2013-05-07T16:27:16-05:00 2012-09-30 720506596 COLE EVANS & PETERSON POST OFFICE DRAWER 1768 SHREVEPORT LA 711661768 990 2011-10-01 720400933 WILLIS-KNIGHTON MEDICAL CENTER WILL 3182124000 POST OFFICE BOX 32600 SHREVEPORT LA 711302600 JAMES K ELROD 3182124000 2013-05-07 1 C WILLIAM GERARDY JR P00024591 3182228367 2011 2016-02-25 16:41:14Z JAMES K ELROD POST OFFICE BOX 32600 SHREVEPORT LA 711302600 852398397 0 X WWW.WKHS.COM X 1949 LA THE MEDICAL CENTER PROVIDES A FULL-RANGE OF HEALTH CARE SERVICES TO THE GENERAL PUBLIC. 11 9 6751 249 1507769 0 4944 26840 801935730 847199480 1730606 1641187 3673880 947805 807345160 849815312 1797776 2340463 0 0 333959691 351641743 0 0 0 395476199 412207323 731233666 766189529 76111494 83625783 888515990 950515940 364310630 370437103 524205360 580078837 X TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE WE SERVE. 0 0 634839264 2279352 842997991 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, FERTILITY AND REPRODUCTIVE HEALTH CLINIC, 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 51,343 ADMITTANCES DURING THE YEAR ENDED SEPTEMBER 30, 2012 WITH A TOTAL OF 203,603 PATIENT DAYS AND 3,897 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, 2012, THE MEDICAL CENTER PROVIDED AN ESTIMATED $12,500,000 IN UNREIMBURSED COSTS ATTRIBUTABLE TO CHARITY CARE (EXCLUDING PROJECT NEIGHBORHEALTH) AND AN ESTIMATED $31,800,000 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, IN CONJUNCTION WITH LSU HEALTH SCIENCES CENTER (A PUBLIC TEACHING AND INDIGENT CARE FACILITY), OPERATES A REGIONAL TRANSPLANT CENTER (WILLIS-KNIGHTON/LSUHSC 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, 2012, 47 PATIENTS RECEIVED ORGAN TRANSPLANTS, CONSISTING OF 32 KIDNEYS (2 OF THOSE PATIENTS ALSO HAD A PANCREAS TRANSPLANT, AND 1 OF THOSE PATIENTS ALSO HAD A LIVER TRANSPLANT), 1 PANCREAS AND 14 LIVERS. OF THE 47 TRANSPLANT SURGERIES PERFORMED AT THE MEDICAL CENTER DURING THE YEAR ENDED SEPTEMBER 30, 2012, 28 PATIENTS WERE BENEFICIARIES OF THE MEDICARE PROGRAM AND 2 PATIENTS WERE BENEFICIARIES OF THE MEDICAID 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, 2012, THE MEDICAL CENTER'S EMERGENCY ROOMS WERE VISITED BY 154,282 PATIENTS, OF WHOM 26,027 WERE ADMITTED TO THE HOSPITAL FOR FURTHER TREATMENT.WOMEN AND CHILDREN'S HEALTH SERVICES THE MEDICAL CENTER PROVIDES A VARIETY OF MEDICAL SERVICES FOR WOMEN AND CHILDREN, INCLUDING OBSTETRICS, GYNECOLOGY, AND NEONATOLOGY. 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 3,897 BIRTHS; 8,783 OBSTETRICAL VISITS TO THE L&D UNITS; AND 6,586 OBSTETRICAL AND GYNECOLOGICAL INPATIENTS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2012.HEALTH 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, 2012 OF 6,324. 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 NICU. 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, 2012, HOSPICE OF LOUISIANA SERVED 208 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, 2012, THE BEHAVIORAL MEDICINE CENTER SPONSORED NUMEROUS INFORMATION SESSIONS FOR VARIOUS GROUPS IN THE SHREVEPORT/BOSSIER AND NORTHWEST LOUISIANA AREAS. SUCH SESSIONS AMOUNTED TO APPROXIMATELY 460 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. 