2014-08-14T15:58:00-05:00 2013-09-30 201941244 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2012-10-01 720535375 LAFAYETTE GENERAL MEDICAL CENTER INC LAFA 3372898125 1214 COOLIDGE BOULEVARD LAFAYETTE LA 705032621 ROGER MATTKE 3372898125 2014-08-13 1 MARSHA H DIECKMAN CPA P00246741 6013261000 2014-08-12 2012 2015-11-30 17:44:51Z DAVID CALLECOD 1214 COOLIDGE BOULEVARD LAFAYETTE LA 70503 364831308 0 X WWW.LAFAYETTEGENERAL.COM X 1911 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 21 15 2106 134 4466468 -831375 176822 596224 267878843 342198784 4544236 8255877 16078835 12660179 288678736 363711064 37046759 39953882 0 0 92736428 100019469 0 0 0 174661444 218930530 304444631 358903881 -15765895 4807183 372408831 425656546 180941977 229673800 191466854 195982746 X LAFAYETTE GENERAL MEDICAL CENTER'S MISSION IS TO IMPROVE, MAINTAIN AND RESTORE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES WE SERVE. 0 0 303393734 39953882 346769712 PROGRAM SERVICES STATISTICS RELATED TO PROVIDING COMMUNITY MEDICAL CARE FOR THE HOSPITAL: TOTAL ACUTE PATIENT DAYS WERE 74,477, TOTAL NURSERY DAYS WERE 4,120, TOTAL REHAB DAYS WERE 3,124 AND TOTAL MENTAL HEALTH DAYS WERE 6,985. OTHER SIGNIFICANT HEALTHCARE SERVICES PROVIDED INCLUDED 65,029 EMERGENCY ROOM VISITS, 12,390 SURGERIES (INPATIENT AND OUTPATIENT), AND 2,059 DELIVERIES.THE ORGANIZATION PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY. SERVICES INCLUDED INPATIENT AND OUTPATIENT CARE IN FURTHERANCE OF THE ORGANIZATION'S HEALTHCARE MISSION. THE REVENUES FORM THESE SERVICES ARE $622,184,303 AND $411,701,788, RESPECTIVELY. THERE WERE ACUTE AND SKILLED CARE SERVICES NOT FULLY COMPENSATED. THESE INCLUDED MEDICARE / MEDICAID CONTRACTUALS WITH $469,849,529 OF UNCOMPENSATED SERVICES, OTHER CONTRACTUALS WITH $221,571,364 OF UNCOMPENSATED SERVICES, AND BAD DEBTS OF $52,274,525. THE NET REVENUES OF THE SERVICES PROVIDED WERE $290,190,673.LAFAYETTE GENERAL MEDICAL CENTER (LGMC) SERVES THE NINE PARISHES IN LOUISIANA DESIGNATED ACADIANA WITH 377 STAFFED BEDS AND 2,106 EMPLOYEES. LGMC REMAINS THE AREA'S LARGEST, FULL SERVICE, ACUTE-CARE MEDICAL CENTER.OUR HOSPITAL MISSION IS TO RESTORE, MAINTAIN, AND IMPROVE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. WE ARE A COMMUNITY-OWNED AND LOCALLY MANAGED HOSPITAL THAT STAYS TRUE TO OUR MISSION BY DEDICATING SIGNIFICANT RESOURCES TO COMPENSATE A COMPASSIONATE, HIGHLY SKILLED STAFF; ACQUIRE ADVANCED TECHNOLOGY; AND DEVELOP SERVICE IMPROVEMENTS EACH YEAR.IN LINE WITH OUR GOAL OF BUILDING A REGIONAL HEALTH CARE SYSTEM, LAFAYETTE GENERAL HAS ESTABLISHED CLINICAL AFFILIATIONS WITH OUTLYING HOSPITALS, EXTENDING OUR BEST PRACTICES IN CANCER TREATMENTS, CARDIOLOGY, AND NEUROSCIENCE SUPPORT TO OUTLYING PARISHES.ON JULY 1, 2013, AFTER LAFAYETTE GENERAL HEALTH TOOK OVER MANAGEMENT OF UNIVERSITY HOSPITAL & CLINICS (FORMERLY UNIVERSITY MEDICAL CENTER) WHEN IT WAS RUN BY THE STATE OF LOUISIANA, THE RESIDENCY PROGRAM WAS EXPANDED TO LAFAYETTE GENERAL MEDICAL CENTER. THESE TWO HOSPITALS SHARE IN A SYNERGISTIC RELATION, WHERE RESIDENTS BASED OUT OF LSU'S NEW ORLEANS AND BATON ROUGE CAMPUSES ROTATE THROUGHOUT EACH OF THESE HOSPITALS.LAFAYETTE GENERAL CONTINUES TO EXPAND ITS SERVICES AND FACILITIES IN ORDER TO MEET THE GROWING NEEDS OF OUR COMMUNITY. ORIGINALLY BUILT IN 1963, THE 10-STORY LAFAYETTE GENERAL MEDICAL CENTER MAIN BUILDING COMPLETED AN EXTERIOR AND INTERIOR DESIGN RENOVATION TO FOCUS ON PATIENT HEALTH CARE BY CREATING A HEALING-FOCUSED AND COMFORTABLE ENVIRONMENT. THE $70 MILLION RENOVATION PROJECT ADDED MORE THAN 65 SQUARE FEET OF SPACE TO PATIENT ROOMS AND MORE THAN 12,500 SQUARE FEET OF OVERALL SPACE WITH LARGER PATIENT BATHROOMS, SHOWERS AND A MODERNIZED