Fayette Physician Network Inc.

“Section A: Governing Body and Management Question 6: Fayette Physician Network, Inc. has two exempt entity members, UPMC Community Medicine, Inc. and Fayette Regional Health System. Question 7A: The two exempt entity members, UPMC Community Medicine, Inc. and Fayette Regional Health System, have the ability to appoint 3 board members each to Fayette Physician Network, Inc. as stipulated in the by-laws of Fayette Physician Network, Inc. Question 7B: UPMC Community Medicine and Fayette Regional Health System, as the members of Fayette Physician Network, Inc., have the right to approve certain actions and transactions of Fayette Physician Network, Inc. The specific transactions that are subject to the approval of the members are stipulated in the By-laws.”

“Section C: Disclosure Question 19: Upon request, management determines public disclosure applicability.”

“SECTION A, OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATIED EMPLOYEESThe disclosure for compensation is based on total calendar year 2017 amounts.”

“SECTION B INDEPENDENT CONTRACTORS The disclosure for independent contractors is based on total calendar year 2017 information.”

“Part III, Statement of Program Service Accomplishments Fayette Physicians Network, Inc. (the Network) was formed on June 5, 2012 as a Pennsylvania non-stock, nonprofit corporation. It is comprised of 61 providers at 10 locations. The Network has at all times since its formation been organized and operated for charitable purposes within the meaning of the Internal Revenue Code Section 501(c)(3). The Network is organized and operated to own and operate medical practices that serve the patients of Fayette County Pennsylvania and surrounding areas. As stated in its Articles of Incorporation, the Network shall be operated exclusively for exempt purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code. Specifically, the purpose of the Network is to own and operate medical practices in Fayette County, Pennsylvania. The Network is made up of 4 divisions: Fayette Anesthesia Providers, Fayette Medical Associates, Fayette Specialty Associates, and Hospital Care Associates. The practices provide medical services to residents throughout Fayette County Pennsylvania and surrounding areas to relieve conditions relating to, and to promote the interests of, the health of these various communities. Medical services are provided to the residents of these underserved communities regardless of their ability to pay. The Network practice are also involved in community education through the Uniontown Hospital (Hospital). These events are open to the public free of charge. They are advertised both on the Hospitals website and in a newspaper that is widely read throughout Fayette County. The practices physicians are critical to these events as they contribute their expertise by serving as speakers, free of charge. Consistent with its charitable mission to meet the health care needs of the residents of the community without regard to their ability to pay, the Networks physician practices adhere to the generous charity care program of the Fayette Regional Health System, called the Safety Net Access Program (SNAP). The SNAP policy is centered on the principle that medically necessary services will be rendered gratuitously to patients that demonstrate financial need and the provision of charity is viewed as the core of the Network, physician practices and the Fayette Regional Health Systems charitable purpose.”

“Question 11: A full copy of the form 990 was provided to each Board of Directors member prior to filing. Question 12c: Fayette Physician Network, Inc. requires all of its key employees and non-employed personnel to comply with its conflict of interest policies when they engage in Fayette Physician Network, Inc.-related business. This COI policy is that of its exempt member UPMC Community Medicine, Inc. People covered by the policies include: -Fayette Physician Network, Inc. entity board members, board committee members, and corporate officers -Fayette Physician Network, Inc. physicians and non-physician employees who hold a position of influence These people are required to complete a questionnaire at least annually. An electronic form has been developed to capture the data from the questionnaire and to monitor completion. The information, along with other data, is used to capture individual and institutional relationships so that potential conflicts of interest can be identified. If a potential conflict is identified regarding a specific activity the corporate compliance department, with the assistance of the legal department of UPMC, would evaluate the activity in relation to the potential conflict. If a perceived or actual conflict is determined to exist and a decision is made to proceed with the activity, a written plan designed to prevent the conflict from influencing decisions related to the activity is developed.”

“Reconciliation of Net Assets Line 9: Other Changes in Net Assets. The amount of $16,334,051 Other Changes in Net Assets represents the transfer from exempt member organizations. Part XI Reconciliation of Net Assets Transfers from Exempt Members 16,334,051 TOTAL 16,334,051”