2013-11-06T14:50:04-06:00 2012-12-31 721202445 POSTLETHWAITE & NETTERVILLE 8550 UNITED PLAZA BLVD SUITE 1001 BATON ROUGE LA 70809 990 2012-01-01 720551963 SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION D/B/A LAKE CHARLES MEMORIAL HOSPITAL SOUT 3374943202 1701 OAK PARK BOULEVARD LAKE CHARLES LA 70601 LARRY GRAHAM 3374943204 2013-11-06 1 GAIL H PITTMAN P01429086 2259224600 2012 2016-02-24 21:20:13Z LARRY GRAHAM 1701 OAK PARK BOULEVARD LAKE CHARLES LA 70601 219692693 0 X WWW.LCMH.COM X 1952 LA PROVIDE HEALTHCARE SERVICES 13 9 2241 60 0 0 310377 218807 206200722 217788512 585096 468351 1107658 1201947 208203853 219677617 15000 35000 0 0 78988111 87652049 0 0 1634369 112841727 110942088 191844838 198629137 16359015 21048480 202568931 186931118 122421634 118337597 80147297 68593521 X THE MISSION OF LAKE CHARLES MEMORIAL HOSPITAL IS TO IDENTIFY AND IMPROVE THE HEALTH OF THE PEOPLE OF SOUTH LOUISIANA AND EAST TEXAS BY PROVIDING A FULL SPECTRUM OF INNOVATIVE SERVICES-INCLUDING HEALTH EDUCATION, DISEASE PREVENTION, AND DIAGNOSTIC AND TREATMENT OPTIONS-IN A PERSONALIZED, CARING AND SAFE MANNER THROUGHOUT THE REGION. 0 0 5485817 2044265 LAKE CHARLES MEMORIAL HOSPITAL2012 COMMUNITY BENEFITS SUMMARYI. INTRODUCTIONAS A COMMUNITY-BASED HOSPITAL, IT IS LAKE CHARLES MEMORIAL HOSPITAL'S MISSION TO HELP IMPROVE THE HEALTH AND WELLNESS OF THE SOUTHWEST LOUISIANA COMMUNITY. WHILE IT IS OUR LEGAL RESPONSIBILITY TO PROVIDE MEDICAL CARE TO ANYONE IN NEED REGARDLESS OF HIS OR HER ABILITY TO PAY, MEMORIAL ALSO PROVIDES A SIGNIFICANT AMOUNT OF COMMUNITY SERVICE PROGRAMS, INCLUDING EDUCATIONAL PROGRAMS AND HEALTH SCREENINGS, FREE OF CHARGE OR AT A GREATLY REDUCED COST TO THE CONSUMER.II. CHARITY CAREMEMORIAL PROVIDES MEDICAL CARE TO MEDICAID RECIPIENTS REGARDLESS OF THEIR ABILITY TO PAY, AND REGARDLESS OF MEDICAID REIMBURSEMENT. IN 2012, MEMORIAL HOSPITAL PROVIDED $12,978,482 IN UN-REIMBURSED MEDICAID COSTS AND $4,473,830 IN CHARITY CARE COSTS. COMMUNITY BENEFIT-$17,452,311SPORTS MEDICINETHE SPORTS MEDICINE ALLIANCE PROVIDED $403,601 IN PRE-PARTICIPATION PHYSICALS FOR AREA ATHLETES, ATHLETIC ASSESSMENTS, LECTURES, IN-SERVICES, WORKSHOPS, SPORTS CAMPS AND CLINICS, STUDENT TRAINER SCHOLARSHIPS, ATHLETIC TRAINER COVERAGE AT AREA SPORTING EVENTS, SPECIAL EVENTS AND MORE FREE OF CHARGE OR FOR A MINIMAL FEE TO THE PARTICIPANTS. COMMUNITY BENEFIT:$403,601III. HEALTH PROFESSIONALS EDUCATIONLAKE CHARLES MEMORIAL INVESTS IN MEDICAL EDUCATION IN AN EFFORT OF PROVIDE THE AREA WITH QUALIFIED PROFESSIONALS. IN 2012, LCMH SPENT $3,037,952 FOR THE LOUISIANA STATE UNIVERSITY HEALTH SERVICES CENTER-FAMILY PRACTICE RESIDENCY PROGRAM.COMMUNITY