OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL INC (EIN 72-1495500)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-13
- IRS object ID
- 202231339349309233
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-13T17:25:55-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 MAIN STREET SUITE 2150 | AddressLine1Txt |
| City | BATON ROUGE | CityNm |
| State Abbreviation | LA | StateAbbreviationCd |
| ZIP | 70801 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 721495500 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OUR LADY OF THE LAKE ASSUMPTION | BusinessNameLine1Txt |
| Business Name Line2 | COMMUNITY HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OURL | BusinessNameControlTxt |
| Phone | 2257657709 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 ESSEN LANE | AddressLine1Txt |
| City | BATON ROUGE | CityNm |
| State Abbreviation | LA | StateAbbreviationCd |
| ZIP | 70809 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LOWELL STANTON | PersonNm |
| Person Title | REGIONAL CFO | PersonTitleTxt |
| Phone | 2257657709 | PhoneNum |
| Signature | 2022-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LOWELL | PersonFirstNm |
| Person Last | STANTON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MAXWELL BARLOW | PreparerPersonNm |
| PTIN | P01959439 | PTIN |
| Phone | 2253444000 | PhoneNum |
| Preparation | 2022-05-10 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KEVIN GUIDRY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 ESSEN LANE | AddressLine1Txt |
| City | BATON ROUGE | CityNm |
| State Abbreviation | LA | StateAbbreviationCd |
| ZIP | 70809 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,500,345 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | LA | LegalDomicileStateCd |
| Activity Or Mission | THE PURPOSE OF THE HOSPITAL IS TO PROVIDE FOR THE CARE OF ILL, INJURED AND SEE SCHEDULE O.DISABLED PERSONS AND TO ENHANCE THE HEALTH OF THOSE IN THE COMMUNITY THROUGH RESEARCH AND EDUCATION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 62 | TotalEmployeeCnt |
| Total Volunteers | 4 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $458,276 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,509,044 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,909,939 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,013,132 | CYProgramServiceRevenueAmt |
| PY Investment Income | $184,455 | PYInvestmentIncomeAmt |
| CY Investment Income | $716,902 | CYInvestmentIncomeAmt |
| PY Other Revenue | $28,417 | PYOtherRevenueAmt |
| CY Other Revenue | $25,986 | CYOtherRevenueAmt |
| PY Total Revenue | $7,581,087 | PYTotalRevenueAmt |
| CY Total Revenue | $9,265,064 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $814 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,943,066 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,159,757 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,105,502 | PYOtherExpensesAmt |
| CY Other Expenses | $4,061,117 | CYOtherExpensesAmt |
| PY Total Expenses | $7,048,568 | PYTotalExpensesAmt |
| CY Total Expenses | $7,221,688 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $532,519 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,043,376 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,367,089 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,816,779 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,559,788 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,429,389 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,807,301 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,387,390 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,997,884 | ExpenseAmt |
| Grant | $814 | GrantAmt |
| Revenue | $7,039,118 | RevenueAmt |
| Desc | OUR LADY OF THE LAKE ASSUMPTION PROVIDES TWENTY-FOUR HOUR HEALTHCARE SERVICES FOR PATIENTS IN THE SURROUNDING RURAL COMMUNITIES. THE HOSPITAL HAD 4,515 EMERGENCY ROOM VISITS THIS YEAR. THE HOSPITAL'S EMERGENCY ROOM IS OPEN TO EVERYONE, REGARDLESS OF ABILITY TO PAY.THE HOSPITAL ALSO PROVIDED 14,028 LAB TESTS AND 14 INPATIENT DAYS DURING THE YEAR. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTHCARE NEEDS OF THE PEOPLE OF GOD, THE MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. | Desc |
| Total Program Service Expenses | $5,997,884 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 62 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMANDA HYMEL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2257656565 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5959 S SHERWOOD FOREST BLVD | AddressLine1Txt |
| City | BATON ROUGE | CityNm |
| State Abbreviation | LA | StateAbbreviationCd |
| ZIP | 70816 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| WENDY GAUDET | |||||||||
