2022-08-05T11:45:19-05:00 2021-09-30 720506596 COLE EVANS & PETERSON POST OFFICE DRAWER 1768 SHREVEPORT LA 711661768 990 2020-10-01 720400933 WILLIS-KNIGHTON MEDICAL CENTER WILL 3182124000 CO COLEEVANS PETERSONPODRAWE SHREVEPORT LA 711661768 JERRY A FIELDER II PRESIDENT 3182124000 2022-08-05 1 JERRY FIELDER II XXX-XX-XXXX BARRY S SHIPP P00024584 3182228367 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JERRY A FIELDER II POST OFFICE BOX 32600 SHREVEPORT LA 711302600 1255472778 0 X WWW.WKHS.COM X 1949 LA THE MEDICAL CENTER PROVIDES A FULL-RANGE OF HEALTH CARE SERVICES TO THE GENERAL PUBLIC. 9 6 7916 203 5516247 0 91161094 8137026 1037931472 1160171533 14376811 20484999 14094598 20571245 1157563975 1209364803 1968375 1580850 0 0 475267173 496269868 0 0 0 672073417 703997635 1149308965 1201848353 8255010 7516450 1736445879 2446133987 687146886 984026196 1049298993 1462107791 X TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE WE SERVE. 0 0 1008337866 1580850 1167776234 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 47,584 ADMITTANCES DURING THE YEAR ENDED SEPTEMBER 30, 2021 WITH A TOTAL OF 214,918 PATIENT DAYS AND 2,401 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, 2021, THE MEDICAL CENTER PROVIDED AN ESTIMATED $15,000,000 IN UNREIMBURSED COSTS ATTRIBUTABLE TO CHARITY CARE (EXCLUDING PROJECT NEIGHBORHEALTH) AND AN ESTIMATED $82,000,000 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, 2021, 73 PATIENTS RECEIVED ORGAN TRANSPLANTS, CONSISTING OF 61 KIDNEYS (9 OF THOSE PATIENTS ALSO HAD A PANCREAS TRANSPLANT AND 2 OF THOSE PATIENTS ALSO HAD A LIVER TRANSPLANT), AND 12 LIVERS. OF THE 73 TRANSPLANT SURGERIES PERFORMED AT THE MEDICAL CENTER DURING THE YEAR ENDED SEPTEMBER 30, 2021, 49 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, 2021, THE MEDICAL CENTER'S EMERGENCY ROOMS WERE VISITED BY 146,196 PATIENTS, OF WHOM 21,588 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 2,401 BIRTHS; 3,115 OBSTETRICAL VISITS TO THE L&D UNITS; DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2021.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, 2021 OF 3,296. 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 30.62 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, 2021, HOSPICE OF LOUISIANA SERVED 184 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. 10615343 5970729 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. 1018953209 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 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 1 404 0 1 7916 1 1 1 0 0 0 0 0 0 0 1 0 X 9 6 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 MILAN G MODY MD PHYSICIAN 40.00 X 2020391 0 32415 JAMES K ELROD PRESIDENT/CEO/TRUSTEE 53.00 X X 1734613 6000 7683 HALIM S ABOU FAYCAL PHYSICIAN 40.00 X 1702281 0 33903 SARAH GLORIOSO MD PHYSICIAN 40.00 X 1675625 0 32604 JOHN G NOLES MD PHYSICIAN 40.00 X 1550469 0 32403 JIHAD M EL-HAYEK PHYSICIAN 40.00 X 1446678 0 33660 MARY JANE WARD SR VICE PRESIDENT OF FINAN 40.00 X 480048 0 28173 JERRY A FIELDER II PRESIDENT/CEO 40.00 X 377366 0 32647 JILL K ELROD VP OF LEGAL AFFAIRS 40.00 X 277161 0 12671 IRA L MOSS VP/ADMIN WK PIERREMONT 40.00 X 251487 0 27341 BRIAN A CRAWFORD SR VP & CAO 40.00 X 255554 0 7195 GREGORY J GAVIN VP/PHYSICIAN NETWORK 40.00 X 243420 0 12118 MICHAEL CHANDLER SR VP/ADMINISTRATOR WKMC 40.00 X 242251 0 12682 PEGGY J GAVIN SR VP