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 private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
A For the 2014 calendar year, or tax year beginning 01-01-2014 , and ending 12-31-2014
BCheck if applicable:
CName of organization
Alle-Kiski Medical Center
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
C/O Tax Dept120 Fifth AveSte 922
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Pittsburgh, PA15212
D Employer identification number

25-1875178
E Telephone number

G Gross receipts $ 129,488,593
F Name and address of principal officer:
Elizabeth Allen
30 Isabella Street
Pittsburgh,PA15212
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.ahn.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 2000
M State of legal domicile: PA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: See Form 990, Page 2, Part III, Question 1
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 13
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 10
5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) ...... 5 1,167
6 Total number of volunteers (estimate if necessary) ............. 6 177
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 2,217,182
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -1,100,507
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 10,000 10,000
9 Program service revenue (Part VIII, line 2g) ......... 54,351,724 105,396,012
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 271,215 673,152
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,819,177 6,155,728
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 58,452,116 112,234,892
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 930 929
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) 26,178,069 50,356,869
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).... 32,053,547 64,370,175
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 58,232,546 114,727,973
19 Revenue less expenses. Subtract line 18 from line 12....... 219,570 -2,493,081
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 104,114,770 112,230,662
21 Total liabilities (Part X, line 26)............. 100,250,416 85,049,343
22 Net assets or fund balances. Subtract line 21 from line 20..... 3,864,354 27,181,319
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 (2014)
Form 990 (2014)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: ALLE-KISKI MEDICAL CENTER IS A TEAM OF CARE GIVERS COMMITTED TO IMPROVING HEALTH AND PROMOTING WELLNESS IN OUR COMMUNITIES, ONE PERSON AT A TIME. IT PLEDGES TO CONSISTENTLY DELIVER SAFE, COMPASSIONATE QUALITY HEALTHCARE BY TREATING THE WHOLE PERSON - BODY, MIND AND SPIRIT.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 38,289,524 including grants of $   ) (Revenue $ 31,939,409 )
Alle-Kiski Medical Center is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. It pledges to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. To complete this mission, Alle-Kiski Medical Center provides Medical services that include endocrine, nephrology, infectious diesease and others to all patients regardless of their ability to pay.
4b (Code:   ) (Expenses $ 7,207,330 including grants of $   ) (Revenue $ 7,175,922 )
Alle-Kiski Medical Center is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. It pledges to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. Alle-Kiski Medical Center provides Onocology services to all patients regardless of their ability to pay.
4c (Code:   ) (Expenses $ 11,403,131 including grants of $   ) (Revenue $ 11,056,785 )
Alle-Kiski Medical Center is a team of care givers committed to improving health and promoting wellness in our communities, one person at a time. It pledges to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind and spirit. Alle-Kiski Medical Center provides Orthopedic services to all patients regardless of their ability to pay.
(Code:   ) (Expenses $ 46,027,779 including grants of $ 929 ) (Revenue $ 58,580,925 )
Other Medical Services Provided To Our Patients
4d Other program services (Describe in Schedule O.)
(Expenses $ 46,027,779 including grants of $ 929 ) (Revenue $ 58,580,925 )
4e Total program service expensesMediumBullet102,927,764
Form 990 (2014)
Form 990 (2014)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? 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 other assistance to or for foreign individuals? 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 (2014)
Form 990 (2014)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) 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
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? 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
 
No
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
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
90
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,167
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” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?.........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring 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 (2014)
Form 990 (2014)
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 or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
10
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
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
Yes
 
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
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
PA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletMATTHEW PETERSON
30 ISABELLA STREET
Pittsburgh,PA15212 (412) 330-6090
Form 990 (2014)
Form 990 (2014)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Russell Evans........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(2) Russell Livingston........................................................................
Chair
 1.0
.......................0.0 		X   X       0 0 0
(3) David Bonvenuto........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(4) Jason Ross........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(5) Robin Bergstrom........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(6) Michael Miller........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(7) Joseph Macerelli........................................................................
EX OFFICIO DIRECTOR
 1.0
.......................10.0 		X           0 0 0
(8) David Blandino........................................................................
Director
 1.0
.......................10.0 		X           0 118,119 0
(9) John Balacko MD........................................................................
Ex Officio Director
 1.0
.......................39.0 		X           0 510,592 22,089
(10) Daniel Casper........................................................................
Director
 1.0
.......................39.0 		X           0 391,554 24,466
(11) John Paul........................................................................
EX OFFICIO DIRECTOR
 1.0
.......................39.0 		X           0 1,864,483 136,134
(12) Joseph Thimons........................................................................
Ex-Officio Director
 1.0
.......................39.0 		X           0 0 0
(13) Michael Harlovic........................................................................
Ex-Officio Director and Pres
 1.0
.......................39.0 		X   X       0 434,319 19,623
(14) Rosemary Musolino........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(15) David Goldberg........................................................................
Director
 1.0
.......................39.0 		X           0 460,256 28,833
(16) Jacqueline Bauer........................................................................
Secretary
 1.0
.......................39.0 		    X       0 412,601 27,316
(17) Elizabeth Allen........................................................................
Treasurer
 1.0
.......................39.0 		    X       0 756,501 55,916
Form 990 (2014)
Form 990 (2014)
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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) William Englert........................................................................
VP - Business Development
 40.0
.......................0.0 		      X     157,714 0 15,682
(19) Walter Hoover........................................................................
Physician
 40.0
.......................0.0 		        X   164,734 0 18,836
(20) Mary Wasilowski........................................................................
Pharmacist
 40.0
.......................0.0 		        X   120,987 0 15,946
(21) Esther Atwood........................................................................
Chief Nursing Officer
 40.0
.......................0.0 		        X   144,046 0 7,749
(22) Kelley Wasicek........................................................................
Director of Pharmacy
 40.0
.......................0.0 		        X   130,460 0 15,125
(23) Thomas Bearer........................................................................
Pharmacist
 40.0
.......................0.0 		        X   115,885 0 15,558
(24) Ned Laubacher........................................................................
Director
 0.0
.......................0.0 		          X 0 221,685 0
(25) Michael Sirott........................................................................
Secretary
 0.0
.......................0.0 		          X 0 114,831 0










