2017-06-22T08:32:35-05:00 2016-09-30 201941244 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2015-10-01 383646817 LAFAYETTE GENERAL HEALTH SYSTEM INC LAFA 3372898125 1214 COOLIDGE BLVD LAFAYETTE LA 70503 ROGER MATTKE CHIEF FINANCIAL OFFICER 3372898125 2017-06-13 1 AMIE T WHITTINGTON CPA P01082167 6013261000 2017-05-24 2015 2021-01-29 14:40:06Z DAVID CALLECOD 1214 COOLIDGE BLVD LAFAYETTE LA 70503 115282775 0 X WWW.LAFAYETTEGENERAL.COM X 2002 LA THE ORGANIZATION WAS ORGANIZED FOR THE BENEFIT AND SUPPORT OF ITS RELATED 501(C)(3) HEALTH CARE ENTITIES WHICH PROVIDE MEDICAL CARE TO RESTORE, MAINTAIN, AND IMPROVE THE HEALTH OF THE COMMUNITY IN WHICH IT SERVES. 22 15 4709 15 3006942 -551296 260986 0 71226555 90350185 25039 -89609 50100160 10410130 121612740 100670706 34438574 426773 0 0 21664010 27745298 0 0 0 46106151 63938196 102208735 92110267 19404005 8560439 777562726 819087820 510397848 537566261 267164878 281521559 THE ORGANIZATION WAS ORGANIZED FOR THE BENEFIT AND SUPPORT OF ITS RELATED 501(C)(3) HEALTH CARE ENTITIES WHICH PROVIDE MEDICAL CARE TO RESTORE, MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITY IN WHICH IT SERVES. 0 0 89762926 426773 97753373 LAFAYETTE GENERAL HEALTH SYSTEM, INC., THE PARENT ENTITY OF LAFAYETTE GENERAL MEDICAL CENTER, INC., ST. MARTIN HOSPITAL INC., UNIVERSITY HOSPITAL AND CLINICS, ACADIA GENERAL HOSIPTAL,LAFAYETTE HEALTH VENTURES, INC., LAFAYETTE GENERAL FOUNDATION, AND KAPLAN GENERAL HOSPITAL PROVIDED SUPPORT OF THE MISSIONS OF THESE 501(C)(3) ORGANIZATIONS AND THEIR RELATED ORGANIZATIONS DURING THE YEAR. THESE HOSPITALS PROVIDE NEEDED MEDICAL CARE TO THE COMMUNITY. THE HEALTH SYSTEMS ALSO PROVIDES MANAGEMENT SUPPORT FOR THESE ORGANIZATIONS. THE REVENUE RECORDED IS THE ORGANIZATIONS SHARE OF ITS SUBSIDIARIES' EARNINGS FOR THE YEAR, AS WELL AS MANAGEMENT FEES PAID BY THE OTHER ORGANIZATION TO THE HEALTH SYSTEM. 89762926 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 0 0 0 1 114 0 1 4709 1 1 1 0 0 0 0 0 0 0 X 22 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 3372898125 1214 COOLIDGE BLVD LAFAYETTE LA 70503 X CLAY ALLEN CHAIRMAN 1.00 4.00 X 0 0 0 MARTIN BECH SECRETARY 1.00 1.00 X 0 0 0 DAVID CALHOUN TRUSTEE 1.00 1.00 X 0 0 0 BRADLEY J CHASTANT MD TRUSTEE 1.00 8.00 X 0 9100 0 BRADEN DESPOT TRUSTEE 1.00 2.00 X 0 0 0 BENJAMIN DOGA MD TRUSEE AND VICE CHAIR - PART YEAR 1.00 3.50 X 0 18720 0 JULIE FALGOUT TRUSTEE 1.00 1.00 X 0 0 0 WILLIAM H FENSTERMAKER PAST CHAIRMAN 1.00 2.00 X 0 0 0 PHILIP GACHASSIN MD TRUSTEE 1.00 8.50 X 0 94600 0 ROBERT GILES TRUSTEE 1.00 1.00 X 0 0 0 JOBY JOHN PHD TRUSTEE 1.00 3.00 X 0 0 0 FLO MEADOWS TREASURER 1.00 1.00 X 0 0 0 MANDI MITCHELL TRUSTEE 1.00 1.00 X 0 0 0 GARY SALMON TRUSTEE 1.00 1.00 X 0 0 0 SAMUEL SHUFFLER MD TRUSTEE 1.00 1.00 X 0 0 0 DAVID WILSON CHAIR ELECT 1.00 