999 Return ofOrganization ExemptFrom IncomeTax · Form •'999 Return ofOrganization ExemptFrom IncomeTax Under section 501(c), 527, or4947(a)(1) of the Internal Revenue Code(except

Form •'9 9 9 Return of Organization Exempt From Income TaxUnder section 501(c), 527, or 4947( a)(1) of the Internal Revenue Code (except black lung

Department of the Treasury benefit trust or private foundation)

Internal Revenue Service ► The organization may have to use a copy of this return to satisfy state reporting requirements

C;=

cL^

c1

M rur me Luu i cale ndar year . or sax y ear oe mnm u - ^ u1 cuv., anu enuin uo .iu Luu4

B Check it applicable Please C Name of organization D Employer identification numberAddresschange

use IRS IIPMC NORTHWEST 25-0489010label Or

Name change print or Number and street (or P 0 box if mail is not delivered to street address ) Room/suite E Telephone number

inmal retun We 200 LOTHROP STREET

fmatretunsee

^C/O CORPORATE TAXATION 8114 ) 677-1928

Amendedreturn

tnstnl c- City or town, state or country, and ZIP + 4

[

Ltb.°

d Cash X AccrualApplication Lions.pend ing PITTSBURGH PA 15213. Other (specify) 00.F

• Section 501(c )( 3) organizations and 4947 ( a)(1) nonexempt charitable H and I are not applicable to section 527 organizations

trusts must attach a completed Schedule A ( Form 990 or 990-EZ). H(a) Is this a group return for affiliates' q Yes q No

G Website : ► WWW. UPMC. COM H (b) If "Yes,* enter number of affiliates ► N/A

J Organization type ( check only one) ► g 501(c) (3 ) (Insert no ) 14947( a)(1) or 527 H(c) Are all affiliates included? Yes -0 No

K Check here ► if the organization's gross receipts are normally not more than $25,000 The(It "No," attach a list See instructions

H(d ) Is this a separate return riled by an

organization need not file a return with the IRS, but if the organization received a Form 990 Package org an i zat ion covered by a g rou p rul i n g ? Yes X No

in the mail, it should file a return without financial data Some states require a complete return . I Group Exemption Number ► N/A

M Check ► if the organization is not required

L Gross receipts Add lines 6b , 8b, 9b, and 10b to line 12 ► 90 , 452,931 . to attach Sch B (Form 990, 990-EZ, or 990-PF)

Revenue , Ex penses , and Changes in Net Assets or Fund Balances (See pa g e 18 of the instructions.)

1 Contributions , gifts, grants , and similar amounts received STMT 1

a Direct public support , • . . . . . . . . . . . . . . . . . . . . . 1 a 51 , 499.

b Indirect public support . . . . . . . . . . . . . . . . . . . . . . 1 b

c Government contributions (grants ) . . . . . . . . . . . . . . . . 1 c 25 , 243.

d Total (add lines la through 1c) (cash $ 76,742 . noncash $ ) 1 d 76,742.

2 Program service revenue including government fees and contracts (from Part VII, line 93 ) . . . . 2 68 659 651.

3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Interest on savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . 4 .103 , 052

5 Dividends and interest from securities . . . . . . . . . . . . . . 5 554 , 882.

6 a Gross rents ,,,, 6a

b Less rental expenses . . . . . . . . . . . . . . . . . . . . . . 6b

c Net rental income or (loss ) ( subtract line 6b from line 6a ) . . . . . . . . . . . . . . . . . . . . . . 6c

7 Other investment income ( describe ► 7

> 8 a Gross amount from sales of assets other (A) Securities ( B) Otherd

than inventory . . . . . . . . . . . . . . 21 012 340. 8a 46 , 264.

b Less cost or other basis and sales expenses , 18 957 292. 8b 885 , 537.

c Gain or ( loss) (attach schedule) . . . . . . 2 055 048. 8c - 839 , 273.

d Net gain or ( loss) (combine line 8c , columns (A) and (B)) .1717 • • . . . . . . S^M+ .1 . . 8d 1 , 215 , 775 .

9 Special events and activities ( attach schedule ) If any amount is from gaming , check here ► q

a Gross revenue ( not including $ of

contributions reported on line 1a). 9a

b Less direct expenses other than fundraising expenses . 9 b

c Net income or (loss ) from special events ( subtract line 9b from line 9a) . . . . . . . . . . . . . 9c

P 10a Gross sales of inventory, less returns and allowances . . . . . . . Oa

7 b Less cost of goods sold . . . . . . . . . . . . . . . . . . . . . 0b

ley c Gross profit or ( loss) from sales of inventory ( attach schedule ) ( subtract line 10b from l ine 1Oa) . . . . 1oc

11 Other revenue (from Part VII, line 103 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 ........Total revenue add lines 1d 2 3, 4 5 6c , 7, 8d, 9c , 10c and 11 ) ........ • 12 70 , 610 , 102.

13 Program services (from II B)) , , , , , , , , , , , , , , , , , , , , , , 13 58 058 021.

dNy

14

^p

Manageme g 1Vh ( C)) , 14 8 , 024 , 110 .

a 15 Fundraising fro 4 , cc umn ( D)) U) 15

W 16 Payments to -affil dices (atta sat^ec 6 16

17

1

.................Total ex en a lire 16 and 44, col rfd A ......... 17 .66 , 082 , 131

4 18 Excess or (de 1c^ for the t 17 f m line 12 ) . . .......... .••...... 18 4 , 527 , 971.

Q 19 Net assets or f nd baFa in - from line 73 , column ( A)) . . . . . . . . . . . . . . 19 77 , 757 , 818.

20 Other changes in nett and balances ( attach explanation ) , . . . S T , 2. . . . . . . . 20 .31 , 840 , 774

Z 21 Net assets or fund balances at end of year ( combine lines 18 , 19 , and 20 ) • • 21 .114 , 126 , 563 _For Paperwork Reduction Act Notice , see the separate instructions.

JSA3E10102000

TS0352 597Y 07/12/2006 13:34:02 V03-8

Form 990 (2003)

4

Form 990 (2003) 25-0489010 Page 2

Statement of All organizations must complete column (A) Columns (B), (C), and (D) are required for section 501(c)(3) and (4) organizations

Functional Expenses and section 4947(a)(1) nonexempt charitable trusts but optional for others (See page 22 of the instructions )

Do not include amounts reported on line6b , 8b , 9b . 10b or 16 of Part I

(A) Total (B) Programservices

(C) Managementand g eneral

( D) Fundraising

22 Grants and allocations (attach schedule)

(cash $ noncash $ ) 22

23 Specific assistance to individuals (attach schedule) 23

24 Benefits paid to or for members (attach schedule) 24

25 Compensation of officers , directors , etc. 25 566 472 . 566 , 472.

26 Other salaries and wages . . . . 26 25 973, 600. 2-2- , -977 , 185. 2 996 415.

27 Pension plan contributions . . . . . 27 1 , 361 , 225 . 1, 178, 821. 182 404.

28 Other employee benefits . . . . 28 4 , 409 , 353. 3 818 , 499. 590 , 854.

29 Payroll taxes . . . . . . . . . . . . . . 29 1 , 952 , 224. 1 , 696 , 043. 256 181.

30 Professional fundraising fees , , , , , 3031 Accounting fees , , , , , , , , , , , , 31 146 879. 146 879.

32 Legal fees . . . . . . . . . . . . . . 32

33 Supplies . . . . . . . . 33 6 , 840 , 619 . 6,477,039. 363,580.

34 Telephone . . . . . . . . . . . . . . 34 336 814 . 297 744 . 39,070.

35 Postage and shipping . . . . . . . . 35 96 , 303. 85 , 132 . 11 , 171.

36 Occupancy . . 36 1 239 , 147. 1, 239, 147.

37 Equipment rental and maintenance , , 37 1 , 795 , 223. 1 , 524 , 526. 270 697.

38 Printing and publications . . . . . . 38 109 793 . 55 , 505. 54 , 288.

39 Travel. . . . . . . . . , . 39 68 , 993. 28 , 791 . 40 , 202.

40 Conferences , conventions, and meetings . 40 54,636. 54 , 636.

41 Intere^ 41 86 , 560. 86,560.,(,_,,i ^

42 Depred^fltbFT kkplLr io etc ( attach schedule ). . 42 3,392,459. 3,392,459.

43 Other expenses not covered above ( itemize ) STMT 3 43a 17 , 651, 831 . 15, 145 934. 2 , 505 , 897.__

b 3bc 43c

d-------------------------- 3d

e 3e

44 Total functional expenses ( add lines 22 through 43)Organizations completing columns (B)-(D), carrythese tota ls to lines 13-15 . 44 66 082 131. 58 058 021. 8 , 024 , 110. 1

Joint Costs . Check ► U if you are following SOP 98-2Are any j oint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services '? , , , , , ► E]Yes No

If "Yes," enter ( i) the aggregate amount of these joint costs $ MA , (ii) the amount allocated to Program services $A

(iii) the amount allocated to Management and general $ , and (iv ) the amount allocated to Fundraising $

Statement of Program Service Accomplishments (See page 25 of the instructions.)

What is the or anization's rima exem t ur se? 10, HEALTHCARE _SEE STMT'S 4 &A -------_9 P rY P P Po L---------------J-----Program Service

Expenses

All organizations must describe their exempt purpose achievements in a clear and concise manner State the number (Required for 501 (c)(3) and

of clients served, publications issued, etc Discuss achievements that are not measurable (Section 501(c)(3) and (4)trusts,

(4) ts, ,oand

optionffor(1)al

organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others) othershers )

a STMT -4

---------------------------------------------------------------------------

---------------------------------------------------------------------------Grants and allocations $ 53 , 752 , 896.

b------------------------------------------------------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------(Grants and allocations $ ) 928,966.

c ---------------------------------------------------------------------------

---------------------------------------------------------------------------

---------------------------------------------------------------------------(Grants and allocations $ ) 1 664 269.

d

---------------------------------------------------------------------------

Grants and allocations $ --------------------------------------------------------- - 1 711,890.

e Other p rog ram services attach schedule Grants and allocations $

f Total of Program Service Expenses (should equal line 44, column (B), Program services). . . ► 58, 058, 021.JSA3E1 020 1 000 Form 9903E 1 (2003)

TS0352 597Y 07/12/2006 13:34:02 V03-8 5

25-0489010

Form 990 ( 2003') Page 3

Balance Sheets (See page 25 of the instructions.)

