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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
Alle-Kiski Medical Center
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
C/O Tax Dept 120 Fifth Ave Suit
Suite
Room/suite
City or town, state or country, and ZIP + 4
Pittsburgh, PA15212
D Employer identification number

25-1875178
E Telephone number

G Gross receipts $ 195,627,889
F Name and address of principal officer:
Matthew Peterson
30 Isabella Street
Pittsburgh,PA15212
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.wpahs.org
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 MediumBullet  
K Form of organization:
 
L Year of formation: 2000
M State of legal domicile: PA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: See Form 990, Page 2, Part III, Question 1
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 13
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 10
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 1,235
6 Total number of volunteers (estimate if necessary) ............. 6 169
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 4,526,454
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -2,813,158
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 75,653 10,020
9 Program service revenue (Part VIII, line 2g) ......... 123,807,673 116,972,070
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,031,554 1,175,923
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 4,877,521 7,791,006
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 129,792,401 125,949,019
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,168 1,000
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) 55,223,034 57,640,689
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 68,225,339 70,515,458
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 123,449,541 128,157,147
19 Revenue less expenses. Subtract line 18 from line 12....... 6,342,860 -2,208,128
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 92,939,334 102,598,203
21 Total liabilities (Part X, line 26)............. 94,485,665 134,186,914
22 Net assets or fund balances. Subtract line 21 from line 20..... -1,546,331 -31,588,711
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 MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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: Alle-Kiski Medical Center is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit.
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 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 $ 35,040,045 including grants of $   ) (Revenue $ 15,611,433 )
Alle-Kiski Medical Center is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. To complete this mission, Alle-Kiski Medical Center provides Medical services to all patients regardless of their ability to pay.
4b (Code:   ) (Expenses $ 23,986,058 including grants of $   ) (Revenue $ 8,002,153 )
Alle-Kiski Medical Center is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. Alle-Kiski Medical Center provides Onocology services to all patients regardless of their ability to pay.
4c (Code:   ) (Expenses $ 8,045,475 including grants of $   ) (Revenue $ 6,646,996 )
Alle-Kiski Medical Center is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. Alle-Kiski Medical Center provides Behavioral Health services to all patients regardless of their ability to pay.
(Code:   ) (Expenses $ 47,288,705 including grants of $ 1,000 ) (Revenue $ 89,676,689 )
Other Medical Services Provided To Our Patients
4d Other program services (Describe in Schedule O.)
(Expenses $ 47,288,705 including grants of $ 1,000 ) (Revenue $ 89,676,689 )
4e Total program service expensesMediumBullet114,360,283
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? 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 I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
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
 
No
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 for escrow or custodial account liability; 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, line 10?
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 VIIClick to see attachment.......
11b
Yes
 
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 VIIIClick 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 IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick 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 XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII 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 and XII 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
 
No
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, Parts I and IV.........
14b
 
No
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 United States? If “Yes,” complete Schedule F, Parts II and IV
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 United States? If “Yes,” complete Schedule F, Parts III and IV...
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 I (see instructions)....
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............
18
 
No
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...................
19
 
No
20a
Did the organization operate one or more hospital facilities? 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 statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
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...
21
 
No
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........
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 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 lines 24b through 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
 
No
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........
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...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
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.........
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 ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
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 direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
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
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part 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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
89
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
1,235
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, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
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 as charitable contributions?...
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
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
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
 
 
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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 .....................
1a
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
10
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
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
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 this 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
 
No
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
 
 
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:
MediumBulletMATTHEW PETERSON30 ISABELLA STREETPittsburghPA15212 (412) 330-6090
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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) Russell Evans........................................................................
Chair
 1.0
.......................   		X   X            
(2) David Bonvenuto........................................................................
Director
 1.0
.......................   		X                
(3) Jason Ross........................................................................
Director
 1.0
.......................   		X                
(4) Russell Livingston........................................................................
Director
 1.0
.......................   		X                
(5) Ginger Taylor........................................................................
Director
 1.0
.......................   		X                
(6) David Shin MD........................................................................
Director
 1.0
.......................   		X                
(7) Janis Evans........................................................................
Director
 1.0
.......................   		X                
(8) Hadi Firoz MD........................................................................
Director
 1.0
.......................39.0 		X           0 334,716 0
(9) Robin Bergstrom........................................................................
Director
 1.0
.......................   		X                
(10) Jerry Taylor MD........................................................................
Ex Officio Director
 1.0
.......................   		X                
(11) John Balacko MD........................................................................
Ex Officio Director
 1.0
.......................39.0 		X           0 594,268 0
(12) Emanual Dinatale........................................................................
Ex-Officio Director
 1.0
.......................   		X                
(13) John Isherwood........................................................................
Ex Officio Director
 1.0
.......................   		X                
(14) Ned Laubacher........................................................................
Hospital President & CEO
 1.0
.......................39.0 		X   X       0 333,121 0
(15) Robert Brandfass........................................................................
Secretary
 1.0
.......................39.0 		    X       0 478,243 0
(16) Matthew Peterson........................................................................
Treasurer
 1.0
.......................39.0 		    X       0 281,808 0
(17) Michael Sirott........................................................................
Secretary
 1.0
.......................39.0 		    X       0 193,042 0
Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line) 		(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) Michael Harlovic........................................................................
Sr. VP and Chief Oper. Officer
 40.0
.......................   		      X     230,813 0 0
(19) William Englert........................................................................
VP - Business Development
 40.0
.......................   		      X     146,703 0 0
(20) Walter Hoover........................................................................
Physician
 40.0
.......................   		        X   140,696 0 0
(21) Nancy Kantorski........................................................................
Pharmacist
 40.0
.......................   		        X   112,714 0 0
(22) Diane Bowser........................................................................
Pharmacist
 40.0
.......................   		        X   115,939 0 0
(23) Mary Wasilowski........................................................................
Pharmacist
 40.0
.......................   		        X   117,502 0 0
(24) Eric Yarnell........................................................................
Director of Pharmacy
 40.0
.......................   		        X   147,611 0 0
(25) Christopher Olivia MD........................................................................
Health System President & CEO
  
.......................   		          X 0 1,261,143 0
(26) Diane Dismukes........................................................................
Health System President & CEO
  
.......................   		          X 0 833,367 0
(27) Roy Santarella........................................................................
Treasurer
  
.......................   		          X 0 703,046 0
(28) David Kiehn........................................................................
Assistant Treasurer
  
.......................   		          X 0 619,128 0
(29) George Sandora........................................................................
Vice President of Finance
  
.......................   		          X 0 157,687 0


1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,011,978 5,789,569 0
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet12
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
MModal Services LTD, PO Box 102467ATLANTAGA30368 Transcription Servic 324,857
Clean Care, 51ST and AV R RPITTSBURGHPA15201 Linen Services 475,031
Emergency Medicine Physician -Alle-, 4535 Dressler RoadCANTONOH44718 Emergency Med. Care 168,000
Laser Technology Services Ltd, 1009 Merchant StreetAMBRIDGEPA15003 Laser Service 143,450
JSO Associates, 1301 Carlisle StNATRONA HEIGHTSPA15065 Lithotripsy Service 156,098
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet5
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		10,020
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 10,020
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 621500 116,972,070 112,909,503 4,062,567  
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 116,972,070
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 645,359     642,214
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 763,238  
b Less: rental expenses    
c Rental income or (loss) 763,238 0
d Net rental income or (loss).......MediumBullet 763,238   463,887 299,351
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 70,208,552 882
b Less: cost or other basis and sales expenses 69,678,870  
c Gain or (loss) 529,682 882
d Net gain or (loss)..........MediumBullet 530,564     530,564
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
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 ELECTRONIC HEALTH RECORDS 621110 2,582,247 2,582,247    
b SCHOOL OF NURSING TUITION 621110 1,649,091 1,649,091    
c CAFETERIA REVENUE 621110 771,380 771,380    
d All other revenue .... 2,025,050 2,025,050    
e Total. Add lines 11a–11d ...... MediumBullet 7,027,768
12 Total revenue. See Instructions......MediumBullet 125,949,019 119,937,271 4,526,454 1,472,129
Form 990 (2012)
Form 990 (2012)
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).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 1,000 1,000
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 .... 405,447   405,447  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 45,669,280 38,818,888 6,850,392  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,268,372 1,928,117 340,255  
9 Other employee benefits ....... 6,187,140 5,259,069 928,071  
10 Payroll taxes ........... 3,110,450 2,643,882 466,568  
11 Fees for services (non-employees):        
a Management ...... 799,975   799,975  
b Legal ......... 43,921 39,529 4,392  
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 53,455   53,455  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 3,273,245 2,945,920 327,325  
12 Advertising and promotion .... 9,302 8,372 930  
13 Office expenses ....... 542,284 488,056 54,228  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 3,594,026 3,234,623 359,403  
17 Travel ............ 89,194 80,275 8,919  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 12,689 11,420 1,269  
20 Interest ........... 3,503,002 3,430,210 72,792  
21 Payments to affiliates ....... 16,073,352 14,466,017 1,607,335  
22 Depreciation, depletion, and amortization ..... 6,286,245 5,657,620 628,625  
23 Insurance .............. 1,811,629 1,811,629    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a PATIENT CARE COSTS 14,807,793 14,807,793    
b BAD DEBT 9,758,674 9,758,674    
c REPAIR AND MAINTENANCE 4,394,200 3,954,780 439,420  
d PA ACT 49 - QUALITY CARE 1,815,468 1,815,468    
e All other expenses 3,647,004 3,198,941 448,063  
25 Total functional expenses. Add lines 1 through 24e 128,157,147 114,360,283 13,796,864 0
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 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 4,255 1 3,264
2 Savings and temporary cash investments ......... 21,841,961 2 10,419,447
3 Pledges and grants receivable, net ........... 0 3 7,777
4 Accounts receivable, net ............. 12,779,072 4 13,635,034
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 1,447,304 8 1,386,999
9 Prepaid expenses and deferred charges .......... 742,999 9 912,305
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 36,493,251
b Less: accumulated depreciation ..... 10b 671,184 29,258,642 10c 35,822,067
11 Investments—publicly traded securities .......... 22,893,369 11 22,878,425
12 Investments—other securities. See Part IV, line 11 ..... 130,306 12 15,046,364
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 2,257,047 14 -77,829
15 Other assets. See Part IV, line 11 ........... 1,584,379 15 2,564,350
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 92,939,334 16 102,598,203
Liabilities 17 Accounts payable and accrued expenses ......... 9,344,001 17 9,165,540
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 3,062,589 19 2,791,815
20 Tax-exempt bond liabilities ............. 64,630,994 20 63,560,927
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other 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 .. 3,817,245 23 2,863,960
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.................... 13,630,836 25 55,804,672
26 Total liabilities. Add lines 17 through 25......... 94,485,665 26 134,186,914
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. -1,725,440 27 -31,767,937
28 Temporarily restricted net assets ........... 179,109 28 179,226
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... -1,546,331 33 -31,588,711
34 Total liabilities and net assets/fund balances ........ 92,939,334 34 102,598,203
Form 990 (2012)
Form 990 (2012)
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
125,949,019
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
128,157,147
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-2,208,128
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
-1,546,331
5
Net unrealized gains (losses) on investments ...............
5
-1,182,007
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-26,652,245
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
-31,588,711
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
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 supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

