2023-08-09T09:24:13-05:00 2022-09-30 720506596 COLE EVANS & PETERSON POST OFFICE DRAWER 1768 SHREVEPORT LA 711661768 990 2021-10-01 720400933 WILLIS-KNIGHTON MEDICAL CENTER WILL 3182124000 CO COLEEVANSPETERSONPO DRAWER17 SHREVEPORT LA 711661768 JERRY A FIELDER II PRESIDENT 3182124000 2023-08-09 1 JERRY FIELDER II XXX-XX-XXXX BARRY S SHIPP P00024584 3182228367 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JERRY A FIELDER II POST OFFICE BOX 32600 SHREVEPORT LA 711302600 1511501732 0 X WWW.WKHS.COM X 1949 LA THE MEDICAL CENTER PROVIDES A FULL-RANGE OF HEALTH CARE SERVICES TO THE GENERAL PUBLIC. 10 8 7997 156 4865656 0 8137026 10092175 1160171533 1251877803 20484999 6101236 20571245 39636632 1209364803 1307707846 1580850 2064083 0 0 496269868 501993540 0 0 0 703997635 797116171 1201848353 1301173794 7516450 6534052 2446133987 2146013923 984026196 919926931 1462107791 1226086992 X TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE WE SERVE. 0 0 1071231872 2064083 1246045136 WILLIS-KNIGHTON MEDICAL CENTER STRIVES TO PROVIDE HIGH QUALITY, COST-EFFECTIVE MEDICAL CARE TO THE COMMUNITIES OF NORTHWEST LOUISIANA, NORTHEAST TEXAS, AND SOUTHWEST ARKANSAS. THE MEDICAL CENTER OFFERS SOPHISTICATED TECHNOLOGY AND PROCEDURES THAT MAKE IT A TERTIARY CARE REFERRAL CENTER. GENERAL THE MEDICAL CENTER PROVIDES 24-HOUR EMERGENCY CARE, REGARDLESS OF THE PATIENT'S ABILITY TO PAY, AT ITS FOUR HOSPITALS. THE MEDICAL CENTER PROVIDES AN ORGAN TRANSPLANT PROGRAM, OBSTETRICS, COMPREHENSIVE HEART AND CANCER PROGRAMS, EXTENSIVE SURGICAL OPTIONS, LEADING-EDGE DIAGNOSTICS AS WELL AS A BROAD NETWORK OF PHYSICIANS ENCOMPASSING MOST SPECIALTIES AND SUBSPECIALTIES. THE MEDICAL CENTER PROVIDES THESE SERVICES REGARDLESS OF RACE, COLOR, RELIGION, SEX, ETHNIC ORIGIN, VETERAN STATUS, DISABILITY OR AGE. THE MEDICAL CENTER HAD 47,185 ADMITTANCES DURING THE YEAR ENDED SEPTEMBER 30, 2022 WITH A TOTAL OF 202,990 PATIENT DAYS AND 2,394 BIRTHS. THE MEDICAL CENTER PARTICIPATES IN THE MEDICAID PROGRAM AND ADMINISTERS A CHARITY CARE POLICY WHEREBY FREE OR DISCOUNTED SERVICES ARE AVAILABLE TO QUALIFIED INDIVIDUALS WITH LIMITED FINANCIAL MEANS. DURING THE YEAR ENDED SEPTEMBER 30, 2022, THE MEDICAL CENTER PROVIDED AN ESTIMATED $15,000,000 IN UNREIMBURSED COSTS ATTRIBUTABLE TO CHARITY CARE (EXCLUDING PROJECT NEIGHBORHEALTH) AND AN ESTIMATED $52,000,000 IN UNREIMBURSED COSTS ATTRIBUTABLE TO MEDICAID PATIENTS. THESE ESTIMATES ARE BASED ON THE MEDICAL CENTER'S OVERALL COST-TO-CHARGE RATIO. IN ADDITION TO THESE SERVICES, WILLIS-KNIGHTON PROJECT NEIGHBORHEALTH OPERATES TWO CLINICS IN COMMUNITIES THAT ARE ECONOMICALLY DISTRESSED AND/OR DESIGNATED AS MEDICALLY UNDER-SERVED AREAS WITH HEALTH PROFESSIONAL SHORTAGES. SEE SCHEDULE H FOR DETAILED INFORMATION REGARDING PROJECT NEIGHBORHEALTH. REGIONAL TRANSPLANT CENTER THE MEDICAL CENTER OPERATES THE JOHN C. MCDONALD REGIONAL TRANSPLANT CENTER AT WILLIS-KNIGHTON MEDICAL CENTER. ALL TRANSPLANT PATIENTS RECEIVE TRANSPLANTS WITHOUT REGARD TO THEIR ECONOMIC STATUS. THE REGIONAL TRANSPLANT CENTER PROVIDES KIDNEY, PANCREAS, AND LIVER TRANSPLANTS. SUBSTANTIALLY ALL THE COSTS OF OPERATING THE REGIONAL TRANSPLANT CENTER ARE BORNE BY WILLIS-KNIGHTON MEDICAL CENTER. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, 55 PATIENTS RECEIVED ORGAN TRANSPLANTS, CONSISTING OF 46 KIDNEYS (13 OF THOSE PATIENTS ALSO HAD A PANCREAS TRANSPLANT AND 2 OF THOSE PATIENTS ALSO HAD A LIVER TRANSPLANT), AND 11 LIVERS. OF THE 55 TRANSPLANT SURGERIES PERFORMED AT THE MEDICAL CENTER DURING THE YEAR ENDED SEPTEMBER 30, 2022, 24 PATIENTS WERE BENEFICIARIES OF THE MEDICARE PROGRAM. AS SUCH, THESE TRANSPLANTS WERE PERFORMED AT VERY LITTLE, IF ANY, COST TO THE PATIENTS.EMERGENCY CARE THE MEDICAL CENTER PROVIDES EMERGENCY SERVICES AT FOUR LOCATIONS ON A 24-HOUR BASIS STAFFED BY FULL-TIME EMERGENCY ROOM PHYSICIANS. EMERGENCY PATIENTS ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY. DURING THE YEAR ENDED SEPTEMBER 30, 2022, THE MEDICAL CENTER'S EMERGENCY ROOMS WERE VISITED BY 149,919 PATIENTS, OF WHOM 21,000 WERE ADMITTED TO THE HOSPITAL FOR FURTHER TREATMENT.WOMEN AND CHILDREN'S HEALTH THE MEDICAL CENTER PROVIDES A VARIETY OF MEDICAL SERVICES FOR WOMEN AND CHILDREN, INCLUDING OBSTETRICS, GYNECOLOGY, NEONATOLOGY, MATERNAL/FETAL HEALTH SERVICES FOR HIGH RISK PREGNANCY, PEDIATRIC INTENSIVE CARE AND PEDIATRIC SUPPORT SERVICES SUCH AS PEDIATRIC GASTROENTEROLOGY, SURGERY, AND PULMONOLOGY. THESE SERVICES INCLUDE BOTH HIGH-RISK AND LOW-RISK OBSTETRICS. MATERNAL TRANSPORTS ARE ACCEPTED. THE LABOR AND DELIVERY (L&D) UNITS ARE DIRECTED BY BOARD CERTIFIED OB-GYN PHYSICIANS AND MANY OF THE NURSES ARE CERTIFIED BY THE ASSOCIATION OF WOMEN'S HEALTH, OBSTETRIC & NEONATAL NURSES (AWHON). THERE WERE 2,394 BIRTHS; 2,449 OBSTETRICAL VISITS TO THE L&D UNITS; DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022.HEALTH AND WELLNESS CENTERS THE MEDICAL CENTER HAS FIVE MEDICALLY-SUPERVISED HEALTH AND WELLNESS CENTERS DEDICATED TO THE PREVENTION OF HEALTH PROBLEMS, FOUR IN SHREVEPORT AND ONE IN BOSSIER CITY WITH A TOTAL MEMBER ENROLLMENT AT SEPTEMBER 30, 2022 OF 3,689. THE CENTERS ARE LOCATED ON EACH OF THE FOUR HOSPITAL CAMPUSES AND IN THE WK COMMUNITY HEALTH & WELLNESS CENTER - ALLENDALE. A MEDICAL EVALUATION, INCLUDING A BLOOD CHEMISTRY WORK-UP, IS REQUIRED FOR MEMBERSHIP. THE CENTERS SERVE PULMONARY AND CARDIAC REHABILITATION PATIENTS AND PROVIDE HEALTH AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE LOCATED. NEONATAL INTENSIVE CARE UNIT WILLIS-KNIGHTON'S CENTER FOR WOMEN'S HEALTH HOUSES A 42-BED LEVEL III REGIONAL OBSTETRICAL AND NEONATAL UNIT. THIS UNIT ACCEPTS REFERRALS FROM THE ARK-LA-TEX AREA AND IS SERVICED BY BOTH AIR AND GROUND EMERGENCY TRANSPORT ON A 24-HOUR BASIS. THIS UNIT IS DIRECTED BY A BOARD CERTIFIED NEONATOLOGIST. THE MAJORITY OF THE NURSING STAFF IS CERTIFIED BY AWHON. THE AVERAGE LENGTH OF STAY PER ADMIT IS 24.19 DAYS.HOSPICE HOSPICE OF LOUISIANA IS A DEPARTMENT OF WILLIS-KNIGHTON MEDICAL CENTER THAT PROVIDES COMPREHENSIVE END-OF-LIFE CARE INCLUDING SKILLED AND SUPPORTIVE SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. THE HOSPICE TEAM, UNDER THE GUIDANCE OF THE ATTENDING PHYSICIAN, FOCUSES ON THE ALLEVIATION OF THE PAIN AND DISCOMFORT CONNECTED WITH LIFE-ENDING ILLNESS. QUALITY OF LIFE, EMOTIONAL AND SPIRITUAL BALANCE, SYMPTOM MANAGEMENT, AND PAIN CONTROL ARE THE GOALS THAT TEAM MEMBERS STRIVE FOR AS THEY ASSIST DYING PATIENTS AND THEIR FAMILIES. BEREAVEMENT SUPPORT FOR THE IMMEDIATE FAMILY AND COMPANIONS IS PROVIDED FOR AT LEAST ONE YEAR FOLLOWING THE PATIENT'S DEATH. FOR THE YEAR ENDED SEPTEMBER 30, 2022, HOSPICE OF LOUISIANA SERVED 144 PATIENTS AND THEIR FAMILIES AS DIRECT ADMITS, NOT INCLUDING VISITATION AND COUNSELING PROVIDED THROUGH PRE-ADMIT AND/OR BEREAVEMENT SERVICES. THE TEAM INCLUDES: REGISTERED NURSES, CERTIFIED NURSING ASSISTANTS, SOCIAL WORKERS, CHAPLAINS, VOLUNTEERS, ATTENDING PHYSICIANS, AND MEDICAL DIRECTOR. 