The Wright Center for Graduate Medical

“No. Although previously, TWCGME was organized as a member non-profit corporation, on February 10, 2023 during a duly called and held Member meeting, TWCGME's Membership voted affirmatively to abolish the membership altogether given the duplicative nature of Member representatives being the same persons as those serving on the governing body, i.e., the Board of Directors. TWCGME's Board of Directors voted affirmatively to amend the Bylaws and reflect the organizational change of abolishing corporate membership, and to amend and restate TWCGME's Articles of Incorporation appropriately.”

“No. Although TWCGME was previously organized as a member non-profit corporation, on February 10, 2023, during a duly called and held Member meeting, TWCGME's Membership voted affirmatively and unanimously to abolish the Membership structure given the duplicative nature of Member representatives being the same persons as those serving on the governing Board of Directors. TWCGME's Board of Directors voted affirmatively and unanimously to amend the non-profit corporation's Bylaws to reflect the organizational change of abolishing corporate membership and to amend and restate TWCGME's Articles of Incorporation appropriately. Prior to fiscal year 2023-2024, there had been corporate members who had the right to appoint members of the Board of Directors. The previous corporate membership structure provided that Class I members who, through affiliation, compensated TWCGME's sponsoring institutional consortium for at least ten resident and/or fellow physician FTEs in GME training had the right to appoint one Class II-A director to TWCGME's board. Additionally, Class I members who, through affiliation, compensated TWCGME's sponsoring institutional consortium for at least twenty-five resident and/or fellow physician FTEs in GME training had the right to appoint two Class II-A directors to TWCGME's Board of Directors. At that time, per TWCGME Bylaws, no Class I member was permitted to appoint more than two voting directors on TWCGME's Board, and no Class I member was permitted to appoint directors to any class other than Class II-A.”

“A written Conflict of Interest Policy created and recommended by the SVP for Enterprise Integrity has been and approved by the President and CEO and Board of Directors. The SVP of Enterprise Integrity and the Chief Compliance Officer work together to ensure it is reviewed, updated if necessary, and renewed annually or more frequently when necessary or appropriate. The SVP for Enterprise Integrity, along with the Governance and Chief Compliance Officers, ensure that the Conflict of Interest Disclosure Form is completed annually by all governing board members ("directors") and officers. Together, this team, along with the VP of Human Resources, ensures that the Conflict of Interest Disclosure Form is completed annually by executive management and all staff, including but not limited to key employees of the organization. Should a conflict of interest or potential conflict arise during the year among directors and officers, the Governance Officer and the SVP for Enterprise Integrity ensure the Conflict of Interest Disclosure Form is updated to reflect the possible conflict. Potential conflicts of directors and officers, if any, are fully disclosed, vetted by internal counsel and the Audit/Compliance Committee, and reviewed by the Board with outside ethics consultation obtained when appropriate. Education on conflicts of interest is provided to new directors and officers during Board Orientation and to the full Board annually during the review, update, and renewal of the Conflict of Interest Policy. Directors officers' compliance with the policy is monitored by the Audit/Compliance Committee of the Board and supported by the Governance Officer and SVP for Enterprise Integrity. Education on conflicts of interest, including any revisions to the Conflict of Interest Policy, is provided to new employees during orientation, and annually during the performance review process. Adherence by staff to the Conflict of Interest policy is monitored by managers with the supportive oversight of the VP of Human Resources, the SVP for Enterprise Integrity and the Chief Compliance Officer.”

“Prior to fiscal year 2023 - 2024, the organization had two classes of members who had the right to appoint members of the board of directors. The amended and restated bylaws removed the membership from the organization.”

“TWCGME'S Form 990 is prepared by the senior leadership team of the Finance and Enterprise Integrity Departments with detailed review and input from the executive management team and President & CEO. The draft Form 990 is then reviewed by an independent, contracted CPA firm. The refined Form 990 is then distributed to the Audit/Compliance and Executive Committees of the Board of Directors and subsequently to the full Board of Directors for review, input, and approval for federal filing. Upon completion of this review, necessary revisions, and approval, the Form 990 is finalized, signed by the organization's President & CEO, and filed with the IRS. TWCGME's three most recently filed 990s, along with three sequential annual reports, are transparently available on our website in a downloadable format, and are kept in a secure location at every required operational site where they may be reviewed in hard copy upon request, consistent with IRS applicable laws, rules, and regulations.”

“TWCGME contracts with its affiliated entity, The Wright Center for Community Health (TWCCH), for the services of TWCGME's President and CEO, who is employed by and serves as President and CEO of TWCCH. Consequently, TWCGME does not directly compensate the President and CEO. The Executive Committees of TWCGME and TWCCH Boards collaboratively determine the respective chief executive's compensation, engaging a third-party external consultant to conduct a formal, periodic objective, comprehensive, organization-wide compensation study generally every three to five years. During contract negotiations with the President and CEO, the relevant components of the study are appropriately aged and supplemented by data from sources such as the American Job Center Network, Medical Group Management Association (MGMA), Form 990s of comparable organizations, and compensation surveys from the Pennsylvania and National Associations of Community Health Centers, among other relevant regional and national benchmarks. Annually, the Executive Committees collaboratively conduct a thorough performance evaluation of the chief executive and the respective organizations, assessing the appropriateness of salary and benefit adjustments. These adjustments, if made between contract terms, are benchmarked against publicly available comparable data. Ultimately, the chief executive's compensation is determined based on a robust performance evaluation, organizational performance, and careful consideration of the independent compensation study, market comparability, and financial feasibility. The Executive Committees' deliberations and decisions regarding executive compensation are meticulously documented in meeting minutes within 60 days of the evaluation's completion and the compensation determination.”

