2016-05-12T12:47:59-05:00 2015-09-30 201941244 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2014-10-01 383646817 LAFAYETTE GENERAL HEALTH SYSTEM INC LAFA 3372898125 1214 COOLIDGE BLVD LAFAYETTE LA 70503 ROGER MATTKE CHIEF FINANCIAL OFFICER 3372898125 2016-05-12 1 AMIE T WHITTINGTON CPA P01082167 6013261000 2016-05-09 2014 2016-08-17 19:52:53Z DAVID CALLECOD 1214 COOLIDGE BLVD LAFAYETTE LA 70503 132612482 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. 21 13 3936 0 808391 -1304510 0 260986 88427846 71226555 0 25039 27458476 50100160 115886322 121612740 39433732 34438574 0 0 16189447 21664010 0 0 0 32982445 46106151 88605624 102208735 27280698 19404005 518883042 777562726 271122159 510397848 247760883 267164878 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 102208735 34438574 120518324 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. 102208735 1 1 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 1 435 0 1 3936 1 1 1 0 0 0 0 0 0 0 X 21 13 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 TRUSTEE 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 7500 0 BRADEN DESPOT SECRETARY 1.00 2.00 X 0 0 0 BENJAMIN DOGA MD TRUSTEE 1.00 3.50 X 0 22660 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 97933 0 ROBERT GILES TRUSTEE 1.00 1.00 X 0 0 0 JOBY JOHN PHD TRUSTEE 1.00 3.00 X 0 0 0 EDWARD KRAMPKE VICE CHAIRMAN 1.00 2.00 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 TRUSTEE 1.00 2.00 X 0 0 0 JOSEPH ZANCO TRUSTEE 1.00 1.00 X 0 0 0 JUAN J PEREZ-RUIZ MD CHIEF OF STAFF - PART YEAR 1.00 41.00 X 271163 0 10667 BRAD BROUSSARD MD TRUSTEE - PART YEAR 1.00 45.00 X 0 54333 0 JOHN SCHUTTE MD TRUSTEE - PART YEAR 1.00 61.00 X 1428105 52000 19469 DENNIS ESCHETE MD CHEIF OF STAFF - PART YEAR 1.00 9.00 X 0 87800 0 DAVID CALLECOD PRESIDENT/CEO-LGHS 40.00 7.00 X 1177776 0 238614 PATRICK W GANDY JR EVP/CEO-LGMC 40.00 1.00 X 596096 0 94150 ROGER MATTKE SVP/CFO 40.00 1.00 X 549661 0 115044 GORDON E ROUNTREE JR SVP/GENERAL COUNSEL 40.00 1.00 X 480889 0 86033 REBECCA BENOIT VP-CNO 40.00 1.00 X 307130 0 48652 AMANDA LOGUE MD VP/CHIEF MEDICAL OFFICER 40.00 0.00 X 333691 0 18867 CRETAN MEADOWS SVP/STRATEGIC PLANNING 40.00 0.00 X 313259 0 5740 KATHERINE D HEBERT COO/VP UHC 0.00 40.00 X 276095 0 49800 DEAN B DUCOTE VP/OPERATIONS 40.00 0.00 X 247546 0 18737 EDWINA S MALLERY AVP/INFORMATION SYSTEMS 40.00 0.00 X 236669 0 5770 6218080 322226 711543 209 0 1 0 ARAMARK CORPORATION 25271 NETWORK PLACE CHICAGO IL 60673 HOUSEKEEPING AND DIETARY 13421535 LSU HSC NEW ORLEANS 433 BOLIVAR STREET NEW ORLEANS LA 70112 MEDICAL SCHOOL RESIDENTS 8786466 CARDIOVASCULAR INSTITUTE OF THE SOUTH AP 225 DUNN STREET HOUMA LA 70360 CARDIOLOGY SERVICES 3553165 PARAGON CONTRACTING SERVICES INC PO BOX 634853 CINCINNATI OH 45263 ER PROVIDER 3228959 COOLIDGE PHYSICIAN GROUP LLC PO BOX 82368 LAFAYETTE LA 70598 HOSPITALIST PROFESSIONAL SERVICES 