENT FINANCIAL COUNSELOR CONTACTS SELF-PAY PATIENTS/GUARANTORS TO DISCUSS PAYMENT ARRANGEMENTS. IF THEY ARE UNABLE TO PAY, SHE EXPLAINS THE PROCESS OF APPLYING FOR CHARITY WHICH INCLUDES APPLYING FOR PA MEDICAL ASSISTANCE FIRST AND IF THEY ARE DENIED OR HAVE A PORTION TO PAY, THEN THEY CAN APPLY FOR CHARITY. THE CHARITY APPLICATION IS ON THE BACK OF OUR SELF-PAY STATEMENTS. ALSO, THE HOSPITAL-OWNED PHYSICIAN PRACTICES ARE AWARE OF THIS PROGRAM AND REFER PATIENTS/GUARANTORS TO THE PATIENT FINANCIAL COUNSELOR.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION: FOR THE PURPOSE OF THIS JOINT CHNA, ALL FIVE OF THE COLLABORATING UPMC HOSPITAL FACILITIES DEFINE THEIR COMMUNITY TO BE THE FOUR-COUNTY REGION. WITH 87 PERCENT OF PATIENTS TREATED AT UPMC COLE, UPMC LOCK HAVEN, UPMC MUNCY, UPMC WELLSBORO, OR UPMC WILLIAMSPORT RESIDING IN CLINTON, LYCOMING, POTTER, OR TIOGA COUNTIES, THESE FIVE HOSPITALS PRIMARILY SERVE RESIDENTS OF THIS GEOGRAPHIC REGION. BY CONCENTRATING ON CLINTON, LYCOMING, POTTER, AND TIOGA COUNTIES, UPMC CAN CONSIDER THE NEEDS OF THE GREAT MAJORITY OF ITS PATIENTS AND DO SO IN A WAY THAT ALLOWS ACCURATE MEASUREMENT USING AVAILABLE SECONDARY DATA SOURCES. SEE PAGE 18 IN THE CHNA REPORT FOR THE NCPA REGION FOR MORE INFORMATION.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: UPMC COLE IS LARGELY DEPENDENT ON PROVIDING SERVICES AND CARE TO THOSE INDIVIDUALS WHO MAY NOT HAVE THE RESOURCES TO BE AWARE OF, ABLE TO PAY FOR, OR HAVE THE EDUCATION/KNOWLEDGE ABOUT CARE, PROGRAMS, AND SERVICES THAT ARE AVAILABLE TO THEM. THROUGH VARIOUS ACTIVITIES, COLE REACHES OUT TO OUR COMMUNITIES TO EDUCATE, IMPROVE HEALTH, PREVENT AND TREAT DISEASE, AND SUPPORT INDIVIDUALS AND GROUPS. IN CONJUNCTION WITH THE AREA AGENCY ON AGING, COLE PROVIDES NO-COST EDUCATION TO COUNTY SENIOR CENTERS FOR A TOTAL OF 30+ SESSIONS. TOPICS INCLUDE IMMUNIZATIONS, COPD, ADVANCE DIRECTIVES, PALLIATIVE CARE, HEART DISEASE, DIET AND NUTRITION, COLE SERVICES, AND MANY MORE. ALONG WITH MANY OTHER PROGRAMS SUCH AS SUPPORT GROUPS, SPEAKER'S BUREAU, WORKFORCE DEVELOPMENT, ECONOMIC SUPPORT, COMMUNITY LEADERSHIP, AND PARTNERSHIPS WITH LOCAL CIVIC, GOVERNMENT, SCHOOL DISTRICTS, AND COMMUNITY GROUPS, UPMC COLE CONTINUES EFFORTS TO ASSURE THAT HEALTHCARE, IN ALL FORMS, IS ACCESSIBLE AND AVAILABLE TO THOSE WHO MAY OTHERWISE GO WITHOUT. OTHER INFORMATION: UPMC COLE PROVIDES THE COMMUNITY WITH SPACE FOR EVENTS, MEETINGS, AND PROGRAMS SUCH AS SUPPORT GROUPS, ANNUAL EVENTS, TRAINING SESSIONS, AND YOUTH SPORTS. UPMC COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN ITS CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES IS TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY, AND AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS. AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS. TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES IS TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY, AND AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM: THE AFFILIATED HEALTH CARE SYSTEM INCLUDES CHARLES COLE MEMORIAL HOSPITAL (UPMC COLE), COLE CARE, INC., HENDORN, INC., HAMOTCOLE VENTURES, INC. AND COLE FOUNDATION. COLE MEMORIAL (THE HOSPITAL) PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN COUDERSPORT, PENNSYLVANIA. THE HOSPITAL ALSO OPERATES A HOME HEALTH AGENCY AND A NUMBER OF PHYSICIAN CLINICS IN THE SAME GEOGRAPHIC AREA. COLE CARE, INC., A WHOLLY OWNED SUBSIDIARY OF THE HOSPITAL, OPERATES A DURABLE MEDICAL EQUIPMENT COMPANY FOR THE SALE AND RENTAL OF EQUIPMENT. HENDORN, INC., D/B/A COLE MANOR (COLE MANOR), OF WHICH THE HOSPITAL IS THE SOLE CORPORATE MEMBER, OWNS AND OPERATES A 30-BED PERSONAL CARE RESIDENTIAL FACILITY. HAMOTCOLE VENTURES, INC., OF WHICH THE HOSPITAL IS THE SOLE CORPORATE MEMBER, PRIMARILY EARNS REVENUE THROUGH LEASE ARRANGEMENTS OF CERTAIN PROPERTIES IN WESTERN PENNSYLVANIA. COLE FOUNDATION PROVIDES SUPPORT TO THESE ORGANIZATIONS THROUGH FUNDRAISING ACTIVITIES. EFFECTIVE MARCH 1, 2018 CHARLES COLE MEMORIAL HOSPITAL WAS ENTERED INTO AN AFFILIATION AGREEMENT WITH UPMC. AS SUCH, THE HOSPITAL IS NOW PART OF THE UPMC SYSTEM WHICH INCLUDES MANY HOSPITALS AND ADDITIONAL RELATED ORGANIZATIONS SERVING THEIR COMMUNITIES. COMMUNITY BUILDING ACTIVITIES ALLOW UPMC COLE TO FULFILL ITS MISSION OF WORKING TOGETHER TO OPTIMIZE THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES COLE SERVES. ONE OF OUR STRATEGIC PRIORITIES IS TO CREATE A CULTURE OF HEALTH FOR THE COMMUNITIES WE SERVE. IN DOING SO, WE NEED TO ADOPT, DEVELOP, CREATE, AND IMPLEMENT THESE COMMUNITY BUILDING ACTIVITIES FOR OUR COMMUNITY RESIDENTS. OUR COMMUNITY BENEFIT ADVISORS, NORTHERN TIER COMMUNITY COLLABORATIVE, AND OUR OUTREACH EFFORTS PLAY A KEY ROLE IN CREATING A CULTURE OF HEALTH AND FULFILLING OUR MISSION.