Note : Where required, attached schedules and amounts within the descnption (A) (B)column should be for end-of-year amounts only. Beginning of year End of year

45 Cash - non-interest-bearing 1 087 415. 45 1 , 097 , 667.

46 Savings and temporary cash investments . . . . . .. . . . . . . . . . . . . . 4 848 , 456 . 46 2 , 332 , 181.

47a Accounts receivable . . . . . . . . . . . . . . . 47a 8 , 996 , 591

b Less, allowance for doubtful accounts , 47b 2,047,981. 6 , 484 , 383. 47c . 6 , 948 , 610.

48a Pledges receivable . . . . . . . . . . . . . . . . 48a

b Less. allowance for doubtful accounts . . . . . . 48b 48c

49 Grants receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

50 Receivables from officers, directors, trustees, and key employees

(attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

51a Other notes and loans receivable (attach

schedule) . . . . . . . . . . . . . . . s ,5, 51a 109,432

b Less- allowance for doubtful accounts , , , , , 51 b 191 , 549. 51c 109 , 432.

Q 52 Inventories for sale or use , , , , , , , , , , , , , , , , , , , , , , , , , , , , 476 182. 52 535 , 189.

53 Prepaid expenses and deferred charges . . . . . . . . . . . . . 445 262 . 53 .477 , 687

54 Investments - securities (attach schedule) $T7 7, ► q Cost FMV 29 332 781. 54 36 , 638 , 096.

55a Investments - land, buildings, and

equipment: basis ................. 55a

b Less: accumulated depreciation (attach

schedule) . . 55b 55c

56 Investments - other (attach schedule) . . . . . . . . . . . . . . . STMT. S. 15 , 181 , 029. 56 16 402 828.

57a Land, buildings, and equipment- basis . . . . . . 57a 133 , 142 , 322 .

b Less. accumulated depreciation (attach

schedule) . . .Srm . A, . . . . 57b 70,436,339 36,318, 904. 57c 62 ,705 983.

58 Other assets (describe ► STMT 9 ) 1,832,187. 58 1 , 845 , 432.

59 Total assets (add lines 45 through 58) (must equal line 74). . . . . . . . . . 96 198 148. 59 129 093 105.

60 Accounts payable and accrued expenses . . . . . . . . . . . . . . . . . . . 6 , 954 , 412. 60 6 , 046 , 334.

61 Grants payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

62 Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

u) 63 Loans from officers, directors, trustees, and key employees (attach

schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

R. .

64a Tax-exempt bond liabilities (attach schedule) . . . . . . . . . . . . . . . . . . 64a

J b Mortgages and other notes payable (attach schedule) , , , , , , $TNT. .Q , 1 483 160. 64b 906 671.

65 Other liabilities (describe ► STMT 12 ) 10, 002 , 758. 65 8 , 013 , 537.

66 Total liabilities (add lines 60 through 65) . . . . . . . . . . . . . . . . . . . 18, 440, 330. 66 14, 966, 542.

Organizations that follow SFAS 117, check here ► X and complete lines

67 through 69 and lines 73 and 74

w 67 Unrestricted . . . . . . . . . . . . . . . . . . 62 636 579. 67 97 767,937.

. . . . . . . . . . . . . . . . . . . . . .68 Temporarily restricted 7 378 910. 68 7 , 824 , 347.. . . . . . .

69 Permanently restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 742 , 329. 69 8 , 534 , 279.

Organizations that do not follow SFAS 117, check here ►q and

LL complete lines 70 through 74

70 Capital stock, trust principal, or current funds 700y 71 Paid-in or capital surplus, or land, building, and equipment fund , , , , , . . 71

H 72 Retained earnings, endowment, accumulated income, or other funds , , , , , 72

73 Total net assets or fund balances (add lines 67 through 69 or lines

Z 70 through 72;

column (A) must equal line 19, column (B) must equal line 21) . . . . . . . 77 757 818. 73 114 , 126,563.

74 Total liabilities and net assets / fund balances ( add lines 66 and 73 ) 96 198 148. 74 129 093 105.

Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about aparticular organization. How the public perceives an organization in such cases may be determined by the information presented

on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's

programs and accomplishments

JSA3E1030 2 000

TS0352 597Y 07/12/2006 13:34:02 V03-8 6

Form 990 (2003)

25-0489010Page 4

Reconciliation of Revenue per Audited Reconciliation of Expenses per AuatteaFinancial Statements with Revenue per Financial Statements with Expenses perReturn (SPA nano 27 of the instructions ) Return NOT APPLICABLE

a Total revenue, gains, and other support a Total expenses and losses per

per audited financial statements ► a audited financial statements , , , , ► a, ,

b Amounts included on line a but not on b Amounts included on line a but not

line 12, Form 990: on line 17, Form 990.

(1) Net unrealized gains NOT APPLICABLE (1) Donated services

on investments $ and use of facilities $

(2) Donated services (2) Prior year adjustments

and use of facilities $ reported on line 20,

(3) Recoveries of prior Form 990 . . . . . $

year grants . . . . $ (3) Losses reported on

(4) Other (specify) line 20, Form 990 $

(4) Other (specify)

SAdd amounts on lines (1) through (4) ► b $

Add amounts on lines (1) through (4) , ► b

c Line a minus line b ► c c Line a minus line b , , , , , , . . . ► c

d Amounts included on line 12, d Amounts included on line 17,

Form 990 but not on line a: Form 990 but not on line a:

(1) Investment expenses (1) Investment expenses

not included on line not included on line

6b, Form 990 , , , $ 6b, Form 990 . . . $

(2) Other (specify) (2) Other (specify)

E $

Add amounts on lines (1) and (2). ► d Add amounts on lines (1) and (2) ► d

e Total revenue per line 12, Form 990 e Total expenses per line 17, Form 990

line c p lus lined. ► e ( line c p lus line d• • • • • • • • • • ► e

UMW List of Officers. Directors. Trustees. and Kev Emnlovees (List each one even if not compensa ted. see Daae 27 of

tha instructinns1

(A) Name and address(B) Title and average

hours per weekdevoted to position

(C) Compensation( If not paid , enter

-0-.

(D) Contributions toemployee benefit plans &deferred compensat ion

(E) Expenseaccount and other

allowances

SEE STATEMENT 15 566 472. 65 , 586 . NON]

75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your

organization and all related organizations, of which more than $10,000 was provided by the related organizations? ► Yes q No

If "Yes," attach schedule - see page 28 of the instructions SEE STATEMENT 16

Form 990 (2003)

JSA3E1040 2 000

TS0352 597Y 07/12/2006 13:34:02 V03-8 7

.Form 990 ( 2003 ) 25-0489010 Page 5

1:M.&IIJI Other Information ( See page 28 of the instructions. ) Yes No76 Did the organization engage in any activity not previously reported to the IRS? If "Yes," attach a detailed description of each activity 76 X

.77 Were any changes made in the organizing or governing documents but not reported to the IRS? . . . . . . . . . . . . . . . . . . . 77 X

If "Yes," attach a conformed copy of the changes

78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? . . . . . . . . . 78a X

b If "Yes," has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78b N1 P,

79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes," attach a statement , , . . . . . . 79 X

80a Is the organization related (other than by association with a statewide or nationwide organization) through common

membership, governing bodies, trustees, officers, etc , to any other exempt or nonexempt organization? 80a X, , , , , , , , , , , , , , , ,

b If "Yes," enter the name of the organization' STMT 17

and check whether it is X exempt or nonexempt

81 a Enter direct and indirect political expenditures See line 81 instructions . . . . . . . . . . . . . . . 81a NONE

b Did the organization file Form 1120-POL for this year? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 81 b N

82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge

or at substantially less than fair rental values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82a X

b If "Yes," you may indicate the value of these items here Do not include this amount h4o+ Q i I y

as revenue in Part I or as an expense in Part II (See instructions in Part III ) . . . . . . . . . . . . . 82b

, , , , , , , ,83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a X, , , , ,

b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? , , , , , , , , , , , , 83b X

84a Did the organization solicit any contributions or gifts that were not tax deductibles 84a X

b If "Yes," did the organization include with every solicitation an express statement that such contributions

or gifts were not tax deductible? 84b NI K

85 501(c)(4), (5), or(6) organizations a Were substantially all dues nondeductible by members? , , , , , , , , , , , , , , , , , , , , , 85a NI &

b Did the organization make only in-house lobbying expenditures of $2,000 or less? 85b NI ;L, , , , , , , , , , , , , , , , , , , , , , ,

If "Yes" was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization

received a waiver for proxy tax owed for the prior year

c Dues, assessments, and similar amounts from members 85c N/A

d Section 162(e) lobbying and political expenditures . . . . . . . . . . . . . . . . . . . . . . . . . 85d N/A

e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices . . . . . . . . . . . . . . 85e N/A

f Taxable amount of lobbying and political expenditures (line 85d less 85e) , , , , , , , , 85f H/A

g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f? ! .a5 N

h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable

estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year'?. . . . . . . . . . . . . 85h N1 k

86 501(c)(7) orgs Enter a Initiation fees and capital contributions included on line 12 , , , , . 86a N/A

b Gross receipts, included on line 12, for public use of club facilities , , , , , , , , , , , , , 86b N/A

87 501(c)(12) orgs Enter a Gross income from members or shareholders 87a N/A

b Gross income from other sources (Do not net amounts due or paid to other

.

sources against amounts due or received from them) , , , , , , , , , , , , , , , , , , , , , , , 87b N/A

88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or

partnership, or an entity disregarded as separate from the organization under Regulations sections

301 7701-2 and 301 7701-3" If "Yes," complete Part IX 88, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

89a 501(c)(3) organizations. Enter Amount of tax imposed on the organization during the year under

section 4911 ► NONE , section 4912 ► NONE , section 4955 ► NO

b 501(c)(3) and 501(c)(4) orgs Did the organization engage in any section 4958 excess benefit transaction

during the year or did it become aware of an excess benefit transaction from a prior year, If "Yes," attach

a statement explaining each transaction , , , , , , , , , , , , , , , , , , , , , , , , 89b X

c Enter Amount of tax imposed on the organization managers or disqualified persons during the year under

sections 4912, 4955, and 4958 ► NONE,,,,,,,,,,,,,,,,, ,,,,,,,,,,

d Enter Amount of tax on line 89c, above, reimbursed by the organization ► NONE. . . . . . . . . . . . . . . . . . . . . . . . . . . .