“The compensation of all other employees, including key employees, is determined by the chief executive (TWCGME President & CEO) and the Human Resources Department, guided by a formal, periodic objective, comprehensive, organization-wide compensation study completed generally every three to five years. The VP of HR and the President & CEO may also consider additional data in determining compensation levels within the organization, such as information from the American Job Center Network website, Medical Group Management Association (MGMA), Form 990s of comparable organizations, and Compensation Surveys of The Pennsylvania Association of Community Health Centers and National Association of Community Health Centers, among other regional and national benchmarks. As with the services of TWCGME's Chief Executive, TWCGME also leases the services of TWCCH's Chief Medical and Information Officer as a key employee/executive for TWCGME in the position of SVP of Clinical Educational Integration. The third-party external compensation consultant jointly engaged by TWCGME and TWCCH also includes the services of this position, like all executive positions, in its formal, periodic objective, comprehensive, organization-wide compensation study completed generally every three to five years.”

“TWCGME's governing documents, conflict of interest policy, and financial statements are kept in a secure location and are available for public inspection during business hours at the organization's administrative office at 501 South Washington Avenue, Suite 1000 in Scranton, Pennsylvania, 18505, and other locations as required by IRS rules and regulations. Hard copies are provided upon request for review. TWCGME's three most recently filed 990s, along with three sequential annual reports, are also available on its website in a downloadable format.”

“Line 2B on the statement of revenue represents the revenue recorded for support services that TWCGME performs as the common paymaster on behalf of TWCCH, an affiliated organization, pursuant to intercompany shared mission covenant and related lease agreements. TWCGME serves as the common paymaster for TWCCH. In operationalizing the common paymaster functionality, TWCGME has entered into staffing lease agreements with TWCCH for the provision of certain administrative and executive services. TWCCH reimbursed TWCGME for these services through well-validated FTE-based intercompany allocation methodologies. Through these shared mission-driven staffing lease agreements, TWCCH leases clinical staff, management services, and back office support services from TWCGME including, but not limited to, human resources, information technology, marketing and communications, finance, grants, governance support, governmental relations, legal and other administrative support services. The costs associated with this revenue, in addition to costs supporting TWCGME management and general expenses, are recorded as management and general expenses on TWCGME's Form 990, section IX (Statement of Functional Expenses), column C.”

“The mission of The Wright Center for Graduate Medical Education (TWCGME) is to improve the health and welfare of our communities through responsive whole person health services for all and the sustainable renewal of an inspired and competent workforce that is privileged to serve. TWCGME, a 501(c)(3) nonprofit corporation and anchor member of a Graduate Medical Education Safety-Net Consortium (GME-SNC), in partnership with its affiliated entity and Federally Qualified Health Center Look-Alike The Wright Center for Community Health, serves as the independent Accreditation Council for Graduate Medical Education (ACGME)-accredited Sponsoring Institution of graduate medical education residency and fellowship programs that train primary care resident and specialty fellow physicians in a safety-net health services network of Essential Community Providers. TWCGME's training programs operating during the reporting period include Internal Medicine, Family Medicine, Psychiatry, and Physical Medicine & Rehabilitation residencies and Geriatrics, Cardiovascular Disease, and Gastroenterology fellowships. TWCGME's GME-SNC strategically engages numerous partnering organizations in its governance and the training of its residents and fellows. These partners include TWCGME's primary affiliated Federally Qualified Health Center Look-Alike (FQHC LAL), The Wright Center for Community Health (TWCCH), as well as four partnering national FQHCs, numerous CMS GME-funded community-based hospital systems, our regional Veteran Affairs Medical Center, two CMS GME-funded Inpatient Rehabilitation Facilities (IRFs), our regional Northeast Pennsylvania Area Health Education Center (AHEC), community resource agencies including The Institute for Public Policy and Economic Development, and also patients of TWCCH and members of the communities served at large. TWCGME and TWCCH also proudly hosted 187 interprofessional students for clinical and educational experiences from over a dozen academic institutions of higher education, including Geisinger Commonwealth School of Medicine (GCSOM), and also A.T. Still University's School of Osteopathic Medicine in Arizona (SOMA) and Central Coast Physician Assistant Program (CCPAP). Partnering community health centers, Geisinger, and ATSU SOMA have an empowered voting presence on TWCGME's governing board, as does Commonwealth Health Systems and the Northeast Pennsylvania Area Health Education Center (AHEC). Committed to community health needs responsive, whole person health services and health care workforce development, TWCGME's GME-SNC model embracing community health centers as integrated academic primary care workforce development platforms is a potential solution for individual community health center workforce recruitment and retention, and a means of addressing our national primary care workforce shortage, mis-distribution, and related health, health care services, and health care career access needs and challenges. Promoting a culture of unifying participatory citizenship and shared learning for board, clinical care teams, staff, patients, and community-based interprofessional health care learners, while stimulating and leveraging each stakeholder group's meaningful contributions to continuous improvements in internal and partnering care delivery and workforce development systems, the GME-SNC's collective impact delivers and enriches talent development, recruitment, and retention for health centers, affiliated organizations, and larger communities served.”