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
2012
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Alle-Kiski Medical Center
  		Employer identification number

25-1875178
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Alle-Kiski Medical Center
  		Employer identification number

25-1875178
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Alle-Kiski Medical Center
  		Employer identification number

25-1875178
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) (2012)

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
2012
Open to Public Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 179,109 108,326 108,131 106,555 102,387
b Contributions ........ 20 70,653   968 2,760
c Net investment earnings, gains, and losses 97 130 195 608 1,408
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ...... 179,226 179,109 108,326 108,131 106,555
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet100.000 %
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)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII 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 .................   588,000 588,000
b Buildings ................   22,506,454 369,058 22,137,396
c Leasehold improvements ............   0 0 0
d Equipment ................   10,903,484 268,362 10,635,122
e Other .................   2,495,314 33,765 2,461,549
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 35,822,067
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
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    
(3)Other
(A) INVESTMENT IN AMERINET 		47,349 F

(B) INVESTMENT IN VHA 		33,075 F

(C) INVESTMENT ACCT 		14,965,940 F






Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 15,046,364
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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
ACCRUED PENSION COSTS 12,898,134
THIRD PARTY SETTLEMENTS 1,776,517
ASBESTOS RETIREMENT OBLIGATION 85,252
DUE TO AFFILIATED ORGANIZATION 41,044,769





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 55,804,672
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI 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 XIII.) ............ 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 XIII.) ........... 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 XII 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 XIII.) ............ 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 XIII.) ............ 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 XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
AKMC Inclusion In The Consolidated Audit of WPAHS Form 990, Schedule D, Part X Question 2 and Part XIII Alle-Kiski Medical Center does not receive its own independent audit. It is a member of a regional healthcare system named West Penn Allegheny Health System. West Penn Allegheny Health System receives a consolidated audit that includes the operations of Alle-Kiski Medical Center. The following analysis represents the reconciliation between the Alle-Kiski Medical Center financial statement net income and the net income as reported on Form 990, Page 1, line 19: Net Income Per Financial Statements ($3,390,253) Plus: Income Reclassified From Restricted Net Assets on the Financial Statements to Unrestricted Revenue on Form 990 118 Less: Unrealized Loss on Investments reflected as current year gain on the financial statements reclassified through net assets on Form 990 1,182,007 ___________ Net Income Per Form 990 ($2,208,128) The following is the footnote to the audited consolidated financial statements of the West Penn Allegheny Health System for FASB ASC 740: WPAHS adopted Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) 740, Income Taxes, which clarifies the accounting for uncertainty in income taxes recognized in an enterprise's financial statements. FASB ASC 740 prescribes a more-likely than-not recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken. Under FASB ASC 740, tax positions will be evaluated for recognition, derecognition, and measurement using consistent criteria and will provide more information about the uncertainty in income tax assets and liabilities. Based on an analysis prepared by WPAHS, it was determined that the application of FASB ASC 740 had no material effect on the recorded assets and liabilities of WPAHS.
Intended Use of the Organization Endowment Funds Schedule D, Page 2, Part V, Line 4 The intended use of Alle-Kiski Medical Center term endowments are for but not exclusive to: capital improvements, research, education, departmental needs, operating efficiencies, and overall patient care.
Schedule D (Form 990) 2012

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
2012
Open to Public Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Part I
Financial Assistance 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) as a factor in determining 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 as a factor in determining 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 used factors other than FPG in determining 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, as a factor in determining 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

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
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) .. 		    347,305   347,305 0.290 %
b Medicaid (from Worksheet 3,
column a) .... 		    10,470,297 6,154,820 4,315,477 3.640 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    10,817,602 6,154,820 4,662,782 3.930 %
Other Benefits
     608,296   608,296 0.510 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    3,304,034 3,298,590 5,444  
g Subsidized health services
(from Worksheet 6) .. 		    188,175 133,948 54,227 0.050 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    6,806   6,806 0.010 %
j Total. Other Benefits ..     4,107,311 3,432,538 674,773 0.570 %
k Total. Add lines 7d and 7j .     14,924,913 9,587,358 5,337,555 4.500 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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     9,572   9,572 0.010 %
7 Community health improvement advocacy     361,171   361,171 0.310 %
8 Workforce development            
9 Other            
10 Total     370,743   370,743 0.320 %
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. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
2,531,400
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
949,635
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
17,513,762
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
21,425,246
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-3,911,484
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
Yes
 