1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 833,826 5,284,941 403,273
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet13
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Carl Walker Construction Group Inc,
935 Vista Park Drive
PITTSBURGH,PA15205 		Construction Service 1,475,839
MBM Contracting Inc,
4999 Old Clairton Road
PITTSBURGH,PA15236 		Contracting Services 794,744
Ruthrauff Services LLC,
419 E Main Street
CARNEGIE,PA15106 		Mechanical Services 481,315
Cura Hospitality Inc,
PO Box 644091
PITTSBURGH,PA15264 		Management Services 424,038
CLARUS LINEN,
60 GRIDER ST
BUFFALO,NY14215 		LINEN SERVICE 403,510
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet69
Form 990 (2014)
Form 990 (2014)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 10,000
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 10,000
Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE 621500 105,396,012 103,360,099 2,035,913  
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 105,396,012
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 795,039     795,039
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 762,786  
b Less: rental expenses    
c Rental income or (loss) 762,786 0
d Net rental income or (loss).......MediumBullet 762,786   181,269 581,517
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 17,128,665 3,149
b Less: cost or other basis and sales expenses 17,253,701  
c Gain or (loss) -125,036 3,149
d Net gain or (loss)..........MediumBullet -121,887     -121,887
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 GRANT REVENUE 621110 2,499,798 2,499,798    
b SCHOOL OF NURSING TUITION 621110 1,116,138 1,116,138    
c CAFETERIA REVENUE 621110 470,019 470,019    
d All other revenue .... 1,306,987 1,306,987    
e Total. Add lines 11a–11d ...... MediumBullet 5,392,942
12 Total revenue. See Instructions......MediumBullet 112,234,892 108,753,041 2,217,182 1,254,669
Form 990 (2014)
Form 990 (2014)
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 or note to any line 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 domestic organizations and domestic governments. See Part IV, line 21 .... 929 929
2 Grants and other assistance to domestic individuals. See Part IV, line 22 .... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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 .... 173,396 173,396    
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 .... 40,914,977 34,777,731 6,137,246  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,076,019 914,616 161,403  
9 Other employee benefits ....... 5,459,549 4,640,617 818,932  
10 Payroll taxes ........... 2,732,928 2,322,989 409,939  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 15,988 14,389 1,599  
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 55,756   55,756  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) .... 4,508,352 4,057,517 450,835  
12 Advertising and promotion .... 3,043 2,739 304  
13 Office expenses ....... 547,722 492,950 54,772  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 3,362,508 3,026,257 336,251  
17 Travel ............ 81,949 73,754 8,195  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 13,541 12,187 1,354  
20 Interest ........... 2,252,484 2,027,236 225,248  
21 Payments to affiliates ....... 18,618,827 16,756,944 1,861,883  
22 Depreciation, depletion, and amortization ..... 4,974,269 4,476,842 497,427  
23 Insurance .............. 1,383,448 1,245,103 138,345 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a PATIENT CARE COSTS 14,018,682 14,018,682    
b BAD DEBT 6,293,128 6,293,128    
c REPAIR AND MAINTENANCE 1,287,822 1,159,040 128,782  
d PA ACT 49 - QUALITY CARE 1,987,680 1,987,680    
e All other expenses 4,964,976 4,453,038 511,938  
25 Total functional expenses. Add lines 1 through 24e 114,727,973 102,927,764 11,800,209 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 (2014)
Form 990 (2014)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 3,264 1 4,064
2 Savings and temporary cash investments ......... 14,407,385 2 20,826,188
3 Pledges and grants receivable, net ........... 11,801 3 46,116
4 Accounts receivable, net ............. 12,488,640 4 11,343,970
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 1,576,897 8 1,753,887
9 Prepaid expenses and deferred charges .......... 712,039 9 456,724
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 43,572,168
b Less: accumulated depreciation ..... 10b 6,907,734 34,744,577 10c 36,664,434
11 Investments—publicly traded securities .......... 23,055,303 11 23,666,445
12 Investments—other securities. See Part IV, line 11 ..... 15,132,130 12 15,225,233
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 ........... 1,982,734 15 2,243,601
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 104,114,770 16 112,230,662
Liabilities 17 Accounts payable and accrued expenses ......... 9,535,132 17 9,376,527
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 2,686,439 19 264,540
20 Tax-exempt bond liabilities ............. 63,010,139 20 0
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 .. 2,663,789 23 60,513,334
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.................... 22,354,917 25 14,894,942
26 Total liabilities. Add lines 17 through 25......... 100,250,416 26 85,049,343
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 .............. 3,685,128 27 27,002,093
28 Temporarily restricted net assets ........... 179,226 28 179,226
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 3,864,354 33 27,181,319
34 Total liabilities and net assets/fund balances ........ 104,114,770 34 112,230,662
Form 990 (2014)
Form 990 (2014)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
112,234,892
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
114,727,973
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-2,493,081
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
3,864,354
5
Net unrealized gains (losses) on investments ...............
5
176,555
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
25,633,491
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
27,181,319
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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 (2014)
Form 990 (2014)
Page 13
Form 990, Special Condition Description:
Special Condition Description
Form 990 (2014)
Form 990 (2014)
Page 14
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 Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
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 listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.)..            
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 section 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) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.) ..            
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors (explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7   Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2014 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2014 		(iii)
Distributable
Amount for 2014
1 Distributable amount for 2014 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2014
(reasonable cause required--see instructions)		  
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2014 distributable amount  
i Carryover from 2009 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2014 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2014 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2014, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)		  
6 Remaining underdistributions for 2014. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2015. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......  
e From 2014.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Name of organization
Alle-Kiski Medical Center
  		Employer identification number

25-1875178
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 

   
 
 
  ,    

$RESTRICTED


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Name of organization
Alle-Kiski Medical Center
  		Employer identification number

25-1875178
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
Alle-Kiski Medical Center
  		Employer identification number

25-1875178
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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) (2014)

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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of 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)
Revenue 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
Revenue 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) 2014

Schedule D (Form 990) 2014
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, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 179,226 179,226 179,109 108,326 108,131
b Contributions ........     20 70,653  
c Net investment earnings, gains, and losses     97 130 195
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ...... 179,226 179,226 179,226 179,109 108,326
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet100.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   588,000 588,000
b Buildings ................   22,911,936 3,727,528 19,184,408
c Leasehold improvements ............        
d Equipment ................   12,966,450 2,884,555 10,081,895
e Other .................   7,105,782 295,651 6,810,131
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 36,664,434
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) INVESTMENT IN AMERINET 		47,349 F

(B) INVESTMENT IN VHA 		30,127 F

(C) INVESTMENT ACCT 		15,147,757 F






Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 15,225,233
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
ACCRUED PENSION COSTS 11,744,658
THIRD PARTY SETTLEMENTS 2,468,582
ASBESTOS RETIREMENT OBLIGATION 77,173
DUE TO AFFILIATED ORGANIZATION 604,529





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 14,894,942
2. Liability for uncertain tax positions. 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) 2014

Schedule D (Form 990) 2014
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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
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.
Return Reference Explanation
AKMC Inclusion In The Consolidated Audit of WPAHS Alle-Kiski Medical Center (AKMC) does not issue independent audited financial statements. AKMC is a component of the Highmark Health consolidated audited financial statements. The following analysis represents the reconciliation between the financial statement net income and the net income as reported on Form 990, Page 1, line 19: Net Loss Per Financial Statements (2,316,526) Less: Unrealized Gain on Investments on the financial statements reclassified through net assets on Form 990 (176,555) ___________ Net Loss Per Form 990 $(2,493,081) Highmark Health records uncertain tax positions in accordance with FASB Accounting Standards Codification (ASC) 740, Income Taxes. ASC 740 clarifies the accounting for uncertainty in income taxes by defining criteria that a tax position on an individual matter must meet before that position is recognized. ASC 740 also provides guidance on measurement, classification, interest and penalties, disclosure and accounting in interim periods. The following is the footnote to the audited consolidated financial statements of Highmark Health for FASB ASC 740: At December 31, 2014 and 2013, gross unrecognized tax benefits (excluding the federal benefit received from state positions) were $150,575,000 and 147,685,000, respectively, and, if recognized, would have impacted the effective tax rate.
Intended Use of the Organization Endowment Funds The intended use of Alle-Kiski Medical Center term endowments are for but not exclusive to: capital improvements, research, education, departmental needs, operating efficiencies, and overall patient care.
Schedule D (Form 990) 2014

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the TreasuryInternal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
 
