2011-04-14T12:30:30-05:00 2010-06-30 ParenteBeard LLC 1650 Market Street Suite 4500 Philadelphia PA 19103 990 2009-07-01 250965387 Hamot Medical Center HAMO 8148776162 201 State Street Erie PA 16550 Stephen M Danch 8148776162 2011-04-12 1 Julius Green CPA 2159720701 2009 2016-02-24 21:20:13Z John T Malone 201 State Street Erie PA 16550 345563310 0 X www.hamot.org X 1881 PA Hamot Medical Center ("HMC") is a premier provider of inpatient and outpatient medical services to residents of Western Pennsylvania, Western New York and northeastern Ohio. Hamot's goal to serve the community is accomplished through a commitment to patient-focused care and outcomes management, outstanding customer service, strong regional partnerships, research, and community education and programs. Hamot is dedicated to serve all patients regardless of their ability to pay. 17 10 3604 200 293728 -62599 1143569 1579814 294252881 316609103 1925118 2133057 5671565 4018085 302993133 324340059 15248150 20562936 0 125001118 131456189 0 0 158839327 170314133 299088595 322333258 3904538 2006801 285001296 340648399 169037512 221436050 115963784 119212349 Hamot Medical Center's mission is to serve our patients and community in the Hamot Tradition of quality, health, healing and education. To put simply, "to serve." 0 0 196203822 14130850 203189254 Inpatient Services: HMC is a 351 bed tertiary hospital with medical specialties that include cardiology, neuroscience, gastrointestinal care, critical care, orthopaedics and woman's health services. During fiscal year 2010, HMC's admissions were approximately 17,700 and had approximately 84,000 patient days. The Medical Center is accredited by the Joint Commission and also has an advanced certification from them as a Primary Stroke Center. Some of the other most current accolades include: Thomson Reuters "100 Top Hospitals" in both Benchmarks for Success and Cardiovascular care; a three year accreditation (with Commendation) from the American College of Surgeons' Commission on cancer care; American Heart Association "Get with the Guidelines" Stroke Gold Plus Performance Award; U.S. News & World Report - America's Best Hospitals Pulmonary and Top 25 Programs for Nurse Anesthesia; Highmark Blue Distinction Center for Knee and Hip Replacement; National Research Corporation Consumer Choice Award; and the American College of Radiology Breast Imaging Center of Excellence. HMC also maintains an Orthopaedic Clinic that serves primarily the indigent of the community. 89308142 6432086 110161391 Outpatient services: Hamot outpatient services include outpatient surgery, emergency room visits, home health visits, outpatient cardiology procedures, radiology procedures, orthopaedic procedures, and physical rehabilitation. The total outpatient volume was approximately 355,000. 6673859 3694465 Medical education and research: To further HMC's goal to provide outstanding patient care, HMC has established the following graduate programs: pharmacy residency, osteopathic neurology residency, orthopaedic surgery residency, orthopaedic hand surgery fellowships, and osteopathic emergency medicine. The continuing Medical Education Department is accredited by the Pennsylvania Medical Society and enables physicians outside of Hamot to receive required educational credits. The department's most recent annual report showed that more than 2,800 doctors attended these courses. HMC houses a School of Anesthesia in conjunction with a local university. The anesthesia program is accredited by the Council on Accreditation of Nurse Anesthesia. Last year, 34 students graduated from that program. Various research activities support medical education and advancements in patient care. HMC participates in clinical trials for drugs and devices in the final testing stages as well as basic science research. 