2023-08-09T10:23:58-05:00 2022-09-30 201941244 HORNE LLP 661 SUNNYBROOK ROAD STE 100 RIDGELAND MS 39157 990 2021-10-01 842046902 THIBODAUX REGIONAL HEALTH SYSTEM INC THIB 9854475500 602 N ACADIA ROAD THIBODAUX LA 70301 STEPHEN EAST CURRENT CFO 9854475500 2023-08-07 1 STEPHEN EAST 999009999 AMIE WHITTINGTON DEAN CPA P01082167 6013261000 2023-08-02 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z GREG STOCK 602 NORTH ACADIA ROAD THIBIDAUX LA 70301 328871253 0 X HTTPS://WWW.THIBODAUX.COM/ X 2019 LA OPERATION OF THIBODAUX REGIONAL MEDICAL CENTER (THE HOSPITAL). THE MISSION OF THE HOSPITAL IS TO PROVIDE THE HIGHEST QUALITY, MOST COST-EFFECTIVE HEALTHCARE SERVICES POSSIBLE TO THE PEOPLE OF THIBODAUX AND SURROUNDING AREAS. 5 3 1775 17 2966363 0 49378454 59051301 240848537 260638158 1950168 1518854 5967978 7656952 298145137 328865265 6076 68030 0 0 105145497 115647614 0 0 0 146852634 162297778 252004207 278013422 46140930 50851843 473318062 514056856 374658321 373250985 98659741 140805871 X THE MISSION OF THE HOSPITAL IS TO PROVIDE THE HIGHEST QUALITY, MOST COST-EFFECTIVE HEALTHCARE SERVICES POSSIBLE TO THE PEOPLE OF THIBODAUX AND SURROUNDING AREAS. THE HOSPITAL, IN RECOGNITION OF ITS MISSION, STRIVES TO ACHIEVE ITS VISION TO BE THE REGIONAL MEDICAL CENTER OF CHOICE FOR SELECTED HEALTHCARE SERVICES IN SOUTHEAST LOUISIANA THROUGH A COMMITMENT TO QUALITY IMPROVEMENT, BY PARTNERING WITH OTHER HEALTHCARE PROVIDERS, AND BY REMAINING FINANCIALLY VIABLE IN A COMPETITIVE ENVIRONMENT. TO ACHIEVE OUR VISION, WE PROMOTE THE FOLLOWING VALUES: RESPECT, INTEGRITY, INNOVATION, EXCELLENCE, ACCOUNTABILITY, AND PASSION. 0 0 206250551 68030 263539271 THE MISSION OF THE HOSPITAL IS TO PROVIDE THE HIGHEST QUALITY, MOST COST-EFFECTIVE HEALTHCARE SERVICES POSSIBLE TO THE PEOPLE OF THIBODAUX AND SURROUNDING AREAS. THE HOSPITAL, IN RECOGNITION OF ITS MISSION, STRIVES TO ACHIEVE ITS VISION TO BE THE REGIONAL MEDICAL CENTER OF CHOICE FOR SELECTED HEALTHCARE SERVICES IN SOUTHEAST LOUISIANA THROUGH A COMMITMENT TO QUALITY IMPROVEMENT, BY PARTNERING WITH OTHER HEALTHCARE PROVIDERS, AND BY REMAINING FINANCIALLY VIABLE IN A COMPETITIVE ENVIRONMENT. TO ACHIEVE OUR VISION, WE PROMOTE THE FOLLOWING VALUES: RESPECT, INTEGRITY, INNOVATION, EXCELLENCE, ACCOUNTABILITY, AND PASSION.THE MEDICAL CENTER IS LICENSED FOR 180 BEDS AND OPERATES 140 INPATIENT BEDS INCLUDING INPATIENT REHAB AND INPATIENT BEHAVIORAL HEALTH. THE AVAILABLE STAFFED BED COMPLEMENT IS AS FOLLOWS:MEDICAL/SURGICAL 79LDRP/ANTE PARTAL 16INTENSIVE CARE 16STEPDOWN 10REHABILITATION 14BEHAVIORAL HEALTH 16THE MEDICAL CENTER HAS APPROXIMATELY 281 PHYSICIANS ON STAFF. THIS INCLUDES 112 ACTIVE STAFF PHYSICIANS, 