2023-05-15T17:36:18-05:00 2022-06-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2021-07-01 721495500 OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL OURL 2257657709 4200 ESSEN LANE BATON ROUGE LA 70809 JENNIFER CLOWERS CFO 2257657709 2023-05-15 1 JENNIFER CLOWERS 999009999 MAXWELL BARLOW P01959439 2253444000 2023-05-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z BRIAN TRIPODE 4200 ESSEN LANE BATON ROUGE LA 70809 14530656 0 X N/A X 2001 LA THE PURPOSE OF THE HOSPITAL IS TO PROVIDE FOR THE CARE OF ILL, INJURED AND SEE SCHEDULE O.DISABLED PERSONS AND TO ENHANCE THE HEALTH OF THOSE IN THE COMMUNITY THROUGH RESEARCH AND EDUCATION. 8 4 59 0 0 0 1509044 396737 7013132 11819737 716902 433167 25986 25380 9265064 12675021 814 121 0 0 3159757 4025130 0 0 0 4061117 4168656 7221688 8193907 2043376 4481114 20816779 21383331 5429389 2768113 15387390 18615218 X SEE SCHEDULE O. 0 0 6293546 121 11845117 OUR LADY OF THE LAKE ASSUMPTION PROVIDES TWENTY-FOUR HOUR HEALTHCARE SERVICES FOR PATIENTS IN THE SURROUNDING RURAL COMMUNITIES. THE HOSPITAL HAD 5,295 EMERGENCY ROOM VISITS THIS YEAR. THE HOSPITAL'S EMERGENCY ROOM IS OPEN TO EVERYONE, REGARDLESS OF ABILITY TO PAY. THE HOSPITAL ALSO PROVIDED 19,267 LAB TESTS AND 40 INPATIENT DAYS DURING THE YEAR. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTHCARE NEEDS OF THE PEOPLE OF GOD, THE MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. 6293546 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 59 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 0 0 X AMANDA HYMEL 2257656565 5959 S SHERWOOD FOREST BLVD BATON ROUGE LA 70816 STEPHANIE G MANSON BOARD MEMBER 2.00 42.00 X 0 567162 50173 LOWELL E STANTON REGIONAL CFO 2.50 55.00 X X 0 634011 42886 BRIAN F TRIPODE BOARD MEMBER/SUPV PHARMACY 40.00 0.00 X 182462 0 24597 KENNETH WESTER BOARD MEMBER/OLOL PRESIDENT 2.00 55.00 X 0 1128872 240484 CHARLES P BOLOTTE MD BOARD MEMBER 10.00 10.00 X 0 0 0 YOLANDA DIXON BOARD SECRETARY 2.00 4.00 X X 0 0 0 HARRY J PHILIPS JR BOARD VICE CHAIR 2.00 4.00 X X 0 0 0 JOHN ENGQUIST BOARD VICE CHAIR 0.00 2.00 X X 0 0 0 KEVIN GUIDRY ADMINISTRATOR/CEO 2.00 40.00 X 109783 197703 44620 DONNA M MULLINGS DIR NURSING 40.00 0.00 X 113547 0 31177 WENDY GAUDET FORMER DIRECTOR 0.00 40.00 X 0 238544 29080 JEFF LIMBOCKER FORMER CFO/CURRENT HEALTH SYSTEM CFO 0.00 60.50 X 0 991087 185197 405792 3757379 648214 3 1 1 0 CORRECT CARE INC 17438 HARD HAT DRIVE COVENGTON LA 70435 MEDICAL SERVICES 1328862 FMOL HEALTH SYSTEM 4200 ESSEN LANE BATON ROUGE LA 70809 LAB MANAGEMENT FEES 423566 TRANE US INC 3600 PAMMEL CREEK ROAD LA CROSSE WI 54601 EQUIPMENT SERVICES 170892 CROTHALL HEALTHCARE INC 5000 HENNESSY BLVD BATON ROUGE LA 70808 CLEANING SERVICES 116857 4 391017 5720 396737 PATIENT SERVICE REVENUE 622110 11725935 11725935 MISCELLANEOUS 900099 83667 83667 OUTREACH LAB 621500 9368 9368 MEDICAL RECORDS 561110 767 767 11819737 63879 63879 25380 0 25380 25380 25380 2224623 300 1855635 0 368988 300 369288 369288 12675021 11845117 0 433167 121 121 187410 146388 41022 2996352 2340486 655866 196240 153285 42955 429242 335623 93619 215886 168631 47255 1557162 1371562 185600 15068 8199 6869 397900 295536 102364 100676 54781 45895 478065 299813 178252 15169 8254 6915 220338 189006 31332 3645 1983 1662 914 497 417 343034 294252 48782 41737 4003 37734 MEDICAL SUPPLIES EXPENS 884468 552154 