Schedule H (Form 990) 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

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Cat. No. 50053T

Schedule J (Form 990) 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)
1JANIE HILFIGER PRESIDENT/CEO	(i) (ii)	0 ------------- 175,835	0 ------------- 104,470	0 ------------- 2,497	0 ------------- 22,461	0 ------------- 11,842	0 ------------- 317,105	0 ------------- 0
2MARY ANN RIGAS MD DIRECTOR	(i) (ii)	154,473 ------------- 0	22,746 ------------- 0	2,020 ------------- 0	15,649 ------------- 0	24,064 ------------- 0	218,952 ------------- 0	0 ------------- 0
3STEVEN P JOHNSON DIRECTOR	(i) (ii)	0 ------------- 504,358	0 ------------- 470,000	0 ------------- 94,409	0 ------------- 122,593	0 ------------- 10,333	0 ------------- 1,201,693	0 ------------- 78,600
4CARRIE ENNIS DIRECTOR	(i) (ii)	0 ------------- 132,335	0 ------------- 45,041	0 ------------- 401	0 ------------- 12,282	0 ------------- 15,300	0 ------------- 205,359	0 ------------- 0
5MARIBETH MCLAUGHLIN DIRECTOR	(i) (ii)	0 ------------- 228,225	0 ------------- 214,000	0 ------------- 4,339	0 ------------- 33,178	0 ------------- 22,922	0 ------------- 502,664	0 ------------- 2,120
6DAVID J LOPATOFSKY MD DIRECTOR/VICE CHAIR END 12/21	(i) (ii)	0 ------------- 353,070	0 ------------- 313,253	0 ------------- 52,497	0 ------------- 93,055	0 ------------- 31,201	0 ------------- 843,076	0 ------------- 47,166
7RON RAPP CHIEF FINANCIAL OFFICER	(i) (ii)	143,990 ------------- 0	43,770 ------------- 0	704 ------------- 0	12,438 ------------- 0	36,478 ------------- 0	237,380 ------------- 0	0 ------------- 0
8PATRICIA JACKSON-GEHRIS PRES UPMC NCPA BEGIN 06/22	(i) (ii)	0 ------------- 163,586	0 ------------- 96,030	0 ------------- 7,516	0 ------------- 16,296	0 ------------- 10,090	0 ------------- 293,518	0 ------------- 0
9SAKET PRASAD MD PHYSICIAN	(i) (ii)	627,548 ------------- 0	17,832 ------------- 0	6,187 ------------- 0	20,854 ------------- 0	47,483 ------------- 0	719,904 ------------- 0	0 ------------- 0
10BRADLEY GIANNOTTI MD PHYSICIAN	(i) (ii)	838,313 ------------- 0	4,526 ------------- 0	8,514 ------------- 0	23,816 ------------- 0	32,298 ------------- 0	907,467 ------------- 0	0 ------------- 0
11ETHAN GABLE MD PHYSICIAN	(i) (ii)	415,045 ------------- 0	14,500 ------------- 0	3,651 ------------- 0	12,058 ------------- 0	11,507 ------------- 0	456,761 ------------- 0	0 ------------- 0
12JEREMY REED MD PHYSICIAN	(i) (ii)	438,909 ------------- 0	18,500 ------------- 0	8,235 ------------- 0	17,577 ------------- 0	21,438 ------------- 0	504,659 ------------- 0	0 ------------- 0
13TERRANCE FOUST DO PHYSICIAN	(i) (ii)	841,573 ------------- 0	10,484 ------------- 0	2,970 ------------- 0	20,854 ------------- 0	43,339 ------------- 0	919,220 ------------- 0	0 ------------- 0
14EDWARD PITCHFORD PRESIDENT/CEO	(i) (ii)	0 ------------- 97,567	0 ------------- 195,132	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 292,699	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
SCHEDULE J, PART I, LINE 1	BENEFITS: UPMC MAY PROVIDE THE FOLLOWING BENEFITS TO CERTAIN EXECUTIVES WHEN THEY ARE NECESSARY TO ACHIEVE UPMC'S CHARITABLE MISSION OBJECTIVES: FIRST-CLASS OR CHARTER TRAVEL; TRAVEL FOR COMPANIONS; TAX INDEMNIFICATION OR GROSS UP PAYMENTS; AND/OR BUSINESS CLUB DUES OR INITIATION FEES. PROVISION OF ANY SUCH BENEFITS IS PREDICATED ON COMPLIANCE WITH THE ORGANIZATION'S POLICIES, IS SUBJECT TO REVIEW AND APPROVAL PROCESSES, AND IS TREATED AS TAXABLE INCOME TO THE EXECUTIVES WHERE REQUIRED UNDER THE INTERNAL REVENUE CODE.
SCHEDULE J, PART I, LINE 4B	NONQUALIFIED RETIREMENT PLAN: ALL PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ARE DISCLOSED IN SCHEDULE J WITH CORRESPONDING AMOUNTS DISCLOSED WITHIN THE TOTAL AMOUNT IN SCHEDULE J COLUMN C "RETIREMENT AND OTHER DEFERRED COMPENSATION". DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE ("CODE"), CERTAIN OFFICERS AND KEY EMPLOYEES ARE LIMITED IN THE AMOUNT OF BENEFITS WHICH MAY BE RECEIVED UNDER A TAX QUALIFIED RETIREMENT PROGRAM. LIKE MANY EMPLOYERS, UPMC SUPPLEMENTS ITS RETIREMENT BENEFITS THROUGH A SUPPLEMENTAL RETIREMENT PROGRAM. THE SUPPLEMENTAL RETIREMENT PROGRAM IS SUBJECT TO MULTI YEAR VESTING WHICH PLACES THE OFFICERS AND KEY EMPLOYEES' RETIREMENT BENEFIT AT RISK OF FORFEITURE IF THE VESTING REQUIREMENTS ARE NOT SATISFIED. ONCE VESTED HOWEVER, PROVISIONS OF THE CODE REQUIRE THAT THE VESTED AMOUNTS BE REPORTED ON THE FORM 990 AND THE VESTED OFFICER OR KEY EMPLOYEE INCLUDE IN CURRENT INCOME THE VALUE OF HER OR HIS SUPPLEMENTAL RETIREMENT BENEFIT. NOTWITHSTANDING THE TAX REQUIREMENT TO RECOGNIZE THE VESTED AMOUNT OF THE SUPPLEMENTAL RETIREMENT BENEFIT AS CURRENT INCOME FOR FICA TAXATION AND REPORTING PURPOSES, THIS BENEFIT, WHICH GENERALLY HAS BEEN EARNED OVER HER OR HIS ENTIRE CAREER, HAS NOT AND WILL NOT BE DISTRIBUTED UNTIL THE OFFICER OR KEY EMPLOYEE RETIRES OR SEPARATES FROM SERVICE FROM UPMC AND SATISFIED THE NON-COMPETE PROVISION OF THEIR EMPLOYMENT AGREEMENT AND/OR SATISFY A POST-RETIREMENT SEPARATION AGREEMENT. THE SUPPLEMENTAL RETIREMENT PROGRAM PROVIDES FOR THE CURRENT DISTRIBUTION OF ONLY THE AMOUNT NECESSARY TO SATISFY ANY INCOME TAX LIABILITY RESULTING FROM THE VESTING DURING ACTIVE EMPLOYMENT. FINALLY, IT SHOULD BE NOTED THAT IN ACCORDANCE WITH IRS INSTRUCTIONS, A SUBSTANTIAL PORTION OF THE AMOUNT REPORTED ON THE FORM 990 ATTRIBUTABLE TO SUPPLEMENTAL RETIREMENT PROGRAM VESTING HAS BEEN REPORTED IN PREVIOUSLY FILED FORMS 990.
SCHEDULE J, PART I, LINE 7	NON-FIXED PAYMENTS: UPMC PROVIDES INCENTIVE COMPENSATION AS PART OF ITS TOTAL COMPENSATION PROGRAM FOR OFFICERS AND KEY EMPLOYEES. THIS COMPONENT IS BASED UPON THE ACCOMPLISHMENT OF PREDETERMINED PERFORMANCE GOALS AND OBJECTIVES WHICH FOCUS ON THE ACHIEVEMENT OF MULTIPLE ANNUAL AND THREE YEAR INDIVIDUAL AND GROUP PERFORMANCE CRITERIA IN THE CONTEXT OF APPROPRIATE RISK TAKING. THESE CRITERIA DIRECTLY SUPPORT UPMC'S MISSION AND INCLUDE: PATIENT QUALITY AND SATISFACTION, COMMUNITY BENEFITS, OPERATIONAL AND FINANCIAL STRENGTH, LEADERSHIP DEVELOPMENT, AND STRATEGIC BUSINESS INITIATIVES AMONG OTHERS.
SCHEDULE J, PART I, LINES 8 & 9	UPMC FOLLOWS THE REBUTTABLE PRESUMPTION OF REASONABLENESS PROCEDURES DESCRIBED IN REGULATIONS SECTION 53.4958-6(C), WHERE APPLICABLE. THIS INCLUDES CONTRACTS THAT MAY QUALIFY FOR THE INITIAL CONTRACT EXCEPTION UNDER REGULATIONS SECTION 53.4958-4(A)(3).

