FURP.ORG / PUBLIC DATA EXPLORER

KAPLAN GENERAL HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
KAPLAN GENERAL HOSPITAL INC (EIN 47-2540179)
Tax period
2016-10-01 to 2017-09-30
Filed
2018-07-26
IRS object ID
201822079349300222
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-07-26T10:53:23-05:00ReturnTs
Tax Period End2017-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN201941244PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1HORNE LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11020 Highland Colony Pkwy Ste 400AddressLine1Txt
CityRidgelandCityNm
State AbbreviationMSStateAbbreviationCd
ZIP39157ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN472540179EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Kaplan General HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlKAPLBusinessNameControlTxt
Phone3376435200PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11214 Coolidge BlvdAddressLine1Txt
CityLafayetteCityNm
State AbbreviationLAStateAbbreviationCd
ZIP70503ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBRYCE QUEBODEAUXPersonNm
Person TitleCEOPersonTitleTxt
Phone3376435200PhoneNum
Signature2018-07-16SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAmie T Whittington CPAPreparerPersonNm
PTINP01082167PTIN
Phone6013261000PhoneNum
Preparation2018-07-16PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1ABROM KAPLAN MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerBRYCE QUEBODEAUXPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11214 Coolidge BlvdAddressLine1Txt
CityLafayetteCityNm
State AbbreviationLAStateAbbreviationCd
ZIP70503ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$16,170,296GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.LAFAYETTEGENERAL.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2014FormationYr
Legal Domicile StateLALegalDomicileStateCd
Activity Or MissionABROM KAPLAN MEMORIAL HOSPITAL'S MISSION IS TO MAKE AVAILABLE QUALITY CARE SERVICES TO OUR COMMUNITY CONSITUENTS IN A PROFICIENT, DEDICATED AND COMPASSIONATE MANNER.ActivityOrMissionDesc
Voting Members Governing Body3VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee105TotalEmployeeCnt
Total Volunteers2TotalVolunteersCnt
Total Gross UBI$134,739TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$35,738NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,881,273PYContributionsGrantsAmt
CY Contributions Grants$1,622,086CYContributionsGrantsAmt
PY Program Service Revenue$16,766,986PYProgramServiceRevenueAmt
CY Program Service Revenue$14,402,976CYProgramServiceRevenueAmt
PY Investment Income$197PYInvestmentIncomeAmt
CY Investment Income$422CYInvestmentIncomeAmt
PY Other Revenue$127,382PYOtherRevenueAmt
CY Other Revenue$144,812CYOtherRevenueAmt
PY Total Revenue$18,775,838PYTotalRevenueAmt
CY Total Revenue$16,170,296CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$5,212,882PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,513,794CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$11,052,242PYOtherExpensesAmt
CY Other Expenses$9,464,392CYOtherExpensesAmt
PY Total Expenses$16,265,124PYTotalExpensesAmt
CY Total Expenses$14,978,186CYTotalExpensesAmt
PY Revenues Less Expenses$2,510,714PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,192,110CYRevenuesLessExpensesAmt
Total Assets BOY$4,874,119TotalAssetsBOYAmt
Total Assets EOY$7,165,582TotalAssetsEOYAmt
Total Liabilities BOY$1,065,787TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,165,138TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,808,332NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$5,000,444NetAssetsOrFundBalancesEOYAmt
MissionABROM KAPLAN MEMORIAL HOSPITAL'S MISSION IS TO MAKE AVAILABLE QUALITY CARE SERVICES TO OUR COMMUNITY CONSITUENTS IN A PROFICIENT, DEDICATED AND COMPASSIONATE MANNER.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$11,338,252ExpenseAmt
Revenue$14,413,049RevenueAmt
DescProgram services statistics related to providing community medical care for the Hospital: total acute care and swing bed patient days were 896, total rehab days were 1,631 and total mental health days were 3,449. Other significant healthcare services provided included 6,591 emergency room visits and 239 surgeries (inpatient and outpatient).Desc
Total Program Service Expenses$11,338,252TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document29IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee105EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members3GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldLAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1The OrganizationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3376435284PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11214 COOLIDGE BLVDAddressLine1Txt