PATIENT CARE INFRASTRUCTURE.CONSTRUCTION BEGAN THIS FISCAL YEAR ON THE $52.5 MILLION EMERGENCY DEPARTMENT AND OPERATING ROOM EXPANSION AND RENOVATION PROJECT. THE EXPANSION WILL INCREASE THE EMERGENCY DEPARTMENT BED CAPACITY AND ADD TWO NEW TRAUMA ROOMS. A NEW TRAUMA ELEVATOR WILL ADD DIRECT ACCESS FROM THE EMERGENCY HELIPAD LANDING AREA TO THE ER, ICU, AND SURGERY AREAS BELOW. CONSTRUCTION IS EXPECTED TO BE COMPLETED IN FISCAL YEAR 2014.IN AN EFFORT TO MEET THE NEEDS OF THE COMMUNITY, LGMC BOASTS A CENTER OF EXCELLENCE IN MINIMALLY INVASIVE GYNECOLOGY, A CENTER OF EXCELLENCE IN NEUROSCIENCE, AND ACCREDITED CANCER CENTER, AN ACCREDITED METABOLIC AND BARIATRIC SURGERY PROGRAM, AND AN ADVANCED CERTIFIED PRIMARY STROKE CENTER.OUR ACCOLADES AND ACCREDITATIONS GROW EACH YEAR. IN OUR FISCAL YEAR 2013 WE RECEIVED THE FOLLOWING: THE HOSPITAL WAS RECOGNIZED BY CARECHEX AS BEING RANKED IN THE TOP 10% IN THE NATION FOR MEDICAL EXCELLENCE AWARDS FOR MAJOR BOWEL PROCEDURES AND MAJOR ORTHOPEDIC SURGERY, AND IN THE TOP 10% IN THE NATION FOR PATIENT SAFETY AWARDS FOR CANCER CARE AND CARDIAC CARE. WE WERE ALSO NAMED AS AMERICA'S BEST 100 HOSPITALS FOR PATIENT EXPERIENCE BY WOMENCERTIFIED. THE HOSPITAL WAS ALSO RECOGNIZED AMONG THE NATIONS "MOST WIRED" BUY HOSPITALS & HEALTH NETWORKS MAGAZINE. THE HOSPITAL WAS AS RECOGNIZED AS A 2012/2013 CONSUMER CHOICE AWARD WINNER FOR THE EIGHTH TIME BY NATIONAL RESEARCH CORPORATION, AND THE HOSPITAL RECEIVED THE 2012 PRESS GANEY TOP IMPROVER AWARD FOR INPATIENT SATISFACTION.LAFAYETTE GENERAL MEDICAL CENTER ASSUMES THE ROLE OF A COMMUNITY PARTNER IN A VARIETY OF WAYS. THROUGH FINANCIAL CONTRIBUTIONS WE WORK TO PRESERVE THE PROSPERITY OF OUR COMMUNITY, FURTHER MEDICAL EDUCATION AND RESEARCH AND HELP OUR CONSTITUENTS ACCESS THE MEDICAL CARE THEY NEED. WE COORDINATE EVENTS AND SCREENINGS FREE OF CHARGE TO MAINTAIN THE HEALTH OF THE LOCAL PUBLIC, INCLUDING FREE EKG SCREENINGS AT MONTHLY HEART FAIRS AND FREE COLORECTAL SCREENING KITS. WE ALSO EXTEND OUR WORKFORCE BEYOND THEIR DAILY RESPONSIBILITIES TO PARTICIPATE IN ACTIVITIES THAT PROVIDE FOR THE SAFETY AND BETTERMENT OF OUR COMMUNITY. FINANCIAL CONTRIBUTIONS:IN 2013 WE DONATED OVER $290,000 SUPPORTING ORGANIZATIONS THAT PARALLEL OUR MISSION IN THE COMMUNITY, EMPLOYEES THROUGH CONTINUING EDUCATION AND HELPING TO IMPROVE THE HEALTH OF THOSE WE SERVE. FROM OFFERING CLINICAL SUPPORT TO CAMP BON CEUR ATTENDEES TO SPONSORING EVENTS THAT RAISE RESEARCH MONEY AND AWARENESS FOR ILLNESSES LIKE BREAST CANCER, DIABETES AND HEART DISEASE. IN 2013 THESE MONIES WERE DONATED TO OVER 50 DIFFERENT ORGANIZATIONS IN OUR COMMUNITY.COMMUNITY OUTREACH & HEALTH CARE ACCESS CONTRIBUTIONS:LAFAYETTE GENERAL MEDIAL CENTER MAINTAINS A PROACTIVE APPROACH TO EDUCATION AND WELLNESS IN OUR COMMUNITY. ANNUALLY LGMC PROVIDES A MULTITUDE OF EDUCATIONAL SEMINARS AIMED AT EDUCATING THE PUBLIC ON PREVENTATIVE CARE AND MAINTAINING A HEALTHY LIFESTYLE. SOME OF THESE ACTIVITIES AND PROGRAMS INCLUDE:DONATED $13,677 IN DIAGNOSTIC SERVICES AS PART OF A PARTNERSHIP WITH THE LAFAYETTE COMMUNITY HEALTH CARE CLINIC.WOMEN'S AND CHILDREN'S SERVICES CURRENTLY OFFERS CLASSES WHICH INCLUDE NEWBORN CARE, LABOR AND DELIVERY PROCESS, SIBLING RELATIONSHIPS, BREASTFEEDING YOUR INFANT AND INFANT CPR. FREE SUPPORT GROUPS ARE OPEN TO RESIDENTS DEALING WITH STROKE SURVIVAL, WEIGHT LOSS SURGERY, INFANT BEREAVEMENT, AND MULTIPLE BIRTHS. LGMC ALSO PROVIDES FREE TRANSPORTATION FOR PATIENTS WITH SPECIAL NEEDS, IN ORDER TO ALLOW THEM ACCESS TO MEDICAL CARE AT THE HOSPITAL.TO IMPROVE HEALTH CARE ACCESS FOR THOSE UNINSURED WORKERS LIVING AT OR BELOW POVERTY LEVEL, LGMC MAINTAINS A REFERRAL AGREEMENT WITH THE LOCAL "LAFAYETTE COMMUNITY HEALTHCARE CLINIC" TO PROVIDE DIAGNOSTIC TESTING TO THEIR PATIENT POPULATION. LAFAYETTE GENERAL MEDICAL CENTER IS TRULY A COMMUNITY OWNED HOSPITAL CARING FOR THE NEEDS OF THE COMMUNITY AND INVESTING IN THE FUTURE WELLNESS OF OUR NEIGHBORS. 