2013-08-15T13:35:18-05:00 2012-09-30 201941244 HORNE LLP 1020 HIGHLAND COLONY PKWY STE 400 RIDGELAND MS 39157 990 2011-10-01 720535375 LAFAYETTE GENERAL MEDICAL CENTER INC LAFA 3372898125 1214 COOLIDGE BOULEVARD LAFAYETTE LA 705032621 ROGER MATTKE 3372898125 2013-08-14 1 MARSHA H DIECKMAN CPA P00246741 6013261000 2013-08-14 2011 2016-02-24 21:20:13Z DAVID CALLECOD 1214 COOLIDGE BOULEVARD LAFAYETTE LA 70503 290582586 0 X WWW.LAFAYETTEGENERAL.COM X 1911 LA THE ORGANIZATION PROVIDES MEDICAL CARE TO IMPROVE, MAINTAIN, AND RESTORE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES WE SERVE, REGARDLESS OF THE PATIENTS' ABILITY TO PAY 20 14 1968 87 4129262 0 55685 176822 208935210 267878843 4263716 4544236 -2497091 16078835 210757520 288678736 164723 37046759 0 0 82736870 92736428 0 0 0 121466800 174661444 204368393 304444631 6389127 -15765895 336016610 372408831 158533156 180941977 177483454 191466854 X LAFAYETTE GENERAL MEDICAL CENTER'S MISSION IS TO IMPROVE, MAINTAIN AND RESTORE THE HEALTH OFTHE PEOPLE IN THE COMMUNITIES WE SERVE. 0 0 258985502 37046759 276410700 PROGRAM SERVICES STATISTICS RELATED TO PROVIDING COMMUNITY MEDICAL CARE FOR THE HOSPITAL: TOTAL ACUTE PATIENT DAYS WERE 72,298, TOTAL NURSERY DAYS WERE 3,767, TOTAL REHAB DAYS WERE 3,105 AND TOTAL MENTAL HEALTH DAYS WERE 2,105. OTHER SIGNIFICANT HEALTHCARE SERVICES PROVIDED INCLUDED 60,318 EMERGENCY ROOM VISITS, 9,376 SURGERIES (INPATIENT AND OUTPATIENT), AND 1,843 DELIVERIES.THE ORGANIZATION PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY, REGARDLESS OF THE PATIENT'S ABILITY TO PAY. SERVICES INCLUDED INPATIENT AND OUTPATIENT CARE IN FURTHERANCE OF THE ORGANIZATION'S HEALTHCARE MISSION. THE REVENUES FORM THESE SERVICES ARE $515,664,238 AND $334,123,372, RESPECTIVELY. THERE WERE ACUTE AND SKILLED CARE SERVICES NOT FULLY COMPENSATED. THESE INCLUDED MEDICARE / MEDICAID CONTRACTUALS WITH $397,834,001 OF UNCOMPENSATED SERVICES, OTHER CONTRACTUALS WITH $184,365,899 OF UNCOMPENSATED SERVICES, AND BAD DEBTS OF $27,061,524. THE NET REVENUES OF THE SERVICES PROVIDED WERE $240,526,186.LAFAYETTE GENERAL MEDICAL CENTER (LGMC) SERVES THE NINE PARISHES IN LOUISIANA DESIGNATED ACADIANA WITH 362 STAFFED BEDS AND 1,670 EMPLOYEES. LGMC REMAINS THE AREA'S LARGEST, FULL SERVICE, ACUTE-CARE MEDICAL CENTER.OUR HOSPITAL MISSION IS TO RESTORE, MAINTAIN, AND IMPROVE HEALTH OF PEOPLE IN THE COMMUNITIES WE SERVE. WE ARE A COMMUNITY-OWNED AND LOCALLY MANAGED HOSPITAL THAT STAYS TRUE TO OUR MISSION BY DEDICATING SIGNIFICANT RESOURCES TO COMPENSATE A COMPASSIONATE, HIGHLY SKILLED STAFF; ACQUIRE ADVANCED TECHNOLOGY; AND DEVELOP SERVICE IMPROVEMENTS EACH YEAR.IN LINE WITH OUR GOAL OF BUILDING A REGIONAL HEALTH CARE SYSTEM, LAFAYETTE GENERAL HAS ESTABLISHED CLINICAL AFFILIATIONS WITH OUTLYING HOSPITALS, EXTENDING OUR BEST PRACTICES IN CANCER TREATMENTS, CARDIOLOGY, AND NEUROSCIENCE SUPPORT TO OUTLYING PARISHES.LAFAYETTE GENERAL CONTINUES TO EXPAND ITS SERVICES AND FACILITIES IN ORDER TO MEET THE GROWING NEEDS OF OUR COMMUNITY. ORIGINALLY BUILT IN 1963, THE 10-STORY LAFAYETTE GENERAL MEDICAL CENTER MAIN BUILDING COMPLETED AN EXTERIOR AND INTERIOR DESIGN RENOVATION TO FOCUS ON PATIENT HEALTH CARE BY CREATING A HEALING-FOCUSED AND COMFORTABLE ENVIRONMENT. THE $70 MILLION RENOVATION PROJECT ADDED MORE THAN 65 SQUARE FEET OF SPACE TO PATIENT ROOMS AND MORE THAN 12,500 SQUARE FEET OF OVERALL SPACE WITH LARGER PATIENT BATHROOMS, SHOWERS AND A MODERNIZED PATIENT CARE INFRASTRUCTURE.OUR ACCOLADES AND