2014-05-15T09:00:56-05:00 2013-06-30 346565596 Ernst & Young US LLP 2100 One PPG Place Pittsburgh PA 15222 990 2012-07-01 611663540 St Clair Health Corporation Group Return STCL 4129424000 1000 Bower Hill Road Pittsburgh PA 15243 Richard C Chesnos 4129424000 2014-05-15 1 James L Ziesche P01264584 4126447800 2012 2015-11-30 17:44:51Z James M Collins 1000 Bower Hill Road Pittsburgh PA 15243 407319298 1 1 5858 X www.stclair.org X Provide highly valued and service oriented healthcare for the community. 47 37 2699 680 2763779 -853877 5594120 4631595 257971724 257753166 4243202 10311726 196533 144436 268005579 272840923 93342 197178 0 0 131174971 137246727 0 0 382581 115762381 113541487 247030694 250985392 20974885 21855531 326894624 347621603 158832126 131911598 168062498 215710005 X Provide highly valued and service oriented healthcare for the community. 0 0 191456196 197178 257898377 St Clair Memorial Hospital's primary exempt purpose is to provide healthcare services to the community and operate a 24 hour Emergency Department to meet the medical needs of the community regardless of ability to pay. In the current year,the Hospital provided 71,956 inpatient days of care to the adult and pediatric population of the community, served 16,026 admissions, performed 270,832 occasions of outpatient services and treated 63,634 Emergency room visits. St Clair Memorial Hospital Foundation provides administrative and support functions associated with program services. St. Clair Professional Services, Inc., a non-profit subsidiary of St. Clair Medical Services, Inc., provides physician and other healthcare services to the community, regardless of ability to pay, (Continued on Schedule O) including, but not limited to, pediatric and certain hospitalists and intensivists services to support, assist, and advance the interests of St. Clair Memorial Hospital(exempt) and other corporations or organizations that are affiliated with St. Clair Health Corporation which are exempt from federal income tax under Sections 501 (c) (3) and public charities exempt under 509 (a) (1) or (2) of the Code. St. Clair Anesthesiology Associates, Inc., a non-profit subsidiary of St. Clair Medical Services, Inc. employs Certified Nurse Anesthetists who provide healthcare services to the community, regardless of ability to pay, including, but not limited to, anesthesia services to support, assist, and advance the interests of St. Clair Memorial Hospital(exempt) and other corporations or organizations that are affiliates with St. Clair Health Corporation which are exempt from federal income tax under Sections 501 (c) (3) and public charities exempt under 509 (a) (1) or (2) of the Code. St. Clair Medical Services, Inc. provides physician and other healthcare services to the community to support, provide assistance, and advance the interests of St. Clair Health Corporation. 191456196 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 X 145 0 2699 1 1 1 0 0 0 0 1 1 0 0 0 0 0 X 47 37 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X Richard C Chesnos SR VP & CFO 4129421250 1000 Bower Hill Road Pittsburgh PA 15243 Andrew Aloe 2.00 2.00 X 0 0 0 Frank Arcuri ESQ 2.00 0.00 X 0 0 0 Wali Bacdayan 2.00 2.00 X 0 0 0 Joseph Banko 2.00 4.00 X 0 0 0 Stephanie Brown MD 2.00 0.00 X 0 0 0 Karl E Bushman MD 2.00 2.00 X 223157 0 28341 Louis A Civitarese DO 2.00 1.00 X 0 0 0 James M Collins 60.00 12.00 X X 851783 0 49777 Mario J Fatigati MD 2.00 60.00 X 0 0 0 Andrew R Hays 2.00 0.00 X 0 0 0 David R Heilman 5.00 8.00 X X 0 0 0 Bryan Hondru 2.00 3.00 X 0 0 0 David R Jardini 2.00 3.00 X 0 0 0 Donald J Jenkins 2.00 2.00 X 0 0 0 Joan L Massella 60.00 0.00 X X 247977 0 35353 Thomas M Medwig 2.00 7.00 X 0 0 0 Donald P Orr MD 2.00 3.00 X 10000 0 0 Alicia G Powell ESQ 2.00 2.00 X 0 0 0 Harriett M Rea 2.00 0.00 X 0 0 0 Melvin D Rex 5.00 5.00 X X 0 0 0 Harry E Serene MD 2.00 3.00 X 0 0 0 Joseph B Smith 2.00 4.00 X 0 0 0 Edward L Symons Jr 2.00 1.00 X 0 0 0 TA Ward 2.00 0.00 X 0 0 0 G Alan Yeasted MD 60.00 2.00 X X 392444 0 51102 Gary J Zentner 2.00 6.00 X 0 0 0 Robert L Allman II 2.00 0.00 X 0 0 0 Andrew Aloe 2.00 2.00 X 0 0 0 Jodi Amos 2.00 0.00 X 0 0 0 Joseph Banko 2.00 4.00 X 0 0 0 Bryan Hondru 2.00 3.00 X 0 0 0 David R Jardini 2.00 3.00 X 0 0 0 Thomas M Medwig 2.00 7.00 X 0 0 0 Vicki McKenna 2.00 0.00 X 0 0 0 Jack B Piatt 2.00 0.00 X 0 0 0 Stephen F Reich 2.00 0.00 X 0 0 0 Andrew F Rodgers 2.00 0.00 X 0 0 0 Harry E Serene MD 2.00 3.00 X X 0 0 0 Robert N Shogry MD 2.00 0.00 X 60000 0 0 Joseph B Smith 2.00 4.00 X 0 0 0 C Vaughn Strimlan MD 2.00 0.00 X 0 0 0 Gary J Zentner 5.00 3.00 X X 0 0 0 Wali Bacdayan 2.00 2.00 X 0 0 0 Joseph Banko 2.00 4.00 X 0 0 0 James W Barson 2.00 1.00 X 0 0 0 Karl E Bushman MD 2.00 2.00 X 0 0 0 James M Collins 2.00 70.00 X X 0 0 0 Mario J Fatigati MD 60.00 2.00 X 326756 0 30249 David R Heilman 5.00 8.00 X X 0 0 0 Thomas M Medwig 2.00 7.00 X 0 0 0 Donald P Orr MD 2.00 3.00 X 0 0 0 Alicia G Powell ESQ 2.00 2.00 X 0 0 0 Melvin D Rex 2.00 8.00 X 0 0 0 Joseph B Smith 2.00 4.00 X 0 0 0 Richard C Chesnos 60.00 12.00 X 352568 0 42500 Michael J Flanagan 60.00 0.00 X 339826 0 35813 Holly M Hampe 60.00 0.00 X 194189 0 30020 Andrea L Kalina 60.00 0.00 X 231765 0 28019 Eric Luttringer 60.00 5.00 X 171794 0 26733 Richard J Schaffer 60.00 0.00 X 222011 0 41973 Barry S Zaiser 60.00 10.00 X 312936 0 37545 James M Collins 2.00 70.00 X 0 0 0 Richard C Chesnos 2.00 70.00 X 0 0 0 Sheila K Gorgonio 60.00 0.00 X 118679 0 10438 Eric Luttringer 2.00 63.00 X 0 0 0 G Alan Yeasted MD 2.00 60.00 X 0 0 0 Richard C Chesnos 2.00 70.00 X 0 0 0 Eric Luttringer 2.00 63.00 X 0 0 0 Barry S Zaiser 2.00 68.00 X 