OF PHYSICIAN SERVICE 40.00 X 231365 0 14020 MARGARET G ELROD SR VP/IND WELLNESS/COMMUN 40.00 X 226162 0 10418 PIERRE V BLANCHARDIV MD TRUSTEE/PHYSICIAN 40.00 X 223633 0 9636 JANET K ELROD VP/ADMIN WK SOUTH 40.00 X 222784 0 9832 TODD J BLANCHARD VP/ADMIN WK BOSSIER 40.00 X 192023 0 37336 DIANE R MCCULLER VP NURSING - PATIENT SERVI 40.00 X 201753 0 15019 MARGARET C REBOUCHE VP QUALITY & CLINICAL PERF 40.00 X 193318 0 15759 JOHN L FORTENBERRY JR VP/MARKETING & STRATEGY 40.00 X 195910 0 2629 DEBORAH D OLDS VP NURSING - PATIENT SERVI 40.00 X 23689 0 1880 FRANK B HUGHES MD TRUSTEE/CHAIRMAN 4.00 X 0 0 0 SAM J TALBOT MD 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 13967981 6000 422024 793 0 1 0 CROSS COUNTRY STAFFING PO BOX 404674 ATLANTA GA 30384 MEDICAL STAFFING 14425612 SHREVEPORT ANESTHESIA SERVICES 2600 GREENWOOD ROAD SHREVEPORT LA 71103 PHYSICIAN SERVICES 6200004 RED RIVER CARDIOVASCULAR 2751 ALBERT BICKNELL DR SUITE 5C SHREVEPORT LA 71103 PHYSICIAN SERVICES 6188888 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY TESTING 6109252 LSU HEALTH SCIENCES CENTER PO BOX 33932 SHREVEPORT LA 71130 MEDICAL STAFFING 5858030 113 8129529 7497 8137026 HOSPITAL SERVICES 900099 1156546893 1156546893 RESIDENTIAL COMMUNITY 900099 3624640 3624640 1160171533 20848721 20848721 3133975 2291938 842037 842037 842037 41849764 1602551 42181796 1634241 -332032 -31690 -363722 -363722 NONOPERATING COMPONENTS OF NET PE 900099 14763140 14763140 LABORATORY REVENUE 621500 5203052 5203052 (LOSS) FROM SUBSIDIARY - VIRGINIA 623000 -822446 -822446 585462 272267 313195 19729208 1209364803 1173746963 5516247 20848721 1580850 1580850 6119672 6119672 353247101 310570212 42676889 20721254 17907622 2813632 85000943 73459103 11541840 31180898 19211951 11968947 832127 832127 2624876 2624876 2685139 1343526 1341613 20125207 20125207 23969583 23969583 61044165 32857418 28186747 10271420 10271420 DIRECT DEPARTMENTAL EXP 560381790 560381790 TAXES & LICENSES 10040446 10040446 BUSINESS OFFICE 6335800 6335800 5687082 1640737 4046345 1201848353 1018953209 182895144 0 13310745 6003411 212109890 75910830 155893029 172978106 2567311 2816975 28115157 27953382 10661258 15545107 1444526473 929741507 510250661 514784966 761618567 1444614094 12830390 11714239 13688 12563 29075183 173800314 1736445879 2446133987 128030434 132503617 12530 26539 74596775 62639756 308539866 702550000 175967281 86306284 687146886 984026196 X 1049298993 1462107791 1049298993 1462107791 1736445879 2446133987 X 7516450 203892996 201399352 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1788837 1788837 0 PART II-B, LINE 1: DURING THE YEAR ENDED SEPTEMBER 30, 2021, THE MEDICAL CENTER PAID DUES TOTALING $78,250 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, $39,125 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2021, THE MEDICAL CENTER PAID DUES TOTALING $12,252 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, $7,351 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2021, THE MEDICAL CENTER PAID DUES TOTALING $264,721 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, $132,361 WAS RELATED TO LOBBYING ACTIVITIES. IN ADDITION TO THE PORTION OF THE DUES ABOVE RELATED TO LOBBYING EXPENSES, THE MEDICAL CENTER HAS ENTERED INTO A WRITTEN SERVICES AGREEMENT WITH PRADOS & ASSOCIATES FOR THE LLC 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, 2021, TOTAL LOBBYING EXPENSES UNDER THIS CONTRACT TOTALED $1,610,000. 