2.00 X 0 0 0 JOSEPH ZANCO TRUSTEE 1.00 1.00 X 0 0 0 BRAD BROUSSARD MD TRUSTEE 1.00 45.00 X 0 56000 0 JOHN SCHUTTE MD TRUSTEE 1.00 61.00 X 1374315 23200 20298 DENNIS ESCHETE MD CHEIF OF STAFF 1.00 9.00 X 0 121000 0 PEGGY GIGLIO TRUSTEE 1.00 X 0 0 0 RICKEY MINIEX TRUSTEE 1.00 X 0 0 0 EDWARD KRAMPE VICE CHAIRMAN - PART YEAR 1.00 2.00 X 0 0 0 DAVID CALLECOD PRESIDENT/CEO-LGHS 40.00 7.00 X 1244305 0 238025 PATRICK W GANDY JR EVP-LGH/CEO-LGMC 40.00 1.00 X 637362 0 95311 ROGER MATTKE SVP/CFO - LGH 40.00 1.00 X 591525 0 116566 GORDON E ROUNTREE JR SVP/GENERAL COUNSEL 40.00 1.00 X 517808 0 88577 AMANDA LOGUE MD VP/CHIEF MEDICAL OFFICER 40.00 X 281555 0 34737 CRETAN MEADOWS SVP/STRATEGIC PLANNING 40.00 X 434203 0 62855 DEAN B DUCOTE VP/OPERATIONS 40.00 X 266580 0 35075 EDWINA S MALLERY AVP/INFORMATION SYSTEMS 40.00 X 241787 0 4617 MICHAEL JAMES DOZIER VP/CIO 40.00 X 285067 0 10098 5874507 322620 706159 220 0 1 0 LSU HSC NEW ORLEANS 433 BOLIVAR STREET NEW ORLEANS LA 70112 MEDICAL SCHOOL RESIDENTS 30126523 ARAMARK CORPORATION 25271 NETWORK PLACE CHICAGO IL 60673 HOUSEKEEPING AND DIETARY 17767488 ACADIANA RADIATION THERAPY LLC 104 WOODMONT BLVD STE 500 NASHVILLE TN 37205 RADIATION THERAPY 4139500 PARISH ANESTHESIA OF LAFAYETTE 3510 N CAUSEWAY BOULEVARD METAIRIE LA 70002 ANESTHESIA SERVICES 4129469 CARDIOVASCULAR INSTITUTE OF THE SOUTH AP 225 DUNN STREET HOUMA LA 70360 CARDIOLOGY SERVICES 3778538 95 MANAGEMENT FEE 900099 90350185 90350185 90350185 1653078 1653078 4950690 12869382 -7918692 -7918692 -7918692 1742687 -1742687 -1742687 -1742687 MISCELLANEOUS REVENUE 900099 13792842 10785900 3006942 EQUITY INTEREST IN SUB EARNINGS 900099 4535980 4535980 18328822 100670706 97753373 3006942 -89609 426773 426773 4924093 4924093 20798750 20056993 741757 701659 690915 10744 -228553 -318315 89762 1549349 1496333 53016 7195544 6149824 1045720 964981 964981 1064381 1059460 4921 3815851 3596857 218994 3307537 3235758 71779 528293 525048 3245 9127104 9127104 8618947 8610796 8151 6529069 6518608 10461 EQUIP REPAIR & MAINT. 16536201 16483240 52961 OTHER NONCLINICAL SERVI 1652947 1652947 DISCOUNTINUED OPERATION 1604833 1604833 NONCLINICAL CONTRACT LA 864916 864916 2127592 2091762 35830 92110267 89762926 2347341 0 35706115 43032332 9987859 11072158 31088 645764 406791 329276 3898174 5154711 407374872 163083460 221861438 244291412 505671261 514562167 777562726 819087820 16923160 25251819 141011987 182018250 54863991 72583661 297598710 257712531 510397848 537566261 X 267164878 281521559 267164878 281521559 777562726 819087820 X 8560439 5796243 -1 X X 0 1 X 1 0 X X 5 UNIVERSITY HOSPITAL AND CLINICS INC 462605366 3 1 0 57371682 ACADIA GENERAL HOSPITAL INC 464958152 3 1 0 19347824 KAPLAN GENERAL HOSPITAL DBA ABROM KAPLAN MEMORIAL HOSPITAL 472540179 3 1 0 6295088 ST MARTIN HOSPITAL INC 