2014-05-15T14:56:45-05:00 2013-06-30 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2012-07-01 720423651 OUR LADY OF THE LAKE HOSPITAL INC % JEFF LIMBOCKER OURL 2257657709 5000 HENNESSY BOULEVARD Suite BATON ROUGE LA 70808 JEFF LIMBOCKER 2257657709 2014-05-12 true KPMG LLP 2253444000 2012 2015-11-30 17:44:51Z OUR LADY OF THE LAKE RMC K SCOTT WESTER 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 910188092 false 0928 X www.ololrmc.com X 1956 LA the purpose of the hospital is to provide for the care of the ill, injured, or disabled persons, and to provide for research, education, and for the enhancement of health of those in the community 15 11 6438 190 7014471 0 5408607 7712549 664647747 768245581 8396637 19589685 -1274499 45125383 677178492 840673198 5152314 10127484 0 0 284957317 321077522 0 0 0 434889017 397136104 724998648 728341110 -47820156 112332088 1250161461 1498370068 534231871 660438993 715929590 837931075 X INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI AND IN THE TRADITION 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 265546500 366658214 THE MEDICAL CENTER PROVIDES QUALITY HOSPITAL AND MEDICAL SERVICES TO ITS PATIENTS. IN THE CURRENT YEAR, SERVICES WERE PROVIDED FOR 163,032 PATIENT DAYS. THE MEDICAL CENTER IS AN ACTIVE, CARING MEMBER OF THE COMMUNITIES IT SERVES. IN CARRYING OUT ITS MISSION, THE MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. FOLLOWING THAT POLICY, HEALTH CARE SERVICES COSTING APPROXIMATELY $12,402,600 WERE PROVIDED WITHOUT CHARGE. ADDITIONAL COSTS WERE INCURRED FOR PARTICIPATION IN PROGRAMS WHICH, IN SOME CASES, PAY AMOUNTS LESS THAN THE COST OF PROVIDING SERVICES. SEE SCHEDULE O FOR FURTHER EXPLANATION. 105367802 145488531 THE MEDICAL CENTER PROVIDES PATIENTS WITH BOTH INPATIENT AND OUTPATIENT SURGICAL CARE. DURING THE YEAR, 19,575 SURGICAL PROCEDURES WERE PERFORMED 40410404 55797409 THE MEDICAL CENTER PROVIDES PATIENTS WITH PHARMACEUTICALS IN THE COURSE OF THEIR MEDICAL CARE. IN THE CURRENT YEAR, THE HOSPITAL DISPENSED 13,197,865 UNIT DOSES 145065190 10127484 200301428 556389896 true true false false false false false false false false true true false false true true false true false false true true true false false false true true true true true false false false false false false false true false false false false true true true true false false true 331 0 true 6438 true true true false false false false false false false false false X 15 11 true false false false true true true true true false false true true true true false true false true true true X JEFF LIMBOCKER 2257656565 5000 HENNESSY BLVD BATON ROUGE LA 70808 X CHARLES FREEBURGH 2.0 4.0 X X 0 0 0 DONALD DAIGLE 2.0 2.0 X X 0 0 0 DANIEL MONTELARO 2.0 2.0 X X 0 0 0 TIMOTHY ANDRUS MD 2.0 0.0 X 0 0 0 WALTER BRINGAZE III MD 2.0 0.0 X 0 0 0 RENEE FURR 2.0 0.0 X X 0 0 0 SR LILLIAN LYNCH OSF 2.0 0.0 X 0 0 0 VAN MAYHALL JR 2.0 0.0 X 0 0 0 JOHN MCCLELLAND MD 42.0 0.0 X 530130 0 25316 DAVID POPE MD 2.0 0.0 X 0 0 0 SR EILEEN ROWE OSF 2.0 0.0 X 0 0 0 ELIZABETH SEITER MD 2.0 0.0 X 0 0 0 JOEL SILVERBERG MD 2.0 0.0 X 0 0 0 KAREN WILLIAMS MD 2.0 0.0 X 0 0 0 KENNETH WESTER 2.0 58.0 X X 0 647415 92415 JAMES CRAVEN MD 2.0 0.0 X 0 0 0 LUTHER KISSAM 2.0 0.0 X 0 0 0 JOHN SELSER 2.0 0.0 X 0 0 0 JEFFERY LIMBOCKER 52.0 8.0 X 370271 0 57112 DENZIL MORAES 60.0 0.0 X 1160839 0 34261 STEVEN GREMILLION 60.0 0.0 X 1026372 0 32061 KENNETH CIVELLO 60.0 0.0 X 897342 0 34734 PAUL GARRETT 60.0 0.0 X 776327 0 32061 JEFFREY HYDE 40.0 0.0 X 813497 0 29484 5574778 647415 337444 239 false true false FMOL HEALTH SYSTEM 4200 ESSEN LANE BATON ROUGE LA 70809 MANAGEMENT SERVICES 49341456 ANESTHESIOLOGY GROUP 8212 SUMMA AVENUE BATON ROUGE LA 70809 PHYSICIAN SERVICES 8227929 CROTHALL HEALTHCARE INC 5000 HENNESSY BLVD BATON ROUGE LA 70809 HEALTHCARE SERVICES 7296087 LOUISIANA STATE UNIVERSITY 204 THOMAS BOYD HALL BATON ROUGE LA 70803 MEDICAL SERVICES 8281243 CARDIOVASCULAR SYSTEMS LLC 7777 HENNESSY BLVD SUITE 1000 BATON ROUGE LA 70808 CONSULTING SERVICES 4716149 152 5711823 837973 1162753 7712549 PATIENT SVC REVENUE 621500 720709565 720709565 OUTREACH LABORATORY 900099 23363969 18764771 4599198 INCOME FROM EQUITY INVESTEES 900099 6682916 6384153 298763 CAFETERIA SALES 900099 2434655 2434655 PHARMACY 900099 2382229 385719 1996510 12672247 12672247 768245581 5877012 62667 5814345 48202 48202 0 10516657 12396106 -1879449 0 -1879449 -1879449 0 70707502 75757 54628209 2490579 16079293 -2414822 13664471 57333 13607138 0 0 0 INCREASE IN ACCRUED PENSION 900099 47004832 47004832 47004832 840673198 806476493 7014471 19469685 