CityLAFAYETTECityNm
State AbbreviationLAStateAbbreviationCd
ZIP70503ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
DAVID CALLECOD
CHAIRMAN1.0045.00Yes (X)$0$902,814$237,726
SCOTT BERGEAUX MD
CHIEF OF STAFF - NON VOTIN40.00Yes (X)$0$229,990$11,562
RONALD MENARD
TRUSTEE1.00Yes (X)$0$0$0
LYMAN TRAHAN
TRUSTEE1.00Yes (X)$0$0$0
BRYCE QUEBODEAUX
CEO40.00$0$113,966$9,456Yes (X)
SALLY ROBERTS
CNO/PART YEAR40.00$0$0$0Yes (X)
MICHAEL JOHNSON
CFO40.00$0$92,495$14,460Yes (X)
DARNELL KOHLENBERG
CNO/PART YEAR40.00$0$97,871$6,870Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,437,136TotReportableCompRltdOrgAmt
Total Other Compensation$280,074TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
COMPASS HEALTH INC
PO BOX 428CROWLEYLA70527BEHAVIORAL HEALTH SERVICES$1,804,720
ARAMARK CORPORATION
25271 NETWORK PLACECHICAGOIL60673FOOD SERVICES$689,345
VERMILION EMERGENCY GROUP INC
PO BOX 82368LAFAYETTELA70598EMERGENCY ROOM COVERAGE$487,600
HUB CITY PHYSICIAN GROUP LLC
1305 CROWLEY RAYNE HWYCROWLEYLA70526HOSPITALIST$388,709
THEREX INC
PO BOX 502096ST LOUISMO631502096REHAB$315,602
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K9CntrctRcvdGreaterThan100KCnt
Government Grants$1,622,086GovernmentGrantsAmt
Total Contributions$1,622,086TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT REVENUEDesc
Business621990BusinessCd
Total Revenue Column$14,402,976TotalRevenueColumnAmt
Related Or Exempt Func Income$14,402,976RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$14,402,976TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$422TotalRevenueColumnAmt
Exclusion$422ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$504RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$504RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$504TotalRevenueColumnAmt
Related Or Exempt Func Income$504RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER REVENUEDesc
Business900099BusinessCd
Total Revenue Column$144,308TotalRevenueColumnAmt
Related Or Exempt Func Income$9,569RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$134,739UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$144,308OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$16,170,296TotalRevenueColumnAmt
Related Or Exempt Func Income$14,413,049RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$134,739UnrelatedBusinessRevenueAmt
Exclusion$422ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$576,670TotalAmt
Program Services$241,552ProgramServicesAmt
Management And General$335,118ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,040,533TotalAmt
Program Services$3,218,716ProgramServicesAmt
Management And General$821,817ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$80,142TotalAmt
Program Services$59,324ProgramServicesAmt
Management And General$20,818ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$494,363TotalAmt
Program Services$349,184ProgramServicesAmt
Management And General$145,179ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$322,086TotalAmt
Program Services$245,513ProgramServicesAmt
Management And General$76,573ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,161,985TotalAmt
Program Services$22,000ProgramServicesAmt
Management And General$1,139,985ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,080,039TotalAmt
Program Services$4,040,953ProgramServicesAmt
Management And General$39,086ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$14,011TotalAmt
Program Services$139ProgramServicesAmt
Management And General$13,872ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$170,393TotalAmt
Program Services$126,073ProgramServicesAmt
Management And General$44,320ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$212,447TotalAmt
Program Services$15,818ProgramServicesAmt
Management And General$196,629ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$6,925TotalAmt
Program Services$2,187ProgramServicesAmt
Management And General$4,738ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$1,030TotalAmt
Program Services$1,030ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$10,493TotalAmt
Program Services$10,207ProgramServicesAmt
Management And General$286ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
EQUIPMENT REPAIR AND RE$1,483,588$735,047$748,541
MEDICAL SUPPLIES$1,149,059$1,149,059
BAD DEBT$1,114,325$1,114,325
DUES$43,828$1,972$41,856

