2018-05-15T15:06:31-05:00 2017-06-30 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2016-07-01 463123178 OUR LADY OF THE ANGELS HOSPITAL INC % AMANDA HYMEL OURL 9857306700 5000 Hennessy Boulevard Baton Rouge LA 70808 JEFF LIMBOCKER REGIONAL CFO 2257656565 2018-05-15 true RYAN HOOKS P00746825 2253444000 2018-05-14 167.68.102.5 72049520181355000014 2018-05-15 P D78E0E32A3BED6F719E9F6F1B81CC8773A5C1E47 606B868638B351F0DD3B21299E8CEABE66140F96 2016 2021-01-29 14:40:06Z RENE RAGAS 433 PLAZA STREET BOGALUSA LA 70427 60496002 false 0928 X N/A X 2013 LA TO PROVIDE FOR THE CARE OF THE ILL, INJURED OR DISABLED PERSONS & TO PROVIDE FOR RESEARCH, EDUCATION, & ENHANCEMENT OF THOSE IN & SURROUNDING WASHINGTON PARISH 8 5 581 5 0 1242958 185995 66142462 60310007 2261 0 0 0 67387681 60496002 0 0 0 0 29312940 28046675 0 0 0 31394893 31476062 60707833 59522737 6679848 973265 25742711 19118625 18763639 13482570 6979072 5636055 X 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. false false 36310378 60310007 OUR LADY OF THE ANGELS HOSPITAL, INC. PROVIDES QUALITY HOSPITAL AND MEDICAL SERVICES PRIMARILY TO RESIDENTS OF SOUTHEAST LOUISIANA. THE HOSPITAL IS AN ACTIVE, CARING MEMBER OF THE COMMUNITIES IT SERVES. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTHCARE NEEDS OF THE PEOPLE OF GOD, THE HOSPITAL HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. THE HOSPITAL PROVIDED 98 LICENSED BEDS AND 9,690 INPATIENT DAYS IN THE YEAR ENDED JUNE 30, 2017. 36310378 true true false false false false false false false false true false 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 5 0 true 581 true false false false false false false false false false false X 8 5 false false false false true true true true true false false true true true true false false false false false X AMANDA HYMEL 2259232701 5959 S SHERWOOD FOREST BLVD BATON ROUGE LA 70809 X ROBERT BURGESS DIRECTOR 2.0 50.0 X X 0 379659 56324 JOHN FINAN JR CHAIRMAN 2.0 50.5 X 0 1444759 30310 REV BOB ADAMS CHAIRMAN 2.0 0.0 X X 0 0 0 ROGER KEESE SECRETARY 2.0 2.0 X X 0 0 0 CRAIG ROBICHAUX Vice Chair 2.0 0.0 X X 0 0 0 CHRIS TREVINO MD DIRECTOR 2.0 0.0 X 0 0 0 SR UYEN VU DIRECTOR 2.0 0.5 X 0 0 0 RENE RAGAS PRESIDENT & CEO 2.0 50.0 X X 0 315433 56584 LEO MICKENHEIM BOARD MEMBER 2.0 0.0 X 0 0 0 SR EILEEN ROWE BOARD MEMBER 2.0 2.5 X 0 0 0 JUDITH WAMSLEY BOARD MEMBER 2.0 0.0 X 0 0 0 CHARLES MIZELL DIRECTOR 2.0 0.0 X 0 0 0 BERNIE CHASCIN DIRECTOR 2.0 0.0 X 0 0 0 JEFFREY D LIMBOCKER REGIONAL CFO 2.0 58.0 X 0 515326 127559 RALPH SERPAS CNO 40.0 0.0 X 171227 0 30968 HAMID HUSSAIN PHYSICIAN 40.0 0.0 X 539029 0 32734 MARIA CHRIST BEUNAFLOR PHYSICIAN 40.0 0.0 X 261602 0 18189 MAXIMO KIOK PHYSICIAN 40.0 0.0 X 285098 0 34705 STEVEN OGDEN PHYSICIAN 40.0 0.0 X 235016 0 9593 WILLIAM KUHN CRNA 40.0 1.0 X 227675 0 9107 1719647 2655177 406073 28 false true false Beckman Coulter 250 S Kramer Brea CA 92822 Chemistry Services 289640 Med Assets 200 North Point Center East Suite Alpharetta GA 30022 AR Billing & Collect 133873 FMOL HEALTH SYSTEM INC 4200 ESSEN LANE BATON ROUGE LA 70809 MANAGEMENT FEE 2118337 3 10000 149119 26876 185995 PATIENT SERVICE REVENUE 622110 59033921 59033921 Purchase Discounts 622110 40395 40395 GIFT SHOP 622110 22870 22870 CAFETERIA 622110 183650 183650 PHARMACY SALES 622110 352336 352336 676835 676835 60310007 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 60496002 60310007 X 0 0 0 0 171227 134580 36647 0 24190545 14656605 9533940 613404 298114 315290 1435579 697691 737888 1635920 795057 840863 2118337 1029512 1088825 29673 14421 15252 0 0 0 0 13483247 6552858 