11279287 5832667 THE MEDICAL CENTER PROVIDES HOUSING, HEALTHCARE, AND RELATED SERVICES TO THE ELDERLY THROUGH THE OAKS OF LOUISIANA. THE OAKS OF LOUISIANA IS A RESIDENTIAL COMMUNITY DESIGNED SPECIFICALLY FOR ADULTS AGED 55 AND OVER. THIS RESIDENTIAL COMMUNITY PROVIDES SECURE, MAINTENANCE-FREE LIVING AND PROMOTES AN ACTIVE, HEALTHY LIFESTYLE. THE CAMPUS OF THE OAKS OF LOUISIANA INCLUDES THE TOWER AT THE OAKS, A RESIDENTIAL COMMUNITY, AND SAVANNAH AT THE OAKS, AN ASSISTED LIVING FACILITY. 1082511159 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 456 0 1 7997 1 1 1 0 0 0 0 0 0 0 1 0 X 10 8 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MR JAF FIELDER 3182124000 2600 GREENWOOD ROAD SHREVEPORT LA 711033908 JAMES K ELROD FORMER PRESIDENT/FORMER CEO/TRUSTEE 40.00 X 1734272 6000 8663 PIERRE V BLANCHARDIV MD TRUSTEE/PHYSICIAN 40.00 X 223626 0 11107 FRANK B HUGHES MD TRUSTEE/CHAIRMAN 4.00 X 0 0 0 SAM J TALBOT TRUSTEE 4.00 X 0 0 0 WILLIAM J COLE CPA TRUSTEE/TREASURER 8.00 X X 0 0 0 RICHARD H SALE TRUSTEE/SECRETARY 4.00 X X 0 0 0 EUGENE W BRYSON JR TRUSTEE 4.00 X 0 0 0 ELAINE SIMPKINS PHD TRUSTEE 4.00 X 0 0 0 RAYMOND J LASSEIGNE TRUSTEE 4.00 X 0 0 0 LAMAR P PUGH TRUSTEE 4.00 X 0 0 0 MARY JANE WARD SR VICE PRESIDENT OF FINANCE 40.00 X 486734 0 30244 JERRY A FIELDER II PRESIDENT/CEO 53.00 X 575072 0 37496 JILL K ELROD VP OF LEGAL AFFAIRS 40.00 X 278065 0 13541 IRA L MOSS VP/ADMIN WK PIERREMONT 40.00 X 253759 0 29521 BRIAN A CRAWFORD SENIOR VICE PRESIDENT 40.00 X 352222 0 9565 GREGORY J GAVIN VP/PHYSICIAN NETWORK 40.00 X 249299 0 13397 MICHAEL CHANDLER SR VP/ADMINISTRATOR WKMC 40.00 X 306029 0 3610 PEGGY J GAVIN SR VP OF PHYSICIAN SERVICE 40.00 X 231718 0 12832 MARGARET G ELROD SR VP/IND WELLNESS/COMMUN 40.00 X 228756 0 11818 JANET K ELROD VP/ADMIN WK SOUTH 40.00 X 221345 0 12887 TODD J BLANCHARD VP/ADMIN WK BOSSIER 40.00 X 193071 0 38066 DIANE R MCCULLER SR VP NURSING - PATIENT SERVI 40.00 X 237370 0 15257 MARGARET C REBOUCHE SR VP QUALITY & CLINICAL PERF 40.00 X 209243 0 17533 JOHN L FORTENBERRY JR VP/MARKETING & STRATEGY 40.00 X 197585 0 2221 ALJAY J FOREMAN JR VP/ADMINISTRATOR WKMC 40.00 X 113600 0 43480 VINCENT R SEDMINIK VP/ADMINISTRATOR WK BOSSIER 40.00 X 209846 0 3090 MILAN G MODY MD PHYSICIAN 40.00 X 2402678 0 35605 SARAH GLORIOSO MD PHYSICIAN 40.00 X 2231932 0 36518 JOHN G NOLES MD PHYSICIAN 40.00 X 1557983 0 37337 WYCHE T COLEMAN III MD PHYSICIAN 40.00 X 1666948 0 39188 ANIL VELUVOLU MD PHYSICIAN 40.00 X 1440636 0 36126 15601789 6000 499102 928 0 1 0 CROSS COUNTRY STAFFING PO BOX 404674 ATLANTA GA 30384 MEDICAL STAFFING 16914046 SHREVEPORT ANESTHESIA SERVICES 2600 GREENWOOD ROAD SHREVEPORT LA 71103 PHYSICIAN SERVICES 7621956 RED RIVER CARDIOVASCULAR 2751 ALBERT BICKNELL DR SUITE 5C SHREVEPORT LA 71103 PHYSICIAN SERVICES 6188712 LSU HEALTH SCIENCES CENTER PO BOX 33932 SHREVEPORT LA 71130 MEDICAL STAFFING 5512341 RADIATION ONCOLOGY SERVICES 2600 KINGS HIGHWAY SHREVEPORT LA 71103 PHYSICIAN SERVICES 4598035 120 10060000 32175 10092175 HOSPITAL SERVICES 900099 1247976982 1247976982 RESIDENTIAL COMMUNITY 900099 3900821 3900821 1251877803 22697300 22697300 3239598 2883236 356362 356362 356362 183565341 749245 200147455 763195 -16582114 -13950 -16596064 -16596064 NONOPERATING COMPONENTS OF NET PE 900099 35157347 35157347 LABORATORY REVENUE 621500 4551901 4551901 (LOSS) FROM SUBSIDIARY - VIRGINIA 623000 -1735474 -1735474 1306496 992741 313755 39280270 1307707846 1270052715 4865656 22697300 1844622 1844622 219461 219461 7155279 7155279 384921346 344790473 40130873 75618348 66726593 8891755 34298567 20199772 14098795 1891538 1891538 2838075 2838075 3313573 1420152 1893421 33062520 33062520 28029279 28029279 68158985 28376611 39782374 8970125 8970125 DIRECT DEPARTMENTAL EXP 617267320 617267320 TAXES & LICENSES 11739579 11739579 BUSINESS OFFICE 6921165 6921165 14924012 1666155 13257857 1301173794 1082511159 218662635 0 6003411 7491534 75910830 39010868 172978106 279662122 2816975 2836284 27953382 29614601 15545107 14589891 1460223480 941052728 514784966 519170752 1444614094 1062845730 11714239 9813726 12563 11438 173800314 180966977 2446133987 2146013923 132503617 145303200 26539 30955 62639756 47483991 702550000 702550000 86306284 24558785 984026196 919926931 X 1462107791 1226086992 1462107791 1226086992 2446133987 2146013923 X 6534052 -249238747 6683896 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1766494 1766494 0 PART II-B, LINE 1: DURING THE YEAR ENDED SEPTEMBER 30, 2022, THE MEDICAL CENTER PAID DUES TOTALING $31,025 TO THE LOUISIANA STATE MEDICAL SOCIETY ON BEHALF OF DOCTORS IN THE MEDICAL CENTER'S PHYSICIAN NETWORK, WHICH CONSISTS OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEDICAL CENTER. A PORTION OF THE DUES, $15,513 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2022, THE MEDICAL CENTER PAID DUES TOTALING $8,445 TO THE AMERICAN MEDICAL ASSOCIATION ON BEHALF OF DOCTORS IN THE MEDICAL CENTER'S PHYSICIAN NETWORK, WHICH CONSISTS OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEDICAL CENTER. A PORTION OF THE DUES, $4,223 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2022, THE MEDICAL CENTER PAID DUES TOTALING $253,515 TO THE LOUISIANA HOSPITAL ASSOCIATION FOR THE MEDICAL CENTER'S MEMBERSHIP IN THE ASSOCIATION AND ON BEHALF OF DOCTORS IN THE MEDICAL CENTER'S PHYSICIAN NETWORK, WHICH CONSISTS OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEDICAL CENTER. A PORTION OF THE DUES, $126,758 WAS RELATED TO LOBBYING ACTIVITIES. IN ADDITION TO THE PORTION OF THE DUES ABOVE RELATED TO LOBBYING EXPENSES, THE MEDICAL CENTER HAS CONTRACTED WITH PRADOS & ASSOCIATES TO PROVIDE LOBBYING SERVICES ON BEHALF OF THE MEDICAL CENTER. SERVICES SHALL INCLUDE STRATEGIC PLANNING, BUSINESS DEVELOPMENT AND LOBBYING. THE CONTRACT CALLS FOR A $135,000 MONTHLY RETAINER FEE. FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, TOTAL LOBBYING EXPENSES UNDER THIS CONTRACT TOTALED $1,620,000. HEALTHCARE POLICY IS CRITICAL TO THE MISSION OF THE MEDICAL CENTER, AND ITS MANAGEMENT BELIEVES THAT HEALTHCARE PROVIDERS SHOULD PARTICIPATE IN FORMING HEALTHCARE POLICY BY INTERACTING WITH NATIONAL, STATE, AND LOCAL REPRESENTATIVES AND THEIR STAFFS, WHEN POSSIBLE, TO HELP THEM BETTER UNDERSTAND THE COMPLEXITIES AND RAMIFICATIONS OF KEY HEALTHCARE ISSUES. THE MEDICAL CENTER'S MANAGEMENT IS AVAILABLE TO LAWMAKERS, GOVERNMENT OFFICIALS, AND THEIR STAFF MEMBERS, FOR INFORMATION AND OCCASIONALLY RESPONDS TO QUESTIONS AND INITIATES COMMUNICATIONS ABOUT HOW PROPOSED LAWS, POLICIES, REGULATIONS, ETC. MIGHT AFFECT THE MEDICAL CENTER'S ABILITY TO DELIVER COST-EFFECTIVE, QUALITY HEALTHCARE. THE AMOUNT OF TIME AND MONEY RESOURCES INVOLVED IN THESE ACTIVITIES IS INSUBSTANTIAL. THE MEDICAL CENTER HAS NOT AND DOES NOT INTERVENE IN ANY POLITICAL CAMPAIGN. 