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$16,269TotalAmt
Program Services$5,153ProgramServicesAmt
Management And General$11,116ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$14,978,186TotalAmt
Program Services$11,338,252ProgramServicesAmt
Management And General$3,639,934ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$31,979BOYAmt
EOY$3,074EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,615,980BOYAmt
EOY$2,015,456EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$322,755BOYAmt
EOY$347,716EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$9,458BOYAmt
EOY$59,974EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$72,118LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$10,911LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$23,327BOYAmt
EOY$61,207EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,870,620BOYAmt
EOY$4,678,155EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,874,119BOYAmt
EOY$7,165,582EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,026,752BOYAmt
EOY$2,077,691EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$39,035BOYAmt
EOY$87,447EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,065,787BOYAmt
EOY$2,165,138EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,808,332BOYAmt
EOY$5,000,444EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,808,332BOYAmt
EOY$5,000,444EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,874,119BOYAmt
EOY$7,165,582EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$1,192,110ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$2OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Organization Belongs Afflt GrpYes (X)OrganizationBelongsAffltGrpInd

Total Grassroots Lobbying TotalGrassrootsLobbyingGrp

FieldValueIRS element (for citing)
Filing Organizations Total$2,095FilingOrganizationsTotalAmt
Affiliated Group Total$222,980AffiliatedGroupTotalAmt

Total Lobbying Expend TotalLobbyingExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$2,095FilingOrganizationsTotalAmt
Affiliated Group Total$222,980AffiliatedGroupTotalAmt

Other Exempt Purpose Expend OtherExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$11,336,157FilingOrganizationsTotalAmt
Affiliated Group Total$749,784,272AffiliatedGroupTotalAmt

Total Exempt Purpose Expend TotalExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$11,338,252FilingOrganizationsTotalAmt
Affiliated Group Total$750,007,252AffiliatedGroupTotalAmt

Lobbying Nontaxable Amount LobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Filing Organizations Total$716,913FilingOrganizationsTotalAmt
Affiliated Group Total$1,000,000AffiliatedGroupTotalAmt

Grassroots Nontaxable GrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Filing Organizations Total$179,228FilingOrganizationsTotalAmt
Affiliated Group Total$250,000AffiliatedGroupTotalAmt

Tot Lbbyng Grassroot Mns Non Tx TotLbbyngGrassrootMnsNonTxGrp

FieldValueIRS element (for citing)
Filing Organizations Total$0FilingOrganizationsTotalAmt
Affiliated Group Total$0AffiliatedGroupTotalAmt

Tot Lbby Expend Mns Lbbyng Non Tx TotLbbyExpendMnsLbbyngNonTxGrp

FieldValueIRS element (for citing)
Filing Organizations Total$0FilingOrganizationsTotalAmt
Affiliated Group Total$0AffiliatedGroupTotalAmt

Avg Lobbying Nontaxable Amount AvgLobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Current Year Minus1$1,000,000CurrentYearMinus1Amt
Current Year$1,000,000CurrentYearAmt
Total$2,000,000TotalAmt
FieldValueIRS element (for citing)
Lobbying Ceiling$3,000,000LobbyingCeilingAmt

Avg Total Lobbying Expend AvgTotalLobbyingExpendGrp

FieldValueIRS element (for citing)
Current Year Minus1$195,488CurrentYearMinus1Amt
Current Year$222,980CurrentYearAmt
Total$418,468TotalAmt