No
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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) .. 		    7,909,537 5,228,306 2,681,231 2.470 %
b Medicaid (from Worksheet 3,
column a) .... 		    12,377,601 7,530,135 4,847,466 4.470 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    20,287,138 12,758,441 7,528,697 6.940 %
Other Benefits
     469,775   469,775 0.430 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    828,187   828,187 0.760 %
g Subsidized health services
(from Worksheet 6) .. 		    59,146,276 46,441,102 12,705,174 11.720 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    929   929  
j Total. Other Benefits ..     60,445,167 46,441,102 14,004,065 12.910 %
k Total. Add lines 7d and 7j .     80,732,305 59,199,543 21,532,762 19.850 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy     306,449   306,449 0.280 %
8 Workforce development            
9 Other            
10 Total     306,449   306,449 0.280 %
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
1,343,350
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
503,891
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
48,403,321
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
54,788,575
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-6,385,254
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Alle-Kiski Medical Center
1301 Carlisle Street
Natrona Heights,PA15065 		X X         X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Alle-Kiski Medical Center
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		 
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?....................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.......... 2   No
3 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 12.................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................ 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public? .............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 12
10 Is the hospital facility's most recently adopted implementation strategy posted on a website? ........ 10   No
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b Yes  
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)? ........................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 12b    
c If "Yes" to line 12b, 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) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Alle-Kiski Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
Financial Assistance Policy (FAP)
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?....... 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 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 all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 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 individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Alle-Kiski Medical Center
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?......... 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?................ 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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
23 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ................................ 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
SCHEDULE H, PART V, SECTION B, LINE 5 Input From Persons Who Represent the Community For the Community Health Needs Assessment, AKMC formed steering committees that consisted of: community leaders representing the broad interests of the community as well as underserved constituencies, individuals with expertise in public health, hospital board members, physicians and internal system and hospital leaders and managers. The hospital took into account input from individuals by interviews and focus groups that captured personal perspectives from community members, providers and leaders with insight and expertise. To assist with the CHNA process, AKMC retained a planning and research firm.
SCHEDULE H, PART V, SECTION B, LINE 7 & 11 The results of the CHNA identified multiple health needs in the communities we serve. The Hospital addressed the following health needs: diabetes, heart disease and breast cancer. The CHNA identified the following health needs the Hospital chose not to address: flu and pneumonia, bronchus and lung cancer and health literacy because existing hospital and/or community resources work to address these needs. AKMC evaluated all top priority needs and put forth plans to address the needs we felt we were best positioned to make a positive impact for the betterment of the health of the communities we serve. AKMC is addressing the identified significant needs by community education, outreach and health screenings, physician outreach and training and programs for patients. AKMC has made the CHNA widely available to the public. The community health needs assessment can be viewed at : www.ahn.org. Schedule H, Part V, Section B, Line 13H AKMC is part of the integrated delivery system named Allegheny Health Network. In 2014, AKMC adopted the Allegheny Health Network Financial Assistance Policy. During 2014, Allegheny Health Network enhanced its Financial Assistance Policy with a Presumptive eligibility program that enables AHN to make an informed decision on the financial need of patients utilizing the best estimates available in the absence of information provided directly by the patient. The Health system utilizes a healthcare industry-recognized model that is based on public record databases. This predictive model incorporates public record data to calculate a socio-economic and financial capacity score that includes estimates for income, assets and liquidity. The electronic technology is designed to assess each patient to the same standards and is calibrated against historical approvals for AHN financial assistance under the traditional application process. The electronic technology is deployed prior to bad debt assignment after all other eligibility and payment sources have been exhausted. This allows AHN to screen all patients for financial assistance prior to pursuing any extraordinary collection actions. The data returned from this electronic eligibility review will constitute adequate documentation of financial need under our policy. When electronic enrollment is used as the basis for presumptive eligibility, the highest discount of full free care is granted for eligible services for retrospective dates of service only.
Schedule H, Part V, line 22D Charges For Medical Care AKMC offers uninsured patients a fifty percent (50%) discount on total gross charges to all hospital charges. The intent of the discount is to standardize charging practices for covered and non covered patients. The discount is offered during patient contact for elective/ urgent (non cosmetic) procedures during the financial counseling process, as well as during the patient statement cycle process for services provided (including Emergency services.) Patient statements are clearly marked with the uninsured discount, reducing the 'amount owed' of the gross charges. An uninsured discount of 50% is applied to the patient account either at the time of payment or prior to transferring the account to bad debt upon conclusion of the routine four statement cycle, for any unpaid balances.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?7
Name and address Type of Facility (describe)
1 Vandergrift Outpatient Care Center
244 Longfellow Street
Vandergrift,PA15690 		Outpatient Care Center
2 Citizens Ambulatory Care Center
651 Fourth Avenue
New Kensington,PA15065 		Ambulatory Care Center
3 AVH Outpatient Physical Therapy
1620 Pacific Avenue
Natrona Heights,PA15065 		Physical Therapy
4 Allegheny Valley Hospital Prolab
1620 Pacific Avenue
Natrona Heights,PA15065 		Laboratory Services
5 Destination Wellness
590 Pittsburgh Mills Circle
Tarentum,PA15084 		General Health and Wellness
6 AKMC Radiological Imaging
2801 Freeport Road
Natorna Heights,PA15065 		Radiological Imaging
7 Nursing School
651 Fourth Avenue
New Kensington,PA15068 		Nursing School
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
Schedule H, Part III, Line 3 and Line 4 Bad Debt Expense Financial Statement Footnote and Costing Methodology AKMC does not issue separate audited financial statements and therefore a footnote does not exist. Bad Debt expense is accounted for on a charge basis in our internal financial statements. A cost to charge ratio is applied to the internal figures to convert the charge to cost. SCHEDULE H, PART III, LINE 8 AKMC receives overall reimbursement from Medicare less than the cost of the services provided. As such, we consider the shortfall a community benefit. The source used to determine the amount reported on line 6 is the cost accounting system.
Schedule H, Part III, Line 9b Collection Practices For Patients Who Qualify For Financial Assistance Patients that qualify for charity care or financial assistance are provided with an approval letter with the effective dates for the assistance. At any time the individual presents for services within a 90 day span of approval, they show the letter and will be registered as a charity care case. Charity care cases are designated in the internal computerized systems with unique plan codes that prevent billing to the patient. Reports are run to capture the patient accounts registered with the charity care plan codes so they can be written off to charity care.
SCHEDULE H, PART VI, LINE 2 Health Needs Assessment AKMC management and staff utilize multiple strategies to continually monitor and assess the health care needs of the communities it serves. One approach to assessing needs involves surveying community members about health needs related to national and state health goals. Alle-Kiski Medical Center also acts on expressed community needs by responding to direct community requests for health screenings, outreach events and other health-related activities and by maintaining longstanding programs that are well attended and positively evaluated by community participants. In addition, Alle-Kiski Medical Center gathers community input through participation in area rotaries, chambers of commerce, through partnerships with community organizations and other community engagement activities. Another means is through reviewing and taking appropriate actions on feedback gathered from the following sources: routine market assessments; patient and family satisfaction surveys; Press Ganey surveys; patient, patient family and staffs' suggestions for improving patient safety; medical staff input and physician surveys. AKMC conducted a Community Health Needs Assessment (CHNA) during the year ended June 30, 2013 in accordance with IRC Section 501(r) and the guidance documented in the Internal Revenue Bulletin 2011-30, Notice 2011-52 and the proposed regulations issued April 5, 2013. The CHNA process began in August 2012 and concluded in May 2013. The Board of Directors that govern AKMC approved an implementation strategy designed to address the community health needs identified in the CHNA on September 23, 2013. The CHNA process included input from persons representing the broad interests of the community including individuals with special knowledge of or expertise in public health, organizations with information relevant to the health needs of the community and representatives of medically underserved populations. To achieve this end, the Hospital included representatives of the following organizations in the conduct of the CHNA: West Penn Allegheny Health System; Highmark, Inc.; Allegheny-Kiski Health Foundation; Family Services of Western Pennsylvania; Allegheny Valley Association of Churches; Citizens General Hospital Foundation; Tri-City Life Center, Inc.; Citizens Family Health Clinic; and Community Health Clinic, Inc. The results of the CHNA identified multiple health needs in the communities we serve. The Hospital addressed the following health needs: diabetes, colorectal cancer and breast cancer. The CHNA identified the following health needs the Hospital chose not to address: high blood pressure/hypertension, cardiovascular disease and obesity. We did not specifically address these because either (1) the health need was considered to be a co-morbidity to a condition we chose to focus on, such as blood pressure/hypertension and obesity could be positively impacted as part of an effective diabetes management program or (2) a strong program already exists within the hospital, as is the case with cardiovascular disease. Alle-Kiski Medical Center is in the process of executing the above mentioned implementation strategy. The Hospital has made the CHNA widely available to the public. The community health needs assessment can be viewed at : www.ahn.org.
