Free Motion for Summary Judgment - District Court of Federal Claims - federal

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

II. hI .hon,. I~ tlsh en .lil-tc InrSl-nu (LIne 12 .Inu. Lill 15) ................. .... ....... 11,517,537 '" (U,_.IIl)

RECONCI LIA lION
17. C..~ an ..ri-te.. Incsi_u,

.

17.1 ..,han'., o( ien ........ ......... .". 17.l EM of ,..r llto. 16 . LI." 17.1)

7 .01l.6M

il.IIl.15
7.'iaAI

26,_,Z23

5

B-124

NEPA042

.
5

.
UNDERWRITING AND INVESTMENT EXHIBIT
PART i
I

F... ii -UAl STATOl FOI ni 'EA "" OF ,ii IOS'ITAl SElIC£ ASSO. OF H.E. 'A

2
3

4

Case 1:05-cv-00503-TCW

lid '...1..
'01 IntIS

Uae of luil.nl
Ais_~
(Col u...
D.cOIr 31
1'..1 IAJ I . Z - 3)

llro.i

,,'.....nc
Aclinirince

VrIU..
Currttt Y.a"
.. .. .. II ,159, 735

Ui.....

Un..rRed

5
7

RnerYl for

I
Tohl Relene

,.il...

".l.. 0.0_' 31

,
ror i-.ni

C....

"to C..dlt. ..=l::~'r.~~'.
an (ipo,i...

Pr.I... '"'
...... U,4O,124

(eoi_ 5 . 11

'r..l_

Pre.t.. b.... (C.l_. 4 . 5 . II

I. 1I.,i..i .. ....... -..........
..... 421,115,'14 ....... ..... -0. ..

-, .... .... ...

... 423,185,'14

...... 32.4155,103......

2. 11041..1 ...

44.Ji5.~JS .................... .......... ....... ......... ....... ...........,...... ................. .................. .................. .................. .................. ..... 3'2,276,6SO J. 01.111 .................. . .................. . ............... -..... .......... .................. .................. .................. .................. .... ............. ................. .................. '.01'.. ..... ....................................... . ................ ......... ........ .................. .................. .................. .................. .................. .................. I. Tolota . ....................... .... 1l3.IIS,464 ....... ... .. .. ........... ...... .. ... 423,185,414 ...... 11,40,714 ...... 11,851,735 ......32.455,103 ...... 4',311,131 ..... Jii .271,ISO .. ..... ... . . . ..

5. '.H..I (..i.,. N..l4h ....flt. P..... 'rot.. ...... .....

Document 30-4

t:
.. .

1. ..1... (C.I_ " LI.. 5.1... li.. IJ .. .......... '"
4l1,II,a71

....... ...... 14.3D,. ..... XII...... .....IIX..... .....XXX...... .....XIX..... ..... XIX ....

N
PART lA
1 '...1-

i

.....Xll...... .....XIX..... .....111...... ....XLl...... .....IIX..

VI

UNEARNED PREMIUMS
Z

In 'an.
......, 31
CulTsl ,...

Mallt .r or rHI llirnec

'..1.

I. ... ,..1_ ...
2. StI.....1 ,...1_ .

..... ........ ... ....... ... 31,741 ......... Z1,IU '" ..... ........ .........172.". . ....... iil,I02
.... 13."S,HI . . . . . .. 1,511.'"
. :... 21,013,1"

Filed 02/28/2007

3. C1rterly '...1... ... '" . ............... ..

4. ""thl, ,rol"l .. .............. ...........
S. A4...ncid ".t_i .......................

.... .. 3,l1,IU

..................

....... t 3M 110 ...... 'Z,I12,1I1 ...... 11,''',135

Page 8 of 35

.. Tokli ............ ............. ............

z '"

I ..

Case 1:05-cv-00503-TCW

Document 30-4

Filed 02/28/2007

Page 9 of 35

Fo.. U _UAL STAT""T FOR THt TtA Ut5 or THt IlPITAL SEITICE ASSO. or I.t. 'A

.
1.
Z.

UNDERWRITING AND INVESTMENT EXHIBIT
1

PART 2 - CLAIMS PAID AND INCURRED NET OF REINSURANCE Z J . Chi. 1l..1.
Curnt 1..r
(COI_ 4.
Pa..
ZA)

4

LI.. of

I..t.us

Chi..

