2021-07-26T15:49:14-05:00 2020-09-30 720506596 COLE EVANS & PETERSON POST OFFICE DRAWER 1768 SHREVEPORT LA 711661768 990 2019-10-01 720400933 WILLIS-KNIGHTON MEDICAL CENTER WILL 3182124000 CO COLEEVANS PETERSONPODRAWE SHREVEPORT LA 711661768 JAMES K ELROD PRESIDENT 3182124000 2021-07-26 1 BARRY S SHIPP P00024584 3182228367 2019 2022-09-23 18:48:47Z JAMES K ELROD POST OFFICE BOX 32600 SHREVEPORT LA 711302600 1199914570 0 X WWW.WKHS.COM X 1949 LA THE MEDICAL CENTER PROVIDES A FULL-RANGE OF HEALTH CARE SERVICES TO THE GENERAL PUBLIC. 10 7 8025 158 4893931 0 4580 91161094 1133815484 1037931472 14276797 14376811 20581223 14094598 1168678084 1157563975 1783377 1968375 0 0 448306160 475267173 0 0 0 685745587 672073417 1135835124 1149308965 32842960 8255010 1575864430 1736445879 567973692 687146886 1007890738 1049298993 X TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE WE SERVE. 0 0 957257245 1968375 1040730384 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 48,769 ADMITTANCES DURING THE YEAR ENDED SEPTEMBER 30, 2020 WITH A TOTAL OF 206,057 PATIENT DAYS AND 2,611 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, 2020, THE MEDICAL CENTER PROVIDED AN ESTIMATED $22,600,000 IN UNREIMBURSED COSTS ATTRIBUTABLE TO CHARITY CARE (EXCLUDING PROJECT NEIGHBORHEALTH) AND AN ESTIMATED $79,600,000 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, 2020, 71 PATIENTS RECEIVED ORGAN TRANSPLANTS, CONSISTING OF 64 KIDNEYS (14 OF THOSE PATIENTS ALSO HAD A PANCREAS TRANSPLANT AND 1 OF THOSE PATIENTS ALSO HAD A LIVER TRANSPLANT), AND 7 LIVERS. OF THE 71 TRANSPLANT SURGERIES PERFORMED AT THE MEDICAL CENTER DURING THE YEAR ENDED SEPTEMBER 30, 2020, 51 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, 2020, THE MEDICAL CENTER'S EMERGENCY ROOMS WERE VISITED BY 149,428 PATIENTS, OF WHOM 19,905 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 2,611 BIRTHS; 5,386 OBSTETRICAL VISITS TO THE L&D UNITS; AND 2,759 OBSTETRICAL AND GYNECOLOGICAL INPATIENTS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2020HEALTH 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, 2020 OF 3,275. 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 30.18 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, 2020, HOSPICE OF LOUISIANA SERVED 186 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.BEHAVIORAL MEDICINE CENTER THE BEHAVIORAL MEDICINE CENTER AT WILLIS-KNIGHTON MEDICAL CENTER OFFERS INPATIENT AND OUTPATIENT SERVICES TO INDIVIDUALS IN NEED OF MENTAL HEALTH CARE. DURING THE YEAR ENDED SEPTEMBER 30, 2020, THE BEHAVIORAL MEDICINE CENTER SPONSORED NUMEROUS INFORMATION SESSIONS FOR VARIOUS GROUPS IN THE SHREVEPORT/BOSSIER AND NORTHWEST LOUISIANA AREAS. SUCH SESSIONS AMOUNTED TO APPROXIMATELY 4 HOURS AND WERE ATTENDED BY APPROXIMATELY 125 PEOPLE. TOPICS INCLUDED:MARRIAGE/FAMILY - DEVELOPMENT OF SKILLS TO ENRICH MARRIAGE AND FAMILY LIFE.SELF-ESTEEM - CONCENTRATES ON HOW GOOD SELF-ESTEEM CAN ENHANCE AN INDIVIDUAL'S QUALITY OF LIFE. PARENTING - FOCUSES ON APPROPRIATE PARENTING SKILLS AT VARIOUS DEVELOPMENTAL STAGES. STRESS MANAGEMENT - DEVELOPING SKILLS TO COPE WITH EVERYDAY STRESSES IN LIFE.PERSONAL ENRICHMENT - EMPOWERING OURSELVES TO REACH MAXIMUM POTENTIAL.MOTIVATION/ATTITUDE - HOW ATTITUDE AFFECTS OUR MENTAL AND PHYSICAL HEALTH.COUNSELING ISSUES/TECHNIQUES - ISSUES CONCERNING PROFESSIONAL DEVELOPMENT FOR COUNSELORS/THERAPISTS.AGING - DEVELOPMENT OF A POSITIVE ATTITUDE TO DEAL WITH ISSUES OF AGING.DEPRESSION/SUICIDE - ASSESSMENT OF DEPRESSION AND SUICIDE, AND LEGAL AND ETHICAL ISSUES SURROUNDING SUICIDE. 