SCHEDULE H, PART VI, LINE 3 Patient Education For Eligibility For Assistance AKMC displays signage in various patient Admission, Registration and Emergency Department areas that alerts that patient to Account Assistance program availability and contact information. During the preservice process, patients are evaluated to determine financial assistance options. AKMC offers the "Account Assistance Program" which consists of application assistance for governmental eligibility, Charity Care application completion and submission support, as well as uninsured provisions. AKMC also provides on-site support through Financial Counselor staff who are available to work with patient walk in's. Financial Counselors work directly with the patients as well as designated agency support regarding qualifying patients for Medical Assistance. Both week day and weekend coverage is available to the patients, as well as field support needed for post discharge follow up needed for application submission. The above support is available at no charge to the patient.
SCHEDULE H, PART VI, LINE 4 Community Served Information AKMC, located in Natrona Heights Pennsylvania, provides health care services to residents of Allegheny, Armstrong, Beaver and Butler Counties. Located approximately 20 miles outside of Pittsburgh, Natrona Heights has approximately 11,800 residents. Allegheny County consists of approximately 1,232,000 residents living in a land area of approximately 745 square miles. The median housing value in Allegheny County is $126,500. Armstrong County consists of approximately 67,800 residents living in a land area of approximately 654 square miles. The median housing value in Armstrong County is $94,100. Beaver County consists of approximately 169,400 residents living in a land area of approximately 434 square miles. The median housing value in Beaver County is $115,400. Butler County consists of approximately 186,000 residents living in a land area of approximately 789 square miles. The median housing value in Butler County is $169,700. Together, Allegheny, Armstrong, Beaver and Bulter Counties form the primary service area for AKMC.
SCHEDULE H, PART VI, LINE 5 Promotion of Community Health The AKMC Emergency Department cares for the community by operating 24 hours a day, 7 days a week with highly skilled and trained emergency medicine physicians and nurses. The Emergency Department is open to all individuals regardless of their ability to pay. The emergency response capabilities of AKMC are provided in conjunction with Alle-Kiski Paramedic Unit for Life Support Emergency Response (AKPULSER), a paramedic response unit and a separate 501(c)(3) organization. AKMC staffs the emergency department physicians who provide medical command to the AKPULSER ambulance crew in the field. Our emergency response service has been designated as the primary 911 responder for the greater Alle-Kiski Valley Service Area. The voting members of the AKMC Board of Directors consist of a majority of independent community members without personal financial ties to the hospital or any of its affiliated organizations.
SCHEDULE H, PART VI, LINE 6 Affiliated Healthcare System West Penn Allegheny Health System (WPAHS) is part of the integrated delivery system named Allegheny Health Network (AHN). In addition to WPAHS, the AHN consists of Saint Vincent Health Center, Saint Vincent Health System and Jefferson Regional Medical Center. WPAHS is comprised of some of the oldest and best-known names in health care in western Pennsylvania. From their inception, the system's hospitals have been in the vanguard of patient care, medical research and health sciences education. Comprised of two tertiary and three community hospitals, WPAHS includes Allegheny General Hospital and The Western Pennsylvania Hospital, both in Pittsburgh; Alle-Kiski Medical Center in Natrona Heights; Canonsburg General Hospital in Canonsburg and the Western Pennsylvania Hospital - Forbes Regional Campus in Monroeville. Offering a comprehensive range of medical and surgical services, the hospitals serve Pittsburgh and the surrounding five-state area, house nearly 1,600 beds and employ more than 12,000 people. Together, the WPAHS hospitals admit nearly 55,000 patients, log over 164,000 emergency visits and deliver more than 3,800 newborns each year. Combined, the hospitals are among the leaders in percentages of total surgeries, cardiac surgeries, neurosurgeries and cardiac catheterization procedures performed throughout the region. West Penn Allegheny Health System, Inc. serves as the flagship for the West Penn Allegheny Health System. Through our Allegheny General, Western Pennsylvania and Forbes Regional Campuses we provide exceptional education to the aspiring healthcare professionals of tomorrow. We fund research that is conducted through the research arm of the health system, known as Allegheny Singer Research Institute. We specialize in areas such as Burn Care at the West Penn Campus and our affiliation with other national organizations such as the Joslin Diabetes Center and the Jones Institute for Reproductive Medicine guarantees the best possible treatment for our patients.
SCHEDULE H, PART VI, LINE 7 State Filing of Community Benefit Report Alle-Kiski Medical Center files the community benefit report with the State of Pennsylvania as part of our obligation to furnish the State of Pennsylvania with a copy of the IRS Form 990 and related schedules.
Schedule H (Form 990) 2014
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, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including 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
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
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 in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1John Balacko MDEx Officio Director (i)
(ii)		 0
...............................
474,533 		0
...............................
35,027 		0
...............................
1,032 		0
...............................
0 		0
...............................
0 		0
...............................
510,592 		0
...............................
0
2Daniel CasperDirector (i)
(ii)		 0
...............................
389,970 		0
...............................
0 		0
...............................
1,584 		0
...............................
0 		0
...............................
0 		0
...............................
391,554 		0
...............................
0
3John PaulEX OFFICIO DIRECTOR (i)
(ii)		 0
...............................
933,552 		0
...............................
900,944 		0
...............................
29,987 		0
...............................
0 		0
...............................
0 		0
...............................
1,864,483 		0
...............................
0
4Ned LaubacherDirector (i)
(ii)		 0
...............................
0 		0
...............................
0 		0
...............................
221,685 		0
...............................
0 		0
...............................
0 		0
...............................
221,685 		0
...............................
221,685
5Michael HarlovicEx-Officio Director and Pres (i)
(ii)		 0
...............................
433,767 		0
...............................
0 		0
...............................
552 		0
...............................
0 		0
...............................
0 		0
...............................
434,319 		0
...............................
0
6William EnglertVP - Business Development (i)
(ii)		 157,157
...............................
0 		0
...............................
0 		557
...............................
0 		0
...............................
0 		0
...............................
0 		157,714
...............................
0 		0
...............................
0
7Jacqueline BauerSecretary (i)
(ii)		 0
...............................
321,366 		0
...............................
71,578 		0
...............................
19,657 		0
...............................
0 		0
...............................
0 		0
...............................
412,601 		0
...............................
0
8Elizabeth AllenTreasurer (i)
(ii)		 0
...............................
409,508 		0
...............................
325,000 		0
...............................
21,993 		0
...............................
0 		0
...............................
0 		0
...............................
756,501 		0
...............................
0
9Walter HooverPhysician (i)
(ii)		 163,800
...............................
0 		0
...............................
0 		934
...............................
0 		0
...............................
0 		0
...............................
0 		164,734
...............................
0 		0
...............................
0
10Michael SirottSecretary (i)
(ii)		 0
...............................
0 		0
...............................
0 		0
...............................
114,831 		0
...............................
0 		0
...............................
0 		0
...............................
114,831 		0
...............................
114,831
11Esther AtwoodChief Nursing Officer (i)
(ii)		 143,782
...............................
0 		0
...............................
0 		264
...............................
0 		0
...............................
0 		0
...............................
0 		144,046
...............................
0 		0
...............................
0
12David GoldbergDirector (i)
(ii)		 0
...............................
320,363 		0
...............................
100,000 		0
...............................
39,893 		0
...............................
7,388 		0
...............................
21,445 		0
...............................
489,089 		0
...............................
0
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
Page 3
Part III
Supplemental Information
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.
Return Reference Explanation
Additional Compensation Disclosure The following represents additional disclosure for Schedule J, line 4a pertaining to officers and key employees listed in Form 990, Part VII, Section A, Line 1a receiving severance pay during the calendar year 2014: Ned Laubacher $ 221,685 Michael Sirott $ 114,831
Supplemental Nonqualified Retirement Plan The following represents additional disclosure for Schedule J, line 4b pertaining to officers and directors listed in Form 990, Part VII, Section A, Line 1a participating in a supplemental nonqualified retirement plan: Jacqueline Bauer $2,740
Deferred Non-qualifying Retirement Plan 457(f) The following individuals have amounts accrued related to 457(f) Non-qualifying retirement plans: Elizabeth Allen $46,733 John Paul $95,127 David Goldberg $5,412
Schedule J (Form 990) 2014

