2021-06-02T15:26:47-05:00 2020-06-30 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2019-07-01 721495500 OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL % AMANDA HYMEL OURL 2257657709 4200 Essen Lane Baton Rouge LA 70809 LOWELL STANTON REGIONAL CFO 2257656565 2021-05-17 true RYAN HOOKS P00746825 2253444000 2021-05-16 2019 2022-09-23 18:48:47Z X Kevin Guidry 4200 Essen Lane Baton Rouge LA 70809 7894196 false X N/A X 2001 LA THE PURPOSE OF THE HOSPITAL IS TO PROVIDE FOR THE CARE OF ILL, INJURED AND DISABLED PERSONS AND TO ENHANCE THE HEALTH OF THOSE IN THE COMMUNITY THROUGH RESEARCH AND EDUCATION. 7 4 59 5 0 0 30000 458276 6638912 6909939 366139 184455 28417 28417 7063468 7581087 3018 0 0 0 3078768 2943066 0 0 0 3510949 4105502 6592735 7048568 470733 532519 16049358 20367089 4645435 8559788 11403923 11807301 X ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING- WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. false false 5688482 6938356 OUR LADY OF THE LAKE ASSUMPTION PROVIDES TWENTY-FOUR HOUR HEALTHCARE SERVICES FOR PATIENTS IN THE SURROUNDING RURAL COMMUNITIES. THE HOSPITAL HAD 5,654 EMERGENCY ROOM VISITS THIS YEAR. THE HOSPITAL'S EMERGENCY ROOM IS OPEN TO EVERYONE, REGARDLESS OF ABILITY TO PAY.THE HOSPITAL ALSO PROVIDED 25,034 LAB TESTS AND 104 INPATIENT DAYS DURING THE YEAR. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTHCARE NEEDS OF THE PEOPLE OF GOD, THE MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. 5688482 true false false false false false false false false false true true false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 0 0 true 59 true false false false false false false false false false false false false X 7 4 false false false false true true true true true false false true true true true false true true false false X AMANDA HYMEL 2257656565 5959 S SHERWOOD FOREST BLVD BATON ROUGE LA 70816 X Kenneth Wester Board Member 2.0 53.5 X 0 1218510 238581 Jeffrey Limbocker Regional CFO-2019 2.0 53.5 X X 0 898795 161397 Stephanie Manson Board Member 2.0 40.0 X 0 517230 75493 Christy Hockaday CEO thru March 2020 2.0 48.0 X X 0 247973 21201 Wendy Gaudet Interim CEO 40.0 0.0 X X 0 174384 24610 Brian F Tripode Supervisor-Pharmacy 40.0 0.0 X 167843 0 22042 Donna M Mullings Director - nursing 1 40.0 0.0 X 106464 0 46079 William E Balhoff Chair 2.0 2.0 X X 0 0 0 Charles P Bolotte MD Chief of Staff 10.0 0.0 X 0 0 0 Yolanda Dixon Secretary 2.0 2.0 X X 0 0 0 Harry J Philips JR Vice Chair 2.0 2.0 X X 0 0 0 Lowell Stanton Regional CFO-2020 2.0 53.5 X 0 0 0 274307 3056892 589403 2 false true false OLOLRMC Laboratory Services 7777 Hennessy Blvd Suite 804 Baton Rouge LA 70808 Lab Services 1178786 Correct Care Inc 17438 Hard Hat Drive Covington LA Covengton LA 70435 Medical Services 1288228 FMOL HEALTH SYSTEM 4200 Essen Lane Baton Rouge LA 70809 Lab Management Fees 798832 GIFTED NURSES 2748 Metairie Lawn Drive Ste B Metairie LA 70002 Labor Services 113294 CROTHALL HEALTHCARE INC 5000 Hennessy Blvd Baton Rouge LA 70808 Housekeeping 111289 5 454217 4059 0 458276 Patient Service Revenue 900099 6903100 6903100 Outreach Lab 900099 1929 1929 Medical Records 900099 504 504 Miscellaneous 900099 1372 1372 All other Program Service Revenue 900099 3034 3034 6909939 65475 