2011-09-14T18:21:23-05:00 2010-10-31 STEVEN M DEROUEN CPA P O BOX 4265 LAKE CHARLES LA 70606 990 2009-11-01 720491106 WEST LOUISIANA HEALTH SERVICES INC BEAUREGARD MEMORIAL HOSPITAL WEST 3374627106 P O BOX 730 DERIDDER LA 70634 THEODORE BADGER JR 3374627106 2011-09-14 Steven M DeRouen 3375134915 X 2009 2016-02-24 21:20:13Z THEODORE BADGER JR 206 KERRY STREET DERIDDER LA 70634 32597483 0 X WWW.BEAUREGARD.ORG X 1946 LA TO PROVIDE MEDICAL CARE AND HEALTH PROGRAMS BY OPERATING A 60 BED FACILITY FOR HOSPITAL SERVICE DISTRICT #2 OF BEAUREGARD PARISH AND FIVE PHYSICIAN CLINICS; RECRUIT AND EMPLOY PHYSICIANS IN HPSA. 14 14 423 90 0 0 0 28259875 31386563 -581542 -10568 23923 27678333 31399918 0 0 1058249 0 0 28689811 31346829 28689811 32405078 -1011478 -1005160 7752380 8104055 3296800 4353335 4455580 3750720 TO PROVIDE MEDICAL CARE AND HEALTH PROGRAMS BY OPERATING A 60 BED FACILITY FOR HOSPITAL SERVICE DISTRICT #2 OF BEAUREGARD PARISH AND FIVE PHYSICIAN'S CLINICS; RECRUIT AND EMPLOY PHYSICIANS IN HPSA. 0 0 30856226 30834989 OPERATED A 60 BED FACILITY FOR HOSPITAL SERVICE DISTRICT #2 OF BEAUREGARD PARISH, PROVIDING GENERAL SHORT TERM CARE TO 2,862 INPATIENTS FOR 10,493 DAYS; 404 NEWBORNS; 1,628 SURGERIES; 16,740 E/R VISITS; AND 23,854 OUTPATIENTS; OPERATED PHYSICIAN'S CLINIC. 74.3% OF HOPITAL ADMISSIONS ARE MEDICARE AND MEDICAID. THE HOSPITAL ALSO CONDUCTS NUMEROUS COMMUNITY SEMINARS AND SERVICES TO BENEFIT THE COMMUNITY. 1548852 564929 OPERATED BEAUREGARD PHYSICIANS GROUP WHICH CONSISTS OF FIVE PHYSICIAN'S CLINICS WHICH PROVIDE MEDICAL SERVICES TO BEAUREGARD PARISH. 32405078 1 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 1 35 0 423 1 0 0 0 0 0 0 0 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DARRELL L KINGHAM CPA VP OF FINA 3374627106 600 SOUTH PINE STREET DERIDDER LA 70634 JULIE OZSOY CPA X 0 0 0 CARL SLOVER X X 0 0 0 TERRI THEAUX X X 0 0 0 JARED MORRIS X 0 0 0 NATHA GANTT X 0 0 0 DAVID BROWN MD X 0 0 0 TOM DOBBINS MD X 0 0 0 CHRISTOPHER GRANGER MD X 0 0 0 TOM RHODES X 0 0 0 GERALD JOHNSON X 0 0 0 MARARETTA MAYES X 0 0 0 ED O'NEAL X X 0 0 0 THOMAS SHIRLEY DDS X 0 0 0 JAY STINE X 0 0 0 THEODORE BADGER JR 45.00 X 213488 0 13346 DARRELL L KINGHAM 52.00 X 166961 0 11338 DARREN CAILLOUET 40.00 X 201688 0 10757 ROBERT RUSHFORD 40.00 X 165345 0 8249 THOMAS FRANKS 40.00 X 182464 0 9285 ALEX MANITZAS RPH 40.00 X 129188 0 6807 JANET LEWIS 40.00 X 224950 0 0 1284084 0 59782 7 0 1 0 CARDIOLOGY CLINIC OF DERIDDER LLC 109 W 4TH STREET DERIDDER LA 70634 PHYSICIAN SERVICES 188204 DAVENPORT FAMILY MEDICAL CLINIC 101 W 6TH STREET DERIDDER LA 70634 PHYSICIAN SERVICES 174423 BEAUREGARD PHYSICAL THERAPY 309 S WASHINGTON DERIDDER LA 70634 PHYSICAL THERAPY SERVICES 166442 JENNIFER MCCANN MD 206 W 5TH STREET DERIDDER LA 70634 PHYSICIAN SERVICES 160736 4 REIMBURSEMENTS FROM HO 900099 30821634 30821634 PATIENT SERVICES 621400 564929 564929 31386563 141378 141378 1045619 1197565 -151946 -151946 -151946 OTHER INCOME 900099 23923 23923 23923 31399918 31399918 0 0 224950 224950 833299 833299 15941 15941 1927 1927 7757 7757 13088 13088 13116 13116 