“The Wright Center for Graduate Medical Education (TWCGME) and its primary affiliated entity, The Wright Center for Community Health (TWCCH), share a mission to improve the health and welfare of our communities through responsive whole person health services for all and the sustainable renewal of an inspired and competent workforce that is privileged to serve. TWCGME'S passionate purpose is to demonstrate an "Achievable by All" Graduate Medical Education Safety-Net Consortium (GME-SNC) Teaching Health Center model that co-creates transformational health care teams of leaders who empower people, families, and communities to own and optimize their health, health care delivery system, and their interprofessional health care workforce development. With full engagement of TWCGME stakeholders, the GME-SNC aspires to optimize its collective impact framework to effectively address America's primary care workforce shortage and mis-distribution, and related health, health care, and health care career access needs and challenges. As a GME-SNC, TWCGME partners with a network of safety-net health services providers and integrates GME federal resources directly from the U.S. Health Resources and Services Administration's (HRSA) THCGME program and the Department of Veteran Affairs' GME, as well as through its affiliation agreements with CMS GME-funded partnering hospitals and Inpatient Rehabilitation Facilities. Notably, TWCGME became a pioneering THCGME consortium grantee in 2011 when HRSA launched the THCGME program. Since then, THCGME grantees, including TWCGME, have been developing and expanding community-based clinical learning environments in community health centers (CHCs) and partnering hospitals and specialty stakeholders across our nation to train primary care resident and fellow physicians to offer nondiscriminatory health services while serving historically marginalized populations in medically underserved settings. Evidence demonstrates that physicians who train at CHCs are more likely to work in a CHC or other underserved settings after graduation, as validated by HRSA's Teaching Health Center GME program's undeniable graduate outcomes fifteen years after its inception. This vital response to the primary care shortage most effectively trains and retains primary care physicians in communities where they are most needed, with 86%, 62%, and 31% of THCGME graduates remaining in primary care practice, serving underserved and rural communities, as compared to 23%, 26%, and 5% of traditional GME graduates respectively. With a notably higher-than-national-average complement of primary care physicians selecting careers in historically underserved settings, including in FQHCs and rural communities, after graduation, HRSA's THCGME program and TWCGME GME-SNC's historical graduate practice pattern outcomes demonstrate logical, delivered solutions to resolve America's primary care crises. Yet this pioneering program's funding remains vulnerable and egregiously discordant and far below its value and impact to our country. This unfortunately unresolved inadequate funding debacle at the federal level continues to leave this notably impactful THC GME-SNC solution under-resourced, nonsensically undermining its national community benefit impact, despite escalating primary care shortages across our country. This bizarre tragedy of the commons reality is illuminated by the just released 2025 National Residency Match Program outcomes that revealed unfilled match positions in primary care disciplines. This repeated reality highlights persistent shortcomings in our historical, national Graduate Medical Education (GME) system championed by traditional academic medical centers controlling isolated CMS centric GME systems. Graduate Medical Education (GME) expansion limited solely to the Centers for Medicare & Medicaid Services (CMS) program clearly will not fix primary care workforce development for America. In essence, relying solely on CMS for GME expans”

“HRSA's THCGME Program has been an effective tool in addressing one of the most crucial aspects of the primary care cliff: nondiscriminatory access to and affordability of primary whole person health services in underserved areas due to a national primary care physician shortage and mis-distribution. Additionally, Teaching Health Center community-governed GME-SNC platforms magnetize and optimize the educational capacity of communities for interprofessional health care workforce development because they generate unprecedented collaboration and CHAMPs partnerships, evidenced by TWCGME's thriving academic institutional affiliations. TWCGME's GME-SNC, as a result, has proudly delivered to its affiliate, TWCCH, 54% of its primary care physician workforce, including Internal Medicine, Family Medicine, and Geriatrics physicians, 92% of its Certified Registered Nurse Practitioners, and 88% of its Physician Assistants. Moreover, 25% of TWCCH's public health dentists recently completed NYU Langone's CODA accredited Advanced Education General Dentistry (AEGD) residency at our health center participating site, a program that launched in 2020. One third of TWCCH's Medical Assistants completed clinical training with the GME-SNC, several through our partnership with National Institute for Medical Assistant Advancement and NEPA Readiness in Skilled Employment programs. Mission driven partnership with our Northeast Pennsylvania AHEC supports interprofessional students rotating with us and ensured training and certification of all 10 of TWCCH's Community Health Workers. Five of seventy Certified Recovery Specialists trained and certified through the GME-SNC's engagement and Project PROGRESS are continuing provision of addiction and recovery services at TWCCH. Because of these talent development, recruitment, and retention outcomes, the GME-SNC is exploring expanded academic partnerships to integrate clinical training for LPNs, dental assistants, case managers, and integrated behavioral and mental health professionals, including mental health peer specialists, as well as a Family Medicine CRNP primary care fellowship. Many additional individuals trained in the GME-SNC are actively practicing in regional partnering organizations, predominantly in underserved settings. TWCGME's current sponsoring institutional and programmatic primary health services curricula are rooted in community-immersed, public health needs-responsive, fully integrated, comprehensive whole person primary care training for family medicine, internal medicine, psychiatry, and physical medicine and rehabilitation residents, as well as geriatric medicine, cardiovascular disease, and gastroenterology fellows. Residents and fellows are deeply immersed in community-driven, responsive solutions to the relentless opioid epidemic, continuing battles with HIV/AIDS and Hepatitis C, escalating public health challenges related to mental health struggles, obesity, diabetes, cardiovascular disease, cancer, and the ever widening gaps in evidence based childhood and adult vaccination rates for preventable illnesses. Our community-based training model within Essential Community Provider networks continued to successfully leverage cross-institutional collaborative learning and broad exposure of trainees to interprofessional team-based care, as well as a variety of health information technology platforms, for both care delivery and educational outcomes reporting and continuous improvements. TWCGME's partnering clinical learning environments demonstrate and engage its learners in continuous quality improvement and value-driven workflow redesign that promotes Patient-Centered Medical Home (PCMH) physician-led interprofessional care teams, leveraging engaged and empowered physicians in practice and training, students, patients and families, robust referral networks of community resource agencies, and both meaningful use and connectivity/interoperability of health and education information technology”