332314 EQUIPMENT & MAINTENANCE 110480 68972 41508 8193907 6293546 1900361 0 10623907 10049496 0 0 0 0 1286643 1150641 0 0 0 0 0 0 0 0 22315 9037 5818812 3374619 1128664 2444193 0 0 7755250 7049958 0 0 0 0 0 680006 20816779 21383331 3466787 2686568 0 0 450981 81545 0 0 0 0 0 0 0 0 0 0 1511621 0 5429389 2768113 X 15287390 18515218 100000 100000 15387390 18615218 20816779 21383331 X 4481114 -1115600 -137686 X 0 1 X 1 1 1 X 55461 55461 2273650 792304 1481346 72547 46085 26462 3417154 2536230 880924 2444193 INVESTMENT IN CAPITAL RESERVE 7049958 F 7049958 X PART X, LINE 2: FIN 48 (ASC740) FOOTNOTE FMOLHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. NO RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. 1 1 1 X 250.000000000000 0 1 1 1 0 1 1 178969 178969 0.02180 3487333 3487333 3666302 3487333 178969 0.02180 6353 6353 0.00080 3183 3183 0.00040 9536 9536 0.00120 3675838 3487333 188505 0.02300 722 722 0.00010 722 722 0.00010 1 39069 1734587 1694725 39862 X 1 1 1 1 ASSUMPTION COMMUNITY HOSPITAL 135 HIGHWAY 402 NAPOLEONVILLE LA 70390 X X X X RURAL HEALTH CLINIC ASSUMPTION COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE PART V, SECTION C X 1 21 0 1 0 1 X 250.000000000000 0.000000000000 X X X X X 1 1 X X X 1 X SEE SUPPLEMENT AT PART V X SEE SUPPLEMENT AT PART V X SEE SUPPLEMENT AT PART V X X X X X X X 1 X 0 X X X X 1 X 0 0 ASSUMPTION COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: ASSUMPTION COMMUNITY HOSPITAL (ACH) CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2021. FOLLOWING THE RESULTS OF A COMMUNITY SURVEY CONDUCTED IN AUGUST 2021, PARTICIPANTS HAD AN OPPORTUNITY TO REVIEW THE RESULTS AND COMPARE THEM WITH THE DATA PRESENTED FROM THE US NEWS HEALTHIEST COMMUNITIES WEBSITE AND THEIR PERSONAL EXPERIENCES IN THE COMMUNITY TO PROVIDE TARGETED FEEDBACK ABOUT THE GREATEST AREAS OF NEED. DISCUSSIONS ALSO TOOK PLACE WITH ASSUMPTION PRIMARY CARE. THESE DISCUSSIONS REVEALED PROBLEMS FACING ASSUMPTION PARISH RESIDENTS, SUCH AS DIFFICULTY MAKING IT TO APPOINTMENTS AND BARRIERS TO ACCESSING MENTAL AND BEHAVIORAL HEALTH. ACCESS TO CANCER SCREENINGS CONTINUE TO BE A NEED AS WELL, EVEN THOUGH BREAST CANCER SCREENINGS HAVE INCREASED SINCE THE LAST CHNA MEASUREMENT PERIOD FROM FOUR VISITS A YEAR TO AN AVERAGE OF 10 VISITS PER YEAR DUE TO UTILIZATION OF THE WOMAN'S HOSPITAL MOBILE MAMMOGRAPHY UNIT. IN PREPARING THIS CHNA, ACH INTERVIEWED DEBRA GONZALES, RN, SUPERVISOR A, WITH THE LOUISIANA DEPARTMENT OF HEALTH / REGION 3 OFFICE OF PUBLIC HEALTH, ON NOVEMBER 18, 2021. MS. GONZALES HELPED ACH COMPARE THE RESULTS FROM ALL SURVEYS AND FEEDBACK RECEIVED TO-DATE TO THE CURRENT PRIORITY AREAS REGION 3 OPH FEELS ARE MOST GREATLY AFFECTING THE PEOPLE IT SERVES. MS. GONZALES ECHOED MUCH OF THE FEEDBACK THAT HAD BEEN RECEIVED REGARDING PATIENTS' STRUGGLES WITH ACCESS TO CARE, POVERTY, MENTAL / BEHAVIORAL HEALTH, AND OBESITY. ADDITIONALLY, ASSUMPTION COMMUNITY HOSPITAL CONSIDERED INPUT FROM THOSE WHO REPRESENT A BROAD INTEREST AND INCLUDED REPRESENTATIVES OF POPULATIONS IN CATEGORIES SUCH AS LOW-INCOME, MINORITY, MEDICALLY UNDERSERVED, AND THOSE EXPERIENCING BARRIERS DUE TO OTHER SOCIAL DETERMINANTS OF HEALTH. CONSIDERING ALL DATA ANALYSIS, STAKEHOLDER DISCUSSIONS, AND SURVEYS RESULTS, ACH DETERMINED THE TOP COMMUNITY NEEDS TO BE: MENTAL / BEHAVIORAL HEALTH CANCER SCREENINGS ACCESS TO CARE / TRANSPORTATION ASSUMPTION COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: DURING THE CURRENT YEAR, ASSUMPTION COMMUNITY HOSPITAL DEVELOPED ITS NEW COMMUNITY HEALTH NEEDS ASSESSMENT AND RELATED IMPLEMENTATION PLAN WHILE THEY CONTINUED TO FOCUS ON THE PRIOR IDENTIFIED COMMUNITY NEEDS OF ACCESS TO PRIMARY CARE, CHILDHOOD OBESITY, DIABETES, AND HEALTH EDUCATION FOR SENIORS. THREE TOP HEALTH NEEDS WERE IDENTIFIED DURING THE CURRENT CHNA: ACCESS TO CARE, BEHAVIORAL HEALTH, AND CANCER SCREENINGS. THESE NEEDS WERE ADDRESSED IN THE FOLLOWING WAYS. THE CURRENT YEAR'S FOCUS WAS PRIMARILY ON ACCESS TO CARE, WHICH THE HOSPITAL ADDRESSED BY IMPLEMENTING A TRANSPORTATION PROGRAM FOR PATIENTS SEEN IN THE EMERGENCY ROOM WHO HAVE NO TRANSPORTATION HOME. AFTER REVIEWING THE NEEDS OF PATIENTS, THE HOSPITAL DETERMINED THAT TRANSPORTATION BARRIERS EXTENDED BEYOND PRIMARY CARE AND NEEDED TO BE ADDRESSED IN THE EMERGENCY ROOM. THE PROGRAM WAS FULLY IMPLEMENTED IN FY 21 AND THE HOSPITAL IS WORKING WITH A LOCAL SERVICE TO TRANSPORT PATIENTS SAFELY.BEHAVIORAL HEALTH: PATIENTS REFERRED FROM PRIMARY CARE TO PSYCHIATRY VISITS IN FY 22 WAS 129, WHICH IS AN INCREASE IN THE MARKET. CANCER SCREENINGS: REFERRALS FROM PRIMARY CARE TO THE MAMMOGRAPHY OUTPATIENT SCREENING SERVICE OFFERED ON THE "WOMAN'S MAMMO COACH" AS A PARTNERSHIP WITH WOMAN'S HOSPITAL INCREASED APPROXIMATELY 25% FROM 3,705 TO 4,623, WITH 871 PATIENTS REQUIRING ADDITIONAL VISITS TO RULE OUT A CANCER DIAGNOSIS. ASSUMPTION COMMUNITY HOSPITAL EXPANDED ITS COMMUNITY ADVOCACY AND COMMUNITY-BUILDING CAPACITY IN THE PARISH SIGNIFICANTLY THIS YEAR, CREATING PARTNERSHIPS TO ESTABLISH THE NEXT CHNA AND IMPLEMENTATION PLAN AS AN EFFORT BASED IN REGIONAL PARTNERSHIPS AND EVIDENCE-BASED PRACTICES. ASSUMPTION COMMUNITY HOSPITAL PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY IS DETERMINED BASED ON INFORMATION THAT MAY BE OBTAINED FROM SOURCES OTHER THAN THE PATIENT, SUCH AS EVIDENCE THAT THE PATIENT IS PARTICIPATING IN ONE OR MORE OF THE FOLLOWING:1. STATE-FUNDING PRESCRIPTION PROGRAMS.2. LACHIP, SUBSIDIZED HOUSING, FREE OR REDUCED SCHOOL LUNCHES, ETC. FOR THE PATIENT'S/GUARANTOR'S CHILDREN.3. LOUISIANA FOOD STAMP PROGRAM.4. STATE MEDICARE PROGRAM. FOR PATIENTS WHO HAVE MEDICARE COVERAGE, THE FINANCIAL ASSISTANCE DETERMINATION WILL RELY ON INFORMATION FROM THE MEDICAID PROGRAM, INCLUDING EVIDENCE THAT:- PATIENT IS CURRENTLY ON MEDICAID, BUT HAS A PRIOR BALANCE WITHIN 12 MONTHS OF THE APPROVAL DATE- PATIENT CURRENTLY HAS MEDICAID WITH LIMITED BENEFITS (ONLY COVERS FAMILY PLANNING). -PATIENT IS IN A HOSPICE AND HAS MEDICAID ONLY-PATIENT HAS MEDICAID THROUGH A NON-CONTRACTED STATE-PATIENT QUALIFIES FOR MEDICAID WITH A "SPEND-DOWN REQUIREMENT"-PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (I.E. MEDICAID SPEND-DOWN)-PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY OR ESTATE. THE DUE DILIGENCE EFFORTS TO VERIFY THE ESTATE ARE TO BE DOCUMENTED VIA THE HOSPITAL APPROVED WEBSITE.ADDITIONALLY, A PATIENT MAY BE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THERE IS AN INDEPENDENT, QUALIFIED ATTESTATION THAT THE PATIENT IS HOMELESS. ASSUMPTION COMMUNITY HOSPITAL PART V, SECTION B, LINE 16J: REGISTRATION PERSONNEL AND FINANCIAL COUNSELORS REFER PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE TO FINANCIAL COUNSELORS TO DISCUSS QUALIFICATION FOR