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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
UPMC Hamot Amended
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
600 Grant Street 58th Floor
C/O Corporate Tax Dept Suite
Room/suite
City or town, state or country, and ZIP + 4
Pittsburgh, PA15219
D Employer identification number

25-0965387
E Telephone number

G Gross receipts $ 366,659,043
F Name and address of principal officer:
V James Fiorenzo
201 STATE STREET
PITTSBURGH,PA16550
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.upmchamot.com
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1881
M State of legal domicile: PA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: UPMC HAMOT IS A PREMIER PROVIDER OF INPATIENT AND OUTPATIENT MEDICAL SERVICES TO RESIDENTS OF WESTERN PENNSYLVANIA, WESTERN NEW YORK AND NORTHEASTERN OHIO. See Schedule O
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 24
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 13
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 3,088
6 Total number of volunteers (estimate if necessary) ............. 6  
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 227,612
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 115,715 1,208,615
9 Program service revenue (Part VIII, line 2g) ......... 372,621,778 352,530,138
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,786,006 3,335,281
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 374,523,499 357,074,034
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 122,160 199,002
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) 167,369,468 167,921,404
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 182,803,264 169,600,533
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 350,294,892 337,720,939
19 Revenue less expenses. Subtract line 18 from line 12....... 24,228,607 19,353,095
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 563,259,430 555,172,287
21 Total liabilities (Part X, line 26)............. 213,633,475 134,613,291
22 Net assets or fund balances. Subtract line 21 from line 20..... 349,625,955 420,558,996
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: UPMC HAMOT'S MISSION IS TO SERVE OUR PATIENTS AND COMMUNITY IN THE HAMOT TRADITION OF QUALITY, HEALTH, HEALING AND EDUCATION. TO PUT SIMPLY, "TO SERVE."
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 308,598,206 including grants of $   ) (Revenue $ 352,530,138 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet308,598,206
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
Yes
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............. Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
268
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
3,088
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
24
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
13
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
PA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletSTEPHEN DANCH300 STATE STREET SUITE 100ERIEPA16507 (814) 877-3896
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Scott B Kern........................................................................
Board Chairman
 1.0
.......................   		X   X       0 0 0
(2) Desmond J McDonald........................................................................
Board Vice Chairman
 1.0
.......................   		X           0 0 0
(3) Gregory S Baldwin Esq........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(4) Jeffrey E Beach CPA........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(5) Mary C Bula........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(6) Elizabeth Concordia R 101812........................................................................
Board Member
 1.0
.......................40.0 		X           0 2,228,779 409,078
(7) George M Currie R 101812........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(8) Leslie Davis........................................................................
Board Member
 1.0
.......................   		X           0 756,195 86,537
(9) Robert DeMichiei........................................................................
Board Member
 1.0
.......................40.0 		X           0 1,205,205 331,342
(10) Robert J Ferraro MD........................................................................
Board Member
 1.0
.......................   		X                
(11) Richard E Griffith........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(12) Richard S Hamilton........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(13) C Talbot Heppenstall Jr........................................................................
Board Member
 1.0
.......................40.0 		X           0 999,374 273,208
(14) Margaret Joy........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(15) Carolynn Masters PhD........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(16) Linda Myers........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(17) Mark H Raimy........................................................................
Board Member
 1.0
.......................   		X           0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Nicholas N Scott........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(19) Thomas A Tupitza Esq........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(20) Joseph Walton........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(21) Gail Welch........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(22) Barry D Stamm MD........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(23) Richard Nygarrd........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(24) Diane Holder E 101812........................................................................
Board Member
 1.0
.......................   		X           0 1,668,231 453,853
(25) Dwane Brock E 101812........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(26) Beth Burnside E 101812........................................................................
Board Member
 1.0
.......................   		X           0 0 0
(27) Donald K Inderlied R 13113........................................................................
Board Secretary / Secretary
 40.0
.......................   		    X       261,600 0 30,598
(28) John T Malone R 13113........................................................................
President
 40.0
.......................   		    X       708,493 0 38,932
(29) Stephen M Danch........................................................................
Treasurer/ CFO
 40.0
.......................   		    X       378,473 0 42,476
(30) V James Fiorenzo........................................................................
Vice President/ President
 40.0
.......................   		    X       613,845 0 33,934
(31) Carrie Ennis E 2113........................................................................
Board Secretary/ Secretary
 40.0
.......................   		    X       68,234 0 19,893
(32) David Gibbons E 8612........................................................................
Chief Operating Officer
 40.0
.......................   		    X       289,546 0 3,110
(33) Richard Long MD........................................................................
VP Medical Affairs
 40.0
.......................   		        X   417,156 0 38,545
(34) Joseph Butler........................................................................
VP Operations
 40.0
.......................   		        X   300,877 0 35,065
(35) James Donnelly........................................................................
CNO, VP Patient Care Service
 40.0
.......................   		        X   256,276 0 25,338
(36) Gary Maras........................................................................
VP Bus Development
 40.0
.......................   		        X   243,075 0 29,578
(37) Debbie Burbules........................................................................
VP Women Services
 40.0
.......................   		        X   240,698 0 30,390
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,778,273 6,857,784 1,881,877
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet47
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Medicor Associates Inc, 120 East 2nd streetERIEPA16507 Medical Services 18,517,210
North American Partners in Anesthes, 68 SOUTH SERVICE ROAD SUITE 350MELVILLNY11747 Anesthesia Services 3,046,934
Edwards LifeSciences, 23146 Network PlaceCHICAGOIL60673 Medical Supplies 1,192,013
Associated Clinical Labs, 1526 Peach StreetERIEPA16501 Laboratory Servicees 1,191,143
Considine Biebel Company, 2949 West 15th StreetERIEPA16505 General Construction 745,693
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet19
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,123,096
e Government grants (contributions)1e 42,078
f All other contributions, gifts, grants, and
similar amounts not included above1f 		43,441
g Noncash contributions included in lines
1a-1f:$ 		423,096
h Total. Add lines 1a-1f.......MediumBullet 1,208,615
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 621990 337,729,308 337,729,308    
b RENTAL INCOME 621110        
c JOINT VENTURE REVENUE 900099 4,430,472 4,430,472    
d OTHER PATIENT SERVICE REVENUE 541900 3,621,480 3,621,480    
e OTHER PROGRAM SERVICE REVENUE 561700 6,748,878 6,521,266 227,612  
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 352,530,138
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 1,922,830     1,922,830
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 10,473,910 523,550
b Less: cost or other basis and sales expenses 9,012,930 572,079
c Gain or (loss) 1,460,980 -48,529
d Net gain or (loss)..........MediumBullet 1,412,451     1,412,451
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 357,074,034 352,302,526 227,612 3,335,281
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 199,002 199,002
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 .... 2,401,008   2,401,008  
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 135,297,377 122,113,330 13,184,047  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 4,596,314 4,157,707 438,607  
9 Other employee benefits ....... 17,870,613 15,913,411 1,957,202  
10 Payroll taxes ........... 7,756,092 6,887,410 868,682  
11 Fees for services (non-employees):        
a Management ...... 1,580,232 447,645 1,132,587  
b Legal ......... 443,872 5,455 438,417  
c Accounting ........... 6,975   6,975  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 606,158   606,158  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 2,794,636 2,792,146 2,490  
12 Advertising and promotion .... 470,190 470,190    
13 Office expenses ....... 335,548 335,548    
14 Information technology ...... 3,431,655 1,909,063 1,522,592  
15 Royalties .. 0      
16 Occupancy ........... 7,955,652 6,252,519 1,703,133  
17 Travel ............ 932,548 632,509 300,039  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 20,421 17,423 2,998  
20 Interest ........... 4,441,892 4,441,892    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 15,410,670 15,410,670    
23 Insurance .............. 6,217,333 6,082,878 134,455  
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 IMPLANTS 32,265,739 32,265,739    
b MEDICAL/PATIENT SUPPLIES 28,705,400 28,705,400    
c PROVISION FOR BAD DEBT 20,411,826 20,411,826    
d DRUGS 17,190,383 17,190,383    
e All other expenses 26,379,403 21,956,060 4,423,343  
25 Total functional expenses. Add lines 1 through 24e 337,720,939 308,598,206 29,122,733 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 1,839 1 9,657
2 Savings and temporary cash investments ......... 1,775,094 2 9,259,075
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 50,676,865 4 50,418,388
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 ............. 163,982,134 7 146,994,045
8 Inventories for sale or use .............. 2,251,299 8 1,731,567
9 Prepaid expenses and deferred charges .......... 10,398,983 9 642,083
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 146,623,122
b Less: accumulated depreciation ..... 10b 5,688,067 142,731,695 10c 140,935,055
11 Investments—publicly traded securities .......... 102,234,499 11 95,840,544
12 Investments—other securities. See Part IV, line 11 ..... 14,256,660 12 22,732,650
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 74,950,362 15 86,609,223
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 563,259,430 16 555,172,287
Liabilities 17 Accounts payable and accrued expenses ......... 14,441,065 17 20,186,324
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 392,250 19 276,456
20 Tax-exempt bond liabilities ............. 93,888,163 20 83,387,248
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 .. 1,496,423 23 1,433,840
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.................... 103,415,574 25 29,329,423
26 Total liabilities. Add lines 17 through 25......... 213,633,475 26 134,613,291
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 259,419,341 27 337,256,644
28 Temporarily restricted net assets ........... 76,121,784 28 68,696,141
29 Permanently restricted net assets ........... 14,084,830 29 14,606,211
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 349,625,955 33 420,558,996
34 Total liabilities and net assets/fund balances ........ 563,259,430 34 555,172,287
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
357,074,034
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
337,720,939
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
19,353,095
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
349,625,955
5
Net unrealized gains (losses) on investments ...............
5
5,130,891
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
46,449,055
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
420,558,996
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

