TY 2012 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) John Echement........................................................................ Director- Emeritus	1.0 .......................	X
(19) John Dempster........................................................................ President and CEO	40.0 .......................	X	X				539,887	0	0
(20) John Paul........................................................................ Director	1.0 .......................39.0	X					0	0	0
(21) Robert Baum MD........................................................................ Director	1.0 .......................39.0	X					0	0	0
(22) David Blandino MD........................................................................ Director	1.0 .......................39.0	X					0	0	0
(23) Patricia Liebman........................................................................ Director	1.0 .......................39.0	X					0	0	0
(24) Thomas VanKirk........................................................................ Director	1.0 .......................39.0	X					0	0	0
(25) James Cooper........................................................................ Senior Executive VP	40.0 .......................		X				385,648	0	0
(26) Richard Collins Jr MD........................................................................ Executive VP & Secretary	40.0 .......................		X				370,605	0	0
(27) JoAnne Hahey........................................................................ Treasurer	40.0 .......................		X				312,242	0	0
(28) Susan Barrett........................................................................ Assistant Secretary	40.0 .......................		X				90,030	0	0
(29) Louise Urban........................................................................ Executive VP/COO	40.0 .......................			X			254,330	0	0
(30) Marcie Caplan........................................................................ Senior Vice President	40.0 .......................			X			236,818	0	0
(31) Rosanne Saunders........................................................................ VP Human Resources	40.0 .......................			X			222,410		0
(32) Albert Ragan........................................................................ Vice President	40.0 .......................			X			199,158	0	0
(33) Michael Evans........................................................................ VP Patient Experience/Support	40.0 .......................				X		205,817	0	0
(34) James Witenske........................................................................ Director-Info Serv/ CIO	40.0 .......................				X		179,350	0	0
(35) John Danek........................................................................ Medical Director OCC Med/E	40.0 .......................				X		177,133	0	0
(36) Guy Skelly........................................................................ Physician Clinical Advisor	40.0 .......................				X		141,424	0	0
(37) Teresa Riskey........................................................................ Director of Pharmacy	40.0 .......................				X		138,847	0	0
(38) Robert Frank........................................................................ Former EVP/COO	.......................					X	326,788	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
South Pittsburgh Anesthesia, 1699 washington Rd Ste 307PITTSBURGHPA15228	Physician	1,835,598
Emergency Physicians of Pittsburgh, 565 Coal Valley RdJEFFERSON HILLSPA15025	Physician	439,762
LDS Partners, 1200 Brooks Ln Ste 130CLAIRTONPA15025	Physician	307,450
Mostoufi Mahpareh MD PC, 105 Quail Hill LnPITTSBURGHPA15238	Physician	295,260
Hope Bariatrics, 111 Hazel Ln Ste 100SEWICKLEYPA15143	Medical Services	220,022
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 8

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	18,350	18,350
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 ....	2,660,437	2,399,714	260,723
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	81,744,145	73,733,219	8,010,926
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,418,111	5,789,137	628,974
9	Other employee benefits .......	9,437,672	8,512,780	924,892
10	Payroll taxes ...........	6,082,833	5,486,716	596,117
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	933,452	841,973	91,479
c	Accounting ...........	151,955	137,063	14,892
d	Lobbying ...........	121,074	121,074
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	330,623		330,623
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	14,903,431	13,439,659	1,463,772
12	Advertising and promotion ....	2,106,151	1,899,748	206,403
13	Office expenses .......	1,048,371	360,892	687,479
14	Information technology ......	4,127,599	3,723,095	404,504
15	Royalties ..	0
16	Occupancy ...........	6,572,031	5,927,972	644,059
17	Travel ............	141,751	127,860	13,891
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	74,656		74,656
20	Interest ...........	3,829,018	3,453,774	375,244
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	15,541,035	15,541,035
23	Insurance ..............	5,138,295	4,634,742	503,553
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	MEDICAL SUPPLIES AND EQUIPMENT	54,569,463	54,569,463
b	BAD DEBTS	12,361,654	12,361,654
c	DATA PROCESSING	9,978,602	9,978,602
d	PREVENTIVE MAINTENANCE	3,583,305	3,583,305
e	All other expenses	8,263,082	7,642,663	620,419
25	Total functional expenses. Add lines 1 through 24e	250,137,096	234,284,490	15,852,606	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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	7,280	1	30,341
2	Savings and temporary cash investments .........	6,901,478	2	3,988,375
3	Pledges and grants receivable, net ...........	0	3	48,538
4	Accounts receivable, net .............	27,625,535	4	45,344,559
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 .............	3,626,575	7	1,829,479
8	Inventories for sale or use ..............	4,105,698	8	4,059,491
9	Prepaid expenses and deferred charges ..........	8,107,834	9	2,332,044
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	143,185,230
b	Less: accumulated depreciation .....	10b	26,177,574	115,076,731	10c	117,007,656
11	Investments—publicly traded securities ..........	103,853,644	11	118,970,249
12	Investments—other securities. See Part IV, line 11 .....	13,717,812	12	4,782,739
13	Investments—program-related. See Part IV, line 11 .....	0	13	0
14	Intangible assets ...............	3,835,347	14	0
15	Other assets. See Part IV, line 11 ...........	72,162,526	15	80,418,417
16	Total assets. Add lines 1 through 15 (must equal line 34)......	359,020,460	16	378,811,888
	17	Accounts payable and accrued expenses .........	98,329,059	17	103,652,492
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	110,005,439	20	105,666,078
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 ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	27,832,806	25	17,987,318
26	Total liabilities. Add lines 17 through 25.........	236,167,304	26	227,305,888
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	122,259,106	27	150,468,852
28	Temporarily restricted net assets ...........	594,050	28	740,362
29	Permanently restricted net assets ...........	0	29	296,786
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	122,853,156	33	151,506,000
34	Total liabilities and net assets/fund balances ........	359,020,460	34	378,811,888

- TIN:

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.

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

Jefferson Regional Medical Center

Employer identification number

25-1260215

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


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

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)		(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)		(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).

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

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)		(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)		(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.)..

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

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

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:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

Jefferson Regional Medical Center

Employer identification number

25-1260215

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... 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 Jefferson Regional Medical Center

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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (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 Jefferson Regional Medical Center

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
Jefferson Regional Medical Center

Employer identification number

25-1260215

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

(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

(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

(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

(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:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Jefferson Regional Medical Center

Employer identification number

25-1260215

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

121,074

Total. Add lines 1c through 1i ...............................

121,074

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Explanantion of Lobbying Activity	Part II-B, Line 1	Lobbying expenses were paid to lobbying consulting firms to lobby on behalf of Jefferson Regional Medical Center. In addition, a portion of the hospital's dues paid to the Hospital and Healthcare System Assoc of PA (HHSAPA) and the Hospital Council of Western PA (HCWP) are used for lobbying purposes in fiscal year 2013.

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Jefferson Regional Medical Center

Employer identification number

25-1260215

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

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)? .......................................

Yes No

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.

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.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

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
1a	Beginning of year balance ....
b	Contributions ........	1,037,148
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	1,037,148

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

28.620 %

Temporarily restricted endowment SchDMd Bullet

71.380 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

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		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	8,721,786		8,721,786
b	Buildings ................	73,406,733	21,913,680	51,493,093
c	Leasehold improvements ............	2,140,795	147,201	1,993,594
d	Equipment ................	56,977,521	4,112,880	52,864,641
e	Other .................	1,938,355	3,814	1,934,541
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				117,007,656

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram 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.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) AMOUNTS DUE FROM AFFILIATES				62,707,095
(2) INVESTMENTS IN SUBS AND PTNR				17,392,165
(3) OTHER ASSETS				244,157
(4) OTHER INVESTMENT				75,000





Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				80,418,417

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
CAPITAL LEASE		1,666,386
MALPRACTICE INSURANCE RECOVERY		12,214,738
LINE OF CREDIT		3,765,000
OTHER LIABILITIES		341,194





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		17,987,318
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

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
JRMC Inclusion In The Consolidated Audit of WPAHS	Form 990, Schedule D, Part X, Question 2, Part XIII	Jefferson Regional Medical Center does not receive its own independent audit. It is a member of a regional healthcare system and receives a consolidated audit that includes the operations of Jefferson Regional Medical Center. The following analysis represents the reconciliation between the Jefferson Medical Center financial statement net income and the net income as reported on Form 990, Page 1, line 19: Net Income Per Financial Statements $7,283,488 Plus: Income Reclassified From Restricted Net Assets on the Financial Statements to Unrestricted Revenue on Form 990 237,092 Less: Expense Reclassified From Restricted Net Assets on the Financial Statements to Unrestricted Revenue on Form 990 (8,378) ___________ Net Income Per Form 990 $7,512,202 The following is the footnote to the audited consolidated financial statements of the Jefferson Regional Medical Center Group ( The Medical Center) for FASB ASC 740: The Medical Center accounts for uncertainty in income taxes using a recognition threshold of more-likely-than not to be substained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold is met. Management determined there were no tax uncertainties that met the recognition threshold in 2013. The Medical Center's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. JRMC determined that the application of FASB ASC 740 had no material effect on the recorded assets and liabilities of WPAHS.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. 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
Jefferson Regional Medical Center

Employer identification number

25-1260215

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total .................