6930389 49995 24298 25697 5137616 2496881 2640735 3913 1902 2011 0 5881929 5360263 521666 99622 48416 51206 0 0 557 271 286 0 178974 99981 78993 763951 371280 392671 Medical Supplies Expense 3728248 3728248 59522737 36310378 23212359 0 7473126 5197311 0 0 0 0 9981054 3922810 0 0 0 0 0 0 726813 651750 5580676 5658722 3938125 259112 1966420 3679013 0 0 0 0 0 0 0 0 14622 9019 25742711 19118625 4718370 5683459 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14045269 7799111 18763639 13482570 X 6660792 5629674 318280 6381 0 0 6979072 5636055 25742711 19118625 X 973265 -2316282 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 125000 125000 872273 111893 760380 904091 147219 756872 2036761 0 2036761 3679013 0 DUE TO AFFILIATES 7066163 DEFINED CONTRIBUTION PAYABLE 347035 OTHER LIABILITIES 385913 7799111 X FIN 48 (ASC 740) FOOTNOTE Form Sch D Part X Line 2 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 3843752 3843752 0.00000 14714207 14714207 0.00000 18557959 18557959 0.00000 4680528 25462 4655066 0.07820 4680528 25462 4655066 0.07820 23238487 18583421 4655066 0.07820 false 4291327 8108856 11134025 -3025169 X true true 1 1 OUR LADY OF THE ANGELS HOSPITAL INC 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 WWW.OLOAH.ORG 2203781960 X X X X OUR LADY OF THE ANGELS HOSPITAL INC 1 false false true X X X X X X X X X 15 true false false true X SEE PART V, SECTION C X true 15 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 TOOK INTO ACCOUNT INPUT FROM THE COMMUNITY BY CONDUCTING EIGHT FOCUS GROUP SESSIONS AS WELL AS CONDUCTING SEMI-STRUCTURED INTERVIEWS WITH VARIOUS INDIVIDUALS REPRESENTING ORGANIZATIONS ACTIVE IN THE COMMUNITY. THE SEMI-STRUCTURED INTERVIEWS INCLUDED THE FOLLOWING INDIVIDUALS WITH SPECIALIZED KNOWLEDGE IN PUBLIC HEALTH: GINA LAGARDE, MD, REGIONAL ADMINISTRATOR/MEDICAL DIRECTOR, OFFICE OF PUBLIC HEALTH, REGION IX, DEPARTMENT OF HEALTH & HOSPITALS DIANE LEWIS, RN, NURSE SUPERVISOR, WASHINGTON PARISH HEALTH UNIT PART V, SECTION B, LINE 11 SINCE THE LAST CHNA IN 2016, OLOAH HAS LAUNCHED SEVERAL PROGRAMS TO ADDRESS BARRIERS TO GOOD HEALTH, SENIOR SERVICES, AND MENTAL HEALTH AND SUBSTANCE ABUSE. CONCERNING BARRIERS TO GOOD HEALTH, OLOAH WAS DESIGNATED A WELL SPOT BY THE LOUISIANA DEPARTMENT OF HEALTH, MEETING POLICY AND PROGRAMMATIC CRITERIA. THE HOSPITAL STARTED THE "WALK WITH A DOC" PROGRAM TO ENCOURAGE PHYSICAL ACTIVITY AND INCREASE ACCESS TO PHYSICIANS. OLOAH ALSO PARTNERED IN THE BOGALUSA FARMERS' MARKET AND THE UNITED WAY BORN LEARNING TRAIL INITIATIVES. IN AN EFFORT TO EXTEND THE RESOURCES OF THE HOSPITAL INTO THE COMMUNITY, OLOAH SPONSORS A DIABETES SELF-MANAGEMENT PROGRAM RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION. THE HOSPITAL IS ALSO PARTNERING WITH LSU AGCENTER, THE LOUISIANA DEPARTMENT OF HEALTH, AND THE MAYOR OF BOGALUSA TO DEVELOP A MULTI-SECTORAL HEALTHY COMMUNITY COALITION. WHILE RELATIVELY NEW, THE COALITION HAS IDENTIFIED SEVERAL GOALS TO PURSUE COLLECTIVELY, INCLUDING: CREATING A COMMUNITY RESOURCE GUIDE, PERFORMING A WALKING AUDIT IN BOGALUSA, SPONSORING A MAYOR'S WALK, AND PROVIDING HEALTH EDUCATION OPPORTUNITIES IN COMMUNITY SETTINGS. THE COALITION IS PREPARING ITS NEXT PHASE TO CREATE WORKING COMMITTEES TO RESPOND TO FURTHER COMMUNITY NEEDS. WITH REGARD TO SENIOR SERVICES, OLOAH HAS EXPANDED SERVICES AND HEALTH EDUCATION FOR SENIORS. STAFF HAS GIVEN END OF LIFE EDUCATION IN COMMUNITY AND CLINIC SETTINGS. OLOAH HAS ALSO PARTNERED WITH A SENIOR LIVING FACILITY FOR MONTHLY HEALTH EDUCATION EVENTS AND HOME VISITS. CLINICAL STAFF, INCLUDING OUR GME RESIDENTS, HAS