2014-04-02T15:54:34-05:00 2013-09-30 721202445 POSTLETHWAITE & NETTERVILLE 8550 UNITED PLAZA BLVD SUITE 1001 BATON ROUGE LA 70809 990 2012-10-01 720652905 WOMAN'S HOSPITAL FOUNDATION D/B/A WOMAN'S HEALTH FOUNDATION WOMA 2259248107 P O BOX 95009 BATON ROUGE LA 70895 STEPHANIE ANDERSON 2259248107 2014-03-28 1 RALPH STEPHENS P00638118 2259224600 2012 2015-11-30 17:44:51Z TERI FONTENOT PO BOX 95009 BATON ROUGE LA 70895 416421045 0 X WWW.WOMANS.ORG X 1968 LA TO IMPROVE THE HEALTH OF WOMEN AND INFANTS. 13 7 2143 167 22928926 0 5800979 744836 380919707 391686546 -23802334 -402418 9752002 16911515 372670354 408940479 60829 86118 0 0 124811245 129523336 44000 96053 657294 239747019 265519094 364663093 395224601 8007261 13715878 743487294 746495408 393018985 373117743 350468309 373377665 TO IMPROVE THE HEALTH OF WOMEN AND INFANTS. 0 0 293542887 86118 381240954 THE MISSION OF WOMAN'S HOSPITAL IS TO IMPROVE THE HEALTH OF WOMEN AND INFANTS. WE RESPOND TO THE SPECIFIC NEEDS OF THE COMMUNITY AND SURROUNDING AREA'S NEEDS BY PROVIDING QUALITY MEDICAL AND EDUCATIONAL SERVICES WITHOUT DISTINCTION AS TO THE FINANCIAL MEANS OF THE PERSON, HIS/HER RACE, OR DOMICILE. WOMAN'S PROVIDES MANY IMPORTANT HEALTH CARE SERVICES THAT ARE NOT OTHERWISE AVAILABLE IN OUR SERVICE AREA. (117,247 PATIENTS) 8234000 75429 WOMAN'S HOSPITAL EDUCATES THE COMMUNITY BY SPONSORING PROGRAMS AND EVENTS, AND DISTRIBUTES LITERATURE ON HEALTH TOPICS OF INTEREST TO WOMEN INCLUDING CHILDBIRTH, MENOPAUSE, HEART HEALTH, DRUG ABUSE, AGING AND SEXUALITY. (241 EDUCATION PROGRAMS) WE ALSO PROVIDE COMMUNITY SERVICE BY ABSORBING VARIOUS COSTS ESSENTIAL TO THE INDIGENT POPULATION, INCLUDING EMERGENCY AND PRENATAL CARE. 448769 232079 WOMAN'S HEALTH RESEARCH INSTITUTE CONCENTRATES ITS SCIENTIFIC RESEARCH ON THE UNIQUE HEALTH CONDITIONS OF VITAL IMPORTANCE TO WOMEN'S HEALTH. ONGOING RESEARCH INCLUDES STUDIES ON MENOPAUSE, HORMONES, OSTEOPOROSIS, BREAST CANCER, MATERNAL-FETAL MEDICINE, NEONATAL MEDICINE, AND GENETICS. (13 NEW PROTOCOLS REVIEWED AND APPROXIMATELY 33 ACTIVE STUDIES) 302225656 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 268 0 1 2143 1 1 1 0 0 0 0 0 0 0 X 13 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X APRIL F CHAISSON 2259248107 100 WOMANS WAY BATON ROUGE LA 70817 W DORE' BINDER 4.00 X 0 0 0 MARKHAM R MCKNIGHT 4.00 X 0 0 0 EDWARD SCHWARTZENBURG MD 4.00 X 0 0 0 AMY W PHILLIPS 4.00 X 0 0 0 MIKE POLITO 4.00 X 0 0 0 MIKE WAMPOLD 4.00 X 0 0 0 MATT MCKAY 4.00 X 0 0 0 RENEE HARRIS MD 4.00 X 4000 0 0 CHRISTEL SLAUGHTER PHD 4.00 X 0 0 0 TERRIE THOMAS MD 4.00 X 19500 0 0 STEVEN FEIGLEY MD 4.00 X 0 0 0 DONNA FRAICHE 4.00 X 0 0 0 TOM HAWKINS JR 4.00 X 0 0 0 NICOLE HOLLIER MD 4.00 X 4500 0 0 TERI G FONTENOT 65.00 X 745158 0 85386 ROBERT S GREER JR 4.00 X 0 0 0 JAMAR A MELTON MD 4.00 X 0 0 0 FRANK BREAUX MD 4.00 X 1000 0 0 STANLEY SHELTON 65.00 X 245886 0 44506 PATRICIA JOHNSON 65.00 X 241245 0 56215 STEPHANIE ANDERSON 65.00 X 293720 0 65976 JAMIE HAEUSER 65.00 X 233792 0 78529 NANCY CRAWFORD 65.00 X 250737 0 52748 PAUL KIRK 65.00 X 233887 0 35992 