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. 792073 58416738 59208811 8394043 816561471 520078039 304877475 1910508 1759517 150991 470913511 387510680 83402831 87538129 20393271 67144858 514784966 MUSEUM ASSETS 662578 SECURITY DEPOSIT QC LAKE FORBING 12424 OPERATING LEASE RIGHT-OF-USE ASSETS 12270607 NET EXCESS FUNDED PENSION BENEFITS 160854705 173800314 INVESTMENT IN SUB. - VIRGINIA HALL NURSING HOME 6315826 OPERATING LEASE LIABILITY 12528394 FINANCE LEASE LIABILITY 5307655 MEDICAID SUPPLEMENTAL 62154409 86306284 1430749730 203892996 203892996 1226856734 -17491931 -17491931 1209364803 1017940932 -183907421 -183907421 1201848353 0 1201848353 PART XI, LINE 4B - OTHER ADJUSTMENTS: UNRELATED BUSINESS INCOME-DATA PROCESSING SUBSIDIARIES EXPENSES PART XII, LINE 2D - OTHER ADJUSTMENTS: SUBSIDIARIES INCOME/EXPENSE UNRELATED BUSINESS INCOME-DATA PROCESSING FASB ASC 715-30 PENSION FORM 990, SCHEDULE D, PART XI, LINE 4D AND PART XII, LINE 2D PART XI, LINE 4B UNRELATED BUSINESS GROSS INCOME: DATA PROCESSING 293,304 SUBSIDIARIES EXPENSES (17,785,235) TOTAL (17,491,931) PART XII, LINE 2D UNRELATED BUSINESS GROSS INCOME: DATA PROCESSING (293,304) SUBSIDIARIES EXPENSES 17,785,235 PENSION RELATED CHANGES (201,399,352) TOTAL (183,907,421) 1 1 X 1 X 1 X 1 1 1 0 1 1 15045723 15045723 0.01250 187410876 105380581 82030295 0.06830 202456599 105380581 97076018 0.08080 3588406 3588406 0.00300 5196248 5196248 0.00430 1754535 492864 1261671 0.00100 1580850 1580850 0.00130 12120039 492864 11627175 0.00960 214576638 105873445 108703193 0.09040 1 14561904 0 231079678 249167385 -18087707 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 18 1 1 0 1 X WWW.WKHS.COM 1 18 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 5: 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.THE SURVEY PARTICIPANT LIST IN THIS PHASE. - PRESIDENT SHREVEPORT / BOSSIER CONVENTION AND TOURIST BUREAU - CADDO PARISH SHERIFF - STATE REPRESENTATIVE - CITY OF SHREVEPORT COMMUNITY DEVELOPMENT OFFICE - STATE SENATOR V DISTRICT 37 - SHREVEPORT CITY COUNCILMAN DISTRICT A - FOOD BANK OF NORTHWEST LOUISIANA - UNITED WAY OF NORTHWEST LOUISIANA - WILLIS-KNIGHTON BOARD MEMBER - MARTIN LUTHER KING HEALTH CENTER - WILLIS-KNIGHTON STAFF - AFFILIATED PHYSICIANS - FOOD BANK OF NORTHWEST LOUISIANAEACH 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 NINE RESPONDENTS' FEEDBACK WAS 3.8.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.ACCESS / BARRIERS - ACCESSING HEALTHCARE - HEALTHCARE LITERACY - INSURANCE COVERAGE TO PAY FOR CAREOPPORTUNITY - PARTNER TO EDUCATE THE POPULATION ON HEALTH LIFESTYLE CHOICES AND DISEASE PREVENTION - COLLABORATE WITH COMMUNITY RESOURCES AND INCREASE AWARENESS - TARGET SPECIFIC AT-RISK COMMUNITIES WITH HEALTH IMPROVEMENT OPPORTUNITIES - ALIGN WITH POPULATION HEALTH STRATEGIESANOTHER COMPONENT DISCUSSED AND EXPLORED IN THE SURVEYS WAS WHICH SPECIALTIES/HEALTH SERVICES WERE LACKING IN THE COMMUNITY. THESE WERE SOME OF THE AREAS MENTIONED IN ALPHABETICAL ORDER: COMMUNITY FEEDBACK: GAPS IN SERVICES OF CARDIOVASCULAR, DERMATOLOGY, ENDOCRINOLOGY, NEUROLOGY, PEDIATRIC NEUROLOGY, AND STROKE SERVICES. 