Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
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| Yes | No | Yes | No | Yes | No | ||||
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| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
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| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 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. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (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. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (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.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
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| 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 in 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 IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| Subsequent Event - Proposed Affiliation | Form 990 - General Information | West Penn Allegheny Health System, of which Allegheny Medical Practice Network is an affiliate, is pursuing a formal corporate affiliation with UPE, a recently formed tax-exempt organization, and Highmark Inc., a non-profit corporation with substantial health insurance operations throughout Western Pennsylvania. UPE has made filings with the applicable regulatory authorities to acquire control of Highmark. Following the anticipated affiliation, UPE also will assume control of West Penn Allegheny Health System. West Penn Allegheny Health System approved the affiliation in 2011 in order to restore financial viability to the System and ensure its long term survival as a provider of quality healthcare services to the communities it has served for several generations. Among other advantages to the transaction, the affiliation will create a regional integrated health care services delivery and financing system that will better position West Penn Allegheny Health System given the competitive pressures in the Western Pennsylvania market. An affiliation agreement was signed by the parties in October, 2011. As of the date of this filing the regulatory agencies that must approve the transaction have either given their approval or are in the process of undertaking their review. We are optimistic that all approvals will be granted by the end of the 2012 calendar year and possibly sooner. |
| Allegheny Medical Practice Network - Board of Director Independence | Form 990, Page 1, Part I, Question 4 | The appointment of the Allegheny Medical Practice Network Board of Directors is made by the sole member of the organization, West Penn Allegheny Health System, Inc. The Bylaws of Allegheny Medical Practice Network provides that the sole member has the exclusive power to fix the number of, and elect, appoint, fill vacancies in and remove, with or without cause, the Directors; and elect and remove, with or without cause, the Chair and Vice Chair of the Board of Directors of the Corporation, and the Secretary and Treasurer of the Corporation. The Board of Directors of the sole member of Allegheny Medical Practice Network is comprised of a majority of independent Board Members. The Board of Directors of Allegheny Medical Practice Network consists of four members who have voting rights on matters pertinent to the organization. Of these four members, none are deemed to be independent to the organization. Because of the independence of the Board of Directors of the sole member, and the rights and powers of the sole member to appoint and fix the Board of Directors of Allegheny Medical Practice Network, we deem that the Board of Directors of Allegheny Medical Practice Network is in fact controlled by a majority of independent Board Members. |
| Statement of Program Service Accomplishments | Form 990, Page 2, Part III, Question 4 | INTRODUCTION TO ALLEGHENY MEDICAL PRACTICE NETWORK (AMPN) Allegheny Medical Practice Network (AMPN) is a Pennsylvania not-for-profit corporation that was incorporated on June 16, 1999 to provide community-based primary and specialty care services to individuals in Southwest Pennsylvania. In doing so, AMPN furthers its charitable purpose by promoting and delivering high-quality cost-efficient health care in the community. This activity supplements the acute care and other inpatient and outpatient services provided by the supported organization of the West Penn Allegheny Health System. AMPN is part of the West Penn Allegheny Health System (WPAHS). Organized in 2000, WPAHS (www.wpahs.org) is comprised of West Penn Allegheny Health System, Inc. (WPAHS, Inc.), Alle-Kiski Medical Center (AKMC), Canonsburg General Hospital (CGH), Allegheny Specialty Practice Network (ASPN), Allegheny-Singer Research Institute (ASRI), West Penn Physician Practice Network (WPPPN), West Penn Allegheny Oncology Network (WPAON), Canonsburg General Hospital Ambulance Service, Inc. (CGH Ambulance), Alle-Kiski Medical Center Trust (AKMC Trust), Forbes Health Foundation (FHF), Suburban Health Foundation (SHF) and The Western Pennsylvania Hospital Foundation (WPHF). AMPN owns and operates forty-three primary care and specialty medical practice sites. These primary and specialty care practices benefit the communities served by expanding and enhancing public access to primary care medical services. We provide high quality cost-efficient health care services to the public regardless of their ability to pay. As part of a large academic health care system, AMPN's many community-based practice sites provide new and expanded opportunities for clinical research in a variety of settings, as well as enriched medical education opportunities for the System's students, the physicians, and the communities served by the System. The addition of a range of primary practice sites is particularly beneficial in expanding opportunities for medical students, residents, and the students of the other health profession programs offered by the System. To be exposed broadly during their training to primary care practice and to the challenges of