10058596 10058596 56888 56888 12000 12000 0 4582299 1816707 2765592 0 248680211 212227102 36453109 26232820 19970742 6262078 25148148 22370512 2777636 16434044 13642185 2791859 13037566 6467672 6569894 1780761 2077 1778684 3855580 15498 3840082 0 0 1121672 1121672 19834720 16871088 2963632 2962455 502324 2460131 29460710 23380839 6079871 863656 350040 513616 0 8716149 7147242 1568907 226116 175121 50995 0 889689 535923 353766 10174037 8342710 1831327 0 29248139 24055073 5193066 6731063 3284160 3446903 MEDICAL SUPPLIES 133027327 133027327 PURCHASED SERVICES 120481646 41380718 79100928 0 EQUIPMENT AND MAINTENANCE 14658918 10631452 4027466 OTHER EXPENSE 65900 65900 728341110 556389896 171951214 0 53927784 51211713 81641790 71117095 0 0 101485562 145949083 0 0 0 0 0 0 10629346 14389326 11926438 14659880 943769371 360812529 467132763 582956842 158534638 220486055 281105013 281775375 33611922 42096434 3498629 11950328 46667576 61777937 1250161461 1498370068 119870069 166841123 0 0 0 0 202632986 300832430 0 0 0 0 0 0 0 0 211728816 192765440 534231871 660438993 X 707726529 825226388 8203061 12704687 0 0 715929590 837931075 1250161461 1498370068 X 112332088 28749785 -19080388 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 73035268 73035268 0 568208468 163272737 404935731 0 3078646 1161023 1917623 0 278420448 186495736 91924712 0 21026541 9883033 11143508 582956842 FIXED INCOME SECURITIES 100670535 F ALTERNATIVE INVESTMENTS 181104841 F 281775376 0 OTHER LIABILITIES 36478623 ACCRUED PENSION COST 156286817 192765440 X FIN 48 (ASC 740 FOOTNOTE) Schedule D The Medical Center 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 judgment occurs. 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URGENT CARE PART I, LINE 3C: ELIGIBILITY FOR CHARITY IS BASED ON AN INDIVIDUALIZED DETERMINATION OF FINANCIAL NEED, AND SHALL NOT TAKE INTO ACCOUNT AGE, GENDER, RACE SOCIAL OR IMMIGRANT STATUS, SEXUAL ORIENTATION OR RELIGIOUS AFFILIATION. DISCOUNTED CARE IS BASED UPON CURRENT FEDERAL POVERTY LEVELS (FPL) WITH THOSE AT 200% OR BELOW ELIGIBLE FOR FREE CARE, AND THOSE ABOVE 200% RECEIVE DISCOUNTED CARE ON A SLIDING SCALE, UP TO BUT NOT MORE THAN 400% OF FPL. PART I, LINE 7G: OUR LADY OF THE LAKE INCLUDES THE COST OF SEVERAL PHYSICIAN CLINICS IN SUBSIDIZED HEALTH SERVICES INCLUDING THOSE THAT PROVIDE SPECIALIZED PEDIATRIC SERVICES, PSYCHIATRIC SERVICES, RURAL HEALTH CLINICS AND HOSPITAL MEDICINE PHYSICIANS THAT HANDLE THE PLAN OF CARE FOR PATIENTS WITHOUT PERSONAL PHYSICIANS AS RELATED TO EMERGENCY ROOM VISITS. PART I, LINE 7F: FOR THE PURPOSE OF CALCULATING THE PERCENTAGE IN PART I, LINE 7, COLUMN F, FUNCTIONAL EXPENSES WERE USED WHICH DID NOT INCLUDE BAD DEBT EXPENSE. PART I, LINE 7: THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINES 7A-7D AND IS BASED ON IRS WORKSHEET 2. FOR PART I LINES 7E, 7F, 7H AND 7I, DIRECT COSTS WERE CAPTURED FROM THE HOSPITAL'S AUDITED FINANCIAL STATEMENT AND THE MEDICARE COST REPORT WHERE APPLICABLE. FOR PART I LINE 7G, THE FOLLOWING METHODOLOGY WAS USED DUE TO THE FACT THAT MANY OF THE DEPARTMENTS INCLUDED IN SUBSIDIZED HEALTH SERVICES HAVE NO CHARGES. THEREFORE, THE COST TO CHARGE RATIO COULD NOT BE UTILIZED. COST FIGURES FOR THESE WERE CALCULATED FROM DIRECT DEPARTMENTAL COSTS PLUS AN OVERHEAD ALLOCATION (AS REFLECTED ON THE MEDICARE COST REPORT) LESS DIRECT OFFSETTING REVENUE. PART III, LINE 4: THE BAD DEBT FOOTNOTE IS ON PAGE 16 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. THE AMOUNT ON PART III, LINE 6 REPRESENTS MEDICARE ALLOWABLE COSTS FROM THE COST REPORT AS ADJUSTED FOR AMOUNTS ALREADY INCLUDED ON SCHEDULE H, LINE 7 RELATED TO SUBSIDIZED HEALTH SERVICES AND HEALTH PROFESSIONS EDUCATION. PART III, LINE 9B: PATIENTS WITH NO MEANS OF PAYMENTS MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS MAY ALSO BE WRITTEN OFF TO CHARITY BASED ON THE INFORMATION PROVIDED BY CREDIT BUREAUS, THROUGH THE SYSTEMS AND TOOLS UTILIZED AS WELL AS THE PATIENT'S MEDICAL EXPENSE. IF IT IS DETERMINED THAT A PATIENT QUALIFIES FOR CHARITY CARE AFTER THE INDIVIDUAL'S ACCOUNT HAS BEEN SENT TO COLLECTIONS, THE ACCOUNT IS IMMEDIATELY REMOVED FROM THE COLLECTIONS PROCESS. TO THE EXTENT APPROPRIATE AND PERMITTED BY LAW, FINANCIAL COUNSELING AND SCREENINGS ARE CONDUCTED AT THE TIME OF ENCOUNTER TO ASSIST IN IDENTIFYING PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. NEEDS ASSESSMENT PART VI, LINE 2: RESPONDING TO THE HEALTH NEEDS OF OUR COMMUNITY, ESPECIALLY TO THOSE MOST IN NEED, IS PRIMARY TO THE HOSPITAL'S MISSION. OUR LADY OF THE LAKE HOSPITAL WORKS TO CONDUCT HEALTH CARE NEEDS