UHS of Westwood Pembroke, Inc. (UHS-WP) owns and operates Pembroke Hospital, a psychiatric hospital located in Pembroke, Massachusetts. UHS of Delaware, Inc. (UHS-DE) serves as the management company for UHS-WP pursuant to a management agreement between the two entities. Following an employee complaint of workplace violence due to patient aggression at Pembroke Hospital, OSHA inspected the hospital on October 11, 2016, and subsequently issued a single citation to UHS-WP and UHS-DE alleging a repeat violation of the Occupational Safety and Health Act’s general duty clause, 29 U.S.C. § 654(a)(1), for exposing hospital employees to physical assaults by patients. Administrative Law Judge Keith E. Bell affirmed the citation as to UHS-WP only, rejecting the Secretary’s claim that the two companies should be treated as a single employer, and recharacterized the general duty clause violation from repeat to serious. Both the Secretary and UHS-WP petitioned for review of the judge’s decision. For the following reasons, we find UHS-WP and UHS-DE operated as a single employer and affirm the citation as repeat.