2016-05-13T13:03:12-05:00 2015-09-30 201941244 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2014-10-01 264626264 ST MARTIN HOSPITAL INC STMA 3375071201 210 CHAMPAGNE BLVD BREAUX BRIDGE LA 70517 KAREN WYBLE CEO 3375071201 2016-05-12 1 AMIE T WHITTINGTON CPA P01082167 6013261000 2016-04-26 2014 2016-08-17 19:52:53Z DAVID CALLECOD 1214 COOLIDGE BLVD LAFAYETTE LA 70503 21351047 0 X WWW.STMARTINHOSPITAL.ORG X 2009 LA THE ORGANIZATION PROVIDES MEDICAL CARE TO IMPROVE, MAINTAIN, AND RESTORE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES WE SERVE, REGARDLESS OF THE PATIENTS' ABILITY TO PAY. 5 2 156 30 0 0 6795 0 20534903 21221727 498 221 201651 129099 20743847 21351047 3235 5795 0 0 7261652 7962954 0 0 0 11956113 11135255 19221000 19104004 1522847 2247043 10101325 13166692 7060144 7878468 3041181 5288224 ST. MARTIN HOSPITAL'S MISSION IS TO IMPROVE, MAINTAIN AND RESTORE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES WE SERVE. 0 0 16833104 5795 21330114 COMMUNITY MEDICAL CARE PROVIDER. THE ORGANIZATION PROVIDES NEEDED MEDICAL CARE TO THE PARISH REGARDLESS OF THE PATIENT'S ABILITY TO PAY. SERVICES INCLUDE INPATIENT AND OUTPATIENT CARE IN FURTHERANCE OF THE ORGANIZATION'S HEALTHCARE MISSION.PROGRAM SERVICE STATISTICS RELATED TO PROVIDING MEDICAL CARE FOR THE HOSPITAL: TOTAL PATIENT DAYS WERE 4,707, TOTAL EMERGENCY ROOM VISITS WERE 19,238, AND TOTAL REHAB VISITS WERE 33,065. 16833104 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 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 32 0 1 156 1 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X THE ORGANIZATION 3375071201 210 CHAMPAGNE BLVD BREAUX BRIDGE LA 70517 DAVID CALLECOD CHAIRMAN/CEO - LGHS 1.00 46.00 X X 0 1177776 238614 KATHERINE D HEBERT CEO/SECRETARY - PART YEAR 40.00 40.00 X X 0 276095 49800 KAREN WYBLE BOARD MEMBER - PART YEAR 40.00 0.00 X 0 0 0 ED KRAMPE VICE CHAIRMAN 1.00 2.00 X 0 0 0 DR WARREN DEGATUR BOARD MEMBER 1.00 0.00 X 0 0 0 BURTON DUPUIS BOARD MEMBER 1.00 0.00 X 0 0 0 MARY DUPUIS DON 40.00 0.00 X 0 156220 6143 BRYAN LAPEROUSE ASSOCIATED ADMIN 40.00 0.00 X 0 123148 2818 DOLLIE HAMNER PHARMACIST 39.00 0.00 X 0 120588 9712 CHARLES CAMBRE RN 50.00 0.00 X 0 112508 4716 DEBORAH K HIGGINBOTHAM RN 47.00 0.00 X 0 111209 6114 0 2077544 317917 6 0 1 0 CARDIOVASCULAR INSTITUTE OF THE SOUTH 225 DUNN STREET HOUMA LA 70360 CARDIOLOGY DIAGNOSTIC SERVICES 669874 REHABCARE GROUP INC PO BOX 502096 ST LOUIS MO 631502096 CONTRACTED REHAB DEPT 523754 ARAMARK CORPOARATION 25271 NETWORK PLACE CHICAGO IL 60673 HOUSEKEEPING AND DIETARY 241289 3 PATIENT SERVICE REVENUE 621990 21221727 21221727 21221727 221 221 20712 0 20712 20712 20712 OTHER REVENUE 900099 82100 82100 DIETARY REVENUE 722210 26287 26287 108387 21351047 21330114 0 20933 5795 5795 6835197 5953689 881508 72713 64212 8501 574954 489448 85506 