ASSESSMENTS. THEY WORK CLOSELY WITH UNITED WAY, PUBLIC HEALTH, AMERICAN HEART ASSOCIATION, ST. VINCENT de PAUL AND MANY OTHER ORGANIZATIONS TO DEFINE COMMUNITY NEEDS AND TO CONSOLIDATE EFFORTS TO MEET THOSE COMMUNITY NEEDS. FOR EXAMPLE, PARISH NURSING, HEALTH SCREENING FOR DIABETES, SKIN CANCER, PROSTRATE CANCER AND BREAST CANCER ARE PROMOTED IN VARIOUS COMMUNITY SETTINGS TO IMPROVE OVERALL COMMUNITY HEALTH. OUR LADY OF THE LAKE HOSPITAL CONDUCTED A CHNA IN COLLABORATION WITH OTHER ORGANIZATIONS AND AGENCIES IN BATON ROUGE THROUGH THE MAYOR'S HEALTHY CITY INITIATIVE. PATIENT EDUCATION OF ELIGIBILITY OF ASSISTANCE PART VI, LINE 3 INDIVIDUALS ARE EDUCATED ABOUT ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE HOSPITAL'S CHARITY CARE POLICY AT VARIOUS STAGES OF THE ENCOUNTER WITH OUR LADY OF THE LAKE HOSPITAL. PATIENTS ARE INFORMED THROUGH A PATIENT HANDBOOK THAT CONTAINS INFORMATION ON THE FINANCIAL POLICIES OF THE HOSPITAL. ADDITIONALLY, SYSTEMS AND TOOLS ARE UTILIZED TO CONDUCT HIGH LEVEL FINANCIAL SCREENING TO ASSIST IN IDENTIFYING PATIENTS ELIGIBLE FOR CHARITY CARE, FINANCIAL ASSISTANCE, AND SELF PAY DISCOUNTS. WHEN AND WHERE APPROPRIATE, FINANCIAL COUNSELORS VISIT PATIENTS AT THE TIME OF THE ENCOUNTER AND EXPLAIN THE ASSISTANCE OPTIONS AVAILABLE. FINANCIAL COUNSELORS WORK WITH PATIENTS TO ASSIST WITH ENROLLMENT FOR MEDICAID FOR THOSE WHO ARE ELIGIBLE AS WELL AS TO ASSIST THOSE WHO QUALIFY FOR CHARITY CARE. COMMUNITY INFORMATION PART VI, LINE 4 OUR LADY OF THE LAKE HOSPITAL (OLOL) IS A COMMUNITY-BASED, NOT-FOR-PROFIT HOSPITAL LOCATED IN BATON ROUGE, LOUISIANA THAT SERVES EAST BATON ROUGE PARISH AND PORTIONS OF THE SURROUNDING PARISHES. OLOL'S PRIMARY SERVICE AREA HAS A POPULATION OF 692,769 AND 263,676 HOUSEHOLDS. THE MEDIAN AGE IS 35 YEARS, THE SENIOR POLULATION COMPRISES ABOUT 11.7% OF THE TOTAL POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $49,769, 25.6% HOUSEHOLDS HAVE INCOMES BELOW $25,000, PER CAPITA INCOME IS $24,673 AND UNEMPLOYMENT RATE IS 4.8%. OLOL'S PRIMARY SERVICE AREA INCLUDES THE FOLLOWING PARISHES: EAST BATON ROUGE PARISH LIVINGSTON PARISH ASCENSION PARISH OLOL'S SECONDARY SERVICE AREA INCLUDES THE FOLLOWING PARISHES: ASSUMPTION PARISH EAST FELICIANA PARISH IBERVILLE PARISH POINTE COUPEE PARISH ST. HELENA PARISH ST. JAMES PARISH WEST BATON ROUGE PARISH WEST FELICIANA PARISH PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 OUR LADY OF THE LAKE HOSPITAL PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES BECAUSE IT UNDERSTANDS THAT IMPROVEMENTS TO A COMMUNITY HAVE A DIRECT LINK TO THE IMPROVED HEALTH OF COMMUNITY RESIDENTS. COMMUNITY BUILDING ACTIVITIES INCLUDE THE FOLLOWING: OUR LADY OF THE LAKE ESTABLISHED CLINICS LOCATED IN AREAS WITHIN UNDER-INSURED/LOW INCOME AREAS. THIS ALLOWS INDIVIDUALS TO ACCESS HEALTH CARE SERVICE THAT WOULD BE FOREGONE OR POSTPONED THEREBY CREATING A COMMUNITY AREA WITH MORE INTENSE HEALTH ISSUES/PROBLEMS. OUR LADY OF THE LAKE PROVIDES OVERSIGHT OF COMMUNITY PROGRAMS AND ACTIVITIES AND COORDINATED HEALTH CARE SCREENING FOR VARIOUS HEALTH ISSUES. AFTER HURRICANE KATRINA, OUR LADY OF THE LAKE BECAME A TEACHING HOSPITAL THROUGH AFFILIATION WITH LOUISIANA STATE UNIVERSITY MEDICAL SCHOOL TO INSURE THE STATE OF LOUISIANA MAINTAIN AN ADEQUATE SUPPLY OF PHYSICIANS. IN 2011 OUR LADY OF THE LAKE RECEIVED ACCREDITATION APPROVAL FOR A PEDIATRIC GRADUATE MEDICAL EDUCATION PROGRAM. THE STATE CHARITY HOSPITAL WILL CLOSE THE INPATIENT PORTION OF THE STATE FACILITY SHIFTING THOSE HEALTH CARE SERVICES TO OUR LADY OF THE LAKE HOSPITAL. THE OUTPATIENT COMPONENT OF THE STATE CHARITY HOSPITAL WILL BE EXPANDED THROUGH THE OPENING OF A 24/7 URGENT CARE CLINIC IN AN AREA WITH A LARGE UNDER-INSURED/UNINSURED POPULATION. THE MAJORITY OF THE GOVERNING BODY OF OUR LADY OF THE LAKE IS COMPRISED OF INDIVIDUALS FROM A BROAD CROSS-SECTION OF THE COMMUNITY WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. OLOL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF THE HOSPITAL DEPARTMENTS AS NEEDED. SURPLUS FUNDS ARE APPLIED TO IMPROVEMENT IN PATIENT CARE AREAS THROUGH THE INVESTMENT IN CLINICAL TECHNOLOGY. MEDICAL INFORMATION TECHNOLOGY, AND CONTINUED TRAINING OF CLINICAL STAFF. AFFILIATED HEALTH CARE SYSTEM ROLES PART VI, LINE 6 OUR LADY OF THE LAKE HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL, NON-STOCK, MEMBER CORPORATION OF WHICH FRANCISCIAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC. (FMOL HEALTH SYSTEM) IS THE SOLE MEMBER. OUR LADY OF THE LAKE HOSPITAL IS PART OF THE FMOL HEALTH SYSTEM WHICH INCLUDES SEVERAL HOSPITALS AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATE OF LOUISIANA. OUR LADY OF THE LAKE HOSPITAL SERVES THE COMMUNITY IN EAST BATON ROUGE PARISH AND SURROUNDING PARISHES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: OUR LADY OF LOURDES REGIONAL MEDICAL CENTER ST. FRANCIS MEDICAL CENTER ST. ELIZABETH HOSPITAL OUR LADY OF THE LAKE ASSUMPTION HOSPITAL PART V, LINE 13G: OUR LADY OF THE LAKE HOSPITAL REGISTRATION PERSONNEL REFER PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE TO FINANCIAL COUNSELORS TO DISCUSS QUALIFICATION FOR FREE OR DISCOUNTED CARE. THE POLICY IS ALSO POSTED AT THE HOSPITAL BUSINESS OFFICES AND AT URGENT CARE CENTERS. PART V, LINE 13G: SURGICAL SPECIALTY CENTER OF BATON ROUGE FOR PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE, FINANCIAL COUNSELORS ARE AVAILABLE TO DISCUSS QUALIFICATION FOR FREE OR DISCOUNTED CARE. PART V, QUESTION 20: OUR LADY OF THE LAKE HOSPITAL THE HOSPITAL FACILITY HAS CALCULATED THE AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE AT APPROXIMATELY A 30% DISCOUNT FROM CHARGE MASTER RATES. UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP), MULTIPLE LEVELS OF DISCOUNTS ARE PROVIDED FOR. THE MAJORITY OF FAP ELIGIBLE PATIENTS FALL IN THE 50%, 75%, AND 100% DISCOUNT LEVELS. THERE IS HOWEVER A 25% DISCOUNT LEVEL. THE HOSPITAL ALSO OFFERS A 25% SELF-PAY DISCOUNT. SO FOR UNINSURED FAP PATIENTS, MULTIPLE DISCOUNTS MAY APPLY. IT IS POSSIBLE, HOWEVER, THAT AN UNDERINSURED PATIENT WITHIN CERTAIN INCOME LEVELS WOULD BE OFFERED ONLY THE 25% CHARITY DISCOUNT. THE NUMBER OF PATIENTS IN THIS SCENARIO WOULD BE EXTREMELY SMALL, IF ANY, BUT IT IS POSSIBLE THAT THIS CATEGORY OF PATIENT MAY HAVE BEEN CHARGED MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE. IN ADDITION, THERE IS LOW PROBABILITY THAT ANY PATIENT IN THIS 25% CHARITY DISCOUNT CATEGORY ACTUALLY PAID MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE. THE HOSPITAL ADOPTED A NEW FAP POLICY AS OF JUNE 2013 THAT WILL ENSURE THAT FAP-ELIGIBLE PATIENTS ARE NOT BILLED MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE. PART V, QUESTION 20: SURGICAL SPECIALTY CENTER OF BATON ROUGE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP), MULTIPLE LEVELS OF DISCOUNTS ARE PROVIDED FOR. THE MAJORITY OF FAP ELIGIBLE PATIENTS FALL IN THE 50%, 75%, AND 100% DISCOUNT LEVELS. THERE IS HOWEVER A 25% DISCOUNT LEVEL. THE HOSPITAL ALSO OFFERS A 25% SELF-PAY DISCOUNT. SO FOR UNINSURED FAP PATIENTS, MULTIPLE DISCOUNTS MAY APPLY. IT IS POSSIBLE, HOWEVER, THAT AN UNDERINSURED PATIENT WITHIN CERTAIN INCOME LEVELS WOULD BE OFFERED ONLY THE 25% CHARITY DISCOUNT. THE NUMBER OF PATIENTS IN THIS SCENARIO WOULD BE EXTREMELY SMALL, IF ANY, BUT IT IS POSSIBLE THAT THIS CATEGORY OF PATIENT MAY HAVE BEEN CHARGED MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE. IN ADDITION, THERE IS LOW PROBABILITY THAT ANY PATIENT IN THIS 25% CHARITY DISCOUNT CATEGORY ACTUALLY PAID MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE. THE HOSPITAL FACILITY IS CURRENTLY WORKING TO CORRECT THIS SITUATION FOR THIS SMALL NUMBER OF PATIENTS. PART V, QUESTION 19D: OUR LADY OF THE LAKE HOSPITAL AND SURGICAL SPECIALTY CENTER OF BATON ROUGE THE HOSPITAL OFFERS VARIOUS LEVELS OF DISCOUNTS WHICH ARE BASED ON A SLIDING SCALE USING THE FEDERAL POVERTY GUIDELINE FAMILY INCOME LEVELS AND OTHER FACTORS. SUCH OTHER FACTORS INCLUDE ASSET LEVELS, MEDICAL INDIGENCY, AND A PATIENT'S QUALIFICATION FOR MEDICARE OR MEDICAID. TOGETHER THESE CRITERIA ARE USED TO SET THE MAXIMUM AMOUNT CHARGED. ALSO, A 25% SELF-PAY DISCOUNT IS GIVEN IN ADDITION TO THE CHARITY DISCOUNTS DESCRIBED ABOVE. PART III, SECTION A, QUESTION 2 THE HOSPITAL ACCOUNTS FOR BAD DEBTS BASED ON THE AGING OF THE ACCOUNTS AND BASED ON HISTORICAL COLLECTION HISOTRY ASSOCIATED WITH THE VARIOUS AGING CATEGORIES. ON A PERIODIC BASIS, THE ORGANIZATION CONDUCTS A RETROSPECTIVE REVIEW TO DETERMINE THE APPROPRIATENESS OF THE COLLECTION PERCENTAGES UTILIZED IN ESTIMATED BAD DEBT EXPENSE. CHARITY AND DISCOUNTS ARE NOT INCLUDED IN BAD DEBT EXPENSE. PAYMENTS RECEIVED ON ACCOUNTS SUBSEQUENT TO BEING CONSIDERED BAD DEBT ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE. PART V, SECTION B, QUESTION 3 OUR LADY OF THE LAKE HOSPITAL AND SURGICAL SPECIALTY CENTER OF BATON ROUGE OLOL JOINED THE MAYOR'S HEALTHY CITY INITIATIVE AND SITS AMONG OTHER LOCAL AREA HOSPITALS IN AN OPEN COLLABORATIVE EFFORT TO IMPROVE THE HEALTH OF THE BATON ROUGE COMMUNITY. THE MAYOR'S HEALTHY CITY INITIATIVE WORKED WITH HEALTHYBR AND MEDBR TO COMPLETE THE COMMUNITY NEEDS ASSESSMENT. AMONG THESE THREE GROUPS, THERE WERE