534944 58641736 59176680 7737337 824700607 546553394 285884550 1910508 1825967 84541 491841356 371743969 120097387 74856992 20929398 53927594 519170752 MUSEUM ASSETS 662578 DEPOSIT 12424 OPERATING LEASE RIGHT-OF-USE ASSETS 8781043 NET EXCESS FUNDED PENSION BENEFITS 171510932 180966977 INVESTMENT IN SUB. - VIRGINIA HALL NURSING HOME 8051300 OPERATING LEASE LIABILITY 8959511 FINANCE LEASE LIABILITY 2805041 MEDICAID SUPPLEMENTAL 4687083 ARBITRAGE REBATE LIABILITY 55850 24558785 1076979588 -249238747 -249238747 1326218335 -18510489 -18510489 1307707846 1313000387 11826593 11826593 1301173794 0 1301173794 PART XI, LINE 4B - OTHER ADJUSTMENTS: UNRELATED BUSINESS INCOME-DATA PROCESSING, LAUNDRY SUBSIDIARIES EXPENSES PART XII, LINE 2D - OTHER ADJUSTMENTS: SUBSIDIARIES INCOME/EXPENSE UNRELATED BUSINESS INCOME-DATA PROCESSNG, LAUNDRY FASB ASC 715-30 PENSION FORM 990, SCHEDULE D, PART XI, LINE 4D AND PART XII, LINE 2D PART XI, LINE 4B DATA PROCESSING 292,803 SUBSIDIARIES EXPENSES (18,803,292) TOTAL (18,510,489) PART XII, LINE 2D DATA PROCESSING (292,803) SUBSIDIARIES EXPENSES 18,803,292 PENSION RELATED CHANGES (6,683,896) TOTAL 11,826,593 0 0 0 0 0 0 0 0 0 0 SUB-SAHARAN AFRICA MEDICAL SUPPLIES 0 7976 MEDICAL SUPPLIES BOOK RUSSIA AND NEIGHBORING STATES MEDICAL SUPPLIES 16025 CHECK 195460 MEDICAL SUPPLIES BOOK 2 0 0 0 0 0 0 0 PART III ACCOUNTING METHOD: 1 1 X 1 X 1 X 1 1 1 0 1 1 14927148 14927148 0.01150 199492574 148431908 51060666 0.03920 214419722 148431908 65987814 0.05070 3465575 3465575 0.00270 4917050 4917050 0.00380 1908631 567239 1341392 0.00100 1844622 1844622 0.00140 12135878 567239 11568639 0.00890 226555600 148999147 77556453 0.05960 1 12101570 0 218884785 243718269 -24833484 X 1 1 4 1 WILLIS-KNIGHTON MEDICAL CENTER 2600 GREENWOOD ROAD SHREVEPORT LA 71103 232 X X X X REHAB CTR, SNF, PHYSICIAN CLINICS A 2 WK PIERREMONT HEALTH CENTER 8001 YOUREE DRIVE SHREVEPORT LA 71115 232-C X X X X PHYSICIAN CLINICS A 3 WK BOSSIER HEALTH CENTER 2400 HOSPITAL DRIVE BOSSIER CITY LA 71111 387 X X X PHYSICIAN CLINICS A 4 WILLIS-KNIGHTON SOUTH 2510 BERT KOUNS INDUSTRIAL LOOP SHREVEPORT LA 71118 232-A X X X X PHYSICIAN CLINICS A WILLIS-KNIGHTON HEALTH SYSTEM 0 0 1 X X X X X X X X X 21 1 1 0 1 X WWW.WKHS.COM 1 21 1 WWW.WKHS.COM 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X WWW.WKHS.COM X WWW.WKHS.COM X WWW.WKHS.COM X X X X X X 1 0 X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: WILLIS-KNIGHTON MEDICAL CENTER, - FACILITY 4: WILLIS-KNIGHTON SOUTH, - FACILITY 3: WK BOSSIER HEALTH CENTER, - FACILITY 2: WK PIERREMONT HEALTH CENTER GROUP A-FACILITY 1 -- WILLIS-KNIGHTON MEDICAL CENTER PART V, SECTION B, LINE 3J: THE COMMUNITY NEEDS ASSESSMENT TEAM ENTERED INTO DIALOGUE WITH KEY HOSPITAL ADMINISTRATORS, PHYSICIANS, KEY COMMUNITY MEMBERS, THOSE WITH KNOWLEDGE/EXPERTISE IN PUBLIC HEALTH, AND THOSE SERVING UNDERSERVED AND CHRONIC DISEASE POPULATIONS. DURING THIS PHASE, THE TEAM CONDUCTED FOCUS GROUPS AND SURVEYS TO GAIN THIS KNOWLEDGE.THERE WERE 23 INTERVIEW AND SURVEY RESPONDENTS WHICH CONSISTED OF THE FOLLOWING. -HEALTH ORGANIZATIONS -PHYSICIANS -PROVIDERS -COMMUNITY LEADERS -COMMUNITY ORGANIZATIONS -LOCAL GOVERNMENTEACH PERSON PARTICIPATING RANKED THE CURRENT HEALTH OF THE COMMUNITY ON A SCALE OF 1 TO 10, 10 BEING THE BEST. THE SCORE AFTER AVERAGING THE 23 RESPONDENTS' FEEDBACK WAS 4.46.RESPONDENTS WERE ASKED WHAT THEY VIEWED AS THE TOP HEALTH ISSUES FACING THE SERVICE AREA PARISHES AND ITS RESIDENTS. THEY WERE THEN ASKED TO ELABORATE ON CERTAIN BARRIERS, GAPS, AND ACCESS TO CARE ISSUES.BASED ON THE FEEDBACK PROVIDED IN THE COMMUNITY INPUT PHASE OF THE CHNA, THE FOLLOWING BARRIERS AND OPPORTUNITIES WERE IDENTIFIED WHEN EVALUATING THE HEALTH OF CADDO AND BOSSIER PARISHES.BARRIERS - ACCESS TO AFFORDABLE HEALTHCARE - ACCESS TO A PRIMARY CARE PROVIDER - EDUCATION ON HEALTHY HABITS - HEALTHCARE LITERACY - RIGHT SITE OF CARE UTILIZATION - CHRONIC CONDITION MANAGEMENT - PATIENTS' NON-COMPLIANCEOPPORTUNITY - WEIGHT MANAGEMENT/OBESITY - COMMUNITY SAFETY - DRUG/SUBSTANCE ABUSE - MENTAL HEALTH SERVICES - PROVIDER ALIGNMENT ONCE THE ISSUES/COMMUNITY NEEDS WERE IDENTIFIED AND ORGANIZED, A PRIORITIZATION SESSION WAS HELD WITH MEMBERS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE. THIS SESSION RESULTED IN THE DEVELOPMENT OF A PRIORITIZATION TABLE. THE PRIORITIES WERE RANKED BASED ON SIGNIFICANCE OF THE COMMUNITY NEED AND WKHS'S ABILITY TO IMPACT THE NEED. THIS PROCESS IDENTIFIED PRIORITY HEALTH ISSUES FOR BOTH BOSSIER AND CADDO PARISHES THAT WKHS FEELS IT HAS AN ABILITY TO IMPACT AT CERTAIN LEVELS. PRIORITIZED 2022 COMMUNITY HEALTH NEEDS ARE PREVENTATIVE CARE, HEALTH COMMUNICATION, HEALTH CARE ACCESS, HEALTH ISSUES OF ADULTS AND 65+, AND MENTAL HEALTH AND MENTAL DISORDERS. GROUP A-FACILITY 1 -- WILLIS-KNIGHTON MEDICAL CENTER PART V, SECTION B, LINE 6A: WK PIERREMONT HEALTH CENTERWK BOSSIER HEALTH CENTERWILLIS-KNIGHTON SOUTH GROUP A-FACILITY 2 -- WK PIERREMONT HEALTH CENTER PART V, SECTION B, LINE 3J: THE COMMUNITY NEEDS ASSESSMENT TEAM ENTERED INTO DIALOGUE WITH KEY HOSPITAL ADMINISTRATORS, PHYSICIANS, KEY COMMUNITY MEMBERS, THOSE WITH KNOWLEDGE/EXPERTISE IN PUBLIC HEALTH, AND THOSE SERVING UNDERSERVED AND CHRONIC DISEASE POPULATIONS. DURING THIS PHASE, THE TEAM CONDUCTED FOCUS GROUPS AND SURVEYS TO GAIN THIS KNOWLEDGE.THERE WERE 23 INTERVIEW AND SURVEY RESPONDENTS WHICH CONSISTED OF THE FOLLOWING. -HEALTH ORGANIZATIONS -PHYSICIANS -PROVIDERS -COMMUNITY LEADERS -COMMUNITY ORGANIZATIONS -LOCAL GOVERNMENTEACH PERSON PARTICIPATING RANKED THE CURRENT HEALTH OF THE COMMUNITY ON A SCALE OF 1 TO 10, 10 BEING THE BEST. THE SCORE AFTER AVERAGING THE 23 RESPONDENTS' FEEDBACK WAS 4.46.RESPONDENTS WERE ASKED WHAT THEY VIEWED AS THE TOP HEALTH ISSUES FACING THE SERVICE AREA PARISHES AND ITS RESIDENTS. THEY WERE THEN ASKED TO ELABORATE ON CERTAIN BARRIERS, GAPS, AND ACCESS TO CARE ISSUES.BASED ON THE FEEDBACK PROVIDED IN THE COMMUNITY INPUT PHASE OF THE CHNA, THE FOLLOWING BARRIERS AND OPPORTUNITIES WERE IDENTIFIED WHEN EVALUATING THE HEALTH OF CADDO AND BOSSIER PARISHES.BARRIERS - ACCESS TO AFFORDABLE HEALTHCARE - ACCESS TO A PRIMARY CARE PROVIDER - EDUCATION ON HEALTHY HABITS - HEALTHCARE LITERACY - RIGHT SITE OF CARE UTILIZATION - CHRONIC CONDITION MANAGEMENT - PATIENTS' NON-COMPLIANCEOPPORTUNITY - WEIGHT MANAGEMENT/OBESITY - COMMUNITY SAFETY - DRUG/SUBSTANCE ABUSE - MENTAL HEALTH SERVICES - PROVIDER ALIGNMENT ONCE THE ISSUES/COMMUNITY NEEDS WERE IDENTIFIED AND ORGANIZED, A PRIORITIZATION SESSION WAS HELD WITH MEMBERS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE. THIS SESSION RESULTED IN THE DEVELOPMENT OF A PRIORITIZATION TABLE. THE PRIORITIES WERE RANKED BASED ON SIGNIFICANCE OF THE COMMUNITY NEED AND WKHS'S ABILITY TO IMPACT THE NEED. THIS PROCESS IDENTIFIED PRIORITY HEALTH ISSUES FOR BOTH BOSSIER AND CADDO PARISHES THAT WKHS FEELS IT HAS AN ABILITY TO IMPACT AT CERTAIN LEVELS. PRIORITIZED 2022 COMMUNITY HEALTH NEEDS ARE PREVENTATIVE CARE, HEALTH COMMUNICATION, HEALTH CARE ACCESS, HEALTH ISSUES OF ADULTS AND 65+, AND MENTAL HEALTH AND MENTAL DISORDERS. GROUP A-FACILITY 2 -- WK PIERREMONT HEALTH CENTER PART V, SECTION B, LINE 6A: WILLIS-KNIGHTON MEDICAL CENTERWK BOSSIER HEALTH CENTERWILLIS-KNIGHTON SOUTH GROUP A-FACILITY 3 -- WK BOSSIER HEALTH CENTER PART V, SECTION B, LINE 3J: THE COMMUNITY NEEDS ASSESSMENT TEAM ENTERED INTO DIALOGUE WITH KEY HOSPITAL ADMINISTRATORS, PHYSICIANS, KEY COMMUNITY MEMBERS, THOSE WITH KNOWLEDGE/EXPERTISE IN PUBLIC HEALTH, AND THOSE SERVING UNDERSERVED AND CHRONIC DISEASE POPULATIONS. DURING THIS PHASE, THE TEAM CONDUCTED FOCUS GROUPS AND SURVEYS TO GAIN THIS KNOWLEDGE.THERE WERE 