0 0 0 Kevin P Bordeau 60.00 0.00 X 950745 0 29510 Arnold J Sholder 60.00 0.00 X 690883 0 32506 Leigh H Nadler 60.00 0.00 X 580856 0 22539 Marilyn Daroski 60.00 0.00 X 413385 0 19669 Nicholas P DiTullio 60.00 0.00 X 402794 0 28761 7094548 0 580848 108 0 1 0 Allscripts Healthcare LLC PO Box 8538-133 Philadelphia PA 191710133 Software Support 6473887 Volpatt Construction Corporation 100 Castleview Road Pittsburgh PA 15243 General Contractor 5934278 MBM General Contracting 4999 Old Clairton Road Pittsburgh PA 15236 General Contractor 2630289 DCK North America LLC One PPG Place 27th Floor Pittsburgh PA 15222 General Contractor 1672623 Massaro Corporation 120 Delta Drive Pittsburgh PA 152382806 General Contractor 1612896 73 182073 40000 2858728 1550794 4631595 Net patient service rev 622110 231007842 227816487 3191355 Program service revenue 621990 21424679 21424679 Senior care pharmacy 623000 2226550 2226550 Cafeteria/Cafe 722210 1657672 1657672 Parking 812930 906087 906087 530336 530336 257753166 3363327 3363327 635065 743199 -108134 -108134 -108134 140392594 23973 133455564 12604 6937030 11369 6948399 6948399 149908 182073 126486 23422 23422 217566 140522 77044 77044 Partnership Activities 561000 145211 145211 Telephone 900002 6893 6893 152104 272840923 249386377 2763779 16059172 144212 144212 52966 52966 6818045 5195543 1466611 155891 103890976 82115215 21713666 62095 8768900 2076839 6673798 18263 10303622 8305323 1982137 16162 7465184 6012230 1440195 12759 587249 587249 426797 426797 228048 228048 24265 24265 81302 81302 13890871 5579672 8289605 21594 1301686 90798 1210888 1643401 1044279 561987 37135 4655985 3683661 969211 3113 6112777 3579084 2533693 161703 70717 89775 1211 160712 117414 42795 503 1132072 776941 355131 15304679 8167667 7114489 22523 2459535 2037736 421799 Patient Care Supplies 52753277 52690707 62570 Other Miscellaneous 4504350 3077677 1396082 30591 PA Quality Care Assessm 3115896 3115896 Equipment Rental & Main 3012088 2658725 353363 1984794 862894 1121159 741 250985392 191456196 59146615 382581 9982 18362 10653660 10851115 436597 486638 24738765 24793891 1974833 1936745 4205126 3970118 3785539 3991333 290810655 170589730 100916282 120220925 150221156 162032703 21853463 8729622 4522853 5475725 1125198 1366268 2451170 3748158 326894624 347621603 22409873 25290105 4213419 4503082 55561185 51526366 76647649 50592045 158832126 131911598 X 153458104 200846750 5700431 5503254 8903963 9360001 168062498 215710005 326894624 347621603 X 21855531 5051887 20740089 X 0 1 X 1 0 X X X 0 0 0 St Clair Memorial Hospital 251010303 3 1 1 1 0 1 0 1638404 1551422 1104721 1900639 1772867 7968053 1638404 1551422 1104721 1900639 1772867 7968053 2942505 5019535 275100 212890 253610 263329 302071 1307000 9275053 10582205 0.54120 0.61770 Schedule A, Part IV, Supplemental Information: Schedule A, Part II Reason for Public Charity Status St Clair Health Corp Group return is comprised of - St Clair Memorial Hospital EIN# 25-1010303 - #3 - St Clair Memorial Hospital Foundation EIN# 25-1407399 - #7 - St Clair Professional Services, Inc EIN# 25-1691194 - #11, Type II - St Clair Anesthesiology Associates, Inc EIN# 71-0875076 - #11, Type II - St Clair Medical Services, Inc EIN# 25-1876056 - #11, Type II RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 24265 0 0 0 24265 0 Explanation of Lobbying Activities: Part II-B, Line 1: Form 990, Part IV, Line 4 St. Clair Hospital is engaged in lobbying activities through membership dues paid to the American Hospital Association, The Hospital & Healthsystem Association of Pennsylvania, and Hospital Council of Western PA. 9894895 902255 100 398065 10398985 10090921 184795 100 380721 9894895 8926091 1302689 100 137759 10090921 8299803 781438 500 154650 8926091 10397353 278115 -1884814 500 490351 8299803 0.09990 0.90010 0 0 5196471 5196471 90508958 41225685 49283273 15216496 5460953 9755543 106507971 74185580 32322391 73380759 49717512 23663247 120220925 Due to Third Parties 1678828 Accrued Retirement Benefits 36210801 Accrued Professional Liability 10613324 Capital Leases 161348 Other Liabilities 1927744 50592045 X Description of Intended Use of Endowment Funds: Part V, Line 4: Endowments are designated by donors and/ or the Board. Schedule D, Part X, Line 2: FIN 48 (ASC 740) Footnote - The Corporation, the Hospital, the Foundation, and SCMS are Pennsylvania nonprofit corporations that are described in Section 501(c)(3) of the Internal Revenue Code and are therefore exempt from federal income tax under Section 501(a) and are not subject to the Pennsylvania Corporate Net Income Tax or Pennsylvania Capital Stock Tax. The Corporation and its subsidiaries have adopted Accounting Standards Codification Subtopic 740-10, Accounting for Uncertainty in Income Taxes an Interpretation of FASB Statement No. 109 (ASC 740-10). ASC 740-10 addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the financial statements. Under ASC 740-10, the Corporation may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. As of June 30, 2013 and 2012, the Corporation does not have any uncertain tax positions. Golf Outing 331981 182073 149908 0 39201 15877 30052 500 40856 331981 182073 149908 39201 15877 30052 500 40856 126486 23422 1 1 X 1 X 0 1 1 1 0 1 1 1986408 1986408 0.00800 17129738 11567677 5562061 0.02220 19116146 11567677 7548469 0.03020 402782 402782 0.00160 259457 259457 0.00100 1645411 1645411 0.00660 221677 221677 0.00090 2529327 2529327 0.01010 21645473 11567677 10077796 0.04030 1022840 1022840 0.00410 61763 61763 0.00020 1084603 1084603 0.00430 1 4497003 0 123350991 136297306 -12946315 X 1 1 1 1 St Clair Memorial Hospital