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

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—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 %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Alle-Kiski Medical Center
1301 Carlisle Street
Natrona Heights,PA15065 		X X         X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Alle-Kiski Medical Center
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 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.
11 Used FPG to determine eligibility for providing discounted care?................. 11 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.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 Check all of the following 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
b
c
d
e
17 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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?7
Name and address Type of Facility (describe)
1 Vandergrift Outpatient Care Center
244 Longfellow Street
Vandergrift,PA15690 		Outpatient Care Center
2 Citizens Ambulatory Care Center
651 Fourth Avenue
New Kensington,PA15065 		Ambulatory Care Center
3 AVH Outpatient Physical Therapy
1620 Pacific Avenue
Natrona Heights,PA15065 		Physical Therapy
4 Allegheny Valley Hospital Prolab
1620 Pacific Avenue
Natrona Heights,PA15065 		Laboratory Services
5 Allegheny Valley Hospital Prolab
2692 Leechburg Road
Lower Burrell,PA15068 		Laboratory Services
6 Destination Wellness
590 Pittsburgh Mills Circle
Tarentum,PA15084 		General Health and Wellness
7 AKMC Radiological Imaging
2801 Freeport Road
Natorna Heights,PA15065 		Radiological Imaging
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
Bad Debt Expense Financial Statement Footnote and Costing Methodology Schedule H, Part III, Question 4 Alle-Kiski Medical Center does not issue separate audited financial statements and therefore a footnote does not exist. Bad Debt expense is accounted for on a charge basis in our internal financial statements. A cost to charge ratio is applied to the internal figures to convert the charge to cost. It is the opinion of Alle-Kiski Medical Center management that because patients are often reluctant to complete the required charity care paperwork that an unquantifiable amount of charity care results in bad debt. Thus, it is our opinion that bad debt expense can be considered a justifiable component of charity care.
Medicare Shortfall as a Community Benefit and Costing Methodology Schedule H, Part III, Question 8 Alle-Kiski Medical Center receives overall reimbursement from medicare less than the cost of the services provided. As such, we consider the shortfall a community benefit. The source used to determine the amount reported on line 6 is the Medicare Cost Report.
Collection Practices For Patients Who Qualify For Financial Assistance Schedule H, Part III, Question 9b Patients that qualify for charity care or financial assistance are provided with an approval letter with the effective dates for the assistance. At any time the individual presents for services within a 90 day span of approval, they show the letter and will be registered as a charity care case. Charity care cases are designated in the internal computerized systems with unique plan codes that prevent billing to the patient. Reports are run to capture the patient accounts registered with the charity care plan codes so they can be written off to charity care.
Charges For Medical Care Schedule H, Part V, Line 19 Alle-Kiski Medical Center offers uninsured patients a fifty percent (50%) discount on total gross charges to all hospital charges. The intent of the discount is to standardize charging practices for covered and non covered patients. The discount is offered during patient contact for elective/ urgent (non cosmetic) procedures during the financial counseling process, as well as during the patient statement cycle process for services provided (including Emergency services.) Patient statements are clearly marked with the uninsured discount, reducing the 'amount owed' of the gross charges. An uninsured discount of 50% is applied to the patient account either at the time of payment or prior to transferring the account to bad debt upon conclusion of the routine four statement cycle, for any unpaid balances.
Charges Equal To Gross Charges For Patient Services Schedule H, Part V, Line 21 The facility offers a variety of procedures. For elective and non medically emergent procedures not covered by health plans, individual fee schedules are published and communicated prior to services. Patients are contacted in advance of the procedure by financial counselors and are required to pay for services in full based on the fee schedule. The patient is required to pay the hospital fee schedule for the technical component and the physician for the professional services rendered.
Health Needs Assessment Schedule H, Part VI, Line 2 Alle-Kiski Medical Center (AKMC) management and staff utilize multiple strategies to continually monitor and assess the health care needs of the communities it serves. One approach to assessing needs involves surveying community members about health needs related to national and state health goals. Alle-Kiski Medical Center also acts on expressed community needs by responding to direct community requests for health screenings, outreach events and other health-related activities and by maintaining longstanding programs that are well attended and positively evaluated by community participants. In addition, Alle-Kiski Medical Center gathers community input through participation in area rotaries, chambers of commerce, through partnerships with community organizations and other community engagement activities. Another means is through reviewing and taking appropriate actions on feedback gathered from the following sources: routine market assessments; patient and family satisfaction surveys; Press Ganey surveys; patient, patient family and staffs' suggestions for improving patient safety; medical staff input and physician surveys. Alle-Kiski Medical Center ( AKMC) conducted a Community Health Needs Assessment (CHNA) during the year ended June 30, 2013 in accordance with IRC Section 501(r) and the guidance documented in the Internal Revenue Bulletin 2011-30, Notice 2011-52 and the proposed regulations issued April 5, 2013. The CHNA process began in August 2012 and concluded in May 2013. The Board of Directors that govern AKMC approved an implementation strategy designed to address the community health needs identified in the CHNA on September 23, 2013. The CHNA process included input from persons representing the broad interests of the community including individuals with special knowledge of or expertise in public health, organizations with information relevant to the health needs of the community and representatives of medically underserved populations. To achieve this end, the Hospital included representatives of the following organizations in the conduct of the CHNA: West Penn Allegheny Health System; Highmark, Inc.; Allegheny-Kiski Health Foundation; Family Services of Western Pennsylvania; Allegheny Valley Association of Churches; Citizens General Hospital Foundation; Tri-City Life Center, Inc.; Citizens Family Health Clinic; and Community Health Clinic, Inc. The results of the CHNA identified multiple health needs in the communities we serve. The Hospital addressed the following health needs: diabetes, colorectal cancer and breast cancer. The CHNA identified the following health needs the Hospital chose not to address: high blood pressure/hypertension, cardiovascular disease and obesity. We did not specifically address these because either (1) the health need was considered to be a co-morbidity to a condition we chose to focus on, such as blood pressure/hypertension and obesity could be positively impacted as part of an effective diabetes management program or (2) a strong program already exists within the hospital, as is the case with cardiovascular disease. The Hospital has made the CHNA widely available to the public. To accomplish this, we have published an executive summary and the full results of AKMC's CHNA at http://www.wpahs.org/community-health-needs-assessments.
Patient Education For Eligibility For Assistance Schedule H, Part VI, Line 3 Alle-Kiski Medical Center displays signage in various patient Admission, Registration and Emergency Department areas that alerts that patient to Account Assistance program availability and contact information. During the preservice process, patients are evaluated to determine financial assistance options. Alle-Kiski Medical Center offers the "Account Assistance Program" which consists of application assistance for governmental eligibility, Charity Care application completion and submission support, as well as uninsured provisions. Account Assistance summaries are available on the West Penn Allegheny Health system website www.wpahs.org under the link titled, "Care for Uninsured" are available to the public. The Charity Care application, as well as, a Medical Assistance check list is available for patients who wish to self-apply. In addition to the documents, toll free telephone numbers regarding Account Assistance, charity and/or other financial inquiries are available. The website also contains a copy of the brochure that summarizes the Account Assistance program, as well as provides various governmental and internal numbers to patients seeking additional support. Alle-Kiski Medical Center also provides on-site support through Financial Counselor staff who are available to work with patient walk in's. Financial Counselors work directly with the patients as well as designated agency support regarding qualifying patients for Medical Assistance. Both week day and weekend coverage is available to the patients, as well as field support needed for post discharge follow up needed for application submission. The above support is available at no charge to the patient.
Community Served Information Schedule H, Part VI, Line 4 Alle-Kiski Medical Center, located in Natrona Heights Pennsylvania, provides health care services to residents of Allegheny, Armstrong, Beaver and Butler Counties. Located approximately 20 miles outside of Pittsburgh, Natrona Heights has approximately 10,500 residents. Allegheny County consists of approximately 1,227,000 residents living in a land area of approximately 730 square miles. The median housing value in Allegheny County is $118,700. Armstrong County consists of approximately 69,000 residents living in a land area of approximately 654 square miles. The median housing value in Armstrong County is $91,600. Beaver County consists of approximately 171,000 residents living in a land area of approximately 434 square miles. The median housing value in Beaver County is $113,600. Butler County consists of approximately 185,000 residents living in a land area of approximately 789 square miles. The median housing value in Butler County is $162,900. Together, Allegheny, Armstrong, Beaver and Bulter Counties form the primary service area for Alle-Kiski Medical Center.
Promotion of Community Health Schedule H, Part VI, Line 5 The Alle-Kiski Medical Center (AKMC) Emergency Department cares for the community by operating 24 hours a day, 7 days a week with highly skilled and trained emergency medicine physicians and nurses. The Emergency Department is open to all individuals regardless of their ability to pay. The emergency response capabilities of AKMC are provided in conjunction with Alle-Kiski Paramedic Unit for Life Support Emergency Response (AKPULSER), a paramedic response unit and a separate 501(c)(3) organization. AKMC staffs the emergency department physicians who provide medical command to the AKPULSER ambulance crew in the field. Our emergency response service has been designated as the primary 911 responder for the greater Alle-Kiski Valley Service Area. The voting members of the AKMC Board of Directors consist of a majority of independent community members without personal financial ties to the hospital or any of its affiliated organizations.
Affiliated Healthcare System Schedule H, Part VI, Line 6 West Penn Allegheny Health System (WPAHS) is comprised of some of the oldest and best-known names in health care in western Pennsylvania. From their inception, the system's hospitals have been in the vanguard of patient care, medical research and health sciences education. Comprised of two tertiary and three community hospitals, WPAHS includes Allegheny General Hospital and The Western Pennsylvania Hospital, both in Pittsburgh; Alle-Kiski Medical Center in Natrona Heights; Canonsburg General Hospital in Canonsburg; and The Western Pennsylvania Hospital - Forbes Regional Campus in Monroeville. Offering a comprehensive range of medical and surgical services, the hospitals serve Pittsburgh and the surrounding five-state areas, house nearly 1,600 beds and employ more than 11,000 people. Together, the WPAHS hospitals admit nearly 56,000 patients, log over 164,000 emergency visits and deliver more than 3,800 newborns each year. Combined, the hospitals are among the leaders in percentages of total surgeries, cardiac surgeries, neurosurgeries and cardiac catheterization procedures performed throughout the region. Through the West Penn Allegheny Health System, Alle-Kiski Medical Center (AKMC) is able to ensure that area residents have access to a complete continuum of health care services. Also, through appropriate integration across the system, both clinically and operationally, the hospital is able to remain a high-quality, low-cost provider with linkages to the latest medical research and advanced technology. AKMC's main campus is in Natrona Heights. The 228-bed hospital serves as AKMC's inpatient facility and offers a broad spectrum of programs, including medical and surgical services, inpatient psychiatric care and geriatric psychiatric care, cardiology and orthopaedics. Virtually all outpatient services are available on the hospital campus. AKMC's Ambulatory Care Center presents a wide array of outpatient programs, including medical oncology services, laboratory studies, cardiac diagnostics and radiology services, such as routine X-rays, CT scans, mammography and ultrasound. In addition, the site is the home of the Joslin Diabetes Center Affiliate at AKMC and an Urgent Care Center for the treatment of minor medical emergencies. On April 29, 2013, WPAHS consummated an affiliation with Highmark Health, a 501(c)(3) tax exempt organization. This affiliation was one step toward the creation of an integrated delivery system named Allegheny Health Network. In addition to WPAHS, the Allegheny Health Network also includes Jefferson Regional Medical Center, Saint Vincent Health System and Saint Vincent Health Center.
State Filing of Community Benefit Report Schedule H, Part VI, Line 7 Alle-Kiski Medical Center files the community benefit report with the State of Pennsylvania as part of our obligation to furnish the State of Pennsylvania with a copy of the IRS Form 990 and related schedules.
Schedule H (Form 990) 2012
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
2012
Open to Public Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
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 of 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 filing organization used 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
 