ACCREDITATIONS GROW EACH YEAR. IN OUR FISCAL YEAR 2012 WE RECEIVED THE FOLLOWING: WE WERE RECOGNIZED BY HEALTHGRADES AS BEING RANKED NUMBER 1 IN LOUISIANA FOR GENERAL SURGERY AND RANKED NUMBER 2 IN OVERALL ORTHOPEDICS AND GI SERVICES. HEALTHGRADES ALSO RECOGNIZED LAFAYETTE GENERAL AS A 5-STAR RATED HOSPITAL FOR JOINT REPLACEMENT (2010-2012), KNEE REPLACEMENT (2010-2012), HIP FRACTURE TREATMENT (2010-2012, GI PROCEDURES AND SURGERIES, TREATMENT OF GI BLEED AND CHOLECYSTECTOMY. THE BARIATRIC SURGERY DEPARTMENT WAS DESIGNATED AS A BARIATRIC SURGERY CENTER OF EXCELLENCE BY THE AMERICAN SOCIETY OF METABOLIC AND BARIATRIC SURGERY. WE ALSO RECEIVED SPECIAL RECOGNITION AS AN ADVANCED CERTIFIED PRIMARY STROKE CENTER BY THE JOINT COMMISSION AND THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION. THE STROKE CENTER AS RECEIVED A BRONZE AWARD UNDER THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATIONS "GET WITH THE GUIDELINES" PROGRAM. THE NEUROSCIENCE PROGRAM WAS AWARDED THE CENTER OF EXCELLENCE STATUS BASED ON THE RESULTS OF THE MOST CURRENT NEUROSCIENCE CENTER OF EXCELLENCE SURVEY BY NEUSTRATEGY. WE WERE ALSO NAMED AS AMERICA'S BEST 100 HOSPITALS FOR PATIENT EXPERIENCE BY WOMENCERTIFIEDLAFAYETTE GENERAL MEDICAL CENTER ASSUMES THE ROLE OF A COMMUNITY PARTNER IN A VARIETY OF WAYS. THROUGH FINANCIAL CONTRIBUTIONS WE WORK TO PRESERVE THE PROSPERITY OF OUR COMMUNITY, FURTHER MEDICAL EDUCATION AND RESEARCH AND HELP OUR CONSTITUENTS ACCESS THE MEDICAL CARE THEY NEED. WE COORDINATE EVENTS AND SCREENINGS FREE OF CHARGE TO MAINTAIN THE HEALTH OF THE LOCAL PUBLIC. WE ALSO EXTEND OUR WORKFORCE BEYOND THEIR DAILY RESPONSIBILITIES TO PARTICIPATE IN ACTIVITIES THAT PROVIDE FOR THE SAFETY AND BETTERMENT OF OUR COMMUNITY. FINANCIAL CONTRIBUTIONS:IN 2012 WE DONATED OVER $267,000 SUPPORTING ORGANIZATIONS THAT PARALLEL OUR MISSION IN THE COMMUNITY, EMPLOYEES THROUGH CONTINUING EDUCATION AND HELPING TO IMPROVE THE HEALTH OF THOSE WE SERVE. FROM OFFERING CLINICAL SUPPORT TO CAMP BON CEUR ATTENDEES TO SPONSORING EVENTS THAT RAISE RESEARCH MONEY AND AWARENESS FOR ILLNESSES LIKE BREAST CANCER, DIABETES AND HEART DISEASE. IN 2012 THESE MONIES WERE DONATED TO OVER 42 DIFFERENT ORGANIZATIONS IN OUR COMMUNITY.COMMUNITY OUTREACH & HEALTH CARE ACCESS CONTRIBUTIONS:LAFAYETTE GENERAL MEDIAL CENTER MAINTAINS A PROACTIVE APPROACH TO EDUCATION AND WELLNESS IN OUR COMMUNITY. ANNUALLY LGMC PROVIDES A MULTITUDE OF EDUCATIONAL SEMINARS AIMED AT EDUCATING THE PUBLIC ON PREVENTATIVE CARE AND MAINTAINING A HEALTHY LIFESTYLE. SOME OF THESE ACTIVITIES AND PROGRAMS INCLUDE:DONATED $8,400 IN DIAGNOSTIC SERVICES AS PART OF A PARTNERSHIP WITH THE LAFAYETTE COMMUNITY HEALTH CARE CLINIC.WOMEN'S AND CHILDREN'S SERVICES CURRENTLY OFFERS CLASSES WHICH INCLUDE NEWBORN CARE, LABOR AND DELIVERY PROCESS, BREASTFEEDING YOUR INFANT AND INFANT CPR. PARTICIPANT IN THE SHOTS FOR TOTS PROGRAM, BY PROVIDING CHILDREN'S IMMUNIZATIONS AT THE HOSPITAL FOUR TIMES DURING THE YEAR.FREE SUPPORT GROUPS ARE OPEN TO RESIDENTS DEALING WITH STROKE SURVIVAL, WEIGHT LOSS SURGERY, INFANT BEREAVEMENT, AND MULTIPLE BIRTHS. LGMC ALSO PROVIDES FREE TRANSPORTATION FOR PATIENTS WITH SPECIAL NEEDS, IN ORDER TO ALLOW THEM ACCESS TO MEDICAL CARE AT THE HOSPITAL.TO IMPROVE HEALTH CARE ACCESS FOR THOSE UNINSURED WORKERS LIVING AT OR BELOW POVERTY LEVEL, LGMC MAINTAINS A REFERRAL AGREEMENT WITH THE LOCAL "LAFAYETTE COMMUNITY HEALTHCARE CLINIC" TO PROVIDE DIAGNOSTIC TESTING TO THEIR PATIENT POPULATION. LAFAYETTE GENERAL MEDICAL CENTER IS TRULY A COMMUNITY OWNED HOSPITAL CARING FOR THE NEEDS OF THE COMMUNITY AND INVESTING IN THE FUTURE WELLNESS OF OUR NEIGHBORS. 