65475 0 0 28417 28417 0 28417 28417 432089 313109 118980 118980 118980 0 0 0 0 0 0 0 0 0 0 7581087 6938356 184455 0 0 0 0 0 0 2226517 1908964 317553 276754 235083 41671 286310 243210 43100 153485 130375 23110 1559194 1373594 185600 8224 8224 0 0 0 14683 14683 571509 525642 45867 0 13870 10560 3310 322640 256434 66206 2866 2182 684 0 256864 64216 192648 3700 2817 883 0 7803 5941 1862 0 0 178376 44594 133782 41819 6241 35578 Medical Supplies Expense 1073497 839185 234312 0 EQUIPMENT & MAINTENANCE 50457 39444 11013 0 7048568 5688482 1360086 0 8327145 12847104 0 0 265779 0 499527 626386 0 0 0 0 0 0 0 0 14702 16363 4015477 3069734 1041680 945743 0 0 5900525 5931493 0 0 0 0 0 0 16049358 20367089 2908032 3768667 0 0 0 3164032 0 0 0 0 0 0 0 0 0 0 1737403 1627089 4645435 8559788 X 11403923 11807301 0 0 11403923 11807301 16049358 20367089 X 532519 -131169 2028 X false true X true false X 55461 55461 860682 687219 173463 82115 48532 33583 3017219 2333983 683236 945743 INVESTMENT IN CAPITAL RESERVE 5931493 5931493 0 DUE TO/FROM RELATED ENTITIES 1627089 1627089 X FIN 48 (ASC 740) FOOTNOTE FMOLHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. NO RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. true true true X 250. false true true true false true true 257905 257905 0.03660 2496758 2496758 2754663 2496758 257905 0.03660 3006 3006 0.00000 3006 3006 0.00000 2757669 2496758 260911 0.03660 true 926547 1475001 1455127 19874 X true true 1 1 ASSUMPTION COMMUNITY HOSPITAL 135 HIGHWAY 402 NAPOLEONVILLE LA 70390 X X X X RURAL HEALTH CLINIC ASSUMPTION COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C X true 18 false true false true X 250. 0. X X X X X true true X X X true X SEE SUPPLEMENT AT PART V X SEE SUPPLEMENT AT PART V X SEE SUPPLEMENT AT PART V X X X X X X X true X false X X X X true X false false PART V, SECTION B, LINE 5 THE HOSPITAL HELD A FOCUS GROUP DISCUSSION WITH VARIOUS COMMUNITY GROUPS IN ORDER TO DISCUSS AND VALIDATE STATISTICAL DATA OBTAINED FROM THE HEALTH COMMUNITIES INSTITUTE. THE FOCUS GROUP WAS ABLE TO HELP IDENTIFY THE COMMUNITYS CHALLENGES AND THE ISSUES WITH THE GREATEST POTENTIAL FOR SUCCESS. IT MET WITH REPRESENTATIVES FROM ASSUMPTION PARISH COUNCIL ON AGING, ASSUMPTION PARISH LIBRARY, ASSUMPTION PARISH SCHOOLS, ASSUMPTION PARISH HEAD START, ACADIAN AMBULANCE SERVICE, LSU AG CENTER, ASSUMPTION HEALTHCARE AND REHAB, ASSUMPTION ASSOCIATION FOR RETARDED CITIZENS, OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER, ASSUMPTION PRIMARY CARE, ASSUMPTION PARISH SHERIFFS OFFICE, ASSUMPTION POLICE JURY, AND REGION III OFFICE OF EMERGENCY PREPAREDNESS. ONE PARTICIPANT WITH SPECIALIZED KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH WAS DEBRA GONZALES, DHH/OFFICE OF PUBLIC HEALTH FOR REGION III. PART V, SECTION B, QUESTION 7 THE CHNA CAN BE FOUND AT HTTPS://OLOLRMC.COM/PAGES/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX PART V, SECTION B, QUESTION 11 ASSUMPTION COMMUNITY HOSPITAL (ACH), A CRITICAL ACCESS HOSPITAL, AN AFFILIATE OF OUR LADY OF LAKE HOSPITAL AND A MEMBER OF THE FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, CONDUCTED A NEW COMMUNITY HEALTH NEEDS ASSESSMENT IN 2018. THE SIGNIFICANT HEALTH NEEDS IDENTIFIED DURING THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WERE: