2014-05-13T07:49:13-05:00 2013-09-30 720506596 COLE EVANS & PETERSON POST OFFICE DRAWER 1768 SHREVEPORT LA 711661768 990 2012-10-01 720400933 WILLIS-KNIGHTON MEDICAL CENTER WILL 3182124000 POST OFFICE BOX 32600 SHREVEPORT LA 711302600 JAMES K ELROD 3182124000 2014-05-12 1 C WILLIAM GERARDY JR P00024591 3182228367 2012 2015-11-30 17:44:51Z JAMES K ELROD POST OFFICE BOX 32600 SHREVEPORT LA 711302600 911312193 0 X WWW.WKHS.COM X 1949 LA THE MEDICAL CENTER PROVIDES A FULL-RANGE OF HEALTH CARE SERVICES TO THE GENERAL PUBLIC. 12 10 6992 302 1188569 0 26840 12857 847199480 891166400 1641187 283508 947805 4132928 849815312 895595693 2340463 1841191 0 0 351641743 375192529 0 0 0 412207323 444496160 766189529 821529880 83625783 74065813 950515940 1006411418 370437103 280746051 580078837 725665367 X TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE WE SERVE. 0 0 684127238 1841191 889000078 WILLIS-KNIGHTON MEDICAL CENTER STRIVES TO PROVIDE HIGH QUALITY, COST-EFFECTIVE MEDICAL CARE TO THE COMMUNITIES OF NORTHWEST LOUISIANA, NORTHEAST TEXAS, AND SOUTHWEST ARKANSAS. THE MEDICAL CENTER OFFERS SOPHISTICATED TECHNOLOGY AND PROCEDURES THAT MAKE IT A TERTIARY CARE REFERRAL CENTER. GENERAL THE MEDICAL CENTER PROVIDES 24-HOUR EMERGENCY CARE, REGARDLESS OF THE PATIENT'S ABILITY TO PAY, AT ITS FOUR HOSPITALS. THE MEDICAL CENTER PROVIDES AN ORGAN TRANSPLANT PROGRAM, OBSTETRICS, COMPREHENSIVE HEART AND CANCER PROGRAMS, EXTENSIVE SURGICAL OPTIONS, LEADING-EDGE DIAGNOSTICS AS WELL AS A BROAD NETWORK OF PHYSICIANS ENCOMPASSING MOST SPECIALTIES AND SUBSPECIALTIES. THE MEDICAL CENTER PROVIDES THESE SERVICES REGARDLESS OF RACE, COLOR, CREED, RELIGION, GENDER, NATIONAL ORIGIN, DISABILITY OR AGE. THE MEDICAL CENTER HAD 50,997 ADMITTANCES DURING THE YEAR ENDED SEPTEMBER 30, 2013 WITH A TOTAL OF 202,918 PATIENT DAYS AND 3,291 BIRTHS. THE MEDICAL CENTER PARTICIPATES IN THE MEDICAID PROGRAM AND ADMINISTERS A CHARITY CARE POLICY WHEREBY FREE OR DISCOUNTED SERVICES ARE AVAILABLE TO QUALIFIED INDIVIDUALS WITH LIMITED FINANCIAL MEANS. DURING THE YEAR ENDED SEPTEMBER 30, 2013, THE MEDICAL CENTER PROVIDED AN ESTIMATED $18,300,000 IN UNREIMBURSED COSTS ATTRIBUTABLE TO CHARITY CARE (EXCLUDING PROJECT NEIGHBORHEALTH) AND AN ESTIMATED $24,000,000 IN UNREIMBURSED COSTS ATTRIBUTABLE TO MEDICAID PATIENTS. THESE ESTIMATES ARE BASED ON THE MEDICAL CENTER'S OVERALL COST-TO-CHARGE RATIO. IN ADDITION TO THESE SERVICES, WILLIS-KNIGHTON PROJECT NEIGHBORHEALTH OPERATES FOUR CLINICS IN COMMUNITIES THAT ARE ECONOMICALLY DISTRESSED AND/OR DESIGNATED AS MEDICALLY UNDER-SERVED AREAS WITH HEALTH PROFESSIONAL SHORTAGES. SEE SCHEDULE H FOR DETAILED INFORMATION REGARDING PROJECT NEIGHBORHEALTH. REGIONAL TRANSPLANT CENTER THE MEDICAL CENTER OPERATES THE JOHN C. MCDONALD REGIONAL TRANSPLANT CENTER AT WILLIS-KNIGHTON MEDICAL CENTER. ALL TRANSPLANT PATIENTS RECEIVE TRANSPLANTS WITHOUT REGARD TO THEIR ECONOMIC STATUS. THE REGIONAL TRANSPLANT CENTER PROVIDES KIDNEY, PANCREAS, AND LIVER TRANSPLANTS. SUBSTANTIALLY ALL THE COSTS OF OPERATING THE REGIONAL TRANSPLANT CENTER ARE BORNE BY WILLIS-KNIGHTON MEDICAL CENTER. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013, 36 PATIENTS RECEIVED ORGAN TRANSPLANTS, CONSISTING OF 28 KIDNEYS (6 OF THOSE PATIENTS ALSO HAD A PANCREAS TRANSPLANT, AND 1 OF THOSE PATIENTS ALSO HAD A LIVER TRANSPLANT) AND 9 LIVERS. OF THE 36 TRANSPLANT SURGERIES PERFORMED AT THE MEDICAL CENTER DURING THE YEAR ENDED SEPTEMBER 30, 2013, 22 PATIENTS WERE BENEFICIARIES OF THE MEDICARE PROGRAM. AS SUCH, THESE TRANSPLANTS WERE PERFORMED AT VERY LITTLE, IF ANY, COST TO THE PATIENTS.EMERGENCY CARE THE MEDICAL CENTER PROVIDES EMERGENCY SERVICES AT FOUR LOCATIONS ON A 24-HOUR BASIS STAFFED BY FULL-TIME EMERGENCY ROOM PHYSICIANS. EMERGENCY PATIENTS ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY. DURING THE YEAR ENDED SEPTEMBER 30, 2013, THE MEDICAL CENTER'S EMERGENCY ROOMS WERE VISITED BY 156,981 PATIENTS, OF WHOM 20,382 WERE ADMITTED TO THE HOSPITAL FOR FURTHER TREATMENT.WOMEN AND CHILDREN'S HEALTH THE MEDICAL CENTER PROVIDES A VARIETY OF MEDICAL SERVICES FOR WOMEN AND CHILDREN, INCLUDING OBSTETRICS, GYNECOLOGY, NEONATOLOGY, MATERNAL/FETAL HEALTH SERVICES FOR HIGH RISK PREGNANCY, PEDIATRIC INTENSIVE CARE AND PEDIATRIC SUPPORT SERVICES SUCH AS PEDIATRIC GASTROENTEROLOGY AND PEDIATRIC SURGERY. THESE SERVICES INCLUDE BOTH HIGH-RISK AND LOW-RISK OBSTETRICS. MATERNAL TRANSPORTS ARE ACCEPTED. THE LABOR AND DELIVERY (L&D) UNITS ARE DIRECTED BY BOARD CERTIFIED OB-GYN PHYSICIANS AND THE MAJORITY OF THE NURSES ARE CERTIFIED BY THE ASSOCIATION OF WOMEN'S HEALTH, OBSTETRIC & NEONATAL NURSES (AWHON). THERE WERE 3,291 BIRTHS; 8,601 OBSTETRICAL VISITS TO THE L&D UNITS; AND 3,579 OBSTETRICAL AND GYNECOLOGICAL INPATIENTS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013HEALTH AND WELLNESS CENTERS THE MEDICAL CENTER HAS SIX MEDICALLY-SUPERVISED HEALTH AND WELLNESS CENTERS DEDICATED TO THE PREVENTION OF HEALTH PROBLEMS, FOUR IN SHREVEPORT, ONE IN BOSSIER CITY, AND ONE IN HOMER WITH A TOTAL MEMBER ENROLLMENT AT SEPTEMBER 30, 2013 OF 6,410. THE CENTERS ARE LOCATED ON EACH OF THE FOUR HOSPITAL CAMPUSES, IN THE WK PIERRE AVENUE COMMUNITY CENTER, AND IN THE WK CLAIBORNE REGIONAL HEALTH CENTER. A MEDICAL EVALUATION, INCLUDING A BLOOD CHEMISTRY WORK-UP, IS REQUIRED FOR MEMBERSHIP. THE CENTERS SERVE PULMONARY AND CARDIAC REHABILITATION PATIENTS AND PROVIDE HEALTH AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE LOCATED. NEONATAL INTENSIVE CARE UNIT WILLIS-KNIGHTON'S CENTER FOR WOMEN'S HEALTH HOUSES A 42-BED LEVEL III REGIONAL OBSTETRICAL AND NEONATAL UNIT. THIS UNIT ACCEPTS REFERRALS FROM THE ARK-LA-TEX AREA AND IS SERVICED BY BOTH AIR AND GROUND EMERGENCY TRANSPORT ON A 24-HOUR BASIS. THIS UNIT IS DIRECTED BY A BOARD CERTIFIED NEONATOLOGIST. THE MAJORITY OF THE NURSING STAFF IS CERTIFIED BY AWHON. THE AVERAGE LENGTH OF STAY PER ADMIT IS 19.4 DAYS.HOSPICE HOSPICE OF LOUISIANA IS A DEPARTMENT OF WILLIS-KNIGHTON MEDICAL CENTER THAT PROVIDES COMPREHENSIVE END-OF-LIFE CARE INCLUDING SKILLED AND SUPPORTIVE SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. THE HOSPICE TEAM, UNDER THE GUIDANCE OF THE ATTENDING PHYSICIAN, FOCUSES ON THE ALLEVIATION OF THE PAIN AND DISCOMFORT CONNECTED WITH LIFE-ENDING ILLNESS. QUALITY OF LIFE, EMOTIONAL AND SPIRITUAL BALANCE, SYMPTOM MANAGEMENT, AND PAIN CONTROL ARE THE GOALS THAT TEAM MEMBERS STRIVE FOR AS THEY ASSIST DYING PATIENTS AND THEIR FAMILIES. BEREAVEMENT SUPPORT FOR THE IMMEDIATE FAMILY AND COMPANIONS IS PROVIDED FOR AT LEAST ONE YEAR FOLLOWING THE PATIENT'S DEATH. FOR THE YEAR ENDED SEPTEMBER 30, 2013, HOSPICE OF LOUISIANA SERVED 202 PATIENTS AND THEIR FAMILIES AS DIRECT ADMITS, NOT INCLUDING VISITATION AND COUNSELING PROVIDED THROUGH PRE-ADMIT AND/OR BEREAVEMENT SERVICES. THE TEAM INCLUDES: REGISTERED NURSES, CERTIFIED NURSING ASSISTANTS, SOCIAL WORKERS, CHAPLAINS, VOLUNTEERS, ATTENDING PHYSICIANS, AND MEDICAL DIRECTOR.BEHAVIORAL MEDICINE CENTER THE BEHAVIORAL MEDICINE CENTER AT WILLIS-KNIGHTON MEDICAL CENTER OFFERS INPATIENT AND OUTPATIENT SERVICES TO INDIVIDUALS IN NEED OF MENTAL HEALTH CARE. DURING THE YEAR ENDED SEPTEMBER 30, 2013, THE BEHAVIORAL MEDICINE CENTER SPONSORED NUMEROUS INFORMATION SESSIONS FOR VARIOUS GROUPS IN THE SHREVEPORT/BOSSIER AND NORTHWEST LOUISIANA AREAS. SUCH SESSIONS AMOUNTED TO APPROXIMATELY 470 HOURS AND WERE ATTENDED BY APPROXIMATELY 3,800 PEOPLE. TOPICS INCLUDED:MARRIAGE/FAMILY - DEVELOPMENT OF SKILLS TO ENRICH MARRIAGE AND FAMILY LIFE.SELF-ESTEEM - CONCENTRATES ON HOW GOOD SELF-ESTEEM CAN ENHANCE AN INDIVIDUAL'S QUALITY OF LIFE. PARENTING - FOCUSES ON APPROPRIATE PARENTING SKILLS AT VARIOUS DEVELOPMENTAL STAGES. STRESS MANAGEMENT - DEVELOPING SKILLS TO COPE WITH EVERYDAY STRESSES IN LIFE.PERSONAL ENRICHMENT - EMPOWERING OURSELVES TO REACH MAXIMUM POTENTIAL.MOTIVATION/ATTITUDE - HOW ATTITUDE AFFECTS OUR MENTAL AND PHYSICAL HEALTH.COUNSELING ISSUES/TECHNIQUES - ISSUES CONCERNING PROFESSIONAL DEVELOPMENT FOR COUNSELORS/THERAPISTS.AGING - DEVELOPMENT OF A POSITIVE ATTITUDE TO DEAL WITH ISSUES OF AGING.DEPRESSION/SUICIDE - ASSESSMENT OF DEPRESSION AND SUICIDE, AND LEGAL AND ETHICAL ISSUES SURROUNDING SUICIDE. 