2014-05-15T19:14:27-05:00 2013-06-30 233022325 ZELENKOFSKE AXELROD LLC 2370 YORK ROAD SUITE A-5 JAMISON PA 18929 990 2012-07-01 232879667 LOWER BUCKS HOSPITAL LOWE 2157859200 501 BATH ROAD BRISTOL PA 19007 ALBERT MEZZAROBA 2157859200 2014-05-15 1 ZELENKOFSKE AXELROD LLC P00671750 2159182277 2012 2015-11-30 17:44:51Z X ALBERT MEZZAROBA 501 BATH ROAD BRISTOL PA 19007 24225783 0 X WWW.LOWERBUCKSHOSPITAL.ORG X 1956 PA HEALTHCARE-COMMUNITY HOSPITAL 14 10 984 0 0 0 0 29927 80908092 23640090 0 0 4820251 555766 85728343 24225783 0 0 0 0 45606664 11619591 0 0 0 48597889 10515218 94204553 22134809 -8476210 2090974 53829195 0 34734085 0 19095110 0 ADVANCED HEALTHCARE FOR THE COMMUNITY 0 0 17932551 23640090 HEALTHCARE TO THE COMMUNITY 17932551 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 1 60 0 984 1 0 0 0 0 0 0 0 0 X 14 10 1 0 0 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 0 PA X CFO 2157859325 501 BATH ROAD BRISTOL PA 19007 DELORES BROWN 1.00 X X 0 0 0 LOUIS BUSICO 1.00 X X 0 0 0 GLADYS MENDIETA 1.00 X X 0 0 0 PHILLIP BRACKIN MD 1.00 X 0 0 0 YAGNESH CHOKSI 1.00 X 0 0 0 HARRY FAWKES JR 1.00 X 0 0 0 HARRY FAWKES SR 1.00 X 0 0 0 BRUCE Q HARRIS 1.00 X 0 0 0 ROBERT LEIPZIGER 1.00 X 0 0 0 LOUIS QUATTROCCHI 1.00 X 0 0 0 RANGA RAO MD 1.00 X 0 0 0 JOANNA SCHNEYDER 1.00 X 0 0 0 JAMES H SELL 1.00 X 0 0 0 RONALD P WALKER 1.00 X 0 0 0 ALBERT MEZZAROBA 40.00 X X X 335356 0 11475 MICHAEL OLIVIERI 40.00 X X X 122132 0 12158 JOHN MCHALE 40.00 X X X 121966 0 248 PATRICIA BAIN 40.00 X X X 133327 0 15774 MICHAEL REGAN 40.00 X X X 113356 0 15035 ALLEN TOADVINE 23.00 X 116795 0 0 KIM CLABBERS MD 40.00 X 257196 0 23526 TATYANA CHERNOVA MD 40.00 X 185313 0 8796 KARL HELMOLD 40.00 X 358989 0 22259 KAZIMIERZ WATOREK 40.00 X 191535 0 19108 PETER MOLLE MD 20.00 X 131774 0 6962 2067739 0 135341 11 0 1 0 SIEMENS MEDICAL SOLUTIONS 51 VALLEY STREAM PARKWAY MALVERN PA 19355 MEDICAL SERVICES/EQUIPMENT 462052 LBH RADIOLOGY 501 BATH ROAD BRISTOL PA 19007 RADIOLOGY SERVICES 318660 HORIZON MENTAL 2941 SOUTH LAKE VISTA DRIVE LEWISVILLE TX 75067 HEALTH SERVICES 295600 SODEXHO PO BOX 905374 CHARLOTTE NC 28290 FOOD SERVICE 259790 MEDISERVE INC 9667 SOUTH 20TH STREET OAK CREEK WI 53154 MEDICAL 257406 5 29927 29927 NET PATIENT REVENUE 621110 23640090 23640090 23640090 OTHER OPERATING REVENUE 621110 555766 555766 555766 24225783 24195856 0 0 698834 133327 565507 8877003 7990991 886012 1368101 1084172 283929 675653 582507 93146 556245 556245 25000 25000 1553177 1524577 28600 54987 3705 51282 148436 148436 482126 482126 12796 12796 1575000 1575000 678268 678268 SUPPLIES 2197958 1955350 242608 OUTSIDE SERVICES 1805996 1042574 763422 EQUIPMENT RENTAL&MAINT/ 935353 378303 557050 DRUGS 206648 206648 283228 282207 1021 22134809 17932551 4202258 0 2279614 0 0 0 17969217 0 0 0 0 4040695 0 2200093 0 0 0 23832040 0 0 540453 0 0 0 2967083 0 53829195 0 27713449 0 7020636 0 34734085 0 X 19095110 0 19095110 0 53829195 0 X 2090974 -21186084 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 1 X 1 X 1 1 0 0 1 1 LOWER BUCKS HOSPITAL