9620280 3584440 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. 644459544 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 1 439 0 1 6751 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X X ROBERT D HUIE 3182124000 2611 GREENWOOD ROAD SHREVEPORT LA 711033908 JAMES K ELROD 53.00 X X 1471942 6000 9602 PIERRE V BLANCHARDIV MD 40.00 X 210243 0 7226 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 JESSE C DEEN 4.00 X 0 0 0 SAM J TALBOT 4.00 X 0 0 0 BENDEL JOHNSON MD 4.00 X 0 0 0 ROBERT D HUIE 52.00 X 1204454 0 17726 NILA C WILLHOITE 40.00 X 247507 0 15314 CHARLES D DAIGLE 40.00 X 424451 0 21608 STEPHEN R RANDALL 40.00 X 302898 0 21611 MARGARET G ELROD 40.00 X 173331 0 8461 JERRY A FIELDER II 40.00 X 161174 0 23842 CLIFFORD M BROUSSARD 40.00 X 171565 0 14882 JANET K ELROD 40.00 X 169680 0 9171 IRA L MOSS 40.00 X 198510 0 17993 JILL K ELROD 40.00 X 219016 0 11957 PEGGY J GAVIN 40.00 X 175959 0 9746 DEBORAH D OLDS 40.00 X 131415 0 16123 RAMONA D FRYER 40.00 X 177152 0 17701 DANIEL J MOLLER JR MD 40.00 X 318570 0 14411 CHARLES A POWERS MD 40.00 X 315523 0 15078 RANDALL P BREWER MD 40.00 X 2050313 0 20118 MILAN G MODY MD 40.00 X 1489434 0 20105 CHRISTIAN M BRIERY MD 40.00 X 1529091 0 19893 MATTHEW S MOSURA MD 40.00 X 1310556 0 20099 CLINT M CORMIER MD 40.00 X 1396614 0 19272 13849398 6000 351939 460 0 1 0 LSU HEALTH SCIENCES CENTER PO BOX 33932 SHREVEPORT LA 71130 MEDICAL STAFFING 5252441 RED RIVER CARDIOVASCULAR SURGEONS 2751 ALBERT BICKNELL DR SUITE 5C SHREVEPORT LA 71103 PHYSICIAN SERVICES 2573333 ESTOPINAL GROUP 903 SPRING STREET JEFFERSONVILLE IN 47130 ARCHITECTURAL FEES 2326324 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY TESTING SERVICES 2325392 COLE EVANS & PETERSON 624 TRAVIS STREET SHREVEPORT LA 71101 PAYROLL EE BENEFIT, ACCT/CONSULTANT SVCS 1845094 106 26840 26840 HOSPITAL SERVICES 900099 843615040 843588889 26151 RESIDENTIAL COMMUNITY 900099 3584440 3584440 847199480 1698272 1698272 1667648 2038374 -370726 -370726 -370726 460127 27499 459443 85268 684 -57769 -57085 -57085 LABORATORY REVENUE 621500 652592 652592 INCOME(LOSS) FROM SUBS 524114 272314 272314 (LOSS) FROM SUBSIDIARY 623000 -250564 -250564 644189 -184837 829026 1318531 849815312 846582431 1507769 1698272 2279352 2279352 61111 61111 6200350 6200350 257392729 225477403 31915326 17364381 14853484 2510897 48801952 41745168 7056784 21882331 18718136 3164195 2594368 2594368 1725013 1725013 2846315 1115733 1730582 7201032 7201032 1053718 1053718 44396146 21650532 22745614 5936442 5936442 DIRECT DEPARTMENTAL EXP 316537807 316537807 TAXES & LICENSES 7709109 7709109 BUSINESS OFFICE 4607772 4607772 17599601 2020818 15578783 766189529 644459544 121729985 0 23704709 98199847 156688418 113588257 126115486 8723990 11401086 21265155 20574027 2964420 3385510 1013861864 503468272 488482781 510393592 110549292 102365990 18291146 16882615 1864249 1648502 882144 1060714 888515990 950515940 78546392 90271313 0 184320743 177443951 101443495 102721839 364310630 370437103 X 524205360 580078837 524205360 580078837 888515990 950515940 X 83625783 -27752306 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 61714 61714 0 0 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DURING