11056139 4485520 THE MEDICAL CENTER PROVIDES HOUSING, HEALTHCARE, AND RELATED SERVICES TO THE ELDERLY THROUGH THE OAKS OF LOUISIANA. THE OAKS OF LOUISIANA IS A RESIDENTIAL COMMUNITY DESIGNED SPECIFICALLY FOR ADULTS AGED 55 AND OVER. THIS RESIDENTIAL COMMUNITY PROVIDES SECURE, MAINTENANCE-FREE LIVING AND PROMOTES AN ACTIVE, HEALTHY LIFESTYLE. THE CAMPUS OF THE OAKS OF LOUISIANA INCLUDES THE TOWER AT THE OAKS, A RESIDENTIAL COMMUNITY, AND SAVANNAH AT THE OAKS, AN ASSISTED LIVING FACILITY. 695183377 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 1 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 550 0 1 6992 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 10 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X X MR JAMES K ELROD 3182124000 2611 GREENWOOD ROAD SHREVEPORT LA 711033908 JAMES K ELROD 53.00 X X 1487262 5500 12899 PIERRE V BLANCHARDIV MD 40.00 X 205307 0 6804 RAY P ODEN JR 4.00 X 0 0 0 PHILLIP A ROZEMAN MD 4.00 X 0 0 0 TIGNER A WALKER 4.00 X 0 0 0 FRANK B HUGHES MD 4.00 X 0 0 0 RAND H FALBAUM 4.00 X 0 0 0 TWAIN K GIDDENS 4.00 X 0 0 0 WILLIS L MEADOWS JR 4.00 X 0 0 0 SAM J TALBOT 4.00 X 0 0 0 VINCENT MARSALA PHD 4.00 X 0 0 0 JOHN C MICIOTTO MD 4.00 X 0 0 0 GILBERT R SHANLEY 4.00 X 0 0 0 ROBERT D HUIE 52.00 X 1147461 0 19888 CHARLES D DAIGLE 40.00 X 444136 0 21319 STEPHEN R RANDALL 40.00 X 308090 0 21252 MARGARET G ELROD 40.00 X 174256 0 8625 JERRY A FIELDER II 40.00 X 164081 0 21773 CLIFFORD M BROUSSARD 40.00 X 174786 0 14117 JANET K ELROD 40.00 X 173649 0 8953 IRA L MOSS 40.00 X 203327 0 15086 JILL K ELROD 40.00 X 229136 0 12208 PEGGY J GAVIN 40.00 X 176291 0 9291 DEBORAH D OLDS 40.00 X 136153 0 15185 RAMONA D FRYER 40.00 X 180248 0 16899 DANIEL J MOLLER JR MD 40.00 X 321969 0 13683 CHARLES A POWERS MD 40.00 X 321409 0 14387 RANDALL P BREWER MD 40.00 X 2217347 0 23903 MILAN G MODY MD 40.00 X 1699363 0 18901 CHRISTIAN M BRIERY MD 40.00 X 1549919 0 18646 MATTHEW S MOSURA MD 40.00 X 1304848 0 18899 CLINT M CORMIER MD 40.00 X 1458837 0 18039 14077875 5500 330757 462 0 1 0 LSU HEALTH SCIENCES CENTER PO BOX 33932 SHREVEPORT LA 71130 MEDICAL STAFFING 5091089 SHREVEPORT ANESTHESIA SERVICE 2600 GREENWOOD ROAD SHREVEPORT LA 71103 PHYSICIAN SERVICES 4097893 RED RIVER CARDIOVASCULAR SURGEONS 2751 ALBERT BICKNELL DR SUITE 5C SHREVEPORT LA 71103 PHYSICIAN SERVICES 3330000 TEG ARCHITECTS LLC 903 SPRING STREET JEFFERSONVILLE IN 47130 ARCHITECTUAL FEES 2241302 MAYO MEDICAL LABORATORIES PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY TESTING SERVICES 2117420 118 12857 12857 HOSPITAL SERVICES 900099 886680880 886680880 RESIDENTIAL COMMUNITY 900099 4485520 4485520 891166400 908669 908669 1558434 1277483 280951 280951 280951 13777004 36852 13754668 684349 22336 -647497 -625161 -625161 LABORATORY REVENUE 621500 484973 484973 (LOSS) FROM SUBSIDIARY - HEALTH P 524114 69559 69559 (LOSS) FROM SUBSIDIARY - VIRGINIA 623000 -434968 -434968 3732413 3028817 703596 3851977 895595693 893485598 1188569 908669 1834039 1834039 7152 7152 6623380 6623380 272060334 237778932 34281402 22519959 19214513 3305446 50623146 43192756 7430390 23365710 19936126 3429584 798546 798546 1712614 1712614 2817683 1140130 1677553 7089213 7089213 710315 710315 45463399 22561253 22902146 5231662 5231662 DIRECT DEPARTMENTAL EXP 347843147 347843147 TAXES & LICENSES 8063166 8063166 BUSINESS OFFICE 5384520 5384520 19381895 1675329 17706566 821529880 695183377 126346503 0 5326613 156688418 118581569 126115486 141524578 11401086 7798107 20574027 21296159 3385510 3864762 1070719690 543441018 510393592 527278672 102365990 165730061 16882615 12754760 1648502 1443318 1060714 812819 950515940 1006411418 90271313 92060255 177443951 164265868 102721839 24419928 370437103 280746051 X 580078837 725665367 580078837 725665367 950515940 1006411418 X 74065813 -338760 71859477 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 65053 65053 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DURING THE YEAR ENDED SEPTEMBER 30, 2013, THE MEDICAL CENTER PAID DUES TOTALING $31,600 TO THE LOUISIANA STATE MEDICAL SOCIETY ON BEHALF OF DOCTORS IN THE MEDICAL CENTER'S PHYSICIAN NETWORK, WHICH CONSISTS OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEDICAL CENTER. A PORTION OF THE DUES, $6,636 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2013, THE MEDICAL CENTER PAID DUES TOTALING $6,790 TO THE AMERICAN MEDICAL ASSOCIATION ON BEHALF OF DOCTORS IN THE MEDICAL CENTER'S PHYSICIAN NETWORK, WHICH CONSISTS OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEDICAL CENTER. A PORTION OF THE DUES, $3,735 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2013, THE MEDICAL CENTER PAID DUES TOTALING $260,390 TO THE LOUISIANA HOSPITAL ASSOCIATION FOR THE MEDICAL CENTER'S MEMBERSHIP IN THE ASSOCIATION AND ON BEHALF OF DOCTORS IN THE MEDICAL CENTER'S PHYSICIAN NETWORK, WHICH CONSISTS OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEDICAL CENTER. A PORTION OF THE DUES, $54,682 WAS RELATED TO LOBBYING ACTIVITIES. HEALTHCARE POLICY IS CRITICAL TO THE MISSION OF THE MEDICAL CENTER, AND ITS MANAGEMENT BELIEVES THAT HEALTHCARE PROVIDERS SHOULD PARTICIPATE IN FORMING HEALTHCARE POLICY BY INTERACTING WITH NATIONAL, STATE, AND LOCAL REPRESENTATIVES AND THEIR STAFFS, WHEN POSSIBLE, TO HELP THEM BETTER UNDERSTAND THE COMPLEXITIES AND RAMIFICATIONS OF KEY HEALTHCARE ISSUES. THE MEDICAL CENTER'S MANAGEMENT IS AVAILABLE TO LAWMAKERS, GOVERNMENT OFFICIALS, AND THEIR STAFF MEMBERS, FOR INFORMATION AND OCCASIONALLY RESPONDS TO QUESTIONS AND INITIATES COMMUNICATIONS ABOUT HOW PROPOSED LAWS, POLICIES, REGULATIONS, ETC. MIGHT AFFECT THE MEDICAL CENTER'S ABILITY TO DELIVER COST-EFFECTIVE, QUALITY HEALTHCARE. THE AMOUNT OF TIME AND MONEY RESOURCES INVOLVED IN THESE ACTIVITIES IS INSUBSTANTIAL. THE MEDICAL CENTER HAS NOT AND DOES NOT INTERVENE IN ANY POLITICAL CAMPAIGN. 1272830 47885590 49158420 9550416 602556749 297534059 314573106 1903870 1247534 656336 310987785 230242390 80745395 96562450 14417035 82145415 527278672 CAPITAL LEASE OBLIGATIONS 2094365 INVESTMENT IN SUB. - VIRGINIA HALL, INC. 3582683 LIABILITY FOR PENSION BENEFITS 18742880 24419928 912442115 -338762 -338762 912780877 -17185184 -17185184 895595693 766855587 -54674293 -54674293 821529880 0 821529880 PART XI, LINE 4B - OTHER ADJUSTMENTS: UNRELATED BUSINESS INCOME-EXTERNAL HOUSEKEEPING, DATA PROCESSING, LAUNDRY SUBSIDIARIES EXPENSES PART XII, LINE 2D - OTHER ADJUSTMENTS: SUBSIDIARIES INCOME/EXPENSE UNRELATED BUSINESS INCOME-EXTERNAL HOUSEKEEPING, DATA PROCESSNG, LAUNDRY FASB ASC 715-30 PENSION PART XII, LINE 4B UNRELATED BUSINESS GROSS INCOME: DATA PROCESSING 297,460 HOUSEKEEPING 81,338 LAUNDRY 262,730 SUBSIDIARIES EXPENSES (17,826,712) TOTAL (17,185,184) PART XIII, LINE 2D UNRELATED BUSINESS GROSS INCOME: DATA PROCESSING (297,460) HOUSEKEEPING (81,338) LAUNDRY (262,730) SUBSIDIARIES EXPENSES 17,826,712 PENSION RELATED CHANGES (71,859,477) TOTAL (54,674,293) 0 0 0 0 0 0 0 0 0 0 RUSSIA & THE NEWLY INDEPENDENT STATES - PROVIDE MEDICAL SUPPLIES FOR MEDICAL MISSION TRIP TO THE UKRAINE 7152 MEDICAL SUPPLIES BOOK 1 0 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 18423846 18423846 0.02240 72549043 48546525 24002518 0.02920 90972889 48546525 42426364 0.05160 4525384 4525384 0.00550 4667879 4667879 0.00570 2508160 904635 1603525 0.00200 1834039 1834039 0.00220 13535462 904635 12630827 0.01540 104508351 49451160 55057191 0.06700 0 18293419 0 217697259 192359558 25337701 X 1 1 4 1 WILLIS-KNIGHTON MEDICAL CENTER