coordinating a spectrum of care for individual patients is particularly significant to students in view of the current national emphasis on encouraging more young physicians to select primary care as their professional specialty. AMPN maintains a fee schedule for its services, and the fee structure reflects the local community's ability to pay for such services, so that reasonable access to the AMPN services is available in the community. In addition, AMPN maintains a charity care policy which was established to assure that all persons seeking treatment receive needed health care services regardless of their ability to pay. This policy provides that persons who lack the means to pay for all or a portion of their needed health care services receive financial assistance in the form of partial or total charge reductions. Finally, AMPN is affiliated with hospitals that maintain 24 hour emergency rooms open to all persons regardless of their ability to pay for services, and have open medical staffs. Accordingly, AMPN alone and in conjunction with its affiliates, provides a substantial benefit to the community. To carry out the foregoing activities, AMPN employs 112 providers in the Western Pennsylvania community, specializing in internal medicine, family practice, pediatrics, obstetrics and gynecology and neurology. PURPOSE AND MISSION Allegheny Medical Practice Network is an organization defined by our talented people. We are an organization committed to excellence; an organization with one purpose and one mission. Our purpose is to improve the health of the people in the Western Pennsylvania region. Our mission is to practice medicine, educate and conduct research as an integrated team of physicians, nurses and support professionals who are committed to improving the health of our patients. UNCOMPENSATED CARE To enhance the health status of the community in which it operates and consistent with its tax-exempt status, AMPN provides needed health care services to individuals regardless of their ability to pay for all or part of the services rendered. These services include both inpatient and outpatient services as well as access to an emergency room that is available 24 hours a day. The components of uncompensated care include charity care and unreimbursed costs of Medicaid. AMPN provided uncompensated care at a cost of $4,455,523 in Fiscal 2011. COMMUNITY ASSESSMENT Community Health Improvement Services and Community Benefit Operations Community health improvement services and community benefit operations include activities intended to improve community health. They extend beyond patient care activities and are subsidized by AMPN. The programs ranged from community health education to free clinics and screenings. Consistent with the filing of Schedule H, AMPN provided the following community health improvement services and community benefit operations during Fiscal 2011 at an estimated cost of $52,440. Medical Lectures and Presentations - AMPN physicians presented on various health topics and then conducted question & answer sessions in various public forum. Lectures and presentations were given on local cable TV, local radio, at senior living quarters, libraries, schools and community centers. Health Fairs and Screenings - the AMPN medical staff provided free blood pressure screenings, preventative gynecological exams, heart health monitoring tips and answered various health related questions at different community centers throughout the fiscal year. Women's Health - AMPN physicians participated in a panel discussion surrounding women's health. The panel gathered questions from the audience and addressed the questions and concerns. Periodicals - On multiple occasions during the fiscal year, AMPN physicians authored articles for community periodicals on various health related topics. Health Professions Education AMPN provides health professionals with educational opportunities to advance their careers in healthcare. AMPN provided the following health professions education during Fiscal 2011 at an estimated cost of $629,970. Training in Primary Care - Physicians teach residents and medical students at free clinics and internal medicine primary care settings. These students are able to interact with the AMPN physicians and they experience valuable lessons in healthcare field. Medical Externships - AMPN physician offices provide externships for Medical Assistants and Medical Receptionists from local colleges and business schools. Other Health Professions Education - AMPN participated in various other health professions education activities devoted to furthering the advancement of our communities healthcare providers. Education focused on the development of clinical skills in the primary care environment. Financial Contributions AMPN supports the community through cash contributions made at the discretion of AMPN and its directors, benefiting not only the non-profit recipient but ultimately the community as a whole. AMPN made cash contributions totaling $2,510 including the following: Vincentian Charitable Foundation Canonsburg Volunteer Fire Department Fraternal Order of Police American Veterans The Committee for Missing Children Canonsburg General Hospital Peters Township Volunteer Fire Company CASA for Kids Community-Building Activities Community building activities include activities engaged in for the purpose of improving or protecting the health, future and wellbeing of the community. AMPN participated in the following community building activities during the fiscal year at an estimated cost of $35,715 Community Health Symposium for African Americans - An AMPN physician in conjunction with the Gateway Medical Society examines issues of disparities among African Americans. The physician helps young children stay clear of the dangers of society by being a mentor and allowing the children to explore the medical field with the hope that a difference can be made that will propel them through a childhood geared toward education and future possibilities. Board and Committee Membership - Several AMPN physicians sit on community advisory boards and councils. These include a chamber of commerce and medical assistant advisory boards. $1,376 |