“The ACGME accreditation of TWCGME's community based Psychiatry Programs in partnership with Geisinger Commonwealth School of Medicine was a historical triumph for Northeast Pennsylvania, especially given our national, regional, and local shortage of psychiatrists and rising mental health and substance use disorder challenges in communities across our nation. Circumstances related to evolving corporatization, including the unanticipated, short notice closures of two community inpatient Psychiatric facilities, the related career implications for our inaugural Program Director, and the discordance between the residents' demand for autonomy and unsupervised practice allowed for CMS approved primary care exception activities and HRSA's THCGME Program, all culminated in an acute, massive collective disturbance. Program leadership and residents acutely expressed distress and dissatisfaction generating unfortunate triangulating dynamics with the ACGME against TWCGME. This all precipitated numerous prompt corrective actions, but also a short timeframe site visit by the Psychiatry Residency Review Committee of the ACGME in the middle of the acute crisis. Despite significant progress, including a program director transition; discontinuation of an inadequately supervised clinical learning venue; addition of a most welcomed, well-supervised new psychiatry clinical continuity learning environment; and engagement of several new board certified or eligible psychiatry faculty, we unfortunately received a notice of withdrawal of accreditation from the ACGME more than six months after the site visit and after comprehensive corrective actions had been successfully implemented. In between the site visit and this irresponsibly delayed and surprising notification, TWCGME actually successfully recruited a full class of new intern psychiatry physician learners through the National Residency Match Program (NRMP). This dysfunctional process caused unnecessary distress to TWCGME's Sponsoring Institution, new program leadership, the Psychiatry residents and newly matched interns, and the entirety of TWCGME's House Staff, because it generated resource-intense dynamics of betrayal. Particularly troubling was the Site Visitor's extensive intentional engagement of the former Program Director who had already been terminated for refusal to follow HRSA compliance requirements and the triangulation of the residents against the Sponsoring Institution. Given the completion and implementation of TWCGME's comprehensive remediation plan for the Psychiatry Residency program and after careful deliberation as a steward of federally funded ACGME accredited GME regarding the historical events, community benefit impact, and optics of challenging the ACGME after a nearly 5 decades of high integrity excellent accreditation, GMEC approved TWCGME's board and Sponsoring Institutional and programmatic leadership's desire to appeal the ACGME Psychiatry Review Committee's decision to withdraw the program's accreditation. The appeal was disappointingly unsuccessful. The Review Committee withdrew the program's accreditation effective June 30, 2024 following what was a robust, evidence-based and expensive but shockingly unsuccessful appeal in Chicago delivered by board members, the DIO, the Program Director, a psychiatry resident, and counsel. Without any possible opportunity for further appeal, TWCGME had no choice but to accept the unsupported decision, and so turned its attention and efforts to administratively support the responsible wind-down of the program and the transitions of the residents into other programs. HRSA's THCGME national network was particularly helpful in the transition process. In response to our request, the ACGME Psychiatry Review Committee thankfully but oddly permitted off-cycle residents to complete their current year of training which went beyond the June 30, 2024 deadline in order for those residents to maintain board eligibility. In full compliance with”

“During the reporting period, TWCGME also experienced two additional unfortunate accreditation decisions by the ACGME Residency Review Committee for Family Medicine (RRC-FM). Similar to the fate of our Psychiatry residency and discrete from the somewhat Pyrrhic victory of the NFMR program subsequently described, we are disheartened to report the ACGME Family Medicine Review Committee also withdrew accreditation of TWCGME's Regional Family Medicine Residency program during the reporting period. In contrast to the ACGME's decision to allow training out of all NFMR residents, the decision to withdraw accreditation for our Regional Family Medicine program will be withdrawn as of June 30, 2025. Mirroring other programs affected by delayed and untimely ACGME notifications of accreditation withdrawal, the ACGME RRC-FM surprisingly issued its adverse accreditation decision months after a site visit, prompted by the challenges described below. Unfortunately, this occurred without interim communication, enabling TWCGME's NRMP engagement and full recruitment of a new intern class. This force-multiplied the unfortunate dynamics of betrayal discussed above. An evolution from one of the first family medicine residency programs in the nation born in the 1970s, the Regional Family Medicine Residency Program was initially housed in a community-based program sponsored by Wilkes-Barre General Hospital and serving Luzerne County, PA. When the hospital was purchased by for-profit Commonwealth Health Systems in the late 2000s, the new for-profit owners struggled to continue the educational program. TWCGME stepped in to save the legacy community-based Family Medicine residency, and also after much tension, to save the faculty practice clinic that served as the family medicine residency practice and essential community provider of nondiscriminatory primary health services for over 5,000 unique patients. The Single Accreditation System led to the merger of this long-standing program with TWCGME's newer, AOA-accredited THCGME funded Family Medicine residency program that was serving Lackawanna County, PA into one 12-12-12 ACGME accredited Family Medicine Residency program. Cultural connectivity was a longstanding source of tension, as once insular programs now had to learn to work together. Nevertheless, the program evolved and thrived through leadership transitions to continue to train and graduate competent Family Medicine residents, boasting continued 100% first time board pass rates and celebrating strong retention of graduates in regional community based practice. During the last fiscal year due to the continued consolidation, commoditization, and corporatization of large regional health systems that resulted in the elimination of critically needed acute care services and, therefore, educational rotations, there were required components of family medicine training that TWCGME was unexpectedly unable to urgently meet. For example, two local hospitals eliminated inpatient pediatric services, precluding a mandatory educational experience for Family Medicine residency trainees. Additionally, the contemporaneous closure of obstetric services at a local hospital presented yet another educational challenge, necessitating TWCGME's immediate but time necessitating outreach for paid engagement of Obstetric and Gynecology new faculty educators to close the unanticipated ACGME-mandated educational gaps. Unfortunately, resident distress expressed on the ACGME resident survey and during a triggered RRC-FM site visit led to the withdrawal of accreditation decision which came many months after corrective actions had resolved all issues within weeks. Because of TWCGME's historical experience and expenses associated with an unproductive ACGME appeal process, GMEC, the governing board and Sponsoring Institutional leadership sadly accepted the Regional Family Medicine Residency program's sunset date of June 30, 2025. In full compliance with ACGME requirements and TWCG”

