Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
UPMC GROUP
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
600 GRANT STREET 58TH FLOOR
C/O CORPORATE TAX DEPARTMENT
Room/suite
City or town, state or country, and ZIP + 4
PITTSBURGH, PA15219
D Employer identification number

20-8295721
E Telephone number

G Gross receipts $ 8,629,937,281
F Name and address of principal officer:
Robert DeMichiei
600 Grant Street 58th Floor
Pittsburgh,PA15219
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.UPMC.COM
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet9707
K Form of organization:
 
L Year of formation: 2006
M State of legal domicile: PA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: HEALTHCARE, EDUCATION, AND RESEARCH
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 52
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 9
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 52,418
6 Total number of volunteers (estimate if necessary) .... 6 4,629
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 4,311,523
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 254,914
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 103,627,637 98,448,539
9 Program service revenue (Part VIII, line 2g) ......... 7,556,131,606 8,179,265,352
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 38,198,999 20,996,660
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -44,261 -197,962
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 7,697,913,981 8,298,512,589
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 32,387,449 23,050,148
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 3,461,133,130 3,832,197,009
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet4,403,589    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 3,751,152,437 4,060,414,011
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 7,244,673,016 7,915,661,168
19 Revenue less expenses. Subtract line 18 from line 12....... 453,240,965 382,851,421
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 4,990,882,812 5,418,993,044
21 Total liabilities (Part X, line 26)............. 840,174,199 909,364,831
22 Net assets or fund balances. Subtract line 21 from line 20..... 4,150,708,613 4,509,628,213
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 7,091,618,958 including grants of $   ) (Revenue $ 8,178,920,310 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 7,091,618,958
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
Yes
 
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
Yes
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
1,090
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
52,418
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletIT , EI , UK , CY , CH
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
52
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
PA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
ROBERT A DEMICHIEI
600 GRANT STREET 58TH FLOOR
PITTSBURGH,PA15219
(412) 647-2345
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) David Baer MD BDF
Board Member
 1.0 X           205,833 0 30,782
(2) John R Blackburn III BDF
Board Chairman
 1.0 X   X       0 0 0
(3) Beth Clark DO BDF
Board Member
 1.0 X           167,349 0 11,162
(4) Angela Duvall BDF
Board Member
 1.0 X           0 0 0
(5) George Fleming MD BDF
Board Member
 1.0 X           311,953 0 33,552
(6) James Gonsman BDF
Board Treasurer
 1.0 X           0 0 0
(7) Garry Goss BDF
Board Member
 1.0 X           0 0 0
(8) Gerald Gronborg DPM BDF
Board Member
 1.0 X           0 0 0
(9) Rep Dick Hess BDF
Board Member
 1.0 X           0 0 0
(10) John Holbert BDF
Board 1st Vice Chair
 1.0 X           0 0 0
(11) Mabel Jordan BDF
Board Member
 1.0 X           0 0 0
(12) David T Martin BDF
Board Member
 1.0 X           0 0 0
(13) Patricia Mueller BDF
Board Secretary
 1.0 X           0 0 0
(14) Joel Pyle BDF
Board Member
 1.0 X           0 0 0
(15) Beverly Ridenour BDF
Board Member
 1.0 X           0 0 0
(16) Todd Roadman BDF
Board 2nd Vice Chair
 1.0 X           0 0 0
(17) Rev Ray Short BDF
Board 3rd Vice Chair
 1.0 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Candi Castleberry-Singleton BDK
Board Vice Chairman
 1.0 X           395,427 0 51,850
(19) Richard Farrell BDK
Board Member
 1.0 X           0 0 0
(20) George A Huber Esq BDK
Board Member
 1.0 X           0 0 0
(21) David T Martin BDK
Board Member
 1.0 X           0 0 0
(22) Tamra Minnier BDK
Board Member
 1.0 X           559,450 0 67,554
(23) Mark Sevco BDK
Board Member
 1.0 X           0 0 0
(24) Thomas W Sterling BDK
Board Chairman
 1.0 X   X       0 0 0
(25) Merle Taylor BDK
Board Secretary
 1.0 X           0 0 0
(26) Thomas Inglesby MD CBS
Board Chair and Pres
 40.0 X   X       329,875 0 84,511
(27) Arthur S Levine MD CBS
Board Member
 1.0 X           0 0 0
(28) Jeffrey A Romoff CBS
Board Member
 1.0 X           0 0 0
(29) Loren Roth MD PhD CBS
Board Member
 1.0 X           1,500 0 8,453
(30) William Cook CEM
Board Vice Chairman
 1.0 X           0 0 0
(31) Douglas Garretson CEM
Board Member and President
 40.0 X   X       323,884 0 34,574
(32) Christopher Gessner CEM
Board Member
 1.0 X           0 0 0
(33) Donald Goodman CEM
Board Member and CFO
 40.0 X   X       226,141 0 32,797
(34) Edward T Karlovich CEM
Board Chairman
 1.0 X   X       0 0 0
(35) Paul Mark Paris MD CEM
Board Member and CMO
 1.0 X           0 0 0
(36) Leslie Braksick PhD CHP
Board Member
 1.0 X           0 0 0
(37) Elizabeth Concordia CHP
Board Member
 1.0 X           0 0 0
(38) Ronald R Davenport Jr CHP
Board Member
 1.0 X           0 0 0
(39) Douglas P Dick CHP
Board Member
 1.0 X           0 0 0
(40) Mary Jo Howard Dively Esq CHP
Board Chairman
 1.0 X   X       0 0 0
(41) Lawrence N Gumberg CHP
Board Member
 1.0 X           0 0 0
(42) Howard W Hanna III CHP
Board Member
 1.0 X           0 0 0
(43) Arthur S Levine MD CHP
Board Member
 1.0 X           0 0 0
(44) Martha Hartle Munsch Esq CHP
Board Member
 1.0 X           0 0 0
(45) Judge Jill Rangos CHP
Board Member
 1.0 X           0 0 0
(46) Joseph C Walton CHP
Board Member
 1.0 X           0 0 0
(47) Shelia Fine CCBH
Board Member
 1.0 X           0 0 0
(48) Michael Flaherty CCBH
Board Member
 1.0 X           0 0 0
(49) Diane Holder CCBH
Board Chairman
 1.0 X   X       0 0 0
(50) George A Huber Esq CCBH
Board Member
 1.0 X           0 0 0
(51) Scott Lammie CCBH
Board Member Sec and Treas
 1.0 X   X       0 0 0
(52) David Lewis CCBH
Board Member
 1.0 X           0 0 0
(53) Ann McGuinn E 3112 CCBH
Board Member
 1.0 X           0 0 0
(54) Douglas Muetzel CCBH
Board Member
 1.0 X           0 0 0
(55) Laurie Mulvey CCBH
Board Member
 1.0 X           0 0 0
(56) Kenneth Nash CCBH
Board Member
 1.0 X           0 0 0
(57) Nikki Nordenberg CCBH
Board Member
 1.0 X           0 0 0
(58) Wilford Payne CCBH
Board Member
 1.0 X           0 0 0
(59) Claudia Roth PhD CCBH
Board Member
 1.0 X           584,107 0 65,183
(60) Loren Roth CCBH
Board Member
 1.0 X           0 0 0
(61) Regis Ryan R 11111 CCBH
Board Member
 1.0 X           0 0 0
(62) Jeannette South-Paul MD CCBH
Board Member
 1.0 X           0 0 0
(63) Laura Thomas CCBH
Board Member
 1.0 X           0 0 0
(64) Paul Castillo R 11111 CFHC
Board Treasurer
 1.0 X           0 0 0
(65) Robert B Devlin Esq CFHC
Board Secretary
 1.0 X           0 0 0
(66) John Innocenti CFHC
Board Chairman and President
 1.0 X   X       0 0 0
(67) Randall Kolb CFHC
Board Member
 1.0 X           186,988 0 29,728
(68) Eileen Simmons E 11111 CFHC
Board Treasurer
 1.0 X           0 0 0
(69) Robert Blosat CMI
Board Member VP and COO
 40.0 X           518,996 0 66,269
(70) Francis Solano MD CMI
Board Member and President
 40.0 X   X       582,575 0 37,399
(71) Ann Evans CMI
Board Member Treasurer and CFO
 40.0 X   X       0 0 0
(72) Neil Y Van Horn CMI
Board Member
 1.0 X           0 0 0
(73) Marshall Webster MD CMI
Board Member
 1.0 X           0 0 0
(74) Deborah S Brodine CPS
Board Member and President
 40.0 X   X       425,845 0 56,100
(75) Elizabeth Concordia CPS
Board Member
 1.0 X           0 0 0
(76) Edward T Karlovich CPS
Board Member
 1.0 X           0 0 0
(77) Stephen Nimmo Esq CPS
Board Member and Secretary
 40.0 X   X       517,792 0 59,183
(78) Jerome Shaffer CPS
Board Member Treasurer and CFO
 40.0 X   X       272,879 0 31,922
(79) Deborah S Brodine CRAN
Board Member and President
 1.0 X   X       0 0 0
(80) Peter W Eisenbrandt CRAN
Board Member
 1.0 X           0 0 0
(81) Barb Grossman E 1112 CRAN
Board Member
 1.0 X           0 0 0
(82) Richard Hamilton CRAN
Board Member
 1.0 X           0 0 0
(83) John D Houston II CRAN
Board Treas and Board Sec
 1.0 X           0 0 0
(84) Margaret M Kimmel PhD CRAN
Board Member
 1.0 X           0 0 0
(85) David A Nace MD CRAN
Board Member
 1.0 X           240,940 0 14,759
(86) Anne Newman E 1112 CRAN
Board Member
 1.0 X           0 0 0
(87) Rev Scott Quinn E 1112 CRAN
Board Member
 1.0 X           0 0 0
(88) Joan Rogers E 1112 CRAN
Board Member
 1.0 X           0 0 0
(89) Jerome Shaffer CRAN
Board Member
 1.0 X           0 0 0
(90) William E Troup CRAN
Board Member
 1.0 X           0 0 0
(91) Neil Y Van Horn CRAN
Board Chairman
 1.0 X   X       0 0 0
(92) Brian Fritz EAST
Board Treasurer/ CFO
 40.0 X   X       135,718 0 24,519
(93) Edward Karlovich EAST
Board Member
 1.0 X           0 0 0
(94) Kotayya Kondaveeti EAST
Board Member
 1.0 X           0 0 0
(95) Michael Anderson EAST
Board Secretary
 1.0 X           166,778 0 17,284
(96) Nicholas G Beckwith EAST
Board Member
 1.0 X           0 0 0
(97) Robert Voinchet EAST
Board Member
 1.0 X           386,989 0 58,819
(98) Sean Logan EAST
Board Chairman
 1.0 X   X       204,461 0 9,785
(99) Timothy Gaul EAST
Board Member
 1.0 X           0 0 0
(100) Robert Blosat EMI
Board Member
 1.0 X           0 0 0
(101) Robert J Maha MD EMI
Board Chairman and President
 40.0 X   X       593,733 0 66,323
(102) Paul Mark Paris MD EMI
Board Vice Chair and V Preside
 1.0 X   X       172,245 0 15,057
(103) Teresa G Petrick EMI
Board Member
 1.0 X           0 0 0
(104) Mark Sevco EMI
Board Member
 1.0 X           0 0 0
(105) Ann Evans EMI
Board Member
 1.0 X           0 0 0
(106) Marshall Webster MD EMI
Board Member
 1.0 X           0 0 0
(107) Donald M Yealy MD EMI
Board Member
 1.0 X           0 0 0
(108) Robert Blosat EPN
Board Secretary
 1.0 X           0 0 0
(109) Ann Evans EPN
Board Treasurer/CFO
 1.0 X   X       0 0 0
(110) Philip M Cacchione EPN
Board Chairman/President
 40.0 X   X       162,577 0 12,118
(111) Paula Garafola FOR
Board Member
 1.0 X           0 0 0
(112) Diane Holder FOR
Board Chairman
 1.0 X   X       0 0 0
(113) George A Huber Esq FOR
Board Member
 1.0 X           0 0 0
(114) John Lovelace FOR
Board Member and President
 40.0 X   X       0 466,332 63,913
(115) Christina Mikolay FOR
Board Member
 1.0 X           0 0 0
(116) Stephen Perkins MD FOR
Board Member
 1.0 X           0 392,086 53,143
(117) George A Huber Esq HCD
Board Member
 0.0 X           0 0 0
(118) John Innocenti HCD
Board Member and V President
 0.0 X   X       0 0 0
(119) Roger A Oxendale HCD
Board Member
 0.0 X           487,317   0
(120) Deborah S Brodine HERT
Board Member and President
 1.0 X   X       0 0 0
(121) Peter W Eisenbrandt HERT
Board Member
 1.0 X           0 0 0
(122) Barb Grossman E 1112 HERT
Board Member
 1.0 X           0 0 0
(123) Richard Hamilton HERT
Board Member
 1.0 X           0 0 0
(124) John D Houston II HERT
Board Treas and Board Sec
 1.0 X           0 0 0
(125) Margaret M Kimmel PHD HERT
Board Member
 1.0 X           0 0 0
(126) David A Nace MD HERT
Board Member
 1.0 X           0 0 0
(127) Anne Newman E 1112 HERT
Board Member
 1.0 X           0 0 0
(128) Rev Scott Quinn E 1112 HERT
Board Member
 1.0 X           0 0 0
(129) Joan Rogers E 1112 HERT
Board Member
 1.0 X           0 0 0
(130) Jerome Shaffer HERT
Board Member
 1.0 X           0 0 0
(131) William E Troup HERT
Board Member
 1.0 X           0 0 0
(132) Neil Y Van Horn HERT
Board Chairman
 1.0 X   X       0 0 0
(133) John Campbell CPA HRZ
Board Member
 1.0 X           0 0 0
(134) John S Dolan CPA R 123111 HRZ
Board Member
 1.0 X           0 0 0
(135) Tulio Estrada MD HRZ
Board Member
 1.0 X           558,379 0 35,523
(136) Linda Evans HRZ
Board Member Treasurer/Secreta
 1.0 X           0 0 0
(137) Steve Gargasz HRZ
Board Member
 1.0 X           0 0 0
(138) David Gibbons HRZ
Board Member
 1.0 X           0 0 0
(139) Hendley Hoge HRZ
Board Member
 1.0 X           0 0 0
(140) Olivia Lazor HRZ
Board Member
 1.0 X           0 0 0
(141) David Martin HRZ
Board Member
 1.0 X           0 0 0
(142) Ronald McCall HRZ
Board Member
 1.0 X           0 0 0
(143) Frank Mindicino CFP HRZ
Board Chairman
 1.0 X   X       0 0 0
(144) Rev Martin Roth HRZ
Board Member
 1.0 X           0 0 0
(145) Roy J Sartori DO HRZ
Board Member
 1.0 X           276,663 0 24,957
(146) Noreen Stegkamper HRZ
Board Member
 1.0 X           0 0 0
(147) Joseph Valentino Esq R 123111
Board Member
 1.0 X           0 0 0
(148) Troy VanAken HRZ
Board Member
 1.0 X           0 0 0
(149) Joseph P Walton HRZ
Board Vice Chairman
 1.0 X           0 0 0
(150) Michael Walton E 13112 HRZ
Board Member
 1.0 X           0 0 0
(151) John Waters E 13112 HRZ
Board Member
 1.0 X           0 0 0
(152) Rod E Wilt HRZ
Board Member
 1.0 X           0 0 0
(153) Russell Adkins E 10611 HRZF
Board Member
 1.0 X           0 0 0
(154) Kelly Bailey HRZF
Board Treasurer/ Secretary
 1.0 X           0 0 0
(155) Sam Bellich HRZF
Board Member
 1.0 X           0 0 0
(156) Steve Bible HRZF
Board Vice Chair/ Chair and V
 1.0 X   X       0 0 0
(157) Sarah Boland HRZF
Board Member
 1.0 X           0 0 0
(158) Gizelle Dean HRZF
Board Member
 1.0 X           0 0 0
(159) Rose DoCampo E 10611 HRZF
Board Member
 1.0 X           0 0 0
(160) Julie Dolan E 10611 HRZF
Board Member
 1.0 X           0 0 0
(161) Jeanne Endicott HRZF
Board Member
 1.0 X           0 0 0
(162) Elizabeth Izenas HRZF
Board Member
 1.0 X           0 0 0
(163) Robert Lindberg MD R 32812 HRZF
Board Member
 1.0 X           0 0 0
(164) Patty McCluskey-Shonka R 10111
Board Secretary
 1.0 X           0 0 0
(165) Joni Murray HRZF
Board Member
 1.0 X           47,306 0 19,986
(166) Kevin Orsinger HRZF
Board Vice Chairman/ Board Mem
 1.0 X           0 0 0
(167) Donald Owrey HRZF
Board Member
 1.0 X           0 0 0
(168) Jessica Phillips E 10611 HRZF
Board Member
 1.0 X           0 0 0
(169) Robert Piccirilli R 3112 HRZF
Board Chairman
 1.0 X   X       0 0 0
(170) Marcy Pickering R 5212 HRZF
Board Member
 1.0 X           0 0 0
(171) Lorrie Speir-Chrastina HRZF
Board Member
 1.0 X           0 0 0
(172) Rev Lee Weber HRZF
Board Member
 1.0 X           0 0 0
(173) Charles Bogosta IMIT
Board Vice Chairman
 1.0 X           0 0 0
(174) Robert A DeMichiei IMIT
Board Member
 1.0 X           0 0 0
(175) Daniel Drawbaugh IMIT
Board Chairman
 1.0 X   X       0 0 0
(176) Edward Marinzel IMIT
Board Member
 1.0 X           250,293 0 36,598
(177) Charles Bogosta IHI
Board Member and President
 1.0 X   X       0 0 0
(178) John Kuzmishin IHI
Board Member and Treas/Sec/CFO
 40.0 X   X       543,219 0 53,525
(179) Rose Almon-Martin MAG
Board Secretary
 1.0 X           0 0 0
(180) Mark Aloe MAG
Board Member
 1.0 X           0 0 0
(181) Deborah Barbarita MAG
Board Member
 1.0 X           0 0 0
(182) Chief Judge Donetta Ambrose MAG
Board Vice Chairman
 1.0 X           0 0 0
(183) Michele Atkins MAG
Board Member
 1.0 X           0 0 0
(184) Elizabeth Concordia MAG
Board Member
 1.0 X           0 0 0
(185) Leslie C Davis MAG
Board Member/President
 40.0 X   X       725,124 0 85,024
(186) Gregory Dell'Omo MAG
Board Member
 1.0 X           0 0 0
(187) Peter W Eisenbrandt MAG
Board Treasurer
 1.0 X           0 0 0
(188) W Allen Hogge MD MAG
Board Member
 1.0 X           0 0 0
(189) Margaret P Joy MAG
Board Member
 1.0 X           0 0 0
(190) Joseph Kelley MAG
Board Member/ Med Staff Pres
 1.0 X           586,804 0 23,340
(191) Arthur S Levine MD MAG
Board Member
 1.0 X           0 0 0
(192) Barbara Mistick MAG
Board Member
 1.0 X           0 0 0
(193) William Pietragallo II Esq MAG
Board Chairman
 1.0 X   X       0 0 0
(194) Jeannette South-Paul MD MAG
Board Member
 1.0 X           0 0 0
(195) Robert Thompson MD R 63012 MAG
Board Member
 1.0 X           315,693 0 20,786
(196) Kathy Mayle Towns MAG
Board Member
 1.0 X           0 0 0
(197) Sue Ann Striffler Galaski MCK
Board Member
 1.0 X           0 0 0
(198) D James Heatherington MCK
Board Chairman/ Vice Chairman
 1.0 X   X       0 0 0
(199) George A Huber Esq MCK
Board Member
 1.0 X           0 0 0
(200) Jo Ellen Kenney MCK
Board Member
 1.0 X           0 0 0
(201) Irving J Latterman MCK
Board Member
 1.0 X           0 0 0
(202) Rebecca Shaw McHolme JD MCK
Board Vice Chairman/ Chairman
 1.0 X   X       0 0 0
(203) Madhusudana Nair MD R 63012MCK
Board Member/Med Staff Pres
 1.0 X           252,538 0 23,693
(204) Curtiss E Porter PhD MCK
Board Member
 1.0 X           0 0 0
(205) Sandy Rader MCK
Board Member
 1.0 X           287,077 0 31,272
(206) Mary Pat Soltis MCK
Board Member
 1.0 X           0 0 0
(207) Jeannette South-Paul MD MCK
Board Member
 1.0 X           0 0 0
(208) Thomas W Sterling MCK
Board Member
 1.0 X           0 0 0
(209) Merle Taylor MCK
Board Secretary
 1.0 X           128,301 0 20,479
(210) Michael Tranovich MD E 7111 MCK
Board Member
 1.0 X           0 0 0
(211) Curits Waligura DO R 63012 MCK
Board Member
 1.0 X           60,003 0 0
(212) Hugh Brannan MHP
Board Member
 1.0 X           0 0 0
(213) Robert J Cindrich Esq MHP
Board Member
 1.0 X           0 0 0
(214) Elizabeth Concordia MHP
Board Member
 1.0 X           0 0 0
(215) William Cook MHP
President/ Board Member
 40.0 X   X       523,043 0 53,075
(216) Renee Crosby-Skinner MHP
Board Member
 1.0 X           0 0 0
(217) Dr Ross DiMarco E 1112 MHP
Board Member
 1.0 X           0 0 0
(218) Lawrence A DiNardo VE JCL MHP
Board Member
 1.0 X           0 0 0
(219) Charles J Dougherty PhD MHP
Board Member
 1.0 X           0 0 0
(220) Korry Green Esq MHP
Board Member
 1.0 X           0 0 0
(221) Edward T Karlovich MHP
Board Member
 1.0 X           0 0 0
(222) Maureen Lally-Green MHP
Board Member/ Chairman
 1.0 X   X       0 0 0
(223) Judith K Linaburg MHP
Board Member
 1.0 X           0 0 0
(224) F J Luccino MHP
Board Member
 1.0 X           0 0 0
(225) John R McGinley Jr Esq R 22112
Board Chairman
 1.0 X   X       0 0 0
(226) Wilma McNeese MHP
Board Member
 1.0 X           0 0 0
(227) Philip A Pollice MD R 1112 MHP
Board Member
 1.0 X           0 0 0
(228) Rachel Riley-Lavelle MHP
Board Member
 1.0 X           0 0 0
(229) Joseph J Whiteside MHP
Board Member
 1.0 X           0 0 0
(230) Larry Adams NWH
Board Member
 1.0 X           0 0 0
(231) Randall Boggess NWH
Board Member
 1.0 X           432,333 0 19,597
(232) James L Daugherty NWH
Board Member
 1.0 X           0 0 0
(233) David Gibbons NWH
President/ Board Member
 40.0 X   X       369,333 0 44,578
(234) Michelle Hartle NWH
Board Member
 1.0 X           0 0 0
(235) James Heasley NWH
Board Member
 1.0 X           0 0 0
(236) Denise Jones NWH
Board Member
 1.0 X           0 0 0
(237) Patricia Kaufman E 1112 NWH
Board Member
 1.0 X           114,289 0 8,229
(238) James E Knarr DMD NWH
Board Chairman
 1.0 X   X       0 0 0
(239) David Martin E 1112 NWH
Board Member
 1.0 X           0 0 0
(240) David McCandless MD NWH
Board Member
 1.0 X           253,482 0 26,169
(241) Robert McFate Esq NWH
Board Member
 1.0 X           0 0 0
(242) James McLaughlin DO R 123111
Board Member
 1.0 X           298,800 0 28,446
(243) Marilyn Neely NWH
Board Member
 1.0 X           0 0 0
(244) Rina Nerlich NWH
Board Secretary
 1.0 X           0 0 0
(245) Donald Owrey NWH
Board Member
 1.0 X           0 0 0
(246) Keith Pemrick R 123111 NWH
Board Vice Chairman
 1.0 X           0 0 0
(247) Mark Salerno MD NWH
Board Member
 1.0 X           0 0 0
(248) Linda Schell NWH
Board Member/ Secretary
 1.0 X           0 0 0
(249) William Shaffner Esq NWH
Board Member
 1.0 X           277,510 0 38,485
(250) Gail Welch R 123111 NWH
Board Member
 1.0 X           0 0 0
(251) James Williams NWH
Board Member
 1.0 X           0 0 0
(252) Terry Wood NWH
Board Member
 1.0 X           0 0 0
(253) Christopher Stockhausen OCC
Board Member Sec and Treas
 1.0 X   X       0 0 0
(254) Jeffrey A Romoff OVR
Board Chair
 1.0 X   X       0 0 0
(255) James W Boyle MD PAV
Board Member
 1.0 X           320,463 0 33,037
(256) Gary Bucciarelli PAV
Board Member
 1.0 X           0 0 0
(257) Eric Cartwright PAV
Board Member
 1.0 X           460,076 0 62,624
(258) ROBERT A DEMICHIEI PAV
Board Member
 1.0 X           0 0 0
(259) Ralph T DeStefano PAV
Board Member
 1.0 X           129,647 0 26,816
(260) Edward A Dills PAV
Board Member
 1.0 X           0 0 0
(261) Debra A Dinnocenzo PAV
Board Member
 1.0 X           0 0 0
(262) Francis W Finley Jr PAV
Board Treasurer
 1.0 X           0 0 0
(263) Anthony Greco R 12511 PAV
Board Member
 1.0 X           0 0 0
(264) Richard S Hamilton PAV
Board Chairman
 1.0 X   X       0 0 0
(265) John D Houston II PAV
Board Member
 1.0 X           0 0 0
(266) George A Huber Esq PAV
Board Member
 1.0 X           0 0 0
(267) Sister Candace Introcaso PAV
Board Member
 1.0 X           0 0 0
(268) Franklin H Kelly PAV
Board Member
 1.0 X           0 0 0
(269) Patricia J Kutcher PAV
Board Member
 1.0 X           0 0 0
(270) Joon Sup Lee MD PAV
Board Member
 1.0 X           0 0 0
(271) Joseph F Long PAV
Board Member
 1.0 X           0 0 0
(272) Gregory K Peaslee PAV
Board Member
 1.0 X           0 0 0
(273) Elmer J Sigety Sr PAV
Board Second Vice Chairman
 1.0 X           0 0 0
(274) Daniel R Sullivan MD PAV
Board First Vice Chairman
 1.0 X           391,242 0 14,241
(275) William E Troup PAV
Board Secretary
 1.0 X           0 0 0
(276) Donna Jasko PPA
Board Member and Secretary
 40.0 X           226,048 0 29,248
(277) David Martin PPA
Board Chairman
 1.0 X   X       0 0 0
(278) Dennis H Tomassetti PPA
Board Member and Treasurer
 1.0 X   X       0 0 0
(279) G Nicholas Beckwith III PUH
Board Chairman
 1.0 X   X       0 0 0
(280) David B Fawcett R 41212 PUH
Board Member
 1.0 X           0 0 0
(281) Karen Wolk Feinstein PhD PUH
Board Member
 1.0 X           0 0 0
(282) H Arnold Gefsky PUH
Board Member
 1.0 X           0 0 0
(283) Randy P Juhl PhD PUH
Board Member/ 2nd Chair
 1.0 X           0 0 0
(284) Mark J Laskow PUH
Board First Vice Chairman
 1.0 X           0 0 0
(285) Arthur S Levine MD PUH
Board Member
 1.0 X           0 0 0
(286) W Duff McCrady PUH
Board Member
 1.0 X           0 0 0
(287) Jeffrey A Romoff PUH
Board Member
 1.0 X           0 0 0
(288) Jeannette South-Paul MD PUH
Board Member
 1.0 X           0 0 0
(289) David Weber MD E 7111 PUH
Board Member
 1.0 X           137,203 0 9,429
(290) Alexander J Ciocca Esq SMH
Board Member and Asst Sec
 1.0 X   X       302,951 0 36,639
(291) Elizabeth Concordia R 11312 SMH
Board Member
 1.0 X           0 0 0
(292) Edward J Donnelly III MD SMH
Board Member
 1.0 X           254,727 0 25,061
(293) James M Ferguson III SMH
Board V Chair and Board Treas
 1.0 X           0 0 0
(294) Kevin Garrett MD SMH
Board Member
 1.0 X           484,011 0 37,423
(295) John R Hamilton SMH
Board Member
 1.0 X           0 0 0
(296) Robert Hofmann E 2112 SMH
Board Member
 1.0 X           0 0 0
(297) Scott Lammie SMH
Board Member
 1.0 X           0 0 0
(298) Valerie C Trott SMH
Board Member
 1.0 X           303,349 0 18,034
(299) Neil Y Van Horn SMH
Board Chairman
 1.0 X   X       0 0 0
(300) Paul Vey E 2112 SMH
Board Member
 1.0 X           0 0 0
(301) Dean George Werner SMH
Board Secretary
 1.0 X           0 0 0
(302) V Thomas Worrall MD SMH
Board Member
 1.0 X           144,528 0 20,826
(303) Deborah Brodine SCS
Board Member and President
 1.0 X   X       0 0 0
(304) Timothy Brooks SCS
Board Member
 1.0 X           0 0 0
(305) David Gibbons SCS
Board Chairman
 1.0 X   X       0 0 0
(306) William Nigro SCS
Board Member Treas and CFO
 1.0 X   X       0 0 0
(307) Nancy Pastorius SCS
Board Secretary and COO
 40.0 X           99,750 0 19,425
(308) William Cook UHCP
Board Member
 1.0 X           0 0 0
(309) Christopher A Gessner UHCP
Board Vice Chair and Vice Pres
 1.0 X           0 0 0
(310) Edward T Karlovich UHCP
Board Member
 1.0 X           0 0 0
(311) Arthur S Levine MD UHCP
Board Member
 1.0 X           0 0 0
(312) David Martin UHCP
Board Member
 1.0 X           0 0 0
(313) Marshall Webster MD UHCP
Board Chairman and President
 1.0 X   X       0 0 0
(314) Charles Bogosta UPCICS
President and Vice Chair
 1.0 X   X       0 0 0
(315) Elizabeth Concordia UPCICS
Board Member
 1.0 X           0 0 0
(316) Nancy Davidson UPCICS
Board Member
 1.0 X           0 0 0
(317) Sy Holzer UPCICS
Board Member
 1.0 X           0 0 0
(318) Edward T Karlovich UPCICS
Board Member
 1.0 X           0 0 0
(319) Scott Lammie UPCICS
Board Member
 1.0 X           0 0 0
(320) Stanley Marks MD UPCICS
Board Chairman
 40.0 X   X       942,082 931,151 179,806
(321) Derek Angus MD UPP
Board Member and Dept Chair
 40.0 X           472,726 0 23,200
(322) K Ty Bae MD UPP
Board Member and Dept Chair
 40.0 X           539,371 0 20,872
(323) G Nicholas Beckwith III UPP
Board Member
 1.0 X           0 0 0
(324) Timothy Robert Billiar MD UPP
Board Secretary and Dept Chair
 40.0 X           660,432 234,287 44,161
(325) Michael Boninger MD UPP
Board Member and Dept Chair
 40.0 X           179,282 0 9,681
(326) Jerome Cochran UPP
Board Member
 1.0 X           0 0 0
(327) Leslie C Davis UPP
Board Member
 1.0 X           0 0 0
(328) Robert P Edwards MD UPP
Board Member
 40.0 X           384,284 0 19,574
(329) Louis D Falo Jr MD UPP
Board Member and Dept Chair
 40.0 X           422,338 0 20,873
(330) Karen S Fisher R 92211 UPP
Board Member
 1.0 X           0 0 0
(331) Robert M Friedlander MD UPP
Board Member and Dept Chair
 40.0 X           1,137,259 0 21,754
(332) Freddie H Fu MD UPP
Board Member and Dept Chair
 40.0 X           1,278,473 0 25,224
(333) Christopher A Gessner UPP
Board Member
 1.0 X           0 0 0
(334) Joel S Greenberger MD UPP
Board Member and Dept Chair
 40.0 X           461,394 0 22,183
(335) Richard S Hamilton UPP
Board Member
 1.0 X           0 0 0
(336) W Allen Hogge MD UPP
Board Member and Dept Chair
 40.0 X           491,520 0 23,263
(337) Jonas T Johnson MD UPP
Board Member/Dept Chair/Treas
 40.0 X   X       670,947 0 24,554
(338) Joon Sup Lee MD E 32912 UPP
Board Member
 40.0 X           948,384 50,000 22,460
(339) Arthur S Levine MD UPP
Board Member
 1.0 X           0 0 0
(340) David A Lewis MD UPP
Board Member and Dept Chair
 40.0 X           423,156 0 21,972
(341) Barry London MD R 32912 UPP
Board Member
 40.0 X           447,600 0 20,120
(342) James D Luketich MD UPP
Board Member and Dept Chair
 40.0 X           1,987,972 0 26,877
(343) George K Michalopoulos MD UPP
Board Member and Dept Chair
 40.0 X           405,957 0 22,135
(344) Victor Morell MD E 32912 UPP
Board Member
 40.0 X           1,718,015 0 24,831
(345) Kenneth C Nash MD UPP
Board Member
 40.0 X           308,833 0 18,051
(346) Joel B Nelson MD UPP
Board Member and Dept Chair
 40.0 X           800,191 0 23,897
(347) Mark A Nordenberg UPP
Board Member
 1.0 X           0 0 0
(348) Roberto Ortiz-Aguayo UPP
Board Member
 40.0 X           211,744 0 11,587
(349) Gregory K Peaslee UPP
Board Member
 1.0 X           0 0 0
(350) David Hirsch Perlmutter MD UPP
Board Member and Dept Chair
 40.0 X           436,319 0 23,323
(351) John J Reilly E 9111 UPP
Board Member and Dept Chair
 40.0 X           335,446 0 21,152
(352) Jeffrey A Romoff UPP
Board Member
 1.0 X           0 0 0
(353) Joshua T Rubin MD UPP
Board Member
 40.0 X           213,646 0 13,503
(354) Joel S Schuman MD UPP
Board Member and Dept Chair
 40.0 X           527,647 0 22,400
(355) Steven Shapiro MD UPP
Board Member and Sr. V.P.
 40.0 X           0 0 0
(356) Jeannette South-Paul MD UPP
Board Member and Dept Chair
 40.0 X           184,813 0 14,991
(357) Stephen R Tritch UPP
Board Member
 1.0 X           0 0 0
(358) Michael A Turturro M UPP
Board Member
 40.0 X           353,014 0 21,617
(359) Neil Y Van Horn UPP
Board Member
 1.0 X           0 0 0
(360) Marshall Webster MD UPP
Board Chair and President
 40.0 X   X       0 0 0
(361) Lawrence Wechsler MD UPP
Board Member and Dept Chair
 40.0 X           566,015 0 22,209
(362) John P Williams MD UPP
Board Member and Dept Chair
 40.0 X           497,113 0 20,843
(363) Donald Yealy MD UPP
Board Member and Dept Chair
 40.0 X           275,585 0 22,986
(364) Deborah Brodine VNA
Board Chair and President
 1.0 X   X       0 0 0
(365) Mike Evans E 113011 VNA
Board Secretary
 1.0 X           0 0 0
(366) Robert Frank R 1111VNA
Board Vice Chairman and VP
 1.0 X           0 0 0
(367) JoAnn Hahey VNA
Board Member and Vice Chair
 1.0 X           0 0 0
(368) Jerome Shaffer VNA
Board Member and Treasurer
 1.0 X   X       0 0 0
(369) Esther Barazzone PhD UPMC
Board Member
 1.0 X           0 0 0
(370) G Nicholas Beckwith III UPMC
Board Chairman
 10.0 X   X       0 0 0
(371) Ester L Bush UPMC
Board Member
 1.0 X           0 0 0
(372) Mary Jo Howard Dively Esq UPMC
Board Member
 1.0 X           0 0 0
(373) Alan Guttman E 7111 UPMC
Board Member
 1.0 X           0 0 0
(374) Richard S Hamilton UPMC
Board Member
 1.0 X           0 0 0
(375) Howard W Hanna III UPMC
Board Member
 1.0 X           0 0 0
(376) Robert M Hernandez UPMC
Board Member and Chair Fin Com
 2.0 X           0 0 0
(377) Margaret P Joy UPMC
Board Member
 1.0 X           0 0 0
(378) Scott B Kern UPMC
Board Member
 1.0 X           0 0 0
(379) Mark J Laskow UPMC
2nd Vice Chair and Board Mem
 3.0 X           0 0 0
(380) Arthur S Levine MD UPMC
Board Member
 1.0 X           0 813,325 33,423
(381) Robert G Lovett UPMC
Board Member
 1.0 X           0 0 0
(382) W Duff McCrady UPMC
Board Member
 1.0 X           0 0 0
(383) Martin G McGuinn UPMC
Board Member
 1.0 X           0 0 0
(384) Marlee S Myers UPMC
Board Member
 1.0 X           0 0 0
(385) Mark A Nordenberg UPMC
Board Member
 1.0 X           0 624,042 140,255
(386) Robert A Paul UPMC
Board Member
 1.0 X           0 0 0
(387) John H Pelusi Jr UPMC
Board Member
 1.0 X           0 0 0
(388) The Honorable Lisa Pupo-Lenihan UP
Board Member
 1.0 X           0 0 0
(389) Patricia Siger UPMC
Board Member
 1.0 X           0 0 0
(390) Stephen Tritch UPMC
1st Vice Chair and Board Mem
 1.0 X           0 0 0
(391) Neil Y Van Horn UPMC
Board Member
 1.0 X           0 0 0
(392) Sunil Wadhwani UPMC
Board Member
 1.0 X           0 0 0
(393) Mario Wilfong BDF
CFO and VP Admin
 40.0     X       112,124 0 18,507
(394) Roger P Winn BDF
President
 40.0     X       374,622 0 36,277
(395) Cynthia Dorundo BDK
President
 1.0     X       0 0 0
(396) Stephen Nimmo Esq CBS
Secretary
 1.0     X       0 0 0
(397) Dan Swayze CEM
Vice President and Secretary
 40.0     X       132,775 0 27,325
(398) Christopher A Gessner CHP
President
 40.0     X       560,331 0 63,960
(399) Kimberly Moses CHP
Secretary
 40.0     X       120,100 0 8,741
(400) Laurel Ragland CHP
Treasurer and CFO
 40.0     X       170,700 0 17,059
(401) James Gavin CCBH
President
 40.0     X       534,241 0 64,529
(402) James Giammarco CCBH
Chief Financial Officer
 40.0     X       219,651 0 22,263
(403) Deborah Redmond CFHC
Vice President
 40.0     X       253,869 0 30,371
(404) Robert B Devlin Esq CMI
Secretary
 40.0     X       256,081 0 34,508
(405) William A Nigro CRAN
Assistant Treasurer and CFO
 40.0     X       0 115,154 23,428
(406) James Anthony Palmer CRAN
Vice Pres and Treasurer
 40.0     X       0 215,375 26,966
(407) Mark Sevco EAST
President
 40.0     X       419,192 0 52,913
(408) Colleen Brennan EMI
Treasurer and CFO
 40.0     X       199,841 0 25,953
(409) Terrence Lewis Esq EMI
Secretary
 40.0     X       157,486 0 18,014
(410) Robert Devlin EPN
Secretary
 1.0     X       0 0 0
(411) Scott Lammie FOR
Treasurer and CFO
 40.0     X       0 863,349 116,663
(412) Daniel Vukmer Esq FOR
Secretary and CLO
 40.0     X       0 420,251 58,726
(413) Marlene R Cooper HCD
Secretary
 0.0     X       0 0 0
(414) William A Nigro HERT
Asst Treasurer and CFO
 1.0     X       0 0 0
(415) James Anthony Palmer HERT
Vice President and COO
 1.0     X       0 0 0
(416) Donald Owrey HRZ
President
 40.0     X       333,878 0 50,377
(417) David Shulik HRZ
Chief Financial Officer
 40.0     X       174,844 0 28,473
(418) Jackie Bonier HRZF
Director of Foundation
 40.0     X       76,530 0 22,445
(419) Thomas Burich HRZF
President
 40.0     X       139,872 0 19,835
(420) David Shulik HRZF
Chief Financial Officer
 1.0     X       0 0 0
(421) Alexander J Ciocca Esq R 12111
Secretary
 1.0     X       0 0 0
(422) Susan Kostilnik MAG
Asst Sec and Sr Executive Asst
 40.0     X       62,315 0 11,933
(423) Eileen Simmons R 11111 MAG
Asst Treasurer and CFO
 40.0     X       309,275 0 24,689
(424) Gerad Theriac E 4212 MAG
Asst. Treasurer and CFO
 40.0     X       0 0 0
(425) Cynthia Dorundo MCK
President
 40.0     X       421,789 0 57,244
(426) Christopher Stockhausen MCK
Treasurer and CFO
 40.0     X       132,362 0 16,196
(427) Nicholas Barcellona MHP
Chief Financial Officer
 40.0     X       161,305 0 25,169
(428) Rebecca O'connor Esq MHP
Secretary and Assoc Counsel
 40.0     X       89,757 0 28,451
(429) Nancy Beichner NWH
Asst Sec and Admn Asst to Pres
 40.0     X       47,380 0 17,498
(430) Roger McCauley NWH
Treasurer and CFO
 40.0     X       202,617 0 24,940
(431) Cynthia Dorundo OCC
President
 1.0     X       0 0 0
(432) Charles Bogosta OVR
President
 1.0     X       0 0 0
(433) Alexander J Ciocca Esq OVR
Secretary
 1.0     X       0 0 0
(434) John Kuzmishin OVR
Treasurer/Sec/ CFO
 1.0     X       0 0 0
(435) Michael Riska R 22812 OVR
Treasurer and CFO
 0.0     X       88,224 0 14,357
(436) David Martin PAV
President
 40.0     X       951,616 0 88,694
(437) Dennis H Tomassetti PAV
Chief Financial Officer
 40.0     X       329,133 0 34,315
(438) Paul Castillo R 11111 PUH
Chief Financial Officer
 40.0     X       332,685 0 32,749
(439) C Talbot Heppenstall JR PUH
Treasurer
 1.0     X       0 0 0
(440) John Innocenti PUH
President
 40.0     X       1,173,274 0 121,048
(441) Michele P Jegasothy Esq PUH
Secretary
 1.0     X       0 0 0
(442) Edward T Karlovich PUH
CFO Academic Comm Hospitals
 40.0     X       993,516 0 103,758
(443) Margarita Marsh PUH
Asst Sec and Asst to Pres
 40.0     X       61,286 0 6,484
(444) Eileen Simmons E 11111 PUH
Chief Financial Officer
 40.0     X       0 0 0
(445) John R Carroll SMH
Asst Sec and VP Admin
 40.0     X       192,567 0 42,441
(446) Thomas Newman SMH
Asst Treasurer and CFO
 40.0     X       246,772 0 31,133
(447) Teresa Petrick SMH
President
 40.0     X       644,758 0 74,541
(448) Cindy Shook SCS
Asst Sec and Admin Asst
 1.0     X       28,153 0 15,395
(449) Marlene R Cooper UHCP
Secretary
 40.0     X       114,180 0 23,242
(450) Ann Evans UHCP
Treasurer and CFO
 1.0     X       0 0 0
(451) Rich Bondi E 8111 UPCICS
Chief Financial Officer
 40.0     X       152,293 0 26,728
(452) Al Ciocca UPCICS
Secretary
 1.0     X       0 0 0
(453) Peter Tate R 72911 UPCICS
Chief Financial Officer
 40.0     X       114,418 0 17,318
(454) James TerwilligerR 121511 UPCIC
Vice President
 40.0     X       282,083 0 18,356
(455) Ann Evans UPP
Chief Financial Officer
 40.0     X       505,533 0 56,400
(456) Robert Griffith E 9611 VNA
Chief Financial Officer
 40.0     X       31,659 0 2,851
(457) Penny Milanovich VNA
President
 40.0     X       219,962 0 23,088
(458) Heidi VanGorder UPMC
Secretary
 40.0     X       40,991 0 19,848
(459) Robert A DeMichiei UPMC
Sr VP and CFO
 60.0     X       1,168,589 0 194,752
(460) Michele P Jegasothy Esq UPMC
Secretary
 40.0     X       191,194 0 27,995
(461) Jeffrey A Romoff UPMC
President and CEO
 60.0     X       4,318,746 0 1,751,004
(462) Charles Bogosta UPMC
EVP and Pres Intl and Comm Srv
 60.0       X     1,441,255 0 200,617
(463) Robert J Cindrich UPMC
Senior Advisor to the Pres
 60.0       X     1,349,168 0 186,423
(464) Elizabeth Concordia UPMC
Executive VP
 60.0       X     2,164,478 0 346,510
(465) Andrea Cotter UPMC
Sr VP and Chief Comm Officer
 60.0       X     575,984 0 52,810
(466) Sandra Danoff UPMC
Sr VP Strategic Planning
 60.0       X     1,225,503 0 90,096
(467) Daniel Drawbaugh UPMC
SR VP and Chief Inform Officer
 60.0       X     2,022,600 0 214,140
(468) David Farner UPMC
Sr VP and Chief of Staff
 60.0       X     1,552,486 0 228,236
(469) C Talbot Heppenstall Jr UPMC
Sr VP and Treasurer
 60.0       X     970,069 0 163,697
(470) Diane Holder UPMC
Exec VP and Pres. Health Plan
 60.0       X     0 1,619,748 290,619
(471) W Thomas McGough UPMC
Sr VP and Chief Legal Officer
 60.0       X     930,045 0 119,082
(472) Gregory K Peaslee UPMC
Sr VP Chief HR and Adm Srv Off
 60.0       X     1,916,723 0 204,197
(473) Steven D Shapiro MD UPMC
Sr VP, Chief Med and Scien Off
 60.0       X     801,309 187,384 176,205
(474) Marshall Webster MD UPMC
Executive Vice President
 60.0       X     1,102,126 115,562 177,840
(475) Ghassan Bejjani MD
Neurosurgeon
 40.0         X   2,449,124 0 33,820
(476) Richard Spiro MD
Neurosurgeon
 40.0         X   1,832,949 0 21,876
(477) Mark Rodosky MD
Orthopedic Surgeon
 40.0         X   1,797,891 0 23,330
(478) Abhinav Humar MD
Transplant Surgeon
 40.0         X   1,335,471 0 20,330
(479) Adnan Abla MD
Neurosurgeon
 40.0         X   1,316,576 0 42,522
(480) David Bartlett MD
Former Board Member
             X 772,587 0 22,333
(481) Marguerite Bonaventura MD
Former Board Member
             X 415,744 0 21,812
(482) Deborah Holder MD
Former Board Member
             X 202,289 0 14,265
(483) Susan Edgar-Hoolahan
Former Board Member
             X 314,246 0 34,226
(484) Mohammad Idrees MD
Former Board Member
             X 22,496 0 0
(485) Mary Korytkowski MD
Former Board Member
             X 226,506 0 13,461
(486) Rita Patel MD
Former Board Member
             X 288,029 0 21,461
(487) Adele Towers MD
Former Board Member
             X 237,120 0 17,075
(488) Eric Weaverling MD
Former Board Member
             X 218,586 0 29,220
(489) Dennis Zerega
Former Board Member
             X 254,104 0 32,876
(490) Rudolph Antoncic Jr MD
Former Board Member
             X 284,557 0 30,417
(491) Jules Sumkin MD
Former Board Member
             X 591,595 0 23,541
(492) Margaretha Casselbrandt MD
Former Board Member
             X 366,232 0 24,057
(493) Anita Courcoulas MD
Former Board Member
             X 657,999 0 24,397
(494) Michael Finikiotis MD
Former Board Member
             X 249,957 0 32,705
(495) Evan Waxman MD
Former Board Member
             X 371,230 0 20,287
(496) Christopher Samuel MD
Former Board Member
             X 421,950 0 35,181
(497) Michael Culyba
Former Board Member
             X 0 148,017 12,497
(498) David Kupfer MD
Former Board Member
             X 136,701 0 12,374
(499) Kenneth Lee MD
Former Board Member
             X 426,395 0 21,829
(500) Domingo Ottonello MD
Former Board Member
             X 57,492 0 22,016
(501) Joel Weinberg MD
Former Board Member
             X 680,843 0 41,435
(502) Joel Yuhas
Former President
             X 0 709,245 197,050
(503) Susan Mammarella
Former CFO/Treasurer
             X 178,595 0 29,385
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 86,000,674 7,905,308 9,973,281
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet157
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Baton Malow PJ DICK JV
1020 Lebanon Road
PITTSBURGH,PA15122 		GENERAL CONTRACTOR 69,958,643
AIM Construction
651 Holiday Drive STE 300
PITTSBURGH,PA15220 		General Contractor 20,354,757
ITXM Clinical Services
PO Box 3455
PITTSBURGH,PA15230 		Lab Services 17,699,747
Rycon Construction
2525 Liberty Avenue
PITTSBURGH,PA15222 		GENERAL CONTRACTOR 19,641,768
Centers for Rehab Services
625 Walnut Street
MCKEESPORT,PA15132 		REHAB SERVICES 23,308,055
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet137
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 227,379
b Membership dues....1b  
c Fundraising events....1c 663,195
d Related organizations...1d 35,213,407
e Government grants (contributions)1e 17,678,565
f All other contributions, gifts, grants, and
similar amounts not included above1f 		44,665,993
g Noncash contributions included in lines 1a-1f:$ 4,108,831
h Total. Add lines 1a-1f.......MediumBullet 98,448,539
Program Service Revenue Business Code
2a NET PATIENT REV 621,500 5,655,270,835 5,653,325,122 1,945,713  
b OTHER PATIENT SERV 541,900 131,970,258 131,970,258    
c OTHER PROG SRV REV 561,000 2,361,954,487 2,359,588,677 2,365,810  
d FEES & CONTRACT FROM GOV'T AGENCIES   17,075,105 17,075,105    
e JOINT VENTURE REVENUE   12,994,667 12,994,667    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 8,179,265,352
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 15,302,254     15,302,254
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 329,691,396 7,011,061
b Less: cost or other basis and sales expenses 328,854,239 2,153,812
c Gain or (loss) 837,157 4,857,249
d Net gain or (loss)..........MediumBullet 5,694,406     5,694,406
8a Gross income from fundraising events (not including
$ 839,934
of contributions reported on line 1c). See Part IV, line 18 ...
a 218,679
b Less: direct expenses ...b 416,641
c Net income or (loss) from fundraising events..MediumBullet -197,962   -197,962
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 0
12 Total revenue. See Instructions....MediumBullet 8,298,512,589 8,174,953,829 4,311,523 20,798,698
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 23,050,148 23,050,148
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 78,057,657 29,339,244 48,718,413  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 1,154,515 1,111,688 42,827  
7 Other salaries and wages 3,171,730,233 2,717,128,677 454,706,556 -105,000
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 118,558,996 96,854,715 21,704,281  
9 Other employee benefits ....... 301,416,134 263,237,336 38,178,798  
10 Payroll taxes ........... 161,279,474 137,637,997 23,641,477  
11 Fees for services (non-employees):        
a Management ...... 21,018,595 19,272,503 1,746,092  
b Legal ......... 10,168,491 1,596,086 8,572,405  
c Accounting ........... 3,393,360   3,393,360  
d Lobbying ........... 1,499,927   1,499,927  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 812,260   812,260  
g Other .......... 70,400,590 69,746,964 653,626  
12 Advertising and promotion .... 15,897,091 15,897,091    
13 Office expenses ....... 69,321,959 43,133,520 26,176,542 11,897
14 Information technology ...... 96,912,853 30,901,186 66,007,408 4,259
15 Royalties .. 0      
16 Occupancy ........... 178,879,348 159,604,838 18,828,344 446,166
17 Travel ............ 16,314,327 11,516,956 4,797,371  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 1,788,906 1,168,500 620,406  
20 Interest ........... 5,618,899 5,520,018 98,881  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 306,921,621 306,921,621    
23 Insurance .............. 80,859,490 77,453,402 3,406,088  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL/PATIENT SUPPLIES 1,009,818,258 1,009,818,258    
b MEDICAL EXPENSES 752,102,653 752,102,653    
c DRUGS 404,629,151 404,629,151    
d MEDICAL IMPLANTS 205,677,804 205,677,804    
e
f All other expenses 808,378,428 708,298,602 96,033,559 4,046,267
25 Total functional expenses. Add lines 1 through 24f 7,915,661,168 7,091,618,958 819,638,621 4,403,589
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 11,042,865 1 21,458,659
2 Savings and temporary cash investments ....... 97,013,260 2 57,328,020
3 Pledges and grants receivable, net ......... 0 3 2,000,000
4 Accounts receivable, net ......... 723,384,727 4 909,528,303
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 15,783,697 7 15,700,252
8 Inventories for sale or use .............. 23,818,144 8 29,355,321
9 Prepaid expenses and deferred charges ............ 9,064,688 9 10,986,337
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 5,726,771,225
b Less: accumulated depreciation. ..... 10b 2,936,634,173 2,604,587,007 10c 2,790,137,052
11 Investments—publicly traded securities .......... 227,116,828 11 233,226,155
12 Investments—other securities. See Part IV, line 11 ...... 39,811,133 12 41,105,023
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 13,454,683 14 14,167,012
15 Other assets. See Part IV, line 11 ........... 1,225,805,780 15 1,294,000,910
16 Total assets. Add lines 1 through 15 (must equal line 34)... 4,990,882,812 16 5,418,993,044
Liabilities 17 Accounts payable and accrued expenses . 303,918,787 17 337,968,759
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 36,402,790 19 32,055,191
20 Tax-exempt bond liabilities .......... 9,343,042 20 6,667,496
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 490,509,580 25 532,673,385
26 Total liabilities. Add lines 17 through 25..... 840,174,199 26 909,364,831
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 3,691,728,838 27 4,062,559,525
28 Temporarily restricted net assets ..... 311,600,976 28 293,880,543
29 Permanently restricted net assets ..... 147,378,799 29 153,188,145
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 4,150,708,613 33 4,509,628,213
34 Total liabilities and net assets/fund balances ..... 4,990,882,812 34 5,418,993,044
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
8,298,512,589
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
7,915,661,168
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
382,851,421
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
4,150,708,613
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-23,931,821
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
4,509,628,213
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
No
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
No
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
No
h
(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?
Yes No Yes No Yes No
(1) SEE SCHEDULE A SUPPLEMENTAL INFORMATION
  		000000000 03   No         0
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....   1,623,424 424,006 1,822,563 2,084,347 5,954,340
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..   1,623,424 424,006 1,822,563 2,084,347 5,954,340
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.           5,954,340
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..   1,623,424 424,006 1,822,563 2,084,347 5,954,340
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..     0     0
11 Total support (Add lines 7 through 10).           5,954,340
12
12
6,225,064,724
13
Section C. Computation of Public Support Percentage
14
14
100.000 %
15
15
99.859 %
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .   1,623,424 424,006 1,822,563 2,084,347 5,954,340
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......   1,214,423,842 1,523,888,856 1,654,369,080 1,832,382,946 6,225,064,724
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.   1,216,047,266 1,524,312,862 1,656,191,643 1,834,467,293 6,231,019,064
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.)           6,231,019,064
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...   1,216,047,266 1,524,312,862 1,656,191,643 1,834,467,293 6,231,019,064
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..   3,309,933 5,283,932 5,540,070 6,909,294 21,043,229
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.   94,890 247,070 91,147   433,107
c Add lines 10a and 10b.   3,404,823 5,531,002 5,631,217 6,909,294 21,476,336
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.)     0     0
13 Total support (Add lines 9, 10c, 11 and 12.).   1,219,452,089 1,529,843,864 1,661,822,860 1,841,376,587 6,252,495,400
14
Section C. Computation of Public Support Percentage
15
15
99.657 %
16
16
99.670 %
Section D. Computation of Investment Income Percentage
17
17
0.344 %
18
18
0.330 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
REASON FOR NON-PRIVATE FOUNDATION STATUS: UPMC PRESBYTERIAN SHADYSIDE: Foundation Status 3 CHILDREN'S HOSPITAL OF PITTSBURGH OF THE UPMC : Foundation Status 3 MAGEE-WOMENS HOSPITAL OF UPMC: Foundation Status 3 UPMC ST MARGARET: Foundation Status 3 UPMC PASSAVANT: Foundation Status 3 UPMC HORIZON: Foundation Status 3 UPMC NORTHWEST: Foundation Status 3 UPMC BRADDOCK: Foundation Status 3 UPMC MCKEESPORT: Foundation Status 3 UPMC EAST: Foundation Status 3 UPMC BEDFORD: Foundation Status 3 UNIVERSITY OF PITTSBURGH CANCER INSTITUTE CANCER SERVICES: Foundation Status 3 UPMC HORIZON COMMUNITY HEALTH FOUNDATION: Foundation Status 11 ;Type 1 UNIVERSITY OF PITTSBURGH PHYSICIANS: Foundation Status 3 COMMUNITY CARE BEHAVIORAL HEALTH ORGANIZATION: Foundation Status 9 UPMC MERCY: Foundation Status 3 PASSAVANT PROFESSIONAL ASSOCIATES, INC.: Foundation Status 9 UPMC COMMUNITY MEDICINE, INC.: Foundation Status 3 COMMUNITY FAMILY HEALTH CENTERS, INC.: Foundation Status 3 HEALTH CENTER DEVELOPMENT: Foundation Status 11 ;Type 1 UPMC EMERGENCY MEDICINE, INC.: Foundation Status 9 UPMC OCCUPATIONAL MEDICINE, INC.: Foundation Status 9 SUGARCREEK STATION: Foundation Status 3 UPMC VISITING NURSES ASSOCIATION: Foundation Status 9 CRANBERRY PLACE: Foundation Status 9 THE HERITAGE SHADYSIDE: Foundation Status 9 UPMC COMMUNTIY PROVIDER SERVICES: Foundation Status 9 UPMC INTERNATIONAL HOLDINGS, INC.: Foundation Status 11 ;Type 2 UPMC OVERSEAS, INC.: Foundation Status 11 ;Type 2 THE CENTER FOR BIOSECURITY OF THE UNIVERSITY OF PITTSBURGH MEDICAL CENTER, INC.: Foundation Status 4 UNIVERSITY HEALTH CENTER OF PITTSBURGH: Foundation Status 11 ;Type 2 UPMC IMITS CENTER: Foundation Status 7 UPMC For You: Foundation Status 9 CENTER FOR EMERGENCY MEDICINE OF WESTERN PA: Foundation Status 11 ;Type 2 ERIE PHYSICIANS NETWORK-UPMC INC.: FOUNDATION STATUS 3
Entity: UPMC Horizon Community Health Foundation (i) Name of Supported Organization: UPMC Horizon (ii) EIN: 25-0523970 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: Yes (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes Entity: Health Center Development (i) Name of Supported Organization: UPMC PRESBYTERIAN SHADYSIDE (ii) EIN: 25-0965480 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: NO (v) Notify Organization of Your Support: YES (vi) Organized in US: YES Entity: UPMC Behavioral Health Services (i) Name of Supported Organization: UPMC Presbyterian Shadyside (ii) EIN: 25-0965480 (iii)Type of Organization: 11 (iv) Organization Listed In Governing Documents: No (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes Entity: UPMC International Holdings Inc. (i) Name of Supported Organization: UPMC Presbyterian Shadyside (ii) EIN: 25-0965480 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: Yes (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes Entity: UPMC Overseas (i) Name of Supported Organization: UPMC Presbyterian Shadyside (ii) EIN: 25-0965480 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: Yes (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes Entity: University Health Center of Pittsburgh (i) Name of Supported Organization: UPMC Presbyterian Shadyside (ii) EIN: 25-0965480 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: Yes (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes Entity: University Health Center of Pittsburgh (i) Name of Supported Organization: Magee-Womens Hospital of UPMC (ii) EIN: 25-0965420 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: Yes (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes Entity: University Health Center of Pittsburgh (i) Name of Supported Organization: Children's Hospital of Pittsburgh of the UPMC Health System (ii) EIN: 25-0402510 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: Yes (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes Entity: Center for Emergency Medicine (i) Name of Supported Organization: UPMC Presbyterian Shadyside (ii) EIN: 25-0965480 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: Yes (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes Entity: Center for Emergency Medicine (i) Name of Supported Organization: Children's Hospital of Pittsburgh of the UPMC Health System (ii) EIN: 25-0402510 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: Yes (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes Entity: Center for Emergency Medicine (i) Name of Supported Organization: UPMC Mercy (ii) EIN: 25-0965429 (iii)Type of Organization: 3 (iv) Organization Listed In Governing Documents: Yes (v) Notify Organization of Your Support: Yes (vi) Organized in US: Yes
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
UPMC GROUP
 