FULLY-DISCOUNTED CARE UNDER THE FINANCIAL ASSISTANCE POLICY. THE POLICY IS ALSO POSTED AT THE HOSPITAL BUSINESS OFFICE AND AT ALL REGISTRATION LOCATIONS. PART V, SECTION B, QUESTION 16A, B, & C THE FINANCIAL ASSISTANCE POLICY (FAP), FAP APPLICATION FORM, AND A PLAIN-LANGUAGE SUMMARY OF THE FAP ARE AVAILABLE AT: HTTPS://FMOLHS.ORG/FINANCIAL-ASSISTANCE-POLICY/ PART V, SECTION B, LINE 7B THE CHNA CAN BE FOUND ATHTTPS://OLOLRMC.COM/ABOUT-US/ASSUMPTION-COMMUNITY-HOSPITAL/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART I, LINE 3C FINANCIAL ASSISTANCE IS AVAILABLE FOR INDIVIDUALS WHO ARE INSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. FULLY-DISCOUNTED CARE IS AVAILABLE IF INCOME AND ASSETS MEET CERTAIN FEDERAL POVERTY GUIDELINE LEVELS. FULLY-DISCOUNTED CARE IS ALSO AVAILABLE FOR THOSE PATIENTS WITH CATASTROPHIC MEDICAL BILLS WHERE MEDICAL BILLS EXCEED A CERTAIN PERCENTAGE OF INCOME AND ASSETS. FULLY DISCOUNTED CARE IS ALSO AVAILABLE WHERE THE PATIENT OR OTHER SOURCES CAN PROVIDE SUFFICIENT EVIDENCE OF PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY IS DETERMINED BASED ON INFORMATION THAT MAY BE OBTAINED FROM SOURCES OTHER THAN THE PATIENT, SUCH AS EVIDENCE THAT THE PATIENT IS PARTICIPATING IN ONE OR MORE OF THE FOLLOWING:1. STATE-FUNDED PRESCRIPTION PROGRAMS;2. LACHIP, SUBSIDIZED HOUSING, FREE OR REDUCED SCHOOL LUNCHES, ETC. FOR THE PATIENT/GUARANTOR'S CHILDREN;3. LOUISIANA FOOD STAMP PROGRAM;4. STATE MEDICAID PROGRAM. FOR PATIENTS THAT HAVE MEDICAID COVERAGE, THE FINANCIAL ASSISTANCE DETERMINATION WILL RELY ON INFORMATION FROM THE MEDICAID PROGRAM, INCLUDING EVIDENCE THAT: - PATIENT IS CURRENTLY ON MEDICAID, BUT HAS A PRIOR BALANCE WITHIN 12 MONTHS OF THE APPROVAL DATE - PATIENT CURRENTLY HAS MEDICAID WITH LIMITED BENEFITS (ONLY COVERS FAMILY PLANNING) - PATIENT IS IN A HOSPICE AND HAS MEDICAID ONLY - PATIENT HAS MEDICAID THROUGH A NON-CONTRACTED STATE - PATIENT QUALIFIES FOR MEDICAID WITH A "SPEND-DOWN REQUIREMENT" - PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (I.E., MEDICAID SPEND-DOWN); - PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY OR ESTATE. THE DUE DILIGENCE EFFORTS TO VERIFY THE ESTATE ASSETS ARE TO BE DOCUMENTED VIA THE HOSPITAL APPROVED WEBSITE.ADDITIONALLY, A PATIENT MAY BE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THERE IS AN INDEPENDENT, QUALIFIED ATTESTATION THAT THE PATIENT IS HOMELESS. PART I, LINE 7 THE OPERATION OF OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS A COMMUNITY BENEFIT IN ITSELF. OUR LADY OF THE LAKE ASSUMPTION IS LOCATED IN AN UNDER-INSURED/LOW INCOME AREA. THE HOSPITAL IS THE ONLY SOURCE OF EMERGENCY HEALTH SERVICES AVAILABLE IN THE IMMEDIATE AREA. THE HOSPITAL DOES NOT HAVE A FORMAL COMMUNITY BENEFIT REPORT BUT IS CONSOLIDATED WITH THE SOLE MEMBER, OUR LADY OF THE LAKE HOSPITAL, INC.PART I, LINE 7, COLUMN FFOR THE PURPOSE OF CALCULATING THE PERCENTAGE IN PART I, LINE 7, COLUMN F, FUNCTIONAL EXPENSES WERE USED WHICH DID NOT INCLUDE BAD DEBT EXPENSE.PART I, LINE 7THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINES 7A-D AND IS BASED ON THE COST ACCOUNTING SYSTEM OF THE ORGANIZATION. FOR PART I LINES 7E, 7F, 7H AND 7I, DIRECT COSTS WERE CAPTURED FROM THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND THE MEDICARE COST REPORT WHERE APPLICABLE. FOR PART I LINE 7G, COST FIGURES WERE CALCULATED