THE YEAR ENDED SEPTEMBER 30, 2012, THE MEDICAL CENTER PAID DUES TOTALING $32,000 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, $6,720 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2012, THE MEDICAL CENTER PAID DUES TOTALING $7,105 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, $3,908 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2012, THE MEDICAL CENTER PAID DUES TOTALING $243,269 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, $51,086 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. 1266950 47891470 49158420 9312521 583459551 271395694 321376378 1903870 1167512 736358 296311678 217188033 79123645 73715824 13717033 59998791 510393592 CAPITAL LEASE OBLIGATIONS 1529967 INVESTMENT IN SUB. - VIRGINIA HALL, INC. 3709474 LIABILITY FOR PENSION BENEFITS 97482398 102721839 849815312 766189529 83625783 -569941 -27182365 -27752306 55873477 863232747 -569941 -569941 863802688 -13987376 -13987376 849815312 807359270 41169741 41169741 766189529 0 766189529 PART XI, LINE 8 - OTHER ADJUSTMENTS: FASB ASC 715-30 PENSION -27,182,365. PART XII, LINE 4B UNRELATED BUSINESS INCOME 790,446 SUBSIDIARIES EXPENSES (14,777,822) TOTAL (13,987,376) PART XIII, LINE 2D UNRELATED BUSINESS INCOME (790,446) SUBSIDIARIES EXPENSES 14,777,822 PENSION RELATED CHANGES 27,182,365 TOTAL 41,169,741 PART XI, LINE 8 PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS - THIS COST IS PRIMARILY ATTRIBUTABLE TO THE EFFECTS OF CHANGES IN FINANCIAL MARKETS ON BOTH INVESTED PLAN ASSETS AND ASSUMED DISCOUNT RATES USED IN THE CALCULATION OF THE PLAN'S FUNDED STATUS. 0 0 0 0 0 0 0 0 0 0 RUSSIA & THE NEWLY INDEPENDENT STATES - PROVIDE MEDICAL SUPPLIES AND DOCTORS' TRAVEL EXPENSES FOR MEDICAL MISSION TRIP TO THE UKRAINE 61111 MEDICAL SUPPLIES AND TRAVEL EXPENSES BOOK 1 0 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 1 0 0 12474895 12474895 0.01630 70841568 39033962 31807606 0.04150 83316463 39033962 44282501 0.05780 2228683 2228683 0.00290 5391803 5391803 0.00700 2163732 686963 1476769 0.00190 2995443 2995443 0.00390 12779661 686963 12092698 0.01570 96096124 39720925 56375199 0.07350 0 21398113 0 206727655 216115299 -9387644 X 1 1 4 1 WILLIS-KNIGHTON MEDICAL CENTER

2600 GREENWOOD ROAD SHREVEPORT LA 71103

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

8001 YOUREE DRIVE SHREVEPORT LA 71115

X X X X PHYSICIAN CLINICS 3 WK BOSSIER HEALTH CENTER

2400 HOSPITAL DRIVE BOSSIER CITY LA 71111

X X X PHYSICIAN CLINICS 4 WILLIS-KNIGHTON SOUTH

2510 BERT KOUNS INDUSTRIAL LOOP SHREVEPORT LA 71118

X X X X PHYSICIAN CLINICS WILLIS-KNIGHTON MEDICAL CENTER 1 1 1 150.000000000000 1 250.000000000000 1 X X X X X X 1 1 X X 1 X 1 X X X X X 1 X 0 0 WK PIERREMONT HEALTH CENTER 2 1 1 150.000000000000 1 250.000000000000 1 X X X X X X 1 1 X X 1 X 1 X X X X X 1 X 0 0 WK BOSSIER HEALTH CENTER 3 1 1 150.000000000000 1 250.000000000000 1 X X X X X X 1 1 X X 1 X 1 X X X X X 1 X 0 0 WILLIS-KNIGHTON SOUTH 4 1 1 150.000000000000 1 250.000000000000 1 X X X X X X 1 1 X X 1 X 1 X X X X X 1 X 0 0 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 6.9 PERCENT AND 6.2 PERCENT FOR THE YEARS ENDED SEPTEMBER 30, 2012 AND SEPTEMBER 30, 2011, 