List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2012

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 Gala (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . .	191,370	191,370
2	Less: Contributions . .	75,675	75,675
3	Gross income (line 1 minus line 2) . . .	115,695	115,695
4	Cash prizes . . .
5	Noncash prizes . .
6	Rent/facility costs . .	58,817	58,817
7	Food and beverages .
8	Entertainment . . .
9	Other direct expenses .	38,708	38,708
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........		97,525
11	Net income summary. Combine line 3, column (d), and line 10. ..........		18,170

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (add col.(a) through col.(c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes
	No

	Yes
	No

	Yes
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2012

Page 3

Does the organization operate gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Identifier	Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Jefferson Regional Medical Center

Employer identification number

25-1260215

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: .........

Yes

200% 250% 300% 350% 400% Other %

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.

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"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

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? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) ..	1,380,000	113,105	1,266,895	0.510 %
b	Medicaid (from Worksheet 3, column a) ....	3,474,706	2,379,706	1,095,000	0.440 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	12,002,430	7,250,335	4,752,095	1.920 %
d	Total Financial Assistance and Means-Tested Government Programs .	16,857,136	9,743,146	7,113,990	2.870 %
Other Benefits		342,769		342,769	0.140 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	342,769		342,769	0.140 %
f	Health professions education (from Worksheet 5) ..	115,394		115,394	0.050 %
g	Subsidized health services (from Worksheet 6) ..	1,133,121		1,133,121	0.460 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	42,155		42,155	0.020 %
j	Total. Other Benefits ..	1,633,439		1,633,439	0.670 %
k	Total. Add lines 7d and 7j .	18,490,575	9,743,146	8,747,429	3.540 %

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.

		(c) Total community building expense	(e) Net community building 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	72,148	72,148
7	Community health improvement advocacy
8	Workforce development	6,395	6,395
9	Other
10	Total	78,543	78,543

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,241,909

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

119,599,729

Enter Medicare allowable costs of care relating to payments on line 5.....

129,794,038

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-10,194,309

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

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 %	(e) Physicians' profit % or stock ownership %
1JeffersSOUPMC CANCER	Oncology Services	50.000 %
2Waterfront Surgery A	Outpatient Surgery	25.000 %	75.000 %
3WSC Realty Partners	Medical Office Building	23.490 %	76.510 %
4UPMC VNA Home Health	Home Health Services	33.420 %
5Chartwell	Infusion Therapy	15.000 %
6Waterfront Medical A	Medical Services	15.000 %
7Upper Medwest Consol	Medical Services	1.270 %
8
9
10
11
12
13

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
1	Jefferson Regional Medical Center 565 Coal Valley Road PO Box 18119 pittsburgh,PA15236 www.jeffersonregional.org	X	X	X

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)

	Jefferson Regional 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

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

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....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

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 ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

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 ........

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)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

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

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: % 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: % 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	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
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	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

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? ............................

If “Yes,” explain in Part VI.

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? .........................

If “Yes,” explain in Part VI.