MENTAL HEALTH SERVICES, OBESITY, DIABETES, AND ACCESS TO CANCER SCREENING. THE SIGNIFICANT COMMUNITY HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015 WERE ACCESS TO PRIMARY CARE, CHILDHOOD OBESITY, DIABETES, AND HEALTH EDUCATION FOR SENIORS. DURING THE 2019-2020 FISCAL YEAR, ACH SERVED OVER 2,200 PARISHIONERS. ACH PARTNERED WITH ASSUMPTION'S COUNCIL OF AGING FOR THE COUNCIL OF AGING COMMUNITY FAIR WHICH TARGETED SENIOR CITIZEN AUDIENCE OF ASSUMPTION PARISH. ACH ADMINISTERED FREE FLU VACCINES, BLOOD PRESSURE AND GLUCOSE SCREENINGS, CHOLESTEROL SCREENINGS, AND WEIGHT AND BMI CHECKS. ACH PURCHASED HEALTHY SNACKS THAT WERE DISTRIBUTED TO THE SENIORS. THERE WERE APPROXIMATELY 135 ATTENDEES AT THE FAIR. ACH PARTICIPATED IN THE ASSUMTPION HEAD START HEALTH FAIR. ACH ADMINISTERED FREE FLU VACCINES, BLOOD PRESSURE AND GLUCOSE SCREENINGS, AND WEIGHT AND BMI CHECKS. ACH PURCHASED HEALTHY FOOD CHOICES, COLORING BOOKS, AND CRAYONS THAT WERE GIVEN TO THE PARENTS AND GRANDPARENTS TO TAKE HOME FOR THEIR CHILDREN AND GRANDCHILDREN. APPROXIMATELY 30 PEOPLE ATTENDED. ACH ADMINISTERED FLU VACCINES TO THE ASSUMPTION RETARDED CENTER CITIZENS AND THEIR STAFF. ACH COLLABORATED AGAIN WITH THE PARISH LSU AG CENTER TO CONTINUE THE GET-FIT-BA-YOU PROGRAM WHICH WAS TAUGHT TO 1200 5TH - 8TH GRADERS IN OUR PARISH PUBLIC SCHOOL SYSTEM. LSU AG CENTER, WITH THE HELP OF LSU, DESIGNED A NUTRITIONAL THREE WEEK PROGRAM. THIS INTRODUCED STUDENTS TO HEALTHY CHOICES THEY CAN MAKE FOR THEMSELVES. ACH PROVIDES THE STAFF TO COOK FOOD TASTING SAMPLES FOR THE 1200 STUDENTS. THROUGH A SERIES OF PRE AND POST TESTS GIVEN TO THE STUDENTS THAT PARTICIPATED THROUGH THEIR PHYSICAL EDUCATION CLASS, ACH DETERMINED THAT THERE WAS A 30% INCREASE IN KNOWLEDGE OF NUTRITION BECAUSE OF THE PROGRAM. ACH WALKING PATH USAGE ALMOST DOUBLED TO 50 TO 60% IN FISCAL YEAR 2019-2020, DUE TO COVID-19. ACH HAS PARTNERED WITH MARY BIRD PERKINS AND WOMAN'S HOSPITAL MOBILE UNIT TO PROVIDE BREAST EXAMS AND SKIN AND PROSTATE CANCER SCREENINGS BETWEEN THREE TO FOUR TIMES A YEAR, COMPLETING 43 EXAMS. IN LATE FEBRUARY AND MARCH ALL OUTREACH PROJECTS WERE CANCELLED DUE TO COVID-19. THIS INCLUDES EVENTS SUCH AS RELAY FOR LIFE, CHILDREN'S GOLF TOURNAMENTS, AND OTHERS. ACH FOLLOWED THE LEAD OF THE FMOLHS AND IMMEDIATELY BEGAN IMPLEMENTING ALL RECOMMENDATIONS AND REQUIREMENTS OF THE CDC. DAILY, ACH COMMUNICATED AND WORKED WITH OUR PARISH, REGION III, AND STATE EMERGENCY PREPAREDNESS AGENGIES. THE STATE'S EFS-8 PORTAL HAS BEEN USED TO SUBMIT THE HOSPITAL'S PREVIOUS DAYS' TOTALS. TOTALS SUCH AS COVID-9 NUMBERS, NUMBER OF ER PATIENTS, STAFFING OUTAGES, TOTAL OF PPE SUPPLIES AND ETC. ARE REPORTED DAILY. PART V, SECTION B, QUESTION 13H PRESUMPTIVE ELIGIBILITY IS DETERMINED BASED ON INFORMATION THAT MAY BE OBTAINED FROM SOURCES OTHER THAN THE PATIENT, SUCH AS EVIDENCE THAT THE PATIENT IS PARTICIPATING IN ONE OR MORE OF THE FOLLOWING: 1. STATE-FUNDING PRESCRIPTION PROGRAMS; 2. LACHIP, SUBSIDIZED HOUSING, FREE OR REDUCED SCHOOL LUNCHES, ETC. FOR THE PATIENT/GUARANTOR'S CHILDREN; 3. LOUISIANA FOOD STAMP PROGRAM; 4. STATE MEDICAID PROGRAM. FOR PATIENTS THAT HAVE MEDICAID COVERAGE, THE FINANCIAL ASSISTANCE DETERMINATION WILL RELY ON INFORMATION FROM THE MEDICAID