Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 1 of 35
Defendant's Exhibit # 10
B-118
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 2 of 35
HOspnAl. H(OICAl AND OflTAl smlCE OR IIDEPITT CllTiOIS
fo.. JJ
.
HAIC Grop Codc: DO
Incoroted: ll1Z11938
iiU111mnllælllJllllDllmlBWIIIIBlmllnn
_I5. 1~I _(a:1I
ANNUAL STATEMENT
for th YeAr Ended Decemr 31, 1995
Of THE CONDITION AND AFFAIRS OF THE
HQTAL SERVICE ASSOC. OF N. E. PA
IlIC c.1O Code: S4747
r.loy.r's ID N...r: 24.0615177
O,...lied unor the l.". of tho Stot. .f I'STLVMIA
INSURACE DEPARTMHT OF THE STATE OF PENNSYLVANIA
. _d. 10 ti.
PURSU TO THE LA THER£F
Stotuto.. _ Office: 70 ~I Mil STRm
Illn AålnlstroUn Office: 70 NORTH MJI STREET
. Vi UES-BAE 'A 11711
C_ lusino..:
IZ/OIII'31
VIUES-IlE. 'A 1871
Iln Adress: 70 IlIlI MIN STlEfT
(7171Z9..ii
. VILlESWAf. PA 11711
(717 B29..ii
'ri.... Lo.Uon of loob .nd ReCO"S: 70 lIi W.II SlRm
VlUCES.II. 'A 18711 .....1 Stot_t Cotoct: JOlN UIrT Slsrl l71718Z6011
OFFICERS
'..I...t ¡ en l'.llI ScereCo.. IflTI JO,. WJERS
Troosurr HICHAl 'ATIICI lilLAGIEl
.
Stote .f Peylv."io
Vi ce Presi dents
MICHL 'ATRICX ~R
ROEn RAT IIITTAI.
alTi JOU' SMII
OOUSE SU CESA .I EAL Iifl ,
DIRECTORS OR TRUSTEE
RDER I'IWPS DEISE
FRr Dl APOlllX ,
Al STfYEI NDWOO ,
JØl .iSEPI LUIMI
JOI 1l1"' GI
w. II MYiD CO PATRICIA ..a EII.
IlEA SlIM
.JITH O'IlLEV GIIAIO SMIlLfT Rl ILEI SlSTEI H. IlTJH de PDUD I1LE
RUSELL WI LLIAM TV'" ,
PATID Joi IIllllMS
T~ JDlW
i- lAl ..- Il I( -. ... 01.... ra a ""rlßnl .. of . lal, il _ _.. .. -. - - lI m.. of .. ..i,..IlI ...... clnr -l...~ ~4':,-.,-. .of.. rtiia: ~. It;i....,-l ..u."-" _ ..In I" r..lla. ,. ii- . ci_ .. .. ... .. lW IM -i .. ...... "I..
.. ..1..11. .... ..I.. ~ It .... I. . fel .. IN .- " ..I .. _ .. lfoWlkln .. " il -iil- .. .... 0I1l .. .. . 01
County of Wl£IIE II
1__.. -11., ,..ii.... -- __...._.. ii¡,..i...iiri. ..lilI...nl......lli-..I...i-1o ""'" -i n1.. "'__11., ,.11.. .. ,.. -i .. .. Il 01 .. 1._... -- .. Itlfrl. -i-Ii.
.. D1itlirs...... 1.1' .. oIlU i- .. _I~ ..,.. .. .. _... iw ... .. .. .. .. to __... .. II -i ._
-
,ør:/~ Á~ /~ -i41,Ql? ;./.-Z/
SvbJCrila end s....n; to befo,. N tJh
L.: .'14 ~ /.
~~t/ NEPAll37
/ dcy ~f l?UnaJ . 1!l .. Is this 'n orl,i..i fil",' YeS (I) .. ( )
f718 U 1./. ~__ _ ii. If J ,. ~: :.i:.f:~:... ..r ~ . 11 -1 "".iii=_ 1M: -. .f _. -Mr=:i:=ic:_ '-'~~á_
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 3 of 35
f... U MIL STATIMUT fOR 1N( YEAR 1'" 0' lit HOS'IlAL SE1VIC£ AS. OF I.E. 'A
.
242 Pio A~DU
-l0l 1~i _. _, :11
ACTUARIAL 51 A TEMEN1
IDIIlllllillllillimmlnlDlinlnmliim 1111111011
JOHN HARACK, A.C.A.S., M.A.A.A.
C~'S"G .lY
EvanslOl, lIis 6001 PIe (7 328-5374
Feb 15, 199
Th Hoi-c Li Kai5C
Jii Comisio
13th Floor
Pcn In Dcpa
Strwbe Squa
Har PcMSlvania i 7120
.
De Comision
item
Hosl Sece Asstion orNorea Penlvaia wi re to los ra aelliailucs and rclaic
I, Jo Harck Coltng Aci, am a membe ofdi Am Aca1 of Aies an haw: be reinc by
I hive exine the asmption an me use in deinig lo rc Kt 1i6ies an rclat iie
list belo as shwn in th annua Sl or ii i:iion as prpa ror til ing wi Slle rela offcials as
orDeber 31, 1995:
I) Claims iøpaid (Pge 3, Jie I)
S8 186,31 0
2) Unpaid Claims adusent expe
(Pge 3. hem 3)
$2885,163
My eiinatiön incude su review ortl aspt an met ux and ofdi unnl bac =ord and
summaes an su le an calclaon lI I coid i-.
. In my opinion th II caed in the ba sht on KC of ii ita idetified ab ar in ac:
wi ai aerial si i:st appie and farly SI in acc will app S1 or
bad on acll asption rclevat to QX prisions an appic io th pu for whch th SW wa ¡mpa me ii reuirments ofdi Ja orth Coonwa or PenlYl an ma ¡o ii suicei
prvisons for ill Ilpaid claim and oi Kt Jilites un ii ti or it c: an a¡ren ar
Prctice an Coplia Guidelin as prulpt by th Ac Si Bo, so -i prnciples ar
.
~ Hak'
./an
;a/~
esis
copw on th bas of Gumpton c: will th us in compng th coini item in ii anUli
sl or Deember 3 J, J 99, an inlu app prvision for an acll iie whcl ought 10 be
1.1
B-120
NEPAOO
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 4 of 35
fon 13 -i 5TAUM¡n FaA TH( 'I lfU or TH( IlSPlTAl SERYlCE USD. OF I.E. 'A
.
ASSETS
I. 10"'" ,.) ................ Z. StoelaC.):
De__.r 31, 1"5
De..,r ii.
1914
..... ..... ... 14I.Sl0.t73 '" 10,101,'01
2.1 Prferra stoe"
i.l c~ icocks ... ................................................... ...
3. Hln,i,.l..ni OI retllSi.ie ........ ...........
4. A..i e.UU, leu S..........
5. Col1Olcrol looos ........
i6l,400,OIZ
115,115,102
en_rinees ...
.....5,IU,3oo ..
CI,I'I,1411
5,013,147
'.1 ~If on ho'" 00' .. I_"ll
C2.54.05l)
'.Z Sllrt-tCl !r,ns_olS .. .............,.................... ........................... ............ .... 21.55.364 7. DtMr l....t-i .i,iti ....... ...... ............ ..... ,. ... ................ ... ..... ......._......... .... li.to.6tZ
IA. Sitotob, .u~ -i i/lstel Illets, (LIne. I 14 I) .................................
ID.JI.J4C
I. An..." wrllo-I.. for I_led IIMt. ...... .......... .......................................... ..... 1...ISt .... . im.sz
... :l7 .717 .cn ... _,2CO,"
19.413.522
.. Uoll_M ..1.. .................................................................
10. Motl reel"."1. "let''' i. untalUm acl"ClC .øc h"lih ,1...
II. fo... held ii or depoltoo .Ith "Ins.re ....Ias .................................
. . .. 1..731,110
n. aCin1.rclKl recrnblei an 1011 all 10$ 14ju,i-nt ,.i-U
13. r'*ra' f__ i- "CO..,."'. .............................................