2600 GREENWOOD ROAD SHREVEPORT LA 71103

X X X X REHAB CTR, SNF, PHYSICIAN CLINICS A 2 WK PIERREMONT HEALTH CENTER

8001 YOUREE DRIVE SHREVEPORT LA 71115

X X X X PHYSICIAN CLINICS A 3 WK BOSSIER HEALTH CENTER

2400 HOSPITAL DRIVE BOSSIER CITY LA 71111

X X X PHYSICIAN CLINICS A 4 WILLIS-KNIGHTON SOUTH

2510 BERT KOUNS INDUSTRIAL LOOP SHREVEPORT LA 71118

X X X X PHYSICIAN CLINICS A WILLIS-KNIGHTON HEALTH SYSTEM 1 X X X X X X X X 12 1 0 1 X X X X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X 1 X 1 X X X X X 1 X 0 0 4 OUTPATIENT CLINICS

VARIOUS LOCATIONS SHREVEPORT LA 71130

OUTPATIENT CLINICS THE OAKS OF LOUISIANA

600 EAST FLOURNOY LUCUS ROAD SHREVEPORT LA 71115

RESIDENTIAL COMMUNITY FOR ADULTS AGE 55 AND OVER SAVANNAH AT THE OAKS

600 EAST FLOURNOY LUCUS ROAD SHREVEPORT LA 71115

ASSISTED LIVING FACILITY EXTENDED CARE CENTER

2550 KINGS HIGHWAY SHREVEPORT LA 71103

SUBACUTE REHABILITATION PART I, LINE 7: ALL ITEMS IN THE TABLE, EXCEPT FOR LINE 7G, USE THE COST-TO-CHARGE RATIO COSTING METHOD. PROJECT NEIGHBORHEALTH, WHICH IS INCLUDED ON LINE 7G, USES THE ACTUAL COST METHOD. PART III, LINE 4: THE MEDICAL CENTER MAINTAINS AN ALLOWANCE FOR DOUBTFUL PATIENT ACCOUNTS RECEIVABLE BASED ON MANAGEMENTS ASSESSMENT OF COLLECTABILITY, CURRENT ECONOMIC CONDITIONS, AND PRIOR EXPERIENCE. AS MANAGEMENT DETERMINES THE COLLECTION OF SPECIFIC PATIENT ACCOUNTS TO BE DOUBTFUL, SUCH ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE. BASED ON THIS ANALYSIS, BAD DEBT EXPENSE AS A PERCENTAGE OF GROSS PATIENT BILLINGS (EXCLUDING MEDICARE CHARGES, MEDICAID CHARGES, AND CHARITY CARE) WAS 5.8 PERCENT AND 6.9 PERCENT FOR THE YEARS ENDED SEPTEMBER 30, 2013 AND SEPTEMBER 30, 2012, RESPECTIVELY. 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. PART III, LINE 9B: MONTHLY STATEMENTS ARE GENERATED AND MAILED BY THE MEDICAL CENTER TO KEEP PATIENTS/GUARANTORS INFORMED OF OUTSTANDING ACCOUNT BALANCES. STATEMENT MESSAGES ARE GENERATED FOR EACH ACCOUNT THAT LET THE PATIENT/GUARANTOR KNOW IF THE BALANCE IS PENDING PAYMENT FROM THEIR INSURANCE CARRIER OR DEEMED TO BE THE PATIENT'S RESPONSIBILITY.THE IN-HOUSE COLLECTIONS DEPARTMENT IS RESPONSIBLE FOR SELF-PAY COLLECTIONS. THIS INCLUDES COLLECTION OF BALANCES AFTER ALL INSURANCE HAS PAID AND COLLECTION OF BALANCES FROM PATIENTS WHO HAVE NO INSURANCE. THE MEDICAL CENTER UTILIZES SELF PAY COMPASS (A COMPANY THAT SPECIALIZES IN ESTIMATING INDIVIDUAL'S INCOME AND FINANCIAL RESOURCES) TO IDENTIFY ACCOUNTS THAT HAVE A HIGH PROBABILITY FOR PAYMENT. THE PROBABILITY OF PAYMENT REPORT GENERATED BY SELF PAY COMPASS IS BASED ON OUTSIDE INFORMATION SOURCES THAT PROVIDE A PERSON'S CREDIT HISTORY, ESTIMATED HOUSEHOLD INCOME, MEDICAL BILL PAYMENT HISTORY, ETC. REPORTS ARE GENERATED FROM SELF PAY COMPASS ON A WEEKLY BASIS FOR ALL ACCOUNTS WITH A SELF-PAY BALANCE AND CALCULATED PROBABILITY OF PAYMENT GREATER THAN 70%. ACCOUNTS FROM THESE REPORTS ARE THEN PROCESSED BY MEDITECH (THE MEDICAL CENTER'S CORE SOFTWARE) TO DETERMINE IF THE GUARANTOR HAS ADDITIONAL SELF-PAY BALANCES. IF THE GUARANTOR IS CURRENTLY PAYING ON ANOTHER ACCOUNT(S), THE ACCOUNT FROM THE REPORT IS COMBINED WITH THE OTHER ACCOUNT(S) SO THE GUARANTOR RECEIVES ONE STATEMENT OR COLLECTION LETTER EACH MONTH. IF THE GUARANTOR HAS NO OTHER ACCOUNTS ON WHICH THEY ARE PAYING, A PHONE CALL IS MADE. A REPORT IS GENERATED FROM SELF PAY COMPASS ON A MONTHLY BASIS TO DETERMINE ACCOUNTS WITH BALANCES LESS THAN $100 THAT ARE DELINQUENT. THESE ACCOUNTS ARE IMPORTED INTO MEDITECH TO RECEIVE A COLLECTION LETTER WHEN APPROPRIATE. A REPORT IS GENERATED FROM MEDITECH ON A MONTHLY BASIS TO IDENTIFY ACCOUNTS WITH BALANCES OVER $10,000. THE IN-HOUSE COLLECTOR REVIEWS THE COLLECTION ACTIVITY AND FOLLOWS UP WITH THE APPROPRIATE ACTION WHICH MAY INCLUDE PHONE CALLS, ASSISTING THE PATIENT WITH APPLYING FOR CHARITY CARE, ESTABLISHING A PAYMENT ARRANGEMENT OR RECOMMENDING THAT THE ACCOUNT BE REFERRED FOR OUTSIDE COLLECTIONS. OTHER REPORTS ARE GENERATED FROM MEDITECH AND SELF PAY COMPASS ON AN AS-NEEDED BASIS TO IDENTIFY OTHER ACCOUNTS REQUIRING COLLECTION ACTIVITY. PART VI, LINE 2: WILLIS-KNIGHTON MEDICAL CENTER OPERATES THROUGHOUT SHREVEPORT, BOSSIER CITY AND NEARBY PARISHES AND PROVIDES FOUR HOSPITALS, NUMEROUS SATELLITE CLINICS, A SKILLED NURSING FACILITY, A RETIREMENT COMMUNITY, AND AN ASSISTED LIVING FACILITY. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT IT SERVES BY STAYING INFORMED ABOUT THE RELEVANT TRENDS OCCURRING IN THE AREAS IN WHICH IT OPERATES. PART VI, LINE 3: WILLIS-KNIGHTON HEALTH SYSTEM IS COMMITTED TO PROVIDING CHARITY CARE TO PERSONS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE. CONSISTENT WITH ITS MISSION TO DELIVER COMPASSIONATE, HIGH QUALITY, AFFORDABLE HEALTHCARE SERVICES AND TO BE AN ADVOCATE FOR THOSE WHO ARE MOST IN NEED, WILLIS-KNIGHTON HEALTH SYSTEM STRIVES TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING CARE. PATIENTS ARE EXPECTED TO COOPERATE WITH WILLIS-KNIGHTON HEALTH SYSTEM'S PROCEDURES FOR OBTAINING CHARITY OR OTHER FORMS OF PAYMENT OR FINANCIAL ASSISTANCE, AND TO CONTRIBUTE TO THE COST OF THEIR CARE BASED ON THEIR INDIVIDUAL ABILITY TO PAY.PATIENTS OF THE MEDICAL CENTER ARE INFORMED OF THEIR ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE ORGANIZATION'S CHARITY CARE POLICY IN THE FOLLOWING MANNERS:1)IF THE PATIENT DOES NOT HAVE INSURANCE, THEN THE MEDICAL CENTER WILL ASSIST THEM IN DETERMINING WHETHER OR NOT THEY QUALIFY FOR MEDICAID.2)INFORMATION CONCERNING THE MEDICAL CENTER'S CHARITY CARE PROGRAM IS AVAILABLE ON THE MEDICAL CENTER'S WESITE, WWW.WKHS.COM.3)ONCE A PATIENT HAS BEEN ADMITTED INTO THE HOSPITAL, AND IT IS DETERMINED THAT THEY DO NOT HAVE INSURANCE, THEN A MEDICAL CENTER EMPLOYEE IS RESPONSIBLE FOR REQUESTING A DEPOSIT FROM THE PATIENT. IF THE PATIENT IS NOT ABLE TO PAY, THEN THE PATIENT IS GIVEN AN APPLICATION FOR THE CHARITY CARE PROGRAM AT THAT TIME.4)IN THE EVENT THERE IS NO WRITTEN DOCUMENTATION TO SUPPORT A PATIENT'S ELIGIBILITY FOR CHARITY CARE, THE MEDICAL CENTER UTILIZES SELF PAY COMPASS (A COMPANY THAT SPECIALIZES IN ESTIMATING AN INDIVIDUAL'S INCOME AND FINANCIAL RESOURCES) TO DETERMINE CHARITY CARE ELIGIBILITY. THE MEDICAL CENTER RELIES ON SELF PAY COMPASS TO ESTIMATE INCOME AND FINANCIAL RESOURCES ONLY FOR THOSE INDIVIDUALS WHOSE INCOME IS ESTIMATED TO BE 400% OR LESS OF THE FEDERAL POVERTY LEVEL. REPORTS ARE GENERATED ON A QUARTERLY BASIS TO IDENTIFY ACCOUNTS THAT MEET THIS CRITERION, AND CHARITY CARE ADJUSTMENTS ARE APPLIED, IF APPLICABLE. PART VI, LINE 4: WILLIS-KNIGHTON'S PRIMARY SERVICE AREA COVERS AN APPROXIMATE 35 MILE RADIUS OF SHREVEPORT, COVERING THE LOUISIANA PARISHES OF CADDO, BOSSIER, WEBSTER, CLAIBORNE, RED RIVER, DESOTO AND BIENVILLE, AND WHICH HAD A 2011 ESTIMATED POPULATION OF APPROXIMATELY 485,023 PERSONS. THE MEDIAN HOUSEHOLD INCOME ACCORDING TO THE 2010 U.S. CENSUS DATA FOR SHREVEPORT IS $39,086. THE MEDIAN HOUSEHOLD INCOME ACCORDING TO THE 2010 U.S. CENSUS DATA FOR BOSSIER PARISH IS $46,518. PART VI, LINE 5: OTHER COMMUNITY BENEFITS:PROJECT NEIGHBORHEALTH - OVERVIEWDURING 1995, THE MEDICAL CENTER BEGAN