BENEFIT:$3,037,952CHARITABLE DONATIONSLCMH MAKES NUMEROUS MONETARY DONATIONS TO A VARIETY OF NON-PROFIT AGENCIES.COMMUNITY BENEFIT:$51,365COMMUNITY EVENTS AND SEMINARSEACH YEAR, LCMH PROVIDES FREE HEALTH SCREENINGS, EDUCATIONAL SEMINARS AND INFORMATIONAL BOOTHS AT A VARIETY OF COMMUNITY EVENTS. THE HOSPITAL ALSO PROVIDES FREE SPEAKERS TO CIVIC GROUPS AND OTHER ORGANIZATIONS. THIS COMMITMENT TO HEALTH AND WELLNESS EDUCATION TAKES MEMORIAL PROFESSIONALS INTO THE FIVE PARISH AREA TO STAFF INDUSTRIAL, CORPORATE AND SCHOOL HEALTH FAIRS. THE HOSPITAL CONTRIBUTED $54,151 IN SPECIAL EVENTS AND SEMINARS.COMMUNITY BENEFIT:$54,151MEMORIAL'S TOTAL 2012 NET COMMUNITY CONTRIBUTIONS - $20,999,380 36683158 22672400 THE HOSPITAL PROVIDES A WIDE RANGE OF INPATIENT AND OUT- PATIENT SERVICES THROUGH A 29-BED LONG-TERM ACCUTE CARE FACILITY, A 339-BED ACUTE CARE FACILITY AND SATELLITE LOCATIONS. THE SYSTEM PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES WITHOUT CHARGE OR AT REDUCED RATES. 138962102 35000 194019708 THE HOSPITAL PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES THROUGH A 29-BED LONG-TERM ACUTE CARE FACILITY, A 339-BED ACUTE CARE FACILITY AND SATELLITE LOCATIONS. 181131077 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 1 0 1 295 0 1 2241 1 0 0 0 0 0 0 0 0 0 0 X 13 9 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X CHARLES WHITSON CHIEF FINANCIAL OF 3374943202 1701 OAK PARK BLVD LAKE CHARLES LA 706018911 CHRISTOPHER THOMPSON 40.00 X 855192 0 7500 GLENN PUMPELLY 1.00 X X 0 0 0 ULYSSES GENE THIBODEAUX 1.00 X X 0 0 0 LOUIS M TODD SR 1.00 X 0 0 0 DAVID WALLACE MD 1.00 X 0 0 0 CHARLES WHITSON CPA 40.00 X X 283618 0 27116 LARRY GRAHAM 40.00 X X 675177 0 19212 DENISE EMERSON RAU 1.00 X X 0 0 0 THOMAS SHEARMAN 1.00 X 0 0 0 BRIAN CLEMENTS MD 40.00 X 428249 0 27116 JOE MILLER 1.00 X 0 0 0 GERALD W MOUTON 40.00 X 269000 0 14093 BRYAN BAROOTES MD 1.00 X 0 0 0 S MARK MCMURRY 1.00 X 0 0 0 MARILYN MCSWAIN RN 40.00 X 219565 0 19731 DAVID B USHER 40.00 X 207184 0 21569 TIM COFFEY 40.00 X 281570 0 15346 DONNA SHIELDS 40.00 X 209061 0 19340 TODD DELAHOUSSAYE 40.00 X 189114 0 13061 KATHLEEN DEROUEN 40.00 X 162822 0 16098 NATHAN COHEN 40.00 X 919818 0 0 LEROY FREDERICKS 40.00 X 897546 0 7500 BRETT CASCIO 40.00 X 1829975 0 7500 MICHAEL BROUSSARD MD 40.00 X 893776 0 7500 FRANCISCO MARERRO 40.00 X 1003154 0 7500 MANLEY M JORDAN MD 40.00 X 429998 0 27116 THOMAS C STRONG MD 40.00 X 408711 0 15548 KEVIN MOCKLIN 40.00 X 239304 0 20355 WILLIAM CONDOS 40.00 X 260583 0 4690 WILLIAM MOSS 40.00 X 512954 0 27116 BEN THOMPSON 40.00 X 482911 0 21593 GARY KOHLER 40.00 X 454850 0 27116 ROBERT BROUSSARD 40.00 X 434213 0 27116 JAMES