23 INTERVIEW AND SURVEY RESPONDENTS WHICH CONSISTED OF THE FOLLOWING. -HEALTH ORGANIZATIONS -PHYSICIANS -PROVIDERS -COMMUNITY LEADERS -COMMUNITY ORGANIZATIONS -LOCAL GOVERNMENTEACH PERSON PARTICIPATING RANKED THE CURRENT HEALTH OF THE COMMUNITY ON A SCALE OF 1 TO 10, 10 BEING THE BEST. THE SCORE AFTER AVERAGING THE 23 RESPONDENTS' FEEDBACK WAS 4.46.RESPONDENTS WERE ASKED WHAT THEY VIEWED AS THE TOP HEALTH ISSUES FACING THE SERVICE AREA PARISHES AND ITS RESIDENTS. THEY WERE THEN ASKED TO ELABORATE ON CERTAIN BARRIERS, GAPS, AND ACCESS TO CARE ISSUES.BASED ON THE FEEDBACK PROVIDED IN THE COMMUNITY INPUT PHASE OF THE CHNA, THE FOLLOWING BARRIERS AND OPPORTUNITIES WERE IDENTIFIED WHEN EVALUATING THE HEALTH OF CADDO AND BOSSIER PARISHES.BARRIERS - ACCESS TO AFFORDABLE HEALTHCARE - ACCESS TO A PRIMARY CARE PROVIDER - EDUCATION ON HEALTHY HABITS - HEALTHCARE LITERACY - RIGHT SITE OF CARE UTILIZATION - CHRONIC CONDITION MANAGEMENT - PATIENTS' NON-COMPLIANCEOPPORTUNITY - WEIGHT MANAGEMENT/OBESITY - COMMUNITY SAFETY - DRUG/SUBSTANCE ABUSE - MENTAL HEALTH SERVICES - PROVIDER ALIGNMENT ONCE THE ISSUES/COMMUNITY NEEDS WERE IDENTIFIED AND ORGANIZED, A PRIORITIZATION SESSION WAS HELD WITH MEMBERS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE. THIS SESSION RESULTED IN THE DEVELOPMENT OF A PRIORITIZATION TABLE. THE PRIORITIES WERE RANKED BASED ON SIGNIFICANCE OF THE COMMUNITY NEED AND WKHS'S ABILITY TO IMPACT THE NEED. THIS PROCESS IDENTIFIED PRIORITY HEALTH ISSUES FOR BOTH BOSSIER AND CADDO PARISHES THAT WKHS FEELS IT HAS AN ABILITY TO IMPACT AT CERTAIN LEVELS. PRIORITIZED 2022 COMMUNITY HEALTH NEEDS ARE PREVENTATIVE CARE, HEALTH COMMUNICATION, HEALTH CARE ACCESS, HEALTH ISSUES OF ADULTS AND 65+, AND MENTAL HEALTH AND MENTAL DISORDERS. GROUP A-FACILITY 3 -- WK BOSSIER HEALTH CENTER PART V, SECTION B, LINE 6A: WILLIS-KNIGHTON MEDICAL CENTERWK PIERREMONT HEALTH CENTERWILLIS-KNIGHTON SOUTH GROUP A-FACILITY 4 -- WILLIS-KNIGHTON SOUTH PART V, SECTION B, LINE 3J: THE COMMUNITY NEEDS ASSESSMENT TEAM ENTERED INTO DIALOGUE WITH KEY HOSPITAL ADMINISTRATORS, PHYSICIANS, KEY COMMUNITY MEMBERS, THOSE WITH KNOWLEDGE/EXPERTISE IN PUBLIC HEALTH, AND THOSE SERVING UNDERSERVED AND CHRONIC DISEASE POPULATIONS. DURING THIS PHASE, THE TEAM CONDUCTED FOCUS GROUPS AND SURVEYS TO GAIN THIS KNOWLEDGE.THERE WERE 23 INTERVIEW AND SURVEY RESPONDENTS WHICH CONSISTED OF THE FOLLOWING. -HEALTH ORGANIZATIONS -PHYSICIANS -PROVIDERS -COMMUNITY LEADERS -COMMUNITY ORGANIZATIONS -LOCAL GOVERNMENTEACH PERSON PARTICIPATING RANKED THE CURRENT HEALTH OF THE COMMUNITY ON A SCALE OF 1 TO 10, 10 BEING THE BEST. THE SCORE AFTER AVERAGING THE 23 RESPONDENTS' FEEDBACK WAS 4.46.RESPONDENTS WERE ASKED WHAT THEY VIEWED AS THE TOP HEALTH ISSUES FACING THE SERVICE AREA PARISHES AND ITS RESIDENTS. THEY WERE THEN ASKED TO ELABORATE ON CERTAIN BARRIERS, GAPS, AND ACCESS TO CARE ISSUES.BASED ON THE FEEDBACK PROVIDED IN THE COMMUNITY INPUT PHASE OF THE CHNA, THE FOLLOWING BARRIERS AND OPPORTUNITIES WERE IDENTIFIED WHEN EVALUATING THE HEALTH OF CADDO AND BOSSIER PARISHES.BARRIERS - ACCESS TO AFFORDABLE HEALTHCARE - ACCESS TO A PRIMARY CARE PROVIDER - EDUCATION ON HEALTHY HABITS - HEALTHCARE LITERACY - RIGHT SITE OF CARE UTILIZATION - CHRONIC CONDITION MANAGEMENT - PATIENTS' NON-COMPLIANCEOPPORTUNITY - WEIGHT MANAGEMENT/OBESITY - COMMUNITY SAFETY - DRUG/SUBSTANCE ABUSE - MENTAL HEALTH SERVICES - PROVIDER ALIGNMENT ONCE THE ISSUES/COMMUNITY NEEDS WERE IDENTIFIED AND ORGANIZED, A PRIORITIZATION SESSION WAS HELD WITH MEMBERS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE. THIS SESSION RESULTED IN THE DEVELOPMENT OF A PRIORITIZATION TABLE. THE PRIORITIES WERE RANKED BASED ON SIGNIFICANCE OF THE COMMUNITY NEED AND WKHS'S ABILITY TO IMPACT THE NEED. THIS PROCESS IDENTIFIED PRIORITY HEALTH ISSUES FOR BOTH BOSSIER AND CADDO PARISHES THAT WKHS FEELS IT HAS AN ABILITY TO IMPACT AT CERTAIN LEVELS. PRIORITIZED 2022 COMMUNITY HEALTH NEEDS ARE PREVENTATIVE CARE, HEALTH COMMUNICATION, HEALTH CARE ACCESS, HEALTH ISSUES OF ADULTS AND 65+, AND MENTAL HEALTH AND MENTAL DISORDERS. GROUP A-FACILITY 4 -- WILLIS-KNIGHTON SOUTH PART V, SECTION B, LINE 6A: WILLIS-KNIGHTON MEDICAL CENTERWK BOSSIER HEALTH CENTERWK PIERREMONT HEALTH CENTER 5 1 - OUTPATIENT CLINICS VARIOUS LOCATIONS SHREVEPORT LA 71130 OUTPATIENT CLINICS 2 - THE OAKS OF LOUISIANA 600 EAST FLOURNOY LUCUS ROAD SHREVEPORT LA 71115 RESIDENTIAL COMMUNITY FOR ADULTS AGE 55 AND OVER 3 - SAVANNAH AT THE OAKS 600 EAST FLOURNOY LUCUS ROAD SHREVEPORT LA 71115 ASSISTED LIVING FACILITY 4 - EXTENDED CARE CENTER 2550 KINGS HIGHWAY SHREVEPORT LA 71103 SUBACUTE REHABILITATION 5 - WK REHABILITATION SERVICES 1111 LINE AVENUE SHREVEPORT LA 71101 REHABILITATION/DIALYSIS PART I, LINE 7: ALL ITEMS IN THE TABLE, EXCEPT FOR LINE 7G, USE THE COST-TO-CHARGE RATIO COSTING METHOD. PROJECT NEIGHBORHEALTH, WHICH IS INCLUDED ON LINE 7G, USES THE ACTUAL COST METHOD. PART III, LINE 4: THE MEDICAL CENTER HAS DETERMINED THAT SUBSTANTIALLY ALL OF ITS UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE REPRESENT IMPLICIT PRICE CONCESSIONS. AS SUCH, AMOUNTS DETERMINED TO BE IMPLICIT PRICE CONCESSIONS ARE NOT INCLUDED IN THE TRANSACTION PRICE AND NOT INCLUDED IN PATIENT ACCOUNTS RECEIVABLE. ACCORDINGLY, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR PATIENTS' ACCOUNTS IS NOT RELEVANT AND NOT MAINTAINED. IN REGARDS TO RECEIVABLES FROM THIRD-PARTY PAYORS, BAD DEBT LOSSES HAVE NOT BEEN MATERIAL IN THE MEDICAL CENTER'S EXPERIENCE; ACCORDINGLY, AN ALLOWANCE FOR BAD DEBTS ON ACCOUNTS FROM THIRD-PARTY PAYORS IS ALSO NOT MAINTAINED. SEE NOTE 3(PAGE 10), IN THE SEPTEMBER 30, 2022, AUDITED FINANCIAL STATEMENTS ATTACHED. PART III, LINE 8: THE MEDICAL CENTER HAS NOT TO DATE INCLUDED MEDICARE SHORTFALLS IN ANY PUBLIC REPRESENTATION OF ITS COMMUNITY BENEFITS. THE MEDICAL CENTER IS AWARE OF THE VARIOUS ARGUMENTS CIRCULATING WITH REGARDS TO WHETHER THE SO CALLED MEDICARE SHORTFALL SHOULD BE IN WHOLE OR PART TREATED AS A COMMUNITY BENEFIT. THE MOST COMPELLING OF THE PROPONENTS' ARGUMENTS IS THAT BECAUSE TAX EXEMPT HOSPITALS MUST SERVE MEDICARE BENEFICIARIES AT NONNEGOTIABLE RATES SET BY THE GOVERNMENT, SHORTFALLS RESULT FROM UNDERPAYMENTS AND AS SUCH ARE UNAVOIDABLE COMMUNITY BENEFITS. OPPONENTS ARGUE SHORTFALLS ARE RELATED TO EFFICIENCY. THE MEDICAL CENTER IS CONFIDENT THAT ITS MEDICARE SHORTFALL IS NOT ATTRIBUTABLE TO INEFFICIENCIES BUT INSTEAD TO UNDERPAYMENTS FOR COSTS OF PROVIDING HIGH QUALITY MEDICAL CARE AND PATIENT SERVICES BY AN APPROPRIATE NUMBER OF COMPETENT STAFF IN HIGH QUALITY WELL EQUIPPED FACILITIES.THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. PART III, LINE 9B: 1. MONTHLY STATEMENTS ARE GENERATED AND MAILED BY THE MEDICAL CENTER TO PATIENTS/GUARANTORS TO MAKE THEM AWARE OF OUTSTANDING BALANCES.2. THE ACCOUNTS RECEIVABLE FILE IS REVIEWED MONTHLY FOR ACCOUNTS THAT HAVE AN OUTSTANDING BALANCE SHOWN TO BE THE PATIENT/GUARANTOR'S RESPONSIBILITY. AN ACCOUNT IS CONSIDERED TO BE IN THE EARLY STAGES OF DELINQUENCY AT A MINIMUM OF 136 DAYS FROM THE FIRST STATEMENT DATE, AT LEAST 3 STATEMENTS HAVE BEEN GENERATED FROM THE