Employer identification number

20-8295721
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
UPMC GROUP
  		Employer identification number

20-8295721
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
UPMC GROUP
  		Employer identification number

20-8295721
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
UPMC GROUP
  		Employer identification number

20-8295721
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
Yes
 
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
96,154
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
2,284,899
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
2,381,053
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Additional Information Part I-A UPMC Group Entities do not engage in any direct or indirect political activity. Part II-B UPMC Group maintains a department of government relations whose primary function is to maintain contact with elected and appointed officials at the federal, state, and local levels. The department promotes legislative actions with respect to healthcare related issues that could impact the organization.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 52,723,527 47,318,207 14,905,084 18,739,823
b Contributions ........ 7,157,850 1,124,392 31,809,381 342,274
c Net investment earnings, gains, and losses ... -952,531 6,919,371 3,095,947 -4,063,202
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		2,111,494 2,638,443 2,492,204 113,811
f Administrative expenses ....        
g End of year balance ...... 56,817,352 52,723,527 47,318,208 14,905,084
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   137,345,410 137,345,410
b Buildings ................   3,232,793,522 1,508,553,237 1,724,240,285
c Leasehold improvements ............   57,439,902 30,696,119 26,743,783
d Equipment ................   1,847,360,653 1,344,513,451 502,847,202
e Other .................   451,831,738 52,871,366 398,960,372
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 2,790,137,052
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM AFFILIATE 557,800,272
(2) BENEFICIAL INT IN FOUNDATIONS 304,981,823
(3) INVESTMENTS WITH RELATED ORGS 155,955,713
(4) LONG TERM BUILDING LEASE 30,857,310
(5) L-T OTHER INVEST (FAS 124) 31,175,533
(6) INVEST IN JOINT VENTURES 92,042,569
(7) OTHER ASSETS 59,041,723
(8) DUE FROM RESTRICTED FUNDS 62,145,967

Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 1,294,000,910
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
DUE TO EXEMPT PARENT 387,608,006
DUE TO THIRD PARTY PAYORS 32,874,511
INSURANCE LIABILITIES 38,132,680
OTHER CURRENT & LT LIABILITIES 28,949,774
PATIENT DEP/CRED BALANCES 45,108,414




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 532,673,385
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Part V Line 4 Endowment funds will be utilized to carry on the exempt mission of the hospital entities.
Part X Line 2 There is no FIN48 footnote disclosure in the consolidated audited financial statements of UPMC.
     