11 ASSOCIATE STAFF PHYSICIANS, 38 COURTESY STAFF PHYSICIANS, 18 EMERGENCY DEPARTMENT PHYSICIANS, 17 CONSULTING STAFF PHYSICIANS, 7 COMMUNITY STAFF PHYSICIANS, 77 TELEMEDICINE PHYSICIANS, AND 1 HOUSE STAFF PHYSICIAN. THE MEDICAL STAFF SUPPORT SERVICES PROVIDED AT THE MAIN HOSPITAL, CANCER CENTER, MEDICAL OFFICE BUILDING, MEDICAL PLAZA AND WELLNESS CENTER AS APPROPRIATE TO THE SERVICES PROVIDED IN THOSE LOCATIONS.ALL SERVICES ARE PLANNED AND DESIGNED ON THE PATIENT POPULATION THE HOSPITAL SERVES, THE HOSPITAL'S MISSION AND VISION STATEMENT, KEY REQUIREMENTS OF OUR PATIENTS AND THEIR FAMILY MEMBERS, AND KEY REQUIREMENTS OF OTHER MAJOR STAKEHOLDERS. THE PROCESS OF PLANNING A SERVICE IS A COLLABORATIVE EFFORT. HOSPITAL STAFF THAT ARE MOST KNOWLEDGEABLE ABOUT THE PARTICULAR SERVICE BEING PLANNED ARE INVOLVED IN THE PLANNING PROCESS AS WELL AS PHYSICIANS AND COMMUNITY LEADERS WHERE APPROPRIATE. IN ACCORDANCE WITH FEDERAL AND STATE REGULATIONS, PROFESSIONAL PRACTICE STANDARDS AND CODES, TRMC PROVIDES THE COMMUNITY WITH AN EXTENSIVE RANGE OF GENERAL AND SPECIALTY MEDICAL SERVICES.SIGNIFICANT HOSPITAL ACHIEVEMENTS & KEY STATISTICS FOR FISCAL YEAR ENDED 9/30/2022 INCLUDE:HEALTHGRADES PATIENT SAFETY EXCELLENCE AWARDMEDICAL EXCELLENCE AWARD - #1 HOSPITAL IN LOUISIANA FOR CARDIAC CARE BY CARECHEXLEAPFROG GROUP PATIENT SAFETY SPRING GRADE "A"50 TOP CARDIOVASCULAR HOSPITAL BY IBM WATSON HEALTHTHE COURIER/DAILY COMET BAYOU'S BEST OF THE BEST -BEST HOSPITALTHE COURIER/DAILY COMET BAYOU'S BEST OF THE BEST - FITNESS CENTER/GYMTHE COURIER/DAILY COMET BAYOU'S BEST OF THE BEST - BEST URGENT CARE/WALK-IN CLINICTHE COURIER/DAILY COMET BAYOU'S BEST OF THE BEST - BEST PAIN MANAGEMENT CLINICTHE COURIER/DAILY COMET BAYOU'S BEST OF THE BEST - BEST WEIGHT LOSS CENTERTHE COURIER/DAILY COMET BAYOU'S BEST OF THE BEST - YOGA/PILATES STUDIOTOTAL INPATIENT DAYS 32,116AVERAGE DAILY CENSUS 88.0INPATIENT ADMISSIONS 6,835AVERAGE LOS (ACUTE) 4.2OBSERVATION PATIENTS 2,838REHAB DAYS 3,120DELIVERIES 1,116OUTPATIENT VISITS 160,206E/R VISITS 37,435HOME HEALTH ADMISSIONS 1,178ADJUSTED PATIENT DAYS 121,687SURGERY CASES 9,393 206250551 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 118 1 1 1775 1 1 1 0 0 0 0 0 0 0 0 0 X 5 3 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X THE ORGANIZATION 9854475500 602 NORTH ACADIA ROAD THIBODAUX LA 70301 GREG K STOCK CEO AND BOARD SEC. - NONVO 40.00 X X 858805 0 31219 JAKE GIARDINA BOARD CHAIRMAN 1.00 X 0 0 0 FRANCIS RICHARD BOARD VICE CHAIRMAN 1.00 X 0 0 0 DR CLEVELAND HILL BOARD MEMBER 1.00 X 0 0 0 DR DAVID ELIAS BOARD MEMBER 1.00 X 0 0 0 DR RAJA TALLURI BOARD MEMBER 1.00 X 0 0 0 DR CHRIS RODRIGUE CHIEF OF STAFF - NON-VOTIN 