“Nevertheless, after a decade of back and forth nonsensical, repeated conversations on its accreditation roller coaster with recurring yet previously resolved citations, the RRC-FM finally and disappointingly delivered the ACGME's clear articulation of its arbitrary and capricious refusal to allow a consortium model at the level of a residency program, despite the NFMR's unprecedented journey through the Single Accreditation System, near perfect first time board pass rates, and undeniably impactful primary care graduate outcomes. Consequently, TWCGME conceded, submitting an application for a new Family Medicine residency program under its Sponsoring Institution for our NFMR partner site at Health Source in Ohio, and supporting new Sponsoring Institutional and Family Medicine Residency applications submitted by our NFMR partners El Rio in Arizona and HealthPoint in Washington state. TWCGME also continues at the time of this writing to support a similar ACGME application for emergence of a new Family Medicine residency program at our NFMR Partner at Unity Health in Washington, DC. Despite its historical achievement of transitioning from its original accreditation by the American Osteopathic Association through the Single Accreditation System to the status of full continuing accreditation by the ACGME, the RRC-FM ultimately resurrected previously negotiated and resolved citations to justify its decision to withdraw accreditation altogether, summatively communicating the ACGME's unwillingness to allow a consortium model like NFMR at the programmatic level (i.e., with four sites in various geographical regions across the country and a single Program Director housed in A.T. Still University's School of Osteopathic Medicine in Arizona (SOMA)), despite its acceptance of consortium platforms for Sponsoring Institutions. Astonishingly, NFMR's 98% Board Pass Rate on first attempt and its unprecedented 32.3%. 43%, and 55.6% graduate retention rates in their host or other FQHCs or other primary care systems serving medically underserved populations were dismissed factors in the accreditation decision. However, the ACGME Family Medicine Review Committee indicated its support for the establishment of four individual programs at each of the existing NFMR sites and also recommended that all engaged residents be allowed to finish their training and graduate from the established program. Extending the NFMR's accreditation until the last trainee graduates with planned program closure on June 30, 2026 notably supersedes historical ACGME continued operational allowances for programs with withdrawn accreditation. Compassionately, the ACGME is currently, as of the time of this 990 submission, permitting the teach-out of residents in the historically successful NFMR program to avoid further disrupting the residents' education and career paths, enabling each class to continue training without interruption. This generous allowance however does not offset the tragic and avoidable emotional impact on all trainees and stakeholders involved. Nevertheless, NFMR's nationally significant demonstrated outcomes to date undeniably prove delivery of its incredible, hopeful, envisioned potential to address our nation's primary care shortage and mis-distribution and related health, health care, and health care career access challenges. Joyfully, two of the four national participating sites in the NFMR program, with endorsement and support from TWCGME, achieved independent ACGME Sponsoring Institution and Family Medicine Residency program accreditation. TWCGME is proud to have been a part of this momentous accomplishment for both FQHC training site partners, made possible by originally embarking on the innovation journey together in 2011 and having collaboratively fostered the NFMR as a peer learning triumph for the communities served for more than a decade. These notable achievements prove supported GME-SNCs are replicable and scalable across America. HealthSource of”

“Despite the traumatic and extremely painful challenges related to pioneering THCGME innovations that challenge the historical status quo, we are as committed to public health workforce development as ever to the ACGME's visionary CHAMPs and Sponsoring Institution 2025 frameworks. We firmly stand by our vision in our original HRSA THCGME grant application (The Teaching Health Center Highway to the Relevance of GME in Communities), "to renew primary care physician manpower with graduates responsive to the needs of individual patients, families, and their communities, rich in social responsibility and skilled in servant leadership of inter-professional delivery teams within medical homes." On the other side of thirteen years of passionate and inspiring collaborative work with the HRSA THCGME Program, including our pioneering grant application (The National Teaching Health Center Highway to the Relevance of GME in Communities), we are humbled and awestruck at what has been achieved. We credit our THCGME journey and the direct mentorship by our NFMR FQHC partners for our successful HRSA designation of The Wright Center for Community Health as a Federally Qualified Health Center Look-Alike, a designation which has changed essential community provider whole person primary health services in Northeast Pennsylvania in unimaginable ways, with community benefit impact on generations we know cannot be overstated. We have renewed the primary care physician workforce in underserved communities across our country, and that public health impact too cannot be overstated. We have gratefully and unapologetically lived our mission to improve the health and welfare of the communities we serve through responsive whole person health services for all and the sustainable renewal of an inspired and competent workforce that is privileged to serve through our Teaching Health Center initiatives. In its CHNA-responsive, recently launched, and now thriving ACGME accredited Physical Medicine and Rehabilitation (PM&R) Residency program, TWCGME further enhanced its work in building robust Community Health Academic Medical Partnerships (CHAMPs) with Allied Services by integrating the Children's Hospital of Philadelphia (CHOP) for important pediatric rehabilitation clinical rotations that are not available for residents of the program regionally. This important collaboration required financial investment and strategic logistical planning to secure stable housing for residents, travel arrangements, etc. The successful integration of CHOP into TWCGME's GME-SNC contributed to the PM&R program's most recent successful ACGME accreditation site visit, yielding a top level Continued Accreditation status for the program that allowed implementation of planned expansion from 20 to 28 resident trainees starting next academic year 2025. These accomplishments demonstrate TWCGME's innovative and resilient spirit, as well as its learning culture and successful application of lessons learned. During the reporting period, responsive to the increasing local and national needs of an aging population, TWCGME's Geriatric Medicine Fellowship successfully engaged Geriatrics board certified physician faculty appropriate to meet accreditation requirements to train six fully funded, and ACGME accredited full-time equivalent (FTE) fellow positions. Notably, TWCGME also successfully received approval from the ACGME and Association of Directors of Geriatrics Academic Programs (ADGAP) for an Advancing Innovations in Advancing Residency Education (AIRE) Medicine-Geriatrics Integrated Residency and Fellowship (Med-Geri pathway). According to ADGAP, the combined Med-Geri pathway provides an alternative for training geriatricians by integrating the clinical experiences required in a geriatrics fellowship across the internal medicine (IM) or family medicine (FM) residency continuum and meeting geriatric competencies in an innovative four-year (48 month) program, after which graduates will be elig”