Paid

Clol.. u.lild

I_mo
Z . l . 4)

Clol.

5

'reioui 't..r

(COL_

..... .. ..... .. ........ ........ .. .... ..... Hi,117.1O ...... 11.III.JIO "spItal 1l1..1 ....... ... ................. "......... .. .. ......... ........ .... .. ...

.. ..

... M.Il.ßO
.. .. .. ..

35.717.52
.. ..

i.
4. 5.

_r ... ..... ............... ...............,........
Totali

Ocn.. i .. .

.... ..... ..... ....... ... ...................

..................
.... ........
311.117._

..

......... ..,
" .. 11.1..310

......

..

........ ...
..
"

......................... ......... ....... ....

.....

......

......

_.UI,51O ..

3..1I7.5Z

PART 2A - CLAIMS UNPAID NET OF REINSURANCE
I

Lice of IusiMII

Ilru ChI.. i. "-II
Z

or

AiCSi-t

Io i-......

3 btf_i. Incur

4

eloi..
..

Totol

Uo Id

........ '................ ..... ......... ,.................. '... i. Molcal ........, .......... .................................. ......... 3. _tol ......... .. .. ..... ......... ............. ................ ....... 4. Otlcr .. ... ...... ... ... .... ......., .. ...... .... ................... louh .... .. ........ .... ............... .......... .. .............. 5.
1. Mospiio!

.....

15.44Q,732

......

70.745.571 .. .

.. 1I,ii,ilO

............. ..... ......... ... ....
... .... ... ...

.... ... .. .. .. ... ...

... .......... .. ..... ....
..

......

1S,440,nz

....

70.745.571

..

..~i.310

.
I.
MolpUol
"'die. i

PART 28 DEFERRED MATERNITY BENEFITS
NET OF REINSURANCE
1

U_ ., lust....
i.
4.

Ll..nfl7 Cwt '..r

Z

".1.. T..r

L1..f1lt7

3

~I.
4

L1..f1fl7

3. Otllr

.... .... .. "" .... .... .., ... ...... ..... ... ...

'.

Totols

'......,..................,......

..

..... .. ... .. ......... ... .... ... .. ...,...........

N

0

N

E

PART 2C - ANALYSIS OF CLAIMS UNPAID - PREVIOUS YEAR NET OF REINSURANCE
eiOl.
I
LI.e of ".hia.
Z on Clol..

Clol. lMid .. II .r eot
Poid Dol", tic '.or

Tear. .fi.: hil.i. L1o.nlti

'.Ior to Ji..'7 on Clol. i 01 eu..\ hor Ocll lhe 'cor

I..

_r II of _i To..
.

3

I_rr

on ei.i. Uiid

l
On CIa..