2596902 85 260986 260986 MANAGEMENT FEE 900099 71226555 71226555 71226555 25039 25039 4540751 10999742 -6458991 -6458991 -6407719 -51272 EQUITY INTEREST IN SUB EARNINGS 900099 55448538 55448538 MISCELLANEOUS REVENUE 900099 1110613 250950 859663 56559151 121612740 120518324 808391 25039 34438574 34438574 5423451 5423451 14552093 14552093 611827 611827 -86090 -86090 1162729 1162729 5009958 5009958 1217722 1217722 823891 823891 882887 882887 2361902 2361902 1020385 1020385 424067 424067 7003606 7003606 6395864 6395864 5424742 5424742 EQUIP REPAIR & MAINT. 12159568 12159568 OTHER NONCLINICAL SERVI 1842969 1842969 COLLECTION SERVICE 733320 733320 DUES 234267 234267 571003 571003 102208735 102208735 0 0 1502 35706115 9987859 46367 31088 5516217 406791 2905573 3898174 367683234 145821796 201633551 221861438 308779832 505671261 518883042 777562726 7241800 16923160 140988744 141011987 51502723 54863991 71388892 297598710 271122159 510397848 X 247760883 267164878 247760883 267164878 518883042 777562726 X 19404005 -10 X X 0 1 X 1 0 X X 5 LAFAYETTE GENERAL MEDICAL CENTER INC 720535375 3 1 0 0 ST MARTIN HOSPITAL INC 264626264 3 1 0 0 UNIVERSITY HOSPITAL AND CLINICS INC 462605366 3 1 15760601 0 ACADIA GENERAL HOSPITAL INC 464958152 3 1 3271473 0 KAPLAN GENERAL HOSPITAL INC 472540179 3 1 441531 0 5 19473605 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, SECTION A, QUESTION 2 THE ORGANIZATION HAS A SUPPORTED ORGANIZATION WHOSE APPLICATION FOR EXEMPTION IS STILL PENDING WITH THE IRS. THE ORGANIZATION FULLY EXPECTS THAT THIS SUPPORTED ORGANIZATION WILL RECEIVE A FAVORABLE DETERMINATION LETTER UPON PROCESSING OF THE EXEMPT APPLICATION. SCHEDULE A, SECTION A, QUESTION 5A THE ORGANIZATION ADDED KAPLAN GENERAL HOSPITAL, D/B/A ABROM KAPLAN MEMORIAL HOSPITAL (FEIN:47-2540179) AS A SUPPORTED ORGANIZATION. KAPLAN IS A HOSPITAL IN THE AREA SURROUNDING LAFAYETTE GENERAL HEALTH SYSTEMS. THE ADDING OF THIS ORGANIZATION HAD FULL BOARD APPROVAL. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 151509 174268 151509 174268 67934210 636621767 68085719 636796035 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 23762 24586 189962 174268 412578 250000 250000 250000 250000 1000000 1500000 23762 24586 189962 174268 412578 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 $121,129 FOR GOVERNMENTAL RELATIONS AND OTHER CONSULTING SERVICES. THIS IS ALSO CONSIDERED LOBBYING EXPENSE. 11531731 11531731 245849812 88051616 157798196 2224160 1152982 1071178 101383244 56617198 44766046 6694287 6694287 221861438 INVESTMENT IN LAFAYETTE HEALTH VENTURES 8212806 INVESTMENT IN LAFAYETTE GENERAL MEDICAL CENTER 309804198 INVESTMENT IN UHC 32525159 INVESTMENT IN AGH 3154921 DUE FROM RELATED PARTY 60469537 FINANCING COSTS 53107 BOND ISSUE COSTS 1657592 GOLDMAN SACHS 82384252 INVESTMENT IN LAFAYETTE FOUNDATION 823823 INVESTMENT IN ABROM KAPLAN MEMORIAL HOSPITAL 