Schedule J (Form 990) 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

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Return Reference	Explanation
FORM 990, PART I, LINE 1	ORGANIZATION'S MISSION: UPMC COLE IS A FULL SERVICE, COMPREHENSIVE HEALTH SYSTEM, SERVING POTTER, MCKEAN, CAMERON, AND TIOGA COUNTIES IN RURAL, NORTH CENTRAL PA AND PORTIONS OF NEW YORK STATE AND IS THE ONLY HOSPITAL IN POTTER COUNTY (COUDERSPORT, PA). UPMC COLE IS A CRITICAL ACCESS HOSPITAL PROVIDING PRIMARY, EMERGENCY, AND SPECIALTY CARE, AS WELL AS REHABILITATION AND WELLNESS SERVICES TO PATIENTS WITHIN A 50-MILE RADIUS. UPMC COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, FIVE COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN OUR CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES ARE TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY, AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS AND ACTIVITIES, AND PROMOTE IMPROVED COMMUNICATIONS BETWEEN THE HOSPITAL AND THE COMMUNITY. THE HOSPITAL PROVIDES DEDICATED ADMINISTRATIVE TIME TO PLANNING AND CONDUCTING FIVE CBAC MEETINGS IN THE COMMUNITIES WE SERVE THREE TIMES PER YEAR.
FORM 990, PART III, LINE 3	TRANSFERRED OF PROGRAM SERVICE: UPMC COLE TRANSFERRED ITS HOME HEALTH, HOSPICE, AND HOMEMAKER PROGRAM TO ANOTHER UPMC EXEMPT ENTITY AS OF 11/1/21.
FORM 990, PART III, LINE 4	PROGRAM SERVICE ACCOMPLISHMENTS: LINE 4A UPMC COLE'S HOME HEALTH AND HOSPICE SERVICES ASSIST PATIENTS THROUGHOUT THE REGION, WITH A GROWING NUMBER OF REFERRALS AND LOWER INFECTION RATES AMONG STATE AND NATIONAL AVERAGES. LINE 4B TWO OUTLYING CENTERS OFFER IMAGING SERVICES, WHILE ALL RHCS PROVIDE LAB DRAWS SO PATIENTS DON'T HAVE TO DRIVE TO RECEIVE NECESSARY TESTING. IN ADDITION TO THE FAMILY AND INTERNAL MEDICINE SERVICES AT RHCS, PHYSICIAN PRACTICES ALSO PROVIDE SPECIALTY CARE INCLUDING PEDIATRICS, GASTROENTEROLOGY, ORTHOPEDICS, PHYSIATRY, SURGERY, PODIATRY, OBSTETRICS/GYNECOLOGY AND ONCOLOGY. LINE 4C IN ADDITION TO THE HOSPITAL'S ACUTE CARE FLOORS, UPMC COLE CARES FOR PATIENTS IN ITS 44-BED SKILLED NURSING AND REHABILITATION UNIT. LINE 4D THE ORGANIZATION ALSO OFFERS CLINICAL SERVICES, CLINICS, CORPORATE AND HOMEMAKERS SERVICES.
FORM 990, PART VI, LINE 1A	VOTING RIGHTS: VOTING RIGHTS OF EXECUTIVE COMMITTEE PER CHARLES COLE MEMORIAL HOSPITAL BYLAWS EFFECTIVE 3/1/2018: SECTION 6.5 EXECUTIVE COMMITTEE. THERE MAY BE AN EXECUTIVE COMMITTEE OF THE BOARD CONSISTING OF DIRECTORS WITH REPRESENTATION SIMILAR TO THE FULL BOARD OF DIRECTORS. ANY EXECUTIVE COMMITTEE OF THE BOARD SHALL BE COMPRISED ONE-THIRD (1/3) OF UPMC DESIGNATED DIRECTORS SELECTED BY UPMC AND TWO-THIRDS (2/3) OF COLE DESIGNATED DIRECTORS SELECTED BY THE COLE DESIGNATED DIRECTORS. THE CHAIR, THE VICE CHAIR AND THE MEMBER'S REPRESENTATIVE SHALL BE MEMBERS OF ANY SUCH EXECUTIVE COMMITTEE EX OFFICIO; PROVIDED, THAT THE MEMBER'S REPRESENTATIVE SHALL HAVE A VOTE ON SUCH EXECUTIVE COMMITTEE ONLY IF HE OR SHE IS A DIRECTOR. UNLESS OTHERWISE DETERMINED BY THE BOARD AND THE MEMBER, AN EXECUTIVE COMMITTEE OF THE BOARD SHALL HAVE THE AUTHORITY TO FULFILL ALL OF THE DUTIES OF THE BOARD OF DIRECTORS EXCEPT AS TO THOSE MATTERS RESERVED TO THE MEMBER BY THESE BYLAWS, OR TO THE FULL BOARD BY ANY APPLICABLE PROVISION OF THE NON-PROFIT CORPORATION LAW OF PENNSYLVANIA. A MAJORITY OF THE ACTUAL THEN-CURRENT MEMBERSHIP OF ANY EXECUTIVE COMMITTEE OF THE BOARD AND THE PRESENCE OF THE MEMBER'S REPRESENTATIVE SHALL CONSTITUTE A QUORUM AND THE VOTE OF A MAJORITY OF THE VOTING EXECUTIVE COMMITTEE MEMBERS PRESENT WHERE A QUORUM EXISTS SHALL CONSTITUTE ACTION BY THE EXECUTIVE COMMITTEE.
FORM 990, PART VI, SECTION A, LINES 6,7A, & 7B	MEMBERS: CHARLES COLE MEMORIAL HOSPITAL HAS ONE SOLE MEMBER, THE FEDERALLY TAX-EXEMPT ENTITY UPMC. UPMC COLE SHALL BE GOVERNED BY A BOARD OF DIRECTORS CONSISTING AS OF THE EFFECTIVE TIME OF SEVENTEEN (17) VOTING DIRECTORS. OVER TIME, AS SET FORTH IN THE BYLAWS, THE BOARD SHALL BE DECREASED TO THIRTEEN (13) TOTAL DIRECTORS. THE DIRECTORS SHALL BE DESIGNATED AS FOLLOWS: AS OF THE EFFECTIVE TIME, THE BOARD WILL BE COMPRISED OF THIRTEEN (13) COLE DESIGNATED DIRECTORS AND FOUR (4) UPMC DESIGNATED DIRECTORS. THE THIRTEEN (13) COLE DESIGNATED DIRECTORS WILL REFLECT THE MEMBERS ON THE CHARLES COLE MEMORIAL HOSPITAL BOARD IMMEDIATELY PRIOR TO CLOSING. THEREAFTER, THE BOARD SHALL DECREASE, OVER TIME, TO THIRTEEN (13) TOTAL DIRECTORS WHICH SHALL CONSIST OF NINE (9) COLE DESIGNATED DIRECTORS AND FOUR (4) UPMC DESIGNATED DIRECTORS. THE COLE DESIGNATED DIRECTORS SHALL DECREASE TO NINE (9) PERSONS WHEN A COLE DESIGNATED DIRECTOR IS NO LONGER ELIGIBLE TO SERVE, OR UPON HIS OR HER VOLUNTARY OR INVOLUNTARY RESIGNATION UNTIL THE NUMBER OF COLE DESIGNEES IS REDUCED TO NINE (9). THIS COMPOSITION OF NINE (9) COLE DESIGNATED DIRECTORS AND FOUR (4) UPMC DESIGNATED DIRECTORS SHALL CONTINUE THROUGH AT LEAST THE PARTICIPATION PERIOD. THE UPMC DESIGNATED DIRECTORS AND THEIR SUCCESSORS WILL BE APPOINTED BY UPMC. THE MEMBER SHALL HAVE THE FOLLOWING RIGHTS AND POWERS: UMPC IS THE PARENT OF CHARLES COLE MEMORIAL HOSPITAL, INC. UPMC HAS THE RIGHTS TO DO ALL OF THE FOLLOWING: (I) APPROVAL OF OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (II) ENTERING INTO NEW OR MATERIALLY CHANGING EXISTING JOINT VENTURE ARRANGEMENTS OF THE CORPORATION; (III) APPROVAL OF THE TERMS OF ANY MANAGEMENT ARRANGEMENTS WITH AN UNRELATED THIRD PARTY; (IV) ANY CHANGE IN THE CORPORATE STRUCTURE OF THE CORPORATION; (V) THE SALE, LEASE, TRANSFER OR JOINT VENTURE, WHETHER WITHIN THE SYSTEM OR EXTERNAL THERETO, INVOLVING SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (VI) THE MERGER, CONSOLIDATION, DIVESTITURE OR DISSOLUTION OF THE CORPORATION; (VII) ANY AMENDMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION; (VIII) SALE OF ANY REAL ESTATE OF THE CORPORATION; THE MEMBER AND UPMC MAY LOOK TO THE BOARD OF DIRECTORS TO PROVIDE GOVERNANCE AND OVERSIGHT WITH RESPECT TO MATTERS WHICH MAY INCLUDE DEVELOPING AND IMPLEMENTING THE GOALS AND OBJECTIVES OF THE CORPORATION IN THE FOUR KEY AREAS OF (1) QUALITY PERFORMANCE; (2) FINANCIAL PERFORMANCE; (3) PLANNING PERFORMANCE; AND (4) GOVERNANCE PERFORMANCE.
FORM 990, PART VI, SECTION B, LINE 11B	FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON INFORMATION SUPPLIED BY CHARLES COLE MEMORIAL HOSPITAL. THE DRAFT 990 IS REVIEWED BY THE FINANCE DEPARTMENT. IT IS THEN POSTED TO AN ONLINE PORTAL FOR THE BOARD OF DIRECTORS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: UPMC REQUIRES KEY EMPLOYED AND NON-EMPLOYED PERSONNEL TO COMPLY WITH ITS CONFLICT OF INTEREST POLICIES WHEN THEY ENGAGE IN UPMC-RELATED BUSINESS. PERSONS COVERED BY THE POLICIES INCLUDE: -UPMC BOARD MEMBERS, BOARD COMMITTEE MEMBERS, CORPORATE OFFICERS, AND KEY EMPLOYEES -UPMC PHYSICIANS AND NON-PHYSICIAN EMPLOYEES WHO HOLD A POSITION OF INFLUENCE -IDENTIFIED NON-EMPLOYED MEMBERS OF THE UPMC MEDICAL STAFF WHO HOLD A POSITION OF INFLUENCE OR TRUST-INDIVIDUALS CONDUCTING CLINICAL RESEARCH AT UPMC, WHETHER OR NOT THEY ARE EMPLOYED BY UPMC. THESE INDIVIDUALS 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 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 BOARD OF DIRECTORS ON BEHALF OF UPMC AND ALL OF ITS SUBSIDIARIES. POTENTIAL CONFLICT OF INTEREST TRANSACTIONS INVOLVING UPMC 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 BOARD OF DIRECTORS. IN ADDITION TO THE GENERAL CORPORATE AND BOARD POLICIES DESCRIBED ABOVE, UPMC 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, LINES 15A & 15B	COMPENSATION DETERMINATION: TO SUPPORT UPMC'S MISSION AND AS SET 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 B, LINES 16A & 16B	JOINT VENTURES: UPMC HAS A FORMAL WRITTEN POLICY PERTAINING TO JOINT VENTURES BETWEEN UPMC 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'S CHARITABLE PURPOSES.
FORM 990, PART VI, SECTION C, LINE 19	DOCUMENT AVAILABILITY: UMPC'S PUBIC WEBSITE (WWW.UPMC.COM) MAKES ITS FINANCIAL RESULTS, CONFLICT OF INTEREST PROCESS, AND VARIOUS INFORMATION ABOUT GOVERNANCE AND OVERSIGHT AVAILABLE TO THE PUBLIC. ADDITIONAL INFORMATION MAY BE SUPPLIED UPON SPECIFIC REQUEST FOR DATA NOT POSTED TO THE WEB SITE.
FORM 990, PART VII, SECTION A	BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE ANY COMPENSATION FOR THEIR DIRECTOR DUTIES. STEVEN JOHNSON, DAVID LOPATOFSKY, MD, MARIBETH MCLAUGHLIN, AND CARRIE ENNIS ARE COMPENSATED BY A RELATED ORGANIZATION FOR THEIR OPERATIONAL ROLES. MARY ANN RIGAS AND MICHAEL CALLAHAN ARE COMPENSATED FOR THEIR ROLES AS PHYSICIANS.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS: $ ( 6,378,012) TRANSFER TO EXEMPT RELATED PARTY ( 71,264) NET ASSETS RELEASED FROM PERMANENTLY RESTRICTION ( 79,487) NET ASSETS RELEASED FROM TEMPORARY RESTRICTION -------------- $ ( 5,065,128)
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES TOTAL FEES:4801635
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:3631992
FORM 990 PART IX LINE 11G	DESCRIPTION:LAB SERVICES TOTAL FEES:903246
FORM 990 PART IX LINE 11G	DESCRIPTION:MAINTENANCE CONTRACTS TOTAL FEES:793371
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:555096
FORM 990 PART IX LINE 11G	DESCRIPTION:HOUSEKEEPING SERVICES TOTAL FEES:192700
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER FEES AND SERVICES TOTAL FEES:171860
FORM 990 PART IX LINE 11G	DESCRIPTION:CONSULTING SERVICES TOTAL FEES:54943