     
     
     
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Europe (Including Iceland and Greenland)     Program Services HEALTH CARE EDUCATION 981,092
North America     Program Services HEALTH CARE EDUCATION 227,744
East Asia and the Pacific     Program Services HEALTH CARE EDUCATION 237,067
South Asia     Program Services HEALTH CARE EDUCATION 81,448
Central America and the Caribbean     Program Services HEALTH CARE EDUCATION 76,889
South America     Program Services HEALTH CARE EDUCATION 65,281
Middle East and North Africa     Program Services HEALTH CARE EDUCATION 44,080
Sub-Saharan Africa     Program Services HEALTH CARE EDUCATION 29,855
Russia and the Newly Independent States     Program Services HEALTH CARE EDUCATION 2,984
East Asia and the Pacific     Investments   20,026
Europe (Including Iceland and Greenland)     Investments   7,902
North America     Investments   2,937
           
           
           
           
           
3a Sub-total .....     1,777,305
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     1,777,305
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

STEELER STYLE
(event type) 		(b) Event #2

ANDY RUSSELL
(event type) 		(c) Other Events

6
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 571,497 262,150 224,966 1,058,613
2 Less: Charitable
contributions . . . 		457,347 231,940 150,647 839,934
3 Gross income (line 1
minus line 2) . . . 		114,150 30,210 74,319 218,679
VerticalDirectExpenses 4 Cash prizes . . .     11,375 11,375
5 Non-cash prizes . .   15,788 14,214 30,002
6 Rent/facility costs . .   1,000 18,245 19,245
7 Food and beverages . . 43,923 83,366 38,173 165,462
8 Entertainment . . .   2,100 9,635 11,735
9 Other direct expenses . 126,845 15,686 36,291 178,822
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 416,641
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -197,962
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2011
Additional Data


Software ID:  
Software Version:  
SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

 

No
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    84,031,570   84,031,570 1.500 %
b Medicaid (from Worksheet 3, column a) .....     724,288,243 598,884,281 125,403,962 2.230 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     19,042,123 15,082,206 3,959,917 0.070 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    827,361,936 613,966,487 213,395,449 3.800 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    50,031,734 2,293,968 47,737,766 0.850 %
f Health professions education
(from Worksheet 5) .. 		    196,193,457 74,154,248 122,039,209 2.170 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)     127,361,351   127,361,351 2.270 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     19,010,350   19,010,350 0.340 %
jTotal Other Benefits ...     392,596,892 76,448,216 316,148,676 5.630 %
kTotal. Add lines 7d and 7j. ..     1,219,958,828 690,414,703 529,544,125 9.430 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
46,400,193
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
9,048,848
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
1,428,945,245
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
1,564,378,147
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-135,432,902
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
 
No
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

 

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1UPMC Oncology Co-Mgt
  		Oncology Service 50.000 % 0 % 50.000 %
2
3
4
5
6
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Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?60
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 UPMC Presbyterian
200 Lothrop Street
Pittsburgh,PA15213 		X X   X   X X    
2 UPMC Shadyside
5230 Centre Avenue
Pittsburgh,PA15232 		X X   X   X X    
3 UPMC SOUTH SURGERY CENTER
1300 OXFORD DRIVE
PITTSBURGH,PA15102 		                OUTPATIENT AMBULATORY & SURGICAL CENTER
4 MAGEE-WOMENS HOSPITAL OF UPMC
300 HALKET STREET
Pittsburgh,PA15213 		X X   X   X X    
5 CHILDREN'S HOSPITAL OF UPMC
4401 PENN AVENUE
PITTSBURGH,PA15224 		X X X X   X X    
6 CHILDREN'S NORTH
2599 WEXFORD-BAYNE ROAD
SEWICKLEY,PA15143 		                OUTPATIENT AMBULATORY & SURGICAL CENTER
7 UPMC MERCY
1400 LOCUST STREET
PITTSBURGH,PA15219 		X X   X     X    
8 UPMC MERCY SOUTH SIDE
2000 MARY STREET
PITTSBURGH,PA15203 		X               OUTPATIENT AMBULATORY & SURGICAL CENTER
9 UPMC PASSAVANT
9100 BABCOCK BLVD
PITTSBURGH,PA15237 		X X       X X    
10 UPMC PASSAVANT CRANBERRY
1 ST FRANCIS WAY
CRANBERRY TWP,PA16066 		X X       X X    
11 UPMC ST MARGARET
815 FREEPORT ROAD
Pittsburgh,PA15215 		X X   X     X    
12 UPMC MCKEESPORT
1500 FIFTH AVENUE
MCKEESPORT,PA15132 		X X   X     X    
13 UPMC HORIZON
110 MAIN STREET
GREENVILLE,PA16125 		X X   X     X    
14 UPMC HORIZON
2200 MEMORIAL DRIVE
FARRELL,PA16121 		X X   X     X    
15 UPMC NORTHWEST
100 FAIRFIELD DRIVE
SENECA,PA16346 		X X         X    
16 CRANBERRY PLACE
5 ST FRANCIS WAY
CRANBERRY TWP,PA16066 		                Skilled Nursing facility
17 UPMC HERITAGE SHADYSIDE
5701 PHILLIPS AVENUE
PITTSBURGH,PA15217 		                Skilled Nursing Facility
18 SUGAR CREEK STATION
315 CAUSEWAY DRIVE
FRANKLIN,PA16323 		                Skilled Nursing Facility
19 UPMC BEDFORD
10455 LINCOLN HIGHWAY
EVERETT,PA15337 		X X         X    
20 UPMC ST MARGARET HARMAR OUTPATIENT CTR
3 MARINER COURT
PITTSBURGH,PA15238 		                outpatient ambulatory & surgical center
21 WEST MIFFLIN IMAGING
1907 LEBANON CHURCH RD
WEST MIFFLIN,PA15122 		                IMAGING CENTER
22 BETHEL PARK IMAGING
1300 OXFORD DRIVE STE 2A
BETHEL PARK,PA15102 		                IMAGING CENTER
23 UPMC AT OXFORD DRIVE
600 OXFORD DRIVE
PITTSBURGH,PA15146 		                IMAGING CENTER
24 MAGEE-WOMENS HOSPITAL OF UPMC
720 PENN AVENUE
PITTSBURGH,PA15221 		                OUTPATIENT CLINIC
25 MAGEE-WOMENS HOSPITAL OF UPMC
FIFTH AVENUE COMMONS 905 WATSON STR
PITTSBURGH,PA15219 		                OUTPATIENT CLINIC
26 MAGEE-WOMENS HOSPITAL OF UPMC
4075 MONROEVILLE BLVD 2 STE 330
MONROEVILLE,PA15146 		                OUTPATIENT CLINIC
27 MAGEE-WOMENS HOSPITAL OF UPMC
559 MILLER AVENUE
CLAIRTON,PA15025 		                OUTPATIENT CLINIC
28 MAGEE-WOMENS HOSPITAL OF UPMC
1630 ARLINGTON AVENUE
PITTSBURGH,PA15210 		                OUTPATIENT CLINIC
29 MAGEE-WOMENS HOSPITAL OF UPMC
4075 MONROEVILLE BLVD 2 STE 225
MONROEVILLE,PA15146 		                OUTPATIENT CLINIC
30 MAGEE-WOMENS HOSPITAL OF UPMC
2599 WEXFORD-BAYNE ROAD STE 1000A
SEWICKLEY,PA15143 		                OUTPATIENT CLINIC
31 WOMANCARE CENTER NORTH (WEXFORD)
2599 WEXFORD-BAYNE RD STE 1000B
SEWICKLEY,PA15143 		                IMAGING SERVICES
32 MAGEE-WOMENS CARE SOUTH HILLS
1300 OXFORD DRIVE
BETHEL PARK,PA15102 		                OUTPATIENT CLINIC
33 MAGEE-WOMENS CARE PLEASANT HILLS
850 CLAIRTON BLVD STE 2100
PLEASANT HILLS,PA15236 		                OUTPATIENT CLINIC
34 WOMEN'S SPECIALTY CTR AT HILLMAN CANCER
5115 CENTER AVENUE STE G 3RD FLR
PITTSBURGH,PA15232 		                IMAGING SERVICES
35 WOMEN'S IMAGING NORTH OF MAGEE-WOMENS
9000 BROOKTREE ROAD 402
WEXFORD,PA15090 		                IMAGING SERVICES
36 MAGEE-CRANBERRY BREAST IMAGING
3 ST FRANCIS WAY
CRANBERRY TWP,PA16066 		                IMAGING SERVICES
37 MAGEE ULTRASOUND-BEAVER
690 STATE AVENUE
BEAVER,PA15009 		                IMAGING SERVICES
38 ULTRA SOUND SERVICES
969 GREENTREE ROAD
PITTSBURGH,PA15220 		                IMAGING SERVICES
39 ULTRA SOUND SERVICES
8955 LINCOLN HIGHWAY
IRWIN,PA15642 		                IMAGING SERVICES
40 UPMC MERCY GREENTREE
969 GREENTREE ROAD
PITTSBURGH,PA15220 		                OUTPATIENT SERVICES & IMAGING SERVICES
41 UPMC MERCY BRENTWOOD
4190 BROWNSVILLE ROAD
PITTSBURGH,PA15227 		                OUTPATIENT SERVICES
42 UPMC ST MARGARET LAWRENCEVILLE FAMILY
3937 BUTLER STREET
PITTSBURGH,PA15201 		                OUTPATIENT CLINIC
43 UPMC ST MARGARET NEW KENSINGTON FAMILY
301 11TH ST
NEW KENSINGTON,PA15068 		                OUTPATIENT CLINIC
44 UPMC ST MARGARET BLOOMFIELD-GARFIELD
5475 PENN AVENUE
PITTSBURGH,PA15206 		                OUTPATIENT SERVICES
45 FOREST HILLS IMAGING
3 PARKWAY CENTER EAST 2020 ARDMORE
FOREST HILLS,PA15221 		                OUTPATIENT SERVICES
46 CARDIAC REHAB
2001 LINCOLN HIGHWAY
WHITE OAK,PA15131 		                OUTPATIENT SERVICES
47 WOMENCARE CENTER
875 N HARMITAGE ROAD
HERMITAGE,PA16148 		                AMBULATORY SERVICES, PHYSICIAN, IMAGING SERVICES
48 MERCER DIAGNOSTIC CENTER
737 GREENVILLE ROAD
MERCER,PA16137 		                AMBULATORY SERVICES
49 NEW WILMINGTON DIAGNOSTIC CENTER
565 NESHANNOCK DRIVE
NEW WILMINGTON,PA16142 		                AMBULATORY SERVICES
50 OCCUPATIONAL & ENVIRONMENTAL MEDICINE
1980 GREEN STREET
FARRELL,PA16121 		                AMBULATORY SERVICES
51 OCCUPATIONAL REHABILITATION SERVICES
2120 LINKENS LANE
FARRELL,PA16121 		                REHABILITATION SERVICES
52 OCCUPATIONAL REHABILITATION SERVICES
26 CONNEAUT LAKE ROAD
GREENVILLE,PA16125 		                REHABILITATION SERVICES
53 REGIONAL CENTER FOR SLEEP DISORDERS
1980 GREEN STREET
FARRELL,PA16121 		                AMBULATORY SERVICES
54 GREENVILLE MEDICAL CENTER FOR RADIOLOGY
90 SHENANGO STREET
GREENVILLE,PA16125 		                IMAGING SERVICES
55 UPMC NORTHWEST MRI CENTER
1671 ALLEGHENY BLVD
RENO,PA16343 		                IMAGING SERVICES
56 UPMC NORTHWEST OUTPATIENT PT CENTER
112 CIRCLE STREET
FRANKLIN,PA16323 		                PHYSICAL THERAPY SERVICES
57 MAGEE WOMENS HOSPITAL OF UPMC
815 FREEPORT ROAD STE 2160
PITTSBURGH,PA15215 		                IMAGING SERVICES
58 MAGEE WOMENS HOSPITAL OF UPMC
5957 LINCOLN HIGHWAY
IRWIN,PA15642 		                IMAGING SERVICES
59 UPMC EAST
2775 MOSSIDE BOULEVARD
MONROEVILLE,PA15146 		X X         X    
60 Children's East
4055 Mosside Boulevard
Monroeville,PA15146 		                Outpatient Ambulatory
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC Presbyterian
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC Shadyside
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC SOUTH SURGERY CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
CHILDREN'S HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
CHILDREN'S NORTH
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):6

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC MERCY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):7

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC MERCY SOUTH SIDE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):8

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC PASSAVANT
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):9

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC PASSAVANT CRANBERRY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):10

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC ST MARGARET
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):11

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC MCKEESPORT
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):12

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC HORIZON
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):13

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC HORIZON
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):14

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC NORTHWEST
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):15

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
CRANBERRY PLACE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):16

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC HERITAGE SHADYSIDE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):17

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
SUGAR CREEK STATION
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):18

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC BEDFORD
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):19

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC ST MARGARET HARMAR OUTPATIENT CTR
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):20

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
WEST MIFFLIN IMAGING
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):21

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
BETHEL PARK IMAGING
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):22

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC AT OXFORD DRIVE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):23

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):24

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):25

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):26

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):27

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):28

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):29

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):30

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
WOMANCARE CENTER NORTH (WEXFORD)
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):31

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS CARE SOUTH HILLS
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):32

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-WOMENS CARE PLEASANT HILLS
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):33

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
WOMEN'S SPECIALTY CTR AT HILLMAN CANCER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):34

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
WOMEN'S IMAGING NORTH OF MAGEE-WOMENS
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):35

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE-CRANBERRY BREAST IMAGING
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):36

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE ULTRASOUND-BEAVER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):37

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
ULTRA SOUND SERVICES
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):38

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
ULTRA SOUND SERVICES
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):39

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC MERCY GREENTREE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):40

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC MERCY BRENTWOOD
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):41

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC ST MARGARET LAWRENCEVILLE FAMILY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):42

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC ST MARGARET NEW KENSINGTON FAMILY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):43

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC ST MARGARET BLOOMFIELD-GARFIELD
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):44

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
FOREST HILLS IMAGING
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):45

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
CARDIAC REHAB
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):46

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
WOMENCARE CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):47

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MERCER DIAGNOSTIC CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):48

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
NEW WILMINGTON DIAGNOSTIC CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):49

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
OCCUPATIONAL & ENVIRONMENTAL MEDICINE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):50

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
OCCUPATIONAL REHABILITATION SERVICES
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):51

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
OCCUPATIONAL REHABILITATION SERVICES
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):52

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
REGIONAL CENTER FOR SLEEP DISORDERS
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):53

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
GREENVILLE MEDICAL CENTER FOR RADIOLOGY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):54

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC NORTHWEST MRI CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):55

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC NORTHWEST OUTPATIENT PT CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):56

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):57

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MAGEE WOMENS HOSPITAL OF UPMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):58

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UPMC EAST
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):59

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Children's East
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):60

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?4
Name and address Type of Facility (describe)
1 University of Pittsburgh Physicians
5200 Centre Ave
Pittsburgh,PA15213 		Physician Services
2 Community Medicine Inc
875 N Hermitage Rd
Hermitage,PA16148 		Physician Services
3 EMERGENCY MEDICINE INC
9100 Babcock Blvd
Pittsburgh,PA15237 		ER Physicians Services
4 ERIE PHYSICIAN NETWORK-UPMC INC
3535 PINE AVENUE
ERIE,PA16504 		PHYSICIAN SERVICES
5
6
7
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I LINE 6A   UPMC Prepares an annual community benefits report. The report encompasses information for the entire integrated delivery system that makes up the UPMC Health System. It is posted to and available to the public via the UPMC website, www.upmc.com. Copies are also available in waiting rooms at UPMC physician offices.
PART I LINE 7 COSTING METHOLODY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I LINE 7 The costing methodology used to calculate the amounts reported in Part I Line 7 is a ratio of costs to charges method. The method employed for determining the ratio of cost to charges is in line with those described in Schedule H, Worksheet 2, "Ratio of Patient Costs to Charges".
PART I LINE 7 COLUMN (F)   The total expenses reported on Form 990 Part IX Line 25 Column A are inclusive of all entities reported within the UPMC Group 990 and includes bad debt expense for all entities. The expense used to calculate the percent of total expense for Form 990 Schedule H Part I Line 7 Column f are only the expenses related to entities within the UPMC Group who provide patient care. From these entities' total expense per Part IX Line 25 the amount related to bad debt expense has been removed from the denominator when calculating the percent of total expense. The amount of bad debt expense removed for calculation purposes is $188,513,013.
PART III LINE 4 COSTING METHODOLOGY USED TO DETERMINE THE AMTS REPORTED IN PT III LINE 2&3 The costing method used to calculate the amounts in Schedule H Part III lines 2 and 3 is a ratio of cost to charges method. Discounts and payments in patients' accounts are deducted before the cost of bad debt expense is determined. The method employed is in line with those described in Schedule H, Worksheet 2, "Ratio of Patient Costs to Charges".
PART III LINE 4 RATIONALE FOR INCLUDING BAD DEBT AMOUNTS IN COMMUNITY BENEFIT The organization's bad debt expense consists solely of self pay patients accounts deemed uncollectable. It is UPMC Group's contention that the cost of bad debt should be stated in Part I Line 7 of Schedule H as they represent the costs for provision of services to patients for which the entity has exhausted all recourse for reimbursement. The services provided to patients who present themselves are provided regardless of a patient's ability to pay as in line with the organization's charitable mission and service to our community. These expenses are incurred regardless of the efficiency of the provision of the related medical care and are deemed to have been medically necessary for the patient.
PART III LINE 4   METHOD THE ORGANIZATION USES TO DETERMINE THE ESTIMATED AMOUNT OF THE ORGANIZATIONS BAD DEBT EXPENSE AT COST ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS CHARITY CARE POLICY: UPMC determines an amount of bad debt that could be classified as charity care by utilizing a predictive model (paro). The model was built as a socio-economic scoring tool that identifies those patients that are most likely to be in the highest need of financial assistance. This is accomplished by analyzing public consumer data and activity such as public court records, public government records, public property files, census data and IRS data. This methodology includes/ensures: - Predictive model that encompasses healthcare economics and credit policies; - Uniform assessment measure for every patient regardless of financial standing; - Accounts for patients that are unresponsive, illiterate, or otherwise unable to apply for a veriety of reasons; - Eliminates barrier to application and meets increased pressure to provide additional financial resources to consumers; - Identifies and supports those community needs efforts to provide assistance to those consumers in need. A random sampling of patient accounts in bad debt are scored using paro in order to determine the percentage of patients that would qualify for financial assistance had the process been completed. There are two data points returned to UPMC in order to make the decision whether the patient would qualify for charity care. The first is the estimated income level based on the federal poverty level guidelines. The second is the paro score which utilizes an algorithm based approach and returns a score based of personal attributes of the patient. Data elements were combined to create two primary indicators of need, the paro score and the federal poverty level. The percentage score from the sampling is then used to determine the extrapolation of an amount of bad debt at cost that would likely fit the charity care criteria.
PART III LINE 8; COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS OF CARE AND AS REPORTED IN THE ORGS MEDICARE COST REPORT The costing methodology used to determine the Medicare allowable costs of care is a ratio of costs to charges method. The method is in line with those described in Schedule H, Worksheet 2, "Ratio of Patient Costs to Charges". It is UPMC Group's contention that all amounts calculated to be shortfalls in reimbursement for services provided to Medicare patients are truly uncompensated care that should be stated in Part I Line 7 of Schedule H of Form 990 as they represent costs for provision of services to patients for which the entity is unable to collect, regardless of the efficiency of provision of the related care costs.
PART VI SECTION B LINES 2,4 AND 5 NEEDS ASSESSMENT   UPMC SUPPORTS NUMEROUS COMMUNITY BUILDING ACTIVITIES THROUGH ALL OF ITS SYSTEM ENTITIES, NOT JUST THOSE ENTITIES REPORTED WITHIN THE UPMC GROUP 990. AS THE LARGEST EMPLOYER IN WESTERN PENNSYLVANIA AND THE SECOND LARGEST NON-GOVERNMENTAL EMPLOYER IN THE STATE, UPMC'S SYSTEM-WIDE OPERATIONS GENERATED A TOTAL ECONOMIC IMPACT OF MORE THAN $21.5 BILLION IN FISCAL 2012. UPMC ALSO SUPPORTS MUNICIPALITIES, COUNTIES AND THE STATE THROUGH APPROXIMATELY $84 MILLION IN TAXES. OVER THE PAST DECADE, UPMC HAS PROVIDED A WIDE VARIETY OF BENEFITS TO THE COMMUNITIES WE SERVE. WORKING IN WAYS BOTH LARGE AND SMALL, WE HAVE IMPLEMENTED INITIATIVES THAT CONTINUE TO ENHANCE THE HEALTH OF THE ENTIRE WESTERN PENNSYLVANIA REGION. AS AN INTEGRATED DELIVERY AND FINANCING SYSTEM (IDFS), WE CONTINUE TO AMPLIFY AND APPLY THE EXPERTISE THAT EXISTS WITHIN OUR ORGANIZATION TO IMPROVE THE DELIVERY OF OUTSTANDING HEALTH CARE TO EVERYONE WE SERVE. IN ADDITION, WE LEVERAGE OUR IDFS STRUCTURE- WHICH EMBRACES OUR HOSPITALS, OUR INSURANCE INFRASTRUCTURE, AND OUR COMMUNITY PROVIDERS- TO IMPROVE MEDICAL PRACTICE THROUGHOUT THE REGION. THE RESULT IS AN EXCEPTIONAL SYNERGY BETWEEN INSURANCE, HEALTH CARE PROVIDERS, PATIENTS, AND THE COMMUNITIES WESTERN PENNSYLVANIANS CALL HOME. MANY OF OUR COMMUNITY BENEFIT ACTIVITIES ARE DIFFICULT TO QUANTIFY OR REPORT WITHIN THE VARIOUS COMMUNITY BENEFIT CATEGORIES OF SCHEDULE H AS THEY OCCUR SYSTEM-WIDE THROUGH UPMC AND ARE NOT CAPTURED AT THE INDIVIDUAL HOSPITAL ENTITY LEVEL. NONETHELESS, THEY ARE IMPORTANT TO UPMC'S COMMITMENT TO THE COMMUNITY. SOME OF THESE INITIATIVES INCLUDED: " ECONOMIC DEVELOPMENT- UPMC'S ECONOMIC FOOTPRINT SPURS THE ECONOMY THROUGH DIRECT HIRING, AND BY BRINGING OUTSIDE DOLLARS INTO THE REGION; OUR CAPITAL SPENDING HAS CREATED CONSTRUCTION JOBS DOWNSTREAM. IN ADDITION, THE ORGANIZATION HAS A NUMBER OF PROGRAMS AND INITIATIVES DESIGNED TO FOSTER A PRODUCTIVE AND EQUITABLE ECONOMY. A KEY COMPONENT IN UPMC'S ECONOMIC DEVELOPMENT STRATEGY IS SUPPLIER DIVERSITY, AND AN INTEGRAL PART OF OUR OVERALL SUPPLY CHAIN MANAGEMENT STRATEGY. DESIGNED TO ENSURE THAT CERTIFIED MINORITY, WOMEN-OWNED, OR DISADVANTAGED BUSINESS ENTERPRISES ARE PROVIDED WITH MAXIMUM OPPORTUNITIES TO PARTICIPATE AS PARTNERS AND SUPPLIERS OF GOODS AND SERVICES, OUR SUPPLIER DIVERSITY PROGRAM ENCOURAGES DEVELOPMENT OF THESE FIRMS TO MAKE THEM COMPETITIVE IN THE OUTSIDE MARKET. UPMC'S SPEND ON SUPPORTING MINORITY AND WOMEN-OWNED BUSINESSES WAS $127 MILLION IN FISCAL 2012. " ENVIRONMENTAL IMPROVEMENTS- UPMC HAS LONG PURSUED A POLICY OF AWARD-WINNING ENVIRONMENTAL RESPONSIBILITY THAT REDUCES OUR ENVIRONMENTAL FOOTPRINT WHILE WE BUILD AND GROW. MANY OF UPMC'S FACILITIES HAVE EARNED LEADERSHIP IN ENERGY AND ENVIRONMENTAL DESIGN (LEED) CERTIFICATIONS FROM THE U.S. GREEN BUILDING COUNCIL, INCLUDING THE CHILDREN'S HOSPITAL OF PITTSBURGH OF UPMC'S HOSPITAL AND RESEARCH CENTER, THE UPMC PASSAVANT PATIENT PAVILION, AND UPMC'S CORPORATE HEADQUARTERS IN THE U.S. STEEL BUILDING IN DOWNTOWN PITTSBURGH. UPMC EAST, OUR NEW HOSPITAL IN MONROEVILLE, PA, OPENED IN JULY OF 2012 AND SHORTLY AFTER OPENING ACHIEVED SILVER LEED CERTIFICATION. IN ADDITION TO TRAFFIC-CONTROL IMPROVEMENTS MADE DURING CONSTRUCTION OF THE HOSPITAL, UPMC VOLUNTARILY BUILT A STORM-WATER CONTROL AND RETENTION SYSTEM THAT HAS THE POTENTIAL TO SIGNIFICANTLY REDUCE THE CHRONIC FLOODING THE AREA EXPERIENCED LONG BEFORE UPMC BROKE GROUND FOR THE NEW FACILITY. OTHER MAJOR "GREEN" CONSTRUCTION PROJECTS INCLUDED THE RECENT MOVE OF UPMC HEALTH PLAN TO THE U.S. STEEL TOWER. IN ADDITION, UPMC CONTINUED ITS WORK WITH GLOBAL LINKS TO RECYCLE MEDICAL AND OTHER EQUIPMENT, CO-SPONSORED THE 2012 SUSTAINABLE HEALTH CARE WORKSHOP SERIES THROUGH SUSTAINABLE PITTSBURGH AND COMMUNITY-BASED HOUSEHOLD HAZARDOUS WASTE COLLECTION EVENTS THROUGHOUT SOUTH WESTERN PA IN 2012, HELD FARMER'S MARKETS AT ALLEGHENY COUNTY HOSPITAL FACILITIES, AND AT LEAST TWO UPMC HOSPITAL FOOD SERVICE DEPARTMENTS DONATE THEIR EXCESS VOLUME OF PREPARED FOODS TO THE GREATER PITTSBURGH COMMUNITY FOOD BANK OR ANOTHER LOCAL NONPROFIT COMMUNITY FOOD PANTRY. " LEADERSHIP AND WORKFORCE DEVELOPMENT- IN FISCAL 2012, UPMC SUPPORTED NUMEROUS PROJECTS TO DEVELOP THE REGIONAL WORKFORCE AND ASSIST INDIVIDUALS IN OBTAINING AND RETAINING QUALITY EMPLOYMENT. UPMC HAS UNDERTAKEN INTERNAL PROGRAMS, SUCH AS THE PARTERSHIP ON WORKFORCE READINESS AND RETENTION AND UPMC HEALTH PLAN PATHWAYS TO WORK, TO HELP TRAIN INDIVIDUALS FROM POPULATIONS WITH SIGNIFICANT BARRIERS TO EMPLOYMENT TO GAIN AND KEEP JOBS IN THE HEALTH CARE SECTOR. OUR ONGOING SUPPORT FOR AND COLLABORATION WITH EXTERNAL PROGRAMS SUCH AS THE BIDWELL TRAINING CENTER, JOBLINKS, AND SCHOOL 2 CAREER HAVE TRAINED HUNDREDS OF INDIVIDUALS FOR SUCCESSFUL EMPLOYMENT IN THE HEALTH CARE INDUSTRY. OTHER PARTNERSHIPS IN FISCAL 2012 INCLUDED A VOCATIONAL PROGRAM THROUGH CHILDREN'S HOSPITAL OF PITTSBURGH OF UPMC CALLED HEALTH RANGERS, A PARTNERSHIP WITH ARSENAL MIDDLE SCHOOL TO SHOW STUDENTS THE PROFESSIONAL LIVES OF HEALTH CARE WORKERS AND WILD (WOMEN IN LEADERSHIP DEVELOPMENT) CONFERENCE, A PARTNERSHIP WITH GANNON UNIVERSITY'S SMALL BUSINESS CENTER THROUGH UPMC HAMOT. UPMC'S AWARD-WINNING DIGNITY AND RESPECT CAMPAIGN IS A MODEL FOR USE BY OTHER ENTITIES THROUGHOUT THE REGION AND NATIONALLY. IN ADDITION, THE CENTER FOR INCLUSION BEGAN ITS CULTURAL COMPETENCY LECTURE SERIES IN FISCAL 2012, WHICH PROVIDES OPPORTUNITIES TO LEARN ABOUT VARIOUS ASPECTS OF DIVERSITY AND DEVELOP TOOLS FOR WORKING IN A COMPLEX AND MULTICULTURAL HEALTH CARE SYSTEM. OUR MEDICAL EDUCATION PROGRAMS, UNDERTAKEN WITH THE UNIVERSITY OF PITTSBURGH, OFFER MANY LOCAL RESIDENTS A PATHWAY TO BETTER-PAYING JOBS. IN ADDITION, OUR IMPORTANT STRATEGIC RESEARCH AND EDUCATION RELATIONSHIP WITH THE UNIVERSITY FUEL A CULTURE OF DISCOVERY THAT CONTINUES TO HELP BUILD LOCAL EDUCATIONAL PROSPECTS WHILE IT DRAWS THE WORLD'S FINEST MINDS TO PITTSBURGH. A CENTERPIECE OF OUR WORKFORCE DEVELOPMENT PORTFOLIO, OUR $100-MILLION MATCHING GRANT TO THE PITTSBURGH PROMISE, ENTERED ITS SIXTH YEAR IN FISCAL 2012. THE PROGRAM WAS ABLE TO DOUBLE ITS FUNDING FOR POST-SECONDARY EDUCATION FOR QUALIFYING GRADUATES OF PITTSBURGH'S PUBLIC HIGH SCHOOLS, WITH THOSE STUDENTS DEMONSTRATING POST-SECONDARY EDUCATION RETENTION RATES EQUAL TO OR BETTER THAN NATIONAL AVERAGES. " COALITION BUILDING- WHILE UPMC HAS AN EXPANSIVE PROGRAM OF COMMUNITY SUPPORT, WE REALIZE THAT EVEN MORE CAN BE ACCOMPLISHED THROUGH ALLIANCES WITH OTHER NONPROFIT ORGANIZATIONS. OFTEN, THE STREET-LEVEL EXPERTISE OF LOCAL COMMUNITY GROUPS, PAIRED WITH UPMC'S FUNDING, INFLUENCE, PURCHASING POWER, AND OTHER RESOURCES, CAN REACH GOALS THAT NEITHER ORGANIZATION COULD ACHIEVE INDEPENDENTLY. TO LEVERAGE COMMUNITY IMPROVEMENT EFFORTS THROUGH JOINT EFFORTS, UPMC WORKED WITH A NUMBER OF NONPROFIT ALLIES IN FISCAL 2012. OUR ALLIANCES INCLUDED RELATIONSHIPS WITH THE BIRMINGHAM CLINIC, WHICH OFFERS CARE TO THE CITY'S HOMELESS POPULATION; THE ALLEGHENY COUNTY DEPARTMENT OF HEALTH AND ITS MANY INITIATIVES; THE GREATER PITTSBURGH COMMUNITY FOOD BANK; HEALTHY ARMSTRONG; THE WE CAN! PROGRAM TO FOSTER YOUTH HEALTH; SPONSORSHIP OF THE PITTSBURGH THREE RIVERS MARATHON; PROJECT SEARCH, A PARTNERSHIP WITH GOODWILL OF SOUTHWESTERN PENNSYLVANIA WHICH HELPS AREA HIGH SCHOOL STUDENTS WITH DISABILITIES OBTAIN COMPETITIVE EMPLOYMENT; AND THE INDEPENDENT FOUNDATIONS OF UPMC'S COMMUNITY HOSPITALS. THE FISCAL 2012 YEAR ALSO SAW THE CONTINUATION OF A MAJOR UNDERTAKING BY UPMC TO STRENGTHEN AND BROADEN ITS COMMUNITY INPUT AND PARTNERSHIPS THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. TO ENSURE THAT OUR COMMUNITY-FOCUSED EFFORTS ARE MOST EFFECTIVELY ADDRESSING THE NEEDS OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, WE ARE REACHING OUT TO COMMUNITY STAKEHOLDERS AND PUBLIC HEALTH EXPERTS TO GET THEIR VIEWS ON COMMUNITY HEALTH, AS WELL AS THEIR UNIQUE POINTS OF VIEW ON HOW WE COULD WORK TOGETHER MORE EFFECTIVELY. WE ARE ACTIVELY ENGAGING OUR HOSPITAL BOARDS, HAVE ASSEMBLED COMMUNITY ADVISORY GROUPS, AND OBTAINED INPUT DIRECTLY FROM THE COMMUNITIES WE SERVE. THE END RESULT WILL BE A STRATEGIC PLAN FOR EACH UPMC LICENSED HOSPITAL. IMPORTANTLY, THESE WILL ADDRESS LOCAL COMMUNITY NEEDS NOT ONLY AT THE HOSPITAL LEVEL, BUT ALSO THOSE UNDERTAKEN IN PARTNERSHIP WITH OTHER UPMC HOSPITALS, EXTERNAL ORGANIZATIONS, AND THE LARGER UPMC SYSTEM. FOR MORE DETAILED INFORMATION ON UPMC'S COMMUNITY BENEFITS EFFORT, SEE OUR FISCAL 2012 COMMUNITY BENEFITS REPORT, AVAILABLE AT HTTP://WWW "UPMC.COM/ABOUT UPMC/COMMUNITYCITIZENSHIP/PAGES/DEFAULT.ASPX."
PART VI LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE   It is the policy of UPMC to provide financial assistance for patients who: " Have limited or no health insurance " Have applied for but are deemed ineligible for governmental assistance (for example Medicare or Medicaid) " Demonstrate financial need " " Supply UPMC with pertinent information about household finances. Financial assistance applies to emergency care and to services that are considered medically necessary. Depending on the individual's need, either free care or reduced patient financial obligations may be offered and may extend to UPMC physician charges as well as UPMC hospital services. UPMC does not have the authority to waive any charges from physicians or other health professional who are not employed by UPMC. Each patient has the opportunity to apply for financial assistance at all times throughout his or her relationship with UPMC-prior to treatment, throughout treatment, and up to the resolution of his or her account. To request financial assistance, patients submit the UPMC Financial Assistance Application form, disclosing household income and expenses. For non-emergency services, financial counselors will also conduct an interview with the patient before the date of service or discharge. Applicants are treated with dignity and respect throughout the process. All information is handled with confidentiality. The patient's cooperation in providing UPMC with necessary information is crucial to the process. Financial assistance applications are available in the offices of physicians employed by UPMC and in area where patients are registered at UPMC hospitals. Signage about financial assistance is posted at these locations. A patient is not eligible for financial assistance until he or she has applied for and has been deemed ineligible for federal and commonwealth governmental assistance programs. As a result, UPMC may make resources available to assist patients in enrolling in and/or applying for such programs. UPMC reserves the right to process the financial assistance application without this determination provided an accurate assessment of the patient's financial status can be made with equivalent or sufficient income information. In determining a reasonable and fair level of assistance, UPMC applies a sliding scale. If a patient's income is below 400% of the federal poverty guidelines, the patient will receive some form of financial assistance. While UPMC's financial assistance program covers most services, there are some exclusions , such as but not limited to, cosmetic surgery, transplant and bariatric services, elective reproductive services, acupuncture, private duty nursing, dental, and services deemed non-covered by Medicare.
PART VI LINE 6   The UPMC Group entities are subordinates to and subsidiaries of UPMC, the parent entity of a large integrated healthcare delivery system. This system includes hospitals, physician practices, and all types of outpatient and ambulatory diagnostic services. UPMC's overall mission encompassing many of its exempt subsidiaries, is to promote healthcare, research and education for the benefit of all it serves and to provide the highest quality of patient care in a dignified environment without regard for a patient's ability to pay.
PART VI LINE 7 STATES RECEIVING COMMUNITY BENEFIT REPORT Pennsylvania
PART V SECTION C LINE 1   The University of Pittsburgh Physicians had 581 clinical locations as of June 30, 2012.
PART V SECTION C LINE 2   UPMC Community Medicine, Inc. had 199 clinical locations as of June 30, 2012.
PART V SECTION C LINE 3   UPMC Emergency Medicine, Inc. had 15 locations as of June 30, 2012.
PART V SECTION C LINE 4   University of Pittsburgh Physicians and Emergency Medicine, Inc. collectively operated 9 urgent care centers as of June 30, 2012.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
UPMC GROUP
 