1000 Bower Hill Road Pittsburgh PA 15243

X X X St Clair Memorial Hospital Line 1 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X 0 0 1 1 200.000000000000 0 1 X X 1 1 X X X X X X X 1 0 X X X X 1 X 0 0 17 SCMS Sholder and Bordeau Urologic Asssoc

1145 Bower Hill Road Mt Lebanon PA 15243

Physician Office SCMS So Hills Cardiology Associates

2000 Oxford Drive Suite 305 Bethel Park PA 15102

Physician Office SCMS Mt Lebanon Internal Medicine

300 Cedar Boulevard Pittsburgh PA 15228

Physician Office SCMS Colorectal Surgical Associates

1050 Bower Hill Road POB Suite 208 Pittsburgh PA 15243

Physician Office SCMS Dobkin & Ricelli Associates

250 Mt Lebanon Boulevard Suite 306 Pittsburgh PA 15243

Physician Office SCMS DeGiovanni & Montini Associates

717 Washington Road Pittsburgh PA 15228

Physician Office SCMS Fatigati Nalin Associates

Washington RoadBognar Bldg Suite 401 Pittsburgh PA 15228

Physician Office SCMS Fatigati Nalin Associates

1025 Washington Pike Bridgeville PA 15017

Physician Office SCMS Budway Surgical Associates

2000 Oxford Drive Suite 301 Bethel Park PA 15102

Physician Office SCMS Fatigati Nalin Associates

5187 Library Road Bethel Park PA 15102

Physician Office SCMS Johnston Internal Medicine

2000 Oxford Drive Suite 302 Bethel Park PA 15102

Physician Office SCMS Fatigati Nalin Associates

4000 Waterdam Plaza Drive Suite 240 McMurray PA 15317

Physician Office SCMS Robinson

5482 Campbells Run Road Pittsburgh PA 15205

Physician Office SCMS Zuckerman Family Practice

2500 Baldwick Road Pittsburgh PA 15205

Physician Office SCMS Evron Endocrinology Associates

2000 Oxford Drive Suite 302 Bethel Park PA 15102

Physician Office SCMS Fatigati Nalin Associates

5482 Campbells Run Road Pittsburgh PA 15205

Physician Office SCMS John E Love Family Practice

1626 Potomac Avenue Dormont PA 15216

Physician Office Part I, Line 7: The Hospital's ratio of cost to charges was applied to the total charges for accounts written off to charity care of $2,424,180 in order to determine a reasonable approximation of the cost of providing services for those patients. Costs were then prorated between payments and charity care write-offs on the accounts to calculate the cost amount disclosed.The cost of Medicaid accounts utilized to calculate the Medicaid Community Benefit expense was derived from St. Clair's internal cost accounting system. All other items in Part I, Line 7 represent actual costs. Part I, L7 Col(f): Actual Bad Debt amounts written off totaling $5,689,421 and St. Clair Memorial Hospital Foundation expenses totaling $1,233,116 have been excluded from the denominator in the calculation of percentage of total expense. Part II: St. Clair Hospital, St. Clair Medical Services and St. Clair Hospital Foundation are Pennsylvania non-profit corporations, exempt from taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended (the "Code"), which own and operate an acute care hospital providing a comprehensive range of general and specialized care along with physician practices supporting the hospital and surrounding communities and a fundraising organization which supports the hospital and its parent, St. Clair Health Corporation. St. Clair is committed to improving the health status of patients in our region without regard to their ability to pay. A comprehensive offering of programs and services is made available both on and off campus (to include partnering with other local healthcare agencies) and encompasses health education and screenings, prenatal education, smoking cessation, mental and behavioral health support programs, addiction, cancer care, nutrition and weight control, and the management of chronic diseases such as diabetes, congestive heart failure, COPD and asthma. In most cases these programs are provided at no cost to participants, and are generally fully subsidized. Among its other charitable works, St. Clair supports numerous community based programs including a subsidized cardiac rehabilitation program, well-baby programs, CPR training for schools and non-profit organizations, annual flu and pneumonia vaccinations for senior citizens, a needle disposal program for diabetics and other individuals who self-administer medications, and mentoring opportunities for young adults interested in healthcare careers. Among its most well received services is the Hospital's van-service program. Intended to improve access to care for the elderly and poor, transportation is provided on a scheduled basis to and from the hospital and its outpatient centers, at no cost, helping to ensure that health related appointments are kept and that the care process is not negatively impacted as a result of lack of transportation. During the year ended June 30, 2013, the van service provided over 14,000 trips to area residents in need and over 200 community outreach education programs were sponsored by St. Clair encompassing nearly every clinical service. St. Clair has established a coordinated program with the nursing schools of surrounding communities and St. Clair's nursing staff serves as preceptors to the nursing students. As many as 181 nursing students were served and more than 2,000 hours were spent on this program in nurturing the future healthcare givers of the region.Additionally, St. Clair serves as a clinical site for post-secondary advanced clinical degree programs for medical imaging students in multiple modalities, CRNA students and 5th and 6th year doctoral students in pharmacy. Its medical school preceptor program hosts between 6 to 8 students for 8 week rotations throughout the year. Job shadowing programs are also coordinated for high-school students. St. Clair is actively involved with the clinical training of over 125 Emergency Medical Technicians and Paramedics. Over 1,900 hours of training were devoted for their education in order to strengthen the quality of care given by these professionals.St. Clair's website (www.stclair.org) provides consumers of healthcare with robust health information. Nearly 250,000 visitors utilize the website each year.St. Clair has a very active volunteer program including over 290 junior and 350 senior volunteers. Approximately 70,000 volunteer hours of service are provided in numerous areas covering a broad range of services from clerical duties to patient assistance and supportive visiting.The following is a sample of other ways in which St. Clair supports the community: - The Chartiers Valley Boys & Girls Club is a non-profit organization dedicated to promoting health, social, educational, vocational and character development for boys and girls ages 6 through 18. Through monetary donations, St. Clair has helped promote after school programs at the club, including Homework Power Hour, NFL Play 60 Challenge, and Dapper Dan Charities, all of which help to provide every child with the essential tools needed for a successful and bright future. - South Hills Interfaith Ministries (SHIM) is a non-profit social service agency, meeting the emergency needs of individuals and families struggling to make ends meet in the South Hills. Through monetary donations, St. Clair is helping to provide food, clothing and assistance with utility bills, while providing support for the individuals and families to attain long term self-sufficiency. St. Clair conducted a Wellness Day at SHIM to promote healthy lifestyles and St. Clair clinicians and physicians provided education and performed free health screenings, including glucose, cholesterol, body mass index and blood pressure.- St. Clair maintains a supportive relationship with the Focus On Renewal Sto-Rox Neighborhood Family Health Center, a non-profit organization that has been a beacon of hope in the Sto-Rox community for more than 40 years. The federally qualified health care facility provides a broad spectrum of services, many of which were identified as needs in St. Clair's Community Health Needs Assessment. These services include general medicine for adults and children, obstetric and gynecologic care, podiatry, optometry, dental medicine and counseling and social services to the residents of Stowe Township and McKees Rocks. St. Clair partners with Tobacco Free Allegheny and Focus on Renewal in the delivery of programs and services aimed at improving the overall health status of moms and babies in neighborhoods like Stowe, Ingram and McKees Rocks. Additionally, St. Clair is partnering with Women, Infants & Children (WIC) to aid prenatal efforts to expectant mothers in the McKees Rocks and Carnegie areas.