No
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
 
No
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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 (E) amounts for that individual.
(A) Name and Title (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)Hadi Firoz MDDirector (i)
(ii)		 0
294,038 		0
40,438 		0
240 		0
8,125 		0
9,476 		0
352,317 		0
0
(2)Christopher Olivia MDHealth System President & CEO (i)
(ii)		 0
0 		0
0 		0
1,261,143 		0
625,000 		0
7,325 		0
1,893,468 		0
1,250,000
(3)Michael HarlovicSr. VP and Chief Oper. Officer (i)
(ii)		 230,315
0 		0
0 		498
0 		9,434
0 		8,732
0 		248,979
0 		0
0
(4)Roy SantarellaTreasurer (i)
(ii)		 0
0 		0
0 		0
703,046 		0
585,817 		0
183 		0
1,289,046 		0
703,046
(5)John Balacko MDEx Officio Director (i)
(ii)		 0
487,034 		0
106,682 		0
552 		0
10,000 		0
10,052 		0
614,320 		0
0
(6)Robert BrandfassSecretary (i)
(ii)		 0
317,358 		0
150,717 		0
10,168 		0
0 		0
10,801 		0
489,044 		0
0
(7)David KiehnAssistant Treasurer (i)
(ii)		 0
13,033 		0
100,000 		0
506,095 		0
0 		0
725 		0
619,853 		0
564,419
(8)George SandoraVice President of Finance (i)
(ii)		 0
88,018 		0
0 		0
69,669 		0
5,782 		0
5,114 		0
168,583 		0
69,389
(9)Diane DismukesHealth System President & CEO (i)
(ii)		 0
0 		0
0 		0
833,367 		0
0 		0
183 		0
833,550 		0
833,367
(10)Ned LaubacherHospital President & CEO (i)
(ii)		 0
326,975 		0
0 		0
6,146 		0
10,000 		0
9,487 		0
352,608 		0
0
(11)Matthew PetersonTreasurer (i)
(ii)		 0
231,605 		0
50,000 		0
203 		0
6,250 		0
9,353 		0
297,411 		0
0
(12)Michael SirottSecretary (i)
(ii)		 0
192,662 		0
0 		0
380 		0
0 		0
9,370 		0
202,412 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Additional Compensation Disclosure Form 990, Schedule J, Page 1, Line 4a The following represents additional disclosure for Schedule J, line 4a pertaining to officers and key employees listed in Form 990, Part VII, Section A, Line 1a receiving severance pay during the calendar year ending within the June 30, 2013 fiscal year end: Christopher Olivia, MD $1,250,000 Diane Dismukes $ 833,367 Roy Santarella $ 703,046 David Kiehn $ 464,419 George Sandora $ 69,389
Deferred Compensation Schedule J, Part II, Column C Retirement and other deferred compensation reflect amounts accrued to the benefit of the applicable individuals related to qualified pension and severance plans. In this regard, the following individuals have amounts accrued related to future severance payments to be made: Christopher Olivia, MD Roy Santarella George Sandora
Schedule J (Form 990) 2012

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
2012
Open to Public
Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number
25-1875178
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
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . .        
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . .        
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . .        
8 Credit enhancement from proceeds . . . . . . . . . . .        
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . .        
11 Other spent proceeds . . . . . . . . . . . . . .        
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . .
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .                
15 Were the bonds issued as part of an advance refunding issue? . . . . .                
16 Has the final allocation of proceeds been made? . . . . . . . .                
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .                
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? . . . . . . .                
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .                
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
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? . . . . . . . . . . . .                
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? . . . . . . . . . . . . . . .                
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   %   %   %   %
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? . . . . .                
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .                
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 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?
               
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .                
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .                
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
               
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .                
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?                
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . . . .                
e Was a hedge terminated? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .                
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .                
7 Has the organization established written procedures to monitor the requirements of section 148? . . .                
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 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
Bond Information Form 990, Schedule K, Part VI Alle-Kiski Medical Center is a member of the West Penn Allegheny Health System obligated group in regards to 2007 Allegheny County Hospital Development Authority tax-exempt bonds. Accordingly, Schedule K has been inserted into this Form 990 for full disclosure purposes. The IRS Form 990 filed for West Penn Allegheny Health System, Inc., EIN: 25-0969492 contains the full disclosure for schedule K.
Schedule K (Form 990) 2012