Avg Grassroots Nontaxable AvgGrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Current Year Minus1$250,000CurrentYearMinus1Amt
Current Year$250,000CurrentYearAmt
Total$500,000TotalAmt
FieldValueIRS element (for citing)
Grassroots Ceiling$750,000GrassrootsCeilingAmt

Avg Grassroots Lobbying Expend AvgGrassrootsLobbyingExpendGrp

FieldValueIRS element (for citing)
Current Year Minus1$195,488CurrentYearMinus1Amt
Current Year$222,980CurrentYearAmt
Total$418,468TotalAmt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$33,593OtherCostOrOtherBasisAmt
Depreciation$2,520DepreciationAmt
Book Value$31,073BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$38,525OtherCostOrOtherBasisAmt
Depreciation$8,391DepreciationAmt
Book Value$30,134BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$61,207TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

FieldValueIRS element (for citing)
DescINTERCOMPANY RECEIVABLEDesc
Book Value$4,678,155BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Other Assets$4,678,155TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescINTERCOMPANY PAYABLEDesc
Amt$87,447Amt
FieldValueIRS element (for citing)
Total Liability$87,447TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart X, Line 2:FormAndLineReferenceDesc
ExplanationThe Organization accounts for uncertain tax positions in accordance with Financial Accounting Standards Board (FASB) ASC 740. FASB ASC 740 prescribes a recognition threshold and measurement process for financial statement recognition of uncertain tax positions taken or expected to be taken in a tax return. The interpretation also provides guidance on recognition, de-recognition, classification, interest and penalties, accounting in interim periods, disclosure and transition. The Organization's various federal income tax and exempt organization income tax returns (IRS Forms 1065, 1120, and 990), whether filed on a calendar or fiscal year basis, are subject to examination by the IRS. The income tax returns are subject to examination by the taxing authorities, generally for three years after they are filed.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,095TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$11,095NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,443,683TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,379,097DirectOffsettingRevenueAmt
Net Community Benefit Expns$64,586NetCommunityBenefitExpnsAmt
Total Expense0.00470TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,454,778TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,379,097DirectOffsettingRevenueAmt
Net Community Benefit Expns$75,681NetCommunityBenefitExpnsAmt
Total Expense0.00550TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,454,778TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,379,097DirectOffsettingRevenueAmt
Net Community Benefit Expns$75,681NetCommunityBenefitExpnsAmt
Total Expense0.00550TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$1,114,325BadDebtExpenseAmt
Bad Debt Expense Attributable$557,163BadDebtExpenseAttributableAmt
Reimbursed By Medicare$7,219,567ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$4,041,502CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$3,178,065MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ABROM KAPLAN MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11310 WEST 7TH STREETAddressLine1Txt
CityKAPLANCityNm
State AbbreviationLAStateAbbreviationCd
ZIP70548ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ABROM KAPLAN MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttp://www.lafayettegeneral.com/our_facilities/main_facilities/abrom_kaplanOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted Website0StrategyPostedWebsiteInd
Strategy AttachedYes (1)StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care200.000000000000FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttp://www.lafayettegeneral.com/sites/www/Uploads/files/FAP/LGMC_Financial_FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttp://www.lafayettegeneral.com/sites/www/Uploads/files/FAP/FAP_LGMC_122815FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttp://www.lafayettegeneral.com/sites/www/Uploads/files/FAP/LGMC_Financial_FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