14. Inie"st ui athr I_SWIll fll_ du ind oc.ni ...,... . . .. . .. . , , , ,
J,III,l17 '.... J,eis._
2,SZI.tS ..... Z,04.:Jl
. .. _.ON .:i .. 41 II 14
IS. k.i,..i. f.. ..roi, ....Idhrlos ."" i"nloies .............................................
16. llici..i..su p....sl.. -l-ii ......................... ............... ..... .......... ...
It. ...011 wrlia-lIl, 'or _, tho 10,atOO as.ets ,.,
.
_nAILS OF ilITE-lIS _
20. TOTAU (uncs M U1..~ U) ................ ............................................... ... 4ll.MI.zi. '" :lI,iil,7Jl
ai, ~I~.=~froi=m:~~~.:: :::::::.: :::.:: :::...:: :::::::::::::. ::::::::::'::: ::::: :::: ............... ..... 4.741.ZI
fE'A&IITSAS .......... . .... ...... .... .................;.............. :::::ï;iiii:5ï ::.:: ~:~:::
0I. T.uls CLInes _I \lni Cl p'" _ICu.. . 0-1 .. ..... . .... ... ..... .... ..... 1._,151 ..... '.~i.451
1~I1. OTl IID.All AlClPIPU ......... ...... ........................ ..... .... ................. .. .. 7.'13,_ ..... 1.1l0.R. AlA .W(-i ØI PU ......... . ............. .......... ...... ...... .. .........2.10.425 ..... ... - CLSS PlM ,........ ...... .. . . .. .. .. ........ ....... .. . .... . .. .. . 1.3Z,OI IlI. All I,.. _1'01..1.1.. ",It..i.. før U.. It r_ ..n.. _ ..................................... Z7.5l:ac;' ... ïi:¡':äö'
-I' 01 ..hl.. ..1l..lns for LI.. . ,_ ..rfl.. P.IO ......... ... .. ...... ..,........... . . . . ... . ..
1m. T".'. (UteS 1101 thru ll0 .1.. I_ICUM I. ...) .... .......... ... ... 3l.lI,Jl ... 41,i1,l
Col 5.... ".Is o'...ieotl... _ AI STATEl AT NITU(D tOST. STQ AI STATtO AT -i YAW( P(11M( /l.A.I.C. '~T101 fJ
SECITIES _.
.
B.121
NEPAOO
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 5 of 35
fo.. 13 JINWlL srATDlENT fOlIE TEA 191 Of lIE HOS'ITAl SERVICE A$. OF I.E. PA
.
LIABI LITI ES,
RESERVES & OTHER FUNDS
..
Oe_r n, 1'"5
16.116,JID
1
Oec-i 3..
!VIM
Z
I. Chi.. _'d (,.rt iA, Line 5, Col_ .)(1"1.... ',.1.1.. lor ...roth. CD' ..j..\MnU
S. .. 10,,,i,170) ...................................................................... .....
i. Pro.hl.. f.r def.rr .....Ul _fn. (Pcrt n, Lh. .. Col_ z) ...................,.
3. Un..,.. cl.t. '''Jlii- op.... (pan i, Lt_ l0, Cel.. 2) ......................... .....
.,.,
.. .
....,
.., 1I.636,Sl .. .. ....
J.2O.13
l,..lID ....
".315,538
.. Uleomc -i- I,"rt I. Co'_ I) ...............................................
5. Un.i", ln,.st_nt. tft ('ut ", Lhi: it C.1-, 4) ............................. .....
6. A. 1.us, lIc..s.. iod flls due Dr .ce,.ed 1_1..1., fcdr.ll_ Use.) ........
.. 44..11...
.. 83,...
'. Ja,I" ..
IS,.U ,Gt
.. ,_..1 1_ .... (_'..1.' lIforrr .....) .................................
II .wo.m
t. O1r apnslS 4u1 or ,i:d ....... .. ,. . ...._. ..... ....... ................. ............. ... -.. 11...705
1. Pm". _sIU _ by .pp,tCOts rejected or ii "':rt .cc.pted os _r. or ..bicrl"n .... ..... J,UZ,llM
.,13,0i
4,01.16
e. 10"'"' S................ ..d tctcrut ..... s................ .......................... ............. .. ... .. .........
,. A- wlUlld Dr rtUlii for .CCOlt of othrs ............................................... .... Jl.1I7.40 .... l'.7Z.-i
10. U.bill'i f.r ,_U hold ...r ..1..... .cel"'" .od health p101s .....................'....... .. 11. ,... _1. ~ co..nl.. UnH retftlUrpce i..tiu . .......... ................. 12A. lI.rn ".1_ on rein..... to ....tlrtzod c_..lcs S................ ....
in. IIlcsur.. paid ..t i-d lou.. s............... rerol. f.. _utrl.." I'.... S................ .. OI ..,.Id,... 1...11 S................ ond _I.. on I............. .......... ............... ..... ............... ......... ........., ...... s..... ,.t
Izt. P.ld and _lid 111..icd 1... cdJIs_t eipes.. ....lc f.. _Uoicd
_01.. S.......... ...... ............ .... .......... ................... ......................... lJO. =l=-.~~r.;.::;:tbr.~r~:;:.I:rs~~~.~~.~~..~~~~~.. ......... .........
13. Prlsl.. for ..utlr1ie' reloll (LIne ill . in . Itc - IZI) .................'..... ....
14. ""..U..Uo-iss for o.her 1I0I111t10i ....................................... ..............
2.M1 ..
" 5.5I.IU
.
15. Totol lhbi1iUcs ............ .............. ..... ............... ......... ........ ................. ... Z0,m,4S0 ... 112,_,13
RESERVES AND SPECIAL FUNDS
16. SUlli."_ .....................
17. 1v,.1.. _II ........................
11. .."toU wlto-Iu '.r ...S .nd ipelol lun.
It. i....si.. loo. ..................... ......
. . ZlS.JI._ ... l5,Ul.10
............. .... .... ..
20. Tot.t "uncs ... ."...... '_1 ('''. 4. L iM 21)
215,"0_
. .. .zi.64.ZI'
1".Ul.IOl
... .1,111.737
21. TOrAL ILl... 15 pl.. ZO) ....... .... .. ..
DETAILS or IITE-III
1401. POST mi_r /CICAL IDtflTS ... ....... ..... ........ .........
'~3;i~: I40S. 'EIEM\ UDG _ElS( ............ ... .. ... . .... .. . .... .. . . . .. . .. .. .. . . .... l.tJl..S7 ::..::: ISl Sl'I S.1I5.5J I.... i-r¡ of ..1.1.. wrl...i.. for LI.. \4 fi- ...rO.. PO" ... ........... . . ... . ... ." ..... l.IU... . . '.. 1,IIS.6d . ..
lOO. P(IISTL'MIA lLU( $I I(LO ...........,' .. .. .. . . , ., ..' ..'" .. .. . .. ..
14". ToUb (Lind 1401 Urv 1103 pl.s I.II)(LI.. 14 -I.. .. .. ............. .............
.......307.64
. . ... 4,110,751
1l1. .................. "', ............. . .. .. . .. .. . ................ ... .... ....... ................ _. ..................... .... .... .. .. ...... ....... .. .. . .. .. ............................... 1l, . ...............................'..., . .. .. .. .. . .. .. .. .. . .. . .. .. .. .. . ... .., .. . .. .. .. ... .. . .. . i-. i-r¡ of ,.I.t., wl1..loi for Lie, 11 ._ owl.. 1M.. ..... ......, ...... .............
iii. Touls (U... 1101 Urv 1I ,I.' i-)(Lle. II -) ..........................................
.
B-122
NEPAOO
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 6 of 35
f... 13 ""HU STATIKT fOR TIt nA. 1"5 or lllt HOSPITAL SEAYlCE ASSOC. or R.E. PA
.
UNDERWRITING AND INVESTMENT EXHIBIT
UNDERWRITING INCOME
1
Z
1"5
I".