303393734 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 0 0 1 328 0 1 2106 1 1 1 0 0 0 0 0 0 0 X 21 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 BOULEVARD LAFAYETTE LA 70503 X CLAY ALLEN 3.00 1.00 X 0 0 0 MARTIN BECH 1.00 1.00 X 0 0 0 BRADLEY J CHASTANT MD 1.00 1.00 X 11000 0 0 BRADEN DESPOT 1.00 2.00 X 0 0 0 BENJAMIN DOGA MD 1.00 1.00 X 35800 0 0 JULIE FALGOUT 1.00 1.00 X 0 0 0 WILLIAM H FENSTERMAKER 1.00 1.00 X 0 0 0 PHILIP GACHASSIN MD 1.00 1.00 X 86680 0 0 ROBERT GILES 1.00 1.00 X 0 0 0 G GARY GUIDRY MD 1.00 1.00 X 0 0 0 JOBY JOHN PHD 1.00 3.00 X 0 0 0 ROSE KENNEDY MD 1.00 1.00 X 11960 0 0 EDWARD KRAMPE 1.00 2.00 X 0 0 0 FLO MEADOWS 1.00 1.00 X 0 0 0 DAVID CALHOUN 1.00 1.00 X 0 0 0 MANDI MITCHELL 1.00 1.00 X 0 0 0 GARY SALMON 1.00 1.00 X 0 0 0 SAMUEL SHUFFLER MD 1.00 1.00 X 0 0 0 E GREG VOORHIES 1.00 1.00 X 0 0 0 DAVID WILSON 1.00 1.00 X 0 0 0 DANIEL BOURQUE MD 1.00 1.00 X 44720 0 0 JOE ZANCO 1.00 1.00 X 0 0 0 JUAN J PEREZ-RUIZ MD 1.00 1.00 X 0 214889 8342 DAVID CALLECOD 40.00 4.00 X 765892 0 145251 PATRICK W GANDY JR 40.00 1.00 X 405442 0 45964 ROGER MATTKE 40.00 2.00 X 361534 0 55073 REBECCA F BENOIT 40.00 1.00 X 249484 0 18904 GORDON E ROUNTREE JR 40.00 1.00 X 311157 0 51064 ZIAD M ASHKAR MD 40.00 X 414057 0 92400 KATHERINE HEBERT 1.00 40.00 X 219825 0 41760 ANGELA MAYEUX-HEBERT MD 15.00 X 244015 0 0 CARRIE E TEMPLETON 40.00 X 172085 0 5298 CAROLYN M HUVAL 40.00 X 168546 0 35265 3502197 214889 499321 65 0 1 0 CARDIOVASCULAR INSTITUTE OF THE SOUTH AP 225 DUNN STREET HOUMA LA 703604413 CARDIOLOGY SERVICES 3635947 PARAGON CONTRACTING SERVICES INC PO BOX 634850 CINCINNATI OH 452634850 EMERGENCY SERVICES 2660921 PARISH ANESTHESIA OF LAFAYETTE 3510 N CAUSEWAY BOULEVARD METAIRIE LA 700023531 ANESTHESIA SERVICES 1538321 WASHER HILL LIPSCOMB 1744 OAKDALE DRIVE BATON ROUGE LA 708103111 ARCHITECTURE 1482274 ACADIA HOSPITAL OF LAFAYETTE 2520 NORTH UNIVERSITY AVENUE LAFAYETTE LA 70507 MANAGEMENT SERVICES 1037119 45 213974 382250 380000 596224 PATIENT REVENUE 621990 342198784 342198784 342198784 3307183 3307183 1577 1577 4356076 646245 3709831 3709831 3709831 4753886 574905 0 380097 4753886 194808 4948694 4948694 0 213974 93902 -93902 -93902 5277 0 5277 5277 OTHER REVENUE 900099 9037396 4570928 4466468 9037396 363711064 346769712 4466468 11878660 39953882 39953882 2283669 190160 2093509 83671928 69982701 13689227 1191095 726563 464532 6689364 5163615 1525749 6183413 5141212 1042201 4728201 1683421 3044780 1442543 5150 1437393 319716 319716 392630 392630 933789 144984 788805 3481661 796361 2685300 6751750 74018 6677732 3923976 866831 3057145 584611 316386 268225 6267103 6267103 17187061 10331139 6855922 4058498 4058498 MEDICAL SUPPLIES 64512040 64508958 3082 BAD DEBT 52274526 52274526 NONCLINICAL CONTRACT LA 10956812 10077175 879637 EQUIPMENT RENTAL AND MA 10945041 8358376 2586665 30170572 26138543 4032029 358903881 303393734 55510147 0 10646 6376 24704541 57816088 54483332 38841856 5500953 17163979 7403946 8531213 4323173 4578244 376977716 178680376 184186867 198297340 72564399 78924983 9778 9778 7758020 7184724 1333333 1333333 10129843 12968632 372408831 425656546 34712798 44071265 34571686 88157258 102100501 55556527 46130612 2515394 2799736 180941977 229673800 X 191466854 195982746 191466854 195982746 372408831 425656546 4807183 -291291 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 24586 27835 24586 27835 303369148 317991369 303393734 318019204 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 22710 23572 23762 24586 94630 250000 250000 250000 250000 1000000 1500000 22710 23572 23762 24586 94630 PART IV, SUPPLEMENTAL INFORMATION: ALL 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. 