Employer identification number
20-8295721
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) A GLIMMER OF HOPEPO BOX 908
n/a
Wexford,PA15090 		25-1627978 501(c)(3) 10,000       Breast Cancer Awareness
(2) ADVISORY BOARD ON AUTISM & REL Diseases35 WILSON ST
STE 100
Pittsburgh,PA15223 		25-1760214 501(c)(3) 11,200       Autism Support
(3) ALCOHOLISM AND SUBSTANCE ABUSE PROVIDERS1 COLUMBIA ST
4th Floor
Albany,NY12207 		14-1793172 501(c)(3) 10,800       Charitable Donation
(4) ALLEG CNTY WORLD WAR II MEMORIAL FUNDPO BOX 23143
n/a
Pittsburgh,PA15222 		25-1889574 501(c)(3) 50,000       War Memorial Building
(5) ALLEGHENY CONFERENCE ON COMMUNITY DEV11 STANWIX STREET
17th Floor
Pittsburgh,PA152221312 		25-0965213 501(c)(3) 275,000       Community Developmt
(6) ALLEGHENY COUNTY MEDICAL SOCIETY713 RIDGE AVE
n/a
Pittsburgh,PA15213 		25-0939212 501(c)(3) 8,820       Charitable Donation
(7) ALS ASSOCIATION OF WESTERN PA416 LINCOLN AVENUE
n/a
Pittsburgh,PA15209 		23-7123851 501(c)(3) 15,000       ALS Research
(8) ALZHEIMERS ASSOCIATION1100 LIBERTY AVE
Suite E201
Pittsburgh,PA15222 		25-1510692 501(c)(3) 5,100       Alzheimers Research
(9) AMERICAN CANCER SOCIETY320 BILMAR DR
n/a
Pittsburgh,PA15205 		25-1798733 501(c)(3) 14,800       Cancer Research
(10) AMERICAN DIABETES ASSOCIATION100 W Station Sq Dr STE 1900
Pgh,PA15219 		13-1623888 501(c)(3) 45,000       Diabetes Research
(11) AMERICAN HEART ASSOCIATION777 PENN AVE
Suite 200
Pittsburgh,PA15235 		13-5613797 501(c)(3) 487,750       Heart Disease Rsch
(12) AMERICAN LIVER FOUNDATION100 W Station Sq Dr STE 215
Pgh,PA15219 		36-2883000 501(c)(3) 62,500       Liver Disease Rsch
(13) AMERICAN LUNG ASSOCIATION11675 PERRY HIGHWAY
n/a
Wexford,PA15090 		13-1632524 501(c)(3) 10,000       Lung Disease Rsch
(14) AMERICAN RED CROSS2025 E STREET NW
n/a
Washington,DC200065009 		25-0965231 501(c)(3) 17,320       Charitable Donation
(15) ARTHRITIS FOUNDATION790 HOLIDAY DRIVE
n/a
Pittsburgh,PA15220 		25-0983073 501(c)(3) 15,000       Arthritis Research
(16) ATTACK THEATRE INC2425 LIBERTY AVE
n/a
Pittsburgh,PA15222 		20-1909284 501(c)(3) 10,000       Charitable Donation
(17) AUGUST WILSON CTR AFRICAN AMER CULTURE980 LIBERTY AVE
n/a
Pittsburgh,PA152223736 		25-1892177 501(c)(3) 7,000       Charitable Donation
(18) AUTISM SPEAKS8035 MCKNIGHT ROAD
suite 301
Pittsburgh,PA15237 		20-2329938 501(c)(3) 8,500       Autism Research
(19) BERINGERS PARTY RENTALS303 MCCOMBS RD
n/a
Venetia,PA15367 		84-1710958 n/a 5,348       Charitable Donation
(20) BIG BROTHERS BIG SISTERS OF GREATER PGH5989 PENN CIRCLE SOUTH
n/a
Pittsburgh,PA15206 		25-6074707 501(c)(3) 8,000       Charitable Donation
(21) BOROUGH OF GREENVILLE125 MAIN STREET
n/a
Greenville,PA16125 		25-6000376 Government 70,750       Charitable Donation
(22) CARNEGIE MUSEUMS OF PGH4400 FORBES AVE
n/a
Pittsburgh,PA15213 		25-0965280 501(c)(3) 22,500       Educational Donation
(23) CARNEGIE MELLON UNIVERSITY5000 FORBES AVENUE
n/a
Pittsburgh,PA15213 		25-0969449 501(c)(3) 12,500       Educational DONATION
(24) CATHOLIC CHARITITES OF DIOCESE OF PGh212 NINTH ST
n/a
Pittsburgh,PA15222 		25-1326213 501(c)(3) 30,000       Charitable Donation
(25) COMMUNITY COLLEGE OF PHILADELPHIA1700 SPRING GARDEN ST
Phil,PA19130 		23-2612698 501(c)(3) 68,000       Educational DONATION
(26) CENTER FOR HEARING AND DEAF SERVICES INC1945 FIFTH AVENUE
n/a
Pittsburgh,PA15219 		25-0974324 501(c)(3) 7,000       H&D Rehabilitation
(27) CHILDRENS HOSP OF PGH FOUNDATION4401 PENN AVE
n/a
Pittsburgh,PA15224 		25-1865744 501(c)(3) 92,477       Child Development
(28) CITY OF FARRELL500 ROEMER BLVD
n/a
Farrell,PA16121 		25-6000858 Government 71,000       Community Development
(29) CITY THEATRE1300 BINGHAM ST
n/a
Pittsburgh,PA15203 		25-1554580 501(c)(3) 25,000       Charitable Donation
(30) CIVIC LIGHT OPERA719 LIBERTY AVE
6th Floor
Pittsburgh,PA15222 		25-6000890 501(c)(3) 26,000       Community Developmt
(31) COUNCIL CULTURE & ARTS816 S ML KING BLVD
n/a
Tallahassee,FL32301 		59-2644263 501(c)(3) 100,000       Charitable Donation
(32) COMMUNITY COLLEGE OF ALLEGHENY COUNTY808 RIDGE AVE
n/a
Pittsburgh,PA15212 		25-1384469 501(c)(3) 54,500       Educational DONATION
(33) COMMUNITY FOUNDATION OF W PA AND E OHIO33 CHESTNUT
n/a
Sharon,PA16146 		25-1407396 501(c)(3) 7,200       Community Developmt
(34) COMMUNITY HUMAN SERVICES CORP374 LAWN ST
Pittsburgh,PA15213 		25-1219610 501(c)(3) 10,000       Charitable Donation
(35) CORO CENTER FOR CIVIC LEADERSHIP33 TERMINAL WAY
suite 429A
Pittsburgh,PA15219 		31-1703402 501(c)(3) 7,500       Charitable Donation
(36) COUNTY OF ALLEGHENYONE SMITHFIELD ST
n/a
Pittsburgh,PA15222 		25-6001017 Government 209,645       Charitable Donation
(37) CROHNS AND COLITIS FOUNDATION OF AMERICA580 S AIKEN AVE
suite 202
Pittsburgh,PA15232 		13-6193105 501(c)(3) 20,000       Charitable Donation
(38) CYSTIC FIBROSIS FOUNDATION6931 ARLINGTON ROAD
suite 200 Office of Grants and Con
Bethesda,MD20814 		25-1155227 501(c)(3) 6,750       Cystic Fibrosis RSCH
(39) DAPPER DAN CHARITIES34 Blvd OF THE ALLIES
n/a
Pittsburgh,PA15222 		23-7216540 501(c)(3) 31,500       Charitable Donation
(40) DELTA FOUNDATION OF PITTSBURGHPO BOX 100057
n/a
Pittsburgh,PA152330057 		23-2874576 501(c)(3) 22,000       Charitable Donation
(41) DEPAUL SCHOOL FOR HEARING AND SPEECH6202 ALDER ST
n/a
Pittsburgh,PA15206 		25-0965321 501(c)(3) 10,000       Charitable Donation
(42) Historical Soc of W PA1212 SMALLMAN ST
n/a
Pittsburgh,PA15222 		25-0965391 501(c)(3) 2,024,000       Community Developmt
(43) DOUBLE EAGLE PRESS LLCPO BOX 321
n/a
Maplewood,NJ07040 		68-0637537 n/a 10,000       Charitable Donation
(44) DUQUESNE UNIVERSITY600 FORBES AVE
637 College Hall
Pittsburgh,PA15282 		25-1035663 501(c)(3) 55,798       Educational Donation
(45) EAST END COOPERATIVE MINISTRY250 N HIGHLAND AVE
n/a
Pittsburgh,PA15206 		23-1722988 501(c)(3) 7,500       Charitable Donation
(46) EAST LIBERTY FAMILY health care6023 HARVARD ST
n/a
Pittsburgh,PA15206 		25-1417228 501(c)(3) 92,980       Charitable Donation
(47) EPILEPSY FOUNDATION WESTERN CENTRAL PA1501 REEDSDALE ST
n/a
Pittsburgh,PA15233 		23-7241930 501(c)(3) 35,652       Epilepsy Research
(48) ERIE REGIONAL CHAMBER GROWTH PARTNERSHIP208 EAST BAYFRONT PKWY
n/a
Erie,PA16507 		25-1231891 501(c)(3) 12,500       Community Developmt
(49) FAMILY GUIDANCE INC307 DUFF ROAD
n/a
Sewickley,PA15143 		25-1128116 501(c)(3) 11,000       Family Guidance
(50) FAMILY HOSPICE AND PALLIATIVE CARE50 MOFFETT STREET
n/a
Pittsburgh,PA152435243 		25-1529649 501(c)(3) 7,700       Charitable Donation
(51) FAMILY HOUSE INC242 MCKEE PLACE
n/a
Pittsburgh,PA15213 		25-1519959 501(c)(3) 174,342       Temporary Housing
(52) FAMILY RESOURCES141 S HIGHLAND AVE
n/a
Pittsburgh,PA15206 		25-0728060 501(c)(3) 16,000       Charitable Donation
(53) FAMILY SERVICES OF WPA3230 WILLIAM PITT WAY
n/a
Pittsburgh,PA15238 		25-0965341 501(c)(3) 7,000       Charitable Donation
(54) FARRELL AREA SCHOOL DISTRICT1600 ROEMER BLVD
n/a
Farrell,PA16121 		76-4325097 Government 58,833       Educational Donation
(55) FRANKLIN INTERIORS2740 SMALLMAN ST
n/a
Pittsburgh,PA15222 		25-1681259 n/a 14,431       Charitable Donation
(56) FRATERNAL ASSOC OF PROF PARAMEDICSPO BOX 8454
n/a
Pittsburgh,PA15220 		25-1368007 501(c)(3) 12,000       Emergency Medical
(57) GATEWAY MEDICAL SOCIETY1835 CENTRE AVENUE
n/a
Pittsburgh,PA15219 		02-0704699 501(c)(3) 10,000       Charitable Donation
(58) GIRL SCOUTS WESTERN PENNSYLVANIA30 ISABELLA ST
suite 107
Pittsburgh,PA15212 		25-1126094 501(c)(3) 11,025       Charitable Donation
(59) GREATER PGH COMMUNITY FOOD BANK1601 BRIGHTON Rd
n/a
Pittsburgh,PA15212 		25-1420599 501(c)(3) 13,450       Community Developmt
(60) GREENVILLE AREA SCHOOL DISTRICT9 DONATON RD
n/a
Greenville,PA16125 		25-6011926 Government 70,750       Educational Donation
(61) HAMOT HEALTH FOUNDATION300 STATE ST
n/a
Erie,PA16507 		25-1400999 501(c)(3) 20,000       Charitable Donation
(62) HILL HOUSE ASSOCiationHILL HOUSE CENTER
n/a
Pittsburgh,PA15219 		25-1146128 501(c)(3) 14,500       Community Development
(63) IMANI CHRISTIAN ACADEMY235 EASTGATE DR
n/a
Pittsburgh,PA15235 		25-1816131 501(c)(3) 6,350       Educational Donation
(64) JEFFREY F HARPER MEMORIAL FUND1 CHATHAM CTR
ste 300
Pittsburgh,PA15219 		45-5278258 501(c)(3) 10,000       Charitable Donation
(65) JEWISH FEDERATION OF GREATER PITTSBURGH233 MCKEE PLACE
n/a
Pittsburgh,PA15213 		25-1017602 501(c)(3) 25,000       Charitable Donation
(66) JOHNSTOWN SYMPHONY ORCHESTRA227 FRANKLIN ST
n/a
Johnstown,PA15901 		25-1100701 501(c)(3) 20,000       Charitable Donation
(67) JUNIOR ACHIEVEMENTONE ALLEGHENY CENTER
suite 210
Pittsburgh,PA15212 		25-0983059 501(c)(3) 6,540       Charitable Donation
(68) JUVENILE DIABETES RESEARCH FOUNDATION960 PENN AVE
suite 1000
Pittsburgh,PA15222 		23-1907729 501(c)(3) 30,850       Juvenile Diabetes Rsch
(69) LADIES HOSPITAL AID SOCIETY200 LOTHROP STREET
n/a
Pittsburgh,PA15213 		23-7257527 501(c)(3) 208,800       Charitable Donation
(70) LAWRENCEVILLE UNITED4825 BUTLER STREET
n/a
Pittsburgh,PA15201 		23-3070601 501(c)(3) 10,000       Charitable Donation
(71) LEUKEMIA AND LYMPHOMA SOCIETY333 E CARSON STREET
suite 441
Pittsburgh,PA15219 		13-5644916 501(c)(3) 31,500       Leukemia & Lymphoma Research
(72) LITTLE SISTERS OF THE POOR1028 BENTON AVE
n/a
Pittsburgh,PA15212 		25-0974310 501(c)(3) 6,250       Community Developmt
(73) LUMINARI INC219 RICHLAND LN
n/a
Pittsburgh,PA15208 		26-4196781 501(c)(3) 10,000       Community Developmt
(74) MAGEE WOMENS RESEARCH INSTITUTE AND FND3339 WARD STREET
n/a
Pittsburgh,PA15213 		25-1462311 501(c)(3) 52,500       Health System
(75) MAJEWSKI TRUST FUND204 EAST MAIN ST
n/a
Ligonier,PA15685 		99-9999999 N/A 25,940       Charitable Donation
(76) MARCH OF DIMESWEST PENN DIVISION
n/a
Pittsburgh,PA15205 		13-1846366 501(c)(3) 8,000       Charitable Donation
(77) MARIO LEMIEUX FOUNDATION816 FIFTH AVE
n/a
Pittsburgh,PA15219 		23-1708231 501(c)(3) 63,500       Charitable Donation
(78) MCKEESPORT HOSPITAL FND1500 FIFTH AVE
n/a
Mckeesport,PA15132 		25-1380418 501(c)(3) 15,550       Charitable Donation
(79) MEDICAL EQUIPMENT RECYCLING PROGRAM110 NORTH MAIN ST
n/a
Greenville,PA16125 		25-1501823 501(c)(3) 60,986       Recycling Program
(80) MENTAL HEALTH AMERICA ALLEGHENY CO100 SHERIDAN SQUARE
n/a
Pittsburgh,PA15206 		25-1070248 501(c)(3) 8,100       Mental Health Aware
(81) MENTAL HEALTH ASSOC OF SOUTHEASTERN PA1211 CHESTNUT ST
n/a
Philadelphia,PA19107 		23-1425035 501(c)(3) 6,500       Mental Health Aware
(82) MENTORING PARTNERSHIP OF SOUTHWESTERN PA1901-15 CENTRE AVE
n/a
Pittsburgh,PA15219 		23-2876447 501(c)(3) 7,500       Community Developmt
(83) MESSAGE CARRIERS OF PA INC5907 PENN AVE
suite 215
Pittsburgh,PA15206 		30-0539015 n/a 12,500       Charitable Donation
(84) MIGHTY PENGUINS SLED HOCKEY INC123 DUNEDIN DR
n/a
Cheswick,PA15024 		25-5095701 501(c)(3) 15,000       Charitable Donation
(85) MIRACLE LEAGUE OF WESTERN PA1142 OLD WLM PENN HWY
n/a
Greensburg,PA15601 		27-1981498 501(c)(3) 50,000       Charitable Donation
(86) MISERICORDIA UNIVERSITY301 LAKE ST
n/a
Dallas,PA18612 		24-0795406 501(c)(3) 10,000       Educational Donation
(87) MON YOUGH CHAMBER OF COMMERCE201 LYSE BLVD
n/a
Mckeesport,PA15132 		23-2917105 501(c)(3) 6,000       Charitable Donation
(88) MONROEVILLE AREA CHAMBER OF COMMERCE2790 MOSSIDE Blvd
n/a
Monroeville,PA15146 		25-1293687 501(c)(3) 10,900       Charitable Donation
(89) MUNICIPALITY OF MONROEVILLE2700 MONROEVILLE BLVD
n/a
Monroeville,PA15146 		25-6004094 Government 10,500       Community Developmt
(90) NAMIPO BOX 367
n/a
Delmont,PA15626 		25-1477291 501(c)(3) 60,980       Charitable Donation
(91) NATIONAL KIDNEY FOUNDATION700 FIFTH AVENUE
4th Floor
Pittsburgh,PA152193017 		13-1673104 501(c)(3) 21,750       Kidney Disease Rsch
(92) NATL ASSOC ADVANCEMENT OF COLORED PEOPLE588 VANCE AVE
n/a
Memphis,TN38126 		62-0637884 501(c)(3) 10,000       Charitable Donation
(93) NATL CAMPAIGN TO STOP VIOLENCE910 17TH ST
n/a
Washington,DC20006 		52-2004310 501(c)(3) 11,000       Community Developmt
(94) NATL OVARIAN CANCER COALITION6507 Wilkins Ave
n/a
Pittsburgh,PA152171305 		65-0628064 501(c)(3) 21,600       Ovarian Cancer Awareness
(95) NEGRO EDUCATIONAL EMERGENCY DRIVE643 LIBERTY AVE
n/a
Pittsburgh,PA15222 		25-6070821 501(c)(3) 16,100       Educational Donation
(96) NEW PITTSBURGH COURIERPO BOX 11346
n/a
Pittsburgh,PA15238 		25-1181398 N/A 22,150       Charitable Donation
(97) NY ASSOC OF PSYCHIATRIC REHAB SERVICES1 COLUMBIA PLACE
n/a
Albany,NY12207 		16-1218560 501(c)(3) 25,000       Charitable Donation
(98) OAKLAND BUSINESS IMPROVEMENT DISTRICT235 ATWOOD ST
n/a
Pittsburgh,PA15213 		25-6000879 501(c)(3) 141,000       Charitable Donation
(99) OPERA THEATER OF PGH INCPO BOX 11018
n/a
Pittsburgh,PA15232 		25-1342994 501(C)(3) 15,000       Charitable Donation
(100) PA COMMUNITY PROVIDERS ASSOCIATION2101 N FRONT STREET
n/a
Harrisburg,PA17112 		23-7291783 501(c)(3) 10,035       Charitable Donation
(101) PA MENTAL HEALTH CONSUMER ASSOCIATION4105 DERRY ST
n/a
Harrisburg,PA17111 		23-2484283 501(c)(3) 12,500       Mental Health Awareness
(102) PA NURSES ASSOCIATION2578 INTERSTATE DR
n/a
Harrisburg,PA17110 		23-0961200 501(c)(3) 25,000       Charitable Donation
(103) PASSAVANT HOSPITAL FOUNDATION9100 BABCOCK BOULEVARD
n/a
Pittsburgh,PA15237 		25-1407815 501(c)(3) 68,000       Charitable Donation
(104) PEER SUPPORT AND ADVOCACY NETWORK938 PENN AVE
n/a
Pittsburgh,PA15222 		75-3065438 501(c)(3) 6,680       Charitable Donation
(105) PENN STATE UNIVERSITY17 OLD MAIN
n/a
University Park,PA16802 		25-1500292 501(c)(3) 5,100       Educational Donation
(106) PENNSYLVANIA BREAST CANCER COALITION344 NORTH READING ROAD
n/a
Ephrata,PA17522 		25-1722323 501(c)(3) 10,000       Breast Cancer Awareness
(107) PENNSYLVANIA RESOURCE COUNCIL64 S 14TH STREET
n/a
Pittsburgh,PA15203 		23-6403971 501(c)(3) 10,000       Charitable Donation
(108) PERSAD CENTER INC5150 PENN AVE
n/a
Pittsburgh,PA15224 		25-1234680 501(c)(3) 25,000       Charitable Donation
(109) PG PUBLISHING COMPANY34 BLVD OF THE ALLIES
n/a
Pittsburgh,PA15222 		94-0692700   25,000       Charitable Donation
(110) PGH AREA JEWISH COMMITTEE4905 FIFTH AVE
n/a
Pittsburgh,PA15213 		26-1341608 501(c)(3) 25,000       Charitable Donation
(111) PGH BLACK NURSES IN ACTIONPO BOX 5554
n/a
Pittsburgh,PA15206 		25-1609325 501(c)(3) 5,050       Health Awareness
(112) PGH TISSUE ENGINEERING INITATIVE INC450 TECHNOLOGY DRIVE
suite 211
Pittsburgh,PA15219 		25-1789285 501(c)(3) 102,500       Charitable Donation
(113) PHILADELPHIA UNIVERSITY402 HENRY AVE
n/a
Pittsburgh,PA19144 		23-1352294 501(c)(3) 10,000       Educational Donation
(114) PHIPPS CONSERVATORY AND BOTANICAL GRDNSONE SCHENLEY PARK
n/a
Pittsburgh,PA152133830 		25-1492587 501(c)(3) 12,500       Charitable Donation
(115) The Primary Health NetworkPO BOX 716
n/a
Sharon,PA16146 		25-1381800 501(c)(3) 15,000       Charitable Donation
(116) PITTSBURGH AIDS TASK FORCE5913 PENN AVE
n/a
Pittsburgh,PA15206 		25-1537128 501(c)(3) 8,040       Charitable Donation
(117) PITTSBURGH BALLET THEATRE INC2900 LIBERTY AVE
n/a
Pittsburgh,PA152011500 		23-7101094 501(c)(3) 31,000       Charitable Donation
(118) PITTSBURGH BRANCH NAACP2203 WYLIE AVE
n/a
Pittsburgh,PA15219 		25-6086867 501(c)(3) 10,000       Charitable Donation
(119) PITTSBURGH CARES239 4th Ave Ste 1007
Pittsburgh,PA15222 		25-1702048 501(c)(3) 11,425       Charitable Donation
(120) PITTSBURGH FILMMAKERS477 MELWOOD AVE
n/a
Pittsburgh,PA15213 		25-1229210   10,000       Charitable Donation
(121) PITTSBURGH OPERA2425 LIBERTY AVE
n/a
Pittsburgh,PA15222 		25-1073139 501(c)(3) 48,500       Charitable Donation
(122) PITTSBURGH PARKS CONSERVANCY2000 TECHNOLOGY DR
n/a
Pittsburgh,PA15219 		23-2882145 501(c)(3) 7,000       Community Development
(123) PITTSBURGH PASSION INC528 SKYLINE DR
n/a
Belle Vernon,PA15012 		20-5047092   15,500       Charitable Donation
(124) PITTSBURGH PROMISE1901 CENTRE AVENUE
suite 204
Pittsburgh,PA15219 		26-1982661 501(c)(3) 5,030,857       Charitable Donation
(125) PITTSBURGH PUBLIC SCHOOLS515 N HIGHLAND AVENUE
n/a
Pittsburgh,PA15206 		25-1157808 Government 21,066       Educational Donation
(126) PITTSBURGH PUBLIC THEATER CORPOREILLY THEATER
n/a
Pittsburgh,PA15222 		23-7398683 501(c)(3) 50,000       Charitable Donation
(127) PITTSBURGH SYMPHONY600 PENN AVENUE
n/a
Pittsburgh,PA15222 		25-0986052 501(c)(3) 35,000       Charitable Donation
(128) PITTSBURGH TECHNOLOGY COUNCIL2000 TECHNOLOGY DR
n/a
Pittsburgh,PA15219 		25-1437854 501(c)(3) 47,800       Charitable Donation
(129) PITTSBURGH THREE RIVERS MARATHON310 GRANT ST
n/a
Pittsburgh,PA15219 		26-2524046 501(c)(3) 10,000       Charitable Donation
(130) PITTSBURGH WINE FESTIVAL LLCONE RIVERFRONT CENTER
n/a
Pittsburgh,PA15222 		20-3730209 n/a 50,000       Charitable Donation
(131) POISE FOUNDATION2228 Wylie Ave
Pittsburgh,PA15219 		25-1393426 501(c)(3) 13,500       Charitable Donation
(132) POWER7445 CHURCH ST
n/a
Pittsburgh,PA15218 		25-1643651 501(c)(3) 17,500       Charitable Donation
(133) PRESQUE ISLE PARTNERSHIP301 PENNINSULA DR
suite 2
Erie,PA16505 		25-1737521 501(c)(3) 15,000       Charitable Donation
(134) PRIMARY HEALTH NETWORK CHARITABLE FND123 E STATE ST
po box 716
Sharon,PA16146 		41-2188011 501(c)(3) 15,000       Charitable Donation
(135) PRINCE OF PEACE502 DARR AVE
po box 89
Farrell,PA16121 		25-1586148 501(c)(3) 7,130       Charitable Donation
(136) PROJECT LIFESAVER815 BATTLEFLD BLVD S
n/a
Chesapeake,VA23322 		26-0000127 501(c)(3) 7,500       Charitable Donation
(137) QUANTUM THEATRE218 N HIGHLAND AVE
n/a
Pittsburgh,PA15206 		25-1760895 501(c)(3) 10,000       Charitable Donation
(138) REGIONAL OPPORTUNITY CENTERPO BOX 1544
n/a
Pittsburgh,PA15230 		20-2939474 501(c)(3) 65,000       Charitable Donation
(139) RJW MEDIA5830 ELLSWORTH AVE
n/a
Pittsburgh,PA15232 		25-1848575 n/a 57,000       Charitable Donation
(140) RODEF SHALOM CONGREGATION4905 5TH AVE
n/a
Pittsburgh,PA15213 		25-0979371 n/a 9,000       Charitable Donation
(141) RONALD MCDONALD HOUSE CHARITIES PGH451 44TH ST
Penthouse F
Pittsburgh,PA15201 		25-1320272 501(c)(3) 10,000       Charitable Donation
(142) ROTARY CLUB OF MONROEVILLEPO BOX 368
n/a
Monroeville,PA15146 		25-6064401 501(c)(4) 11,550       Charitable Donation
(143) SAFE HARBOR BEHAVIORAL HEALTH1330 WEST 26TH ST
n/a
Erie,PA16508 		25-1317492 501(c)(3) 25,377       Charitable Donation
(144) SETON HILL UNIVERSITYSETON HILL DR
n/a
Greensburg,PA15601 		25-0965557 501(c)(3) 25,000       Educational
(145) SHADYSIDE CHAMBER OF COMMERCE5541 WALNUT ST
n/a
Pittsburgh,PA15232 		25-1373067 501(c)(3) 20,000       Charitable Donation
(146) SILK SCREEN ASIAN AMERICAN424 SOUTH 27TH ST
n/a
Pittsburgh,PA15203 		20-2602704 501(c)(3) 25,000       Charitable Donation
(147) SISTERS OF DIVINE PROVIDENCE399 BISHOPS HWY
n/a
Kingston,MA02364 		04-2212181 501(c)(3) 10,000       Charitable Donation
(148) SMALL SEEDS DEVELOPMENT INC204 N HIGHLAND AVE
n/a
Pittsburgh,PA15206 		25-1834826 501(c)(3) 6,500       Community Developmt
(149) SOUTHSIDE LOCAL DEV CORP2000 E CARSON ST
Pittsburgh,PA15203 		25-1419017 501(c)(3) 20,000       Community Developmt
(150) SPECIAL OLYMPICS PENNSYLVANIA124 WASHINGTON SQUARE
suite 300
Norristown,PA19403 		23-2078543 501(c)(3) 25,000       Special Olympics Donation
(151) SPROUT FUND5423 PENN AVE
n/a
Pittsburgh,PA15206 		20-4077513 501(c)(3) 5,500       Community Development
(152) ST MARGARET FOUNDATION815 FREEPORT ROAD
n/a
Pittsburgh,PA15215 		25-1520340 501(c)(3) 7,500       Charitable Donation
(153) SUSAN G KOMEN PITTSBURGH AFFILIATE1133 S BRADDOCK AVE
n/a
Pittsburgh,PA15218 		75-1835298 501(c)(3) 34,182       Cancer Awareness
(154) THE AMERICAN IRELAND FUND1133 PROSPECT ROAD
n/a
Pittsburgh,PA15227 		25-1306992 501(c)(3) 65,000       Charitable Donation
(155) THE FRIENDSHIP CIRCLE OF PITTSBURGH5872 NORTHUMBERLAND ST
n/a
Pittsburgh,PA15217 		20-8950616 501(c)(3) 6,800       Charitable Donation
(156) MIDWIFE CENTER FOR BIRTH & WOMENS hlth2825 PENN AVE
n/a
Pittsburgh,PA15222 		25-1864282 501(c)(3) 10,250       Charitable Donation
(157) MIRACLE LEAGUE OF SOUTHWESTERN PA310 DEEMERS DR
n/a
Cranberry Twp,PA16066 		26-1774863 501(c)(3) 28,500       Charitable Donation
(158) THE PITTSBURGH CULTURAL TRUST803 LIBERTY AVE
n/a
Pittsburgh,PA15222 		25-1469002 501(c)(3) 55,000       Charitable Donation
(159) PLUM BOROUGH CHAMBER OF COMMERCE4555 NEW TEXAS RD
n/a
Plum,PA15239 		27-1072734 501(c)(3) 6,000       Charitable Donation
(160) THE WOODMARK GROUP1424 NE 155TH ST
n/a
Seattle,WA98155 		91-2070217 501(c)(3) 25,000       Charitable Donation
(161) THREE RIVERS YOUTH6117 BROAD ST
n/a
Pittsburgh,PA15206 		25-1206924 501(c)(3) 10,000       Charitable Donation
(162) UNIONTOWN HOSPITALOFFICE OF MEDICAL STAFF
n/a
Uniontown,PA15401 		25-0965588 501(c)(3) 8,500       Charitable Donation
(163) UNITED WAY OF ALLEGHENY COUNTYP O BOX 735
500 west berkeley Street
Pittsburgh,PA152300735 		25-1043578 501(c)(3) 287,350       Charitable Donation
(164) UNIVERSITY OF PITTSBURGH4200 FIFTH AVENUE
n/a
Pittsburgh,PA15260 		25-0965591 501(c)(3) 10,064,371       Educational Donation
(165) UPTOWN PARTNERS OF PITTSBURGHPO BOX 53074
n/a
Pittsburgh,PA15219 		54-0560925 501(c)(3) 20,000       Charitable Donation
(166) URBAN LEAGUE OF PGH610 WOOD ST
n/a
Pittsburgh,PA152222222 		25-0965592 501(c)(3) 28,500       Charitable Donation
(167) VENANGO AREA RIDING FOR THE HANDICAPPED150 WAGNER DR
n/a
Franklin,PA16323 		25-1425799 501(c)(3) 7,550       Charitable Donation
(168) WESLEY SPECTRUM SERVICES221 PENN AVE
n/a
Pittsburgh,PA15221 		25-1686715 501(c)(3) 13,425       Charitable Donation
(169) WESTERN PA MINORITY SUPPLIER DEVELOPMENT424 SIXTH AVE
n/a
Pittsburgh,PA15219 		25-1236795 501(c)(3) 10,600       Charitable Donation
(170) WESTERN PENNSYLVANIA CONSERVANCY800 WATERFRONT DRIVE
n/a
Pittsburgh,PA15222 		25-1053485 501(c)(3) 20,000       Charitable Donation
(171) WOMEN BUSINESS LEADERS1227 25TH ST NW
n/a
Washington,DC20037 		51-0410145 501(c)(3) 13,000       Charitable Donation
(172) WOODLANDS FOUNDATION134 SHENOT ROAD
n/a
Wexford,PA15090 		25-1818538 501(c)(3) 8,000       Charitable Donation
(173) WORLD AFFAIRS COUNCIL OF PITTSBURGH2638 ONE MELLON CENTER
n/a
Pittsburgh,PA15219 		25-1064871 501(c)(3) 8,333       Community Development
(174) PA Interscholastive Ath Assoc615 IRON CITY DR
Pittsburgh,PA15205 		23-1382410 501(c)(3) 18,000       Charitable Donation
(175) Western Psych Inst & Clinic200 LOTHROP ST
Pittsburgh,PA15213 		25-0965480 501(c)(3) 26,732       Charitable Donation
(176) YMCA420 FT DUQUESNE BLVD
n/a
Pittsburgh,PA15222 		25-0969497 501(c)(3) 23,800       Community Developmt
(177) CHILDRENS MUSEUM OF PGH4401 PENN AVENUE
PITTSBURGH,PA15224 		25-1379704 501(C)(3) 6,000       COMMUNITY DEVELOPMT
(178) OAKLAND TRANSPORTATION MGMT ASSOCiation235 ATWOOD ST 3RD FL
Pittsburgh,PA15213 		25-1701562 501(c)(3) 7,500       Charitable Donation
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
166
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
12
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Part 1 Line 2   It is the policy of UPMC to contribute financial and in kind support to tax exempt organizations and agencies that support the upmc mission and strengthen the health and quality of life of those who live and work in the communities we serve. UPMC makes certain support payments to the University of Pittsburgh (EIN 25-0965591) under an affiliation agreement between the two organizations for the purpose of furthering their joint educational and research mission. The total of this support for the Fiscal Year ending June 30, 2012 exclusive of amounts reported above and inclusive of amounts paid by all UPMC entities is in excess of $158M.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) David Baer MD BDF (i)
(ii)		 204,460
0 		0
0 		1,373
0 		13,650
0 		17,132
0 		236,615
0 		0
0
(2) Beth Clark DO BDF (i)
(ii)		 138,725
0 		28,402
0 		222
0 		5,052
0 		6,110
0 		178,511
0 		0
0
(3) George Fleming MD BDF (i)
(ii)		 311,574
0 		0
0 		379
0 		17,150
0 		16,402
0 		345,505
0 		0
0
(4) Roger P Winn BDF (i)
(ii)		 197,024
0 		145,000
0 		32,598
0 		18,012
0 		18,265
0 		410,899
0 		27,838
0
(5) Candi Castleberry-Singleton BDK (i)
(ii)		 242,473
0 		145,000
0 		7,954
0 		35,481
0 		16,369
0 		447,277
0 		3,375
0
(6) Tamra Minnier BDK (i)
(ii)		 288,914
0 		220,000
0 		50,536
0 		53,299
0 		14,255
0 		627,004
0 		41,167
0
(7) Thomas Inglesby MD CBS (i)
(ii)		 329,875
0 		0
0 		0
0 		0
0 		84,511
0 		414,386
0 		0
0
(8) Douglas Garretson CEM (i)
(ii)		 201,118
0 		120,641
0 		2,125
0 		19,649
0 		14,925
0 		358,458
0 		136
0
(9) Donald Goodman CEM (i)
(ii)		 161,062
0 		64,571
0 		508
0 		16,503
0 		16,294
0 		258,938
0 		0
0
(10) Dan Swayze CEM (i)
(ii)		 132,399
0 		0
0 		376
0 		9,702
0 		17,623
0 		160,100
0 		0
0
(11) Christopher A Gessner CHP (i)
(ii)		 286,020
0 		250,000
0 		24,311
0 		51,010
0 		12,950
0 		624,291
0 		10,398
0
(12) Laurel Ragland CHP (i)
(ii)		 120,344
0 		50,000
0 		356
0 		9,089
0 		7,970
0 		187,759
0 		0
0
(13) James Gavin CCBH (i)
(ii)		 253,439
0 		195,000
0 		85,802
0 		47,460
0 		17,069
0 		598,770
0 		71,202
0
(14) James Giammarco CCBH (i)
(ii)		 145,931
0 		73,000
0 		720
0 		13,157
0 		9,106
0 		241,914
0 		0
0
(15) Claudia Roth PhD CCBH (i)
(ii)		 291,414
0 		230,000
0 		62,693
0 		50,922
0 		14,261
0 		649,290
0 		51,033
0
(16) Randall Kolb CFHC (i)
(ii)		 174,634
0 		11,694
0 		660
0 		15,149
0 		14,579
0 		216,716
0 		0
0
(17) Deborah Redmond CFHC (i)
(ii)		 170,321
0 		82,000
0 		1,548
0 		14,682
0 		15,689
0 		284,240
0 		0
0
(18) Robert Blosat CMI (i)
(ii)		 264,394
0 		210,415
0 		44,187
0 		46,499
0 		19,770
0 		585,265
0 		31,499
0
(19) Robert B Devlin Esq CMI (i)
(ii)		 173,871
0 		80,000
0 		2,210
0 		17,600
0 		16,908
0 		290,589
0 		0
0
(20) Francis Solano MD CMI (i)
(ii)		 437,026
0 		140,000
0 		5,549
0 		19,600
0 		17,799
0 		619,974
0 		0
0
(21) Deborah S Brodine CPS (i)
(ii)		 216,478
0 		200,000
0 		9,367
0 		39,008
0 		17,092
0 		481,945
0 		4,200
0
(22) Stephen Nimmo Esq CPS (i)
(ii)		 239,318
0 		182,000
0 		96,474
0 		47,093
0 		12,090
0 		576,975
0 		36,958
0
(23) Jerome Shaffer CPS (i)
(ii)		 180,679
0 		91,000
0 		1,200
0 		16,100
0 		15,822
0 		304,801
0 		0
0
(24) David A Nace MD CRAN (i)
(ii)		 109,992
0 		87,276
0 		43,672
0 		13,809
0 		950
0 		255,699
0 		0
0
(25) James Anthony Palmer CRAN (i)
(ii)		 0
163,870 		0
51,000 		0
505 		0
10,929 		0
16,037 		0
242,341 		0
0
(26) Brian Fritz EAST (i)
(ii)		 125,640
0 		10,000
0 		78
0 		7,266
0 		17,253
0 		160,237
0 		0
0
(27) Mark Sevco EAST (i)
(ii)		 244,272
0 		160,000
0 		14,920
0 		40,185
0 		12,728
0 		472,105
0 		7,005
0
(28) Michael Anderson EAST (i)
(ii)		 129,542
0 		37,000
0 		236
0 		9,215
0 		8,069
0 		184,062
0 		0
0
(29) Robert Voinchet EAST (i)
(ii)		 218,188
0 		160,000
0 		8,801
0 		36,882
0 		21,937
0 		445,808
0 		0
0
(30) Sean Logan EAST (i)
(ii)		 163,925
0 		40,000
0 		536
0 		7,350
0 		2,435
0 		214,246
0 		0
0
(31) Colleen Brennan EMI (i)
(ii)		 136,453
0 		62,434
0 		954
0 		10,345
0 		15,608
0 		225,794
0 		0
0
(32) Terrence Lewis Esq EMI (i)
(ii)		 133,155
0 		24,068
0 		263
0 		9,570
0 		8,444
0 		175,500
0 		0
0
(33) Robert J Maha MD EMI (i)
(ii)		 390,829
0 		180,000
0 		22,904
0 		45,296
0 		21,027
0 		660,056
0 		8,852
0
(34) Paul Mark Paris MD EMI (i)
(ii)		 158,116
0 		10,313
0 		3,816
0 		13,478
0 		1,579
0 		187,302
0 		0
0
(35) Philip M Cacchione EPN (i)
(ii)		 71,950
0 		75,000
0 		15,627
0 		9,224
0 		2,894
0 		174,695
0 		0
0
(36) Scott Lammie FOR (i)
(ii)		 0
400,027 		0
420,000 		0
43,322 		0
101,057 		0
15,606 		0
980,012 		0
16,500
(37) John Lovelace FOR (i)
(ii)		 0
243,231 		0
199,000 		0
24,101 		0
52,165 		0
11,748 		0
530,245 		0
7,071
(38) Stephen Perkins MD FOR (i)
(ii)		 0
269,756 		0
90,000 		0
32,330 		0
43,299 		0
9,844 		0
445,229 		0
0
(39) Daniel Vukmer Esq FOR (i)
(ii)		 0
246,201 		0
167,500 		0
6,550 		0
40,463 		0
18,263 		0
478,977 		0
2,573
(40) Roger A Oxendale HCD (i)
(ii)		 0
  		0
  		487,317
  		0
  		0
  		487,317
  		0
 