A PROGRAM KNOWN AS "PROJECT NEIGHBORHEALTH." THE PROGRAM'S PURPOSE IS TO PROMOTE HEALTH AND WELL-BEING IN COMMUNITIES THAT ARE ECONOMICALLY DISTRESSED AND/OR DESIGNATED AS MEDICALLY UNDER-SERVED, HEALTH-PROFESSIONAL-SHORTAGE AREAS. THE PROGRAM PROVIDES FREE COMMUNITY PROGRAMS INCLUDING ANTI-DRUG/GANG PROGRAMS, LIFE SKILLS TRAINING, MENTORING PROGRAMS, NUTRITIONAL COUNSELING, POLICE COMMUNITY FORUMS, AND OTHER COMMUNITY-RELATED PROGRAMS. AS PART OF PROJECT NEIGHBORHEALTH, THE MEDICAL CENTER OPERATES THE FOLLOWING CLINICS: SIMPKINS COMMUNITY HEALTH & EDUCATION CENTER, WK PIERRE AVENUE HEALTH & WELLNESS CENTER, WK BRADLEY MEDICAL CLINIC, AND THE CHILDREN'S DENTAL CLINIC AND WK COMMUNITY EDUCATION CENTER.SIMPKINS COMMUNITY HEALTH & EDUCATION CENTERPROJECT NEIGHBORHEALTH: ON SEPTEMBER 1, 1995, AT A COST OF APPROXIMATELY $1,300,000, THE MEDICAL CENTER OPENED A 6,463 SQUARE FOOT, FEDERALLY DESIGNATED INDIGENT CARE MEDICAL CLINIC AND A 3,914 SQUARE FOOT COMMUNITY EDUCATION BUILDING ON SHREVEPORT-BLANCHARD ROAD AT DR. MARTIN LUTHER KING DRIVE IN SHREVEPORT, LOUISIANA. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THESE FACILITIES ARE CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. SERVICES ARE PROVIDED WITHOUT REGARD TO THE PATIENTS' ABILITY TO PAY. THE LOCATION OF THE CLINIC (CENSUS TRACT 246 IN THE DR. MARTIN LUTHER KING DRIVE AREA IN CADDO PARISH) WAS DESIGNATED BY THE DEPARTMENT OF HEALTH AND HOSPITALS AS A HEALTH-PROFESSIONAL-SHORTAGE AREA AND AS A MEDICALLY UNDER-SERVED AREA. PRIOR TO THE CLINIC'S OPENING, THIS AREA WAS THE SECOND LARGEST CONTIGUOUS POPULATION OF MEDICALLY UNDER-SERVED PEOPLE IN THE UNITED STATES. THE CLINIC HAS AN EMERGENCY AND SPECIAL PROCEDURES ROOM, AN X-RAY DEPARTMENT, AND A FULLY EQUIPPED LABORATORY AND DENTAL FACILITY. PREVENTATIVE CARE PROGRAMS INCLUDE BLOOD PRESSURE CHECKS, HEALTH SCREENINGS, IMMUNIZATIONS, AND DIABETES COUNSELING. THE CLINIC'S STAFF INCLUDES 2 PART-TIME FAMILY PRACTICE PHYSICIANS, A PART-TIME NURSE PRACTITIONER, AND SUPPORT STAFF. THE CLINIC HAD 4,500 MEDICAL PATIENT VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2013. THE EDUCATION FACILITY HOUSES CLASSROOMS, AN AUDITORIUM, A NURSERY, A CONFERENCE ROOM, AND A LIBRARY WITH STUDY AREAS.WK PIERRE AVENUE COMMUNITY HEALTH & WELLNESS CENTERPROJECT NEIGHBORHEALTH: ON AUGUST 1, 1998, THE MEDICAL CENTER OPENED A 15,062 SQUARE FOOT MEDICAL CLINIC KNOWN AS THE "WK PIERRE AVENUE COMMUNITY CENTER" ON PIERRE AVENUE IN SHREVEPORT AT A COST OF APPROXIMATELY $1,375,000. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THIS FACILITY IS CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. THIS FACILITY ALSO CONTAINS A HEALTH AND FITNESS CENTER. THE MEDICAL CENTER PROVIDES EQUIPMENT AND MEDICAL STAFF FOR THE CLINIC. THE CLINIC'S STAFF INCLUDES 2 PART-TIME FAMILY PRACTICE PHYSICIANS, A PART-TIME PHYSICIAN ASSISTANT, AND SUPPORT STAFF. THE CLINIC HAD 4,441 MEDICAL PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2013. WK BRADLEY MEDICAL CLINIC ON AUGUST 24, 1998, THE MEDICAL CENTER OPENED A 3,915 SQUARE FOOT MEDICAL CLINIC KNOWN AS THE "WK BRADLEY MEDICAL CLINIC" IN BRADLEY, ARKANSAS AT A COST OF APPROXIMATELY $140,000. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THIS FACILITY IS CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. THE MEDICAL CENTER PROVIDES EQUIPMENT AND MEDICAL STAFF FOR THE CLINIC. THE CLINIC'S STAFF INCLUDES A NURSE PRACTITIONER AND VARIOUS SUPPORT STAFF. THE CLINIC HAD 1,980 MEDICAL PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2013. THE CHILDREN'S DENTAL CLINIC AND WK COMMUNITY EDUCATION CENTERPROJECT NEIGHBORHEALTH: ON OCTOBER 15, 2001, THE MEDICAL CENTER OPENED A 3,049 SQUARE FOOT MEDICAL CLINIC KNOWN AS THE "THE CHILDREN'S DENTAL CLINIC AND WK COMMUNITY EDUCATION CENTER" ON SOUTHERN AVENUE IN SHREVEPORT. THE MEDICAL CLINIC IS HOUSED IN A DONATED BUILDING THAT THE MEDICAL CENTER RENOVATED AT A COST OF APPROXIMATELY $162,000. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THIS FACILITY IS CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. THE MEDICAL CENTER PROVIDES EQUIPMENT AND MEDICAL STAFF FOR THE CLINIC. THE CLINIC'S STAFF INCLUDES 57 DENTISTS FROM THE NORTHWEST LOUISIANA DENTAL VOLUNTEERS, WHO EACH DONATE ONE-THIRD DAY PER MONTH TO THE CLINIC. THE CLINIC HAD APPROXIMATELY 750 PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2013. DURING THE YEAR ENDED SEPTEMBER 30, 2013, UNDER PROJECT NEIGHBORHEALTH, THE MEDICAL CENTER PROVIDED OVER 15,000 HOURS TO COMMUNITY SERVICES/PROJECTS AT NO COST TO THE RECIPIENTS BY 3 FULL-TIME EMPLOYEES, 1 PART-TIME EMPLOYEE, AND VOLUNTEERS IN ADDITION TO HOURS PROVIDED BY VARIOUS DEPARTMENTS WITHIN THE MEDICAL CENTER.OTHER COMMUNITY SERVICESTHE MEDICAL CENTER MAKES AVAILABLE, FREE-OF-CHARGE, MEETING SPACE TO OUTSIDE COMMUNITY OUTREACH ORGANIZATIONS SUCH AS QUEENSBOROUGH NEIGHBORHOOD ASSOCIATION, BOSSIER MEDICAL SOCIETY, CADDO PARISH SHERIFF'S OFFICE, ICE (INNER CITY ENTREPRENEUR), NORTH LOUISIANA AHEC, LIFESHARE BLOOD CENTER, LSU PSYCHIATRY PROGRAM, TEXAS WESLEYAN UNIVERSITY CRNA PROGRAM, NORTHWEST LOUISIANA COALITION FOR WOMEN AND CHILDREN, NORTHWEST LOUISIANA INTERFAITH PHARMACY, VOLUNTEERS FOR YOUTH JUSTICE AND OTHER CHARITABLE AND GOVERNMENTAL ORGANIZATIONS. ROOMS ARE ALSO PROVIDED FOR OFF CAMPUS CLASSES TAUGHT BY BOSSIER PARISH COMMUNITY COLLEGE AT THE WK CAREER INSTITUTE.THE MEDICAL CENTER OFFERS EXTENSIVE ONLINE HEALTH INFORMATION ON ITS WEB SITE. FREE HEALTH INFORMATION IS AVAILABLE, TARGETED TO BOTH ADULTS AND CHILDREN. INFORMATION FOR ADULTS INCLUDES A HEALTH LIBRARY, DRUG INTERACTION CHECKER, NUTRITION AND WELLNESS INFORMATION AND DESCRIPTION OF PROCEDURES, WRITTEN BY HEALTH PROFESSIONALS AND REVIEWED AND UPDATED REGULARLY. THE MEDICAL CENTER ALSO PARTNERS WITH THE NEMOURS FOUNDATION TO OFFER KIDSHEALTH, A HEALTH AND WELLNESS INFORMATION SITE TARGETED TO CHILDREN, TEENS AND THEIR PARENTS. THE WILLIS-KNIGHTON CANCER CENTER WEB SITE OFFERS INFORMATION ON VARIOUS TYPES OF CANCER AND TREATMENTS AS WELL AS AN UPDATED LIST OF CLINICAL TRIALS. DURING THE PAST YEAR THE MEDICAL CENTER'S ON-LINE HEALTH LIBRARY ATTRACTED 260,000 VISITS FROM A TOTAL OF 219,000 VISITORS. KIDSHEALTH ATTRACTED OVER 191,000 VISITS.IMMUNIZATIONS FOR CHILDREN WILLIS-KNIGHTON PROVIDES A MOBILE UNIT THAT OFFERS "SHOTS FOR TOTS". USING ITS MOBILE VAN AND STAFF, VACCINES ARE TAKEN TO VARIOUS NEIGHBORHOODS TO MAKE THEM CONVENIENT FOR PARENTS. UNDER THIS PROGRAM, ANY CHILD MAY RECEIVE IMMUNIZATION SHOTS, FREE OF CHARGE, FOR MEASLES, MUMPS, RUBELLA, DIPHTHERIA, PERTUSSIS, TETANUS, HEPATITIS B, POLIO, MENINGITIS, FLU, AND CHICKEN POX. THE MEDICAL CENTER SUBSIDIZES ALL EXPENSES OF THE PROGRAM EXCEPT THE VACCINE, WHICH IS PROVIDED BY THE LOUISIANA DEPARTMENT OF PUBLIC HEALTH. DURING THE YEAR ENDED SEPTEMBER 30, 2013, THE MEDICAL CENTER IMMUNIZED 3,129 PATIENTS UNDER THIS PROGRAM.HEALTH PROFESSIONS EDUCATIONTHE MEDICAL CENTER PROVIDES VARIOUS EDUCATION PROGRAMS THAT RESULT IN HEALTH CARE PROFESSIONALS RECEIVING DEGREES, CERTIFICATES OR TRAINING THAT IS NECESSARY TO BE LICENSED TO PRACTICE AS HEALTH CARE