264626264 3 1 0 10443451 LAFAYETTE GENERAL MEDICAL CENTER INC 720535375 3 1 0 209054308 5 0 302512353 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 X 174280 195488 174280 195488 89588644 741511044 89762924 741706532 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 24586 189962 174268 195488 584304 250000 250000 250000 250000 1000000 1500000 24586 189962 174268 195488 584304 FORM 990, SCHEDULE C, PART II-A, LINE 1A LOBBYING ACTIVITIES OCCUR INDIRECTLY THROUGH THE AMERICAN HOSPITAL ASSOCIATION AND THE LOUISIANA HOSPITAL ASSOCIATION. THE HOSPITAL DOES NOT HAVE ANY CONTROL OR DIRECTION IN DETERMINING HOW SUCH DUES PAID TO THESE TWO ORGANIZATIONS ARE USED. ADDITIONALLY, LAFAYETTE GENERAL HEALTH SYSTEMS, INC. PAID THE PICARD GROUP, LLC $146,200 FOR GOVERNMENTAL RELATIONS AND OTHER CONSULTING SERVICES. THIS IS ALSO CONSIDERED LOBBYING EXPENSE. 13055330 13055330 271511196 94921664 176589532 2286451 1293823 992628 116512481 66867973 49644508 4009414 4009414 244291412 INVESTMENT IN LAFAYETTE HEALTH VENTURES 8720302 INVESTMENT IN LAFAYETTE GENERAL MEDICAL CENTER 360536420 INVESTMENT IN UHC 25974359 INVESTMENT IN AGH 4550944 DUE FROM RELATED PARTY 1912093 BOND ISSUE COSTS 2573013 GOLDMAN SACHS 87548618 INVESTMENT IN LAFAYETTE FOUNDATION 3217674 INVESTMENT IN ABROM KAPLAN MEMORIAL HOSPITAL 3808333 INVESTMENT IN ST. MARTIN HOSPITAL 6844027 BOND TRUSTEED FUNDS 8876384 514562167 DUE TO RELATED PARTY 235950228 SELF FUNDED HEALTH INSURANCE 2417089 SHORT TERM NOTES PAYABLE 19102773 CAPITALIZED LEASE OBLIGATION 242441 257712531 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 AMERICAN HEART ASSOCIATION 312 GUILBEAU RD STE 6C LAFAYETTE LA 70506 135613797 501(C)(3) 7750 DONATION CITY OF YOUNGSVILLE 305 IBERIA STREET YOUNGSVILLE LA 70592 720593322 GOV'T 17500 DONATION COMMUNITY FOUNDATION OF ACADIA 1035 CAMELLIA BLVD SUITE 100 LAFAYETTE LA 70508 721493023 501(C)(3) 19800 DONATION FESTIVAL INTERNATIONAL DE LOUISIANE 200 GARFIELD STREET LAFAYETTE LA 70501 581705676 501(C)(3) 27500 DONATION LAFAYETTE YOUTH SOCCER ASSOCIATION 210 SONNY ROY LANE LAFAYETTE LA 70507 581902571 501(C)(3) 50000 DONATION LOUISIANA OPEN INC 124 HEYMANN BLVD STE 202 LAFAYETTE LA 70503 721043611 501(C)(3) 13500 DONATION LOUISIANA SUCCESS 9331 BLUEBONNET BLVD BATON ROUGE LA 70810 205591232 501(C)(3) 7500 DONATION MILES PERRET CENTER CANCER SERVICES 2130 KALISTE SALOOM RD 200 LAFAYETTE LA 70508 753023211 501(C)(3) 10000 DONATION NEW CARDIOVASCULAR HORIZONS FOUNDATION 3639 AMBASSADOR CAFFERY PARKWAY STE 605 LAFAYETTE LA 70503 463186713 501(C)(3) 30000 DONATION SOUTH LOUISIANA COMMUNITY COLLEGE 1101 BERTRAND DRIVE LAFAYETTE LA 70506 721425264 501(C)(3) 41667 DONATION LAFAYETTE GENERAL FOUNDATION 1214 COOLIDGE BLVD LAFAYETTE LA 70503 371766778 501(C)(3) 56200 AFFILIATE SUPPORT 10 1 PART