- St. Clair partners with other local nonprofit organizations like Gilda's Club, South Hills Interfaith Ministry, Adagio, Susan B. Komen and Livestrong to provide cancer support and education.- Consistent with St. Clair's Community Health Needs Assessment and in order to combat high rates of obesity and diabetes, often linked to poor diet and physical inactivity, St. Clair offers a seven-week community weight reduction program to area residents struggling with these conditions. The Weigh of Life program provides nutritional counseling, weigh-ins, individual meal plan development and group support. Health symposiums are offered throughout the region and provide participants with education aimed at developing a healthful lifestyle through proper nutrition and preventative healthcare. Health screenings are offered and participants are encourged to dialogue with St. Clair clinicians to better understand and manage health concerns.- Monetary and in-kind donations were made by St. Clair to support non-profit agencies such as Global Links, American Heart Association, Greenbrier Treatment Center, Project Linus and others. Part III, Line 2 The Hospital's ratio of cost to charges was applied to the total charges for accounts written off in order to determine a reasonable approximation of the cost of providing services for those patients. Costs were then prorated between payments and bad debt write-offs on the accounts to calculate the cost amount disclosed in Part III section A. Part III, Line 3 St. Clair's Financial Assistance/Charity Care policy includes presumptive charity care as an addition to the regular financial assistance discount process. Patients that do not complete a formal charity care application are screened for presumptive charity care prior to being placed in the regular collection process and qualify for charity care if the patients' credit score is below St. Clair's threshold credit score or their estimated income is within the policy guidelines. Presumptive charity care is extended to a single account. As such, St. Clair expects the amount of bad debt expense attributable to patients eligible under the financial assistance policy to be negligible. Part III, Line 4: St. Clair's audited financial statements, Note 2, pages 14-16 describe bad debt expense and uncompensated care. Part III, Line 8: The Hospital provides services regardless of the level of reimbursement to be received from the patient or its insurer. Reimbursement from the government-sponsored programs including Medicare and state Medical Assistance and indigent care programs are often less than the cost of providing these services and therefore should be treated as community benefit. The Hospital's ratio of cost to charges was utilized to estimate this shortfall. Part III, Line 9b: St. Clair provides quality medical health care regardless of race, creed, sex, national origin, age, sexual orientation, or the ability to pay. The care include both inpatient and outpatient services as well as maintaining an emergency department that is available twenty-four (24) hours a day and treats nearly 64,000 patients annually. St. Clair provides free or discounted care to patients who meet certain criteria under St. Clair's Financial Assistance and Charity Care Program. St. Clair ensures that its financial assistance program is easily accessible to patients in need and the policy is posted in all key public areas, all registration areas and in all ancillary departments. The policy extends free or discounted services to low-income, uninsured or underinsured, patients with extraordinary medical expenses and indigent individuals who do not otherwise have the ability to pay fully for medically necessary health care. All patients without insurance are billed services at a discount regardless of income. Inpatient and outpatient services are discounted to a level approximating the average of Medicare and all commercial payment rates. Once St. Clair determines that a patient has qualified for formal charity care or free care, based on a sliding scale of 200%, 250% or 300% of federal poverty guidelines an additional adjustment of 100%, 30% or 20%, respectively, is applied to all accounts reviewed in the charity care/financial assistance application process. Those patients that do not complete a formal charity care application are screened for presumptive charity care prior to being placed in the regular collection process and qualify for charity care if the patients' credit score is below St. Clair's threshold credit score or if their estimated income is within the policy guidelines. Presumptive charity care is extended to a single account. No further collection efforts are made on those qualifying for the 100% discount. For the patients qualifying for the 20% or 30% discount, the balance due is adjusted by the applicable percentage and the remaining balance continues through the regular collection process. During the year ended June 30, 2013, $7,936,280 of uninsured discounts were provided. Part V, Section B, Line 5a St Clair Memorial Hospital, Line 1: A link to the CHNA is posted at www.stclair.org/221/about. St Clair Memorial Hospital, Line 1 Part V, Section B, Line 3: St. Clair completed all phases of its Community Health Needs Assessment, publicizing its findings in May 2013. Using primary and secondary data sources, interviews with public health experts, stakeholder input and guidance, and community member feedback, a priority index was developed in order to establish an implementation plan. Key areas of focus included: improving access to care for seniors and the underserved; improving the quality of prenatal care available in the region; reducing the incidence of prevalent cancers such as colon, lung and breast cancer; better education and management of chronic lifestyle conditions and lack of community services for behavioral and mental health patients. Additional and expanded program development is currently underway resulting in new programs being delivered directly in community neighborhoods. St Clair gathered information through interviews and surveys of dozens of persons who are invested in healthcare in the community. Also, St. Clair Hospital interviews were conducted in June and July of 2011. The web-based survey was conducted from September-November of 2011. These included external stakeholders - those not affiliated with St. Clair - as well as members of our medical and Hospital staff. These persons shared their perspectives and experience on community health needs and their ideas for interventions and innovative programs to meet those needs. St. Clair Hospital acknowledges the following leaders for their valuable feedback and ideas:ST. CLAIR HOSPITAL COMMUNITY BENEFIT COMMITTEE MEMBERSJoseph B. Smith, Senior Vice President, Marketing, Dollar Bank Chairman, Community Benefit Committee, St. Clair Hospital Board of DirectorsAndrew Aloe, Chair CE 411, Vistage International, St. Clair Hospital Board of DirectorsFrank Arcuri, Esq., Law Office of Frank Arcuri, St. Clair Hospital Board of DirectorsKarl E. Bushman, M.D., Mt. Lebanon Internal Medicine, St. Clair Hospital Board of DirectorsJames M. Collins, President & Chief Executive Officer, St. Clair Hospital, St. Clair Hospital Board of DirectorsAndrew R. Hays, Managing Director, Strategic Advisors, St. Clair Hospital Board of DirectorsAndrea L. Kalina, Executive Liaison, Community Benefit Committee, Vice President of Human Resources andOrganizational Development, St. Clair HospitalJoan R. Massella, Administrative Vice President and Chief Nursing Officer, St. Clair Hospital, St. Clair Hospital