1297622 INVESTMENT IN ST. MARTIN HOSPITAL 5288244 505671261 DUE TO RELATED PARTY 268638309 SELF FUNDED HEALTH INSURANCE 1277796 SHORT TERM NOTES PAYABLE 24634904 CAPITALIZED LEASE OBLIGATION 3047701 297598710 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 ACADANIA OUTREACH CENTER 355 MONROE STREET LAFAYETTE LA 70501 581925867 501(C)(3) 6000 DONATION AMERICAN HEART ASSOCIATION 312 GUILBEAU RD STE 6C LAFAYETTE LA 70501 135613797 501(C)(3) 15000 DONATION CITY OF YOUNGSVILLE 305 IBERIA STREET YOUNGSVILLE LA 70592 720593322 GOVERNMENT 17500 DONATION FESTIVAL INTERNATIONAL DE LOUISIANE 200 GARFIELD STREET LAFAYETTE LA 70501 581705676 501(C)(3) 25000 DONATION FREE TO BREATHE 1 POINT PLACE STE 200 MADISON WI 53719 450505050 501(C)(3) 5000 DONATION KOMEN ACADIANA 303 CHANCE STREET LAFAYETTE LA 70506 721436764 501(C)(3) 6500 DONATION LAFAYETTE COMMUNITY HEALTHCARE 1317 JEFFERSON ST LAFAYETTE LA 70501 721221982 501(C)(3) 10000 DONATION LAFAYETTE YOUTH SOCCER ASSOCIATION 210 SONNY ROY LANE LAFAYETTE LA 70507 581902571 501(C)(3) 15000 DONATION LOUISIANA OPEN INC 124 HEYMANN BLVD 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 SER 2130 KALISTE SALOOM RD 200 LAFAYETTE LA 70508 753023211 501(C)(3) 10000 DONATION NEW CARDIOVASCULAR HORIZONS FO 3639 AMBASSADOR CAFFERY PARKWAY SUITE 605 LAFAYETTE LA 70503 463186713 PENDING 501(C)(3) 25000 DONATION OIL CENTER RENAISSANCE ASSOC 1005 W SAINT MARY BLVD LAFAYETTE LA 70503 721257087 501(C)(6) 27800 DONATION SOUTH LA COMMUNITY COLLEGE 1101 BERTRAND DR LAFAYETTE LA 70506 721425264 501(C)(3) 38500 DONATION UNITED WAY OF ACADIANA 215 E PINHOOK RD LAFAYETTE LA 70501 720513639 501(C)(3) 15560 DONATION LAFAYETTE HEALTH VENTURES INC 1214 COOLIDGE BLVD LAFAYETTE LA 70503 721006966 501(C)(3) 14291554 AFFILIATE SUPPORT UNIVERSITY HOSPITAL AND CLINICS 1214 COOLIDGE BLVD LAFAYETTE LA 70503 462605366 501(C)(3) 15760601 AFFILIATE SUPPORT KAPLAN GENERAL HOPSITAL 1214 COOLIDGE BLVD LAFAYETTE LA 70503 472540179 PENDING 501(C)(3) 441531 AFFILIATE SUPPORT ACADIA GENERAL HOSPITAL 1305 CROWLEY RAYNE HWY CROWLEY LA 70526 464958152 501(C)(3) 3271473 AFFILIATE SUPPORT LAFAYETTE GENERAL FOUNDATION 1214 COOLIDGE BLVD LAFAYETTE LA 70503 371766778 501(C)(3) 357867 AFFILIATE SUPPORT 19 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 0 1 0 0 0 1 1 0 0 JUAN J PEREZ-RUIZ MD CHIEF OF STAFF - PART YEAR 271163 0 0 0 0 0 3522 0 7145 0 281830 0 0 0 JOHN SCHUTTE MD TRUSTEE - PART YEAR 1274945 52000 153160 0 0 0 11725 0 7744 0 1447574 52000 0 0 DAVID CALLECOD PRESIDENT/CEO-LGHS 774176 0 309670 0 93930 0 228970 0 9644 0 1416390 0 0 0 PATRICK W GANDY JR EVP/CEO-LGMC 425620 0 127686 0 42790 0 87193 0 6957 0 690246 0 0 0 ROGER MATTKE SVP/CFO 393952 0 118186 0 37523 0 104281 0 10763 0 664705 0 0 0 GORDON E ROUNTREE JR SVP/GENERAL COUNSEL 345644 0 103693 0 31552 0 77922 0 8111 0 566922 0 0 0 REBECCA BENOIT VP-CNO 236912 