| Form 990 Review Process | Form 990, Page 6, Part VI, Section B, Question 11A | Form 990 is prepared internally by an employee of the West Penn Allegheny Health System, Inc. (Health System) Tax Department who is a certified public accountant. The document is then reviewed internally by top management officials of the Health System. A detailed external review is conducted by Health System external tax advisors, who sign the return as preparer. Members of the Audit and Compliance committee of the Health System Board review the Form 990 and recommend changes or accept the document as presented. A copy of the Form 990 is made available to every board member for review prior to filing the document with the Internal Revenue Service. |
| Monitoring and Enforcement of the Conflict of Interest Policy | Form 990, Page 6, Part VI, Section B, Question 12c | Allegheny Medical Practice Network is a member of the West Penn Allegheny Health System (WPAHS). WPAHS has a corporate compliance department that monitors and oversees compliance with the conflict of interest policy of all organizations in the health system. The following describes the manner in which the corporate compliance department monitors and oversees compliance with the conflict of interest policy for Allegheny Medical Practice Network as well as the other WPAHS affiliates: Conflict of Interest disclosure forms are completed on an annual basis by all board members, officers, employees who have a title of Manager and above, physicians in leadership roles, Pharmacy and Therapeutic Committee members, all employees of the System's Compliance and Internal Audit Departments as well as personnel involved with contracting in the Corporate Purchasing Department. Upon completion of the above disclosure statement by all applicable individuals, a report is generated listing all individuals that have reported a conflict. The System Compliance Officer and General Counsel review the conflicts disclosed. Those that require additional information or clarification receive a letter from the Compliance Officer requesting such. Once received, all additional information is added to the report and again reviewed by the Compliance Officer and General Counsel. Those conflicts that require a mitigation plan are sent to the respective organization's senior management for development of the mitigation plan. The organization's senior management is responsible to discuss the mitigation plan with the individual as needed and monitor compliance with the mitigation plan. Once mitigation is received, a final report is reviewed with the System Compliance Executive Committee and finally the Audit & Compliance Committee of the Board. In addition, all WPAHS board members, officers and key employees complete an annual independence disclosure statement which assists the System's Compliance Officer and Internal Audit Department to determine and monitor the levels of independence in each of the System's tax exempt affiliates as well as to determine the level of Form 990, Schedule L reporting. |
| Process For Determining Executive Compensation | Form 990, Page 6, Part VI, Section B, Question 15b | West Penn Allegheny Health Systems (WPAHS) process for determining compensation for executive positions (including officers, key employees and other management positions) within Allegheny Medical Practice Network is covered by the WPAHS Executive Compensation Policy. This policy was approved by the WPAHS Board of Directors. It is the policy of WPAHS and its Board of Directors to compensate its executives in accordance with the market and in relation to the experience, service and accomplishments of the individual both prior to and during their service with WPAHS. The Compensation Committee of the WPAHS Board of Directors approves the compensation for WPAHS senior executives. The Compensation Committee approves the initial compensation for newly hired senior executives, which shall include all compensation components, including without limitation, base compensation, incentive compensation, deferred compensation, fringe and other benefits, as well as the total compensation. It also approves all base compensation adjustments and all incentive compensation awards, as well as material changes to deferred compensation, fringe, or other benefits. The Compensation Committee uses comparability data provided by the System Human Resources Department, which may include industry surveys, expert compensation studies, documented compensation of persons holding similar positions, or other comparable data in approving any executive compensation. The Compensation Committee periodically retains the services of an independent compensation consultant to provide an expert opinion report as to the reasonableness of total compensation of Allegheny Medical Practice Network officers and key employees. Each Compensation Committee member voting on a senior executive's compensation arrangement ensures that he or she has no conflict of interest, including that he or she (a) does not economically benefit from the proposed employment; (b) does not receive compensation subject to the approval of the proposed employee; and (c) has no material financial interest affected by the transaction. The Compensation Committee consists of five independent Board Members of WPAHS. All decisions of the Compensation Committee regarding executive compensation matters are documented. |