258985502 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 312 0 1 1968 1 1 1 0 0 0 0 0 0 0 X 20 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 3372898125 1214 COOLIDGE BOULEVARD LAFAYETTE LA 70503 X CLAY ALLEN 1.00 X 0 0 0 DAVID CALHOUN 1.00 X 0 0 0 BRADLEY J CHASTANT MD 1.00 X 19000 0 0 BRADEN DESPOT 1.00 X 0 0 0 BENJAMIN DOGA MD 1.00 X 20000 0 0 JULIE FALGOUT 1.00 X 0 0 0 WILLIAM H FENSTERMAKER 1.00 X 0 0 0 PHILIP GACHASSIN MD 1.00 X 70860 0 0 ROBERT GILES 1.00 X 0 0 0 G GARY GUIDRY MD 1.00 X 18000 0 0 JOBY JOHN PHD 1.00 X 0 0 0 ROSE KENNEDY MD 1.00 X 10200 0 0 EDWARD KRAMPE 1.00 X 0 0 0 FLO MEADOWS 1.00 X 0 0 0 RAE ROBINSON BRODNAX - 1ST PART OF 1.00 X 0 0 0 MANDI MITCHELL 1.00 X 0 0 0 GARY SALMON 1.00 X 0 0 0 SAMUEL SHUFFLER MD 1.00 X 0 0 0 E GREG VOORHIES 1.00 X 0 0 0 DAVID WILSON 1.00 X 0 0 0 DANIEL BOURQUE MD 1.00 X 42840 0 0 DAVID CALLECOD 40.00 X 720606 0 110070 PATRICK W GANDY JR 40.00 X 368338 0 40526 ROGER MATTKE 40.00 X 334555 0 52355 DEBRA CLARK 40.00 X 69528 0 1265 REBECCA F BENOIT 40.00 X 115405 0 456 GORDON E ROUNTREE JR 40.00 X 311027 0 38633 ZIAD M ASHKAR MD 40.00 X 389667 0 0 KATHERINE HEBERT 1.00 X 253716 0 18794 MAURICE SULLIVAN MD 40.00 X 164818 0 4651 DEAN B DUCOTE 40.00 X 153736 0 76 EDWINA S MALLERY 40.00 X 148832 0 5241 3211128 0 272067 55 0 1 0 HOSPITAL HOUSEKEEPING SYSTEMS LTD PO BOX 826 SAN ANTONIO TX 782930826 HOUSEKEEPING SERVICES 2614814 CARDIOVASCULAR INSTITUTE OF THE SOUTH AP 225 DUNN STREET HOUMA LA 703604413 CARDIOLOGY SERVICES 2070284 COMPREHENSIVE PHARMACY SERVICES INC 6409 QUAIL HOLLOW ROAD MEMPHIS TN 381201414 PHARMACY SERVICES 1601113 WASHER HILL LIPSCOMB 1744 OAKDALE DRIVE BATON ROUGE LA 708103111 ARCHITECTURE 1186270 PARISH ANESTHESIA OF LAFAYETTE 3510 N CAUSEWAY BOULEVARD METAIRIE LA 700023531 ANESTHESIA SERVICES 1048748 30 175011 1500 311 176822 PATIENT REVENUE 621990 267878843 267878843 267878843 2343368 2343368 1548 1548 3894645 512881 3381764 3381764 3381764 3360117 450 0 1159699 3360117 -1159249 2200868 2200868 0 175011 36373 -36373 -36373 265674 194897 70777 70777 OTHER REVENUE 900099 12661119 8531857 4129262 12661119 288678736 276410700 4129262 7961952 37039559 37039559 7200 7200 2100359 180900 1919459 78158970 65391872 12767098 998445 684062 314383 5837223 4375738 1461485 5641431 4675667 965764 2593573 1176477 1417096 983845 713 983132 209431 209431 784154 155985 628169 4571783 3855396 716387 6240868 54611 6186257 3645023 689746 2955277 478333 203219 275114 6062843 6062000 843 -332960 -332960 16644911 10239003 6405908 3369654 3369654 MEDICAL SUPPLIES 59373415 59373415 BAD DEBT 27061524 27061524 EQUIPMENT RENTAL AND MA 10812014 8491253 2320761 NONCLINICAL CONTRACT LA 8183863 7832263 351600 23979170 21434899 2544271 304444631 258985502 45459129 0 9960 10646 28005070 24704541 12459 36474682 54483332 5319705 5500953 6600609 7403946 2742021 4323173 349039274 164852407 175516154 184186867 63724191 72564399 9778 9778 8755928 7758020 1333333 1333333 7512720 10129843 336016610 372408831 29912905 34712798 84164015 88157258 41470563 55556527 2985673 2515394 158533156 180941977 X 177483454 191466854 177483454 191466854 336016610 372408831 X -15765895 29749295 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 23762 25583 23762 25583 258961740 272496729 258985502 272522312 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 20618 22710 