(41) Tulio Estrada MD HRZ (i)
(ii)		 538,510
0 		14,167
0 		5,702
0 		17,150
0 		18,373
0 		593,902
0 		0
0
(42) Donald Owrey HRZ (i)
(ii)		 214,220
0 		116,000
0 		3,658
0 		33,360
0 		17,017
0 		384,255
0 		1,428
0
(43) Roy J Sartori DO HRZ (i)
(ii)		 249,845
0 		24,030
0 		2,788
0 		16,316
0 		8,641
0 		301,620
0 		0
0
(44) David Shulik HRZ (i)
(ii)		 135,461
0 		38,323
0 		1,060
0 		12,586
0 		15,887
0 		203,317
0 		0
0
(45) Thomas Burich HRZF (i)
(ii)		 128,892
0 		9,837
0 		1,143
0 		13,988
0 		5,847
0 		159,707
0 		0
0
(46) Edward Marinzel IMIT (i)
(ii)		 177,703
0 		70,000
0 		2,590
0 		14,560
0 		22,038
0 		286,891
0 		0
0
(47) John Kuzmishin IHI (i)
(ii)		 296,960
0 		228,000
0 		18,259
0 		47,619
0 		5,906
0 		596,744
0 		8,441
0
(48) Leslie C Davis MAG (i)
(ii)		 379,763
0 		310,000
0 		35,361
0 		66,622
0 		18,402
0 		810,148
0 		15,900
0
(49) Joseph Kelley MAG (i)
(ii)		 418,976
0 		105,000
0 		62,828
0 		19,600
0 		3,740
0 		610,144
0 		0
0
(50) Eileen Simmons R 11111 MAG (i)
(ii)		 198,653
0 		110,000
0 		622
0 		17,130
0 		7,559
0 		333,964
0 		0
0
(51) Robert Thompson MD R 63012 MA (i)
(ii)		 219,963
0 		43,751
0 		51,979
0 		19,136
0 		1,650
0 		336,479
0 		0
0
(52) Cynthia Dorundo MCK (i)
(ii)		 240,797
0 		170,000
0 		10,992
0 		40,207
0 		17,037
0 		479,033
0 		4,980
0
(53) Madhusudana Nair MD R 63012MC (i)
(ii)		 242,764
0 		6,400
0 		3,374
0 		9,800
0 		13,893
0 		276,231
0 		0
0
(54) Sandy Rader MCK (i)
(ii)		 190,136
0 		96,000
0 		941
0 		14,640
0 		16,632
0 		318,349
0 		0
0
(55) Nicholas Barcellona MHP (i)
(ii)		 125,231
0 		36,000
0 		74
0 		9,946
0 		15,223
0 		186,474
0 		0
0
(56) William Cook MHP (i)
(ii)		 270,261
0 		235,000
0 		17,782
0 		44,008
0 		9,067
0 		576,118
0 		7,450
0
(57) Randall Boggess NWH (i)
(ii)		 374,128
0 		50,555
0 		7,650
0 		7,350
0 		12,247
0 		451,930
0 		0
0
(58) David Gibbons NWH (i)
(ii)		 244,692
0 		115,000
0 		9,641
0 		37,203
0 		7,375
0 		413,911
0 		4,200
0
(59) David McCandless MD NWH (i)
(ii)		 250,948
0 		0
0 		2,534
0 		11,300
0 		14,869
0 		279,651
0 		0
0
(60) Roger McCauley NWH (i)
(ii)		 157,372
0 		43,107
0 		2,138
0 		13,589
0 		11,351
0 		227,557
0 		0
0
(61) James McLaughlin DO R 123111 (i)
(ii)		 297,631
0 		0
0 		1,169
0 		14,300
0 		14,146
0 		327,246
0 		0
0
(62) William Shaffner Esq NWH (i)
(ii)		 169,719
0 		88,000
0 		19,791
0 		21,634
0 		16,851
0 		315,995
0 		0
0
(63) James W Boyle MD PAV (i)
(ii)		 319,349
0 		0
0 		1,114
0 		14,675
0 		18,362
0 		353,500
0 		0
0
(64) Eric Cartwright PAV (i)
(ii)		 252,880
0 		160,000
0 		47,196
0 		43,873
0 		18,751
0 		522,700
0 		36,913
0
(65) Ralph T DeStefano PAV (i)
(ii)		 120,268
0 		7,500
0 		1,879
0 		10,660
0 		16,156
0 		156,463
0 		0
0
(66) David Martin PAV (i)
(ii)		 428,422
0 		355,000
0 		168,194
0 		69,220
0 		19,474
0 		1,040,310
0 		145,769
0
(67) Daniel R Sullivan MD PAV (i)
(ii)		 289,997
0 		41,200
0 		60,045
0 		12,250
0 		1,991
0 		405,483
0 		0
0
(68) Dennis H Tomassetti PAV (i)
(ii)		 237,586
0 		68,000
0 		23,547
0 		25,435
0 		8,880
0 		363,448
0 		3,282
0
(69) Donna Jasko PPA (i)
(ii)		 149,975
0 		75,000
0 		1,073
0 		15,400
0 		13,848
0 		255,296
0 		0
0
(70) Paul Castillo R 11111 PUH (i)
(ii)		 212,766
0 		115,000
0 		4,919
0 		17,151
0 		15,598
0 		365,434
0 		1,748
0
(71) John Innocenti PUH (i)
(ii)		 427,971
0 		485,000
0 		260,303
0 		89,699
0 		31,349
0 		1,294,322
0 		234,974
0
(72) Edward T Karlovich PUH (i)
(ii)		 350,541
0 		515,000
0 		127,975
0 		81,899
0 		21,859
0 		1,097,274
0 		86,205
0
(73) John R Carroll SMH (i)
(ii)		 152,791
0 		37,000
0 		2,776
0 		27,571
0 		14,870
0 		235,008
0 		0
0
(74) Alexander J Ciocca Esq SMH (i)
(ii)		 188,247
0 		112,000
0 		2,704
0 		19,972
0 		16,667
0 		339,590
0 		256
0
(75) Edward J Donnelly III MD SMH (i)
(ii)		 245,392
0 		6,628
0 		2,707
0 		15,994
0 		9,067
0 		279,788
0 		0
0
(76) Kevin Garrett MD SMH (i)
(ii)		 274,814
0 		207,640
0 		1,557
0 		19,600
0 		17,823
0 		521,434
0 		0
0
(77) Thomas Newman SMH (i)
(ii)		 164,937
0 		81,000
0 		835
0 		14,630
0 		16,503
0 		277,905
0 		0
0
(78) Teresa Petrick SMH (i)
(ii)		 300,498
0 		225,000
0 		119,260
0 		58,696
0 		15,845
0 		719,299
0 		99,920
0
(79) Valerie C Trott SMH (i)
(ii)		 197,590
0 		105,000
0 		759
0 		15,644
0 		2,390
0 		321,383
0 		0
0
(80) V Thomas Worrall MD SMH (i)
(ii)		 143,004
0 		0
0 		1,524
0 		7,500
0 		13,326
0 		165,354
0 		0
0
(81) Rich Bondi E 8111 UPCICS (i)
(ii)		 132,302
0 		19,750
0 		241
0 		10,945
0 		15,783
0 		179,021
0 		0
0
(82) Stanley Marks MD UPCICS (i)
(ii)		 910,192
931,151 		0
0 		31,890
0 		91,908
74,492 		13,406
0 		1,047,396
1,005,643 		0
0
(83) James TerwilligerR 121511 UPC (i)
(ii)		 100,990
0 		0
0 		181,093
0 		3,269
0 		15,087
0 		300,439
0 		6,120
0
(84) Derek Angus MD UPP (i)
(ii)		 349,994
0 		121,000
0 		1,732
0 		19,600
0 		3,600
0 		495,926
0 		0
0
(85) K Ty Bae MD UPP (i)
(ii)		 344,829
0 		175,000
0 		19,542
0 		17,150
0 		3,722
0 		560,243
0 		0
0
(86) Timothy Robert Billiar MD UPP (i)
(ii)		 333,997
212,287 		302,811
0 		23,624
22,000 		19,600
0 		4,633
19,928 		684,665
254,215 		0
0
(87) Michael Boninger MD UPP (i)
(ii)		 49,656
0 		112,500
0 		17,126
0 		7,200
0 		2,481
0 		188,963
0 		0
0
(88) Robert P Edwards MD UPP (i)
(ii)		 288,327
0 		94,000
0 		1,957
0 		17,150
0 		2,424
0 		403,858
0 		0
0
(89) Louis D Falo Jr MD UPP (i)
(ii)		 195,963
0 		207,499
0 		18,876
0 		18,550
0 		2,323
0 		443,211
0 		0
0
(90) Robert M Friedlander MD UPP (i)
(ii)		 1,018,899
0 		83,333
0 		35,027
0 		14,702
0 		7,052
0 		1,159,013
0 		0
0
(91) Freddie H Fu MD UPP (i)
(ii)		 875,894
0 		366,290
0 		36,289
0 		19,600
0 		5,624
0 		1,303,697
0 		0
0
(92) Joel S Greenberger MD UPP (i)
(ii)		 233,496
0 		195,252
0 		32,646
0 		19,600
0 		2,583
0 		483,577
0 		0
0
(93) W Allen Hogge MD UPP (i)
(ii)		 329,194
0 		138,000
0 		24,326
0 		19,600
0 		3,663
0 		514,783
0 		0
0
(94) Jonas T Johnson MD UPP (i)
(ii)		 409,993
0 		249,750
0 		11,204
0 		19,600
0 		4,954
0 		695,501
0 		0
0
(95) Joon Sup Lee MD E 32912 UPP (i)
(ii)		 765,012
50,000 		125,345
0 		58,027
0 		17,150
0 		5,310
0 		970,844
50,000 		0
0
(96) David A Lewis MD UPP (i)
(ii)		 233,496
0 		169,500
0 		20,160
0 		19,600
0 		2,372
0 		445,128
0 		0
0
(97) Barry London MD R 32912 UPP (i)
(ii)		 258,411
0 		170,250
0 		18,939
0 		17,150
0 		2,970
0 		467,720
0 		0
0
(98) James D Luketich MD UPP (i)
(ii)		 1,725,816
0 		250,000
0 		12,156
0 		21,144
0 		5,733
0 		2,014,849
0 		0
0
(99) George K Michalopoulos MD UPP (i)
(ii)		 190,464
0 		186,750
0 		28,743
0 		19,903
0 		2,232
0 		428,092
0 		0
0
(100) Victor Morell MD E 32912 UPP (i)
(ii)		 1,537,935
0 		121,370
0 		58,710
0 		17,150
0 		7,681
0 		1,742,846
0 		0
0
(101) Kenneth C Nash MD UPP (i)
(ii)		 147,374
0 		109,513
0 		51,946
0 		16,357
0 		1,694
0 		326,884
0 		0
0
(102) Joel B Nelson MD UPP (i)
(ii)		 527,194
0 		252,000
0 		20,997
0 		18,606
0 		5,291
0 		824,088
0 		0
0
(103) Roberto Ortiz-Aguayo UPP (i)
(ii)		 58,870
0 		103,511
0 		49,363
0 		8,597
0 		2,990
0 		223,331
0 		0
0
(104) David Hirsch Perlmutter MD UPP (i)
(ii)		 331,455
0 		83,333
0 		21,531
0 		17,150
0 		6,173
0 		459,642
0 		0
0
(105) John J Reilly E 9111 UPP (i)
(ii)		 331,518
0 		0
0 		3,928
0 		17,150
0 		4,002
0 		356,598
0 		0
0
(106) Joshua T Rubin MD UPP (i)
(ii)		 126,898
0 		30,031
0 		56,717
0 		12,554
0 		949
0 		227,149
0 		0
0
(107) Joel S Schuman MD UPP (i)
(ii)		 331,982
0 		172,500
0 		23,165
0 		17,150
0 		5,250
0 		550,047
0 		0
0
(108) Jeannette South-Paul MD UPP (i)
(ii)		 70,797
0 		95,000
0 		19,016
0 		13,389
0 		1,602
0 		199,804
0 		0
0
(109) Ann Evans UPP (i)
(ii)		 289,395
0 		200,000
0 		16,138
0 		46,801
0 		9,599
0 		561,933
0 		7,650
0
(110) Michael A Turturro M UPP (i)
(ii)		 198,749
0 		96,530
0 		57,735
0 		19,600
0 		2,017
0 		374,631
0 		0
0
(111) Lawrence Wechsler MD UPP (i)
(ii)		 338,494
0 		91,500
0 		136,021
0 		19,600
0 		2,609
0 		588,224
0 		0
0
(112) John P Williams MD UPP (i)
(ii)		 257,028
0 		214,500
0 		25,585
0 		17,150
0 		3,693
0 		517,956
0 		0
0
(113) Donald Yealy MD UPP (i)
(ii)		 166,828
0 		90,600
0 		18,157
0 		21,060
0 		1,926
0 		298,571
0 		0
0
(114) Penny Milanovich VNA (i)
(ii)		 188,066
0 		28,000
0 		3,896
0 		17,359
0 		5,729
0 		243,050
0 		0
0
(115) Charles Bogosta UPMC (i)
(ii)		 433,603
0 		689,000
0 		318,652
0 		180,151
0 		20,466
0 		1,641,872
0 		297,059
0
(116) Robert J Cindrich UPMC (i)
(ii)		 576,467
0 		595,000
0 		177,701
0 		165,333
0 		21,090
0 		1,535,591
0 		136,448
0
(117) Elizabeth Concordia UPMC (i)
(ii)		 652,071
0 		1,475,000
0 		37,407
0 		324,922
0 		21,588
0 		2,510,988
0 		16,500
0
(118) Andrea Cotter UPMC (i)
(ii)		 273,362
0 		100,000
0 		202,622
0 		44,999
0 		7,811
0 		628,794
0 		0
0
(119) Sandra Danoff UPMC (i)
(ii)		 329,841
0 		475,033
0 		420,629
0 		71,363
0 		18,733
0 		1,315,599
0 		399,853
0
(120) Robert A DeMichiei UPMC (i)
(ii)		 443,661
0 		689,000
0 		35,928
0 		174,295
0 		20,457
0 		1,363,341
0 		16,500
0
(121) Daniel Drawbaugh UPMC (i)
(ii)		 495,406
0 		662,750
0 		864,444
0 		201,066
0 		13,074
0 		2,236,740
0 		842,401
0
(122) David Farner UPMC (i)
(ii)		 441,427
0 		770,250
0 		340,809
0 		205,545
0 		22,691
0 		1,780,722
0 		321,556
0
(123) C Talbot Heppenstall Jr UPMC (i)
(ii)		 346,337
0 		584,000
0 		39,732
0 		146,601
0 		17,096
0 		1,133,766
0 		16,500
0
(124) Diane Holder UPMC (i)
(ii)		 0
578,423 		0
1,012,500 		0
28,825 		0
277,033 		0
13,586 		0
1,910,367 		0
16,500
(125) Michele P Jegasothy Esq UPMC (i)
(ii)		 126,963
0 		64,000
0 		231
0 		11,480
0 		16,515
0 		219,189
0 		0
0
(126) Arthur S Levine MD UPMC (i)
(ii)		 0
743,544 		0
0 		0
69,781 		0
29,402 		0
4,021 		0
846,748 		0
0
(127) W Thomas McGough UPMC (i)
(ii)		 577,283
0 		325,000
0 		27,762
0 		98,649
0 		20,433
0 		1,049,127
0 		0
0
(128) Mark A Nordenberg UPMC (i)
(ii)		 0
556,588 		0
38,297 		0
29,157 		0
71,976 		0
68,279 		0
764,297 		0
0
(129) Gregory K Peaslee UPMC (i)
(ii)		 439,171
0 		636,500
0 		841,052
0 		179,250
0 		24,947
0 		2,120,920
0 		820,870
0
(130) Jeffrey A Romoff UPMC (i)
(ii)		 958,992
0 		2,933,000
0 		426,754
0 		1,728,427
0 		22,577
0 		6,069,750
0 		385,733
0
(131) Steven D Shapiro MD UPMC (i)
(ii)		 414,130
165,384 		375,000
0 		12,179
22,000 		154,307
0 		6,045
15,853 		961,661
203,237 		3,300
0
(132) Marshall Webster MD UPMC (i)
(ii)		 228,624
93,562 		689,000
0 		184,502
22,000 		157,786
0 		4,199
15,855 		1,264,111
131,417 		79,537
0
(133) David Bartlett MD (i)
(ii)		 684,992
0 		83,395
0 		4,200
0 		17,150
0 		5,183
0 		794,920
0 		0
0
(134) Marguerite Bonaventura MD (i)
(ii)		 264,961
0 		88,543
0 		62,240
0 		19,600
0 		2,212
0 		437,556
0 		0
0
(135) Deborah Holder MD (i)
(ii)		 112,878
0 		47,303
0 		42,108
0 		11,344
0 		2,921
0 		216,554
0 		0
0
(136) Susan Edgar-Hoolahan (i)
(ii)		 199,841
0 		100,000
0 		14,405
0 		18,977
0 		15,249
0 		348,472
0 		755
0
(137) Mohammad Idrees MD (i)
(ii)		 22,496
0 		0
0 		0
0 		0
0 		0
0 		22,496
0 		0
0
(138) Mary Korytkowski MD (i)
(ii)		 118,589
0 		36,952
0 		70,965
0 		12,444
0 		1,017
0 		239,967
0 		0
0
(139) Rita Patel MD (i)
(ii)		 234,997
0 		50,000
0 		3,032
0 		19,600
0 		1,861
0 		309,490
0 		0
0
(140) Adele Towers MD (i)
(ii)		 138,798
0 		44,511
0 		53,811
0 		14,761
0 		2,314
0 		254,195
0 		0
0
(141) Eric Weaverling MD (i)
(ii)		 206,927
0 		10,041
0 		1,618
0 		14,453
0 		14,767
0 		247,806
0 		0
0
(142) Joel Yuhas (i)
(ii)		 0
267,110 		0
195,000 		0
247,135 		0
44,765 		0
152,285 		0
906,295 		0
7,350
(143) Dennis Zerega (i)
(ii)		 181,637
0 		68,000
0 		4,467
0 		17,682
0 		15,194
0 		286,980
0 		0
0
(144) Rudolph Antoncic Jr MD (i)
(ii)		 247,103
0 		32,013
0 		5,441
0 		16,393
0 		14,024
0 		314,974
0 		0
0
(145) Jules Sumkin MD (i)
(ii)		 429,992
0 		94,156
0 		67,447
0 		19,600
0 		3,941
0 		615,136
0 		0
0
(146) Margaretha Casselbrandt MD (i)
(ii)		 283,339
0 		52,821
0 		30,072
0 		19,600
0 		4,457
0 		390,289
0 		0
0
(147) Anita Courcoulas MD (i)
(ii)		 524,824
0 		130,000
0 		3,175
0 		19,600
0 		4,797
0 		682,396
0 		0
0
(148) Michael Finikiotis MD (i)
(ii)		 226,926
0 		22,218
0 		813
0 		17,150
0 		15,555
0 		282,662
0 		0
0
(149) Evan Waxman MD (i)
(ii)		 193,753
0 		130,663
0 		46,814
0 		17,150
0 		3,137
0 		391,517
0 		0
0
(150) Susan Mammarella (i)
(ii)		 130,150
0 		48,000
0 		445
0 		11,551
0 		17,834
0 		207,980
0 		0
0
(151) Ghassan Bejjani MD (i)
(ii)		 1,238,228
0 		1,209,150
0 		1,746
0 		9,800
0 		24,020
0 		2,482,944
0 		0
0
(152) Richard Spiro MD (i)
(ii)		 973,469
0 		811,432
0 		48,048
0 		14,700
0 		7,176
0 		1,854,825
0 		0
0
(153) Mark Rodosky MD (i)
(ii)		 499,475
0 		1,243,516
0 		54,900
0 		17,150
0 		6,180
0 		1,821,221
0 		0
0
(154) Abhinav Humar MD (i)
(ii)		 943,737
0 		311,000
0 		80,734
0 		14,700
0 		5,630
0 		1,355,801
0 		0
0
(155) Adnan Abla MD (i)
(ii)		 893,823
0 		402,230
0 		20,523
0 		19,600
0 		22,922
0 		1,359,098
0 		0
0
(156) Christopher Samuel MD (i)
(ii)		 420,966
0 		0
0 		984
0 		16,681
0 		18,500
0 		457,131
0 		0
0
(157) Michael Culyba (i)
(ii)		 0
41,700 		0
100,000 		0
6,317 		0
11,121 		0
1,376 		0
160,514 		0
5,950
(158) David Kupfer MD (i)
(ii)		 126,935
0 		0
0 		9,766
0 		10,723
0 		1,651
0 		149,075
0 		0
0
(159) Kenneth Lee MD (i)
(ii)		 267,195
0 		155,536
0 		3,664
0 		19,600
0 		2,229
0 		448,224
0 		0
0
(160) Domingo Ottonello MD (i)
(ii)		 57,348
0 		0
0 		144
0 		5,200
0 		16,816
0 		79,508
0 		0
0
(161) Joel Weinberg MD (i)
(ii)		 415,998
0 		256,351
0 		8,494
0 		19,600
0 		21,835
0 		722,278
0 		0
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J Part 1 Question 1: UPMC may provide the following benefits to certain executives when they are necessary to achieve UPMC's charitable mission objectives: first-class or charter travel; tax indemnification or gross up payments; and/or business club dues or initiation fees. Provision of any such benefits is predicated on compliance with the organization's policies and is subject to review and approval processes. Question 4b: ALL PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ARE DISCLOSED IN SCHEDULE J WITH CORRESPONDING AMOUNTS DISCLOSED WITHIN THE TOTAL AMOUNT IN SCHEDULE J COLUMN C "DEFERRED COMPENSATION". Due to restrictions imposed by the Internal Revenue Code ("Code"), certain officers and key employees are limited in the amount of benefits which may be received under a tax qualified retirement program. Like many employers, UPMC supplements its retirement benefits through a supplemental retirement program. The supplemental retirement program is subject to multi year vesting which places the officers and key employees' retirement benefit at risk of forfeiture if the vesting requirements are not satisfied. Once vested however, provisions of the Code require that the vested amounts be reported on the Form 990 and the vested officer or key employee include in current income the value of her or his supplemental retirement benefit. Notwithstanding the tax requirement to recognize the vested amount of the supplemental retirement benefit as current income, this benefit, which has been earned over her or his entire career, has not and will not be distributed until the officer or key employee retires or separation from service from UPMC. The supplemental retirement program provides for the distribution of only the amount necessary to satisfy any income tax liability resulting from the vesting during active employment. Finally, it should be noted that in accordance with IRS instructions, a substantial portion of the amount reported on the Form 990 attributable to supplemental retirement program vesting has been reported in previously filed Forms 990. Question 7: UPMC provides incentive compensation as part of its total compensation program for officers and key employees. This component is based upon the accomplishment of predetermined performance goals and objectives which focus on the achievement of multiple annual and three year individual and group performance criteria in the context of appropriate risk taking. These criteria directly support UPMC's mission and include: patient quality and satisfaction, community benefits, operational and financial strength, leadership development, and strategic business initiatives among others.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
UPMC GROUP
 
Employer identification number
20-8295721
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Allegheny County Hospital Development Authority
  		25-1327925   05-03-2006 5,753,346 CEM 5/3/2006 Financing See Schedul   X   X   X
B Allegheny County Hospital Development Authority
  		25-1327925   12-22-2006 25,000,000 CEM 12/22/2006 Financing See Sched   X   X   X
C Allegheny County Hospital Development Authority
  		25-1327925   03-28-2007 9,826,081 CEM 3/28/2007 Financing See Schedu   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 1,729,430 5,237,432 1,964,954  
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . 5,753,346 25,000,000 9,826,081  
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 0  
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0  
7 Issuance costs from proceeds . . . . . . . . . . . 29,878 0 0  
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0  
9 Working capital expenditures from proceeds . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . 5,723,468 25,000,000 9,826,081  
11 Other spent proceeds . . . . . . . . . . . 0 0 0  
12 Other unspent proceeds . . . . . . . . . . . 0 0 0  
13 Year of substantial completion . . . . . . . . . . . 2006 2007 2007
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X   X   X    
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X    
16 Has the final allocation of proceeds been made? . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X    
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X    
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X   X    
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet   %   %   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . .   %   %   %   %
7 Does the bond issue meet the private security or payment test? . . . X   X   X      
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X    
2 Is the bond issue a variable rate issue?   X   X   X    
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X    
b Name of provider . . . . . . 0
  		0
  		0
  		 