PROGRAM, INLUDING EVIDENCE THAT: -PATIENT IS CURRENTLY ON MEDICAID, BUT HAS A PRIOR BALANCE WITHIN 12 MONTHS OF THE APPROVAL DATE -PATIENT CURRENTLY HAS MEDICAID WITH LIMITED BENEFITS (ONLY COVERS FAMILY PLANNING) -PATIENT IS IN A HOSPICE AND HAS MEDICAID ONLY -PATIENT HAS MEDICAID HROUGH A NON-CONTRACTED STATE -PATIENT QUALIFIES FOR MEDICAID WITH A "SPEND-DOWN REQUIREMENT" -PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (I.E. MEDICAID SPEND-DOWN) -PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY OR ESTATE. THE DUE DILIGENCE EFFORTS TO VERIFY THE ESTATE ARE TO BE DOCUMENTED VIA THE HOSPITAL APPROVED WEBSITE. ADDITIONALLY, A PATIENT MAY BE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THERE IS AN INDEPENDENT, QUALIFIED ATTESTATION THAT THE PATIENT IS HOMELESS. PART V, SECTION B, QUESTION 16J REGISTRATION PERSONNEL AND FINANCIAL COUNSELORS REFER PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE TO FINANCIAL COUNSELORS TO DISCUSS QUALIFICATION FOR FULLY-DISCOUNTED CARE UNDER THE FINANCIAL ASSISTANCE POLICY. THE POLICY IS ALSO POSTED AT THE HOSPITAL BUSINESS OFFICE AND AT ALL REGISTRATION LOCATIONS. PART V, SECTION B, QUESTION 16A, B, & C The Financial Assistance Policy (FAP), FAP application form, and a plain-language summary of the FAP are available at: https://fmolhs.org/financial-assistance-policy/ PART I, LINE 3C FINANCIAL ASSISTANCE IS AVAILABLE FOR INDIVIDUALS WHO ARE INSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. FULLY-DISCOUNTED CARE IS AVAILABLE IF INCOME AND ASSETS MEET CERTAIN FEDERAL POVERTY GUIDELINE LEVELS. FULLY-DISCOUNTED CARE IS ALSO AVAILABLE FOR THOSE PATIENTS WITH CATASTROPHIC MEDICAL BILLS WHERE MEDICAL BILLS EXCEED A CERTAIN PERCENTAGE OF INCOME AND ASSETS. FULLY DISCOUNTED CARE IS ALSO AVAILABLE WHERE THE PATIENT OR OTHER SOURCES CAN PROVIDE SUFFICIENT EVIDENCE OF PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY IS DETERMINED BASED ON INFORMATION THAT MAY BE OBTAINED FROM SOURCES OTHER THAN THE PATIENT, SUCH AS EVIDENCE THAT THE PATIENT IS PARTICIPATING IN ONE OR MORE OF THE FOLLOWING: 1. STATE-FUNDED PRESCRIPTION PROGRAMS; 2. LACHIP, SUBSIDIZED HOUSING, FREE OR REDUCED SCHOOL LUNCHES, ETC. FOR THE PATIENT/GUARANTOR'S CHILDREN; 3. LOUISIANA FOOD STAMP PROGRAM; 4. STATE MEDICAID PROGRAM. FOR PATIENTS THAT HAVE MEDICAID COVERAGE, THE FINANCIAL ASSITANCE DETERMINATION WILL RELY ON INFORMATION FROM THE MEDICAID PROGRAM, INCLUDING EVIDENCE THAT: - PATIENT IS CURRENTLY ON MEDICAID, BUT HAS A PRIOR BALANCE WITHIN 12 MONTHS OF THE APPROVAL DATE - PATIENT CURRENTLY HAS MEDICAID WITH LIMITED BENEFITS (ONLY COVERS FAMILY PLANNING) - PATIENT IS IN A HOSPICE AND HAS MEDICAID ONLY - PATIENT HAS MEDICAID THROUGH A NON-CONTRACTED STATE - PATIENT QUALIFIES FOR MEDICAID WITH A "SPEND-DOWN REQUIREMENT" - PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (I.E., MEDICAID SPEND-DOWN); - PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY OR ESTATE. THE DUE DILIGENCE EFFORTS TO VERIFY THE ESTATE ASSETS ARE TO BE DOCUMENTED VIA THE HOSPITAL APPROVED WEBSITE. ADDITIONALLY, A PATIENT MAY BE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THERE IS AN INDEPENDENT, QUALIFIED ATTESTATION THAT THE PATIENT IS HOMELESS. PART I, LINE 7 THE OPERATION OF OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS A COMMUNITY BENEFIT IN ITSELF. OUR LADY OF THE LAKE ASSUMPTION IS LOCATED IN AN UNDER-INSURED/LOW INCOME AREA. THE HOSPITAL IS THE ONLY SOURCE OF EMERGENCY HEALTH SERVICES AVAILABLE IN THE IMMEDIATE AREA. THE HOSPITAL DOES NOT HAVE A FORMAL COMMUNITY BENEFIT REPORT BUT IS CONSOLIDATED WITH THE SOLE MEMBER, OUR LADY OF THE LAKE HOSPITAL, INC. PART I, LINE 7, COLUMN F FOR THE PURPOSE OF CALCULATING THE PERCENTAGE IN PART I, LINE 7, COLUMN F, FUNCTIONAL EXPENSES WERE USED WHICH DID NOT INCLUDE BAD DEBT EXPENSE. PART I, LINE 7 THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINES 7A-D AND IS BASED ON IRS WORKSHEET 2. PART III, SECTION A, QUESTION 2 PART III, SECTION A, QUESTION 2 AMOUNT REPRESENTS THE ACTUAL CUSTOMER AMOUNTS DUE TO OUR LADY OF THE LAKE ASSUMPTION THAT WERE WRITTEN OFF BECAUSE THEY WERE UNCOLLECTIBLE. PART III, LINE 4 THE BAD DEBT FOOTNOTE IS ON PAGE 18 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. THE AMOUNT ON PART III, LINE 6 REPRESENTS MEDICARE ALLOWABLE COSTS FROM THE COST REPORT. PART III, LINE 9B PATIENTS WITH NO MEANS OF PAYMENT MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME, ASSETS, AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS MAY ALSO BE FULLY DISCOUNTED BASED ON A PRESUMPTIVE CHARITY SCORING SYSTEM WHICH IS SIMILAR TO CREDIT SCORING. TO THE EXTENT APPROPRIATE AND PERMITTED BY LAW, FINANCIAL COUNSELING AND SCREENINGS ARE CONDUCTED AT THE TIME OF ENCOUNTER TO ASSIST IN IDENTIFYING PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S POLICY. THESE PROCESSES HELP IDENTIFY (EARLY IN THE PROCESS) PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. THIS HELPS KEEP QUALIFYING PATIENTS OUT OF THE HOSPITAL'S COLLECTION PROCESSES BECAUSE AMOUNTS COVERED BY FINANCIAL ASSISTANCE ARE NOT SUBJECT TO THE HOSPITAL'S COLLECTION PRACTICES. HOWEVER, IF IT IS DETERMINED THAT A PATIENT QUALIFIES FOR DISCOUNTED CARE AFTER THE INDIVIDUAL'S ACCOUNT HAS BEEN SENT TO COLLECTIONS, THE DISCOUNTED AMOUNT IS IMMEDIATELY REMOVED FROM THE COLLECTIONS PROCESS. PART VI, LINE 2 NEEDS ASSESSMENT THE HOSPITAL WORKED WITH THE ASSUMPTION RURAL HEALTH CLINIC COMMUNITY, THE ASSUMPTION COUNCIL ON AGING, THE ASSUMPTION PARISH SCHOOL NURSES, DEPARTMENT OF HEALTH AND HOSPITALS/OFFICE OF PUBLIC HEALTH, AND OTHER COMMUNITY AND BUSINESS LEADERS TO IDENTIFY THE COMMUNITY'S HEALTH CARE NEEDS. THE IDENTIFIED NEEDS WILL CONTINUE TO BE ADDRESSED THROUGH CONTINUED DIALOGUE AND COLLABORATION WITH SPECIFIC GROUPS IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. IN ADDITION TO WORKING WITH SPECIFIC GROUPS TO ADDRESS THE COMMUNITY'S HEALTH CARE NEEDS, THE HOSPITAL AND THE RURAL HEALTH CARE CLINIC PROVIDE VARIOUS OUTREACH PROGRAMS SUCH AS AN ANNUAL HEALTH FAIR, PERIODIC SMOKING CESSATION CLASSES, AND PERIODIC DIABETES EDUCTION PROGRAMS. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: INDIVIDUALS ARE EDUCATED ABOUT ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AT VARIOUS STAGES OF THE ENCOUNTER WITH OUR LADY OF THE LAKE HOSPITAL. PATIENTS ARE INFORMED THROUGH A PATIENT HANDBOOK THAT CONTAINS INFORMATION ON THE FINANCIAL POLICIES OF THE HOSPITAL. ADDITIONALLY, SYSTEMS AND TOOLS ARE UTILIZED TO CONDUCT HIGH LEVEL FINANCIAL SCREENING TO ASSIST IN IDENTIFYING PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. WHEN AND WHERE APPROPRIATE, FINANCIAL COUNSELORS VISIT PATIENTS AT THE TIME OF THE ENCOUNTER AND EXPLAIN THE ASSISTANCE OPTIONS AVAILABLE. FINANCIAL COUNSELORS WORK WITH PATIENTS TO ASSIST WITH ENROLLMENT FOR MEDICAID FOR THOSE WHO ARE ELIGIBLE AS WELL AS TO ASSIST THOSE WHO QUALIFY FOR HOSPITAL FINANCIAL ASSISTANCE. PART VI, LINE 4 COMMUNITY INFORMATION Assumption Parish is a very rural area with only one incorporated community of approximately 700 residents known as the Village of Napoleonville. Assumption Parish is a community heavily dependent on agriculture (primarily sugar cane production) and has only a few large employers such as the Assumption Parish School system and a local marine shipyard. Based on the most recent CHNA, the median household income for the parish for 2018 was $45,457. Other small communities located in the parish include, Labadieville, Paincourtville, Plattenville, Bertrandville, Belle Rose, Pierre Part and Bayou L'Ourse. 13.93% of families live below the poverty line. 29% of the Assumption Parish population did not graduate high school. The majority of Assumption Parish speaks only English, but 13% speak Indo-European languages. PART VI, LINE 5 OTHER INFORMATION THE MAJORITY OF THE GOVERNING BODY OF OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS COMPRISED OF INDIVIDUALS WITH A BROAD CROSS-SECTION OF HEALTH CARE AND BUSINESS EXPERIENCE. OUR LADY OF THE LAKE ASSUMPTION HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF THE HOSPITAL DEPARTMENTS AS NEEDED. SURPLUS FUNDS ARE APPLIED TO IMPROVEMENTS IN PATIENT CARE AREAS THROUGH INVESTMENT IN CLINICAL TECHNOLOGY, MEDICAL INFORMATION TECHNOLOGY, AND CONTINUED TRAINING OF CLINICAL STAFF. PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS A NOT-FOR-PROFIT, NON-STOCK, MEMBER CORPORATION OF WHICH OUR LADY OF THE LAKE HOSPITAL, INC. IS THE SOLE MEMBER. OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS PART OF THE FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC. WHICH INCLUDES SEVERAL HOSPITALS AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATE. OUR LADY OF THE LAKE ASSUMPTION SERVES THE COMMUNITY IN LOUISIANA'S ASSUMPTION PARISH AND SURROUNDING PARISHES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER OUR LADY OF LOURDES REGIONAL MEDICAL CENTER ST. FRANCIS MEDICAL CENTER OUR LADY OF THE LAKE ASCENSION OUR LADY OF THE ANGELS HOSPITAL false true false false false false false false false Kenneth Wester Board Member 0 680881 0 397346 0 140283 208896 29685 0 1457091 119260 Brian F Tripode Supervisor-Pharmacy 167348 0 370 0 125 0 6930 15112 189885 0 Christy Hockaday CEO thru March 2020 0 208958 0 37828 0 1187 10024 11177 0 269174 Donna M Mullings Director - nursing 1 93808 0 12531 0 125 0 26323 19756 152543 0 Wendy Gaudet Interim CEO 154370 19889 125 7281 17329 198994 Stephanie Manson Board Member 0 380528 0 135885 0 817 48926 26567 0 592723 Jeffrey Limbocker Regional CFO-2019 550613 293047 55135 135652 25745 1060192 45920 PART I QUESTION 4A A board member is entitled to a severance benefit. The payout of such benefit is remote as it is effective only for termination of employment without cause for good reason and for