Board of DirectorsHarriett M. Rea, St. Clair Hospital Board of DirectorsMelvin D. Rex, Chairman, St. Clair Hospital Board of DirectorsT.A. Ward, President, T.A. Ward Constructors, Inc., St. Clair Hospital Board of DirectorsG. Alan Yeasted, M.D., Sr. Vice President & Chief Medical Officer St. Clair Hospital, St. Clair Hospital Board of DirectorsCOMMUNITY LEADERS AND EXPERTSFrank Aggazio, Director, Allegheny County Housing AuthorityBarbara Baulding, Resident Services Assistant Director Allegheny County Housing AuthoritySister Ruth Bearer, Associate Director Sto-Rox Neighborhood Health Center (Focus on Renewal)James Brophy, Former Director of Operations Outreach Teen and Family ServicesVenard Campbell, EMS and Emergency Communications Coordinator St. Clair HospitalRichard C. Chesnos, Senior Vice President and Chief Financial Officer St Clair HospitalMary Jo Dickson, Administrator, Adult Mental Health Services Allegheny County Department of Human ServicesBruce Dixon, M.D. (Now deceased), Former Director, Allegheny County Health DepartmentMichael J. Flanagan, Sr. Vice President and Chief Operating Officer St Clair HospitalHarry Fruecht, Police Chief, Peters TownshipJames Guffey, Executive Director, South Hills Interfaith MinistriesNora Helfrich, EMS Director, Tr-Community South EMSKeith Kanel, Chief Medical and Learning Officer Pittsburgh Regional Health InitiativeTim Kimmel, Director, Washington County Department of Human ServicesChad King, Chief of Police, BridgevilleDave Kish, Executive Director, St. Clair Hospital Emergency ServicesSue Martone, Assistant Deputy Director, Office of Behavioral Health Allegheny County Department of Human ServicesColeman McDonough, Police Chief, Mt. LebanonJenny Michaux, Director of Community Impact United Way of Allegheny CountyMildred Morrison, Director, Area Agency on Aging, Allegheny County Department of Human ServicesBarbara Murphy, President, United Way of Washington CountyMarianne K. Olschesky, Community Outreach and Marketing Coordinator St. Clair HospitalKathe Niznik, Director, St. Clair Hospital Behavioral HealthMichael Panka, Former Superintendent, Sto-Rox School DistrictTodd Pritchard, Director, Medical Rescue Team SouthNan Rees, Former Director, St. Clair Hospital Care ManagementFather Regis Ryan, Former Executive Director, Sto-Rox Neighborhood Health Center (Focus on Renewal)Tom Salerno, Director of Operations, Scott TownshipAndrea Schachner, Program Director Angel's PlaceJames Secrete, Chief of Police, Scott TownshipMary Sedore, Administrative Services Coordinator, Chartiers Community Mental HealthScott Seltzer, Assistant Superintendent, Mt. Lebanon School DistrictRichard M. Sieber, Director of Marketing and Development St. Clair HospitalMary Lynn Spilak, Director of Aging Services, Washington County Department of Human ServicesTimothy Steinhauer, Superintendent, Mt. Lebanon School DistrictKay Stepp, Executive Director, Compassion ConnectionMichelle Tipton Executive Director Angel's PlaceDenis Valentine, Director, Southbridge EMSJoe Wissel, Director, Kirwan Heights EMSReginald Young, Deputy Director, Office of Community Services Allegheny County Department of Human ServicesJanet Yuhasz, Health Services Coordinator, Pittsburgh Public SchoolsPatricia Zurawski, Medical Services Director, Sto-Rox Neighborhood Health Center St Clair Memorial Hospital, Line 1 Part V, Section B, Line 5c: The CHNA was also made available in hard copy in public areas throughout the Hospital. St Clair Memorial Hospital, Line 1 Part V, Section B, Line 7: There were three primary health needs identified in the most recent CHNA that St. Clair did not address in its implementation strategy. Specifically the need for improved dental care among the underserved population was not included as it is not a core competency of the hospital. Two other areas of need, addiction services and insufficient food sources were also not addressed directly. However, recognizing the importance and value of collaboration among community agencies we are partnering with organizations better equipped to address these issues. With respect to addiction services, St. Clair is not licensed to provide this treatment however we are partnering with community agencies such as Greenbriar Treatment Center and Outreach Teen to facilitate services for residents in need. Additionally we have a strong relationship with all of the local food banks and partner with them to meet the food shortage needs of the region. St Clair Memorial Hospital, Line 1 Part V, Section B, Line 11: All patients without insurance are billed services at a discount regardless of income. Inpatient and outpatient services are discounted to a level approximating the average of Medicare and all commercial payment rates. St Clair Memorial Hospital, Line 1 Part V, Section B, Line 14g: St. Clair's full Financial Assistance Policy is available on the website and upon request. In all other methods specified, a summary of the policy is provided. St Clair Memorial Hospital, Line 1 Part V, Section B, Line 20d: In accordance with Internal Revenue Code Section 501(r) Proposed Regulations, the Hospital facility used the average of Medicare and all commercial payment rates when calculating the maximum amounts that can be charged. Part VI, Line 2: St. Clair completed all phases of its Community Health Needs Assessment, publicizing its findings in May 2013. Using primary and secondary data sources, interviews with public health experts, stakeholder input and guidance, and community member feedback, a priority index was developed in order to establish an implementation plan. Key areas of focus included: improving access to care for seniors and the underserved; improving the quality of prenatal care available in the region; reducing the incidence of prevalent cancers such as colon, lung and breast cancer; better education and management of chronic lifestyle conditions and lack of community services for behavioral and mental health patients. Additional and expanded program development is currently underway resulting in new programs being delivered directly in community neighborhoods. St. Clair has regular dialogue with regional healthcare experts, government officials, partnering agencies and community members regarding the health status of the community. That feedback is used to supplement the CHNA action plan as appropriate. Part VI, Line 3: The Hospital's process for educating patients about the Charity Care/Financial Assistance Policy is as follows:All uninsured patients who are registered through the emergency department are given a handout with information about the Hospital's Charity Care/Financial Assistance Policy. All patients who are admitted as inpatients receive a Patient Handbook and one section of the Handbook describes the Charity Care/Financial Assistance Policy. All self-pay patients are mailed the charity care letter and application.The Hospital's customer service representatives discuss the charity care policy when patients call the customer service line.All Self-pay patients who are admitted are seen by an outside consulting firm for Medicaid screening process. The firm also handles high-dollar outpatient accounts.The Hospital strives to be as helpful as possible in discussing charity care for our scheduled and unscheduled patient population.All patient statements notify patients that the hospital offers financial assistance/charity care.The hospital's website notifies patients that the hospital offers financial assistance and provides access to the financial assistance/charity care application.Financial assistance notification is posted in all registration and other high volume patient areas. Part VI, Line 4: St. Clair is located in the municipality of Mt. Lebanon, in the southwest suburban quadrant of metropolitan Pittsburgh, Pennsylvania, approximately six miles from the downtown proper. St. Clair considers its service area to include thirty-two zip codes within six regions in southwestern Allegheny and northern Washington County, along with five other community hospitals. In 2010, the total population