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

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	Schedule H, Part III, Question 4	Net patient service revenue and receivables are derived from patients who reside primarily in the medical center's local geographic region. Patient service revenue is reported at the estimated net realizable amounts from patients and third-party payers for services rendered at the time the service is performed and includes estimated retroactive revenue adjustments due to future audits, reviews and investigations. Revenue received under some third-party agreements is subject to examination and retroactive adjustment by the third-party payers. Provisions for estimated third-party payer settlements are provided in the period the related services are rendered. Differences between the amounts provided and subsequent adjustment are recorded in operations, as the adjustment becomes known. The costing methodology used in determining bad debts expense at cost and estimated amount of the organization's bad debt expense attributed to patients eligible under the organization's charity care policy is bad debt expense times the cost to charge ratio. Jefferson Regional Medical Center is diligent in the classification of amounts as charity care or bad debt. We believe none of the amounts in bad debt would be reclassified to charity care given additional information.
Medicare Shortfall as a Community Benefit and Costing Methodology	Schedule H, Part III, Question 8	The information in this section was derived based on JRMC's decision support system based on payor specific reports. A large percentage of the population served (32.9%) are age 55 or older. These individuals are reliant on Medicare for their health care needs. We are committed to serving this sector of the population with the best care available. Thus, the unreimbursed costs we incur benefit the community with healthier and more independent seniors and should be treated as community benefit.
Collection Practices For Patients Who Qualify For Financial Assistance	Schedule H, Part III, Question 9b	Understanding that some patients will not communicate the need for financial assistance until receipt of a bill, the patient financial services department accepts applications within 90 days of the date of service or within 90 days of denial by a third party payer. All applicants must apply for medical assistance coverage and final determination made by medical assistance before consideration of eligibility for the uncompensated care program. However, if because of a patient's resources it is evident that he will not be eligible on medical assistance coverage, this clause for eligibility consideration for the uncompensated care program is waived. Jefferson Regional Medical Center utilized the Paro scoring software product as a final attempt to identify patients who qualify on charity care prior to being referred to an outside collection agency. Paro scoring is a software product that uses a compilation of public data bases and a methodology to categorize self pay balance for eligible charity care. If the patient qualifies, Jefferson Regional Medical Center will write them off to free care.
Health Needs Assessment	Schedule H, Part V, line 7 and Part VI, Line 2	Jefferson Regional Medical Center has created multiple touch points in the community that provide a conduit for the expression of community needs. Community Health Council: This is a formal group comprised of representatives from all of the 14 municipalities in our core service area. The council meets quarterly and is our link to organizations within their respective municipalities. The council keeps us in touch with community need and assists us in many ways such as obtaining sites in their communities for us to conduct our free stroke screenings. Members of the council act as a sounding board for any programming that we are developing so that the outcome dovetails the community need. Health for Her: this program educates women and provides tools on current health topics which empower them and enable them to be better healthcare consumers, practice preventive healthcare and positively pursue management of chronic disease. The topics for inclusion in the program are solicited directly from the many attendees and future programming is driven by this community input as well as input from family practice physicians who see firsthand what major healthcare problems are seen in their practices. Speakers Bureau: This program serves over 100 community organization and responds directly to their individual needs. These organizations include AARP groups, church groups, neighborhood crime watch, schools, retired union clubs, civic organizations, long term care facilities, chamber of commerce, senior groups, dept. of energy, support groups, senior fairs, lunch & learn, teachers associations, family foundation, etc. Our presentations are tailored to the health topic requested by the caller thereby addressing an immediate community need. It may be a concern about H1N1 flu or information regarding how to quickly assess possible stroke and action to take. The presentations always include extensive question and answer periods and the speaker stays afterwards to address individual needs of the attendees. We also participate in community-sponsored health fairs. Retired Nurses Program: We provide outreach in the form of a monthly blood pressure clinic at off-sites which have determined a need for the community groups they serve. These include service to the lifespan senior sites (county programs) in our service area. The county area agency on aging has determined this community need for those they serve. Community Stroke Outreach: This program was developed in response to the significant number (35%) of individuals 55 years of age and older in our primary service area that are vulnerable to stroke with the risk doubling in each successive decade of life. Since the inception of the program we have identified 90% of the participants with risk factors. We were able to obtain broad-based grant funding from many foundations, insurers, and community appeal campaigns; This is proof of the high community priority given to this program and validation of the community need. Senior Services: This free program is offered to the community as described in other sections of Schedule H. It is included here to demonstrate the need for services as evidenced in the number of clients served during this tax reporting period: a total of 1,449 clients. This number served is a validation of the need that exists in our community which has a large senior population with few resources and a great need for comprehensive assistance and follow-up in order to decrease barriers to access of services for which they qualify. We also collaborate with other county and state programs for which the community need is already well established. the senior services program offers free non-medical assistance (information, referral and follow-up)to those in need, which this relieves a burden that has been documented to have a beneficial effect of improving overall health status. Assistance with access to in-home services, application to government programs, transportation, and care-giving are representative of the calls received. We work in collaboration with the PA Dept. of Aging (HHS) to provide medical insurance counseling (apprise) and with AARP as a site for tax preparation and driver's safety. Senior Services' emphasis is on keeping seniors in their own homes to age-in-place. This ultimately reduces the burden on long term care and this goal is consistent with that of the Allegheny County Area Agency on Aging. The program utilizes a community-wide database for referrals and allows us to be an extension for government programs, with community needs already well established. All the above varied and diverse responses to community needs are delivered in varying degrees of collaboration with the community. Our outreach is comprehensive and very responsive to any need which is communicated to us. Jefferson Regional Medical Center 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 April 2012 and concluded May 2013. The Board of Directors that govern Jefferson Regional Medical Center approved an implementation strategy designed to address the community health needs identified in the CHNA on May 20, 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: Allegheny County Dept of Human Services, Agency on Aging; Sister's Place, Inc.; Coldwell Banker Real Estate; Community College of Allegheny County, South Campus; Mon Valley Initiative; Highmark, Jefferson Regional Medical Center Board Members; and Jefferson Regional Medical Center Foundation Board Members. The results of the CHNA identified multiple health needs in the communities we serve. The Hospital addressed the following health need: Increasing access to Women's Health Services in the Jefferson Regional Medical Center Service region. The CHNA identified the following health needs the Hospital chose not to address: Transportation to/from Medical Services was identified as a priority need in the community, but the hospital itself, does not have the resources to provide public transportation. Availability of broader community based services, indicating the need for more satellite offices was also identified, but the hospital did not have the resources to pursue additional satellite offices. Also, the affiliation with Highmark, opened the service area to a broader range of services through partnership with other providers. Other priorities identified included perception of quality of local care; affordability of heath care/insurance; lack of physical activity; and air and water quality, all items that the hospital would not have the resources or the influence directly. The Hospital has made the CHNA widely available to the public. To accomplish this, we have included the Community Health Needs Assessment on our website www.jeffersonregional.com . Once in the website, the Assessment can be found under "ABOUT" then under "Community Commitment". Assessment can be found under "ABOUT" then under "Community Commitment".
Patient Education For Eligibility For Assistance	Schedule H, Part VI, Line 3	Jefferson Regional Medical Center 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 Jefferson Regional's charity care policy with a variety of communications during registration/admission and on their bills. Jefferson Regional Medical Center's charity care policy is communicated to eligible patients at registration through brochures available in the registration department that explain the program. A brochure titled Patient Payment Alternatives is provided to patients as part of the registration/admission process.This brochure describes Jefferson Regional Medical Center's credit policy, payment options, and the Health Concern Program, which provides for services at a reduced rate or without charge. Financial assistance contact information is provided in the brochure. Every in-patient is referred to a financial counselor for verification of insurance coverage benefits. If the patient has no insurance or minimum insurance, they are screened for referral to one of two outside agencies that we use to assist the patient for applying for medical assistance. The financial counselor also has the patient complete the uncompensated care (free care) application for Jefferson Regional Medical Center. This process is designed to identify patients who need medical assistance (uncompensated care and medical assistance criteria is not the same; the process searches for patients eligible for both). The front of the patient bills clearly state three payment options: option A is payment in full, with a 20 percent discount if the payment is received within 20 days of billing. Option B is the opportunity to make a payment arrangement, and pay off the bill in three equal monthly installments. Option C is the medical finance program for individuals needing more than three months to pay off their account balance. The back of the patient bill includes a section titled For Assistance in Paying Bills and provides income limits to qualify for the Health Concern Program. Financial assistance contact information is provided both on the front and the back of the patient bills. Additional Information: Translation services are available, if needed. Our financial counselors are trained on eligibility of both medical assistance (conducted by our outside vendors) and uncompensated care program (conducted by Jefferson Regional Medical Center management). We use an outside firm to assist the patient in actually applying for medical assistance. This company visits the patients in their home for follow up, or transports them to appointments, if necessary and conducts follow up as needed. Roles and responsibilities of financial assistance counselor include reviewing patient insurance and determining benefits available for that particular hospital stay. If there are no or limited benefits, they look to medical assistance. Social workers also identify financial assistance needs. Posted on Jefferson Regional Medical Center's website (in the patients/patient guide/billing): "Patients with no hospital insurance will need to schedule an appointment with one of our financial counselors. The financial counselor can visit you in your room or may help make arrangements to meet with a financial counselor on the day of your discharge. The financial counselor will review payment options with you and may help you in applying for medical assistance or the Jefferson Regional Medical Center's Health Concern program. Patients who do not qualify for either the medical assistance program or the medical center's health concern program will be expected to pay a deposit for services they received. Payment can be made by cash, check or credit care, as stated under the first option. In addition, application for a help loan is also a choice. All of these options will be discussed whenever you meet with the financial counselor. If you have any questions, please call our financial counselor's office at 412-469-5366. Please be prepared to stop at our cashier's office on your day of discharge to pay for your phone bill, and any deposit determined by your meeting with a financial counselor. Please be assured that we will do all that we can to assist you with meeting your financial obligations for this hospital bill. Brochures explaining the availability, criteria and process of applying for financial assistance are included with the patient bills; a summary of financial assistance options available is also printed on the patient bills. Jefferson Regional Medical Center utilizes the paro scoring software product as a final attempt to identify patients who qualify on charity care prior to being referred to an outside collection agency. Paro scoring is a software product that uses a compilation of public data bases and a methodology to categorize self pay balances for eligible charity care. If the patient qualifies, Jefferson Regional Medical Center will write them off to free care.
Community Served Information	Schedule H, Part VI, Line 4	The community that Jefferson Regional Medical center serves is located in southwest Pennsylvania, in an area south of Pittsburgh, including the southern part of the City of Pittsburgh, and can best be described by geographic boundaries. The type of community Jefferson Regional Medical Center serves is primarily suburban, but also includes some urban and rural communities. The Hospitals in our service area include: A. UPMC Mercy B. Mon Valley Hospital C. St. Clair Hospital D. UPMC Braddock E. UPMC McKeesport F. UPMC Presby/Shadyside The community we serve can be described from a demographic perspective as primarily white (87.7 percent), with some presence of African Americans (9.6percent) and only 2.7 percent other; only 1.1 percent Hispanic; 52.4 percent female and 47.6 percent male; skewing older with 28.7 percent ages 24 and under, 22.6 percent ages 25-45, 15.8 percent ages 45-54, and 32.9 percent ages 55 and older. In terms of income, 26.3 percent of the community has income at $24,999 and below, 28.3 percent between $25,000 and $49,999, 19.4 percent between $50,000 and $74,999 and 26percent are at $75,000 and above. Percent of households below the poverty guidelines is not available. While the rate of uninsured or underinsured for the community we serve is undetermined at this point, 31 percent of the total cases treated in our emergency department in 2011 were uninsured or underinsured. The percent of families who are on Medicaid or other assistance in our service area is 15.5 percent; at Jefferson Regional Medical Center, the percent is 9.9 percent.
Promotion of Community Health	Schedule H, Part VI, Line 5	A majority of Jefferson Regional Medical Center's 19 member governing body is comprised of persons who reside in the primary service area; only one member, 5 percent, is also an employee, and only three members, 16 percent are contracted physicians. Jefferson Regional extends medical staff privileges to all qualified physicians in its community for most of its departments. Jefferson Regional Medical Center is involved in governance and advisory groups through its community health council, which was created 30+ years ago as a way for the communities in which we serve to be partners with their health care provider. Council members are appointed by the mayor of each community and serve as a liaison for their municipality. Jefferson Regional Medical Center is involved in advocacy initiatives through its participation in the Hospital Council of Western PA Hospital Council works closely with governments throughout the region in conjunction with its members, on a local, state and federal level. Hospital Council assists members by providing and using data and information with local government outlining trends. State legislators often turn to hospital council and its members for the regional perspective on pending legislation and budget-related issues. Hospital council also provides testimony and comments when requested at local and state-related hearings, and works closely with Pennsylvania congressional and senate delegation on issues of importance to members and impacting the delivery of health care across the continuum in Western Pennsylvania. The emergency department, including or urgent care center called quick care, serves all persons regardless of the ability to pay. Of the total cases treated during FY 2010, approximately 33 percent were uninsured or underinsured. Jefferson Regional Medical Center participates in government sponsored health care programs including Medicare, Medicaid, Champus and Tricare. Financial assistance and sliding scale discounts are available (as described in section 3, above.) Jefferson Regional Medical Center is the primary hospital in our community. The hospital is involved in health professions education, particularly nursing education, and is involved in research on a minor scale. Community members utilize the hospital as a vehicle to connect with individuals and the overall community through philanthropy and volunteering, throughout the Jefferson Foundation and the Auxiliary. As part of its mission statement, the Foundation obtains gifts and grants and disburses funds for health care services. Special initiatives are directed towards ministering to the indigent and medically needy. The Foundation sponsors several fund-raising activities throughout the year including the annual health concern golf benefit. The Auxiliary of Jefferson Regional Medical Center is a dedicated group of people who contribute their time and talents to enhancing our services. Among the many services that Auxiliary members provide are planning annual fundraisers, a holiday giving tree, and a spring fashion show and luncheon, and serving in the Jefferson Regional Medical Center guest shoppe by preparing lunch and selling newspapers, flowers and gifts. Their chartable efforts support such causes as lifeline, a 24-hour personal response service; Jefferson Regional Medical Center Senior Services and the Heart Institute. Volunteers make a valuable contribution to the health care team at Jefferson Regional Medical Center. Adults and teens annually donate more than 100,000 hours of their time and talents to Jefferson Regional Medical Center. Volunteers are called upon to assist staff in many ways, including patient escorts, guest shop and gift cart services, physical/occupational therapy, information desk volunteer, mail room assistance, nursing unit assistance, patient representatives, intensive care and emergency department hosts, spiritual care representatives, x-ray patient representatives, and visitor/patient greeters. The Hospital enhances the overall well -being of the community by serving as a meeting place for many community groups, such as AA, Alanon, Alateen, Drivers Safety, Bereavement, Computer Classes, etc. Jefferson Regional Medical Center uses surplus funds to replace obsolete or work medical equipment, purchase innovative medical equipment and systems and make improvements to or expand physical plant in order to provide quality patient care. Jefferson is also consistently assessing community needs and addressing those needs with additional services. Often these additional services. Often these additional services require capital and other start -up costs requiring initial cash outlays. Currently any remaining surplus is used to meet pension funding requirements.
Affiliated Healthcare System	Schedule H, Part VI, Line 6	Jefferson Regional Medical Center is an independent community hospital, located just south of the City of Pittsburgh, PA. Jefferson Regional Medical Center provides quality health care services from emergency admissions to inpatient hospitalization and leading edge surgery to rehabilitation and home care. On March 1, 2013, the Hospital 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 Jefferson Regional Medical Center, the Allegheny Health Network also includes West Penn Allegheny Health System, Saint Vincent Health System and Saint Vincent Health Center.
State Filing of Community Benefit Report	Schedule H, Part VI, Line 7	Jefferson Regional 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:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
Jefferson Regional Medical Center