ABROM KAPLAN MEMORIAL HOSPITALPart V, Section B, Line 5: Phone surveys were conducted between January 28, 2017 and January 29, 2017. There were 200 respondents to the survey, all from Vermilion Parish. Respondents were asked about their top concerns for the health of the community, their satisfaction with the community resources available to deal with their concerns, and whether their concerns were getting worse over time.
ABROM KAPLAN MEMORIAL HOSPITALPart V, Section B, Line 11: based on the findings of the CHNA, an implementation strategy for AKMH that addresses the community health needs was developed and adopted by the end of fiscal year 2017, see attached.
ABROM KAPLAN MEMORIAL HOSPITALPart V, Section B, Line 16j: THE POLICY IS DESCRIBED IN OUR PATIENT INFORMATION PACKETS PROVIDED DURING THE ADMISSION PROCESS.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line11 - PRIMARY CARE CLINIC OF KAPLANBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 WEST 8TH STREETAddressLine1Txt
CityKAPLANCityNm
State AbbreviationLAStateAbbreviationCd
ZIP70548ZIPCd
FieldValueIRS element (for citing)
FacilityFAMILY MEDICINEFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 6a:The annual community benefit report included all of the healthcare facilities that Lafayette General Medical Center, Inc is affiliated with. The community benefit report included Lafayette General Health System, University Hospital & Clinics, Acadia General Hospital, Kaplan General Hospital, DBA Abrom Kaplan Memorial Hospital, Lafayette General Surgical Hospital, Oil Center Surgial Plaza, St. Martin Hospital, Lafayette Health Ventures, and Lafayette General Foundation.
Part I, Line 7:THE HOSPITAL USED TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, EXCLUDING BAD DEBT EXPENSE. A COST-TO-CHARGE RATIO WAS USED TO ESTIMATE COSTS INCLUDED IN LINE 7. THE COST-TO-CHARGE WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGE, AS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H.PART I, LINE 7B, MEDICAID: Kaplan is a member of the rural health care coalition. These rural hospitals are protected statutorily by state legislation. The state provides supplemental Medicaid payments to help offset the uncompensated cost of services provided to both Medicaid and uninsured patients.
Part I, Line 7, Column (f):The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,114,325.
Part III, Line 4:THE FOOTNOTE TO THE AUDITED FINANCIAL STATEMENTS READS: Patient accounts receivable are reported at net realizable value. Accounts are written off when they are determined to be uncollectible based upon management's assessment of individual accounts. Patients' accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of patients' accounts receivable, the Organization analyzes its past history and identifies trends to estimate the appropriate allowance for doubtful accounts. Management regularly reviews data about the Organization's major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Organization analyzes contractually due amounts and provides an allowance for doubtful accounts, if necessary (e.g., for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely).For receivables associated with self-pay patients, those with no third-party coverage, the Organization records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected, after all reasonable collection efforts have been exhausted, is written off against the allowance for doubtful accounts.The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected, after all reasonable collection efforts have been exhausted, is written-off against the allowance for doubtful accounts.The Organization's allowance for uncollectible accounts remained at 99% of self pay accounts receivable at September 30, 2017 and 2016. THE ORGANIZATION CONTINUES TO EXPERIENCE HIGH LEVELS OF CHARITY CARE AND BAD DEBT WRITE-OFFS AS A RESULT OF RISING PATIENT RESPONSIBILITIES DUE IN PART TO HIGH DEDUCTIBLE AND HIGH CO-PAY INSURANCE PLANS.BAD DEBT EXPENSE EQUALS THE BAD DEBT EXPENSE ON THE AUDITED FINANCIAL STATEMENTS. the Hospital analyzed its bad debt population and its charity population. The Hospital did not include any bad debts in our community benefit calculations.