8829052 8829052 188937214 76038583 112898631 3924235 1832402 2091833 146075585 100408982 45666603 29211630 400409 28811221 198297340 SELF INSURANCE RESERVES 2493127 DUE TO RELATED PARTY 306609 2799736 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. GALA - 2012 121381 121381 1800 21744 5000 17806 GALA - 2013 92593 92593 3500 27503 3400 13149 213974 213974 5300 49247 8400 30955 93902 -93902 1 1 1 X 1 X 1 1 0 1 1 677694 677694 0.00220 28118835 68735407 -40616572 0.00000 28796529 68735407 -39938878 0.00220 8264861 8264861 0.02700 1146892 128001 1018891 0.00330 304440 304440 0.00100 9716193 128001 9588192 0.03130 38512722 68863408 -30350686 0.03350 1 52274526 9996000 82251530 90185355 -7933825 X 1 1 1 1 LAFAYETTE GENERAL MEDICAL CENTER INC

1214 COOLIDGE BLVD LAFAYETTE LA 70503

X X X X LAFAYETTE GENERAL MEDICAL CENTER INC 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X 1 0 1 1 100.000000000000 1 200.000000000000 1 X 1 1 X X X X 1 0 1 X 0 0 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 $ 52274526. 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 EQUALS THE 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 44% OF THE UNINSURED OUTPATIENT EMERGENCY ROOM VISITS THAT WERE ADJUSTED TO BAD DEBT MAY HAVE BEEN PATIENTS THAT COULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE POLICY BUT DID NOT INITIATE OR COMPLETE THE NECESSARY DOCUMENTATION.THE HOSPITAL DID NOT INCLUDE ANY BAD DEBTS IN OUR COMMUNITY BENEFIT CALCULATIONS. 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 2013 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. DISCLOSURE OF FAILURE - CONDUCTING OF CHNA FORM 990, PART V, SECTION B TO CONDUCT A CHNA, ALL OF THE FOLLOWING STEPS MUST BE COMPLETED:1. DEFINE COMMUNITY IT SERVES2. ASSESS THE HEALTH NEEDS OF THAT COMMUNITY3. IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY, TAKE INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THAT COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH4. DOCUMENT THE CHNA IN A WRITTEN REPORT THAT IS ADOPTED FOR THE HOSPITAL FACILITY BY AN AUTHORIZED BODY OF THE HOSPITAL FACILITY; AND5. MAKE THE CHNA REPORT WIDELY AVAILABLE TO PUBLIC (WEBSITE AND AVAILABLE IN PRINT FOR PUBLIC INSPECTION)LAFAYETTE GENERAL MEDICAL CNETER MET STEPS 1-3, BUT STEPS 4 AND 5 WEREN'T MET UNTIL OCTOBER 2013; WHICH IS AFTER THEIR YEAR END OF 9/30/13. HOSPITALS WITH YEAR ENDS BEGINNING AFTER MARCH 2012 SHOULD HAVE CONDUCTED THE CHNA BY THE END OF THEIR FISCAL YEAR. THEREFORE, LGMC DID NOT MEET THIS REQUIREMENT. HOWEVER, SINCE THE CHNA REPORT WAS COMPLETE BUT NOT ADOPTED, WE BELIEVE THEY WOULD QUALIFY FOR THE CORRECTION OF FAILURE EXEMPTION UNDER IRS NOTICE 2014-3. UNDER IRS NOTICE 2014-3, THE HOSPITAL ORGANIZATION WILL BE CONSIDERED TO HAVE DISCLOSED THE FAILURE IF IT REPORTS THE FOLLOWING INFORMATION ON ITS IRS FORM 990 SCHEDULE H:- A DESCRIPTION OF THE FAILURE, INCLUDING THE TYPE OF FAILURE, LOCATION, DATE, NUMBER OF OCCURRENCES, NUMBER OF PERSONS AFFECTED (IF ANY), FINANCIAL IMPACT, CAUSE, AND THE RELEVANT PRACTICES AND PROCEDURES IN PLACE (IF ANY) PRIOR TO THE FAILURE;LAFAYETTE GENERAL MEDICAL CENTER FAILED TO COMPLETE THE FINAL STEPS IN CONDUCTING THEIR CHNA UNTIL AFTER THEIR FISCAL YEAR END; HOWEVER, THE CHNA REPORT WAS COMPLETED AND IN ITS FINAL FORM AS OF SEPTEMBER 10, 2013. HOWEVER, THEIR SEPTEMBER BOARD MEETING WAS UNEXPECTEDLY POSTPONED UNTIL OCTOBER 1ST. THE CHNA REPORT WAS PROMPTLY ADOPTED BY THE HOSPITAL BOARD ON OCTOBER 1ST, 2013 AND IT WAS UPLOADED TO THE HOSPITAL WEBSITE SOON AFTERWARDS, MAKING IT WIDELY AVAILABLE TO THE PUBLIC. WE FEEL THAT THERE WAS NO FINANCIAL IMPACT AND NO PERSON AFFECTED BY THIS LATE ISSUING OF REPORT. PROCEDURES ARE IN PLACE TO ENSURE THE NEXT CHNA IS ADOPTED AND PUBLISHED TO THEIR WEBSITE BEFORE THAT FISCAL YEAR ENDS.