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

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
UPMC Hamot Amended
 
Employer identification number

25-0965387
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
UPMC Hamot Amended
 
Employer identification number

25-0965387
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
UPMC Hamot Amended
  		Employer identification number

25-0965387
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
UPMC Hamot Amended
  		Employer identification number

25-0965387
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
UPMC Hamot Amended
  		Employer identification number

25-0965387
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
UPMC Hamot Amended
 
Employer identification number

25-0965387
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
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 ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   4,979,701 4,979,701
b Buildings ................   76,359,722 -3,019,581 79,379,303
c Leasehold improvements ............   -1,588,191 -1,695,326 107,135
d Equipment ................   62,916,625 10,983,281 51,933,344
e Other .................   3,955,265 -580,307 4,535,572
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 140,935,055
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) JV INVESTMENTS 34,611,098
(2) OTHER TRUSTEED ASSETS 2,155,586
(3) DEFERRED FINANCING COSTS 1,670,968
(4) BENEFICIAL INT IN FOUNDATION 22,081,464
(5) LONG TERM OTHER INVESTMENT 1,553,302
(6) DUE TO THIRD PARTY PAYORS 148,256
(7) LONG TERM ADVANCES 6,312,409
(8) OTHER ASSETS 1,723,062
(9) DUE FROM AFFILIATE 16,353,078
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 86,609,223
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
OTHER CURRENT & LONG TERM LIAB 2,821,736
ACCRUED PENSION 19,552,536
MALPRACTICE LOSS RESERVE 6,179,379
BONDS/OID/OIP/REBATE 775,772





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 29,329,423
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
UPMC Hamot Amended
 
Employer identification number

25-0965387
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    5,242,730   5,242,730 1.650 %
b Medicaid (from Worksheet 3,
column a) .... 		    50,293,522 38,242,947 12,050,575 3.800 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    55,536,252 38,242,947 17,293,305 5.450 %
Other Benefits
     3,186,295 17,035 3,169,260 1.000 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    6,283,698 2,998,988 3,284,710 1.040 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)     343,303   343,303 0.110 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    199,002   199,002 0.060 %
j Total. Other Benefits ..     10,012,298 3,016,023 6,996,275 2.210 %
k Total. Add lines 7d and 7j .     65,548,550 41,258,970 24,289,580 7.660 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     311,402   311,402 0.100 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     378,088   378,088 0.120 %
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     689,490   689,490 0.220 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,437,352
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
309,362
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
136,769,052
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
143,705,534
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-6,936,482
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1HAMOT SURGERY CENTER
  		OUTPATIENT SURGERY CENTER 51.000 %   49.000 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 UPMC HAMOT
201 STATE STREET
ERIE,PA16550 		X X   X   X X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