23572 23762 90662 250000 250000 250000 250000 1000000 1500000 20618 22710 23572 23762 90662 PART IV, SUPPLEMENTAL INFORMATION: ALL LOBBYING ACTIVITIES OCCUR INDIRECTLY THROUGH THE AMERICAN HOSPITAL ASSOCIATION AND THE LOUISIANA HOSPITAL ASSOCIATION. THE HOSPITAL DOES NOT HAVE ANY CONTROL OR DIRECTION IN DETERMINING HOW SUCH DUES PAID TO THESE TWO ORGANIZATIONS ARE USED. 8897050 8897050 188340510 70993566 117346944 3832688 1539103 2293585 141867128 91990373 49876755 6101898 329365 5772533 184186867 SELF INSURANCE RESERVES 2258123 DUE TO RELATED PARTY 257271 2515394 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACS 740. FASB ACS 740 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR FINANCIAL STATEMENT RECOGNITION OF UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE INTERPRETATION ALSO PROVIDES GUIDANCE ON RECOGNITION, DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE AND TRANSITION. THE ORGANIZATION'S VARIOUS FEDERAL INCOME TAX AND EXEMPT ORGANIZATION INCOME TAX RETURNS (IRS FORMS 1065, 1120, AND 990), WHETHER FILED ON A CALENDAR OR FISCAL YEAR BASIS, ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY ARE FILED. GALA - OCTOBER 6, 2011 72506 72506 30009 GALA - OCTOBER 2, 2012 102505 102505 6364 175011 175011 36373 36373 -36373 1 1 1 X 1 X 1 1 0 1 1 1336704 1336704 0.00480 25999517 22300669 3698848 0.01330 27336221 22300669 5035552 0.01810 6875104 6875104 0.02480 283720 109713 174007 0.00060 267489 267489 0.00100 7426313 109713 7316600 0.02640 34762534 22410382 12352152 0.04450 1 27061524 5400000 72847209 81837775 -8990566 X 1 1 1 1 LAFAYETTE GENERAL MEDICAL CENTER INC

1214 COOLIDGE BLVD LAFAYETTE LA 70503

X X X LAFAYETTE GENERAL MEDICAL CENTER INC 1 1 1 100.000000000000 1 200.000000000000 1 X 1 1 X X 1 0 1 X 0 0 PART I, LINE 7: THE HOSPITAL USED TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, EXCLUDING BAD DEBT EXPENSE. A COST-TO-CHARGE RATIO WAS USED TO ESTIMATE COSTS INCLUDED IN LINE 7. THE COST-TO-CHARGE WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGE, AS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 27061524. PART III, LINE 4: THE FOOTNOTE TO THE AUDITED FINANCIAL STATEMENTS READS: THE ORGANIZATION REPORTS ACCOUNTS RECEIVABLE NET OF ESTIMATED ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS AND ADJUSTMENTS. TO PROVIDE FOR ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE, THE ORGANIZATION ESTABLISHES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS TO REDUCE THE CARRYING AMOUNT OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THE AMOUNT CHARGED TO THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON THE ORGANIZATION'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, AND TRENDS IN GOVERNMENT REIMBURSEMENT. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN OFF WHEN THE ORGANIZATION HAS DETERMINED THE ACCOUNT WILL NOT BE COLLECTED.BAD DEBT EXPENSE EQUALS THE BAD DEBT EXPENSE ON THE AUDITED FINANCIAL STATEMENTS. THE HOSPITAL ANALYZED THE POPULATION THAT WAS WRITTEN OFF TO BOTH CHARITY AND BAD DEBT DURING THE YEAR. IT WAS ESTIMATED THAT 44% OF THE UNINSURED OUTPATIENT EMERGENCY ROOM VISITS THAT WERE ADJUSTED TO BAD DEBT MAY HAVE BEEN PATIENTS THAT COULD HAVE QUALIFIED FOR THE HOSPITAL'S CHARITY CARE POLICY BUT DID NOT INITIATE OR COMPLETE THE NECESSARY DOCUMENTATION. THE HOSPITAL DID NOT INCLUDE ANY BAD DEBTS IN OUR COMMUNITY BENEFIT CALCULATIONS. PART III, LINE 8: THE COSTING METHODOLOGY USED FOR LINE 6 WAS THE STANDARD MEDICARE COST REPORT COST