- A DESCRIPTION OF THE DISCOVERY;THIS DISCOVERY WAS MADE UPON REALIZATION THAT THE BOARD MEETING WAS BEING POSTPONED.- A DESCRIPTION OF THE CORRECTION MADE, INCLUDING THE METHOD, DATE, AND WHETHER ALL PERSONS WERE RESTORED TO THE POSITION THEY WOULD HAVE BEEN IN HAD THE FAILURE NOT OCCURRED (AND IF NOT, THE REASON WHY); ANDCORRECTION WAS MADE BY APPROVING AND PUBLISHING THE CHNA REPORT TO THEIR WEBSITE AS SOON AS POSSIBLE.- A DESCRIPTION OF (1) ANY NEW OR REVISED PRACTICES AND PROCEDURES IN PLACE TO MINIMIZE THE CHANCE OF THE FAILURE RECURRING AND TO PROMPTLY IDENTIFY THE FAILURES THAT DO OCCUR; OR (2) IF NO NEW OR REVISED PRACTICES AND PROCEDURES WERE PUT IN PLACE, AN EXPLANATION AS TO WHY THEY WERE NOT NEEDED.AS NOTED ABOVE, PROCEDURES ARE IN PLACE TO ENSURE THE NEXT CHNA IS ADOPTED AND PUBLISHED TO THEIR WEBSITE BEFORE THAT FISCAL YEAR ENDS. LAFAYETTE GENERAL MEDICAL CENTER INC. PART V, SECTION B, LINE 3: THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY BY GATHERING INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVICED BY THE HOSPITAL FACILITY, AS WELL AS INDIVIDUALS PROVIDING INPUT WHO HAVE SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH. IT IS MEANT TO PROVIDE DEPTH AND RICHNESS TO THE QUANTITATIVE DATA COLLECTED. ADDITIONALLY, 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.INDIVIDUALS PROVIDING INPUT:MANDI MITCHELL, DIRECTOR OF GOVERNMENTAL AFFAIRS -LOUISIANA DEPARTMENT OF ECONOMIC DEVELOPMENT; AREA REPRESENTED: GOVERNMENT OFFICIALREBECCA BENOIT, CHIEF NURSING OFFICER - LGMC; AREA REPRESENTED:HOSPITAL STAFFBOOTSIE DURAND, CHIEF EXECUTIVE OFFICER - SOUTHWEST LOUISIANA AREA HEALTH EDUCATION CENTER; AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATION REPRESENTATIVEDR. BRYAN SIBLEY, PEDIATRICIAN; AREA REPRESENTED: COMMUNITY PHYSICIANCLAY ALLEN, CHAIRMAN OF THE BOARD OF TRUSTEES - LGMC; AREA REPRESENTED: HOSPITAL ADMINISTRATIONDAVID CALLECOD, PRESIDENT AND CEO - LGMC; AREA REPRESENTED: HOSPITAL ADMINISTRATIONFLO MEADOWS, BOARD OF TRUSTEES MEMBER - LGMC AND REALTOR - COLDWELL BANKER PELICAN REAL ESTATE; AREA REPRESENTED: HOSPITAL ADMINISTRATIONDR. GARY GUIDRY, PULMONOLOGIST AND BOARD OF TRUSTEES MEMBER - LGMC; AREA REPRESENTED: HOSPITAL STAFFJEANETTE ALCON, EXECUTIVE DIRECTOR - LAFAYETTE COMMUNITY HEALTHCARE CLINIC; AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATION REPRESENTATIVEJOEY DUREL, PRESIDENT - LAFAYETTE CITY-PARISH; AREA REPRESENTED: GOVERNMENT OFFICIALMARIA PLACER, EXECUTIVE DIRECTOR - 232-HELP; AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATION REPRESENTATIVEPATRICK GANDY, CHIEF OPERATING OFFICER- LGMC; AREA REPRESENTED: HOSPITAL ADMINISTRATIONPAULA WALTERS, EXECUTIVE DIRECTOR - LAFAYETTE COUNCIL ON AGING; AREA REPRESENTED: MEDICALLY UNDERSERVED COMMUNITY ORGANIZATION REPRESENTATIVEPHILIP GACHASSIN, BARIATRIC SURGEON - ACADIANA WEIGHT LOSS SURGERY; AREA REPRESENTED: COMMUNITY PHYSICIANRAYMOND HEBERT, EXECUTIVE DIRECTOR - COMMUNITY FOUNDATION OF ACADIANA; AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATION REPRESENTATIVEZIAD ASHKAR, CHIEF MEDICAL OFFICER - LGMC; AREA REPRESENTED: HOSPITAL ADMINISTRATIONMARGARET TRAHAN, UNITED WAY OF ACADIANA, AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATION REPRESENTATIVELOUIS HEBERT, HOSPICE FOUNDATION OF ACADIANA, INC.; AREA REPRESENTED: COMMUNITY HEALTH ORGANIZATION REPRESENTATIVEDR. PHILLIP CAILLOUET, UNIVERSITY OF LOUISIANA AT LAFAYETTE, AREA