EXPANDED HOME VISITS AND THE HOSPITAL IS PLACING A PHYSICIAN ASSISTANT IN A NURSING HOME TO PILOT A HOME VISIT PROGRAM. THE HOSPITAL ALSO HAS PLANS TO ESTABLISH A PALLIATIVE CARE TEAM. FURTHERMORE, WITH REGARD TO MENTAL HEALTH AND SUBSTANCE ABUSE, OLOAH HAS EXPANDED ITS BEHAVIORAL HEALTH UNIT CAPACITY AND QUALITY OF SERVICE. THE HOSPITAL IS IN COLLABORATION WITH LOCAL AND STATE COMMUNITY PARTNERS IN ORDER TO STUDY AND RESPOND TO THE OPIOID EPIDEMIC AND SUBSTANCE ABUSE ISSUES IN WASHINGTON PARISH. PART V, SECTION B, LINE 7A THE CHNA CAN BE LOCATED AT HTTP://WWW.OLOAH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML PART V, SECTION B, LINE 16J REGISTRATION PERSONNEL REFER UNINSURED AND/OR LOW-INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, 16A, B, & C THE FINANCIAL ASSISTANCE POLICY (FAP), FAP APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY OF THE FAP WERE ALL AVAILABLE AT: HTTPS://FMOLHS.ORG/PAGES/FINANCIAL-ASSISTANCE-POLICY.ASPX PART V, SECTION B, LINE 13H PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: 1. THE PATIENT RECEIVING FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOSPITAL; 2. STATE-FUNDED PRESCRIPTION PROGRAMS; 3. HOMELESS, INDIGENT, OR HOMELESS CLINIC PATIENT; 4. PATIENTS' CHILDREN WHO QUALIFY FOR OTHER FINANCIAL ASSISTANCE PROGRAMS; 5. PATIENT ELIGIBLE FOR FOOD STAMPS; 6. MEDICAID ELIGIBLE PATIENT; 7. PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY; 8. PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY PART I, LINE 3C: Financial assistance is available for individuals who are uninsured, 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. PART I, LINE 7F: 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 LINE 7A-7D AND WAS OBTAINED FROM THE HOSPITAL'S MEDICARE COST REPORT. PART III, SECTION A, QUESTION 2 THE HOSPITAL ACCOUNTS FOR BAD DEBTS BASED ON THE AGING OF THE ACCOUNTS AND BASED ON THE HISTORICAL COLLECTION ASSOCIATED WITH THE VARIOUS AGING CATEGORIES. ON A PERIODIC BASIS, THE ORGANIZATION CONDUCTS A RETROSPECTIVE REVIEW TO DETERMINE THE APPROPRIATENESS OF THE COLLECTION PERCENTAGES UTILIZED IN ESTIMATED BAD DEBT EXPENSE. CHARITY AND DISCOUNTS ARE NOT INCLUDED IN BAD DEBT EXPENSE. PAYMENTS RECEIVED ON ACCOUNTS SUBSEQUENT TO BEING CONSIDERED BAD DEBT ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE. PART III, LINE 4: THE BAD DEBT FOOTNOTE IS ON PAGE 15 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. PART III, LINE 9B: PATIENTS WITH NO MEANS OF PAYMENT MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME, ASSETS, RESIDENCY, AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. 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: RESPONDING TO THE HEALTH NEEDS OF OUR COMMUNITY, ESPECIALLY TO THOSE MOST IN NEED, IS PRIMARY TO THE HOSPITAL'S MISSION. AS SUCH, OUR LADY OF THE ANGELS HOSPITAL WORKS CLOSELY WITH CHARITABLE ORGANIZATIONS TO DEFINE COMMUNITY NEEDS AND CONSOLIDATE EFFORTS TO MEET THOSE COMMUNITY NEEDS. OUR LADY OF THE ANGELS ADOPTED A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT BY JUNE 30, 2016 AND WILL CONTINUE TO USE COMMUNITY BASED DATA TO SUPPORT DECISIONS FOR OUTREACH IN THE COMMUNITY. 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 ANGELS HOSPITAL. PATIENTS ARE INFORMED THROUGH A PATIENT HANDBOOK THAT CONTAINS INFORMATION ON THE FINANCIAL POLICIES OF THE HOSPITAL. 