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.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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 Benefiting 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) 2014
Schedule L (Form 990 or 990-EZ) 2014
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Robin Bergstrom Director 54,783 See Supplemental Disclosure   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Business Transactions Involving Interested Persons Robin Bergstrom - Family member of Robin Bergstrom is employed by the filing organization.
Schedule L (Form 990 or 990-EZ) 2014

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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Return Reference Explanation
Statement of Program Service Accomplishments Introduction to Allegheny Valley Hospital Alle-Kiski Medical Center, DBA Allegheny Valley Hospital (AVH)is a member of the integrated delivery system named Allegheny Health Network. In 2013, to be consistent with the Highmark Health tax year, Alle-Kiski Medical Center changed its tax year from a fiscal year ended June 30th to Calendar year. This transition caused the short period July 1, 2013 through December 31, 2013. Prior period balances on the calendar year 2014 Form 990 are not reflective of a full twelve month period. Alle-Kiski Medical Center is dedicated to providing exceptional health care to nearly 170,000 people in portions of Allegheny, Butler, Westmoreland and Armstrong counties. AVH is part of the Allegheny Health Network which is an integrated delivery network that includes seven hospitals in Pennsylvania. With nearly 2,400 licensed beds, Allegheny Health Network is comprised of Allegheny General Hospital, West Penn Hospital, Allegheny Valley Hospital (AVH), Canonsburg Hospital, Forbes Hospital, Jefferson Hospital and Saint Vincent Hospital. AVH is comprised of a hospital campus, located in Allegheny County at 1301 Carlisle Street, Natrona Heights, Pa., and outpatient care centers located throughout the community. The AVH Outpatient Care Center - New Kensington is located in Westmoreland County at 651 Fourth Avenue, New Kensington, Pa., and offers a number of outpatient services, including radiology, laboratory, medical oncology and hematology, Joslin Diabetes Center and an Urgent Care Center for minor emergencies. AVH also offers two off-campus lab draw sites, one in Lower Burrell, Pa., and another in Natrona Heights, Pa. An off-campus outpatient physical therapy center in Natrona Heights offers patients rehabilitation services in a convenient location. AVH Radiological Imaging, located in Allegheny County at 2801 Freeport Road, Natrona Heights Pa., offers outpatient radiology imaging services including X-rays, CT scans, mammography, MRI, ultrasound and bone-density testing. In October 2010, AVH opened an outpatient care center in Vandergrift. This site offers basic imaging services, cardiac services, lab draws and sleep studies. Honors and awards bestowed upon AVH in 2014 include recognition by the Joint Commission as a 2013 Top Performer on Key Quality Measures for heart attack, heart failure, pneumonia and surgical care. The hospital also received the 2014 Fine Platinum Award for Teamwork Excellence in Elevating and Disseminating Best Practices in Infection control and Pain Management, HealthGrades America's 50 Best 2013 - Top 1%, CareChex - 2013 - #1 Hospital in PA for overall medical care, cardiac care, MI and pulmonary care and the Heart Failure Gold Plus Award from the American Heart Association. For the twelve months ended December 31, 2014, AVH treated 5,789 inpatient discharges, 201,355 outpatients, 38,923 emergency department visits; 543 inpatient and outpatient surgeries. The hospital has 317 physicians on staff and 1,020 employees. PURPOSE AND MISSION Alle-Kiski Medical Center is a team of caregivers committed to improving health and promoting wellness in our communities, one person at a time. It pledges to consistently deliver safe, compassionate quality healthcare by treating the whole person - body, mind, and spirit. UNCOMPENSATED CARE To enhance the health status of the community in which it operates and consistent with its tax-exempt status, AVH provides needed health care services to individuals regardless of their ability to pay for all or part of the services rendered. These services include both inpatient and outpatient services as well as an emergency room that remains available 24 hours a day. Consistent with the filing of Schedule H, the components of uncompensated care include charity care and unreimbursed Medicaid costs. AKMC provided uncompensated care at a cost of $7,528,697 for the year ended December 31, 2014. COMMUNITY ASSESSMENT Community Health Services Community health services include activities intended to improve community health. They extend beyond patient care activities and are subsidized by the hospital. The programs ranged from community health education to free clinics and screenings. AVH provided the following community health services during the twelve months at an estimated cost of $469,775. Destination Wellness - Destination Wellness is a community health and wellness education resource center sponsored by AVH. One of the few community-based outreach centers of its kind, Destination Wellness is a storefront located in the Galleria at Pittsburgh Mills. Destination Wellness provides a variety of health-related activities including classes and "Doc Talks" on topics ranging from arthritis to peripheral vascular disease. Destination Wellness is staffed with a registered dietitian and a registered nurse to assist visitors in finding a physician, checking blood pressure or researching a topic in the on-site health resource library. Destination Wellness also sponsors the "Mills Milers", a no-charge, indoor walking program designed to engage members of the community in physical exercise in a safe, controlled environment. Numerous programs are available exclusively for members of the Mills Milers. Paramedics Staffing - AVH staffs the mall with on-site paramedics to respond to a variety medical emergencies at the mall and surrounding businesses. In the twelve months paramedics responded to over 100 calls. PriorityCare Senior Membership Program - Since 1987, AVH has offered this outreach program to adults age 55 and older with the purpose of improving their health and their knowledge about health care and other issues related to the aging process. A newsletter is mailed quarterly to over 13,000 households reaching a total membership of over 18,000 adults. Cumulatively, over 36,000 adults have enrolled in the program. In addition to health education articles, the newsletter keeps members informed about hospital and community services and contains a calendar of monthly educational programs and support groups. AARP's 55 Alive Mature Driving Program - AVH co-sponsored this two-day driver refresher course 20 times during the calendar year 2014. During the year, 243 drivers participated in the program offered at Allegheny Valley Hospital's main campus, AVH's Outpatient Care Center in New Kensington or Destination Wellness. Free meeting space, parking, refreshments and publicity are provided through the hospital. Look Good - Feel Better! - The hospital hosted five classes in 2014, providing free space for the American Cancer Society to host the program. Center for Organ Recovery and Education (CORE) - Annually, AVH notifies CORE of potential donors and provides space to CORE to encourage organ donation. Influenza and Pneumonia Immunization - During the year, flu shots were administered to the public and subsidized by the hospital. A total of 3,054 influenza immunizations and 21 pneumonia immunizations were provided at several sites throughout the community. Babysitting Classes - Six babysitting classes were held in the twelve month period. The classes are an educational tool to help teach parents, grandparents and babysitters on safe sitting techniques. Twenty two community members attended these sessions. Costs are included with Destination Wellness. Doc/Medical Professionals Talks - AVH hosts many "Doc Talks" and other educational workshops at the campus and in the community during 2014. These events target all segments of the community population and are presented on current topics of interest. The Doc Talks are interactive and include topics such as, but not limited to: Coping with Sleep Apnea, Crohn's Disease, Healthy Lifestyle/Healthy Brain, Kidney Smart, Living with Psoriasis, Atrial-Fibrillation, Diabetes Control, Blood Pressure awareness and Women's Health. Community Health Fairs, Screenings and Workshops - AVH provides numerous health fairs within the community and at community events. These fairs target a broad range of the community and focus on topics that are prevalent to the well-being of the community. Exercise Classes - AVH sponsors a variety of exercise classes throughout the year to members of the community. Classes held during the twelve months included Wise Walk, Tai Chi and Yoga for Beginners. Costs included with Destination Wellness. Support Groups - AVH sponsors a variety of support groups in the community. Some examples would include Alzheimer's and cardiac disease Hope Cancer Support Group and Care for the Caregiver. CPR Classes - AVH instructors teach a variety of CPR classes each year. From Basic Life Support for Healthcare providers, to Friends & Family CPR, to AED usage, AVH held 40 classes during the twelve months. Total Costs are included in Destination Wellness. Health Professions Education AVH provided the following education for health professionals during the calendar year at an estimated net cost of $828,187. Citizens School of Nursing - Open since
Statement of Program Service Accomplishments - Continued Cash and In-Kind Donations Cash Donations - AKMC supports the community through cash contributions made at the discretion of the Hospital and its directors, benefiting not only the non-profit recipient but ultimately the community as a whole. The Hospital made cash contributions totaling $929. In-Kind Donations - In addition to the cash contributions listed above, AKMC also made in-kind donations of time and resources to help support various community functions. Community Building Activities Community Building Activities include activities engaged in for the purpose of improving or protecting the health, future and wellbeing of the community. Consistent with the filing of Schedule H, AKMC provided these services at a cost of $306,449 for the current year ended December 31, 2014. Social Services - AKMC social work services are available to help patients and their families adjust to changes in their lives due to illness and hospitalization. Our social workers help patients and families identify and manage factors that may interfere with health and recovery. Through counseling, discharge planning and providing information and referrals, the staff helps to ensure a comfortable return home or other level of care that is appropriate at the time of discharge. Board Memberships - AKMC employees serve as board members on numerous local boards including the local Rotary, New Kensington Chamber of Commerce, Strongland Chamber of Commerce, Alle-Kiski Paramedic Unit for Life Support Emergency Response (AKPULSER), Leadership Alle-Kiski Valley, Salvation Army, Westmoreland County Community College, Penn State New Ken Nursing Advisory Board, North Western Career and Vocational School Advisory Board, New Ken Civic Theater Executive Board and the YMCA.