REPRESENTED: HOSPITAL REPRESENTATIVE LAFAYETTE GENERAL MEDICAL CENTER INC. PART V, SECTION B, LINE 14G: THE POLICY IS DESCRIBED IN OUR PATIENT INFORMATION PACKETS PROVIDED DURING THE ADMISSION PROCESS. PART VI, LINE 2: A FORMAL NEEDS ASSESSMENT WAS UNDERTAKEN FOR THE YEAR ENDING 09/30/13. WE ENGAGED THE CARNAHAN GROUP TO COMPLETE OUR COMMUNITY HEALTH NEEDS ASSESSMENT DURING 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. IN ADDITION, 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 EDUCATION. THE HOSPITAL ALSO MAINTAINS AN OPEN MEDICAL STAFF.THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE ACCESSED AT: HTTP://WWW.LAFAYETTEGENERAL.COM/SITES/WWW/UPLOADS/FILES/COMMUNITY%20REPORTS/LGMC-COMMUNITY-NEEDS-ASSESSMENT-FY2013.PDF PART VI, LINE 3: THE HOSPITAL COMPLIES WITH FEDERAL AND JACHO REQUIREMENTS OF POSTING NOTICES TO PATIENTS AS REQUIRED BY FEDERAL PROGRAMS. HANDOUTS ARE INCLUDED WITH THE ADMISSION PACKAGE THAT INFORMS THE PATIENT OF CONTACT INFORMATION TO DISCUSS PAYMENT OPTIONS. THE HOSPITAL IS A MEDICAID ENROLLMENT FACILITY, AND AS SUCH, THE HOSPITAL OFFERS SCREENING SERVICES FOR ELIGIBILITY FOR MEDICAID AND POSSIBLE CHARITY CARE ASSISTANCE. HOSPITAL PERSONNEL ALSO SCREEN LARGER ACCOUNTS AFTER THE ORIGINAL BILL IS ISSUED, AND CONTACT THE PATIENT TO DETERMINE QUALIFICATIONS FOR CHARITY CARE POLICY. PART VI, LINE 4: THE HOSPITAL SERVES THE NINE PARISHES IN LOUISIANA DESIGNATED AS ACADIANA AS THE LARGEST, FULL SERVICE, ACUTE CARE MEDICAL CENTER. APPROXIMATELY ONE THIRD OF THE HOSPITAL'S DISCHARGES COME FROM LAFAYETTE PARISH. THE HOSPITAL MAINTAINS AN EMERGENCY ROOM OPEN TO ALL PEOPLE REQUIRING EMERGENCY CARE WITHOUT REGARD TO THEIR ABILITY TO PAY. PART VI, LINE 5: THE HOSPITAL DOES MAINTAIN AN OPEN MEDICAL STAFF THUS ALLOWING IT TO OFFER A VARIETY OF SPECIALISTS, AND CONTINUES TO RECRUIT PHYSICIANS TO OUR AREA TO ENSURE THAT THE HOSPITAL WILL CONTINUE TO BE THE FULL SERVICE HEALTHCARE PROVIDER THAT THE COMMUNITY EXPECTS. THE HOSPITAL JOINS FORCES WITH OTHER LOCAL ORGANIZATIONS TO PROVIDE HEALTHCARE SCREENINGS AND TEST AT LOCAL EVENTS. PART VI, LINE 6: THE HOSPITAL IS AFFILIATED WITH OTHER HEALTHCARE ORGANIZATIONS. SEE FORM 990 SCHEDULE R FOR A COMPLETE LISTING. ALL OF THE ORGANIZATIONS ARE LOCAL HEALTHCARE ORGANIZATIONS WITH THE SAME PURPOSE AS THE HOSPITAL. 1 ACADIANA OUTREACH CENTER 625 N UNIVERSITY AVENUE LAFAYETTE LA 70502 581925867 501(C)(3) 5000 DONATION CAMP BON COEUR 405 W MAIN LAFAYETTE LA 70501 581710741 501(C)(3) 10000 DONATION COMMUNITY FOUNDATION OF ACADIANA 1035 CAMELIA BLVD SUITE 100 LAFAYETTE LA 70508 721493023 501(C)(3) 17500 DONATION FIBERCORPS PO BOX 3034 LAFAYETTE LA 70502 208233506 501(C)(6) 10000 DONATION GREATER LAFAYETTE CHAMBER OF COMMERCE 804 E ST MARY BLVD LAFAYETTE LA 70503 720232780 501(C)(6) 6300 DONATION LAFAYETTE COMMUNITY HEALTHCARE CLINIC 1317 JEFFERSON STREET LAFAYETTE LA 70501 721221982 501(C)(3) 11500 13677 FEE SCHEDULE LAB SERVICES DONATION; REFERENCE LAB SERVICES MILES PERRET CENTER CANCER SERVICES 2130 KALISTE SALOAM RD 200 LAFAYETTE LA 70508 753023211 501(C)(3) 9000 DONATION NAMI LOUISIANA 10842 RANCHWOOD DR BATON ROUGE LA 70835 721038877 501(C)(3) 5000 DONATION OIL CENTER RENAISSANCE ASSOCIATES 1005 E ST MARY BLVD LAFAYETTE LA 70503 721257087 501(C)(6) 8100 DONATION SOUTH LOUISIANA CLINICAL RESEARCH FOUNDATION 3639 AMBASSADOR CATTERY PKWY STE 605 LAFAYETTE LA 70503 721430540 501(C)(3) 27500 DONATION UNITED WAY OF ACADIANA 215 E PINHOOK ROAD LAFAYETTE LA 70501 720513639 501(C)(3) 15560 DONATION UNIVERSITY OF LOUISIANA AT LAFAYETTE 104 E UNIVERSITY AVENUE LAFAYETTE LA 70504 726023836 501(C)(3) 25540 DONATION SOUTH LOUISIANA COMMUNITY COLLEGE 1101 BERTRAND DRIVE LAFAYETTE LA 70506 