FROM DEPARTMENTAL COSTS LESS DIRECT OFFSETTING REVENUE. PART III, LINE 2 AMOUNT REPRESENTS THE ACTUAL CUSTOMER AMOUNTS DUE TO OUR LADY OF THE LAKE ASSUMPTION THAT WERE WRITTEN OFF BECAUSE THEY WERE UNCOLLECTIBLE. PART III, LINE 4 THE BAD DEBT FOOTNOTE IS ON PAGE 17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. THE AMOUNT ON PART III, LINE 6 REPRESENTS MEDICARE ALLOWABLE COSTS FROM THE COST REPORT. PART III, LINE 9B PATIENTS WITH NO MEANS OF PAYMENT MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME, ASSETS, AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS MAY ALSO BE FULLY DISCOUNTED BASED ON A PRESUMPTIVE CHARITY SCORING SYSTEM WHICH IS SIMILAR TO CREDIT SCORING. TO THE EXTENT APPROPRIATE AND PERMITTED BY LAW, FINANCIAL COUNSELING AND SCREENINGS ARE CONDUCTED AT THE TIME OF ENCOUNTER TO ASSIST IN IDENTIFYING PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S POLICY. THESE PROCESSES HELP IDENTIFY (EARLY IN THE PROCESS) PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. THIS HELPS KEEP QUALIFYING PATIENTS OUT OF THE HOSPITAL'S COLLECTION PROCESSES BECAUSE AMOUNTS COVERED BY FINANCIAL ASSISTANCE ARE NOT SUBJECT TO THE HOSPITAL'S COLLECTION PRACTICES. HOWEVER, IF IT IS DETERMINED THAT A PATIENT QUALIFIES FOR DISCOUNTED CARE AFTER THE INDIVIDUAL'S ACCOUNT HAS BEEN SENT TO COLLECTIONS, THE DISCOUNTED AMOUNT IS IMMEDIATELY REMOVED FROM THE COLLECTIONS PROCESS. PART VI, LINE 2 NEEDS ASSESSMENT RESPONDING TO THE HEALTH NEEDS OF OUR COMMUNITY, ESPECIALLY TO THOSE MOST IN NEED, IS PRIMARY TO THE HOSPITAL'S MISSION. AS SUCH, ASSUMPTION COMMUNITY HOSPITAL WORKS TO CONDUCT HEALTH CARE NEEDS ASSESSMENTS. THE HOSPITAL WORKS CLOSELY WITH ASSUMPTION PARISH COUNCIL ON AGING, ASSUMPTION PARISH LIBRARY, ASSUMPTION PARISH SCHOOLS, ACADIAN AMBULANCE SERVICE, LOCAL MEDIA OUTLETS, ASSUMPTION PARISH HEAD START, DHH / OFFICE OF PUBLIC HEALTH REGION III, LOCAL CLERGY, LSU AG CENTER, ASSUMPTION HEALTHCARE AND REHABILITATION, ASSUMPTION ASSOCIATION FOR RETARDED CITIZENS, OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER, LOCAL HEALTHCARE PROVIDERS, ASSUMPTION PARISH SHERIFF'S OFFICE, POLICE JURY, REGION III OFFICE OF EMERGENCY PREPAREDNESS, ASSUMPTION PARISH DETENTION CENTER, AND OTHER COMMUNITY STAKEHOLDERS TO DEFINE COMMUNITY NEEDS AND TO CONSOLIDATE EFFORTS TO MEET THOSE COMMUNITY NEEDS. FOR EXAMPLE, BEHAVIORAL HEALTH PROGRAMMING HAS BEEN EXPANDED AFTER THE NEED WAS IDENTIFIED IN THE COMMUNITY, AND A TRANSPORTATION PROGRAM HAS BEEN PUT IN PLACE TO HELP PATIENTS WITH IDENTIFIED BARRIERS TO CARE. THE HOSPITAL CONDUCTED AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT IN TAX YEAR 2021 AND WILL CONTINUE TO USE COMMUNITY-BASED DATA TO SUPPORT DECISIONS FOR OUTREACH IN THE COMMUNITY. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: INDIVIDUALS ARE EDUCATED ABOUT ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AT VARIOUS STAGES OF THE ENCOUNTER WITH OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. PATIENTS ARE INFORMED THROUGH A PATIENT HANDBOOK THAT CONTAINS INFORMATION ON THE FINANCIAL POLICIES OF THE HOSPITAL. ADDITIONALLY, SYSTEMS AND TOOLS ARE UTILIZED TO CONDUCT HIGH LEVEL FINANCIAL SCREENING TO ASSIST IN IDENTIFYING PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. WHEN AND WHERE APPROPRIATE, FINANCIAL COUNSELORS VISIT PATIENTS AT THE TIME OF THE