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: Our Lady of the Angels Hospital is a community-based, not-for-profit hospital located in Bogalusa, Louisiana, that serves Washington Parish and portions of the surrounding parishes. Based on the last CHNA, Washington Parish has a population of approximately 45,997 and 17,761 households. The Senior population compromises about 17.08% of the total population. The median household income is $31,750, and 20.14% of households have income below the poverty level. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: OUR LADY OF THE ANGELS HOSPITAL PARTICIPATES IN COMMUNITY IMPROVEMENT ACTIVITIES BECAUSE IT UNDERSTANDS THAT IMPROVEMENTS TO A COMMUNITY HAVE A DIRECT LINK TO THE IMPROVED HEALTH OF COMMUNITY RESIDENTS. COMMUNITY IMPROVEMENT ACTIVITIES INCLUDE THE FOLLOWING: OUR LADY OF THE ANGELS ESTABLISHED CLINICS LOCATED IN AREAS WITHIN UNDER-INSURED/LOW INCOME AREAS. THIS ALLOWS INDIVIDUALS TO ACCESS HEALTH CARE SERVICE THAT MAY BE FOREGONE OR POSTPONED RESULTING IN MORE INTENSE HEALTH ISSUES/PROBLEMS. OUR LADY OF THE ANGELS PROVIDES OVERSIGHT OF COMMUNITY PROGRAMS AND ACTIVITIES AND COORDINATED HEALTH CARE SCREENING FOR VARIOUS HEALTH ISSUES. THE MAJORITY OF THE GOVERNING BODY OF OUR LADY OF THE ANGELS HOSPITAL IS COMPRISED OF INDIVIDUALS FROM A BROAD CROSS-SECTION OF THE COMMUNITY WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. OUR LADY OF THE ANGELS HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL 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 ANGELS HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL, NON-STOCK, MEMBER CORPORATION OF WHICH FRANCISCIAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC. (FMOL HEALTH SYSTEM) IS THE SOLE MEMBER. OUR LADY OF THE ANGELS HOSPITAL IS PART OF THE FMOL HEALTH SYSTEM WHICH INCLUDES SEVERAL HOSPITALS AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATE OF LOUISIANA. OUR LADY OF THE ANGELS HOSPITAL SERVES THE COMMUNITY IN WASHINGTON PARISH AND SURROUNDING PARISHES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: OUR LADY OF THE LAKE HOSPITAL OUR LADY OF LOURDES REGIONAL MEDICAL CENTER ST. FRANCIS MEDICAL CENTER ST. ELIZABETH HOSPITAL OUR LADY OF THE LAKE ASSUMPTION HOSPITAL false true false false false false false true false ROBERT BURGESS DIRECTOR 285119 74005 20535 46454 9870 435983 JOHN FINAN JR CHAIRMAN 934368 463850 46541 30310 1475069 RENE RAGAS PRESIDENT & CEO 237043 59765 18625 32843 23741 372017 HAMID HUSSAIN PHYSICIAN 414433 124596 10600 22134 571763 RALPH SERPAS CNO 143614 27368 245 7177 23791 202195 MARIA CHRIST BEUNAFLOR PHYSICIAN 261602 0 0 0 0 0 10120 0 8069 0 279791 0 JEFFREY D LIMBOCKER REGIONAL CFO 402952 93599 18775 103542 24017 642885 MAXIMO KIOK PHYSICIAN 285098 10600 24105 319803 STEVEN OGDEN PHYSICIAN 199016 36000 8981 612 244609 WILLIAM KUHN CRNA 227550 125 9107 236782 PART 1, QUESTION 3 The CEO is paid by FMOL Health System, a related tax exempt organization. The FMOLHS board of directors designates a compensation committee, made up of independent board members, to review and set the CEO's compensation annually. The compensation committee obtains and relies upon comparable data including a compensation study/survey from an independent compensation consultant. The compensation committee reviews compensation packages and appropriate compensation is determined and approved. The basis for making such determination is documented by the compensation committee. PART 1, QUESTION 4A A director 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 chairman is entitled to a severance benefit. The payout of such benefit is remote as it is effective only for termination of employment without cause. If triggered, the executive would be paid 75% of his base salary and 75% of his incentive payment