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

CHARLES COLE MEMORIAL HOSPITAL

Employer identification number

24-0802108

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)HENDORN INC DBA COLE MANOR 1001 EAST SECOND STREET COUDERSPORT,PA16915 23-1972659	RESIDENT CARE	PA	501(C)(3)	12A I	C COLE MEM H	Yes
(2)HAMOTCOLE VENTURES INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 27-3172100	REAL ESTATE	PA	501(C)(3)	12A I	C COLE MEM H	Yes
(3)COLE FOUNDATION 1001 EAST SECOND STREET COUDERSPORT,PA16915 45-5417308	SUPPORT	PA	501(C)(3)	12A I	C COLE MEM H	Yes
(4)LAUREL REALTY INC 32-36 CENTRAL AVENUE WELLSBORO,PA16901 23-1403678	REAL ESTATE	PA	501(C)(2)		UPMC SUSQUEH		No
(5)THE GREEN HOME 32-36 CENTRAL AVENUE WELLSBORO,PA16901 24-0804365	SKILLED NURSI	PA	501(C)(3)	10	UPMC SUSQUEH		No
(6)WILLIAMSPORT AREA AMBULANCE SERVICES 700 HIGH ST WILLIAMSPORT,PA17701 23-2416166	AMBULANCE SVC	PA	501(C)(3)	10	UPMC WILLIAM		No
(7)UPMC SENIOR COMMUNITIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1574736	SR. LIVING	PA	501(C)(3)	10	UPMC		No
(8)PITTSBURGH LIFETIME CARE COMMUNITY 600 GRANT STREET PITTSBURGH,PA15219 25-1335247	CCRC	PA	501(C)(3)	10	UPMC SR COMM		No
(9)CANTERBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-0965334	SR LIVING	PA	501(C)(3)	10	UPMC SR COMM		No
(10)SENECA PLACE 600 GRANT STREET PITTSBURGH,PA15219 72-1562844	SR. LIVING	PA	501(C)(3)	10	UPMC SR COMM		No
(11)SHADYSIDE HOSPITAL SUPPORTING FND 600 GRANT STREET PITTSBURGH,PA15219 26-0303394	FOUNDATION	PA	501(C)(3)	12A I	UPMC		No
(12)UPMC LEE 600 GRANT STREET PITTSBURGH,PA15219 25-0613830	INACTIVE	PA	501(C)(3)	3	UPMC		No
(13)PITTSBURGH CARE PARTNERSHIP INC 600 GRANT STREET PITTSBURGH,PA15219 25-1753852	SR CARE MGMT	PA	501(C)(3)	10	UPMC		No
(14)UPMC CENTER FOR HIGH VALUE HEALTHCARE 600 GRANT STREET PITTSBURGH,PA15219 45-2178782	RESEARCH	PA	501(C)(3)	7	UPMC		No
(15)SHADYSIDE HOSPITAL FOUNDATION 532 SOUTH AIKEN AVE PITTSBURGH,PA15232 25-1290546	FOUNDATION	PA	501(C)(3)	12C III	UPMC PRESBY		No
(16)PASSAVANT HOSPITAL FOUNDATION 9100 BABCOCK BLVD PITTSBURGH,PA15237 25-1407815	FOUNDATION	PA	501(C)(3)	12B II	UPMC PASS		No
(17)NORTHWEST HOSPITAL FOUNDATION 100 FAIRFIELD DRIVE SENECA,PA16346 25-1483624	FOUNDATION	PA	501(C)(3)	12D III	UPMC NORTHWE		No
(18)ST MARGARET FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1520340	FOUNDATION	PA	501(C)(3)	7	UPMC ST MARG		No
(19)MAGEE-WOMEN RES INST AND FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1462312	FOUNDATION	PA	501(C)(3)	7	NA		No
(20)GREAT LAKES PHYSICIAN PRACTICE 600 GRANT STREET PITTSBURGH,PA15219 46-4186362	PHYSICIAN SRV	NY	501(C)(3)	3	REGNL HEALTH		No
(21)HAMOT HEALTH FOUNDATION 302 FRENCH STREET ERIE,PA16507 25-1400999	FOUNDATION	PA	501(C)(3)	12B II	UPMC HAMOT		No
(22)CHILDREN'S HOSPITAL OF PITTSBURGH FND 600 GRANT STREET PITTSBURGH,PA15219 25-1865744	FOUNDATION	PA	501(C)(3)	7	UPMC CHD		No
(23)UPMCJAMESON CANCER CENTER 1211 WILMINGTON AVE NEW CASTLE,PA16105 20-1459415	ONCOLOGY SVC	PA	501(C)(3)	10	UPMC JAMESON		No
(24)VENANGO VNA FOUNDATION 491 ALLEGHENY BLVD FRANKLIN,PA16323 25-1472179	FOUNDATION	PA	501(C)(3)	12D III	NA		No
(25)UPMC CHAUTAUQUA AT WCA 207 FOOTE AVE JAMESTOWN,NY14701 16-0743226	HOSPITAL	NY	501(C)(3)	3	UPMC CHAUTAU		No
(26)WCA GROUP INC 207 FOOTE AVE JAMESTON,NY14701 22-2392582	HOLDING CO	NY	501(C)(3)	12B II	CHAUT AT WCA		No
(27)STARFLIGHT INC 135 ALLEN STREET JAMESTOWN,NY14701 16-1557878	AIR AMBULANCE	NY	501(C)(3)	7	CHAUT AT WCA		No
(28)SOUTH CENTRAL ALPHA HOUSING AND HEALTH 3410 W PITTSBURGH RD NEW CASTLE,PA16101 25-1701701	SNF & AL	PA	501(C)(3)	10	UPMC SR COMM		No
(29)SOUTH WESTERN ALPHA HOUSING AND HEALTH 745 GREENVILLE RD MERCER,PA16137 25-1701700	SKILLED NURSE	PA	501(C)(3)	10	UPMC SR COMM		No
(30)KANE COMMUNITY HOSPITAL FOUNDATION 4372 ROUTE 6 KANE,PA16735 26-3906925	SNF & IL	PA	501(C)(3)	12B II	NA		No
(31)JUNIOR GUILD OF JAMESON MEMORIAL HOS 1211 WILMINGTON AVE NEW CASTLE,PA16105 25-6005313	SUPPORT	PA	501(C)(3)	12D III	NA		No
(32)WCA FOUNDATION INC 300 FOOTE AVE JAMESTOWN,NY14702 22-2393584	FOUNDATION	PA	501(C)(3)	12C III	NA		No
(33)LAUREL HEALTH FOUNDATION 32-36 CENTRAL AVENUE WELLSBORO,PA16101 25-1810488	FOUNDATION	PA	501(C)(3)	12B II	NA		No
(34)UPMC PINNACLE 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778658	SUPPORTNG ORG	PA	501(C)(3)	12B II	UPMC		No
(35)UPMC CARLISLE 361 ALEXANDER SPRING ROAD CARLISLE,PA17105 82-0880337	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(36)UPMC PINNACLE LANCASTER 250 COLLEGE AVENUE LANCASTER,PA17603 82-0896436	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(37)UPMC LITITZ 1500 HIGHLANDS AVENUE LITITZ,PA17543 82-0844453	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(38)UPMC MEMORIAL 325 SOUTH BELMONT STREET YORK,PA17405 82-0912090	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(39)PINNACLE HEALTH REGIONAL PHYSICIANS 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-0947698	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC PINNACL		No
(40)UPMC PINNACLE FOUNDATION 409 SOUTH SECOND STREET HARRISBURG,PA17104 22-2691718	FOUNDATION	PA	501(C)(3)	12B II	UPMC PINNACL		No
(41)COMMUNITY LIFE TEAM INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1890444	MED TRANSPORT	PA	501(C)(3)	7	UPMC PINNACL		No
(42)HANOVER HEALTHCARE PLUS INC 300 HIGHLAND AVENUE HANOVER,PA17331 22-2658574	SUPPORTNG ORG	PA	501(C)(3)	12A I	UPMC PINNACL		No
(43)UPMC HANOVER 300 HIGHLAND AVENUE HANOVER,PA17331 23-1360851	HOSPITAL	PA	501(C)(3)	3	HANOVER HEAL		No
(44)PINNACLE HEALTH MEDICAL SERVICES 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1709054	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC PINNACL		No
(45)UPMC PINNACLE HOSPITALS 409 SOUTH SECOND STREET HARRISBURG,PA17104 25-1778644	HOSPITAL	PA	501(C)(3)	3	UPMC PINNACL		No
(46)ASBURY HEIGHTS OF UPMC 600 GRANT STREET PITTSBURGH,PA15219 25-1555687	SUPPORTNG ORG	PA	501(C)(3)	12B II	UPMC SR COMM		No
(47)ASBURY HEALTH CENTER 600 GRANT STREET PITTSBURGH,PA15219 25-0969472	CCRC	PA	501(C)(3)	10	ASBURY HEIGH		No
(48)ASBURY VILLAS 600 GRANT STREET PITTSBURGH,PA15219 25-1819952	PERSONAL CARE	PA	501(C)(3)	10	ASBURY HEIGH		No
(49)ASBURY PLACE 600 GRANT STREET PITTSBURGH,PA15219 25-1729266	PERSONAL CARE	PA	501(C)(3)	10	ASBURY HEIGH		No
(50)WESLEY HILLS 600 GRANT STREET PITTSBURGH,PA15129 25-1507472	INDEP LIVING	PA	501(C)(3)		ASBURY HEIGH		No
(51)ASBURY FOUNDATION 600 GRANT STREET PITTSBURGH,PA15219 25-1555688	FOUNDATION	PA	501(C)(3)	7	ASBURY HEIGH		No