90a List the states with which a copy of this return is filed .PENNSYLVANIA

b Number of employees employed in the pay period that includes March 12, 2003 (See instructions) . . . . . . . . . . . . . . . . . . 1 90b 1870

91 The books are in care of ► DAVID SHULIK, REGIONAL CFO Telephone no ► 814-67 7-1490

Located at ► 100 FAIRFIELD DRIVE, SENECA, PA ZIP +4 ► 16346

92 Section 4947(a)(1) nonexempt chantable trusts Ong Form 990 in lieu of Form 1041 -Check here , , , , , , ►, , , , , . , , , ,

and enter the amount of tax-exempt interest received or accrued dunnq the tax year . . . . . . . . . . . . . . . . ► 192 I NONE

JSA3E 1041 2 000

Form 990 (2003)

TS0352 597Y 07/12/2006 13:34:02 V03-8 8

roan vvu cvw 67-VY07U1V r e v

Analysis of Income-Producing Activities (See page 33 of the instructions.)

Note : Enter gross amounts unless otherwise Unre lated business income Excluded by section 512, 513, or 514 (E)indicated.

93 Program service revenue

(A)Business code

(B)Amount

(C)Exclusion code

(D)Amount

Related orexempt function

income

a PATIENT SERVICES 6-7 , 869 , 351.

b OTHER PATIENT SVCS 03 598,147.-c RENTAL INCOME 16 192,153.

d

0

If Medicare/Medicaid payments . . . . . . .

Q Fees and contracts from government agencies •

94 Membership dues and assessments . . .

95 interest on savings and temporary cash investments 14 103 , 052.

96 Dividends and interest from securities 14 554 , 882.

97 Net rental income or (loss) from real estate

a debt-financed property . . . . . . . . .

b not debt-financed property . . . . . . .

98 Net rental income or (loss) from personal property . .

99 Other investment income . . . . . . . .

100 Gain or (loss) from sales of assets other than inventory 18 1,215 , 775.

101 Net income or (loss) from special events

102 Gross profit or (loss) from sales of inventory

103 Other revenue a

b

cd0

104 Subtotal (add columns (B), (D), and (E)) . 2 , 664 , 009. 1 . 67 869 351.

105 Total (add line 104, columns (B), (D), and (E )) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 70, 533, 360.Note : Line 105 plus line 1d, Part 1, should equal the amount on line 12, Part /

F^Tll Relationship of Activities to the Accomplishment of Exempt Purposes (See page 34 of the instructions.)

Line No.y

Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishmentof the organization's exempt purposes (other than by providing funds for such purposes)

Information Regarding Taxable Subsidiaries and Disregarded Entities See page 34 of the instructions. )(A)

Name , address, and EIN of corporation ,p artnership , or disregarded enti ty

(B)Percentage of

ownersh ip interest

(C)Nature of activities

(D)Total income

(EEndof-year

assets

STMT 19 % 11. NONE

%• .. Information Reaardina Transfers Associated with Personal Benefit Contracts (See Daoe 34 of the instructions)

(a) Did the organization , during the year , receive any funds, directly or indirectly , to pay premiums on a personal benefit contract '? , • . . . . .

(b) Did the organization , during the year , pay premiums , directly ?

Note : If "Yes" to (b), file Form 8870 and Form 4720 (see instructionUnder p enalties of perj ury, I declare that I have examined this retand belief , it is true , correct , and complete Declaration of prepa

PleaseSign V Signature of officerHere

DAVID D . SHULIK , VP REGIONAL CFType or print name and title

Preparers

Paid signature

Preparer 'sFirm's name (or yours

Use Only if self-employed),address, and ZIP + 4

Yes x No

JSA

3E1050 1 000

TS0352 597Y 07/12/2006 13:34:02 V03-8

SCHEDULE A Organization Exempt Under Section 501(c)(3) OMB No 1545-0047

(Form 990 or 990-EZ)(Except Private Foundation ) and Section 501(e ), 501(f), 501(k),

501(n ), or Section 4947( a)(1) Nonexempt Charitable Trust 003

Department of the Treasury Supplementary Information - (See separate instructions.)Internal Revenue Service ► MUST be completed by the above organizations and attached to their Form 990 or 990-EZ

Name of the organization Employer identification number

UPMC NORTHWEST J 25-0489010

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees(See page 1 of the instructions. List each one. If there are none, enter "N one.")

(a) Name and address of each employee paid more (b) Title and average (d) Contributions to (e) Expense

than $50 000hours per week (c) Compensation employee benefit plans & account and other

, devoted to position deferred compensation allowances

MELINDA REMLEY VP, PATIENT MGMT

100 FAIRFIELD DRIVE

SENECA , PA 16346 40 HRS /WK 105 467. 14 , 206. NON]

COURTNEY- COX---------------------------------

VP, HUMAN RESOUR ES

100 FAIRFIELD DRIVE

SENECA , PA 16346 40 HRS WK 100 001. 10 , 074. NONI

DOUGLAS-FRANKENBURG- - - - - - - - - - - - - - -------------------

VP, CLINICAL SRV S

100 FAIRFIELD DRIVE

SENECA , PA 16346 40 HRS /WK 99 , 231. 9 , 653. NONE

LELA-MOODY- - - - - - - - - - - - - - - - - - - - - - - -

-

VP, NURSING

100 FAIRFIELD DRIVE

SENECA , PA 16346 40 HRS/WK 93,572. 10 , 031. NONE

BERNARD-BIIRANOSKY---------------------------------

MANAGER, PHARMACY

100 FAIRFIELD DRIVE

SENECA , PA 16346 40 HRS WK 88 138. 12 367. NONE

Total number of other employees paid over

$50,000 ► NONE

Li .J Compensation of the Five Highest Paid Independent Contractors for Professional Services(See Daae 2 of the instructions. List each one (whether individuals or firms). If there are none. enter "None.")

(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation

NORTHWEST EMERGENCY PHYSICIAN_S_ LLP ---___---___

P.O.BOX 793 , TRAVERSE CITY , MI 49685 EMERGENCY MEDICINE 602 752.

NORTHWEST ANESTHESIA--------------------- -----------------

100 FAIRFIELD DRIVE , SENECA PA 16346 ANESTHESIA SERVICES 560 915.

NORTHWEST-PATHOLOGISTS------------------------ -----------------

100 FAIRFIELD DRIVE, SENECA PA 16346 PATHOLOGY SERVICES 269 000.

VENANGO DIAGNOSTIC IMAGING------------ -----------------

100 FAIRFIELD DRIVE , SENECA PA 16346 RADIOLOGY SERVICES 220 910.

CTI

300 STATE STR. , ERIE PA 16507 EMGS , EEGS , PVDS 185 883.

Total number of others receiving over $50,000 forprofessional services ► 3

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

JSA

3E12102000

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Schedule A (Form 990 or 990-EZ) 2003

10

^ Schedule A (Foam 990 or 990-EZ) 2003 25-0489010 Page 2

Statements About Activities (See page 2 of the instructions. ) Yes No1 During the year, has the organization attempted to influence national , state, or local legislation , including any

attempt to influence public opinion on a legislative matter or referendum? If "Yes," enter the total expenses paid

or incurred in connection with the lobbying activities ► $ ( Must equal amounts on line 38,

Part VI -A, or line I of Part VI-B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 X

Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other

organizations checking "Yes," must complete Part VI-B AND attach a statement giving a detailed description of

the lobbying activities

2 During the year , has the organization , either directly or indirectly , engaged in any of the following acts with any

substantial contributors , trustees , directors , officers, creators , key employees , or members of their families, or

with any taxable organization with which any such person is affiliated as an officer , director , trustee , majority

owner , or principal beneficiary' (If the answer to any question is "Yes," attach a detailed statement explaining

the transactions ) Sec. S.A1mc-n+ (9)a Sale, exchange , or leasing of property? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a X

b Lending of money or other extension of credit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b X

c Furnishing of goods , services, or facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$T)' . 2Q 2c X

d Payment of compensation ( or payment or reimbursement of expenses if more than $ 1,000)' . SEN . R 9.0,, . PART. V . . . . 2d X

e Transfer of any part of its income or assets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e X

3a Do you make grants for scholarships , fellowships , student loans , etc ? ( If "Yes ," attach an explanation of how

you determine that recipients qualify to receive payments ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a X

b Do you have a section 403 ( b) annuity plan for your employees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3b X

4 Did you maintain any separate account for participating donors where donors have the right to provide advice

on the use or distribution of funds 4 X

Reason for Non-Private Foundation Status (See pages 3 through 6 of the instructions.)

The or anization is not a private foundation because it is (Please check only ONE applicable box )

5 A church, convention of churches, or association of churches Section 170(b)(1)(A)(i)

6 A school Section 170(b)(1)(A)(u) (Also complete Part V )

7 X A hospital or a cooperative hospital service organization Section 170(b)(1)(A)(ul)

8 A Federal, state, or local government or governmental unit Section 170(b)(1)(A)(v)

9 A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(iii) Enter the hospital 's name, city,

and state

10 An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(iv)

(Also complete the Support Schedule in Part IV-A )

11 a El An organization that normally receives a substantial part of its support from a governmental unit or from the general public

Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A)

1 1 b F] A community trust Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A )

12 An organization that normally receives ( 1) more than 33 113% of its support from contributions, membership fees, and gross

receipts from activities related to its charitable, etc , functions - subject to certain exceptions, and (2 ) no more than 33 1/3% 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) (Also complete the Support Schedule in Part IV-A )

13 An organization that is not controlled by any disqualified persons ( other than foundation managers ) and supports organizations

described in (1) lines 5 through 12 above , or (2) section 501 (c)(4 ), ( 5), or (6 ), if they meet the test of section 509(a )( 2) (See

section 509(a)(3) )

(a) Name(s) of supported organization(s)I (b) Line number

from above

14 An organization organized and operated to test for public safety Section 509(a)(4) (See page 6 of the instructions )JSA3E1220 2 000 Schedule A (Form 990 or 990-EZ) 2003

TS0352 597Y 07/12/2006 13:34:02 V03-8 11

. Schedule A ( Form 990 or 990-EZ 2003 25-0489010 P e 3

MIRTMSupport Schedule (Complete only if you checked a box on line 10, 11, or 12.) Use cash method of accounting.