3975378 Community education and support programs: HMC works in close partnership with the community to provide services. HMC participates in the "PILOT" (payment in lieu of taxes) program which was approximately $1,131,000 in fiscal year 2010, and subsidizes the local emergency transportation for approximately $400,000 annually. In addition, HMC provides many other educational and support services to the community including support to build up the downtown district within which HMC's campus resides. Hamot also conducts various free health screenings and education sessions at locations throughout the city including car seat safety, community vaccination programs, Hamot Heart for Women, ATV safety training, Speakers Bureau and Lecture Series, Let Me Call You Sweetheart, Heart and Soles, and Wear Red for Women. 3975378 296161201 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 398 0 1 3604 1 1 1 1 CJ 0 0 0 0 0 0 0 17 10 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X JUDITH L JOHNSON 8148773896 300 STATE STREET SUITE 100 ERIE PA 16507 John T Malone 50.00 X X 569921 0 21902 B SCOTT KERN 15.00 X X 0 0 0 DESMOND J MCDONALD 15.00 X X 0 0 0 NANCY J ANDERSON 15.00 X 0 0 0 GEORGE M CURRIE 15.00 X 0 0 0 ROBERT J FERRARO MD 10.00 X 0 0 0 RICHARD E GRIFFITH 10.00 X 0 0 0 NICHOLAS N SCOTT 10.00 X 0 0 0 DENNIS SCULLY MD 10.00 X 0 0 0 THOMAS TUPITZA ESQ 15.00 X 0 0 0 GREGORY S BALDWIN 10.00 X 0 0 0 MARY C BULA 10.00 X 0 0 0 PHILLIP GARCIA 10.00 X 0 0 0 CAROLYNN MASTERS PHD 10.00 X 0 0 0 MARK H RAIMY 15.00 X 0 0 0 JEFFREY BEACH 10.00 X 0 0 0 LINDA MYERS 10.00 X 0 0 0 Stephen M Danch 50.00 X 320317 0 23698 Donald K Inderlied 50.00 X 213557 0 20831 V James Fiorenzo 50.00 X 387486 0 21902 Richard Long MD 50.00 X 295035 0 17302 Gary Maras 50.00 X 208658 0 21058 Joseph Butler 50.00 X 208035 0 20783 James Donnelly 50.00 X 198490 0 22132 JOHN LYONS MD 40.00 X 243450 0 0 DEBBIE BURBULES 40.00 X 180898 0 21242 RAYMOND MOLUSKI 40.00 X 181304 0 8987 ISAM KHOJA MD 40.00 X 238827 0 7846 BRIAN COON 40.00 X 176804 0 23944 3422782 0 231627 129 0 1 0 PERRY CONSTRUCTION GROUP 1440 W 21ST ST ERIE PA 16512 General Contractor 18283285 CLINICAL PATHOLOGY INSTITUTE 1526 Peach Street Erie PA 16501 Laboratory Services 10635069 MEDICOR ASSOCIATES INC 120 East 2nd Street Erie PA 16507 Medical Services 4779351 ANESTHESIOLOGISTS OF ERIE INC 201 STATE STREET Erie PA 16550 Medical Services 2638438 sodexho rt 532 general sullivan road washington crossing PA 18977 food service 1702156 41 1433308 146506 1579814 Net patient service re 621990 312997369 312997369 TEACHING INCOME 611710 3040968 3040968 CLINICAL TRIALS RESEAR 900099 570766 570766 316609103 2160804 2160804 986578 775912 210666 210666 210666 20417024 2568 20412711 34628 4313 -32060 -27747 -27747 Income-equity investee 900099 1962676 7034 1955642 Bio-Med/Maint. Svcs 561700 385042 148673 236369 Utility Reimbursement 900099 205035 205035 1254666 436007 138021 680638 3807419 324340059 317045110 293728 5421407 20562936 20562936 2571107 1902619 668488 6230 6230 99230428 89565384 9665044 5948652 5267719 680933 16418167 14819038 1599129 7281605 6641552 640053 609986 33976 576010 130803 130803 13071 13071 120636 120636 35432921 31628892 3804029 839121 839121 67236042 63847825 3388217 3722254 2977803 744451 7070380 5946897 1123483 678546 598681 79865 643812 173121 470691 3083641 3083641 13767007 12491004 1276003 5731381 5672061 59320 Provision for Bad Debts 28185126 28185126 Minor Equipment/Instrum 860530 860530 Recruiting Expense 599503 599503 Other Operating Expense 401608 391004 10604 Membership Dues 371280 258434 112846 816485 653455 163030 322333258 296161201 26172057 0 3965 3039 16873618 25493660 33378464 35964226 200000 114375 6447881 7322470 8132867 11420274 320824037 178663144 122521540 142160893 76164370 89198489 7573604 9740050 13704987 19230923 285001296 340648399 29188868 35814385 285548 260341 83414361 102088633 3135510 16233754 53013225 67038937 169037512 221436050 X 114421040 117684531 148898 50774 1393846 1477044 115963784 119212349 285001296 340648399 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13071 13071 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: The organization pays membership dues to the Hospital & Healthsystem Association of Pennsylvania ("HAP"). A portion of the dues paid to HAP are used for lobbying purposes by HAP. This amount represents the portion of membership dues used by HAP for lobbying purposes. 