(52)JAMESON CARE CENTER INC 1211 WILMINGTON AVE NEW CASTLE,PA16105 23-2871396	SR SERVICES	PA	501(C)(3)	10	UPMC SR COMM		No
(53)UPMC SOMERSET 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-0965570	HOSPITAL	PA	501(C)(3)	3	UPMC		No
(54)SOMERSET COMMUNITY HOSPITAL FOUNDATION 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-1441863	FOUNDATION	PA	501(C)(3)	12C III	UMPC SOMERSE		No
(55)SOMERSET HEALTH SERVICES INC 225 SOUTH CENTER AVENUE SOMERSET,PA15501 25-1441920	PHYSICIAN SRV	PA	501(C)(3)	3	UPMC SOMERSE		No
(56)UPMC WESTERN MARYLAND CORPORATION PO BOX 539 CUMERLAND,MD21501 52-0591531	HOSPITAL	PA	501(C)(3)	3	UPMC		No
(57)WESTERN MARYLAND HEALTH SYSTEM FND PO BOX 539 CUMBERLAND,MD21501 35-2289841	FOUNDATION	PA	501(C)(3)	12C III	UPMC WESTERN		No
(58)HANOVER HOSPITAL FOUNDATION 300 HIGHLAND AVENUE HANOVER,PA17331 82-2553293	FOUNDATION	PA	501(C)(3)	12C III	UPMC PINNACL		No
(59)RUSH TO CRUSH CANCER 200 LOTHROP STREET PITTSBURGH,PA15213 87-4771624	FOUNDATION	PA	501(C)(3)	7	UOFP CANCER		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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) SENECA HILLS ASSISTED LIVING 600 GRANT STREET PITTSBURGH,PA15219 23-2873106	ASSISTED LIVING	PA	NA				No			No
(2) ST MARGARET MEDICAL ARTS ASSOC 600 GRANT STREET PITTSBURGH,PA15219 25-1786655	MED OFFICE BL	PA	NA				No			No
(3) SHADYSIDE MEDICAL CENTER ASSOC 600 GRANT STREET PITTSBURGH,PA15219 25-1608318	MED OFFICE BL	PA	NA				No			No
(4) CHARTWELL PA LP 600 GRANT STREET PITTSBURGH,PA15219 25-1729714	HOME HEALTH	PA	UPMC COMM PROV				No			No
(5) LIFE CARE HOME SRV OF NW PA 1647 SASSAFRAS ST ERIE,PA16507 25-1536879	HOME HEALTH	PA	UPMC HAMOT				No			No
(6) HAMOT-KCH REAL ESTATE VENTURE 300 STATE ST ERIE,PA16507 26-3691782	MEDICAL OFFICE	PA	UPMC HAMOT				No			No
(7) HAMOT SURGERY CENTER LLC 200 STATE STREET ERIE,PA16507 25-1863661	AMBULATORY SU	PA	UPMC HAMOT				No			No
(8) EPN-HAMOT URGENT CARE LLC 600 GRANT STREET PITTSBURGH,PA15219 27-2147949	URGENT CARE	PA	VARIOUS				No			No
(9) MEDCARE SUSQUEHANNA VALLEY LLC 409 SOUTH SECOND STREET HARRISBURG,PA17104 82-1673688	DME	PA	PINNACLE HEALTH				No			No
(10) OMICELO RE I LP 2525 LIBERTY AVENUE PITTSBURGH,PA15222 47-5603393	REAL ESTATE D	DE	UPMC FOR YOU				No			No
(11) UPMC LEADER SURGERY CENTER LLC 1703 INNOVATION DRIVE YORK,PA17408 23-3035083	SURGERY CENTER	PA	UPMC MEMORIAL				No			No
(12) BAYFRONT PROFESSIONAL BUILDING LLC 3645 WEST LAKE ROAD ERIE,PA16505 25-1480837	REAL ESTATE	PA	UPMC HAMOT				No			No
(13) CHAUTAUQUA INTEGRATED DELIVERY SYSTEM 200 HARRISON STREET 2ND FLOOR JAMESTOWN,NY14701 16-1542139	INTEGRATED DELIV	NY	UPMC CHAUTAUQUA				No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) COLE CARE INC 1001 EAST SECOND STREET COUDERSPORT,PA16915 25-1497347	DURABLE MED EQUIP	PA	COLE MEMORIAL	C CORP	2,387,176	1,141,544	100.000 %	Yes
(2) HC PHARMACY CENTRAL INC 600 GRANT STREET PITTSBURGH,PA15219 25-1364192	PHARMACY CO-OP	PA	VARIOUS	C CORP					No
(3) CHILDREN'S COMMUNITY CARE 600 GRANT STREET PITTSBURGH,PA15219 25-1781887	PHYSICIAN SERV	PA	NA	C CORP					No
(4) UPMC PHYSICIAN SERVICES HOLDING COMPANY 600 GRANT STREET PITTSBURGH,PA15219 25-1877017	HOLDING CO	PA	NA	C CORP					No
(5) ONCOLOGY HEMATOLOGY ASSOCIATION INC 600 GRANT STREET PITTSBURGH,PA15219 25-1762980	PHYSICIAN SERV	PA	NA	C CORP					No
(6) TRI-STATE NEUROSURGICAL ASSOCIATES - UPM 600 GRANT STREET PITTSBURGH,PA15219 25-1458655	PHYSICIAN SERV	PA	NA	C CORP					No
(7) RENAISSANCE FAMILY PRACTICE-UPMC INC 600 GRANT STREET PITTSBURGH,PA15219 26-2942406	PHYSICIAN SERV	PA	NA	C CORP					No
(8) UPMC HOLDING COMPANY INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777713	HOLDING CO	PA	NA	C CORP					No
(9) UPMC COVERAGE PRODUCTS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1777710	HOLDING CO	PA	NA	C CORP					No
(10) FREEDOM INSURANCE COMPANY 600 GRANT STREET PITTSBURGH,PA15219 03-0308944	INSURANCE	VT	NA	C CORP					No
(11) TRI-CENTURY INSURANCE CO 600 GRANT STREET PITTSBURGH,PA15219 25-1500739	INSURANCE	PA	NA	C CORP					No
(12) UPMC DNA INC 600 GRANT STREET PITTSBURGH,PA15219 25-1883237	INSURANCE	PA	NA	C CORP					No
(13) UPMC HEALTH BENEFITS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1844144	HEALTH INSURANCE	PA	NA	C CORP					No
(14) UPMC HEALTH NETWORK INC 600 GRANT STREET PITTSBURGH,PA15219 72-1527566	HEALTH INSURANCE	PA	NA	C CORP					No
(15) UPMC HEALTH PLAN INC 600 GRANT STREET PITTSBURGH,PA15219 23-2813536	HEALTH INSURANCE	PA	NA	C CORP					No
(16) UPMC BENEFIT MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1769564	WORKER'S COMP	PA	NA	C CORP					No
(17) UPMC DIVERSIFIED SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1778454	HOLDING CO	PA	NA	C CORP					No
(18) MONROEVILLE SPECIALTY CLINIC 600 GRANT STREET PITTSBURGH,PA15219 25-1666087	AMB SURG	PA	NA	C CORP					No
(19) MEDICAL ARCHIVAL SYSTEMS INC 600 GRANT STREET PITTSBURGH,PA15219 23-2912501	SOFTWARE DEVE	DE	NA	C CORP					No
(20) RX PARTNERS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1801966	PHARMACY	PA	NA	C CORP					No
(21) BIOTRONICS INC 600 GRANT STREET PITTSBURGH,PA15219 25-1843500	EQUIP MAINTENANCE	PA	NA	C CORP					No
(22) MEDICAL CENTER PROPERTIES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1796940	REAL ESTATE	PA	NA	C CORP					No
(23) ASKESIS DEVELOPMENT GROUP INC 600 GRANT STREET PITTSBURGH,PA15219 54-1625585	SOFTWARE DEVE	DE	NA	C CORP					No
(24) PANTHER REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN,CAYMAN ISLANDS CJ 98-1402742	INSURANCE	CJ	NA	C CORP					No
(25) FORBES REINSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN,CAYMAN ISLANDS CJ 98-1400710	INSURANCE	CJ	NA	C CORP					No
(26) CATHEDRAL (RE) INSURANCE CO PO BOX 1109 GRAND CAYMAN,CAYMAN ISLANDS CJ 98-1400837	INSURANCE	CJ	NA	C CORP					No
(27) UPMC IRELAND LIMITED 6TH FLOOR BEACON HOSPITAL SANDYFORD,DUBLIN 18 EI	HEALTHCARE SU	EI	UPMC INT'L HOLD	C CORP					No
(28) BAYFRONT REGIONAL DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401388	RE HOLDING CO	PA	NA	C CORP					No
(29) BAYSIDE DEVELOPMENT CORP 300 STATE STREET ERIE,PA16507 25-1401386	REAL ESTATE	PA	NA	C CORP					No
(30) UPMC WORK ALLIANCE INC 600 GRANT STREET PITTSBURGH,PA15219 45-2825053	INSURANCE	PA	NA	C CORP					No
(31) UPMC CANADA TECHNOLOGIES LIMITED 600 GRANT STREET PITTSBURGH,PA15219	SOFTWARE	CA	UPMC INT'L HOLD	C CORP					No
(32) UPMC HEALTH COVERAGE INC 600 GRANT STREET 58TH FLOOR PITTSBURGH,PA15219 46-2824537	INSURANCE	PA	NA	C CORP					No