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

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9    
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10    
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    
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    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13    
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15    
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17    
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19    
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21    
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
PART 1 LINE 3C   Financial assistance or charity care is available for eligible individuals who have health care needs and are uninsured, underinsured, ineligible for government programs or otherwise unable to pay for their own care. A patient may be determined to have financial need based on the following: 1. Indigency: If income fallS below 200% of the federal poverty guidelines, the patient will have no financial responsibility. The patient is approved for 100% free care. 2. Low Income Sliding Scale: Assistance may be a discounted or reduced patient liability depending on the patient's income: a. If the combined family income IS greater than or equal to 200% and less than or equal to 300% of the federal poverty guidelines, the patient is eligible for a reduced charity care. There will be an 80% reduction in the patient bill. b. If the combined family income IS greater than or equal to 300% and less than or equal to 400% of the federal poverty guidelines, the patient is eligible for a reduced charity care. There will be a 70% reduction in the patient bill. The discounted charity care scale is listed below: 2012 Financial Assistance Income Guidelines F/S FINANCIAL 100% PatIENT 0% FINANCIAL 85% PatIENT 15% ASSISTANCE ASSISTANCE 1 $22,340 $44,680 2 $30,260 $60,520 3 $38,180 $76,360 4 $46,100 $92,200 5 $54,020 $108,040 6 $61,940 $123,880 7 $69,860 $139,720 8 $77,780 $155,560 + $7,920 $15,840 3. Financial Hardship: If a patient is approved for discounted or reduced charity care and cannot afford to pay the remaining balance, the patient may be considered for financial hardship. The patient will be liable to pay 15% of their calculated income and assets towards their medical bill or the reduced amount whichever is less.
PART I LINE 6A   UPMC PREPARES AN ANNUAL COMMUNITY BENEFITS REPORT. THE REPORT ENCOMPASSES INFORMATION FOR THE ENTIRE INTEGRATED DELIVERY SYSTEM THAT MAKES UP THE UPMC HEALTH SYSTEM INCLUDING UPMC HAMOT. IT IS POSTED TO AND AVAILABLE TO THE PUBLIC VIA THE UPMC WEBSITE, WWW.UPMC.COM.
PART I FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINE 6B, LINE 7, LINE 7G, LINE 7 COLUMN F PART I LINE 7 COSTING METHODOLODY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I LINE 7: The costing methodology used to calculate the amounts reported in Part 1 Line 7 is a combination of direct costs as well as indirect costs where obtainable. Where appropriate, to determine cost a ratio of costs to charges method is employed. The method is in line with those described in Schedule H, Worksheet 2, "Ratio of Patient Costs to Charges". PART 1 LINE 7 Column f: The Bad Debt expense of $20,411,826 from line 24(b) of Part IX is subtracted from the total expenses of $337,720,939 per line 25 Column A of Part IX in order to calculate the percentages in part I Line 7 Column
PART III LINE 3   Process for reallocation from bad debt to charity care UPMC including UPMC Hamot reclassifies bad debt accounts as charity care by utilizing a predictive model PARO. PARO was built as a socio-economic score that identifies those patients that are most likely to be the highest need of financial assistance. This is accomplished by analyzing consumer data and activity, court records, government records, property files, Census data and IRS data. PARO provides a systematic approach to Financial Assistance: " Predictive model that encompasses healthcare economics and credit policies; " Uniform assessment measure for every patient regardless of financial standing; " Accounts for patients that are unresponsive, illiterate, or otherwise challenged to apply; " Eliminate barrier to application and meets increased pressure to provide additional financial resources to Consumers; " Identify and support those Community needs efforts to provide assistance to those Consumers in need. All bad debt accounts with a balance of $1000.00 and greater are "scored" by PARO. There are two data points returned to UPMC in order to make the decision whether the patient would qualify for charity care. The first is the estimated income level based on the Federal Poverty Level guidelines. The second is the PARO score which utilizes an algorithm based approach and returns a score based on personal attributes of the patient. Data elements were combined to create two primary indicators of need, the PARO score and the Federal Poverty Level. PARO analyzed our historical approvals to determine what our PARO threshold and the FPL threshold for the historical approvals. The approved accounts were compared against accounts that were in active AR. This was done to determine if the distributions were similar or if any pattern existed based on the approved accounts and the unknown accounts If the patient's estimated income and PARO score are within the scores identified by the calibration of UPMC existing charity care patients, the account is reclassified from bad debt to charity care. Every patient is able to apply for charity care; however, the automated strategy focuses on patients that do not complete the applications process. The US Department of Education estimates that 1 in 5 consumers are functionally illiterate. This, coupled with the low levels of participation in traditional banking methods, makes the application process virtually impossible for some consumers.
PART III BAD DEBT, MEDICARE, & COLLECTION PRACTICES LINES 2 & 3 PART III LINE 4 COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED IN PART III LINE 2 AND 3: The costing method used to calculate the amounts in Schedule H Part III lines 2 and 3 is a ratio of cost to charges method. Discounts and payments in patient's accounts are deducted before the cost of bad debt expense is determined. The method employed is in line with those described in Schedule H, Worksheet 2, "Ratio of Patient Costs to Charges". RATIONALE FOR INCLUDING BAD DEBT AMOUNTS IN COMMUNITY BENEFIT: The organization's bad debt expense consists solely of self pay patients accounts deemed uncollectable. It is UPMC Hamot's contention that the cost of bad debt should be stated in Part I Line 7 of Schedule H as they represent the costs for provision of services to patients for which the entity has exhausted all recourse for reimbursement. The services provided to patients who present themselves are provided regardless of a patient's ability to pay as in line with the organizations charitable mission and service to our community. These expenses are incurred regardless of the efficiency of the provision of the related medical care and are deemed to have been medically necessary for the patient. METHOD THE ORGANIZATION USES TO DETERMINE THE ESTIMATED AMOUNT OF THE ORGANIZATIONS BAD DEBT EXPENSE AT COST ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS CHARITY CARE POLICY: The method that the organization uses to determine the amount of the cost of bad debts that reasonably could be attributable to patients who likely would quality for financial assistance under the hospital's charity care policy if sufficient information had been available to make a determination of their true eligibility is based on a statistical model applied to a sampling of inpatient accounts. The predictive model takes into consideration consumer activity and data, court records, government records, census data and encompasses healthcare economics, local demographics and credit policies. PART III LINE 8 COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS OF CARE AND AS REPORTED IN THE ORGANIZATIONS MEDICARE COST REPORT: The costing methodology used to determine the Medicare allowable costs of care is a ratio of costs to charges method. The method is in line with those described in Schedule H, Worksheet 2, "Ratio of Patient Costs to Charges". It is UPMC Hamot's contention that all amounts calculated to be shortfalls in reimbursement for services provided to Medicare patients are truly uncompensated care that should be stated in Part I Line 7 of Schedule H of Form 990 as they represent costs for provision of services to patients for which the entity has no recourse for reimbursement, regardless of the efficiency of provision of the related care costs. PART III LINE 9b COLLECTION PRACTICES SET FORTH IN THE ORGANIZATIONS COLLECTION POLICY THAT APPLY TO PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE: If determined at any point prior to or during the patients stay that the patient is medically indigent, credit personnel will assist the patient, patient's family or guarantor in completing an application for state medical assistance and may suspend certain admission and in house payment requirements pending final determination as to medical assistance eligibility. Patients may request charity care post discharge by either calling or visiting the hospital and speaking with the patient accounting office. Personnel in patient accounting are designated to handle charity care applications. handle charity care applications.
PART III LINE 9   UPMC has a debt collection policy outlining collection practices for patients. If at any time the patient expresses an inability to pay, they are sent a Financial Assistance application. Information regarding Financial Assistance is printed on all collection letters. PART V SECTION B LINE 5A WESBITE FOR CHNA: http://www.upmc.com/locations/hospitals/hamot/about/Pages/default.aspx http://ecdh.org/showcase.php/2012-Erie-County-Community-Health-Needs-Asses sment/40/2152/314/3464
PART VI - SUPPLEMENTAL INFORMATION - LINES 2, 4 AND 5 LINE 2 DURING FISCAL YEAR 2013 UPMC HAMOT PARTICIPATED IN IRS-REQUIRED COMMUNITY HEALTH NEEDS ASSESSMENTS WITH BOTH UPMC HEALTH SYSTEM AND WITH A COLLABORATIVE OF ERIE COUNTY, PA HOSPITALS LEAD BY THE ERIE COUNTY DEPARTMENT OF HEALTH. THESE ASSESSMENTS STRENGTHENED AND BROADENED COMMUNITY INPUT AND PARTNERSHIPS. TO ENSURE THAT UPMC HAMOT'S COMMUNITY-FOCUSED EFFORTS ARE MOST EFFECTIVELY ADDRESSING THE NEEDS OF THE INDIVIDUALS AND COMMUNITIES IT SERVES, THE ORGANIZATION WORKED WITH COMMUNITY STAKEHOLDERS AND PUBLIC HEALTH EXPERTS TO IDENTIFY COMMUNITY HEALTH NEEDS AND DETERMINE HOW TO COLLABORATE MOST EFFECTIVELY TO ADDRESS THESE NEEDS. UPMC HAMOT ACTIVELY ENGAGED ITS HOSPITAL BOARD, ASSEMBLED A COMMUNITY ADVISORY GROUP, AND OBTAINED INPUT DIRECTLY FROM THE COMMUNITY IT SERVES. THE END RESULT IS A STRATEGIC PLAN SPECIFIC TO UPMC HAMOT TO ADDRESS SIGNIFICANT COMMUNITY HEALTH NEEDS. IMPORTANTLY, THE PLAN ADDRESSES LOCAL COMMUNITY NEEDS NOT ONLY AT THE HOSPITAL LEVEL, BUT ALSO INCLUDE EFFORTS UNDERTAKEN IN PARTNERSHIP WITH OTHER LOCAL HOSPITALS, EXTERNAL ORGANIZATIONS, AND THE LARGER UPMC SYSTEM. CHNA REPORTS AND STRATEGIC PLANS FOR UPMC HAMOT CAN BE FOUND ON THE INTERNET: UPMC HAMOT COMMUNITY HEALTH NEEDS ASSESSMENT: http://www.upmc.com/locations/hospitals/hamot/about/Pages/default.aspx ERIE COUNTY DEPARTMENT OF HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT: http://ecdh.org/showcase.php/2012-Erie-County-Community-Health-Needs-Asses sment/40/2152/314/3464
PART VI LINE 3   The charity care policy is posted throughout the medical center including postings at each registration window. Charity care applications are provided to all uninsured patients. Patients are also given information regarding financial assistance in their information packet and it is reviewed during the admission process.
PART VI LINE 4   UPMC Hamot's primary service area is Erie county in Pennsylvania and its secondary service area encompasses Crawford, Warren and McKean counties in Pennsylvania, Ashtabula county in Ohio, and Chautauqua County in New York. The population in the primary and secondary service areas is almost 700,000. While Erie County is largely urban and suburban the secondary service areas are largely rural. Median household income in Erie County is $45,249 and 16.1% of the residents fall below the federal poverty level with over 20% of the population being Medicaid recipients. There are over 92,500 Medicaid recipients in the Pennsylvania counties that are the in the main areas served by UPMC Hamot. In the City of Erie more than 43% of the children live in poverty and over 26% of the residents are classified as poor by U.S Census officials. The City of Erie has the second highest poverty rate of any major city in Pennsylvania. There are nearly 50,000 Medicaid recipients (20% of total population) in the New York and Ohio counties. Median household income in the entire secondary service area counties averages $41,800 and the percent of residents below the federal poverty level ranges from 12% in Warren County up to 19% in Chautauqua County. Erie County has 13 federally designated Medically Underserved Areas ("MUAS") while Crawford and McKean counties have 25 MUAS together. Chautauqua County has 1 MUA.
PART VI LINE 5   Through UPMC Hamot's financial support, organizations and communities can provide health services that might not otherwise have the means. Without these sponsored programs, the community could not otherwise financially support them. UPMC Hamot supports the community by subsidizing the local emergency transportation entity. Without Hamot's support the transportation entity could not remain financially viable. Though tax exempt, UMPC Hamot pays property taxes exceeding $1.5 million through its PILOT program entered into with local, school district and county taxing authorities. UPMC Hamot has an open medical staff extending privileges to all qualified physicians for all departments. The Board of Directors of UPMC Hamot is made up in the majority of community members who are independent to UPMC Hamot. Surplus funds of UPMC Hamot are all reinvested in the hospital and the surrounding communities to promote the health of all served.
PART VI LINE 6   The delivery system of entities affiliated with UPMC Hamot is able to provide patients with all medically necessary services. These services include ambulatory surgery, durable medical equipment, home care services, medial transportation, physicians in all specialties to provide healthcare services, and all types of outpatient and ambulatory diagnostic services. UPMC Hamot's mission is to promote healthcare for the benefit of all it services and to provide the highest quality of patient care in a dignified environment without regard to a patient's ability to pay.
PART VI LINE 7   STATES RECEIVING COMMUNITY BENEFIT REPORT Pennsylvania
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
UPMC Hamot Amended
 