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 150% 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: WK COMMUNITY HEALTH AND EDUCATION CENTER - MLK CLINIC, WK PIERRE AVENUE HEALTH & WELLNESS CENTER, WK BRADLEY MEDICAL CLINIC, AND THE CHILDREN'S DENTAL CLINIC AND WK COMMUNITY EDUCATION CENTER.WK COMMUNITY HEALTH AND EDUCATION CENTER - MLK CLINICPROJECT 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 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 1 FAMILY PRACTICE PHYSICIAN, A PART-TIME NURSE PRACTITIONER, AND SUPPORT STAFF. THE CLINIC HAD 3,580 MEDICAL PATIENT VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2012. 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 A FAMILY PRACTICE PHYSICIAN, A PART-TIME NURSE PRACTITIONER, AND SUPPORT STAFF. THE CLINIC HAD 8,964 MEDICAL PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2012. 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 1,939 MEDICAL PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2012. 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 A FULL-TIME OFFICE MANAGER AND 45 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, 2012. DURING THE YEAR ENDED SEPTEMBER 30, 2012, 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, 2 PART-TIME EMPLOYEES, 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, ALLIANCE FOR EDUCATION, BOSSIER MEDICAL SOCIETY, CADDO-BOSSIER CANCER FOUNDATION LEAGUE, 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 317,000 VISITORS. KIDSHEALTH ATTRACTED OVER 205,000 VISITORS.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, 2012, THE MEDICAL CENTER IMMUNIZED 3,043 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. 1 AIRLINE HIGH SCHOOL 2801 AIRLINE DRIVE BOSSIER CITY LA 71111 726000185 GOVERNMENT 6000 SPONSOR FOR BASKETBALL TOURNAMENT 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 DONATION - BARON'S BALL, SPONSOR CADDO AND BOSSIER RELAY FOR LIFE AMERICAN HEART ASSOCIATION PO BOX 37388 SHREVEPORT LA 71133 135613797 501(C)(3) 40000 DONATION FOR OPERATIONS BLUEPRINT LOUISIANA 9331 BLUEBONNET BLVD BATON ROUGE LA 70810 205591232 501(C)(6) 10000 DONATION FOR OPERATIONS BOOKER T WASHINGTON HIGH SCHOOL 204 MILAM STREET SHREVEPORT LA 71103 726000224 GOVERNMENT 5049 PURCHASED SCHOOL SIGN CADDO BOSSIER SOCCER ASSOCIATION 1780 EAST BERT KOUNS SUITE 901 SHREVEPORT LA 71105 581652966 501(C)(3) 21570 SPONSORSHIP CADDO BOSSIER CANCER FOUNDATION LEAGUE INC 2900 WHEELESS SHREVEPORT LA 71104 453188641 501(C)(3) 10000 DONATION FOR OPERATIONS CADDO PARISH SHERIFF'S DEPARTMENT 505 TRAVIS STREET 7TH FLOOR SHREVEPORT LA 71101 726000179 GOVERNMENT 14163 DONATION FOR EQUIPMENT CALVARY ACADEMY 9333 LINWOOD AVENUE SHREVEPORT LA 71106 720482882 501(C)(3) 6000 DONATION FOR OPERATIONS CE BYRD HIGH SCHOOL 3201 LINE AVENUE SHREVEPORT LA 71103 726000224 GOVERNMENT 8462 SPONSORSHIP CHILDREN AND ARTHRITIS 2751 ALBERT BICKNELL DRIVE SUITE 2E 2E SHREVEPORT LA 71103 721170530 501(C)(3) 15000 DONATION FOR OPERATIONS CITY OF SHREVEPORT 263 N COMMON STREET SHREVEPORT LA 71101 726001326 GOVERNMENT 333767 DONATION OF 3 SPRINT VEHICLES - FIRE DEPARTMENT COMMUNITY FOUNDATION OF NORTH LOUISIANA 401 EDWARDS STREET NO 105 SHREVEPORT LA 71101 726022365 501(C)(3) 