of this community was 497,000, with 20% of all households having incomes below $25,000. St. Clair also maintains a comprehensive outpatient center located in Bethel Park, approximately three miles from the main hospital, and a second outpatient center located in Peters Township, Washington County, approximately ten miles from the Hospital, as well as two smaller outpatient centers within similar proximity. The Hospital is licensed for 328 beds of which 303 were set up and staffed during the year ended June 30, 2013. Part VI, Line 5: St. Clair's mission is to provide highly valued, service-oriented healthcare to the community. St. Clair's values are demonstrated through performance, integrity, compassion, pride and innovation. With more than 2,200 employees, St. Clair is the largest employer in southern Allegheny County. St. Clair's board of directors is comprised of members of the local community so that community needs can be properly determined and addressed. Subsidized Health ServicesIn addition to charity care and costs not covered by Medicaid payments, another community benefit provided by St. Clair is subsidized health services. These services yield low or negative margins, but are necessary to serve the community. $1,645,411 of subsidized health services were provided for the year ended June 30, 2013.Healthcare ServicesSt. Clair offers a comprehensive array of inpatient and outpatient services, including advanced cardiovascular services; specialized care for women, children and infants; diabetes treatment; oncology services; emergency care; general surgery services; primary care; behavioral health services; and pulmonary care. In addition to the high quality, broad range of clinical services offered, St. Clair is equally committed to capital improvements and purchases of new technology, to enhance its services to meet the community's health needs, investing in excess of $100,000,000 over the past five years.Each of these areas is staffed by a team of skilled physicians, nurses and other clinicians. St. Clair considers requests for clinical privileges and medical staff memembership based upon the needs of the community and Medical Staff Development Plan.In addition, each area is attractive, modern, and fully equipped for a full continuum of diagnostic, treatment, and rehabilitation procedures.Cardiovascular Services - From diagnosis to treatment to rehabilitation and wellness, our multidisciplinary team of caregivers at St. Clair offers a full range of cardiac care services. Our highly skilled professionals have, in fact, helped St. Clair achieve industry-leading treatment times for heart attack victims arriving at our Emergency Department, resulting in better outcomes than some of the most recognized hospitals in the United States. St. Clair excels in a host of other cardiac performance measurements as well, having been named a Blue Distinction Center for Cardiac Care for its best practices and standards of care. Our cardiologists and cardiac surgeons are available 24 hours a day, seven days a week to provide scheduled and emergency cardiac care, seamlessly delivered with St. Clair's longtime reputation for quality, compassionate, personalized care. Additionally, Cardiovascular Services provides a comprehensive offering of screening, prevention, cardiac rehabilitation and educational programs to the community. St. Clair subsidizes one of the busiest Cardiac Rehabilitation programs in southwestern Pennsylvania, with more than 35,000 annual visits.Behavioral and Mental Health Services - St. Clair provides comprehensive diagnosis, treatment and follow-up care for persons suffering from mental illness and substance abuse. The Behavioral and Mental Health program offers a safe compassionate treatment environment where patients can learn to understand their illness and begin the recovery process. It engages a multi-disciplinary team of caring professionals (physicians, nurses, therapists and social workers) to develop individual treatment plans to best meet the specific needs of each patient. As one of the few remaining area hospitals to provide this much needed care, the program offers services to nearly 4,000 patients annually. (Inpatient unit, Outpatient Services, Mental Health Consultation-Liaison Program, Community Outreach)Orthopedics - St. Clair's orthopedics program includes a variety of services focused on the prevention, diagnosis and treatment of disorders of the musculoskeletal system. From diagnostic testing to arthroscopic and minimally invasive surgery to elective surgery to rehabilitation, St. Clair provides access to leading edge technologies in a compassionate and caring setting. Our multidisciplinary team of physicians, nurses, and therapists develop coordinated treatment plans for each patient to ensure that each individual receives personalized attention and comprehensive care with the ultimate goals of better results and fewer complications. St. Clair also was recognized as a Blue Distinction Center for Spine Surgery and for Knee and Hip Replacement by the Blue Cross and Blue Shield Association. Additionally, it offers an extensive variety of community education and prevention programs monthly, aimed at improving the health status of orthopedic patients.Women's and Children's Services - Women's and Children's Services provides a comprehensive continuum of care, spanning from pre-natal, obstetrics, newborn and pediatric services to complete gynecological and urological services. The state-of-the-art Family Birth Center includes 11 Labor, Delivery, Recovery and Post-Partum (LDRP) beds, a Level II neonatal intensive care unit and an 8 bed Pediatric unit. As one of 5 hospitals in the service area providing Obstetric services, St. Clair performed 1,269 deliveries during the year ended June 30, 2013. Additionally, it provides an extensive offering of education and support programs. A board certified pediatrician is on-site 24 hours a day.Cancer Care- Cancer Care provides comprehensive inpatient and outpatient services to patients diagnosed with cancer, and their families. The focus is to treat the physical, emotional, spiritual and psychological needs of patients throughout all stages of the cancer continuum, from diagnosis to treatment, recovery and rehabilitation. Additionally, Cancer Care provides a significant number of cancer screening, education and wellness programs to the community.St. Clair's Sipe Infusion Center is used by patients being treated with chemotherapy, blood transfusions and injections for various ailments. The experienced Infusion Center team consists of registered nurses who have received specialized education and training in cancer care, including certifications in oncology, infusion therapy, critical care and medical-surgical care. The staff consistently receives high satisfaction ratings from patients and their families for their excellent care. Services include: chemotherapy, blood/blood products and IV solutions/medications administration; PICC and mid-line insertions for both inpatients and outpatients; maintenance, care, repair and de-clotting of central IV lines/ports; and therapeutic phlebotomies.The UPMC/St. Clair Hospital Cancer Center, located on the Hospital campus, provides a full spectrum of radiation treatment services, which are designed to help treat cancerous tumors while preserving healthy surrounding tissue. The Center is a joint venture between UPMC CancerCenters, a partner with University of Pittsburgh Cancer Institute, and St. Clair Hospital. The Center recently expanded and now includes Intensity-Modulated Radiation Therapy (IMRT) capabilities. IMRT gives radiation oncologists the ability to more precisely "custom sculpt" the shape of a tumor, delivering the right amount of radiation with more accuracy and helping to preserve healthy tissue around the tumor. Located at St. Clair, this partnership offers area residents access to convenient, advanced, comprehensive, and high-quality care close to home.Emergency Services - St. Clair is home to the region's largest Emergency Department, with