| INTERIM CEO | 2.00 | 40.00 | Yes (X) | Yes (X) | $0 | $179,098 | $22,231 | ||
| STEPHANIE G MANSON | |||||||||
| BOARD MEMBER | 2.00 | 40.00 | Yes (X) | $0 | $502,460 | $87,112 | |||
| LOWELL E STANTON | |||||||||
| REGIONAL CFO | 2.00 | 52.50 | Yes (X) | Yes (X) | $0 | $561,274 | $24,388 | ||
| KENNETH WESTER | |||||||||
| BOARD MEMBER | 2.00 | 53.50 | Yes (X) | $0 | $1,046,740 | $258,135 | |||
| WILLIAM E BALHOFF | |||||||||
| CHAIR | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| CHARLES P BOLOTTE MD | |||||||||
| BOARD MEMBER | 10.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| YOLANDA DIXON | |||||||||
| SECRETARY | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| HARRY J PHILIPS JR | |||||||||
| VICE CHAIR | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| KEVIN GUIDRY | |||||||||
| CEO | 2.00 | 40.00 | Yes (X) | $0 | $266,142 | $93,611 | |||
| DONNA M MULLINGS | |||||||||
| DIR. NURSING | 40.00 | 0.00 | $110,580 | $0 | $50,191 | Yes (X) | |||
| BRIAN F TRIPODE | |||||||||
| SUPV PHARMACY | 40.00 | 0.00 | $179,655 | $0 | $22,549 | Yes (X) | |||
| CHRISTINA HOCKADAY | |||||||||
| FORMER CEO | 0.00 | 0.00 | $0 | $118,314 | $6,375 | Yes (X) | |||
| JEFF LIMBOCKER | |||||||||
| FORMER CFO | 0.00 | 60.50 | $0 | $971,153 | $196,661 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $290,235 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,645,181 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $761,253 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| FMOL HEALTH SYSTEM | |||||
| 4200 ESSEN LANE | BATON ROUGE | LA | 70809 | LAB MANAGEMENT FEES | $1,538,421 |
| CORRECT CARE INC | |||||
| 17438 HARD HAT DRIVE | COVINGTON | LA | 70435 | MEDICAL SERVICES | $1,340,718 |
| GIFTED NURSES | |||||
| 2748 METAIRIE LAWN DRIVE STE B | METAIRIE | LA | 70002 | LABOR SERVICES | $157,654 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,509,044 | GovernmentGrantsAmt |
| Total Contributions | $1,509,044 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 622110 | $6,997,431 | $6,997,431 |
| MISCELLANEOUS | 900099 | $11,681 | $11,681 |
| OUTREACH LAB | 621500 | $3,663 | $3,663 |
| MEDICAL RECORDS | 561110 | $357 | $357 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,013,132 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $60,068 | TotalRevenueColumnAmt |
| Exclusion | $60,068 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,986 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,986 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,986 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $25,986 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,437,921 | SecuritiesAmt |
| Other | $454,194 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,189,855 | SecuritiesAmt |
| Other | $45,426 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $248,066 | SecuritiesAmt |
| Other | $408,768 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $656,834 | TotalRevenueColumnAmt |
| Exclusion | $656,834 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,265,064 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,039,118 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $716,902 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $814 | TotalAmt |
| Program Services | $814 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,533,806 | TotalAmt |
| Program Services | $2,292,886 | ProgramServicesAmt |
| Management And General | $240,920 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,520 | TotalAmt |
| Program Services | $134,618 | ProgramServicesAmt |
| Management And General | $14,902 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $303,989 | TotalAmt |
| Program Services | $273,706 | ProgramServicesAmt |
| Management And General | $30,283 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,442 | TotalAmt |
| Program Services | $155,256 | ProgramServicesAmt |
| Management And General | $17,186 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,515,486 | TotalAmt |
| Program Services | $1,360,819 | ProgramServicesAmt |
| Management And General | $154,667 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55 | TotalAmt |
| Management And General | $55 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,798 | TotalAmt |
| Management And General | $15,798 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,369 | TotalAmt |
| Program Services | $42,433 | ProgramServicesAmt |
| Management And General | $268,936 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,431 | TotalAmt |
| Program Services | $46,847 | ProgramServicesAmt |
| Management And General | $15,584 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $404,348 | TotalAmt |
| Program Services | $296,763 | ProgramServicesAmt |