0 59228 0 10990 0 46105 0 2547 0 355782 0 0 0 AMANDA LOGUE MD VP/CHIEF MEDICAL OFFICER 250635 0 83056 0 0 0 5962 0 12905 0 352558 0 0 0 CRETAN MEADOWS SVP/STRATEGIC PLANNING 233731 0 71625 0 7903 0 2576 0 3164 0 318999 0 0 0 KATHERINE D HEBERT COO/VP UHC 213772 0 42754 0 19569 0 42691 0 7109 0 325895 0 0 0 DEAN B DUCOTE VP/OPERATIONS 213720 0 32058 0 1768 0 16800 0 1937 0 266283 0 0 0 EDWINA S MALLERY AVP/INFORMATION SYSTEMS 204183 0 30825 0 1661 0 4307 0 1463 0 242439 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, LINE 4B 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 $555,800. 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, DEAN DUCOTE, VP/OPERATIONS, REBECCA BENOIT, CNO AND KATHERINE HEBERT, COO/VP - UHC. DISTRIBUTIONS FROM SERP PLAN, INCLUDED IN 2014 W-2 WAGES, TOTALLED $82,286. WAGES: DAVID CALLECOD, PRESIDENT/CEO-LGHS, PATRICK GANDY, EVP/COO-LGMC, ROGER MATTKE, SVP/CFO,KATHERINE HEBERT COO/VP-UHC, 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 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 A 3245000 84137555 3733975 1550751 78852829 2011 1 0 1 1 B 3459857 3850000 59703 3790297 2011 0 0 1 1 C 60000000 414018 59585982 2015 0 0 1 1 A 0 0 1 1 0 0.00000 0.04000 0.04000 1 0 1 B 0 0 1 1 0 0.00000 0.04000 0.04000 1 0 1 C 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 A 1 B 1 C 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 582250 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 112654 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 944529 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 5000 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 $85,381.68. 0 ACADIANA FAMILY PHYSICIANS DR. BENJAMIN DOGA, TRUSTEE, IS A MEMBER OF ACADIANA FAMILY PHYSICIANS 221057 ACADIANA FAMILY PHYSICIANS LEASES MEDICAL OFFICE SPACE FROM LAFAYETTE GENERAL HEALTH SYSTEMS IN THE ANNUAL AMOUNT OF $221,057 0 DR BRADLEY CHASTANT II DR. BRADLEY CHASTANT, II IS THE SON OF TRUSTEE, DR. BRADLEY CHASTANT 251337 DR. BRADLEY CHASTANT, II IS A PAID EMPLOYEE OF LAFAYETTE GENERAL HEALTH SYSTEMS. HIS GROSS EARNINGS, INCLUDING WAGES AND BENEFITS WAS 251,337 FOR FYE 9/30/15. 0 DR RYAN P CHASTANT DR. RYAN P. CHASTANT IS THE SON OF TRUSTEE, DR. BRADLEY CHASTANT 120558 DR. RYAN P. CHASTANT IS A PAID EMPLOYEE OF LAFAYETTE GENERAL HEALTH SYSTEMS. HIS GROSS EARNINGS, INCLUDING WAGES AND BENEFITS WAS 120,558 FOR FYE 9/30/15. 0 ACADIANA UROLOGY LLC DR. SAMUEL SHUFFLER, TRUSTEE, IS A MEMBER OF ACADIANA UROLOGY, LLC 66660 ACADIANA UROLOGY,LLC LEASES MEDICAL OFFICE SPACE FROM LAFAYETTE GENERAL HEALTH SYSTEMS IN THE ANNUAL AMOUNT OF $66,660 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. 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 -10. FORM 990, PART XII, LINE 2C THE PROCESS FOR SELECTION OF AUDITOR HAS NOT CHANGED FROM THE PRIOR YEAR. 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