Employer identification number
25-1260215

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) Best of the Batch Foundation 200 West St Homestead,PA15120	34-1900914	501(c)(3)	10,000	FMV	N/A	Contribution to community outreach program

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2012

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information.

Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Identifier	Return Reference	Explanation

Schedule I (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

Jefferson Regional Medical Center

Employer identification number

25-1260215

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

Yes

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? .......

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable 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
(1)John DempsterPresident and CEO	(i) (ii)	475,937 0	43,050 0	20,900 0	287,980 0	7,190 0	835,057 0	0 0
(2)James CooperSenior Executive VP	(i) (ii)	337,329 0	32,550 0	15,769 0	7,500 0	16,342 0	409,490 0	0 0
(3)Richard Collins Jr MDExecutive VP & Secretary	(i) (ii)	326,455 0	32,750 0	11,400 0	7,500 0	16,206 0	394,311 0	0 0
(4)JoAnne HaheyTreasurer	(i) (ii)	283,792 0	28,450 0	0 0	7,500 0	20,002 0	339,744 0	0 0
(5)Louise UrbanExecutive VP/COO	(i) (ii)	230,480 0	22,050 0	1,800 0	7,500 0	17,811 0	279,641 0	0 0
(6)Marcie CaplanSenior Vice President	(i) (ii)	214,768 0	22,050 0	0 0	6,033 0	21,330 0	264,181 0	0 0
(7)Rosanne SaundersVP Human Resources	(i) (ii)	203,360	19,050	0	6,704	1,922	231,036	0
(8)Albert RaganVice President	(i) (ii)	181,108 0	18,050 0	0 0	6,158 0	19,528 0	224,844 0	0 0
(9)Michael EvansVP Patient Experience/Support	(i) (ii)	187,767 0	18,050 0	0 0	6,187 0	1,000 0	213,004 0	0 0
(10)James WitenskeDirector-Info Serv/ CIO	(i) (ii)	179,350 0	0 0	0 0	0 0	20,192 0	199,542 0	0 0
(11)John DanekMedical Director OCC Med/E	(i) (ii)	177,133 0	0 0	0 0	5,412 0	14,839 0	197,384 0	0 0
(12)Robert FrankFormer EVP/COO	(i) (ii)	0 0	0 0	326,788 0	289,852 0	19,761 0	636,401 0	0 0

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
Questions Regarding Compensation Received by Listed Individuals	Form 990, Schedule J, Page 1, Line 1a	The following represents additional disclosure pertaining to a director and officer listed in Form 990, Part VII, Section A who received a benefit listed on Schedule J, Line 1a from the organization during the year ended December 31, 2012: Tax Indenification and Gross Up Payments - James Cooper received gross up life insurance payments from the organization during the year ended December 31, 2012. These payments were included in his Box 5 of the IRS Form W-2.
Additional Compensation Disclosure	Form 990, Schedule J, Page 1	The following represents additional disclosure for Schedule J, line 4a pertaining to officers 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: Robert Frank $326,788
Deferred Compensation	Schedule J, Page 2, 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: Robert Frank $289,852

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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
Jefferson Regional Medical Center

Employer identification number
25-1260215

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Allegheny County Hospital Development Authority	25-1260215	01728AZ41	09-22-2010	17,500,000	Construction-Renovation of Operati		X		X		X
B	Allegheny County Hospital Development Authority	25-1260215	01728AS31	07-24-2008	14,500,000	Miscellaneous Capital Projects		X		X		X
C	Allegheny County Hospital Development Authority	25-1260215		01-25-2007	14,105,000	Refund 2000B Bonds		X		X		X
D	Allegheny County Hospital Development Authority	25-1260215	01728AE51	04-27-2006	22,000,000	Refund 1996A Bonds		X		X		X
	Allegheny County Hospital Development Authority	25-1260215		04-11-2006	19,670,000	Refund 1996A Bonds		X		X		X
	Allegheny County Hospital Development Authority	25-1260215		05-07-2004	6,935,000	Refund 1994A Bonds		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	645,000		1,045,000		3,900,000		0
2 Amount of bonds legally defeased . . . . . . . . . . .	0		0		0		0
3 Total proceeds of issue . . . . . . . . . . . . . .	17,500,000		14,500,000		14,105,000		22,000,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .	0		0		0		0
5 Capitalized interest from proceeds . . . . . . . . . . .	0		0		0		0
6 Proceeds in refunding escrows . . . . . . . . . . . .	0		0		0		0
7 Issuance costs from proceeds . . . . . . . . . . . .	231,077		150,643		152,762		174,012
8 Credit enhancement from proceeds . . . . . . . . . . .	0		0		0		0
9 Working capital expenditures from proceeds . . . . . . . . .	0		0		0		0
10 Capital expenditures from proceeds . . . . . . . . . . .	17,268,923		0		0		0
11 Other spent proceeds . . . . . . . . . . . . . .	0		14,349,357		13,952,238		21,825,988
12 Other unspent proceeds . . . . . . . . . . . . . .	0		0		0		0
13 Year of substantial completion . . . . . . . . . . . .	2012		2010		2007		2006
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X		X	X		X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

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? . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		0%		0%		0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . . . .	X		X		X		X
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?. . . . . . . . . . . . . . . . .		X		X		X		X
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? . . . . . . . . . . . . .		X		X		X		X
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?		X		X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X		X		X
b Exception to rebate? . . . . . . . .	X		X		X		X
c No rebate due? . . . . . . . . . .		X		X		X		X
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? . . . .	X		X			X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X			X	X
b Name of provider . . . . . . . . .	0		PNC Bank		0
c Term of hedge . . . . . . . . . .	29.		29.				19.
d Was the hedge superintegrated? . . . . . .		X		X				X
e Was a hedge terminated? . . . . . . .		X		X				X

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)? . . . . . . . . .		X		X		X		X
b Name of provider . . . . . . . . .	0		0		0		0
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? . . . . . . . .		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X		X		X

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?		X		X		X		X

Part VI

Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation
Written Procedures in FY 2013	Schedule K, Part III, Line 9 and Part IV, Line 7 and Part V	Jefferson Regional Medical Center is working towards finalizing the referenced procedures.