MEDICAL CENTER AND IT HAS BEEN GREATER THAN 45 DAYS SINCE THE LAST PAYMENT WAS RECEIVED FROM INSURANCE OR THE PATIENT/GUARANTOR.3. ACCOUNTS MEETING THE ABOVE CRITERIA ARE REFERRED TO AN EARLY OUT AGENCY FOR COLLECTION. THE EARLY OUT AGENCY WILL ATTEMPT TO COLLECT THE OUTSTANDING BALANCE FOR A PERIOD OF 90 DAYS. THE EARLY OUT COLLECTION EFFORTS WILL INCLUDE BOTH PHONE AND WRITTEN COMMUNICATIONS. PAYMENTS AND PATIENT CORRESPONDENCE WILL BE DIRECTED TO THE MEDICAL CENTER, NOT THE EARLY OUT AGENCY.4. THE EARLY OUT AGENCY WILL RETURN FILES TO THE MEDICAL CENTER AT THE END OF THE 90 DAY PERIOD WITH STATUS INFORMATION AS FOLLOWS:A. RETURNED WITH A PAYMENT ARRANGEMENT - ACCOUNTS ARE MAINTAINED IN-HOUSE AND MONITORED BY THE BUSINESSS OFFICE. THE BAD DEBT AGENCY IS CHANGED TO WK-REG. STATEMENTS ARE GENERATED AND MAILED TO THE PATIENT/GUARANTOR MONTHLY. ACCOUNTS ARE MONITORED MONTHLY. IF THE PATIENT DEFAULTS ON THE PAYMENT ARRANGEMENT, THE MEDICAL CENTER WILL MAIL NOTIFICATION CONCERNING THE WILLIS-KNIGHTON HEALTH SYSTEM FINANCIAL ASSISTANCE POLICY AND A FINANCIAL ASSISTANCE APPLICATION AND ALLOW A MINIMUM OF 30 DAYS FOR RESPONSE. APPLICATIONS RECEIVED WILL BE PROCESSED AND NOTIFICATION WILL BE SENT TO THE PATIENT. ACCOUNTS WILL NOT BE REFERRED TO AN OUTSIDE COLLECTION AGENCY UNLESS THE PATIENT FAILS TO RESPOND OR DOES NOT MEET THE FINANCIAL REQUIREMENTS FOR FINANCIAL ASSISTANCE.B. RETURNED WITH NO PAYMENT ARRANGEMENT - THE MEDICAL CENTER WILL MAIL NOTIFICATION CONCERNING THE WILLIS-KNIGHTON HEALTH SYSTEM FINANCIAL ASSISTANCE POLICY AND A FINANCIAL ASSISTANCE APPLICATION AND ALLOW A MINIMUM OF 30 DAYS FOR RESPONSE. APPLICATIONS RECEIVED WILL BE PROCESSED AND NOTIFICATION WILL BE SENT TO THE PATIENT. ACCOUNTS WILL NOT BE REFERRED TO AN OUTSIDE COLLECTION AGENCY UNLESS THE PATIENT FAILS TO RESPOND OR DOES NOT MEET THE FINANCIAL REQUIREMENTS FOR FINANCIAL ASSISTANCE. THE BUSINESS OFFICE DIRECTOR WILL HAVE THE FINAL AUTHORITY FOR DETERMINING THAT THE MEDICAL CENTER HAS MADE REASONABLE EFFORTS TO DETERMINE THAT A PATIENT IS NOT FINANCIAL ASSISTANCE ELIGIBLE AND MAY THEREFORE ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS AGAINST THE PATIENT. COLLECTION EFFORTS MAY INCLUDE REPORTING TO CREDIT AGENCIES, LAWSUITS OR WAGE GARNISHMENTS.5. THE BUSINESS OFFICE DIRECTOR WILL HAVE THE FINAL AUTHORITY FOR DETERMINING THAT THE MEDICAL CENTER HAS MADE REASONABLE EFFORTS TO DETERMINE THAT A PATIENT IS NOT FINANCIAL ASSISTANCE ELIGIBLE AND MAY THEREFORE ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS AGAINST THE PATIENT. COLLECTION EFFORTS MAY INCLUDE REPORTING TO CREDIT AGENCIES, LAWSUITS OR WAGE GARNISHMENT. PART VI, LINE 2: WILLIS-KNIGHTON MEDICAL CENTER OPERATES THROUGHOUT SHREVEPORT, BOSSIER CITY AND NEARBY PARISHES AND PROVIDES FOUR HOSPITALS, URGENT CARE CENTERS, NUMEROUS SATELLITE CLINICS, A SKILLED NURSING FACILITY, A RETIREMENT COMMUNITY, AN ASSISTED LIVING FACILITY, AND A REHABILITATION INSTITUTE. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT IT SERVES BY STAYING INFORMED ABOUT THE RELEVANT TRENDS OCCURRING IN THE AREAS IN WHICH IT OPERATES. PART VI, LINE 3: WILLIS-KNIGHTON HEALTH SYSTEM IS COMMITTED TO PROVIDING CHARITY CARE TO PERSONS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE. CONSISTENT WITH ITS MISSION TO DELIVER COMPASSIONATE, HIGH QUALITY, AFFORDABLE HEALTHCARE SERVICES AND TO BE AN ADVOCATE FOR THOSE WHO ARE MOST IN NEED, WILLIS-KNIGHTON HEALTH SYSTEM STRIVES TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING CARE. PATIENTS ARE EXPECTED TO COOPERATE WITH WILLIS-KNIGHTON HEALTH SYSTEM'S PROCEDURES FOR OBTAINING CHARITY OR OTHER FORMS OF PAYMENT OR FINANCIAL ASSISTANCE, AND TO CONTRIBUTE TO THE COST OF THEIR CARE BASED ON THEIR INDIVIDUAL ABILITY TO PAY. PART VI, LINE 4: WILLIS-KNIGHTON'S PRIMARY SERVICE AREA (PSA) COVERS AN APPROXIMATE 35 MILE RADIUS OF SHREVEPORT, COVERING THE LOUISIANA PARISHES OF CADDO, BOSSIER, WEBSTER, CLAIBORNE, RED RIVER, DESOTO AND BIENVILLE, AND WHICH HAS AN ESTIMATED POPULATION OF APPROXIMATELY 470,000 PERSONS. THE AVERAGE HOUSEHOLD INCOME FOR THE PSA IS $59,460. PART VI, LINE 5: OTHER COMMUNITY BENEFITS:THE MEDICAL CENTER OPERATES THE FOLLOWING COMMUNITY CARE CLINICS: SIMPKINS COMMUNITY HEALTH & EDUCATION CENTER - MLK AND THE WK COMMUNITY HEALTH & WELLNESS CENTER - ALLENDALE.SIMPKINS COMMUNITY HEALTH & EDUCATION CENTER - MLK ON SEPTEMBER 1, 1995, AT A COST OF APPROXIMATELY $1,300,000, THE MEDICAL CENTER OPENED A 6,463 SQUARE FOOT, FEDERALLY DESIGNATED INDIGENT CARE MEDICAL CLINIC AND A 3,914 SQUARE FOOT COMMUNITY EDUCATION BUILDING ON HILRY HUCKABY AVENUE IN SHREVEPORT, LOUISIANA. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THESE FACILITIES ARE CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. SERVICES ARE PROVIDED WITHOUT REGARD TO THE PATIENTS' ABILITY TO PAY. THE LOCATION OF THE CLINIC (CENSUS TRACT 246 IN THE DR. MARTIN LUTHER KING DRIVE AREA IN CADDO PARISH) WAS DESIGNATED BY THE DEPARTMENT OF HEALTH AND HOSPITALS AS A HEALTH-PROFESSIONAL-SHORTAGE AREA AND AS A MEDICALLY UNDER-SERVED AREA. PRIOR TO THE CLINIC'S OPENING, THIS AREA WAS THE SECOND LARGEST CONTIGUOUS POPULATION OF MEDICALLY UNDER-SERVED PEOPLE IN THE UNITED STATES. THE CLINIC HAS AN EMERGENCY AND SPECIAL PROCEDURES ROOM, AN X-RAY DEPARTMENT, AND A FULLY EQUIPPED LABORATORY AND DENTAL FACILITY. PREVENTATIVE CARE PROGRAMS INCLUDE BLOOD PRESSURE CHECKS, HEALTH SCREENINGS, IMMUNIZATIONS, AND DIABETES COUNSELING. THE CLINIC'S STAFF INCLUDES A FAMILY PRACTICE PHYSICIAN SPECIALIST, A NURSE PRACTITIONER, AND SUPPORT STAFF. THE CLINIC HAD 2,622 MEDICAL PATIENT VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2022. THE EDUCATION FACILITY HOUSES CLASSROOMS, AN AUDITORIUM, A NURSERY, A CONFERENCE ROOM, AND A LIBRARY WITH STUDY AREAS.WK PIERRE AVENUE COMMUNITY HEALTH & WELLNESS CENTER - ALLENDALE ON AUGUST 1, 1998, THE MEDICAL CENTER OPENED A 15,062 SQUARE FOOT MEDICAL CLINIC KNOWN AS THE "WK COMMUNITY HEALTH & WELLNESS CENTER" ON PIERRE AVENUE IN SHREVEPORT AT A COST OF APPROXIMATELY $1,375,000. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THIS FACILITY IS CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. THIS FACILITY ALSO CONTAINS A HEALTH AND FITNESS CENTER. THE MEDICAL CENTER PROVIDES EQUIPMENT AND MEDICAL STAFF FOR THE CLINIC. THE CLINIC'S STAFF INCLUDES A FAMILY PRACTICE PHYSICIAN SPECIALIST, A NURSE PRACTITIONER, AND SUPPORT STAFF. THE CLINIC HAD 2,529 MEDICAL PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2022. OTHER COMMUNITY SERVICESTHE MEDICAL CENTER MAKES AVAILABLE, FREE-OF-CHARGE, MEETING SPACE TO OUTSIDE COMMUNITY OUTREACH ORGANIZATIONS SUCH AS BAYOU NORTH AREA HEALTH EDUCATION CENTER, COURT APPOINTED SPECIAL ADVOCATES (CASA), ICE (INNER CITY ENTREPRENEUR), LIFESHARE BLOOD CENTER, NORTHWEST LOUISIANA COALITION FOR WOMEN AND CHILDREN, UNITED WAY, NORTHWEST LOUISIANA FAMILY JUSTICE CENTER, COMMON GROUND COMMUNITY, NURSE FAMILY PARTNERSHIP AND OTHER CHARITABLE AND GOVERNMENTAL ORGANIZATIONS. THE MEDICAL CENTER OFFERS ITS VIRTUAL HOSPITAL AT THE WK INNOVATION CENTER TO THE FOLLOWING EDUCATIONAL INSTITUTIONS/ORGANIZATIONS