GAHARAN 40.00 X 835839 0 7500 DENNIS WALKER 40.00 X 428847 0 25842 GREGORY RUBINO MD 40.00 X 750006 0 7500 14563037 0 441674 94 1 1 0 LEWING CONSTRUCTION INC PO BOX 5216 LAKE CHARLES LA 706065216 CONTRUCTION/CONTRACTOR 2027185 LA COMMERCIAL LAUNDRY LLC PO BOX 503 SCOTT LA 705830503 LAUNDRY/LINEN SERVICE 1325296 INSTITUTE FOR NEUROPSYCHIATRY APMC 2829 4TH AVENUE LAKE CHARLES LA 70601 PSYCH SERVICES 1316597 EMERGENCY MEDICAL SPECIALIST APMC PO BOX 95385 NEW ORLEANS LA 701959385 ER/PSYCH TRIAGE SERVICES 666672 COMPREHENSIVE PHARMACY SERVICE P O BOX 116474 ATLANTA GA 303686474 PHARMACY SERVICE 649249 144 112119 106688 218807 PATIENT SERVICE REVENU 900099 211527448 211527448 MISC. PATIENT REVENUE 900099 3621809 3621809 MEDICAID MANAGED CARE PAYMENTS 900099 1365275 1365275 CAFETERIA 900099 1273980 1273980 217788512 462466 462466 259971 0 259971 259971 259971 20961 15076 5885 5885 5885 INCOME FROM SECOND AVENUE MRI, LL 621990 823390 823390 NET INCOME FROM GIFT SHOP 453220 65940 65940 INCOME FROM LA PET/CT IMAGING LAK 621990 52646 52646 941976 219677617 218736373 0 722437 35000 35000 14563037 5097063 8446561 1019413 51351696 50581421 770275 1212834 1024487 169590 18757 16211856 13694231 2266899 250726 4312626 3642896 603033 66697 774564 749778 22850 1936 248828 240866 7340 622 2665484 2580188 78632 6664 1356906 1126232 122122 108552 262236 253845 7080 1311 5707938 5479620 228318 11924089 11089403 834686 4024986 3743237 281749 SUPPLIES 39243436 37987646 1157681 98109 PURCHASED SERVICES 17395261 16838613 513160 43488 BAD DEBT 15392185 15392185 CONTRACT LABOR 4316346 4230019 86327 7629829 7344347 267388 18094 198629137 181131077 15863691 1634369 14230375 10578185 14776693 14862985 25038213 24207133 3487210 4156378 2098358 2617752 265734715 196343512 73204849 69391203 54461450 43797209 15271783 17320273 202568931 186931118 28318913 27579755 87540000 84520000 4207702 3065397 2355019 3172445 122421634 118337597 X 80147297 68593521 80147297 68593521 202568931 186931118 X 21048480 -32602256 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3625824 3625824 128668436 93685795 34982641 1322876 1322876 0 120413581 93801814 26611767 11703998 7533027 4170971 69391203 INVESTMENT - LA PET IMAGING 176288 C INVESTMENT-CORPORATE SHARE LCCC 12000 C INVESTMENTS-VHA-E 82786 C INVESTMENTS-LAKE CHARLES HEALTH PLANS 37500 C INVESTMENT - SWLHS, INC. 43488635 C 43797209 INTERCOMPANY RECEIVABLES 1793229 ASSETS WHOSE USE IS LIMITED 11419742 DEFERRED FINANCING COSTS 1923326 OTHER RECEIVABLES 2081471 OTHER ASSET-MSO 102505 17320273 BOND PREMIUM 32845 INVESTMENT-AMRI 3139600 3172445 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE SYSTEM APPLIES