721425264 501(C)(3) 37500 DONATION LAFAYETTE ASSOCIATION FOR RETARDED CITIZENS INC 303 NEW HOPE ROAD LAFAYETTE LA 70506 720604268 501(C)(3) 5000 DONATION LOUISIANA SUCCESS 9331 BLUEBONNET BLVD BATON ROUGE LA 70810 205591232 501(C)(3) 20000 DONATION FESTIVAL INTERNATIONAL DE LOUISIANE 444 JEFFERSON STREET LAFAYETTE LA 70501 581705676 501(C)(3) 25000 DONATION LAFAYETTE HEALTH VENTURES INC 1211 COOLIDGE STREET LAFAYETTE LA 70503 721006966 501(C)(3) 10736774 AFFILIATE SUPPORT UNIVERSITY HOSPITAL AND CLINICS 1214 COOLIDGE STREET LAFAYETTE LA 70503 462605366 501(C)(3) - PENDING 28912668 AFFILIATE SUPPORT 15 3 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CHARITABLE DONATIONS ARE MADE TO LOCAL NON-PROFIT ORGINIZATIONS THAT PARALLEL OUR HEALTHCARE MISSION IN THE COMMUNITY. DISBURSEMENTS FOR SCHOLARSHIPS, FELLOWSHIPS, AND STUDENT LOANS ARE MADE DIRECTLY IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PROGRAMS-THE PURPOSE OF WHICH THE HOSPITAL WAS ORGANIZED AND OPERATES. THE DISBURSEMENTS ARE BASED ON PERSONAL INTERVIEWS, ACADEMIC ACHIEVEMENTS, AND THE APPROVAL OF THE HOSPITAL'S ADMINISTRATION CERTAIN STANDARDS AND CONDITIONS ARE ESTABLISHED TO ENSURE THAT RECIPIENTS ARE QUALIFIED AND THE DISBURSEMENTS ARE FOR HEALTH CARE OCCUPATIONS. THE CRITERIA FOR EDUCATIONAL LOANS ARE 1) EMPLOYEES MUST HAVE COMPLETED ONE YEAR OF EMPLOYMENT. 2) EMPLOYEE HAS ATTEMPTED TO GAIN OTHER FINANCIAL ASSISTANCE. 3) MUST HAVE A LETTER OF RECOMMENDATION FROM DEPARTMENT DIRECTOR. 4) MUST NOT HAVE AN UNSATISFACTORY EVALUATION. 5)THE EMPLOYEE MUST SIGN A CONTRACT. 6) ANY SINGLE LOAN MUST NOT EXCEED $ 10,000. X X X 1 1 X X X X X 0 1 0 0 0 1 1 0 0 JUAN J PEREZ-RUIZ MD 0 214889 0 0 0 0 0 3231 0 5111 0 223231 0 0 DAVID CALLECOD 572400 0 175154 0 18338 0 135225 0 10026 0 911143 0 0 0 PATRICK W GANDY JR 317331 0 72828 0 15283 0 39625 0 6339 0 451406 0 0 0 ROGER MATTKE 290031 0 66413 0 5090 0 42725 0 12348 0 416607 0 0 0 REBECCA F BENOIT 200000 0 38250 0 11234 0 16898 0 2006 0 268388 0 0 0 GORDON E ROUNTREE JR 256381 0 48662 0 6114 0 41525 0 9539 0 362221 0 0 0 ZIAD M ASHKAR MD 334750 0 64021 0 15286 0 92400 0 0 0 506457 0 0 0 KATHERINE HEBERT 187387 0 28670 0 3768 0 32351 0 9409 0 261585 0 0 0 ANGELA MAYEUX-HEBERT MD 244015 0 0 0 0 0 0 0 0 0 244015 0 0 0 CARRIE E TEMPLETON 140000 0 28000 0 4085 0 4770 0 528 0 177383 0 0 0 CAROLYN M HUVAL 150960 0 17586 0 0 0 29896 0 5369 0 203811 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 A 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 $400,100. THE BOARD DETERMINES WHICH EMPLOYEES ARE ELIGIBLE FOR PLAN CONTRIBUTIONS. PARTICIPANTS WERE DAVID CALLECOD, PRESIDENT/CEO-LGHS, PATRICK GANDY, EVP/COO-LGMC, ROGER MATTKE, SVP/CFO, GORDON ROUNTREE, GENERAL COUNSEL, REBECCA BENOIT, CNO, KATHERINE HEBERT, ADMINISTRATOR, ZIAD ASHKAR, MD, CMO, CARRIE TEMPLETON, ADMINISTRATOR, AND CAROLYN HUVAL, VICE-PRESIDENT. 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. 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 2110000 84137555 3733975 1550751 78852829 2011 1 0 1 1 B 1666018 3850000 59703 3790297 2011 0 0 1 1 C 60000000 414018 19088353 40497629 2015 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 1 0 0 0 0 0 0 C 0 0 1 0 1 0 0 0 0 A 1 B 1 C 1 SCHEDULE K, PART I, LINE A, COLUMN C: MULTIPLE CUSIP NUMBERS: 546395H98, 546395J21, 546395J39, 546395J47, 546395J54 SCHEDULE K, PART II, LINE 3, COLUMN C SUPPLEMENTAL INFORMATION: BOTH SERIES A AND B BONDS WERE ISSUED AS DRAW-DOWN BONDS WITH ONLY $20 MILLION CUMULATIVE REQUESTED AT THE END OF THE TAX YEAR. SCHEDULE K, PART II, LINE 9 SUPPLEMENTAL INFORMATION 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 SUPPLEMENTAL INFORMATION THE BOND DOCUMENTS DO REQUIRE COMPLIANCE WITH