10848504 6080071 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. 968105749 1 1 0 1 0 0 0 0 0 0 1 0 0 0 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 1 424 0 1 8025 1 1 1 0 0 0 0 0 0 0 1 0 X 10 7 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MR JAMES K ELROD 3182124000 2600 GREENWOOD ROAD SHREVEPORT LA 711033908 MILAN G MODY MD PHYSICIAN 40.00 X 2239596 0 32912 JAMES K ELROD PRESIDENT/CEO/TRUSTEE 53.00 X X 1745162 6000 7842 SARAH GLORIOSO MD PHYSICIAN 40.00 X 1718965 0 34107 CHRISTOPHER L SHELBY MD PHYSICIAN 40.00 X 1667891 0 35513 JOHN G NOLES MD PHYSICIAN 40.00 X 1555237 0 34005 HALIM S ABOU FAYCAL MD PHYSICIAN 40.00 X 1434180 0 32977 MARY JANE WARD SR VICE PRESIDENT OF FINAN 40.00 X 403348 0 29091 JERRY A FIELDER II SR VP - HOSPITAL OPERATIONS 40.00 X 359734 0 33607 CHRISTOPHER E MANGIN SR VP - CLINICAL LINES 40.00 X 293293 0 35556 JILL K ELROD VP OF LEGAL AFFAIRS 40.00 X 273412 0 12575 IRA L MOSS VP/ADMIN WK PIERREMONT 40.00 X 244986 0 26334 GREGORY J GAVIN VP/PHYSICIAN NETWORK 40.00 X 248388 0 12278 MICHAEL CHANDLER SR VP/ADMINISTRATOR WKMC 40.00 X 227615 0 12003 PIERRE V BLANCHARDIV MD TRUSTEE/PHYSICIAN 40.00 X 223973 0 9795 MARGARET G ELROD SR VP/IND WELLNESS/COMMUN 40.00 X 220396 0 10938 PEGGY J GAVIN SR VP OF PHYSICIAN SERVICE 40.00 X 215857 0 9342 BRIAN A CRAWFORD SR VP & CAO 40.00 X 217873 0 7142 JANET K ELROD VP/ADMIN WK SOUTH 40.00 X 213201 0 9692 TODD J BLANCHARD VP/ADMIN WK BOSSIER 40.00 X 178803 0 36441 DEBORAH D OLDS VP NURSING - PATIENT SERVI 40.00 X 178167 0 24844 JOHN L FORTENBERRY JR VP/MARKETING & STRATEGY 40.00 X 193147 0 1986 MARGARET C REBOUCHE VP QUALITY & CLINICAL PERFORMANCE 40.00 X 175178 0 15076 DIANE R MCCULLER VP NURSING - PATIENT SERVI 40.00 X 171321 0 14302 CLIFFORD M BROUSSARD VP/ADMIN WK BOSSIER/QUALIT 40.00 X 66228 0 0 FRANK B HUGHES MD TRUSTEE/CHAIRMAN 4.00 X 0 0 0 SAM J TALBOT TRUSTEE 4.00 X 0 0 0 JOHN C MICIOTTO MD TRUSTEE 4.00 X 0 0 0 GILBERT R SHANLEY CPA TRUSTEE 4.00 X 0 0 0 WILLIAM J COLE CPA TRUSTEE/TREASURER 4.00 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 14465951 6000 478358 765 0 1 0 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 6166700 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY TESTING 5949707 SHREVEPORT ANESTHESIA SERVICES 2600 GREENWOOD ROAD SHREVEPORT LA 71103 PHYSICIAN SERVICES 5566668 SHAMS GROUP INC 1304 W WALNUT HILL LANE SUITE 240 IRVING TX 75038 DATA PROCESSING 4933848 112 91160054 1040 91161094 HEALTHCARE SERVICES 900099 1034172353 1034172353 RESIDENTIAL COMMUNITY 900099 3759119 3759119 1037931472 14567389 14567389 2975451 2279309 696142 696142 696142 39702368 178340 39619643 451643 82725 -273303 -190578 -190578 NONOPERATING COMPONENTS OF NET PE 900099 6846263 6846263 LABORATORY REVENUE-UBI 621500 4399681 4399681 (LOSS) FROM SUBSIDIARY - MULTI-FA 623000 1000068 1000068 1152444 658194 494250 13398456 1157563975 1046810455 4893931 14567389 1968375 1968375 6294471 6294471 340239330 301922917 38316413 23906711 20829091 3077620 74760451 65136196 9624255 30066210 27152354 2913856 1272752 1272752 2563432 2563432 2433747 1177095 1256652 29688682 29688682 17304978 17304978 75711599 34625601 41085998 8069404 8069404 DIRECT DEPARTMENTAL EXP 513852834 513852834 TAXES & LICENSES 10116090 10116090 BUSINESS OFFICE 4961173 4961173 6098726 1441286 4657440 1149308965 968105749 181203216 0 16056838 13310745 242508248 212109890 212475919 155893029 3329234 2567311 27094014 28115157 9265806 10661258 1401147527 890896866 542615982 510250661 507708448 761618567 11830323 12830390 14813 13688 2964805 29075183 1575864430 1736445879 114147047 128030434 8222680 12530 103012702 74596775 302798694 308539866 39792569 175967281 567973692 687146886 X 1007890738 1049298993 1007890738 1049298993 1575864430 1736445879 X 8255010 63639632 -30486387 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1676579 1676579 0 PART II-B, LINE 1: DURING THE YEAR ENDED SEPTEMBER 30, 2020, THE MEDICAL CENTER PAID DUES TOTALING $60,775 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, $30,388 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2020, THE MEDICAL CENTER PAID DUES TOTALING $7,940 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, $4,764 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2020, THE MEDICAL CENTER PAID DUES TOTALING $262,854 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, $131,427 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 ENTERPRISES, LLC 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 $125,000 MONTHLY RETAINER FEE THROUGH AUGUST 31, 2020. THE CONTRACT WAS REVISED EFFECTIVE SEPTEMBER 1, 2020, CALLING FOR A $135,000 MONTHLY RETAINER FEE. FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2020, TOTAL LOBBYING EXPENSES UNDER THIS CONTRACT TOTALED $1,510,000. 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. 998600 57183386 58181986 8102437 808885086 493696752 323290771 1919425 1701864 217561 465323989 375132277 90191712 58734604 20365973 38368631 510250661 INVESTMENT IN SUB. - VIRGINIA HALL NURSING HOME 5493380 LIABILITY FOR PENSION BENEFITS 30823393 OPERATING LEASE LIABILITY 16133959 FINANCE LEASE LIABILITY 7655634 MEDICAID SUPPLEMENTAL 4507523 MEDICARE ACCELERATED PAYMENT PROGRAM PAYABLE 111353392 175967281 1238867495 63639632 63639632 1175227863 -17663888 -17663888 1157563975 1197459240 48150275 48150275 1149308965 0 1149308965 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 336,234 SUBSIDIARIES EXPENSES (18,000,122) TOTAL (17,663,888) PART XII, LINE 2D UNRELATED BUSINESS GROSS INCOME: DATA PROCESSING (336,234) SUBSIDIARIES EXPENSES 18,000,122 PENSION RELATED CHANGES 30,486,387 TOTAL 48,150,275 1 1 X 1 X 1 X 1 1 1 0 1 1 22603592 22603592 0.01970 181205897 101613772 79592125 0.06930 203809489 101613772 102195717 0.08900 3560893 3560893 0.00310 6331516 6331516 0.00550 1745809 456063 1289746 0.00110 1968375 1968375 0.00170 13606593 456063 13150530 0.01140 217416082 102069835 115346247 0.10040 1 