PROFESSIONALS. WHILE THE MEDICAL CENTER ALSO PROVIDES A VARIETY OF EDUCATION, TRAINING AND STIPEND PROGRAMS THAT ARE EXCLUSIVE TO THE MEDICAL CENTER'S EMPLOYEES AND MEDICAL STAFF, THOSE COSTS ARE NOT INCLUDED IN THIS CATEGORY. THE MEDICAL CENTER MAINTAINS AN ASSOCIATION WITH LSU HEALTH SCIENCES CENTER (A PUBLIC TEACHING, RESEARCH, AND INDIGENT CARE FACILITY) BY PROVIDING GRANTS, ASSISTANCE WITH RESIDENTS AND FELLOWS, ALONG WITH UNDERWRITING THE COST OF CLINICAL SETTINGS FOR TRAINING AND INTERSHIPS FOR A VARIETY OF OTHER HEALTH PROFESSIONALS.SPORTS MEDICINESPORTS MEDICINE EXPERTS AT WILLIS-KNIGHTON SPORTS MEDICINE WORK WITH ATHLETES ON THE PREVENTION AND TREATMENT OF SPORTS-RELATED INJURIES, HELPING THEM TO MAINTAIN A HEALTHY LIFESTYLE. THIS SERVICE IS OFFERED TO VARIOUS SCHOOLS AND PROGRAMS THROUGHOUT THE LOCAL AREA. PART V, LINE 8 FACILITY REPORTING GROUP A SEE BELOW FACILITY 1 -- WILLIS-KNIGHTON MEDICAL CENTER PART V, SECTION B, LINE 3: CONDUCTED 17 INTERVIEWS (LIST OF INTERVIEWEES FOLLOWS) WITH THE THREE GROUPS OUTLINED IN IRS NOTICE 2011-52.DISCUSSED THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS. GATHERED BACKGROUND INFORMATION, INCLUDING CREDENTIALS, ON EACH INTERVIEWEE.SHERRI BUFFINGTON, STATE SENATOR DISTRICT 38(CADDO AND DESOTO PARISH); VICE CHAIR HEALTH & WELFAREBARROW PEACOCK, STATE SENATOR DISTICT 37 (SHREVEPORT AND BOSSIER PARISH)WILLIS BRADFORD, WILLIS-KNIGHTON DIRECTOR OF PROJECT NEIGHBORHEALTHMARTHA MARAK, DIRECTOR OF THE FOOD BANK OF NORTHWEST LOUISIANADR. DAN MOLLER, CMO, WILLIS-KNIGHTON HEALTH SYSTEMDR. ANIL NANDA, NEUROSURGEON, LSU HEALTH - SHREVEPORTDR. CHARLES POWERS, CMO - WILLIS-KNIGHTON BOSSIER HOSPITALRON WEBB, CITY COUNCILMAN, DISTRICT E, CITY OF SHREVEPORTDR. MARTHA WHYTE, DIRECTOR - DEPARTMENT OF PUBLIC HEALTH REGION 7BRIDGET CAUSEY, RN, BSN, NURSING SUPERVISOR, CADDO PARISH PUBLIC SCHOOLSWILLIE WHITE, CEO OF DAVID RAINES COMMUNITY HEALTH CENTERSDR. JOHN MICIOTTO, RETIRED OB/GYN, FORMER MEDICAL DIRECTOR, NORTHWEST LOUISIANA DEPT. OF HEALTHANTHONY MARTIN, DIRECTOR - WILLIS-KNIGHTON HOME HEALTH/HOSPICETIM WILCOX, DIRECTOR - WILLIS-KNIGHTON BEHAVIORAL HEALTHC.O. SIMPKINS, SR., DDS - COMMUNITY LEADER, EX-CITY COUNCILMANBRUCE WILSON, DIRECTOR - UNITED WAY OF NORTHWEST LOUISIANADR. PHILLIP ROZEMAN, CARDIOLOGIST, COMMUNITY LEADER FACILITY 1 -- WILLIS-KNIGHTON MEDICAL CENTER PART V, SECTION B, LINE 4: WK PIERREMONT HEALTH CENTERWK BOSSIER HEALTH CENTERWILLIS-KNIGHTON SOUTH FACILITY 2 -- WK PIERREMONT HEALTH CENTER PART V, SECTION B, LINE 3: CONDUCTED 17 INTERVIEWS (LIST OF INTERVIEWEES FOLLOWS) WITH THE THREE GROUPS OUTLINED IN IRS NOTICE 2011-52.DISCUSSED THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS. GATHERED BACKGROUND INFORMATION, INCLUDING CREDENTIALS, ON EACH INTERVIEWEE.SHERRI BUFFINGTON, STATE SENATOR DISTRICT 38(CADDO AND DESOTO PARISH); VICE CHAIR HEALTH & WELFAREBARROW PEACOCK, STATE SENATOR DISTICT 37 (SHREVEPORT AND BOSSIER PARISH)WILLIS BRADFORD, WILLIS-KNIGHTON DIRECTOR OF PROJECT NEIGHBORHEALTHMARTHA MARAK, DIRECTOR OF THE FOOD BANK OF NORTHWEST LOUISIANADR. DAN MOLLER, CMO, WILLIS-KNIGHTON HEALTH SYSTEMDR. ANIL NANDA, NEUROSURGEON, LSU HEALTH - SHREVEPORTDR. CHARLES POWERS, CMO - WILLIS-KNIGHTON BOSSIER HOSPITALRON WEBB, CITY COUNCILMAN, DISTRICT E, CITY OF SHREVEPORTDR. MARTHA WHYTE, DIRECTOR - DEPARTMENT OF PUBLIC HEALTH REGION 7BRIDGET CAUSEY, RN, BSN, NURSING SUPERVISOR, CADDO PARISH PUBLIC SCHOOLSWILLIE WHITE, CEO OF DAVID RAINES COMMUNITY HEALTH CENTERSDR. JOHN MICIOTTO, RETIRED OB/GYN, FORMER MEDICAL DIRECTOR, NORTHWEST LOUISIANA DEPT. OF HEALTHANTHONY MARTIN, DIRECTOR - WILLIS-KNIGHTON HOME HEALTH/HOSPICETIM WILCOX, DIRECTOR - WILLIS-KNIGHTON BEHAVIORAL HEALTHC.O. SIMPKINS, SR., DDS - COMMUNITY LEADER, EX-CITY COUNCILMANBRUCE WILSON, DIRECTOR - UNITED WAY OF NORTHWEST LOUISIANADR. PHILLIP ROZEMAN, CARDIOLOGIST, COMMUNITY LEADER FACILITY 2 -- WK PIERREMONT HEALTH CENTER PART V, SECTION B, LINE 4: WILLIS-KNIGHTON MEDICAL CENTERWK BOSSIER HEALTH CENTERWILLIS-KNIGHTON SOUTH FACILITY 3 -- WK BOSSIER HEALTH CENTER PART V, SECTION B, LINE 3: CONDUCTED 17 INTERVIEWS (LIST OF INTERVIEWEES FOLLOWS) WITH THE THREE GROUPS OUTLINED IN IRS NOTICE 2011-52.DISCUSSED THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS. GATHERED BACKGROUND INFORMATION, INCLUDING CREDENTIALS, ON EACH INTERVIEWEE.SHERRI BUFFINGTON, STATE SENATOR DISTRICT 38(CADDO AND DESOTO PARISH); VICE CHAIR HEALTH & WELFAREBARROW PEACOCK, STATE SENATOR DISTICT 37 (SHREVEPORT AND BOSSIER PARISH)WILLIS BRADFORD, WILLIS-KNIGHTON DIRECTOR OF PROJECT NEIGHBORHEALTHMARTHA MARAK, DIRECTOR OF THE FOOD BANK OF NORTHWEST LOUISIANADR. DAN MOLLER, CMO, WILLIS-KNIGHTON HEALTH SYSTEMDR. ANIL NANDA, NEUROSURGEON, LSU HEALTH - SHREVEPORTDR. CHARLES POWERS, CMO - WILLIS-KNIGHTON BOSSIER HOSPITALRON WEBB, CITY COUNCILMAN, DISTRICT E, CITY OF SHREVEPORTDR. MARTHA WHYTE, DIRECTOR - DEPARTMENT OF PUBLIC HEALTH REGION 7BRIDGET CAUSEY, RN, BSN, NURSING SUPERVISOR, CADDO PARISH PUBLIC SCHOOLSWILLIE WHITE, CEO OF DAVID RAINES COMMUNITY HEALTH CENTERSDR. JOHN MICIOTTO, RETIRED OB/GYN, FORMER MEDICAL DIRECTOR, NORTHWEST LOUISIANA DEPT. OF HEALTHANTHONY MARTIN, DIRECTOR - WILLIS-KNIGHTON HOME HEALTH/HOSPICETIM WILCOX, DIRECTOR - WILLIS-KNIGHTON BEHAVIORAL HEALTHC.O. SIMPKINS, SR., DDS - COMMUNITY LEADER, EX-CITY COUNCILMANBRUCE WILSON, DIRECTOR - UNITED WAY OF NORTHWEST LOUISIANADR. PHILLIP ROZEMAN, CARDIOLOGIST, COMMUNITY LEADER FACILITY 3 -- WK BOSSIER HEALTH CENTER PART V, SECTION B, LINE 4: WILLIS-KNIGHTON MEDICAL CENTERWK PIERREMONT HEALTH CENTERWILLIS-KNIGHTON SOUTH FACILITY 4 -- WILLIS-KNIGHTON SOUTH PART V, SECTION B, LINE 3: CONDUCTED 17 INTERVIEWS (LIST OF INTERVIEWEES FOLLOWS) WITH THE THREE GROUPS OUTLINED IN IRS NOTICE 2011-52.DISCUSSED THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS. GATHERED BACKGROUND INFORMATION, INCLUDING CREDENTIALS, ON EACH INTERVIEWEE.SHERRI BUFFINGTON, STATE SENATOR DISTRICT 38(CADDO AND DESOTO PARISH); VICE CHAIR HEALTH & WELFAREBARROW PEACOCK, STATE SENATOR DISTICT 37 (SHREVEPORT AND BOSSIER PARISH)WILLIS BRADFORD, WILLIS-KNIGHTON DIRECTOR OF PROJECT NEIGHBORHEALTHMARTHA MARAK, DIRECTOR OF THE FOOD BANK OF NORTHWEST LOUISIANADR. DAN MOLLER, CMO, WILLIS-KNIGHTON HEALTH SYSTEMDR. ANIL NANDA, NEUROSURGEON, LSU HEALTH - SHREVEPORTDR. CHARLES POWERS, CMO - WILLIS-KNIGHTON BOSSIER HOSPITALRON WEBB, CITY COUNCILMAN, DISTRICT E, CITY OF SHREVEPORTDR. MARTHA WHYTE, DIRECTOR - DEPARTMENT OF PUBLIC HEALTH REGION 7BRIDGET CAUSEY, RN, BSN, NURSING SUPERVISOR, CADDO PARISH PUBLIC SCHOOLSWILLIE WHITE, CEO OF DAVID RAINES COMMUNITY HEALTH CENTERSDR. JOHN MICIOTTO, RETIRED OB/GYN, FORMER MEDICAL DIRECTOR, NORTHWEST LOUISIANA DEPT. OF HEALTHANTHONY MARTIN, DIRECTOR - WILLIS-KNIGHTON HOME HEALTH/HOSPICETIM WILCOX, DIRECTOR - WILLIS-KNIGHTON BEHAVIORAL HEALTHC.O. SIMPKINS, SR., DDS - COMMUNITY LEADER, EX-CITY COUNCILMANBRUCE WILSON, DIRECTOR - UNITED WAY OF NORTHWEST LOUISIANADR. PHILLIP ROZEMAN, CARDIOLOGIST, COMMUNITY LEADER FACILITY 4 -- WILLIS-KNIGHTON SOUTH PART V, SECTION B, LINE 4: WILLIS-KNIGHTON MEDICAL CENTERWK BOSSIER HEALTH CENTERWK