“TWCGME continued to connect clinical educational programming with TWCCH and affiliated hospital operations, aspiring towards the vision of the ACGME Sponsoring Institution 2025 that calls forth the seamless integration of clinical and educational programming. This includes working toward a more successful integration of dental, mental, and behavioral health into primary health services delivery. With the increased focus on value-based care (VBC) in clinical delivery sites and concordant dynamics in value based payment changes, TWCGME integrated VBC initiatives into its Sponsoring Institutional Population Health Curriculum to enhance the education of residents and fellows to best prepare them for the future. During the reporting period, TWCGME also invested significant effort in preparedness for a successful and impactful ACGME Clinical Learning Environment Review (CLER) site visit with our ambulatory and hospital partners. The CLER Program was implemented by the ACGME as part of the Next Accreditation System in recognition of the "public's need for a physician workforce capable of meeting the challenges of a rapidly evolving health care environment." Therefore, the ACGME CLER Program provides periodic feedback to clinical settings affiliated with ACGME-accredited programs and institutions, addressing the following six areas of importance to resident and fellow physician training: patient safety; health care quality; teaming; supervision; well-being; and professionalism. GMEC launched a CLER Subcommittee led by Clinical Leadership of TWCCH (TWCGME's primary ambulatory clinical training environment partner). TWCGME's CLER materials have been updated to reflect version 3.0 of CLER Pathways to Excellence, released by the ACGME in February 2024. CLER mock site visits occurred at: Geisinger Community Medical Center (GCMC) and TWCCH's Mid Valley clinic locations in January 2024; 501 S. Washington Ave. in Scranton in March 2024; and Regional Hospital in June 2024. Mock site visit reports were developed for and shared with each site. The CLER Subcommittee continues to meet quarterly as TWCGME awaits the most welcomed announcement of a future CLER site visit by ACGME. TWCGME is pleased to report that, twelve years after commencing and contributing to advocacy for federally-designated community health centers to be eligible to operate Advanced Education in General Dentistry Residency programs as sponsoring institutions, the Commission on Dental Accreditation (CODA) has finally revised Standard 1-1. Now, organizations that "receive regular on-site inspections through the Health Resources and Services Administration Operational Site Visit (HRSA-OSV) process" are eligible to sponsor AEGD programs, expanding the ability for community health centers to develop the primary care workforce America needs. Meanwhile, TWCGME continued to support its affiliate TWCCH's flourishing Advanced General Education Dentistry residency in partnership with NYU Langone's CODA accredited consortium program, notably noting CODA's allowance of a consortium at a program level disallowed by the ACGME as demonstrated in the unfortunate fate of our NFMR program. During the reporting period in partnership with TWCCH, TWCGME proudly introduced a 12-month Nurse Practitioner Postgraduate Fellowship program in family medicine that provided hands-on clinical training experience for licensed nurse practitioners who are entering their first year of practice. The focus of the fellowship is to provide nurse practitioners who want to remain in family practice with the primary care experience they need to provide high-quality primary and preventative care to the communities served by TWCCH. The nurse practitioners chosen for the fellowship will receive increased clinical exposure during the first year of their practice and specialty clinical experiences, while supervising advanced practice nurse practitioners develop mentorship and leadership skills through engagement in clinical”

“TWCGME continued its passionate, deep investment in the transformational work to progress on our three year journey towards Sanctuary Model Certification. Several accomplishments this year demonstrated TWCGME's progress from a classic primary care oriented, historically over-responsibilitied and under-resourced, trauma-organized Enterprise to become an adversity-competent, resilience-skilled employer, provider of whole person health services, and health care workforce development enterprise. The Sanctuary Model is a blueprint for clinical and organizational change and transformational culture shift which promotes physical, emotional, and psychological safety and recovery from adversity through the active creation of an adversity-informed and competent community. An adversity-competent, resilience-skilled organization is one that recognizes the inherent vulnerability of all human beings to the effects of adverse experiences and organizes system-wide interventions aimed at mitigating the negative effects of adversity and stress that are manifested in those employed in and served by the organization and the organization itself. "Sanctuary" can be offered as a guiding constructive framework for transformation from survival-mode oriented, often divisive care delivery and educational platforms to resilience-focused and competent systematized approaches for teaming that promote psychological safety, trust, participatory citizenship, democratization, social responsibility and accountability, and social learning. TWGME began its deep investment and roll-out of Sanctuary training in earnest in August 2022. Since that time, TWCGME has implemented multiple cohorts of 5-day immersion training events to spread learning across the organization, including governing board members and executive management as well as employees and resident and fellow physicians in training. In January 2024, a 3-Day Train the Trainer requirement was completed. Additionally, during the reporting period, TWCGME and TWCCH Board members received short bursts of training in every regular board meeting. The Executive Management Team, as the Sanctuary Steering Committee, approved the required training for all staff to occur on a rotating schedule during work hours as a testament to the investment of the enterprise in the success of the model. Sanctuary language has been fully integrated into TWCGME's and TWCCH's operational policies and procedures manuals. With costs of providing health insurance for employees continuing to climb beyond multiples of average inflation without boundaries and the increasing concern about the role pharmacy benefit managers (PBMs) play in the costs of commercial health insurance premiums, TWCGME and TWCCH began exploring the viability of self-insuring for health benefits and internalizing pharmacy services. TWCGME anticipates that these initiatives will bring additional benefits to patients, learners and staff such as ensuring timely and affordable medication access. The Wright Center Enterprise also explored the feasibility of engagement in or with insurance brokerage activities to ensure that patients, learners, and staff have the best information possible to make informed coverage decisions. These futuristic initiatives show promising potential to better steward the precious public resources we receive to implement the shared mission of TWCGME and TWCCH while also offering additional resources to all stakeholders. Having finally recouped TWCGME's decade-long investments in the Keystone Accountable Care Organization for the first time, TWCGME had the opportunity to explore how shared savings from participation in Medicare's Shared Savings Program would be best stewarded. Concluding that investing those dollars back into the population served, TWCGME (KACO owner/partner) passed through the majority of shared savings to TWCCH (KACO participant) which uses those resources to enrich the health services delivered to patients. Enriched services”