10000 DONATION FOR OPERATIONS DESOTO REGIONAL HEALTH SYSTEM PO BOX 1636 MANSFIELD LA 71052 721491325 501(C)(3) 62751 DONATION FOR OPERATIONS EVERGREEN FOUNDATION 2101 HIGHWAY 80 HAUGHTON LA 71037 237089068 501(C)(3) 25000 DONATION TO BETTER HEALTH BETTER LIVES CAMPAIGN FOR THE HANDICAPPED FORENSIC NURSE EXAMINERS PO BOX 44466 SHREVEPORT LA 71134 352262163 501(C)(3) 20000 DONATION FOR OPERATIONS GRAMBLING STATE UNIVERSITY PO BOX 913 GRAMBLING LA 71245 581736948 GOVERNMENT 207000 ENDOWED PROFESSORSHIPS, SPONSORSHIP HEART OF HOPE MINISTRIES INC PO BOX 18776 SHREVEPORT LA 71138 412187038 501(C)(3) 10000 DONATIONS FOR COMPUTERS HOLY ANGELS RESIDENTIAL FACILITY INC 10450 ELLERBE ROAD SHREVEPORT LA 71106 720628035 501(C)(3) 60000 DONATION FOR OPERATIONS INDEPENDENCE BOWL FOUNDATION PO BOX 1723 SHREVEPORT LA 71166 720297228 501(C)(3) 40000 SPONSORSHIP INNER CITY ENTREPRENEUR INSTITUTE 820 JORDAN STREET SUITE 360 SHREVEPORT LA 71101 721418314 501(C)(3) 20000 BIZCAMP SPONSOR JUNIOR ACHIEVEMENT 3003 KNIGHT STREET SHREVEPORT LA 71105 720595081 501(C)(3) 27600 DONATION FOR OPERATIONS NORTHWEST LOUISIANA LIONS EYE BANK 721 BOULEVARD SHREVEPORT LA 71104 720928468 501(C)(3) 20000 DONATION FOR OPERATIONS LOUISIANA TECH UNIVERSITY FOUNDATION PO BOX 3046 RUSTON LA 71272 726021176 501(C)(3) 54250 SPONSORSHIP LSUHSC PO BOX 31650 SHREVEPORT LA 71115 721402222 GOVERNMENT 240000 DONATION FOR OPERATIONS LSU-SHREVEPORT FOUNDATION ONE UNIVERSITY PLACE SHREVEPORT LA 71105 721031108 501(C)(3) 25000 DONATION FOR OPERATIONS MARCH OF DIMES FOUNDATION 1120 SOUTH POINTE PARKWAY BLDG D SHREVEPORT LA 71105 131846366 501(C)(3) 41500 DONATION FOR OPERATIONS NORTH AMERICA IAPB INC 137 HAMPTON ROAD SOUTHAMPTON NY 11968 043796216 501(C)(3) 27500 DONATION FOR OPERATIONS NORTH LOUISIANA CRIME LAB BENEFIT PO BOX 7957 SHREVEPORT LA 711377957 720707474 501(C)(3) 10000 SPONSORSHIP NORTHWEST LOUISIANA FOOD BANK 2307 TEXAS AVENUE SHREVEPORT LA 71103 721328890 501(C)(3) 30000 DONATION FOR OPERATIONS THE ODYSSEY FOUNDATION 401 TEXAS STREET SHREVEPORT LA 71101 331055253 501(C)(6) 10000 DONATION TO WALKING THE WALK FUNDRAISER PROVIDENCE HOUSE 814 COTTON STREET SHREVEPORT LA 71101 721205164 501(C)(3) 25000 DONATION FOR OPERATIONS PUBLIC AFFAIRS RESEARCH COUNCIL OF LA PO BOX 14776 BATON ROUGE LA 70898 720436118 501(C)(3) 25000 DONATION TO CAPITAL CAMPAIGN RED RIVER RADIO PUBLIC BROADCASTING PO BOX 5250 SHREVEPORT LA 71135 720702001 501(C)(3) 23000 DONATION FOR OPERATIONS RED RIVER REVEL ARTS FESTIVAL 101 CROCKET STREET SUITE C SHREVEPORT LA 71101 720953274 501(C)(3) 25000 SPONSORSHIP OF REGIONAL CULTURAL EVENT ROBINSON FILM CENTER PO BOX 155 SHREVEPORT LA 71161 421562125 501(C)(3) 15000 DONATION FOR OPERATIONS AFRICAN-AMERICAN CHAMBER OF COMMERCE 1315 MILAM STREET SHREVEPORT LA 71101 726028366 501(C)(3) 7500 SPONSORSHIP SHREVEPORT-BOSSIER RESCUE MISSION 2033 TEXAS AVENUE SHREVEPORT LA 71103 237050551 501(C)(3) 138711 HEALTH INSURANCE FOR RESCUE MISSION EMPLOYEES AND DONATION FOR OPERATIONS SHREVEPORT OPERA 212 TEXAS STREET NO 1 SHREVEPORT LA 71101 726021455 501(C)(3) 9000 DONATION FOR OPERATIONS SHREVEPORT POLICE DEPARTMENT 712 MILAM STREET SUITE 101 SHREVEPORT LA 71101 726001326 GOVERNMENT 