Schedule K (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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
Jefferson Regional Medical Center

Employer identification number
25-1260215

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Allegheny County Hospital Development Authority	25-1260215	01728AZ41	09-22-2010	17,500,000	Construction-Renovation of Operati		X		X		X
B	Allegheny County Hospital Development Authority	25-1260215	01728AS31	07-24-2008	14,500,000	Miscellaneous Capital Projects		X		X		X
C	Allegheny County Hospital Development Authority	25-1260215		01-25-2007	14,105,000	Refund 2000B Bonds		X		X		X
D	Allegheny County Hospital Development Authority	25-1260215	01728AE51	04-27-2006	22,000,000	Refund 1996A Bonds		X		X		X
	Allegheny County Hospital Development Authority	25-1260215		04-11-2006	19,670,000	Refund 1996A Bonds		X		X		X
	Allegheny County Hospital Development Authority	25-1260215		05-07-2004	6,935,000	Refund 1994A Bonds		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	645,000		1,045,000		3,900,000		0
2 Amount of bonds legally defeased . . . . . . . . . . .	0		0		0		0
3 Total proceeds of issue . . . . . . . . . . . . . .	17,500,000		14,500,000		14,105,000		22,000,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .	0		0		0		0
5 Capitalized interest from proceeds . . . . . . . . . . .	0		0		0		0
6 Proceeds in refunding escrows . . . . . . . . . . . .	0		0		0		0
7 Issuance costs from proceeds . . . . . . . . . . . .	231,077		150,643		152,762		174,012
8 Credit enhancement from proceeds . . . . . . . . . . .	0		0		0		0
9 Working capital expenditures from proceeds . . . . . . . . .	0		0		0		0
10 Capital expenditures from proceeds . . . . . . . . . . .	17,268,923		0		0		0
11 Other spent proceeds . . . . . . . . . . . . . .	0		14,349,357		13,952,238		21,825,988
12 Other unspent proceeds . . . . . . . . . . . . . .	0		0		0		0
13 Year of substantial completion . . . . . . . . . . . .	2012		2010		2007		2006
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X		X	X		X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

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? . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		0%		0%		0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . . . .	X		X		X		X
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?. . . . . . . . . . . . . . . . .		X		X		X		X
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? . . . . . . . . . . . . .		X		X		X		X
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?		X		X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X		X		X
b Exception to rebate? . . . . . . . .	X		X		X		X
c No rebate due? . . . . . . . . . .		X		X		X		X
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? . . . .	X		X			X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X			X	X
b Name of provider . . . . . . . . .	0		PNC Bank		0
c Term of hedge . . . . . . . . . .	29.		29.				19.
d Was the hedge superintegrated? . . . . . .		X		X				X
e Was a hedge terminated? . . . . . . .		X		X				X

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)? . . . . . . . . .		X		X		X		X
b Name of provider . . . . . . . . .	0		0		0		0
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? . . . . . . . .		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X		X		X

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?		X		X		X		X

Part VI

Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation
Written Procedures in FY 2013	Schedule K, Part III, Line 9 and Part IV, Line 7 and Part V	Jefferson Regional Medical Center is working towards finalizing the referenced procedures.

Schedule K (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Jefferson Regional Medical Center

Employer identification number

25-1260215

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) James Graham	Board Director	1,713,041	See Part V		No

Part V

Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
Business Transactions with Interested Persons	Schedule L, Part IV	Mr. Graham is an Executive Vice President of PNC Bank. Jefferson Regional Medical Center made banking and financial service payments to PNC for banking, investing and debt advisory services. All business conducted by the parties is at arms length and at fair market value.