“During the reporting period, TWCGME engaged in activities of the American College of Physicians and the Pennsylvania and Northeast Pennsylvania Medical Societies, passionately promoting the concept of "participatory citizenship" empower our staff and learners to better understand our public health responsibilities and the important role each individual plays in contributing to our collective mission delivery impact. TWCGME also continued its support of staff and learner engagement on relevant external committees with associations such as the ACGME, the American Association of Teaching Health Centers (AATHC), the Pennsylvania Association of Community Health Centers (PACHC), National Association of Community Health Centers (NACHC), the Area Health Education Center (AHEC), and in forums in support of its "participatory citizenship" philosophy. Hosting ACP Days of Giving augmented the community volunteer activities required of TWCGME and TWCCH employees. TWCGME continued to formally support TWCCH's clinical training partnership with A.T. Still University's School of Osteopathic Medicine (SOMA), hosting 30 osteopathic medical students for didactics and clinical training in Scranton, Pennsylvania. TWCGME also continued its formal support of TWCCH entering its second year as a training site for the public health oriented Central Coast Physician Assistant Program (CCPAP), its similarly designed Hometown Scholars pipeline partnership with A.T. Still University School of Health Sciences, NACHC, and the Community Health Centers of the Central Coast California. Additionally, TWCGME continued its support for TWCCH to develop and train its own medical assistants (MAs) in partnership with the National Institute for Medical Assistant Advancement (NIMAA), and also community health workers (CHWs) through both the AHEC-affiliated Community Health Worker Training Program and the National Health Corps, as well as the local Readiness in Skilled Employment (RISE) academic initiative. TWCCH, in partnership with TWCGME, presented its Wilkes-Barre Health City Hub New Markets Tax Credit (NMTC) project in May 2024 in Miami, Florida to multiple Community Development Entities (CDEs), and since that time, several have gauged interest. TWCCH also received a second Redevelopment Assistance Capital Program (RACP) grant from the Governor for this important GME-SNC project in Wilkes-Barre, PA. TWCCH also submitted a second RACP grant application for its Teaching Health Center FQHC Look-Alike in Jermyn, PA. TWCGME continued its work toward the development and deployment of an effective partner satisfaction survey, in addition to its mission-critical internal climate resident and faculty surveys. During this period, The Institute for Public Policy and Economic Development in Wilkes-Barre, PA (now known as "The Institute") was engaged to design and administer multiple surveys, including but not limited to the above as well as the semi-annual employee satisfaction survey, and also the annual Agency for Healthcare Research and Quality (AHRQ) Medical Office Surveys on Patient Safety Culture (MOSOPS) and Patient-Centered Medical Home Assessment (PCMH-A) surveys. During the covered period, the Audit Committee of the Board approved the new Compliance Program, which prompted the appointment of a new Chief Compliance Officer and the posting and hiring of a Director of Clinical Compliance. The position of Director of Educational Compliance was approved for inclusion in the 2024-2025 fiscal year, and candidates were actively interviewed. Additionally, the Balanced Score Card (BSC)/Key Performance Indicators (KPIs) were published to the Board of Directors through the governance web-based portal in the spring of 2024 to ensure that governance had full visibility into organizational performance metrics upon demand.”

“A decade and a half of pioneering primary care GME-SNC innovations, with futuristic mission driven work on behalf of America, deliberately challenged status quo historical accreditation and single federal agency GME funding boundaries, thereby resulting in unintended and extremely painful accreditation repercussions discussed in more detail below. Notably, during fiscal year 2023-2024, TWCGME celebrated the full restoration of its Sponsoring Institution's continuing accreditation status by the ACGME. The ACGME's placement of TWCGME's Sponsoring Institution on probationary accreditation status in January 2022 ignited an arduous and necessary 18 month deep dive into TWCGME's Institutional and Graduate Medical Education Committee (GMEC) authority and compliance with ACGME requirements and its appropriate exercise of respective oversight authorities. In December 2023, TWCGME's Corrective Action Plan successfully resulted in the ACGME Institutional Review Committee's formal notification that TWCGME's Sponsoring Institutional accreditation status had been fully restored to Continued Accreditation. Only one citation related to the tragic program closures discussed below remained. This result directly reflects TWCGME's deeply rooted commitment to high integrity accreditation and fiduciary oversight responsibilities. Integrating GMEC into the well-systematized corporate governance structure catalyzed significant improvements and enhancements to policies, procedures, and processes resulting in authority and oversight quality improvement enrichments that have become systematized into TWCGME's daily operations. TWCGME also increased the residents fellows' proximity to and empowered voting voice on GMEC at the fundamental governance level. This enhanced their understanding of fiduciary stewardship responsibilities for federal funding, as well as ACGME accreditation processes and requirements. This proximity empowered and exposed the residents and fellows, as future public health enthusiasts and public servants, to TWCGME's and TWCCH's governing boards and its executive leadership, including the President & CEO, thereby enhancing their understanding of the sacred roles and responsibilities of the GME-SNC's governance and administration as stewards of federal GME resources and patient care delivery revenues. This exposure illuminated and generated deeper, experiential understanding amongst the residents and fellows of the GME-SNC's mission driven activities to meet the highest standards of legal, financial and accreditation requirements, as well as the opportunities and challenges of historical and current regulatory educational mandates, priorities, preferences, and sometimes unintended repercussions of true transformational, pioneering innovations. The accreditation challenges described above distressed our workforce which was expressed in our annual ACGME surveys. Responsively, our sponsoring institution and programmatic leadership aligned with our enterprise executive team and governing boards to launch a Survey Subcommittee of the GMEC to steward processes to improve resident and fellow, as well as faculty, ACGME survey results. TWCGME implemented an Internal Climate Survey Cycle with a semi-annual distribution of resident/fellow and faculty surveys with a 14-day window for responses. A neutral third party was engaged to oversee all aspects of the Internal Climate Survey process and to guarantee privacy for respondents and objectivity of data assessment. Data results and third party analyses were shared with GMEC and amongst program directors, faculty, and residents/fellows. This inspired iterative quality improvement initiatives that resulted in a significant overall improvement in learner and faculty understanding, engagement, and satisfaction with TWCGME's Sponsoring Institution's performance. While celebrating the preparation and submission of accreditation applications for an ACGME approved Internal Medicine/Geriatrics Advancing In”