3t .IZO,iz4
I. '...1_ .'med (Port 1. Une 5, tol_ ') ............................................. .......... 3l.276,i5 .. 2. A. Chi. lii... (',rt 2. ll.. S. e.1_ S) ..t.f ..l...ren.. (S.:.. .... .......) ... .. .... ... .. UI.11 .52
311.'44,107
.. Ilrc... (doc"".) I. p..i.i.. f.r dd... ..ter.iiy _fits (Port 21, Un " tol_ 4) ...
i. U""5l1 lllrro ('ort i, LI.. 11),
A. Clt," .dj.,t_t ... I. Ad.fnlnr.ti.. ....... C. Sollclthig ........
I3,Sll,I07
IZ.7" .501
n.t4l,4U
12.150.716
tlS.65 ..
31,1!.7'7 .. .. I.lIS.au
1.39I,i03
404 .34 411
to 1.IM.ranee Ill..AC. ..,.c w aptriCKI "tV" ...............
5. Totol __Itl., dcilou (Lt... Z tàh .) ....................
i. ki ..de_hi., pin or (lon) (U.. 1 ollIS Lf.. 5) ................
INVESTM INCOM
7. i.t i.fts_.t 1.._ cornd (P,rt '. Lt.. 14, tol_ I) .....
... (7,'14,167)
15.Z54,270 .... 13,_,714
i. i.t ...lIzed ..pllIl .olns or (1_.) (Pert lA. Lf.. 10. tol.. iJ ...............................
1.'13.SS1
Zl 474
t. Rot 1.ft.i-t pt. or (loss) (Uno 7 pluS li.. iJ ..................... .......................... 17 ,06 .ai . ... 13,_.i.
OTHER INCE
10. Ilt ,o10 .r (iossJ ,.. o,..ts' Of '..1.. hl.octs ....,.. 0"
(_t ...... 5.. ..... ......... _t ch..,ed ." S. ...............) .....
11. ....t. wrlt..i.. for oOer I.. ....
U55.HS) . . . .. U.. iu
.. .... n.Z_,U3 ..... 1.731,'"
.. 10.170.1O
544 117
IZ. lot ..I. or (loss) bef... fedrol I.. li... (Ll... I . t . 10 . 11)
13. Fedr.l I.. l.. 1-i ...... . ..... ..... ..
.
14. llt ,.1. .. lloss) (t. Llc. II) (Line 12 .1_ Llno 13) ..
RESERVES AND UNASSIGNED FUS
IS. itl.,... OI' ..isl..' f.lli 00_ 31. ,...10... !'r ('." 4. U.. zi. tol_ z) ..'
ii,1n,711 ..... 5.117,$1
.. 15,m.104 '" 111,5I.I
GANS AND (LOSSES)
U. ht '.1. or (1...) (f_ U.. 14) .. .. .. ..
..... 13,IZ,711 ..... 5.111.551
17. Itt ,"...1"'" .oplul ..I.. or (I.....) (,... ... .Llne 11, Col_ I) ..
II. Ch.... I. _.dotttd ....u (Wlblt Z, Uno I. eol_ 3) ... ...
11. Atre,t. ."th..ln, fOT d\es te rest".. e"" un,,",. r.nd ... .....
lo. e..... t. ro..."u .. .....Ipo ,... lor tht 1"'" (LI.. 11 th..h It)
,,1,17,1'" 21,73l,zn ..
.. 1'.12.10
.. 57 .'lI.711
m.m
115,514.IIU)
1 in 7ll
~'.33.751)
. .. 15a.ZZ.I04
U. IlI..S so _"'fl fun. Ool-r 31, ci..t lUr (Ltc. 15 ,10. Uno ZO)
. .. iu.Il,1l
mAIU Of IIRITE,JIS
.. ... (155,36) ..... (141.35) 1101. MISCIUMIl lil" ........ ............... ..... .................. ... ......................
1101. ........... ................. ..... .............................................................
1103. .. .. .. .. .. .. .. .. . .. . .. .. .. . .. .. .. .. .. .... . . ..... .. .. .. .. .. . .. .. .. .. . .. .. .. .. .. ..
IIt1. _ry .f ..1.1.. wrl,,-i.. for Ll.. II i.. oyrfl.. _ ...................................
II". Toub (li... 11'1 il 1103 'I.. I1t1IlLl.. 11 .lltJ ........................................
. .. ... (155,31) ...... (l4I.3S)
19O. lET lJUD TAU . -rAlLE SlOlITU ........... ......................................... 1l. POST Iinlll IlICAL IEJIFITS . 1ISm_L ..... .............. .... .... ............. ....
1!I3. oiFEiaED TAl i~ s.'l of ~.ftl'"ASET ADlI ....... ............................. 0" .0.................. wrt...f.. fer U.. U 1.. ..rnew,. ..0... ,. ......................
.. . 21,210.171 ...zt
:.: ï':~s.zij ::: ::.~~~~~~~.
.. 191. T.l.1s (Llnos 1101 ~rv 1103 ,Ius l"'IlLt.. i' .llc) ........... ............................... 1I.l5._ .. '" 1 .Hi,,.2
.
4
B.123
NEPA01
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 7 of 35
F... 13 AlHUl STA1IHT 'U TIt TW 1"5 Of TK( IISPITAl SERTICE ASSOC. Of'I.E. ,,,
.
CASH FLOW
I
2
I'~
I"'
2. Chl....d.i.I.."j.._.I........ ....................... ................. ...... 375,Cl.771 _,lI,ia
3. Uno..IU., upOSCI paId .......................... .... .............. ........ ...... .,242,50.... 10,7I,_
i. Pre_... collect" Mt.f "'....r.ne. ................. .......... .0. ........... ....... 4!Z.50.1l 4Z',7IO,m
4. Otlir _I,In, 1_ (ap..su) .... ............................ ....... ..... .... .. m.4I ... !7 5I
S. c:i" fre ulJrwrhtni (Lt.. i.. ,"i.. i - Lt.:3.. Lt.. '" .' '. ...................... ....... ....31.12,01 Z.._.IO
.5. 10..11_., 1_ (nel of 1......1 .......) .............. ......... ...... ... ..... 15,15,Z56 .. U.ZI5.1i
1. Ot~.r h._ (....) ..... ........ ........................................... ......... (14.311.ZI8) .. (J,I57.H:)
e. '.d...1 1_ tu 1..ld) re.....d .. ........... .................................... ........ ... is.7t.IOI '3 Z5 J!
,. N.I ...~ ,.. oprall_ (LI.e 5 . ll.t I . Llno 1 . Line I) ..................................... .... 34,67'.515 .... ..1_,113
10. pFV f.. tavestoll saId. ..t...~ or I'ld:
10.1 .. .... ........ ........... .............. .... ................... ........................... ....
12 .iil.ZI
. . .. 18,1,OO
10.Z 5t""'" ................................................. .. ............ ..... .......... ..... ... .... 11.64.27
.. 11'-._
10.3 li"'.... 1_ .................................................................. .............. . ......... .. .............
10.4 loil lI"to ........................ .................. ..................................... ................
10.5 eolloi.",i 1... ...................................................................
10.' lir 1M.lud a.,.ti ................................................... .......
10.7 leI ioins or (losses)l/ cosh ond Shrt-io..lovui-u ....................................
.... (i.18._)... 5,",,11
10.11 NIsc.ll_ ,nitos ............. .......... ......... ......... .............. ..............
lD.t Toull.'I1"" ,-n. (LIne 10.1 tJ.. ID..) .................. .........................
II. Dther cuk _Idad: 11.1 /lt transfer f.. offlll.les ...... ......... .. ........... ..................
11.2 .... f_ re.l_
....... '..
26,_,51' .... D.4I.11
.
11.3 CapItol paId I. ...................... 11.4 Sulus paId In ........ .............. 11.5 Otc. _re.. .......... .... ..... .. ...........
11.' loW Olll. cult _i... (U... 11.1 UN 11.5)
IZ. Tolol (LI.. . . LIne 10.' . LI.. 11.1) .......... ..
... II.21D.D3I. .... 71,.,740
13. Con.f I..._to ....... (1..1... onl,):
13.1 ...s .... ..
15,01 ,7Z0 ... 10,411,114
IJ.2 Stoe'" .... ..... ... ... ..
1'.31,_ .... 15.75,U1
13.3 ","''''0 I.... .... . .. . . .. ..
IJ.4 Illl in.t. ..... ... ...... .....