40.00 X 0 0 0 THEUNETTE ANTILL CHIEF FINANCIAL OFFICER 40.00 X 211607 0 1336 BLAIN ARTHURS STAFF PHYSICIAN 40.00 X 1073139 0 28262 CARLOS R GIMENEZ STAFF PHYSICIAN 40.00 X 1001884 0 22220 JARED GILMORE STAFF PHYSICIAN 40.00 X 890552 0 21641 SCOTT HEBERT STAFF PHYSICIAN 40.00 X 1087048 0 18000 GREGORY DOBARD STAFF PHYSICIAN 40.00 X 912277 0 22220 6035312 0 144898 129 0 1 0 MEDDATA 120 INNWOOD DR COVINGTON LA 70433 AMBULATORY BILLING/COLLECTION/OTHER SERV 1918951 HEALTH CATALYST 3165 MILLROCK DRIVE SUITE 400 SALT LAKE CITY UT 84121 SOFTWARE SERVICES CONTRACT 1709055 POWER WELLNESS MANAGEMENT 851 OAK CREEK DR LOMBARD IL 60148 FITNESS CENTER ADMIN SERVICES 1534318 THIBODAUX EMERGENCY PHYSICIAN GROUP 5000 AMBASSADOR CAFFERY PKWY BLDG 1 LAFAYETTE LA 70508 ER PHYSICIANS SERVICES 1200388 CARDIOVASCULAR INSTITUTE OF THE SOUTH 225 DUNN STREET HOUMA LA 70360 EKG READS/MANAGEMENT SERVICES 864379 32 2966716 56084585 59051301 PATIENT SERVICE REVENUE 621990 260638158 260638158 260638158 1518854 1518854 1817223 0 1817223 1817223 1817223 1664 5988 -4324 -4324 FITNESS CENTER REVENUE 713940 3168758 2876963 291795 CAFETERIA AND VENDING 722514 1110474 1110474 EQUITY IN EARNINGS OF SUBSIDIARY 702557 702557 862264 381333 89400 391531 5844053 328865265 263539271 2966363 3308330 68030 68030 1070412 1070412 95995234 78483186 17512048 2251562 1821514 430048 10535534 8424811 2110723 5794872 4837546 957326 5382185 77094 5305091 5840403 267659 5572744 5757310 2798364 2958946 233959 200918 33041 44009 38898 5111 14974088 14974088 17940129 13096294 4843835 1739290 1739290 MEDICAL SUPPLIES 59482998 59482998 PURCHASED SERVICES 24485790 16192192 8293598 BAD DEBTS 14353911 14353911 EQUIPMENT RENTAL AND MA 9809760 6107136 3702624 2253946 2253946 278013422 206250551 71762871 0 13672146 13343551 2163715 2168366 38696024 28643884 4031061 4119908 63175263 108640131 88645643 49384376 32826261 39261267 117158541 106006963 5426410 201595051 206446376 473318062 514056856 22854336 20433919 351803985 352817066 374658321 373250985 X 98659741 140805871 98659741 140805871 473318062 514056856 50851843 -8705713 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 50648 50648 206199903 206250551 1000000 250000 0 0 1000000 1000000 1000000 3000000 4500000 48883 45860 50648 145391 250000 250000 250000 750000 1125000 48883 45860 50648 145391 SCHEDULE C, PART II-A, LINE 1A $32,400 IS FOR PAYMENTS TO HAYNIE AND ASSOCIATES FOR LOBBYING RELATED SERVICES. $6,683 IS FOR THE PORTION OF DUES TO AHA THAT HAS BEEN DEEMED FOR LOBBYING, AND $11,566 IS FOR THE PORTION OF DUES TO LHA THAT HAS BEEN DEEMED FOR LOBBYING. 