480090 424764 55326 138472 138472 9740 730 9010 207767 182806 24961 293509 212236 81273 17008 3601 13407 13262 2737 10525 277465 281 277184 329306 329306 BAD DEBT 4029230 4029230 MEDICAL SUPPLIES 2299464 2299464 CONTRACT LABOR 1941152 1859828 81324 EQUIP. RENTAL & REPAIR 1234743 856443 378300 344137 118534 225603 19104004 16833104 2270900 0 377610 41963 2563726 2412718 504738 513442 13713 10802 4693730 1247477 3724264 3446253 2917274 6741514 10101325 13166692 1006766 1174667 6053378 6703801 7060144 7878468 X 3041181 5288224 3041181 5288224 10101325 13166692 2247043 0 X X 0 1 X 1 0 X X 3955 174268 3955 174268 16829149 636621767 16833104 636796035 991655 1000000 247914 250000 0 0 0 0 826841 881274 1000000 1000000 3708115 5562173 1821 3249 189962 174268 369300 206710 220319 250000 250000 927029 1390544 1821 3249 189962 174268 369300 FORM 990, SCHEDULE C, PART II-A, LINE 1A ALL LOBBYING ACTIVITIES OCCUR INDIRECTLY THROUGH LOUISIANA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. THE HOSPITAL DOES NOT HAVE ANY CONTROL OR DIRECTION IN DETERMINING HOW SUCH DUES PAID TO THESE TWO ORGANIZATIONS ARE USED. 3147411 541631 2605780 648419 109694 538725 890724 596152 294572 7176 7176 3446253 OTHER ASSETS 28913 OTHER ACCOUNTS RECEIVABLE 56012 RELATED PARTY RECEIVABLES 6656589 6741514 OTHER ACCOUNTS PAYABLE 3277490 RELATED PARTY PAYABLES 2745 CAPITAL LEASE OBLIGATION 3423566 6703801 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 0 71696 71696 0.00480 1889896 4399414 -2509518 0.00000 1961592 4399414 -2437822 0.00480 1330057 960684 369373 0.02450 5795 5795 0.00040 1335852 960684 375168 0.02490 3297444 5360098 -2062654 0.02970 1 4029230 3223384 9996021 9897050 98971 X 1 1 1 1 ST MARTIN HOSPITAL INC 210 CHAMPAGNE BLVD BREAUX BRIDGE LA 70517 X X X ST MARTIN HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X SEE SUPPLEMENTAL SCHEDULE FOR FULL WEB ADDRESS 1 12 0 1 0 1 X 100.000000000000 200.000000000000 1 1 X X X 1 X HTTP://WWW.LAFAYETTEGENERAL.COM/SITES/WWW/UPLOADS/FILES/FAP/FAP_SMH_122815. X HTTP://WWW.LAFAYETTEGENERAL.COM/SITES/WWW/UPLOADS/FILES/FAP/FINANCIAL_ASSIS X X X X 1 0 1 X 0 0 ST. MARTIN HOSPITAL PART V, SECTION B, LINE 5: INTERVIEW METHODOLOGYEIGHT INTERVIEWS WERE CONDUCTED IN-PERSON FROM NOVEMBER 13-14, 2012. INTERVIEWS REQUIRED APPROXIMATELY 30 MINUTES TO COMPLETE. INTERVIEWERS FOLLOWED THE SAME PROCESS FOR EACH INTERVIEW, WHICH INCLUDED DOCUMENTING THE INTERVIEWEE'S EXPERTISE AND EXPERIENCE RELATED TO THE COMMUNITY. ADDITIONALLY, THE FOLLOWING COMMUNITY-FOCUSED QUESTIONS WERE USED AS THE BASIS FOR DISCUSSION:-INTERVIEWEE'S NAME-INTERVIEWEE'S TITLE-INTERVIEWEE'S ORGANIZATION-OVERVIEW INFORMATION ABOUT THE INTERVIEWEE'S ORGANIZATION-WHAT ARE THE TOP THREE STRENGTHS OF THE COMMUNITY?-WHAT ARE THE TOP THREE HEALTH CONCERNS OF THE COMMUNITY?-WHAT ARE THE HEALTH ASSETS AND RESOURCES AVAILABLE IN THE COMMUNITY?