13839635 0 241421159 271156204 -29735045 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, URGENT CARE CENTER A 2 WK PIERREMONT HEALTH CENTER 8001 YOUREE DRIVE SHREVEPORT LA 71115 232-C X X X X PHYSICIAN CLINICS, URGENT CARE CENTER A 3 WK BOSSIER HEALTH CENTER 2400 HOSPITAL DRIVE BOSSIER CITY LA 71111 387 X X X PHYSICIAN CLINICS, URGENT CARE CENTER A 4 WILLIS-KNIGHTON SOUTH 2510 BERT KOUNS INDUSTRIAL LOOP SHREVEPORT LA 71118 232-A X X X X PHYSICIAN CLINICS, URGENT CARE CENTER 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 15), IN THE SEPTEMBER 30, 2020, 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 470,399 PERSONS. THE MEDIAN HOUSEHOLD INCOME FOR THE PSA IS $46,767. 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 2,464 MEDICAL PATIENT VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2020. 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 2,361 MEDICAL PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2020. 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 701,843 VISITORS WITH MORE THAN 1,713,184 PAGE VIEWS. THE ONLINE HEALTH LIBRARY HAD 39,555 VISITORS. KIDSHEALTH HAD 37,446 VISITORS AND 45,955 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, 2020, THE MEDICAL CENTER IMMUNIZED 1,365 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. 1 CADDO PARISH SHERIFF'S DEPARTMENT 505 TRAVIS STREET 7TH FLOOR SHREVEPORT LA 71101 726000179 GOVERNMENT 122117 DONATION FOR EQUIPMENT BOSSIER CHAMBER OF COMMERCE 710 BENTON ROAD BOSSIER CITY LA 71111 720382231 501(C)(6) 13220 DONATION FOR PATRIOT AWARENESS CADDO BOSSIER SOCCER ASSOCIATION 1780 EAST BERT KOUNS SUITE 901 SHREVEPORT LA 71105 581652966 501(C)(3) 32500 SPONSORSHIP CADDO-BOSSIER CANCER FOUNDATION 3300 ALBERT BICKNELL DRIVE SHREVEPORT LA 71103 453188641 501(C)(3) 25000 DONATION FOR OPERATIONS FOUNDATION FOR EXCELLENCE IN LOUISIANA PUBLIC BROADCASTING 7733 PERKINS ROAD BATON ROUGE LA 70810 721233347 501(C)(3) 21000 SPONSORSHIP FRIENDS OF LOUISIANA PUBLIC BROADCASTING INC 7733 PERKINS ROAD BATON ROUGE LA 70810 720794108 501(C)(3) 10000 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) 65000 DONATION FOR OPERATIONS AND SPONSORSHIP INDEPENDENCE BOWL FOUNDATION PO BOX 1723 SHREVEPORT LA 71166 720297228 501(C)(3) 27750 SPONSORSHIP LOUISIANA TECH UNIVERSITY FOUNDATION PO BOX 3046 RUSTON LA 71272 726021176 501(C)(3) 57813 SPONSORSHIP LA TROOPER FOUNDATION PO BOX 65076 BATON ROUGE LA 70896 742918404 501(C)(3) 25000 SPONSORSHIP LOUISIANA HERO'S PROJECT 2515 VANCE AVENUE ALEXANDRIA LA 71301 462720419 501(C)(3) 14999 SPONSORSHIP LSUHSC PO BOX 31650 SHREVEPORT LA 71115 721402222 GOVERNMENT 9725 DONATION FOR OPERATIONS AND SPONSORSHIP MARTIN LUTHER KING HEALTH CENTER POST OFFICE BOX 393 SHREVEPORT LA 71162 721079721 501(C)(3) 30000 DONATION FOR OPERATIONS NORTHWEST LOUISIANA FOOD BANK 2307 TEXAS AVENUE SHREVEPORT LA 71103 721328890 501(C)(3) 15000 DONATION FOR OPERATIONS NORTHWESTERN FOUNDATION UNIVERSITY PARKWAY NATCHITOCHES LA 71497 726021495 501(C)(3) 737500 DONATION FOR OPERATIONS SHREVEPORT-BOSSIER RESCUE MISSION 2033 TEXAS AVENUE SHREVEPORT LA 71103 237050551 501(C)(3) 45058 HEALTH INSURANCE FOR RESCUE MISSION EMPLOYEES