31 .:f cf:r.l':~

CI.i_ I"" __r
ToUI

I

7

to

~~~1130:'
ii... ii of:

bU..,..

~r 31 or ,"lOls '0..

DulOO

Incurr
Ui Tur

(COI_i

In 'rhir 'I_n
2 . .,

Pr.,I... 'iar

.

I. IIplUl ...... ...... 45,10 ,US ..... 315 .ie,_ i. ""icol ....... ...............,.. .. ............... 3. haul ........ .................. .................. 4. Ner ......... ............ .... .. . 5. Totoh ... ..... 45,10 ,its ..... i15.ie,J0

...... is.W.1O ...... 70,'S.SlO ...... Il.OD.ZIS .................. .............. ... .................. .................. ....... ......... .... ............. ..' ........ .. ... ..... IS , ZSS .10 ... 70,t3.510 II.l1.Zt

...... _.131.li .................. .................. ..................
.....
_,UI,HO

7

B-126
NEPAOO94

Case 1:05-cv-00503-TCW

Document 30-4

Filed 02/28/2007

Page 10 of 35

fon ii AIL STAT£INT fOR Tit TEA 1m Of Tftl HOSPITAL SERTICE ASSO. or ..E. 'A

.

UNDERWRITING AND INVESTMENT EXHIBIT

PART 3 ANALYSIS OF EXPENSES
c:01. MJust_, ~Inhtrat". Sollclti", . 1...._'

2 3 . S
i.curre4 ÜJIlS
181.1.

Toul

1

i. C_hifen, ............ 2. AAlrihin, ......................
3. ,..nls, ~TØul iad Iliocht1.ln
.. S.la.le.

las.J72 ...

J41.Jl
.. 3U.370

.. ',442 ... ....
... 1,09i.6Z

no... ... ... 2.'10 ...

'.I46.Dl1 ..... 1.35.131

5. 1..107"1 ..latl... .no ..1f... .....
6. JAI.,.",c, ucept on riil "Uti ..
7. Tr..il iod tra..l ii- ....................

.., Z.211.315 ..... Z.ltl.DS ....... 320."'
.. iio.11l ...... 107.021 ......... 1,21'

.... ...... .. 5.310,_
.. .. .... .... ... .......... ni.3l
.. . .. . .... 0I3.UI

.. la,5,.._

ZZ.ISI

'54.103 ....... 13.17Z

a. let ind "nt tins~ "ncluding

S.....,. 494,.'" for torr.U...1 acc_i of tu "" iil1dt... Iou $......... ....... re.Ived unc. ...l...e ... ....... 740,759
. .. 1.I!.D26
32,146
'10.141

1,70.12&
3.307.141

.. 1S,493 .. 10.731 ... ..

Z,533,318

i. £qul..n' ............................ 10. Prntl., .no .to'lon'7 ...... ....... 11. Poltag. i.i.ii. ood icl.irO"'. ..... and up.... ..................

. . 5..1.113
1.517.021

1,0t,541

tn.R' ...
140.aI7 '"
.... Z56

1..3.372

.. .. .... 2.'25.03
.......... Z11.'.

12. Loil
13. Audttln,. on...i.i ,ed .....lll'"

....... 2n.ie

SO"lco. .................................... ....... 221.150 .....I.P..'" ..... .. ~,.311 ............ ... ........ 1.71.711

14. Tl&n. Ucelll iad tees:
A. 5totl an loc.' In..... tua ....
.0 Insurinc. dI,.rtt 1 ieMSiI

... 1.1 .,. ... ........ ..........

........... 66 ........ a.... ..
... ..... 570.100 ....... 55Z.112 ..

...... i.ci:n

...........ø._
1,Z32,D5
... ii 121 ..

.

C. ")'ll ua ......
O. Otr (...Iudl.. '....1 inc_ and

... lot.71

,.,1 estlte) ...,....... ..............
1i70, 166

iaUIl
1.663.166

Eo lotll tuu li..iis ..d fe.. (i...c.dl

57 .050 ..
25.771

110.a19 ....... 38.12'

15. 1011 o.toto .._. ....

112,55

n._

..... ..... 31,"1

I'. ..11 .".ia ,..

17. 101...._11 ., u.I..... ...Idoo,
oed htolt1 ,ion. . .... .. .. ... ..

ia. An.egIU wrto-IM for otl _'II

C2.ot....31 .. ClO.7J5.1201... II IIi 711' 13.521,107 .. . LZ. 136.501 ... .. 115.lI ...

U. Toul eapni lKlned
20. ee.iril eapn..' ..id:

.. ...... '14 sll in 38.18 (.,.... Z7.56._
. . . .. .. t,IU.54J
..... 1I0IZ325

A. Go....l up.. ...Id Do.... '31,
pre"'''' )"ar .. ... ,.. .... ..

3.20.03

.. 1,212.153

'55,35

to Sellr.l '''HI Uft~ DecaD, 31, curret .,r .. . . . .. ....................
21. "-... ..Id 'LInt II . Line ZO . LIce Zot) ...