THE ACCOUNTING GUIDANCE RELATED TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, WHICH SETS OUT A CONSISTENT FRAMEWORK TO DETERMINE THE APPROPRIATE LEVEL OF TAX RESERVES TO MAINTAIN FOR UNCERTAIN TAX POSITIOINS. THE SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE RECORDED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN THE RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE SYSTEM HAS EVALUATED ITS POSITION REGARDING THE ACCOUNTING FOR UNCERTAIN INCOME TAX POSITIONS AND DOES NOT BELIEVE THAT IT HAS ANY MATERIAL UNCERTAIN TAX POSITIONS. WITH FEW EXCEPTIONS, THE SYSTEM IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS ENDED BEFORE DECEMBER 31, 2009. 1 1 1 X 1 X 1 1 1 0 1 1 6069497 5037220 1032277 0.00520 30613662 17635180 12978482 0.06530 36683159 22672400 14010759 0.07050 5078419 2040468 3037951 0.01530 407398 3797 403601 0.00200 5485817 2044265 3441552 0.01730 42168976 24716665 17452311 0.08780 1 4845130 2907078 62948280 90926804 -27978524 X 1 1 1 SECOND AVENUE MRI LLC IMAGING 0.51000 0.49000 2 LA PET IMAGING IMAGING 0.24500 1 1 LAKE CHARLES MEMORIAL HOSPITAL

1701 OAK PARK BLVD LAKE CHARLES LA 70601

X X X X LAKE CHARLES MEMORIAL HOSPITAL 1 1 1 150.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X 1 X X X 1 X X X X X 1 X 0 1 PART II: N/A PART III, LINE 4: THE FOLLOWING FOOTNOTE REGARDING BAD DEBT EXPENSE IS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS: "THE SYSTEM MAINTAINS ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS, DOUBTFUL ACCOUNTS, AND CHARITY CARE BASED ON MANAGEMENT'S ASSESSMENT OF COLLECTIBILITY, CURRENT ECONOMIC CONDITIONS, AND PRIOR EXPERIENCE. THE SYSTEM DETERMINES IF PATIENT ACCOUNTS RECEIVABLE ARE PAST-DUE BASED ON THE DISCHARGE DATE; HOWEVER, THE SYSTEM DOES NOT CHARGE INTEREST ON PAST-DUE ACCOUNTS. THE SYSTEM CHARGES OFF PATIENT ACCOUNTS RECEIVABLE IF MANAGEMENT CONSIDERS THE COLLECTON OF THE OUTSTANDING BALANCES TO BE DOUBTFUL."COSTING METHODOLOGY IS OPERATING EXPENSE (LESS BAD DEBT) TIMES PAYOR MIX TIMES ALLOWABLE PERCENT. THE SHORTFALL AS RELATES TO THIS QUESTION SHOULD BE TREATED AS A COMMUNITY BENEFIT IN THAT CARE IS PROVIDED TO MEMBERS OF OUR COMMUNITY AT LESS THAN THE ALLOWABLE COST. PART III, LINE 8: COSTING METHODOLOGY USED FOR LINE 6 IS OPERATING EXPENSES (LESS BAD DEBT) TIMES PAYOR MIX TIMES 92% ALLOWABLE. THE SHORTFALL AS RELATES TO THIS QUESTION SHOULD BE TREATED AS A COMMUNITY BENEFIT IN THAT CARE IS PROVIDED TO MEMBERS OF OUR COMMUNITY AT LESS THAN THE ALLOWABLE COST. PART III, LINE 9B: THE COLLECTION POLICY IS THE SAME AS FOR THOSE WHO DON'T QUALIFY. THOSE ENTITLED TO FREE CARE HAVE NO COLLECTION ACTIVITY AS THERE IS NO CHARGE FOR THEIR CARE. THOSE WHO QUALIFY FOR DISCOUNTED CARE WILL BE TREATED AS ANY OTHER PATIENT WHO HAS A BALANCE DUE THE HOSPITAL, JUST THAT THE BALANCE DUE WILL BE AT THE DISCOUNTED RATE FOR WHICH THEY QUALIFY. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 12H: ALL PATIENTS ARE CHARGED THE SAME. THE DISCOUNT IS DETERMINED BASED ON THESE GUIDELINES. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY IS OFFERED BY FINANCIAL COUNSELORS. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 22: ALL PATIENTS ARE CHARGED THE SAME. DISCOUNTS ARE CALCULATED BASED ON FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: LCMH PROVIDES PROGRAMS & ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH & HEALING. THESE SCREENINGS, SEMINARS, CLASSES, ETC. RESPOND TO THE NEEDS OF PERSONS LIVING IN OUR COMMUNITY AND IMPROVES OVERALL COMMUNITY HEALTH. MEMORIAL HOSPITAL PROVIDES COMMUNITY HEALTH EDUCATION, COMMUNITY-BASED CLINICAL SERVICES, SUCH AS HEALTH SCREENINGS, SUPPORT GROUPS, SELF-HELP PROGRAMS, SUCH AS SMOKING CESSATION AND WEIGHT LOSS PROGRAMS, PASTORAL OUTREACH PROGRAMS AND SPIRITUAL CARE FOR THE WELL BEING OF OUR COMMUNITY. PART VI, LINE 3: LCMH UTILIZES FINANCIAL COUNSELORS TO APPRISE OUR PATIENTS OF PROGRAMS AVAILABLE TO ASSIST THEM WITH THE COSTS ASSOCIATED WITH THEIR CARE. PART VI, LINE 4: LCMH SERVICES A COMMUNITY WHICH IS APPROXIMATELY TWO HOURS EAST OF HOUSTON, TX AND TWO HOURS WEST OF BATON ROUGE, LA. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $44,826, WHICH IS SLIGHTLY ABOVE THE STATE AVERAGE. APPROXIMATELY 15.4% OF THE POPULATION LIVES BELOW THE POVERTY LEVEL, WHICH IS SLIGHTLY BELOW THE STATE AVERAGE. PART VI, LINE 5: N/A 1 REALLIETY ATHLETIC PRODUCTIONS 2023 CHARVAIS LAKE CHARLES LA 70601 461240215 N/A 5000 SPONSORSHIP SWLA CENTER FOR HEALTH SERVICES PO BOX 19010 LAKE CHARLES LA 706169010 721015384 501(C)(3) 5000 SPONSORSHIP VHA FOUNDATION INC 220 EAST LAS COLINAS BLVD IRVING TX 75039 222710552 501(C)(3) 25000 SPONSORSHIP 2 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: RECONCILIATION OF GRANTS ARE MONITORED MONTHLY BY AN ACCOUNTANT IN THE ACCOUNTING OFFICE AND REVEIWED BY THE CONTROLLER AND VICE PRESIDENT. X 1 1 X X X X X X 0 1 0 0 0 1 1 1 0 CHRISTOPHER THOMPSON 700003 0 155189 0 0 0 7500 0 0 0 862692 0 0 0 CHARLES WHITSON CPA 283618 0 0 0 0 0 7500 0 19616 0 310734 0 0 0 LARRY GRAHAM 560009 0 107420 0 7748 0 7500 0 11712 0 694389 0 0 0 BRIAN CLEMENTS MD 325780 0 102469 0 0 0 7500 0 19616 0 455365 0 0 0 GERALD W MOUTON 269000 0 0 0 0 0 0 0 14093 0 283093 0 0 0 MARILYN MCSWAIN RN 219565 0 0 0 0 0 5662 0 14069 0 239296 0 0 0 DAVID B USHER 207184 0 0 0 0 0 7500 0 14069 0 228753 0 0 