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X   X    
6 Did the bond issue qualify for an exception to rebate? . X   X   X      
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X      
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Sch K, Part III Line 7 0 UPMC has been following management practices and procedures for several years, having evolved from systems and practices dating back to 2005. Therefore, UPMC believes it adopted management practices and procedures several years ago and answered Part III, Line 7 "yes". UPMC's System Policy Review Committee met on August 9, 2012 to unanimously approve its Tax-Exempt Bond Post-Issuance Compliance policy as written procedures were published on August 30, 2012. Since this occurred after June 30, 2012, Part V was answered "no".
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) See Schedule O          
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 2 3,356,540 Value at Donation
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles ..... X 40 10,135 Fair Market Value
19 Food inventory ... X 7 4,321 Fair Market Value
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( Baby Formula ) X 1 629,346 Fair Market Value
26 Other Right pointing arrow large image ( Gift Baskets ) X 37 6,305 Fair Market Value
27 Other Right pointing arrow large image ( Admission Tickets ) X 45 18,184 Fair Market Value
28 Other Right pointing arrow large image ( Accommodations ) X 18 5,989 Fair Market Value
Other Right pointing arrow large image ( Gift Certificates ) X 69 7,594 Fair Market Value
Other Right pointing arrow large image ( Football Events ) X 5 18,730 Fair Market Value
Other Right pointing arrow large image ( Advertising ) X 1 50,000 Fair Market Value
Other Right pointing arrow large image ( Rental Items ) X 4 2,806 Fair Market Value
Other Right pointing arrow large image ( Childrens Treat Bag ) X 6 13,937 Fair Market Value
Other Right pointing arrow large image ( Landscaping ) X 1 3,408 Fair Market Value
Other Right pointing arrow large image ( Miscellaneous ) X 17 4,559 Fair Market Value
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ............................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2011
Schedule M (Form 990) 2011
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
Additional Information Part 1, Line 9 Line 9, column b represents the number of contributions. Each contribution included numerous shares of different securities. Magee Womens Hospital of UPMC receives donations of infant formula that it in turn distributes to needy mothers of infants who could not otherwise afford the formula. For various fundraising events Steeler items, amusement park admission tickets and other such items are donated for use in the fundraising event.
Schedule M (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Identifier Return Reference Explanation
Part 1 Summary Line 8: Contributions and Grants PART I, LINE 8 CONTRIBUTIONS, GRANTS AND SIMILAR AMOUNTS RECEIVED: Pursuant to Treasury regulation Section 1.6033-2(D)(5) the sponsoring entity of UPMC Group, UPMC, has elected to report information about contributions, grants and similar amounts received; compensation and other information about officers, directors, trustees, and key employees; certain other highly paid employees; certain independent contractors on a consolidated basis along with all members of the UPMC Group in the UPMC Group return.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments UPMC GROUP - EIN 20-8295721 FORM 990 - FISCAL YEAR ENDED 06/30/2012 Part III - Statement of Program Service Accomplishments UPMC Group reflects the composite information and operations of thirty-five (35) tax exempt entities, including 12 hospitals, 9 physician service entities, 3 skilled nursing facilities, and 11 other ancillary service and support entities from within the UPMC (University of Pittsburgh Medical Center) integrated healthcare delivery system (IHDS). This delivery system is comprised of premier healthcare providers in the areas of acute inpatient hospitals, cancer treatment facilities, physician services, skilled nursing facilities and other ancillary healthcare support services a patient may need . During the fiscal year ended June 30, 2012, the entities within UPMC Group admitted 181,558 inpatients, recorded 1,080,103 inpatient days, 520,487 emergency room visits, 163,242 surgeries, and 590 transplants. They provided charity care and other uncompensated care, including Medicaid and Medicare shortfalls, at cost, of approximately $410,000,000. UPMC Group members provided services to the community through charitable donations, outreach programs, screenings, educational classes, and volunteer services at a cost of over $78,000,000. UPMC Group also provided funding for research and health professions education in excess of $249,000,000. UPMC Presbyterian Shadyside - EIN 25-0965480; 170(b)(1)(A)(iii); 509(a)(1) UPMC Presbyterian Shadyside (the Hospital) is the academic hub of UPMC's inpatient provider services, and is the region's largest inpatient acute care hospital. The mission of UPMC Presbyterian Shadyside is to provide premier programs in patient care, biomedical and health services research, and teaching that will contribute to the prevention, diagnosis, and treatment of human disease and disability, regardless of patients' ability to pay. The facilities that are a part of the UPMC Presbyterian Shadyside campuses are UPMC Presbyterian, UPMC Shadyside, Western Psychiatric Institute and Clinic (WPIC), UPMC Montefiore, Eye and Ear Institute, and the Hillman Cancer Center. The Hospital has leading programs in organ transplantation, oncology, cardiology and cardiothoracic surgery, critical care medicine and trauma services, neurosurgery, orthopedics, ophthalmology, and behavioral health, as well as other medical specialties. UPMC Presbyterian is a 792-bed teaching hospital that has been providing health care since 1893. UPMC Shadyside is a 520-bed tertiary hospital that has been serving the residents of Pittsburgh and the tri-state area since 1866 and is a Magnet designated hospital. Magnet status is one of the highest achievements a hospital can obtain in professional nursing, and demonstrates nursing excellence, a commitment to quality patient care, and a healthy work environment. Western Psychiatric Institute and Clinic is a 312-inpatient-bed facility that is a national leader in the treatment of mental health and addictive disorders. During the fiscal year ended June 30, 2012, the UPMC Presbyterian Shadyside facilities admitted 65,956 inpatients, recorded 480,273 inpatient days, 122,036 emergency room visits, 49,190 surgeries, 58 liver transplants, 103 kidney transplants, and 329 other transplants. UPMC Presbyterian Shadyside provided charity care and other uncompensated care, including Medicaid and Medicare shortfalls, at cost, of approximately $229,000,000. Over 65% of patients were covered by Medicare or state Medicaid health insurance. UPMC Presbyterian Shadyside is actively involved in sponsoring many programs for patients, children, teens, seniors, and the community as a whole. The Hospital provides the services to the community through charitable donations, outreach programs, referral centers, screenings, educational classes, and mentorships, which are targeted at patients, patients' families, and the community at large, at an estimated cost of $34,200,000. UPMC Presbyterian Shadyside funded research and health professions education at an estimated cost of $100,500,000. The Hospital reached the community through many educational presentations, video conferences, podcasts, health fairs at schools and neighborhood centers, free screenings, and support groups. For example, The Dignity and Respect for Youth program was presented in area schools to administrators, faculty, and students. Other programs that benefited patients were free/ parking during day of discharge and emergency room visits and use of the Blue Shuttle, which provides free transportation from Family House to the Hospital. Free parking was offered to participants in the Race for the Cure, Oakland Farmers Market, and for commencement exercises at area universities. The Hospital provided medications to patients being discharged who could not afford the cost of prescriptions. Assistance with guardianship services was provided to patients with financial difficulty, and housing assistance was provided to patients' families who experienced financial difficulty. Bus, wheelchair van, and ambulance transportation was provided for patients in need. Sports Medicine provided information to various groups on concussions, safe removal of athletic equipment of potential C-spine injured athletes, injury prevention, sports safety, nutrition, hydration, and it held a workshop for high school students interested in pursuing careers in sports medicine. Sports medicine education was provided to marathon runners at the Pittsburgh Marathon Expo, and medical coverage was provided on the day of the event. Athletic training injury evaluation and treatment was provided to participants in the Pittsburgh Figure Skating Sectional Championships and to members of the Pittsburgh Ballet Theater. Staff attended numerous health fairs in the area. Subjects covered included injury prevention, cancer prevention and early detection, nutrition, smoking cessation, and many other medical issues. Staff participated in Scouting for Food, the School Tools initiative, and the Karing for Kids Toy Drive which provides toys for children in foster care and homeless shelters. The Hospital held Pink Week to go with National Breast Cancer Month; all money raised was donated to the American Cancer Society.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) Children's Hospital of Pittsburgh of the UPMC Health System - EIN 25-0402510; 170(b)(1)(A)(iii); 501(a)(1) Renowned for its outstanding clinical services, research programs and medical education, Children's Hospital of Pittsburgh of UPMC (the Hospital) has helped to establish the standards of excellence in pediatric care. From ambulatory care to transplantation and cardiac care, talented and committed pediatric experts care for infants, children and adolescents who make more than 1,000,000 visits to Children's and its satellite locations each year. The primary mission of Children's Hospital of Pittsburgh is to serve as a community resource dedicated to improving the health and well-being of children of all ages, through excellence in patient care, teaching, and research, regardless of their ability to pay. Children's Hospital of Pittsburgh leads the way in advanced technology application for its use of electronic medical records and has been recognized by an independent health care research organization as the number one pediatric hospital in its use of health care information technology. During the fiscal year ended June 30, 2012, the Hospital admitted 13,804 inpatients, recorded 75,325 inpatient days, 77,031 emergency room visits, 100 transplants, and 21,670 surgeries. They provided charity care and other uncompensated care, including Medicaid shortfall, at cost, of over $26,400,000. The Hospital provided services to the community through charitable contributions, outreach programs, referral centers, screenings, educational classes and mentorships which are targeted at patients, patients' families and the community at large, at a cost of $6,000,000. The Hospital supported unfunded research and health professions education at an estimated cost of $34,600,000 during fiscal year 2012. One of the community programs offered by the Hospital is the Family Care Connection (FCC), whose goal is to improve the health of children and families in areas with high rates of child abuse, infant mortality, and poverty. The FCC offers a variety of family support programs enhancing relationships between parents and children, improving maternal and child health, addressing school readiness through child development activities, and assessing and educating to prevent child abuse and neglect. FCC staff provides home visits, on-site programming and consultation, referral and linkages to a vast number of community agencies, and child development, parenting education, and community-building activities. Children's Hospital of Pittsburgh's Ronald McDonald House Charities Mobile Health Care Unit, in partnership with other community resources, is focused on improving healthy outcomes, promoting well-being, and providing continuity of care for children who are medically underserved. Patients are seen five days per week. The Discovery Program is presented at preschools, day care centers, primary schools, and community organizations to prepare children for a visit to the emergency department or doctor's office. The children develop comfort with medical care through hands on activities. Babysitting 101 was offered to boys and girls ages 11 and up to learn about safety for themselves and the children in their care, including first aid basics, choking rescue techniques, and injury prevention. CPR and first aid classes were presented to children and adults in Boy Scouts, Girl Scouts, hospital sites, and schools. Middle school students were mentored through the Health Rangers program to introduce them to the workplace and jobs in a health care setting. The program encouraged them to stay in school, plan for further education, and taught positive social behaviors. Staff attended several health fairs in area communities, schools, and the Pittsburgh Zoo and PPG Aquarium. Information promoted pediatric and family health through educational games, demonstrations, and displays. The Hospital provided free orthodontic care to those who are uninsured or underinsured and would not have this care available to them. They also provided dental health care to children currently not receiving dental care and to women and families in a women's shelter. A camp was provided to a population with chronic illnesses. The camp enhances normalization, peer interaction, skill building, and provides a supportive environment for emotional development. Magee-Womens Hospital of UPMC - EIN 25-0965420; 170(b)(1)(A)(iii); 509(a)(1) Magee-Womens Hospital of UPMC (the Hospital/Magee) enhances the health care and well-being of women, infants, and their families. As a National Center of Excellence in Women's Health, Magee is consistently recognized for medical excellence and innovation, outstanding patient care, education, research, standards development, and advocacy. Magee is committed to providing superior care to area families, regardless of their ability to pay. Magee is a full-service acute care, research and teaching center for women, men, and newborns. The Hospital has expanded to include a range of services to both men and women: diagnostic imaging, including CT and MRI, a heart center, bariatric surgery, orthopaedics, digestive disorders, pulmonology, thoracic surgery, plastic surgery, vascular surgery, cancer, neurology, and urology. Recognized as a National Center of Excellence in Women's Health by the US Department of Health and Human Services, Magee serves as the teaching facility for obstetrics, gynecology, gynecologic oncology, and neonatology for the University of Pittsburgh (the University). Members of the medical staff hold academic appointments at the University and are actively involved in education and research, as well as patient care. Nearly 10,000 births occur at Magee each year. Magee is also the regional referral center for high-risk maternal care. The hospital's neonatal intensive care unit is the largest in Pennsylvania, treating more than 1,500 seriously or critically ill infants annually. During the fiscal year ended June 30, 2012, Magee admitted 20,892 patients, recorded 88,861 inpatient days, 22,602 emergency room visits, and 17,677 surgeries. It provided charity care and other uncompensated care, including Medicare shortfall, at cost, of approximately $23,000,000. Magee is actively involved in the community, serving infants, teens, women and men, and their families. During the fiscal year ended June 30, 2012, the Hospital provided charitable contributions and community service programs and similar funding of approximately $6,200,000. Magee provided funding for research and health professions education at a cost of $12,400,000. The Hospital offers prenatal yoga classes which help to provide the tools for managing the intense physical and emotional transitions of pregnancy. They also provide weekly prenatal emails to pregnant women and their family members. The emails include health information on the growing baby, current research findings on newborn health, and healthy behaviors for pregnant women, such as smoking cessation, breastfeeding, and postpartum depression awareness. Nurse educators respond to various health concerns of women in the community who call Magee and are directed to the Department of Education for phone consultation. These calls are often from the general public rather than patients. The Pregnancy Safety Information Line serves as a resource for women and health professionals who have questions regarding the use of medications or exposures to environmental agents during pregnancy or nursing. Most consultations are done over the phone and are free of charge. Breast cancer and ovarian cancer education series were held for cancer patients and their caregivers about treatment and management of cancer. The Hospital addressed child issues with the Children at Birth program which prepared them to be present during labor and delivery, and with the Sibling program which addressed separation issues during mom's hospital stay and incorporated a tour to the nursery. Conference center space was donated to various organizations to hold their meetings or educational programs. The Hospital also provided coordination of events, including arranging space, audiovisual support, dietary, and conference registration. The Hospital participated in numerous health fairs, provided screenings, offered free parking for patients, and gave health education presentations to women in a drug and alcohol abuse residential treatment center.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) UPMC Mercy - EIN 25-0965429; 170(b)(1)(A)(iii); 509(a)(1) UPMC Mercy (formerly The Mercy Hospital of Pittsburgh) was the first hospital in Pittsburgh and the first Mercy Hospital in the U.S. established in 1847 by the Sisters of Mercy. UPMC Mercy (the Hospital) offers a broad range of services, and provides compassionate care in the Catholic tradition. The social responsibility of Catholic health care is guided by five essential principles: to promote human dignity, to care for the poor, to contribute to the common good, to exercise responsible stewardship, and adherence to the moral teachings of the Church. UPMC Mercy is Pittsburgh's only Catholic hospital with specialized services, including the neurosciences, Level 1 trauma and burn services, women's health, orthopaedics, and physical medicine and rehabilitation. Care is provided to all in need, regardless of their ability to pay. The Hospital carries out its mission through its core values and with a commitment to being a transforming, healing presence within the communities it serves. During the fiscal year ended June 30, 2012, UPMC Mercy admitted 21,886 inpatients, recorded 129,930 inpatient days, 72,008 emergency room visits, 20,521 surgeries, and provided charity care and other uncompensated care, including Medicaid shortfall, at cost, of approximately $28,300,000. The Medicare and Medicaid programs covered 61% of the payor population at UPMC Mercy for the fiscal year ended June 30, 2012. UPMC Mercy provides services to the community through various outreach and other community services programs at a cost of $6,000,000 which is borne by the Hospital. Mercy provided funding for research and health professions education of almost $12,000,000. Staff from UPMC Mercy participated in various community health fairs. They provided educational information in areas of rehabilitation, stroke, diabetes, screenings, and counseling. Support groups for stroke, brain injury, cancer, diabetes, burn victims, cardiac patients, spinal cord injury victims, and amputees are offered. The Hospital also provided spiritual care and health care to the homeless. Programs for families included baby care basic training, infant and child CPR and first aid, preparing for childbirth, and a sibling program. The Hospital also made contributions to support several area programs and charities. UPMC Mercy provides job shadowing and mentoring experiences for nursing students and clinical training for phlebotomy students. UPMC St. Margaret - EIN 23-2875070; 170(b)(1)(A)(iii); 509(a)(1) UPMC St. Margaret (the Hospital) is a 249-bed acute-care and teaching hospital serving primarily the more than 250,000 residents of Pittsburgh's northern and eastern suburbs and is a Magnet designated hospital. Magnet status is the highest international recognition for nursing excellence and leadership. Founded in 1898, UPMC St. Margaret is home to one of the oldest and largest family practice residency programs in Pennsylvania. UPMC St. Margaret is committed to its mission of providing quality health care to all in need and has put in place policies to assure access to its services, regardless of ability to pay. During the fiscal year ended June 30, 2012, UPMC St. Margaret admitted 14,365 inpatients, recorded 72,266 inpatient days, 41,519 emergency room visits, and 16,515 surgeries. They provided charity care and other uncompensated care, including Medicaid and Medicare shortfalls, at cost, of approximately $14,000,000. The Medicare and Medicaid programs covered 57% of the payor population at UPMC St. Margaret for the fiscal year ended June 30, 2012. UPMC St. Margaret also provided services to the community through free or low-cost outreach programs targeted at patients, patients' families, and the community. All of these programs and support have assisted thousands of people in the community. UPMC St. Margaret also funds schools of health professions and medical residency programs as well as medical research. These all accounted for over $7,000,000 in fiscal year 2012 in order to operate these programs. The paramedic response team provides advanced life support to patients and assistance to local ambulance services. The unit is staffed with a staff paramedic who responds to assist when dispatched by county 911. Patients, family members and members of the community have access to the Health Sciences Library at the Hospital. The library provides health and disease-specific research, internet, email access, and recreational reading materials. The community, including students, patients, nurses, and physicians, routinely accesses the library's extensive collection of books and periodicals as a part of information gathering. Free medications are distributed through the family health center pharmacists and physicians to supply indigent patients with maintenance medications. Staff provided information on Chronic Obstructive Pulmonary Disease (COPD), support groups, smoking cessation materials, and pulse oximetry to participants in the National Senior Health and Fitness Day. Hospital dermatologists gave presentations on types of skin cancers, warning signs, prevention, and treatment options, and orthopaedic surgeons discussed treatments for hip preservation and breakthrough surgical techniques for foot and ankle arthritis. Kids Say Don't Smoke is presented to third grade school students to give them a strong tobacco avoidance message. A poster contest is held, and the initiative is supplemented with Tar Wars, an anti-smoking program presented to fifth grade elementary students. Staff provided information on healthcare careers to high school students and offered job shadowing experiences. The Hospital performs physical exams for children through the School Health Partnership. Information is provided to parents, teachers, and school nurses regarding health concerns. The Hospital offered free flu vaccines for the community, as well as free skin cancer and cardiovascular screenings. Staff represented the Hospital at the Diabetes Expo and provided materials on weight control, diabetes, and a healthy diet. The Hospital also held the 24th Annual Fitness Classic 5K Run/Walk with proceeds benefiting the Bed Fund. This helps Hospital patients who are uninsured or underinsured with transportation, medication, medical supplies, and nutritional education. Staff attended a National Night Out event and provided healthy living information and heart disease risk factor materials.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) UPMC Passavant - EIN 25-0965451; 170(b)(1)(A)(iii); 509(a)(1) Founded in 1849, UPMC Passavant (the Hospital) is a provider of quality health care services to patients in the areas of acute care, emergency, inpatient, outpatient, and community outreach. It provides these services to patients in the northern metropolitan region of Pittsburgh and Allegheny County and southern Butler County, regardless of their ability to pay. As UPMC's tertiary care center north of Pittsburgh, this state-of-the-art hospital offers UPMC's brand of world-class medical care at two campuses to serve communities north of the city. Through Passavant, high-quality care and all of the resources of an academic medical center are now available closer to residents north of Pittsburgh. With strong specialty programs in heart care, cancer care, orthopaedics, and spine surgery at the McCandless campus; a Comprehensive Breast Center and state-of-the-art Imaging Center at the Cranberry campus; a truly patient-and-family-centered atmosphere; and expansion projects under way at both hospital campuses, UPMC Passavant is demonstrating its commitment to excellence in patient care. During the fiscal year ended June 30, 2012, UPMC Passavant admitted 18,070 inpatients, recorded 96,608 inpatient days, 59,323 emergency room visits, and performed 17,861 surgeries. They provided charity care and other uncompensated care, including Medicaid and Medicare shortfalls, at cost, of over $24,000,000. The Medicare and Medicaid programs covered 53% of the payor population at UPMC Passavant for the fiscal year ended June 30, 2012. UPMC Passavant provided many community outreach and support programs in fiscal year 2012 that included health fairs, health screenings, educational/counseling programs, immunizations, support groups, and other programs that benefited the general population of the community. These services helped thousands of community members understand and manage a wide array of health care issues and conditions. The value of these programs and other funding to the community was approximately $6,300,000. The community benefited from many health fairs in which the Hospital participated. Information was offered on diabetes, cardiac care, cancer, safety, and stroke. Screenings for diabetes, blood pressure, and pulmonary function testing were available. Free skin cancer screenings were performed and attendees were given educational materials regarding prevention of skin cancer and self-skin monitoring. Free flu vaccinations were provided to anyone over 65 years of age. The EnCare program, a part of the healthy lifestyle center of the Hospital, provided information to area high school students regarding the dangers of drinking and driving and injury prevention. High school seniors with developmental disabilities benefited from Project SEARCH, a business-driven job training program. The Hospital offered conference room space to area groups, including Breast Cancer Support Group, Living with Cancer Support Group, Lupus Support Group, and Stop Smoking Program Support Group. UPMC Horizon - EIN 25-0523970; 170(b)(1)(A)(iii); 509(a)(1) Founded in 1906, UPMC Horizon (the Hospital) strives to be the premier health care delivery system in Mercer County. Its mission is to provide exemplary health care services. UPMC Horizon provides patient-centered, quality health care in a cost-effective manner, subscribing to the values of excellence, compassion, and the respect for human dignity, regardless of a patient's ability to pay. UPMC Horizon, with campuses in Greenville and Shenango Valley, offers programs of clinical expertise in primary care medicine, cardiology, oncology services, digestive disorders, bariatric surgery, women's health, radiology/imaging services, and pain management. During the fiscal year June 30, 2012, UPMC Horizon admitted 7,310 inpatients, recorded 35,044 inpatient days, had 36,908 emergency room visits, and performed 7,293 surgeries. They provided charity care and other uncompensated care, including Medicaid and Medicare shortfalls, at cost, in excess of $11,500,000. Over 62% of the patients of UPMC Horizon were comprised of Medicare and Medicaid enrollees. The communities served by UPMC Horizon are located in an economically distressed and medically underserved area. During the fiscal year ended June 30, 2012, UPMC Horizon provided community service programs and funding, including funding for education and research, of approximately $5,100,000. Many groups within the community benefited from UPMC Horizon's diabetes initiative. Blood sugar screenings and educational presentations were given to diabetes support groups to raise public awareness of the disease. The Hospital participated in numerous health fairs. Topics covered included cancer, primary care, and women's health. Other initiatives that benefited the community were diabetes screenings, heel (bone density) screenings, and nutritional counseling. Staff participated in the Views and Voices Women's Expo and distributed information on women's health, breastfeeding, and services offered by the Hospital. Lamaze classes and refresher classes were offered to expectant parents, and baby care basics classes were offered to new parents to learn basic skills including care and feeding, as well as insight into infant behavior with an emphasis on safety and health promotion. The class also includes a tour of the Birth Place and a car seat safety check. Safe driving classes were provided to senior citizens. UPMC Horizon provided meeting space to area support groups: Bereavement, Cancer, Mercer County Diabetes, Weight Loss, Mercer County Breast Cancer, Ostomy, Pulmonary Hypertension, and Parents of Murdered Children. The Hospital donated Automated External Defibrillators (AED's) to area schools and businesses in Mercer County. Basic life support and first aid was taught to members of the community.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) UPMC Northwest - EIN 25-0489010; 170(b)(1)(A)(iii); 509(a)(1) UPMC Northwest (the Hospital), established in 1899, serves the residents of the Franklin and Oil City areas and surrounding communities. UPMC Northwest is a state-of-the-art medical facility providing acute inpatient, outpatient, behavioral health, rehabilitation, skilled nursing, and support and education services. The Hospital provides services to all persons, regardless of ability to pay. Greater than 65% of patients were Medicare or state Medicaid patients. During the fiscal year ended June 30, 2012, UPMC Northwest admitted 7,217 patients, recorded 36,200 inpatient days, had 31,534 emergency room visits, and performed 5,419 surgeries. They provided charity care and other uncompensated care, including Medicaid shortfalls, at cost, in excess of $6,000,000. The Hospital provided funding and services to the community in the aggregate of $3,700,000 through community outreach programs targeted at patients, their families, and the community. Families benefited from the Prepared Childbirth Classes, which readied participants for their childbirth experience. The Hospital offered infant care classes which provided information to parents on how to care for newborns, and sibling classes which prepared children to become big brothers or big sisters. Especially for Women provided information and screenings for women's health, and health fairs and educational programs provided blood pressure screenings, smoking cessation information, nutrition information, stroke screenings, stroke education, carotid artery evaluations, osteoporosis screenings, body composition, prostate screenings, and diabetes education. Staff processed approximately 750 results from health fair screenings. Staff provided educational material on various health issues at the local 4-H Fair, and attended Thunder on the River, a local motorcycle event to provide education on motorcycle safety as well as what to do if involved in a crash. The Hospital provided complementary room space to several organizations. Some of these organizations included Safe Kids Coalition, Venango Forest Cancer Coalition, Lupus Support Group, Kiwanis Club, Medical Coders, Seniors for Safe Driving, and the Diabetic Flu Shot Clinic. Children benefited from several health fairs that focused on their health and well-being. They were educated on nutrition and making healthy food choices using My Plate as a guide. Staff collected school items to donate to local children in need. The Behavioral Health Patient Transportation Program benefited patients who were unable to afford or find transportation back to their homes. Cancer survivors and their family members were celebrated at the Annual Survivor's Night Picnic and commemorative ceremony. Blood drives held throughout the year benefited the entire community. The Better Breathing Clinic was an initiative to improve the care of COPD patients. This clinic enhanced self-management skills of those with COPD and provided education for families/friends supporting those with the disease. UPMC McKeesport - EIN 25-0965423; 170(b)(1)(A)(iii); 509(a)(1) Founded in 1894, UPMC McKeesport (the Hospital) is a nonprofit acute care community hospital that primarily serves the residents of McKeesport and the surrounding area. UPMC McKeesport is a teaching hospital, with residency programs in both family practice and internal medicine. UPMC McKeesport provides a wide range of quality health care services, regardless of race, creed, sex, national origin, handicap, age, or ability to pay. It is located in a geographical area of economic distress, and much of the surrounding community is recognized as underserved with a population that is elderly and economically disadvantaged. To serve this population, the Hospital is an approved site for the Program of All-inclusive Care for the Elderly (PACE). As a PACE site, UPMC McKeesport offers an innovative program of seamless health care to older patients. The Hospital's mission is to serve the community with respect to providing health care services and health care education to all persons. Therefore, in keeping with the Hospital's commitment to serve all members of its community, the following were provided regardless of an individual's ability to pay: free care and/or subsidized care, care provided to persons covered by governmental programs at below cost, and health activities and programs to support the community. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. This population represented 76% of UPMC McKeesport's patient population base for fiscal year 2012. During the fiscal year ended June 30, 2012, UPMC McKeesport, in medical, surgical, behavioral health, rehabilitation, and transitional care, admitted 10,163 inpatients, recorded 60,722 inpatient days, 41,347 emergency room visits, and 4,266 surgeries. The Hospital provided charity care and other uncompensated care, including Medicaid shortfall, at cost, in excess of $8,500,000. The Hospital provides services to the community through outreach programs, referral centers, screenings, educational classes, and funding of schools of health professions, which are targeted at patients, patients' families, and the community at an estimated cost of $7,800,000. The community benefited from the Hospital's annual Harvest of Health Fair, which provided health testing, screenings (blood pressure, carotid occlusion, bone density, visual acuity, diabetes, etc.), breast and prostate exams, and information and health education including smoking cessation, heart health, stroke prevention, exercise, and nutrition. Also benefiting the community were the Adult Smoking Cessation Classes. These classes offered education and pharmacotherapy instruction, and nicotine patches, gum, and lozenges were provided at no cost to participants. The Hospital provided free parking for clients, community programming, and non-employee initiatives as well as valet parking to aide patients with ease of access. The Hospital has a leadership role in The McKeesport Healthier Communities PartnerSHIP and Mon River Fleet Community Partnership. These organizations are members of the PA State Health Improvement PartnerSHIPS and are actively involved in improvements for residents of the Mon River Valley and fringe areas. The Mon River Fleet Community Partnership provided free influenza immunizations at 157 sites. Over 8,400 vaccines were distributed through the Hospital. Staff participated in blood drives for an area blood bank. Case management services and behavioral counseling was provided for a women's halfway house. The Hospital sponsors a summer camp which serves approximately 100 children. Administrative services, laundry services, and equipment and supplies storage were all provided by the Hospital. The Hospital offered space to various organizations at reduced rates. Organizations that benefited from this rent reduction were the YMCA, McKeesport Hospital Foundation, the McKeesport Symphony, and Bradford Day Care. Used equipment was donated by the Hospital to the Rainbow Kitchen, which is a source of aid to those in need. Senior citizens participated in the UPMC McKeesport Golden Key Club, which provided speakers for health education lectures on related community issues. The Hospital also provided geriatric van support for the McKeesport community.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) UPMC Bedford - EIN 23-1396795; 170(b)(1)(A)(iii); 509(a)(1) UPMC Bedford (the Hospital) is an acute care general hospital, located in Everett, Pennsylvania, with units for medical, surgical, obstetrical, intensive care, coronary care, and telemetry services. It offers a variety of diagnostic capabilities, including CT scan, MRI, and lithotripsy. The Hospital operates a cardiac-pulmonary rehabilitation program, an outpatient procedure unit, and an ambulatory surgical unit. The emergency facilities include 24-hour in-house coverage, a licensed heliport for emergency transport, and trauma center affiliation. The Hospital is committed to providing services to all members of the community, regardless of their ability to pay. In fiscal year 2012, 43% of the total patients served were covered by Medicare and 15% had state Medicaid coverage. During the fiscal year ended June 30, 2012, UPMC Bedford admitted 1,895 inpatients, recorded 4,874 inpatient days, had 16,179 emergency room visits, and performed 2,830 surgeries. They provided charity care and other uncompensated care, including Medicaid shortfall, at cost, of approximately $2,400,000. The Hospital also provided services to the community whose aggregate value was over $2,100,000 through outreach programs targeted at patients, patients' families, and the community. Families benefited from the Prepared Childbirth Classes which discussed the basics of labor and delivery. Children participated in Sibling Classes where they learned how to hold a baby and change a diaper. Car seat check clinics were available for members of the community. Area elementary students benefited from the School Tools Drive in which the Hospital employees "adopted" children who needed supplies but could not afford them, purchased book bags, and filled the bags with school supplies appropriate to the age of the child. UPMC Bedford contributes space for several area groups. They include the TOPPS Bedford, Multiple Sclerosis Support Group, and Overeaters Anonymous. Staff attended several area health fairs, and the community benefited from numerous screenings sponsored by the Hospital. The Hospital participated in the Good Turn Food Drive to assist area Scouts in collecting non-perishable food items and had monthly collections for the Bedford County Food Bank. UPMC East - EIN 27-4814831; 170(b)(1)(A)(iii); 509(a)(1) Opening in the summer of 2012, UPMC East will be a full-service community hospital to provide patient-centered care. Located in Monroeville, PA, UPMC East will serve patients using advanced technologies and is being built using environmentally efficient construction practices. All activities at UPMC East will be undertaken to reflect the four core values of "Your Care. Our Commitment," an initiative that represents our mission to embrace: quality and safety, dignity and respect, care and compassion, and community service.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) University of Pittsburgh Cancer Institute Cancer Services - EIN 25-1899326; 170(b)(1)(A)(iii); 509(a)(1) University of Pittsburgh Cancer Institute Cancer Services (Cancer Centers) provides the highest level of oncology services to patients throughout the tri-state region. Working in tandem with the University of Pittsburgh Cancer Institute (UPCI), which comprises the academic and research activities for oncology at the University of Pittsburgh and UPMC, UPMC Cancer Centers offers patients the latest advances in cancer prevention, detection, diagnosis, and treatment. The mission of UPMC Cancer Centers reflects the overall mission of UPCI as a premier National Cancer Institute-designated Comprehensive Cancer Center to provide the highest level of clinical care to the 30,000 patients treated at its facilities each year while performing cutting-edge cancer research. At UPMC Cancer Centers, more than 2,300 physicians, scientists, administrative staff, and other health care professionals work together to reduce the burden of cancer. They represent a variety of specialties including surgical oncology, medical oncology, radiation oncology, otolaryngology, neuro-oncology, gynecologic oncology, palliative care, and behavioral medicine. Combined, these disciplines give the Cancer Centers a range of knowledge which covers virtually all types of adult cancer. The medical professionals at UPMC Cancer Centers encompass 13 areas of expertise, each focusing on a specific type or treatment of cancer. These include a world-renowned Melanoma Program, as well as programs devoted to brain cancers, breast cancer, colon and gastrointestinal cancers, head and neck cancers, leukemias and lymphomas, liver cancer, lung cancer, gynecologic cancers, prostate and urologic cancers, and stem cell transplantation. Pediatric cancers are treated by specialists at the Children's Hospital of Pittsburgh of UPMC. UPMC Cancer Centers is committed to providing quality care regardless of a patient's ability to pay. This is evidenced by the fact that in the fiscal year ended June 30, 2012, UPMC Cancer Centers provided charity care and other uncompensated care, at cost, of $1,300,000. UPMC Cancer Centers is one of the largest integrated community networks of cancer physicians and health care specialists in the country, and has now expanded internationally. The domestic network covers a geographic area of more than 200 miles around greater Pittsburgh, comprised of 180 affiliated oncologists at more than 35 locations throughout western Pennsylvania. These network locations were selected to make it possible for any patient in the region to access a UPMC Cancer Centers location within 20 minutes. These network locations are closely tied to the Hillman Cancer Center through personnel and technology linkages. Similarly, the overseas locations in Dublin and Waterford, Ireland, allow patients access to the expertise and technology available at the Hillman Cancer Center. In addition to the many services offered by UPMC Cancer Centers, there is also significant involvement in the community. During fiscal year 2012, UPMC Cancer Centers funded over $9,800,000 to operate community benefit programs and to fund research. The Healthy Choices for Students Program and Summer Program offers students the knowledge of various topics about cancer prevention, with an emphasis in the areas of tobacco use, proper nutrition, skin care related to sun exposure, and environmental factors. The program includes lectures, along with opportunities for the students to participate in hands-on activities. The yearly Celebration of Life luncheon brought together African American survivors of cancer, many of whom participate in the Hillman Cancer Center support group. The community benefited from prostate, breast, and cervical cancer screenings, education, and support groups; healthy lifestyles, skin cancer, and cancer risk reduction and early detection education; and health fairs. Hillman Cancer Center (the Center) is the flagship treatment and research facility of the UPMC Cancer Centers network. Home to the state-of-the-art clinical services of UPMC Cancer Centers and the nationally and internationally recognized research of the University of Pittsburgh Cancer Institute, Hillman Cancer Center provides specialized diagnosis, treatment, prevention, and care for patients and their families. Hillman Cancer Center is home to internationally regarded surgical, medical, and radiation oncology specialists, who perform treatment procedures unavailable elsewhere in the region. The Center also has the region's most advanced imaging technologies to detect cancer and monitor treatment. Hillman Cancer Center is home to a component of the National Institutes of Health-funded General Clinical Research Center, which provides support for the conducting of clinical trials. Beyond clinical care, Hillman Cancer Center also has a full range of services to help patients better cope with cancer. Patients and their families have access to a wide array of educational, counseling, nutritional and genetic resources. Blood drives were held at the Hillman Cancer Center throughout the year.