2 ._5.113 . ... 1I 02' ..5
li...I,f1 ..... 7,17J.80

~.311

1.0i._

ia.18 .. . . ... ZZ,4Ø.614

DEAILS or lI-lU
1101. cai, FOOATlDI .... ......................

1~i. txtlU StKlas ........ ........ ....... .:': :'z;iü;ir.' ::: ::ïJ::= ::::: :::ï.;i5i' 181. IIIWIN _ ...................... ..... ... .. 1,073.12' ................................
I... _., of ..1010, ..lu_l.. for LI.. II
fi- ...rfl" po,. ........................

. .. . .. . ... 2ie_
. .. . .... 1.073.72'

.. .. . ... 3.'11.53
n'.72.501'

(5.aU.9Isi ClZ iea 6l1 ... 11.11'.1111
(1.5II.nl) ..........

1-. lotlla (LI... WI t'" 181 . I-I

(Lloe I. _.1 .... ............ .......... .. (2.ot..oul ... (10.73.1icl

... ...... (1. .5U ,l7l

1.)1..104.. ..nc.i_t f... of i ............... pold t. o/fl1htu oed I................ plld to _.affllI.te.
hUo of .~_si of sell

cUt.. ....it. .. _Iatstntt.. _ t. ..t prcI_ ..Itt..:
Act.ii
L-l L1-lt

.. i- ii ioicU., _1m _.,... 'or I. Ii. 11. Coi- . Ie"" .. 'or L II.. i, COL. 4 ..........

0.3' ..... ..... ......,
5.1... ................,
S.l a . ......,

.. "¡,I'IF"I.. i..., _. '. .. Por I. II.. 11. CoI_ i . J . 5 Ie""" M I. U. 5. Col. .

.

c. 1.111 li..: .. '. .. 'ir i, II. D, Coi- I .. Po I, tor i. U.. 5. COL. . .

. B.l27
NEPAOO

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

.

UNDERWRITING AND INVESTMENT EXHIBIT
PART 4 - INTEREST, DIVIDENDS AND REAL ESTATE INCOME
COI_ Iill i. 1m hi. lo

ri

1cl, ..

.. .

_1.4 "". , CI To '"

c. Pr..

It.. ,.

....-If) i I

.. ',or

i-

.

1C1-i 1-4'1.ldl

:: 5'¡:i~~!:::::::::::::::::::::::::::::::: : m ::::::::.~~~. ::::::::::::::::::: ::::::::::::::::::: ::::::::.i~. :::::::: .~:~~. :::.:::: ~:::: r.1 "... ._..rmlo",i.. ........................ I..... ................... ................... ................... ..................... ........... ...:.::::.::......

ril!i;!!d¡ii_!!!!!! .~í: i~¡~ );;;;--1: !¡!i::~~ ;...!!.;.~:;.¡~
t. ia ................................................... ........ ....... U,16,Z ................... ................... ........ I.I ........ J,Il. .... .. u.ie.i

DaiOl
~ =.::": "=~.~.~:.~~~.~~:.~~.~.:::::::::::::::.:::::::::::::::::::::::::::::::::::::::::::::::::::::::.::::::::::. ..:::::.:: ::: u. .. wittil lo.. -ii- ...................................................... ...... ......................... .................... ...................

u. i.1-i.. .................................................................................................................................................... __ II. 1r1__ 1_ i. iii-, Il_u. nii.... I, ll.ll............................................................................................... ....... u..il
HTAILS Of ll-IIS

~". ,..b (II.. -i II.. -i . ..i
por I.

~e~i;:f;~:~:::::::::::: :::::::: ::::::::::.æ .................. .......::::::::::::::::::: ::::::::::::5 :::::::::::~~. ::::::::::.~ ::::::::::::::::::: .......... ................... .............. .... .. ....... .... .............. Mr... ............................................ ........
II.. '1..................:..................., ........ ..........15.14 ................... ................... .......... _"lO .......... SI.. .........-.~i
DEDUC1lOlS

.

æ ~: ~L~i~~: ~~~~ :~~:¡~~:~:¡:: ~:=: ::;~: ~ ~~~;:~ :~~:::; :~~:~:' ::::: :~~::~:::::~:~~:~ ::::: ::::::~~:::: :~~~ :~~ ~~:: :::::~:~: ::::::: ::::: :::::::