Employer identification number
25-0965387
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. 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 (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) DR GERTRUDE A BARBER FOUNDATION INC
100 Barber Place
Erie,PA16507 		25-1753149 501(c)(3) 5,250       Charitable Donation
(2) AMERICAN CANCER SOCIETY
320 BILMAR DR
Pittsburgh,PA15205 		25-1798733 501(c)(3) 6,000       Charitable Donation
(3) GANNON UNIVERSITY
109 UNIVERSITY SQ
Erie,PA16541 		25-0496976 501(c)(3) 11,000       Educational Donation
(4) UNITED WAY OF ERIE COUNTY
420 WEST 6TH ST
Erie,PA16507 		25-1053091 501(c)(3) 17,000       Charitable Donation
(5) REGIONAL CANCER CENTER
2500 W 12th St
Erie,PA16505 		25-1385075 501(c)(3) 25,000       Charitable Donation
(6) Wayne Primary Care School Based Health Center
650 East Avenue
Erie,PA16503 		25-6001265 Government 80,000       Charitable Donation












2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
 
3
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

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:  


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
UPMC Hamot Amended
 
Employer identification number

25-0965387
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Donald K Inderlied R 13113Board Secretary / Secretary (i)
(ii)		 196,486
0 		37,000
0 		28,114
0 		16,695
0 		13,903
0 		292,198
0 		5,054
0
(2)Elizabeth Concordia R 101812Board Member (i)
(ii)		 0
651,082 		0
1,539,500 		0
38,197 		0
387,108 		0
21,970 		0
2,637,857 		0
17,000
(3)Leslie DavisBoard Member (i)
(ii)		 0
395,669 		0
340,000 		0
20,526 		0
68,434 		0
18,103 		0
842,732 		0
17,000
(4)Robert DeMichieiBoard Member (i)
(ii)		 0
444,841 		0
723,650 		0
36,714 		0
310,969 		0
20,373 		0
1,536,547 		0
17,000
(5)C Talbot Heppenstall JrBoard Member (i)
(ii)		 0
345,883 		0
612,500 		0
40,991 		0
256,474 		0
16,734 		0
1,272,582 		0
17,000
(6)John T Malone R 13113President (i)
(ii)		 457,633
0 		193,390
0 		57,470
0 		20,641
0 		18,291
0 		747,425
0 		25,383
0
(7)Stephen M DanchTreasurer/ CFO (i)
(ii)		 257,728
0 		92,000
0 		28,745
0 		28,452
0 		14,024
0 		420,949
0 		9,021
0
(8)V James FiorenzoVice President/ President (i)
(ii)		 377,433
0 		200,750
0 		35,662
0 		20,001
0 		13,933
0 		647,779
0 		12,875
0
(9)Richard Long MDVP Medical Affairs (i)
(ii)		 328,923
0 		66,750
0 		21,483
0 		25,517
0 		13,028
0 		455,701
0 		0
0
(10)Joseph ButlerVP Operations (i)
(ii)		 213,065
0 		66,000
0 		21,812
0 		19,299
0 		15,766
0 		335,942
0 		0
0
(11)James DonnellyCNO, VP Patient Care Service (i)
(ii)		 200,351
0 		55,000
0 		925
0 		10,802
0 		14,536
0 		281,614
0 		0
0
(12)Gary MarasVP Bus Development (i)
(ii)		 203,846
0 		37,500
0 		1,729
0 		16,872
0 		12,706
0 		272,653
0 		0
0
(13)Debbie BurbulesVP Women Services (i)
(ii)		 202,047
0 		37,000
0 		1,651
0 		17,381
0 		13,009
0 		271,088
0 		0
0
(14)Diane Holder E 101812Board Member (i)
(ii)		 0
577,933 		0
1,060,875 		0
29,423 		0
440,258 		0
13,595 		0
2,122,084 		0
17,000
(15)David Gibbons E 8612Chief Operating Officer (i)
(ii)		 124,540
0 		160,000
0 		5,006
0 		0
0 		3,110
0 		292,656
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J Part 1 Question 3: See Schedule O response to Part VI Question 15. Question 4b: ALL PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ARE DISCLOSED IN SCHEDULE J WITH CORRESPONDING AMOUNTS DISCLOSED WITHIN THE TOTAL AMOUNT IN SCHEDULE J COLUMN C "DEFERRED COMPENSATION". Question 7: UPMC Hamot provides incentive compensation as part of its total compensation program for officers and key employees. The components are based upon the accomplishment of predetermined performance goals and objectives which focus on the achievement of multiple annual and three year individual and group performance criteria in the context of appropriate risk taking. These criteria directly support UPMC Hamot's mission and include: patient quality and satisfaction, community benefit, operational and financial strength, leadership development and strategic business initiatives, among others.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
UPMC Hamot Amended
 