0 TIM COFFEY 281570 0 0 0 0 0 7297 0 8049 0 296916 0 0 0 DONNA SHIELDS 209061 0 0 0 0 0 5271 0 14069 0 228401 0 0 0 TODD DELAHOUSSAYE 189114 0 0 0 0 0 5012 0 8049 0 202175 0 0 0 KATHLEEN DEROUEN 162822 0 0 0 0 0 4386 0 11712 0 178920 0 0 0 NATHAN COHEN 919818 0 0 0 0 0 0 0 0 0 919818 0 0 0 LEROY FREDERICKS 897546 0 0 0 0 0 7500 0 0 0 905046 0 0 0 BRETT CASCIO 1829975 0 0 0 0 0 7500 0 0 0 1837475 0 0 0 MICHAEL BROUSSARD MD 893776 0 0 0 0 0 7500 0 0 0 901276 0 0 0 FRANCISCO MARERRO 1003154 0 0 0 0 0 7500 0 0 0 1010654 0 0 0 MANLEY M JORDAN MD 429998 0 0 0 0 0 7500 0 19616 0 457114 0 0 0 THOMAS C STRONG MD 356002 0 52709 0 0 0 7500 0 8048 0 424259 0 0 0 KEVIN MOCKLIN 239304 0 0 0 0 0 6286 0 14069 0 259659 0 0 0 WILLIAM CONDOS 260583 0 0 0 0 0 0 0 4690 0 265273 0 0 0 WILLIAM MOSS 512954 0 0 0 0 0 7500 0 19616 0 540070 0 0 0 BEN THOMPSON 482911 0 0 0 0 0 7500 0 14093 0 504504 0 0 0 GARY KOHLER 454850 0 0 0 0 0 7500 0 19616 0 481966 0 0 0 ROBERT BROUSSARD 434213 0 0 0 0 0 7500 0 19616 0 461329 0 0 0 JAMES GAHARAN 835839 0 0 0 0 0 7500 0 0 0 843339 0 0 0 DENNIS WALKER 428847 0 0 0 0 0 0 0 25842 0 454689 0 0 0 GREGORY RUBINO MD 750006 0 0 0 0 0 7500 0 0 0 757506 0 0 0 PART I, LINE 1A THE HOSPITAL PAYS ANNUAL DUES TO THE PIONEER CLUB, A SOCIAL CLUB, FOR LARRY GRAHAM, PRESIDENT AND CEO IN THE AMOUNT OF $736.30 PER YEAR. ANY NONBUSINESS USE OF THE CLUB IS ACCOUNTED FOR AND INCLUDED AS COMPENSATION IN THE CEO W-2. PART I, LINE 6 WILLIAM MOSS, M.D., BEN THOMPSON, M.D., GARY KOHLER M.D., ROBERT BROUSSARD, M.D.,LUCIEN K. MOSS M.D. AND MANLEY JORDAN, M.D. ARE SUBJECT TO A BONUS STRUCTURE OF COLLECTIONS MINUS EXPENSES. 85% OF THE EXCESS IS PAID TO THE PHYSICIAN, BUT NOT TO EXCEED 85% OF THE PHYSICIAN BASE. PART I, LINE 7 LARRY GRAHAM, PRESIDENT AND CEO, IS SUBJECT TO AN INCENTIVE PAY BASED ON EMPLOYEE SUCCESS IN ACHIEVING GOALS ESTABLISHED BY THE BOARD. THE MAXIMUM AMOUNT TO BE PAID IN ANY ONE YEAR IS 25% OF HIS BASE PAY. A LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 546395D84 2007-11-01 69371392 BOND REFUNDING, FACILITY AND EQUIPMENT UPGRADE AND RESERVES 0 0 0 A 690000 69371392 6641478 2007 1 1 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 1 NATIXIS FUNDING CORP 12.000000000000 1 1 1 A 1 FORM 990, SCHEDULE K, PART IV, LINE 2C: BKD PERFORMED ARBITRAGE CALCULATION MAY 14, 2012 AND DETERMINED THAT NO REBATE WAS DUE ON THE BOND ISSUES. THOMAS SHEARMAN THOMAS SHEARMAN IS A MEMBER OF THE BOARD & EMPLOYED BY LC AMERICAN PRESS 111386 LC AMERICAN PRESS PROVIDES ADVERTISING FOR THE HOSPITAL. 