Part III, Line 8:The costing methodology used for Line 6 is the standard Medicare cost report costing system. The amounts were recapped from the Hospital's filed 2016 cost report; the corresponding revenue amounts were included on line 5.
Part III, Line 9b:The Hospital's collection policy addresses those who are known to qualify for charity care or financial assistance. Our Hospital practice includes sending statements with graduated messages to patients before they are written off to bad debt; at this time, they are informed of the financial assistance practice and are encouraged to contact the Hospital if they feel that they would qualify. At any time, any patient may request a charity care application form.
Part VI, Line 2:A formal needs assessment was undertaken for the year ending 09/30/17. We engaged The Carnahan Group to complete our community health needs assessment during 2017. This assessment includes using national data, interviews with healthcare providers in the community and focus groups made up of a diverse group of community citizens. In addition, the hospital does have a Board of Trustees and members of the corporation comprised of individuals from the local community, which are independently aware of the medical needs of the community. Surplus receipts over disbursements are invested to improve the quality of patient care, expand hospital facilities and equipment, advance medical training and education. The hospital also maintains an open medical staff.
Part VI, Line 3:Patient education of eligibility for assistance. The hospital complies with federal and JACHO requirements of posting notices to patients as required by federal programs. Handouts are included with the admission package that informs the patient of contact information to discuss payment options. The hospital is a Medicaid enrollment facility, and as such, the hospital offers screening services for eligibility for Medicaid and possible charity care assistance. Hospital personnel also screen larger accounts after the original bill is issued, and contact the patient to determine qualifications for charity care policy.
Part VI, Line 4:THE HOSPITAL SERVES THE RESIDENTS OF VERMILLION PARISH AND THE SURROUNDING AREA. THE HOSPITAL ALSO MAITAINS AN EMERGENCY ROOM AVAILABLE TO ALL PEOPLE WHO REQUIRE EMERGENCY CARE.
Part VI, Line 5:THE HOSPITAL DOES MAINTAIN AN OPEN MEDICAL STAFF, THUS ALLOWING IT TO OFFER A VARIETY OF SPECIALISTS, AND CONTINUES TO RECURIT PHYSICIANS TO OUR AREA TO ENSURE THAT THE HOSPITAL WILL CONTINEU TO BE THE FULL SERVICE HEALTHCARE PROVIDER THAT THE COMMUNITY EXPECTS. THE HOSPITAL JOINS FORCES WITH OTHER LOCAL ORGANIZATIONS TO PROVIDE HEALTHCARE SCREENINGS AND TESTS AT LOCAL EVENTS.
Part VI, Line 6:The hospital is affiliated with other healthcare organizations. See Form 990 schedule R for a complete listing. All of the organizations are local healthcare organizations with the same purpose as the Hospital.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DAVID CALLECOD
CHAIRMAN$0$825,700$0$0$0$77,114$0$225,327$0$12,399$0$1,140,540$0$0
SCOTT BERGEAUX MD
CHIEF OF STAFF - NON VOTIN$0$180,038$0$49,952$0$0$0$4,752$0$6,810$0$241,552$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 4bA SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN (SERP) WAS ADOPTED EFFECTIVE JANUARY 01,2008. THE SERP IS CLASSIFIED AS A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN, THE PURPOSE OF WHICH IS TO PROVIDE PARTICIPANTS WITH SUPPLEMENTAL RETIREMENT BENEFITS. CONTRIBUTION FOR THE YEAR WAS $220,000. THE BOARD DETERMINES WHICH EMPLOYEES ARE ELIGIBLE FOR PLAN CONTRIBUTIONS. PARTICIPANTS WERE DAVID CALLECOD, CHAIRMAN. DISTRIBUTIONS FROM SERP PLAN, INCLUDED IN 2016 W-2 WAGES, TOTALED $72,600. THE FOLLOWING RECEIVED DISTRIBUTIONS, INCLUDED IN THEIR 2016 W-2 WAGES: DAVID CALLECOD, CHAIRMAN.
Part I, Line 6THE ORGANIZATION DOES HAVE An incentive plan FOR ALL EMPLOYEES IN GOOD STANDING, DETERMINED IN PART ON NET EARNINGS. The criteria used to determine if profit sharing will be made is based on metrics developed within five areas; 20% employees, 15% service, 20% quality, 35% funding our future, and 10% growth. Earnings in excess of budgeted earnings must be available for profit sharing to be paid. THE OFFICERS', AS LISTED ON PART VII OF FORM 990, CALCULATION OF incentive plan payments are IN PART BASED ON THE CONSOLIDATED NET EARNINGS.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6THE ORGANIZATION IS A NON-STOCK NOT-FOR-PROFIT CORPORATION WITH ONE CLASS OF MEMBERSHIP.
