2015-07-31T08:18:26-05:00 2014-09-30 201941244 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2013-10-01 264626264 ST MARTIN HOSPITAL INC STMA 3375071201 210 CHAMPAGNE BLVD BREAUX BRIDGE LA 70517 BRYAN LAPEROUSE INTERIM ADMINISTRATOR 3375071201 2015-07-30 1 MARSHA H DIECKMAN CPA P00246741 6013261000 2015-07-30 2013 2016-03-07 17:11:31Z DAVID CALLECOD 1214 COOLIDGE BLVD LAFAYETTE LA 70503 20743847 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 2 178 30 0 0 40 6795 16428076 20534903 0 498 154866 201651 16582982 20743847 3596 3235 0 0 6583701 7261652 0 0 0 11297441 11956113 17884738 19221000 -1301756 1522847 7335156 10101325 5816822 7060144 1518334 3041181 ST. MARTIN HOSPITAL'S MISSION IS TO IMPROVE, MAINTAIN AND RESTORE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES WE SERVE. 0 0 15233791 3235 20708404 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 4,284, TOTAL EMERGENCY ROOM VISITS WERE 17,310, AND TOTAL REHAB VISITS WERE 19,461. 15233791 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 50 0 1 178 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 44.00 X X 0 1232869 142939 KATHERINE D HEBERT CEO/SECRETARY 40.00 1.00 X X 0 283489 10427 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 DOLLIE HAMNER PHARMACIST 40.00 0.00 X 115684 0 6054 DEBORAH K HIGGINBOTHAM RN 53.00 0.00 X 123065 0 5317 CATHIE A BOUDREAUX RN 40.00 0.00 X 115857 0 11289 354606 1516358 176026 3 0 1 0 SOUTHWEST CONTRACTORS LLC 100 CENTRAL STREET STE 100 LAFAYETTE LA 70501 CONSTRUCTION CONTRACTORS 1991723 REHABCARE GROUP INC PO BOX 502096 ST LOUIS MO 631502096 CONTRACTED REHAB DEPT 717715 CARDIOVASCULAR INSTITUTE OF THE SOUTH 225 DUNN STREET HOUMA LA 70360 CARDIOLOGY DIAGNOSTIC SERVICES 609328 CORRECT CARE INC PO BOX 9146 MANDEVILLE LA 70470 ER PHYSICIAN SERVICES 158639 WARREN J DEGATUR MD 206 CHAMPAGNE BLVD BREAUX BRIDGE LA 70517 INCOME GUARANTEE PHYSICIAN SERVICES 122204 5 6795 6795 PATIENT SERVICE REVENUE 621990 20534903 20534903 20534903 498 498 28150 0 28150 28150 28150 OTHER REVENUE 900099 147473 147473 DIETARY REVENUE 722210 26028 26028 173501 20743847 20708404 0 28648 3235 3235 6223633 5374729 848904 65626 49704 15922 526599 422858 103741 445794 375670 70124 278602 278602 51914 1428 50486 177967 158038 19929 273339 183560 89779 9495 6307 3188 7813 2536 5277 288865 1895 286970 330107 330107 48368 48368 BAD DEBT 3964357 3964357 CONTRACT LABOR 3701849 2089445 1612404 MEDICAL SUPPLIES 1541181 1541181 EQUIP. RENTAL & REPAIR 858450 490093 368357 423806 238648 185158 19221000 15233791 3987209 0 462248 377610 1901143 2563726 405245 504738 14487 13713 4643486 919222 3926213 3724264 625820 2917274 7335156 10101325 854635 1006766 4962187 6053378 5816822 7060144 X 1518334 3041181 1518334 3041181 7335156 10101325 1522847 0 X X 0 1 X 1 0 X X 5889 189962 5889 189962 15227902 550741154 15233791 550931116 911690 1000000 227923 250000 0 0 0 0 826841 881274 1000000 2708115 4062173 1821 3249 189962 195032 206710 220319 250000 677029 1015544 1821 3249 189962 195032 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. 3147410 408963 2738447 632739 82194 550545 824188 428065 396123 39149 39149 3724264 OTHER ASSETS 26854 OTHER ACCOUNTS RECEIVABLE 115920 RELATED PARTY RECEIVABLES 2774500 2917274 OTHER ACCOUNTS PAYABLE 2404643 RELATED PARTY PAYABLES 149972 CAPITAL LEASE OBLIGATION 3498763 6053378 X PART X, LINE 2: THE ORGANIZATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACS 740. FASB ACS 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, DERECOGNITION, 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 FOR YEARS 2010 THROUGH 2012 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 13144 2911660 -2898516 0.00000 2745746 1511060 1234686 0.08090 2758890 4422720 -1663830 0.08090 1173630 769620 404010 0.02650 3235 3235 0.00020 1176865 769620 407245 0.02670 3935755 5192340 -1256585 0.10760 1 3964357 3171486 7261771 6985652 276119 X 1 1 1 1 ST MARTIN HOSPITAL INC 210 CHAMPAGNE BLVD BREAUX BRIDGE LA 70517 X X X ST MARTIN HOSPITAL 1 1 X X X X X X X X X X 12 1 0 1 X HTTP://WWW.LAFAYETTEGENERAL.COM/SITES/WWW X X X X X X 0 0 1 1 100.000000000000 1 200.000000000000 1 X 1 1 X X X X 1 0 1 X 0 0 ST. MARTIN HOSPITAL PART V, SECTION B, LINE 1J: CHNA ALSO DESCRIBES THE INTERVIEWS WITH HEALTHCARE PROVIDERS IN THE COMMUNITY AND THE FOCUS GROUPS USED IN ORDER TO OBTAIN DATA. ST. MARTIN HOSPITAL PART V, SECTION B, LINE 3: 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 7: 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. ST. MARTIN HOSPITAL PART V, SECTION B, LINE 14G: THE POLICY IS DESCRIBED IN OUR PATIENT INFORMATION PACKETS PROVIDED DURING THE ADMISSION PROCESS. 