GREG SMITH 65.00 X 213988 0 53319 DONNA BODIN 65.00 X 192139 0 54904 STACI SULLIVAN 65.00 X 175277 0 47345 LYNN WEILL 65.00 X 190441 0 37365 MARSHALL ST AMANT MD 40.00 X 621052 0 74705 MEREDITH WARNER MD 40.00 X 587630 0 26924 MARK G NEWMAN MD 40.00 X 557886 0 72472 ALBERT L DIKET MD 40.00 X 496037 0 41581 EDWARD VEILLON MD 40.00 X 475781 0 64325 DAVID KLEIN 0.00 X 100000 0 0 5883656 0 892292 84 1 1 0 LSUHSC OFFICE OF SPONSORED PROJECTS 433 BOLIVAR STREET NEW ORLEANS LA 70112 MEDICAL SERVICES 8767253 SOUTH LOUISIANA MEDICAL ASSOCIATES 1900 INDUSTRIAL BLVD HOUMA LA 70363 MEDICAL SERVICES 7315740 JE DUNN SOUTH CENTRAL INC 901 S MOPAC EXPY BLDG IV STE 290 AUSTIN TX 78746 PROFESSIONAL SERVICE - CONSTRUCTION 5345394 VALLEY INNOVATIVE SERVICES INC PO BOX 5454 JACKSON MS 392885454 FOOD SERVICE 4772163 HURON HEALTHCARE 3005 MOMENTUM PLACE CHICAGO IL 60689 CONSULTING 2455776 61 199050 545786 744836 HOSPITAL SERVICES 541900 383852410 366947950 16904460 FITNESS CENTER 713940 4530375 1965962 2564413 CAFETERIA 722210 2224467 2148347 76120 CHILD CARE 624410 1006691 278192 728499 PATIENT EDUCATION 611710 72603 72603 391686546 2701100 2701100 3253204 3176610 76594 76594 76594 49085 118924 0 3271527 49085 -3152603 -3103518 -3103518 217064 83125 133939 133939 1934976 949304 985672 985672 OTHER OPERATING REVENUE 900099 15715310 13059876 2655434 15715310 408940479 381369412 22928926 3897305 86118 86118 3121800 2368959 741530 11311 104623528 79392944 24851517 379067 21778008 16526112 5172991 78905 96053 96053 1380311 197207 1124457 58647 2519978 1616870 899967 3141 726731 717680 9051 259663 145973 104785 8905 18800217 18800217 17456262 4521855 12930763 3644 CONTRACTUAL ADJUSTMENTS 163446569 163446569 PATIENT RELATED SUPPLIE 21631490 21621611 9879 PURCHASED SERVICES 13524061 2650698 10873363 0 OTHER EXPENSES 7979946 1979173 5992070 8703 17793866 6953887 10831061 8918 395224601 302225656 92341651 657294 58303621 102534226 34211325 37309010 2832609 2964110 462948422 66474095 407140364 396474327 62054858 32858985 178944517 174354750 743487294 746495408 42814783 27640227 199800 199800 349416068 345045663 588334 232053 393018985 373117743 X 348568953 371460358 649356 667307 1250000 1250000 350468309 373377665 743487294 746495408 X 13715878 9189421 4057 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 1 0 0 1 0 1 132763 132763 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: ALL OF THE FOLLOWING MEMBERSHIP DUES AMOUNTS RELATE TO THE LOBBYING EXPENSE PORTION OF THE DUES: 1. $4,800 FOR MEMBERSHIP DUES TO THE BATON ROUGE AREA CHAMBER 2. $252 FOR MEMBERSHIP DUES TO THE LOUISIANA STATE MEDICAL SOCIETY. 3. $14,055.03 FOR MEMBERSHIP DUES TO THE LOUISIANA HOSPITAL ASSOCIATION 5. $9.75 FOR MEMBERSHIP DUES TO THE AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES. 6. $693 FOR MEMBERSHIP DUES TO THE AMERICAN MEDICAL ASSOCIATION. 7. $22 FOR MEMBERSHIP DUES TO THE AMERICAN ORGANIZATION OF NURSE EXECUTIVES. 8. $95,904.90 TO JUDY EWELL DAY FOR A LOBBYING CONTRACT. 9. 