85461 85461 44112007 24598458 19513549 32179768 17944608 14235160 12268407 6841310 5427097 39261267 INVESTMENT FUNDS 105881963 C OTHER INVESTMENTS 125000 C 106006963 OTHER RECEIVABLES 7285481 CAPITAL LEASE 191479621 INVESTMENT IN THIB REG SURGICAL 3753317 INVESTMENT IN JV IMAGING CENTER 3332000 DEFERRED COMPENSATION PLAN 595957 206446376 COST REPORT RECEIVABLE MEDICAID 3952894 TRMC LEASE 133095297 CAPITAL LEASES 186010014 COST REPORT RECEIVABLE MEDICARE -245915 ACCRUED INTEREST 18570637 INSURANCE LIABILITY 4365232 AMOUNTS DUE TO HSD 7068907 352817066 1 1 1 X 1 X 325.000000000000 1 1 1 0 0 3052504 3052504 0.01160 27151728 15503048 11648680 0.04420 30204232 15503048 14701184 0.05580 68030 68030 0.00030 68030 68030 0.00030 30272262 15503048 14769214 0.05610 1 14353911 717696 45720196 41722158 3998038 1 1 1 TIC JV LLC SUBLEASE OF IMAGING CENTER 0.84730 0.00000 0.15270 1 1 THIBODAUX REGIONAL HEALTH SYSTEM INC 602 NORTH ACADIA ROAD THIBODAUX LA 70301 X X INPATIENT REHAB AND INPATIENT PSYCH THIBODAUX REGIONAL HEALTH SYSTEM INC 0 0 1 X X X X X X X X X 21 1 0 0 1 X HTTPS://WWW.THIBODAUX.COM/DOCUMENTS/2022-COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 21 1 HTTPS://WWW.THIBODAUX.COM/DOCUMENTS/2022-CHNA-STRATEGY-AND-ACTION-PLAN.PDF 0 1 X 200.000000000000 325.000000000000 1 1 X X X 1 X HTTPS://WWW.THIBODAUX.COM/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/ X WWW.THIBODAUX.COM/DOCUMENTS/FINANCIAL-HARDSHIP-APPLICATION-6-2016.PDF X HTTPS://WWW.THIBODAUX.COM/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/ X X X X X X 1 X 0 X X 1 X 0 0 THIBODAUX REGIONAL HEALTH SYSTEM, INC. PART V, SECTION B, LINE 5: PLEASE REFER TO THE CHNA, POSTED ON THE HOSPITAL'S WEBSITE: HTTPS://WWW.THIBODAUX.COM/DOCUMENTS/2022-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF THIBODAUX REGIONAL HEALTH SYSTEM, INC. PART V, SECTION B, LINE 11: PLEASE SEE THE IMPLEMENTATION STRATEGY, POSTED ON HOSPITAL'S WEBSITE AT: HTTPS://WWW.THIBODAUX.COM/DOCUMENTS/2022-CHNA-STRATEGY-AND-ACTION-PLAN.PDF 22 1 - THIBODAUX REGIONAL WOMEN'S CLINIC 604 N ACADIA RD STE 500 THIBODAUX LA 70301 OB/GYN 2 - THIBODAUX REGIONAL CANCER CENTER 608 N ACADIA RD THIBODAUX LA 70301 CANCER CARE 3 - THIBODAUX REGIONAL URGENT CARE - THIB 2031 AUDUBON AVE THIBODAUX LA 70301 URGENT CARE 4 - THIBODAUX REGIONAL UROLOGY CLINIC 504 N ACADIA RD THIBODAUX LA 70301 UROLOGY 5 - THIBODAUX REGIONAL URGENT CARE - HOUMA 1411 ST CHARLES ST HOUMA LA 70360 URGENT CARE 6 - THIBODAUX REGIONAL PULMONOLOGY CLINIC 604 N ACADIA RD STE 411 THIBODAUX LA 70301 PULMONOLOGY 7 - THIBODAUX REGIONAL PEDIATRIC CLINIC 807 RIDGEFIELD RD THIBODAUX LA 70301 PEDIATRICS 8 - THIBODAUX REGIONAL INTERNAL MEDICINE CLI 506 N ACADIA RD THIBODAUX LA 70301 INTERNAL MEDICINE 9 - THIBODAUX REGIONAL