FOR TRAINING IN A REALISTIC SETTING: NORTHWESTERN STATE UNIVERSITY COLLEGE OF NURSING AND CRNA PROGRAM, U.S. NAVY, UNIVERSITY OF LOUISIANA-MONROE, NORTHWEST LOUISIANA TECHNICAL COLLEGE, LSU HEALTH SERVICES CENTER - SHREVEPORT, LSU SHREVEPORT, LOUISIANA TECH UNIVERSITY, SOUTHERN UNIVERSITY SHREVEPORT, LIFE AIR RESCUE AND BAPTIST HEALTH.THE MEDICAL CENTER OFFERS EXTENSIVE ONLINE HEALTH INFORMATION ON ITS WEB SITE. FREE HEALTH INFORMATION IS AVAILABLE, TARGETED TO BOTH ADULTS AND CHILDREN. INFORMATION FOR ADULTS INCLUDES A VIDEO HEALTH LIBRARY AND A DESCRIPTION OF PROCEDURES, WRITTEN BY HEALTH PROFESSIONALS AND REVIEWED AND UPDATED REGULARLY. THE MEDICAL CENTER ALSO PARTNERS WITH THE NEMOURS FOUNDATION TO OFFER KIDSHEALTH, A HEALTH AND WELLNESS INFORMATION SITE TARGETED TO CHILDREN, TEENS AND THEIR PARENTS. THE WILLIS-KNIGHTON CANCER CENTER WEB SITE OFFERS INFORMATION ON VARIOUS TYPES OF CANCER AND TREATMENTS AS WELL AS AN UPDATED LIST OF CLINICAL TRIALS. DURING THE PAST YEAR THE WK WEBSITE ATTRACTED 960,000 VISITORS WITH MORE THAN 1,950,000 PAGE VIEWS. KIDSHEALTH HAD 144,000 PAGE VIEWS.IMMUNIZATIONS FOR CHILDREN WILLIS-KNIGHTON PROVIDES A MOBILE UNIT THAT OFFERS "SHOTS FOR TOTS". USING ITS MOBILE VAN AND STAFF, VACCINES ARE TAKEN TO VARIOUS NEIGHBORHOODS TO MAKE THEM CONVENIENT FOR PARENTS. UNDER THIS PROGRAM, ANY CHILD MAY RECEIVE IMMUNIZATION SHOTS, FREE OF CHARGE, FOR MEASLES, MUMPS, RUBELLA, DIPHTHERIA, PERTUSSIS, TETANUS, HEPATITIS B, POLIO, MENINGITIS, FLU, AND CHICKEN POX. THE MEDICAL CENTER SUBSIDIZES ALL EXPENSES OF THE PROGRAM EXCEPT THE VACCINE, WHICH IS PROVIDED BY THE LOUISIANA DEPARTMENT OF PUBLIC HEALTH. DURING THE YEAR ENDED SEPTEMBER 30, 2022, THE MEDICAL CENTER IMMUNIZED 1,052 PATIENTS UNDER THIS PROGRAM.HEALTH PROFESSIONS EDUCATIONTHE MEDICAL CENTER PROVIDES VARIOUS EDUCATION PROGRAMS THAT RESULT IN HEALTHCARE PROFESSIONALS RECEIVING DEGREES, CERTIFICATES OR TRAINING THAT IS NECESSARY TO BE LICENSED TO PRACTICE AS HEALTH CARE PROFESSIONALS. WHILE THE MEDICAL CENTER ALSO PROVIDES A VARIETY OF EDUCATION, TRAINING AND STIPEND PROGRAMS THAT ARE EXCLUSIVE TO THE MEDICAL CENTER'S EMPLOYEES AND MEDICAL STAFF, THOSE COSTS ARE NOT INCLUDED IN THIS CATEGORY. THE MEDICAL CENTER MAINTAINS AN ASSOCIATION WITH LSU HEALTH SCIENCES CENTER (A PUBLIC TEACHING, RESEARCH, AND INDIGENT CARE FACILITY) BY PROVIDING GRANTS, ASSISTANCE WITH RESIDENTS AND FELLOWS, ALONG WITH UNDERWRITING THE COST OF CLINICAL SETTINGS FOR TRAINING AND INTERNSHIPS FOR A VARIETY OF OTHER HEALTH PROFESSIONALS.SPORTS MEDICINESPORTS MEDICINE EXPERTS AT WILLIS-KNIGHTON SPORTS MEDICINE WORK WITH ATHLETES ON THE PREVENTION AND TREATMENT OF SPORTS-RELATED INJURIES, HELPING THEM TO MAINTAIN A HEALTHY LIFESTYLE. THIS SERVICE IS OFFERED TO VARIOUS SCHOOLS AND PROGRAMS THROUGHOUT THE LOCAL AREA. THE MEDICAL CENTER SPONSORS FREE ATHLETIC PHYSICALS FOR YOUNG ATHLETES, STAFFED BY SPORTS MEDICINE PHYSICIANS AND STAFF.WK INTEGRIN HEALTHIN JUNE 2019, WILLIS-KNIGHTON HEALTH SYSTEM FORMED WK INTEGRIN HEALTH, L3C, DBA HEALTH PLUS NETWORK, A CLINICALLY INTEGRATED NETWORK (CIN) DESIGNED TO IMPROVE THE QUALITY OF PATIENT CARE DELIVERED TO RESIDENTS OF NORTHWEST LOUISIANA. HEALTH PLUS NETWORK CIN IS A PHYSICIAN-LED ENTITY THAT INCENTIVIZES HIGH-QUALITY PATIENT CARE THROUGH COORDINATED EFFORTS BETWEEN CARE PROVIDERS. THE CIN'S PRIMARY OBJECTIVE IS TO FOSTER A HEALTHCARE INFRASTRUCTURE CENTERED AROUND PREVENTATIVE CARE, PROACTIVE CHRONIC DISEASE MANAGEMENT AND APPROPRIATE UTILIZATION OF HEALTHCARE RESOURCES. THROUGH ITS FIRST THREE YEARS IN OPERATION, HEALTH PLUS NETWORK CIN HAS SERVED AS A CATALYST IN IMPROVING THE QUALITY OF CARE DELIVERED TO PATIENTS THROUGHOUT NORTHWEST LOUISIANA. CIN-LED EFFORTS HAVE GENERATED SHARED SAVINGS/VALUE BASED PURCHASING REVENUE IN EXCESS OF $5 MILLION, OF WHICH 60% HAS BEEN SHARED WITH PARTICIPATING PROVIDERS AND 40% HAS BEEN RETAINED WITHIN WK HEALTH PLUS NETWORK CIN, L3C. WK INTEGRIN HEALTH, L3C, DBA HEALTH PLUS NETWORK IS COMPRISED OF 450 PHYSICIANS AND MID-LEVEL PROVIDERS, AND IS GOVERNED BY A 13-MEMBER BOARD OF DIRECTORS, COMPRISED OF 11 WKHS EMPLOYED PHYSICIANS AND 2 WKHS ADMINISTRATORS-JERRY A. FIELDER, II, CEO, AND MARGARET C. REBOUCHE, SR. VP QUALITY & CLINICAL PERFORMANCE. 1 AMERICAN CANCER SOCIETY 920 PIERREMONT SUITE 300 SHREVEPORT LA 71106 237040934 501(C)(3) 10000 0 SPONSORSHIP BOSSIER CHAMBER OF COMMERCE 710 BENTON ROAD BOSSIER CITY LA 71111 720382231 501(C)(6) 21590 0 SPONSORSHIP CHILDREN AND ARTHRITIS 2751 ALBERT BICKNELL DRIVE SUITE 2 SHREVEPORT LA 71103 721170530 501(C)(3) 24000 0 SPONSORSHIP SHREVEPORT CHAMBER OF COMMERCE 400 EDWARDS STREET SHREVEPORT LA 71101 720315700 501(C)(6) 50000 0 SPONSORSHIP HOLY ANGELS RESIDENTIAL FACILITY INC 10450 ELLERBE ROAD SHREVEPORT LA 71106 720628035 501(C)(3) 55000 0 DONATION FOR OPERATIONS INDEPENDENCE BOWL FOUNDATION PO BOX 1723 SHREVEPORT LA 71166 720297228 501(C)(3) 23500 0 SPONSORSHIP LOUISIANA TECH UNIVERSITY FOUNDATION PO BOX 3046 RUSTON LA 71272 726021176 501(C)(3) 69750 0 SPONSORSHIP LA TROOPER FOUNDATION PO BOX 65076 BATON ROUGE LA 70896 742918404 501(C)(3) 25000 0 DONATION FOR OPERATIONS MARTIN LUTHER KING HEALTH CENTER POST OFFICE BOX 393 SHREVEPORT LA 71162 721079721 501(C)(3) 20000 0 DONATION FOR OPERATIONS NORTHWEST LOUISIANA FOOD BANK 2307 TEXAS AVENUE SHREVEPORT LA 71103 721328890 501(C)(3) 25000 0 DONATION FOR OPERATIONS NORTHWESTERN FOUNDATION UNIVERSITY PARKWAY NATCHITOCHES LA 71497 726021495 501(C)(3) 944700 0 DONATION FOR OPERATIONS SHREVEPORT-BOSSIER RESCUE MISSION 2033 TEXAS AVENUE SHREVEPORT LA 71103 237050551 501(C)(3) 36299 0 HEALTH INSURANCE FOR RESCUE MISSION EMPLOYEES AND DONATION FOR OPERATIONS SHREVEPORT LITTLE THEATRE 812 MARGARET PLACE SHREVEPORT LA 71101 720363143 501(C)(3) 10000 0 SPONSORSHIP SHREVEPORT OPERA 212 TEXAS STREET NO 1 SHREVEPORT LA 71101 726021455 501(C)(3) 10000 0 DONATION FOR OPERATIONS SHREVEPORT SYMPHONY 619 LOUISIANA AVENUE SHREVEPORT LA 71101 726001334 501(C)(3) 97479 0 SPONSORSHIP ST JUDE'S CHILDREN'S RESEARCH HOSPITAL PO BOX 810 MEMPHIS TN 38101 620646012 501(C)(3) 10000 0 DONATION FOR OPERATIONS VOLUNTEERS FOR YOUTH JUSTICE 900 JORDAN STREET SHREVEPORT LA 71101 721057695 501(C)(3) 110000 0 DONATION FOR OPERATIONS PROVIDENCE HOUSE 814 COTTON STREET SHREVEPORT LA 71101 721205164 501(C)(3) 20000 0 DONATION FOR OPERATIONS RED RIVER RADIO PO BOX 5250 SHREVEPORT LA 71135 720702001 501(C)(3) 7000 0 SPONSORSHIP FRIENDS OF LOUISIANA PUBLIC BROADCASTING INC 7733 PERKINS ROAD BATON ROUGE LA 70810 720794108 501(C)(3) 31500 0 SPONSORSHIP GINGERBREAD HOUSE 1700 BUCKNER SQUARE NO 101 SHREVEPORT LA 71101 721390471 501(C)(3) 10000 0 SPONSORSHIP LA HUMAN RESOURCES DEVELOPMENT INSTITUTE 1991 WOODDALE BOULEVARD BATON ROUGE LA 70806 721124184 501(C)(3) 7500 0 SPONSORSHIP LSUHSC PO BOX 31650 SHREVEPORT LA 71115 721402222 GOVERNMENT 35975 0 DONATION FOR OPERATIONS SHREVEPORT LITTLE LEAGUE 1651 EAST 70TH STREET NO 183 SHREVEPORT LA 71105 721422019 501(C)(3) 15000 0 SPONSORSHIP SHRINER'S HOSPITAL FOR CHILDREN 3100 SAMFORD AVENUE SHREVEPORT LA 71103 362192608 501(C)(3) 20000 0 DONATION FOR OPERATIONS INSTITUTE FOR