2016-05-16T10:16:33-05:00 2015-06-30 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2014-07-01 720780429 Ollie Steele Burden Manor INC % JEFF LIMBOCKER OLLI 2257657709 4250 ESSEN LANE Baton Rouge LA 70809 JEFF LIMBOCKER CFO 2257657709 2016-05-11 true RYAN HOOKS P00746825 2253444000 2016-05-11 2014 2016-08-17 19:52:53Z KAREN ALLEN 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 20370263 false 0928 X N/A X 1963 LA The purpose of the hospital is to provide CARE FOR THE ill INJURED OR DISABLED PERSONS,ESPECIALLY THE ELDERLY AND FOR THE ENHANCEMENT OF HEALTH OF THE ELDERLY IN THE COMMUNITY 10 8 595 123 0 244443 3867 19862601 20362907 1106 3489 0 0 20108150 20370263 0 0 0 0 14386385 14506031 0 0 0 6948032 7328239 21334417 21834270 -1226267 -1464007 20815805 20370055 14240896 15255431 6574909 5114624 X ATTACHMENT 1 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 16768397 20362907 Ollie Steele Burden Manor operates two nursing home facilities specially designed to provide the highest level of care for those suffering with complex physical health issues including Alzheimer's disease and dementia. The nursing homes provide 24 hour nursing care in a rehabilitative setting that ministers to the needs of the whole person. The nursing home provided care and housing for 107,587 resident days. 16768397 true false false false false false false false false false true false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 12 0 true 595 true false false false false false false false false false false X 10 8 false false false false true true true true true false false true false false false false false false X JEFF LIMBOCKER 2257656565 5000 HENNESSY BLVD BATON ROUGE LA 70808 X Karen B Allen President of SSD 12.5 37.5 X X 0 266509 60880 K Scott Wester Board Member 1.0 56.5 X X 0 784733 64461 Mary Tauzin Board Member 1.0 0.0 X 0 0 0 James W Firnberg Sr Board Member 1.0 0.0 X 0 0 0 Kevin Curry Board Member 1.0 0.0 X 0 0 0 Sr Ann Catherine Nguyen Board Member 1.0 0.0 X 0 0 0 SR BARBARA ARCENEAUX BOARD MEMBER 1.0 0.0 X 0 0 0 ALDEN L ANDRE CHAIRMAN 1.0 3.0 X X 0 0 0 Arthur Landry BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID THOMPSON Chairman 1.0 0.0 X X 0 0 0 Lawrence Braud MD BOARD MEMBER 1.0 0.0 X 0 0 0 Jayne Apple BOARD MEMBER 1.0 0.0 X 0 0 0 Jeffrey D Limbocker CFO 1.0 49.0 X 0 474458 59003 0 1525700 184344 0 false true false TRITON HEALTHCARE 8128 FLORIDA BLVD DENHAM SPRINGS LA 70726 THERAPY SERVICES 642306 ADVANTAGE NURSING SERVICE 3340 SEVERN AVE SUITE 320 METARIE LA 700027410 STAFFING SERVICES 188974 SOUTHERN MEDICAL STAFFING 1305 METRO DRIVE SUITE 6 ALEXANDRIA LA 71301 STAFFING SERVICES 246480 3 3867 3867 PATIENT REVENUE 900099 20264788 20264788 BEAUTY/BARBER SERVICES 900099 54896 54896 MISCELLANEOUS REVENUE 900099 27176 27176 FRANCISCAN SISTER SERVICES 900099 9600 9600 VENDING REVENUE 900099 6447 6447 20362907 3489 3489 0 0 0 0 0 0 0 0 0 0 20370263 20362907 3489 0 0 0 0 0 0 0 10824989 8443491 2381498 809920 607440 202480 2094784 1256870 837914 776338 613307 163031 53815 53815 3341 3341 0 0 0 0 1845811 1661230 184581 38943 25313 13630 1996918 1297997 698921 58916 58916 0 773118 595301 177817 3237 363 2874 0 6905 753 6152 25483 25483 0 1038710 830968 207742 67650 67650 PROVIDER FEES 1075870 1075870 MEDICAL SUPPLIES EXPENSE 334011 334011 RECRUITMENT 5511 5511 21834270 16768397 5065873 0 X 0 0 1898349 2274662 0 0 1333403 1225943 0 0 0 0 0 0 62531 47631 120655 124509 30287914 13941855 17031863 16346059 0 0 155004 161251 0 0 214000 190000 0 0 20815805 20370055 1802376 1630230 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12438520 13625201 14240896 15255431 X 6570047 5109298 4862 5326 0 0 6574909 5114624 20815805 20370055 -1464007 3722 X false true X true false X 905168 905168 23190218 9748426 13441792 573962 428506 145456 5434290 3764923 1669367 184276 184276 16346059 0 DEPOSITS 71301 DUE TO AFFLILIATES 9154575 ACCRUED PENSION COSTS 4399325 13625201 X FIN 48 (ASC 740) FOOTNOTE SCHEDULE D 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 judgement occurs. No reserves for uncertain tax positions have been recorded. reserves for uncertain tax positions have been recorded. false true false false false false false false false Karen B Allen President of SSD 0 192362 0 53500 0 20647 0 38360 0 22520 0 327389 0 Jeffrey D Limbocker CFO 0 354015 0 103280 0 17163 0 35804 0 23199 0 533461 0 K Scott Wester Board Member 0 583808 0 180278 0 20647 0 37476 0 26985 0 849194 0 PART I QUESTION 3 THE PRESIDENT 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 PRESIDENT'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 DETERMINATION IS THEN DOCUMENTED BY THE COMPENSATION COMMITTEE. PART I QUESTION 4A A board member, who is the CEO of a related organization, 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. 