4351489 4351489 108121587 54336874 53784713 134737 121833 12904 156902366 121063556 35838810 51313858 3140881 48172977 142160893 COMMUNITY HEALTH ALLIANCE ADVANCE PAYMENTS 5324354 INTERCOMPANY RECEIVABLES 8085583 DEFERRED FINANCING COSTS, Net 2245202 other assets 7500 estimated third-party payor settlements and advances 3568284 19230923 ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY 10281661 PENSION LIABILITY 17932861 DEFERRED COMPENSATION 15659807 Intercompany Payables 19237403 Capital lease obligations 3927205 67038937 324340059 322333258 2006801 2284369 -1042605 1241764 3248565 326305178 2284369 186564 2470933 323834245 505814 505814 324340059 323056339 2157777 2157777 320898562 120636 1314060 1434696 322333258 Part X: Description of Uncertain Tax Positions Under FIN 48: The Corporation accounts for uncertainty in income taxes using a recognition threshold of more-likely-than not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has been met. The Corporation's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. Part XI, Line 8 - Other Adjustments: Pension liability adjustment: 227994. Net Assets Released from Restrictions: 77069. loss on early extinguishment of debt: -1349805. Other change in fund balance: 2137. Part XII, Line 2d - Other Adjustments: Pension liability adjustment: 227994. NET ASSETS RELEASED FROM RESTRICTIONS: 77069. investment management fees netted with revenue on financial statements: -120636. Other change in fund balance: 2137. Part XII, Line 4b - Other Adjustments: RENTAL EXPENSE: -775912. LOSS ON SALE AND DISPOSAL OF PROPERTY AND EQUIPMENT: -32060. Other Revenue: 1313786. Part XIII, Line 2d - Other Adjustments: Rental expense: 775912. LOSS ON SALE AND DISPOSAL OF PROPERTY AND EQUIPMENT: 32060. loss on early extinguishment of debt: 1349805. Part XIII, Line 4b - Other Adjustments: TRANSFER TO AFFILIATE: 1303338. Other Expenses: 10722. 1 1 1 X 0 1 1 1 0 1 1 771130 771130 0.00260 33593073 16221320 17371753 0.05910 34364203 16221320 18142883 0.06170 193797 193797 0.00070 6175024 3040968 3134056 0.01070 1419484 7823 1411661 0.00480 7788305 3048791 4739514 0.01620 42152508 19270111 22882397 0.07790 400000 400000 0.00140 791565 791565 0.00270 1170532 1170532 0.00400 2362097 2362097 0.00810 1 5637025 771130 86821141 80261472 6559669 X 1 1 Hamot Surgery Center Outpatient surgery center 0.51000 0.49000 HAMOT MEDICAL CENTER

201 STATE STREET ERIE PA 16550

X X X X X Regional Ambulatory Surgery Center LLC

1376 Bucktail Road St Marys PA 15857

outpatient surgery center hamot surgery center

200 state street erie PA 16507

outpatient surgery center Part I, Line 3c: The organization does not use FPG to determine eligibility for providing "discounted" care to low income individuals. Instead, any uninsured patient can receive discounting based on account balance size. No formula is used to determine discounting. Instead, individuals with self-pay balances that have an issue paying for medical care or insured individuals which have a remaining balance may be eligible for discounting. Part I, Line 6a: The organization's community benefit report is contained in a report prepared by Hamot Health Foundation, a related organization. Part I, Line 7: Costing methodology used to calculate the amounts reported in Part I, line 7: Direct costs are posted to the activity. Indirect costs were calculated using a cost accounting system which addresses all patient segments. Where a cost to charge ratio was used, the ratio calculated in Schedule H worksheet 2 was used. Part I, Line 7g: The organization included as subsidized health services costs attributable to a physician clinic in the amount of $324,484. Part I, Line 7f: The amount of bad debt expense of $28,185,126 included on Form 990, Part IX, line 25, column (A) was subtracted from total expenses for purposes of calculating the percentage in this column. Part III, Line 4: Costing methodology used to determine the amount reported in Part III, lines 2 and 3: Cost to charge ratio calculated in worksheet 2.Rationale for including other bad debt amounts in community benefit: The organization's bad debt expense consists solely of self pay patient accounts deemed uncollectible. The organization still had to provide the service and incur the cost regardless of whether or not it was paid. Because we service patients in our region, we