2013-05-15T17:48:24-05:00 2012-06-30 233022325 ZELENKOFSKE AXELROD LLC 2370 YORK ROAD SUITE A-5 JAMISON PA 18929 990 2011-07-01 232879667 LOWER BUCKS HOSPITAL LOWE 2157859200 501 BATH ROAD BRISTOL PA 19007 ALBERT MEZZAROBA 2157859200 2013-05-15 1 ZELENKOFSKE AXELROD LLC P00671750 2159182277 2011 2016-02-24 21:20:13Z ALBERT MEZZAROBA 501 BATH ROAD BRISTOL PA 19007 85728343 0 X WWW.LOWERBUCKSHOSPITAL.ORG X 1956 PA HEALTHCARE-COMMUNITY HOSPITAL 14 10 1061 0 0 0 0 0 87448361 80908092 16334 0 4705323 4820251 92170018 85728343 0 0 0 0 47545820 45606664 0 0 3151 49263488 48597889 96809308 94204553 -4639290 -8476210 59643051 53829195 73694796 34734085 -14051745 19095110 ADVANCED HEALTHCARE FOR THE COMMUNITY 0 0 75455913 75455913 HEALTHCARE TO THE COMMUNITY 75455913 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 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 0 0 0 1 0 0 0 0 1 43 0 1061 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 CHOKSKI 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 408499 0 8473 MICHAEL OLIVIERI 40.00 X X X 147927 0 6231 JOHN MCHALE 40.00 X X X 138263 0 7616 PATRICIA BAIN 40.00 X X X 127512 0 5811 MICHAEL REGAN 40.00 X X X 0 0 0 KIM CLABBERS MD 40.00 X 311377 0 8572 TATYANA CHERNOVA MD 40.00 X 229819 0 7509 ANNA SOSNOVSKY MD 40.00 X 131948 0 5119 KARL HELMOLD 40.00 X 295472 0 5284 KAZIMIERZ WATOREK 40.00 X 164300 0 5458 1955117 0 60073 9 0 1 0 SODEXHO PO BOX 905374 CHARLOTTE NC 28290 FOOD SERVICE 1730874 HORIZON MENTAL 2941 SOUTH LAKE VISTA DRIVE LEWISVILLE TX 75067 HEALTH SERVICES 1211791 PINNACLE MID-AT 13601 PRESTON ROAD DALLAS TX 75240 ANESTHESIA SERVICES 1118937 LBH RADIOLOGY 501 BATH ROAD BRISTOL PA 19007 RADIOLOGY SERVICES 791159 LOWER BUCKS PHYSICIANS 66 WEST GILBERT STREET SUITE 6000 RED BANK NJ 07701 MEDICAL 537386 5 NET PATIENT REVENUE 621110 80908092 80908092 80908092 OTHER OPERATING REVENU 621110 4820251 4820251 4820251 85728343 85728343 0 0 683938 127512 556426 37489978 31993115 5494243 2620 4645581 3762973 882608 2787167 2345631 441339 197 2004824 2004824 161945 161945 6404026 6182426 221600 303147 21288 281525 334 733710 733710 2403318 2403318 64448 64448 6300000 6300000 3180238 2675274 504964 OUTSIDE SERVICES 11883874 7124841 4759033 SUPPLIES 8634898 7992925 641973 EQUIPMENT RENTAL&MAINT/ 3802079 1775367 2026712 DRUGS 2459395 2459395 261987 227400 34587 94204553 75455913 18745489 3151 6920338 2279614 13990977 17969217 2648786 4040695 2195399 2200093 123826412 99994372 28902881 23832040 561437 540453 4423233 2967083 59643051 53829195 42243591 27713449 24816406 0 6634799 7020636 73694796 34734085 X -14051745 19095110 -14051745 19095110 59643051 53829195 X -8476210 41623065 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1040412 1040412 122786000 99994372 22791628 23832040 DUE FROM RELATED PARTY 2967083 2967083 DUE TO RELATED PARTY 7020636 7020636 85728343 94204553 -8476210 41623065 41623065 33146855 PART XI, LINE 8 - OTHER ADJUSTMENTS: ALL ADJUSTMENTS MADE THROUGH BANKRUPTCY 41,623,065. GOLF OUTING 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 408499 0 0 0 0 0 8473 0 0 0 416972 0 0 0 MICHAEL OLIVIERI 147927 0 0 0 0 0 6231 0 0 0 154158 0 0 0 JOHN MCHALE 138263 0 0 0 0 0 7616 0 0 0 145879 0 0 0 PATRICIA BAIN 127512 0 0 0 0 0 5811 0 0 0 133323 0 0 0 MICHAEL REGAN KIM CLABBERS MD 311377 0 0 0 0 0 8572 0 0 0 319949 0 0 0 TATYANA CHERNOVA MD 229819 0 0 0 0 0 7509 0 0 0 237328 0 0 0 ANNA SOSNOVSKY MD 131948 0 0 0 0 0 5119 0 0 0 137067 0 0 0 KARL HELMOLD 295472 0 0 0 0 0 5284 0 0 0 300756 0 0 0 KAZIMIERZ WATOREK 164300 0 0 0 0 0 5458 0 0 0 169758 0 0 0 DELORES BROWN CHAIRPERSON INDIVIDUAL IS ALSO ON THE BOARDS OF RELATED ORGANIZATIONS, ADVANCED PRIMARY CARE PHYSICIANS, ADVANCED SPECIALTY PHYSICIAN GROUP, LOWER HEALTH BUCKS ENTERPRISES AND BUCKS COUNTY HEALTH FOUNDATION. 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 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 5: ALL ADJUSTMENTS MADE THROUGH BANKRUPTCY 41,623,065. TOTAL TO FORM 990, PART XI, LINE 5: 41,623,065. 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 1 0 0 1 0 0 0 0 0 0 LOWER BUCKS HEALTH ENTERPRISES INC D 370719 ACTUAL LOWER BUCKS HEALTH ENTERPRISES INC L 385803 ACTUAL ADVANCED PRIMARY CARE PHYSICIANS D 393575 ACTUAL LOWER BUCKS HEALTH ENTERPRISES INC I 16000 ACTUAL BUCKS COUNTY PARTNERS IN PET LLC 1455 BROAD STREET 4TH FLOOR BLOOMFIELD NJ 07003 331040092 HEALTHCARE PA 0 0 0