10605 10605 34194 34194 OTHER PROFESSIONAL EXPE 15423227 15423227 FISCAL & ADMINISTRATIVE 7524132 7524132 NURSING EXPENSES 4628420 4628420 GENERAL SERVICE EXPENSE 3245855 3245855 MINOR EQUIPMENT 150478 150478 278089 278089 32405078 32405078 0 0 1228768 857339 26449 170456 434765 568813 1872 13462 5084 94430 56911 14377 41488 42534 5749694 5285067 873805 264260 198149 7752380 8104055 3032540 1259450 264260 3093885 3296800 4353335 X 0 0 0 0 4455580 3750720 4455580 3750720 7752380 8104055 X 0 1 1 X 0 X 7416 56 7472 7342 74 7416 0 0 56911 14377 42534 42534 CERTIFICATES OF DEPOSIT 873805 C 873805 DUE TO HSD #2 1923758 ACCRUED PAYROLL 398106 ACCRUED VACATION PAYABLE 596057 ACCRUED DISABILITY BENEFITS 175964 3093885 31399918 32405078 -1005160 300300 300300 -704860 31700218 300300 300300 31399918 0 31399918 32405078 0 32405078 0 32405078 1 1 1 X 1 X 1 0 0 1 1 4506841 3507634 999207 0.03080 6289354 5620333 669021 0.02060 10796195 9127967 1668228 0.05140 66962 0 66962 0.00210 263000 0 263000 0.00810 2172638 618189 1554449 0.04800 2502600 618189 1884411 0.05820 13298795 9746156 3552639 0.10960 315549 0 315549 0.00970 315549 315549 0.00970 1 2254715 901886 10749625 11188323 -438698 X 1 1 HOSPITAL SERVICE DISTRICT #2

600 S PINE STREET DERIDDER LA 70634

X X X BEAUREGARD PHYSICIAN GROUP LLC

600 S PINE STREET DERIDDER LA 70634

A disregarded entity; physician recruitment to a HPSA Part I, Line 7: PART I, LINE 7 - COSTS ON 7A AND 7B WERE TAKEN FROM THE SCHEDULE OF UNCOMPENSATED CARE COST FOR SMALL RURAL HOSPITALS, A REPORT USED BY THE LA. DEPT. OF HEALTH AND HOSPITALS TO DETERMINE UNCOMPENSATED MEDICAID AND INDIGENT COSTS AND REIMBURSEMENTS. A COST TO CHARGH RATIO WAS ALSO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES AND USED WHEN NEEDED. COSTS ON LINE 7E, 7F AND 7G ARE ACTUAL COSTS PER RECORDS. Part I, Line 7g: PART I, LINE 7 G - IN ACCORDANCE WITH IDENTIFIED COMMUNITY NEEDS THE HOSPITAL HAD RECRUITED PHYSICIANS TO SERVE IN THE COMMUNITY, WHICH IS IN A PROFESSIONAL SHORTAGE AREA (HPSA). SUBSIDIZED HEALTH SERVICES INCLUDE SUBSIDIES OF $1,435,584 TO NINE CLINICS WHICH PROVIDE ORTHOPEDIC, SURGICAL, PEDIATRIC, INTERNAL MEDICINE, OB/GYN, CARDIOLOGY AND FAMILY PRACTICE SERVICES TO THE COMMUNITY. THE HOSPITAL SUBSIDIZED AN OB/GYN CLINIC $41,112 FOR MALPRACTICE INSURANCE AS THE MAJORITY OF PATIENTS SERVED WERE MEDICAID. Part I, Line 7f: PART 3 LINE 4 BAD DEBT EXPENSE - LINE 2, BAD DEBT COST WAS CALCULATED BY MULTIPLYING BAD DEBT CHARGES PER ACCOUNTING RECORDS BY THE WORKSHEET 2 COST TO CHARGE RATIO. LINE 3 IS 40% OF THE BAD DEBT COSTS, BASED ON HISTORICAL INFORMATION. SELF PAY PATIENTS PAY 5% OF CHARGES ON AVERAGE, WHICH CHARGES TOTALED $12.3 MILLION. THE COMMUNITY BENEFITS FROM THE HOSPITAL'S POLICY THAT ALL PATIENTS WHO ARE UNINSURED ARE ACCEPTED BY THE HOSPITAL. Part III, Line 4: THE ACCOUNTING POLICY OF THE HOSPITAL REGARDING BAD DEBTS STATES THAT THE ALLOWANCE METHOD IN ACCOUNTING FOR BAD DEBTS IS USED. THE ALLOWANCE ACCOUNT CONSISTS OF AN ESTIMATE OF UNCOLLECTABLE ACCOUNTS AND A GENERAL RESERVE. MANAGEMENT'S EVALUATION OF THE