REPRESENTATIVES FROM NUMEROUS BUSINESSES, HOSPITALS, GOVERNMENT ORGANIZATIONS, NONPROFIT ORGANIZATIONS AND SCHOOLS. THE LOCAL HOSPITALS PARTICIPATING WERE WOMAN'S HOSPITAL, BATON ROUGE GENERAL, OCHSNER MEDICAL CENTER, LSU HEALTH SCIENCES, LANE REGIONAL MEDICAL CENTER, AND EARL K. LONG/LSU HEALTH. THE REPRESENTATIVES ALSO INCLUDED INDIVIDUALS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THESE INDIVIDUALS WERE JIMMY GUIDRY, MD, STATE HEALTH OFFICER OF LOUISIANA AND DHH'S MEDICAL DIRECTOR; PAM ROMERO, RD, LDN, CDE, REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR; AND MARILYN REYNAUD, MD, MPH, REGIONAL ADMINISTRATOR/MEDICAL DIRECTOR FOR THE DEPARTMENT OF HEALTH AND HOSPITALS, REGION 2 OFFICE OF PUBLIC HEALTH. DEPARTMENT OF HEALTH AND HOSPITALS, REGION 2 OFFICE OF PUBLIC HEALTH. PART V, SECTION B, QUESTION 4 OUR LADY OF THE LAKE HOSPITAL: THE CHNA WAS CONDUCTED IN COLLABORATION WITH WOMAN'S HOSPITAL, BATON ROUGE GENERAL MEDICAL CENTER, LANE REGIONAL MEDICAL CENTER, AND LSU HEALTH/EARL K. LONG MEDICAL CENTER THROUGHTHE MAYOR'S HEALTHY CITY INITIATIVE. SURGICAL SPECIALTY CENTER OF BATON ROUGE: SURGICAL SPECIALTY CENTER OF BATON ROUGE FORMALLY ADOPTED THE COMMUNITY HEALTH NEEDS ASSESSMENT OF OUR LADY OF THE LAKE HOSPITAL , AN AFFILIATED ENTITY. SSC AND OLOL SHARE THE SAME DEMOGRAPHIC COMMUNITY SO SSC FELT THAT THE NEEDS IDENTIFIED BY THE MAYOR'S HEALTHY CITY INITIATIVE WERE REPRESENTATIVE OF ITS COMMUNITY'S NEEDS AS WELL. PART V, SECTION B, Q5 OUR LADY OF THE LAKE HOSPITAL: THE CHNA CAN BE FOUND AT HTTPS://FMOLHS.ORG/OLOLRMC/PAGES/QUALITY/COMMUNITY-HEALTH-ASSESSMENT.ASPX SURGICAL SPECIALTY CENTER OF BATON ROUGE: THE CHNA CAN BE FOUND AT WWW.SSCBR.COM. PART V, SECTION B, QUESTION 7 OUR LADY OF THE LAKE HOSPITAL (OLOL): OLOL DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA. OLOL (AND THE MAYOR'S HEALTHY CITY INITIATIVE AS A WHOLE) AGREED THAT THE COMMUNITY SHOULD WORK ON THE TOP FOUR IDENTIFIED PRIORITIES SINCE THEY POSE THE HIGHEST RISK TO THE COMMUNITY. AS SUCH, OLOL CHOSE NOT TO FOCUS ON THE FOLLOWING: HEART DISEASE/HIGH BLOOD PRESSURE/STROKE; CANCER; DIABETES; CHILD AND ADOLESCENT HEALTH; LIFESTYLE ISSUES; AND BARRIERS. HOWEVER OLOL CURRENTLY CONDUCTS AND WILL CONTINUE TO CONDUCT PROGRAMS AND/OR PROVIDE SERVICES THAT HELP ADDRESS THESE NEEDS. SURGICAL SPECIALTY CENTER OF BATON ROUGE: SURGICAL SPECIALTY CENTER OF BATON ROUGE (SSC) DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA. IT CHOSE NOT TO ADDRESS OBESITY, HIV/AIDS, CHILDREN & ADOLESCENT HEALTH, HEART DISEASE/HIGH BLOOD PRESSURE/STROKE BECAUSE OUR LADY OF THE LAKE HOSPITAL (AN AFFILIATED ENTITY) AND OTHERS HAVE SELECTED THESE ISSUES TO ADDRESS. SSC WILL ASSIST OTHER LOCAL HOSPITALS AND ORGANIZATIONS IN THE COMMUNITY IF REQUESTED AND WHERE APPROPRIATE. SSC ALSO CHOSE NOT TO ADDRESS MENTAL AND BEHAVIORAL HEALTH, HIV/AIDS, AND OVER UTILIZATION OF EMERGENCY DEPARTMENT BECAUSE SSC IS A SPECIALTY HOSPITAL NOT EQUIPT TO ADDRESS SUCH ISSUES. true BATON ROUGE AREA CHAMBER 564 LAUREL STREET BATON ROUGE LA 70801 720126959 501(C)(6) 76308 GENERAL SUPPORT GENERAL GROWTH PROPERTIES 6401 BLUEBONNET BLVD STE 5050 BATON ROUGE LA 70836 300247204 88000 PLAYGROUND EQUIPMENT CARDIOVASCULAR RESEARCH 7777 HENNESSY BLVD BATON ROUGE LA 70808 721490943 501(C)(3) 100000 GENERAL SUPPORT BATON ROUGE SPEECH AND HEARING FOUNDATION 535 W ROOSEVELT ST BATON ROUGE LA 70802 720542134 501(C)(3) 45500 GENERAL SUPPORT LOUISIANA PEDIATRIC CARDIOLOGY FOUNDATION 2137A QUAIL RUN STE B BATON ROUGE LA 70808 721476551 501(C)(3) 30000 GENERAL SUPPORT ARTHRITIS ASSOCIATION OF LA 4939 JAMESTOWN AVE STE 104-A BATON ROUGE LA 70809 760750333 501(C)(3) 25000 GENERAL SUPPORT CANCER SERVICES OF BATON ROUGE 550 LOBDELL AVENUE BATON ROUGE LA 70806 720517180 501(C)(3) 21250 GENERAL SUPPORT VOLUNTEER HEALTH CORPS 4655 SHERWOOD COMMON BLVD BATON ROUGE LA 70816 204852337 501(C)(3) 20000 GENERAL SUPPORT MARY BIRD PERKINS CANCER P O BOX 11407 DEPT 1299 BIRMINGHAM AL 352461299 237010520 501(C)(3) 16250 GENERAL SUPPORT community BATON ROUGE SYMPHONY ORCHESTRA 2354 S ACADIAN THRUWAY STE A BATON ROUGE LA 70808 726001959 501(C)(3) 10000 GENERAL SUPPORT INTERNATIONAL RETT SYNDROME FOUNDATION 4600 DEVITT DR CINCINNATI OH 45246 311682518 501(C)(3) 10000 GENERAL SUPPORT SOUTHERN UNIVERSITY SYSTEM P O BOX 9270 BATON ROUGE LA 70813 237052911 501(C)(3) 10000 GENERAL SUPPORT BOYS & GIRLS CLUB 8281 GOODWOOD BLVD STE H BATON ROUGE LA 70806 720928014 501(C)(3) 6000 GENERAL SUPPORT FAMILIES HELPING FAMILIES 2356 DRUSILLA LANE BATON ROUGE LA 70809 721406289 501(C)(3) 7500 GENERAL SUPPORT ISTROUMA AREA