NEUROLOGY CLINIC 726 N ACADIA RD STE 2300 THIBODAUX LA 70301 NEUROLOGY 10 - THIBODAUX REGIONAL PAIN MANAGEMENT CLINI 726 N ACADIA RD STE 2400 THIBODAUX LA 70301 PAIN MANAGEMENT 11 - THIBODAUX REGIONAL FAMILY MEDICINE CLINI 114 HIGHWAY 403 PAINCOURTVILLE LA 70391 FAMILY MEDICINE 12 - THIBODAUX REGIONAL RHEUMATOLOGY CLINIC 726 N ACADIA RD STE 3400 THIBODAUX LA 70301 RHEUMATOLOGY 13 - THIBODAUX REGIONAL PODIATRY CLINIC 726 N ACADIA RD STE 1700 THIBODAUX LA 70301 PODIATRY 14 - THIBODAUX REGIONAL ENDOCRINOLOGY CLINIC 726 N ACADIA RD STE 3300 THIBODAUX LA 70301 ENDOCRINOLOGY 15 - THIBODAUX REGIONAL FAMILY MEDICINE CLINI 3928 HIGHWAY 70 SOUTH PIERRE PART LA 70339 FAMILY MEDICINE 16 - THIBODAUX REGIONAL BRAIN & SPINE CLINIC 726 N ACADIA RD STE 2100 THIBODAUX LA 70301 BRAIN & SPINE 17 - THIBODAUX REG MULTI-SPECIALTY CLINIC - H 1238 ST CHARLES ST HOUMA LA 70360 MULTI-SPECIALTY 18 - THIBODAUX REGIONAL FAMILY MEDICINE CLINI 602 NORTH ACADIA RD STE 101 THIBODAUX LA 70301 ORTHOPEDIC SURGERY 19 - THIBODAUX REGIONAL PHYSICAL MEDICINE AND 1107 AUDUBON AVE B THIBODAUX LA 70301 PHYSICAL MEDICINE 20 - THIBODAUX REGIONAL CARDIOVASCULAR CLINIC 604 N ACADIA RD STE 409 THIBODAUX LA 70301 CARDIOVASCULAR 21 - THIBODAUX REGIONAL RACELAND MULTISPECIAL 4560 HIGHWAY 1 STE 3 RACELAND LA 70394 MULTI-SPECIALTY 22 - THIBODAUX REGIONAL PLASTIC & RECONSTRUCT 604 N ACADIA RD ST 410 THIBODAUX LA 70301 PLASTIC SURGERY PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 14,353,911. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 2: SEE EXPLANATION, BELOW, REFERENCING THE BAD DEBT EXPENSE AUDIT FOOTNOTE. PART III, LINE 3: NONE OF THE BAD DEBT EXPENSE HAS BEEN INCLUDED IN THE COMMUNITY BENEFIT CALCULATIONS. HOWEVER, HOSPITAL ESTIMATES THAT FIVE PERCENT OF BAD DEBTS COULD BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. THIS ESTIMATE IS BASED ON PATIENT DEMOGRAPHICS, BILLINGS, COLLECTIONS AND OTHER HISTORICAL DATA. PART III, LINE 4: THE FOOTNOTE TO THE AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS ON PAGE 21 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PLEASE NOTE THAT BAD DEBT EXPENSE IS NOW REFERRED TO AS IMPLICIT PRICE CONCESSIONS, AS DESCRIBED ON PAGE 12 OF AUDITED FINANCIALS. BAD DEBT EXPENSE REFLECTED IN PART III EQUALS BAD DEBT EXPENSE REFLECTED ON THE ORGANIZATION'S TRIAL BALANCE AND CLASSSIFIED AS IMPLICIT PRICE CONCESSIONS IN THE AUDITED FINANCIAL STATEMENTS.THE HOSPITAL DID NOT INCLUDE ANY BAD DEBTS IN OUR COMMUNITY BENEFIT CALCULATIONS. PART III, LINE 8: THE COSTING METHODOLOGY USED FOR LINE 6 WAS THE STANDARD MEDICARE COST REPORT COST SYSTEM. THE AMOUNTS WERE RECAPPED FROM THE HOSPITALS FILED 2021 COST REPORT. THE CORRESPONDING