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
2012
Open to Public
Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Identifier Return Reference Explanation
IRS Form 990 - Organizational Comment IRS Form 990 On April 29, 2013, West Penn Allegheny Health System, Inc., the parent organization of the West Penn Allegheny Health System formalized an affiliation with Highmark Health, EIN: 45-3674900, a 501(c)(3) tax exempt organization to become a member of a newly created integrated delivery system named Allegheny Health Network (the "Network"). West Penn Allegheny Health System, Inc. is the sole member of Alle-Kiski Medical Center. In addition to West Penn Allegheny Health System, the Allegheny Health Network also consists of Jefferson Regional Medical Center, Saint Vincent Health Center and Saint Vincent Health System. In total, the Network consists of 22 different organizations exempt from federal income tax under IRS Section 501(c)(3). The parent organization of the Network is Allegheny Health Network, EIN: 45-3674924, a 501(c)(3) tax exempt organization. Together, these organizations have combined to create a cost-effective health system that raises quality, enhances outcomes and preserves consumer choice for everyone. Statement of Program Service Accomplishments Form 990, Page 2, Part III, Line 4a INTRODUCTION TO ALLE-KISKI MEDICAL CENTER Alle-Kiski Medical Center is dedicated to providing exceptional health care to nearly 170,000 people in portions of Allegheny, Butler, Westmoreland and Armstrong counties. AKMC is a member of the Allegheny Health Network by virtue of being affiliated with West Penn Allegheny Health System (WPAHS). Organized in 2000, WPAHS (www.wpahs.org) is comprised of West Penn Allegheny Health System, Inc. (WPAHS, Inc.), Canonsburg General Hospital (CGH), Allegheny Medical Practice Network (AMPN), Allegheny Specialty Practice Network (ASPN), Allegheny-Singer Research Institute (ASRI), West Penn Allegheny Oncology Network (WPAON), West Penn Physician Practice Network (WPPPN), Canonsburg General Hospital Ambulance Service (CGH Ambulance), Alle-Kiski Medical Center Trust (AKMC Trust), Forbes Health Foundation (FHF), Suburban Health Foundation (SHF), The Western Pennsylvania Hospital Foundation (WPHF) as well as AKMC. AKMC is comprised of a hospital campus, located in Allegheny County at 1301 Carlisle Street, Natrona Heights, Pa., and outpatient care centers located throughout the community. The AVH Outpatient Care Center - New Kensington is located in Westmoreland County at 651 Fourth Avenue, New Kensington, Pa., and offers a number of outpatient services, including radiology, laboratory, medical oncology and hematology, the Joslin Diabetes Center and an Urgent Care Center for minor emergencies. AKMC also offers two off-campus lab draw sites, one in Lower Burrell, Pa., and another in Natrona Heights, Pa. An off-campus outpatient physical therapy center in Natrona Heights offers patients rehabilitation services in a convenient location. AKMC Radiological Imaging, located in Allegheny County at 2801 Freeport Road, Natrona Heights Pa., offers outpatient radiology imaging services including X-rays, CT scans, mammography, MRI, ultrasound and bone-density testing. The AKMC outpatient care center in Vandergrift offers basic imaging services, cardiac services, lab draws and sleep studies. For the 12 months ended June 30, 2013, AKMC treated 7,523 inpatient discharges, 216,933 outpatients, 44,593 emergency department and urgent care center visits and 5,731 inpatient and outpatient surgeries. The hospital has 313 physicians on staff and 1,235 employees at December 31, 2012. PURPOSE AND MISSION Alle-Kiski Medical Center is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. We pledge to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. UNCOMPENSATED CARE To enhance the health status of the community in which it operates and consistent with its tax-exempt status, AKMC provides needed health care services to individuals regardless of their ability to pay for all or part of the services rendered. These services include both inpatient and outpatient services as well as an emergency room that remains available 24 hours a day. Consistent with the filing of Schedule H, the components of uncompensated care include charity care and unreimbursed Medicaid costs. AKMC provided uncompensated care at a cost of $4,662,782 in Fiscal 2013. COMMUNITY ASSESSMENT Community Health Improvement Services and Community Benefit Operations Community health improvement services and community benefit operations include activities intended to improve health and wellness. They extend beyond patient care activities and are subsidized by the Hospital. The programs ranged from community health education to free clinics and screenings. Consistent with the filing of Schedule H, AKMC provided the following community health services during Fiscal 2013 at an estimated cost of $608,296. Destination Wellness - Destination Wellness is a community health and wellness education resource center sponsored by AKMC. One of the few community-based outreach centers of its kind, Destination Wellness is a storefront located in the Galleria at Pittsburgh Mills shopping mall. Destination Wellness provides a variety of health-related activities including classes and "Doc Talks" on topics ranging from arthritis to peripheral vascular disease. Destination Wellness is staffed with a registered dietitian and registered nurses to assist visitors in finding a physician, checking blood pressure or researching a topic in the on-site health resource library. During Fiscal 2013, Destination Wellness sponsored or hosted 188 events. Destination Wellness also sponsors the "Mills Milers", a no-charge, indoor walking program designed to engage members of the community in physical exercise in a safe, controlled environment. Numerous programs are available exclusively for members of the Mills Milers. Over 2,280 members have enrolled in this program since its inception in September, 2005. Paramedics Staffing - AKMC staffs the mall with on-site paramedics to respond to a variety medical emergencies at the mall and surrounding businesses. In Fiscal 2013 paramedics responded to 172 calls. PriorityCare Senior Membership Program - AKMC offers this outreach program to adults age 55 and older with the purpose of improving their health and their knowledge about health care and other issues related to the aging process. A newsletter is mailed quarterly to over 13,000 households reaching a total membership of over 18,000 adults. Cumulatively, over 36,000 adults have enrolled in the program. In addition to health education articles, the newsletter keeps members informed about hospital and community services and contains a calendar of monthly educational programs and support groups. Childbirth Education - AKMC offered a class involving the experience of childbirth and newborn care. Class topics included areas of interest such as breast feeding, newborn care and sibling interaction. Babysitting Classes - Six babysitting classes were held in Fiscal 2013. The classes are an educational tool to help teach parents and babysitters on safe sitting techniques. techniques. Doc/Medical Professionals Talks - AVH hosts many "Doc Talks" at the campus and in the community. These events target all segments of the community population and are presented on current topics of interest. The Doc Talks are interactive and include topics such as, but not limited to: Coping with Chronic Pain, Congestive Heart Failure, Understanding and Managing Hypertension, Eye Health, Prostate Health and Women's Health.
Statement of Program Service Accomplishments - Continued Form 990, Page 2, Part III, Line 4a Community Health Fairs, Screenings and Workshops - AKMC provides numerous health fairs within the community and at community events. These fairs target a broad range of community members and focus on topics that are prevalent to the well-being of the community. Exercise Classes - During Fiscal 2013, the Hospital sponsored a variety of exercise classes free of charge to members of the community. Classes included Belly Dancing, Tai Chi and Yoga. Support Groups - AKMC acknowledges the stress and distress medical conditions can cause to families and their loved ones. AKMC sponsors a variety of support groups in the community to address these needs. Examples of support groups sponsored by AKMC would include but not be limited to Alzheimer's, Cardiac Disease and Restless Leg Syndrome. Health Professions Education AKMC provides aspiring health professionals with many educational opportunities to further their career in healthcare. Consistent with the filing of Schedule H, AKMC provided these services at a cost of $5,444 in Fiscal 2013. Citizens School of Nursing - Open since 1913, the Citizens School of Nursing has provided over 2,200 graduates with a strong foundation on which to build their future nursing careers. The school earned its first National League of Nursing accreditation in 1960 and continues to enjoy the privilege of full accreditation, due in part to a constantly evolving curriculum that consistently meets the needs of its students and reflects the changes of the nursing profession. The school prepares each student with the knowledge and skills necessary to exceed the challenges of providing quality nursing in the 21st century. Financial Contributions This category includes monetary and in-kind services donated to individuals and the community at large. In-kind services include hours donated by staff to the community during hospital work hours, overhead expenses of meetings, other space donated to not-for-profit community groups, and donations of food, equipment, and supplies. Consistent with the filing of Schedule H, AKMC provided financial contributions during Fiscal 2013 totaling $6,806. Cash Donations - AKMC supports the community through cash contributions made at the discretion of the Hospital and its directors, benefiting not only the non-profit recipient but ultimately the community as a whole. The Hospital made cash contributions totaling $1,000 including contributions to: The American Cancer Society In-Kind Donations - In addition to the cash contributions listed above, AKMC also made in-kind donations of time and resources to help support various community functions. For Fiscal 2013, in-kind contributions amounted to $5,806 and consisted of the following: AARP's 55 Alive Mature Driving Program - The Hospital co-sponsored this two-day driver refresher course 22 times during Fiscal 2013. During the year, 243 drivers participated in the program offered at the Hospital's main campus, the Outpatient Care Center in New Kensington or Destination Wellness. Free meeting space, parking, refreshments and publicity are provided through the hospital. Look Good - Feel Better! - The hospital provides free space for the American Cancer Society to host the program Look Good - Feel Better, a program directed toward helping cancer patients feel good about their appearance. Community Building Activities Community Building Activities include activities engaged in for the purpose of improving or protecting the health, future and wellbeing of the community. Consistent with the filing of Schedule H, AKMC provided these services at a cost of $370,743 in Fiscal 2013. Social Services - AKMC social work services are available to help patients and their families adjust to changes in their lives due to illness and hospitalization. Our social workers help patients and families identify and manage factors that may interfere with health and recovery. Through counseling, discharge planning and providing information and referrals, the staff helps to ensure a comfortable return home or other level of care that is appropriate at the time of discharge. Board Memberships - AKMC employees serve as board members on numerous local boards including the local Rotary, New Kensington Chamber of Commerce, Strongland Chamber of Commerce, Alle-Kiski Paramedic Unit for Life Support Emergency Response (AKPULSER) and the YMCA.
Family Relationships Among Alle-Kiski Medical Center Directors Form 990, Page 6, Part VI, Section A, Line 2 The following Alle-Kiski Medical Center Directors are related as husband and wife: Russell Evans Janis Evans Jerry Taylor, MD Ginger Taylor