Employer identification number
25-0965387
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Erie County Hospital Authority
  		23-2302072 295200sz3 04-11-2006 23,921,150 Hamot Series 2006 See Schedule O   X   X   X
B Erie County Hospital Authority
  		23-2302072 295200ta7 07-31-2007 30,141,552 Hamot Series 2007 See Schedule O   X   X   X
C Erie County Hospital Authority
  		23-2302072   05-06-2010 35,000,000 Hamot Series 2010ABC See Schedule   X   X   X
D Erie County Hospital Authority
  		23-2302072   07-16-2009 4,691,500 Hamot 7/16/2009 Financing See Sche   X   X   X
Erie County Hospital Authority
  		23-2302072   08-31-2010 5,904,069 Hamot 8/31/2010 Financing See Sche   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0 0 6,585,000  
2 Amount of bonds legally defeased . . . . . . . . . . . 0 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . . 25,307,118 31,252,910 35,000,000  
4 Gross proceeds in reserve funds . . . . . . . . . . . . 2,155,586 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . . 0 0 0  
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 0 0  
7 Issuance costs from proceeds . . . . . . . . . . . . 277,420 328,700 522,137  
8 Credit enhancement from proceeds . . . . . . . . . . . 535,160 500,770 0  
9 Working capital expenditures from proceeds . . . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . . 22,338,951 30,423,440 10,527,255  
11 Other spent proceeds . . . . . . . . . . . . . . 0 0 0  
12 Other unspent proceeds . . . . . . . . . . . . . . 0 0 0  
13 Year of substantial completion . . . . . . . . . . . . 2010 2010 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X   X X      
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X X      
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X     X X      
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . 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? . . . . . . . . . . . . . . . . X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0% 0% 0%   %
7 Does the bond issue meet the private security or payment test? . . . . .   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    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.00000% 0.00000% 0.00000%   %
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    
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      
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    
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X   X X      
b Exception to rebate? . . . . . . . .   X   X   X    
c No rebate due? . . . . . . . . . .
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    
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider . . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . . . .                
e Was a hedge terminated? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X     X   X    
b Name of provider . . . . . . . . . Ixis Funding Corp
  		0
  		0
  		 
 
c Term of GIC . . . . . . . . . . 10.      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X     X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . . 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      
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Hamot Series 2006 0 $1,385,967.79 was earned in the construction fund during construction and spent according to the purpose of the bonds. Rebate computation performed on October 30, 2010.
Hamot Series 2007 0 $1,111,358.09 was earned int he construction fund during construction and spent according to the purpose of the bonds. Rebate computation performed on June 30, 2010.
Hamot Series 2010ABC Schedule O 0 n/a
Hamot 7/16/2009 Financing 0 $879.78 was earned in the construction fund during construction and spent according to the purpose of the bonds.
Hamot 8/31/2010 Financing 0 $776.16 was earned in the construction fund during construction and spent according to the purpose of the bonds.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
UPMC Hamot Amended
 
Employer identification number
25-0965387
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Erie County Hospital Authority
  		23-2302072 295200sz3 04-11-2006 23,921,150 Hamot Series 2006 See Schedule O   X   X   X
B Erie County Hospital Authority
  		23-2302072 295200ta7 07-31-2007 30,141,552 Hamot Series 2007 See Schedule O   X   X   X
C Erie County Hospital Authority
  		23-2302072   05-06-2010 35,000,000 Hamot Series 2010ABC See Schedule   X   X   X
D Erie County Hospital Authority
  		23-2302072   07-16-2009 4,691,500 Hamot 7/16/2009 Financing See Sche   X   X   X
Erie County Hospital Authority
  		23-2302072   08-31-2010 5,904,069 Hamot 8/31/2010 Financing See Sche   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0 0 6,585,000  
2 Amount of bonds legally defeased . . . . . . . . . . . 0 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . . 25,307,118 31,252,910 35,000,000  
4 Gross proceeds in reserve funds . . . . . . . . . . . . 2,155,586 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . . 0 0 0  
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 0 0  
7 Issuance costs from proceeds . . . . . . . . . . . . 277,420 328,700 522,137  
8 Credit enhancement from proceeds . . . . . . . . . . . 535,160 500,770 0  
9 Working capital expenditures from proceeds . . . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . . 22,338,951 30,423,440 10,527,255  
11 Other spent proceeds . . . . . . . . . . . . . . 0 0 0  
12 Other unspent proceeds . . . . . . . . . . . . . . 0 0 0  
13 Year of substantial completion . . . . . . . . . . . . 2010 2010 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X   X X      
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X X      
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X     X X      
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . 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? . . . . . . . . . . . . . . . . X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0% 0% 0%   %
7 Does the bond issue meet the private security or payment test? . . . . .   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    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.00000% 0.00000% 0.00000%   %
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    
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      
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    
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X   X X      
b Exception to rebate? . . . . . . . .   X   X   X    
c No rebate due? . . . . . . . . . .
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    
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider . . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . . . .                
e Was a hedge terminated? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X     X   X    
b Name of provider . . . . . . . . . Ixis Funding Corp
  		0
  		0
  		 
 
c Term of GIC . . . . . . . . . . 10.      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X     X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . . 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      
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Hamot Series 2006 0 $1,385,967.79 was earned in the construction fund during construction and spent according to the purpose of the bonds. Rebate computation performed on October 30, 2010.
Hamot Series 2007 0 $1,111,358.09 was earned int he construction fund during construction and spent according to the purpose of the bonds. Rebate computation performed on June 30, 2010.
Hamot Series 2010ABC Schedule O 0 n/a
Hamot 7/16/2009 Financing 0 $879.78 was earned in the construction fund during construction and spent according to the purpose of the bonds.
Hamot 8/31/2010 Financing 0 $776.16 was earned in the construction fund during construction and spent according to the purpose of the bonds.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, 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
UPMC Hamot Amended
 
Employer identification number

25-0965387
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





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

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-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?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of 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
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?
Yes 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
Transactions with Interested Persons   A: NAME OF INTERESTED PERSON: BALDWIN BROTHERS INC. B: RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION BOARD MEMBER GREGORY S. BALDWIN IS AN OFFICER AND DIRECTOR OF INTERESTED PERSON C: AMOUNT OF TRANSACTION $222,091 D: DESCRIPTION OF TRANSACTION REAL ESTATE E: SHARING OF ORGANIZATION REVENUE NO A: NAME OF INTERESTED PERSON: KNOX MCLAUGHLIN GORNALL & SENNETT PC B: RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION BOARD MEMBER THOMAS TUPITZA ESQ. IS A SHAREHOLDER AND DIRECTOR OF INTERESTED PERSON C: AMOUNT OF TRANSACTION $189,229 D: DESCRIPTION OF TRANSACTION LEGAL SERVICES E: SHARING OF ORGANIZATION REVENUE NO A: NAME OF INTERESTED PERSON: MEDICOR ASSOCIATES INC. B: RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION BOARD MEMBER ROBERT J. FERRARO M.D. IS > 5% PARTNER OF INTERESTED PERSON C: AMOUNT OF TRANSACTION $18,116,325 D: DESCRIPTION OF TRANSACTION CARDIOLOGY SERVICES E: SHARING OF ORGANIZATION REVENUE NO A: NAME OF INTERESTED PERSON: MARY JERGE B: RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION FAMILY MEMBER OF CFO STEPHEN DANCH C: AMOUNT OF TRANSACTION $19,545 D: DESCRIPTION OF TRANSACTION COMPENSATION E: SHARING OF ORGANIZATION REVENUE NO A: NAME OF INTERESTED PERSON: Patrick Pontzer B: RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION FAMILY MEMBER OF BOARD MEMBER RICHARD NYGARRD C: AMOUNT OF TRANSACTION $59,937 D: DESCRIPTION OF TRANSACTION COMPENSATION E: SHARING OF ORGANIZATION REVENUE NO A: NAME OF INTERESTED PERSON: MACKENZIE BEACH B: RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION FAMILY MEMBER OF BOARD MEMBER JEFFREY BEACH, CPA C: AMOUNT OF TRANSACTION $48,802 D: DESCRIPTION OF TRANSACTION COMPENSATION E: SHARING OF ORGANIZATION REVENUE NO A: NAME OF INTERESTED PERSON: ANN BULA B: RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION FAMILY MEMBER OF BOARD MEMBER MARY BULA C: AMOUNT OF TRANSACTION $19,545 D: DESCRIPTION OF TRANSACTION COMPENSATION E: SHARING OF ORGANIZATION REVENUE NO
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
UPMC Hamot Amended
 
Employer identification number

25-0965387
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial .. X 1 423,096 Fair Market Valule
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
 
No
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2012)
Schedule M (Form 990) (2012)
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule M (Form 990) (2012)
Additional Data