501 BATH ROAD BRISTOL PA 19007

X X X LOWER BUCKS HOSPITAL 1 0 1 1 10000.000000000000 1 10000.000000000000 1 X X X X 1 0 1 X X X 1 X X X X X X X 1 X 0 0 PART I, LINE 3C: LOWER BUCKS HOSPITAL OPERATES A FREE CARE-FLEXIBLE FEE SCHEDULE BASED ON HHS 2011 POVERTY INCOME GUIDELINES. DEPENDING ON THE SIZE OF THE FAMILY AND THE ANNUAL INCOME, THE PATIENT RECEIVES EITHER FREE CARE OR DISCOUNTED RATES - ANYWHERE FROM 25% TO 100%. ANY FAMILY UNIT WHO HAS MORE THAN 8 MEMBERS, $3,820 IS ADDED FOR EACH ADDITIONAL MEMBER. LOWER BUCKS HOSPITAL PART V, SECTION B, LINE 3: WHEN A PATIENT EXPRESSES THE INABILITY TO MEET THE FINANCIAL RESPONSIBILITIES OCCASIONED BY SERVICES RENDERED AT THE HOSPITAL, A PATIENT FINANCIAL WORKSHEET WILL BE INITIATED AND COMPLETED BY A CREDIT AND COLLECTION REPRESENTATIVE. THE CREDIT AND COLLECTION REPRESENTATIVE WILL COMPLETE A FREE CARE/BAD DEBT CHECKLIST FROM THE INFORMATION OBTAINED FROM THE PATIENT FINANCIAL WORKSHEET, INTERVIEWS AND OTHER RESEARCH METHODS. AN ACCOUNT MAY BE ELIGIBLE FOR FREE CARE BASED ON INDIGENCE OR FINANCIAL HARDSHIP. THE HOSPITAL RESERVES THE RIGHT TO REQUIRE THE PATIENT TO APPLY FOR AVAILABLE ASSISTANCE THROUGH EXTERNAL AGENCIES. IF FULL OR PARTIAL PAYMENT IS NOT POSSIBLE, THE DATA INCLUDED IN THE FINANCIAL WORKSHEET SHOULD BE USED TO DOCUMENT AND SUPPORT CLASSIFICATION AS FREE CARE. THE HOSPITAL USES THE HHS POVERTY INCOME GUIDELINES TO DETERMINE FREE CARE ELIGIBILITY AND ALSO RESERVES THE RIGHT TO CONSIDER LIQUID ASSETS AS PART OF THE ASSESSMENT. THERE ARE MULTIPLE LEVELS OF FREE CARE ELIGIBILITY. FREE CARE ADJUSTMENTS, AS DETERMINED BY THE FREE CARE POLICY OF LOWER BUCKS HOSPITAL, WILL BE EFFECTIVE AFTER ALL PATIENT BALANCES HAVE BEEN PAID OR SETTLED. FAILURE TO SATISFY APPROPRIATE PATIENT BALANCES WILL VOID THE APPLICATION AND THE PATIENT WILL BE LIABLE FOR THE ENTIRE PATIENT BALANCE. X X X 0 0 0 0 0 0 0 0 0 ALBERT MEZZAROBA 335356 0 0 0 0 0 11475 0 0 0 346831 0 0 0 MICHAEL OLIVIERI 122132 0 0 0 0 0 12158 0 0 0 134290 0 0 0 JOHN MCHALE 121966 0 0 0 0 0 248 0 0 0 122214 0 0 0 PATRICIA BAIN 133327 0 0 0 0 0 15774 0 0 0 149101 0 0 0 MICHAEL REGAN 113356 0 0 0 0 0 15035 0 0 0 128391 0 0 0 ALLEN TOADVINE 116795 0 0 0 0 0 0 0 0 0 116795 0 0 0 KIM CLABBERS MD 257196 0 0 0 0 0 23526 0 0 0 280722 0 0 0 TATYANA CHERNOVA MD 185313 0 0 0 0 0 8796 0 0 0 194109 0 0 0 KARL HELMOLD 358989 0 0 0 0 0 22259 0 0 0 381248 0 0 0 KAZIMIERZ WATOREK 191535 0 0 0 0 0 19108 0 0 0 210643 0 0 0 PETER MOLLE MD 131774 0 0 0 0 0 6962 0 0 0 138736 0 0 0 DELORES BROWN CHAIRPERSON INDIVIDUAL IS ALSO ON THE BOARDS OF RELATED ORGANIZATIONS, ADVANCED PRIMARY CARE PHYSICIANS, ADVANCED SPECIALTY PHYSICIAN GROUP AND LOWER HEALTH BUCKS ENTERPRISES. 