0 LOUIS TODD LOUIS TODD IS A MEMBER OF THE BOARD & IS SELF-EMPLOYED (TODD & ASSOCIATES) 785743 TODD & ASSOCIATES PROVIDES BROKERAGE SERVICES FOR MEDICAL MALPRACTICE INSURANCE FOR THE HOSPITAL'S EMPLOYED PHYSICIANS THROUGH LAMMICO. LOUIS TODD RECEIVES A COMMISSION FROM THE PREMIUMS THAT THE HOSPITAL PAYS TO LAMMICO. 0 DAVID WALLACE MD DAVID WALLACE IS A MEMBER OF THE BOARD, & A PHYSICIAN OF CHILDREN CLINIC 136938 CHILDREN CLINIC PROVIDES MEDICAL DIRECTORSHIP OF THE PEDIATRIC NURSERY, NEONATAL INTENSIVE CARE UNIT AND PEDIATRIC INTENSIVE CARE UNIT PROGRAMS AT THE HOSPITAL 0 FORM 990, PART VI, SECTION A, LINE 3 THE HOME HEALTH AGENCY, PHARMACY, AND WOUND CARE FACILITY HAVE BEEN OUTSOURCED TO MANAGEMENT COMPANIES. FORM 990, PART VI, SECTION A, LINE 6 THE ENTITY HAS BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THEY ELECT BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 BOARD MEMBERS WILL BE PROVIDED A COPY OF THE 990 FOR REVIEW PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE IS MONITORED THROUGHOUT THE YEAR VIA MANUAL SIGNATURES BEING REQUIRED ON ALL AP CHECKS EXCEPT SMALL BALANCE PATIENT REFUNDS. THESE CHECKS HAVE AUTOMATED SIGNATURES, BUT ARE REVIEWED BEFORE MAILING. IN ADDITION LARGE CONSTRUCTION JOBS ARE REQUIRED TO BE BID OUT AND BIDS ARE RETURNED SEALED TO OUR ATTORNEYS. RELATIONSHIPS SUCH AS BANKING, INSURANCE AND OTHERS THAT HAVE BEEN DISCLOSED BY BOARD MEMBERS ARE SUBJECT TO DISCUSSION AT BOARD MEETINGS AND GENERALLY THE BOARD MEMBER WITHIN THAT RELATIONSHIP WILL EXCLUDE THEMSELVES FROM THE MEETING. FORM 990, PART VI, SECTION B, LINE 15 COMPARISON WITH VHA GULF STATES GREATER NEW ORLEANS SOCIETY OF HUMAN RESOURCES ASSN AND LHA DATA WAS DONE BY THE SALARY COMMITTEE OF THE BOARD OF TRUSTEES. MINUTES OF THE SALARY COMMITTEE WERE MAINTAINED. FORM 990, PART VI, SECTION C, LINE 19 IN ADDITION TO THE DOCUMENTS THAT ARE ON FILE WITH THE SECRETARY OF STATE THAT WERE REQUIRED TO ESTABLISH THE LEGAL ENTITY, THE GOVERNING DOCUMENTS (INCLUDING THE CONFLICT OF INTEREST POLICY) WILL BE PROVIDED TO THE PUBLIC UPON REQUEST AND SUBJECT TO OUR LEGAL COUNSEL'S APROVAL. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: BOOK/TAX DIFFERENCE - LA PET/CT IMAGING LAKE CHARLES LLC -1,117. BOOK/TAX DIFFERENCE - GIFT SHOP -65,940. BOOK/TAX DIFFERENCE - 2ND AVENUE MRI, LLC -823,390. GAAP ADJUSTMENT TO RECORD EQUITY IN SUBSIDIARIES -31,711,809. FORM 990 PART XII LINE 2C THE ORGANIZATION'S PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. SOUTHWEST LOUISIANA HEALTH CARE SYSTEM INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721103255 SUPPORT OF LAKE CHARLES MEMORIAL HOSPITAL LA 501(C)(3) PUBLIC CHARITY N/A 0 SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION FOUNDATION INC PO BOX 2900 LAKE CHARLES LA 70602 270833927 