Nnte:You may use the worksheet in the instructions forconvertina from the accrual to the cash method of accountina. NOT APPLICABLE

Calendar year (or fiscal year beginning In ) ( a ) 2002 b 2001 c 2000 (d ) 1999 (e ) Total

15 Gifts, grants, and contributions received (Do

not include unusual grants See line 28

16 Membershi p fees received . .

17 Gross receipts from admissions, merchandise

sold or services performed, or furnishing of

facilities in any activity that is related to the

organization's charitable , etc purpose .

18 Gross income from interest, dividends,

amounts received from payments on securities

loans (section 512(a)(5)), rents, royalties, and

unrelated business taxable income (less

section 511 taxes) from businesses acquired

by the org anization after June 30 , 1975

19 Net income from unrelated business

activities not included in line 18 • • • • • • • • •

20 Tax revenues levied for the organization's

benefit and either paid to it or expended on

....................its behalf

21 The value of services or facilities furnished to

the organization by a governmental unit

without charge Do not include the value of

services or facilities generally furnished to the

p ublic without charge ..............

22 Other income Attach a schedule Do not

include gain or (loss) from sale of capital assets

23 Total of lines 15 throu g h 22

..............24 Line 23 minus line 17

...............25 Enter 1 % of line 23

26 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), line 24 1;TQT, A$1?I,1,C"I . . ► 26a

b Prepare a list for your records to show the name of and amount contributed by each person (other than a

governmental unit or publicly supported organization) whose total gifts for 1999 through 2002 exceeded the

amount shown in line 26a Do not file this list with your return . Enter the total of all these excess amounts ► 26b

c Total support for section 509(a)(1) test Enter line 24, column ( e) ► 26c

d Add Amounts from column (e) for lines 18 19

22 26b . . . . . . . . . . . . ' 26d

. . . . . . . . . . . . . . . . . . . . . . . . . . ►e Public support (line 26c minus line 26d total) 26e. . . . . . . . . . . . .

f Public support percentage ( line 26e ( numerator ) divided by line 26c (denominator )) . ► 26f °/a

27 Organizations described on line 12 : a For amounts included in lines 15, 16, and 17 that were received from a "disqualified

person," prepare a list for your records to show the name of, and total amounts received in each year from, each "disqualified person "

Do not file this list with your return . Enter the sum of such amounts for each year

(2002) ---------------- (2001) ----------_-------- (2000) --- NOT APPLICABLE - (1999) --------------

b For any amount included in line 17 that was received from each person (other than "disqualified persons"), prepare a list for your records toshow the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000

(Include in the list organizations described in lines 5 through 11, as well as individuals) Do not file this list with your return . After computingthe difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess

amounts) for each year

(2002) ---------------- (2001) ------------------- (2000) ------------------- (1999)---------------

c Add. Amounts from column (e) for lines 15 16

17 20 21 . . . . . . . • • • • • ► 27c

d Add Line 27a total and line 27b total . . . . . . . . . . . . . ► 27d

e Public support (line 27c total minus line 27d total) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 27e

f Total support for section 509(a)(2) test Enter amount from line 23, column (e) . . . . . . . . . . ► 27f

g Public support percentage ( line 27e ( numerator) divided by line 27f (denominator )) . . . . . . . . . . . . . . . . . . ► 27 %

h Investment Income percenta g e ( line 18 , column ( e ) ( numerator) divided by line 27f ( denominator)) 27h %

28 Unusual Grants : For an organization described in line 10, 11, or 12 that received any unusual grants during 1999 through 2002,prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief

description of the nature of the grant Do not file this list with your return . Do not include these g rants in line 15SSA Schedule A (Form 990 or 990-EZ) 20033E 1221 2 000

TS0352 597Y 07/12/2006 13:34:02 V03-8 12

Schedule A ( Form 990 or 990-EZ) 2003 25-0489010 Page 4

Private School Questionnaire (See page 7 of the instructions.)(To be completed ONLY by schools that checked the box on line 6 in Part IV) NOT APPLICABLE

29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, Yes No

other governing instrument, or in a resolution of its governing body? . . . . . , , , , , , 29

30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its

brochures, catalogues, and other written communications with the public dealing with student admissions,

programs, and scholarships? . . 30.. . . .. .. . ....31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during

the period of solicitation for students, or during the registration period if it has no solicitation program, in a way

that makes the policy known to all parts of the general community it serves? , , , , , , , , , , , , , , , , , 31

If "Yes," please describe, if "No," please explain. (If you need more space, attach a separate statement )

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-----------------------------------------------------------------------------32 Does the organization maintain the following:

a Records indicating the racial composition of the student body, faculty, and administrative staff? 32a

b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory

basis? 32b....................................................c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing

with student admissions, programs, and scholarships? , , , . , , , , , , , 32c

d Copies of all material used by the organization or on its behalf to solicit contributions? . . . . . . . . . . . . . . . . 32d

If you answered "No" to any of the above, please explain. (If you need more space, attach a separate statement )

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-----------------------------------------------------------------------------33 Does the organization discriminate by race in any way with respect to:

a Students' rights or privileges? ,,,,,,,,,, 33a,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,

b Admissions policies? 33b................................. ..................

c , , ,,Employment of faculty or administrative staff? , , , , , , , , , , , , , , , , , 33c, , , , , , , , , , , , , , ,

d Scholarships or other financial assistance? 33d

e Educational policies? 33e

f Use of facilities? 33f................................... ..................

g Athletic programs? 33. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Other extracurricular activities? 33h

If you answered "Yes" to any of the above, please explain. (If you need more space, attach a separate statement.)

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34a Does the organization receive any financial aid or assistance from a governmental agency? , , , , , , , , , , , , ,

b Has the organization's right to such aid ever been revoked or suspended? , , , , , , , , , , , , , , , , , , , , , ,

If you answered "Yes" to either 34a or b, please explain using an attached statement

35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4 05

of Rev Proc 75-50, 1975-2 C.B. 587, covering racial nondiscrimination? If "No," attach an explanation 35JSA3E1230 2 000 Schedule A (Form 990 or 990 EZ) 2003

TS0352 597Y 07/12/2006 13:34:02 V03-8 13

Schedule A Form 990 or 990-EZ ) 2003 25 -04 89010 Page 5

Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions.)

(To be completed ONLY by an eligible organization that filed Form 5768) NOT APPLICABLE(:herb ► if the nrnnni7ntinn halnnne to nn nff Bator nrrnin rhprk ► h if vnu checked "a" and "limited control" orovisions aooly_

(a) (b)Limits on Lobbying Expenditures Affiliated group To be completed

totals for ALL electing(The term "expenditures" means amounts paid or incurred.) organizations

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36

37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37

38 Total lobbying expenditures (add lines 36 and 37) 38, , , , , , , , , , , , , , , ,

. . . . . .. . . . . . . . .39 Other exempt purpose expenditures 39. . . . . . . . .

40 Total exempt purpose expenditures (add lines 38 and 39) 40

41 Lobbying nontaxable amount. Enter the amount from the following table -

If the amount on line 40 is - The lobbying nontaxable amount is -

Not over $500,000 . . . . . . . . . . . . 20% of the amount on line 40 . . . . . . . . .

Over $500,000 but not over $1,000,000 • . $100,000 plus 15% of the excess over $500,000

$175,000 plus 10% of the excess over $1,000,000Over $1,000,000 but not over $1,500,000 41, ,

Over $1,500,000 but not over $17,000,000. . $225,000 plus 5% of the excess over $1,500,000

Over $17,000,000 , , , , , , , , , , , , $1,000,000 , , , , , , , , , , , , , , , ,

42 Grassroots nontaxable amount (enter 25% of line 41) 42• • • • • • . .

43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36 43

44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 44

Caution : If there is an amount on either line 43 or line 44, you must file Form 4720

4-Year Averaging Period Under Section 501(h)(Some organizations that made a section 501(h) election do not have to complete all of the five columns below

See the instructions for lines 45 through 50 on page 11 of the instructions.)

Lobbying Expenditures During 4-Year Averaging Period

Calendar year (or fiscal (a) (b) (c) (d) (e)

year beginning in ) ► 2003 2002 2001 2000 Total

Lobbying nontaxable

45 amount

Lobbying ceiling amount

46 ( 150% of line 45 ( e))

47 Total lobb yi n g expenditures

Grassroots nontaxable

48 amount ••••••••

Grassroots ceiling amount

49 ( 150% of line 48 (e ))

Grassroots lobbying

50 expenditures . .

Lobbying Activity by Nonelecting Public Charities

( For re p ortin g onl y by org anizations that did not complete Part VI-A (See a e 12 of the instructions.

During the year, did the organization attempt to influence national, state or local legislation, including anyYes No Amount

attempt to influence public opinion on a legislative matter or referendum, through the use of

a Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..JL A

b Paid staff or management (Include compensation in expenses reported on lines c through h) . . N A

c Media advertisements N A

d Mailings to members, legislators, or the public, , , , , , , , , , , , , , , , , , , , , , , , , , , , , N A

e Publications, or published or broadcast statements , , , , , , , , , , , , , , , , , , , , , , , , , , N A

f Grants to other organizations for lobbying purposes , , , , , , , , , , , , , , , , • . . . . . . . N A

g Direct contact with legislators, their staffs, government officials, or a legislative body • , , , , , , , N A

h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means , , , , , , NAA

i Total lobbying expenditures (Add lines c through h ) . . . . . . . . . . . . . . . . . . . . . . . . . .

