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LOWER BUCKS HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
LOWER BUCKS HOSPITAL (EIN 23-2879667)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-15
IRS object ID
201421359349309822
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-15T19:14:27-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN233022325EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ZELENKOFSKE AXELROD LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12370 YORK ROAD SUITE A-5AddressLine1
CityJAMISONCity
StatePAState
ZIP Code18929ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN232879667EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LOWER BUCKS HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlLOWENameControl
Phone2157859200Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1501 BATH ROADAddressLine1
CityBRISTOLCity
StatePAState
ZIP Code19007ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameALBERT MEZZAROBAName
TitleCEOTitle
Phone2157859200Phone
Date Signed2014-05-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameZELENKOFSKE AXELROD LLCName
PTINP00671750PTIN
Phone2159182277Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Terminated ReturnXTerminatedReturn
Name Of Principal Officer PersonALBERT MEZZAROBANameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1501 BATH ROADAddressLine1
CityBRISTOLCity
StatePAState
ZIP Code19007ZIPCode
FieldValueIRS element (for citing)
Gross Receipts24225783GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.LOWERBUCKSHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionHEALTHCARE-COMMUNITY HOSPITALActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees984TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year29927ContributionsGrantsCurrentYear
Program Service Revenue Prior Year80908092ProgramServiceRevenuePriorYear
Program Service Revenue CY23640090ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year4820251OtherRevenuePriorYear
Other Revenue Current Year555766OtherRevenueCurrentYear
Total Revenue Prior Year85728343TotalRevenuePriorYear
Total Revenue Current Year24225783TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year45606664SalariesEtcPriorYear
Salaries Etc Current Year11619591SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year48597889OtherExpensePriorYear
Other Expenses Current Year10515218OtherExpensesCurrentYear
Total Expenses Prior Year94204553TotalExpensesPriorYear
Total Expenses Current Year22134809TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-8476210RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2090974RevenuesLessExpensesCY
Total Assets BOY53829195TotalAssetsBOY
Total Assets EOY0TotalAssetsEOY
Total Liabilities BOY34734085TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY19095110NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY0NetAssetsOrFundBalancesEOY
Mission DescriptionADVANCED HEALTHCARE FOR THE COMMUNITYMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense17932551Expense
Revenue23640090Revenue
DescriptionHEALTHCARE TO THE COMMUNITYDescription
Total Program Service Expense17932551TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated1Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109660NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees984NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2157859325TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1501 BATH ROADAddressLine1
CityBRISTOLCity
StatePAState
ZIP Code19007ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
DELORES BROWN
CHAIRPERSON1.00XX000
LOUIS BUSICO
VICE CHAIRPERSON1.00XX000
GLADYS MENDIETA
SECRETARY/TREASURER1.00XX000
PHILLIP BRACKIN MD
BOARD MEMBER1.00X000
YAGNESH CHOKSI
BOARD MEMBER1.00X000
HARRY FAWKES JR
BOARD MEMBER1.00X000
HARRY FAWKES SR
BOARD MEMBER1.00X000
BRUCE Q HARRIS
BOARD MEMBER1.00X000
ROBERT LEIPZIGER
BOARD MEMBER1.00X000
LOUIS QUATTROCCHI
BOARD MEMBER1.00X000
RANGA RAO MD
BOARD MEMBER1.00X000
JOANNA SCHNEYDER
BOARD MEMBER1.00X000
JAMES H SELL
BOARD MEMBER1.00X000
RONALD P WALKER
BOARD MEMBER1.00X000
ALBERT MEZZAROBA
CHIEF EXECUTIVE OFFICER40.00X335356011475XX
MICHAEL OLIVIERI
CHIEF FINANCIAL OFFICER40.00X122132012158XX
JOHN MCHALE
EXECUTIVE VICE PRESIDENT40.00X1219660248XX
PATRICIA BAIN
CHIEF NURSING OFFICER40.00X133327015774XX
MICHAEL REGAN
CHIEF INFORMATION OFFICER40.00X113356015035XX
ALLEN TOADVINE
VP LEGAL SERVICES23.0011679500X
KIM CLABBERS MD
ORTHOPEDIC SURGEON40.00257196023526X
TATYANA CHERNOVA MD
PATHOLOGIST40.0018531308796X
KARL HELMOLD
ORTHOPEDIC SURGEON40.00358989022259X
KAZIMIERZ WATOREK
NEONATOLOGIST40.00191535019108X
PETER MOLLE MD
PHYSICIAN20.0013177406962X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2067739TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation135341TotalOtherCompensation
Number Individuals GT100 K11NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SIEMENS MEDICAL SOLUTIONS
51 VALLEY STREAM PARKWAYMALVERNPA19355MEDICAL SERVICES/EQUIPMENT462052
LBH RADIOLOGY
501 BATH ROADBRISTOLPA19007RADIOLOGY SERVICES318660
HORIZON MENTAL
2941 SOUTH LAKE VISTA DRIVELEWISVILLETX75067HEALTH SERVICES295600
SODEXHO
PO BOX 905374CHARLOTTENC28290FOOD SERVICE259790
MEDISERVE INC
9667 SOUTH 20TH STREETOAK CREEKWI53154MEDICAL257406
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions29927AllOtherContributions
Total Contributions29927TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT REVENUEDescription
Business Code621110BusinessCode
Total Revenue Column23640090TotalRevenueColumn
Related Or Exempt Function Income23640090RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue23640090TotalProgramServiceRevenue