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.THE SURVEY PARTICIPANT LIST IN THIS PHASE. - PRESIDENT SHREVEPORT / BOSSIER CONVENTION AND TOURIST BUREAU - CADDO PARISH SHERIFF - STATE REPRESENTATIVE - CITY OF SHREVEPORT COMMUNITY DEVELOPMENT OFFICE - STATE SENATOR V DISTRICT 37 - SHREVEPORT CITY COUNCILMAN DISTRICT A - FOOD BANK OF NORTHWEST LOUISIANA - UNITED WAY OF NORTHWEST LOUISIANA - WILLIS-KNIGHTON BOARD MEMBER - MARTIN LUTHER KING HEALTH CENTER - WILLIS-KNIGHTON STAFF - AFFILIATED PHYSICIANS - FOOD BANK OF NORTHWEST LOUISIANAEACH 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 NINE RESPONDENTS' FEEDBACK WAS 3.8.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.ACCESS / BARRIERS - ACCESSING HEALTHCARE - HEALTHCARE LITERACY - INSURANCE COVERAGE TO PAY FOR CAREOPPORTUNITY - PARTNER TO EDUCATE THE POPULATION ON HEALTH LIFESTYLE CHOICES AND DISEASE PREVENTION - COLLABORATE WITH COMMUNITY RESOURCES AND INCREASE AWARENESS - TARGET SPECIFIC AT-RISK COMMUNITIES WITH HEALTH IMPROVEMENT OPPORTUNITIES - ALIGN WITH POPULATION HEALTH STRATEGIESANOTHER COMPONENT DISCUSSED AND EXPLORED IN THE SURVEYS WAS WHICH SPECIALTIES/HEALTH SERVICES WERE LACKING IN THE COMMUNITY. THESE WERE SOME OF THE AREAS MENTIONED IN ALPHABETICAL ORDER: COMMUNITY FEEDBACK: GAPS IN SERVICES OF CARDIOVASCULAR, DERMATOLOGY, ENDOCRINOLOGY, NEUROLOGY, PEDIATRIC NEUROLOGY, AND STROKE SERVICES. 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.THE SURVEY PARTICIPANT LIST IN THIS PHASE. - PRESIDENT SHREVEPORT / BOSSIER CONVENTION AND TOURIST BUREAU - CADDO PARISH SHERIFF - STATE REPRESENTATIVE - CITY OF SHREVEPORT COMMUNITY DEVELOPMENT OFFICE - STATE SENATOR V DISTRICT 37 - SHREVEPORT CITY COUNCILMAN DISTRICT A - FOOD BANK OF NORTHWEST LOUISIANA - UNITED WAY OF NORTHWEST LOUISIANA - WILLIS-KNIGHTON BOARD MEMBER - MARTIN LUTHER KING HEALTH CENTER - WILLIS-KNIGHTON STAFF - AFFILIATED PHYSICIANS - FOOD BANK OF NORTHWEST LOUISIANAEACH 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 NINE RESPONDENTS' FEEDBACK WAS 3.8.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.ACCESS / BARRIERS - ACCESSING HEALTHCARE - HEALTHCARE LITERACY - INSURANCE COVERAGE TO PAY FOR CAREOPPORTUNITY - PARTNER TO EDUCATE THE POPULATION ON HEALTH LIFESTYLE CHOICES AND DISEASE PREVENTION - COLLABORATE WITH COMMUNITY RESOURCES AND INCREASE AWARENESS - TARGET SPECIFIC AT-RISK COMMUNITIES WITH HEALTH IMPROVEMENT OPPORTUNITIES - ALIGN WITH POPULATION HEALTH STRATEGIESANOTHER COMPONENT DISCUSSED AND EXPLORED IN THE SURVEYS WAS WHICH SPECIALTIES/HEALTH SERVICES WERE LACKING IN THE COMMUNITY. THESE WERE SOME OF THE AREAS MENTIONED IN ALPHABETICAL ORDER: COMMUNITY FEEDBACK: GAPS IN SERVICES OF CARDIOVASCULAR, DERMATOLOGY, ENDOCRINOLOGY, NEUROLOGY, PEDIATRIC NEUROLOGY, AND STROKE SERVICES. 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 5: 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.THE SURVEY PARTICIPANT LIST IN THIS PHASE. - PRESIDENT SHREVEPORT / BOSSIER CONVENTION AND TOURIST BUREAU - CADDO PARISH SHERIFF - STATE REPRESENTATIVE - CITY OF SHREVEPORT COMMUNITY DEVELOPMENT OFFICE - STATE SENATOR V DISTRICT 37 - SHREVEPORT CITY COUNCILMAN DISTRICT A - FOOD BANK OF NORTHWEST LOUISIANA - UNITED WAY OF NORTHWEST LOUISIANA - WILLIS-KNIGHTON BOARD MEMBER - MARTIN LUTHER KING HEALTH CENTER - WILLIS-KNIGHTON STAFF - AFFILIATED PHYSICIANS - FOOD BANK OF NORTHWEST LOUISIANAEACH 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 NINE RESPONDENTS' FEEDBACK WAS 3.8.