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 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 $ 3,964,357. 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: THE ORGANIZATION REPORTS ACCOUNTS RECEIVABLE NET OF ESTIMATED ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS AND ADJUSTMENTS. TO PROVIDE FOR ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE, THE ORGANIZATION ESTABLISHES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS TO REDUCE THE CARRYING AMOUNT OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THE AMOUNT CHARGED TO THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON THE ORGANIZATION'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, AND TRENDS IN GOVERNMENT REIMBURSEMENT. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN OFF WHEN THE ORGANIZATION HAS DETERMINED THE ACCOUNT WILL NOT BE COLLECTED.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 2014 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 744400 0 291805 0 196664 0 133617 0 9322 0 1375808 0 0 KATHERINE D HEBERT CEO/SECRETARY 0 205544 0 40288 0 37657 0 3297 0 7130 0 293916 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 $228,600, 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 2013 W-2 WAGES, TOTALLED $210,535. THE FOLLOWING RECEIVED DISTRIBUTIONS, INCLUDED IN THEIR 2013 W-2 WAGES: DAVID CALLECOD, PRESIDENT/CEO-LGHS AND KATHERINE HEBERT, ADMINISTRATOR. PART I, LINE 6 THE ORGANIZATION DOES HAVE A PROFIT SHARING PLAN (SUCCESS SHARING) 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 PROFIT SHARING IS 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. 122204 DR. DEGATUR'S PRACTICE WAS ISSUED A FORM 1099 IN THE AMOUNT OF $122,203.60. OF THIS AMOUNT, 101,472.43 WAS FOR INCOME GUARANTEE PAYMENTS, UNDER AGREEMENT, BETWEEN THE PRACTICE AND THE HOSPITAL. $2,500 WAS FOR ON CALL PAY AND $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. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM PREVIOUS YEAR LAFAYETTE GENERAL MEDICAL CENTER INC 1214 COOLIDGE BLVD LAFAYETTE LA 70503 720535375 HOSPITAL LA 501(C)(3) 170(B)(1)(A) (III) LAFAYETTE GENERAL HEALTH SYSTEMS 0 LAFAYETTE HEALTH VENTURES INC PO BOX 53092 LAFAYETTE LA 70503 721006966 PHYSICIAN PRACTICES LA 501(C)(3) 509 (A)(3) LAFAYETTE GENERAL HEALTH SYSTEMS 0 LAFAYETTE GENERAL HEALTH SYSTEMS INC 1214 COOLIDGE BLVD LAFAYETTE LA 70503 383646817 HEALTHCARE SUPPORT LA 501(C)(3) 509 (A)(3) N/A 0 UNIVERSITY HOSPITAL & CLINICS INC 1214 COOLIDGE BLVD LAFAYETTE LA 70503 462605366 HOSPITAL LA 501(C)(3) 170(B)(1)(A) (III) LAFAYETTE GENERAL HEALTH SYSTEMS 0 ACADIA GENERAL HOSPITAL INC 1305 CROWLEY RAYNE HWY CROWLEY LA 70526 464958152 HEALTHCARE SUPPORT LA PENDING 501(C)(3) 170(B)(1)(A) (III) LAFAYETTE GENERAL HEALTH SYSTEMS 0 LAFAYETTE GENERAL FOUNDATION INC 1214 COOLIDGE BLVD LAFAYETTE LA 70503 371766778 FOUNDATION LA PENDING 501(C)(3) 509 (A)(3) LAFAYETTE GENERAL HEALTH SYSTEMS 0 LAFAYETTE INVESTMENT GROUP LLC 1000 W PINHOOK SUITE 206 LAFAYETTE LA 70503 421594593 MANAGEMENT LA N/A LAFAYETTE GENERAL SURGICAL HOSPITAL LLC 1000 W PINHOOK LAFAYETTE LA 70503 481300080 SURGICAL HOSPITAL LA N/A OIL CENTER SURGICAL PLAZA LLC 1000 W PINHOOK STE 204 LAFAYETTE LA 70503 464090110 SURGERY CENTER LA N/A GREATER LAFAYETTE PHYSICIANS HOSPITAL ORG 117 AUDUBON BLVD LAFAYETTE LA 70503 721286969 SUPPORT SERVICES LA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 LAFAYETTE GENERAL MEDICAL CENTER 1214 COOLIDGE BOULEVARD LAFAYETTE LA 705032621 720535375 X 0 0 0 297068790 297068790 1000000 250000 0 0 0 ST MARTIN HOSPITAL 210 CHAMPAGNE BOULEVARD BREAUX BRIDGE LA 70517 264626264 X 5889 0 5889 15227902 15233791 911690 227923 0 0 0 UNIVERSITY HOSPITAL AND CLINICS INC 1214 COOLIDGE BOULEVARD LAFAYETTE LA 705032621 462605366 X 7246 0 7246 138358132 138365378 1000000 250000 0 0 0 ACADIA GENERAL HOSPITAL INC 1305 CROWLEY RAYNE HWY CROWLEY LA 70526 464958152 X 2142 0 2142 11655391 11657533 732877 183219 0 0 0 LAFAYETTE GENERAL HEALTH SYSTEMS 1214 COOLIDGE BOULEVARD LAFAYETTE LA 705032621 383646817 X 174685 0 174685 88430939 88605624 1000000 250000 0 0 0