13.5 Collite",1 I...s .. .. .. .
...... ................ ................ .. ....... 55,51 .. .. 1,10,42 ..... .,. ................ .......... ....
.'
13.1 Oiher I~n.d UMII ....
13.7 NI...Il-lS o"lIcoilccs ........... ...... .... .... . ... ..... .....
13.. T.t.1 I....i-i ....1.. (L1... 13.1 t,, 13.1) ......................
....35,ODS,.
411,51
...nZ.1I4
214,1)
II. OUlr .... 0"11",
14.1 In irlllc" 10 itlillo\.. ....
11.2..". lun. _Id ....................................................................... ................ ................
14.3 _. 1f1I.ill... ....... ....... ................................. ............. ........ ..... 7.U5.ZQ :I 1114 zt
10.4 ratol ather t..h i"it" (U... 11.1 "' 11.3) ............................................. ... 7.701'- .. ".m P3
15. Totol (ll.. 13.1. U.. 14.4' .................................................................... 4Z.7I1,4"... t7.C1110
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NEPAOO94
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 10 of 35
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UNDERWRITING AND INVESTMENT EXHIBIT
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Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 11 of 35
Fo.. IJ Al-l STA1EHII' FOllM( TI 1n5 OF THE HOITAL SERTICf ASSO. Of I.f. 'A
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NEPAOOOO
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 12 of 35
Defendant's Exhibit # 11
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Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 13 of 35
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Pre."' Finn's na (or .. I E.I. No . Use On :: .:~) ,. .. MI SQ. Wllkes-Sarre, P.. 18701 I lJ Cl .
Ca No 1145
,. ~ Of ol V o. ,. TiI :=' ~ rl¿i 0,. ~ ~ '~A.I~\o.-~ I~o 1177 : 4a~;; B.130
NEPAO12
/
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 14 of 35
IIIT SECE AS'lOI OF It.. PL.
m YE El 12/31/1)1
m '~151n
Fa 1120, PlGE 1
Ll 26
1I. SIvia
00 TTlft EL'lOR
_cm DIOI: 1ll CO'r lI m' SECE
1,73,88
0
0
ISfiOl
or 1.1. PL.
1I II. ~YD II
II or
cu,DC.
(46,07)
(98,184)
lI cw SlCE
iaci IE SECE
1,73,093 98,184
16,190
43,672
II lIDP EI E(
'.VE
1l, Btll, lI Ic:'I(B
(1,12,36)
(55,22)
1,12,36
35,194 32,628 70,07
104,871 37,618
SO,700
35,194 34,145
25,04
3,918 28,175
73,70
. ora S1
II DI tm MI
'1
LI
IlDrIZlrICI
!l plIr.ui EI
104,_
37,618
(29)
(92,26)
(5,514) (43)
64,2O
196,099
ii lI mu
SU
65,169
29,73
rn ,54
45,070 26,616
49,390
17,81
31,501
19,816 6,695
84,11 68,76 13,89 22,18
30 ,'!
(45,42) (33,37)
(140)
80,878
57,53
109,141 113,659
79,45 43,22
16,961
52,64
10,95 103,i9 10,79 63,02
75,55
61,475 13,768
30,597 754,55
61,475 13,768
SIVICI CI - :o PL BU
DJ DEmt - LI FE
!I lE EI
RI 'l HE
IC
'l
CL LO
sii
IJ mEI IIICl ClP D1
re 45
ii CI - SP ØI
28,33
13,06
173,40
0
28,32
13,06
173,40
(98,239)
98,239
7,53,62
547,196
48,12
7,53,62 49,07
19,94
80, !l1)
HI'l IDCl'lIOi EI
DID PBO
POC IELll'ca
34,22 8O,m 13,36
14,71
13,36
22,84
22,84
59,98
59,_
6,00
1,13,774
41)1,782
6,00
1,13,774
491,782 33,770
QOMJQØ IS CLI
33,77
B1 DP PlCl nr
iaci DICi DPI!
9,60
24,395 4,085
9,60
24,395
4,08
4D,210,02
42,159,52
10,347,08
44,901,101
(3,780,152)
17,94,50
29,610,28
SPCI DIICI 0J S£ 8J(h)
10,3,081
42,37,77
753,::
5c.t. eJoJ/e
AJo, il6
B.131
NEPAO29
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 15 of 35
Defendant's Exhibit # 12
B.132
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 16 of 35
OMB No. 1545-0123
I.
I I
r
c~~ 1120
:.DII..1 Oiin. T..ur
u.s. Corporation Income Tax Return
For calendar year 1 992 or iax year beginning .. .. . . ... ,1 992. ending ...... _ .. ,19 .. .
.'e~ Rfu. Sile
~ Insructions are i. ra.. See øage 1 lor Peperwork Reduction Act Notice.
A Chec" 8: Use , ; I COllicled reum ct IRS ;8l1h Fon 8511 ia label. f
iZI Pe~cn hOØiIl co. 0 Other. Nu Ilr. ~ IÇlm CI SUlle no. ¡If a P.O. bo.. s" Dage 6 of inlliUC1io.1
~~92
77
B Employer idliflc.t1on rir
iJIØO ,n Tomoll print cora.CIIOWt; Slate. ana zip COde (. P-ii Slce or I C~y P/~a~e 70 S"~ u
. .'. 2 Cost 01 goos sold (Sc;heule A: line 8)
o u .5
'InlC Sch. PH) ~e :l '" t
::,;~':~::'4T-O tye. Ik". ire. " "
1. Gias receips or sales I Vir 9-l, '1V51 I b les reiums ana IlIowaCII ¡
1:;..1/
in adnt
E 'Cheek 8Cablt boes: 11 0 Inilia ,.iu.rn 121 Finsl ,.turn ,31 0 C
-0-
$
. c Bal ~ 1c
2
3
3 Gross profit. Subtract line 2 Irom line 1 c
I
I
I I
e
..
6 Grossrets.......
7 Gross rcllles. . . . . '.
8 Capial gain nel income (attich Schedule 0 (For 1120))
5 Interest. . .
4 Oivdens (Schedule C. line 19) ,
4
5
6
II Net gain or (lo) frm For 4797. P8I11. line 20 (att For 479n . '. '..' "0')'
10 Other Inco (se. instructionHtt sd1ule) .(re.. f"~.J../., ..u. '_'
11 Tota/lncome, Add lin 3 thrc h 10. .. .. . . . . .
,
.~
7 8
10
11
,;
.6
Y
12 Compensation 01 offici,. (Scheeule E, line 4). . . . . .
, g
¡ " 15 Bad debts . . . . ,i. n. O. . R r.l r:.
~~ Rents . . PARENTE, RAr;QeLPH..IJRL.:'H)O,'
-014 Repa. COpy ""on Y' 'U . ri Lr138 Salari and wages 1/'( 'la., (;"'7 I I b Less jobs çreil
I c Balanc .
12 13ç
14 15 16 17 18.
111
17 Tax,. . , , , CAREY 8i ASSOCIf\TE:' . .
Il
'\ .I
I
,
I
I el 23 Aø. . . . .. . . .
22 Detio . . _ . . . .
24 Pen profit.shang, etc., plans .
27
l ~ j!
18 Interesl. . . . . . . I'i=imi:l i: øiinii!" 4f'r.irNTArr~'
11 Chata contrios 1- lnltt'l fOlItulM '. , '.
20 . Oetlo (att Form 456 " . . . . . . . . .
21 Les depration cl on Scheeut A and ...wher on retur
28 Otdeduc(atllCheule). Séc. .S'rJtl..fl, 40,,~,
25 Employe befi prorams. .. .,..... _ . . . .
Total deueon Ad li 12 thro 26 . . . , . . . . . . . . ~
28 .. Taxbl ineme tiore ne opting ioi. dedllon an ipe deuctior Sublr lin 27 Ir lin 11
J
2I Le..: a Net oping 10 diducti (se Intrions). ~c. s;. ~.. a ø. Ii 'l
b I dlducloi (Schl C. line 2 2l I i'J i.