If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities.JSA Schedule A (Form 990 or 990 -EZ) 20033E1240 2 000

TS0352 597Y 07/12/2006 13:34:02 V03-8 14

Schedule A ( Form 990 or 990-EZ ) 2003 25-0489010 Page 6' Information Regarding Transfers To and Transactions and Relationships With NoncharitableExempt Organizations (See page 12 of the instructions.)

51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations

a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No

(i) Cash .......................................................(ii) Other assets .............................. .............. . a(ii) X

b Other transactions:

(i) Sales or exchanges of assets with a nonchantable exempt organization . . . . . . .

b(ii) X(ii) Purchases of assets from a noncharitable exempt organization , , , , , , , , , , , , , , , , , , , , , , ,

(iii) Rental of facilities, equipment, or other assets , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,(iv) Reimbursement arrangements,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

(v) Loans or loan guarantees , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

(vi) Performance of services or membership or fundraising solicitations , , , , , , , , , , , , , , , , , , , , ,

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees , , , , , , , , , , , , , , , , , , ,

d If the answer to any of the above is "Yes," complete the following schedule Column (b) should always show the fair market value of the

goods, other assets, or services given by the reporting organization If the organization received less than fair market value in any

transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received

(a) (b) (c) (d)Line no Amount involved Name of nonchantable exempt organization Description of transfers, transactions, and sharing arrangements

A

52a Is the organization directly or indirectly affiliated with , or related to , one or more tax-exempt organizations

described in section 501 ( c) of the Code (other than section 501 (c)(3)) or in section 527? , , . , , , , , , , ►0 Yes q No

TS0352 597Y 07/12/2006 13:34:02 V03-8 15

JSASchedule A (Form 990 or 990-EZ) 2003

3E1250 2 000

UPMC NORTHWEST

FORM 990, PART I - LIST OF CONTRIBUTORS

NAME AND ADDRESS DATE

---------------- ----

TOTAL CONTRIBUTIONS < $ 5,000 EACH

08/15/2003

09/25/2003

VARIOUS

TOTAL CONTRIBUTION AMOUNTS

25-0489010

DIRECT

PUBLIC

SUPPORT

51,499.

---------------51,499.

------------------------------

GOVERNMENT

GRANTS

19,243.

6,000.

---------------25,243.

------------------------------

TS0352 597Y 07/12/2006 13:34:02 V03-8 19 STATEMENT 1

UPMC NORTHWESTEIN: 25-0489010FEDERAL FORM 990FOR TAX YEAR ENDED 6/30/04

PART I, PAGE 1, LINE 8 - GAIN ON SALE OF ASSETS OTHER THAN INVENTORY - SECURITIES

GROSS PROCEEDSCOST BASIS

21,012,34018,957,292

NET GAIN ON SALE OF SECURITIES 2,055,048

STATEMENT 1A

UPMC NorthwestSummary of Gain/Loss on Sale of Equip Account

Account #05960-17150FY 6/30/2004

Original NBV @Acquisition Disposal Gross sales Cost Accum Write-down or Gain/loss

Asset # Date Date Price Basis Depr Disposition on disposal

Write-off of West Unit.Grdvw-downpayment 1 12/31/83 06/30/04 $786,000 00 $531,053.84 $254,946.16Grdvw-West unit bldg 3 12/31/83 06/30/04 $2,343,242.20 $2,115,905 38 $227,336 82Grdvw-cip phase I 4 12/31/83 06/30/04 $649,259.80 $586,081 83 $63,177 97Grdvw-cip phase II 5 12/31/84 06/30/04 $63,657.90 $56,924.91 $6,732 99Grdvw-cip phase II 6 12/31/84 06/30/04 $645,105 90 $576,873.54 $68,232 36Grdvw-cip phase I art 7 12/31/84 06/30/04 $5,220.10 $4,667.97 $552.13Grdvw-cip phase I 9 12/31/84 06/30/04 $41,265 80 $36,901.20 $4,364 60Grdvw-construction 10 12/31/85 06/30/04 $342,389 40 $303,277.99 $39,111.41Grdvw-construction 11 12/31/85 06/30/04 $245,645 40 $217,585.64 $28,059 76Grdvw-west unit 12 12/31/86 06/30/04 $34,839.60 $30,565.09 $4,274.51Grdvw-linear accelerator changes 13 12/31/86 06/30/04 $68,039 40 $65,771.42 $2,267.98Bldg-intenor finishes 110 06/30/92 06/30/04 $30,712.65 $25,593.91 $5,118.74Bldg-donated window 112 06/30/92 06/30/04 $8,415.00 $7,013.00 $1,402.00Bldg-roofing, ext canopy, drywall 119 08/19/93 06/30/04 $159,857.26 $149,200.06 $10,657.20Bldg-masonry, steel, floors 120 08/19/93 06/30/04 $215,019 85 $209,644.33 $5,375 52Bldg-gutter replacement 192 06/19/98 06/30/04 $17,889.00 $11,62785 $6,261.15Bldg-roof replacement-partial 193 06/30/98 06/30/04 $23,800.00 $15,470.00 $8,330.00Bldg-interior finishes-dr gardner 194 06/30/98 06/30/04 $27,735.00 $25,886.04 $1,848.96Bldg-ceiling,drywall-dr gardner 195 06/30/98 06/30/04 $15,056.00 $13,550.36 $1,505.64Bldg-roof repl over dr peracha 220 08/03101 06/30/04 $20,575.00 $18,517 48 $2,057.52Bldg-roof replacement over xray 221 08/03/01 06/30/04 $9,330.00 $2,367.84 $6,962.16Fixed-installation 480v 3- 141 12/31186 06/30/04 $1,106.40 $968.10 $138.30Fixed-installation of w 151 04/30/87 06/30/04 $1,360.00 $1,190.22 $169.78Fixed-installation of 3 sp 156 09/30/87 06/30/04 $1,190.00 $785.61 $404.39Fixed-construction and install 162 01/31/88 06/30/04 $2,480.00 $2,046.00 $434.00Fixed-bathroom project for w 232 04/30/90 06/30/04 $919.93 $666.99 $252.94Fixed-cabinetry, insulation, etc 273 06/30/92 06/30/04 $48,604.64 $40,503.87 $8,100.77Fixed-hvac 274 06/30/92 06/30/04 $6,996.85 $5,144.75 $1,852.10Fixed-plumbing,wall units,etc 275 06/30/92 06/30/04 $44,790 48 $27,994.02 $16,796.46Fixed-carpentry work-lin accel 304 08/19/93 06/30/04 $30,787.19 $28,734.71 $2,052 48Fixed-hvac 305 08/19/93 06/30/04 $149,769.89 $140,959.97 $8,809 92Fixed-plumbing,electncal, cabinetry 306 08119/93 06/30/04 $232,616.49 $220,985.61 $11,630.88Fixed-fire protection 307 08/19/93 06/30/04 $35,883.06 $34,447.74 $1,435 32Fixed-patient call system upgrade 527 12/24/02 06/30/04 $1,490.00 $223.50 $1,266.50Fixed-cctv system 528 12/24/02 06/30/04 $7,617.00 $1,142.55 $6,474 45L.I -sidewalk 79 06/30/92 06/30/04 $2,859.70 $2,383.15 $476.55L.I.-extenor signs 84 06/30/93 06/30/04 $1,264.37 $1,211.73 $52.64 ($808,923.06)

Sale of Webb property:Land 03/08/01 06/30/04 $46,248.60 $67,151.48 $67,151.48 ($20,902.88)

Other.NPB 7200 ventilator 2939 07/25/97 $22,706.21 $13,623.72 $9,082 49 ($9,082 49)

2619 03/24/95 $889.95 $510.48 $37947 ($379.47)

$46,248.60 $6,413,538.90 $5,528,002 40 $885,536.50 ($839,287 90)

no gain or loss Various Various Various $184,232.01 $184,232.01 $0.00 $0.00

Sale of old Fkln equip to employees $1500 $0 00 $15 00

$46,263 60 $6,597,770.91 $5,712,234 41 $885,536.50 ($839,272 90)

S1AiZ IN, JEVT 19

UPMC NORTHWEST 25-0489010

FORM 990, PART I - OTHER INCREASES IN FUND BALANCES ILine- 70 ,

DESCRIPTION AMOUNT

----------- ------

UNREALIZED GAIN ON INVESTMENTS (FAS124) 808,637.

CAPITAL CONTRIBUTIONS FROM PARENT(CONST) 25,648,064.

FOUNDATION/AUX. DONATIONS FOR CAPITAL 1,649.

NET SPECIAL PURPOSE FUND ACTIVITY 300.

MINIMUM PENSION LIABILITY ADJ (FAS 132) 4,166,140.

CHANGE IN BENEF. INTEREST IN FOUNDATION 1,215,984.

TOTAL 31,840,774.

STATEMENT 2

TS0352 597Y 07/12/2006 13:34:02 V03-8 20

• UPMC NORTHWESTEIN. 25-0489010FEDERAL FORM 990FOR TAX YEAR ENDED 6/30/04

PART II, PAGE 2, LINE 42 - DEPRECIATION EXPENSE (STRAIGHT LINE BASIS)

PROGRAM MANAGEMENTTOTAL SERVICES & GENERAL

BUILDINGS 1,077,009 1,077,009 0

EQUIPMENT 2,315,450 2,315,450 0

TOTAL 3,392 ,459 3 ,392,459 0

STATEMENT 2A

UPMC NORTHWEST

FORM 990, PART II - OTHER EXPENSES£LLiI3)

--------------------------------------------------------------------

DESCRIPTION

PURCHASED SERVICES

MEDICAL SPEC/PHYS. SALARIES

BAD DEBTS NET OF RECOVERIES

COMPUTER SERVICES

DRUGS

PURCHASED LAB SERVICES

BLOOD BANK CHARGES

FILM

INSURANCE

MISC. OTHER EXPENSES

ENTERPRISE SHARED SERVICES

CMI EXPENSE

TOTALS

25-0489010

PROGRAM MANAGEMENTTOTAL

-----

SERVICES

--------

AND GENERAL

-----------

2,773,154 . 2,230,167. 542,987.2,406,513. 2 , 406,513.2,622,246. 2 , 622,246.