Operational Oversight By A Third Party Management Company Alle-Kiski Medical Center is a member of the integrated delivery system named Allegheny Health Network. Deloitte Financial Advisory Services, LLP (Deloitte) was engaged to assign a Chief Financial Officer and Treasurer to Allegheny Health Network. Elizabeth Allen was appointed in an interim capacity to these positions and was under the employment of Deloitte from January 1, 2014 until May 5, 2014. She has daily oversight of all financial matters pertinent to the operation of the network. Elizabeth Allen became an employee of the Allegheny Health Network on May 5, 2014.
Form 990 Review Process The IRS Form 990 of the Alle-Kiski Medical Center was prepared by the Highmark Health Tax Department. Prior to filing the final tax return with the Internal Revenue Service, members of senior management reviewed components of the tax return and the voting members of the governing body received a copy of the tax return.
Monitoring and Enforcement of the Conflict of Interest Policy Highmark Health (HH), the parent organization of Allegheny Health Network (AHN), has a corporate compliance department that monitors and oversees compliance with the AHN conflict of interest policy. Alle-Kiski Medical Center (AKMC)is a member of the Allegheny Health Network by virtue of being affiliated with West Penn Allegheny Health System (WPAHS). WPAHS has a corporate compliance department that, in conjuction with the HH Compliance Department, monitors compliance with AHN COI policy. The following describes the manner in which the corporate compliance department monitors and oversees compliance with the conflict of interest policy for AHN: Conflict of Interest disclosure forms are completed on an annual basis by all board members, officers, any person who has authority to act on behalf of the BOD, key employees,employed physicians and non-employed physicians serving in an elected or appointed leadership position, managers and above, persons with purchasing or contracting authority including procurement department employees and committees which may influence purchasing decisions, and any other employees as designated by the Compliance Department. Upon completion of the above disclosure statement by all applicable individuals, the Integrity and Compliance Department reviews all disclosures. Those that require additional information or clarification are contacted by the Integrity and Compliance Department requesting such. Once received, all information is evaluated in consultation with the Legal Department and Senior Management as applicable to determine whether a real or potential conflict of interest exists. Those conflicts that require a mitigation plan are developed and approved in coordination with the respective responsible senior management. The senior managers are responsible for discussing the mitigation plan with the individual as needed and monitoring compliance with the mitigation plan. A final report of all board and executive level management disclosures is submitted for review to the Audit and Compliance Subcommittee of the Board, as well as by the board of directors. management disclosures is submitted for review to the Audit and Compliance Subcommittee of the Board, as well as by the board of directors.
Process Used To Determine Executive Compensation The top management official, officers and key employees of AKMC are employed by both AKMC and related organizations. The executive compensation policy is different for certain individuals. Stated below is the executive compensation policies that cover the top management official, officers and key employees of AKMC: The Allegheny Health Network (AHN) process for determining compensation for executive positions (including officers, key employees and other management positions) is covered by the HH Executive Compensation Policy. This policy was approved by the HH Board of Directors. It is the policy of HH and its Board of Directors to compensate its executives in accordance with the market and in relation to the experience, service and accomplishments of the individual both prior to and during their service with HH. The Personnel and Compensation Committee makes recommendations to the HH Board of Directors who ultimately approve the compensation for the President and CEO of AHN and all senior executives who report directly to the President and CEO of AHN. All other AHN senior executives' compensation is approved by the HH CEO and HH CHRO. Compensation includes all compensation components, including without limitation, base compensation, incentive compensation, deferred compensation, fringe and other benefits. The Board of Directors also approve all base compensation adjustments and all incentive compensation awards, as well as material changes to deferred compensation, fringe, or other benefits. The Personnel & Compensation Committee uses comparability data provided by an independent compensation consultant. The external consultant provides a letter of reasonability for all offers made to new executives that report to the AHN CEO. Each Board of Director member voting on a senior executive's compensation arrangement ensures that he or she has no conflict of interest, including that he or she (a) does not economically benefit from the proposed employment; (b) does not receive compensation subject to the approval of the proposed employee; and (c) has no material financial interest affected by the transaction. Allegheny Health Network follows the requirement in the regulations to comply with the rebuttable presumption of the reasonableness of compensation. The WPAHS, Inc. executive compensation program is administered by the CEO of Allegheny Health Network ("AHN") with respect to the WPAHS, Inc. CEO, COO and CFO, and by the WPAHS, Inc. CEO, for all other officers, each pursuant to overall guidelines established by the Personnel and Compensation Committee ("P&C Committee") of the Board of Directors of Highmark Health. It is the policy of the WPAHS, Inc. to compensate its executives in accordance with competitive market practices, taking into account both organization performance and the skills, experience, qualifications, and performance of each executive. The WPAHS, Inc. generally targets the median of the relevant market, with reasonable variation based on each executive's skills, experience, performance and current positioning relative to market. Compensation may include several forms of cash compensation, including base salary, performance-based incentive compensation, and a competitive employee benefits program. Base salary is the fixed element of compensation intended to align with each executive's role, responsibilities, overall performance and other contributions. Incentive compensation is used to provide variable, or "at risk" compensation based on the performance of both the executive and the organization. The hospital executives can earn incentive compensation only if the organization achieves certain pre-determined financial goals. The plans are intended to hold executives accountable for achieving performance that is consistent with the long-term goals and objectives of the hospital. The Human Resources Department obtains appropriate market comparability data for each entity, including nationally published compensation surveys and/or specific organization peer groups, to prepare compensation recommendations for all key executives, including officers, key employees, and other disqualified persons. Recommendations are reviewed and approved by a governing body that is independent with respect to the compensation provided to the executives.
Public Access To Organizational Documents Alle-Kiski Medical Center (AKMC) does not make its governing documents available to the public. Highmark Health (HH) financial statements are on a consolidated basis which include Alle-Kiski Medical Center. The audited financial statements of HH are available upon the request and approval by the CFO of Highmark Health. WPAHS has adopted a conflict of interest policy that is uniformly applied to all organizations of the health system, including AKMC. This is not available to the public.
Officer, Director and Key Employee Hour Allocation Alle-Kiski Medical Center (AKMC) is a member of the Allegheny Health Network by virtue of being affiliated with West Penn Allegheny Health System (WPAHS). Individuals employed by one organization may be assigned to provide management for an affiliated organization. As such, many individuals play key roles or serve as officers or directors on multiple affiliated organizations. Each individual will be assigned forty hours to the organization of their actual employment. If the individual is employed by one organization and appointed as an officer, director or key employee of affiliated organizations the hour allocation on Form 990, Part VII, Page 7, Column (B) takes various factors into account when attempting to assign hours in a reasonable manner. Thus, it is possible for a single individual to have hours assigned in excess of forty hours per week if all affiliated organization IRS Forms 990 is taken into account. Directors who are not employed and volunteer their services are assigned one hour of service. One director is compensated for services provided in the capacity of a director for a for-profit affiliated organization. This individual serves as a volunteer on the Alle-Kiski Medical Center Board of Directors due to their experience and knowledge of the healthcare field. The actual time served for all individuals disclosed in IRS Form 990 can vary based upon the need of the organization.
Officers and Directors - Partial Year Terms The following list represents Officer or Directors of Alle-Kiski Medical Center listed on Form 990, Part VII who did not serve a full consecutive tenure during the period January 1, 2014 through December 31, 2014 along with the dates served: Michael Harlovic 01-01-2014 - 06-03-2014
Rent Expense Alle-Kiski Medical Center does not account for rental expense in a manner that would allow for a direct offset of rental income on Form 990, page 9, Part VIII, Line 6b. The components of rental expense are reflected on Form 990, Page 10, Statement of Functional Expense.
Other Changes In Net Assets The following is a reconciliation of the other changes in net assets of Alle-Kiski Medical Center for the year ended December 31, 2014: Change in Minimum Pension Liability $ (1,718,142) Transfers from Supported Entities 27,351,633 ___________ Other Changes in Net Assets $ 25,633,491
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Alle-Kiski Medical Center
 