-WHAT ARE THE HEALTH ASSETS OR RESOURCES THAT THE COMMUNITY LACKS?-WHAT ASSETS OR RESOURCES IN THE COMMUNITY ARE NOT BEING USED TO THEIR FULL CAPACITY?-WHAT ARE THE BARRIERS TO OBTAINING HEALTH SERVICES IN THE COMMUNITY?-WHAT IS THE SINGLE MOST IMPORTANT THING THAT COULD BE DONE TO IMPROVE THE HEALTH IN THE COMMUNITY?-WHAT CHANGES OR TRENDS IN THE COMMUNITY DO YOU EXPECT OVER THE NEXT FIVE YEARS?-WHAT OTHER INFORMATION CAN BE PROVIDED ABOUT THE COMMUNITY THAT HAS NOT ALREADY BEEN DISCUSSED?THESE INTERVIEWS WERE CONDCUTED WITH THE FOLLOWING COMMUNITY LEADERS:JODY WEST,COORDINATOR, ST. MARTIN PARISH SCHOOL-BASED HEALTH CENTER, AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATIONJACK DALE DELHOMME, MAYOR-CITY OF BREAUX BRIDGE, AREA REPRESENTED: ELECTED OFFICIALDR. GUS INGRALDI, CARDIOLOGIST-CARDIOVASCULAR INSTITUTE OF THE SOUTH, AREA REPRESENTED: PHYSICIANSTACEY SAVOY, COMMUNITY HEALTH SERVICES COORDINATOR-ST. MARTIN HEALTH UNIT, AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATIONFRANCINE GUILLORY, PSYCHOTHERAPIST/WELLNESS COUNSELOR, AREA REPRESENTED: MENTAL HEALTHAIMEE GUIDRY, NURSE PRACTITIONER-PARTNERS IN HEALTH CARE, AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATIONDIANE SANT, ACADIANA HOME HEALTH, AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATIONTEDDY THOMAS, CLERK/NUTRITION EDUCATOR-ST. MARTIN HEALTH UNIT AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATIONIN ADDITION TO INTERVIEWS WITH COMMUNITY LEADERS, FOCUS GROUPS FOCUS GROUPS WERE CONDUCTED TO ALLOW PARTICIPANTS TO PROVIDE INFORMATION ABOUT THEIR EXPERIENCES IN THE COMMUNITY AND WAYS IN WHICH THEY THINK THE SERVICES AND RESOURCES PROVIDED TO THE COMMUNITY CAN BE IMPROVED. PARTICIPANTS COMPLETED A DEMOGRAPHIC QUESTIONNAIRE AND A CONSENT FORM AGREEING TO PARTICIPATE IN THE FOCUS GROUP. THE REQUESTED INFORMATION INCLUDED: -GENDER-AGE -ZIP CODE -ETHNICITY -RACE -EDUCATION LEVEL -EMPLOYMENT STATUS -HOUSEHOLD INCOME -HEALTH INSURANCE STATUS ST. MARTIN HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL HAS ADOPTED AND EXECUTED AN IMPLEMENTATION STRATEGY. THE HOSPITAL ALSO HAS INCLUDED A COMMUNITY BENEFIT SECTION IN ITS OPERATIONAL PLANS AND ADOPTED A BUDGET FOR PROVISION OF SERVICES THAT ADDRESSES THE NEEDS IDENTIFIED IN THE CHNA. THE HOSPITAL IS PRIORITIZING THE HELATH NEEDS OF THE COMMUNITY AND THE SERVICES THAT THE HOPSITAL WILL UNDERTAKE TO MEET THE HEALTH NEEDS OF THE COMMUNITY, AS DETAILED IN THE CHNA AND ITS IMPLEMENTATION STRATEGY.UNADDRESSED PRIORITIES INCLUDED:COMMUNICABLE DISEASE: INTERVIEWEES EXPRESSED CONCERN MOSTLY RELATING TO PEDIATRIC IMMUNIZATION RATES. ST. MARTIN HOSPITAL DOES NOT OFFER WOMEN'S OR PEDIATRIC HEALTH SERVICES, AND DOES NOT ADVERTISE LABOR AND DELIVERY SERVICES TO THE COMMUNITY. NOT ONLY ARE RESOURCES LIMITED TO