COUNCIL P O BOX 66676 BATON ROUGE LA 70896 720411324 501(C)(3) 7500 GENERAL SUPPORT SHAQUILLE O'NEAL CHAMPSLIFE SKILLS 107 GYM ARMORY BATON ROUGE LA 70803 721004960 501(C)(3) 8500 GENERAL SUPPORT PENNINGTON BIOMEDICAL RESEARCH FOUNDATION 6400 PERKINS ROAD BATON ROUGE LA 708084124 581767810 501(C)(3) 6500 GENERAL SUPPORT ALLIANCE SAFETY COUNCIL 10099 NORTH REIGRE ROAD BATON ROUGE LA 70809 720702946 501(c)(3) 30000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 752314596 135613797 501(C)(3) 80000 GENERAL SUPPORT BR ECONOMIC & AGRICULTURAL DEVELOPMENT ALLIANCE PO BOX 3976 BATON ROUGE LA 70821 721332566 501(C)(3) 10000 GENERAL SUPPORT CATHOLIC DIOCESE OF BATON ROUGE 18000 S ACADIAN THRUWAY BATON ROUGE LA 70806 720550127 501(C)(3) 7500 GENERAL SUPPORT ARTS COUNCIL OF GREATER BATON ROUGE 427 LAUREL STREET BATON ROUGE LA 70802 720735814 501(C)(3) 6000 GENERAL SUPPORT MCMAINS CHILDREN'S DEVELOPMENTAL CENTER 1805 COLLEGE DRIVE BATON ROUGE LA 70808 720459036 501(C)(3) 35967 GENERAL SUPPORT JUNIOR ACHIEVEMENT 7809 JEFFERSON HWY STE D-4 BATON ROUGE LA 70809 720485727 501(C)(3) 11000 GENERAL SUPPORT LOUISIANA 4-H FOUNDATION PO BOX 25100 BATON ROUGE LA 70894 721367519 501(C)(3) 10000 GENERAL SUPPORT LOUISIANA STATE UNIVERSITY- OFFICE OF ACCTG SVCS 204 THOMAS BOYD HALL BATON ROUGE LA 708032901 726000848 GOVT 2148011 GENERAL SUPPORT LOURDES FOUNDATION PO BOX 4027 LAFAYETTE LA 70502 721494532 501(C)(3) 10000 GENERAL SUPPORT LSUHSC CLINICS EARL K LONG MEDICAL CENTER 5825 AIRLINE HWY BATON ROUGE LA 70805 721304948 501(C)(3) 833909 GENERAL SUPPORT LSUHSC-NEW ORLEANS 1901 PERDIDO STREET BOX P3-1 NEW ORLEANS LA 70112 726087770 501(C)(3) 360433 GENERAL SUPPORT ST ELIZABETH HOSPITAL 1125 WEST HWY 30 GONZALES LA 70737 721470744 501(C)(3) 10354 GENERAL SUPPORT OUR LADY OF THE LAKE COLLEGE 5000 HENNESSY BLVD BATON ROUGE LA 70808 721173156 501(C)(3) 2929167 GENERAL SUPPORT CITY YEAR INC 287 COLUMBUS AVENUE BOSTON MA 02116 222882549 501(C)(3) 7500 GENERAL SUPPORT NATIONAL INFUSION SERVICES 5344 BRITTANY DRIVE BATON ROUGE LA 70808 721508782 18130 INFUSION THERAPY F JEFFERSON LINER JR MD & DOROTHY A LEWIS PTRS PO BOX 2308 HAMMOND LA 70404 720955002 157714 SEE PART IV BATON ROUGE RADIOLOGY GROUP 7887 PICARDY AVENUE BATON ROUGE LA 70809 720692720 1514302 SVCS FOR INDIGENT PATIENTS 30 5 SCHOLARSHIP 1 3438 MEDICAL CARE FOR NEEDY INDIVIDUALS 6 53450 Monitoring grants FORMAL REQUESTS ARE RECEIVED BY THE BUSINESS PAYOR RELATIONS DEPARTMENT. THE REQUESTS ARE CHECKED FOR ALL APPROPRIATE INFORMATION AND DOCUMENTATION AND ARE PRESENTED TO EXECUTIVE ADMINISTRATION FOR APPROVAL. UPON APPROVAL THE REQUESTS ARE SUBMITTED TO ACCOUNTS PAYABLE FOR PAYMENT. PART II, PAGE 3, LINE 10 THE PURPOSE OF THE GRANT TO F JEFFERSON LINER JR., MD AND DOROTHY A. LEWIS PTRS WAS FOR SURGICAL SERVICES PROVIDED TO CHARITY HOSPITAL. false true false false false false false true false JOHN MCCLELLAND MD 398468 0 130870 0 792 0 10000 0 15316 0 555446 0 0 0 KENNETH WESTER 0 481556 0 147200 0 18659 0 78953 0 13462 0 739830 0 0 JEFFERY LIMBOCKER 298157 0 60125 0 11989 0 28981 0 28131 0 427383 0 0 0 DENZIL MORAES 770773 0 345370 0 44696 0 10000 0 24261 0 1195100 0 0 0 STEVEN GREMILLION 664203 0 290055 0 72114 0 10000 0 22061 0 1058433 0 0 0 KENNETH CIVELLO 579843 0 279545 0 37954 0 10000 0 24734 0 932076 0 0 0 PAUL GARRETT 534987 0 207948 0 33392 0 10000 0 22061 0 808388 0 0 0 JEFFREY HYDE 528656 0 250131 0 34710 0 10000 0 19484 0 842981 0 0 0 PART 1, QUESTION 4A THE CEO 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. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS 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. PART 1, QUESTION 4B FMOLHS MAINTAINS AN UNFUNDED DEFERRED COMPENSATION PLAN WHICH MEETS THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLAN PROVIDES 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 PLAN 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. PART 1, QUESTION 7 DISCRETIONARY BONUSES WERE PAID WITH REGARD TO PERSONS LISTED ON PART VII, SECTION A, LINE 1A. SUCH BONUSES WERE APPROVED BY THE CEO OR THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. PART 1, QUESTION 3 THE CEO 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 CEO'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 MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE. SURGICAL MANAGEMENT SERVICES LLC 2 BM ARE OWNERS 2003294 PROVIDED MANAGEMENT SERVICES false CVT VASCULAR LAB INC 2 BM ARE OWNERS 1077917 PROVIDED MEDICAL SERVICES false CVT SURGICAL CENTER 2 BM ARE OWNERS 208723 PROVIDED MEDICAL SERVICES false BONE AND JOINT CLINIC 1 BOARD MEMBER IS OWNER 467362 PROVIDED MEDICAL SERVICES false GOVERNING DOCUMENTS PART VI, SECTION C, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. PART VI, SECTION A, QUESTION 6 FMOL HEALTH SYSTEM (AN IRC SECTION 501 (C)(3) ORGANIZATION) IS THE SOLE MEMBER OF OUR LADY OF THE LAKE HOSPITAL, INC. MEMBERS PART VI, SECTION A, QUESTION 7B THE RESERVED POWERS TO THE MEMBER ARE AS FOLLOWS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES AND PURPOSES OF CORPORATION 2. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION 3. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION, OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES 5. TO DISSOLVE AND TO DISTRIBUTE ASSETS OF THE CORPORATION 6. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION 7. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF THE CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION 9. TO APPOINT THE FISCAL AUDITOR FOR THE CORPORATION 10. 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 11. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION AND 12. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION CONFLICT OF INTEREST PART VI, SECTION B, QUESTION 12C OUR LADY OF THE LAKE HOSPITAL, INC. 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 OUR LADY OF THE LAKE HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OUR LADY OF THE LAKE HOSPITAL, INC. 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. PART VI, SECTION A, QUESTION 11 AFTER PREPARATION AND REVIEW OF THE FORM 990 BY KPMG, THE FORM 990 IS REVIEWED BY MANAGEMENT. A COPY OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED WITH THE IRS. PART VI, SECTION A, QUESTION 7A FMOL HEALTH SYSTEM, AS THE SOLE MEMBER OF OUR LADY OF THE LAKE HOSPITAL, INC. RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF OUR LADY OF THE LAKE Hospital, Inc. DETERMINING COMPENSATION PART VI, SECTION B, QUESTION 15A & 15B OUR BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE MADE UP OF INDEPENDENT BOARD MEMBERS TO REVIEW AND SET THE COMPENSATION ANNUALLY OF OUR OFFICERS AND KEY EMPLOYEES. 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. THE COMPENSATION FOR THE CEO OF OUR LADY OF THE LAKE HOSPITAL, INC. IS SET BY THE COMPENSATION COMMITTEE OF FMOL HEALTH SYSTEM (A RELATED TAX-EXEMPT ORGANIZATION) ACCORDING TO THEIR PAY PRACTICES WHICH ARE SIMILAR TO THOSE DESCRIBED ABOVE. COMMUNITY BENEFIT STATEMENT FORM 990 PART III THE MEDICAL CENTER PARTICIPATES IN GOVERNMENT PROGRAMS, INCLUDING MEDICARE, MEDICAID, AND THE TRICARE PROGRAM. UNDER THESE PROGRAMS, THE MEDICAL CENTER PROVIDES CARE TO PATIENTS AT PAYMENT RATES THAT ARE DETERMINED BY THE FEDERAL AND STATE GOVERNMENTS, REGARDLESS OF ACTUAL COST. IN SOME CASES, THESE PROGRAMS PAY THE MEDICAL CENTER AT AMOUNTS THAT ARE LESS THAN ITS COST OF PROVIDING SERVICES. THE FOLLOWING TABLE SUMMARIZES THE AMOUNTS OF CHARGES FOREGONE (I.E., CONTRACTUAL ALLOWANCES) AND THE ESTIMATED LOSSES INCURRED BY THE MEDICAL CENTER DUE TO INADEQUATE PAYMENTS BY THESE PROGRAMS AND FOR CHARITY FOR THE YEAR END JUNE 30, 2013. THIS TABLE DOES NOT INCLUDE DISCOUNTS OFFERED BY THE MEDICAL CENTER UNDER MANAGED CARE OR OTHER SUCH ARRANGEMENTS. THE BELOW FIGURES USE A SLIGHTLY DIFFERENT ASSUMPTION FROM SCHEDULE H AND THEREFORE AMOUNTS MAY VARY. CHARITY CARE AND MEANS TESTED PROGRAMS: JUNE 30, 2013 CHARGES FOREGONE NET COMMUNITY BENEFIT EXPENSE CHARITY CARE $12,003,000 $4,354,000 UNREIMBURSED MEDICAID 146,088,000 29,889,000 UNREIMBURSED MEDICARE 296,872,000 23,933,000 TOTAL $454,963,000 $58,176,000 IN ADDITION TO COMMUNITY SERVICES DIRECTLY ASSOCIATED WITH PROVIDING HOSPITAL BASED CARE, THE MEDICAL CENTER SERVES THE COMMUNITY IN NUMEROUS OTHER WAYS. THE METHOD FOR ESTIMATING COSTS OF COMMUNITY SERVICES WAS REVISED FOR FISCAL YEAR 2013 TO REFLECT THE INTERNAL REVENUE SERVICE'S GUIDELINES FOR FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX. THE FOLLOWING TABLE FOR THE YEAR ENDED JUNE 30, 2013 SUMMARIZES ESTIMATED COSTS OF THE COMMUNITY SERVICES: COMMUNITY BENEFIT AT COST: COMMUNITY HEALTH IMPROVEMENT SERVICES: 1,949,000 HEALTH CARE PROFESSIONS EDUCATION: 5,858,000 SUBSIDIZED HEALTH SERVICES: 8,842,000 FINANCIAL CONTRIBUTION: 3,572,000 TOTAL $20,221,000 COMMUNITY HEALTH IMPROVEMENT SERVICES IMMUNOLOGICAL SUPPORT THE MEDICAL CENTER ORGANIZED, OWNS AND OPERATES A HOME WHICH IS DESIGNED TO HELP THE MEMBERS OF OUR COMMUNITY WHO HAVE CONTRACTED ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) TO DEAL WITH THE VERY DEBILITATING PHYSICAL, SOCIAL, AND PSYCHOLOGICAL PROBLEMS ASSOCIATED WITH THE DISEASE. PARISH NURSE PROGRAM TO ASSIST