| Management And General | $107,585 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,600 | TotalAmt |
| Program Services | $8,704 | ProgramServicesAmt |
| Management And General | $2,896 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $184,445 | TotalAmt |
| Program Services | $184,445 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,754 | TotalAmt |
| Program Services | $6,569 | ProgramServicesAmt |
| Management And General | $2,185 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,060 | TotalAmt |
| Program Services | $5,298 | ProgramServicesAmt |
| Management And General | $1,762 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,971 | TotalAmt |
| Program Services | $257,971 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,916 | TotalAmt |
| Program Services | $5,354 | ProgramServicesAmt |
| Management And General | $34,562 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES EXPENS | $1,157,009 | $862,156 | $294,853 |
| EQUIPMENT & MAINTENANCE | $84,875 | $63,245 | $21,630 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,221,688 | TotalAmt |
| Program Services | $5,997,884 | ProgramServicesAmt |
| Management And General | $1,223,804 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,847,104 | BOYAmt |
| EOY | $10,623,907 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $626,386 | BOYAmt |
| EOY | $1,286,643 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,363 | BOYAmt |
| EOY | $22,315 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,437,363 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,308,699 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $945,743 | BOYAmt |
| EOY | $1,128,664 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,931,493 | BOYAmt |
| EOY | $7,755,250 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,367,089 | BOYAmt |
| EOY | $20,816,779 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,768,667 | BOYAmt |
| EOY | $3,466,787 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,164,032 | BOYAmt |
| EOY | $450,981 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,627,089 | BOYAmt |
| EOY | $1,511,621 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,559,788 | BOYAmt |
| EOY | $5,429,389 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,807,301 | BOYAmt |
| EOY | $15,287,390 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $100,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,807,301 | BOYAmt |
| EOY | $15,387,390 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,367,089 | BOYAmt |
| EOY | $20,816,779 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,043,376 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,536,713 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $55,461 | OtherCostOrOtherBasisAmt |
| Book Value | $55,461 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $861,569 | OtherCostOrOtherBasisAmt |
| Depreciation | $707,070 | DepreciationAmt |
| Book Value | $154,499 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $82,115 | OtherCostOrOtherBasisAmt |
| Depreciation | $52,212 | DepreciationAmt |
| Book Value | $29,903 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,438,218 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,549,417 | DepreciationAmt |
| Book Value | $888,801 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,128,664 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENT IN CAP RESERVE | Desc |
| Book Value | $7,755,250 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $7,755,250 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO/FROM RELATED ENTITIES | Desc |
| Amt | $1,511,621 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,511,621 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | FIN 48 (ASC740) FOOTNOTE FMOLHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. NO RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $464,444 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $464,444 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06430 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,655,065 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,655,065 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,119,509 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,655,065 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $464,444 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06430 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,797 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,797 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,797 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,797 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,122,306 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,655,065 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $467,241 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06470 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $36,376 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $1,413,713 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $1,366,302 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $47,411 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASSUMPTION COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 135 HIGHWAY 402 | AddressLine1Txt |