Operational Oversight By A Third Party Management Company Form 990, Page 6, Part VI, Section A, Line 3 Alle-Kiski Medical Center ( AKMC) is a member of the Allegheny Health Network by virtue of being affiliated with West Penn Allegheny Health System (System). The System consists of thirteen operational IRC Section 501(c)(3) organizations. The parent organization for AKMC and the other eleven operational IRC Section 501(c)(3) organizations is West Penn Allegheny Health System, Inc. (WPAHS, Inc.). The board of directors of WPAHS, Inc. is comprised of a majority of independent members. On November 7, 2011 (Effective Date), the board of directors of WPAHS, Inc. engaged Alvarez & Marsal Healthcare Industry Group, LLC (A&M) to assign an Interim Chief Executive Officer of the System, Interim Chief Operating Officer of the System and Interim Chief Financial Officer of the System. All individuals appointed to their respective positions are under the employment of A&M and have daily oversight of all matters pertinent to the operation of the System as a whole and all organizations on an independent basis. All interim management personnel under the employment of A&M are responsible to and report to the WPAHS, Inc. board of directors. The term of the engagement is to last one year from the effective date with the option to renew the engagement beyond the initial one year term. During the course of the engagement, the WPAHS, Inc. board of directors upon written notice may cause any individual employed by A&M to be removed from their respective position and replaced by another similarly qualified individual. AKMC did not directly compensate A&M for their management services. WPAHS, Inc. compensates A&M directly for these services. The decision was made to allocate a portion of the expenditures of WPAHS, Inc. to AKMC. Thus, the portion of management expense allocated from WPAHS, Inc. to AKMC is reflected on Form 990, Page 10, Line 11a. On April 29, 2013, West Penn Allegheny Health System, Inc., the sole member of Alle-Kiski Medical Center consummated a formal affiliation to establish a regional integrated health care services delivery system. With the establishment of this formal affiliation, the management team from A&M were removed from their respective positions and ceased to provide management services.
Change to Organizational Governing Documents Form 990, Page 6, Part VI, Section A, Question 4 The bylaws of Alle-Kiski Medical Center were amended effective May 17, 2013 to reflect an affiliation with Highmark Health, EIN: 45-3674900 and the creation of a regional integrated healthcare delivery system, the parent organization of which is Allegheny Health Network, EIN: 45-3674924. In accordance with the affiliation, Highmark Health assumed certain reserve powers over Alle-Kiski Medical Center. Among the reserve powers given to Highmark Health includes the right to approve the election, re-election and removal of all officers of the corporation; to amend, revise and restate the corporation's Articles of Incorporation and Bylaws; adopt or change the mission, purpose, philosophy or objective of the corporation; to change the general structure of the corporation; to dissolve or liquidate, consolidate or merge and sell or acquire assets in excess of certain thresholds; approve the capital, operating plan and budget of the corporation; approve the incurrence of debt by the corporation and the making of capital expenditures in excess of certain thresholds; to approve donations or other transfers in excess of certain thresholds; approve the strategic plan and mission statement; approve investment policies; approve the closure or relocation of a licensed healthcare facility; approve the creation of or dissolution of subsidiary corporations, partnerships or other joint ventures in excess of certain thresholds; manage the corporations program for compliance with all legal requirements; selection of auditors and the designation of the fiscal year of the corporation.
Form 990 Review Process Form 990, Page 6, Part VI, Section B, Line 11a The IRS Form 990 of the Alle-Kiski Medical Center was prepared by the Highmark Health Tax Department. Prior to filing the final tax return with the Internal Revenue Service, members of senior management reviewed components of the tax return and the voting members of the governing body received a copy of the tax return.
Monitoring and Enforcement of the Conflict of Interest Policy Form 990, Page 6, Part VI, Section B, Line 12c Alle-Kiski Medical Center is a member of the Allegheny Health Network by virtue of being affiliated with West Penn Allegheny Health System (WPAHS). WPAHS has a corporate compliance department that monitors and oversees compliance with the conflict of interest policy of all organizations in the health system. The following describes the manner in which the corporate compliance department monitors and oversees compliance with the conflict of interest policy for Alle-Kiski Medical Center as well as the other WPAHS affiliates: Conflict of Interest disclosure forms are completed on an annual basis by all board members, officers, employees who have a title of Manager and above, physicians in leadership roles, Pharmacy and Therapeutic Committee members, all employees of the System's Compliance and Internal Audit Departments as well as personnel involved with contracting in the Corporate Purchasing Department. Upon completion of the above disclosure statement by all applicable individuals, a report is generated listing all individuals that have reported a conflict. The System Compliance Officer and General Counsel review the conflicts disclosed. Those that require additional information or clarification receive a letter from the Compliance Officer requesting such. Once received, all additional information is added to the report and again reviewed by the Compliance Officer and General Counsel. Those conflicts that require a mitigation plan are sent to the respective organization's senior management for development of the mitigation plan. The organization's senior management is responsible to discuss the mitigation plan with the individual as needed and monitor compliance with the mitigation plan. Once mitigation is received, a final report is reviewed by System Executive Compliance Council with the Legal Department and the Allegheny Health Network(AHN)senior management and finally with the AHN Audit and Compliance Subcommittee of the Board.
Process Used To Determine Executive Compensation Form 990, Page 6, Part VI, Section B, Line 15b The West Penn Allegheny Health Systems (WPAHS) process for determining compensation for executive positions (including officers, key employees and other management positions) within Alle-Kiski Medical Center is covered by the WPAHS Executive Compensation Policy. This policy was approved by the West Penn Allegheny Health System, Inc. Board of Directors. It is the policy of WPAHS and its Board of Directors to compensate its executives in accordance with the market and in relation to the experience, service and accomplishments of the individual both prior to and during their service with WPAHS. The Compensation Committee of the West Penn Allegheny Health System, Inc. Board of Directors approves the compensation for WPAHS senior executives. The Compensation Committee approves the initial compensation for newly hired senior executives, which shall include all compensation components, including without limitation, base compensation, incentive compensation, deferred compensation, fringe and other benefits, as well as the total compensation. It shall also approve all base compensation adjustments and all incentive compensation awards, as well as material changes to deferred compensation, fringe, or other benefits. The Compensation Committee uses comparability data provided by the System Human Resources Department, which may include industry surveys, expert compensation studies, documented compensation of persons holding similar positions, or other comparable data in approving any executive compensation. The Compensation Committee shall periodically retain the services of an independent compensation consultant to provide an expert opinion report as to the reasonableness of total compensation of Alle-Kiski Medical Center officers and key employees. Each Compensation Committee member voting on a senior executive's compensation arrangement ensures that he or she has no conflict of interest, including that he or she (a) does not economically benefit from the proposed employment; (b) does not receive compensation subject to the approval of the proposed employee; and (c) has no material financial interest affected by the transaction. The Compensation Committee consists of five independent Board Members of West Penn Allegheny Health System, Inc. All decisions of the Compensation Committee regarding executive compensation matters are documented.
Public Access To Organizational Documents Form 990, Page 6, Part VI, Section C, Line 19 Alle-Kiski Medical Center (AKMC) does not make its governing documents available to the public. AKMC is a member of the West Penn Allegheny Health System (WPAHS). The WPAHS makes available their annual and quarterly financial statements through the use of a dissemination agent. These financial statements are on a consolidated basis with AKMC being one of the consolidated entities. In addition, the WPAHS annual report and quarterly financial results are available on the WPAHS website. WPAHS has adopted a conflict of interest policy that is uniformly applied to all organizations of the health system, including AKMC. A condensed version of this conflict of interest policy is available on the WPAHS website.
Officer, Director and Key Employee Hour Allocation Form 990, Page 7, Part VII, Section A, Column B Alle-Kiski Medical Center ( AKMC)is a member of the Allegheny Health Network by virtue of being affiliated with West Penn Allegheny Health System (WPAHS). Individuals employed by one organization may be assigned to provide management for an affiliated organization. As such, many individuals play key roles or serve as officers or directors on multiple affiliated organizations. Each individual will be assigned forty hours to the organization of their actual employment. If the individual is employed by one organization and appointed as an officer, director or key employee of affiliated organizations the hour allocation on Form 990, Part VII, Page 7, Column (B) takes various factors into account when attempting to assign hours in a reasonable manner. Thus, it is possible for a single individual to have hours assigned in excess of forty hours per week if all affiliated organization IRS Forms 990 is taken into account. Directors who are not employed and volunteer their services are assigned one hour of service. The actual time served for all individuals disclosed in IRS Form 990 can vary based upon the need of the organization.
Officers and Directors - Partial Year Terms Form 990, Page 7, Part VII, Column C The following list represents Officer or Directors of Alle-Kiski Medical Center listed on Form 990, Part VII who did not serve a full consecutive twelve month tenure during the year ended June 30, 2013 along with the dates served: Robert Brandfass 07-01-2012 - 11-16-2012 Jerry Taylor, MD 07-01-2012 - 02-28-2013 Robin Bergstrom 02-28-2013 - 06-30-2013 David Shin, MD 02-28-2013 - 06-30-2013 Michael Sirott 02-28-2013 - 06-30-2013
Rent Expense Form 990, Page 9, Part VIII, Line 6b Alle-Kiski Medical Center does not account for rental expense in a manner that would allow for a direct offset of rental income on Form 990, page 9, Part VIII, Line 6b. The components of rental expense are reflected on Form 990, Page 10, Statement of Functional Expense.
Purpose Of Tax Exempt Bond Issuance Form 990, Page 11, Part X, Line 20 Alle-Kiski Medical Center is a member of the West Penn Allegheny Health System obligated group in regards to 2007 Allegheny County Hospital Development Authority tax-exempt bonds. Accordingly, Schedule K has been inserted into this Form 990 for full disclosure purposes. The purpose of the issue of the Allegheny County Hospital Development Authority (ACHDA) Hospital Revenue Bonds, Series 2007 A is to refund the outstanding ACHDA Series 2000A and B Bond Issues, the Dauphin County General Authority (DCGA) Series 1992A and B Hospital Bonds, the Pennsylvania Higher Education Facility Authority (PHEFA) Series 1991A Revenue Bonds, the Monroeville Hospital Authority (MHA) Series 1992 and 1995 Revenue Bonds, the funding of a project fund for certain prior and future capital expenditures and to pay the cost of issuing Series 2007A Debt. The amount of $63,560,927 reflected on Form 990, Page 11, Line 20 represents the internal allocation of debt to Alle-Kiski Medical Center by the parent organization, West Penn Allegheny Health System, Inc. The IRS Form 990 filed by West Penn Allegheny Health System, Inc., EIN: 25-0969492 has completed Schedule K in its entirety. Please refer to the IRS Form 990 filed by West Penn Allegheny Health System, Inc., EIN: 25-0969492 to review Schedule K with regard to this bond issue.
Other Changes In Net Assets Form 990, Page 12, Part XI, Line 9 The following is a reconciliation of the other changes in net assets of Alle-Kiski Medical Center for the year ended June 30, 2013: Change in Minimum Pension Liability $1,264,704 Net Transfers To Affiliated Organizations 58,006 Purchase Accounting Adjustments (27,974,955) ___________ Other Changes in Net Assets ($26,652,245)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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
2012
Open to Public Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) 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