30 Tau 1_. Subct lin 29 fr Il 28 .
31 Total ta (S.. J, line 10) . . , , ,
!Ii . b. 1002' .._ee tai paym , .:.;;m'
32...; ii 1:1.' Mr CI to Igg.,
e'. ,l-.189 rw lK loan Foi ~"." ,(
I
ii e . Tax ,deed wit For 700 . . , . .
1 'Crw'io t.tii invent ~Ie (8.Fo 243'. . .. . .. 9 Creit foFe ta on fu (a Form.4136, SH iniNlos
~ 33 Esimled ta pe (_InINj. Chec:tlf For 222 .
l
I
attch
~~
3l 0Vrp If lin 32h is ia th lh /OIl of linN 31 ii 33 an.. II ovid, . Ii wa CNIt to 1l1 -l ta . '2 Re ~ 30 un i- ci . I dI _I,. NI.. i- _...iy _ -l lIlO 1h ii ci"" kn_ Please bt II IS ". ;r ~ ~ ~ 01 ~.1o tI lU IS bt an .. ~ ci wi pr i- "' Il
31 Ener 8I 01
34 Tu du " li 32h I. ii tl th tol of he 31 an 33, ener -i 0M . . .
I
I u.. Only
e~
Henf
Sign
,aiSl 01 oH ' o.' TIIf ~11o -. nu o. ci ,
.. lj ((,v..U ¡J~i...~. ¡,$ I ..
PN. ~
Fi'i _ (O
an -t
yo it..~
* FUlii.lC SQUAñE, 5TE '.0 't.7:.E.BAA FA 1
r. ., .
1I-l 0 : !- ~ :r 03/
E. No. ~. A94"
ZJi: ~
Ca NI 1141
,
B-133
41
1l
1,901
NEPAOO0201
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 17 of 35
I
'1OSI' SEVICE ASso OF Ji'. 1'.
fA lE ODED 12/31/
~
I
m 124-01517
FO 1120, PAGE 1
Lm 26
lIP. SERVICE
I
OT DECTOIS:
ca EL'fat ----~- or IU. Pl.
AOOI7 COmB AN En SERVICE
ASU'loi
iK HæOF IW ' lJ PEVIl Cl,llC.
6,53
447,13
2,ff,09
o
(618,797)
I
IWGED CW SERVICE MEICA REEW SERVICE
(805,09)
(1,419,416)
(77,156)
(115,402)
(335)
o
BO, JlDS, AN lSSOCTI
I
382,22
395,622 114,978
2,237,22 805,09 i,419,4l6 382,22
381,374 113,707 72,614 47,582 472,790
'lYE
MW mi EJ
EQOIP ElER!
61,22
71,087
1T! ,089
I
PR
ED . Il EXEN
n ,94 47,58 649,54
30,184 1,271 49,645
OFCE SUPLIES
I
TEEP
Ie
I
IW
DICB DEAR - LICEI FE SECE CRE - DI PL BU
IW CHGE . SPEC GROU
LEG
Il
DlCE
MIS
PO ii E1
SUOlS
44,04
105,40 96,074 732,95
105,639 212,567
(22,86)
411,29
63,521 912,749 596,109 55,485
106 ,44
34,24
34,528 106,058 58,639 23,337 47,113
(26)
(59,53)
(39,494)
(SO)
21,375 7,615 8,801 117,702
i6,817
34,25
816,036 122,736 23,741 Z18,697 16,102 196,628
o
34,25
816,03 12,736
23,741 Z18,697
59,05
I
Il EXElU
16,102 196,628
(1,289,449 )
imiCI CIl'fal ElOS
I
IWIl FE mmE
1,289,44
11,198,576
SEl
AIOI F0 452
11,198,576
389,06
49,501 115,839 25,521 91,014
ff , 50
I
l
ooI' asCE CAE IW
imiCl DIR ElERSE
lCC DATA PROC
1I'l EO'lOI RE ElEI 'ry HE
PUBC RELlnOl
301,56 36,9Z 115,63
25,521
12,581
91,Da
58,29
26 ,26
1,494,902
58,29 26,26
1,494,902
1,02,133
85,562
1,021,13
85,562
J
ci LO
I
PRIOR FES
MAL
BIL EX
7,66
13,651
7,66
13,651
21,34 413,83,06
21,34
38,955,751
28,876,317 "
Ø,53,26 ~ (4,447,85) 39,921,074 45,24,86
817,182
I.
I
,/,
s:~ecv/c-
Në),
a'
B-134
NEPAO218
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 18 of 35
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 19 of 35
Defendant's Exhibit # 13
B-135
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 20 of 35
Fon 1120
OM No. 1545-0123
1993
I
15,173,00
2.85,1120
10.88 25
5520
I
7fSm 38.2
I
12 88.273
5C7 617 Sl
1,037 088
187&78
I
27.48
4 27 ,e01
1 313148
I
1 2S 175
1 1 27.024
o
n
.
434.274
44 811U83
1 5a e1e
38lI
478.l5,711
.108.201
1 757 788
87.35 43 1e 873 31
.
.
t
n
p
y m
17.278.80
o o
40 40
o
o
B-l36
~
NEPAOlX24
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 21 of 35
I
I.
I
FORM 1120, PAGE 1
UNE211
HOSPITAL SERVIE ASSOCIATION OF N.E. PA TAX YEAR ENDED 12/31/93 E1N #24-08151n
HOSP. SERVICE
HMO OF
UNIVERSL
MANAGED
CONSOU-
I
I
OTHER DEDUCTIONS; ACCOUNTING AMORTZATION
DATED
EUMINAllONS
ASSOCIATION OF N.E. PA.
NORTEASTERN
PENNSYLVANIA
CARE.lNC.
12,000 154,167
87,500
2,723, 678
12,00 66,68
81,1117
AUDIT, CONSULllNG, AND EXRNAL SERVICES
BOARDS, BUREAUS. AND ASSOCIATIONS DATA PROCESSING EDP EQUIPMENT EXPENSE EQUIPMENT EXPENSE
2.08,895 39,885
1,9C,126
60.689 100.987
(74,729)
(801)
4,200
399,885
1,06.126 .
80,889 100,985 12,909
169.1215
I I I I
74,731
HANDUNG CHARGE SPECIAL GROUPS HEALTH EDUCAllON EXPENSES INSURANCE INSURANCE DEPARTMENT UCENSE FEE INVESTMENT EXPENSES
LEGAL MAINTENANCE MANAGEMENT FEE EXPENSE MEALS AND ENTERTAINMENT MEDICAL CAPITAllON EXPENSES MEDICAL DIRECTOR EXENSE
12,SI
8,548 210,184 20,379 313,706 244.783 956.035
0
8,54
41,MO
20.379 311,123 205.005
2.58
39.n8
3,282,457
3O,411l
856035
(3,292.1l73) (728)
.
I I I
I
I
MISCEUAëOUS
OFFICE SUPPUES
119,221 18,370,164 2.700 189.218
119,949
HU70. HI4
(37)
44.810
967.426 681,318 68.172 1.189.753 49,574
2118,878
POSTAGE AND EXPRESS PRINTING PUBUC RELATIONS
(178,047) (77,496)
142,020 636,897 893.659 395,840
2.700 47,235
90.65
1151,2lS
285,478
611172
1,189,753
41l,574
288,1176
QUAUlY ASSURANCE
SEMINARS SERVICE CHARGE INTERPLA BANK
SUBSCRIPTONS TELEPHONE
TEMPORARY HELP
147,619
(2.880)
102,281
48 1 08
70,909
(55.93)
(38,97)
672.142 624.495 335,829 379,107.251
388,246.2112
TRVEL
UT UTI ES
6l,170
33,829
41 Il. 1 !l3.3!l9
37.374
91,780 37,874 102.572
39.04.108
118.057 .35e
CLAIMS LOSSES
TOTAL
447.815.563
(3.722.671\
341l11l
I
I
,.
S'cl- l)I,L~ tJo. ~ b
I
B.137
N EPA()
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 22 of 35
Defendant's Exhibit # 14
B-138
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 23 of 35
Form 11 20
oeparMnt of... T..ury
u. S. Corporation Income Tax Return ClI1I Fa' c: Y' 199 a' - YM beln
ol_on.._
Che H a:
Ne
70 NORTH MAIN STREET
. Se
--
OMB No. 114.Q21
No.