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.ACCESS / BARRIERS - ACCESSING HEALTHCARE - HEALTHCARE LITERACY - INSURANCE COVERAGE TO PAY FOR CAREOPPORTUNITY - PARTNER TO EDUCATE THE POPULATION ON HEALTH LIFESTYLE CHOICES AND DISEASE PREVENTION - COLLABORATE WITH COMMUNITY RESOURCES AND INCREASE AWARENESS - TARGET SPECIFIC AT-RISK COMMUNITIES WITH HEALTH IMPROVEMENT OPPORTUNITIES - ALIGN WITH POPULATION HEALTH STRATEGIESANOTHER COMPONENT DISCUSSED AND EXPLORED IN THE SURVEYS WAS WHICH SPECIALTIES/HEALTH SERVICES WERE LACKING IN THE COMMUNITY. THESE WERE SOME OF THE AREAS MENTIONED IN ALPHABETICAL ORDER: COMMUNITY FEEDBACK: GAPS IN SERVICES OF CARDIOVASCULAR, DERMATOLOGY, ENDOCRINOLOGY, NEUROLOGY, PEDIATRIC NEUROLOGY, AND STROKE SERVICES. 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, 2021, 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 470,347 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 2,481 MEDICAL PATIENT VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2021. 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 2,404 MEDICAL PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2021. OTHER COMMUNITY SERVICESTHE MEDICAL CENTER MAKES AVAILABLE, FREE-OF-CHARGE, MEETING SPACE TO OUTSIDE COMMUNITY OUTREACH ORGANIZATIONS SUCH AS ICE (INNER CITY ENTREPRENEUR), NORTH LOUISIANA AHEC, LIFESHARE BLOOD CENTER, LSU PSYCHIATRY PROGRAM, NORTHWEST LOUISIANA COALITION FOR WOMEN AND CHILDREN, NORTHWEST LOUISIANA INTERFAITH PHARMACY, UNITED WAY, NORTHWEST LOUISIANA FAMILY JUSTICE CENTER, COMMON GROUND COMMUNITY, SUSAN KOMEN FOUNDATION, 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 428,393 VISITORS WITH MORE THAN 1,364,798 PAGE VIEWS. THE ONLINE HEALTH LIBRARY HAD 158,912 PAGE VIEWS. KIDSHEALTH HAD 130,728 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, 2021, THE MEDICAL CENTER IMMUNIZED 1,288 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 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 OBJECTIVE IS TO TAKE A PROACTIVE APPROACH TO DELIVERING HEALTH CARE BY CONNECTING ALL PATIENTS TO A PRIMARY CARE PROVIDER (PCP) FOR THE PURPOSE OF PREVENTING OR MANAGING CHRONIC DISEASE. ONCE PATIENTS ARE CONNECTED TO A PCP, CARE TEAMS WORKING WITH THE CIN WORK TO ENSURE THAT THE PATIENTS RECEIVE PROACTIVE AND PREVENTATIVE CARE IN THE RIGHT SETTING AT THE RIGHT TIME. 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-JAF FIELDER, CEO, AND CLAIRE REBOUCHE, SR. VP QUALITY & CLINICAL PERFORMANCE. THROUGH ITS FIRST TWO YEARS IN OPERATION, HEALTH PLUS NETWORK CIN HAS IMPROVED QUALITY METRICS, LEADING TO VALUE BASED PURCHASING REVENUE IN EXCESS OF $3 MILLION, OF WHICH 60% HAS BEEN SHARED WITH PARTICIPATING PROVIDERS AND 40% HAS BEEN RETAINED WITHIN WK HEALTH PLUS NETWORK CIN, L3C TO COVER OPERATING EXPENSES. 1 AMERICAN CANCER SOCIETY 920 PIERREMONT SUITE 300 SHREVEPORT LA 71106 237040934 501(C)(3) 7500 SPONSORSHIP CADDO BOSSIER SOCCER ASSOCIATION 1780 EAST BERT KOUNS SUITE 901 SHREVEPORT LA 71105 581652966 501(C)(3) 32500 SPONSORSHIP FOUNDATION FOR EXCELLENCE IN LOUISIANA PUBLIC BROADCASTING 7733 PERKINS ROAD BATON ROUGE LA 70810 721233347 501(C)(3) 31500 SPONSORSHIP SHREVEPORT CHAMBER OF COMMERCE 400 EDWARDS STREET SHREVEPORT LA 71101 720315700 501(C)(6) 50000 SPONSORSHIP HOLY ANGELS RESIDENTIAL FACILITY INC 10450 ELLERBE ROAD SHREVEPORT LA 71106 720628035 501(C)(3) 55000 DONATION FOR OPERATIONS INDEPENDENCE BOWL FOUNDATION PO BOX 1723 SHREVEPORT LA 71166 720297228 