I, LINE 2: CHARITABLE DONATIONS ARE MADE TO LOCAL NON-PROFIT ORGANIZATIONS THAT PARALLEL OUR HEALTH MISSION IN THE COMMUNITY. THESE CHARITIES MUST ALSO BETTER THE SOCIETY BY LEADING WITH PURPOSE AND SERVING WITH PASSION. X X X 1 1 X X X X X 1 1 0 0 0 1 1 0 0 JOHN SCHUTTE MD TRUSTEE 1226944 23200 147371 0 0 0 12060 0 8238 0 1394613 23200 0 0 DAVID CALLECOD PRESIDENT/CEO-LGHS 835637 0 344735 0 63933 0 231626 0 6399 0 1482330 0 0 0 PATRICK W GANDY JR EVP-LGH/CEO-LGMC 451960 0 156836 0 28566 0 87860 0 7451 0 732673 0 0 0 ROGER MATTKE SVP/CFO - LGH 423201 0 147322 0 21002 0 105127 0 11439 0 708091 0 0 0 GORDON E ROUNTREE JR SVP/GENERAL COUNSEL 368279 0 132063 0 17466 0 78576 0 10001 0 606385 0 0 0 AMANDA LOGUE MD VP/CHIEF MEDICAL OFFICER 244505 0 37050 0 0 0 27206 0 7531 0 316292 0 0 0 CRETAN MEADOWS SVP/STRATEGIC PLANNING 305325 0 116597 0 12281 0 57837 0 5018 0 497058 0 0 0 DEAN B DUCOTE VP/OPERATIONS 221200 0 43180 0 2200 0 33500 0 1575 0 301655 0 0 0 EDWINA S MALLERY AVP/INFORMATION SYSTEMS 210191 0 31596 0 0 0 3108 0 1509 0 246404 0 0 0 MICHAEL JAMES DOZIER VP/CIO 225492 0 59575 0 0 0 4300 0 5798 0 295165 0 0 0 PART I, LINE 1A THE ORGANIZATION DOES ALLOW FOR SPOUSAL TRAVEL FOR THE TRUSTEES AND OFFICERS. SUCH EXPENSES ARE REPORTED ON THEIR W-2'S OR 1099'S. SOCIAL CLUB DUES WERE PAID FOR THE PRESIDENT/CEO-LGHS AND THE EVP/CEO-LGMC AND WERE INCLUDED AS WELL AS COMPENSATION ON THEIR W-2'S. PART I, LINES 4A-B THE FOLLOWING EMPLOYEES RECEIVED SEVERANCE PAYMENTS DURING 9/30/16 - IN TOTAL THE PAYMENTS WERE, AS FOLLOWS, AND WERE INCLUDED IN THEIR W-2S FOR 2016 AND 2017. DEAN DUCOTE - $227,836 CRETAN MEADOWS - $300,562 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 $571,900. THE BOARD DETERMINES WHICH EMPLOYEES ARE ELIGIBLE FOR PLAN CONTRIBUTIONS. PARTICIPANTS WERE DAVID CALLECOD, PRESIDENT/CEO-LGHS, PATRICK GANDY, EVP/CEO - LGMC, ROGER MATTKE, SVP/CFO, GORDON ROUNTREE, GENERAL COUNSEL, MIKE DOZIER, VP/CIO, AMANDA LOGUE, VP/CHIEF MED INFO OFFICER, DEAN DUCOTE, VP/OPERATIONS, AND CRETAN MEADOWS, SVP. DISTRIBUTIONS FROM SERP PLAN, INCLUDED IN 2015 W-2 WAGES, TOTALLED $151,338. WAGES: DAVID CALLECOD, PRESIDENT/CEO-LGHS, PATRICK GANDY, EVP/COO-LGMC, ROGER MATTKE, SVP/CFO, AND GORDON ROUNTREE, GENERAL COUNSEL. 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 MADE 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. A LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 546395H80 2010-08-12 84137555 TOWER RENOVATION PROJECT AND REFUND OF 08-19-98 ISSUE 0 0 0 B LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 2011-02-25 3850000 REPLACE/UPGRADE CARDIAC CATH LAB 0 0 0 C LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 2012-07-26 60000000 A&B-EXPANSION/RENOVATION/EQUIPPING OF OR/ER AREA AND PARKING FACILITY 0 0 0 D LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 