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER OPERATING REVENUEDescription
Business Code621110BusinessCode
Total Revenue Column555766TotalRevenueColumn
Related Or Exempt Function Income555766RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue555766TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column24225783TotalRevenueColumn
Related Or Exempt Function Income24195856RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total698834Total
Program Services133327ProgramServices
Management And General565507ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8877003Total
Program Services7990991ProgramServices
Management And General886012ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1368101Total
Program Services1084172ProgramServices
Management And General283929ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total675653Total
Program Services582507ProgramServices
Management And General93146ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total556245Total
Management And General556245ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total25000Total
Management And General25000ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1553177Total
Program Services1524577ProgramServices
Management And General28600ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total54987Total
Program Services3705ProgramServices
Management And General51282ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total148436Total
Management And General148436ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total482126Total
Program Services482126ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total12796Total
Program Services12796ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1575000Total
Program Services1575000ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total678268Total
Program Services678268ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES21979581955350242608
OUTSIDE SERVICES18059961042574763422
EQUIPMENT RENTAL&MAINT/935353378303557050
DRUGS206648206648

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total283228Total
Program Services282207ProgramServices
Management And General1021ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total22134809Total
Program Services17932551ProgramServices
Management And General4202258ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2279614BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY17969217BOY
EOY0EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY4040695BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2200093BOY
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis0LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec0LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY23832040BOY
EOY0EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY540453BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2967083BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY53829195BOY
EOY0EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY27713449BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY7020636BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY34734085BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY19095110BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19095110BOY
EOY0EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY53829195BOY
EOY0EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2090974ReconcilationRevenueExpenses
Reconcilation Other Changes-21186084ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1LOWER BUCKS HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1501 BATH ROADAddressLine1
CityBRISTOLCity
StatePAState
ZIP Code19007ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1LOWER BUCKS HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted0CHNAConducted
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent10000.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent10000.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures0IncludesPublicityMeasures
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (2 entries)

ExplanationExplanationIdentifierIdentifier
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.
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.LOWER BUCKS HOSPITAL

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ALBERT MEZZAROBA
CHIEF EXECUTIVE OFFICER3353560000011475000346831000
MICHAEL OLIVIERI
CHIEF FINANCIAL OFFICER1221320000012158000134290000
JOHN MCHALE
EXECUTIVE VICE PRESIDENT12196600000248000122214000
PATRICIA BAIN
CHIEF NURSING OFFICER1333270000015774000149101000
MICHAEL REGAN
CHIEF INFORMATION OFFICER1133560000015035000128391000
ALLEN TOADVINE
VP LEGAL SERVICES116795000000000116795000
KIM CLABBERS MD
ORTHOPEDIC SURGEON2571960000023526000280722000
TATYANA CHERNOVA MD
PATHOLOGIST185313000008796000194109000
KARL HELMOLD
ORTHOPEDIC SURGEON3589890000022259000381248000
KAZIMIERZ WATOREK
NEONATOLOGIST1915350000019108000210643000
PETER MOLLE MD
PHYSICIAN131774000006962000138736000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)

RelationshipRelationshipDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
DELORES BROWN
CHAIRPERSONINDIVIDUAL 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 MEMBERPARTNER OF LOWER BUCKS RADIOLOGY ASSOCIATES WHICH HAS A CONTRACT WITH THE HOSPITAL TO PROVIDE PROFESSIONAL COMPONENT OF RADIOLOGY SERVICES.0
HARRY FAWKES JR
BOARD MEMBERINDIVIDUAL IS RELATED BY BLOOD TO ANOTHER BOARD MEMBER.0
HARRY FAWKES SR
BOARD MEMBERINDIVIDUAL 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 MEMBERINDIVIDUAL IS ALSO A MEMBER OF THE HOSPITAL MEDICAL STAFF.0
LOUIS QUATTROCCHI
BOARD MEMBERINDIVIDUAL 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

Schedule N IRS990ScheduleN

Liquidation Table LiquidationTable

Liquidation Detail LiquidationDetail

FieldValueIRS element (for citing)
Description Of AssetALL ASSETS AND LIABILITIES OF LOWER BUCKS HOSPITAL WERE PURCHASED BY PRIME HEALTHCARE SERVICES-LOWER BUCKS LLCDescriptionOfAsset
Date Of Distribution2012-10-03DateOfDistribution
FMV Of Asset31278328FMVOfAsset
Method Of FMV DeterminationDIRECT FROM ENTITY'S BALANCE SHEETMethodOfFMVDetermination
EIN800859948EIN

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PRIME HEALTHCARE SERVICES-LOWER BUCKS LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1501 BATH ROADAddressLine1
CityBRISTOLCity
StatePAState
ZIP Code19007ZIPCode
FieldValueIRS element (for citing)
IRC SectionLIMITED LIABILITY CORPORATIONIRCSection
FieldValueIRS element (for citing)
Director Of Successor0DirectorOfSuccessor
Employee Of Successor0EmployeeOfSuccessor
Owner Of Successor0OwnerOfSuccessor
Receive Compensation0ReceiveCompensation
Assets Distributed1AssetsDistributed
Required To Notify AG1RequiredToNotifyAG
AG Notified1AGNotified
Liabilities Paid1LiabilitiesPaid
Bonds Outstanding0BondsOutstanding

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2TWO BOARD MEMBERS ARE FATHER AND SON.
FORM 990, PART VI, SECTION B, LINE 11FORM 990 IS REVIEWED BY THE CEO AND CFO/CONTROLLER PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE CEO REVIEWS THE CONFLICT OF INTEREST POLICY STATEMENTS ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15THE 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 19FORMS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:SALE -21,186,084.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionControlled OrgControlledOrg
ADVANCED PRIMARY CARE PHYSICIANS
501 BATH ROADBRISTOLPA19007261429053OPERATIONAL SUPPORTPA501(C)(3)0
ADVANCED SPECIALTY PHYSICIANS GROUP
501 BATH ROADBRISTOLPA19007262414312HEALTHCAREPA501(C)(3)0
BUCKS COUNTY HEALTH FOUNDATION
501 BATH ROADBRISTOLPA19007208367267HEALTHCAREPA501(C)(3)0
BUCKS COUNTY HEALTH ENTERPRISES
501 BATH ROADBRISTOLPA19007232547355HEALTHCAREPA501(C)(3)0
BUCKS COUNTY INSURANCE COMPANY LTD
501 BATH ROADBRISTOLPA19007980490086SELF INSURANCEPACFC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
LOWER BUCKS HEALTH ENTERPRISES INC
D119812ACTUAL
LOWER BUCKS HEALTH ENTERPRISES INC
M136436ACTUAL
ADVANCED PRIMARY CARE PHYSICIANS
D192042ACTUAL
LOWER BUCKS HEALTH ENTERPRISES INC
J4000ACTUAL

Form990 Schedule R Part VI Form990ScheduleRPartVI

Name Of Business NameOfBusiness

FieldValueIRS element (for citing)
Business Name Line1BUCKS COUNTY PARTNERS IN PET LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11455 BROAD STREET 4TH FLOORAddressLine1
CityBLOOMFIELDCity
StateNJState
ZIP Code07003ZIPCode
FieldValueIRS element (for citing)
EIN331040092EIN
Primary ActivityHEALTHCAREPrimaryActivity
Legal Domicile StatePALegalDomicileState
All Partners C3 S0AllPartnersC3S
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner0GeneralOrManagingPartner