Form 990, Part VI, Section A, line 7aTHE MEMBERS RATIFY THE SELECTION OF THE INDIVIDUALS THAT SERVE ON THE BOARD OF TRUSTEES (GOVERNING BODY) AFTER THOSE INDIVIDUALS HAVE BEEN SELECTED AS A TRUSTEE BY THE BOARD OF TRUSTEES.
Form 990, Part VI, Section A, line 7bYES, THE INDIVIDUALS OF THE TRUSTEES (GOVERNING BODY) AND THE MEMBERS MUST BE APPROVED BY THE MEMBERSHIP BODY.
Form 990, Part VI, Section B, line 11bTHE FORM 990 IS REVIEWED BY THE ORGANIZATION'S ACCOUNTING STAFF AND A CPA FIRM. THE COMPLETED FORMS ARE REVIEWED BY THE OFFICERS AND THEN PRESENTED TO THE BOARD FOR REVIEW, COMMENT AND CORRECTIONS IF NEEDED BEFORE FILING WITH THE IRS.
Form 990, Part VI, Section B, line 12cAn annual survey is sent to the Board members and officers requiring them to disclose conflicts of interest. After receipt of these surveys, the Goverence Committee and its Chairperson review all conflicts and report on same to the Governance Committee. Thereafter the Chairperson of the Governance Committee and the organization's General Council (who attends all Board meetings) insures that all conflicts are timely disclosed and appropriate recusals are made on business matters that may be related to the conflict.
Form 990, Part VI, Section B, line 15An independent external consultant firm, Sullivan Cotter and Associates, is engaged by the Compensation Committee of the Board of Trustees, which is comprised of Disinterested Directors, to prepare compensation survey and fair market value report. The Compensation Committee annually reviews the market comparables and makes adjustment the President/CEO's compensation thereafter.
Form 990, Part VI, Section C, line 19BASIC FINANCIAL INFORMATION IS MADE AVAILABLE AND SENT OUT TO THE COMMUNITY BY MEANS OF THE ORGANIZATION'S ANNUAL REPORT. OTHER DOCUMENTS AND MORE DETAILED FINANCIAL INFORMATION ARE AVAILABLE TO THE PUBLIC UPON REQUEST WITHIN THE PARAMETERS OF REGULATORY / LEGAL AUTHORITIES.
Form 990, Part IX, line 11gCONTRACT LABOR: Program service expenses 4,040,953. Management and general expenses 39,086. Fundraising expenses 0. Total expenses 4,080,039.
Form 990, Part XI, line 9:ROUNDING 2.
FORM 990, PART XII, LINE 2CTHE PROCESS FOR OVERSIGHT AND SELECTIOn OF INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
ST MARTIN HOSPITAL INC
210 CHAMPAGNE BOULEVARDBREAUX BRIDGELA70517264626264HOSPITALLA501(C)(3)170(B)(1)(A)(III)lAFAYETTE GENERAL HEALTH SYSTEMS INC0
LAFAYETTE GENERAL HEALTH SYSTEMS INC
1214 COOLIDGE BLVDLAFAYETTELA70503383646817HEALTHCARE SUPPORTLA501(C)(3)509(A)(3)0
LAFAYETTE HEALTH VENTURES INC
PO BOX 53092LAFAYETTELA70503721006966PHYSICIAN PRACTICESLA501(C)(3)509(A)(3)lAFAYETTE GENERAL HEALTH SYSTEMS INC0
LAFAYETTE GENERAL MEDICAL CENTER INC
1214 COOLIDGE BLVDLAFAYETTELA70503720535375HOSPITALLA501(C)(3)170(B)(1)(A)(III)lAFAYETTE GENERAL HEALTH SYSTEMS INC0
acadia general hospital inc
1305 crowley rayne hwyCROWLEYLA70526464958152HOSPITALLA501(C)(3)170(B)(1)(A)(III)lAFAYETTE GENERAL HEALTH SYSTEMS INC0
lafayette general foundation inc
1214 COOLIDGE BLVDLAFAYETTELA70503371766778FOUNDATIONLA501(C)(3)509(A)(3)lAFAYETTE GENERAL HEALTH SYSTEMS INC0
UNIVERSITY HOSPITAL & CLINICS INC
2390 WEST CONGRESSLAFAYETTELA70503462605366HOSPITALLA501(C)(3)170(B)(1)(A)(III)LAFAYETTE GENERAL HEALTH SYSTEMS INC0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
LAFAYETTE INVESTMENT GROUP LLC
1000 W PINHOOK SUITE 206LAFAYETTELA70503421594593MANAGEMENTLAN/A
LAFAYETTE GENERAL SURGICAL HOSPITAL LLC
1000 W PINHOOKLAFAYETTELA70503481300080SURGICAL HOSPITALLAN/A
oil center surgical plaza llc
1000 W PINHOOK ste 204LAFAYETTELA70503464090110SURGERY CENTERLAN/A
ACADIANA RADIATION THERAPY LLC
104 WOODMONT BLVD STE 500NASHVILLETN37205471752607RADIATION CENTERTNN/A
MTS-LGH THERAPY SERVICES LLC MCLEOD-TRAHAN-SHEFFIELD PHYSICAL
920 W PINHOOK ROADlAFAYETTELA70503821448014physical therapyLAN/A
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Affiliated Group Schedule AffiliatedGroupSchedule