feel it is a community benefit.How the organization accounts for discounts and payments on patient accounts in determining bad debt expense: Discounts are not calculated as part of bad debt expense; rather, they are a part of contractual allowances. Method the organization uses to determine the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy, if sufficient information had been available to make a determination of their eligibility: The charity care on the books represents charges forgone as part of the charity care policy, and to arrive at cost the charges are multiplied by a cost to charge ratio, which is how the amount of $771,130 is calculated. Text of the footnote to the organization's financial statements that describes bad debt expense: Accounts receivable are reported at net realizable value. Accounts are written off when they are determined to be uncollectible based upon management's assessment of individual accounts. The allowance for doubtful collections is estimated based upon a periodic review of the accounts receivable aging, payor classifications, and application of historical write-off percentages. Part III, Line 8: Costing methodology used to determine the Medicare allowable costs reported in the organization's Medicare Cost Report, as reflected in the amount reported in Part III, line 6: The traditional step down method to allocate indirect costs was used from the Medicare cost report. Allowable costs represent fully allocated costs less costs that Medicare considers to be unallowable or nonreimbursable and any costs subject to the RCE limits. Part III, Line 9b: Collection practices set forth in the organization's debt collection policy that apply to patients qualifying for charity care or financial assistance: If determined at any point prior to or during the patient's stay that the patient is medically indigent, credit personnel will assist the patient, patient's family, or guarantor in completing an application for State Medical Assistance and may suspend certain admission and in-house payment requirements pending final determination as to MA status. Patients may request charity care post-discharge by either calling or visiting the hospital and speaking with the Patient Accounting office. Personnel in Patient Accounting are designated to handle charity care applications. Part V: The organization is also an owner of Tri-State Emergency Systems which provides medical transportation. Part VI, Line 2: Hamot Medical Center assesses the health care needs of the community as part of our regular strategic planning cycle. Every three years we complete a comprehensive assessment of our environment, including health care needs of our communities. We then update the assessment annually. Each year we present this assessment to the Strategic Planning Committee of our Board of Trustees and use it as the basis for our strategic plan. Assessment includes evaluating current environmental, demographic, and economic factors both globally and locally as well as industry specific factors. Sources we regularly reference are the Pennsylvania Department of Health's Behavioral Risk Factor Surveillance Survey, Healthy People 2010 statistics, Health Status Indicators, and Cancer Incidence and Mortality reports. These are all available at the County level. We also use consumer surveys regarding health care utilization and access administered by National Research Corporation. In March 2009 we also commissioned a detailed study of the physician supply in our primary service area and have been using the results of that survey as our physician recruitment plan. There are also various hospital industry publications we consult. We have also worked actively with partners in our community. Two recent collaborative projects with the Erie Community Foundation include publication of "Access to High Quality Primary Health Care Services" and development of www.erievitalsigns.org. Going forward we have approached our County Department of Health, the Erie Community Foundation, as well as the other hospital providers in Erie County to work together on a more formal community health needs assessment. Part VI, Line 3: The charity care policy is posted throughout