13352 DONATION FOR OPERATIONS SHREVEPORT SYMPHONY 619 LOUISIANA AVENUE SHREVEPORT LA 71101 726001334 501(C)(3) 80882 CONCERT SPONSOR AND DONATION FOR OPERATIONS SHRINER'S HOSPITAL FOR CHILDREN 3100 SAMFORD AVENEUE SHREVEPORT LA 71103 362192608 501(C)(3) 100000 DONATION FOR SURGICAL EQUIPMENT SOUTH LOUISIANA CLINICAL RESEARCH 225 DUNN STREET HOUMA LA 70360 721430540 501(C)(3) 7500 SPONSOR FOR PERIPHERAL ARTERY DISEASE CONFERENCE SOUTHERN HILLS ELEMENTARY SCHOOL 9075 KINGSTON ROAD SHREVEPORT LA 71118 726000224 GOVERNMENT 5049 REFURBISH SCHOOL SIGN AND ADDED TRACK FOR LIGHTING SOUTHERN UNIVERSITY 610 TEXAS STREET SUITE 400 SHREVEPORT LA 71101 721454141 501(C)(3) 10000 DONATION FOR ALLIED HEALTH AND NURSING SCHOLARSHIPS VOLUNTEERS OF AMERICA 360 JORDAN STREET SHREVEPORT LA 71101 720506820 501(C)(3) 20000 DONATION FOR OPERATIONS WASKOM VOLUNTEER FIRE DEPARTMENT PO BOX 1757 WASKOM TX 75692 752340733 501(C)(3) 28000 DONATION TO UPGRADE FIRE FIGHTING EQUIPMENT YMCA 400 MCNEIL SHREVEPORT LA 71101 720408997 501(C)(3) 40800 SPONSORSHIP 40 9 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 1078709 6000 0 0 393233 0 0 0 9602 0 1481544 6000 0 0 PIERRE V BLANCHARDIV MD 200000 0 0 0 10243 0 1953 0 5273 0 217469 0 0 0 ROBERT D HUIE 584193 0 0 0 620261 0 2441 0 15285 0 1222180 0 0 0 NILA C WILLHOITE 219131 0 0 0 28376 0 2606 0 12708 0 262821 0 0 0 CHARLES D DAIGLE 400881 0 0 0 23570 0 1685 0 19923 0 446059 0 0 0 STEPHEN R RANDALL 282270 0 0 0 20628 0 1688 0 19923 0 324509 0 0 0 MARGARET G ELROD 146926 0 0 0 26405 0 3360 0 5101 0 181792 0 0 0 JERRY A FIELDER II 158296 0 0 0 2878 0 4949 0 18893 0 185016 0 0 0 CLIFFORD M BROUSSARD 167109 0 0 0 4456 0 1839 0 13043 0 186447 0 0 0 JANET K ELROD 148558 0 0 0 21122 0 3065 0 6106 0 178851 0 0 0 IRA L MOSS 175675 0 0 0 22835 0 2757 0 15236 0 216503 0 0 0 JILL K ELROD 196217 0 0 0 22799 0 1728 0 10229 0 230973 0 0 0 PEGGY J GAVIN 146283 0 0 0 29676 0 4146 0 5600 0 185705 0 0 0 RAMONA D FRYER 159890 0 0 0 17262 0 2277 0 15424 0 194853 0 0 0 DANIEL J MOLLER JR MD 296685 0 0 0 21885 0 1875 0 12536 0 332981 0 0 0 CHARLES A POWERS MD 295000 0 0 0 20523 0 1875 0 13203 0 330601 0 0 0 RANDALL P BREWER MD 2053148 0 0 0 -2835 0 1695 0 18423 0 2070431 0 0 0 MILAN G MODY MD 1491793 0 0 0 -2359 0 1682 0 18423 0 1509539 0 0 0 CHRISTIAN M BRIERY MD 1531772 0 0 0 -2681 0 1680 0 18213 0 1548984 0 0 0 MATTHEW S MOSURA MD 1314112 0 0 0 -3556 0 1676 0 18423 0 1330655 0 0 0 CLINT M CORMIER MD 1399382 0 0 0 -2768 0 1678 0 17594 0 1415886 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-$165,322 UNUSED SICK PAY-$24,996 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$3,988 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$24,026 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,030) CABLE/INTERNET-$873 PERSONAL USE OF EMPLOYER VEHICLES-$3,619 SEVERANCE PAY-$154,739** TOTAL--$393,233 **THE INCREASE IN GROSS SEVERANCE BENEFIT, TO BE PAID TO MR. ELROD AND MR. HUIE ON TERMINATION OF EMPLOYMENT (AS ADDITIONAL COMPENSATION FOR EACH OF THEIR YEARS OF SERVICE TO WILLIS-KNIGHTON MEDICAL CENTER), WAS TAXABLE DURING 2011, AND, ACCORDINGLY, WAS INCLUDED IN EACH OF THEIR 2011 FORMS 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 