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

Jefferson Regional Medical Center

Employer identification number

25-1260215

Identifier	Return Reference	Explanation
Statement of Program Service Accomplishments	Form 990, Page 2, Part III, Line 4a	IRS Form 990 - Organizational Comment IRS Form 990 On July 1, 2013, Jefferson Regional Medical Center 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"). In addition to Jefferson Regional Medical Center, the Allegheny Health Network also consists of West Penn Allegheny Health System, 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. everyone. everyone. INTRODUCTION Jefferson Regional Medical Center (JRMC)is a member of the Allegheny Health Network (AHN). The AHN is an integrated delivery network focused on preserving health care choice and providing affordable, high-quality care to the people in our communities. In addition to JRMC, the AHN consists of six hospitals and numerous other organizations dedicated to serving the community. You can visit the AHN at www.alleghenyhealthnetwork.com. UNCOMPENSATED CARE To enhance the health status of the community in which it operates and consistent with its tax-exempt status, JRMC provides needed health care services to individuals regardless of their ability to pay for all or part of the services rendered. Consistent with the filing of Schedule H, the components of uncompensated care include charity care, unreimbursed Medicaid costs and other means tested government programs. JRMC provided uncompensated care at a cost of $7,113,990 in Fiscal 2013. JRMC's uncompensated care policy bases eligibility on household gross income of those persons applying for uncompensated care. A sliding scale based upon federally approved poverty income guidelines is used to determine levels of uncompensated care eligibility. JRMC annually updates uncompensated care eligibility requirements to adhere to Federal guidelines. A large percentage of the population served (32.9%) are age 65 or older. These individuals are reliant on Medicare for their health care needs. We are committed to serving this sector of the population with the best care available. Thus, the unreimbursed costs we incur benefit the community with healthier and more independent seniors and should be treated as a community benefit. Understanding that some patient will not communicate the need for financial assistance until receipt of a bill, the patient financial services department accepts applications within 90 days of the date of service or within 90 days of denial by a third party payer. All applicants must apply for medical assistance coverage and final determination made by medical assistance before consideration of eligibility for the uncompensated care program. However, if because of a patient's resources it is evident that he will not be eligible on medical assistance coverage, this clause for eligibility consideration for the uncompensated care program is waived. JRMC utilized the Paro scoring software product as a final attempt to identify patients who qualify on charity care prior to being referred to an outside collection agency. Paro scoring is a software product that uses a compilation of public data bases and a methodology to categorize self pay balances for eligible charity care. If the patient qualifies, JRMC will move the amount to free care. 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, JRMC provided the following community health services during Fiscal 2013 at an estimated cost of $342,769.
Statement of Program Service Accomplishments - continued	Form 990, Page 2, Part III, Line 4a	Senior Services - Senior Services is a free program offering free non-medical assistance (information, referral and follow-up) to those seniors in need. The 1,547 client served is validation to the need that exists in our community. Our service area has a large senior population, with few resources and a great need for comprehensive assistance and follow-up in order to decrease the barriers to access healthcare. The program also collaborates with other Allegheny County and Pennsylvania programs for which the community need is already well established. Community Stroke Outreach Program - The Community Stroke Outreach program was developed in response to the significant number (35%) of individuals 55 years of age and older in our primary service area that are vulnerable to stroke with the risk doubling in each successive decade of life. Screenings are held in a variety of venues in order to identify risk factors for as many as possible. Blood Pressure Clinics- Outreach services are also provided by monthly offsite blood pressure clinics. Locations include lifespan senior sites (Allegheny County program) in our service area. The County Agency on Aging has determined this to be a community need for those they serve. Health For Her Program - The Health for Her program educations women and provides tools on current health topics which empower women and enable them to be better healthcare consumers, practice preventive healthcare and positively pursue management of chronic disease. The topics for inclusion in the program are solicited directly from the many attendees and future programming is driven by this community input as well as input from family practice physicians that see the needs of the community first hand. JRMC Speakers Bureau - The Speakers Bureau serves over 100 community organizations and responds directly to their individual needs. These organizations include AARP groups, church groups, neighborhood crime watches, schools, civic organizations, long term care facilities, chambers of commerce, senior groups, etc. Our presentations are tailored to the health topic requested by the caller thereby addressing an immediate need in the community. It may be a concern about flu or information regarding how to quickly assess a possible stroke and what action to take. The presentations always include extensive question and answer periods and the speaker stays afterwards to address individual concerns of the attendees. We also participate in community-sponsored health fairs. HEALTH PROFESSIONS EDUCATION JRMC provides aspiring health professionals with many educational opportunities to further their career in healthcare. Consistent with the filing of Schedule H, JRMC provided these services at a cost of $115,394. Higher Education Partnership - JRMC has partnerships with multiple colleges and universities to provide clinical experience for students completing their degrees. These partnerships include programs for nursing, pharmacy and technicians. SUBSIDIZED HEALTH SERVICES Subsidized health services represent those programs provided to the community by JRMC despite the fact the organization incurs a financial loss to do so. Jefferson Regional Medical Center recognizes the need of its community and voluntarily subsidizes these programs in support of its charitable mission. In this regard, Jefferson Regional Medical Center subsidized the Congestive Heart Failure (CHF) clinic; The Wellness Center; wound care; and emergency dispatch services. These services are available to all in the community regardless of whether the participant is a patient of JRMC. Consistent with the filing of Schedule H, JRMC, provided subsidized health services at a cost of $1,133,121 in Fiscal 2013. Cash Donations - Jefferson Regional Medical Center 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 organization made cash contributions totaling $42,155 including contributions to: Medical and Health Sciences Foundation Autism Connection of PA Care Partners Hospice Foundation March of Dimes Pleasant Hills Middle School - Angle Project Multiple Sclerosis Services Society Leukemia & Lymphoma Society Mon-Vale Health Resource COMMUNITY BUILDING ACTIVITES 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, JRMC provided these services at a cost of $78,543 in Fiscal 2013. Community Health Council - The community health council originated more than 30 years ago in response to the construction of the hospital as a way for the communities we serve to be partners with their healthcare provider. The members were appointed by the mayor of each community as the representative who would be the liaison for their municipality. During the past year, the council worked to find community sites for the medical center to conduct free stroke screenings. Through their community contacts they were able to obtain venues that would not otherwise have been available. The council disseminates information to the communities, informing them of the many opportunities for improved access and health education for prevention and chronic disease management. Job Shadowing and Career Exploration - JRMC also has partnerships with multiple colleges, universities, technical schools and high schools and provide a site for job shadowing and career exploration. This involves approximately 20 different departments and many types of programs spanning degrees in nursing to ultrasound/vascular technicians. The programs allow students to explore opportunities in the health care industries and/or to "shadow" a professional through their day, learning the rewards and challenges that the career offers. An area adjacent to the emergency room has been designated for the safe haven project which provides a safe place for newborns that might otherwise be abandoned or harmed. industries and/or to "shadow" a professional through their day, learning the rewards and challenges that the career offers. An area adjacent to the emergency room has been designated for the safe haven project which provides a safe place for newborns that might otherwise be abandoned or harmed.
Change to Organizational Governing Documents	Form 990, Page 6, Part VI, Section A, Question 4	The bylaws of Jefferson Regional 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 Jefferson Regional 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 Jefferson Regional Medical Center was prepared by the Highmark Health Tax Department and reviewed externally by a third party CPA Firm who signed the return as paid preparer. 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	Jefferson Regional Medical Center (JRMC)is a member of the Allegheny Health Network. JRMC has a corporate compliance department that monitors and oversees compliance with the conflict of interest policy of JRMC. The following describes the manner in which the corporate compliance department monitors and oversees compliance with the conflict of interest policy for JRMC. Conflict of Interest disclosure forms are completed on an annual basis by all board members, officers, key employees, members of a committee with board delegated powers, persons who have access to restricted sensitive or confidential information which could be valuable to non-JRMC entities and persons with a significant financial interest or influential interest. The President and Chief Operating Officer, by authority of the Board, is the designated Administrator for interpretation and implementation of this policy and all procedures relating to it. Failure to comply with this policy may include determination for the potentially interested party to sever all ties with JRMC.
Process Used To Determine Executive Compensation	Form 990, Page 6, Part VI, Section B, Line 15b	Jefferson Regional Medical Center utilizes a compensation comittee which follows a process that includes review of comparable data to ensure that compensation does not exceed fair market value. The review and approval of compensation is documented in committee minutes.
Public Access To Organizational Documents	Form 990, Page 6, Part VI, Section C, Line 19	Jefferson Regional Medical Center makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Compensation Reported For Individuals Serving Less Than a Full Year Form 990, Page 7, Part VII, Section A, Column A Multiple individuals listed on Form 990, Part VII will not have compensation disclosed. This is due to the filing organization not being related to their compensating organization during the period for which compensation is required to be reported.
Purpose Of Tax Exempt Bond Issuance	Form 990, Page 11, Part X, Line 20	In September 2010, Jefferson Regional Medical Center (JRMC) issued $17,500 (2010-A) of bonds through the Allegheny County Hospital Development Authority of which the proceeds were deposited into a project fund and are to be used primarily for expansion and renovation of the surgical suites. The bonds are secured by a Trust Indenture between the Authority and the JRMC and from the JRMCs 2010 Promissory Note issued to the Authority. The 2010-A is a 30-year variable rate bond, with annual principal payments which began in 2012 and continue until maturity in 2040. In July 2008, JRMC issued $14,500 (2008-A) bonds through the Authority of which the majority of the proceeds were used for various capital projects with the remaining $1,940 held in trust at U.S. Bank. The 2008-A is a variable rate bond, with annual principal payments which began in 2010 and continue until maturity in 2038. In February 2007, JRMC issued $14,105 (2007-A) bonds through the Authority of which the proceeds were used primarily for refunding the Medical Centers Series 2000-B serial bonds. $6,695 of this issue is due over a period of 10 years and $7,410 is due May 1, 2025. In May 2006, JRMC issued $22,000 (2006-A) and $19,670 (2006-B) of bonds through the Authority of which the proceeds were used primarily for refunding JRMCs Series 1996-A serial bonds. The principal payments for the 2006-B serial bonds are due over a period of 12 years. The first principal payment for the Series 2006-A variable rate bonds is due on May 1, 2018, and the payments are due over a period of nine years. In May 2004, JRMC issued $6,935 (2004-A) of bonds through the Authority of which the proceeds were used primarily for refunding JRMCs Series 1994-A serial bonds. The principal payments for the 2004-A bonds are due over a period of 10 years. In May 2000, JRMC issued $15,000 (2000-A) of bonds through the Authority of which the proceeds were used primarily to finance various capital projects. The principal payments for the 2000-A bonds are due over a period of 27 years. In March 1998, JRMC issued $22,460 (1998-A) of bonds through the Authority of which the proceeds were used primarily for refunding JRMCs Series 1992-A serial bonds. The principal payments for the 1998-A bonds are due over a period of 10 years beginning on May 1, 2020. Schedule K has been inserted into this Form 990 for full disclosure purposes.
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 Jefferson Medical Center for the year ended June 30, 2013: Purchase Accounting Adjustments $2,120,109 Contributions 2,332,578 Transfers To Affiliated Organizations 16,687,955 ___________ Other Changes in Net Assets $21,140,642

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:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Jefferson Regional Medical Center

Employer identification number

25-1260215

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
(1) JRMC Diagnostic Services LLC 565 Coal Valley Road Pittsburgh,PA15236 80-0069336	Medical Pract	PA	2,373,021	431,085	JRMC