“(Expenses $ 1,350,332 including grants of $ 1,229,773)(Revenue $ 8,048,111) Other - Common Paymaster: In accordance with IRS regulations, TWCGME acts as the common paymaster for its primary affiliate, The Wright Center for Community Health (TWCCH), a Federally Qualified Health Center Look-Alike. To operationalize this common paymaster function, TWCGME and TWCCH have established shared mission-driven covenants and staffing lease agreements for the provision of various services. TWCCH compensated TWCGME through intercompany allocation methodologies for these services, which include clinical, executive, administrative, and back-office support, encompassing human resources, information technology, marketing and communications, finance, billing, grants, governance support, government relations, legal, and other related services. The revenue recorded for these support services, as performed by TWCGME on behalf of TWCCH, is represented on Line 2B of the statement of revenue ($6,325,776). In operationalizing the common paymaster functionality, TWCGME has entered into staffing lease agreements with TWCCH for the provision of certain administrative and executive services. This consolidated payroll system covers all employees except for TWCCH's President and Chief Executive Officer, Chief Medical and Information Officer, and Chief Clinical Operating Officer, who are directly employed by TWCCH. The services of TWCCH's Chief Executive and Chief Medical and Information Officer are contracted for services as key employees/executives for TWCGME in the positions of President and CEO and SVP of Clinical Educational Integration, respectively. TWCGME reports all remaining employees on its Form W-3. Therefore, all Full-Time Equivalents (FTEs) are accurately allocated to each respective entity, avoiding duplication, based on a shared mission covenant and related staffing lease agreements. TWCCH reimbursed TWCGME for these services through well-validated FTE-based intercompany allocation methodologies. Through these shared mission-driven staffing lease agreements, TWCCH leases clinical staff, management services, and back office support services from TWCGME including, but not limited to, human resources, information technology, marketing and communications, finance, grants, governance support, governmental relations, legal and other administrative support services. The costs associated with this revenue, in addition to costs supporting TWCGME management and general expenses, are recorded as management and general expenses on TWCGME's Form 990, section IX (Statement of Functional Expenses), column C. Other - Office of Research Support and Compliance: TWCGME facilitates opportunities for trainees, staff, and faculty to participate in community-oriented primary care scholarly activity and research, contingent upon funding availability. During the reporting period, two staff members supported this department, collaborating with one resident physician program chief and two resident physician leaders to advance scholarly activity, which is subsequently reported to the ACGME to fulfill training program and sponsoring institutional accreditation requirements. Furthermore, TWCGME operates an Institutional Review Board (IRB). The IRB's mission is to safeguard the rights, welfare, and informed participation of human subjects involved in research conducted within TWCGME educational or TWCCH clinical learning environments, partner organizations' clinical settings, or by TWCGME residents, fellows, and faculty in the communities served. The IRB comprises physicians, educators, academic and clinical research experts, and community members.”

“In November 2017, TWCGME, and its affiliated organization, TWCCH, executed a lease agreement with Wyoming Avenue Development, LLC to develop and rent a 36,500 sq. ft. flagship clinical, educational, and administrative hub at 501 South Washington Avenue, Scranton, Pennsylvania, a formally economically distressed city at that time. Mr. Joseph Ferrario was the Chair of TWCGME's Board of Directors, and served as a volunteer director on TWCGME's affiliated entities, inclusive of but not limited to TWCCH. On July 12, 2019, Mr. Ferrario resigned from TWCGME's Board of Directors and from all Boards of Directors of its affiliated organizations. At the time the lease transaction was consummated, Mr. Ferrario owned more than 35% of Wyoming Avenue Development, LLC. Mr. Ferrario's conflict of interest was fully disclosed and communicated, ethically assessed, and approved by the Board of Directors of TWCGME and TWCCH prior to entering into the transaction. The conflict of interest policy described in Form 990, Part VI, Section B, Line 12c was followed, and a legal ethics opinion approving and offering best practices for addressing and managing a conflict of interest on a non-profit board was obtained from outside legal counsel, with all guidance being followed. On July 25, 2019, the 15-year lease agreement was amended for purposes of complying with the federal New Markets Tax Credit program requirements, and TWCGME became the sole lessee of the rented space. TWCGME subleases space to TWCCH at 501 South Washington Avenue, Scranton, Pennsylvania for FQHC Look-Alike primary health services and administrative operations. The lease went into effect on November 26, 2019, clarifying that TWCGME was the primary lessee of 41,990 sq. ft. of space, utilizing additional space on the second floor of the property for educational and other activities. Renovations of the demised premises on the first and second floors of the building occurred between early 2018 and December 2019, with the commencement date of the amended and restated lease agreement for the first floor occurring on November 26, 2019.”

“TWCGME is affiliated with TWCCH (EIN: 23-2772504), sharing a mission to improve the health and welfare of our communities through responsive whole person health services for all and the sustainable renewal of an inspired and competent workforce that is privileged to serve. To streamline operational efficiency, TWCGME serves as the common paymaster for both TWCGME and TWCCH, adhering to IRS regulations for W-2 reporting. This consolidated payroll system covers all employees except for TWCCH's President and Chief Executive Officer, Chief Medical and Information Officer, and Chief Clinical Operating Officer, who are directly employed by TWCCH. The services of TWCCH's Chief Executive and Chief Medical and Information Officer are contracted for services as key employees/executives for TWCGME in the positions of President and CEO and SVP of Clinical Educational Integration, respectively. TWCGME reports all remaining employees on its Form W-3. Therefore, all Full-Time Equivalents (FTEs) are accurately allocated to each respective entity, avoiding duplication, based on a shared mission covenant and related staffing lease agreements.”