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) Highmark Health

120 Fifth Ave Suite 922

Pittsburgh,PA15222
45-3674900 		Healthcare PA 501(c)(3) 11-I NA
 
 
No
(2) Allegheny Health Network

120 Fifth Ave Suite 922

Pittsburgh,PA15222
45-3674924 		Healthcare PA 501(c)(3) 11-I Highmark Hea
 
 
No
(3) Allegheny Medical Practice Network

4800 Friendship Ave

Pittsburgh,PA15224
25-1838457 		Healthcare PA 501(c)(3) 3 WPAHS Inc
 
 
No
(4) Allegheny Singer Research Institute

320 East North Ave

Pittsburgh,PA15212
25-1320493 		Sci Research PA 501(c)(3) 4 WPAHS Inc
 
 
No
(5) Allegheny Specialty Practice Network

320 East North Ave

Pittsburgh,PA15212
25-1838458 		Healthcare PA 501(c)(3) 3 WPAHS Inc
 
 
No
(6) Alle-Kiski Medical Center Trust

1301 Carlisle Street

Pittsburgh,PA15065
20-5855753 		Fundraising PA 501(c)(3) 11-I AKMC
 
Yes
 
(7) Canonsburg General Hospital

100 Medical Blvd

Canonsburg,PA15317
25-1737079 		Healthcare PA 501(c)(3) 3 WPAHS Inc
 
 
No
(8) Canonsburg General Hospital Ambulance Se

100 Medical Blvd

Canonsburg,PA15317
23-2939715 		ER Response PA 501(c)(3) 9 CGH
 
 
No
(9) Canonsburg Hospital & Health Foundation

100 Medical Blvd

Canonsburg,PA15317
25-1818505 		Inactive PA 501(c)(3) 11-I NA
 
 
No
(10) Forbes Health Foundation

2570 Haymaker Rd

Monroeville,PA15146
25-1798379 		Fundraising PA 501(c)(3) 7 WPAHS Inc
 
 
No
(11) Greater Canonsburg Health System

100 Medical Blvd

Canonsburg,PA15317
25-1488089 		Inactive PA 501(c)(3) 11-I NA
 
 
No
(12) The Western Pennsylvania Hospital Founda

4800 Friendship Ave

Pittsburgh,PA15224
25-1470766 		Fundraising PA 501(c)(3) 11-I WPAHS Inc
 
 
No
(13) West Allegheny Hospital

100 Medical Blvd

Pittsburgh,PA15317
25-1054206 		Inactive PA 501(c)(3) 3 NA
 
 
No
(14) West Penn Allegheny Health System Inc

Two Allegheny Ctr

Pittsburgh,PA15212
25-0969492 		Healthcare PA 501(c)(3) 3 AHN
 
 
No
(15) West Penn Allegheny Oncology Network

4800 Friendship Ave

Pittsburgh,PA15224
11-3683376 		Healthcare PA 501(c)(3) 11-III FL WPAHS Inc
 
 
No
(16) West Penn Physician Practice Network

4800 Friendship Ave

Pittsburgh,PA15224
25-1494317 		Healthcare PA 501(c)(3) 9 WPAHS Inc
 
 
No
(17) JRMCUPMC Cancer Associates

565 Coal Valley Rd

Jefferson Hills,PA15236
20-1634783 		Healthcare PA 501(c)(3) 3 NA
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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) Employee Benefit Data Services Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1824465 		Data Services PA  
NONE 0 0   No 0   No 0 %
(2) Gateway Health Plan LP

444 Liberty Avenue Suite 2100
Pittsburgh,PA15222
25-1691945 		Insurance PA  
NONE 0 0   No 0   No 0 %
(3) Jenkins Empire Associates

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1524682 		Property Mgmt PA  
NONE 0 0   No 0   No 0 %
(4) Silver Rain LP

120 Fifth Ave Suite 922
Pittsburgh,PA15222
27-3035436 		Property Mgmt PA  
NONE 0 0   No 0   No 0 %
(5) Provider PPI LLC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
32-0429947 		Facilities Suppor PA  
NONE 0 0   No 0   No 0 %
(6) Chartwell Pennsylvania LP

120 Fifth Ave Suite 922
Pittsburgh,PA15222
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(7) Waterfront Surgery Assoc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(8) Waterfront Medical Assoc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(9) Upper Midwest Consol Services Ctr LLC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(10) UPMC VNA Home Health

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1844485 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(11) 5148 Liberty Avenue Associates

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(12) Allegheny Imaging of McCandless

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(13) Forbes Regional Urologic

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(14) McCandless Endoscopy Center

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(15) North Shore Endoscopy Center

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(16) West Penn Ambulatory Center

15305 Dallas Parkway
Pittsburgh,PA15224
27-2344847 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(17) Peters Ambulatory Surgery Ctr LLC

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Delaware Ancillary Insurance Agency

800 Delaware Avenue
Wilmington,DE198011368
51-0383213 		Insurance Service DE Highmark Inc
  		C Corporation          
(2) The Gateway Group LTD

800 Delaware Avenue
Wilmington,DE198011368
51-0293417 		Benefit Administr DE Highmark Inc
  		C Corporation          
(3) Highmark BCBSD Inc

800 Delaware Avenue
Wilmington,DE198011368
51-0020405 		Insurance DE Highmark Inc
  		C Corporation          
(4) Davis Vision Inc

175 East Houston Street
San Antonio,TX78205
11-3051991 		Vision Service TX Highmark Inc
  		C Corporation          
(5) Davis Vision IPA Inc

175 East Houston Street
San Antonio,TX78205
11-2958041 		TPA TX Highmark Inc
  		C Corporation          
(6) Visionworks Distribution Services Inc

175 East Houston Street
San Antonio,TX78205
04-3742989 		Optical Retail TX Highmark Inc
  		C Corporation          
(7) Visionworks Enterprises Inc

175 East Houston Street
San Antonio,TX78205
35-2196998 		Trademarks TX Highmark Inc
  		C Corporation          
(8) ECCA Managed Vision Care Inc

175 East Houston Street
San Antonio,TX78205
74-2759084 		Physician Service TX Highmark Inc
  		C Corporation          
(9) Empire Vision Center Inc

175 East Houston Street
San Antonio,TX78205
14-1586016 		Retail Sales TX Highmark Inc
  		C Corporation          
(10) Eye Drx Retail Management Inc

175 East Houston Street
San Antonio,TX78205
74-2924030 		Office Administra TX Highmark Inc
  		C Corporation          
(11) Visionworks Inc

175 East Houston Street
San Antonio,TX78205
02-0677066 		Optical Retail TX Highmark Inc
  		C Corporation          
(12) Gateway Health Plan Inc

444 Liberty Avenue Suite 2100
Pittsburgh,PA15222
25-1505506 		Insurance PA Highmark Inc
  		C Corporation          
(13) Gateway Health Plan of Ohio Inc

444 Liberty Avenue Suite 2100
Pittsburgh,PA15222
30-0282076 		Insurance PA Highmark Inc
  		C Corporation          
(14) HM Broker Services Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
23-2384777 		Marketing Agent PA Highmark Inc
  		C Corporation          
(15) HCI Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
75-3002215 		Finance & Insuran PA Highmark Inc
  		C Corporation          
(16) Highmark Casualty Insurance Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1334623 		Insurance PA Highmark Inc
  		C Corporation          
(17) HM Health Insurance Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
54-1637426 		Insurance Sales PA Highmark Inc
  		C Corporation          
(18) Highmark Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
23-1294723 		Insurance PA Highmark Inc
  		C Corporation          
(19) HM Casualty Insurance Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
87-0807723 		Insurance Sales PA Highmark Inc
  		C Corporation          
(20) HM Benefits Administrators Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1128451 		Funds Administrat PA Highmark Inc
  		C Corporation          
(21) HM Captive Insurance Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
65-1274122 		Insurance PA Highmark Inc
  		C Corporation          
(22) HM Insurance Group

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1646315 		Management Servic PA Highmark Inc
  		C Corporation          
(23) Highmark West Virginia

PO Box 1948
Parkersburg,WV26102
55-0624615 		Insurance Sales WV Highmark Inc
  		C Corporation          
(24) HM Life Insurance Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
06-1041332 		Insurance Sales PA Highmark Inc
  		C Corporation          
(25) HM Life Insurance Company of New York

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1800302 		Insurance Sales PA Highmark Inc
  		C Corporation          
(26) Highmark Senior Resources

120 Fifth Ave Suite 922
Pittsburgh,PA15222
20-2353206 		Insurance Sales PA Highmark Inc
  		C Corporation          
(27) HVHC Inc

175 East Houston Street
San Antonio,TX78205
25-1801124 		Holding Company TX Highmark Inc
  		C Corporation          
(28) Highmark Ventures Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1645888 		Holding Company PA Highmark Inc
  		C Corporation          
(29) JEA Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1712017 		Management Servic PA Highmark Inc
  		C Corporation          
(30) Keystone Health Plan West Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1522457 		Insurance Sales PA Highmark Inc
  		C Corporation          
(31) Miracle Optics Inc

3140 Route 22 West
Somerville,NJ08876
95-4481411 		Trading NJ Highmark Inc
  		C Corporation          
(32) Parker Benefits

PO Box 1948
Parkersburg,WV26102
55-0625743 		TPA WV Highmark Inc
  		C Corporation          
(33) South Shore Optometrists PC

2921 Erie Boulevard
Syracuse,NY13224
04-3429510 		Health Care NY Highmark Inc
  		C Corporation          
(34) Standard Property Corporation

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1668093 		Real Estate Opera PA Highmark Inc
  		C Corporation          
(35) Union Benefit Management Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1845908 		Benefit Plan Mgmt PA Highmark Inc
  		C Corporation          
(36) United Concordia Companies Inc

4401 Deer Path Road
Harrisburg,PA17110
25-1687586 		Dental Insurance PA Highmark Inc
  		C Corporation          
(37) United Concordia Dental Corporation of

4401 Deer Path Road
Harrisburg,PA17110
63-1028262 		Dental Insurance PA Highmark Inc
  		C Corporation          
(38) United Concordia Dental Plans of Califor

4401 Deer Path Road
Harrisburg,PA17110
23-7328765 		Dental Insurance PA Highmark Inc
  		C Corporation          
(39) United Concordia Dental Plans of Florida

4401 Deer Path Road
Harrisburg,PA17110
65-0243292 		Dental Insurance PA Highmark Inc
  		C Corporation          
(40) United Concordia Dental Plans Inc

4401 Deer Path Road
Harrisburg,PA17110
52-1542269 		Dental Insurance PA Highmark Inc
  		C Corporation          
(41) United Concordia Dental Plans of Kentuck

4401 Deer Path Road
Harrisburg,PA17110
61-1012900 		Dental Insurance PA Highmark Inc
  		C Corporation          
(42) United Concordia Dental Plans of the Mid

4401 Deer Path Road
Harrisburg,PA17110
38-2289438 		Dental Insurance PA Highmark Inc
  		C Corporation          
(43) United Concordia Dental Plans of Pennsyl