ADEQUACY OF THE ALLOWNACE IS BASED ON A CONTINUING REVIEW OF ALL ACCOUNTS AND INCLUDES A CONSIDERATION OF PAST PATIENT HISTORY, AND ADVERSE SITUATIONS THAT MIGHT AFFECT THE PATIENT'S ABILITY TO PAY, AND CURRENT ECONOMIC CONDITIONS. Part III, Line 8: PART III, LINE 8 - THE COSTING METHODOLOGY FOR MEDICARE WAS DERIVED FROM THE MEDICARE FORM CMS-2552 FILED FOR FYE 10/31/10. THE HOSPITAL CONTINUES TO TREAT MEDICARE PATIENTS, EVEN AS MEDICARE REIMBURSEMENT IS DECLINING. THE HOSPITAL VIEWS THE $438,698 MEDICARE SHORTFALL AS A COMMUNITY BENEFIT, AS ALL HOSPITLA PATIENTS ARE ACCEPTED REGARDLESS OF REIMBURSENT. Part III, Line 9b: PART III, LINE 9B - REGARDING COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THE HOSPITAL TRIES TO CONDUCT A PRE ADMISSION INTERVIEW WITH THE PATIENT OR GUARANTOR PRIOR TO ADMISSION WHEN POSSIBLE. POTENTIAL CHARITY CARE PATIENTS ARE OFFERED THE OPPORTUNITY TO APPLY FOR CHARITY CARE AT THE TIME OF ADMISSION. OUTPATIENTS AND ER PATIENTS ARE SENT A NOTIFICATION ABOUT CHARITY CARE THROUGH THE MAIL. PATIENT WITH NO INSURANCE RECEIVE A LETTER WITHIN 30 DAYS OF SERVICE, STATING THAT THE HOSPITAL HAS GIVEN THEM A 52% DISCOUNT AND THAT THEY ARE RESPONSIBLE FOR THE BALANCE OF THE BILL. THE LETTER ALSO STATES THAT THE HOSPITAL HAS A CHARITY CARE/FINANCIAL ASSISTANCE PROGRAM AND GIVES THE CONTACT PERSON'S NAME AND PHONE NUMBER TO OBTAIN AN APPLICATION. THE LETTER ALSO GIVES THE NAME AND NUMBER TO APPLY FOR MEDICAID AT THE HOSPITAL. THE LETTER STATES THE ACCOUNT BALANCE THAT IS DUE AND THAT PAYMENTS CAN BE SPREAD OVER 12 TO 18 MONTHS. IT ALSO STATES THAT FAILURE TO PAY THE BILL OR SET UP FINANCIAL ARRANGEMENTS WILL RESULT IN ADDITIONAL COLLECTION EFFORTS. A SECOND LETTER IN THE FOLLOWING MONTH IS SENT THAT STATES THEIR ACCOUNT IS DELINQUENT, IS DUE AND FAILURE TO RESPOND WILL RESULT IN FURTHER COLLECTION ACTION. IF NO RESPONSE, A THIRD LETTER IS SENT STATING THEIR ACCOUNT IS DELIQUENT AND IS BEING REVIEWED TO GO TO AN OUTSIDE COLLECTION AGENCY. A FINAL NOTICE IS SENT STATING THIS A FINAL NOTICE, FAILURE TO PAY WILL RESULT IN THE ACCOUNT BEING PLACED WITH A COLLECTION AGENCY, AND THAT THEY MUST HAVE AN AUTHORIZED FINANCIAL AGREEMENT WITH THE HOSPITAL TO STOP THE ACCOUNT FROM BEING PLACED WITH AN OUTSIDE COLLECTION AGENCY. PART I, LINE 6A THE HOSPITAL'S COMMUNITY BENEFIT REPORT WAS PREPARED BY THE HOSPITAL AND WAS NOT PREPARED BY A RELATED ORGANIZATION. X 1 1 X X X 0 0 0 0 0 0 0 1 0 THEODORE BADGER JR 205366 0 0 0 8122 0 11000 0 2346 0 226834 0 0 0 DARRELL L KINGHAM 166961 0 0 0 0 0 8992 0 2346 0 178299 0 0 0 DARREN CAILLOUET 201688 0 0 0 0 0 10757 0 0 0 212445 0 0 0 ROBERT RUSHFORD 165345 0 0 0 0 0 8249 0 0 0 173594 0 0 0 THOMAS FRANKS 182464 0 0 0 0 0 9285 0 0 0 191749 0 0 0 JANET LEWIS 224950 0 0 0 0 0 0 0 0 0 224950 0 0 0 Part I, Line 1b SCHEDULE J, PART 1, LINE 1a - Reasonable expenses submitted for a traveling spouse (except for airfare) accompanying a trustee on approved travel is reimbursed. Part I, Line 7 SCHEDULE J, PART 1, LINE 7 - The CEO bonus criteria is weighted 40% quality, 40% financial, and 20% community. 