(33) UPMC COMPLETE CARE INC 5215 CENTRE AVE PITTSBURGH,PA15232 46-3605753	PHYSICIAN SERV	PA	NA	C CORP					No
(34) AMERICAN HOME HEALTH SERVICES 868 CORPORATE WAY WESTLAKE,OH44145 31-1521422	HOME HEALTH	OH	QUALITY FIRST	C CORP					No
(35) HEALTH FIDELITY INC 210 S B ST SAN MATEO,CA94401 45-2538963	TECHNOLOGY SV	CA	NA	C CORP					No
(36) PENSIAMO INC 600 GRANT STREET 59TH FLOOR PITTSBURGH,PA15219 81-2069236	SUPPLY CHAIN	DE	NA	C CORP					No
(37) ALTOONA FAMILY INC 620 HOWARD AVE ALTOONA,PA16601 25-1444935	MGMT SVCS	PA	UPMC ALTOONA	C CORP					No
(38) LEXINGTON HOLDINGS INC 620 HOWARD AVE ALTOONA,PA16601 25-1794386	HOLDING CO	PA	CTRL PA MED FND	C CORP					No
(39) LEXINGTON ONE INC 620 HOWARD AVE ALTOONA,PA16601 25-1468889	RENTAL	PA	LEXINGTON HOLD	C CORP					No
(40) LEXINGTON TWO INC HOWARD AVE AND 7TH ST ALTOONA,PA16601 25-1555689	DURABLE MED EQUIP	PA	LEXINGTON HOLD	C CORP					No
(41) LEXINGTON FOUR INC 620 HOWARD AVE ALTOONA,PA16601 25-1793736	HOLDING CO	PA	LEXINGTON HOLD	C CORP					No
(42) UPMC ALTOONA REGIONAL HEALTH SERVICES 1414 9TH AVE ALTOONA,PA16602 25-1219302	PHYSICIAN SERV	PA	LEXINGTON FOUR	C CORP					No
(43) LEXINGTON ANESTHESIA ASSOCIATES INC 620 HOWARD AVE ALTOONA,PA16601 25-1897765	PHYSICIAN SERV	PA	LEXINGTON FOUR	C CORP					No
(44) UPMC EXCESS PL TR 600 GRANT STREET PITTSBURGH,PA15219 82-6254351	TRUST	PA	NA	TRUST					No
(45) RXANTE INC 511 CONGRESS STREET PORTLAND,ME04101 45-4040219	MEDICATION MG	DE	NA	C CORP					No
(46) WCA SERVICE CORPORATION INC 207 FOOTE AVE JAMESTOWN,NY14701 16-1151438	SUPPORT	NY	CHAUT AT WCA	C CORP					No
(47) HEMATOLOGY ONCOLOGY ASSOCIATION INC 600 GRANT STREET PITTSBURGH,PA12519 42-1648357	PHYSICIAN SERV	PA	NA	C CORP					No
(48) UPMC HEALTH OPTIONS INC 600 GRANT STREET PITTSBURGH,PA15219 46-2824626	INSURANCE	PA	NA	C CORP					No
(49) PINNACLE HEALTH CARDIOVASCULAR INSTITUT 409 SOUTH SECOND STREET HARRISBURG,PA17104 32-0321362	PHYSICIAN SERV	PA	NA	C CORP					No
(50) HANOVER HEALTH CORPORATION 300 HIGHLAND AVENUE HANOVER,PA17331 90-0498067	HOLDING CO	PA	NA	C CORP					No
(51) HANOVER APOTHECARY INC 310 STOCK STREET SUITE 1 HANOVER,PA17331 03-0594526	PHARMACY	PA	NA	C CORP					No
(52) UNITED CENTRAL PA RECIPROCAL RISK RETEN 76 SAINT PAUL STREET SUITE 500 BURLINGTON,VT05401 13-4224033	INSURANCE	VT	NA	C CORP					No
(53) PINNACLE HEALTH VENTURES INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 61-1677624	HOLDING CO	PA	NA	C CORP					No
(54) PINNACLE HEALTH IMAGING INC 409 SOUTH SECOND STREET HARRISBURG,PA17104 23-1718571	IMAGING SRV	PA	NA	C CORP					No
(55) UPMC ITALY HEALTH SERVICES SRL VIA DISCESA DEI GIUDICI 4 PALERMO90133 IT	HEALTH SVC	IT	UPMC ITALY SRL	C CORP					No
(56) UPMC INVESTMENTS LTD C/O UPMC WHITEFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	HOLDING CO	EI	UPMC IRELAND LT	C CORP					No
(57) UPMC PROPERTY LTD C/O UPMC WHITEFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY	EI	UPMC INVEST LTD	C CORP					No
(58) EURO CARE INFRASTRUCTURE LTD C/O UPMC WHITEFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY MGMT	EI	NA	C CORP					No
(59) EURO CARE PROPERTY MANAGEMENT LTD C/O UPMC WHITEFIELD CORK ROAD BUTLER,WATERFORDX91 DH EI	PROPERTY MGMT	EI	NA	C CORP					No
(60) BLUESPHERE BIO 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 82-4979766	IMMUNOTHERAPY	DE	NA	C CORP					No
(61) INFECTIOUS DISEASE CONNECT INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 83-3311071	TELEMEDICINE	DE	NA	C CORP					No
(62) UPMC HILLMAN CANCER CENTER - PINNACLE 101 ERFORD ROAD CAMP HILL,PA17701 83-3640945	CANCER TREATMENT	PA	NA	C CORP					No
(63) SHANGHAI UPMC CO LTD 288 SHIMEN 1ST ROAD JINGAN DIST SHANGHAI 200041 CH	HEALTHCARE MG	CH	UPMC INT'L HOLD	C CORP					No
(64) SALVATOR MUNDI INTERNATIONAL HOSPITAL ROMA VIALE DELLE MURA GIANICOLENSI CAP 00152 IT	HOSPITAL	IT	UPMC ITALY SRL	C CORP					No
(65) SOMERSET ANESTHESIA INC 600 GRANT STREET PITTSBURGH,PA15219 45-5135437	PHYSICIAN SER	PA	NA	C CORP					No
(66) SOMERSET MANAGEMENT SERVICES INC 600 GRANT STREET PITTSBURGH,PA15219 25-1512960	MOB OWNERSHIP	PA	NA	C CORP					No
(67) GENERIAN PHARMACEUTICALS INC 2425 SIDNEY STREET PITTSBURGH,PA15203 82-1101143	PHARMACY	PA	NA	C CORP					No
(68) ASTRATA INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-4804493	SOFTWARE	DE	NA	C CORP					No
(69) VEGAVECT 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-4280784	GENE THERAPY	DE	NA	C CORP					No
(70) NOVIMAB 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 84-1494905	CLINICAL RESEARCH	DE	NA	C CORP					No
(71) HAYSTACK CONSOLIDATED SERVICES INC 12500 WILLOWBROOK ROAD CUMBERLAND,MD21502 52-1335895	INACTIVE	PA	NA	C CORP					No
(72) WESTERN MARYLAND INSURANCE COMPANY LTD PO BOX 10233 GRAND CAYMAN,CAYMAN ISLANDS CJ	INSURANCE	CJ	NA	C CORP					No
(73) WILLOWBROOK HEALTHCARE CONDO 12401 WILLOWBROOKE ROAD CUMBERLAND,MD21502 37-1538510	REAL ESTATE	DE	NA	C CORP					No
(74) CLANE HOSPITAL DEVELOPMENT ASSOCIATES C/O UPMC WHITFIELD CORK ROAD BUTLERSTOWN NORTH,WATERFORDX91 DH9W EI	MANAGEMENT	EI	UPMC IRELAND LT	C CORP					No
(75) GENERIAN PHARMACEUTICALS AUSTRALIA PTY LEVEL 5 63 PIRIE STREET ADELAIDE 5001 AS	PHARMACY	AS	GENERIAN PHARM	C CORP					No
(76) NOVASENTA INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 82-5443222	IMMUNOTHERAPY	DE	NA	C CORP					No
(77) RXANTE PHARMACY SERVICES INC 511 CONGRESS STREET 803 PORTLAND,ME04101 83-3402761	PHARMACY	DE	NA	C CORP					No
(78) UPMC AUT EVEN HOSPITAL LTD FRESHFORD ROAD COUNTY KILKENNY R95 D3760 EI	HOSPITAL	EI	UPMC INVEST LTD	C CORP					No
(79) UPMC GLOBAL OPERATIONS CENTER LTD 6TH FLOOR BEACON HOSPITAL SANDYFORD DUBLIN 18 EI	CANCER TREATMENT	EI	UPMC IRELAND LT	C CORP					No
(80) UPMC KILDARE HOSPITAL LTD PROSPEROUS ROAD CLANE W91 W535 EI	HOSPITAL	EI	CLANE HOSPITAL	C CORP					No
(81) UPMC WHITFIELD HOSPITAL LTD C/O UPMC WHITFIELD CORK ROAD BUTLER,WATERFORD EI	HOSPITAL	EI	UPMC INVEST LTD						No
(82) SUSQUEHANNA VENTURES INC 1201 GRAMPIAN BLVD WILLIAMSPORT,PA17701 23-2470623	PHARMACY	PA	NA	C CORP					No
(83) WORK PARTNERS NATIONAL INC 600 GRANT STREET PITTSBURGH,PA15219 84-3141950	INSURANCE	PA	NA	C CORP					No
(84) AVISTA THERAPEUTICS INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 85-3454001	GENE THERAPY	PA	NA	C CORP					No
(85) REALYZE INTELLEGENCE INC 6425 PENN AVENUE STE 200 PITTSBURGH,PA15206 85-0873923	SOFTWARE	DE	NA	C CORP					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) .......................