determined at target and provided retirement and welfare benefits for an entitlement period. The entitlement period is 24 months. No payments were made in the current year. PART 1, 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 the approval of FMOLHS Board of directors or a designated committee of such board. No one listed on Part VII, Section A received a payment from the plans in the current year. PART I, QUESTION 7 DISCRETIONARY BONUSES WERE PAID WITH REGARD TO PERSONS LISTED ON PART VII, SECTION A, LINE 1A. SUCH BONUSES WERE APPROVED BY THE CEO OR THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. Form 990, PART III, LINE 1 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. FORM 990, PART VI, LINE 6 FMOL HEALTH SYSTEM (AN IRC SECTION 501(C)(3) ORGANIZATION) IS THE SOLE MEMBER OF OUR LADY OF THE ANGELS HOSPITAL, INC. Form 990 Part VI Line 7a FMOL HEALTH SYSTEM, AS THE SOLE MEMBER OF OUR LADY OF THE ANGELS HOSPITAL, INC., RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF OUR LADY OF THE ANGELS HOSPITAL, INC. Form 990 Part VI Line 7b THE RESERVED POWERS TO FMOL HEALTH SYSTEM, INC. ARE AS FOLLOWS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES AND PURPOSES OF CORPORATION 2. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION 3. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION, OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES 5. TO DISSOLVE AND TO 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 THE CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION 9. TO APPOINT THE FISCAL AUDITOR FOR THE CORPORATION 10. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHARGE 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. Form 990 Part VI Line 11b AFTER PREPARATION AND REVIEW BY KPMG, LLP, MANAGEMENT WILL REVIEW THE FORM 990. A COPY OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED WITH THE IRS. Form 990 Part VI Line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. PART VI, SECTION B, QUESTION 12 OUR LADY OF THE ANGELS HOSPITAL, INC. 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 OUR LADY OF THE ANGELS HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OUR LADY OF THE ANGELS HOSPITAL, INC. 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, QUESTIONS 13 & 14 THROUGHOUT THE TAX YEAR, THE ORGANIZATION HAD A DOCUMENT RETENTION POLICY AND A WHISTLEBLOWER POLICY IN PLACE ALTHOUGH THEY WERE NOT APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS OR A COMMITTEE THEREOF BEFORE JUNE 30, 2017. PART VI, SECTION B, QUESTION 15A & 15B THE PRESIDENT & CEO, AND CFO OF THIS ORGANIZATION ARE EMPLOYEES OF FMOL HEALTH SYSTEM, A RELATED TAX-EXEMPT ORGANIZATION, WHOSE SALARIES ARE DETERMINED BY THE PAY PRACTICES OF THAT ORGANIZATION. SUCH PAY PRACTICES INCLUDE THE USE OF AN INDEPENDENT BOARD COMMITTEE WHICH REVIEWS COMPENSATION ANNUALLY AFTER OBTAINING AND RELYING UPON INDUSTRY WIDE COMPENSATION INFORMATION FROM OUTSIDE SOURCES. THE BOARD COMMITTEE APPROPRIATELY DOCUMENTS ITS DECISIONS. Part XI Line 9 CAPITAL TRANSFER 2,316,280 SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION OUR LADY OF THE ANGELS HOSPITAL INC. DOES HAVE APPLICABLE FINANCIAL STATEMENTS FOR THE YEAR OF THE ELECTION, AND INTEND TO APPLY THE DE MINIMIS SAFE HARBOR 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)(II). SECTION 1.263(A)-3(N) ELECTION- BOOK CONFORMITY ELECTION OUR LADY OF THE ANGELS HOSPITAL INC. IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THOSE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2017. 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