PIERREMONT HEALTH CENTER 1 HOLY ANGELS RESIDENTIAL FACILITY INC 10450 ELLERBE ROAD SHREVEPORT LA 71106 720628035 501(C)(3) 215000 DONATION FOR OPERATIONS INDEPENDENCE BOWL FOUNDATION PO BOX 1723 SHREVEPORT LA 71166 720297228 501(C)(3) 35750 SPONSORSHIP INNER CITY ENTREPRENEUR INSTITUTE 820 JORDAN STREET SUITE 360 SHREVEPORT LA 71101 721418314 501(C)(3) 20000 BIZCAMP SPONSOR INSTITUTE FOR GLOBAL OUTREACH 1024 PIERRE AVENUE ROOM B SHREVEPORT LA 71103 331180777 501(C)(3) 25000 WALK FOR HUMANITY WORLDKARE NORTH AMERICA IAPB INC 137 HAMPTON ROAD SOUTHAMPTON NY 11968 043796216 501(C)(3) 50000 DONATION FOR OPERATIONS JUNIOR ACHIEVEMENT 3003 KNIGHT STREET SHREVEPORT LA 71105 720595081 501(C)(3) 20000 DONATION FOR OPERATIONS LSUHSC PO BOX 31650 SHREVEPORT LA 71115 721402222 GOVERNMENT 210500 DONATION FOR OPERATIONS LOUISIANA TECH UNIVERSITY FOUNDATION PO BOX 3046 RUSTON LA 71272 726021176 501(C)(3) 76500 SPONSORSHIP NORTH LOUISIANA ECONOMIC PARTNERSHIP INC 415 TEXAS STREET SHREVEPORT LA 71101 720936419 501(C)(3) 20400 DONATION FOR OPERATIONS MARCH OF DIMES FOUNDATION 1120 SOUTH POINTE PARKWAY BLDG D SHREVEPORT LA 71105 131846366 501(C)(3) 23000 DONATION FOR OPERATIONS NEW CARDIOVASCULAR HORIZONS FOUNDATION 3639 AMBASSADOR CAFFERY PARKWAY SUITE 605 LAFAYETTE LA 70503 463186713 501(C)(3) 10000 DONATION FOR CARDIOVASCULAR SYMPOSIUM NORTHWEST LOUISIANA FOOD BANK 2307 TEXAS AVENUE SHREVEPORT LA 71103 721328890 501(C)(3) 30000 DONATION FOR OPERATIONS NORTHWESTERN FOUNDATION UNIVERSITY PARKWAY NATCHITOCHES LA 71497 726021495 501(C)(3) 240000 DONATION FOR OPERATIONS OAKWOOD HOME FOR WOMEN INC 1700 HIGHLAND AVENUE SHREVEPORT LA 71101 237368054 501(C)(3) 10000 DONATION FOR OPERATIONS THE ODYSSEY FOUNDATION 401 TEXAS STREET SHREVEPORT LA 71101 331055253 501(C)(6) 19600 DONATION FOR AUTISM LIBRARY AND WALKING FOR AUTISM FUNDRAISER PROVIDENCE HOUSE 814 COTTON STREET SHREVEPORT LA 71101 721205164 501(C)(3) 50000 DONATION FOR OPERATIONS RED RIVER REVEL ARTS FESTIVAL 101 CROCKET STREET SUITE C SHREVEPORT LA 71101 720953274 501(C)(3) 25200 SPONSORSHIP OF REGIONAL CULTURAL EVENT RED RIVER RADIO PUBLIC BROADCASTING PO BOX 5250 SHREVEPORT LA 71135 720702001 501(C)(3) 9000 DONATION FOR OPERATIONS SAMARITAN COUNSELING CENTER 1525 STEPHENS AVENUE SHREVEPORT LA 71101 721014069 501(C)(3) 10500 DONATION FOR OPERATIONS SHREVEPORT CHAMBER OF COMMERCE 400 EDWARDS STREET SHREVEPORT LA 71101 720315700 501(C)(6) 25000 DONATION FOR OPERATIONS SHREVEPORT-BOSSIER RESCUE MISSION 2033 TEXAS AVENUE SHREVEPORT LA 71103 237050551 501(C)(3) 134335 HEALTH INSURANCE FOR RESCUE MISSION EMPLOYEES AND DONATION FOR OPERATIONS SHREVEPORT SYMPHONY 619 LOUISIANA AVENUE SHREVEPORT LA 71101 726001334 501(C)(3) 65000 DONATION FOR OPERATIONS SOUTH LOUISIANA CLINICAL RESEARCH 225 DUNN STREET HOUMA LA 70360 721430540 501(C)(3) 7500 SPONSORSHIP SOUTHERN UNIVERSITY FOUNDATION 610 TEXAS STREET SUITE 400 SHREVEPORT LA 71101 721454141 501(C)(3) 12500 SPONSORSHIP ST JUDE'S CHILDREN'S RESEARCH HOSPITAL PO BOX 810 MEMPHIS TN 38101 620646012 501(C)(3) 25000 DREAM HOME DONATION ULM FOUNDATION 3601 DESIARD STREET MONROE LA 71209 726028527 501(C)(3) 120000 DONATION FOR OPERATIONS WOODLAWN HIGH SCHOOL 7340 WYNGATE BLVD SHREVEPORT LA 71106 726000224 GOVERNMENT 5499 PURCHASED SCHOOL SIGN YMCA 400 MCNEIL SHREVEPORT LA 71101 720408997 501(C)(3) 40800 SPONSORSHIP ALLIANCE FOR EDUCATION 820 JORDAN STREET SHREVEPORT LA 71101 721466587 501(C)(3) 25000 DONATION FOR PATHWAY TO EXCELLENCE AMERICAN CANCER SOCIETY 920 PIERREMONT SUITE 300 SHREVEPORT LA 71106 237040934 501(C)(3) 15000 SPONSOR CADDO AND BOSSIER RELAY FOR LIFE AMERICAN HEART ASSOCIATION PO BOX 37388 SHREVEPORT LA 71133 135613797 501(C)(3) 39500 DONATION FOR OPERATIONS BOSSIER CHAMBER OF COMMERCE 710 BENTON ROAD BOSSIER CITY LA 71111 720382231 501(C)(6) 10000 DONATION FOR OPERATIONS CADDO BOSSIER SOCCER ASSOCIATION 1780 EAST BERT KOUNS SUITE 901 SHREVEPORT LA 71105 581652966 501(C)(3) 18000 SPONSORSHIP CALVARY ACADEMY 9333 LINWOOD AVENUE SHREVEPORT LA 71106 720482882 501(C)(3) 6000 SPONSORSHIP CHILDREN AND ARTHRITIS 2751 ALBERT BICKNELL DRIVE SUITE 2E 2E SHREVEPORT LA 71103 721170530 501(C)(3) 15000 DONATION FOR OPERATIONS COUNCIL FOR A BETTER LOUISIANA PO BOX 4308 BATON ROUGE LA 70821 720570930 501(C)(6) 10000 DONATION FOR OPERATIONS DESOTO REGIONAL HEALTH SYSTEM PO BOX 1636 MANSFIELD LA 71052 721491325 501(C)(3) 29597 DONATION FOR OPERATIONS FRIENDS OF LOUISIANA STATE EXHIBIT MUSEUM PO BOX 38356 SHREVEPORT LA 71133 720960820 501(C)(3) 30000 DONATION FOR OPERATIONS COALITION TO PROTECT AMERICA'S HEALTHCARE PO BOX 30211 BETHESDA MD 20824 522253225 501(C)(4) 10000 DONATION FOR OPERATIONS 34 5 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE MEDICAL CENTER HAS A CONTRIBUTION COMMITTEE THAT APPROVES SUBSTANTIALLY ALL CONTRIBUTIONS. THE CONTRIBUTION COMMITTEE REQUESTS THAT THE ORGANIZATION REQUESTING THE DONATION COMPLETE A CONTRIBUTION REQUEST FORM THAT IS AVAILABLE ON THE MEDICAL CENTER'S WEBSITE. BEFORE THE MEDICAL CENTER'S CONTRIBUTION COMMITTEE WILL APPROVE THE CONTRIBUTIONS THE PURPOSE OF THE CONTRIBUTION MUST BE STATED ON THE CONTRIBUTION REQUEST FORM. X 0 1 X X X X X 0 1 0 1 0 0 0 0 0 JAMES K ELROD 1120674 5500 0 0 366588 0 0 0 12899 0 1500161 5500 0 0 PIERRE V BLANCHARDIV MD 200091 0 0 0 5216 0 1953 0 4851 0 212111 0 0 0 ROBERT D HUIE 588867 0 0 0 558594 0 2356 0 17532 0 1167349 0 0 0 CHARLES D DAIGLE 420925 0 0 0 23211 0 1621 0 19698 0 465455 0 0 0 STEPHEN R RANDALL 288085 0 0 0 20005 0 1554 0 19698 0 329342 0 0 0 MARGARET G ELROD 149953 0 0 0 24303 0 2789 0 5836 0 182881 0 0 0 JERRY A FIELDER II 161557 0 0 0 2524 0 4015 0 17758 0 185854 0 0 0 CLIFFORD M BROUSSARD 170552 0 0 0 4234 0 1769 0 12348 0 188903 0 0 0 JANET K ELROD 151618 0 0 0 22031 0 3011 0 5942 0 182602 0 0 0 IRA L MOSS 179294 0 0 0 24033 0 2418 0 12668 0 218413 0 0 0 JILL K ELROD 200259 0 0 0 28877 0 2101 0 10107 0 241344 0 0 0 PEGGY J GAVIN 149296 0 0 0 26995 0 3858 0 5433 0 185582 0 0 0 DEBORAH D OLDS 130489 0 0 0 5664 0 3932 0 11253 0 151338 0 0 0 RAMONA D FRYER 163183 0 0 0 17065 0 2377 0 14522 0 197147 0 0 0 DANIEL J MOLLER JR MD 296685 0 0 0 25284 0 1860 0 11823 0 335652 0 0 0 CHARLES A POWERS MD 296667 0 0 0 24742 0 1862 0 12525 0 335796 0 0 0 RANDALL P BREWER MD 975000 0 1250506 0 -8159 0 1605 0 22298 0 2241250 0 0 0 MILAN G MODY MD 675000 0 1026991 0 -2628 0 1603 0 17298 0 1718264 0 0 0 CHRISTIAN M BRIERY MD 700000 0 852846 0 -2927 0 1638 0 17008 0 1568565 0 0 0 MATTHEW S MOSURA MD 860950 0 447778 0 -3880 0 1601 0 17298 0 1323747 0 0 0 CLINT M CORMIER MD 700000 0 761368 0 -2531 0 1650 0 16389 0 1476876 0 0 0 PART I, LINE 1A THE VALUE OF EACH PERSON'S FREE MEMBERSHIP IN THE MEDICAL CENTER'S HEALTH & WELLNESS CENTERS IS ADDED TO THE EMPLOYEE'S W-2 WAGES. PART I, LINE 3 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES THE COMPENSATION OF THE TOP TWO EXECUTIVES (CEO AND CFO) OF THE MEDICAL CENTER. A SECOND COMPENSATION COMMITTEE, CONSISTING OF THE CEO AND CFO, DETERMINES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEES STUDY DATA FROM INDEPENDENT SALARY SURVEYS. OFFICERS AND OTHER KEY EMPLOYEES