ii loC 11-.. II ~i'''1 (P I.U. II ........... ................... .... ............................... ..................... ...................

ii/ i- s....... DI.ID .. 01"_ le L..... ii.ø ..il.. 01,... 1l1o..,................ .. .r a_ i. s................ -ii. of ....

lcll- L.... lll,l .. -i _ 01111.. "'..

I" 1o_1................ - ""-Io $................ -iaii...,.i..

.) I._I................ _" ,,_ Io I................ _mi. If....

III 1di- I.. 00,. 11~I _I. " acl.l_ .. -i's _ " Iii .. lol"..

PART 4A - CAPITAL GAINS AND (LOSSES) ON INVESTMENTS
..U,io .. iii)

""I' . l0.

.._.,

Las . III..
" ...."

i- ., ~tc .. 0. lo IG_I. -i, Ie 11"- ... rI '"1_ NI ,..
ii loh

5I

- .... I II I ....htl
..ii.. (J. i . J . ..II

i. i._ ................................................. ................... .................. ................. ......n........... ................... .................
:1 =::J=I~.:::::::::::::::::::::::::::::::::::::::: ::::::::::.~~. ::::::::::::::::::: ::::::::::::::::::: ::::::::::::::::::: ::::::::::::::::::: :::::::::::.~~. i. ".-._1-1111_ ............................:...... ................... ................... ...n.............. .................. .........n........ ................... i.ll ""_ _ 01 oIii- .............................. ..... .................n . .................. .................. ................... ................... n................ i:~ =:: ~..Jm='.:::::::::::::::::::::::::::::::::::::: ::::::::.~. ::::::::.~~~. ::::::::ï:ti:ijj' ::::::::::::::::::: ::::::::::::::::::: :::::::: k:::

i. Co"".. i- ...n.......................................... .. ................... ................... ................... ..........n...... ................... ................... u c.........11 ..................................... ................... ................... ................... ................... ................... ................... U l-..I_ ...........n.............................. ................... ................... .................. ................... ....n............. ................... I. "'haih, i-i- ............................................ ................... ................... ...n.............. ................... .................. .......n......... .. =".:¡¡j.~~.~~~................................... ........... ,..... ................... .................. ............................ ......... .. ......

l: =:..~.::::::::::::::::::::::::::::::::::::::::::::::::::...::::::::::::::::::::::::::::::::::::::::::::::::::::::::i~:::::::::::::::::::::::::::::::::::::

L -i ........................................................... ........ r.II._ ........ i. ........ I."'.i .................. ................... ....... II,1

'" M ......."'...... P_I "ir. i. ii..II(t_ i. 1.1..'1 ..................................................................................... ........ i. I. .... ",iii,.. or Cl)" I,. 4. u. 11)1~ J. II. S. u." ...................................n.....................n............ ........ i.YI.il
iin,uLS or ll-II

(I...... 01 u. t. Co_ II

.

i ~¿~;:=~¡~::~~:::i::;:¿~:=::;::;; ::;;:::::::;;;::::: :;::::::::::::::::: :::::;:::.::;::;::; ;;;:::;;::':::::::: ;:::::::::::::::::; :;:::'::::::;:::;:;

II i.. Ill.. _ li -i. -i (lor ..II.." ........... .................. ................... ................... ................... ....... ........... ................... lS) Ix.. I....... .. ..... ...iI. mI .lI LOI.. Ie hi I. 110, U.