a change of control. If triggered, the executive would be paid his/her base salary and an annual incentive at target and provided retirement and welfare benefits for an entitlement period. The entitlement period is 24 months. No payments were made under the plan in the current year. The CEO is entitled to a severance benefit. The payout of such benefit is remote as it is effective only for a termination of employment without cause, for good reason or due to change of control. If triggered, the employee would be paid his/her base salary and provided retirement and welfare benefits for an entitlement period. The entitlement period is 12 months. No payments were made under the plan in the current year. The entitlement period is 12 months. No payments were made under the plan in the current year. PART I QUESTION 4B FMOLHS maintains three unfunded deferred compensation plans which meet the requirements of IRC Section 457(f) and IRC Section 409A. The plans provide for compensation to be deferred and paid upon the occurrence of certain events such as termination without cause, disability, death or attainment of a specific payment date. Participation in the plans is limited to certain executives and is subject to approval of FMOLHS board of directors or a designated committee of such board. Kenneth Scott Wester received a payment of $137,584 and Jeffrey Limbocker received a payment of $52,976 from the plans in the current year. PART III, QUESTION 1 - ORGANIZATION'S MISSION INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI AND IN THE TRADITION OF THE ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING- WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. PART VI, SECTION A, QUESTION 6 OUR LADY OF THE LAKE HOSPITAL (AN IRC SECTION 501 (C) (3) ORGANIZATION) IS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. PART VI, SECTION A, QUESTION 7A OUR LADY OF THE LAKE HOSPITAL, AS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL, RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS AND THE OFFICERS OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. PART VI, SECTION A, QUESTION 7B OUR LADY OF THE LAKE HOSPITAL, INC. AS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL CAN MAKE THE DECISIONS AS FOLLOWS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES, AND PURPOSES OF CORPORATION 2. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF THE CORPORATION. 3. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION OR AFFILIATION, OR PARTICIPATION IN JOINT VENTURES 5. TO DISSOLVE AND DISTRIBUTE ASSETS OF THE CORPORATION 6. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION 7. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY CORPORATION 9. TO APPOINT THE FISCAL AUDITOR OF THE CORPORATION 10. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHANGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION 11. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION 12. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION PART VI, SECTION A, QUESTION 11 AFTER PREPARATION OF THE FORM 990 BY KPMG LLP, MANAGEMENT REVIEWED THE FORM 990. A COPY OF THE FORM 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. PART VI, SECTION B, QUESTION 12C OLOL ASSUMPTION COMMUNITY HOSPITAL HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY THAT REQUIRES EACH OFFICER, TRUSTEE, BOARD COMMITTEE MEMBER AND EMPLOYEE TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. COMPLETED DISCLOSURE FORMS ARE REVIEWED AND MAINTAINED BY THE CHIEF COMPLIANCE OFFICER. IF ANY TRUSTEE, BOARD COMMITTEE MEMBER OR SENIOR MANAGER HAS A POTENTIAL CONFLICT, THE EXECUTIVE COMMITTEE OF THE BOARD DETERMINES WHETHER ACTION NEEDS TO BE TAKEN AND COMMUNICATES ANY SUCH ACTION TO THE INDIVIDUAL. A POTENTIAL CONFLICT OF ANY OTHER EMPLOYEE IS REVIEWED BY THE CEO OR HIS DESIGNEE. THE EXECUTIVE COMMITTEE, CEO OR DESIGNEE, AS APPLICABLE, DETERMINES IF A CONFLICT OF INTEREST EXISTS OR CREATES THE APPEARANCE OF IMPROPRIETY. IF SUCH A DETERMINATION IS MADE, THE INDIVIDUAL WILL BE EXCUSED FROM PARTICIPATING IN THE BUSINESS DECISION. DURING THE YEAR, ANY CHANGE TO THE INFORMATION IN THE DISCLOSURE STATEMENT MUST BE DISCLOSED PROMPTLY TO THE CHIEF COMPLIANCE OFFICER, WHO TAKES APPROPRIATE ACTION. THE PROCESS ALSO REQUIRES AFFIRMATION FROM EACH INDIVIDUAL THAT HE OR SHE (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) HAS AGREED TO COMPLY WITH THE POLICY; AND (D) UNDERSTANDS THAT OLOL ASSUMPTION COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OLOL ASSUMPTION COMMUNITY HOSPITAL PROVIDES MECHANISMS FOR CONFIDENTIAL REPORTING OF COMPLIANCE ISSUES. THESE MECHANISMS INCLUDE AN ANONYMOUS HOTLINE AND WEB SITE WHERE INDIVIDUALS MAY RAISE ISSUES, SEEK CLARIFICATION, AND REPORT POSSIBLE CONFLICTS OF INTEREST OR OTHER CONCERNS. THESE REPORTS, INCLUDING REPORTS OF POSSIBLE CONFLICTS OF INTEREST, ARE REVIEWED AND INVESTIGATED BY THE CORPORATE COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN. PART VI, SECTION B QUESTION 13 Throughout the tax year, the organization had a whistleblower policy in place although it was not approved by the organization's board of directors before June 30, 2020. The whistleblower policy has, however, been approved by the board of directors of Our Lady of the Lake Hospital, Inc. (the organization's sole-member). PART VI, SECTION B, QUESTION 15A & 15B OTHER RELATED ORGANIZATIONS SET THE COMPENSATION AND PAY FOR THE EXECUTIVES. THAT BOARD OF DIRECTORS DESIGNATES THE COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY OUTSIDE SOURCES. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE COMPENSATION COMMITTEE. PART VI, SECTION C, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. SECTION 1.263(A)-3(N) ELECTION-BOOK CONFORMITY ELECTION OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2020. SECTION 1.263 (A)-1(F) - ELECTION- DE MINIMIS SAFE HARBOR ELECTION OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL HEREBY MAKES THE DE MINIMIS SAFE HARBOR ELECTION UNDER SECTION 1.263(A)-1(F) OF THE TREASURY REGULATIONS, EFFECTIVE ONLY FOR THE TAX YEAR ENDING JUNE 30, 2020. TAXPAYER HAS AN APPLICABLE FINANCIAL STATEMENT FOR THE YEAR OF THE ELECTION. THIS ELECTION PERMITS THE TAXPAYER TO DEDUCT FOR TAX PURPOSES ANY ITEM DEDUCTED UNDER ITS BOOK POLICY THAT DOES NOT EXCEED $5,000 PER INVOICE (OR PER ITEM, AS SUBSTANTIATED BY THE INVOICE) OR ITEMS HAVING AN ECONOMIC USEFUL LIFE OF TWELVE MONTHS OR LESS AS DESCRIBED IN SECTION 1.263(A)-1(F)(1)(I). 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