1% OF TERI FONTENOT'S (PRESIDENT/CEO) ANNUAL SALARY IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. THIS AMOUNTS TO $5,494.30 10. $77.84 FOR MEMBERSHIP DUES TO THE AMERICAN NURSES ASSOCIATION. 11. $11,190.22 FOR MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION. 12. $26.25 FOR MEMBERSHIP DUES TO THE AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION. 13. $237.84 FOR MEMBERSHIP DUES TO THE AMERICAN CONGRESS OF OBSTETRICIANS AND GYNECOLOGISTS. 1250000 1250000 1250000 1250000 1250000 1250000 1250000 1250000 1250000 1250000 0 0 12102621 12102621 325075277 18312976 306762301 85692470 48161119 37531351 40078054 40078054 396474327 OTHER RECEIVABLES 10007948 DEFERRED FINANCING CHARGES 3357606 RESTRICTED DONATIONS - OTHERS 5100758 RESTRICTED DONATION - B.R. AREA FOUNDATION 1705193 DEPRECIATION RESERVE 143183083 OTHER ASSETS 4263316 ESTIMATED THIRD PARTY SETTLEMENTS 903806 UNAMORTIZED BOND DISCOUNT 5833040 174354750 OTHER LIABILITIES 232053 232053 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE FOUNDATION HOLDS AN ENDOWMENT FUND IN THE AMOUNT OF $1,250,000 FROM THE HELEN BARNES TRUST. THIS AMOUNT IS PERMANENTLY RESTRICTED BUT THE ANNUAL EARNINGS FROM THIS ENDOWMENT ARE FOR USE BY THE FOUNDATION. THE INCOME IS REPORTED ON THE CORE FORM 990, BUT THE BALANCE ON THIS ENDOWMENT DOES NOT CHANGE FROM YEAR TO YEAR SINCE ONLY THE $1,250,000 IS RESTRICTED. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL APPLIES THE ACCOUNTING GUIDANCE RELATED TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES WHICH SETS OUT A CONSISTENT FRAMEWORK TO DETERMINE THE APPROPRIATE LEVEL OF TAX RESERVES TO MAINTAIN FOR UNCERTAIN TAX POSITIONS. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE RECORDED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN THE RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE HOSPITAL HAS EVALUATED ITS POSITION REGARDING ACCOUNTING FOR UNCERTAIN INCOME TAX POSITIONS AND DOES NOT BELIEVE THAT IT HAS ANY MATERIAL UNCERTAIN TAX POSITIONS. WITH FEW EXCEPTIONS, THE HOSPITAL IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE SEPTEMBER 30, 2010. X X 1 DISTEFANO & ASSOCIATES PO BOX 80377 BATON ROUGE LA 70898 CONSULTING, GRANT WRITING SERVICES 0 536108 55276 480832 ALLEGIANT DIRECT INC 278 FRANKLIN ROAD BRENTWOOD TN 37027 DIRECT MARKETING, INCLUDING STRATEGY AND CONSULTING SERVICES 0 28497 40777 -12280 564605 96053 468552 GOLF TOURNAMENT 217064 217064 3842 79283 217064 217064 3842 79283 83125 133939 EXPLANATION OF FUNDRAISING PAYMENTS SCHEDULE G, PART I, LINE 2B, COLUMN (V) WOMAN'S HOSPITAL FOUNDATION IS UNABLE TO TRACK THE AMOUNT OF MONEY RAISED SPECIFICALLY BY THE FUNDRAISERS. AMOUNT OF MONEY RAISED BY FUNDRAISER SCHEDULE G WOMAN'S HOSPITAL FOUNDATION IS UNABLE TO TRACK THE AMOUNT OF MONEY RAISED SPECIFICALLY BY THE FUNDRAISERS. THE FUNDRAISERS ARE HIRED TO PROVIDE CONSULTING SERVICES AND ASSISTANCE WITH GENERAL TYPE FUNDRAISING THROUGHOUT THE YEAR. 1 1 X 1 X 0 1 1 0 1 1 2345000 2345000 0.00590 27527000 27527000 0.06960 878452 878452 0.00220 30750452 30750452 0.07770 382965 382965 0.00100 5394029 5394029 0.01360 302510 302510 0.00080 112097 112097 0.00030 6191601 6191601 0.01570 36942053 36942053 0.09340 1 3340672 54056 1914491 4514131 -2599640 X 1 0 1 WOMAN'S RETAIL VENTURES LLC HOSPITAL GIFT SHOP 0.74000 0.08000 0.18000 1 1 WOMAN'S HOSPITAL FOUNDATION