C Di Incpa ,
24 0816177
.:'994
S Employ iden, iu
1 Consolidah retn
2 Pellne hoing co.
HOSPIAL SERVCE ASlAll OF NORTEA Pi" Numbe. ii_. an roo a'.ui no. (If a P. O. bo _ p. 6.)
Cit Of to, ... an zip co
3 P8ne..ce
(at Sc PH
D TDl.. (s1~)
SEPTEMBER 7,193
WILKES-BARRE PENNSY VANIA 18711
E Che applile bo: 0 Ir1 renn 0 Rr renn 0 ci..iioi._ $ 414,818,521
,. Gros. receipts or .al.. 525.725,822 b i. r8tlllS 0 c; Bi 1 c 525.728,82'
2 Cost of goods sold (Schedule A. line 8) . . . . . . . . .' . . . 0 . . . . .. ....,. 2
3 Gross profit Subtract line 2 from line 1 e . . . . . . . . . . . . . . . . . . . , . . . , , . 0 . 3
n o
o
m
.
4 5 6 7
Dividend. (Schedule C. line 19) . . . . 0 . 0 0 0 , . 0 0 . 0 . . 0 . . , . . . Interest 0 0 . '. 0 0 . . . . . 0 . 0 . 0 0 . , . . . 0 0 0 . , , . . . . . 0 Gross renls . . . . . 0 , . . 0 . . . . . . . 0 . 0 0 . . , '.' . . 0 . 0 . Gros. royaltes 0 . 0 0 0 . . . 0 . . . . . . . . 0 0 , . '. 0 . . , . 0 "., 0
. . . 0
, 0 . .
. . . 0
. . . .
0 . . .
.. .. .' ..
4 5 8 7
8 Capital gain net Income (atlch Schedule 0 (Form 1120)) '.";' " . . . 0 , . . 0 . . . . . 0 0 . . 0 8
9 Net gain or (Ios.) from Form 4797. Pert II. IIns 20 (atlcf Form 4797)' " . 0 . . .'. . ., . ..'; . . o. ll
10 Other Income (..e initructloni - attch schedule) 0 . . . . . . . . 0 SE SC6)UlNO, 10. , . ., to' 11 Total income. Add line. 3 throu h 10 . . . ..... . 0 . . 0 . 0 . . . . . .t'o " '. . . . . . . . 11
12 Compeniaton of ofcers (Schedulee. line
4) ,. 0COPYFOR,YOURFlLE.... U '1.048,43
11,879 4 844 283 , 1 478 061
13 Salarlnandwages(l..employmentcredlt) . . . . . . . . . . . . . . , . . . . . o. . . .' 13 HI988115
14 Repair and maim.nance 0 . PARENT.E,. RANDOLPH, ORLMWO, . . 1415 Baddebti . . . . . , , 0 . . . . . . .CAREY:& ASSOCIATES. . , . . 0 . . . 15
r
o 18
Rent. ......... ...0 'CERIIFIED.PUBLIC'AOCOliNTAN'FS'" 0..18
.
e 17 Taxe. and license. . . . . . , 0 . . 0 . . . 0 0 , 0 0 0 . . . . . . . . . . . . . 0 0 " 17
d 18 Interest . . . . . . . . 0 . . . . . . . . , . 0 . . to. , . . . 18,
u 19 Charl1le contributions (iee Ini"ucton. for 1 O'l limitation) . . 0 . 0 0 . . " ";." 18 ,;
t(\, 20 Oepreclattn (attch Form 4582) 0 0 . . . . . : . . . . . . ' .' 20 . 1.824.029 :
331S
110.750
21 L... depreciation claimed onSchecule A and eliewh-re on return 1a . .'.' 2ib
I
.1,524,829
o
22 Oeplettn . . . . . . . . . . . . 0 , 0 . . . . . . . 0 . . " ." .,...' . .... 0 22. .
o 28 Adverising , . 0 . . . , . . . . . . . .'. . 21
n 24 Penilon, profit-sharing. eto.. plani
s 25 Employee benef
1.187,48
1 131 0C
4 229 782
48932 818
28 Other deductions (atlch ichedule) . SEE SCHEDULE NO. 26.'; , . , .
27 Total deductions, Add lines 12 through 28 , . . . . . .'. . . . ..;. , , . , 28 Taxable Income before NOL deduction and ipeclal deducton.. $,bt.'ct line 27 from lÌne .11 .
29 Less: a Ne1 operallng 1018 deduction (iee Initructlon) . 0 ; ". ~.'. . . . , '. ":' 29a
programs 0 . . "." . . . " ' .... ....... .
524191.986
30 128 078
b S .cial deductins Schedule C. line 20 , . . 2llb
80 Taicbl. Income. Subiract line 28c from line 28
T 31 Total ta (ScheduleJ. line
1,9111.452
28212824
9,807 873
10) . . . . . , . . 0
. 32 Payments:
II a 1883 overpeyment cred Ited to 1994 0 . 0 . , . 82. b 1994 ..tlmated tax payments . . . . . . . . 32b c Lsas 1994 refund applied for on Form 4466 . . 82c P . Tax deposi1d wilh Form 7004 , . . . . . . . . .
.
y
f Ci.dit from regulal. Investent companle. (attch Form 2439) 0
II Credit for Federal ta on fueli (attch Form 4136). Seelnitructni
m
. 83 estimated tal( penalty (... In,"uctns). Check If Form 2220 Ie atlched
n 84 Tax due, If line 32h I. smaller thn the total of Unei 31 and 33. enter amount owed
.10 489,40 o o
581 733 o
Ii 38 Enter amount of line 35 ou want: Credited to 1995 eitimated tax 561 733 FW
u.___ 01 Ilry.
t 85 Overpayment If ii~ 32h 18 larger than the tol of line. 31 and 33, enter amount owrpald . 0 .
110 lNo con~~. ~ro'. of ~ 100i-lho.lUPClllo _.. on.. "'1_ 01 whic pn_ hi. on, -ci,
raue 20-84-7I . an adeu ZI co
Ar'i res E. I. No. 2S-1~
B.139
NEPAO674
S( nle of of Da ll Plepers Che If ae- Prspe. SS
1- _I ___tN... -*__yi coho-l __ 0...1..._ 01 "'..........."
~~ I 9/15/95 VP OF FINANCe I TREA8URER
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 24 of 35
I
I.
I
I
FORM 1120, PAGE 1 UNE 26
HOAL SEE ASIATIN OF N.E. PA
TAX YE ENED 12/1/9 EN #24-01J1 5177
CONSOU- ELNIN- ASll NORlEAR' MNGE SER\S
HQ. SERV:: l- OF UNIVRS A)
7.PI
69.711
11.111
DAlE AllNS OFN.E PA.. PENSVAN CAIN. INC.
80,82 4.23699 25.419
OTHER DEDUCS: ACCNTNG
AMORTI
7,Æ7
AUDIT, COSULTING, AND EXRNL SERICES
(441,o)
4,5222
255,4'9
152,05
(2
113,79
I
BOARJS, BURES, AN ASIATJS
DATA PROESSING
3,7067
I
HADUN CHE SÆIAGfOPS HELTH ED'f EXSES
INSURAE
INSURAE DEPARTENT LIENE FEE
EQIPMEN EXSE
EDP EQIPMEN EXE
24.M 4,40
57.314
244,701
97._
97,_
(157 ,8)
11 ,2i
3,69277
171 ,48
4,40
191,417
57,314
I I I
l£L MAIN EXENSE MAEN FE
MEDIC
NVESEN EXENSES
55.820 1,011,55
o 8O.M!