nearly 64,000 annual visits in the year ended June 30, 2013. The Emergency Department is open 24 hours a day and accessible by all patients, providing emergency care ranging from minor injuries and illness to life-threatening accidents or illnesses. The Emergency Department is fully integrated with all of the other service areas of St. Clair to ensure that, should patients require additional specialized treatment, it is provided in a coordinated environment. To accommodate the growing needs of the community, St. Clair completed a two-phase, $13.5 million construction project in 2009 to accommodate up to 80,000 patient visits per year. St. Clair has made improvements in our throughput processes to better serve our community as evidenced by a patients-left-without-being-seen rate of 0.12%, which is well below the national average of between 2.5%-3%. Door-to-room times averaged 3 minutes and door-to-doctor times averaged 15 minutes during the year ended June 30, 2013. Patient satisfaction scores for St. Clair's Emergency Department were in the 98th percentile nationwide for the year ended June 30, 2013. See Additional Information for other Services Reports Filed With States Part VI, Line 7 PA ADDITIONAL INFORMATION Surgical Services - St. Clair's Surgical Services Department performs a wide range of operative procedures, including: endoscopy, gynecological surgery, ear, nose and throat surgery, orthopedic surgery, pediatric surgery, oral/maxillofacial surgery, minimally invasive surgery, podiatric surgery, open chest (heart) surgery, urological surgery, ophthalmologic surgery, pain control services, laser surgery, general surgery, vascular surgery, plastic and reconstructive surgery, lithotripsy, and thoracic surgery. In the year ended June 30, 2011, St. Clair also initiated a robotic-assisted, minimally-invasive surgical program, for which it acquired the da Vinci Si robotic surgical system. This system benefits our patients by using the most advanced technology to enable surgeons to perform delicate and complex operations through a few tiny incisions with increased vision, precision, dexterity and control, resulting in less pain and blood loss, a shorter hospital stay, and quicker recovery and return to everyday activities. Other ServicesInpatient Rehabilitation Unit - St. Clair's Inpatient Rehabilitation Unit (IRU) provides therapy programs that help patients reach the maximum independence in living skills, mobility, and communication. The IRU provides acute, individualized rehabilitative services for patients with conditions such as stroke, brain injuries, spinal cord injuries, burns, fractures, and neurological disorders. Medical Imaging - Physicians at St. Clair use the most sophisticated imaging and diagnostic equipment available to ensure that their patients are receiving the fastest and most accurate readings to determine their conditions and to serve as the foundation to developing a course of treatment. A full-service Medical Imaging Department offers a variety of diagnostic and interventional studies in four locations in southern Allegheny County using the modalities of general radiology, nuclear medicine, ultrasound, mammography, CT scanning, MRI, PET scanning and special procedures. Laboratory Services - St. Clair's full-service Laboratory is staffed by a team of professionals operating 24 hours a day, seven days a week to provide quick and accurate test results. The lab is equipped with leading-edge technology and analyzers, offering comprehensive testing in the specialties of hematology, chemistry, microbiology, histology, cytology and blood banking. St. Clair's outreach program operates four community-based service centers and provides services to more than 90 physician offices and eleven long-term care facilities. Physical and Occupational Therapy - St. Clair's Physical Therapy Department offers comprehensive rehabilitation services to inpatients and outpatients. Licensed Physical Therapists and Physical Therapist Assistants focus their treatment on restoring patients' loss of motion, strength and function. Physical Therapy works as a treatment for existing problems and prevention of complications. The goal is to return patients to their optimum level of function through exercise, walking therapy, heat and cold treatments, and tissue mobilization. The health care professionals within St. Clair's Occupational Therapy Department help individuals who are suffering from an illness, injury or disability return to a healthy way of living. With a personalized plan of care, patients are assisted in resuming activities they need or want to participate in, including independent self-care, home and work-related skills, and leisure activities. Utilizing purposeful activity to maximize independence, prevent disability and maintain health, the department promotes safety at home, work or school. Respiratory Care/Respiratory Therapy - The Respiratory Care Department at St. Clair delivers comprehensive, consistent, state-of-the art pulmonary services to patients. The department treats patients of all ages, offering a full continuum of care, ranging from diagnostic testing, Emergency Department care, inpatient and outpatient pulmonary rehabilitation, and education. Services include:-Respiratory Care-Sleep Disorders Center-Intensive Care Unit-22-Bed Pulmonary/Telemetry-Inpatient Unit-Pulmonary Rehabilitation Program-Pulmonary Health Education-Smoking Cessation ClassesHeart Testing - St. Clair offers a full range of diagnostic testing, including ECG, holter monitoring, event recording, echocardiogram, cardiac CT angiography, and stress tests at multiple locations. 1 Employee assistance-expenses 28 42129 Family Assistance 32 10737 Scholarship-Nursing student 1 100 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Funds are budgeted and approved by St. Clair Memorial Foundation Board on an annual basis. St. Clair Memorial Hospital Social Service department identifies employees and patients in need from a care perspective and makes recommendations to senior management. Based on established criteria and need senior management forwards approved recommendations to St. Clair Memorial Foundation for disbursement of approved funding. Form 990, Part IV, Line 21 St. Clair Memorial Hospital and St. Clair Memorial Hospital Foundation individually and in the aggregate, reported grants or assistance to governments or organizations in the US in excess of $5,000 in the current year on Part IX, Col A, Line 1. However, no recipient received grants or assistance in excess of $5,000. As such, Schedule I, Part II has not been completed. X 1 1 X X X X X X 1 1 0 0 0 0 0 0 0 Karl E Bushman MD 215933 0 7224 0 0 0 13687 0 14654 0 251498 0 0 0 James M Collins 526783 0 325000 0 0 0 26358 0 23419 0 901560 0 0 0 Joan L Massella 192527 0 55450 0 0 0 26976 0 8377 0 283330 0 0 0 G Alan Yeasted MD 294099 0 98345 0 0 0 33227 0 17875 0 443546 0 0 0 Mario J Fatigati MD 233335 0 93421 0 0 0 17218 0 13031 0 357005 0 0 0 Richard C Chesnos 252753 0 99815 0 0 0 23683 0 18817 0 395068 0 0 0 Michael J Flanagan 243006 0 96820 0 0 0 17382 0 18431 0 375639 0 0 0 Holly M Hampe 151559 0 42630 0 0 0 13712 0 16308 0 224209 0 0 0 Andrea L Kalina 182030 0 49735 0 0 0 23211 0 4808 0 259784 0 0 0 Eric Luttringer 156171 0 15623 0 0 0 10466 0 16267 0 198527 0 0 0 Richard J Schaffer 173696 0 48315 0 0 0 24675 0 17298 0 263984 0 0 0 Barry S Zaiser 222936 0 90000 0 0 0 19483 0 18062 0 350481 0 0 0 Kevin P Bordeau 718070 0 232675 0 0 0 15000 0 14510 0 980255 0 0 0 Arnold J Sholder 540766 0 150117 0 0 0 17500 0 15006 0 723389 0 0 0 Leigh H Nadler 333235 0 247621 0 0 0 17500 0 5039 0 603395 0 0 0 Marilyn Daroski 324238 0 89147 0 0 0 15000 0 4669 0 433054 0 0 0 Nicholas P DiTullio 252202 0 150592 0 0 0 15000 0 13761 0 431555 0 0 0 Part I, Line 1a Duquesne Club: Membership dues are paid for James M. Collins at the Duquesne Club. The Duquesne Club is a social club where local leaders meet to conduct business and accepts only individual memberships. The Hospital conducts business meetings at the facility. The accountable