PO BOX 95009 BATON ROUGE LA 70895

X WOMAN'S HOSPITAL 1 1 X X X X X X X X 12 1 1 1 X X X X X X X X X 1 0 1 1 200.000000000000 0 0 1 1 X 1 0 X X 1 X 0 1 PART I, L7 COL(F): THE HOSPITAL MAINTAINS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON AN ASSESSMENT OF COLLECTABILITY, CURRENT ECONOMIC CONDITIONS, AND PRIOR EXPERIENCE. THE HOSPITAL DETERMINES IF PATIENT ACCOUNTS RECEIVABLE ARE PAST-DUE BASED ON THE ORIGINAL BILL DATE; HOWEVER, THE HOSPITAL DOES NOT CHARGE INTEREST ON PAST-DUE ACCOUNTS. THE HOSPITAL WRITES OFF PATIENT ACCOUNTS RECEIVABLE IF MANAGEMENT CONSIDERS THE COLLECTION OF THE OUTSTANDING BALANCES TO BE DOUBTFUL. THIS IS ONLY AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN FOLLOWED AS OUTLINED IN OUR COLLECTION POLICY. BAD DEBT EXPENSE OF $3,340,672 IS A COMBINATION OF ACTUAL ACCOUNTS WRITTEN OFF AND ADJUSTMENTS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. BASED ON A REVIEW OF ALL ACCOUNTS IN WHICH WE WERE UNABLE TO FULLY DETERMINE ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (BECAUSE THE FINANCIAL ASSISTANCE APPLICATION WAS INCOMPLETE), WE IDENTIFIED $54,056 OF ACCOUNTS THAT WERE WRITEN OFF AS BAD DEBT (AFTER ALL REASONABLE COLLECTION EFFORTS WERE FOLLOWED AS OUTLINED IN OUR COLLECTION POLICY). PART III, LINE 8: 100% OF THE SHORTFALL IS TREATED AS COMMUNITY BENEFIT. THE METHOD USED TO DETERMINE THE MEDICARE ALLOWABLE COST OF CARE IS COST TO CHARGE RATIO. WOMAN'S HOSPITAL PART V, SECTION B, LINE 14G: UNINSURED PATIENTS ARE REFERRED TO A FINANCIAL COUNSELOR TO DISCUSS OUR FINANCIAL ASSISTANCE POLICY. WOMAN'S HOSPITAL PART V, SECTION B, LINE 18E: WE NOTIFY PATIENTS OF OUR FINANCIAL ASSISTANCE POLICY UPON ADMISSION. PATIENTS ARE REFERRED TO A FINANCIAL COUNSELOR WHO DISCUSSES OUR FINANCIAL ASSISTANCE POLICY IN DETAIL. WE DOCUMENT WHEN AN APPLICATOIN IS PROVIDED TO A PATIENT/GUARANTOR, WHEN AN APPLICATION IS RECEIVED FROM A PATIENT/GUARANTOR (WHETHER COMPLETE OR INCOMPLETE), FURTHER COMMUNICATION WITH THE PATIENT/GUARANTOR IF THE APPLICATION IS INCOMPLETE, IF THE APPLICATION IS APPROVED OR DENIED, AND THE NOTIFICATION OF THE APPROVAL OR DENIAL TO THE PATIENT/GUARANTOR. WE MAKE REASONABLE EFFORTS TO DETERMINE A PATIENT'S ELIGIBILITY BEFORE WE TAKE ANY ACTION TO COLLECT. WOMAN'S HOSPITAL PART V, SECTION B, LINE 20D: THE HOSPITAL CHARGES ALL PATIENTS THE SAME GROSS CHARGE FOR ANY SERVICE REGARDLESS OF THE PAYOR, E.G. SELF PAY, INSURANCE, ETC. WE OFFER DISCOUNTS TO PATIENTS THAT HAVE NO INSURANCE OR THOSE WITH OUT-OF-NETWORK BENEFITS. WE ALSO PROVIDE FREE CARE (BY FULLY DISCOUNTING THE GROSS CHARGE) TO THOSE THAT QUALIFY FOR FINANCIAL ASSISTANCE AS OUTLINED IN OUR FINANCIAL ASSISTANCE POLICY. WOMAN'S HOSPITAL PART V, SECTION B, LINE 22: THE HOSPITAL CHARGES ALL PATIENTS THE SAME GROSS CHARGE FOR ANY SERVICE REGARDLESS OF THE PAYOR, E.G. SELF