ENCOUNTER AND EXPLAIN THE ASSISTANCE OPTIONS AVAILABLE. FINANCIAL COUNSELORS WORK WITH PATIENTS TO ASSIST WITH ENROLLMENT FOR MEDICAID FOR THOSE WHO ARE ELIGIBLE AS WELL AS TO ASSIST THOSE WHO QUALIFY FOR HOSPITAL FINANCIAL ASSISTANCE.PART VI, LINE 4COMMUNITY INFORMATION ASSUMPTION COMMUNITY HOSPITAL IS A COMMUNITY-BASED, NOT-FOR-PROFIT HOSPITAL LOCATED IN NAPOLEONVILLE, LOUISIANA, THAT SERVES ASSUMPTION PARISH AND PORTIONS OF THE SURROUNDING PARISHES. FOR PURPOSE OF THE CHNA, THE HOSPITAL DEFINES ITS PRIMARY SERVICE AREA AS ASSUMPTION PARISH. PURSUANT TO THE HOSPITAL'S MOST RECENT CHNA, ASSUMPTION'S PRIMARY SERVICE AREA HAS A 2021 POPULATION OF APPROXIMATELY OF 21,891, AND THE SENIOR POPULATION COMPRISES ABOUT 18.7% OF THE TOTAL POPULATION. THE PARISH'S MEDIAN HOUSEHOLD INCOME FOR 2021 IS $45,457, AND 13.93% OF FAMILIES LIVE BELOW THE POVERTY LINE.PART VI, LINE 5PROMOTION OF COMMUNITY HEALTH:ASSUMPTION COMMUNITY HOSPITAL PARTICIPATES IN COMMUNITY INVOLVEMENT ACTIVITIES BECAUSE IT UNDERSTANDS THAT IMPROVEMENTS TO A COMMUNITY HAVE A DIRECT LINK TO THE IMPROVED HEALTH OF COMMUNITY RESIDENTS. COMMUNITY IMPROVEMENT ACTIVITIES INCLUDE THE FOLLOWING: PATIENT TRANSPORTATION PROGRAMS TO ADDRESS BARRIERS TO CARE, SCREENING PROGRAMS IN PARTNERSHIP WITH OTHER HEALTHCARE PROVIDERS (WITH A SPECIFIC FOCUS ON CANCER SCREENINGS), IN-KIND DONATIONS TO ADDRESS FOOD INSECURITY, ACTIVE PARTICIPATION IN THE HEALTHY COMMUNITIES COALITION SPONSORED BY LSU AG CENTER, ONGOING SPONSORSHIP OF BLOOD DRIVES TO SUPPORT THE LOCAL SUPPLY AVAILABLE TO PATIENTS, DONATIONS TO NOT-FOR-PROFIT ORGANIZATIONS ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH AND/OR SUPPORTING THE PRIORITY AREAS IDENTIFIED IN THE CHNA, AND COMMUNITY EDUCATIONAL EVENTS AND SUPPORT OF EVENTS PROMOTED BY OTHER NOT-FOR-PROFIT ORGANIZATIONS. ASSUMPTION COMMUNITY HOSPITAL PROVIDES MANAGEMENT OVERSIGHT OF COMMUNITY PROGRAMS AND ACTIVITIES, INCLUDING COMMUNITY BENEFIT SALARY DOLLARS, AND PROVIDES LEADERSHIP AND COORDINATION FOR LOCAL EMERGENCY PREPAREDNESS ACTIVITIES. A MAJORITY OF THE GOVERNING BODY OF ASSUMPTION COMMUNITY HOSPITAL IS COMPRISED OF INDIVIDUALS FROM A BROAD CROSS-SECTION OF THE COMMUNITY WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF THE DEPARTMENTS, AS NEEDED, AND APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE THROUGH INVESTMENT IN CLINICAL TECHNOLOGY, MEDICAL INFORMATION TECHNOLOGY, AND CONTINUED TRAINING OF CLINICAL STAFF. PART VI, LINE 6AFFILIATED HEALTH CARE SYSTEM OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS A NOT-FOR-PROFIT, NON-STOCK, MEMBER CORPORATION OF WHICH OUR LADY OF THE LAKE HOSPITAL, INC. IS THE SOLE MEMBER. OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS PART OF THE FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC. WHICH INCLUDES SEVERAL HOSPITALS AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATE. OUR LADY OF THE LAKE ASSUMPTION SERVES THE COMMUNITY IN LOUISIANA'S ASSUMPTION PARISH AND SURROUNDING PARISHES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER OUR LADY OF LOURDES REGIONAL MEDICAL CENTERST. FRANCIS MEDICAL CENTER OUR LADY OF THE LAKE ASCENSIONOUR LADY OF THE ANGELS HOSPITALRELATED HOSPITAL IN MISSISSIPPI:ST. DOMINIC JACKSON MEMORIAL HOSPITAL X X 0 1 0 0 0 0 0 0 0 KENNETH WESTER BOARD MEMBER/OLOL PRESIDENT 0 690598 0 254965 0 183309 0 210730 0 29754 0 