GLOBAL OUTREACH 1024 PIERRE AVENUE ROOM B SHREVEPORT LA 71103 331180777 501(C)(3) 25000 0 SPONSORSHIP 24 2 PART I, LINE 2: THE MEDICAL CENTER HAS A CONTRIBUTION COMMITTEE THAT APPROVES SUBSTANTIALLY ALL CONTRIBUTIONS. THE CONTRIBUTION COMMITTEE REQUESTS THAT THE ORGANIZATION REQUESTING THE DONATION COMPLETE A CONTRIBUTION REQUEST FORM THAT IS AVAILABLE ON THE MEDICAL CENTER'S WEBSITE. BEFORE THE MEDICAL CENTER'S CONTRIBUTION COMMITTEE WILL APPROVE THE CONTRIBUTIONS THE PURPOSE OF THE CONTRIBUTION MUST BE STATED ON THE CONTRIBUTION REQUEST FORM. THE MEDICAL CENTER CONRIBUTIONS ARE USUALLY PROVIDED TO ORGANIZATIONS FOR GENERAL OPERATIONS AND ARE NOT MONITORED. X 1 1 X X X X X 0 1 0 1 0 0 0 0 0 MILAN G MODY MD PHYSICIAN 1199977 0 1208842 0 -6141 0 785 0 34820 0 2438283 0 0 0 SARAH GLORIOSO MD PHYSICIAN 719986 0 1518291 0 -6345 0 1494 0 35024 0 2268450 0 0 0 JAMES K ELROD FORMER PRESIDENT/FORMER CEO/TRUSTEE 1465778 6000 0 0 268494 0 0 0 8663 0 1742935 6000 0 0 WYCHE T COLEMAN III MD PHYSICIAN 803537 0 872573 0 -9162 0 1347 0 37841 0 1706136 0 0 0 JOHN G NOLES MD PHYSICIAN 1074979 0 489520 0 -6516 0 1774 0 35563 0 1595320 0 0 0 ANIL VELUVOLU MD PHYSICIAN 799985 0 646780 0 -6129 0 1318 0 34808 0 1476762 0 0 0 JERRY A FIELDER II PRESIDENT/CEO 537841 0 0 0 37231 0 2251 0 35245 0 612568 0 0 0 MARY JANE WARD SR VICE PRESIDENT OF FINANCE 455616 0 0 0 31118 0 2317 0 27927 0 516978 0 0 0 BRIAN A CRAWFORD SENIOR VICE PRESIDENT 303328 0 20000 0 28894 0 1069 0 8496 0 361787 0 0 0 MICHAEL CHANDLER SR VP/ADMINISTRATOR WKMC 294839 0 0 0 11190 0 0 0 3610 0 309639 0 0 0 JILL K ELROD VP OF LEGAL AFFAIRS 249390 0 0 0 28675 0 2051 0 11490 0 291606 0 0 0 IRA L MOSS VP/ADMIN WK PIERREMONT 226645 0 0 0 27114 0 3175 0 26346 0 283280 0 0 0 GREGORY J GAVIN VP/PHYSICIAN NETWORK 220940 0 0 0 28359 0 2734 0 10663 0 262696 0 0 0 DIANE R MCCULLER SR VP NURSING - PATIENT SERVI 232621 0 0 0 4749 0 3031 0 12226 0 252627 0 0 0 PEGGY J GAVIN SR VP OF PHYSICIAN SERVICE 198506 0 0 0 33212 0 2669 0 10163 0 244550 0 0 0 MARGARET G ELROD SR VP/IND WELLNESS/COMMUN 199320 0 0 0 29436 0 2435 0 9383 0 240574 0 0 0 PIERRE V BLANCHARDIV MD TRUSTEE/PHYSICIAN 199996 0 2308 0 21322 0 2444 0 8663 0 234733 0 0 0 JANET K ELROD VP/ADMIN WK SOUTH 198715 0 0 0 22630 0 1474 0 11413 0 234232 0 0 0 TODD J BLANCHARD VP/ADMIN WK BOSSIER 195973 0 0 0 -2902 0 821 0 37245 0 231137 0 0 0 MARGARET C REBOUCHE SR VP QUALITY & CLINICAL PERF 204996 0 0 0 4247 0 6408 0 11125 0 226776 0 0 0 VINCENT R SEDMINIK VP/ADMINISTRATOR WK BOSSIER 203912 0 0 0 5934 0 1736 0 1354 0 212936 0 0 0 JOHN L FORTENBERRY JR VP/MARKETING & STRATEGY 190828 0 0 0 6757 0 1451 0 770 0 199806 0 0 0 ALJAY J FOREMAN JR VP/ADMINISTRATOR WKMC 118385 0 0 0 -4785 0 2057 0 41423 0 157080 0 0 0 FORM 990, SCHEDULE J, PART II, COLUMN (B)(III) EXPLANATION OF PART II, COLUMN (B)(III) OTHER COMPENSATION JAMES K. ELROD UNUSED SICK PAY-$33,826 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$717 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$4,820 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN CONTRIBUTION-$211,190 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,759) TOTAL--$268,494 MARY JANE WARD UNUSED SICK PAY-$10,904 VALUE ADDED FOR CELL PHONE USAGE-$960 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$7,011 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,257) TOTAL--$31,118 MARGARET G. ELROD UNUSED SICK PAY-$4,770 VALUE ADDED FOR CELL PHONE USAGE-$1,564 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,081 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,479) TOTAL--$29,436 JERRY A. FIELDER,II UNUSED SICK PAY-$20,769 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$1,043 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,279 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,718) VALUE ADDED FOR CABLE/INTERNET- 2,158 TOTAL--$37,231 JANET K. ELROD UNUSED SICK PAY-$4,671 VALUE ADDED FOR CELL PHONE USAGE-$1,742 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,226 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,509) TOTAL--$22,630 IRA L. MOSS UNUSED SICK PAY-$5,328 VALUE ADDED FOR CELL PHONE USAGE-$503 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$7,268 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,676) PERSONAL USE OF EMPLOYER VEHICLES-$191 TOTAL--$27,114 JILL K. ELROD UNUSED SICK PAY-$5,862 VALUE ADDED FOR CELL PHONE USAGE-$983 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,322 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,586) VALUE ADDED FOR CABLE/INTERNET- $1,441 PERSONAL USE OF EMPLOYER VEHICLES-$3,153 TOTAL--$28,675 PEGGY J. GAVIN UNUSED SICK PAY-$4,751 VALUE ADDED FOR CELL PHONE USAGE-$1,123 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,056 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,259) PERSONAL USE OF EMPLOYER VEHICLES-$5,041 TOTAL--$33,212 PIERRE V. BLANCHARD,IV, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$368 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,213 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,759) TOTAL--$21,322 TODD J. BLANCHARD UNUSED SICK PAY-$4,607 VALUE ADDED FOR CELL PHONE USAGE-$977 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,233 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(9,719) TOTAL--($2,902) MICHAEL CHANDLER VALUE ADDED FOR CELL PHONE USAGE-$905 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,893 SECTION 457(B) DEFERRED COMPENSATION PLAN-$8,125 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(733) TOTAL--$11,190 GREGORY J. GAVIN UNUSED SICK PAY-$5,194 VALUE ADDED FOR CELL PHONE USAGE-$503 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,921 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,759) TOTAL--$28,359 MILAN G. MODY, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$828 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,969) TOTAL--($6,141) JOHN G. NOLES, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$834 VALUE ADDED FOR HEALTH & FITNESS USAGE-$368 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,718) TOTAL--($6,516) SARAH GLORIOSO, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$564 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,909) TOTAL--($6,345) BRIAN A. CRAWFORD COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,346 VALUE ADDED FOR CELL PHONE USAGE-$563 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,592) SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 UNUSED SICK PAY-$8,077 TOTAL--$28,894 JOHN L. FORTENBERRY, JR. UNUSED SICK PAY-$5,980 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,173 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(396) TOTAL--$6,757 MARGARET C. REBOUCHE UNUSED SICK PAY-$5,077 VALUE ADDED FOR CELL PHONE USAGE-$983 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,407 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,220) TOTAL--$4,247 DIANE R. MCCULLER UNUSED SICK PAY-$5,711 VALUE ADDED FOR CELL PHONE USAGE-$638 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,722 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-($5,322) TOTAL--$4,749 ALJAY J. FOREMAN, JR. UNUSED SICK