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. An officer is entitled to a severance benefit. The payout of such benefit is remote as it is effective only for a termination of employment without cause, for good reason or due to change of control. If triggered, the employee would be paid his/her base salary and provided retirement and welfare benefits for an entitlement period. The entitlement period is 12 months. No payments were made under the plan in the current year. PART I QUESTION 4B FMOLHS maintains two 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 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 plan in the current year. FORM 990, PART VI, QUESTION 6 OUR LADY OF THE LAKE HOSPITAL, INC.( AN IRC SECTION 501 (C)(3) ORGANIZATION) IS THE SOLE MEMBER OF OLLIE STEELE BURDEN MANOR, INC. FORM 990, PART VI, QUESTION 7A OUR LADY OF THE LAKE HOSPITAL INC., AS THE SOLE MEMBER OF OLLIE STEEL BURDEN MANOR, INC., RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF OLLIE STEELE BURDEN MANOR, INC. FORM 990, PART VI, QUESTION 7B OUR LADY OF THE LAKE HOSPITAL, AS THE SOLE MEMBER OF OLLIE STEELE BURDEN MANOR, INC. RESERVES THE FOLLOWING POWERS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES, PURPOSES OF CORPORATION 2. TO AMEND, ALTER, MODIFY OR REPEAL ARTICLES OF INCORPORATION AND BYLAWS OF CORPORATION 3. TO AUTHORIZE MERGER, CONSOLIDATION OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES 4. TO DISSOLVE AND DISTRIBUTE ASSETS OF THE CORPORATION 5. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION 6. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER IMMOVABLE PROPERTY ON BEHALF OF CORPORATION 7. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION 8. TO APPOINT FISCAL AUDITOR OF CORPORATION 9. 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 10. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION 11. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION 12. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION FORM 990, PART VI, QUESTION 12C OLLIE STEELE BURDEN MANOR 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 OLLIE STEELE BURDEN MANOR IS A CHARITABLE ORGANIZATION, AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OLLIE STEELE BURDEN MANOR 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. FORM 990, PART VI, SECTION C, QUESTION 19 OLLIE STEELE BURDEN MANOR, INC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990 PART VI, SECTION B QUESTION 15A & 15B OTHER RELATED TAX EXEMPT ORGANIZATIONS SET THE COMPENSATION AND PAY THE EXECUTIVES. THAT BOARD OF DIRECTORS DESIGNATES THE COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE COMPENSATION ANNUALLY OF EXECUTIVES. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY OUTSIDE SOURCES. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, QUESTION 11 AFTER PREPARATION OF THE FORM 990 BY KPMG LLP, MANAGEMENT REVIEWED THE FORM 990. A COPY OF THE FORM 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. FORM 990, PART VI, QUESTIONS 12-14 THROUGHOUT THE TAX YEAR, THE ORGANIZATION HAD A CONFLICT OF INTEREST POLICY, DOCUMENT RETENTION POLICY, AND A WHISTLEBLOWER POLICY IN PLACE ALTHOUGH THEY WERE NOT APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE JUNE 30, 2015. THE CONFLICT OF INTEREST POLICY AND THE DOCUMENT RETENTION POLICY HAVE, HOWEVER, BEEN APPROVED BY THE BOARD OF DIRECTORS OF OUR LADY OF THE LAKE HOSPITAL, INC. (THE ORGANIZATION'S SOLE-MEMBER). Section 1.263(A)-3 (N) Election - BOOK CONFORMITY ELECTION OLLIE STEELE BURDEN MANOR, 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, 2015. Section 1.263(a)-1(f) ELECTION- DE MINIMIS SAFE HARBOR Ollie Steele Burden Manor, INC. hereby makes the de minimis safe harbor election under Section 1.263(a)-1(f) of the Treasury Regulations, effective only for the tax year ending June 30,2015. Taxpayer does not have an Applicable Financial Statement for the year of the election. This election permits the taxpayer to deduct for tax purposes any item deducted under its book policy that does not exceed $500 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). 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