Employer identification number

25-1875178
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on 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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


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

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) Allegheny Clinic
320 East North Ave

Pittsburgh,PA15212
25-1838458 		Healthcare PA 501(c)(3) 3 WPAHS Inc
 
 
No
(2) Allegheny Health Network
120 Fifth Ave Suite 922

Pittsburgh,PA15222
45-3674924 		Healthcare PA 501(c)(3) 11-I Highmark Hea
 
 
No
(3) Allegheny Medical Practice Network
4800 Friendship Ave

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

Pittsburgh,PA15212
25-1320493 		Sci Research PA 501(c)(3) 4 WPAHS Inc
 
 
No
(5) Alle-Kiski Medical Center Trust
1301 Carlisle Street

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

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

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

Canonsburg,PA15317
25-1818505 		Inactive PA 501(c)(3) 11-I NA
 
 
No
(9) Clinical Pathology Institute Cooperative
1526 Peach Street

Erie,PA16501
25-1528055 		Healthcare PA 501(c)(3) 3 SVHC
 
 
No
(10) Community Blood Bank
232 West 25th Street

Erie,PA16544
25-1181389 		Healthcare PA 501(c)(3) 11-I SVHC
 
 
No
(11) EnergyCare Inc
232 West 25th Street

Erie,PA16544
25-1430922 		Healthcare PA 501(c)(3) 9 SVHC
 
 
No
(12) Forbes Health Foundation
2570 Haymaker Rd

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

Canonsburg,PA15317
25-1488089 		Inactive PA 501(c)(3) 11-I NA
 
 
No
(14) Highmark Health
120 Fifth Ave Suite 922

Pittsburgh,PA15222
45-3674900 		Healthcare PA 501(c)(3) 11-I NA
 
 
No
(15) Jefferson Regional Medical Center
565 Coal Valley Rd

Jefferson Hills,PA15236
25-1260215 		Healthcare PA 501(c)(3) 3 AHN
 
 
No
(16) JRMCUPMC Cancer Associates
565 Coal Valley Rd

Jefferson Hills,PA15236
20-1634783 		Healthcare PA 501(c)(3) 3 JRMC
 
 
No
(17) Regional Cancer Center
232 West 25th Street

Erie,PA16544
25-1385705 		Healthcare PA 501(c)(3) 3 SVHS
 
 
No
(18) Regional Heart Network
232 West 25th Street

Erie,PA16544
25-1856341 		Healthcare PA 501(c)(3) 3 SVHC
 
 
No
(19) Regional Home Health and Hospice
232 West 25th Street

Erie,PA16544
83-0371265 		Healthcare PA 501(c)(3) 9 SVHS
 
 
No
(20) Saint Vincent Affiliated Physicians
1910 Sassafras Street

Erie,PA16502
20-3784338 		Healthcare PA 501(c)(3) 9 SVHS
 
 
No
(21) Saint Vincent Foundation - HHS
232 West 25th Street

Erie,PA16544
25-1669168 		Fundraising PA 501(c)(3) 11-I SVHS
 
 
No
(22) Saint Vincent Health Center
232 West 25th Street

Erie,PA16544
25-0965547 		Healthcare PA 501(c)(3) 3 AHN
 
 
No
(23) Saint Vincent Health System
232 West 25th Street

Erie,PA16544
25-1406710 		Healthcare PA 501(c)(3) 11-I E AHN
 
 
No
(24) Saint Vincent Med Ed & Research
1910 Sassafras Street

Erie,PA16502
25-1679140 		Healthcare PA 501(c)(3) 9 SVHS
 
 
No
(25) Suburban Health Foundation
100 South Jackson Ave

Pittsburgh,PA15202
25-1472073 		Fundraising PA 501(c)(3) 11-I WPAHS Inc
 
 
No
(26) The Western Pennsylvania Hospital Founda
4800 Friendship Ave

Pittsburgh,PA15224
25-1470766 		Fundraising PA 501(c)(3) 11-I WPAHS Inc
 
 
No
(27) Vantage Health Group
232 West 25th Street

Erie,PA16544
25-1498145 		Healthcare PA 501(c)(3) 3 SVHC
 
 
No
(28) West Allegheny Hospital
100 Medical Blvd

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

Pittsburgh,PA15212
25-0969492 		Healthcare PA 501(c)(3) 3 AHN
 
 
No
(30) West Penn Allegheny Oncology Network
4800 Friendship Ave

Pittsburgh,PA15224
11-3683376 		Healthcare PA 501(c)(3) 11-III FL WPAHS Inc
 
 
No
(31) Westfield Memorial Hospital Inc
189 East Main Street

Westfield,NY14787
16-0743222 		Healthcare NY 501(c)(3) 3 SVHS
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) 5148 Liberty Avenue Associates

4800 Friendship Ave
Pittsburgh,PA15224
25-0969492 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(2) Allegheny Imaging of McCandless

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(3) Associated Clinical Lab LP

312 West 25th Street
Erie,PA16502
25-1533746 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(4) Associated Clinical Lab of PA Ltd

312 West 25th Street
Erie,PA16502
45-3688292 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(5) Employee Benefit Data Services Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1824465 		Data Services PA  
NONE 0 0   No 0   No 0 %
(6) Erie Medical Complex LLC

312 West 25th Street
Erie,PA16502
20-1017545 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(7) Forbes Regional Urologic

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(8) Gateway Health Plan LP

444 Liberty Avenue Suite 2100
Pittsburgh,PA15222
25-1691945 		Insurance PA  
NONE 0 0   No 0   No 0 %
(9) Jefferson Medical Associates LP

1200 Brooks Ln 150
Clairton,PA15025
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(10) Jenkins Empire Associates

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1524682 		Property Mgmt PA  
NONE 0 0   No 0   No 0 %
(11) JV Holdco LLC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(12) McCandless Endoscopy Center

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

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(14) Peters Ambulatory Surgery Ctr LLC

4800 Friendship Ave
Pittsburgh,PA15224
 Medical Practice PA  
NONE 0 0   No 0   No 0 %
(15) Provider PPI LLC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
32-0429947 		Facilities Suppor PA  
NONE 0 0   No 0   No 0 %
(16) Saint Vincent NWPA Surgery Ct Ltd

312 West 25th Street
Erie,PA16502
05-0591755 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(17) Saint Vincent Professional Bldg Leasehol

312 West 25th Street
Erie,PA16502
25-1578290 		Property Mgmt PA  
NONE 0 0   No 0   No 0 %
(18) Silver Rain LP

120 Fifth Ave Suite 922
Pittsburgh,PA15222
27-3035436 		Property Mgmt PA  
NONE 0 0   No 0   No 0 %
(19) South Hills Surgery Center LLC

6161 Clairton Rd
West Mifflin,PA15122
27-4011352 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(20) Tri State Regional Assoc LLP

312 West 25th Street
Erie,PA16502
23-2919277 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(21) UPMC VNA Home Health LP

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1844485 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(22) Upper Midwest Consol Services Ctr LLC

7601 Frances Ave Ste 500
Minneapolis,MN55435
26-3112347 		Supply Chain PA  
NONE 0 0   No 0   No 0 %
(23) Vantage Capital Management Ltd

312 West 25th Street
Erie,PA16502
23-3099689 		Capital Mgmt PA  
NONE 0 0   No 0   No 0 %
(24) Vantage Holding Company LLC

312 West 25th Street
Erie,PA16502
03-0477182 		Capital Mgmt PA  
NONE 0 0   No 0   No 0 %
(25) Waterfront Surgery Center LLC

495 E Waterfront Dr Ste 110
Homestead,PA15120
25-1898743 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(26) West Penn Ambulatory Center

15305 Dallas Parkway
Pittsburgh,PA15224
27-2344847 		Medical Practice PA  
NONE 0 0   No 0   No 0 %
(27) WSC Realty Partners LP

495 E Waterfront Dr Ste 110
Homestead,PA15120
25-1874990 		Property Mgmt PA  
NONE 0 0   No 0   No 0 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Burn Care Associates Ltd

4800 Friendship Avenue
Pittsburgh,PA15224
23-2899534 		Medical Practice PA WPAHS Inc
  		C Corporation          
(2) Clinical Services Inc

232 West 25th Street
Erie,PA16544
25-1403846 		Health Care PA SVHS
  		C Corporation          
(3) Davis Vision IPA Inc

175 East Houston Street
San Antonio,TX78205
11-2958041 		TPA TX Highmark Inc
  		C Corporation          
(4) Davis Vision Inc

175 East Houston Street
San Antonio,TX78205
11-3051991 		Vision Service TX Highmark Inc
  		C Corporation          
(5) Delaware Ancillary Insurance Agency

800 Delaware Avenue
Wilmington,DE198011368
51-0383213 		Insurance Service DE Highmark Inc
  		C Corporation          
(6) ECCA Managed Vision Care Inc

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

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

175 East Houston Street
San Antonio,TX78205
74-2924030 		Office Administra TX Highmark Inc
  		C Corporation          
(9) Family Practice Medical Associates South

2414 Lytle Rd Ste 300
Bethel Park,PA15102
25-1684735 		Medical Practice PA JRMC
  		C Corporation          
(10) Gateway Health Plan of Ohio Inc

444 Liberty Avenue Suite 2100
Pittsburgh,PA15222
30-0282076 		Insurance PA Highmark Inc
  		C Corporation          
(11) Gateway Health Plan Inc

444 Liberty Avenue Suite 2100
Pittsburgh,PA15222
25-1505506 		Insurance PA Highmark Inc
  		C Corporation          
(12) Grandis Rubin Shanahan & Assoc

565 Coal Valley Rd
Jefferson Hills,PA15025
45-3355906 		Medical Practice PA JRMC
  		C Corporation          
(13) HCI Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
75-3002215 		Finance & Insuran PA Highmark Inc
  		C Corporation          
(14) Health System Services Corp & Subs

565 Coal Valley Rd
Jefferson Hills,PA15025
25-1403745 		Medical Office Bl PA JRMC
  		C Corporation          
(15) Highmark BCBSD Inc