1369356 0 125808 JEFF LIMBOCKER FORMER CFO/CURRENT HEALTH SYSTEM CFO 0 670983 0 234110 0 85994 0 160910 0 24287 0 1176284 0 60058 LOWELL E STANTON REGIONAL CFO 0 454544 0 176720 0 2747 0 14500 0 28386 0 676897 0 0 STEPHANIE G MANSON BOARD MEMBER 0 407207 0 158120 0 1835 0 26100 0 24073 0 617335 0 0 KEVIN GUIDRY ADMINISTRATOR/CEO 57614 181955 50018 10250 2151 5498 0 26100 4921 13599 114704 237402 0 0 WENDY GAUDET FORMER DIRECTOR 0 202837 0 34573 0 1134 0 12142 0 16938 0 267624 0 0 BRIAN F TRIPODE BOARD MEMBER/SUPV PHARMACY 179587 0 2750 0 125 0 9406 0 15191 0 207059 0 0 0 PART I QUESTION 4A THE CFO IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR TERMINATION OF EMPLOYMENT WITHOUT CAUSE FOR GOOD REASON AND FOR A CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 18 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. A BOARD MEMBER IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 12 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. A BOARD MEMBER AND THE FORMER CFO ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON, AND FOR A CHANGE OF CONTROL. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS/HER BASE SALARY AND AN ANNUAL INCENTIVE AT TARGET AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 24 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. PART I QUESTION 4B FMOLHS MAINTAINS THREE UNFUNDED DEFERRED COMPENSATION PLANS WHICH MEET THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLANS PROVIDE FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURRENCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLANS IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. KENNETH SCOTT WESTER RECEIVED A PAYMENT OF $180,562 AND JEFFREY LIMBOCKER RECEIVED A PAYMENT OF $83,247 FROM THE PLANS IN THE CURRENT YEAR. FORM 990, PART III, LINE 1 INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI AND IN THE TRADITION OF ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING- WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. FORM 990, PART VI, SECTION A, LINE 6 OUR LADY OF THE LAKE HOSPITAL (AN IRC SECTION 501 (C) (3) ORGANIZATION) IS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A OUR LADY OF THE LAKE HOSPITAL, AS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL, RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS AND THE OFFICERS OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B OUR LADY OF THE LAKE HOSPITAL, INC. AS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL CAN MAKE THE DECISIONS AS FOLLOWS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES, AND PURPOSES OF CORPORATION 2. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF THE CORPORATION. 3. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION OR AFFILIATION, OR PARTICIPATION IN JOINT VENTURES 5. TO DISSOLVE AND DISTRIBUTE ASSETS OF THE CORPORATION 6. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION 7. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY CORPORATION 9. TO APPOINT THE FISCAL AUDITOR OF THE CORPORATION 10. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHANGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION 11. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION 12. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION FORM 990, PART VI, SECTION B, LINE 11B AFTER PREPARATION OF THE FORM 990 BY KPMG LLP, MANAGEMENT REVIEWED THE FORM 990. A COPY OF THE FORM 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OLOL ASSUMPTION COMMUNITY HOSPITAL HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY THAT REQUIRES EACH OFFICER, TRUSTEE, BOARD COMMITTEE MEMBER AND EMPLOYEE TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. COMPLETED DISCLOSURE FORMS ARE REVIEWED AND MAINTAINED BY THE CHIEF COMPLIANCE OFFICER. IF ANY TRUSTEE, BOARD COMMITTEE MEMBER OR SENIOR MANAGER HAS A POTENTIAL CONFLICT, THE EXECUTIVE COMMITTEE OF THE BOARD DETERMINES WHETHER ACTION NEEDS TO BE TAKEN AND COMMUNICATES ANY SUCH ACTION TO THE INDIVIDUAL. A POTENTIAL CONFLICT OF ANY OTHER EMPLOYEE IS REVIEWED BY THE CEO OR HIS DESIGNEE. THE EXECUTIVE COMMITTEE, CEO OR DESIGNEE, AS APPLICABLE, DETERMINES IF A CONFLICT OF INTEREST EXISTS OR CREATES THE APPEARANCE OF IMPROPRIETY. IF SUCH A DETERMINATION IS MADE, THE INDIVIDUAL WILL BE EXCUSED FROM PARTICIPATING IN THE BUSINESS DECISION. DURING THE YEAR, ANY CHANGE TO THE INFORMATION IN THE DISCLOSURE STATEMENT MUST BE DISCLOSED PROMPTLY TO THE CHIEF COMPLIANCE OFFICER, WHO TAKES APPROPRIATE ACTION. THE PROCESS ALSO REQUIRES AFFIRMATION FROM EACH INDIVIDUAL THAT HE OR SHE (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) HAS AGREED TO COMPLY WITH THE POLICY; AND (D) UNDERSTANDS THAT OLOL ASSUMPTION COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OLOL ASSUMPTION COMMUNITY HOSPITAL PROVIDES MECHANISMS FOR CONFIDENTIAL REPORTING OF COMPLIANCE ISSUES. THESE MECHANISMS INCLUDE AN ANONYMOUS HOTLINE AND WEB SITE WHERE INDIVIDUALS MAY RAISE ISSUES, SEEK CLARIFICATION, AND REPORT POSSIBLE CONFLICTS OF INTEREST OR OTHER CONCERNS. THESE REPORTS, INCLUDING REPORTS OF POSSIBLE CONFLICTS OF INTEREST, ARE REVIEWED AND INVESTIGATED BY THE CORPORATE COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN. PART VI, SECTION B QUESTION 13 THROUGHOUT THE TAX YEAR, THE ORGANIZATION HAD A WHISTLEBLOWER POLICY IN PLACE ALTHOUGH IT WAS NOT APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE JUNE 30, 2022. THE WHISTLEBLOWER POLICY HAS, HOWEVER, BEEN APPROVED BY THE BOARD OF DIRECTORS OF OUR LADY OF THE LAKE HOSPITAL, INC. (THE ORGANIZATION'S SOLE-MEMBER). FORM 990, PART VI, SECTION B, LINE 15A OTHER RELATED ORGANIZATIONS SET THE COMPENSATION AND PAY FOR THE EXECUTIVES. THAT BOARD OF DIRECTORS DESIGNATES THE COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY OUTSIDE SOURCES. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. SECTION 1.263(A)-3(N) ELECTION-BOOK CONFORMITY ELECTION OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2022. SECTION 1.263 (A)-1(F) - ELECTION- DE MINIMIS SAFE HARBOR ELECTION OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL HEREBY MAKES THE DE MINIMIS SAFE HARBOR ELECTION UNDER SECTION 1.263(A)-1(F) OF THE TREASURY REGULATIONS, EFFECTIVE ONLY FOR THE TAX YEAR ENDING JUNE 30, 2022. TAXPAYER HAS AN APPLICABLE FINANCIAL STATEMENT FOR THE YEAR OF THE ELECTION. THIS ELECTION PERMITS THE TAXPAYER TO DEDUCT FOR TAX PURPOSES ANY ITEM DEDUCTED UNDER ITS BOOK POLICY THAT DOES NOT EXCEED $5,000 PER INVOICE (OR PER ITEM, AS SUBSTANTIATED BY THE INVOICE) OR ITEMS HAVING AN ECONOMIC USEFUL LIFE OF TWELVE MONTHS OR LESS AS DESCRIBED IN SECTION 1.263(A)-1(F)(1)(I). FORM 990, PART XI, LINE 9: CAPITAL TRANSFERS -137,686. 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