Affiliated Schedule AffiliatedScheduleGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINElecting OrganizationElectingOrganizationIndTotal Grassroots LobbyTotalGrassrootsLobbyAmtTotal Direct LobbyTotalDirectLobbyAmtTotal Lobby ExpenditureTotalLobbyExpenditureAmtOther Exempt Purpose ExpendOtherExemptPurposeExpendAmtTotal Exempt Purpose ExpendTotalExemptPurposeExpendAmtLobby NontxLobbyNontxAmtGrassroots NontxGrassrootsNontxAmtTotal Lobby Grssroot Mns NontxTotalLobbyGrssrootMnsNontxAmtTot Lbby Expend Mns Lobby NontxTotLbbyExpendMnsLobbyNontxAmtShare Excess Lobby ExpendShareExcessLobbyExpendAmt
acadia general hospital inc
1305 crowley rayne hwycrowleyLA70526464958152Yes (X)$7,959$0$7,959$37,700,536$37,708,495$1,000,000$250,000$0$0$0
st martin hospital inc
210 champagne boulevardbreaux bridgeLA70517264626264Yes (X)$4,511$0$4,511$15,933,961$15,938,472$946,924$236,731$0$0$0
lafayette general health systems inc
1214 coolidge streetlafayetteLA70503383646817Yes (X)$195,824$0$195,824$86,278,206$86,474,030$1,000,000$250,000$0$0$0
lafayette general foundation inc
1214 coolidge streetlafayetteLA70503371766778Yes (X)$0$0$0$579,350$579,350$111,903$27,976$0$0$0
lafayette general medical center inc
1214 coolidge streetlafayetteLA70503720535375Yes (X)$0$0$0$466,491,171$466,491,171$1,000,000$250,000$0$0$0
university hospital and clinics inc
2390 west congresslafayetteLA70506462605366Yes (X)$12,591$0$12,591$131,464,891$131,477,482$1,000,000$250,000$0$0$0
kaplan general hospital
1214 coolidge streetlafayetteLA70503472540179Yes (X)$2,095$0$2,095$11,336,157$11,338,252$716,913$179,228$0$0$0