SYSTEM. THE AMOUNTS WERE RECAPPED FROM THE HOSPITALS FILED 2012 COST REPORT. THE CORRESPONDING REVENUE AMOUNTS WERE INCLUDED ON LINE 5. THE HOSPITAL DID NOT INCLUDE THE MEDICARE SHORTFALL IN OUR COMMUNITY BENEFIT CALCULATIONS REPORTED ON PART I, LINE 7. PART III, LINE 9B: WE SEEK TO SCREEN PATIENTS TO DETERMINE IF THEY HAVE THIRD PARTY COVERAGE OR ASSIST THEM IN APPLYING FOR FEDERAL ASSISTANCE. IF THEY DO NOT HAVE THIRD PARTY COVERAGE OR CANNOT QUALIFY FOR FEDERAL ASSISTANCE, WE THEN SCREEN TO SEE IF THEY MEET QUALIFICATIONS FOR OUR CHARITY CARE PROGRAM. THOSE NOT QUALIFYING FOR CHARITY CARE ,WE TRY TO COLLECT OR MAKE MONTHLY PAYMENT ARRANGEMENTS, IF THEY DO NOT COMPLY WE WILL REFER TO OUR COLLECTION AGENCY. LAFAYETTE GENERAL MEDICAL CENTER INC. PART V, SECTION B, LINE 13G: THE POLICY IS DESCRIBED IN OUR PATIENT INFORMATION PACKETS PROVIDED DURING THE ADMISSION PROCESS. LAFAYETTE GENERAL MEDICAL CENTER INC. PART V, SECTION B, LINE 17E: LARGER BALANCES ARE MANUALLY CHECKED TO SEE IF THEY MAY QUAILIFY FOR CHARITY ASSISTANCE. LAFAYETTE GENERAL MEDICAL CENTER INC. PART V, SECTION B, LINE 19D: THE AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS ARE BASED ON A SLIDING SCALE MODEL INCORPORATING THE POVERTY INCOME GUIDELINES. THE INDIVIDUAL'S INCOME LIMITS AND QUALIFYING FAMILY SIZE ARE COMPARED TO THE SLIDING SCALE AND THE MAXIMUM AMOUNT THAT CAN BE CHARGED IS DETERMINED. PART VI, LINE 2: THE HOSPITAL DOES HAVE A BOARD 0F TRUSTEES AND MEMBERS OF THE CORPORATION COMPRISED OF INDIVIDUALS FROM THE LOCAL COMMUNITY, WHICH ARE INDEPENDENTLY AWARE OF THE MEDICAL NEEDS OF THE COMMUNITY. SURPLUS RECEIPTS OVER DISBURSEMENTS ARE INVESTED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND HOSPITAL FACILITIES AND EQUIPMENT, ADVANCE MEDICAL TRAINING AND EDUCATI0N. THE H0SPITAL ALSO MAINTAINS AN OPEN MEDICAL STAFF.A FORMAL NEEDS ASSESSMENT WAS NOT UNDERTAKEN FOR YEAR ENDING 9/30/12, HOWEVER, WE ENGAGED THE CARNAHAN GROUP TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT DURING 2013. THIS ASSESSMENT INCLUDES USING NATIONAL DATA, INTERVIEWS WITH HEALTHCARE PROVIDERS IN THE COMMUNITY AND FOCUS GROUPS MADE UP OF A DIVERSE GROUP OF COMMUNITY CITIZENS. PART VI, LINE 3: THE HOSPITAL COMPLIES WITH FEDERAL AND JACHO REQUIREMENTS OF POSTING NOTICES TO PATIENTS AS REQUIRED BY FEDERAL PROGRAMS. HANDOUTS ARE INCLUDED WITH THE ADMISSION PACKAGE THAT INFORMS THE PATIENT OF CONTACT INFORMATION TO DISCUSS PAYMENT OPTIONS. THE HOSPITAL IS A MEDICAID ENROLLMENT FACILITY, AND AS SUCH, THE HOSPITAL OFFERS SCREENING SERVICES FOR ELIGIBILITY FOR MEDICAID AND POSSIBLE CHARITY CARE ASSISTANCE. HOSPITAL PERSONNEL ALSO SCREEN LARGER ACCOUNTS AFTER THE ORIGINAL BILL IS ISSUED, AND CONTACT THE PATIENT TO DETERMINE QUALIFICATIONS FOR CHARITY CARE POLICY. PART VI, LINE 4: THE HOSPITAL SERVES THE NINE PARISHES IN LOUISIANA DESIGNATED AS ACADIANA AS THE LARGEST, FULL SERVICE, ACUTE CARE MEDICAL CENTER. APPROXIMATELY ONE THIRD OF THE HOSPITAL'S DISCHARGES COME FROM LAFAYETTE PARISH. THE HOSPITAL MAINTAINS AN EMERGENCY ROOM OPEN TO ALL PEOPLE REQUIRING EMERGENCY CARE WITHOUT REGARD TO THEIR ABILITY TO PAY. PART VI, LINE 5: THE HOSPITAL DOES MAINTAIN AN OPEN MEDICAL STAFF THUS ALLOWING IT TO OFFER A VARIETY OF SPECIALISTS, AND CONTINUES TO RECRUIT PHYSICIANS TO OUR AREA TO ENSURE THAT THE HOSPITAL WILL CONTINUE TO BE THE FULL SERVICE HEALTHCARE PROVIDER THAT THE COMMUNITY EXPECTS. THE HOSPITAL JOINS FORCES WITH OTHER LOCAL ORGANIZATIONS TO PROVIDE HEALTHCARE SCREENINGS AND TEST AT LOCAL EVENTS. PART VI, LINE 6: THE HOSPITAL IS AFFILIATED WITH OTHER HEALTHCARE ORGANIZATIONS. SEE FORM 990 SCHEDULE R FOR A COMPLETE LISTING. ALL OF THE ORGANIZATIONS ARE LOCAL HEALTHCARE ORGANIZATIONS WITH THE SAME PURPOSE AS THE HOSPITAL. 