546395N42 2016-01-21 71134478 REFUND 2012A SERIES BOND AND FINANCE IMPROVEMENT PROJECT 0 0 0 A 3245000 84137555 3733975 1550751 78852829 2011 1 0 1 1 B 3850000 3850000 59703 3790297 2011 0 0 1 1 C 30000000 60000000 414018 59585982 2015 0 0 1 1 D 71134478 30106042 1020528 40007909 2016 1 0 1 1 A 0 0 1 1 0 0.04000 0.04000 1 0 1 B 0 0 1 1 0 0.04000 0.04000 1 0 1 C 0 0 1 1 0 0.04000 0.04000 1 0 1 D 0 0 1 1 0 0.00000 0.04000 0.04000 1 0 1 A 0 1 0 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 1 0 0 0 0 D 0 1 0 1 0 0 0 0 0 A 1 B 1 C 1 D 1 SCHEDULE K, PART I, LINE A, COLUMN C: 546395H98, 546395J21, 546395J39, 546395J47, 546395J54 SCHEDULE K, PART II, LINE 3, COLUMN C: BOTH SERIES A AND B BONDS WERE ISSUED AS DRAW-DOWN BONDS SCHEDULE K, PART III, LINE 9 THE BOND DOCUMENTS DO REQUIRE COMPLIANCE WITH THESE SECTIONS AND THE REQUIREMENTS ARE REVIEWED PERIODICALLY TO ENSURE CONTINUED COMPLIANCE WITH PRIVATE BUSINESS TESTS OR THE PRIVATE LOAN FINANCING TEST. SCHEDULE K, PART IV, LINE 7 THE BOND DOCUMENTS DO REQUIRE COMPLIANCE WITH THIS SECTION AND THE REQUIREMENTS ARE REVIEWED PERIODICALLY TO ENSURE CONTINUED COMPLIANCE WITH YIELD RESTRICTIONS AND ARBITRAGE. SCHEDULE K, PART IV, LINE 2C, COLUMN A THE REBATE CALCULATION WAS PERFORMED NOV 24, 2014 GACHASSIN LAW FIRM PHILIP GACHASSIN, M.D., LGHS TRUSTEE, IS A FAMILY MEMBER OF PRINCIPLE OWNER 537659 LAFAYETTE GENERAL HEALTH SYSTEM PAYS GACHASSIN LAW FIRM FOR LEGAL SERVICES. 0 ACADIANA ORTHOPEDIC PROPERTIES LLC JOHN SCHUTTE MD IS A TRUSTEE OF LGHS AND IS A MEMBER OF AOP, LLC 104763 LAFAYETTE GENERAL HEALTH SYSTEM, INC HAS ENTERED INTO A LEASE AGREEMENT WITH INTERESTED PERSON TO PROVIDE OFFICE BUILDING SPACE. 0 LAFAYETTE INVESTMENT GROUP LLC BRADLEY J CHASTANT MD IS A TRUSTEE OF LGHS AND IS A MEMBER OF LIG, LLC 1157998 LAFAYETTE GENERAL HEALTH SYSTEM, INC HAS ENTERED INTO A LEASE AGREEMENT WITH LAFAYETTE INVESTMENT GROUP,LLC TO LEASE SPACE FROM THEM. 0 PLACE DE LAFAYETTE LLC EDWARD KRAMPE LGHS TRUSTEE, IS A MEMBER OF PLACE DE LAFAYETTE, LLC 642481 LAFAYETTE GENERAL HEALTH SYSTEM HAS ENTERED INTO A LEASE AGREEMENT WITH INTERESTED PERSON TO PROVIDE OFFICE BUILDING SPACE. 0 PHILLIPP GACHASSIN MD PHILIP GACHASSIN, M.D. IS A LGHS TRUSTEE 85382 PHILIP GACHASSIN, MD LEASES MEDICAL OFFICE SPACE FROM LAFAYETTE GENERAL HEALTH SYSTEMS IN THE ANNUAL AMOUNT OF $85,382.. 0 ACADIANA FAMILY PHYSICIANS DR. BENJAMIN DOGA, TRUSTEE, IS A MEMBER OF ACADIANA FAMILY PHYSICIANS 221687 ACADIANA FAMILY PHYSICIANS LEASES MEDICAL OFFICE SPACE FROM LAFAYETTE GENERAL HEALTH SYSTEMS IN THE ANNUAL AMOUNT OF $221,687 0 DR BRADLEY CHASTANT II DR. BRADLEY CHASTANT, II IS THE SON OF TRUSTEE, BRADLEY J CHASTANT MD 353893 DR. BRADLEY CHASTANT, II IS A PAID EMPLOYEE OF LAFAYETTE GENERAL HEALTH SYSTEMS. HIS GROSS EARNINGS, INCLUDING WAGES AND BENEFITS WAS 353,893 FOR FYE 9/30/16. 