730,906. 730,906.3,343,251. 3 , 343,251.

637,508 . 637,508.702,164 . 702,164.218,459. 218,459.973,375. 973,375.671,080. 671,080.

1,232,004 . 1,232,004.1,341,171.-

1,341,171.---------17651831 .

--------------------

----------15145934 .

--------------------

----------2,505,897.--------------------

TS0352 597Y 07/12/2006 13:34:02 V03-8 21 STATEMENT 3


FORM 990, PART III - STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS----------------------------------------------------------------------------------------------------------------------------------

DESCRIPTION

UPMC NORTHWEST PROVIDES HIGH QUALITY, INTEGRATED, COST

EFFECTIVE CARE TO THE COMMUNITY REGARDLESS OF ABILITY TO PAY

AS EVIDENCED BY THE $3,086,000 OF FREE CARE PROVIDED. IT

PROVIDES ACUTE INPATIENT, OUTPATIENT, SUPPORT & EDUCATIONSERVICES. FOR FISCAL YEAR ENDED JUNE 30, 2004 NORTHWEST HAD34673 PATIENT DAYS, 31,219 E.R.VISITS, AND 5,018 SURGERIES.

THE REHABILITATION CENTER OF UPMC NORTHWEST OFFERS

CARE TO PEOPLE WHO HAVE SUFFERED STROKES, SERVERE ARTHRITIS,

VICTIMS OF SERIOUS FALL INJURIES, AUTO ACCIDENTS, OR SEVERE

ORTOPEDIC PROBLEMS. THE GOAL OF THE REHAB.CENTER IS TO LEADPEOPLE TO THE HIGHEST LEVEL OF INDEPENDENCE POSSIBLE. THEREHAB.UNIT CURRENTLY HAS 16 LICENSED BEDS.

THE PSYCHIATRIC CENTER OF UPMC NORTHWEST OFFERS

ADULT INPATIENT PSYCHIATRIC CARE TO THE PEOPLE OF THEREGION. THE PSYCHIATRIC UNIT IS CURRENTLY LICENSED FOR 15

BEDS.

THE TRANSITIONAL CARE UNIT PROVIDES INPATIENT CARE TO

PATIENTS WHOSE EPISODES OF ILLNESS HAVE PASSED THE ACUTE

CARE PHASE BUT ARE NOT WELL ENOUGH TO BE DISCHARGED. THETRANSITIONAL CARE UNIT IS CURRENTLY LICENSED FOR 16 BEDS.

TOTAL

EXPENSES

53,752,896.

928,966.

1,664,269.

1,711,890.

--------------58,058,021.

----------------------------

TS0352 597Y 07/12/2006 13:34:02 V03-8 22 STATEMENT 4

UPMC NORTHWESTEIN: 25-0489010FISCAL YEAR ENDING JUNE 30, 2004

Form 990, Part III - Statement of Program Service Accomplishments

UPMC Northwest (the Hospital), established in 1899, serves the residents of the Franklin and

Oil City, PA area and surrounding communities . Merging with UPMC in 2001, UPMC

Northwest is a state-of-the-art medical facility providing services in:

• General medical care

• Behavioral health services

• Medical/surgical intensive care

UPMC Northwest also provides acute inpatient , outpatient, behavioral health, rehabilitation,

skilled nursing, and support and education services . The Hospital provides services to all that

present themselves regardless of ability to pay.

Greater than 63% of patients received Medicare or state medical assistance.

During the fiscal year ended June 30, 2004 , UPMC Northwest admitted 7 , 799 patients,

recorded 34,673 inpatient days, had 31 , 219 emergency room visits, performed 5,018 surgeries,

and provided free or uncompensated care as follows:

Measurement of foregone charges:Free Care $3,086,000

The Hospital also provided services to the community in the aggregate of $523,358 throughoutreach programs targeted at patients, patient families and the community, some of which are

enumerated below.

The Hello Hospital Program provided to local kindergarten students in their classrooms, anintroduction of the hospital, including a program and a hands-on review of stethoscopes, bloodpressure cuffs, and miscellaneous equipment.

UPMC Northwest has an extensive diabetes initiative. In addition to management classes thatuse interactive group activities, films, lectures, handouts, and other visual aids to teach thegeneral facts of diabetes, stress management, social support, nutrition, and exercise, etc., theHospital has support groups to assist patients. UPMC Northwest also provides primary carephysicians office staffs with statistics, manuals, referral agencies, and information on self-management classes and support groups.

UPMC Northwest physicians, along with hospital staff, provided the Youth Football Leaguewith physicals, blood pressure screenings, and other help as needed.

"Stethoscope" was a local public access TV show presenting a Bioterrorism update. It detailed

Federal, State, UPMC, and UPMC Northwest preparedness efforts, and provided a narrative on

the challenges that a Bioterrorism event would cause.

STATEMENT 4A

The suicide prevention initiative provided a community educator to meet with volunteers whoanswer the Victims Resource Hotline. The volunteers were instructed how to handle callswhere the caller is threatening suicide.

Drugs, Sex, `Rents, and Raves were evenings of information about local drug problems andother adolescent issues to educate parents and the general public. The Hospital displayprovided information about signs of alcohol or drug use, safety concerns, and the importanceof good communication between parents and teenaged children.

UPMC Northwest's Safe Sitter program provided youth aged 11-13 with instruction in skillsrequired to begin babysitting.

The Hospital's volunteer services coordinated a toy drive for needy children in the area. Itemscollected were donated to the Franklin Salvation Army for distribution.

The Canned Food Drive was a joint effort of UPMC Northwest, Sugar Creek Station, and theVisiting Nurses Association. Items collected were forwarded to the Community Services ofVenango County for distribution. Over 2,500 items were collected.

The Hospital expresses its significant commitment to the surrounding community throughnumerous free screenings and services. Some of the free screenings include blood pressure,diabetes, stroke, cholesterol, body fat checks, osteoporosis, skin cancer, and prostate providedby The Hospital at various fairs and community events. UPMC Northwest also provides alocation for community blood drives, as well as meals for workers, and volunteers to assist.

UPMC Northwest has made monetary donations to help sponsor organizations and eventsthroughout the Franklin and Oil City areas and outlying communities. Some of theseorganizations and events were the Venango County 4-H Club, Rails to Trails Conservancy,Oil City Chamber of Commerce, Stat Medevac, Rocky Grove Volunteer Fire Department,Special Olympics, American Heart Association, March of Dimes, Franklin Light Up Night,and the American Cancer Society Relay for Life.

STATEMENT 4A


FORM 990, PART IV - OTHER NOTES AND LOANS RECEIVABLE^C..1) 5hne.

BORROWER: DAVID BROOKER, M.D.

ORIGINAL AMOUNT: 100,000.

INTEREST RATE: 9.500000

DATE OF NOTE: 09/09/1998

MATURITY DATE: 09/01/2005

REPAYMENT TERMS: $1,634.40 MONTHLY PAYMENT

SECURITY PROVIDED: ANY OF HIS PROPERTY

PURPOSE OF LOAN: ACQUIRE MEDICAL PRACTICE

BEGINNING BALANCE DUE ..................................... 39,591.

ENDING BALANCE DUE ........................................ 23,030.

---------------

BORROWER: VANTAGE-LINEN

ORIGINAL AMOUNT:

INTEREST RATE:

DATE OF NOTE:

MATURITY DATE:

REPAYMENT TERMS:

PURPOSE OF LOAN:

80,500.8.00000001/20/1996

01/20/2003

$2,522.58 MONTHLY PAYMENT

WORKING CAPITAL



---------------

BORROWER: VISITING NURSES ASSOC. OF VENANGO COUNTY


INTEREST RATE: 6.750000

DATE OF NOTE: 07/01/2001MATURITY DATE: 07/01/2006

REPAYMENT TERMS: $531.45 MONTHLY PAYMENT

PURPOSE OF LOAN: OFFICE RENOVATIONS



---------------

STATEMENT 5

TS0352 597Y 07/12/2006 13:34:02 V03-8 23


BORROWER: P. DEAN CUMMINGS, M.D.

ORIGINAL AMOUNT:

INTEREST RATE:DATE OF NOTE:MATURITY DATE:REPAYMENT TERMS:PURPOSE OF LOAN:

150,000.9.75000007/01/1999

08/01/2004

$1,250 MONTHLY PAYMENTS

WORKING CAPITAL


BORROWER: PAMELA CRAWFORD


INTEREST RATE: 9.000000DATE OF NOTE: 04/01/1998

MATURITY DATE: 01/01/2001

REPAYMENT TERMS: $852.19 MONTHLY PAYMENT

SECURITY PROVIDED: SEPARATE AGREEMENT

PURPOSE OF LOAN: PURCHASE EQUIPMENT


TOTAL BEGINNING OTHER NOTES AND LOANS RECEIVABLE 191,549.------------------------------

TOTAL ENDING OTHER NOTES AND LOANS RECEIVABLES 109,432.------------------------------

STATEMENT 6

TS0352 597Y 07/12/ 2006 13:34 : 02 V03-8 24


FORM 990, PART IV - INVESTMENTS - SECURITIES (Line_ 50--------------------------------------------

ENDING

DESCRIPTION BOOK VALUE

----------- ----------

BOARD DESIGNATED FUNDS:

FIXED INCOME:

CORPORATE 226,682.

US GOVERNMENT 898,029.MORTGAGES 454,806.ASSET-BACKED 13,397.

CASH EQUIVILENTS 814,015.

INTERNATIONAL 20,643.

OTHER 186,900.EQUITIES 5,630,608.

LIMITED PARTNERSHIPS 1,267,038.

OTHER UNRESTRICTED INVESTMENTS

FIXED:

CORPORATE 699,981.

US GOVERNMENT 2,773,058.