| Public Availability of Organizational Documents | Form 990, Page 6, Part VI, Section C, Question 19 | Allegheny Medical Practice Network (AMPN) does not make its governing documents available to the public. AMPN is a member of the West Penn Allegheny Health System (WPAHS). The WPAHS makes available their annual and quarterly financial statements through the use of a dissemination agent. These financial statements are on a consolidated basis with AMPN being one of the consolidated entities. In addition, the WPAHS annual report and quarterly financial results are available on the WPAHS website. WPAHS has adopted a conflict of interest policy that is uniformly applied to all organizations of the health system, including AMPN. A condensed version of this conflict of interest policy is available on the WPAHS website. The condensed policy is contained in the code of ethics disclosure. |
| Officer, Director and Key Employee Hour Allocation | Form 990, Page 9, Line 6b(i) | Allegheny Medical Practice Network allocates hours to officers, directors and key employees employed by Allegheny Medical Practice Network or a related organization on the basis of a 40 hour work week. Allegheny Medical Practice Network is a member of an integrated healthcare delivery system consisting of 13 different organizations. Many individuals are Health System executives who serve prominent roles on various organizations. Every employed individual who serves as an officer, director or key employee of any related organization as well as Allegheny Medical Practice Network will be allocated time served out of the 40 hour work week for each separate related organization. Thus, the cumulative total for each individual spread out between Allegheny Medical Practice Network and the 12 related organizations will equal 40 hours. Directors of Allegheny Medical Practice Network serving on a volunteer basis are allocated one hour of service per week to Allegheny Medical Practice Network. If the director also volunteers time to one of the 12 related organizations in the capacity of a director for that related organization, one hour per week is reflected as devoted to each related organization served. The time and efforts of the volunteer directors of Allegheny Medical Practice Network may vary upon the needs of the organization. The one hour per week reported in Part VII is an estimate of the average time spent per week by the Allegheny Medical Practice Network volunteer directors when viewed on an annual basis. |
| Rental Expense | Form 990, Page 9, Part VIII, Line 6b | Allegheny Medical Practice Network does not account for rental expenses in a manner that would allow us to reflect the expense as a direct offset to rental income. The components of rental expense are captured on Form 990, Page 10 - Statement of Functional Expense. |
| Health System Tax Exempt Bond Issuance | Form 990, Page 11, Part X, Line 20 | Allegheny Medical Practice Network is a member of the West Penn Allegheny Health System obligated group in regards to 2007 Allegheny County Hospital Development Authority tax-exempt bonds. The purpose of the issue of the Allegheny County Hospital Development Authority (ACHDA) Hospital Revenue Bonds, Series 2007 A is to refund the outstanding ACHDA Series 2000A and B Bond Issues, refund the Dauphin County General Authority (DCGA) Series 1992A and B Hospital Bonds, the Pennsylvania Higher Education Facility Authority (PHEFA) Series 1991A Revenue Bonds, the Monroeville Hospital Authority (MHA) Series 1992 and 1995 Revenue Bonds, the funding of a project fund for certain prior and future capital expenditures and to pay the cost of issuing Series 2007A Debt. No internal allocation of debt has been made to Allegheny Medical Practice Network, however, the organization's assets are security for purposes of this bond issue. |
| Other Changes In Net Assets | Form 990, Page 12, Part XI, Line 5 | The following is a reconciliation of the Other Changes in Net Assets of Allegheny Medical Practice Network for the year ended June 30, 2011: Net Transfers From Affiliated Organization $16,318,778 Change in Minimum Pension Liability 2,711,537 ___________ Other Changes in Net Assets $19,030,315 |
| Allegheny Medical Practice Network - Schedule H Filing Requirements | Schedule A, Part I, Line 3 | Internal Revenue Service Form 990, Schedule H is required to be completed by all organizations that meet the IRS definition of a Hospital and in addition, is required to be licensed, registered or similarly recognized by a state as a Hospital. Allegheny Medical Practice Network is classified by the Internal Revenue Service as a Hospital under IRC section 170(b)(1)(A)(iii). Allegheny Medical Practice Network is not required to be licensed, registered or similarly recognized as a Hospital by the State of Pennsylvania. Accordingly, Internal Revenue Service Form 990, Schedule H is not completed by Allegheny Medical Practice Network. |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Dawn Gideon TITLE:Director HOURS:39 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Roy Santarella TITLE:Director & Treasurer HOURS:39 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Christopher Olivia MD TITLE:Health System President & CEO HOURS:39 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Sanford Kurtz MD TITLE:Director & PO President & CEO HOURS:30 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Diane Dismukes TITLE:Health System President & CEO HOURS:39 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Thomas Albanesi TITLE:Assistant Treasurer HOURS:39 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Judy Hlafcsak TITLE:Secretary HOURS:39 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Robert Brandfass TITLE:Secretary HOURS:39 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:David Kiehn TITLE:Assistant Treasurer HOURS:39 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Deborah Olszewski TITLE:Assistant Secretary HOURS:39 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Tony Farah, MD TITLE:P.O. Interim President and CEO HOURS:30 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Susan Manzi, MD TITLE:Chair, System Dept of Medicine HOURS:38 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Edward Roeber TITLE:AMPN Chief Financial Officer HOURS:10 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Mark Barnhart TITLE:AMPN Chief Operating Officer HOURS:30 |
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