3l48
(3.78.73)
(1.94)
49.59
(137)
53,42
49,59 314,87
~.820
1,011.55
82,788
51,W 15.20
3,m,814
10,4E,718
9.104
1,02
MEALSAN ENAMEN MEDIC CAATIN EXSES
MISCELlEOS
DIRER EXE
10,48,718
OFFE SUPPES
POAGE AND EXRESS
55318
U72676
1,132325
1~23
o
(315,476) (153,747)
88,84
749,447
1,18097
473.163
ll,8S 121,347 34,44
lJ1 ,217
0
PRNG
PUBU AELATl
QUAUT ASRANCE
SEMNAAS
139,38
971,217
(8.41)
ll,lI 139,38
116,11
103,011
Ie
I
SUBSPT TEEHELP -rPORA
TRVEL
SERE CHE INRP BAK
273.*
204,SI
789,967
116,11
75,~
(2.38) (40,15)
(7,30)
UlUTES
CLAMS LOSSES
972.411 507.528
273,* 104.34 63,04 823,_
507,528
198,42
1ll.34
79,515.69
75.55
48.817.93
48.325.813 (4.914.58
381.lD,247
TOAl
39.2l.l5
100.8.150
8.81
114.8IB
I
I
I
I
I
I
,.
I
SCH~()L AJO. ab
B.140
NEPA07
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 25 of 35
Defendant's Exhibit # 15
B-141
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 26 of 35
.
0"._1 01 Ili T...-
Form 1120
U.S. Corporation Income Tax Return
For calandiir y.ir1995 ortixy.iirhiiiiiiing . 1115. ."diiii 19
~ Instructions .ri II irili. S..- -.-; .1-f-.; P; -i~ork Rldiicli;n- Ã~1 Ñ;IiC-I~ - . - - -
I~.. ao_ s.... _I A~iIE "I.il IY H 1 c._Ioi
lal_'..1S1I tA
tot.. Sd ri
2 'IrH .. -0
.... nc 1.441-T
B i..'. iøUCiClii- .1I
i r:..lI~~ D '..._..1.._ 10'__1
E CI ii- _IS III Cl .,_~i
_ iiio
ii. C D.ii lnltod
11..::'" i:8Il~ 1c
8 Cipitll gein n.t income letuch Scedule 0 ¡Form 1120)) . . . . . . . . . . 8
9 Net pi or lloii) from Form 4791. P.t II rine 20 Iiittich Form 4197) ............... 9
2 Cost of go sold (Schedule A.Ii. 81 . . . . . . . . . . . . . . . . . . . . . . . . .. 2 ¡ Gros profit. Subtriict II. 2 Irm Jl 1c . . . . . . . . . . . . . . . . . . . . . . . . .. 3
. Dividends lScldUl C, line 19) ........... . . . . . . . . . . . . . . . . . , . . . . . .. ... 4
g & Gross ,enti . . . .. . . .. .. .. . . . .. . . .. . . . .. . . . . .. . .. .. . .. . . . . . .. e .. 7 Gross royilti . . . .. " .. . . .. .. . . .. .. . .. .. .. . . .. .. , , . . . .. .. .. . . . . . .. . . . . ... 7
; 5 Interest ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
10 Other inome I... pege 7 of intructions' eUlch icedulel . . . . . . . . . . . . . . . . . 10
11 Tot.lm_oiie. Add lines 3 throu 10.............. ................. ~ 11
. 1Z ComenSltlon of officers ISchedle E. lina 41 .......... ................ 12
113 Sillrie Ind wiges (Iiis eIplovmint credtil . . . . . . . . . . . . . . . . . . . 13
: 14 Riieirs an miintenence. . . . . . . . . . . . . . . . . . . . . . . . . .. I'
i 15 Bed debts .... . . . . . .. ....................... 15
:; 1& Rets................................................. 11
.
= 17 T.xis .rlicen.s ..."........."............................. 17 ~ ,. Interest................................................ 1.
i 19 Clriteble contrutions (see pege 9 of instructloll for 10" rlltltionJ ....... 19 i: ZO Diirecletion Iittach For 4512) ................ 20
.! 21 Less ilreclttion delied on Scie A and e1sewherl on rell Z1a
. :22
Depitlon ....................
i 23 Advwtil ...................... t " . " " . " " " " . . . . " . . . . .
: 2& Employ.. bent progrims .." .. . .. . " . . .. .. . " " , . . .. . " . . .. . . .. . .. .. ..
; 24 Penion profit-shlrinV. etc., pli ......... . . . . . . . . . . . . . . . . . . . . . . . . . . 1
.: 2& Other deduction (enict schedia) ..................................
-¡ 28 T ixab.. incoe before net opitig toss deductin and splåll dedctlOf.
i 29 L..s: _ Net operiting las deductio (se. p.ge 11 of InstrUCtJoi) Z9.
! 27 T otil didii~IDns. Add lines 12 though 26 5
30 Tixab.. incomi. Sutnct ... 29c from Ine 2'
~ b Siecil dectJa (Schidui C. li ZL' ........ Z!lb
31 Totll ttxlSdecl. J.lile 10) . .
:. . Tix depited \Miih For" 7004 " n.
i i Credit from regul'tid invastlent compani (attach Form 2439) ... 31'
_ 32 ::=l ::.. II ins . 32. ¡ b '.1 ii.nt'" iu,. ,,32b E '11'11 f....ii... ip . . 3Zc ~ il i. 1"5 . . .
11 861 733
i- 33 Esiimtld tax pinaty ts.. pei. 12 of ..truction). Check If F_ 2220 Ii IUiih.d .
34 Tix du.. If line 32h ii smaller tha the toiil of Dnes 31 Ind 33 ent. emount owed
:: II Credit for Feeril tix on fuel (ltiich Fo 41361. Sei intructions . . 3Z
35 Overpiym.nt. If line 32h is 'irger thi ibe totll ofliei 31 en 33. enter imount oVlrlid ..
.
nA
5Ç II
3& £nt" _I 01 iN 35 you Wil" Crodilod to
Sign
r'"ia 01 prip."11 ..ii_tid tix ~ 234yad 6ii..en... 0 knw. IUm.mc I.. ,..p"orl it ~ 1f iil-- 01 SV ..-" .. g ice 4621If.dI. wli FINCE/TRUR be.i. II (olh ..
0.11 r TIle ~.
lJcld
Here
Paid
.... '(,S- y7f EI ~
1'. ......
Prip.,Ir'S Uii oiily
.. /7/0
NEPA03
B-142
.
HOSPITAL SERVlCE.ASllON OF N.E. PI. TAX 'YAR ENOE 12/11\5 EIN .24-0815177
.
EARN
INC.
.
402,4111 01,1187
FORM 11211. PAGE 1
LINE 211
PHICIANS UNIVERSA UNIVESA HOSP. SERVICE HMO OF UNIVERSAL AXS MANAGEMEN MANED MAAGED CAE EASERN CONSOU- ELIMIN- ASAllON NORTEASTN MAGED SEVICES SERVICES CAE HOLDING REA ESTATE PHYSCIS
DATE AnONS OF N.E. PI.. PENNSVLVANA CAE.INC. INC. ORG.JNC. COMAN INC. COMPANY.INC. GROU.
O'ER DEDnONS:
1li,8
4,750,710 (7114.00)
o (402,4111)
ACCONTING AMORZATION AUDIT, COSUlTIG, AND EXERNA SERVICES
21,1li
4.200
112,102
3311,8
o (1,40,102)
84,032 4,726.101 277,573
o
737,511 133
24,llDl
1,40.1112
BOARDS, BUREAUS, AND ASSOQATIONS DATA PROCSSING EDP EQUPMENT EXENSE EQUIPMENT EXeNSe
204.140
451,t
o
301,475
(211.101)
Case 1:05-cv-00503-TCW
HeAL'1 eDUCTION eXPENses
(5,84)
(3,178)
4ll,l1i7 501"24
8,832
204,140 i 57.e25 o 241,405
",734
o
3,2711
3,178
INSUANCE INSUANCE DEARTMNTUCENSE FEE
21,01
1411,444
211,11311
2f1,l
2,5113
INVEENT EXNSES
1.711
315,128
217,3111
2111,732
LEGA
o (e,121.182)
MAINANCE
11,244,35
300,472
213,3 217.3
101l47
14,S1I1,8111
MANeMENT FEE EXENSE
1711,355
MEAS AND ENTRTAINMENT
105.17
14"51 ,115
MEDICA CAITATION EXPENSES MEDICA DIRECTOR EXNSE
2,700
17,111
MISNEOUS
1 ,1l711.a3
2,70 2"70,28
l,3l2,8
524,117 5711,32
30
13,170
111,885
3,585
111.522
1,045,71
1,1120,411
OFFICE lIlES POSAG AND EXRESS
Document 30-4
PHAMA PRICE GAURANe
11.H.f
11.H.534
30,200
431,1111
1,1111,l 1,1I21,l
410,240
(5.15e5) (11122 (!11,11l)
24,474
583
lI83
PRINNG
738,3
1.li,172
38,141
o: i
,.....172
434,714
~
1,417,3li 1.417,3li
13l,81111 (1311) 121,540 15,1111
31,841
PUBIC RBllONS QUALIl ASRANCE
W
SEMINAR
SlRVe CHARGE INTRPL BANK
SUSCIP10NS
180 o
1,3811
TELePHONE
1,787,001 (1,200 1,454 358,720
TEPORY HELP TRVB
450,1l 4!1,II80
1,20
130
UlLmES
ClS LOSSES
483,252.781 3112,71.25 80,411,&33
842,411 (731) 1172,142 2118,021 0 782 738 2.010,047 (1,134) 2,002711 0 1,781 1,54
Filed 02/28/2007
TOTAL
fI3043 113 f1 I 111 6031 310.fllll21 131111 0C 17.8 304 702 i 213123 0 0 02311
Page 27 of 35
z
I
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 28 of 35
Defendant's Exhibit # 16
B-144
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 29 of 35
OMB No 1S41z:
u.4orporation Income Tax Ret.