PROVIDENCE HOUSE 814 COTTON STREET SHREVEPORT LA 71101 721205164 501(C)(3) 25000 DONATION FOR OPERATIONS SHREVEPORT OPERA 212 TEXAS STREET NO 1 SHREVEPORT LA 71101 726021455 501(C)(3) 20000 DONATION FOR OPERATIONS SHREVEPORT SYMPHONY 619 LOUISIANA AVENUE SHREVEPORT LA 71101 726001334 501(C)(3) 61350 DONATION FOR OPERATIONS RED RIVER RADIO PO BOX 5250 SHREVEPORT LA 71135 720702001 501(C)(3) 7000 SPONSORSHIP ST JUDE'S CHILDREN'S RESEARCH HOSPITAL PO BOX 810 MEMPHIS TN 38101 620646012 501(C)(3) 10000 SPONSORSHIP 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) 40800 DONATION FOR OPERATIONS SHREVEPORT FIRE DEPARTMENT 263 NORTH COMMON STREET SHREVEPORT LA 71101 726001326 GOVERNMENT 14000 DONATION FOR MASK-UP T-SHIRTS SHREVEPORT POLICE DEPARTMENT 712 MILAM STREET SUITE 101 SHREVEPORT LA 71101 726001326 GOVERNMENT 48237 DONATION FOR TRANSPORT VAN ULM FOUNDATION 3601 DESIARD STREET MONROE LA 71209 726028527 501(C)(3) 120000 DONATION FOR OPERATIONS INSTITUTE FOR GLOBAL OUTREACH 1024 PIERRE AVENUE ROOM B SHREVEPORT LA 71103 331180777 501(C)(3) 25000 SPONSORSHIP 26 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 0 1 X X X X X 1 1 0 1 0 0 0 0 0 MILAN G MODY MD PHYSICIAN 1199977 0 1045426 0 -5807 0 1430 0 31482 0 2272508 0 0 0 JAMES K ELROD PRESIDENT/CEO/TRUSTEE 1465778 6000 0 0 279384 0 0 0 7842 0 1753004 6000 0 0 SARAH GLORIOSO MD PHYSICIAN 719986 0 1005236 0 -6257 0 1407 0 32700 0 1753072 0 0 0 CHRISTOPHER L SHELBY MD PHYSICIAN 799985 0 876354 0 -8448 0 1390 0 34123 0 1703404 0 0 0 JOHN G NOLES MD PHYSICIAN 1074979 0 486674 0 -6416 0 1529 0 32476 0 1589242 0 0 0 HALIM S ABOU FAYCAL MD PHYSICIAN 304994 0 1134986 0 -5800 0 1501 0 31476 0 1467157 0 0 0 MARY JANE WARD SR VICE PRESIDENT OF FINAN 373743 0 0 0 29605 0 2824 0 26267 0 432439 0 0 0 JERRY A FIELDER II SR VP - HOSPITAL OPERATIONS 256995 0 80000 0 22739 0 1850 0 31757 0 393341 0 0 0 CHRISTOPHER E MANGIN SR VP - CLINICAL LINES 222496 0 70000 0 797 0 2880 0 32676 0 328849 0 0 0 JILL K ELROD VP OF LEGAL AFFAIRS 243307 0 0 0 30105 0 2006 0 10569 0 285987 0 0 0 IRA L MOSS VP/ADMIN WK PIERREMONT 217738 0 0 0 27248 0 2452 0 23882 0 271320 0 0 0 GREGORY J GAVIN VP/PHYSICIAN NETWORK 215552 0 0 0 32836 0 2436 0 9842 0 260666 0 0 0 MICHAEL CHANDLER SR VP/ADMINISTRATOR WKMC 202496 0 0 0 25119 0 2161 0 9842 0 239618 0 0 0 PIERRE V BLANCHARDIV MD TRUSTEE/PHYSICIAN 199996 0 3308 0 20669 0 1953 0 7842 0 233768 0 0 0 MARGARET G ELROD SR VP/IND WELLNESS/COMMUN 187859 0 0 0 32537 0 2436 0 8502 0 231334 0 0 0 PEGGY J GAVIN SR VP OF PHYSICIAN SERVICE 187056 0 0 0 28801 0 0 0 9342 0 225199 0 0 0 BRIAN A CRAWFORD SR VP & CAO 197881 0 20000 0 -8 0 0 0 7142 0 225015 0 0 0 JANET K ELROD VP/ADMIN WK SOUTH 188481 0 0 0 24720 0 1850 0 7842 0 222893 0 0 0 TODD J BLANCHARD VP/ADMIN WK BOSSIER 181572 0 0 0 -2769 0 2124 0 34317 0 215244 0 0 0 DEBORAH D OLDS VP NURSING - PATIENT SERVI 171724 0 0 0 6443 0 2162 0 22682 0 203011 0 0 0 JOHN L FORTENBERRY JR VP/MARKETING & STRATEGY 186173 0 0 0 6974 0 1612 0 374 0 195133 0 0 0 MARGARET C REBOUCHE VP QUALITY & CLINICAL PERFORMANCE 153227 0 20000 0 1951 0 5403 0 9673 0 190254 0 0 0 DIANE R MCCULLER VP NURSING - PATIENT SERVI 171051 0 0 0 270 