2018-07-26T10:53:23-05:00 2017-09-30 201941244 HORNE LLP 1020 Highland Colony Pkwy Ste 400 Ridgeland MS 39157 990 2016-10-01 472540179 Kaplan General Hospital KAPL 3376435200 1214 Coolidge Blvd Lafayette LA 70503 BRYCE QUEBODEAUX CEO 3376435200 2018-07-16 1 Amie T Whittington CPA P01082167 6013261000 2018-07-16 2016 2022-09-23 18:48:47Z ABROM KAPLAN MEMORIAL HOSPITAL BRYCE QUEBODEAUX 1214 Coolidge Blvd Lafayette LA 70503 16170296 0 X WWW.LAFAYETTEGENERAL.COM X 2014 LA ABROM KAPLAN MEMORIAL HOSPITAL'S MISSION IS TO MAKE AVAILABLE QUALITY CARE SERVICES TO OUR COMMUNITY CONSITUENTS IN A PROFICIENT, DEDICATED AND COMPASSIONATE MANNER. 3 2 105 2 134739 35738 1881273 1622086 16766986 14402976 197 422 127382 144812 18775838 16170296 0 0 0 0 5212882 5513794 0 0 0 11052242 9464392 16265124 14978186 2510714 1192110 4874119 7165582 1065787 2165138 3808332 5000444 ABROM KAPLAN MEMORIAL HOSPITAL'S MISSION IS TO MAKE AVAILABLE QUALITY CARE SERVICES TO OUR COMMUNITY CONSITUENTS IN A PROFICIENT, DEDICATED AND COMPASSIONATE MANNER. 0 0 11338252 14413049 Program 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). 11338252 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 29 0 1 105 1 1 1 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 LA X The Organization 3376435284 1214 COOLIDGE BLVD LAFAYETTE LA 70503 DAVID CALLECOD CHAIRMAN 1.00 45.00 X 0 902814 237726 SCOTT BERGEAUX MD CHIEF OF STAFF - NON VOTIN 40.00 X 0 229990 11562 RONALD MENARD TRUSTEE 1.00 X 0 0 0 LYMAN TRAHAN TRUSTEE 1.00 X 0 0 0 BRYCE QUEBODEAUX CEO 40.00 X 0 113966 9456 SALLY ROBERTS CNO/PART YEAR 40.00 X 0 0 0 MICHAEL JOHNSON CFO 40.00 X 0 92495 14460 DARNELL KOHLENBERG CNO/PART YEAR 40.00 X 0 97871 6870 0 1437136 280074 1 0 1 0 COMPASS HEALTH INC PO BOX 428 CROWLEY LA 70527 BEHAVIORAL HEALTH SERVICES 1804720 ARAMARK CORPORATION 25271 NETWORK PLACE CHICAGO IL 60673 FOOD SERVICES 689345 VERMILION EMERGENCY GROUP INC PO BOX 82368 LAFAYETTE LA 70598 EMERGENCY ROOM COVERAGE 487600 HUB CITY PHYSICIAN GROUP LLC 1305 CROWLEY RAYNE HWY CROWLEY LA 70526 HOSPITALIST 388709 THEREX INC PO BOX 502096 ST LOUIS MO 631502096 REHAB 315602 9 1622086 1622086 PATIENT REVENUE 621990 14402976 14402976 14402976 422 422 504 0 504 504 504 OTHER REVENUE 900099 144308 9569 134739 144308 16170296 14413049 134739 422 X 576670 241552 335118 4040533 3218716 821817 80142 59324 20818 494363 349184 145179 322086 245513 76573 1161985 22000 1139985 4080039 4040953 39086 14011 139 13872 170393 126073 44320 212447 15818 196629 6925 2187 4738 1030 1030 10493 10207 286 EQUIPMENT REPAIR AND RE 1483588 735047 748541 MEDICAL SUPPLIES 1149059 1149059 BAD DEBT 1114325 1114325 DUES 43828 1972 41856 16269 5153 11116 14978186 11338252 3639934 0 31979 3074 2615980 2015456 322755 347716 9458 59974 72118 10911 23327 61207 1870620 4678155 4874119 7165582 1026752 2077691 39035 87447 1065787 2165138 X 3808332 5000444 3808332 5000444 4874119 7165582 X 1192110 2 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 2095 222980 2095 222980 11336157 749784272 11338252 750007252 716913 1000000 179228 250000 0 0 0 0 1000000 1000000 2000000 3000000 195488 222980 418468 250000 250000 500000 750000 195488 222980 418468 33593 2520 31073 38525 8391 30134 61207 INTERCOMPANY RECEIVABLE 4678155 4678155 INTERCOMPANY PAYABLE 87447 87447 X Part X, Line 2: The 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. 1 1 1 X 1 X 1 1 1 0 1 1 11095 11095 0.00080 2443683 2379097 64586 0.00470 2454778 2379097 75681 0.00550 2454778 2379097 75681 0.00550 1 1114325 557163 7219567 4041502 3178065 X 1 1 1 1 ABROM KAPLAN MEMORIAL HOSPITAL 1310 WEST 7TH STREET KAPLAN LA 70548 X X X X ABROM KAPLAN MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X http://www.lafayettegeneral.com/our_facilities/main_facilities/abrom_kaplan X 1 16 0 1 0 1 X 200.000000000000 200.000000000000 X 1 1 X X X 1 X http://www.lafayettegeneral.com/sites/www/Uploads/files/FAP/LGMC_Financial_ X http://www.lafayettegeneral.com/sites/www/Uploads/files/FAP/FAP_LGMC_122815 X http://www.lafayettegeneral.com/sites/www/Uploads/files/FAP/LGMC_Financial_ X X X X X X X 1 0 X X X 1 X 0 0 ABROM KAPLAN MEMORIAL HOSPITAL Part 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 HOSPITAL Part 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 HOSPITAL Part V, Section B, Line 16j: THE POLICY IS DESCRIBED IN OUR PATIENT INFORMATION PACKETS PROVIDED DURING THE ADMISSION PROCESS. 1 1 - PRIMARY CARE CLINIC OF KAPLAN 1402 WEST 8TH STREET KAPLAN LA 70548 FAMILY MEDICINE 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. X X X X X 0 1 0 0 0 1 1 0 0 DAVID CALLECOD CHAIRMAN 0 825700 0 0 0 77114 0 225327 0 12399 0 1140540 0 0 SCOTT BERGEAUX MD CHIEF OF STAFF - NON VOTIN 0 180038 0 49952 0 0 0 4752 0 6810 0 241552 0 0 Part I, Line 4b A 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 6 THE 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. Form 990, Part VI, Section A, line 6 THE ORGANIZATION IS A NON-STOCK NOT-FOR-PROFIT CORPORATION WITH ONE CLASS OF MEMBERSHIP. Form 990, Part VI, Section A, line 7a THE 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 7b YES, THE INDIVIDUALS OF THE TRUSTEES (GOVERNING BODY) AND THE MEMBERS MUST BE APPROVED BY THE MEMBERSHIP BODY. Form 990, Part VI, Section B, line 11b THE 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 12c An 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 15 An 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 19 BASIC 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 11g CONTRACT 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 2C THE PROCESS FOR OVERSIGHT AND SELECTIOn OF INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM PRIOR YEAR. 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