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) COLE FOUNDATION	C	21,890	FMV
(2) COLE CARE INC	J	199,648	FMV
(3) HAMOTCOLE VENTURES INC	K	572,900	FMV
(4) UPMC	M	236,357	FMV
(5) UPMC PRESBYTERIAN SHADYSIDE	M	6,005,256	FMV
(6) UPP	P	80,000	FMV
(7) UPMC	R	2,168,919	FMV

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

SCHEDULE R, PARTS II, III, AND IV

UPMC SYSTEM ENTITIES: THE ENTITIES MARKED WITH AN ASTERISK ARE NOT TECHNICALLY "RELATED PARTIES," AS DEFINED BY THE IRS FORM 990 INSTRUCTIONS, OF THE FILING ORGANIZATION. HOWEVER, THEY ARE LISTED ON SCHEDULE R TO REFLECT THAT THEY ARE PART OF THE UPMC SYSTEM OF ENTITIES, AS THEY ALL SHARE UPMC AS THEIR ULTIMATE PARENT CORPORATION. THERE ARE ORGANIZATIONS INCLUDED IN THE UPMC GROUP FORM 990 TAX RETURN FOR FY 2022 WHICH ARE RELATED TO CHARLES COLE MEMORIAL HOSPITAL. THESE ORGANIZATIONS ARE NOT REQUIRED TO BE LISTED ON SCHEDULE R, PART II. THE ORGANIZATIONS ARE RELATED THROUGH DIRECT AND/OR INDIRECT CONTROL.