OR MR. HUIE 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 EACH OF THEIR RESPECTIVE EMPLOYMENT TERMINATES. ACCORDINGLY, THERE WAS NO CURRENT DISBURSEMENT TO MR. ELROD OR MR. HUIE FOR SEVERANCE PAY. ROBERT D. HUIE NONQUALIFIED DEFERRED COMPENSATION PLAN-$466,985 (PLEASE SEE EXPLANATION FOLLOWING) UNUSED VACATION PAY-$35,200 UNUSED SICK PAY-$13,589 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$2,082 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$5,200 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,944) GIFT CERTIFICATE-$125 SEVERANCE PAY-$84,124** TOTAL--$620,261 NILA C. WILLHOITE UNUSED SICK PAY-$5,097 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$2,073 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,007 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,813) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$187 TOTAL--$28,376 CHARLES D. DAIGLE UNUSED SICK PAY-$9,515 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,230 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$558 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,558) GIFT CERTIFICATE-$125 TOTAL--$23,570 STEPHEN R. RANDALL UNUSED SICK PAY-$6,566 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,234 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$560 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,557) GIFT CERTIFICATE-$125 TOTAL--$20,628 MARGARET G. ELROD UNUSED SICK PAY-$3,418 VALUE ADDED FOR CELL PHONE USAGE-$3,504 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,400 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,030) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$1,488 TOTAL--$26,405 JERRY A. FIELDER,II UNUSED SICK PAY-$3,682 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$1,699 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$417 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,658) VALUE ADDED FOR CABLE/INTERNET- $953 GIFT CERTIFICATE-$125 TOTAL--$2,878 CLIFFORD M. BROUSSARD UNUSED SICK PAY-$3,887 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$940 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,868 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,024) GIFT CERTIFICATE-$125 TOTAL--$4,456 JANET K. ELROD UNUSED SICK PAY-$3,456 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$1,977 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$368 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,030) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$66 TOTAL--$21,122 IRA L. MOSS UNUSED SICK PAY-$4,086 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,597 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,025 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,195) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$1,497 TOTAL--$22,835 JILL K. ELROD UNUSED SICK PAY-$4,564 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$2,168 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$759 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,030) GIFT CERTIFICATE-$125 VALUE ADDED FOR CABLE/INTERNET- $953 PERSONAL USE OF EMPLOYER VEHICLES-$3,100 TOTAL--$22,799 PEGGY J. GAVIN UNUSED SICK PAY-$3,403 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$3,614 