the Medical Center, including postings at each registration window. Charity care applications are provided to uninsured patients. Patients are also given information regarding assistance in their information packet and it is reviewed during the admission process. Part VI, Line 4: Hamot Medical Center's primary service area is Erie County, Pennsylvania and its secondary service area encompasses Crawford, Warren, and McKean Counties in Pennsylvania, Ashtabula County in Ohio, and Chautauqua County in New York. Erie County, PA has a population of 280,000 and our secondary service area population is 400,000. While Erie County is largely urban and suburban, the secondary service area is largely rural. Median household income in Erie County is $43,456, and 15.1% of our residents are below the federal poverty level and over 58,000 residents are MA eligible. Of the 304,000 residents of our New York and Pennsylvania secondary service area, nearly 64,000 are Medicaid eligible. Median household income in the secondary service area counties hovers around $40,000, while the percent of residents below the federal poverty level ranges from 12.5% in Warren county up to 16.3% in Chautauqua County. Erie County is serviced by Hamot and 3 other hospitals for a total of 945 licensed beds. The secondary service area contains 12 community hospitals. Erie County has 13 federally designated medically underserved areas ("MUAs"), Crawford and McKean Counties have 25 MUAs together, and Chautauqua County has 1 MUA. Part VI, Line 5: Through the Medical Center's financial support, organizations and communities can provide health services without otherwise having the means. Without these sponsored programs, the community would not be able to otherwise provide them. Hamot supports the community by subsidizing the local emergency transportation entity. Without that, they would not be in existence. Though tax exempt, Hamot pays property taxes exceeding $1 million through the PILOT program. Additionally, Hamot provided support and guidance for a regional hospital in danger of closing and leaving that community with no other way to provide that service. That activity also created other synergies in health care in the region. Hamot purchased and then donated much needed equipment for the local fire department and coordinated the local disaster preparedness team. Part VI, Line 6: With the exception of one member who resides in our secondary service area, Hamot's Directors all reside in Erie County. The majority of the directors are independent. Hamot Medical Center does have an open medical staff, extending privileges to all qualified physicians for all of its departments. Surplus funds are all reinvested to promote the health of the communities we serve. The Board of Directors does review and approve the capital budget and all significant expenditures. Part VI, Line 7: Great Lakes Home Health provides home health services and sells durable medical equipment. They participate in many health fairs and educational sessions in the community.Hamot Surgery Center is an outpatient surgery facility.Regional Cancer Center is a non-profit outpatient cancer treatment facility. They conduct numerous community events to raise the awareness of cancer and provide a mobile mammography unit to reach women in isolated areas.Regional Health Services employs the physicians for the Hamot system. They provide sports training services at a reduced price and subsidize the Hamot Health Connection which provides education to the community for free or greatly reduced prices.Emergycare is a non profit organization and is the local medical transportation company. Associated Clinical Laboratory provides the lab services for all of the health care providers in the area. PA 1 REGIONAL HEALTH SERVICES INC 300 STATE STREET ERIE PA 16507 251403958 501(C)(3) 18975443 ELIMINATE INTERCOMPANY BALANCE HAMOT HEALTH FOUNDATION 300 STATE STREET ERIE PA 16507 251400999 501(C)(3) 1582897 ELIMINATE INTERCOMPANY BALANCE AND TRANSFER OF UNUSED SPECIAL FUNDS 2 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Hamot Medical Center grants funds to two affiliated tax-exempt organizations to support their operating