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

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
UPMC Hamot Amended
 
Employer identification number

25-0965387
Identifier Return Reference Explanation
PART I SUMMARY LINE 1 PART I, LINE 1 CONTINUED - UPMC HAMOT'S GOAL TO SERVE THE COMMUNITY IS ACCOMPLISHED THROUGH A COMMITMENT TO PATIENT-FOCUSED CARE AND OUTCOMES MANAGEMENT, OUTSTANDING CUSTOMER SERVICE, STRONG REGIONAL PARTNERSHIPS, RESEARCH, AND COMMUNITY EDUCATION AND PROGRAMS. UPMC HAMOT IS DEDICATED TO SERVICE ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.
PART III STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS   UPMC Hamot ("Hamot") is a 412 bed tertiary medical center with specialties that include cardiology, neuroscience, critical care, orthopedics and women's health services. The medical center reaches out to more than 1 million people in northwestern Pennsylvania, western New York and eastern Ohio. Our mission is to serve our patients, communities, and one another in the UPMC Hamot tradition of quality, health, healing, and education. To put it simply, "to serve." UPMC Hamot will, in partnership with its physicians, payers, and other stakeholders, continue to advance the health and wellness of the communities it serves by achieving clinical quality of the highest national standards and maximizing operational efficiencies. Our Core Values are to fulfill UPMC Hamot's mission through commitment to these values: quality, compassion, service, respect, integrity, and cooperation. During the fiscal year ended June 30, 2013, the UPMC Hamot admitted 18,203 inpatients, recorded 84,129 inpatient days, 80,823 emergency room visits, and performed 11,188 surgeries. UPMC Hamot provided charity care and other uncompensated care, including Medicaid and Medicare shortfalls, at cost, of over $35,500,000. Over 50% of UPMC Hamot patients were covered by Medicare or state Medicaid health insurance. UPMC Hamot is accredited by the Joint Commission and also has an advanced certification from them as a Primary Stroke Center. Some of the other most current accolades include: Truven Health Analytics 50 Top Cardiovascular Hosptials; a three year accreditation (with Commendation) from the American College of Surgeons' Commission on cancer care; American Heart Association "Get with the Guidelines" Stroke Gold Plus Performance Award; Joint Commission Advanced Certification in Stroke Care and Heart Failure Program; U.S. News & World Report - Best Regional Hospitals ; Highmark Blue Distinction Center for Cardiac, Bariatric and Knee and Hip Replacement; National Research Corporation Consumer Choice Award; and the American College of Radiology Breast Imaging Center of Excellence. Hamot also maintains an Orthopaedic Clinic that serves primarily the indigent of the community. Hamot outpatient services include outpatient surgery, emergency room visits, home health visits, outpatient cardiology procedures, radiology procedures, orthopedic procedures, and physical rehabilitation. The total outpatient volume was approximately 241,057. To further Hamot's goal to provide outstanding patient care, Hamot has established the following graduate programs: pharmacy residency, neurology residency, orthopedic surgery residency, orthopedic hand surgery fellowships, and emergency medicine. The continuing Medical Education Department is accredited by the Pennsylvania Medical Society and enables physicians outside of Hamot to receive required educational credits. The department's most recent annual report showed that more than 3,360 doctors attended these courses. Hamot houses a School of Anesthesia in conjunction with a local university. The anesthesia program is accredited by the Council on Accreditation of Nurse Anesthesia Programs. Last year, 15 students graduated from that program. Various research activities support medical education and advancements in patient care. Hamot participates in clinical trials for drugs and devices in the final testing stages as well as basic science research. Overall Hamot supported research and education endeavors at a cost of over $3,000,000 in fiscal year 2013. Hamot works in close partnership with the community to provide services. Hamot participates in the "PILOT" (payment in lieu of taxes) program which was $1,294,000 in fiscal year. Hamot also subsidizes the local emergency transportation at an approximate annual cost of $300,000. In addition, Hamot provides many other educational and support services to the community including such things as support to build up the downtown district within which Hamot's campus resides. Hamot also conducts various free health screenings and education session at locations throughout the city which touch thousands of residents. Some of these programs include including charitable donations to support other nonprofit entities, car seat safety, community vaccination programs, Hamot Heart for Women, ATV safety training, Speakers Bureau and Lecture Series, Let Me Call You Sweetheart, Heart and Soles, and Wear Red for Women. The underwriting of these community benefit programs is in excess of $1,650,000 annually.
PART VI GOVERNANCE, MANAGEMENT, AND DISCLOSURE SECTION B, LINE 11; LINE 12C; SECTION C, LINE 19 SECTION B LINE 11 - A COPY OF THE FORM 990 IS PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING. ADDITIONALLY, THE CFO REVIEWS THE 990 PRIOR TO FILING. LINE 12C - UPMC HAMOT REQUIRES KEY EMPLOYED AND NON-EMPLOYED PERSONNEL TO COMPLY WITH ITS CONFLICT OF INTEREST POLICY WHEN THEY ENGAGE IN UPMC HAMOT-RELATED BUSINESS. PERSONS COVERED BY THE POLICY INCLUDE: UPMC HAMOT BOARD MEMBERS, BOARD COMMITTEE MEMBERS, CORPORATE OFFICERS, AND KEY EMPLOYEES. THESE PEOPLE ARE REQUIRED TO COMPLETE A QUESTIONNAIRE AT LEAST ANNUALLY, WHICH ALONG WITH OTHER DATA IS USED TO IDENTIFY POSSIBLE INDIVIDUAL AND INSTITUTIONAL CONFLICTS OF INTEREST. UPMC HAMOT DISTRIBUTES A SEPARATE TAX QUESTIONNAIRE TO OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ANNUALLY THAT SPECIFICALLY ADDRESSES DISCLOSURE REQUIREMENTS OF FORM 990. LINE 15 - UPMC has established a rigorous compensation review process for its top executives which includes review by its executive compensation committee in a process intended to satisfy the "rebuttable presumption of reasonableness" set forth in the regulations to section 4958 of the Internal Revenue Code. UPMC gives authority to those executives to establish the compensation of executives of other subsidiaries and business units, including those of UPMC Hamot. Question 16A and B: UPMC has a formal written policy pertaining to joint ventures between UPMC Tax-Exempt entities and taxable entities. The policy employs an internal procedure for review of all transactions involving potential participation in joint ventures and similar arrangements to ensure that such entities operate in accordance with applicable IRS policies and within UPMC's charitable purposes. SECTION C LINE 19 - THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
PART X BALANCE SHEET SCHEDULE K TAX EXEMPT BONDS - DESCRIPTION OF PURPOSE SERIES 2006 - CONSTRUCTION AND EQUIPPING OF A NEW TWO-STORY GENERATOR BUILDING TO PROVIDE EMERGENCY AND STANDBY ELECTRICAL POWER FOR THE MEDICAL CENTER AND RELATED FACILITIES, EXPANSION AND RENOVATION OF THE FACILITIES HOUSING THE IMAGING CENTER, EXPANSION OF THE RESOURCE CENTER TO HOUSE ADDITIONAL FACILITIES, RENOVATION AND CONSTRUCTION OF THE WOMEN'S AND BABIES INPATIENT SERVICES FACILITIES, AND FINANCING VARIOUS EQUIPMENT AND RENOVATION PROJECTS FOR THE MEDICAL CENTER. SERIES 2007 - CONSTRUCTION AND EQUIPPING OF A NEW HOSPTIAL AND HEALTH CENTER FOCUSED ON WOMEN'S AND BABIES' HEALTH CARE NEEDS. SERIES 2010ABC - REFUNDED ERIE COUNTY HOSPITAL AUTHORITY'S REVENUE SERIES 1998A BONDS ISSUED 6/30/1998; ADVANCE REFUNDED ERIE COUNTY HOSPITAL AUTHORITY'S REVENUE SERIES 2002 BONDS ISSUED 12/5/2002; CONSTRUCTED, RENOVATED, EQUIPPED INPATIENT AND OUTPATIENT HOSPITAL AND HEALTH CARE FACILITIES TO BE OWNED AND OPERATED BY THE MEDICAL CENTER, INCLUDING THE HAMOT WOMEN'S HOSPITAL. 7/16/2009 FINANCING - FINANCE CAPITAL EXPENDITURES OR REIMBURSE FOR PREVIOUSLY INCURRED CAPITAL EXPENDITURES FOR HOSPITAL AND/OR HEALTH CARE FACILITIES. 8/31/2010 FINANCING - FINANCE CAPITAL EXPENDITURES OR REIMBURSE FOR PREVIOUSLY INCURRED CAPITAL EXPENDITURES FOR HOSPITAL AND/OR HEALTH CARE FACILITIES. believes it adopted management practices and procedures several years ago and answered Part III, Line 7 "yes". UPMC's system policy review committee met on August 9, 2012 to unanimously approve its tax-exempt bond post-issuance compliance policy as written procedures were published on August 30, 2012. Since this occurred after June 30, 2012, Part V was answered "no".
PART XI RECONCILIATION OF NET ASSETS LINE 5 RECONCILIATION OF NET ASSETS DIVIDEND FROM SUBSIDIARY 17,000,000 CHANGE IN PENSION LIABILITY 2,823,914 ASSET VALUE ADJ IN SUBSIDIARY (1,209,006) NET RELEASED FROM RESTRICTION 684,921 CHANGES IN BENEFICIAL INTEREST 2,737,484 TRANSFERS FROM EXEMPT PARENT 25,729,629 TRANSFERS TO EXEMPT AFFILIATE (1,317,887) NET CHANGES IN FUND BALANCE 46,449,055
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
UPMC Hamot Amended
 