501(C)(3) 33500 SPONSORSHIP LOUISIANA TECH UNIVERSITY FOUNDATION PO BOX 3046 RUSTON LA 71272 726021176 501(C)(3) 69750 SPONSORSHIP LOUISIANA HIGH SCHOOL ATHLETIC ASSOCIATION 12720 OLD HAMMOND HIGHWAY BATON ROUGE LA 70816 720513180 501(C)(3) 17250 SPONSORSHIP LA TROOPER FOUNDATION PO BOX 65076 BATON ROUGE LA 70896 742918404 501(C)(3) 25000 DONATION FOR OPERATIONS MARTIN LUTHER KING HEALTH CENTER POST OFFICE BOX 393 SHREVEPORT LA 71162 721079721 501(C)(3) 20000 DONATION FOR OPERATIONS NORTHWEST LOUISIANA FOOD BANK 2307 TEXAS AVENUE SHREVEPORT LA 71103 721328890 501(C)(3) 20000 DONATION FOR OPERATIONS NORTHWESTERN FOUNDATION UNIVERSITY PARKWAY NATCHITOCHES LA 71497 726021495 501(C)(3) 715500 DONATION FOR OPERATIONS SHREVEPORT-BOSSIER RESCUE MISSION 2033 TEXAS AVENUE SHREVEPORT LA 71103 237050551 501(C)(3) 35045 HEALTH INSURANCE FOR RESCUE MISSION EMPLOYEES AND DONATION FOR OPERATIONS SHREVEPORT LITTLE THEATRE 812 MARGARET PLACE SHREVEPORT LA 71101 720363143 501(C)(3) 10000 SPONSORSHIP SHREVEPORT OPERA 212 TEXAS STREET NO 1 SHREVEPORT LA 71101 726021455 501(C)(3) 10000 DONATION FOR OPERATIONS SHREVEPORT SYMPHONY 619 LOUISIANA AVENUE SHREVEPORT LA 71101 726001334 501(C)(3) 51440 SPONSORSHIP ST JUDE'S CHILDREN'S RESEARCH HOSPITAL PO BOX 810 MEMPHIS TN 38101 620646012 501(C)(3) 10000 DONATION FOR OPERATIONS VOLUNTEERS FOR YOUTH JUSTICE 900 JORDAN STREET SHREVEPORT LA 71101 721057695 501(C)(3) 220000 DONATION FOR OPERATIONS YMCA 400 MCNEIL SHREVEPORT LA 71101 720408997 501(C)(3) 37400 DONATION FOR OPERATIONS NORWELA COUNCIL OF BOY SCOUTS PO BOX 4341 SHREVEPORT LA 71104 720423629 501(C)(3) 19741 SPONSORSHIP PROVIDENCE HOUSE 814 COTTON STREET SHREVEPORT LA 71101 721205164 501(C)(3) 20000 DONATION FOR OPERATIONS RED RIVER RADIO PO BOX 5250 SHREVEPORT LA 71135 720702001 501(C)(3) 6000 SPONSORSHIP TAKING AIM AT CANCER PO BOX 10185 NEW ORLEANS LA 70181 834430802 501(C)(3) 15000 DONATION FOR OPERATIONS INSTITUTE FOR GLOBAL OUTREACH 1024 PIERRE AVENUE ROOM B SHREVEPORT LA 71103 331180777 501(C)(3) 25000 SPONSORSHIP 23 1 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 0 1 X X X X X 1 1 0 1 0 0 0 0 0 MILAN G MODY MD PHYSICIAN 1199977 0 826221 0 -5807 0 1592 0 30823 0 2052806 0 0 0 JAMES K ELROD PRESIDENT/CEO/TRUSTEE 1465778 6000 0 0 268835 0 0 0 7683 0 1742296 6000 0 0 HALIM S ABOU FAYCAL PHYSICIAN 304994 0 1404588 0 -7301 0 1586 0 32317 0 1736184 0 0 0 SARAH GLORIOSO MD PHYSICIAN 719986 0 961088 0 -5449 0 1563 0 31041 0 1708229 0 0 0 JOHN G NOLES MD PHYSICIAN 1074979 0 481003 0 -5513 0 1586 0 30817 0 1582872 0 0 0 JIHAD M EL-HAYEK PHYSICIAN 304994 0 1148181 0 -6497 0 1571 0 32089 0 1480338 0 0 0 MARY JANE WARD SR VICE PRESIDENT OF FINAN 449992 0 0 0 30056 0 2349 0 25824 0 508221 0 0 0 JERRY A FIELDER II PRESIDENT/CEO 273662 0 80000 0 23704 0 2149 0 30498 0 410013 0 0 0 JILL K ELROD VP OF LEGAL AFFAIRS 247841 0 0 0 29320 0 2211 0 10460 0 289832 0 0 0 IRA L MOSS VP/ADMIN WK PIERREMONT 225237 0 0 0 26250 0 2452 0 24889 0 278828 0 0 0 BRIAN A CRAWFORD SR VP & CAO 209996 0 20000 0 25558 0 3329 0 3866 0 262749 0 0 0 GREGORY J GAVIN VP/PHYSICIAN NETWORK 219567 0 0 0 23853 0 2435 0 9683 0 255538 0 0 0 MICHAEL CHANDLER SR VP/ADMINISTRATOR WKMC 217121 0 0 0 25130 0 2299 0 10383 0 254933 0 0 0 PEGGY J GAVIN SR VP OF PHYSICIAN SERVICE 196056 0 0 0 35309 0 4837 0 9183 0 245385 0 0 0 MARGARET G ELROD SR VP/IND WELLNESS/COMMUN 196859 