shortfall. At the end of each year, Hamot Medical Center will forgive the intercompany balance that arose from the support of those organizations. X X X X 0 1 0 0 0 0 0 0 0 John T Malone 490695 0 53 0 79173 0 9200 0 12702 0 591823 0 0 0 Stephen M Danch 291090 0 53 0 29174 0 9200 0 14498 0 344015 0 0 0 Donald K Inderlied 193650 0 53 0 19854 0 8129 0 12702 0 234388 0 0 0 V James Fiorenzo 346727 0 53 0 40706 0 9200 0 12702 0 409388 0 0 0 Richard Long MD 292327 0 53 0 2655 0 4600 0 12702 0 312337 0 0 0 Gary Maras 192681 0 153 0 15824 0 8356 0 12702 0 229716 0 0 0 Joseph Butler 207363 0 53 0 619 0 8081 0 12702 0 228818 0 0 0 James Donnelly 197454 0 153 0 883 0 7634 0 14498 0 220622 0 0 0 JOHN LYONS MD 243450 0 0 0 0 0 0 0 0 0 243450 0 0 0 DEBBIE BURBULES 180032 0 153 0 713 0 6744 0 14498 0 202140 0 0 0 RAYMOND MOLUSKI 180891 0 53 0 360 0 5964 0 3023 0 190291 0 0 0 ISAM KHOJA MD 199027 0 39800 0 0 0 7846 0 0 0 246673 0 0 0 BRIAN COON 176726 0 53 0 25 0 9446 0 14498 0 200748 0 0 0 Part I, Line 4a RETIREMENT PLAN: THE FOLLOWING OFFICERS AND KEY EMPLOYEES PARTICIPATED IN THE ORGANIZATION'S SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN, AND HAD THE FOLLOWING AMOUNTS INCLUDED IN THEIR TAXABLE INCOME FOR 2009: JOHN T. MALONE - $74,655 STEPHEN M. DANCH - $26,555 DONALD K. INDERLIED - $14,860 V. JAMES FIORENZO - $37,868 GARY MARAS - $14,137 ERIE COUNTY HOSPITAL AUTHORITY 232302072 295200SZ3 2006-04-11 23921150 TO REIMBURSE HAMOT HEALTH FOUNDATION FOR CONSTRUCTION COSTS 0 0 ERIE COUNTY HOSPITAL AUTHORITY 232302072 295200TA7 2007-07-31 30141552 TO REIMBURSE HAMOT HEALTH FOUNDATION FOR CONSTRUCTION COSTS 0 0 ERIE COUNTY HOSPITAL AUTHORITY 232302072 295200TK5 2008-07-01 8210000 TO PAY THE COSTS OF THE CURRENT REFUNDING OF THE SERIES 1998B BONDS 0 0 ERIE COUNTY HOSPITAL AUTHORITY 232302072 2010-05-06 35000000 CURRENT REFUNDING-1998A BONDS; ADVANCE REFUNDING-2002 BONDS; CONSTRUCTION 1 0 ERIE COUNTY HOSPITAL AUTHORITY 232302072 2006-12-12 4000000 Capital equipment financing for hamot medical center 0 0 23921150 2155586 812580 20952984 2009 0 0 1 1 30141552 1170 829470 29312082 2010 0 0 0 1 8210000 158283 1 0 1 1 35000000 5222860 10470607 522137 5304395 2010 1 1 0 1 4000000 4000000 2008 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 1 Natixis Funding Corp 10.000000000000 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ERIE COUNTY HOSPITAL AUTHORITY 232302072 2009-07-16 4691500 capital equipment financing for hamot medical center 0 0 4691500 4023692 23500 644308 2011 0 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 ROBERT J FERRARO MD DIRECTOR 4795698 Board Member DR. FERRARO IS EMPLOYED BY MEDICOR ASSOCIATES WHICH PROVIDED PHYSICIAN SERVICES TO THE ORGANIZATION. 0 THOMAS TUPITZA ESQ DIRECTOR 620712 Board member Thomas Tupitza is a partner at the Law Firm of Knox McLaughlin Gornall & Sennett, PC which provides legal counsel to the organization. 0 GREGORY S BALDWIN DIRECTOR 393370 GREGORY BALDWIN IS EMPLOYED BY BALDWIN BROTHERS, INC. WHICH PROVIDED REAL ESTATE SERVICES TO THE ORGANIZATION. 0 Form 990, Part VI, Section A, line 2 The following officers, directors and key employees of the organization have business relationships: Joseph Butler and Richard Long are key employees of the organization. Both are on the board of directors of Emergycare, Inc. Form 990, Part VI, Section B, line 11 A copy of the Form 990 is posted to a secure website for all board members to review. The CFO provides Form 990 highlights to the Audit Committee of the Board, and the Chair of the Audit Committee receives an entire copy of the Forms 990 and 990-T. Also, the Compliance Officer reviews the officers' compensation with the Compensation Committee of the Board of Trustees. The Chair of the Compensation Committee reviews the officer and key executive compensation with the full board. The Executive Compensation and Audit committee memberships consist of only "independent" Trustees as defined by the Governance Policy. Form 990, Part VI, Section B, line 12c BOARD MEMBERS, OFFICERS, KEY EMPLOYEES AND OTHER SENIOR EXECUTIVES ARE REQUIRED TO SUBMIT FORMAL CONFLICT OF INTEREST STATEMENTS ON AT LEAST AN ANNUAL BASIS AND WHENEVER THE PERSON FIRST BECOMES SUBJECT TO THE