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?
(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	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 1301 Carlisle Street Pittsburgh,PA15065 25-1875178	Healthcare	PA	501(c)(3)	3	WPAHS Inc		No
(7) Alle-Kiski Medical Center Trust 1301 Carlisle Street Pittsburgh,PA15065 20-5855753	Fundraising	PA	501(c)(3)	11-I	AKMC		No
(8) Canonsburg General Hospital 100 Medical Blvd Canonsburg,PA15317 25-1737079	Healthcare	PA	501(c)(3)	3	WPAHS Inc		No
(9) Canonsburg General Hospital Ambulance Se 100 Medical Blvd Canonsburg,PA15317 23-2939715	ER Response	PA	501(c)(3)	9	CGH		No
(10) Canonsburg Hospital & Health Foundation 100 Medical Blvd Canonsburg,PA15317 25-1818505	Inactive	PA	501(c)(3)	11-I	NA		No
(11) Forbes Health Foundation 2570 Haymaker Rd Monroeville,PA15146 25-1798379	Fundraising	PA	501(c)(3)	7	WPAHS Inc		No
(12) Greater Canonsburg Health System 100 Medical Blvd Canonsburg,PA15317 25-1488089	Inactive	PA	501(c)(3)	11-I	NA		No
(13) Suburban Health Foundation 100 South Jackson Ave Pittsburgh,PA15202 25-1472073	Fundraising	PA	501(c)(3)	11-I	WPAHS Inc		No
(14) The Western Pennsylvania Hospital Founda 4800 Friendship Ave Pittsburgh,PA15224 25-1470766	Fundraising	PA	501(c)(3)	11-I	WPAHS Inc		No
(15) West Allegheny Hospital 100 Medical Blvd Pittsburgh,PA15317 25-1054206	Inactive	PA	501(c)(3)	3	NA		No
(16) West Penn Allegheny Health System Inc Two Allegheny Ctr Pittsburgh,PA15212 25-0969492	Healthcare	PA	501(c)(3)	3	AHN		No
(17) West Penn Allegheny Oncology Network 4800 Friendship Ave Pittsburgh,PA15224 11-3683376	Healthcare	PA	501(c)(3)	11-III FL	WPAHS Inc		No
(18) West Penn Physician Practice Network 4800 Friendship Ave Pittsburgh,PA15224 25-1494317	Healthcare	PA	501(c)(3)	9	WPAHS Inc		No
(19) JRMCUPMC Cancer Associates 565 Coal Valley Rd Jefferson Hills,PA15236 20-1634783	Healthcare	PA	501(c)(3)	3	NA		No
(20) Jefferson Regional Medical Center Founda 565 Coal Valley Rd Jefferson Hills,PA15236 56-2420913	Fundraising	PA	501(c)(3)	11-I	NA	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Employee Benefit Data Services Company 120 Fifth Ave Suite 922 Pittsburgh,PA15222 25-1824465	Data Services	PA	N/A		0	0
(2) Gateway Health Plan LP 444 Liberty Avenue Suite 2100 Pittsburgh,PA15222 25-1691945	Insurance	PA	N/A		0	0
(3) Jenkins Empire Associates 120 Fifth Ave Suite 922 Pittsburgh,PA15222 25-1524682	Property Mgmt	PA	N/A		0	0
(4) Silver Rain LP 120 Fifth Ave Suite 922 Pittsburgh,PA15222 27-3035436	Property Mgmt	PA	N/A		0	0
(5) Provider PPI LLC 120 Fifth Ave Suite 922 Pittsburgh,PA15222 32-0429947	Facilities Suppor	PA	N/A		0	0
(6) Chartwell Pennsylvania LP 120 Fifth Ave Suite 922 Pittsburgh,PA15222	Medical Practice	PA	JRMC	R	0	0		No			No	15.000 %
(7) Waterfront Surgery Assoc 120 Fifth Ave Suite 922 Pittsburgh,PA15222	Medical Practice	PA	JRMC	R	0	0		No			No	25.000 %
(8) Waterfront Medical Assoc 120 Fifth Ave Suite 922 Pittsburgh,PA15222	Medical Practice	PA	JRMC	R	0	0		No			No	15.000 %
(9) Upper Midwest Consol Services Ctr LLC 120 Fifth Ave Suite 922 Pittsburgh,PA15222	Medical Practice	PA	JRMC	R	0	0		No			No	1.270 %
(10) 5148 Liberty Avenue Associates 4800 Friendship Ave Pittsburgh,PA15224	Medical Practice	PA	N/A		0	0
(11) Allegheny Imaging of McCandless 4800 Friendship Ave Pittsburgh,PA15224	Medical Practice	PA	N/A		0	0
(12) Forbes Regional Urologic 4800 Friendship Ave Pittsburgh,PA15224	Medical Practice	PA	N/A		0	0
(13) McCandless Endoscopy Center 4800 Friendship Ave Pittsburgh,PA15224	Medical Practice	PA	N/A		0	0
(14) North Shore Endoscopy Center 4800 Friendship Ave Pittsburgh,PA15224	Medical Practice	PA	N/A		0	0
(15) West Penn Ambulatory Center 15305 Dallas Parkway Pittsburgh,PA15224	Medical Practice	PA	N/A		0	0
(16) Peters Ambulatory Surgery Ctr LLC 4800 Friendship Ave Pittsburgh,PA15224	Medical Practice	PA	N/A		0	0
(17) UPMC Jefferson Regional Home Health LP 565 Coal Valley Rd Jefferson Hills,PA15236 25-1844485	Healthcare	PA	Fundraising		0	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?
(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		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	2,984,339	443,607	100.000 %	Yes
(58) Primary Care Group 2 Inc 6011 Baptist Rd Ste 220 Pittsburgh,PA15236 90-0451375	Medical Practice	PA	JRMC	C Corporation	830,101	103,903	100.000 %	Yes
(59) Primary Care Group 3 Inc 5426 Mifflin Rd Pittsburgh,PA15227 90-0451380	Medical Practice	PA	JRMC	C Corporation	634,900	157,002	100.000 %	Yes
(60) Primary Care Group 4 Inc 1907 Lebanon Church Rd West Mifflin,PA15122 80-0403090	Medical Practice	PA	JRMC	C Corporation	580,223	109,207	100.000 %	Yes
(61) Primary Care Group 5 Inc 624 Monongahela Ave Glassport,PA15045 80-0403100	Medical Practice	PA	JRMC	C Corporation	677,962	171,067	100.000 %	Yes
(62) Primary Care Group 6 Inc PO Box 333 West Mifflin,PA15122 45-3684432	Medical Practice	PA	JRMC	C Corporation	359,057	53,895	100.000 %	Yes
(63) Primary Care Group 7 Inc 575 Coal Valley Rd Jefferson Hills,PA15025 90-0503600	Medical Practice	PA	JRMC	C Corporation	596,210	116,848	100.000 %	Yes
(64) Primary Care Group 8 Inc 803 Miller Ave Clairton,PA15025 01-0927360	Medical Practice	PA	JRMC	C Corporation	180,926	121,131	100.000 %	Yes
(65) Primary Care Group 9 Inc 1200 Brooks Ln 270 Clairton,PA15025 01-0929359	Medical Practice	PA	JRMC	C Corporation	430,935	79,820	100.000 %	Yes
(66) Primary Care Group 10 Inc 3726 Brownsville Rd Pittsburgh,PA15227 38-3807173	Medical Practice	PA	JRMC	C Corporation	335,714	90,400	100.000 %	Yes
(67) Primary Care Group 11 Inc 455 Valley Brook Rd Ste 300 McMurray,PA15317 80-0494617	Medical Practice	PA	JRMC	C Corporation		18,360	100.000 %	Yes
(68) Primary Care Group 12 Inc 17 Arentzen Blvd Ste 101 Charleroi,PA15022 90-0614054	Medical Practice	PA	JRMC	C Corporation	1,040,297	236,565	100.000 %	Yes
(69) Park Cardiothoracic & Vascular Inst 565 Coal Valley Rd Jefferson Hills,PA15236 72-1529328	Medical Practice	PA	JRMC	C Corporation	1,454,138	156,557	100.000 %	Yes
(70) Family Practice Medical Associates South 2414 Lytle Rd Ste 300 Bethel Park,PA15102 25-1684735	Medical Practice	PA	JRMC	C Corporation	6,366,941	1,828,737	100.000 %	Yes
(71) Health System Services Corp & Subs 565 Coal Valley Rd Jefferson Hills,PA15236 25-1403745	Medical Office Bl	PA	JRMC	C Corporation	2,874,266	14,493,067	100.000 %	Yes
(72) JRMC Health Pavilion 565 Coal Valley Rd Jefferson Hills,PA15236 25-1203449	Medical Practice	PA	JRMC	C Corporation			100.000 %	Yes
(73) HSSC Diversified Services Inc 565 Coal Valley Rd Jefferson Hills,PA15236 25-1770047	Medical Practice	PA	JRMC	C Corporation			100.000 %	Yes
(74) Specialty Group Practice 1 Inc 575 Coal Valley Rd Ste 365 Jefferson Hills,PA15025 35-2367818	Medical Practice	PA	JRMC	C Corporation	646,968	554,730	100.000 %	Yes
(75) Grandis Rubin Shanahan & Assoc 565 Coal Valley Rd Jefferson Hills,PA15236 45-3355906	Medical Practice	PA	JRMC	C Corporation	3,390,755	392,167	100.000 %	Yes
(76) Steel Valley Orthopedics & Sports Medici 1200 Brooks Ln 240 Clairton,PA15025 45-3540378	Medical Practice	PA	JRMC	C Corporation	3,370,923	819,092	100.000 %	Yes
(77) Jefferson Hills Surgical Specialists PA 1200 Brooks Ln 150 Clairton,PA15025 30-0477313	Medical Practice	PA	JRMC	C Corporation	3,636,386	781,502	100.000 %	Yes
(78) JRMC Specialty Group Practice 565 Coal Valley Rd Jefferson Hills,PA15236 72-1529332	Medical Practice	PA	JRMC	C Corporation	1,572,490	269,163	100.000 %	Yes
(79) JRMC Physician Service Corp 565 Coal Valley Rd Jefferson Hills,PA15236 86-1159658	Medical Practice	PA	JRMC	C Corporation	206,568	27,298	100.000 %	Yes
(80) Pace Re Ltd 565 Coal Valley Rd Jefferson Hills,PA15236 98-1109020	Medical Practice	PA	JRMC	C Corporation			100.000 %	Yes
(81) Pittsburgh Bone Joint and Spine Inc 565 Coal Valley Rd Jefferson Hills,PA15236 25-1203449	Medical Practice	PA	JRMC	C Corporation	1,696,408	1,089,122	100.000 %	Yes
(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	AHN	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	Insurance	PA	HMPG Inc	C Corporation