PAY-$2,932 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$451 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(8,168) TOTAL--($4,785) ANIL VELUVOLU, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$840 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,969) TOTAL--($6,129) WYCHE T. COLEMAN, III, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$557 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(9,719) TOTAL--($9,162) VINCENT R. SEDMINIK UNUSED SICK PAY-$5,204 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,711 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(981) TOTAL--$5,934 EXPLANATION OF PART II, COLUMN (C) DEFERRED COMPENSATION THIS EMPLOYEE PARTICIPATES IN A DEFINED BENEFIT PENSION PLAN, THE CONTRIBUTIONS TO WHICH ARE ACTUARIALLY DETERMINED. THE AMOUNT SHOWN IS THE INCREASE IN THE ANNUAL VESTED BENEFIT AT NORMAL RETIREMENT FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2021 (NOT DISCOUNTED TO PRESENT VALUE) (NORMAL RETIREMENT IS AGE 65 WITH 5 YEARS OF PARTICIPATION). MR. ELROD HAS REACHED THE MAXIMUM BENEFIT UNDER THE PLAN. EXPLANATION OF PART II, COLUMN (D) NONTAXABLE BENEFITS INCLUDED IN THIS COLUMN IS THE COST OF THE FOLLOWING NONTAXABLE BENEFITS: LONG-TERM DISABILITY INCOME INSURANCE PLAN, GROUP TERM-LIFE INSURANCE, AND THE ESTIMATED COST OF SELF-FUNDED HEALTH INSURANCE PLAN. FRANK B HUGHES MD TRUSTEE 114231 RENT-BUILDING 0 JENIFER LASSEIGNE FAMILY MEMBER OF RAYMOND LASSEIGNE, TRUSTEE 43466 EMPLOYMENT 0 CHARLES L HANKINS FAMILY MEMBER OF RENEE MCCULLER, OFFICER 144881 EMPLOYMENT 0 CHARLES E MULLINS FAMILY MEMBER OF PEGGY GAVIN, OFFICER 113202 EMPLOYMENT 0 ROGER S DEVILBISS FAMILY MEMBER OF JILL K. ELROD, OFFICER 139847 EMPLOYMENT 0 PIERRE V BLANCHARD MD TRUSTEE 3023397 PURCHASED SERVICE AGREEMENT WITH POST ACCUTE MEDICAL,FOR WHICH PIERRE BLANCHARD, M.D., TRUSTEE, IS THE MEDICAL DIRECTOR, RENT-BUILDING 0 WILLIAM J COLE CPA TRUSTEE 3207820 ACCOUNTING, PAYROLL AND CONSULTING SERVICES PAID TO COLE, EVANS & PETERSON FOR WHICH WILLIAM J. COLE, TRUSTEE, IS THE MANAGING PARTNER. 0 ARIEN WARD PYSD FAMILY MEMBER OF MARY JANE WARD, OFFICER 105019 EMPLOYMENT 0 GREGORY BLANCHARD FAMILY MEMBER OF PIERRE V. BLANCHARD, M.D., TRUSTEE 141616 EMPLOYMENT 0 CECILIA BLANCHARD FAMILY MEMBER OF PIERRE V. BLANCHARD, M.D., TRUSTEE 41054 EMPLOYMENT 0 JAMES D REBOUCHE FAMILY MEMBER OF MARGARET C. REBOUCHE, OFFICER 86048 EMPLOYMENT 0 JENNA A FIELDER FAMILY MEMBER OF JERRY A. FIELDER, II, OFFICER 67859 EMPLOYMENT 0 LAMAR P PUGH TRUSTEE 779549 EXECUTIVE AND DEPARTMENT LEVEL ASSISTANCE AND REPRESENTATION RELATED TO LEGAL ISSUES AND REGULATORY COMPLIANCE PAID TO THE LAW FIRM OF PUGH, PUGH & PUGH, L.L.P. FOR WHICH LAMAR P. PUGH, TRUSTEE, IS A PARTNER. 0 FORM 990, PART VI, SECTION A, LINE 2 1. FAMILY RELATIONSHIPS WITH JAMES K. ELROD - PRESIDENT, CEO, AND TRUSTEE MARGARET ELROD, SPOUSE - VP-MARKETING, LIVE OAK RETIREMENT COMMUNITY, QUICK CARE, OCCUPATIONAL MEDICINE, AND WELLNESS CENTERS JILL K. ELROD, DAUGHTER - VP OF LEGAL AFFAIRS JANET K. ELROD, DAUGHTER - VP AND ADMINISTRATOR OF WK SOUTH HOSPITAL FORM 990, PART VI, SECTION B, LINE 11B THE MEDICAL CENTER'S CPA FIRM PREPARES THE FORM 990 WITH THE ASSISTANCE OF SEVERAL OF THE MEDICAL CENTER'S EMPLOYEES. THE FORM 990 IS THEN REVIEWED BY THE MEDICAL CENTER'S PRESIDENT. AFTER THIS REVIEW, A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD OF TRUSTEES, AND THE PRESIDENT, GENERAL COUNSEL AND CPA FIRM REVIEW AND DISCUSS THE FORM 990 WITH THE TRUSTEES BEFORE THE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICTS OF INTEREST POLICY COVERS ALL "INTERESTED PERSONS." AN "INTERESTED PERSON" IS DEFINED AS ANY TRUSTEE, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD DESIGNATED POWERS WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST IN AN ENTITY WITH WHICH THE MEDICAL CENTER HAS A TRANSACTION OR ARRANGEMENT; OR A COMPENSATION ARRANGEMENT WITH THE MEDICAL CENTER OR WITH ANY ENTITY OR INDIVIDUAL WITH WHICH THE MEDICAL CENTER HAS A TRANSACTION OR ARRANGEMENT; OR A POTENTIAL OWNERSHIP OR INVESTMENT INTEREST IN, OR COMPENSATION ARRANGEMENT WITH, ANY ENTITY OR INDIVIDUAL WITH WHICH THE MEDICAL CENTER IS NEGOTIATING A TRANSACTION OR ARRANGEMENT. INTERESTED PERSONS HAVE A DUTY TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST AND ALL MATERIAL FACTS RELATED TO THE PROPOSED TRANSACTION OR ARRANGEMENT TO THE TRUSTEES AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. THE INTERESTED PERSON IS ALLOWED TO MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION THE INTERESTED PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. IF THE BOARD OR COMMITTEE BELIEVES A MEMBER HAS VIOLATED THE CONFLICTS OF INTEREST POLICY, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE. IF THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS, IN FACT, FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. PERIODIC REVIEWS ARE CONDUCTED WHICH, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: 1. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULT OF ARM'S-LENGTH BARGAINING. 2. WHETHER ACQUISITIONS OF GOODS OR SERVICES RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. 3. WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS AND ARRANGEMENTS WITH MANAGEMENT SERVICE ORGANIZATIONS AND PHYSICIAN HOSPITAL ORGANIZATIONS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. 4. WHETHER AGREEMENTS TO PROVIDE HEALTH CARE AND AGREEMENTS WITH OTHER HEALTH CARE PROVIDERS, EMPLOYEES, AND THIRD PARTY PAYORS FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES THE COMPENSATION OF THE CEO OF THE MEDICAL CENTER. A SECOND COMPENSATION COMMITTEE, WHICH INCLUDES THE CEO, DETERMINES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEES STUDY DATA FROM INDEPENDENT SALARY SURVEYS (SUCH AS "MANAGER AND EXECUTIVE COMPENSATION IN HOSPITALS AND HEALTH SYSTEMS," WHICH IS AN ANNUAL SURVEY PREPARED BY SULLIVAN COTTER) TO UNDERSTAND COMPENSATION PAID TO SIMILARLY QUALIFIED INDIVIDUALS IN COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THE COMPENSATION COMMITTEES ALSO COMPILE DATA FROM OTHER TAX-EXEMPT HEALTH SYSTEMS OF SIMILAR SIZE AND COMPLEXITY AND USE THAT INFORMATION AS COMPARATIVE COMPENSATION. THE COMMITTEES USE THE INFORMATION FROM THESE SOURCES AS BENCHMARKS IN DETERMINING OFFICER AND KEY EMPLOYEE COMPENSATION. THE COMMITTEES ALSO CONSIDER OTHER FACTORS IN DETERMINING OFFICER AND KEY EMPLOYEE COMPENSATION, SUCH AS LENGTH OF EMPLOYMENT AND THEIR RESPONSIBILITIES. THE EXECUTIVE COMPENSATION COMMITTEE PERIODICALLY HIRES INDEPENDENT CONSULTANTS FOR ANALYSIS OF THE COMPENSATION OF THE MEDICAL CENTER'S CEO. THE COMMITTEES MAINTAIN CONTEMPORANEOUS DOCUMENTATION OF THE BASIS FOR THEIR DECISIONS REGARDING COMPENSATION ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 WILLIS-KNIGHTON MEDICAL CENTER'S GOVERNING DOCUMENTS AND ITS CONFLICT OF INTEREST POLICY ARE AVAILABLE ON ITS WEBSITE: WWW.WKHS.COM. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE FOLLOWING WEBSITE: HTTP://WWW.EMMA.MSRB.ORG. FORM 990, PART XI, LINE 9: FASB ASC 715-30 PENSION 6,683,896. 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