PAY, INSURANCE, ETC. WE OFFER DISCOUNTS TO PATIENTS THAT HAVE NO INSURANCE OR THOSE WITH OUT-OF-NETWORK BENEFITS. WE ALSO PROVIDE FREE CARE (BY FULLY DISCOUNTING THE GROSS CHARGE) TO THOSE THAT QUALIFY FOR FINANCIAL ASSISTANCE AS OUTLINED IN OUR FINANCIAL ASSISTANCE POLICY. DESCRIPTION OF COMMUNITY HEALTH ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 3 WOMAN'S DEVELOPED ITS COMMUNITY HEALTH ASSESSMENT IN COLLABORATION WITH OTHER AREA PROVIDERS AND THE MAYOR-PRESIDENT'S HEALTHY CITY INITIATIVE (MHCI). THE TEAM OF HEALTH CARE LEADERS DEVELOPED A LIST OF BATON ROUGE' S 10 HEALTH PRIORITIES, WHICH WAS REVIEWED AND APPROVED BY ALL MHCI PARTNERS. OTHER HOSPITAL FACILITIES INCLUDED IN COMMUNITY NEEDS ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 4 REPRESENTATIVES FROM WOMAN'S HOSPITAL, OUR LADY OF LAKE REGIONAL MEDICAL CENTER, BATON ROUGE MEDICAL CENTER, LANE REGIONAL MEDICAL CENTER, AND THE LSU HEALTH/EARL K. LONG MEDICAL CENTER MET TO DISCUSS AN ASSESSMENT OF COMMUNITY HEALTH. 0 BATON ROUGE AREA CHAMBER 564 LAUREL STREET BATON ROUGE LA 70801 720126959 501(C)(3) 33333 CASH GRANT ECONOMIC DEVELOPMENT CAMPAIGN AMERICAN HEART ASSOCIATION 2644 S SHERWOOD FOREST SUITE 108 BATON ROUGE LA 70816 135613797 501(C)(3) 5284 FMV IN KIND PRINTING GO RED FOR WOMEN MATERIALS MARCH OF DIMES FOUNDATION 12015 JUSTICE AVE BATON ROUGE LA 70816 131846366 501(C)(3) 5000 CASH GRANT 2013 RACE SPONSORSHIP BATON ROUGE KOMEN RACE FOR THE CUTE PO BOX 14615 BATON ROUGE LA 70898 752854972 501(C)(3) 5000 CASH GRANT 2013 RACE SPONSORSHIP GULF COAST EVENT GROUP INC PO BOX 1835 ABITA SPRINGS LA 70420 270160488 32500 CASH GRANT 2013 RACE SPONSORSHIP GRIEF RECOVERY CENTER 4939 JAMESTOWN AVE SUITE 101 BATON ROUGE LA 70808 721185336 501(C)(3) 5000 CASH GRANT 2013 DONATION 5 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS ARE GIVEN TO ORGANIZATIONS FOR SPECIFIC PURPOSES AND ARE NOT MONITORED FURTHER. X X 1 1 X X X X X 0 0 0 0 0 1 0 0 0 TERI G FONTENOT 549430 0 189577 0 6151 0 73333 0 12053 0 830544 0 0 0 STANLEY SHELTON 192886 0 39702 0 13298 0 34970 0 9536 0 290392 0 0 0 PATRICIA JOHNSON 197890 0 40616 0 2739 0 39185 0 17030 0 297460 0 0 0 STEPHANIE ANDERSON 231934 0 47739 0 14047 0 46399 0 19577 0 359696 0 0 0 JAMIE HAEUSER 191362 0 39702 0 2728 0 61387 0 17142 0 312321 0 0 0 NANCY CRAWFORD 197890 0 40616 0 12231 0 47224 0 5524 0 303485 0 0 0 PAUL KIRK 190675 0 31322 0 11890 0 34505 0 1487 0 269879 0 0 0 GREG SMITH 175749 0 28485 0 9754 0 34078 0 19241 0 267307 0 0 0 DONNA BODIN 165096 0 26539 0 504 0 35726 0 19178 0 247043 0 0 0 STACI SULLIVAN 146458 0 23464 0 5355 0 28279 0 19066 0 222622 0 0 0 LYNN WEILL 161970 0 26301 0 2170 0 27973 0 9392 0 227806 0 0 0 MARSHALL ST AMANT MD 595899 0 1217 0 23936 0 53088 0 21617 0 695757 0 0 0 MEREDITH WARNER MD 585000 0 1217 0 1413 0 18700 0 8224 0 614554 0 0 0 MARK G NEWMAN MD 534830 0 968 0 22088 0 60550 0 11922 0 630358 0 0 0 ALBERT L DIKET MD 491982 0 1217 0 2838 0 30875 0 10706 0 537618 0 0 0 EDWARD VEILLON MD 436245 0 1217 0 38319 0 41825 0 22500 0 540106 0 0 0 DAVID KLEIN 