ACCOMODATE THE NEED, ST. MARTIN HOSPITAL DOES NOT HAVE THE EXPERTISE TO ADDRESS PEDIATRIC HEALTHCONCERNS AMONG ITS PHYSICIANS AS THEIR COMPETENCIES ARE FOCUSED ON OTHER AREAS OF MEDICINE.MENTAL HEALTH: ST. MARTIN HOSPITAL DOES NOT HAVE A BEHAVIORAL HEALTH UNIT. THEY DO NOT HAVE THE RESOURCES OR EXPERTISE TO CONTINUOUSLY REMAIN ACTIVE IN THE SEARCH FOR ENHANCEMENT IN MENTALHEALTH SERVICES. THE HOSPITAL'S FOCUS IS TO ENHANCE MEDICAL SERVICES IN THE COMMUNITY TO MEET OTHER HEALTH NEEDS MORE WITHIN THEIR SCOPE OF CARE AND COMPETENCY.SUBSTANCE ABUSE: ST. MARTIN HOSPITAL DOES NOT HAVE A BEHAVIORAL HEALTH OR ACUTE SUBSTANCE ABUSE TREATMENT UNIT. THE HOSPITAL DOES NOT HAVE THE RESOURCES OR EXPERTISE TO CONTINUOUSLY REMAINACTIVE IN THE SEARCH FOR ENHANCEMENT IN SUBSTANCE ABUSE SERVICES. THE HOSPITAL'S FOCUS IS TO ENHANCE MEDICAL SERVICES IN THE COMMUNITY TO MEET OTHER HEALTH NEEDS MORE WITHIN THEIR SCOPE OF CARE AND COMPETENCY.PLEASE SEE ATTACHED IMPLEMENTATION STRATEGY FOR FURTHER INFORMATION. ST. MARTIN HOSPITAL PART V, SECTION B, LINE 16I: THE POLICY IS DESCRIBED IN OUR PATIENT INFORMATION PACKETS PROVIDED DURING THE ADMISSION PROCESS. PART V, QUESTION 7A: WEB ADDRESS OF CHNA HTTP://WWW.LAFAYETTEGENERAL.COM/SITES/WWW/UPLOADS/FILES/COMMUNITY%20REPORTS/ST-MARTIN-COMMUNITY-NEEDS-ASSESSMENT.PDF PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY ST. MARTIN HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.LAFAYETTEGENERAL.COM/SITES/WWW/UPLOADS/FILES/FAP/FAP_SMH_122815. ST. MARTIN HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.LAFAYETTEGENERAL.COM/SITES/WWW/UPLOADS/FILES/FAP/FINANCIAL_ASSIS 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: SMH 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 $ 4,029,230. PART II, COMMUNITY BUILDING ACTIVITIES: WE PROVIDE HEALTH SCREENINGS, WHICH INCLUDE BLOOD PRESSURE CHECKS, GLUCOSE SCREENING AND EKGS. WE ALSO PROVIDE EDUCATIONAL PROGRAMS WITHIN OUR COMMUNITY. 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 THEAMOUNTS 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 PAYACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2015 AND 2014. THE ORGANIZATION HAS EXPERIENCED AN INCREASE IN 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, AND AN OVERALL INCREASE IN UNINSURED PATIENTS RESULTING FROM THE COLLABORATION WITH THE STATE TO OPERATE THE FORMER LSU TEACHING HOSPITAL IN LAFAYETTE WHICH SERVES A PREDOMINATELY MEDICAID AND UNINSURED POPULATION.BAD DEBT EXPENSE REFLECTED IN PART III EQUALS BAD DEBT EXPENSE ON THE AUDITED FINANCIAL STATEMENTS. THE HOSPITAL ANALYZED THE POPULATION THAT WAS WRITTEN OFF TO BOTH CHARITY AND BAD DEBT DURING THE YEAR. IT WAS ESTIMATED THAT AT LEAST 80% OF THE PATIENTS THAT WERE ADJUSTED TO BAD DEBT ARE LIKELY PATIENTS THAT COULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE POLICY