plan rules are met. Part I, Line 3 A subcommittee of the Board of Directors of St. Clair Health Corporation, the parent of St. Clair Memorial Hospital, St. Clair Memorial Foundation and St. Clair Medical Services, serves as the executive compensation committee and is charged annually with evaluating, determining and approving the annual compensation of executives. Salary survey information and 990 comparative evaluations are considered along with the written performance evaluation for each executive. In addition, data provided by an independent compensation consultant is used to validate and support executive compensation. Part I, Lines 4a-b These officers participated in the Hospital's Supplemental Nonqualified Retirement Plan James M. Collins $8,858 Richard Chesnos $6,183 Barry S. Zaiser $1,983 Alan Yeasted $13,227 Michael Flanagan $2,382 Andrea Kalina $4 Joan Massella $2 A Mt Lebanon Hosp Authority 256189519 621820C09 2007-12-01 10000000 Finance Capital Improvements 0 0 0 B Mt Lebanon Hosp Authority 256189519 2010-12-23 20000000 Finance Capital Improvements 0 0 0 C Mt Lebanon Hosp Authority 256189519 621820CS6 2012-08-22 24746452 2002 Bond Refinancing 0 0 0 A 1750000 10000000 16980 9983020 2009 0 0 1 1 B 1344156 20139725 29457 20110268 2013 0 0 1 1 C 24746452 510468 24235984 2013 1 0 1 1 A 1 0 1 1 0 0.00000 0.00000 0 0 1 B 1 1 1 1 0 0.00000 0.00000 0 0 1 C 1 0 1 1 0 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 Part II, Line 3, column B Proceeds Variance The Series 2010 Revenue Note Project Fund variance between the issue price and the total proceeds of issue represents investments earnings on the project fund. Project Fund was established to fund costs over construction period. SH Radiology D Orr Pres SHR Brd Mbr-SCH, SCMS 905970 Interpretation of Radiology Exams 0 PPCP L Civitarese PPCP shrhlder Brd Mbr-SCH 467116 Professional Services 0 Millcraft Dev Svcs LLC J Piatt O Brd Mbr-SCF 130000 Management Services 0 Form 990, Part VI, Section A, line 2 Board members Don Jenkins, Gary Zentner and Bryan Hondru each hold greater than 10% of interest in the same real estate investment partnership. Form 990, Part VI, Section A, line 6 - St. Clair Memorial Hospital, St. Clair Memorial Hospital Foundation, and St. Clair Medical Services do not have members or stockholders. St. Clair Medical Services is the sole member of St. Clair Anesthesiology Associates and St. Clair Professional Services. Form 990, Part VI, Section A, line 7a - According to the governing documents of St. Clair Memorial Hospital and St. Clair Memorial Hospital Foundation, St. Clair Health Corporation, as the parent company, has the power to approve the election or nomination of the board of directors of such organizations. St. Clair Anesthesiology Associates and St. Clair Professional Services are governed by the board of directors of St. Clair Medical Services. Form 990, Part VI, Section A, line 7b According to the governing documents of St. Clair Memorial Hospital and St. Clair Memorial Hospital Foundation, St. Clair Health Corporation, as the parent company of such organizations, has the power to make or approve certain decisions of such organizations including approval of the sale or encumberance of a substantial amount of assets, the approval of annual operating and capital budgets, and the approval of strategic plans. Form 990, Part VI, Section B, line 11 (b) - This Form 990 is prepared internally, reviewed by management, and reviewed by a third-party account firm, Ernst & Young LLP. The draft Form 990 is provided to each board member for review via a secure website prior to filing. Form 990, Part VI, Section B, line 12c Conflicts are monitored through an annual survey completed by Board Members and Officers. Enforcements of the corporations policies are managed by the CEO and Board Members, to whom all conflicts are reported. The Director of Compliance also manages enforcement of St. Clair Hospital policies. To the extent any conflicts are identified, such Board members or Officers are excluded from participating in the relative decision making process. Form 990, Part VI, Section B, line 15 (a & b) - A subcommittee of the Board of Directors of St. Clair Health Corporation, the parent of St. Clair Memorial Hospital, St. Clair Memorial Foundation and St. Clair Medical Services, serves as the executive compensation committee and is charged with annually evaluating, determining and approving the annual compensation of executives. Salary survey information and 990 comparative evaluations are considered along with the written performance evaluations for each executive. In addition, data provided by an independent compensation consultant is used to validate and support executive compensation. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy and financial statements are made available to the public upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in pension liability 21,801,040. Transfer (to)/from affiliates 1,050,364. Investment income 118. Contributions 175,825. Grants received -157,177. Assets released from restriction for operations -478,482. Other increases / (decreases) -1,651,599. Form 990, Part IV, Line 2 St. Clair Memorial Hospital receives and reports amounts exceeding $5,000 from any one contributor, and St. Clair Memorial Hospital Foundation receives and reports amounts exceeding the threshold from any one contributor. Form 990, Part IV, Line 4 St. Clair Hospital is engaged in lobbying activities and has properly reported the allowable costs on Schedule C. Form 990, Part IV, Line 10 St. Clair Memorial Hospital and St. Clair Memorial Hospital Foundation hold assets in term, permanent, or endowments and have properly reported on Schedule D, Part V. Form 990, Part IV, Line 18 St. Clair Foundation's gross receipts from fundraising events exceeded $15,000 and have been properly included in Schedule G, Part II. Form 990, Part IV, Line 20 St. Clair Memorial Hospital operates one hospital and has properly completed Schedule H. Form 990, Part IV, Line 24a St. Clair Hospital has tax-exempt bond issues exceeding $100,000 issued after December 31, 2002 and have properly reported on Schedule K. Form 990, Part V, Line 3a. St. Clair Memorial Hospital recorded more than $1,000 in unrelated gross business income. Form 990, Part V, Line 3b. St. Clair Memorial Hospital has filed a 990-T to report unrelated gross business income. Form 990, Part V, Line 7a. St. Clair Memorial Hospital Foundation provided goods or services in exchange for a contribution more than $75. The Foundation notified the donor of the value. Schedule B, Contributions covered by General or Special Rule The organizations comprising St. Clair Health Corp Group return are covered by both the General Rule and Special Rule. - St. Clair Memorial Hospital - General Rule - St. Clair Professional Services, Inc. - General Rule - St. Clair Anesthisiology Associates, Inc. - General Rule - St. Clair Medical Services, Inc. - General Rule - St. Clair Memmorial Hospital Foundation - Special Rule St Clair HospitalUPMC Cancer Center PETCT 1000 Bower Hill Road Pittsburgh PA 15243 202814053 Community Healthcare Provider PA 501(c)(3) 11 St Clair Health Corporation 1 SCNSC Properties 1000 Bower Hill Road Pittsburgh PA 15243 262004682 Real Estate PA NA C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 St Clair HospitalUPMC Cancer Center PETCT B 924000 Actual St Clair HospitalUPMC Cancer Center PETCT O 194409 Actual St Clair HospitalUPMC Cancer Center PETCT P 923995 Actual St Clair Memorial Hospital Foundation O 699730 Actual St Clair Memorial Hospital Foundation Q 457560 Actual St Clair Professional Services Inc O 3070085 Actual St Clair Professional Services Inc Q 297932 Actual St Clair Professional Services Inc S 2014189 Actual St Clair Anesthesiology Associates Inc O 5627176 Actual St Clair Anesthesiology Associates Inc Q 598485 Actual St Clair Anesthesiology Associates Inc S 2548226 Actual St Clair Medical Services Inc O 16241686 Actual St Clair Medical Services Inc Q 6060260 Actual St Clair Medical Services Inc S 219252 Actual