ARE PROVIDED WITH A WRITTEN EMPLOYMENT CONTRACT BEFORE EMPLOYMENT COMMENCES. PART I, LINE 4B CERTAIN OFFICERS INCLUDED IN FORM 990, PART VII, SECTION A, LINE 1A, PARTICIPATE IN A SECTION 457(B) DEFERRED COMPENSATION PLAN. PART I, LINE 5 PHYSICIANS INCLUDED IN FORM 990, PART VII, SECTION A, LINE 1A, ARE COMPENSATED BASED ON THEIR OWN PERSONAL PRODUCTIVITY. THE PHYSICIANS ARE PAID A PERCENTAGE OF THEIR INDIVIDUAL COLLECTIONS BASED ON THE CONDITIONS OF EACH PHYSICIAN CONTACT. SUPPLEMENTAL INFORMATION PART III EXPLANATION OF PART II, COLUMN (B)(III) OTHER COMPENSATION JAMES K. ELROD UNUSED VACATION PAY-$155,748 UNUSED SICK PAY-$26,150 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$2,597 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$12,638 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,113) CABLE/INTERNET-$1,051 PERSONAL USE OF EMPLOYER VEHICLES-$2,309 SEVERANCE PAY-$150,008** TOTAL--$366,588 **THE INCREASE IN GROSS SEVERANCE BENEFIT, TO BE PAID TO MR. ELROD ON TERMINATION OF EMPLOYMENT (AS ADDITIONAL COMPENSATION FOR EACH OF HIS YEARS OF SERVICE TO WILLIS-KNIGHTON MEDICAL CENTER), WAS TAXABLE DURING 2012, AND, ACCORDINGLY, WAS INCLUDED IN HIS 2012 FORM W-2. WILLIS-KNIGHTON DISBURSED TO THE INTERNAL REVENUE SERVICE AND TO THE LOUISIANA DEPARTMENT OF REVENUE THE REQUIRED TAX WITHHOLDING. WILLIS-KNIGHTON DID NOT PAY MR. ELROD THE NET-OF-TAX AMOUNT OF THIS COMPENSATION, BUT, UNDER THE TERMS OF THE AGREEMENT, THE MEDICAL CENTER IS RETAINING THE NET-OF-TAX AMOUNT UNTIL HIS EMPLOYMENT TERMINATES. ACCORDINGLY, THERE WAS NO CURRENT DISBURSEMENT TO MR. ELROD FOR SEVERANCE PAY. ROBERT D. HUIE NONQUALIFIED DEFERRED COMPENSATION PLAN-$506,205 (PLEASE SEE EXPLANATION FOLLOWING) UNUSED VACATION PAY-$35,482 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$1,377 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$5,200 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(8,070) TOTAL--$558,594 CHARLES D. DAIGLE UNUSED SICK PAY-$9,991 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,245 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$558 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,783) TOTAL--$23,211 STEPHEN R. RANDALL UNUSED SICK PAY-$6,894 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,132 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$562 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,783) TOTAL--$20,005 MARGARET G. ELROD UNUSED SICK PAY-$3,588 VALUE ADDED FOR CELL PHONE USAGE-$2,268 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,543 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,013) PERSONAL USE OF EMPLOYER VEHICLES-$917 TOTAL--$24,303 JERRY A. FIELDER,II UNUSED SICK PAY-$3,866 VALUE ADDED FOR CELL PHONE USAGE-$1,940 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$650 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,983) VALUE ADDED FOR CABLE/INTERNET- $1,051 TOTAL--$2,524 CLIFFORD M. BROUSSARD UNUSED SICK PAY-$4,081 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$791 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,972 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,270) TOTAL--$4,234 JANET K. ELROD UNUSED SICK PAY-$3,628 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$2,270 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$586 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,113) TOTAL--$22,031 IRA L. MOSS UNUSED SICK PAY-$4,290 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,332 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,192 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,561) PERSONAL USE OF EMPLOYER VEHICLES-$580 TOTAL--$24,033 JILL K. ELROD UNUSED SICK PAY-$4,792 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$4,408 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,229 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,113) VALUE ADDED FOR CABLE/INTERNET- $1,051 PERSONAL USE OF EMPLOYER VEHICLES-$5,850 TOTAL--$28,877 PEGGY J. GAVIN UNUSED SICK PAY-$3,573 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$2,057 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,526 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,613) PERSONAL USE OF EMPLOYER VEHICLES-$2,252 TOTAL--$26,995 RAMONA D. FRYER UNUSED SICK PAY-$2,604 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$1,279 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$992 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,470) TOTAL--$17,065 DEBORAH D. OLDS UNUSED SICK PAY-$3,122 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$1,922 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,321 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,361) TOTAL--$5,664 DANIEL J. MOLLER, JR., M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$9,985 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,361) TOTAL--$25,284 CHARLES A. POWERS, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$2,113 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$7,699 SECTION 457(B) DEFERRED COMPENSATION PLAN-$17,000 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,270) TOTAL--$24,742 PIERRE V. BLANCHARD,IV, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,329 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,113) TOTAL--$5,216 RANDALL P. BREWER, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$564 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(9,383) TOTAL--($8,159) MATTHEW S. MOSURA, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$503 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,383) TOTAL--($3,880) MILAN G. MODY, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$554 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,382) TOTAL--($2,628) CHRISTIAN M. BRIERY, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$506 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,093) TOTAL--($2,927) CLINT M. CORMIER, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$503 VALUE ADDED FOR HEALTH & FITNESS USAGE-$440 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,474) TOTAL--($2,531) EXPLANATION OF PART II, COLUMN (B)(III) OTHER COMPENSATION THE AMOUNT CONTRIBUTED FOR THE CALENDAR YEAR 2012 FOR MR. HUIE'S SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IS INCLUDED IN THE DETAILS FOR PART II, COLUMN (B)(III). EXPLANATION OF PART II, COLUMN (C) DEFERRED COMPENSATION THIS EMPLOYEE PARTICIPATES IN A DEFINED BENEFIT PENSION PLAN, THE CONTRIBUTIONS TO WHICH ARE ACTUARIALLY DETERMINED. THE AMOUNT SHOWN IS THE INCREASE IN THE ANNUAL VESTED BENEFIT AT NORMAL RETIREMENT FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2012 (NOT DISCOUNTED TO PRESENT VALUE) (NORMAL RETIREMENT IS AGE 65 WITH 5 YEARS OF PARTICIPATION). MR. ELROD HAS REACHED THE MAXIMUM BENEFIT UNDER THE PLAN. EXPLANATION OF PART II, COLUMN (D) NONTAXABLE BENEFITS INCLUDED IN THIS COLUMN IS THE COST OF THE FOLLOWING NONTAXABLE BENEFITS: LONG-TERM DISABILITY INCOME INSURANCE PLAN, GROUP TERM-LIFE INSURANCE, AND THE ESTIMATED COST OF SELF-FUNDED HEALTH INSURANCE PLAN. FRANK B HUGHES MD TRUSTEE 124616 RENT-BUILDING 0 PHILLIP A ROZEMAN MD TRUSTEE 79641 