Employer identification number

25-0965387
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) KANE COMMUNITY HOSPITAL

4372 ROUTE 6

KANE,PA16735
25-0998168 		HOSPITAL PA   3 UPMC HAMOT
 
Yes
 
(2) REGIONAL HEALTH SERVICES INC

300 STATE STREET NO 100A

ERIE,PA19103
25-1403958 		OUTPATIENT SV PA   9 UPMC HAMOT
 
Yes
 
(3) UPMC

600 GRANT STREET

PITTSBURGH,PA15219
25-1423657 		HEALTHCARE PA   11 TYPE III NA
 
 
No
(4) UPMC Senior Communities Inc

600 Grant Street

Pittsburgh,PA15219
25-1574736 		SR Living PA 501(c)(3) 9 UPMC
 
Yes
 
(5) Pittsburgh Lifetime Care Community

600 Grant Street

Pittsburgh,PA15219
25-1335247 		CCRC PA 501(c)(3) 9 UPMC Senior
 
Yes
 
(6) Canterbury Place

600 Grant Street

Pittsburgh,PA15219
25-0965334 		Sr Living PA 501(c)(3) 11(A)I UPMC Senior
 
Yes
 
(7) Seneca Place

600 Grant Street

Pittsburgh,PA15219
72-1562844 		Sr Living PA 501(c)(3) 9 UPMC Senior
 
Yes
 
(8) UPMC Lee

600 Grant Street

Pittsburgh,PA15219
25-0613830 		inactive PA 501(c)(3) 3 UPMC
 
Yes
 
(9) Community Physician Services Inc

600 Grant Street

Pittsburgh,PA15219
25-1722923 		Inactive PA 501(c)(3) 9 UPMC
 
Yes
 
(10) Pittsburgh Care Partnership Inc

2400 Ardmore Boulevard

Pittsburgh,PA15221
25-1753852 		Healthcare PA 501(c)(3) 9 UPMC
 
Yes
 
(11) UPMC Center for High Value Healthcare

600 Grant Street

Pittsburgh,PA15219
45-2178782 		Research PA 501(c)(3) 7 UPMC
 
Yes
 
(12) ClinicalConnect HIE

600 Grant Street

Pittsburgh,PA15219
27-4585032 		Technology PA 501(c)(3) 11(b)II UPMC
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) HAMOT-KCH REAL ESTATE VENTURE LLC

300 STATE ST
ERIE,PA16501
26-3691782 		MEDICAL OFFIC PA UPMC HAMOT
  		                 
(2) HAMOT SURGERY CENTER LLC

200 STATE ST
ERIE,PA16550
25-1863661 		AMBULATORY SU PA UPMC HAMOT
  		        No 0      
(3) LIFE CARE HOME SERVICES OF NW PA

1647 SASSAFRAS ST
ERIE,PA16502
25-1536879 		HOME HEALTH S PA UPMC Hamot
  		          0      
(4) HAMOT PROFESSIONAL BUILDING CONDOMINIUM

2950 WEST 12TH ST
ERIE,PA16505
25-1761211 		REAL ESTATE PA N/A
         No 0      
(5) Liliane S Kaufman MOB Assoc

600 Grant Street
Pittsburgh,PA15219
25-1551779 		MOB PA NA
  		N/A 0 0     0     0 %
(6) Seneca Hills Assisted LivingLP

600 Grant Street
Pittsburgh,PA15219
23-2873106 		Asst Living PA NA
  		N/A 0 0     0     0 %
(7) St Margaret Medical Arts Associates

600 Grant Street
Pittsburgh,PA15219
25-1786655 		MOB PA NA
  		N/A 0 0     0     0 %
(8) CORE NETWORK LLC

600 Grant Street
Pittsburgh,PA15219
25-1786209 		Physical Therapy PA NA
  		N/A 0 0     0     0 %
(9) UPMC Jefferson Regional Home Health LP

600 Grant Street
Pittsburgh,PA15219
25-1844485 		Healthcare Srv PA NA
  		N/A 0 0     0     0 %
(10) Life Home Care LP

600 Grant Street
Pittsburgh,PA15219
25-1847839 		Healthcare Srv PA NA
  		N/A 0 0     0     0 %
(11) Shadyside Medical Center Associates I

600 Grant Street
Pittsburgh,PA15219
25-1608318 		MOB PA NA
  		N/A 0 0     0     0 %
(12) UPMC Italy SRL

piazza sett angeli 10
  Palermo90134
IT
Healthcare IT NA
  		none 0 0     0     0 %
(13) chartwell PA LP

600 Grant Street
Pittsburgh,PA15219
25-1729714 		Healthcare PA NA
  		NONE 0 0     0     0 %
(14) EPN-Hamot Urgent Care LLC

600 Grant Street
Pittsburgh,PA15219
27-2147949 		Urgent Care PA NA
  		NONE 0 0     0     0 %
(15) Mountain View Medical Oncology

600 Grant Street
Pittsburgh,PA15219
46-1449241 		Healthcare PA NA
  		NONE 0 0     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?
Yes No
(1) KANE ANESTHESIA PROFESSIONAL SERVICES

4372 ROUTE 6
KANE,PA16735
05-0555457 		ANESTHESIA SV PA KANE COMMUNITY
  		C CORP          
(2) BAYFRONT REGIONAL DEVELOPMENT CORP

300 STATE STREET SUITE 100
ERIE,PA16507
25-1401388 		RE HOLDINGS C PA UPMC HAMOT
  		C CORP          
(3) BAYSIDE DEVELOPMENT CORP

300 STATE STREET SUTIE 100
ERIE,PA16507
25-1401386 		REAL ESTATE/P PA BAYFRONT REG DE
  		C CORP          
(4) HC Pharmacy Central Inc

600 Grant Street
Pittsburgh,PA15219
25-1364192 		Pharmacy Co PA NA
  		C 0 0 0 %    
(5) Children's Community Care

600 Grant Street
Pittsburgh,PA15219
25-1781887 		Pediactric Srv PA NA
  		C 0 0 0 %    
(6) UPMC Cancer Center Ireland Limited