62% of the 18 goals were met, resulting in the additional non-fixed payment of $6,200 of a possible $10,000 maximum amount available. Other officers, key employees and the highly compensated employees are not eligible for bonuses. JAY STINE WEST LA HEALTH SERVICES BOARD MEMBER 7197 WLHS PURCHASED MATERIALS FOR HOSPITAL REPAIRS AND MAINTENANCE FROM LUMBER COMPANY PARTIALLY OWNED BY BOARD MEMBER. 0 DR DAVID BROWN WEST LA HEALTH SERVICES BOARD MEMBER 48000 BOARD MEMBER PROVIDED CONTRACT PHYSICIAN SERVICES TO WLHS MANAGED HOSPITAL. 0 DR TOM DOBBINS WEST LA HEALTH SERVICES BOARD MEMBER 600 BOARD MEMBER PROVIDED CONTRACT PHYSICIAN SERVICES TO WLHS MANAGED HOSPITAL. 0 Form 990, Part VI, Section B, line 11 PART VI SECTION A, LINE 10: AVAILABILITY OF FORM 990 - The Form 990 is available to the Board of Trustees by its posting on the hospital's intranet portal for subsequent board meeting discussion. Form 990, Part VI, Section B, line 12c PART VI SECTION B, LINE 12C: CONFLICT OF INTEREST POLICY - Every January, a Conflict of Interest Questionaire is completed by each trustee. These documents are reviewed and retained in the Board of Trustee's files. Form 990, Part VI, Section B, line 15 PART VI SECTION B, LINE 15A: CEO COMPENSATION PROCESS - The Board of Trustees' Executive Committee conducts an annual performance evaluation following the end of each fiscal year. Comparable compensation data for CEOs at other similiarly situated organizations is used. Resources include the VHA Gulf States CEO Compensation Survey, the Hay Group Hospital Compensation Report, the Jackson Survey for quality goals, Health Stream Employee Satisfaction, Emergency Department, Inpatient, Same Day Surgery, Lab and Radiology Satifaction Surveys, and other various reports. The CEO's compensation is criteria based. A bonus is dependent on achieving goals in community health, quality and financial areas. A analysis of salary history, employee retention and self evaluation is also considered. PART VI SECTION B, LINE 15B: OTHER KEY EMPLOYEE COMPENSATION PROCESS - Annual employee evaluations are conducted in November of each year. These evaluations consider the employee's achievement of goals, salary and expense budgets, compliance with quality controls and Joint Commission, performance and competency, and other criteria based objectives in determining remuneration. In addition, the CEO also considers the following salary surveys: The Hay Group, VHA Department Head Survey, Louisiana Hospital Salary and Benefits Survey, Greater New Orleans Society for Healthcare Human Resources Administration Executive Director and Management Survey. Form 990, Part VI, Section C, line 19 PART VI SECTION C, LINE 19: AVAILABILITY OF THE ORGANIZATION'S DOCUMENTS AND POLICIES - Information is available upon request. PART XI, LINE 2C NO CHANGE IN PROCESSES FROM PRIOR YEAR THERE HAS BEEN NO CHANGE IN INDEPENDENT ACCOUNTANT OVERSIGHT AND SELECTION PROCESS FROM THE PRIOR YEAR. BEAUREGARD PHYSICIAN GROUP LLC P O BOX 1540 DERIDDER LA 70634 270602265 PHYSICIAN SERVICES LA 566477 899125 N/A