IN EDUCATING THE COMMUNITY REGARDING HEALTH RELATED ISSUES, THE MEDICAL CENTER PARTICIPATES IN NUMEROUS HEALTH FAIRS AND SPONSORS TALKS TO VARIOUS SCHOOLS AND INDUSTRY GROUPS REGARDING SUCH ISSUES AS DRUG ABUSE AND SAFETY IN THE WORKPLACE. LAKELINE DIRECT THE MEDICAL CENTER OPERATES A NURSE CALL CENTER, LAKELINE DIRECT, OFFERING COMPLIMENTARY 24 HOUR NURSE ADVICE, HEALTH INFORMATION AID, AND PHYSICIAN REFERRAL SERVICE TO THE COMMUNITY. ST. MARTHA ACTIVITY CENTER THE MEDICAL CENTER PROVIDES AN ACTIVITY CENTER LOCATED AT THE ELDERLY HOUSING FACILITY FOR THE RESIDENTS OF THE HOUSING FACILITY AS WELL AS OTHER ELDERLY COMMUNITY MEETINGS. ELDERLY SERVICES THE MEDICAL CENTER SPONSORS AND INCURS THE SALARY OF THE DIRECTOR OF THE HUD HOUSING FACILITY, PASTORAL CARE ASSOCIATE AND MEDICAL DIRECTOR OF ELDERLY SERVICES. ELDERLY HOUSING OLLIE STEELE BURDEN MANOR, A SUBSIDIARY OF THE MEDICAL CENTER, OPERATES ST. CLARE MANOR WHICH HAS 216 TOTAL BEDS, OF WHICH 120 ARE MEDICAID LICENSED. HEALTH CARE PROFESSIONAL'S EDUCATION OLOL COLLEGE IN AN EFFORT TO ENSURE THAT AN ADEQUATE SUPPLY OF NURSES ARE AVAILABLE FOR THE BATON ROUGE COMMUNITY, THE MEDICAL CENTER FOUNDED AND ORGANIZED OUR LADY OF THE LAKE COLLEGE, INC. THE MEDICAL CENTER SUBSIDIZES THE OPERATIONS OF THE COLLEGE WITH GRANTS. INTERNS AND RESIDENTS THE MEDICAL CENTER PARTICIPATES IN MEDICARE'S GRADUATE MEDICAL EDUCATION THROUGH AFFILIATION WITH LOUISIANA MEDICAL SCHOOL AND MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS TO CONTINUE TO SUPPORT AVAILABILITY OF PHYSICIANS IN FUTURE YEARS. SUBSIDIZED HEALTH SERVICES FAMILY EDUCATION THE MEDICAL CENTER PROMOTES A HEALTHY ENVIRONMENT FOR THE FAMILY THROUGH ITS PEDIATRIC PROGRAMS, WHICH INCLUDE KID-MED CLINIC, PEDIATRIC ASSESSMENT CENTER AND CHILD LIFE PROGRAMS. OLOL NEIGHBORHOOD CLINIC THE MEDICAL CENTER OPERATES A SCOTLANDVILLE CLINIC TO PROVIDE WALK IN CARE FOR MINOR ILLNESS AND INJURY DURING EVENINGS AND WEEKENDS. COPE THE MEDICAL CENTER PROVIDES CRISIS ORIENTED PSYCHIATRIC EVALUATION (COPE) TO THE COMMUNITY. PALLIATIVE CARE THE MEDICAL CENTER PROVIDES PALLIATIVE CARE SERVICE FOR PATIENTS IN THE FINAL STATE OF LIFE AND THEIR FAMILY MEMBERS. RESEARCH CLINICAL RESEARCH THE MEDICAL CENTER PARTICIPATES IN CLINICAL RESEARCH PROJECTS TO IMPROVE THE HEALTH AND CARE OF PATIENTS AND COMMUNITY MEMBERS. FINANCIAL CONTRIBUTIONS CASH CONTRIBUTIONS THE MEDICAL CENTER ALSO ORGANIZES EMPLOYEE PARTICIPATION IN FUND RAISING FOR ORGANIZATIONS SUCH AS CAPITAL AREA UNITED WAY, MARCH OF DIMES OF AMERICA, JUNIOR ACHIEVEMENT, CYSTIC FIBROSIS AND THE COMMUNITY FUND FOR THE ARTS. THE MEDICAL CENTER ALSO MAKES CORPORATE DONATIONS TO VARIOUS AREA COMMUNITY SERVICE ORGANIZATIONS. COMMUNITY BUILDING ACTIVITIES ELDERLY HOUSING COMPLEX THE MEDICAL CENTER OPERATES FOUR ELDERLY HOUSING PROJECTS: VILLA ST. FRANCIS, INC., ASSISI VILLAGE, INC., CALAIS HOUSE, INC., AND CHATEAU LOUISE, INC. THESE PROJECTS ARE DESIGNED TO PROMOTE THE HEALTH, SECURITY, AND HAPPINESS OF THE ELDERLY AND HANDICAPPED PERSONS OF THE GREATER BATON ROUGE AREA. MARY BIRD PERKINS THE MEDICAL CENTER ALSO SPONSORS THE CHARITABLE ACTIVITIES OF OTHER NOT-FOR-PROFIT ORGANIZATIONS IN BATON ROUGE. THE MEDICAL CENTER PROVIDES LAND ADJOINING THE MEDICAL CENTER TO THE MARY BIRD PERKINS CANCER CENTER FOR ITS OPERATIONS AND FORGOES ALL RENTAL INCOME FOR THE USE OF THIS LAND. COMMUNITY CLINIC THE MEDICAL CENTER PROVIDES A BUILDING THAT SPONSORS A COMMUNITY CLINIC AND FOREGOES ALL RENTAL INCOME RELATED TO THE USE OF THE BUILDING. Part XI, Line 9 Other Changes in net assets or fund balances: Paid in Capital - PPASC 432,874 Capital Transfers FMOL 18,647,514 Total Other Adj. to FB 19,080,388 PART VI, SECTION A QUESTION 2 JAMES CRAVEN, M.D. AND WALTER BRINGAZE III, M.D. - BUSINESS RELATIONSHIP OUR LADY OF THE LAKE PHYSICIANS GROUP LL 5000 HENNESSY BLVD BATON ROUGE LA 70808 274026658 HEALTHCARE LA 114910925 37941872 OLOL ST BERNARD HEALTH FUND 4200 ESSEN LANE BATON ROUGE LA 70809 204685614 HEALTHCARE LA 501(c)(3) 11 TYPE 1 FMOL false HEALTH PARTNERS NETWORK OF SOUTH LA 4801 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 HEALTHCARE LA 501(c)(3) 3 LOURDES RMC true HEALTH CARE CENTERS IN SCHOOLS 5000 HENNESSY BLVD BATON ROUGE LA 70808 721443935 HEALTHCARE LA 501(c)(3) 7 OLOL true HEART HOSPITAL OF ACADIANA 1105 KALISTE SALOOM ROAD LAFAYETTE LA 70508 300442368 HEALTHCARE LA LOURDES N/A false true PERKINS PLAZA MEDICAL ARTS DEVELOPMENT 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 450516574 REAL ESTATE LA OLOL RELATED 259855 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