REVENUE AMOUNTS WERE INCLUDED ON LINE 5. THE HOSPITAL DOES NOT INCLUDE ANY MEDICARE SHORTFALL IN OUR COMMUNITY BENEFIT CALCULATIONS REPORTED ON PART I, LINE 7. PART III, LINE 9B: THE POLICY OF THIBODAUX REGIONAL HEALTH SYSTEM, INC. ("TRHS") IS TO PROVIDE EMERGENCY CARE AND MEDICALLY NECESSARY CARE ON A NON-PROFIT BASIS TO PATIENTS WITHOUT REGARD TO RACE, CREED, OR ABILITY TO PAY. PATIENTS WHO DO NOT HAVE THE MEANS TO PAY FOR SERVICES PROVIDED AT TRHS FACILITIES MAY REQUEST FINANCIAL ASSISTANCE, WHICH WILL BE AWARDED SUBJECT TO TERMS AND CONDITIONS. THE ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE PURSUANT TO THIS POLICY ARE INTENDED TO ENSURE THAT TRHS WILL HAVE THE FINANCIAL RESOURCES TO PROVIDE CARE TO PATIENTS WHO ARE IN THE GREATEST FINANCIAL NEED. THIS POLICY APPLIES TO THIBODAUX REGIONAL HEALTH SYSTEM (THE "HOSPITAL") AND ALL TRHS FACILITIES, INCLUDING ANY CARE PROVIDED WITHIN THE HOSPITAL BY A SUBSTANTIALLY-RELATED ORGANIZATION.IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ELIGIBLE AMOUNT IS WRITTEN OFF THE PATIENT ACCOUNT AND ANY PARTIAL REMAINING BALANCE, IF ANY, IS THEN BILLED IN ACCORDANCE WITH THE BILLING AND COLLECTION POLICY AS STATED BELOW. PART VI, LINE 2: HAVE USED PRC COMMUNITY HEALTH SURVEY TO STUDY AS WELL AS STATISTICS OTHER HEALTH-RELATED DATA FOR THE AREA. PART VI, LINE 3: DISPLAYED ON PATIENT STATEMENTS AS WELL AS LOCATED ON OUR WEBSITE. HOSPITAL ALSO HAS AN POLICY INTERNALLY. (PFS - CUSTOMER SERVICE- FINANCIAL HARDSHIP) PART VI, LINE 4: THE COMMUNITIES INCLUDE ASSUMPTION, LAFOURCHE, ST. JAMES, ST. MARY, AND TERREBONNE PARISHES WHICH IS BASED ON THE ZIP CODES OF RESIDENCE FOR RECENT PATIENTS. PART VI, LINE 5: THE GOVERNING BODY RESIDES IN THE ORGANIZATION'S PRIMARY SERVICE AREA, TRHS EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITY, AND SURPLUS FUNDS ARE USED TO PURCHASE NEW EQUIPMENT WITH ADVANCED TECHNOLOGY, ALONG WITH FACILITY UPGRADES AND ADDITIONS (I.E. NEW CANCER CENTER BUILDING & NEW EQUIPMENT, ADDITIONAL WELLNESS CENTER PHASE II). PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES LA 0 TRMC EMPLOYEE RELIEF FUND INC 602 N ACADIA RD THIBODAUX LA 70301 273160403 67450 0 HURRICANE IDA MATCH HURRICANE IDA MATCH 1 0 X X X 0 0 0 0 0 0 0 0 0 SCOTT HEBERT STAFF PHYSICIAN 1087048 0 0 0 0 0 18000 0 0 0 1105048 0 0 0 BLAIN ARTHURS STAFF PHYSICIAN 1073139 0 0 0 0 0 12001 0 16261 0 1101401 0 0 0 CARLOS R GIMENEZ STAFF PHYSICIAN 1001884 0 0 0 0 0 12001 0 10219 0 1024104 0 0 0 GREGORY DOBARD STAFF PHYSICIAN 912277 0 0 0 0 0 12001 0 10219 0 934497 0 0 0 JARED GILMORE STAFF PHYSICIAN 890552 0 0 0 0 0 11600 0 10041 0 912193 0 0 0 GREG K STOCK CEO AND BOARD SEC. - NONVO 858805 0 0 0 0 0 21000 0 10219 0 890024 0 0 0 THEUNETTE ANTILL CHIEF FINANCIAL OFFICER 211607 0 0 0 0 0 0 0 1336 0 212943 0 0 0 ORTHO LA DR. ELIAS, BOARD MEMBER, IS A 16.67% OWNER IN ORTHO LA 696644 ORTHO LA AND THE HOSPITAL PARTICIPATE IN A CO-MANAGEMENT AGREEMENT 0 ORTHO LA DR. ELIAS, BOARD MEMBER, IS A 16.67% OWNER IN ORTHO LA 276186 ORTHO LA RENTS SPACE FROM THE HOSPITAL. 