0 PHILLIP BRACKIN MD BOARD MEMBER PARTNER OF LOWER BUCKS RADIOLOGY ASSOCIATES WHICH HAS A CONTRACT WITH THE HOSPITAL TO PROVIDE PROFESSIONAL COMPONENT OF RADIOLOGY SERVICES. 0 HARRY FAWKES JR BOARD MEMBER INDIVIDUAL IS RELATED BY BLOOD TO ANOTHER BOARD MEMBER. 0 HARRY FAWKES SR BOARD MEMBER INDIVIDUAL IS RELATED BY BLOOD TO ANOTHER BOARD MEMBER AND IS ON THE BOARD OF AFFILIATED ORGANIZATION, LOWER BUCKS HEALTH ENTERPRISES. 0 RANGA RAO MD BOARD MEMBER INDIVIDUAL IS ALSO A MEMBER OF THE HOSPITAL MEDICAL STAFF. 0 LOUIS QUATTROCCHI BOARD MEMBER INDIVIDUAL IS A BOARD MEMBER WHO IS ALSO THE PRESIDENT AND MAJOR STOCKHOLDER IN BRISTOL FUEL COMPANY AND CBM OF DELAWARE VALLEY. LOWER BUCKS HOSPITAL PURCHASES FUEL FOR THEIR OUTSIDE PROPERTIES AND LUMBER FROM THEM. 0 ALL ASSETS AND LIABILITIES OF LOWER BUCKS HOSPITAL WERE PURCHASED BY PRIME HEALTHCARE SERVICES-LOWER BUCKS LLC 2012-10-03 31278328 DIRECT FROM ENTITY'S BALANCE SHEET 800859948 PRIME HEALTHCARE SERVICES-LOWER BUCKS LLC 501 BATH ROAD BRISTOL PA 19007 LIMITED LIABILITY CORPORATION 0 0 0 0 1 1 1 1 0 FORM 990, PART VI, SECTION A, LINE 2 TWO BOARD MEMBERS ARE FATHER AND SON. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE CEO AND CFO/CONTROLLER PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CEO REVIEWS THE CONFLICT OF INTEREST POLICY STATEMENTS ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL USES SURVEYS FROM DELAWARE VALLEY HEALTH COUNCIL (DVHC) AND KEEPS TRENDS ON WHAT OTHER AREA HOSPITALS ARE DOING. FORM 990, PART VI, SECTION C, LINE 19 FORMS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: SALE -21,186,084. ADVANCED PRIMARY CARE PHYSICIANS 501 BATH ROAD BRISTOL PA 19007 261429053 OPERATIONAL SUPPORT PA 501(C)(3) 0 ADVANCED SPECIALTY PHYSICIANS GROUP 501 BATH ROAD BRISTOL PA 19007 262414312 HEALTHCARE PA 501(C)(3) 0 BUCKS COUNTY HEALTH FOUNDATION 501 BATH ROAD BRISTOL PA 19007 208367267 HEALTHCARE PA 501(C)(3) 0 BUCKS COUNTY HEALTH ENTERPRISES 501 BATH ROAD BRISTOL PA 19007 232547355 HEALTHCARE PA 501(C)(3) 0 BUCKS COUNTY INSURANCE COMPANY LTD 501 BATH ROAD BRISTOL PA 19007 980490086 SELF INSURANCE PA CFC 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 LOWER BUCKS HEALTH ENTERPRISES INC D 119812 ACTUAL LOWER BUCKS HEALTH ENTERPRISES INC M 136436 ACTUAL ADVANCED PRIMARY CARE PHYSICIANS D 192042 ACTUAL LOWER BUCKS HEALTH ENTERPRISES INC J 4000 ACTUAL BUCKS COUNTY PARTNERS IN PET LLC 1455 BROAD STREET 4TH FLOOR BLOOMFIELD NJ 07003 331040092 HEALTHCARE PA 0 0 0