POLICY OR THERE HAS BEEN ANY MATERIAL CHANGE IN THE PERSON'S RESPONSES TO THE PREVIOUSLY PROVIDED STATEMENT. THE STATEMENTS ARE PROVIDED TO, REVIEWED BY AND MAINTAINED BY THE CORPORATION'S CHIEF GOVERNANCE OFFICER. CONFLICTS OF INTEREST MUST BE DISCLOSED TO THE BOARD OF DIRECTORS OR COMMITTEE CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. IN ORDER TO MONITOR CONFLICTS OF INTEREST ARISING OUT OF TRANSACTIONS THAT WOULD NOT IN THE ORDINARY COURSE BE PRESENTED TO THE BOARD OR A COMMITTEE WITH BOARD DELEGATED POWERS, THE CHIEF GOVERNANCE OFFICER REVIEWS THE CONFLICT. QUARTERLY, THE CORPORATION'S ACCOUNTS PAYABLE DEPARTMENT WILL PROVIDE A COMPREHENSIVE LIST OF ANY TRANSACTIONS WITH A MEMBER OF THE BOARD, THEIR COMPANY/ORGANIZATION OR IMMEDIATE FAMILY MEMBER. QUARTERLY OR MORE FREQUENTLY IF CIRCUMSTANCES WARRANT, THE TRANSACTION LIST WILL BE REVIEWED BY THE GOVERNANCE AND NOMINATING COMMITTEE. Form 990, Part VI, Section B, line 15 An independent national consulting firm is retained by the Hamot board of trustees and reports directly to the executive compensation committee of the board, which is comprised of "independent" trustees. The board monitors a list of performance metrics and evaluates the executive team annually based on the quality of patient care, patient satisfaction, financial performance, and community stewardship. The consultant's study includes: understanding the target competitive market through discussion with Hamot executives and compensation committee, reviewing the duties and responsibilities for each position under the scope of the study, selecting credible published survey sources, analyzing market data, and comparing Hamot compensation levels by each component of the executive total compensation to the competitive market practices. An official opinion is rendered by the consultant in accordance with Treasury Regulation Section 53.4958-6(2) and 53.4958-1(d)(4)(iii). They also certify their independence. The study is performed annually with the most recent study conducted in May 2010. The scope of this study is for positions held with the Hamot Health Foundation, Hamot Medical Center, and Regional Health Services. The positions under the scope of this study are: CEO, COO, CFO, CMO, CNO, SVP of Corp Service/Corporate Compliance, SVP of Business Development, VP of Outpatient Services, VP of Support Services, VP of Strategic Resources, VP of Patient Accounting, VP of General Services, VP of Hamot Physician Network, VP of Pharmacy, and the President of Regional Health Services. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SCHEDULE L, PART IV BUSINESS TRANSACTIONS INVOLVING BOARD MEMBERS ALL TRANSACTIONS THAT ARE ENTERED INTO WITH ORGANIZATIONS WITH WHICH BOARD MEMBERS, OFFICERS, KEY EMPLOYEES OR SENIOR EXECUTIVES ARE AFFILIATED WITH, ARE CONDUCTED AT ARM'S LENGTH. THE BOARD MAINTAINS A CONFLICT OF INTEREST POLICY WHICH GOVERNS SUCH TRANSACTIONS. HAMOT HEALTH FOUNDATION 300 STATE STREET ERIE PA 16507 251400999 OVERALL CORPORATE PLANNING & MANAGEMENT OF HAMOT GROUP PA 501(c)(3) Line 11a, I N/A REGIONAL HEALTH SERVICES INC 300 STATE STREET ERIE PA 16507 251403958 OUTPATIENT SERVICES PA 501(c)(3) Line 9 N/A HAMOT SURGERY CENTER LLC 200 STATE STREET ERIE PA 16550 251863661 AMBULATORY SURGERY CENTER PA N/A RELATED 928693 3680910 0 0 HAMOT-KCH REAL ESTATE VENTURE LLC 300 STATE STREET SUITE 100 ERIE PA 16501 263691782 MEDICAL OFFICE BUILDING PA N/A HAMOT PROFESSIONAL BUILDING CONDOMINIUM ASSOCIATION C/O 2950 WEST 12TH STREET SUITE 50 ERIE PA 16505 251761211 REAL ESTATE PA N/A INVESTMENT -35660 310742 0 1 LIFE CARE HOME SERVICES OF NW PENNSYLVANIA 1647 SASSAFRAS STREET ERIE PA 16502 251536879 HOME HEALTH SERVICES & DME PA N/A BAYFRONT REGIONAL DEVELOPMENT CORPORATION 300 STATE STREET SUITE 100 ERIE PA 16507 251401388 REAL ESTATE HOLDING COMPANY PA N/A C BAYSIDE DEVELOPMENT CORPORATION INC 300 STATE STREET SUITE 100 ERIE PA 16507 251401386 REAL ESTATE/PHARMACY PA N/A C 0 1 1 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 HAMOT SURGERY CENTER LLC K 193123 HAMOT SURGERY CENTER LLC I 108390 HAMOT SURGERY CENTER LLC R 1090000 HAMOT SURGERY CENTER LLC P 243322 HAMOT PROFESSIONAL BUILDING CONDOMINIUM ASSOCIATION O 225089