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CHARLES COLE MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, SKILLED NURSING & ANCILLARY HEALTHCARE SERVICES TO SURROUNDING RURAL COMMUNITIES OF NORTH CENTRAL PENNSYLVANIA.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	619
6	Total number of volunteers (estimate if necessary) .............	6	16
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	127,564
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	125,856

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	656,685	1,464,838
9	Program service revenue (Part VIII, line 2g) .........	103,907,312	107,005,582
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	387,461	359,493
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	17,619	-128,849
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	104,969,077	108,701,064
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	20,000
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)	52,542,013	51,919,507
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)....	52,042,609	49,453,959
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	104,584,622	101,393,466
19	Revenue less expenses. Subtract line 18 from line 12.......	384,455	7,307,598
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	66,801,913	68,147,041
21	Total liabilities (Part X, line 26).............	13,530,294	9,442,204
22	Net assets or fund balances. Subtract line 21 from line 20.....	53,271,619	58,704,837

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	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 27,177,515 including grants of $ 20,000 ) (Revenue $ 64,321,716 )
	UPMC COLE OFFERS OUTPATIENT SERVICES, EXCEEDING 373,000 TESTS/TREATMENTS ANNUALLY THROUGHOUT THE HOSPITAL'S FOUR-COUNTY AREA AND INCLUDING IMAGING, LAB, CARDIO-PULMONARY, ONCOLOGY, HOME HEALTH, WOUND CARE AND REHABILITATION SERVICES. OUTPATIENT SURGERIES EXCEED 4,600 ANNUALLY. THE UPMC HILLMAN CANCER CENTER PROVIDES SPECIALTY ONCOLOGY SERVICES AND ADDITIONAL SUPPORTIVE SERVICES FOR PATIENTS AND THEIR FAMILIES. SEE SCHEDULE O FOR DETAIL.

4b	(Code: ) (Expenses $ 26,662,467 including grants of $ ) (Revenue $ 16,153,357 )
	UPMC COLE PROVIDES PRIMARY CARE TO THE SURROUNDING COMMUNITIES IN FOUR COUNTIES AT RURAL HEALTH CENTERS(RHCS), LOCATED IN COUDERSPORT, GALETON, ULYSSES, WESTFIELD, SHINGLEHOUSE, PORT ALLEGANY, ELDRED, SMETHPORT, AND EMPORIUM. COLLECTIVELY, 102,400 PATIENT VISITS WERE REPORTED LAST YEAR IN ADDITION TO 11,700 DENTAL VISITS. FOUR OF THOSE LOCATIONS ALSO INCLUDE WELLNESS AND REHABILITATION CENTERS, MAKING IT MORE CONVENIENT FOR PATIENTS TO RECEIVE THE SERVICES AND CARE THEY NEED CLOSE TO HOME. SEE SCHEDULE O FOR DETAIL.

4c	(Code: ) (Expenses $ 14,440,271 including grants of $ ) (Revenue $ 17,744,220 )
	UPMC COLE OFFERS VARIOUS INPATIENT SERVICES. UPMC COLE ADMITTED 1,260 ACUTE PATIENTS LAST YEAR (5,050 ACUTE CARE DAYS) TO INPATIENT SERVICES INCLUDING MEDICAL/SURGICAL, INTENSIVE CARE AND OBSTETRICS UNITS. UPMC COLE'S 24-HOUR EMERGENCY DEPARTMENT ADMITTED 880 PATIENTS LAST YEAR AND HAD 9,970 VISITS LAST YEAR. THE HOSPITAL'S MATERNITY UNIT WELCOMED 129 BABIES INTO THE WORLD LAST YEAR AND ALSO SUPPORTS MOTHERS-TO-BE WITH BREASTFEEDING SUPPORT PROGRAMS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 21,912,594 including grants of $ ) (Revenue $ 8,786,289 )
4e	Total program service expenses90,192,847

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC/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) PATRICK LARSEN........................................................................ DIRECTOR	1.0 .......................2.0	X		0	0	0
(19) CHARLES UPDEGRAFF........................................................................ CHAIR/DIRECTOR END 09/21	1.0 .......................2.0	X	X	0	0	0
(20) JOHN LEETE........................................................................ TREASURER/CHAIR BEG 12/21	1.0 .......................2.0	X	X	0	0	0
(21) ELIZABETH WALLACE........................................................................ DIRECTOR	1.0 .......................2.0	X		0	0	0
(22) JOSHUA COSTA........................................................................ DIRECTOR BEGIN 03/22	1.0 .......................3.0	X		0	0	0
(23) MATTHEW SPLAIN........................................................................ DIRECTOR BEGIN 03/22	1.0 .......................2.0	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,624,490	3,254,561	741,406

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	21,890
e	Government grants (contributions)		1e	1,291,187

f	All other contributions, gifts, grants, and similar amounts not included above		1f	151,761

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

h Total. Add lines 1a-1f.......		1,464,838

		Business Code
2a	NET PATIENT SERVICE REVENUE	621990	103,741,728	103,741,728
b	PHARMACY	621990	2,709,367	2,709,367
c	RENT FROM EXEMPT AFFILIATES	900099	241,208	241,208
d	CAFETERIA	722514	192,327	192,327
e	OTHER	621990	120,952	120,952
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		107,005,582

3 Investment income (including dividends, interest, and othersimilar amounts) ......			72,789			72,789
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			18,058		2,433	15,625
		(ii) Personal	(i) Real
6a	Gross rents		42,990	6a
b	Less: rental expenses		288,411	6b
c	Rental income or (loss)	0	-245,421	6c
d	Net rental income or (loss).......			-245,421			-245,421
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		578,646	7a
b	Less: cost or other basis and sales expenses	2,619	289,323	7b
c	Gain or (loss)	-2,619	289,323	7c
d	Net gain or (loss).........			286,704			286,704
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	INVESTMENT IN LAB PARTNERSHIP		900099	98,514		125,131	-26,617
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			98,514
12	Total revenue. See instructions.....			108,701,064	107,005,582	127,564	103,080

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	20,000	20,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	456,330	218,951	237,379
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	40,840,885	39,231,759	1,609,126
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,889,915	1,824,985	64,930
9	Other employee benefits .......	5,993,459	5,785,731	207,728
10	Payroll taxes ...........	2,738,918	2,624,936	113,982
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	50,865		50,865
c	Accounting ...........	2,400		2,400
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	26,041		26,041
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	11,104,843	10,287,030	817,813
12	Advertising and promotion ....	75,816	6,849	68,967
13	Office expenses .......	9,741,506	3,094,242	6,647,264
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	2,149,897	1,902,578	247,319
17	Travel ............	209,225	192,309	16,916
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	2,101	2,101
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	3,243,396	2,939,780	303,616
23	Insurance ...	1,108,670	395,737	712,933
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES & DRUGS	15,165,811	15,165,811
b	BAD DEBT EXPENSE	5,496,475	5,496,475
c	REPAIRS AND MAINTENANCE	999,333	931,893	67,440
d	LICENSES, DUES, SUBSCRIPTIONS	45,086	39,186	5,900
e	All other expenses	32,494	32,494
25	Total functional expenses. Add lines 1 through 24e	101,393,466	90,192,847	11,200,619	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			1,024,271	1	1,224,963
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			5,034	3	117,371
4	Accounts receivable, net .............			5,238,315	4	9,431,174
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			0	8	1,057,034
9	Prepaid expenses and deferred charges ......			0	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	45,035,880
b	Less: accumulated depreciation	10b	16,113,312	27,693,793	10c	28,922,568
11	Investments—publicly traded securities .			6,506,432	11	6,227,695
12	Investments—other securities. See Part IV, line 11 .....			2,233,998	12	1,776,568
13	Investments—program-related. See Part IV, line 11 ..			0	13	1,333,691
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			24,100,070	15	18,055,977
16	Total assets. Add lines 1 through 15 (must equal line 33)...			66,801,913	16	68,147,041

17	Accounts payable and accrued expenses .....	1,510,474	17	1,060,237
18	Grants payable ...	0	18	0
19	Deferred revenue .........	7,432,155	19	4,832,817
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	12,532	21	778
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	4,575,133	25	3,548,372
26	Total liabilities. Add lines 17 through 25..	13,530,294	26	9,442,204

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	47,782,858	27	53,342,701
28	Net assets with donor restrictions ...........	5,488,761	28	5,362,136
	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 ...........	53,271,619	32	58,704,837
33	Total liabilities and net assets/fund balances ........	66,801,913	33	68,147,041