6th Floor Beacon Hospital
Sandyford   Dublin 18
EI
Cancer Treatment EI NA
  		C 0 0 0 %    
(7) UPMC Cancer Center Holding Company Inc

600 Grant Street
Pittsburgh,PA15219
25-1877017 		Holding Co PA NA
  		C 0 0 0 %    
(8) Hematology Oncology Association

600 Grant Street
Pittsburgh,PA15219
42-1648357 		Healthcare PA NA
  		C 0 0 0 %    
(9) Oncology Hematolgy Association Inc

600 Grant Street
Pittsburgh,PA15219
25-1762980 		Healthcare PA NA
  		C 0 0 0 %    
(10) Tri-State Neurosurgical Assoc-UPMC Inc

600 Grant Street
Pittsburgh,PA15219
25-1458655 		Healthcare PA NA
  		C 0 0 0 %    
(11) Renaissance Family Practice-UPMC INc

600 Grant Street
Pittsburgh,PA15219
26-2942406 		Healthcare PA NA
  		C 0 0 0 %    
(12) UPMC Holding Company Inc

600 Grant Street
Pittsburgh,PA15219
25-1777713 		Holding Corp PA NA
  		C 0 0 0 %    
(13) UPMC Coverage Products Inc

600 Grant Street
Pittsburgh,PA15219
25-1777710 		Holding Corp PA NA
  		C 0 0 0 %    
(14) Freedom Insurance Company

600 Grant Street
Pittsburgh,PA15219
03-0308944 		Insurance VT NA
  		C 0 0 0 %    
(15) Tri-Century Insurance Co

600 Grant Street
Pittsburgh,PA15219
25-1500739 		Insurance PA NA
  		C 0 0 0 %    
(16) UPMC Insurance Agency Inc

600 Grant Street
Pittsburgh,PA15219
25-1883237 		Insurance PA NA
  		C 0 0 0 %    
(17) UPMC Health Benefits Inc

600 Grant Street
Pittsburgh,PA15219
25-1844144 		Health Insurance PA NA
  		C 0 0 0 %    
(18) UPMC Health Network Inc

600 Grant Strett
Pittsburgh,PA15219
72-1527566 		Health Insurance PA NONE
  		C 0 0 0 %    
(19) UPMC Health Plan Inc

600 Grant Street
Pittsburgh,PA15219
23-2813536 		Health Insurnace PA NA
  		C 0 0 0 %    
(20) UPMC Benefit Management Services Inc

600 Grant Street
Pittsburgh,PA15219
25-1769564 		Workers Comp PA NA
  		C 0 0 0 %    
(21) UPMC Diversified Services Inc

600 Grant Street
Pittsburgh,PA15219
25-1778454 		Holding Corp PA NA
  		C 0 0 0 %    
(22) Monroeville Specialty Clinic

600 Grant Street
Pittsburgh,PA15219
25-1666087 		Healthcare PA NA
  		C 0 0 0 %    
(23) Medical Archival Systems

600 Grant Street
Pittsburgh,PA15219
23-2912501 		Software Develop DE NA
  		C 0 0 0 %    
(24) Presby Health Resource Mgmt

600 Grant Street
Pittsburgh,PA15219
25-1422155 		Healthcare PA NA
  		C 0 0 0 %    
(25) Biotronics Inc

600 Grant Street
Pittsburgh,PA15219
25-1843500 		Equip Maintenance PA NA
  		C 0 0 0 %    
(26) Medical Center Properties

600 Grant Street
Pittsburgh,PA15219
25-1796940 		Real Estate PA NA
  		C 0 0 0 %    
(27) RX Partners Inc

600 Grant Street
Pittsburgh,PA15219
25-1801966 		Retail Services PA NA
  		C 0 0 0 %    
(28) UPMC Environmental Research Center

600 Grant Street
Pittsburgh,PA15219
20-4309237 		Inactive PA NA
  		C 0 0 0 %    
(29) Askesis Development Group Inc

600 Grant Street
Pittsburgh,PA15219
54-1625585 		Software Develop DE NA
  		C 0 0 0 %    
(30) Panther Reinsurance Company LTD

PO Box 1109
Grand Cayman   Cayman Islands
CJ
Insurance CJ NA
  		C 0 0 0 %    
(31) Forbes Reinsurance Company LTD

PO Box 1109
Grand Cayman   Cayman Islands
CJ
Insurance CJ NA
  		C 0 0 0 %    
(32) Cathedral (Re)Insurance Company LTD

PO Box 1109
Grand Cayman   Cayman Islands
CJ
Insurance CJ NA
  		C 0 0 0 %    
(33) UPMC International Health Initiatives

600 Grant Street
Pittsburgh,PA15219
84-1706741 		Inactive PA NA
  		C 0 0 0 %    
(34) UPMC Ireland Limited

6th Floor Beacon Hospital
Sandyford   Dublin 18
EI
Healthcare Suppor EI NA
  		C 0 0 0 %    
(35) UPMC United Kingdom LTD

C/O NairCO 11th Floor Whitefriars
Lewins Mead,BristolBS1 2NT
UK
Software Licen UK NA
  		C 0 0 0 %    
(36) UPMC Cyprus Holdings LTD

Julia House 3 Themistocles Dervis
Nicosia   CY 1066
CY
Healthcare Suppor CY NA
  		C 0 0 0 %    
(37) UPMC Cyprus LTD

Julia House 3 Themistocles Dervis
Nicosia   CY 1066
CY
Healthcare Suppor CY NA
  		C 0 0 0 %    
(38) UPMC Beacon Sandyford Limited

STE 36 Beacon Hall Beacon Court
Sandyford   Dublin 18
EI
Hospital Operatio EI NA
  		C 0 0 0 %    
(39) UPMC BCS Limited

STE 36 Beacon Hall Beacon Court
Sandyford   Dublin 18
EI
Holding Company EI NA
  		C 0 0 0 %    
(40) UPMC BMGS Limited

STE 36 Beacon Hall Beacon Court
Sandyford   Dublin 18
EI
Triology Lease EI NA
  		C 0 0 0 %    
(41) UPMC BHSH Limited

Beacon Hall The Mall at Becon Crt
Sandyford   Dublin 18
EI
Holding Company EI NA
  		C 0 0 0 %    
(42) 21st Century Biodefense Inc

600 Grant Street
Pittsburgh,PA15219
26-3806281 		Healthcare PA NA
  		C 0 0 0 %    
(43) Evolent Health Inc

600 Grant Street
Pittsburgh,PA15219
45-3084136 		Healthcare Suppor DE NA
  		C 0 0 0 %    
(44) UPMC Work Alliance Inc

600 Grant Street
Pittsburgh,PA15219
45-2825053 		Insurance PA NA
  		C 0 0 0 %    
(45) UPMC Canada Technologies Limited

600 Grant Street
PIttsburgh,PA15219
 Software CA NA
  		C 0 0 0 %    
(46) Allied Orthopedics Appliances Inc

335 E 3rd Street
Jamestown,NY14701
16-1092951 		Med Appliances PA NA
  		C 0 0 0 %    
(47) UPMC Health Coverage Inc

600 Grant Street
Pittsburgh,PA15219
46-2824537 		Insurance PA NA
  		C 0 0 0 %    
(48) UPMC Health Options INc

600 Grant Street
Pittsburgh,PA15219
46-2824626 		Insurance PA NA
  		C 0 0 0 %    
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Regional Health Services

 M 1,853,700 cost
(2) Regional Health Service

 Q 1,955,400 cost
(3) Kane Community Hospital

 Q 780,191 cost
(4) Bayside Development Corp

 Q 174,984 cost
(5) Regional Health Services

 P 4,275,250 cost
(6) Bayside Development Corp

 P 134,656 cost
(7) Bayside Development Corp

 N 141,804 cost
(8) Hamot Pro Building Condo Assoc

 N 349,988 cost
(9) Bayfront Regional Development

 K 125,939 cost
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

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




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






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


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