~J li.. -I.. __ .,111"" .... of ",,,...

II

B-128
NEPAOOOO

Case 1:05-cv-00503-TCW

Document 30-4

Filed 02/28/2007

Page 12 of 35

Defendant's Exhibit # 11

B.129

Case 1:05-cv-00503-TCW

Document 30-4

Filed 02/28/2007

Page 13 of 35

a:ti=iif aSé"',ce. A!f-...lio" ".fl.~sfe.'1\Emor Id "" U.. Nam · PeMf..II/t ~"-Ot,I.~/" ~~m;S ~Il,l.1
. (3) ~:.s:~, :: 70 A/",,.+~ M..tl rt~c,'" 1.1" !;¡V
E Che -- i- /11 0 in ie DI ri Fl ni /3 0 ci in il_
1. Gro IIIl or iiI..

u.s. Corporation Income Tax Return 0. 01.. T... For caen year 1991 or ta yea tiimlng ......... ,1991, ening ........ . 19 ... In..lI Re.. ii. ~ Ii-oi.,. -l Se pai. 1 fo P.. ~ Reuctn Ac Notice.

Fow 1120

OMS No. 15~123

il~91

(2) PIIIl cO'O Qt_ Nu6e, sii, øn ro or SU\1 no. (111 P.O, box, li plg e of inaiiO¡ ç Date tn

tvinl LJ ty. 'M tM:s-or CI A"" sv)i/~ an zipIICl D TOl - .. Sp IIl i- r.¡~-.. pr ~G"'.- or io /I ,"' i'? ..
I '15'190' ,'t3 I .111 l8 'lIunu,lC -iI -0.

I cSl"

$

d'" n1i~"'l
10 1l_(f19óll~ll_~ .~
2 3
4 5

2 ci of goo sold (Sc Á. lin n . 3 Gross pro Subtra line 2 fro lne 1 c

1l~'cR ,
" (,..', :l~

-j

4 Divdendi (Scule C. line 19) ,

5 Inte
8 GIQ re .

q 'el' lJ~

8
7

.(~~

8 Ca "* ne Inco (ii Scule 0 (F 1120)
II Ne gl 0I (i fr Fo 4'T. P8 II. lin 18 (at Fo 4197)

7 Gio ro .

8
1 10
. ~.

.2 0':: 1:2,; /'

I :1ll ".

10 Ot in (.. 1r. -.Iil. ii . . .

I .r- 9.i

11 Tolln. Ad ii 3 tt 10. . . .. . 12 Coi- 01 of (S Eo One 41. '. . . . . .

11

II~ oc ;i 11.

I

14 Reprs. .. . d' . 18 Ba deb
131 Saar an wal/~ 9~ .:/0 I I b Le ..

jo cre I

-0- I

I c Ba ..

12 130 14 15

r,j. ~~
l:Ja.. '...- J'

~8 ~~
. 18
11 20

Ren
Tax.

1.
11

J~-i .,&.J ,
C¡or 'l~7 ,'lL" ..., ;J

I;J ,,~ "

Cor1bu (.. li- fr 10% IIrnon ) . 1'-' I. .. go' _.: '. ;-

Int8f

1.
11

Le dett cli on Scedule A in el on return . r 21. T . o. I 21b (ß "1.. "

De (att Fo 45) . . ."" K"t-C' ,rt I

I ~
l 2:

.:":ng: : : : : : : : : : . ~:FÓR y6in~:Fiæ: : :: '~'J lci~ ,.
~ti~ . . . . . P-ARHlTE, R,A. . .'. l-. . . '.'28..IIR'"ol 101 21 .;.,,,.x:i r SQCIl'iTt.S' .
00 c: (a sc. . . . . GAR.Y. &. ~S l'.........
Pe pr-iti, et. pt . COP. . . . t(OlPH .ORtNDl . f. . 2M 'llt¡'-n
T-i dIduallo... Ad 0n 12 tt2e ,,'cotimD PUBLIC ACOOUNTANl . . . .... ri. II.ß'$1050'

T8l Inc bi ne ~ ID deili -- di. su lt 27 fr lin 11 . 0 i":l 7"ln
I Ë

i. . b SD deucon (SUI C, lne . . . . . . . . . r 2l T '" V'l"I' 2I ~ ,_', ~D Neoplode(..~. 2m. . . .1-2l1-,¡~,09 Jo.;i y. 10

31 Toll-(ScJ,Une10)......... ,.~. 31 'llHø37" 32 Pay' 198 Mf CI to 199 ai -0i b 1991 es la pe . .. 32 -lo'''oo .. .
l . Tax dep wi For 700 A. c lM1991 ni ap fa lJ. Fo . . 32. (. -0 . .) .dil" . .. LlN' Oo ./ . 44 , . . . 3I ;)0 I ti

30 T/I lna. SUtr lne 29c fr line 28 . . 30 ~ .:,',/l/';¡So I)

. g Cn fo Fe ta on fu (id Fo 4138). s. in . . . 3l 32 (;, Cl S 33 esma ta ~ (.. P- 4 alir). Ct " Fa 22 Is at .. ~. - o-

'I f Cn fr nied ir capi (at Fo 243. . . . 32

M Ta du If th to of ii 31 an 33 ia ii th li 32 en ai o- . 84-0-

35 () If line 32 Is la th th to of Ui' 31 en 33, ener ~~ ~. . .. 31 ii.~ Cf'~

38 Enter _... ..-e 35 YO wii cr to 1_ -l l-" / L'§ ..i. ,'I i-" 31 - 0-

.:
Paid

Please

lI..-i;_,., I ~ lI I l- -* ti I' In Øt_ ii _10 .. bI Of my II Ig ft~, _ ._ ~ . -- Of Il (o 1I IaIi li on II Wl Of wh P" Il ", ki

.. ( ) tv '.7 ¡:' lJ Á-A-"~P'" I CJ.Il'''~ .. vlá plU,J...l .l- F....."',.~

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