SUPPORT OF LAKE CHARLES MEMORIAL HOSPITAL LA 501(C)(3) PUBLIC CHARITY SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION 0 LAKE CHARLES MEDICAL PLAZA SOUTH 1701 OAK PARK BLVD LAKE CHARLES LA 70601 621447910 REAL ESTATE MANAGEMENT LA SWLHS INC RELATED 1 0 0 0.01000 SECOND AVENUE MRI LLC 2800 SECOND AVE SUITE C LAKE CHARLES LA 70601 202226374 IMAGING SERVICES LA SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION RELATED 823390 108689 0 0 0.51000 THE DIGESTIVE HEALTH CENTER OF SWLA LLC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 272663607 MEDICAL SERVICES LA N/A LAKE CHARLES PHARM & MED EQUIP SUPPLY CO LLC 7000 CARDINAL PLACE DUBLIN OH 43017 721300617 MEDICAL SERVICES OH N/A WLW PROPERTIES INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721023846 REAL ESTATE / EQUITY LA SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION C 57433 262214 1.00000 0 LAKE CHARLES MEDICAL SERVICES INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721285200 MEDICAL SERVICES LA N/A C 0 SWLHS INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721103283 MEDICAL SERVICES LA SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION C -17093023 8620821 1.00000 0 SWLHS ONCOLOGY INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 201541727 MEDICAL SERVICES-ONCOLOGY LA N/A C 0 LAKE CHARLES MEMORIAL HEART AND VASCULAR CENTER INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721381266 MEDICAL SERVICES LA N/A C 0 LAKE CHARLES MEMORIAL PHO 1701 OAK PARK BLVD LAKE CHARLES LA 70601 726013916 PHYSICIAN NETWORK AND CONTRACTING LA SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION C 1.00000 0 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 1 1 LAKE CHARLES MEDICAL SERVICES INC J 535293 FAIR MARKET VALUE SWLHS INC A 208812 FAIR MARKET VALUE SWLHS ONCOLOGY INC J 76351 FAIR MARKET VALUE LAKE CHARLES HEART & VASCULAR INC J 161327 FAIR MARKET VALUE WLW PROPERTIES INC K 34284 FAIR MARKET VALUE FAIR MARKET VALUE FAIR MARKET VALUE FAIR MARKET VALUE SECOND AVENUE MRI LLC J 94203 FAIR MARKET VALUE SECOND AVENUE MRI LLC Q 402448 CASH SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION FOUNDATION INC O 146089 CASH SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION FOUNDATION INC P 42183 CASH SWLHS INC Q 1771116 CASH LAKE CHARLES HEART & VASCULAR INC Q 1225516 CASH LAKE CHARLES MEDICAL SERVICES INC Q 2927234 CASH SWLHS ONCOLOGY INC Q 343431 CASH LAKE CHARLES MEDICAL SERVICES INC J 262668 FAIR MARKET VALUE SWLHS INC J 43776 FAIR MARKET VALUE SWLHS ONCOLOGY INC J 2006 FAIR MARKET VALUE SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION FOUNDATION INC R 162702 CASH SWLHS INC B 20996039 CASH