RENT-BUILDING 0 GREGORY J GAVIN FAMILY MEMBER OF PEGGY GAVIN, OFFICER 196938 EMPLOYMENT 0 KIMBERLY M MULLINS FAMILY MEMBER OF PEGGY GAVIN, OFFICER 58047 EMPLOYMENT 0 CHARLES E MULLINS FAMILY MEMBER OF PEGGY GAVIN, OFFICER 77805 EMPLOYMENT 0 SHARLENE ANN BROUSSARD FAMILY MEMBER OF CLIFFORD BROUSSARD, OFFICER 46125 EMPLOYMENT 0 TODD JUSTIN BLANCHARD FAMILY MEMBER OF PIERRE BLANCHARD, M.D., TRUSTEE 136896 EMPLOYMENT 0 PIERRE V BLANCHARD MD TRUSTEE 5551922 RENT-BUILDING, PURCHASED SERVICE AGREEMENT WITH LIFECARE HOSPITALS, INC., FOR WHICH PIERRE BLANCHARD, M.D. IS THE MEDICAL DIRECTOR 0 SARAH GLORIOSO MD FAMILY MEMBER OF TWAIN K. GIDDENS, TRUSTEE 855983 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 2 1. FAMILY RELATIONSHIPS WITH JAMES K. ELROD - PRESIDENT, CEO, AND TRUSTEE MARGARET ELROD, SPOUSE - VP-MARKETING, LIVE OAK RETIREMENT COMMUNITY, QUICK CARE, OCCUPATIONAL MEDICINE, AND WELLNESS CENTERS JILL K. ELROD, DAUGHTER - VP OF LEGAL AFFAIRS JANET K. ELROD, DAUGHTER - VP AND ADMINISTRATOR OF WK SOUTH HOSPITAL FORM 990, PART VI, SECTION B, LINE 11 THE MEDICAL CENTER'S CPA FIRM PREPARES THE FORM 990 WITH THE ASSISTANCE OF SEVERAL OF THE MEDICAL CENTER'S EMPLOYEES. THE FORM 990 IS THEN REVIEWED BY THE MEDICAL CENTER'S PRESIDENT. AFTER THIS REVIEW, A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD OF TRUSTEES, AND THE PRESIDENT, VICE-PRESIDENT AND CPA FIRM REVIEW AND DISCUSS THE FORM 990 WITH THE TRUSTEES BEFORE THE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICTS OF INTEREST POLICY COVERS ALL "INTERESTED PERSONS." AN "INTERESTED PERSON" IS DEFINED AS ANY TRUSTEE, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD DESIGNATED POWERS WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST IN AN ENTITY WITH WHICH THE MEDICAL CENTER HAS A TRANSACTION OR ARRANGEMENT; OR A COMPENSATION ARRANGEMENT WITH THE MEDICAL CENTER OR WITH ANY ENTITY OR INDIVIDUAL WITH WHICH THE MEDICAL CENTER HAS A TRANSACTION OR ARRANGEMENT; OR A POTENTIAL OWNERSHIP OR INVESTMENT INTEREST IN, OR COMPENSATION ARRANGEMENT WITH, ANY ENTITY OR INDIVIDUAL WITH WHICH THE MEDICAL CENTER IS NEGOTIATING A TRANSACTION OR ARRANGEMENT. INTERESTED PERSONS HAVE A DUTY TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST AND ALL MATERIAL FACTS RELATED TO THE PROPOSED TRANSACTION OR ARRANGEMENT TO THE TRUSTEES AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. THE INTERESTED PERSON IS ALLOWED TO MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION THE INTERESTED PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. IF THE BOARD OR COMMITTEE BELIEVES A MEMBER HAS VIOLATED THE CONFLICTS OF INTEREST POLICY, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE. IF THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS, IN FACT, FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. PERIODIC REVIEWS ARE CONDUCTED WHICH, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: 1. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULT OF ARM'S-LENGTH BARGAINING. 2. WHETHER ACQUISITIONS OF GOODS OR SERVICES RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. 3. WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS AND ARRANGEMENTS WITH MANAGEMENT SERVICE ORGANIZATIONS AND PHYSICIAN HOSPITAL ORGANIZATIONS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. 4. WHETHER AGREEMENTS TO PROVIDE HEALTH CARE AND AGREEMENTS WITH OTHER HEALTH CARE PROVIDERS, EMPLOYEES, AND THIRD PARTY PAYORS FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES THE COMPENSATION OF THE TOP TWO EXECUTIVES (CEO AND CFO) OF THE MEDICAL CENTER. A SECOND COMPENSATION COMMITTEE, CONSISTING OF THE CEO AND CFO, DETERMINES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEES STUDY DATA FROM INDEPENDENT SALARY SURVEYS (SUCH AS "MANAGER AND EXECUTIVE COMPENSATION IN HOSPITALS AND HEALTH SYSTEMS," WHICH IS AN ANNUAL SURVEY PREPARED BY SULLIVAN COTTER) TO UNDERSTAND COMPENSATION PAID TO SIMILARLY QUALIFIED INDIVIDUALS IN COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THE COMPENSATION COMMITTEES ALSO COMPILE DATA FROM OTHER TAX-EXEMPT HEALTH SYSTEMS OF SIMILAR SIZE AND COMPLEXITY AND USE THAT INFORMATION AS COMPARATIVE COMPENSATION. THE COMMITTEES USE THE INFORMATION FROM THESE SOURCES AS BENCHMARKS IN DETERMINING OFFICER AND KEY EMPLOYEE COMPENSATION. THE COMMITTEES ALSO CONSIDER OTHER FACTORS IN DETERMINING OFFICER AND KEY EMPLOYEE COMPENSATION, SUCH AS LENGTH OF EMPLOYMENT AND THEIR RESPONSIBILITIES. THE EXECUTIVE COMPENSATION COMMITTEE PERIODICALLY HIRES INDEPENDENT CONSULTANTS FOR ANALYSIS OF THE COMPENSATION OF THE MEDICAL CENTER'S TOP TWO EXECUTIVES (CEO AND CFO). THE COMMITTEES MAINTAIN CONTEMPORANEOUS DOCUMENTATION OF THE BASIS FOR THEIR DECISIONS REGARDING COMPENSATION ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 WILLIS-KNIGHTON MEDICAL CENTER'S GOVERNING DOCUMENTS AND ITS CONFLICT OF INTEREST POLICY ARE AVAILABLE ON ITS WEBSITE: WWW.WKHS.COM. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE FOLLOWING WEBSITE: HTTP://WWW.EMMA.MSRB.ORG. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FASB ASC 715-30 PENSION 71,859,477. FORM 990, PART XII, LINE 2C WILLIS-KNIGHTON MEDICAL CENTER DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DUING THE YEAR ENDED 9/30/13. VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER 2715 ALBERT BICKNELL DRIVE SHREVEPORT LA 711033925 721047744 NURSING CARE-SKILLED NURSING FACILITY FOR THE ELDERLY AND DISABLED LA 501(C)(3) 9 N/A 0 MULTI-FAITH RETIREMENT SERVICES DBA LIVE OAK RETIREMENT 600 E FLOURNOY LUCAS ROAD SHREVEPORT LA 711153855 720809402 PROVIDE HOUSING, HEALTHCARE AND RELATED SERVICES TO THE ELDERLY LA 501(C)(3) 9 N/A 0 SOUTH SHREVEPORT PHARMACY INC PO BOX 1768 SHREVEPORT LA 711661768 721131182 INACTIVE LA N/A C 1.00000 0 CLAIMS & BENEFITS ADMINISTRATORS OF LOUISIANA INC PO BOX 32600 SHREVEPORT LA 711302600 721296277 INACTIVE LA N/A C 1.00000 0 WILLIS-KNIGHTON LAB AND X-RAY SERVICES INC PO BOX 32600 SHREVEPORT LA 711302600 721137503 INACTIVE LA N/A C 1.00000 0 HEALTH PLUS OF LOUISIANA INC 2219 LINE AVENUE SHREVEPORT LA 711042128 721264135 THIRD-PARTY ADMINISTRATOR LA N/A C 29461 2625116 1.00000 0 HPL INSURANCE AGENCY INC PO BOX 32625 SHREVEPORT LA 711302625 202199735 HEALTH INSURANCE AGENT LA HEALTH PLUS OF LOUISIANA INC C 702 40248 1.00000 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0 1 VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER A 213112 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER K 259020 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER B 163000 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER O 1312615 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER L 1223486 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER J 213112 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC A 16250 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC S 2000000 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC P 2817074 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC J 16250 FAIR MARKET VALUE MULTI-FAITH RETIREMENT SERVICES DBA LIVE OAK RETIREMENT COMMUNITY K 381600 FAIR MARKET VALUE