0 3027 0 11275 0 185623 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-$772 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$16,068 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN CONTRIBUTION-$211,190 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,672) TOTAL--$279,384 MARY JANE WARD UNUSED SICK PAY-$10,385 VALUE ADDED FOR HEALTH & FITNESS USAGE-$768 VALUE ADDED FOR CELL PHONE USAGE-$360 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,937 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,845) TOTAL--$29,605 MARGARET G. ELROD UNUSED SICK PAY-$4,543 VALUE ADDED FOR CELL PHONE USAGE-$1,117 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$10,209 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,332) TOTAL--$32,537 JERRY A. FIELDER,II UNUSED SICK PAY-$6,277 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$1,101 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,269 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,235) VALUE ADDED FOR CABLE/INTERNET- $1,359 VALUE ADDED FOR HEALTH & FITNESS USAGE-$768 TOTAL--$22,739 JANET K. ELROD UNUSED SICK PAY-$4,557 VALUE ADDED FOR HEALTH & FITNESS USAGE-$384 VALUE ADDED FOR CELL PHONE USAGE-$1,309 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,143 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,673) TOTAL--$24,720 IRA L. MOSS UNUSED SICK PAY-$5,197 VALUE ADDED FOR HEALTH & FITNESS USAGE-$768 VALUE ADDED FOR CELL PHONE USAGE-$550 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,897 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,460) PERSONAL USE OF EMPLOYER VEHICLES-$296 TOTAL--$27,248 JILL K. ELROD UNUSED SICK PAY-$5,720 VALUE ADDED FOR HEALTH & FITNESS USAGE-$768 VALUE ADDED FOR CELL PHONE USAGE-$1,400 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,322 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,399) VALUE ADDED FOR CABLE/INTERNET- $1,421 PERSONAL USE OF EMPLOYER VEHICLES-$3,873 TOTAL--$30,105 PEGGY J. GAVIN UNUSED SICK PAY-$4,524 VALUE ADDED FOR CELL PHONE USAGE-$1,030 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,263 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,172) PERSONAL USE OF EMPLOYER VEHICLES-$1,156 TOTAL--$28,801 DEBORAH D. OLDS UNUSED SICK PAY-$3,364 VALUE ADDED FOR HEALTH & FITNESS USAGE-$384 VALUE ADDED FOR CELL PHONE USAGE-$1,062 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$5,893 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,260) TOTAL--$6,443 PIERRE V. BLANCHARD,IV, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$128 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,214 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,673) TOTAL--$20,669 TODD J. BLANCHARD UNUSED SICK PAY-$4,494 VALUE ADDED FOR HEALTH & FITNESS USAGE-$384 VALUE ADDED FOR CELL PHONE USAGE-$1,024 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$613 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(9,284) TOTAL--($2,769) MICHAEL CHANDLER UNUSED SICK PAY-$4,881 VALUE ADDED FOR CELL PHONE USAGE-$1,270 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,641 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,673) TOTAL--$25,119 GREGORY J. GAVIN