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) University of Pittsburgh Physicians - EIN 23-2919472; 170(b)(1)(A)(iii); 509(a)(1) The University of Pittsburgh Physicians (UPP) is a multi-specialty faculty/physician practice plan whose mission is to support the clinical and academic missions of UPMC, including all of its exempt 501(c)(3) hospitals, and support health care services subsidiaries and the University of Pittsburgh School of Medicine (School of Medicine), and to provide highly accessible, high-quality patient care through a wide array of physician/medical specialties at UPMC and its affiliated hospitals and health care entities. UPP includes 2,288 academic physicians and allied health care providers. The physicians' specialties include: anesthesiology, critical care medicine, cardiovascular services, urology, physical medicine and rehabilitation, emergency medicine, family medicine, pathology, psychiatry, radiology, radiation oncology, internal medicine, orthopaedics, neurology, neurosurgery, pediatrics, obstetrics and gynecology, surgery, dermatology, ophthalmology, otolaryngology, and heart, lung and esophageal surgery, as well as sub specialties within each of these broad categories. All UPP physicians are also members of the faculty of the University of Pittsburgh's School of Medicine. As faculty, they educate medical students and doctors in training. In addition to clinical patient care and resident education, many UPP physicians are involved in cutting-edge medical research. One of the primary exempt purposes and missions of UPP is to provide quality and accessible medical care to the public, without regard for a patient's ability to pay. This commitment is evidenced by the fact that UPP provided charity care and other uncompensated care, at cost, of over $24,000,000 in the fiscal year ended June 30, 2012. UPP serves to enhance the quality health care services of all of the tertiary and advanced care entities, as well as academic subsidiaries and affiliates of UPMC. As part of this mission, UPP also serves the community by providing free services and programs. Throughout the year UPP offered lipid, blood pressure, glucose, and BMI screenings. UPP provided educational information on bariatric surgery, nutrition, cancer, and stroke. The homeless, working poor, transiently housed, and uninsured are provided health care services at no charge through the Program for Health Care to Underserved Populations. The volunteer-staffed basic care clinics offer services that include general primary care, acute care, chronic disease management, specialty care, and behavioral health services, as well as free pharmaceuticals/pharmaceutical assistance programs and health education. The clinics are staffed by volunteer physicians and pharmacists. The Guerrilla Eye Service is staffed by students, residents, and faculty who provide comprehensive eye care to area residents who would otherwise go without. In total, the community service programs provided by UPP, including funding of medical education and its extensive funding of research, combine to provide over $69,000,000 of health care related services to the community in the fiscal year ended June 30, 2012. UPMC Community Medicine, Inc. - EIN 25-1727721; 170(b)(1)(A)(iii); 509(a)(1) It is the mission of UPMC Community Medicine, Inc. (CMI) to provide high-quality and accessible patient care through primary care physicians and other physician/medical specialties at UPMC and its affiliated hospitals and health care entities. The creation of CMI as a multi-specialty physician/practice plan has made obtaining medical care easier, more efficient, and more effective for patients. The resources of the vast array of medical physicians and specialists are easily and readily accessible to virtually all patients within CMI's service areas which include western Pennsylvania and the tri-state area. The physicians' specialties available within CMI include: family medicine, internal medicine, geriatrics, orthopaedics, neurosurgery, pediatrics, obstetrics/gynecology, surgery, ophthalmology, neurology, rheumatology, endocrinology, and pulmonology. As of June 30, 2012, CMI employed approximately 339 doctors in 117 practices and at 199 facilities. One of the primary exempt missions of CMI is to provide accessible, quality medical care to the public, without regard for a patient's ability to pay. This commitment is evidenced by the fact that CMI provided charity care or other uncompensated care and community services, at cost, of over $2,200,000 in the fiscal year ended June 30, 2012. CMI also serves to enhance the quality health care services of the hospitals and other healthcare subsidiaries and affiliates of UPMC. Greater than 42% of CMI's patients are covered by either Medicare and/or state Medical Assistance health insurance programs. As a part of its mission, CMI physicians and staff provide services to the community through various programs which are targeted to patients, patient families, and the community at large in an effort to educate and promote good health. On a routine basis and in conjunction with other UPMC entities and community resources, CMI physicians/practices/staff participate in various screening programs for medical conditions such as: osteoporosis, high blood pressure, diabetes, coronary heart failure, bariatric surgery, etc. Many CMI physicians and staff also participate in ongoing patient/family/community/physician educational programs related to the previously mentioned medical conditions and a variety of other timely medical topics which are designed to improve the quality of patient care and patient outcomes. CMI provides physician/medical services throughout Western Pennsylvania and the tri-state area in both urban and rural areas, including many underserved areas. Some of these areas would have no other physician presence otherwise.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) UPMC Horizon Community Health Foundation - EIN 25-1501823; 509(a)(3) UPMC Horizon Foundation (the Foundation) provides a volunteer network of community members to increase philanthropic support for UPMC Horizon (the Hospital). The Foundation raises and distributes money in support of programs and services that contribute to good health and improved quality of life for residents in the UPMC Horizon service area. The Foundation gave over $100,000 to provide general financial support to the activities and operations of various community organizations/projects in fiscal year 2012. UPMC McKeesport Physicians, Inc. - EIN 75-2994341; 170(b)(1)(A)(iii); 509(a)(1) UPMC McKeesport Physicians, Inc. in furtherance of their exempt purpose delivers or arranges for the delivery of health care services at UPMC McKeesport or at other tax-exempt hospitals affiliated with UPMC. The corporation also assists in the advancement and improvement of the provision of physicians services and other health care services. Passavant Professional Associates, Inc. - EIN 25-1755608; 509(a)(2) Passavant Professional Associates, Inc. provides diagnostic cardiac support services for UPMC Passavant patients and related parties. Community Family Health Centers, Inc. - EIN 25-1790210; 170(b)(1)(A)(iii); 509(a)(1) Community Family Health Centers, Inc. (CFHC) is organized and operated exclusively for charitable, scientific, and educational purposes. CFHC has three primary activities: 1) to assist in developing and maintaining a neighborhood health center and to provide healthcare services to patients and their families in the underserved surrounding communities, regardless of their ability to pay; 2) to train and educate family practice physicians and residents of medical programs who serve in the surrounding community; and 3) to provide additional programs/services to educate and benefit the surrounding communities. CFHC currently operates a neighborhood health center to serve many diverse sectors of the Pittsburgh community, regardless of their ability to pay. Services provided at the health center include care for the entire family, such as sick and well-child visits, women's health care, total adult health care, and care for older adults. CFHC also offers family planning and pregnancy care, including delivery; care for emotional, marital, and social problems; sports medicine and treatment of minor injuries, including fractures; treatment of minor skin problems; house calls in the area if needed; laboratory services; radiology services. For the fiscal year ending June 30, 2012, the neighborhood clinic received 31,754 visits and provided all services regardless of patients' ability to pay. Health Center Development - EIN 25-1412496; 509(a)(3) Health Center Development provides facilities for its tax-exempt affiliate, UPMC Presbyterian Shadyside, in furtherance of UPMC Presbyterian Shadyside's exempt mission. UPMC Emergency Medicine, Inc. - EIN 25-1787601; 509(a)(2) UPMC Emergency Medicine, Inc. (EM) provides emergency medical care and services to individuals in need of immediate medical treatment, regardless of their ability to pay, providing EM physician services and operating emergency departments of tax-exempt community hospitals that cannot adequately staff their emergency departments. As an emergency medical care provider, EM advances better coordination of patient care and efficiencies by providing each hospital's emergency department with a consistent core team of EM physicians and a medical director. In addition, EM enhances the transition of care from pre-hospital providers, such as emergency medical technicians (EMTs) to each hospital's emergency department by collaborating through its core team of EM physicians with ambulance services and EMTs serving the respective hospital. During the fiscal year ending June 30, 2012, hospital emergency rooms staffed by EM physicians and staff received 477,812 visits, and Urgent Care Centers had 65,959 visits. EM provided charity care and other uncompensated care, at cost, of over $5,100,000 in the fiscal year ended June 30, 2012.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) UPMC Occupational Medicine, Inc. - EIN 25-1525060; 509(a)(2) As part of UPMC's integrated delivery system of health care services, UPMC Occupational Medicine, Inc. offers physician services. Its mission is to work with the various organizations and corporations within the community to supply pre-employment physicals and drug testing. In addition, exams are given for Workers' Compensation claims. The physician determines the course of action that might be needed so that the employee can return to work as soon as possible. After a plan of action is determined, the UPMC McKeesport Worknet group assists with setting up appointments for physical therapy and occupational therapy. Follow up visits are also scheduled, as well as appointments to determine the level of work an employee can do upon their return to work. Sugarcreek Station - EIN 25-1472178; 170(b)(1)(A)(iii); 509(a)(1) Sugarcreek Station is a licensed, Medicare/Medicaid certified skilled nursing facility that provides skilled and intermediate long-term care services to residents 24 hours/day. The facility had an average daily census of 132.7, providing 48,576 days of care. The facility had a high Medicaid occupancy (71.1%) and accepted Medicaid reimbursement as total payment. During the fiscal year ended June 30, 2012, Sugarcreek Station provided uncompensated care of over $1,000,000. UPMC Visiting Nurses Association - EIN 25-1222033; 509(a)(2) UPMC Visiting Nurses Association (VNA) is ranked by The National Association of Home care Providers as the largest Pennsylvania home health provider and No. 14 nationally. The organization provides complete home health nursing services, including behavioral health, IV therapy, medical-surgical, obstetrics, pediatrics, and rehabilitation regardless of a patient's ability to pay. During the fiscal year ended June 30, 2012, VNA conducted 464,851 home visits, recorded 8,198 days of hospice care, 6,160 hospice visits, 152 hospice patients, and 49,021 private duty hours of service. The VNA offers emotional support through a bereavement support group to community residents who have experienced the loss of a loved one, and a caregiver support group to support others who are caring for an ill loved one. Camp Good Grief offers bereavement support to youth and teens who have experienced loss of a family member or friend. The VNA offers community memorial services to deceased patients' families and friends. Staff attends community health fairs and provides blood pressure screenings at area sites. Cranberry Place - EIN 04-3709885; 509(a)(2) Cranberry Place is licensed as a Continuing Care Retirement Community (CCRC). As such, Cranberry Place operates the entire continuum of senior care-independent living, personal care, and skilled nursing facilities. Cranberry Place's skilled nursing facility is a 150-bed residence that offers skilled nursing services, rehabilitative services, comprehensive long-term care and hospice care for the terminally ill. There is an on-site dialysis center. The facility is dually certified by Medicare and Medicaid. Spacious grounds, courtyards, and single level design allows for safe movement throughout the residence. The Cranberry Place skilled nursing site is located on the campus of UPMC Passavant-Cranberry Hospital of Cranberry Township. Cranberry Place offers personal care at its Cumberland Crossing Manor site. Personal Care residences make perfect homes for seniors who are generally independent but who may need an extra touch of care with day-to-day routines, like medications, nutritional support, and help with personal care. Cumberland Woods Village, an Independent Congregate Living Facility (ICL), is a residential facility for the elderly who are ambulatory without assistance, able to self-manage medications, and require no assistance with the activities of daily living. These residents are generally independent, but may need a little assistance in daily routines, including instrumental activities of daily living (IADLs), such as meal preparation and transportation. In addition to enjoying all of the amenities of the facility, these residents are free to come and go as they please and enjoy the added-benefit of live-in resident managers who are available to provide them with a worry-free lifestyle in a safe and secure environment. Cranberry Place is committed to older adults who live in the independent living facility and can provide the resident with skilled nursing and support services, if they are required, as the resident ages in the community. Cranberry Place provides the highest level of skilled care needed regardless of a patient's ability to pay. During the fiscal year ended June 30, 2012, Cranberry Place provided uncompensated care of approximately $1,000,000. The Heritage Shadyside - EIN 02-0614185; 509(a)(2) The Heritage Shadyside (Heritage) is a 145-bed continuing care facility located in the Squirrel Hill area of Pittsburgh. The Heritage provides a warm and caring atmosphere for patient care. The Heritage Shadyside is a residence that offers skilled nursing services, rehabilitative services, comprehensive long-term care, and hospice care for the terminally ill. The professional staff offers the emotional support of a family by remaining sensitive to every individual's needs. The mission of The Heritage Shadyside is to provide the best patient care regardless of a patient's ability to pay. During the fiscal year ended June 30, 2012, The Heritage Shadyside provided free or uncompensated care of approximately $1,500,000.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) UPMC Community Provider Services - EIN 25-1804746; 509(a)(2) UPMC Community Provider Services' programs include Living-at-Home, Follow-Me-Home, the Institute for Rehabilitation and Research, and the Institute on Aging. Living-at-Home and Follow-Me-Home are community outreach programs that provide ongoing case management services to senior citizens. The Institute for Rehabilitation and Research and the Institute on Aging are both collaborative programs that are designed to improve clinical and research capabilities to improve quality of care and outcomes for specific populations within western Pennsylvania and the nation. The Aging Institute information and referral line provides access to information, services, and resources for older adults, caregivers, researchers, educators and professionals through advocacy services focused on guidance and support. Each call is handled by a social worker who provides appropriate counseling and support based on a thorough needs assessment. The social worker also provides outreach and education. The Living-at-Home program provides chronic care management to help maintain independence and function of community-dwelling elderly by coordinating their care, providing education about their conditions, and assisting them to manage their medications and obtain services through community resources. This program also provides health self-management information through senior centers and housing. Overall for community benefit programs, UPMC Community Provider Services provided over $1,000,000 in support. UPMC Overseas, Inc. - EIN 23-2897716; 509(a)(3) UPMC Overseas supports the international organ transplantation program of UPMC Presbyterian Shadyside by coordinating the purchase of management and professional services for the Istituto, an Italian transplant facility operated as a joint venture between several Italian governmental hospitals and UPMC. The Center for Biosecurity of the University of Pittsburgh Medical Center - EIN 04-3770052; 170(b)(1)(A)(iii); 509(a)(1) The Center for Biosecurity of the University of Pittsburgh Medical Center (the Center) was organized to conduct scientific research and education: (a) to prevent the development and use of biological weapons; (b) to catalyze advances in science and governance that diminish the power of biological weapons as agents of mass lethality; and (c) to lessen the human suffering that would result if the prevention efforts failed. Modern societies are highly vulnerable to bioattacks because global travel enables rapid spread of contagious diseases. Adequate response is not dependent on military strength, but on medical and public health systems and the availability of effective drugs and vaccines. To counter the threat of bioterrorism, the United States is developing a new paradigm for defense, and realigning its national security priorities and investments accordingly. Hospital personnel, clinicians, public health officials and bioscientists are the frontline defenders in this new security era. An effective defense against bioattacks must include the design and construction of new operational systems that can deliver emergency medical care to a large number of critically ill individuals. To accomplish this, the time to develop new vaccines and create new drugs must be dramatically reduced in order to respond to unanticipated and bioengineered weapons. The work of the Center is intended to benefit the security of nations against biological weapons. The faculty of the Center gives presentations at medical, public health, and science meetings around the world on issues related to biodefense. The faculty of the Center serves on numerous task forces and committees that serve local, state, and international governments, and the faculty often testify before the United States Congress. University Health Center of Pittsburgh - EIN 25-6073026; 509(a)(3) The organization's primary exempt purpose is to provide leadership and management to graduate medical education programs. The University Health Center of Pittsburgh's (UHCP) primary activities consist of implementing, with non-profit Board direction and approval, policies and procedures for the common benefit of its member hospitals. These policies and procedures promote the operation of UHCP as an efficient, well-rounded, and effective community and regional health resource. UHCP also develops, focuses, facilitates, and implements, with the specific approval of its members, the relationships with the University of Pittsburgh and more particularly with the Schools of Medicine and Health Sciences. UHCP coordinates graduate medical education programs on behalf of the members and coordinates affiliations with health care providers consistent with its mission as a regional health resource.
Part III Statement of Program Service Accomplishments Organizations Programs and Accomplishments (continued) UPMC International Holdings, Inc. - EIN 23-2897712; 509(a)(3) The organization was established as a holding company to support the international activities of UPMC that support the overall exempt missions of UPMC's exempt entities. UPMC IMITs Center - EIN 20-8392908; 170(b)(1)(A)(vi); 509(a)(1) The University of Pittsburgh Medical Center's (UPMC) Innovative Medical and Information Technologies (IMITs) Center is a healthcare research, education, and management delivery system within UPMC. In collaboration with the United States military and government agencies, IMITs Center provides services and brings novel ideas to life. Through collaborations that shape tomorrow's civilian and military healthcare system, IMITs Center provides resources, solutions, and clinical innovation, research, and education. Possibilities for future innovation are limitless; creating a brighter future for military members, their families, veterans, and civilians. As an affiliate of UPMC, the IMITs Center serves as a national resource to rapidly and efficiently introduce innovative technologies and treatments to military healthcare providers and soldiers. The IMITs Center has the infrastructure and expertise to work with all sectors - government, private industry, and academic partners - to effect change on regional, national, and international levels. IMITs Center develops clinical and technology initiatives through academic, government, and private industry collaborations. The IMITs Center serves as a conduit between the Department of Defense and organizations seeking opportunities for partnership. Combining the most advanced telemedicine and telehealth technologies and innovations, some created and developed by IMITs Center itself, and state-of-the-art medical education and simulation technologies, IMITs Center offers relevant and innovative training methodologies to combat medics. Since military medical personnel operating behind the scenes play a vital role in the survival rate of troops, IMIT's programs provide training that improves resuscitative surgical care far forward on the battlefield, as well as advanced research and best practice care. IMITs Center enables medical personnel to strengthen skills working side-by-side with civilian colleagues who have treated trauma and critical care patients in state of the art facilities using proven medical protocol. Community Care Behavioral Health Organization - EIN 25-1799823; 509(a)(2) Community Care Behavioral Health Organization (Community Care), is a behavioral health managed care organization (BH-MCO) which manages behavioral health services for approximately one million members whose health coverage is sponsored through Medicaid, Medicare and commercial plans. Community Care's mission is to improve the health and well-being of the community through the delivery of clinically effective, cost-efficient, and accessible behavioral health services. It seeks to improve the quality of services for members through a stakeholder partnership focused on outcomes. Community Care believes that quality is measured by the improved health of its members, which translates to higher functioning in the community. Community Care believes that the highest quality services are best provided through a not-for-profit partnership with public agencies, experienced local providers, and involved members and families. Community Care manages behavioral health services, as well as treatment for drug and alcohol abuse to Medical Assistance enrollees under contracts with certain Pennsylvania counties and with the Commonwealth of Pennsylvania pursuant to the HealthChoices managed care program that was established by the Pennsylvania Department of Public Welfare. Individuals eligible for the Medical Assistance program are low-income or indigent members of the community who otherwise would not be able to afford to pay for mental health therapy and treatment and/or treatment for alcohol or drug addiction or dependency. With a network of approximately 3,000 behavioral health care providers, Community Care is the only BH-MCO with contracts in every Pennsylvania HealthChoices region (Southeast, Southwest, Northeast, North Central, and Lehigh-Capital). As of June 30, 2012, Community Care managed behavioral health care for nearly 671,000 Medicaid managed care enrollees in both urban and rural settings. In addition to its HealthChoices contracts, Community Care also manages behavioral health services under a contract with its affiliate, UPMC Health Plan, and a contract with the New York Office of Mental Health. Community Care's activities include the full range of services necessary to manage effective treatment to its behavioral/mental health enrollees, including care management, treatment coordination with other healthcare providers, claims processing, and quality management pursuant to National Committee for Quality Assurance standards. In addition to being the largest non-profit BH-MCO in the country, Community Care has been awarded "full" accreditation - the highest level possible - by the National Committee for Quality Assurance (NCQA). NCQA is a nationally recognized independent organization dedicated to measuring the quality of America's health care. NCQA's rigorous accreditation process includes on-site and off-site evaluations conducted by a team of physicians and managed care experts. Community Care received the highest rating given in all applicable standards. Specifically, NCQA noted Community Care's strong communications with practitioners and members, its ample network of providers, its network access standards, its strong incorporation of member input into preventive health programs, and its full collaboration with UPMC Health Plan and other physical and behavioral health practitioners. As of June 30, 2012, Community Care managed the behavioral health services of a population of approximately 1.5 million. Of those individuals, 671,000 or approximately 46%, are Medical Assistance recipients who pay no fee for the services provided. However, this population generates 98.6% of Community Care's total revenue earned in the fiscal year ended June 30, 2012. Community Care also further assisted the community by way of donations to local nonprofits that exceeded $700,000. UPMC for You, Inc. - EIN 90-0174238; 509(a)(2) UPMC for You is a Managed Care Organization (MCO) licensed by the Pennsylvania Department of Health and the Pennsylvania Insurance Department. Through contracts with the Department of Public Welfare (DPW), UPMC for You offers coverage to eligible Medical Assistance recipients living in 14 counties in Western Pennsylvania. UPMC for You has been the fastest growing Medical Assistance MCO in Southwest Pennsylvania (serving more than 153,709 individuals) in recent years. Additionally UPMC for You is ranked as the number one Medical Assistance MCO in Pennsylvania by NCQA and is ranked 13th nationally for CY2008. UPMC for You serves those members that meet certain federal poverty guidelines, including the aged, blind, and disabled, and has been very successful in meeting the needs of this unique population. UPMC for You further assisted community nonprofits with donations exceeding $1,100,000. Center for Emergency Medicine of Western Pennsylvania - EIN 25-1443759; 509(a)(3) The Center was originally formed in 1978 to bring the City of Pittsburgh and the University of Pittsburgh School of Medicine together to improve the quality and delivery of emergency medical services in Pittsburgh. Currently, the Center provides medical direction for the City of Pittsburgh Bureau of EMS. STAT MedEvac, a service of the Center for Emergency Medicine, provides air medical transport to patients with critical illnesses and/or injuries. STAT MedEvac is the Region's only helicopter service with three single pilot instrument rated helicopters. Each of STAT MedEvac's helicopters are staffed 24-hours a day with an EMS pilot and a two-person medical crew including a nurse, paramedic, or physician. As a consortium, the Center for Emergency Medicine is a unique model of success -- an advanced system of emergency transport, clinical care, education and research governed by a group of tertiary care and community hospitals and a leading university in concert with a major metropolitan municipality. The Center has become the world's leading institute for the advancement of emergency medicine research and education, and most importantly, patient care.
Part IV Checklist of Required Schedules   Question 12: An external audit is completed at a consolidated UPMC system level only, including UPMC and all subsidiaries.
Part VI Governance, Management, and Disclosure SECTION A: GOVERNING BODY AND MANAGEMENT QUESTION 1: The total number of voting board members and total number of independent board members represent a composite of all of the UPMC Group subordinates. However, these numbers do not include ex-officio or other board members who are not entitled to vote on board matters or members of boards that are advisory in nature and subject to the authority of the UPMC parent board for material board decisions. Although the composite numbers for the UPMC Group do not reflect majority board independence, all of these boards are ultimately subordinate to the UPMC parent board which is comprised of a majority (greater than 65%) of independent board members. Please see the UPMC parent Form 990 for more information. Question 2: Multiple UPMC Officers, Directors, Trustees, and/or Key Employees have business relationships by virtue of the fact that they are also Officers, Directors, Trustees, and/or Key Employees of UPMC subsidiaries and affiliates, which are not separately disclosed below. There are no other UPMC Officers, Directors, Trustees, and/or Key Employees that have business relationships, required to be disclosed by Form 990 Part VI, Section A, Line 2, by virtue of the fact that they are also Officers, Directors, Trustees, or Key Employees of other unrelated taxable organizations. Question 6: MOST OF THE UPMC GROUP ENTITIES HAVE A SOLE MEMBER, WHICH IS UPMC PARENT. A SMALL NUMBER OF GROUP ENTITIES HAVE MORE THAN ONE MEMBER. IN ALL CASES, THE MEMBERS ARE EXEMPT ORGANIZATIONS. ULTIMATELY THE GROUP ENTITIES AND THEIR RESPECTIVE MEMBERS (IF THE MEMBER(S) ARE NOT UPMC PARENT) ARE CONTROLLED BY UPMC PARENT. Question 7A and B: IN THE CASE OF MOST OF THE UPMC GROUP ENTITIES, THE MEMBER(S) APPOINT A SIGNIFICANT PORTION OF THE ENTITIES' BOARDS OF DIRECTORS (IF NOT THE ENTIRE BOARD). IN THE CASE OF MOST OF THE GROUP ENTITIES, THE MEMBER(S) ALSO HAVE THE RIGHT TO INITIATE, APPROVE OR OVERTURN ACTIONS OF THE ENTITIES' BOARDS. IN ADDITION, THE MEMBERS' ACTIONS, IF THE MEMBER(S) ARE NOT UPMC PARENT, ARE IN MOST CASES SUBJECT TO THE OVERALL AUTHORITY OF THE UPMC PARENT BOARD.
Part VI Governance, Management, and Disclosure SECTION B: POLICIES Question 11a & b: UPMC is the parent organization of the filing group and has, with respect to most entities in the group, the discretion and authority to initiate or veto actions taken by group member governing bodies. With respect to the remaining members, UPMC's authority is limited slightly but still significant, encompassing major matters including financial and tax matters. The completed Form 990 was reviewed by the UPMC Chief Financial Officer, members of the Corporate Tax Department, members of the Corporate Legal Department, and other members of UPMC's management prior to its filing. Various sections of the 990 were also reviewed by the Chief Executive Officer of UPMC and committees of UPMC's Board of Directors, as applicable. For example, the Executive Compensation Committee of the Board reviewed sections related to compensation and related party transactions. In addition, the Board of Directors established a 990 Subcommittee, comprised of the Chairs of the UPMC Board, Executive Compensation Committee, Ethics and Compliance Committee, Finance Committee and Audit Committee, which reviewed the entire completed Form 990. Additionally the Form 990 is reviewed by an outside independent public accounting firm who as part of the process signs the return as Paid Preparer. After this review but prior to filing, the full UPMC Board of Directors was notified that the completed Form 990 was available for review on the Board's secure website. Also prior to filing, management held a Form 990 question and answer session in which all members of the full UPMC Board were invited to participate. Question 12c: UPMC requires key employed and non-employed personnel to comply with its conflict of interest policies when they engage in UPMC-related business. Persons covered by the policies include: -UPMC board members, board committee members, corporate officers, and key employees -UPMC physicians and non-physician employees who hold a position of influence -Identified Non-employed members of the UPMC medical staff who hold a position of influence or trust -Individuals conducting clinical research at UPMC, whether or not they are employed by UPMC. These people are required to complete a questionnaire at least annually, which along with other data is used to identify possible individual and institutional conflicts of interest. If a potential conflict is identified regarding a specific UPMC activity, the corporate compliance department, with the assistance of the legal department, either develops a written plan designed to prevent the conflict from influencing decisions related to that activity, or requires that the conflicting relationship be divested, as appropriate. For employed personnel and non-Board member, non-employed personnel, the conflict of interest identification and management process is ultimately overseen by an Ethics and Compliance committee of the UPMC board of directors on behalf of UPMC and all of its subsidiaries. Potential conflict of interest transactions involving UPMC Board members and entities with which they are affiliated are monitored and subject to pre-approval by the Governance and Nominating Committee of the UPMC Board of Directors. In addition to the general corporate and Board policies described above, UPMC has also developed and implemented a separate tax questionnaire distributed to Officers, Directors, Trustees, and Key Employees annually that specifically addresses disclosure requirements of Form 990. Question 15a and b: To support UPMC's mission and as set forth in the UPMC Bylaws, the Board of Directors has formed an Executive Compensation Committee ("Committee") and delegated to it the responsibility for establishment and implementation of officer and key employee total compensation programs. As part of this responsibility, at least annually, the Committee reports to the Board of Directors. With Board of Directors approval, the Committee has adopted a formal Charter, which includes the establishment of a compensation philosophy and related policies with respect to the total compensation paid by UPMC to its officers and key employees. The UPMC total compensation program for officers and key employees is predicated upon an incentive compensation component. This component is based upon the accomplishment of predetermined performance goals and objectives which focus on the achievement of multiple annual and three year individual and group performance criteria in the context of appropriate risk taking. These criteria directly support UPMC's mission and include: patient quality and satisfaction, community benefits, operational and financial strength, leadership development, and strategic business initiatives among others. The total compensation program is integrated with and reinforces the UPMC business planning cycle as well as management development and succession planning processes. It is the Committee's judgment that the structure of the total compensation program is vital to, and strongly supportive of, the high level of ongoing success of UPMC and fosters the retention of critical officer and key employee talent. The total compensation determination process utilized by the Committee is intended to satisfy the "rebuttable presumption of reasonableness" as set forth in the regulations to Section 4958 of the Internal Revenue Code ("Code"). This means that compensation programs and levels are approved in advance by the Committee which is composed entirely of outside Directors who do not have a conflict of interest, as defined by the relevant regulations, with respect to the compensation program and levels. The Committee obtains and relies upon a broad range of appropriate data as to comparability prior to making its determinations. The Committee then contemporaneously documents, in formal meeting minutes, the basis and reasons for its determinations. The total compensation program is designed and administered in accordance with the UPMC Bylaws, sound business practices, the tenets of common law business judgment and fiduciary responsibility as well as adherence to all relevant federal, state and local laws. In addition to Code Section 4958, as set forth above, this includes but is not limited to Code Section 501(c)(3) and the applicable regulations thereunder as well as all laws and regulations prohibiting private inurnment, private benefit transactions and discrimination. Further, the Committee has identified and adopted, as appropriately modified for UPMC, compensation program "best practices" from the business world (e.g. Sarbanes Oxley, SEC, etc.). The Committee believes that while these practices are not required in the tax exempt sector, they are in the best interests of the organization and further support UPMC's nonprofit mission. In accordance with the above, determination of total compensation for the CEO is made exclusively by the Committee. Determination of total compensation for other officers and key employees is recommended by the CEO and subject to review and approval by the Committee. The Committee, which meets at least four times a year, obtains professional advice from its own experts, including accountants, executive compensation consultants and legal counsel. Question 16A and B: UPMC has a formal written policy pertaining to joint ventures between UPMC Tax-Exempt entities and taxable entities. The policy employs an internal procedure for review of all transactions involving potential participation in joint ventures and similar arrangements to ensure that such entities operate in accordance with applicable IRS policies and within UPMC's charitable purposes.
Part VI Governance, Management, and Disclosure SECTION C: DISCLOSURE Question 19: UPMC's Public Website (www.upmc.com) makes its financial results, conflict of interest process, and various information about the governance and oversight available to the public. ADDITIONAL INFORMATION MAY BE SUPPLIED UPON SPECIFIC REQUEST FOR DATA NOT POSTED TO THE WEB SITE.
Part VII Compensation of Officers, Directors, Trustees, Key Employees HIGHEST COMPENSATED EMPLOYEES AND INDEPENDENT CONTRACTORS Pursuant to Treasury regulation Section 1.6033-2(D)(5) The sponsoring entity of UPMC Group, UPMC, has elected to report information about contributions, gifts, grants and similar amounts received; compensation and other information about officers, directors, trustees, and key employees; certain other highly paid employees; certain professional contractors; and certain other contractors on a consolidated basis along with all members of the group in the UPMC Group return. THE COMPENSATION AMOUNTS LISTED REPRESENT THE FULL AND COMPLETE COMPENSATION PACKAGES PAID TO THE INDIVIDUALS FOR PERFORMING THEIR ASSIGNED DUTIES AT UPMC. A PORTION OF THE COMPENSATION DISCLOSED MAY RELATE TO EARNED AND PREVIOUSLY REPORTED DEFERRED COMPENSATION. A PORTION OF THE BENEFITS DISCLOSED MAY RELATE TO EARNED BUT UNPAID DEFERRED COMPENSATION. ALL SALARIES AND BENEFITS REPORTED ARE BASED ON INDIVIDUALS' OPERATIONAL POSITIONS AND ARE NOT FOR SERVICES PERFORMED AS DIRECTORS OR BOARD MEMBERS. BOARD POSITIONS ARE ALL VOLUNTEER AND UNPAID. PART VII OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES INDIVIDUALS THAT HOLD REPORTING POSITIONS WITH MORE THAN ONE ORGANIZATION ARE LISTED SEPARATELY IN PART VII WITH REGARD TO EACH ENTITY. INDIVIDUALS ARE COMPENSATED FOR OPERATIONAL ROLES ONLY, NOT FOR DUTIES PERFORMED AS DIRECTORS OR BOARD MEMBERS. The total hours disclosed in Part VII relates to the position for which the person is disclosed except in the case where the person is also employed by the same distinct entity. In such case, the hours reflect average hours spent in their operational role. For purposes of disclosure average hours per week for a full time person is listed as 40 hours, however, in almost all cases, this is a conservative estimate and most work hours in excess of 40 per week.
Part X Balance Sheet SCHEDULE K PART I, DESCRIPTION OF PURPOSE, COLUMN (F) MAY 3, 2006 FINANCING ONE NEW EUROCOPTER EC145 MODEL BK117C2 HELICOPTER, SERIAL NUMBER 9069, REGISTRATION NUMBER N698ME. DECEMBER 22, 2006 FINANCING ONE NEW EUROCOPTER EC145 MODEL BK117C2 HELICOPTER, SERIAL NUMBER 9084, REGISTRATION NUMBER N980ME; ONE NEW EUROCOPTER DEUTSCHLAND EC135T2 HELICOPTER, SERIAL NUMBER 0493, REGISTRATION NUMBER N831ME; ONE NEW EUROCOPTER DEUTSCHLAND EC135T2 HELICOPTER, SERIAL NUMBER 0504, REGISTRATION NUMBER N308ME; ONE NEW EUROCOPTER DEUTSCHLAND EC145 MODEL BK117C2 HELICOPTER, SERIAL NUMBER 9097, REGISTRATION NUMBER N304ME; ONE NEW EUROCOPTER DEUTSCHLAND EC145 MODEL BK117C2 HELICOPTER, SERIAL NUMBER 9100, REGISTRATION NUMBER N307ME. MARCH 28, 2007 FINANCING ONE NEW EUROCOPTER DEUTSCHLAND EC145 MODEL BK117C2 HELICOPTER, SERIAL NUMBER 9097, REGISTRATION NUMBER N304ME; ONE NEW EUROCOPTER DEUTSCHLAND EC145 MODEL BK117C2 HELICOPTER, SERIAL NUMBER 9100, REGISTRATION NUMBER N307ME; ONE NEW EUROCOPTER DEUTSCHLAND EC135T2 HELICOPTER, SERIAL NUMBER 0552, REGISTRATION NUMBER N527ME; ONE NEW EUROCOPTER DEUTSCHLAND EC135T2 HELICOPTER, SERIAL NUMBER 0563, REGISTRATION NUMBER N639ME. The Center for Emergency Medicine equipment financing amortization schedules that are used for general ledger reporting do not equal the debt amortization schedules as used and reported on Schedule K. For GAAP reporting, the balloon payments at the end of the lease are present valued over the life of the lease rather than having a large payment at the end of the lease.
Part XI Reconciliation of Net Assets   Reconciliation of Net Assets Net Unrealized Gains/Losses -502,092 Transfers from Exempt Parent 15,508,435 Net Restricted/SPF Activity -3,962,111 Other Increases/Decreases in Fund Balance -7,286,927 Currency Adjustment -8,228,160 Change in Beneficial Interest -18,562,455 Transfers to/from Exempt Affiliate -898,511 TOTAL -23,931,821 An external audit is completed at a consolidated UPMC system level only, including UPMC and all taxable and tax-exempt subsidiaries.
Part XII Financial Statements and Reporting Question 2C UPMC has an Audit Committee that is established to assist the Board of Directors in fulfilling its oversight responsibilities by monitoring UPMC consolidated financial reports and other financial information provided by UPMC to governmental bodies, the public or other external entities. The UPMC's system of internal controls regarding finance, accounting, legal compliance and ethics that management and the Board have established and UPMC's internal auditing, accounting and financial reporting processes also provided oversight.
Schedule L Transactions with Interested Persons PART IV BUSINESS TRANSACTIONS INVOLVING INTERESTED PARTIES (A) Name of Interested Person: Edith Tzeng M.D. (B) Relationship Between Interested Family Member of University Person and the Organization: of Pittsburgh Physicians Board Member Timothy Billiar M.D. (c) Amount of Transaction: $136,109 (D) Description of Transaction: Compensation (E) Sharing of Organizations Revenue: NO (A) Name of Interested Person: Ellen Frank M.D. (B) Relationship Between Interested Family Member of Former Person and the Organization: University of Pittsburgh Physicians Board Member David Kupfer M.D. (c) Amount of Transaction: $34,319 (D) Description of Transaction: Compensation (E) Sharing of Organizations Revenue: NO (A) Name of Interested Person: Anna Roman PhD (B) Relationship Between Interested Family Member of University Person and the Organization: of Pittsburgh Physicians Board Member George Michalopoulos M.D. (c) Amount of Transaction: $347,516 (D) Description of Transaction: Compensation (E) Sharing of Organizations Revenue: NO (A) Name of Interested Person: Barbara Cohlan M.D. (B) Relationship Between Interested Family Member of University Person and the Organization: of Pittsburgh Physicians Board Member David H. Perlmutter M.D. (c) Amount of Transaction: $272,361 (D) Description of Transaction: Compensation (E) Sharing of Organizations Revenue: NO (A) Name of Interested Person: Valerie Trott (B) Relationship Between Interested Family Member of University Person and the Organization: of Pittsburgh Physicians Board Member John P. Williams M.D. (c) Amount of Transaction: $321,383 (D) Description of Transaction: Compensation (E) Sharing of Organizations Revenue: NO (A) Name of Interested Person: Patricia McCauley (B) Relationship Between Interested Family Member of UPMC Person and the Organization: Northwest Key Employee Roger McCauley (c) Amount of Transaction: $42,827 (D) Description of Transaction: Compensation (E) Sharing of Organizations Revenue: NO
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:BAD DEBT TOTAL EXPENSES:XXX-XX-XXXX PROGRAM SERVICES:XXX-XX-XXXX
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:OTHER EXPENSES TOTAL EXPENSES:XXX-XX-XXXX PROGRAM SERVICES:XXX-XX-XXXX MANAGEMENT AND GENERAL:563507 FUNDRAISING:4038785
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:PURCHASED SERVICES TOTAL EXPENSES:XXX-XX-XXXX PROGRAM SERVICES:XXX-XX-XXXX MANAGEMENT AND GENERAL:19897878 FUNDRAISING:7482
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:ALLOCATION TO/FR SUBSIDIARY TOTAL EXPENSES:42396992 MANAGEMENT AND GENERAL:42396992
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:DIETARY SUPPLIES TOTAL EXPENSES:36160092 PROGRAM SERVICES:36160092
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:CONSULTING SERVICES TOTAL EXPENSES:26595297 PROGRAM SERVICES:10631638 MANAGEMENT AND GENERAL:15963659
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:ORGAN ACQUISITION TOTAL EXPENSES:19519055 PROGRAM SERVICES:19519055
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:LAUNDRY & LINEN SERVICES TOTAL EXPENSES:14356941 PROGRAM SERVICES:14356941
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:ADMINISTRATIVE FEES TOTAL EXPENSES:12683297 PROGRAM SERVICES:10197669 MANAGEMENT AND GENERAL:2485628
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:PURCHASED SERVICES PROF/MED TOTAL EXPENSES:10357115 PROGRAM SERVICES:8253002 MANAGEMENT AND GENERAL:2104113
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:PURCHASED LAB SERVICES TOTAL EXPENSES:9229553 PROGRAM SERVICES:9229553
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:DUES & SUBSCRIPTIONS TOTAL EXPENSES:8976500 PROGRAM SERVICES:5990024 MANAGEMENT AND GENERAL:2986476
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:HOSPITAL SUPPORT TOTAL EXPENSES:7601907 PROGRAM SERVICES:7601907
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:RECRUITMENT TOTAL EXPENSES:6834852 PROGRAM SERVICES:2822670 MANAGEMENT AND GENERAL:4012182
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:PURCHASED SALARIES TOTAL EXPENSES:5926112 PROGRAM SERVICES:4968548 MANAGEMENT AND GENERAL:957564
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:RESEARCH TOTAL EXPENSES:3646254 PROGRAM SERVICES:3178646 MANAGEMENT AND GENERAL:467608
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:BANK FEES TOTAL EXPENSES:3564821 MANAGEMENT AND GENERAL:3564821
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:LICENSES TOTAL EXPENSES:838619 PROGRAM SERVICES:694724 MANAGEMENT AND GENERAL:143895
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:BILLING FEES TOTAL EXPENSES:489236 MANAGEMENT AND GENERAL:489236
OTHER EXPENSES FORM 990 PART IX DESCRIPTION:DONATIONS TOTAL EXPENSES:485255 PROGRAM SERVICES:485255
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UPMC GROUP
 