800 Delaware Avenue
Wilmington,DE198011368
51-0020405 		Insurance DE Highmark Inc
  		C Corporation          
(16) Highmark Benefits Group Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
46-4763378 		Insurance Sales PA Highmark Inc
  		C Corporation          
(17) Highmark Casualty Insurance Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1334623 		Insurance PA Highmark Inc
  		C Corporation          
(18) Highmark Coverage Advantage Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
46-4757476 		Insurance Sales PA Highmark Inc
  		C Corporation          
(19) Highmark Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
23-1294723 		Insurance PA Highmark Inc
  		C Corporation          
(20) Highmark Select Resources Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
20-2353206 		Insurance Sales PA Highmark Inc
  		C Corporation          
(21) Highmark Senior Health Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
46-4156633 		Insurance Sales PA Highmark Inc
  		C Corporation          
(22) Highmark Senior Solutions Company

120 Fifth Ave Suite 922
Pittsburgh,PA15222
46-4156854 		Insurance Sales PA Highmark Inc
  		C Corporation          
(23) Highmark Ventures Inc

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

PO Box 1948
Parkersburg,WV26102
55-0624615 		Insurance Sales WV Highmark Inc
  		C Corporation          
(25) HM Benefits Administrators Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1128451 		Funds Administrat PA Highmark Inc
  		C Corporation          
(26) HM Broker Services Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
23-2384777 		Marketing Agent PA Highmark Inc
  		C Corporation          
(27) HM Captive Insurance Company

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

120 Fifth Ave Suite 922
Pittsburgh,PA15222
87-0807723 		Insurance Sales PA Highmark Inc
  		C Corporation          
(29) HM Health Insurance Company

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

120 Fifth Ave Suite 922
Pittsburgh,PA15222
46-3823617 		Info Technology PA Highmark Inc
  		C Corporation          
(31) HM Insurance Group

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1646315 		Management Servic PA Highmark Inc
  		C Corporation          
(32) HM Life Insurance Company

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

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

120 Fifth Ave Suite 922
Pittsburgh,PA15222
45-3444325 		Holding Company PA AHN
  		C Corporation          
(35) HSSC Diversified Services Inc

565 Coal Valley Rd
Jefferson Hills,PA15025
25-1770047 		Medical Practice PA JRMC
  		C Corporation          
(36) HVHC Inc

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

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1712017 		Management Servic PA Highmark Inc
  		C Corporation          
(38) Jefferson Hills Surgical Specialists PA

1200 Brooks Ln 150
Clairton,PA15025
30-0477313 		Medical Practice PA JRMC
  		C Corporation          
(39) JRMC Health Pavilion

565 Coal Valley Rd
Jefferson Hills,PA15025
25-1203449 		Medical Practice PA JRMC
  		C Corporation          
(40) JRMC Physician Service Corp

565 Coal Valley Rd
Jefferson Hills,PA15025
86-1159658 		Medical Practice PA JRMC
  		C Corporation          
(41) JRMC Specialty Group Practice

565 Coal Valley Rd
Jefferson Hills,PA15025
72-1529332 		Medical Practice PA JRMC
  		C Corporation          
(42) Keystone Health Plan West Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1522457 		Insurance Sales PA Highmark Inc
  		C Corporation          
(43) Klingensmith Healthcare Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1375204 		Health Care PA HMPG Inc
  		C Corporation          
(44) Lake Erie Medical Group PC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
45-3444157 		Health Care PA AC
  		C Corporation          
(45) Medical Center Clinic PC

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

4800 Friendship Avenue
Pittsburgh,PA15224
25-1652874 		Medical Practice PA WPAHS Inc
  		S Corporation          
(47) Palladium Risk Retention Group

409 Broad St Ste 270
Sewickley,PA15143
46-3476730 		Health Care PA HMPG Inc
  		C Corporation          
(48) Park Cardiothoracic & Vascular Inst

565 Coal Valley Rd
Jefferson Hills,PA15025
72-1529328 		Medical Practice PA JRMC
  		C Corporation          
(49) Parker Benefits

PO Box 1948
Parkersburg,WV26102
55-0625743 		TPA WV Highmark Inc
  		C Corporation          
(50) Physician Landing Zone PC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
45-3913973 		Health Care PA AC
  		C Corporation          
(51) Pittsburgh Bone Joint and Spine Inc

1200 BROOKS LN STE G20
Jefferson Hills,PA15025
25-1203449 		Medical Practice PA JRMC
  		C Corporation          
(52) Pittsburgh Pulmonary & Critical Care Ass

1200 BROOKS LN STE 130
Clairton,PA15025
46-3274101 		Medical Practice PA JRMC
  		C Corporation          
(53) Premier Medical Associates PC

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1742869 		Health Care PA AC
  		C Corporation          
(54) Primary Care Group 10 Inc

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

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

17 Arentzen Blvd Ste 101
Charleroi,PA15022
90-0614054 		Medical Practice PA JRMC
  		C Corporation          
(57) Primary Care Group 2 Inc

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

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

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

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

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

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

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

1200 Brooks Ln 270
Clairton,PA15025
01-0929359 		Medical Practice PA JRMC
  		C Corporation          
(65) Prime Medical Group PCG 1

1200 Brooks Ln 110
Clairton,PA15025
26-4194208 		Medical Practice PA JRMC
  		C Corporation          
(66) PWH Holdco

120 Fifth Ave Suite 922
Pittsburgh,PA15222
46-4682160 		Medical Practice PA Highmark Inc
  		C Corporation          
(67) Remworks Sleep Store Inc

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1411844 		Rental & Sales PA Highmark Inc
  		C Corporation          
(68) South Pittsburgh Urology Associates

1200 BROOKS LN STE 220
Clairton,PA15025
46-4954859 		Medical Practice PA JRMC
  		C Corporation          
(69) Specialty Group Practice 1 Inc

575 Coal Valley Rd Ste 365
Clairton,PA15025
35-2367818 		Medical Practice PA JRMC
  		C Corporation          
(70) Standard Property Corporation

120 Fifth Ave Suite 922
Pittsburgh,PA15222
25-1668093 		Real Estate Opera PA Highmark Inc
  		C Corporation          
(71) Steel Valley Orthopedics & Sports Medici

1200 Brooks Ln 240
Clairton,PA15025
45-3540378 		Medical Practice PA JRMC
  		C Corporation          
(72) The Gateway Group LTD

800 Delaware Avenue
Wilmington,DE198011368
51-0293417 		Benefit Administr DE Highmark Inc
  		C Corporation          
(73) Union Benefit Management Inc

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

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

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

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

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

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

4401 Deer Path Road
Harrisburg,PA17110
74-2489037 		Dental Insurance PA Highmark Inc
  		C Corporation          
(80) United Concordia Dental Plans of the Mid

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

4401 Deer Path Road
Harrisburg,PA17110
52-1542269 		Dental Insurance PA Highmark Inc
  		C Corporation          
(82) United Concordia Insurance Company

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

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

4401 Deer Path Road
Harrisburg,PA17110
23-1661402 		Dental Insurance PA Highmark Inc
  		C Corporation          
(85) United Concordia Services Inc

4401 Deer Path Road
Harrisburg,PA17110
37-1494957 		Dental Insurance PA Highmark Inc
  		C Corporation          
(86) Visionary Properties Inc

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

175 East Houston Street
San Antonio,TX78205
74-2849552 		Office Administra TX Highmark Inc
  		C Corporation          
(88) Visionworks Distribution Services Inc

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

175 East Houston Street
San Antonio,TX78205
35-2196998 		Trademarks TX Highmark Inc
  		C Corporation          
(90) Visionworks Lab Services Inc

175 East Houston Street
San Antonio,TX78205
04-3742977 		Optical Retail TX Highmark Inc
  		C Corporation          
(91) Visionworks of America Inc

175 East Houston Street
San Antonio,TX78205
74-2337775 		Retail Sales TX Highmark Inc
  		C Corporation          
(92) Visionworks Inc

175 East Houston Street
San Antonio,TX78205
02-0677066 		Optical Retail TX Highmark Inc
  		C Corporation          
(93) West Penn Corporate Medical Services In

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

4800 Friendship Avenue
Pittsburgh,PA15224
25-1630719 		Medical Practice PA WPAHS Inc
  		C Corporation          
(95) West Virginia Family Health Plan Inc

1219 Virginia Street East
Charleston,WV25301
45-2763165 		Insurance WV Highmark Inc
  		C Corporation          
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on 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
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Alle-Kiski Medical Center Trust

 1c 35,769 GAAP Accounting





Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




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






























Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2014
Additional Data


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