4401 Deer Path Road
Harrisburg,PA17110
23-2541529 		Dental Insurance PA Highmark Inc
  		C Corporation          
(44) United Concordia Dental Plans of Texas

4401 Deer Path Road
Harrisburg,PA17110
74-2489037 		Dental Insurance PA Highmark Inc
  		C Corporation          
(45) United Concordia Insurance Company

4401 Deer Path Road
Harrisburg,PA17110
86-0307623 		Dental Insurance PA Highmark Inc
  		C Corporation          
(46) United Concordia Insurance Company of Ne

4401 Deer Path Road
Harrisburg,PA17110
11-3008245 		Dental Insurance PA Highmark Inc
  		C Corporation          
(47) United Concordia Life and Health Insuran

4401 Deer Path Road
Harrisburg,PA17110
23-1661402 		Dental Insurance PA Highmark Inc
  		C Corporation          
(48) Visionworks Lab Services Inc

175 East Houston Street
San Antonio,TX78205
04-3742977 		Optical Retail TX Highmark Inc
  		C Corporation          
(49) Visionary Properties Inc

175 East Houston Street
San Antonio,TX78205
74-2849554 		Leasing TX Highmark Inc
  		C Corporation          
(50) Visionary Retail Management Inc

175 East Houston Street
San Antonio,TX78205
74-2849552 		Office Administra TX Highmark Inc
  		C Corporation          
(51) Viva Europa Inc

3140 Route 22 West
Somerville,NJ08876
22-3390239 		Investing NJ Highmark Inc
  		C Corporation          
(52) Viva International Inc

3140 Route 22 West
Somerville,NJ08876
22-3106453 		Wholesale Distrib NJ Highmark Inc
  		C Corporation          
(53) Viva IP Corp

3140 Route 22 West
Somerville,NJ08876
22-3841079 		Holding Company NJ Highmark Inc
  		C Corporation          
(54) Viva Optique Inc

3140 Route 22 West
Somerville,NJ08876
22-2192365 		Wholesale Distrib NJ Highmark Inc
  		C Corporation          
(55) Visionworks of America Inc

175 East Houston Street
San Antonio,TX78205
74-2337775 		Retail Sales TX Highmark Inc
  		C Corporation          
(56) West Virginia Family Health Plan Inc

1219 Virginia Street East
Charleston,WV25301
45-2763165 		Insurance WV Highmark Inc
  		C Corporation          
(57) Prime Medical Group PCG 1

1200 Brooks Ln 110
Clairton,PA15025
26-4194208 		Medical Practice PA JRMC
  		C Corporation          
(58) Primary Care Group 2 Inc

6011 Baptist Rd Ste 220
Pittsburgh,PA15236
90-0451375 		Medical Practice PA JRMC
  		C Corporation          
(59) Primary Care Group 3 Inc

5426 Mifflin Rd
Pittsburgh,PA15227
90-0451380 		Medical Practice PA JRMC
  		C Corporation          
(60) Primary Care Group 4 Inc

1907 Lebanon Church Rd
West Mifflin,PA15122
80-0403090 		Medical Practice PA JRMC
  		C Corporation          
(61) Primary Care Group 5 Inc

624 Monongahela Ave
Glassport,PA15045
80-0403100 		Medical Practice PA JRMC
  		C Corporation          
(62) Primary Care Group 6 Inc

PO Box 333
West Mifflin,PA15122
45-3684432 		Medical Practice PA JRMC
  		C Corporation          
(63) Primary Care Group 7 Inc

575 Coal Valley Rd
Jefferson Hills,PA15025
90-0503600 		Medical Practice PA JRMC
  		C Corporation          
(64) Primary Care Group 8 Inc

803 Miller Ave
Clairton,PA15025
01-0927360 		Medical Practice PA JRMC
  		C Corporation          
(65) Primary Care Group 9 Inc

1200 Brooks Ln 270
Clairton,PA15025
01-0929359 		Medical Practice PA JRMC
  		C Corporation          
(66) Primary Care Group 10 Inc

3726 Brownsville Rd
Pittsburgh,PA15227
38-3807173 		Medical Practice PA JRMC
  		C Corporation          
(67) Primary Care Group 11 Inc

455 Valley Brook Rd Ste 300
McMurray,PA15317
80-0494617 		Medical Practice PA JRMC
  		C Corporation          
(68) Primary Care Group 12 Inc

17 Arentzen Blvd Ste 101
Charleroi,PA15022
90-0614054 		Medical Practice PA JRMC
  		C Corporation          
(69) Park Cardiothoracic & Vascular Inst

565 Coal Valley Rd
Jefferson Hills,PA15236
72-1529328 		Medical Practice PA JRMC
  		C Corporation          
(70) Family Practice Medical Associates South

2414 Lytle Rd Ste 300
Bethel Park,PA15102
25-1684735 		Medical Practice PA JRMC
  		C Corporation          
(71) Health System Services Corp & Subs

565 Coal Valley Rd
Jefferson Hills,PA15236
25-1403745 		Medical Office Bl PA JRMC
  		C Corporation          
(72) JRMC Health Pavilion

565 Coal Valley Rd
Jefferson Hills,PA15236
25-1203449 		Medical Practice PA JRMC
  		C Corporation          
(73) HSSC Diversified Services Inc

565 Coal Valley Rd
Jefferson Hills,PA15236
25-1770047 		Medical Practice PA JRMC
  		C Corporation          
(74) Specialty Group Practice 1 Inc

575 Coal Valley Rd Ste 365
Jefferson Hills,PA15025
35-2367818 		Medical Practice PA JRMC
  		C Corporation          
(75) Grandis Rubin Shanahan & Assoc

565 Coal Valley Rd
Jefferson Hills,PA15236
45-3355906 		Medical Practice PA JRMC
  		C Corporation          
(76) Steel Valley Orthopedics & Sports Medici

1200 Brooks Ln 240
Clairton,PA15025
45-3540378 		Medical Practice PA JRMC
  		C Corporation          
(77) Jefferson Hills Surgical Specialists PA

1200 Brooks Ln 150
Clairton,PA15025
30-0477313 		Medical Practice PA JRMC
  		C Corporation          
(78) JRMC Specialty Group Practice

565 Coal Valley Rd
Jefferson Hills,PA15236
72-1529332 		Medical Practice PA JRMC
  		C Corporation          
(79) JRMC Physician Service Corp

565 Coal Valley Rd
Jefferson Hills,PA15236
86-1159658 		Medical Practice PA JRMC
  		C Corporation          
(80) Pace Re Ltd

565 Coal Valley Rd
Jefferson Hills,PA15236
98-1109020 		Medical Practice PA JRMC
  		C Corporation          
(81) Pittsburgh Bone Joint and Spine Inc

565 Coal Valley Rd
Jefferson Hills,PA15236
25-1203449 		Medical Practice PA JRMC
  		C Corporation          
(82) West Penn Corporate Medical Services In

4800 Friendship Avenue
Pittsburgh,PA15224
25-1437405 		Medical Practice PA WPAHS Inc
  		C Corporation          
(83) West Penn Neurosurgery PC

4800 Friendship Avenue
Pittsburgh,PA15224
25-1630719 		Medical Practice PA WPAHS Inc
  		C Corporation          
(84) Burn Care Associates Ltd

4800 Friendship Avenue
Pittsburgh,PA15224
23-2899534 		Medical Practice PA WPAHS Inc
  		C Corporation          
(85) Medical Center Clinic PC

4800 Friendship Avenue
Pittsburgh,PA15224
23-2894939 		Medical Practice PA WPAHS Inc
  		C Corporation          
(86) Optima Imaging

4800 Friendship Avenue
Pittsburgh,PA15224
25-1652874 		Medical Practice PA WPAHS Inc
  		S Corporation          
(87) HMPG Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
45-3444325 		Holding Company PA Highmark Inc
  		C Corporation          
(88) Physician Landing Zone PC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
45-3913973 		Health Care PA HMPG Inc
  		C Corporation          
(89) Lake Erie Medical Group PC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
45-3444157 		Health Care PA HMPG Inc
  		C Corporation          
(90) Premier Medical Associates PC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1742869 		Health Care PA HMPG Inc
  		C Corporation          
(91) Beam Medical Associates PC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
28-1816080 		Health Care PA HMPG Inc
  		C Corporation          
(92) Palladium Risk Retention Group

120 Fifth Ave Suite 922
Pittsburgh,PA15222
46-3476730 		Health Care PA HMPG Inc
  		C Corporation          
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Alle-Kiski Medical Center Trust

 1q 50,740  





Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 section 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) 2012
Schedule R (Form 990) 2012
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
Transactions with Affiliated Organizations Schedule R, Part V, Line 2 Alle-Kiski Medical Center has chosen not to complete Schedule R, Part V, line 2 for organizations that are not controlled entities within the meaning of section 512(b)(13). The disclosure of this information is only required for organizations listed in Schedule R, Part V, line 2 that are controlled entities within the meaning of section 512(b)(13). The only organization listed in Schedule R, Part V, line 2 that is a controlled entity within the meaning of section 512(b)(13) for Alle-Kiski Medical Center is the Alle-Kiski Medical Center Trust.

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