0 TORI STOCK TORI STOCK IS THE DAUGHER IN LAW OF OFFICER GREG STOCK 3330 WORKS AS A COACH WITH THE RISE VOLLEYBALL TEAM AS NEEDED (NOT EMPLOYED, CONTRACT LABOR). 0 MICHELLE GIARDINA MICHELLE GIARDINA IS THE DAUGHTER IN LAW OF THE BOARD PRESIDENT, JAKE GIARD 1521 SHE WORKS PRN IN HOME HEALTH DEPARTMENT 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS JAKE GIARDINA AND DR. CLEVELAND HILL BOTH SERVE ON THE BOARD FOR THE HOSPITAL SERVICE DISTRICT #3. FORM 990, PART VI, SECTION A, LINE 6 PER THE ARTICLES OF INCORPORATION, THE CORPORATION HAS ONE CLASS OF MEMBERSHIP, ALL DESIGNATED AS "MEMBERS." THE MEMBERS OF THE BOARD OF DIRECTORS FROM TIME TO TIME ARE AND SHALL BE THE ONLY MEMBERS OF THE CORPORATION. EACH MEMBER OF THE CORPORATION SHALL BE ENTITLED TO CAST ONE VATE AT ALL MEETING OF THE MEMBERS OF THE CORPORATION. THE ONLY RIGHTS PRIVILEGES, RESTRICTIONS, OR LIMIATION GRANTED TO IMPOSED UPON MEMBERS OF THE CORPORATION ARE THOSE IN THE ARTICLES, BYLAWS OR THE LNCL. FORM 990, PART VI, SECTION A, LINE 7A THIE INITIAL DIRECTORS OF THE CORPORATION WERE LISTED IN THE ARTICLES OF INCORPORATION. SUBSEQUENT DIRECTORS OF THE CORPORATION ARE ELECTED BY A MAJORITY VOTE OF THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS SHARED WITH THE BOARD AHEAD OF FILING AND IS REVIEWED IN DETAIL BY ACCOUNTING DEPARTMENT AHEAD OF FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO THE FOLLOWING INDIVIDUALS: DIRECTORS, OFFICERS, BOARD, OR MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS. ANNUALLY, THE BOARD OF DIRECTORS COMPLETE A CONFLICT OF INTEREST QUESTIONAIRE. ADDITIONALLY, THE BOARD MEMBERS ARE REQUIRED TO SELF DISCLOSE IN THE EVENT OF A POTENTIALK CONFLICT OF INTEREST IS IDENTIFIED OR SUSPECTED. THE BOARD THEN DETERMINES IF A CONFLICT OF INTEREST IS PRESENT. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION IS APPLIED UNIFORMLY TO ALL EMPLOYEES BASED ON POSITION OFFERED AND RELATED PRIOR EXPERIENCE. HR DEPARTMENT REVIEWS SURVEY DATA AND THE BOARD APPROVES OFFICER COMPENSATION AND MAKES CONTEMPORANEOUS SUBSTATION OF THE DECISION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS FOR SELECTION AND OVERSIGHT OF INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM PRIOR YEAR. BOARD APPROVAL IS REQUIRED. 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