Fonn 1120
i-i oIll i-viy
II.. Awii Sclc
fc
CIyw
1. .l-)W-i 1~ ..
70 NORTH MAIN STREET
stte, and zip CC
,11_
EXTENSION GRATED TÓ 09/1~797
~ Instrctl n ii rat 8 for rt d ct n A N II 8
1996
B Er_I_...i,,_
A Ch8Ctn I:
(a Fc eii e 1 2__hoInClUl QoIo ni rv 0
~mIHOSPITAL SERVICE ASSOCIATION OF NORTHEASTERN PA & SUBSIDIARIES
I'mbei. slll.and room or suli no. (Ill P.O. bo Sll pagi 6 of InluttS.)
24-0615177
C 0- iii-
'l-8cPH 3.. _ ai
09/07/1938
D TOI =. I 01
ludellnT"" D ~ i- 1.441-4
City or tow,
1Io-i-plor_ 17 ,471. bi.__II_ cBaI~
2 Cosl of good i sold (SchlCuIeA, rin 8)' ...................................................................................................
IRlla' fium 2 fi "ium
WILKES-BAR
412. 471.
572 171 471.
a Gios profl. Subtrct Un. 2 ,!om llni1c ..................................................................................................... 4 Dividens (Scheduli C, On119) .............................................................................................................. Ii Inliiis( . ................ ................. ............... ............ .... ..................................... .......... ............. ..... ............... . Gios iinlS .. ...... ....... ....... ............... ........ ........ ............ ...... .......... .............. ......... .......... ............... ...... .....
1S 727,615.
8 708 284.
3,432,695.
J
7 Gro rolt ....... .............. ................ ................ ............... ........ .................... .............. ............... ........... . Capll gain nallnco/l (allch SCul D (Form 1120)) .............................................................................
V NIl gain or Ooss) from Fonn 4787, PaIt 1I,lil 20 (all Foim 4797 ..............................................................
10 OIlr Income (i\tch sclCUII) .....,.s.s....ÇQS,.S.Q1JP.h.'l.S.P.....lN-.Ç.Q~...mP....p..E.p.gg.T-,l.QN-. 11 Tofilincami. Mil Dnis 3 throu h 10 ................................................................................................
12 Compnsallon of offCIis (Schedule E,line4) ................................................................................................
13 Salaris and wages (l1S empionl cIlIl) ..............................................................................................
14 RepaIrs ind mllnlenanCl ........ ............... ................ ............ ............................... ....... .............................. 11i Bad d.bt ................. ..................... ..... .......... ............. .......... ............... .......... ..... ..... .......... ....... ....... ......
111 Rin1 ..... ......... ...... ........... ............ ..... ................. ........ .......... ......... ......... ........ ........ .......... ...... ....... .........
1,424,180.
2,320 332.
44 5
17 Taisind IcenslS ....................................................................................................................................
18 Intirest ..................... .............. ........ ..... ..... ....... ........ ......... ........ ............... .......... ...... ....... ........ ...,.........
-Il
111 CliliIble contrtutons ............... .......................... ...... ............. .............. ........ ................... ..... ...... .............
264 784.
20 Dip"cIon (llt Faim 456) .................................................................. 20 2 , 839 671.
21 Les depreciation c1in on Sctidull A ancllSlwtlre on return ..................... 211 22 Deplellon ... ....... ........ ............ ....... ....... .......... .......... ..... ...... ............ ....... .............. ................. ..... .... ....
23 J\Vli1ln . ................ ...... ................ ............... .......... ......... ................................ ..... .......... .......... ....... 24 Penon, pro-sharing, etc.. plans ............................................................................................................ 25 Emloye binifl programs ...................................................................................................................... 21 Olhir deductions (Itlch schedule) s-1S.~...ç.QN-S-QLl.P.A~~P...J.N-ç.Q~~...~p....nEp.Qç.Tl.QN27 Tciil dl.actlons. Add lines 12
through 26 ........................................................................................ ~
28 2e
Q.
t
i .
2,500,000.
1 093,1
~
t
111BDI
Sign Here
Pil'
Pre.
~
SUITE 4000
1
ri~e"l
Only
11.21.87
JWA
)9560911
6882909
050 HOSPITAL SERVICE ASSOCIATION 0 68~
NEPAOO1065
Case 1:05-cv-00503-TCW
Document 30-4
Filed 02/28/2007
Page 30 of 35
HOSPITAL SERVICE ASSOCI~ON OF NORTHEA
FORM 1120
COMBINED OTHER DEDUCTIONS
COMBINED
AMOUNTS
e
24-0615177
STATEMENT 18
EASTERN
e
ACQUISITIONS & DIVERSIFICATIONS AUDIT, CONSULTING AND EXTERNAL SERVICES AUTO & TRAVEL AUTO AND TRAVEL
AMORTIZATION
HOSPITAL HMO OF SERVICE NORTHEASTERN
ASSOCIATION OF PENSYLVANIA,
PHYSICIANS GROUP, PC
208,542.
BC - DEVELOPMENT
COSTS
11,104,190. 3,506. 4,147. l08,709. 663,755.
8,670,334.
94,032.
2,433,856.
4,147. 14,677.
BC PERSONNEL AND
SUPPORT
BOARDS, BUREAUS AND ASSOC.
1,060,241. 259,456.
88,662. 23,321. 502,429,399. 243,924. 110,724. 284,122. 4,204,038.
259,456.
BOARDS, BUREAUS, AN
ASSOC. BUILDING MAINTENANCE CLAIMS EXPENSE CONSULTING FEES DRUGS & MEDICATIONS EDP EQUIPMENT
88,662.
, 349,543,937.
152,885,462.
110,724.
IPMENT EXPENSE IPMENT IENSE EXPENSE~ON-MEDICAL
284,122. 3,601,287.
602,751.
5,365.
7,862. 596,165. 379,587. 515,632. 319,444. 29,728. 1,900,918. 12,032,801.
19,179.
EQUIPMENT RENTAL- ,
JFFICE
BEALTH EDUCATION BXPENSE
INSURACE INVSTMENT EXPENSES
LEGAL
LICENSES IfINTENANCE
296,841. 446,594. 319,444. 29,728. 1,900,918.
596,765. 24,890.
43,168.
69,0311.
'iAGEMENT FEES
IiEALS AND
11,416,904.
19,179.
615,897.
:;ERTAINMENT
iEDICAL CAPITATION
~XPENSE
1EDICAL SUPPLIES
1EDICAL SUPPLIES AND
~OUIPMENT
19,248,833. 22,151.
19,248,833.
62,318.
22,157.
10.,504.
1EMBERSHIPS AND DUES
USCELLAEOUS mALS AND
~TERTAINMENT )CCUPANCY PLAN
6,428. 73,891. 977,009.
71,028. 758,6