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,392 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,530) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$3,972 TOTAL--$29,676 RAMONA D. FRYER UNUSED SICK PAY-$3,719 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$1,063 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$619 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,424) GIFT CERTIFICATE-$125 TOTAL--$17,262 DANIEL J. MOLLER, JR., M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$1,568 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$5,227 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,195) GIFT CERTIFICATE-$125 TOTAL--$21,885 CHARLES A. POWERS, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,808 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$4,039 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,024) TOTAL--$20,523 PIERRE V. BLANCHARD,IV, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$11,273 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,030) TOTAL--$10,243 RANDALL P. BREWER, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$564 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,059) TOTAL--($2,835) MATTHEW S. MOSURA, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$503 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,059) TOTAL--($3,556) MILAN G. MODY, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$499 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,058) TOTAL--($2,359) CHRISTIAN M. BRIERY, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$506 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,847) TOTAL--($2,681) CLINT M. CORMIER, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$461 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,229) TOTAL--($2,768) EXPLANATION OF PART II, COLUMN (B)(III) OTHER COMPENSATION THE AMOUNT CONTRIBUTED FOR THE CALENDAR YEAR 2011 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, 2011 (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 84209 RENT-BUILDING 0 TIMOTHY B WILLHOITE FAMILY MEMBER OF NILA WILLHOITE, OFFICER 46926 EMPLOYMENT 0 GREGORY J GAVIN FAMILY MEMBER OF PEGGY GAVIN, OFFICER 186921 EMPLOYMENT 0 KIMBERLY M MULLINS FAMILY MEMBER OF PEGGY GAVIN, OFFICER 52884 EMPLOYMENT 0 CHARLES E MULLINS FAMILY MEMBER OF PEGGY GAVIN, OFFICER 71258 EMPLOYMENT 0 SHARLENE ANN BROUSSARD FAMILY MEMBER OF CLIFFORD BROUSSARD, OFFICER 43137 EMPLOYMENT 0 WINSTON E MOORE III FAMILY MEMBER OF MARGARET ELROD, OFFICER 20088 EMPLOYMENT 0 TODD JUSTIN BLANCHARD FAMILY MEMBER OF PIERRE BLANCHARD, M.D., TRUSTEE 130432 EMPLOYMENT 0 PIERRE V BLANCHARD MD TRUSTEE 5386045 RENT-BUILDING, PURCHASED SERVICE AGREEMENT WITH LIFECARE HOSPITALS, INC., FOR WHICH PIERRE BLANCHARD, M.D. IS THE MEDICAL DIRECTOR 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 5: NET UNREALIZED LOSSES ON INVESTMENTS: -569,941. FASB ASC 715-30 PENSION -27,182,365. TOTAL TO FORM 990, PART XI, LINE 5: -27,752,306. FORM 990, PART XII, LINE 2C WILLIS-KNIGHTON MEDICAL CENTER DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DUING THE YEAR ENDED 9/30/12. 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