BUT DID NOT OR ARE UNWILLING TO INITIATE OR COMPLETE THE NECESSARY DOCUMENTATION. THE HOSPITAL DID NOT INCLUDE ANY BAD DEBTS IN OUR COMMUNITY BENEFIT CALCULATIONS. HOWEVER, HOSPITAL BELIEVES THAT THE COST OF THIS BAD DEBT IS A COMMUNITY BENEFIT BECAUSE BY CONTINUING TO TREAT PATIENTS THAT ARE UNABLE TO AFFORD CARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL CARE. PART III, LINE 8: THE COSTING METHODOLOGY USED FOR LINE 6 WAS THE STANDARD MEDICARE COST REPORT COST SYSTEM. THE AMOUNTS WERE RECAPPED FROM THE HOSPITALS FILED COST REPORT. THE CORRESPONDING REVENUE AMOUNTS WERE INCLUDED ON LINE 5. THE HOSPITAL DID NOT INCLUDE THE MEDICARE SHORTFALL IN OUR COMMUNITY BENEFIT CALCULATIONS REPORTED ON PART I, LINE 7. PART III, LINE 9B: WE SEEK TO SCREEN PATIENTS TO DETERMINE IF THEY HAVE THIRD PARTY COVERAGE OR ASSIST THEM IN APPLYING FOR FEDERAL ASSISTANCE. IF THEY DO NOT HAVE THIRD PARTY COVERAGE OR CANNOT QUALIFY FOR FEDERAL ASSISTANCE, WE THEN SCREEN TO SEE IF THEY MEET QUALIFICATIONS FOR OUR CHARITY CARE PROGRAM. THOSE NOT QUALIFYING FOR CHARITY CARE ,WE TRY TO COLLECT OR MAKE MONTHLY PAYMENT ARRANGEMENTS, IF THEY DO NOT COMPLY WE WILL REFER TO OUR COLLECTION AGENCY. PART VI, LINE 2: 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 EDUCATI0N. THE H0SPITAL ALSO MAINTAINS AN OPEN MEDICAL STAFF.A FORMAL NEEDS ASSESSMENT WAS UNDERTAKEN FOR YEAR ENDING 9/30/13. WE ENGAGED THE CARNAHAN GROUP TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS COMPLETED IN JUNE OF 2013. 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.THE CHNA CAN BE ACCESSED AT: HTTP://WWW.LAFAYETTEGENERAL.COM/SITES/WWW/UPLOADS/FILES/COMMUNITY%20REPORTS/ST-MARTIN-COMMUNITY-NEEDS-ASSESSMENT.PDF PART VI, LINE 3: WE POST A NOTICE THAT WE HAVE A CHARITY POLICY THAT PROVIDES FOR FINANCIAL ASSISTANCE TO THOSE THAT MEET SPECIFIC CRITERIA IN THE RECEPTION AREA OF THE HOSPITAL. PART VI, LINE 4: WE ARE LOCATED IN A RURAL PARISH IN LOUISIANA. ST. MARTIN PARISH IS AN AGRICULTURAL COMMUNITY WITH COMMERCIAL FISHING. WE ARE THE ONLY HOSPITAL IN OUR PARISH (ST. MARTIN). WE ALSO HAVE BEEN DESIGNATED AS A MEDICALLY UNDERSERVED AREA.THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING GEOGRAPHIC AND DEMOGRAPHIC AREAS, IS ADDRESSED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED DURING 2013. THE CHNA CAN BE ACCESSED AT:HTTP://WWW.LAFAYETTEGENERAL.COM/SITES/WWW/UPLOADS/FILES/COMMUNITY%20REPORTS/ST-MARTIN-COMMUNITY-NEEDS-ASSESSMENT.PDF PART VI, LINE 5: OUR BOARD OF TRUSTEES IS COMPRISED OF MEMBERS FROM OUR COMMUNITY, WHICH MAKE UP OUR PRIMARY SERVICE AREA. ST. MARTIN HOSPITAL EXTENDS PRIVILEGES TO PRIMARY CARE PHYSICIANS IN OUR COMMUNITY. SURPLUS FUNDS ARE USED TO PROVIDE CAPITAL IMPROVEMENTS TO OUR HOSPITAL TO ENRICH THE QUALITY CARE THAT WE PROVIDE. WE ALSO RECRUIT PHYSICIANS INTO OUR COMMUNITY, ORGANIZE