100000 0 0 0 0 0 0 0 0 0 100000 0 0 0 PART I, LINE 1A ON THREE SEPARATE OCCASIONS, WOMAN'S HOSPTIAL PROVIDED FOR TRAVEL TO A CONFERENCE FOR THE SPOUSE OF A BOARD MEMBER. WOMAN'S HOSPITAL PAID FOR PERSONAL SERVICES ON BEHALF OF TERI FONTENOT, CEO DURING THE FISCAL YEAR 2012. THE COSTS ASSOCIATED WITH THESE WERE MISTAKENLY INCLUDED IN HER W-2 FOR 2012. UPON REVIEW OF THIS, TERI FONTENOT REIMBURSED WOMAN'S HOSPITAL IN 2013 FOR THE COST OF THE SERVICES PROVIDED. PART I, LINE 6 WOMAN'S HOSPITAL'S MANAGEMENT INCENTIVE PLAN PROVIDES FOR COMPENSATION IF CERTAIN GOALS/TARGETS ARE ACHIEVED, ONE BEING NET INCOME FROM OPERATIONS. A LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AK0 2010-02-10 3545000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 B LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AC8 2010-02-10 3720000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 C LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AD6 2010-02-10 3915000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 D LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AE4 2010-02-10 4110000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 A 0 0 0 0 B 0 0 0 0 C 0 0 0 0 D 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AF1 2010-02-10 24380000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 B LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AG9 2010-02-10 32210000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 C LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AH7 2010-02-10 101095000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 D LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AJ3 2010-02-10 60165000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 A 0 0 0 0 B 0 0 0 0 C 0 0 0 0 D 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AT1 2010-02-10 1325000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 B LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AL8 2010-02-10 1395000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 C LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AM6 2010-02-10 1465000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 D LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AN4 2010-02-10 1545000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 A 0 0 0 0 B 0 0 0 0 C 0 0 0 0 D 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AP9 2010-02-10 9005000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 B LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AQ7 2010-02-10 11930000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 C LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AR5 2010-02-10 37120000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 D LA LOCAL GOVERNMENT ENVIR FACILITIES & COMM DEVELOPMENT AUTHORITY 721416168 546282AS3 2010-02-10 22595000 FINANCE CONSTRUCTION/EQUIP ASSOC. W/REPLACEMENT FACILITY/MEDICAL COMPLEX 0 0 0 A 0 0 0 0 B 0 0 0 0 C 0 0 0 0 D 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 DR FRANK BREAUX DR. FRANK BREAUX IS AN OFFICER OF THE FOUNDATION 1516245 LWCA AND LWHA RENT OFFICE SPACE FROM THE FOUNDATION. DR. FRANK BREAUX IS A MEMBER OF THESE GROUPS. 