0 DR RYAN P CHASTANT DR. RYAN P. CHASTANT IS THE SON OF TRUSTEE, BRADLEY J CHASTANT MD 438396 DR. RYAN P. CHASTANT IS A PAID EMPLOYEE OF LAFAYETTE GENERAL HEALTH SYSTEMS. HIS GROSS EARNINGS, INCLUDING WAGES AND BENEFITS WAS 438,396 FOR FYE 9/30/16. 0 ACADIANA UROLOGY LLC DR. SAMUEL SHUFFLER, TRUSTEE, IS A MEMBER OF ACADIANA UROLOGY, LLC 66840 ACADIANA UROLOGY,LLC LEASES MEDICAL OFFICE SPACE FROM LAFAYETTE GENERAL HEALTH SYSTEMS IN THE ANNUAL AMOUNT OF $66,840 0 MICHAEL SCHUTTE MD MICHAEL SCHUTTE, M.D. IS THE BROTHER OF TRUSTEE, JOHN SCHUTTE, M.D. 722164 MICHAEL SCHUTTE, M.D. IS A PAID EMPLOYEE OF LAFAYETTE GENERAL HEALTH SYSTEMS. HIS GROSS EARNINGS, INCLUDING WAGES AND BENEFITS WAS 722,164 FOR FYE 9/30/16. 0 FORM 990, PART VI, SECTION A, LINE 2 TRUSTEES, CLAY ALLEN AND ROBERT GILES ARE INVOLVED IN SEPARATE BUSINESS VENTURES TOGETHER THAT ARE WHOLLY UNRELATED TO THE ORGANIZATION. THE FOLLOWING TRUSTEES ALL HAVE OWNERSHIP IN LAFAYETTE GENERAL SURGICAL HOSPITAL: DR. SCHUTTE, DR. CHASTANT, DR. SHUFFLER AND DR. GACHASSIN. PHILIP GACHASSIN, M.D. AND DENNIS ESCHETE, M.D. ARE PARTNERS IN A GENERAL SURGERY OFFICE PRACTICE AND SHARE OFFICE SPACE. 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 THE INDIVIDUALS OF THE TRUSTEES (GOVERNING BODY) AND THE MEMBERS MUST BE APPROVED BY THE MEMBERSHIP BODY. FORM 990, PART VI, SECTION B, LINE 11 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 MEMBER AND OFFICERS REQUIRING THEM TO DISCLOSE CONFLICTS OF INTEREST. AFTER RECEIPT OF THESE SURVEYS, THE GOVERNANCE COMMITTEE AND ITS CHAIR-PERSON REVIEW ALL CONFLICTS AND REPORT TO THE GOVERNANCE COMMITTEE. THEREAFTER THE CHAIR-PERSON OF THE GOVERNANCE COMMITTEE AND THE ORGAIZATION'S GENERAL COUNCIL (WHO ATTENDS ALL BOARD MEETINGS) ENSURES THAT ALL CONFLICTS ARE TIMELY DISCLOSED AND THAT 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 A COMPENSATION SURVEY AND FAIR MARKET VALUE REPORT. THE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE MARKET COMPARABLES AND MAKES ADJUSTMENTS TO THE PRESIDENT/CEO'S COMPENSATION THEREAFTER. THIS SAME PROCESS IS FOLLOWED FOR THE FOLLOWING SENIOR EXECUTIVES OF THE ORGANIZATION: COO, CFO, CNO AND GENERAL COUNSEL. 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 VII, LINE 1A PAYMENTS TO THE PHYSICIANS THAT SERVE AS TRUSTEES WERE REPORTED ON A 1099-MISC IN BOX 6 OR AN A W-2. ALL SUCH PAYMENTS WERE IN CONSIDERATION FOR PROVIDING CALL COVERAGE IN OUR EMERGENCY ROOM OR SERVING AS MEDICAL DIRECTORS FOR VARIOUS HOSPITAL DEPARTMENTS. NO PAYMENTS WERE MADE IN THEIR CAPACITY AS TRUSTEE. FORM 990, PART XI, LINE 9: ROUNDING -1. FORM 990, PART XII, LINE 2C THE PROCESS FOR SELECTION OF AUDITOR HAS NOT CHANGED FROM THE PRIOR YEAR. 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