1 ACADIANA OUTREACH CENTER 625 N UNIVERSITY AVENUE LAFAYETTE LA 70502 581925867 501(C)(3) 13000 DONATION AMERICAN HEART ASSOCIATION 139-B JAMES COMEAUX ROAD 596 LAFAYETTE LA 70508 360726140 501(C)(3) 15000 DONATION CAMP BON COEUR 405 W MAIN LAFAYETTE LA 70501 581710741 501(C)(3) 10000 DONATION COMMUNITY FOUNDATION OF ACADIANA 1035 CAMELIA BLVD SUITE 100 LAFAYETTE LA 70508 721493023 501(C)(3) 10000 DONATION FIBERCORPS PO BOX 3034 LAFAYETTE LA 70502 208233506 501(C)(6) 15000 DONATION HOSPICE OF ACADIANA 2600 JOHNSTON ST 200 LAFAYETTE LA 70503 720966231 501(C)(3) 5000 DONATION GREATER LAFAYETTE CHAMBER OF COMMERCE 804 E ST MARY BLVD LAFAYETTE LA 70503 720232780 501(C)(6) 6525 DONATION LAFAYETTE COMMUNICTY HEALTHCARE CLINIC 1317 JEFFERSON STREET LAFAYETTE LA 70501 721221982 501(C)(3) 10950 8408 FEE SCHEDULE LAB SERVICES DONATION LSU EUNCIE 2048 JOHNSON HWY EUNICE LA 70535 582028025 501(C)(3) 7700 DONATION MILES PERRET CENTER CANCER SERVICES 2130 KALISTE SALOAM RD 200 LAFAYETTE LA 70508 753023211 501(C)(3) 25000 DONATION NAMI LOUISIANA 10842 RANCHWOOD DR BATON ROUGE LA 70835 721038877 501(C)(3) 5000 DONATION OIL CENTER RENAISSANCE ASSOCIATES 1005 E ST MARY BLVD LAFAYETTE LA 70503 721257087 501(C)(6) 15000 DONATION SACRED HEART OF JESUS ROMAN CATHOLIC CHURCH OF BROUSSARD 200 W MAIN STREET BROUSSARD LA 70518 720544168 501(C)(3) 21410 COST MEDICAL SUPPLIES DONATION SOUTH LOUISIANA CLINICAL RESEARCH FOUNDATION 3639 AMBASSADOR CATTERY PKWY STE 605 LAFAYETTE LA 70503 721430540 501(C)(3) 42500 DONATION UNITED WAY OF ACADIANA 215 E PINHOOK ROAD LAFAYETTE LA 70501 720513639 501(C)(3) 21870 DONATION UNIVERSITY OF LOUISIANA AT LAFAYETTE 104 E UNIVERSITY AVENUE LAFAYETTE LA 70504 726023836 501(C)(3) 11040 DONATION LAFAYETTE HEALTH VENTURES INC 1211 COOLIDGE STREET LAFAYETTE LA 70503 721006966 501(C)(3) 36758339 AFFILIATE SUPPORT 14 3 SCHOLARSHIPS TO LPN SCHOOL STUDENTS 5 7200 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CHARITABLE DONATIONS ARE MADE TO LOCAL NON-PROFIT ORGINIZATIONS THAT PARALLEL OUR HEALTHCARE MISSION IN THE COMMUNITY. DISBURSEMENTS FOR SCHOLARSHIPS, FELLOWSHIPS, AND STUDENT LOANS ARE MADE DIRECTLY IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PROGRAMS-THE PURPOSE OF WHICH THE HOSPITAL WAS ORGANIZED AND OPERATES. THE DISBURSEMENTS ARE BASED ON PERSONAL INTERVIEWS, ACADEMIC ACHIEVEMENTS, AND THE APPROVAL OF THE HOSPITAL'S ADMINISTRATION CERTAIN STANDARDS AND CONDITIONS ARE ESTABLISHED TO ENSURE THAT RECIPIENTS ARE QUALIFIED AND THE DISBURSEMENTS ARE FOR HEALTH CARE OCCUPATIONS. THE CRITERIA FOR EDUCATIONAL LOANS ARE 1) EMPLOYEES MUST HAVE COMPLETED ONE YEAR OF EMPLOYMENT. 2) EMPLOYEE HAS ATTEMPTED TO GAIN OTHER FINANCIAL ASSISTANCE. 3) MUST HAVE A LETTER OF RECOMMENDATION FROM DEPARTMENT DIRECTOR. 4) MUST NOT HAVE AN UNSATISFACTORY EVALUATION. 5)THE EMPLOYEE MUST SIGN A CONTRACT. 