UNUSED SICK PAY-$5,067 VALUE ADDED FOR HEALTH & FITNESS USAGE-$768 VALUE ADDED FOR CELL PHONE USAGE-$550 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$11,124 SECTION 457(B) DEFERRED COMPENSATION PLAN-$19,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,673) TOTAL--$32,836 CHRISTOPHER E. MANGIN UNUSED SICK PAY-$6,000 VALUE ADDED FOR CELL PHONE USAGE-$1,030 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$834 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,835) VALUE ADDED FOR HEALTH & FITNESS USAGE-$768 TOTAL--$797 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-$384 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,634) TOTAL--($6,416) CHRISTOPHER L. SHELBY, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$837 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(9,285) TOTAL--($8,448) SARAH GLORIOSO, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$564 VALUE ADDED FOR HEALTH & FITNESS USAGE-$768 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(7,589) TOTAL--($6,257) BRIAN A. CRAWFORD VALUE ADDED FOR CELL PHONE USAGE-$391 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,103) VALUE ADDED FOR HEALTH & FITNESS USAGE-$704 TOTAL--($8) HALIM S. ABOU FAYCAL, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$834 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,634) TOTAL--($5,800) JOHN L. FORTENBERRY, JR. UNUSED SICK PAY-$5,834 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,140 TOTAL--$6,974 MARGARET C. REBOUCHE UNUSED SICK PAY-$3,709 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,745 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,503) TOTAL--$1,951 DIANE R. MCCULLER UNUSED SICK PAY-$2,747 VALUE ADDED FOR CELL PHONE USAGE-$550 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,078 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,105) TOTAL--$270 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, 2019 (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 110821 EMPLOYMENT 0 SHARLENE A BROUSSARD FAMILY MEMBER OF CLIFFORD BROUSSARD, OFFICER 83086 EMPLOYMENT 0 PIERRE V BLANCHARD MD TRUSTEE 3502003 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 2886547 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 101769 EMPLOYMENT 0 HOLLI T MANGIN FAMILY MEMBER OF CHRISTOPHER E. MANGIN, OFFICER 25128 EMPLOYMENT 0 GREGORY J BLANCHARD FAMILY MEMBER OF PIERRE V. BLANCHARD, M.D., TRUSTEE 132521 EMPLOYMENT 0 JAMES D REBOUCHE FAMILY MEMBER OF MARGARET C. REBOUCHE, OFFICER 82882 EMPLOYMENT 0 ROGER S DEVILBISS FAMILY MEMBER OF JILL K. ELROD, OFFICER 134147 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 2 1. FAMILY RELATIONSHIPS WITH JAMES K. ELROD - PRESIDENT, CEO, AND TRUSTEE MARGARET ELROD, SPOUSE - SR VP-INDUSTRY WELLNESS/COMMUNITY MISSIONS OUTREACH, 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 TOP TWO EXECUTIVES (CEO AND CFO) OF THE MEDICAL CENTER. A SECOND COMPENSATION COMMITTEE, CONSISTING OF THE CEO AND CFO, 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 TOP TWO EXECUTIVES (CEO AND CFO). 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 -30,486,387. 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