MORTGAGES 1,404,411.

ASSET-BACKED 41,370.

CASH EQUIVALENTS 2,060,633.

INTERNATIONAL 63,744.

OTHER 79,218.

EQUITIES 16,419,977.

LIMITED PARTNERSHIPS 3,583,586.

TOTALS 36, 638,096.

STATEMENT 7

TS0352 597Y 07/12/ 2006 13:34 : 02 V03-8 25

UPMC NORTHWEST

-FORM 990, PART IV - INVESTMENTS - OTHER

DESCRIPTION

INVESTMENT VANTAGE HOLDING CO.

BENEFICIAL INTEREST

IN FOUNDATION

TOTALS

^Linc. 56)

25-0489010

ENDING

BOOK VALUE

249,717.16, 153, 111.

---------------

16,402,828.------------------------------

STATEMENT 8

TS0352 597Y 07/12/2006 13:34:02 V03-8 26

UPMC NORTHWESTEIN: 25-0489010FEDERAL FORM 990FOR TAX YEAR ENDED 6/30/04

PART IV, LINE 57a-57b, Land, Buildings, and Equipment

Land and Land Improvements

Buildings

Equipment

Construction in Progress

TOTAL

NETACCUM. BOOK

COST DEPR. VALUE

2,253,400 1,137,935 1,115,465

31,541,334 29,659,112 1,882,222

47,768,756 39,639,292 8,129,464

51,578,832 - 51,578,832

133,142,322 70 ,436,339 62 , 705,983

Depreciation is computed using the straight-line method over the estimated useful lives of the assets.

STATEMENT 8A


•. FORM 990, PART IV - OTHER ASSETS (L ine_ 58)

ENDING

DESCRIPTION BOOK VALUE----------- ----------

ASSETS HELD IN TRUST BY OTHERS 196,918.

DUE FR. FOUNDATION FOR CAPITAL 1,500,000.

INVESTMENT IN HC PHARMACY 148,514.

---------------

TOTALS 1,845,432.------------------------------

STATEMENT 9

TS0352 597Y 07/12/2006 13:34:02 V03-8 27


• FORM 990, PART IV - MORTGAGES AND OTHER NOTES PAYABLE inc- 6q b)

LENDER: COMDOC

ORIGINAL AMOUNT:

INTEREST RATE:

DATE OF NOTE:

MATURITY DATE:

REPAYMENT TERMS:

SECURITY PROVIDED:

PURPOSE OF LOAN:

257,590.11.24000002/28/1999

02/29/2004

$5,452.63 MONTHLY PAYMENT

COPIERS/FAX MACHINES

COPIERS/FAX MACHINES


LENDER: COMDOC

ORIGINAL AMOUNT:

INTEREST RATE:

DATE OF NOTE:

MATURITY DATE:

REPAYMENT TERMS:

SECURITY PROVIDED:

PURPOSE OF LOAN:

18,279.0.54000010/31/2001

10/31/2004

$512 MONTHLY PAYMENTS

COLOR COPIER

COLOR COPIER



---------------

LENDER: CITIBANK

ORIGINAL AMOUNT:

INTEREST RATE:

DATE OF NOTE:

MATURITY DATE:

REPAYMENT TERMS:

SECURITY PROVIDED:

PURPOSE OF LOAN:

2,097,585.8.33000010/04/199912/01/2004

$37,813. 63 MONTHLY PAYMENTS

PHILLIPS MRI SCANNER

CAPITAL LEASE



---------------

STATEMENT 10

TS0352 597Y 07/12/2006 13:34:02 V03-8 28

UPMC NORTHWEST

LENDER: GE ANGIOGRAPHY EQUIPMENT

ORIGINAL AMOUNT:

INTEREST RATE:

DATE OF NOTE:

MATURITY DATE:

REPAYMENT TERMS:

SECURITY PROVIDED:

PURPOSE OF LOAN:

783,808.5.40000011/17/2001

11/17/2006

$13,063.43 MONTHLY PAYMENTS

GE ANGIO SUITE

GE ANGIO SUITE

25-0489010



---------------

TOTAL BEGINNING MORTGAGES AND OTHER NOTES PAYABLE 1,483,160.------------------------------

TOTAL ENDING MORTGAGES AND OTHER NOTES PAYABLE 906,671.------------------------------

STATEMENT 11

TS0352 597Y 07/12/2006 13:34:02 V03-8 29

UPMC NORTHWEST

FORM 990, PART IV - OTHER LIABILITIES

DESCRIPTION

ACCRUED POSTRETIREMENT BENEFIT

THIRD PARTY RATE ADJUSTMENT

DUE TO EXEMPT AFFILIATE

TOTALS

(Jne, 65.

25-0489010

ENDING

BOOK VALUE

4,164,765.909,629.

2,939,143.

---------------8,013,537.

------------------------------

STATEMENT 12

TS0352 597Y 07/12/2006 13:34:02 V03-8 30


FORM 990, PART V - LIST OF OFFICERS,

------------------------------------

DIRECTORS, AND TRUSTEES

------------------------

CONTRIBUTIONS EXPENSE ACCTTITLE AND TIME TO EMPLOYEE AND OTHER

NAME AND ADDRESS DEVOTED TO POSITION COMPENSATION BENEFIT PLANS ALLOWANCES---------------- ------------------- ------------ ------------- ----------

WILLIAM E. LUCIA CFO 135,938. 21,389. NONE100 FAIRFIELD AVENUE 40 HRS/WK

SENECA, PA 16346

NEIL TODHUNTER CEO 294,465. 31,513. NONE100 FAIRFIELD AVENUE 40 HRS/WK

SENECA, PA 16346

EDWARD B. COWART BOARD MEMBER NONE NONE NONE100 FAIRFIELD AVENUE <1 HR/WK

SENECA, PA 16346

JAMES L. DAUGHERTY BOARD MEMBER NONE NONE NONE100 FAIRFIELD AVENUE <1 HR/WK

SENECA, PA 16346

HENRY W. GENT, III, ESQUIRE BOARD MEMBER NONE NONE NONE100 FAIRFIELD AVENUE <1 HR/WK

SENECA, PA 16346

JAMES E. KNARR, D.M.D. BOARD MEMBER NONE NONE NONE

100 FAIRFIELD AVENUE <1 HR/WK

SENECA, PA 16346

PAULA LOGUE-PHENICIE BOARD MEMBER NONE NONE NONE

100 FAIRFIELD AVENUE <1 HR/WK

SENECA, PA 16346

SANFORD POWELL BOARD MEMBER NONE NONE NONE100 FAIRFIELD AVENUE <1 HR/WK

SENECA, PA 16346

TS0352 597Y 07/12/2006 13:34:02 V03-8 31 STATEMENT 13


FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES------------------------------------------------------------------------------------------------------------------------

NAME AND ADDRESS

DANIEL PAULO, DVM

100 FAIRFIELD AVENUE

SENECA, PA 16346

RICHARD O. WAY


SENECA, PA 16346

WILLIAM H. CLARK


SENECA, PA 16346

ROBERT MILLER


SENECA, PA 16346

DEAN ECKENRODE

PRESIDENT & CEO UPMC HORIZON

2200 MEMORIAL DRIVE

FARRELL, PA 16121

JAMES MCLAUGHLIN, D.O.


SENECA, PA 16346

JOHN O. CONNOR, M.D.


SENECA, PA 16346

KEITH PEMRICK


CONTRIBUTIONS EXPENSE ACCT

TITLE AND TIME TO EMPLOYEE AND OTHERDEVOTED TO POSITION

-------------------

COMPENSATION

------------

BENEFIT PLANS

-------------

ALLOWANCES

----------

BOARD MEMBER NONE NONE NONE

<1 HR/WK


<1 HR/WK

BOARD MEMBER NONE NONE NONE<1 HR/WK

BOARD MEMBER NONE NONE NONE<1 HR/WK


<1 HR/WK


<1 HR/WK


<1 HR/WK


<1 HR/WK

TS0352 597Y 07/12/2006 13:34:02 V03-8 32 STATEMENT 14

UPMC NORTHWEST

FORM 990, PART V - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

NAME AND ADDRESS

----------------SENECA, PA 16346

WILLIAM SCHAFFNER

ASSOC. COUNCIL UPMC HEALTH SYSTEM200 LOTHROP STREET

PITTSBURGH, PA 15213

GAIL WELCH


SENECA, PA 16346

W. ROGER MCCAULEY100 FAIRFIELD AVENUE

SENECA, PA 16346

TITLE AND TIMEDEVOTED TO POSITION

-------------------

BOARDMEMBER

<1 HR/WK

BOARD MEMBER<1 HR/WK

SR VP FINANCE& ADMIN40 HRS/WK

GRAND TOTALS

25-0489010

COMPENSATION------------

NONE

NONE

:9136,069.

NONE

NONE

12,684.

EXPENSE ACCTAND OTHERALLOWANCES

NONE

NONE

NONE

566,472 65,586 )K NONE

* FOOTNOTE : COMPENSATION IS IN RELATION TO ROLE IN HOSPITAL MANAGEMENT AND OPERATIONS ACTIVITY.NO COMPENSATION IS PAID FOR INDIVIDUALS' ROLES AS BOARD MEMBERS.

** A PORTION OF THE BENEFITS DISCLOSED RELATE TO EARNED BUT UNPAID DEFERRED COMPENSATION.

CONTRIBUTIONS

TO EMPLOYEEBENEFIT PLANS-------------

TS0352 597Y 07/12/2006 13:34:02 V03-8 33 STATEMENT 15


FORM 990, PART V - COMPENSATION PROVIDED BY RELATED ORGANIZATION

NAME AND ADDRESS----------------

UPMC NORTHWEST FOUNDATION

25-1483624

W. ROGER MCCAULEY


SENECA, PA 16346

COMPENSATION------------

32,445.