0 DR W DORE' BINDER DR. W. DORE' BINDER IS A DIRECTOR OF THE FOUNDATION. 1516245 LWCA AND LWHA RENT OFFICE SPACE FROM THE FOUNDATION. DR. W. DORE' BINDER IS A MEMBER OF THESE GROUPS. 0 DR EDWARD SCHWARTZENBURG DR. EDWARD SCHWARTZENBURG BINDER IS A DIRECTOR OF THE FOUNDATION. 217856 SCHWARTZENBURGS, LAFRANCA, AND GUIDRY RENTS OFFICE SPACE FROM THE FOUNDATION. DR. EDWARD SCHWARTZENBURG IS A MEMBER OF THIS GROUP. 0 DR RENEE HARRIS DR. W. RENEE HARRIS IS A DIRECTOR OF THE FOUNDATION. 243047 ASSOCIATES IN WOMEN'S HEALTH RENTS OFFICE SPACE FROM THE FOUNDATION. DR RENEE HARRIS IS A MEMBER OF THIS GROUP. 0 DR TERRIE THOMAS DR. THOMAS IS A DIRECTOR OF THE FOUNDATION 243047 ASSOCIATES IN WOMEN'S HEALTH RENTS OFFICE SPACE FROM THE FOUNDATION. DR. TERRIE THOMAS IS A MEMBER OF THIS GROUP. 0 DR STEVEN FEIGLEY DR. STEVEN FEIGLEY IS A DIRECTOR OF THE FOUNDATION 1485367 LWHA RENTS OFFICE SPACE FROM THE FOUNDATION. DR. STEVEN FEIGLEY IS A MEMBER OF THIS GROUP. 0 DR NICOLE HOLLIER DR. NICOLE HOLLIER IS A DIRECTOR OF THE FOUNDATION 1485367 LWHA RENTS OFFICE SPACE FROM THE FOUNDATION. DR. NICOLE HOLLIER IS A MEMBER OF THIS GROUP. 0 FORM 990, PART VI, SECTION A, LINE 2 THROUGH HIS EMPLOYER, MARKHAM MCKNIGHT HAS BUSINESS RELATIONSHIPS WITH MIKE WAMPOLD AND MIKE POLITO. TERRIE THOMAS, MD, IS THE BUSINESS PARTNER OF RENEE HARRIS, MD. FORM 990, PART VI, SECTION A, LINE 6 BOARD MEMBERS ARE ELECTED BY FOUNDATION MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS ARE ELECTED BY FOUNDATION MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B SOME DECISIONS MADE BY THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBERS. THE FOUNDATION CAN VOTE SEPARATELY FROM THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PRESENTED TO THE BOARD FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C A LETTER AND QUESTIONNAIRE ARE SENT TO EACH BOARD MEMBER ANNUALLY WITH A LIST OF OFFICERS, DIRECTORS, AND KEY PERSONNEL TO USE FOR REFERENCE IN REPORTING ANY POSSIBLE CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 A MARKET COMPARISON AND RESULTING RECOMMENDATIONS FOR TOTAL COMPENSATION AND MANAGEMENT INCENTIVE PLANS ARE CONDUCTED BY A CONSULTING FIRM AND APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION'S TAX DOCUMENTS ARE AVAILABLE UPON REQUEST. THE FORM 990 IS ALSO UPLOADED ONTO GUIDESTAR'S WEBSITE WHERE IT CAN BE VIEWED BY THE GENERAL PUBLIC. THE FOUNDATION'S ANNUAL REPORT IS AVAILABLE ON THE HOSPITAL WEBSITE. THE FOUNDATION ALSO ISSUES QUARTERLY BOND DISCLOSURE REQUIREMENTS TO BONDHOLDERS AND RATING AGENCIES. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN AUXILIARY ACCOUNT 4,057. THE ORGANIZATION'S PROCESS HAS NOT CHANGED FROM THE FILING OF THE PREVIOUS FORM 990. WOMAN'S RETAIL VENTURES LLC 9000 AIRLINE HWY STE 330 BATON ROUGE LA 70895 043845778 GIFT SHOP RETAIL LA 144443 821111 0 0 0.74000 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 WOMAN'S RETAIL VENTURES LLC S 80338 CASH WOMAN'S RETAIL VENTURES LLC J 79196 CASH