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

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) Jefferson Regional Medical Center Foundation	C	113,965	Cash
(2) Jefferson Hills Surgical Specialists	C	385,250	Cash

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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: See Form 990, Page 2, Part III, Line 1
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	23
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	20
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	2,321
6	Total number of volunteers (estimate if necessary) .............	6	250
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	495,821	518,422
9	Program service revenue (Part VIII, line 2g) .........	241,100,576	229,330,105
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,131,189	16,078,823
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,091,530	11,721,948
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	249,819,116	257,649,298
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	34,708	18,350
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)	102,852,161	106,343,198
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	143,180,710	143,775,548
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	246,067,579	250,137,096
19	Revenue less expenses. Subtract line 18 from line 12.......	3,751,537	7,512,202
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	359,020,460	378,811,888
21	Total liabilities (Part X, line 26).............	236,167,304	227,305,888
22	Net assets or fund balances. Subtract line 21 from line 20.....	122,853,156	151,506,000

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 35,033,435 including grants of $ ) (Revenue $ 111,100,409 )
	Jefferson Regional 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, Jefferson Regional Medical Center provides Medical services to all patients regardless of their ability to pay.

4b	(Code: ) (Expenses $ 22,484,292 including grants of $ ) (Revenue $ 50,835,159 )
	Jefferson Regional 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, Jefferson Regional Medical Center provides Orthopedic services to all patients regardless of their ability to pay.

4c	(Code: ) (Expenses $ 17,740,484 including grants of $ ) (Revenue $ 50,893,140 )
	Jefferson Regional 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, Jefferson Regional Medical Center provides Respiratory services to all patients regardless of their ability to pay.

	(Code: ) (Expenses $ 159,026,279 including grants of $ ) (Revenue $ 20,630,422 )
	Other Program Services

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 159,026,279 including grants of $ 18,350 ) (Revenue $ 20,630,422 )
4e	Total program service expenses234,284,490

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,780,487	0	0

(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)
(A) Name and Title
(1) Charles Modispacher........................................................................ Chair	1.0 .......................	X	X
(2) Gregory Harbaugh........................................................................ Vice Chair	1.0 .......................	X	X
(3) Edward Marasco........................................................................ Vice Chair	1.0 .......................	X	X
(4) Ambaram Chauhan MD........................................................................ Director	1.0 .......................	X
(5) Sister Marguerite Coyne CSJ........................................................................ Director	1.0 .......................	X
(6) Gary Deschamps........................................................................ Director	1.0 .......................	X
(7) Richard Talarico........................................................................ Director	1.0 .......................	X
(8) Kenneth Evancic........................................................................ Director	1.0 .......................	X
(9) Karen Evans........................................................................ Director	1.0 .......................	X
(10) Arnold Fingeret MD........................................................................ Director	1.0 .......................	X
(11) Natalie Vaccari Furlong DO........................................................................ Director	1.0 .......................	X
(12) David Graffam........................................................................ Director	1.0 .......................	X
(13) James Graham........................................................................ Director	1.0 .......................	X
(14) Sister Geraldine Grandpre CSJ........................................................................ Director	1.0 .......................	X
(15) Timothy Honkala MD........................................................................ Director	1.0 .......................	X
(16) Cheri Bomar........................................................................ Director	1.0 .......................	X
(17) William Richardson........................................................................ Director	1.0 .......................	X

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a		15,033
b	Membership dues....1b
c	Fundraising events....1c		75,675
d	Related organizations...1d		128,965
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		298,749

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			518,422
			Business Code
2a	NET PATIENT SERVICE REVENUE		623000	229,330,105	229,330,105
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			229,330,105
3	Investment income (including dividends, interest, and other similar amounts).......			2,389,354			2,389,354
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	2,162,752
b	Less: rental expenses	1,663,487
c	Rental income or (loss)	499,265	0
d	Net rental income or (loss).......			499,265			499,265
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	13,702,255	-12,786
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	13,702,255	-12,786
d	Net gain or (loss)..........			13,689,469			13,689,469
8a	Gross income from fundraising events (not including $ 75,675 of contributions reported on line 1c). See Part IV, line 18 ..
	a		115,695
b	Less: direct expenses ...b		97,525
c	Net income or (loss) from fundraising events..			18,170			18,170
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...			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..			0
Miscellaneous Revenue			Business Code
11a	EARNINGS OF OPERATIONS			6,033,365			6,033,365
b	MEANINGFUL USE			3,544,975	3,544,975
c	REBATE REVENUE			1,042,123			1,042,123
d	All other revenue ....			584,050	584,050
e	Total. Add lines 11a–11d ......			11,204,513
12	Total revenue. See Instructions......			257,649,298	233,459,130		23,671,746


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			7,280	1	30,341
2	Savings and temporary cash investments .........			6,901,478	2	3,988,375
3	Pledges and grants receivable, net ...........			0	3	48,538
4	Accounts receivable, net .............			27,625,535	4	45,344,559
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 .............			3,626,575	7	1,829,479
8	Inventories for sale or use ..............			4,105,698	8	4,059,491
9	Prepaid expenses and deferred charges ..........			8,107,834	9	2,332,044
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	143,185,230
b	Less: accumulated depreciation .....	10b	26,177,574	115,076,731	10c	117,007,656
11	Investments—publicly traded securities ..........			103,853,644	11	118,970,249
12	Investments—other securities. See Part IV, line 11 .....			13,717,812	12	4,782,739
13	Investments—program-related. See Part IV, line 11 .....			0	13	0
14	Intangible assets ...............			3,835,347	14	0
15	Other assets. See Part IV, line 11 ...........			72,162,526	15	80,418,417
16	Total assets. Add lines 1 through 15 (must equal line 34)......			359,020,460	16	378,811,888
17	Accounts payable and accrued expenses .........			98,329,059	17	103,652,492
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			110,005,439	20	105,666,078
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 ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			27,832,806	25	17,987,318
26	Total liabilities. Add lines 17 through 25.........			236,167,304	26	227,305,888
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			122,259,106	27	150,468,852
28	Temporarily restricted net assets ...........			594,050	28	740,362
29	Permanently restricted net assets ...........			0	29	296,786
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			122,853,156	33	151,506,000
34	Total liabilities and net assets/fund balances ........			359,020,460	34	378,811,888