FUND-RAISERS FOR CANCER RESEARCH THROUGH OUR PARTICIPATION IN THE RELAY FOR LIFE. WE ALSO PROVIDE SUPPORT TO THE UNITED WAY OF ACADIANA BY HAVING A FUND-RAISING CAMPAIGN AND HAVING MEMBERS OF OUR STAFF ON THEIR BOARD AND COMMITTEES. PART VI, LINE 6: THE HOSPITAL IS OWNED BY LAFAYETTE GENERAL HEALTH SYSTEMS. THIS ALLIANCE HAS ALLOWED THE HOSPITAL TO EXTEND ITS OUTREACH TO ALL THE CITIZENS OF ST. MARTIN PARISH. THE HOSPITAL WAS ABLE TO EXPAND ITS OUTPATIENT AND EMERGENCY SERVICES. THE HOSPITAL WAS ALSO ABLE TO ENRICH ITS INPATIENT SERVICES BY IMPLEMENTING A HOSPITALIST PROGRAM. 0 1 0 0 0 1 1 0 0 DAVID CALLECOD CHAIRMAN/CEO - LGHS 0 774176 0 309670 0 93930 0 228970 0 9644 0 1416390 0 0 KATHERINE D HEBERT CEO/SECRETARY - PART YEAR 0 213772 0 42754 0 19569 0 42691 0 7109 0 325895 0 0 MARY DUPUIS DON 0 142350 0 13870 0 0 0 3199 0 2944 0 162363 0 0 PART I, LINE 3 AN INDEPENDENT EXTERNAL CONSULTANT FIRM, SULLIVAN COTTER AND ASSOCIATES, IS ENGAGED BY A RELATED ORGANIZATION'S COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, WHICH IS COMPRISED OF DISINTERESTED DIRECTORS, TO PREPARE COMPENSATION SURVEY AND FAIR MARKET VALUE REPORT. THIS RELATED ORGANIZATION'S COMPENSATION COMMITTEE ANNUALLY REVIEWS THE MARKET COMPARABLES AND MAKES ADJUSTMENT THE PRESIDENT/CEO'S COMPENSATION THEREAFTER. PART I, LINE 4B A SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN (SERP) WAS ADOPTED BY LAFAYETTE GENERAL MEDICAL CENTER, THE SOLE MEMBER OF ST. MARTIN HOSPITAL, 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 $260,100.00, WHICH INCLUDES BOTH LAFAYETTE GENERAL MEDICAL CENTER AND ST. MARTIN HOSPITAL EMPLOYEES. THE BOARD DETERMINES WHICH EMPLOYEES ARE ELIGIBLE FOR PLAN CONTRIBUTIONS. PARTICIPANTS WERE DAVID CALLECOD, CEO OF LAFAYETTE GENERAL HEALTH SYSTEMS AND KATHERINE D. HEBERT, CEO OF ST. MARTIN HOSPITAL. DISTRIBUTIONS FROM SERP PLAN, INCLUDED IN 2014 W-2 WAGES, TOTALLED $42,916.50. THE FOLLOWING RECEIVED DISTRIBUTIONS, INCLUDED IN THEIR 2014 W-2 WAGES: DAVID CALLECOD, PRESIDENT/CEO-LGHS AND KATHERINE HEBERT, ADMINISTRATOR. 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. WARREN J DEGATOR JR MD INC WARREN DEGATUR, BOARD MEMBER, IS SOLE OWNER OF WARREN J DEGATOR JR MD INC. 6000 DR. DEGATUR'S PRACTICE WAS ISSUED A FORM 1099 IN THE AMOUNT OF $6,000. THE $6,000 WAS FOR MEDICAL DIRECTOR PAY. 0 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 11 THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S ACCOUNTING STAFF 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 GOVERNANCE 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 15A 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 OTHER DOCUMENTS AND FINANCIAL INFORMATION ARE AVAILABLE TO THE PUBLIC UPON REQUEST WITHIN THE PARAMETERS OF REGULATORY/LEGAL AUTHORITIES. 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