Employer identification number

20-8295721
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) UPMC ITALY SRL
PIAZZA SETT ANGELI 1090134
  PALERMO  
IT
HEALTHCARE IT 43,172,010 27,401,108 UPMC OVERSEA
 










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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) UPMC SENIOR COMMUNITIES INC

600 GRANT STREET

PITTSBURGH,PA15219
25-1574736 		SR. LIVING PA 501(C)(3) 9 UPMC
 
Yes
 
(2) PITTSBURGH LIFETIME CARE COMMUNITY

600 GRANT STREET

PITTSBURGH,PA15219
25-1335247 		CCRC PA 501(C)(3) 9 UPMC SR COMM
 
Yes
 
(3) CANTERBURY PLACE

600 GRANT STREET

PITTSBURGH,PA15219
25-0965334 		SR. LIVING PA 501(c)(3) 11(A) I UPMC SR COMM
 
Yes
 
(4) SENECA PLACE

600 GRANT STREET

PITTSBURGH,PA15219
72-1562844 		SR LIVING PA 501(C)(3) 9 UPMC SR COMM
 
Yes
 
(5) SHADYSIDE HOSPITAL SUPPORTING FOUNDATION

600 GRANT STREET

PITTSBURGH,PA15219
26-0303394 		FOUNDATION PA 501(C)(3) 11(A) I UPMC
 
Yes
 
(6) UPMC LEE

600 GRANT STREET

PITTSBURGH,PA15219
25-0613830 		INACTIVE PA 501(c)(3) 3 UPMC
 
Yes
 
(7) COMMMUNITY PHYSICIAN SERVICES INC

600 GRANT STREET

PITTSBURGH,PA15219
25-1722923 		INACTIVE PA 501(C)(3) 9 UPMC
 
Yes
 
(8) PITTSBURGH CARE PARTNERSHIP INC

600 GRANT STREET

PITTSBURGH,PA15219
25-1753852 		ADULTDAYCARE PA 501(c)(3) 9 UPMC
 
Yes
 
(9) UPMC CENTER FOR HIGH VALUE HEALTHCARE

600 GRANT STREET

PITTSBURGH,PA15219
45-2178782 		RESEARCH PA 501(c)(3) 7 UPMC
 
Yes
 
(10) CLINICALCONNECT HIE

600 GRANT STREET

PITTSBURGH,PA15219
27-4585032 		TECHNOLOGY PA 501(C)(3) 11(B)II UPMC
 
Yes
 
(11) SHADYSIDE HOSPITAL FOUNDATION

532 SOUTH AIKEN AVENUE

PITTSBURGH,PA15232
25-1290546 		FOUNDATION PA 501(c)(3) 11(C)III UPMC PRESBY
 
Yes
 
(12) PASSAVANT HOSPITAL FOUNDATION

9100 BABCOCK BLVD

PITTSBURGH,PA15237
25-1407815 		FOUNDATION PA 501(c)(3) 11(B)II UPMC PASS
 
Yes
 
(13) UPMC NORTHWEST FOUNDATION

100 FARFIELD DRIVE

SENECA,PA16346
25-1483624 		FOUNDATION PA 501(c)(3) 11(D)III UPMC NORTHWE
 
Yes
 
(14) ST MARGARET FOUNDATION

600 GRANT STREET

PITTSBURGH,PA15219
25-1520340 		FOUNDATION PA 501(c)(3) 7 UPMC ST MARG
 
Yes
 
(15) CHILDREN'S HOSPITAL OF PITTSBURGH FND

600 GRANT STREET

PITTSBURGH,PA15219
25-1865744 		FOUNDATION PA 501(c)(3) 7 UPMC CHP
 
Yes
 
(16) MAGEE-WOMEN RES INST AND FOUNDATION

600 GRANT STREET

PITTSBURGH,PA15219
25-1462311 		FOUNDATION PA 501(c)(3) 7 NA
 
 
No
(17) UPMC HAMOT

201 STATE STREET

ERIE,PA16550
25-0965387 		HOSPITAL PA 501(c)(3) 7 UPMC
 
 
No
(18) KANE COMMUNITY HOSPITAL

4372 ROUTE 6

KANE,PA16735
25-0998168 		HOSPITAL PA 501(c)(3) 3 UPMC HAMOT
 
 
No
(19) REGIONAL HEALTH SERVICES INC

300 STATE STREET

ERIE,PA16507
25-1403958 		OUTPATIENT SV PA 501(c)(3) 9 UPMC HAMOT
 
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) LILIANE S KAUFMANN MOB ASSOC

600 GRANT STREET
PITTSBURGH,PA15219
25-1551779 		MED OFFICE BL PA UPMC PRESBYSHA
  		Related 370,591 5,513,797   No 0     93.514 %
(2) SENECA HILLS ASSISTED LIVING LP

600 GRANT STREET
PITTSBURGH,PA15219
23-2873106 		ASSISTED LIVI PA NA
  		N/A                
(3) ST MARGARET MEDICAL ARTS ASSOCIATES

600 GRANT STREET
PITTSBURGH,PA15219
25-1786655 		MED OFFICE BL PA NA
  		N/A                
(4) CORE NETWORK LLC

600 GRANT STREE
PITTSBURGH,PA15219
25-1786209 		HEALTHCARE PA UPMC COMM PROVI
  		related 4,821,879 8,435,807   No 0     74.712 %
(5) UPMC JEFFERSON REGIONAL HOME HEALTH LP

600 GRANT STREET
PITTSBURGH,PA15219
25-1844485 		HOMECARE PA UPMC COMM PROVI
  		related -8,975 0   No 0     60.810 %
(6) LIFE HOME CARE LP

600 GRANT STREET
PITTSBURGH,PA15219
25-1847839 		HOMECARE PA UPMC COMM PROV
  		RELATED 329,118 7,872,485   No 0     66.670 %
(7) SHADYSIDE MEDICAL CENTER ASSOCIATION

600 GRANT STREET
PITTSBURGH,PA15219
25-1608318 		MED OFFICE BL PA NA
  		N/A                
(8) CHARTWELL PA LP

600 GRANT STREET
PITTSBURGH,PA15219
25-1729714 		HOMEHEALTH PA UPMC COMM PROV
  		RELATED 13,559,076 14,003,217   No   Yes   78.100 %
(9) LIFE Care Home SERVCS NORTHWESTERN PENN

1647 SASSAFRAS STREET
ERIE,PA16501
25-1536879 		HOME HEALTH S PA NA
  		N/A                
(10) HAMOT-KCH REAL ESTATE VENTURE

300 STATE STREET
ERIE,PA16501
26-3691782 		MEDICAL OFFIC PA NA
  		N/A                
(11) HAMOT SURGERY CENTER LLC

200 STATE STREET
ERIE,PA16507
25-1863661 		AMBULATORY SU PA NA
  		N/A                
(12) EPN-Hamot Urgent Care LLC

600 Grant Street
Pittsburgh,PA15219
27-2147949 		Urgent Care PA UPMC Comm Medi
  		RELATED 0 0   No 0 Yes   60.000 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) HCPHARMACY CENTRAL INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1364192 		PHARMACY CO-O PA VARIOUS
  		C 1,928,848 345,373 78.571 %
(2) CHILDREN'S COMMUNITY CARE
600 GRANT STREET
PITTSBURGH,PA15219
25-1781887 		PEDIATRIC SVC PA CHILDREN'S HOSP
  		C 77,743,024 7,132,455 100.000 %
(3) NORTHWEST RADIATION TREATMNT
600 GRANT STREET
PITTSBURGH,PA15219
25-1562979 		RADIATION SVC PA UPMC HORIZON
  		C 0 0 66.670 %
(4) COOLOCK ENTERPRISES INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1512753 		REAL ESTATE PA UPMC MERCY
  		C 19,300 1,217,887 100.000 %
(5) UPMC CANCER CENTERS INTERNATIONAL LIMITE
6TH FLOOR BEACON HOSPITAL
SANDYFORD   DUBLIN 18
EI
HOLDING CO EI na
  		C      
(6) UPMC CANCER CENTERS IRELAND LIMITED
6TH FLOOR BEACON HOSPITAL
SANDYFORD   DUBLIN 18
EI
CANCER TREATM EI na
  		C      
(7) UPMC CANCER CENTERS HOLDING
600 GRANT STREET
PITTSBURGH,PA15219
25-1877017 		HOLDING CO PA na
  		C      
(8) HEMATOLOGY ONCOLOGY ASSOC
600 GRANT STREET
PITTSBURGH,PA15219
42-1648357 		HEALTHCARE PA na
  		C      
(9) ONCOLOGY HEMATOLOGY ASSOC
600 GRANT STREET
PITTSBURGH,PA15219
25-1762980 		HEALTHCARE PA na
  		C      
(10) TRI-STATE NEUROSURGICAL ASSOCIATES
600 GRANT STREET
PITTSBURGH,PA15219
25-1458655 		HEALTHCARE PA na
  		C      
(11) RENAISSANCE FAMILY PRACTICE - UPMC INC
600 GRANT STREET
PITTSBURGH,PA15219
26-2942406 		HEALTHCARE PA na
  		C      
(12) UPMC HOLDING COMPANY INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1777713 		HOLDING CORP PA na
  		C      
(13) UPMC COVERAGE PRODUCTS INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1777710 		HOLDING CORP PA na
  		C      
(14) FREEDOM INSURANCE COMPANY
600 GRANT STREET
PITTSBURGH,PA15219
03-0308944 		INSURANCE VT na
  		C      
(15) TRI-CENTURY INSURANCE CO
600 GRANT STREET
PITTSBURGH,PA15219
25-1500739 		INSURANCE PA na
  		C      
(16) UPMC INSURANCE AGENCY INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1883237 		INSURANCE PA na
  		C      
(17) UPMC HEALTH BENEFITS INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1844144 		INSURANCE PA na
  		C      
(18) UPMC HEALTH NETWORK INC
600 GRANT STREET
PITTSBURGH,PA15219
72-1527566 		INSURANCE PA na
  		C      
(19) UPMC HEALTH PLAN INC
600 GRANT STREET
PITTSBURGH,PA15219
23-2813536 		INSURANCE PA na
  		c      
(20) UPMC BENEFIT MANAGEMENT SERVICES INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1769564 		WORKERS' COMP PA na
  		C      
(21) UPMC DIVERSIFIED SERVICES INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1778454 		HOLDING CORP PA na
  		C      
(22) MONROEVILLE SPECIALTY CLINIC
600 GRANT STREET
PITTSBURGH,PA15219
25-1666087 		HEALTHCARE PA na
  		C      
(23) MEDICAL ARCHIVAL SYSTEMS INC
600 GRANT STREET
PITTSBURGH,PA15219
23-2912501 		SOFTWARE DEVE DE na
  		C      
(24) PRESBY HEALTH RESOURCE MGMT
600 GRANT STREET
PITTSBURGH,PA15219
25-1422155 		HEALTHCARE PA na
  		C      
(25) RX PARTNERS INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1801966 		RETAIL PHARM PA na
  		C      
(26) BIOTRONICS INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1843500 		EQUIP MAINTEN PA na
  		C      
(27) MEDICAL CENTER PROPERTIES INC
600 GRANT STREET
PITTSBURGH,PA15219
25-1796940 		REAL ESTATE PA na
  		C      
(28) UPMC ENVIRONMENTAL RESEARCH CENTER
600 GRANT STREET
PITTSBURGH,PA15219
20-4309237 		INACTIVE PA na
  		C      
(29) ASKESIS DEVELOPMENT GROUP INC
600 GRANT STREET
PITTSBURGH,PA15219
54-1625585 		SOFTWARE DEVE DE na
  		C      
(30) PANTHER REINSURANCE COMPANY LTD
 
 
INSURANCE CJ na
  		C      
(31) FORBES REINSURANCE COMPANY LTD
 
 
INSURANCE CJ na
  		C      
(32) CATHEDRAL (RE) INSURANCE CO
 
 
INSURANCE CJ na
  		C      
(33) UPMC INTERNATIONAL HEALTH INITIATIVES
600 GRANT STREET
PITTSBURGH,PA15219
84-1706741 		INACTIVE PA na
  		C      
(34) UPMC IRELAND LIMITED
6TH FLOOR BEACON HOSPITAL
SANDYFORD   DUBLIN 18
EI
HEALTHCARE SU EI na
  		C      
(35) UPMC UNITED KINGDOM LTD
C/O NAIRCO 11TH FLOOR WHITEFRIARS
LEWINS MEAD,Bristol UKBS1 2NT
UK
98-0571026 		SOFTWARE LICE UK na
  		C      
(36) UPMC CYPRUS HOLDINGS LTD
JULIA HOUSE 3 THEMISTOCLES DERVIS
NICOSIA   CY 1066
CY
HEALTHCARE SU CY na
  		C      
(37) UPMC CYPRUS LTD
JULIA HOUSE 3 THEMISTOCLES DERVIS
NICOSIA   CY 1066
CY
HEALTHCARE SU CY na
  		C      
(38) UPMC Beacon Sandyford Limited
Ste 36 Beacon Hall Beacon Court
Sandyford,N/ADublin 18
EI
Hospital Oper EI na
  		C      
(39) UPMC BCS Limited
Ste 36 Beacon Hall Beacon Court
Sandyford,N/ADublin 18
EI
Holding Compa EI na
  		C      
(40) UPMC BMGS Limtied
Ste 36 Beacon Hall Beacon Court
Sandyford,N/ADublin 18
EI
Triology Leas EI na
  		C      
(41) UPMC BHSH Limited
Beacon Hall The Mall at Beacon Crt
Sandyford,N/ADublin 18
EI
HOLDING COMPA EI na
  		C      
(42) KANE ANESTHESIA PROFESSIONAL SERVICES
4372 ROUTE 6
KANE,PA16735
05-0555457 		ANESTHESIA SV PA na
  		C      
(43) BAYFRONT REGIONAL DEVELOPMENT CORP
300 STATE STREET
ERIE,PA16507
25-1401388 		RE HOLDING CO PA na
  		C      
(44) BAYSIDE DEVELOPMENT CORP
300 STATE STREET
ERIE,PA16507
25-1401386 		REAL ESTATE/P PA na
  		C      
(45) 21ST CENTURY BIODEFENSE INC
600 GRANT STREET
PITTSBURGH,PA15219
26-3806281 		INACTIVE PA na
  		C      
(46) Evolent Health Inc
600 Grant Street
Pittsburgh,PA15219
45-3084136 		Healthcare Suppor DE na
  		C      
(47) UPMC Work Alliance Inc
600 Grant Street
Pittsburgh,PA15219
45-2825053 		Insurance PA na
  		C      
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) CORE NETWORK LLC

 O 28,895,321 COST
(2) UPMC

 J 18,697,407 COST
(3) SHADYSIDE MEDICAL CENTER ASSOCIATES

 J 2,524,282 COST
(4) LILIANE S KAUFMANN MOB ASSOCIATES

 J 1,641,816 COST
(5) ST MARGARET MEDICAL ARTS ASSOCIATES

 J 365,704 COST
(6) UPMC

 O 71,838,809 COST
(7) CHILDREN'S COMMUNITY CARE

 O 384,044 COST
(8) CHILDREN'S COMMUNITY CARE

 P 345,925 COST
(9) THE CENTER FOR BIOSECURITY OF UPMC INC

 P 174,899 COST
(10) STRATEGIC BUSINESS INITIATIVES LLC

 P 1,493,807 COST
(11) UNIVERSITY OF PGH CANCER INST CANCER SERVICE

 P 1,980,046 COST
(12) UNIVERSITY OF PITTSBURGH PHYSICIANS

 P 62,045,702 COST
(13) UPMC COMMUNITY PROVIDER SERVICES

 P 7,025,416 COST
(14) UPMC COMMUNITY MEDICINE INC

 P 6,839,769 COST
(15) UPMC EMERGENCY MEDICINE INC

 P 365,855 COST
(16) UPMC HORIZON

 P 5,132,003 COST
(17) UPMC BEDFORD

 P 1,117,098 COST
(18) UPMC NORTHWEST

 P 2,888,779 COST
(19) MAGEE WOMENS HOSPITAL OF UPMC

 P 77,068,345 COST
(20) UPMC PASSAVANT

 P 33,317,171 COST
(21) UPMC ST MARGARET

 P 23,047,680 COST
(22) CHILDREN'S HOSPITAL OF PGH OF UPMC

 P 31,815,704 COST
(23) UPMC MCKEESPORT

 P 6,930,005 COST
(24) UPMC MERCY

 P 19,733,585 COST
(25) UPMC FOR YOU

 P 4,143,574 COST
(26) COMMUNITY CARE BEHAVIORAL HEALTH ORG

 P 5,605,977 COST
(27) HC PHARMACY CENTRAL INC

 P 51,256 COST
(28) HEMATOLOGY ONCOLOGY ASSOCIATION

 P 1,147,041 COST
(29) ONCOLOGY-HEMATOLOGY ASSOCIATION INC

 P 646,865 COST
(30) UPMC HEALTH BENEFITS INC

 P 172,926 COST
(31) UPMC BENEFIT MANAGEMENT SERVICES INC

 P 2,954,930 COST
(32) UPMC HEALTH PLAN INC

 P 5,772,886 COST
(33) UPMC HEALTH NETWORK INC

 P 3,837,506 COST
(34) CATHEDRAL REINSURANCE COMPANY LTD

 P 627,880 COST
(35) FORBES REINSURANCE COMPANY LTD

 P 508,284 COST
(36) PANTHER REINSURANCE COMPANY LTD

 P 134,546 COST
(37) TRI-CENTURY INSURANCE COMPANY

 P 224,243 COST
(38) MONROEVILLE SPECIALTY CLINIC INC

 P 439,609 COST
(39) TRI-STATE NEUROSURGICAL ASSOCIATES-UPMC INC

 P 411,195 COST
(40) UPMC HOLDING COMPANY INC

 P 7,495,328 COST
(41) RENAISSANCE FAMILY PRACTICE-UPMC INC

 P 731,962 COST
(42) UPMC PRESBYTERIAN SHADYSIDE

 O 315,881,872 COST
(43) upmc

 Q 35,789,113 COST
(44) upmc

 Q 26,841,030 COST
(45) upmc

 Q 8,011,591 COST
(46) upmc

 Q 84,429,304 COST
(47) upmc

 Q 10,903,053 COST
(48) upmc

 Q 33,779,900 COST
(49) upmc

 Q 7,089,943 COST
(50) upmc

 C 10,562,976 COST
(51) upmc

 C 2,461 COST
(52) upmc

 C 11,826,222 COST
(53) upmc

 C 119,267,556 COST
(54) RX PARTNERS INC

 O 331,105 COST
(55) UNIVERSITY OF PITTSBURGH PHYSICIANS

 O 390,971,305 COST
(56) UPMC EMERGENCY MEDICINE INC

 O 689,500 COST
(57) UPMC COMMUNITY MEDICINE INC

 O 99,479 COST
(58) UPMC BEDFORD

 P 188,720 COST
(59) CENTER FOR EMERGENCY MEDICINE OF WESTERN PA

 P 900,443 COST
(60) CHILDREN'S HOSPITAL OF PGH OF UPMC

 P 55,063,891 COST
(61) UPMC EAST

 P 119,276 COST
(62) UPMC COMMUNITY PROVIDER SERVICES

 P 165,649 COST
(63) UPMC FOR YOU

 P 104,490 COST
(64) UPMC HORIZON

 P 1,996,985 COST
(65) MAGEE-WOMENS HOSPITAL OF UPMC

 P 35,501,084 COST
(66) upmc mckeesport

 P 5,750,085 COST
(67) UPMC MERCY

 P 37,787,177 COST
(68) UPMC PASSAVANT

 P 18,767,264 COST
(69) UPMC NORTHWEST

 P 3,208,716 COST
(70) UNIVERSITY OF PGH CANCER INST CANCER SERVICES

 P 598,271 COST
(71) UPMC OVERSEAS

 P 195,481 COST
(72) UPMC PRESBYTERIAN SHADYSIDE

 P 228,434,714 COST
(73) UPMC ST MARGARET

 P 11,658,894 COST
(74) UPMC PRESBYTERIAN SHADYSIDE

 J 9,890,922 COST
(75) CHILDREN'S HOSPITAL OF PGH OF UPMC

 J 7,044,505 COST
(76) MAGEE-WOMENS HOSPITAL OF UPMC

 J 1,888,215 COST
(77) UPMC ST MARGARET

 J 870,071 COST
(78) UPMC PASSAVANT

 J 3,772,366 COST
(79) UPMC HORIZON

 J 959,765 COST
(80) UPMC MCKEESPORT

 J 289,462 COST
(81) UPMC BEDFORD

 J 134,250 COST
(82) UPMC MERCY

 J 2,899,262 COST
(83) UNIVERSITY OF PGH CANCER INST CANCER SERVICES

 J 114,511 COST
(84) UNIVERSITY OF PITTSBURGH PHYSICIANS

 J 295,894 COST
(85) UPMC COMMUNITY MEDICINE INC

 J 473,270 COST
(86) CENTER FOR EMERGENCY MEDICINE OF WESTERN PA

 I 109,800 COST
(87) CHILDREN'S COMMUNITY CARE

 I 70,091 COST
(88) CHILDREN'S HOSPITAL OF PGH OF UPMC

 I 71,505 COST
(89) CORE NETWORK LLC

 I 749,493 COST
(90) THE HERITAGE SHADYSIDE

 I 202,744 COST
(91) UPMC COMMUNITY PROVIDER SERVICES

 I 182,341 COST
(92) COMMUNITY CARE BEHAVIORAL HEALTH ORG

 I 71,080 COST
(93) UPMC HORIZON

 I 76,844 COST
(94) MAGEE-WOMENS HOSPITAL OF UPMC

 I 1,447,882 COST
(95) UNIVERSITY OF PGH CNACER INST CANCER SERVICES

 I 83,244 COST
(96) UNIVERSITY OF PGH CANCER INST CANCER SERVICES

 I 306,141 COST
(97) UPMC PRESBYTERIAN SHADYSIDE

 I 1,068,286 COST
(98) SHADYSIDE MEDICAL CENTER ASSOCIATES

 I 124,800 COST
(99) SENECA PLACE

 I 168,644 COST
(100) UNIVERSITY OF PITTSBURGH PHYSICIANS

 I 17,934,402 COST
(101) UPMC COMMUNITY MEDICINE INC

 I 2,941,047 COST
(102) TRI-STATE NEUROSURGICAL ASSOCIATES-UPMC INC

 I 193,924 COST
(103) RENAISSANCE FAMILY PRACTICE-UPMC INC

 I 72,713 COST
(104) CRANBERRY PLACE

 I 2,182,848 COST
(105) UPMC ST MARGARET

 P 131,235 COST
(106) COMMUNITY FAMILY HEALTH CENTERS INC

 P 85,759 COST
(107) UPMC BEDFORD

 P 75,602 COST
(108) UNIVERSITY OF PITTSBURGH PHYSICIANS

 O 2,721,865 COST
(109) UPMC

 C 1,583,333 cost
(110) upmc horizon

 o 143,703 cost
(111) upmc horizon community healthy foundation

 p 143,703 cost
(112) UPMC OVERSEAS

 O 4,619,347 COST
(113) UPMC ITALY SRL

 P 4,619,347 COST
(114) UPMC PRESBYTERIAN SHADYSIDE

 O 875,858 COST
(115) UNIVERSITY OF PITTSBURGH PHYSICIANS

 P 875,858 COST
(116) MAGEE WOMENS HOSPITAL OF UPMC

 O 125,508 COST
(117) UNIVERSITY OF PITTSBURGH PHYSICIANS

 P 102,913 COST
(118) CHARTWELL

 P 1,056,000 COST
(119) BIOTRONICS

 O 80,305 COST
(120) BIOTRONICS

 O 667,719 COST
(121) UPMC PRESBYTERIAN SHADYSIDE

 O 1,917,576 COST
(122) COMMUNITY FAMILY HEALTH CENTERS INC

 P 1,917,576 COST
(123) UNIVERSITY OF PGH CANCER INST CANCER SERVICES

 P 4,774,017 COST
(124) CHILDREN'S HOSPITAL OF PITTSBURGH OF UPMC

 O 196,797 COST
(125) MAGEE WOMENS HOSPITAL OF UPMC

 O 552,746 COST
(126) UPMC MCKEESPORT

 O 253,476 COST
(127) UPMC MERCY

 O 76,438 COST
(128) UPMC PASSAVANT

 O 505,118 COST
(129) UPMC NORTHWEST

 O 168,757 COST
(130) UPMC PRESBYTERIAN SHADYSIDE

 O 2,755,743 COST
(131) UPMC ST MARGARET

 O 244,649 COST
(132) ERIE PHYSICIANS NETWORK-UPMC INC

 P 4,222,636 COST
(133) UPMC PASSAVANT

 O 84,992 COST
(134) PASSAVANT PROFESSIONAL ASSOCIATES INC

 P 84,992 COST
(135) UPMC EMERGENCY MEDICINE INC

 P 4,026,763 COST
(136) UPMC HORIZON

 O 898,419 COST
(137) MAGEE WOMENS HOSPITAL OF UPMC

 O 744,962 COST
(138) UPMC MCKEESPORT

 O 704,246 COST
(139) UPMC NORTHWEST

 O 1,168,343 COST
(140) PASSAVANT PROFESSIONAL ASSOCIATES INC

 O 397,902 COST
(141) UPMC ST MARGARET

 O 51,000 COST
(142) UPMC ST MARGARET

 P 452,244 COST
(143) UNIVERSITY OF PITTSBURGH PHYSICIANS

 O 85,405 COST
(144) UPMC COMMUNITY MEDICINE INC

 O 257,732 COST
(145) UPMC SENIOR COMMUNITIES

 O 1,859,626 COST
(146) UPMC HEALTH PLAN INC

 O 600,502 COST
(147) UPMC COMMUNITY PROVIDER SERVICES

 P 338,420 COST
(148) UPMC VISITING NURSES ASSOCIATION

 O 116,478 COST
(149) UPMC COMMUNITY MEDICINE INC

 P 62,931,798 COST
(150) UPMC BEDFORD

 O 3,412,139 COST
(151) UPMC HORIZON

 O 9,814,300 COST
(152) MAGEE WOMENS HOSPITAL OF UPMC

 O 3,169,147 COST
(153) UPMC MCKEESPORT

 O 3,544,925 COST
(154) UPMC MERCY

 O 3,507,695 COST
(155) UPMC PASSAVANT

 O 9,096,844 COST
(156) UPMC NORTHWEST

 O 6,493,158 COST
(157) UPMC PRESBYTERIAN SHADYSIDE

 O 12,695,021 COST
(158) UPMC ST MARGARET

 O 11,198,569 COST
(159) UPMC PRESBYTERIAN SHADYSIDE

 O 410,892 COST
(160) COMMUNITY FAMILY HEALTH CENTERS INC

 P 410,892 COST
(161) UNIVERSITY OF PGH CANCER INST CANCER SERVICES

 P 5,732,970 COST
(162) UPMC NORTHWEST

 O 740,446 COST
(163) UPMC PRESBYTERIAN SHADYSIDE

 O 4,992,542 COST
(164) PRESBYTERIAN HEALTH RESOURCE MANAGEMENT INC

 O 2,725,712 COST
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
PART III IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP RESPONSES AND AMOUNT IN COLUMNS F-K REPRESENT TOTALS/RESPONSE FOR UPMC(PARENT) AND/OR ALL UPMC GROUP MEMBERS
PART IV IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A CORPORATION OR TRUST AMOUNTS REPORTED IN COLUMNS F-G REPRESENT TOTALS FOR UPMC(PARENT) AND/OR ALL UPMC GROUP MEMBERS.
Additional Data


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