THIS SECTION AND THE REQUIREMENTS ARE REVIEWED PERIODICALLY TO ENSURE CONTINUED COMPLIANCE WITH YIELD RESTRICTIONS AND ARBITRAGE. GBR LLC G. GARY GUIDRY IS A TRUSTEE OF LGMC AND IS A MEMBER OF GBR, LLC 1175524 LAFAYETTE GENERAL MEDICAL CENTER, INC HAS ENTERED INTO A CONTRACT WITH GBR, LLC TO PROVIDE CRITICAL CARE SERVICES, PULMONARY/VENTILATOR CARE MANAGEMENT SERVICES AND INTENSIVIST SERVICES FOR HOSPITAL'S ICU AND ASSUME THE ROLE OF MEDICAL DIRECTOR OF THE ICU. TRUSTEE G. GARY GUIDRY MD IS A MEMBER OF GBR, LLC. IN ADDITION, GBR, LLC WAS PAID TO SERVE AS GRADUATE MEDICAL EDUCATION PROGRAM FACULTY. 0 SURGICAL HOSPITAL MANAGEMENT SYSTEM PHILIP GACHASSIN, M.D. IS A TRUSTEE OF LGMC AND IS A MEMBER OF SHMS, LLC. 500000 LAFAYETTE GENERAL MEDICAL CENTER, INC. HAS ENTERED INTO A CONTRACT WITH INTERESTED PERSON TO PROVIDE SURGICALIST SERVICES. 0 GACHASSIN LAW FIRM PHILIP GACHASSIN, M.D.,TRUSTEE OF LGMC, IS A FAMILY MEMBER OF OWNER OF FIRM 452706 GACHASSIN LAW FIRM PROVIDES LEGAL SERVICES FOR LAFAYETTE GENERAL MEDICAL CENTER. 0 X 1 380000 APPRAISED BY EXPERT 1 0 0 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. 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 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 MEMBERS AND OFFICERS REQUIRING THEM TO DISCLOSE CONFLICTS OF INTEREST. AFTER RECEIPT OF THESE SURVEYS, THE GOVERENCE COMMITTEE AND ITS CHAIRPERSON REVIEW ALL CONFLICTS AND REPORT ON SAME TO THE GOVERNANCE COMMITTEE. THEREAFTER THE CHAIRPERSON OF THE GOVERNANCE COMMITTEE AND THE ORGANIZATIONS 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 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 COMPENSATION SURVEY AND FAIR MARKET VALUE REPORT. THE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE MARKET COMPARABLES AND MAKES ADJUSTMENT THE PRESIDENT/CEOS COMPENSATION THEREAFTER. THIS SAME PROCESS IS FOLLOWED FOR THE FOLLOWING SENIOR EXECUTIVES OF THE ORGANIZATION: CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER 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, SECTION A, LINE 1A PAYMENTS TO THE PHYSICIANS THAT SERVE AS TRUSTEES WERE REPORTED ON 1099 MISC BOX 6. 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. THE PAYMENTS TO THE PHYSICIAN SERVING AS CHIEF OF STAFF WERE FROM A RELATED ORGANIZATION AS AN EMPLOYED PHYSICIAN. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANED FROM THE PREVIOUS YEAR. ST MARTIN HOSPITAL INC 210 CHAMPAGNE BOULEVARD BREAUX BRIDGE LA 70517 264626264 HOSPITAL LA 501(C)(3) 170(B)(1)(A) (III) LAFAYETTE GENERAL MEDICAL CENTER 1 LAFAYETTE HEALTH VENTURES INC 1211 COOLIDGE STREET 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 STREET LAFAYETTE LA 70503 383646817 HEALTHCARE SUPPORT LA 501(C)(3) 509(A)(3) 0 UNIVERSITY HOSPITAL & CLINICS INC 1211 COOLIDGE STREET LAFAYETTE LA 70503 462605366 HOSPITAL LA PENDING 501(C)(3) 170(B)(1)(A) (III) LAFAYETTE GENERAL HEALTH SYSTEMS 0 LAFAYETTE INVESTMENT GROUP LLC 1000 WEST PINHOOK ROAD STE 206 LAFAYETTE LA 70503 421594593 MANAGEMENT LA LAFAYETTE GENERAL MEDICAL CENTER RELATED 118436 1534739 0 0 0.29430 LAFAYETTE GENERAL SURGICAL HOSPITAL LLC 1000 WEST PINHOOK ROAD LAFAYETTE LA 70503 481360080 SURGICAL HOSPITAL LA LAFAYETTE GENERAL MEDICAL CENTER RELATED 2452080 2667003 0 0 0.50000 GREATER LAFAYETTE PHYSICIANS HOSPITAL 117 AUDUBON BOULEVARD LAFAYETTE LA 70503 721286969 SUPPORT SERVICES LA LAFAYETTE GENERAL MEDICAL CENTER C 1.00000 1 0 1 0 0 0 0 0 0 0 1 1 1 1 0 1 1 1 1 1 ST MARTIN HOSPITAL INC L 1373404 COST ST MARTIN HOSPITAL INC R 1084945 COST ST MARTIN HOSPITAL INC Q 3033858 COST LAFAYETTE INVESTMENT GROUP LLC K 1068093 CONTRACT LAFAYETTE GENERAL SURGICAL HOSPITAL LLC Q 1634237 COST LAFAYETTE GENERAL SURGICAL HOSPITAL LLC S 1250000 COST