0 0 0 29303 0 2435 0 7983 0 236580 0 0 0 PIERRE V BLANCHARDIV MD TRUSTEE/PHYSICIAN 199996 0 2308 0 21329 0 1953 0 7683 0 233269 0 0 0 JANET K ELROD VP/ADMIN WK SOUTH 197481 0 0 0 25303 0 2149 0 7683 0 232616 0 0 0 TODD J BLANCHARD VP/ADMIN WK BOSSIER 194746 0 0 0 -2723 0 3829 0 33507 0 229359 0 0 0 DIANE R MCCULLER VP NURSING - PATIENT SERVI 197885 0 0 0 3868 0 3853 0 11166 0 216772 0 0 0 MARGARET C REBOUCHE VP QUALITY & CLINICAL PERF 170422 0 20000 0 2896 0 5945 0 9814 0 209077 0 0 0 JOHN L FORTENBERRY JR VP/MARKETING & STRATEGY 189625 0 0 0 6285 0 1611 0 1018 0 198539 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-$971 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-$211,190 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,672) TOTAL--$268,835 MARY JANE WARD UNUSED SICK PAY-$10,385 VALUE ADDED FOR HEALTH & FITNESS USAGE-$576 VALUE ADDED FOR CELL PHONE USAGE-$480 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$7,010 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,895) TOTAL--$30,056 MARGARET G. ELROD UNUSED SICK PAY-$4,543 VALUE ADDED FOR CELL PHONE USAGE-$1,151 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,081 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,972) TOTAL--$29,303 JERRY A. FIELDER,II UNUSED SICK PAY-$6,277 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$1,067 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,279 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,635) VALUE ADDED FOR CABLE/INTERNET- $1,440 VALUE ADDED FOR HEALTH & FITNESS USAGE-$576 TOTAL--$23,704 JANET K. ELROD UNUSED SICK PAY-$4,557 VALUE ADDED FOR CELL PHONE USAGE-$1,693 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,225 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,672) TOTAL--$25,303 IRA L. MOSS UNUSED SICK PAY-$5,198 VALUE ADDED FOR HEALTH & FITNESS USAGE-$576 VALUE ADDED FOR CELL PHONE USAGE-$527 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$7,268 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,960) PERSONAL USE OF EMPLOYER VEHICLES-$141 TOTAL--$26,250 JILL K. ELROD UNUSED SICK PAY-$5,719 VALUE ADDED FOR HEALTH & FITNESS USAGE-$576 VALUE ADDED FOR CELL PHONE USAGE-$1,060 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,322 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,449) VALUE ADDED FOR CABLE/INTERNET- $1,441 PERSONAL USE OF EMPLOYER VEHICLES-$3,151 TOTAL--$29,320 PEGGY J. GAVIN UNUSED SICK PAY-$4,524 VALUE ADDED FOR CELL PHONE USAGE-$1,081 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$10,901 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,172) PERSONAL USE OF EMPLOYER VEHICLES-$2,475 TOTAL--$35,309 PIERRE V. BLANCHARD,IV, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$288 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,214 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,673) TOTAL--$21,329 TODD J. BLANCHARD UNUSED SICK PAY-$4,494 VALUE ADDED FOR HEALTH & FITNESS USAGE-$288 VALUE ADDED FOR CELL PHONE USAGE-$1,004 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$826 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(9,335) TOTAL--($2,723) MICHAEL CHANDLER UNUSED SICK PAY-$5,192 VALUE ADDED FOR CELL PHONE USAGE-$1,161 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,649 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,372) TOTAL--$25,130 GREGORY J. GAVIN VALUE ADDED FOR HEALTH & FITNESS USAGE-$576 VALUE ADDED FOR CELL PHONE USAGE-$527 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,922 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,672) TOTAL--$23,853 MILAN G. MODY, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$828 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,635) TOTAL--($5,807) JOHN G. NOLES, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$834 VALUE ADDED FOR HEALTH & FITNESS USAGE-$288 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,635) TOTAL--($5,513) JIHAD EL-HAYEK, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$562 VALUE ADDED FOR HEALTH & FITNESS USAGE-$576 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,635) TOTAL--($6,497) SARAH GLORIOSO, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$564 VALUE ADDED FOR HEALTH & FITNESS USAGE-$576 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,589) TOTAL--($5,449) BRIAN A. CRAWFORD COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,346 VALUE ADDED FOR CELL PHONE USAGE-$587 VALUE ADDED FOR HEALTH & FITNESS USAGE-$576 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,297) SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,500 UNUSED SICK PAY-$4,846 TOTAL--$25,558 HALIM SALIM ABOU FAYCAL COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$834 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(8,135) TOTAL--($7,301) JOHN L. FORTENBERRY, JR. UNUSED SICK PAY-$5,835 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$831 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(381) TOTAL--$6,285 MARGARET C. REBOUCHE UNUSED SICK PAY-$4,154 VALUE ADDED FOR CELL PHONE USAGE-$671 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,874 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,803) TOTAL--$2,896 DIANE R. MCCULLER UNUSED SICK PAY-$5,192 VALUE ADDED FOR CELL PHONE USAGE-$527 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,303 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,154) TOTAL--$3,868 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, 2020 (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 124616 RENT-BUILDING 0 CHARLES E MULLINS FAMILY MEMBER OF PEGGY GAVIN, OFFICER 110730 EMPLOYMENT 0 HOLLI T MANGIN FAMILY MEMBER OF CHRISTOPHER E. MANGIN, OFFICER 10569 EMPLOYMENT 0 PIERRE V BLANCHARD MD TRUSTEE 3469574 RENT-BUILDING, PURCHASED SERVICE AGREEMENT WITH LIFECARE HOSPITALS, INC., FOR WHICH PIERRE BLANCHARD, M.D. IS THE MEDICAL DIRECTOR 0 WILLIAM J COLE CPA TRUSTEE 3010091 ACCOUNTING, PAYROLL AND CONSULTING SERVICES PAID TO COLE, EVANS & PETERSON FOR WHICH WILLIAM J. COLE IS THE MANAGING PARTNER. 0 ARIEN WARD PYSD FAMILY MEMBER OF MARY JANE WARD, OFFICER 66318 EMPLOYMENT 0 GREGORY BLANCHARD FAMILY MEMBER OF PIERRE V. BLANCHARD, M.D., TRUSTEE 138163 EMPLOYMENT 0 CECILIA BLANCHARD FAMILY MEMBER OF PIERRE V. BLANCHARD, M.D., TRUSTEE 41599 EMPLOYMENT 0 JAMES D REBOUCHE FAMILY MEMBER OF MARGARET C. REBOUCHE, OFFICER 86898 EMPLOYMENT 0 ROGER S DEVILBISS FAMILY MEMBER OF JILL K. ELROD, OFFICER 134151 EMPLOYMENT 0 JENNIFER LASSEIGNE FAMILY MEMBER OF RAYMOND LASSEIGNE, TRUSTEE 39442 EMPLOYMENT 0 CHARLES L HANKINS FAMILY MEMBER OF DIANE R. MCCULLER, OFFICER 102535 EMPLOYMENT 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, 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 201,399,352. 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