6) ANY SINGLE LOAN MUST NOT EXCEED $ 10,000. X X X 1 1 X X X X X 0 1 0 0 0 1 1 0 0 DAVID CALLECOD 540000 0 165295 0 15311 0 95643 0 14427 0 830676 0 0 0 PATRICK W GANDY JR 288483 0 61122 0 18733 0 31792 0 8734 0 408864 0 0 0 ROGER MATTKE 275049 0 57842 0 1664 0 38291 0 14064 0 386910 0 0 0 GORDON E ROUNTREE JR 245662 0 51343 0 14022 0 32663 0 5970 0 349660 0 0 0 ZIAD M ASHKAR MD 325000 0 51126 0 13541 0 0 0 0 0 389667 0 0 0 KATHERINE HEBERT 180180 0 30541 0 42995 0 14872 0 3922 0 272510 0 0 0 MAURICE SULLIVAN MD 164818 0 0 0 0 0 2792 0 1859 0 169469 0 0 0 DEAN B DUCOTE 135863 0 17873 0 0 0 0 0 76 0 153812 0 0 0 EDWINA S MALLERY 130183 0 16849 0 1800 0 3036 0 2205 0 154073 0 0 0 PART I, LINE 1A THE ORGANIZATION DOES ALLOW FOR SPOUSAL TRAVEL FOR THE TRUSTEES AND OFFICERS. SUCH EXPENSES ARE REPORTED ON THEIR W-2'S OR 1099'S. SOCIAL CLUB DUES WERE PAID FOR THE PRESIDENT/CEO AND THE COO AND WERE INCLUDED AS WELL AS COMPENSATION ON THEIR W-2'S. TAXABLE FRINGE BENEFITS SUCH AS SPOUSAL TRAVEL AND SOCIAL CLUB DUES ARE ACCUMULATED AND GROSSED UP WHEN ADDED TO THE W-2 EARNINGS FOR THE YEAR. PART I, LINE 4B A SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN (SERP) WAS ADOPTED EFFECTIVE JANUARY 01,2008. THE SERP IS CLASSIFIED AS A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN, THE PURPOSE OF WHICH IS TO PROVIDE PARTICIPANTS WITH SUPPLEMENTAL RETIREMENT BENEFITS. CONTRIBUTION FOR THE YEAR WAS $163,348. THE BOARD DETERMINES WHICH EMPLOYEES ARE ELIGIBLE FOR PLAN CONTRIBUTIONS. PARTICIPANTS WERE DAVID CALLECOD, CEO, PATRICK GANDY, COO, ROGER MATTKE, CFO, GORDON ROUNTREE, GENERAL COUNSEL, DEBRA CLARK, CNO, KATHERINE HEBERT, VICE-PRESIDENT, AND ZIAD ASHKAR, MD, CMO. DEBRA CLARK, CNO. PRIOR CONTRIBUTIONS WERE FORFEITED IN 2011 UPON HER SEPARATION. PART I, LINE 6 THE ORGANIZATION DOES HAVE A PROFIT SHARING PLAN (SUCCESS SHARING) FOR ALL EMPLOYEES IN GOOD STANDING, DETERMINED IN PART ON NET EARNINGS. THE CRITERIA USED TO DETERMINE IF PROFIT SHARING WILL BE MADE IS BASED ON METRICS DEVELOPED WITHIN FIVE AREAS; 20% EMPLOYEES, 15% SERVICE, 15% QUALITY, 40% FUNDING OUR FUTURE, AND 10% GROWTH. EARNINGS IN EXCESS OF BUDGETED EARNINGS MUST BE AVAILABLE FOR PROFIT SHARING TO BE PAID. THE OFFICERS', AS LISTED ON PART VII OF FORM 990, CALCULATION OF PROFIT SHARING IS IN PART BASED ON THE CONSOLIDATED NET EARNINGS. LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 546395H80 2010-08-12 84137555 TOWER RENOVATION PROJECT AND REFUND OF 08-19-98 ISSUE 0 0 0 LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 2011-02-25 3850000 REPLACE/UPGRADE CARDIAC CATH LAB 0 0 0 LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 2012-07-26 60000000 A&B-EXPANSION/RENOVATION/EQUIPPING OF OR/ER AREA AND PARKING FACILITY 0 0 0 1030000 84137555 3733975 1550751 78852829 2011 1 0 1 1 857301 3850000 59703 3790297 2011 0 0 1 1 60000000 333208 1578668 58088124 2014 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 X SCHEDULE K, PART I, LINE A, COLUMNC C: MULTIPLE CUSIP NUMBERS: 546395J21, 546395J39, 546395J47, 546395J54 SCHEDULE K, PART II, LINE 3, COLUMN C SUPPLEMENTAL INFORMATION: BOTH SERIES A AND B BONDS WERE ISSUED AS DRAW-DOWN BONDS WITH ONLY $5 MILLION REQUESTED AT THE END OF THE TAX YEAR. GBH LLC G. GARY GUIDRY IS A TRUSTEE OF LGMC AND IS A MEMBER OF GBH, LLC 916667 LAFAYETTE GENERAL MEDICAL CENTER, INC HAS ENTERED INTO A CONTRACT WITH GBH, LLC TO PROVIDE CRITICAL CARE SERVICES, PULMONARY/VENTILATOR CARE MANAGEMENT SERVICES AND INTENSIVIST SERVICES FOR HOSPITAL'S ICU AND ASSUME THE ROLE OF MEDICAL DIRECTOR OF THE ICU. TRUSTEE G. GARY GUIDRY MD IS A MEMBER OF GBH, LLC. 0 FORM 990, PART VI, SECTION A, LINE 2 TRUSTEES, CLAY ALLEN AND ROBERT GILES, ARE INVOLVED IN SEPARATE BUSINESS VENTURES TOGETHER THAT ARE WHOLLY UNRELATED TO THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A NON-STOCK NOT-FOR-PROFIT CORPORATION WITH ONE CLASS OF MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS RATIFY THE SELECTION OF THE INDIVIDUALS THAT SERVE ON THE BOARD OF TRUSTEES (GOVERNING BODY) AFTER THOSE INDIVIDUALS HAVE BEEN SELECTED AS A TRUSTEE BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B YES, THE INDIVIDUALS OF THE TRUSTEES (GOVERNING BODY) AND THE MEMBERS MUST BE APPROVED BY THE MEMBERSHIP BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S ACCOUNTING STAFF AND A CPA FIRM. THE COMPLETED FORMS ARE REVIEWED BY THE OFFICERS AND THEN PRESENTED TO THE BOARD FOR REVIEW, COMMENT AND CORRECTIONS IF NEEDED BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C AN ANNUAL SURVEY IS SENT TO THE BOARD MEMBERS AND OFFICERS REQUIRING THEM TO DISCLOSE CONFLICTS OF INTEREST. AFTER RECEIPT OF THESE SURVEYS, THE GOVERNANCE COMMITTEE AND ITS CHAIRPERSON REVIEW ALL CONFLICTS AND REPORT ON SAME TO THE GOVERNANCE COMMITTEE. THEREAFTER THE CHAIRPERSON OF THE GOVERNANCE COMMITIEE AND THE ORGANIZATION'S GENERAL COUNCIL (WHO ATTENDS ALL BOARD MEETINGS) INSURES THAT ALL CONFLICTS ARE TIMELY DISCLOSED AND APPROPRIATE RECUSALS ARE MADE ON BUSINESS MATTERS THAT MAYBE RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 AN INDEPENDENT EXTERNAL CONSULTANT FIRM, SULLIVAN COTTER AND ASSOCIATES, IS ENGAGED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, WHICH IS COMPRISED OF DISINTERESTED DIRECTORS, TO PREPARE COMPENSATION SURVEY AND FAIR MARKET VALUE REPORT. THE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE MARKET COMPARABLES AND MAKES ADJUSTMENT TO THE PRESIDENT/CEO'S COMPENSATION THEREAFTER. THIS SAME PROCESS IS FOLLOWED FOR THE FOLLOWING SENIOR EXECUTIVES OF THE ORGANIZATION: CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER AND GENERAL COUNSEL. FORM 990, PART VI, SECTION C, LINE 19 BASIC FINANCIAL INFORMATION IS MADE AVAILABLE AND SENT OUT TO THE COMMUNITY BY MEANS OF THE ORGANIZATION'S ANNUAL REPORT. OTHER DOCUMENTS AND MORE DETAILED FINANCIAL INFORMATION ARE AVAILABLE TO THE PUBLIC UPON REQUEST WITHIN THE PARAMETERS OF REGULATORY / LEGAL AUTHORITIES. FORM 990, PART VII, SECTION A, LINE 1A PAYMENTS TO THE PHYSICIANS THAT SERVICE AS TRUSTEES WERE REPORTED ON 1099 MISC BOX 6. ALL SUCH PAYMENTS WERE IN CONSIDERATION FOR PROVIDING CALL COVERAGE IN OUR EMERGENCY ROOM, OR SERVING AS MEDICAL DIRECTORS FOR VARIOUS HOSPITAL DEPARTMENTS. NO PAYMENTS WERE MADE IN THEIR CAPACITY AS TRUSTEE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 4,722,447. PRIOR PERIOD ADJUSTMENTS: 25,026,848. TOTAL TO FORM 990, PART XI, LINE 5: 29,749,295. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. AVERAGE HOURS PER WEEK- RELATED ORGS. FORM 990, PART VII, LINE 1A, COLUMN B KATHERINE HEBERT, ADMINISTRATOR SPENDS AN ADDITIONAL 40 HRS/WEEK ON RELATED ORGS. DAVID CALLECOD, PRESIDENT SPENDS AN ADDITIONAL 3 HRS/WEEK ON RELATED ORGS. EDWARD KRAMPE, BOARD MEMBER SPENDS AN ADDITIONAL 1 HRS/WEEK ON RELATED ORGS. BRADLEY CHASTANT, BOARD MEMBER SPENDS AN ADDITIONAL 2 HRS/WEEK ON RELATED ORGS. PATRICK GANDY, BOARD MEMBER SPENDS AN ADDITIONAL 1 HRS/WEEK ON RELATED ORGS. BRADEN DESPOT, BOARD MEMBER SPENDS AN ADDITIONAL 1 HRS/WEEK ON RELATED ORGS. JOBY JOHN, BOARD MEMBER SPENDS AN ADDITIONAL 1 HRS/WEEK ON RELATED ORGS. ROGER MATTKE, CFO SPENDS AN ADDITIONAL 1 HRS/WEEK ON RELATED ORGS. IN ADDITION TO THE HOURS LISTED ABOVE, THE OFFICERS AND BOARD MEMBERS FOR LAFAYETTE GENERAL MEDICAL CENTER ARE THE SAME AS THOSE OF LAFAYETTE GENERAL HEALTH SYSTEMS. 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