CONTRIBUTIONS

TO EMPLOYEE

BENEFIT PLANS-------------

EXPENSE ACCT

AND OTHER

ALLOWANCES

GRAND TOTALS

9,620. NONE

-------------- -------------- --------------

32,445. 9,620. NONE-------------- -------------- ---------------------------- -------------- --------------

TS0352 597Y 07/12/2006 13:34:02 V03-8 34 STATEMENT 16


,FORM 990, PART VI - NAMES OF RELATED ORGANIZATIONS ^Ljne 800

UPMC HEALTH SYSTEM EXEMPT

VISITING NURSES ASSOCIATION OF VENANGO COUNTY EXEMPT

SUGARCREEK STATION EXEMPT

STATEMENT 17

TS0352 597Y 07/12/2006 13:34:02 V03-8 35


FORM 990, PART VIII - ACCOMPLISHMENT OF EXEMPT PURPOSES--------------------------------------------------------------------------------------------------------------

EXPLANATION OF HOW EACH ACTIVITY FOR WHICH INCOMELINE IS REPORTED IN COLUMN (E) OF PART VII CONTRIBUTED

NO. IMPORTANTLY TO THE ACCOMPLISHMENT OF EXEMPT PURPOSES

--- ----------------------------------------------------

93A PROVISION OF INTEGRATED HIGH QUALITY INPATIENT ANDOUTPATIENT SERVICES TO RESIDENTS OF THE SURROUNDING

COMMUNITY REGARDLESS OF ABILITY TO PAY.93B REVENUE FROM OTHER PATIENT SERVICES INCLUDING CAFETERIA,

MEDICAL RECORD REVENUE, AND OTHER MISCELLANEOUS SERVICESPROVIDED FOR THE CONVENIENCE OF PATIENTS AND EMPLOYEES.

93C THE HOSPITAL RENTS FACILITIES TO AN AFFILIATED EXEMPT

ORGANIZATION AND AFFILIATED PHYSICIANS IN ORDER TO ACHIEVEGREATER OPERATIONAL EFFICIENCIES AND MORE THOROUGHLY MEETTHE GOALS OF SERVING ITS PATIENTS.

STATEMENT 18

TS0352 597Y 07/12/2006 13:34:02 V03-8 36

UPMC NORTHWEST

FORM 990, PART IX - INFORMATION REGARDING TAXABLE SUBSIDIARIES----------------------------------------------------------------------------------------------------------------------------

PERCENTAGE NATURE OFNAME AND ADDRESS OWNERSHIP BUSINESSEMPLOYER IDENTIFICATION NUMBER INTEREST ACTIVITIES

------------------------------ -------- ----------

FRANKLIN JOINT VENTURE, INC. 50.000000 MEDICAL SRVCS

ONE SPRUCE STREET

FRANLKIN, PA 16323

25-1483501

TOTAL INCOME

TS0352 597Y 07/12/2006 13:34:02 V03-8

25-0489010

TOTAL ENDINGINCOME ASSETS------ ------

11. NONE

------------ ------------11. NONE

------------ ------------------------ ------------

37 STATEMENT 19


SCHEDULE A, PART III - EXPLANATION FOR LINE 2C

MEMBERS OF THE BOARD PROVIDED SERVICES TO THE ORGANIZATION. HENRY GENT

PROVIDED LEGAL COUNSEL AND JAMES DAUGHERTY PROVIDED REAL ESTATE ANALYSYS.

ALL TRANSACTIONS OCCURRED ON AN ARM'S LENGTH BASIS.

STATEMENT 20

TS0352 597Y 07/12/2006 13:34:02 V03-8 38

i

UPMC NORTHWEST

EIN: 25-0489010

FEDERAL FORM 990

FOR TAX YEAR ENDED 6/30/2004

Schedule A. Part III - Statements About Activities - Question # 2

All transactions and activities between the entity, UPMC Northwest, and any of its

trustees, directors, officers, creators, key employees, or members of their families, or with taxableorganizations or their associates' businesses are entered into as arm's length transactions and at arm'slength's rates. Any payments made by UPMC Northwest were for goods and/or services rendered.All payments were made to business entities; no payments were made directly to individual taxpayers.

STATEMENT 21

' Form 8868 Application for Extension of Time To File an(December2000) Exempt Organization Return OMB No 1545-1709

Department of the Treasury

Internal Revenue Seance ► File a separate application for each return

• If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box .................... ►• If you are filing for an Additional ( not automatic) 3-Month Extension , complete only Part II (on page 2 of this form).

Note : Do not complete Part 11 unless you have already been granted an automatic 3-month extension on a previously filedForm 8868.

Part I Automatic 3-Month Extension of Time - Only submit original (no copies needed)Note : Form 990- T corporations requesting an automatic 6-month extension - check this box and complete Part I only .... ► q

All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns.Partnerships, REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041.

Type or Name of Exempt Organization Employer identification number

print UPMC NORTHWEST 25-0489010

File by thedue date forfiling yourreturn Seeinstructions

Number, street, and room or suite no If a P 0 box, see instructions.

200 LOTHROP STREET C/O CORPORATE TAXATIONCity, town or post office, state, and ZIP code For a foreign address, see instructions

PITTSBURGH, PA 15213

Check type of return to be filed (file a separate application for each return):

Form 990 q Form 990-T (corporation) q Form 4720

q Form 990-BL q Form 990-T (sec. 401(a) or 408(a) trust) q Form 5227

q Form 990-EZ q Form 990-T (trust other than above) q Form 6069

q Form 990-PF q Form 1041-A q Form 8870

• If the organization does not have an office or place of business in the United States, check this box .................. ► q

• If this is for a Group Return , enter the organization's four digit Group Exemption Number (GEN) . If this isfor the whole group, check this box ► q . If it is for part of the group, check this box ► q and attach a list with the names andEINs of all members the extension will cover.

I I request an automatic 3-month (6-month , for 990-T corporation) extension of time until 02/15 , 20 05 ,

to file the exempt organization return for the organization named above. The extension is for the organization's return for:

► q calendar year 20- or

► tax year beginning 07/01 , 20.9-3, and ending 06/30 -,20-9-4.

2 If this tax year is for less than 12 months, check reason: q Initial return q Final return q Change in accounting period

3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less anynonrefundable credits. See instructions ..................................................... $

b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax paymentsmade. Include any prior year overpayment allowed as a credit ....................................

c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, depositwith FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). Seeinstructions ..........................................................................

Signature and VerificationUnder penalties of perjury I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,correct, and complete , and that I am authorized to prepare this form

Signature ► CPA Dates 11/01/2004

For Paperwork Reduction Act Notice, see I Form 8868 (12-2000)

ISA

STF FED9056F 1

orm 8868 (1 2-2000) Page 2

• If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box. . . .. ►Note: Only complete Part U if you have already been granted an automatic 3-month extens9t?n a previously filed Form 8868.

• If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).

Part ll Additional (not automatic) 3-Month Extension of Time - Must File Original and One Copy.

Type or Name of Exempt Organization Employer identification number

print UPMC NORTHWEST 25-0489010File by theextended

Number, street , and room or suite no If a P O box, see instructions For IRS use only

due date for 200 LOTHROP STREET, C/O CORPORATE TAXATIONfiling thereturn See

City, town or post office, state, and ZIP code For a foreign address, see instructions _

instructions PITTSBURGH, PA 15213

Check type of return to be filed (File a separate application for each return)-

q Form 990 q Form 990-EZ q Form 990-T (sec 401(a) or 408(a) trust) q Form 1041-A q Form 5227 q Form 8870

q Form 990-BL q Form 990-PF q Form 990-T (trust other than above) q Form 4720 q Form 6069

STOP: Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.

• If the organization does not have an office or place of business in the United States , check this box ........ ......... ► q

• If this is for a Group Return , enter the organization ' s four digit Group Exemption Number (GEN) . If this isfor the whole group , check this box ► q . If it is for part of the group , check this box ► q and attach a list with the names andEINs of all members the extension is for.

4 I request an additional 3-month extension of time until MAY 16 _

5 For calendar year , or other tax year beginning JULY 1 , 20 03 and ending JUNE 30 20 04

6 If this tax year is for less than 12 months, check reason : q Initial return q Final return q Change in accounting period

7 State in detail why you need the extension ADDITIONAL TIME IS NEEDED TO GATHER THE

INFORMATION REQUIRED TO FILE A COMPLETE AND ACCURATE TAX RETURN.-

8a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less anynonrefundable credits. See instructions .. ..... . ....... .... ....... .......... . .. $

b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimatedtax payments made. Include any prior year overpayment allowed as a credit and any amount paidpreviously with Form 8868 . .. .... ..... . . . ..... .. ....... . . .............. $

c Balance Due. Subtract line 8b from line 8a Include your payment with this form, or, if required, depositwith FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). Seeinstructions .......... .... .. .... ... ................. ... ........ . ...... .. $

Signature and VerificationUnder penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,correct , and complete, and that I am authorized to prepare this form

Signature ► ^ ,_,^ ,,y^ ^^rif_ Title. CPA Date ► 02/01/2005

Notice to licant - To Be Completed by the IRSZWe have approved this application Please attach this form to the organization ' s return

q We have not approved this application However , we have granted a 10-day grace period from the later of the date shown below or the due date of theorganization 's return ( including any prior extensions ) This grace period is considered to be a valid extension of time for elections otherwise required to bemade on a timely return Please attach this form to the organization 's return

q We have not approved -this application After considering the reasons stated in dem 7, we cannot grant your request for an extension of time to file We arenot granting a 10-day grace period. @*^+^^

q We cannot consider this application because it was filed after the due date of the return for° tefision was requested

q OtherEXTENSION APPROVED

MAR 0 8 2005BT FER 2 8 2009

Director Date^^^CORR

Alternate Mailing Address- Enter the address if you want the copy of this app Ica Ion o a al J1 ftW@MI9flELD DIRECTOR,returned to an address different than the one entered above . SUBMISSION PROCESSING, OGDEN

Name

Type or Number and street (include suite , room, or apt no .) Or a P. O. box number

print

City or town , province or state, and country ( including postal or ZIP code)

Form 8868 (12-2000)

STF FED9056F 2

Documents

999 Return ofOrganization ExemptFrom IncomeTax · Form •'999 Return ofOrganization ExemptFrom IncomeTax Under section 501(c), 527, or4947(a)(1) of the Internal Revenue Code(except