| City | NAPOLEONVILLE | CityNm |
| State Abbreviation | LA | StateAbbreviationCd |
| ZIP | 70390 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | RURAL HEALTH CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASSUMPTION COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE PART V SECTION B | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SUPPLEMENT AT PART V | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SUPPLEMENT AT PART V | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SUPPLEMENT AT PART V | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ASSUMPTION COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: THE HOSPITAL HELD A FOCUS GROUP DISCUSSION WITH VARIOUS COMMUNITY GROUPS IN ORDER TO DISCUSS AND VALIDATE STATISTICAL DATA OBTAINED FROM THE HEALTH COMMUNITIES INSTITUTE. THE FOCUS GROUP WAS ABLE TO HELP IDENTIFY THE COMMUNITY'S CHALLENGES AND THE ISSUES WITH THE GREATEST POTENTIAL FOR SUCCESS. IT MET WITH REPRESENTATIVES FROM ASSUMPTION PARISH COUNCIL ON AGING, ASSUMPTION PARISH LIBRARY, ASSUMPTION PARISH SCHOOLS, ASSUMPTION PARISH HEAD START, ACADIAN AMBULANCE SERVICE, LSU AG CENTER, ASSUMPTION HEALTHCARE AND REHAB, ASSUMPTION ASSOCIATION FOR RETARDED CITIZENS, OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER, ASSUMPTION PRIMARY CARE, ASSUMPTION PARISH SHERIFF'S OFFICE, ASSUMPTION POLICE JURY, AND REGION III OFFICE OF EMERGENCY PREPAREDNESS. ONE PARTICIPANT WITH SPECIALIZED KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH WAS DEBRA GONZALES, DHH/OFFICE OF PUBLIC HEALTH FOR REGION III. |
| ASSUMPTION COMMUNITY HOSPITAL | PART V, SECTION B, LINE 7D: THE CHNA CAN BE FOUND ATHTTPS://OLOLRMC.COM/PAGES/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX |
| ASSUMPTION COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: ASSUMPTION COMMUNITY HOSPITAL (ACH), A CRITICAL ACCESS HOSPITAL, AN AFFILIATE OF OUR LADY OF THE LAKE HOSPITAL AND A MEMBER OF THE FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, CONDUCTED A NEW COMMUNITY HEALTH NEEDS ASSESSMENT IN 2018. THE SIGNIFICANT HEALTH NEEDS IDENTIFIED DURING THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT WERE: MENTAL HEALTH SERVICES, OBESITY, DIABETES, AND ACCESS TO CANCER SCREENING. THE SIGNIFICANT COMMUNITY HEALTH NEEDS IDENTIFIED DURING THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015 WERE ACCESS TO PRIMARY CARE, CHILDHOOD OBESITY, DIABETES, AND HEALTH EDUCATION FOR SENIORS.DURING THE 2020-2021 FISCAL YEAR, ACH SERVED OVER 2,800 PARISHIONERS.HEALTH FAIRS WERE CANCELLED FOR THIS YEAR DUE TO THE COVID-19 PANDEMIC AND CONCERNS FOR THE COMMUNITY'S SAFETY. ACH PARTNERSHIPS ARE STILL STRONG WITH ASSUMPTION'S COUNCIL OF AGING, ASSUMPTION HEAD START PROGRAM, AND THE ASSUMPTION ASSOCIATION FOR RETARDED CITIZENS, INC. THE ACH STAFF AND ALL THE AGENCIES ACH HAS WORKED WITH IN THE PAST ARE LOOKING FORWARD TO WORKING TOGETHER SOON TO CONTINUE THE PARISH'S HEALTH FAIRS.ACH'S COLLABORATION WITH THE ASSUMPTION PARISH LSU AG CENTER HAS CHANGED DUE TO A RETIREMENT IN THE AGENCY'S MANAGEMENT. MONTHLY ZOOM MEETINGS BEGAN WITH SEVERAL DIFFERENT AGENCIES WITHIN THE PARISH. TOPICS THAT WERE DISCUSSED INCLUDED CLEANING UP PARKS, STARTING FARMER'S MARKETS, ADDING SIDEWALKS TO CERTAIN AREAS OF THE PARISH, AND IMPROVING PARISH PARKS. ALL PLANS CENTERED ON GIVING RESIDENTS A PLACE TO EXERCISE AND CHOICES FOR HEALTHIER LIFESTYLES. ACH PLANS TO CONTINUE THE GET-FIT-BAYOU PROGRAM WHEN PUBLIC GROUPS ARE ALLOWED BACK IN SCHOOLS.ACH WALKING PATH USAGE DOUBLED, PARTIALLY DUE TO COVID-19. ACH WAS ABLE TO PROVIDE A SAFE PLACE FOR PEOPLE TO GET EXERCISE AND IMPROVE THEIR MENTAL HEALTH DURING THE SOCIAL DISTANCING OF THE COVID-19 PANDEMIC. MARY BIRD PERKINS AND THE WOMAN'S HOSPITAL MOBILE UNIT PARTNERED WITH ACH TO PROVIDE BREAST EXAMS AND SKIN AND PROSTATE CANCER SCREENINGS BETWEEN 8 AND 10 TIMES A YEAR, COMPLETING APPROXIMATELY 160 EXAMS. THE NUMBER OF THE WOMAN'S MOBILE VISITS CONTINUE TO INCREASE SIGNIFICANTLY EACH YEAR. ACH FOLLOWED THE LEAD OF FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM AND IMPLEMENTED ALL RECOMMENDATIONS AND REQUIREMENTS OF THE CDC WITH REGARD TO COVID-19 SAFETY. AT BOTH ACH PUBLIC ENTRANCES, FRONT LOBBY, AND ER ENTRANCE, STAFF AND SECURITY GUARDS SCREENED ER PATIENTS, OUTPATIENTS AND VISITORS FOR COVID-19 SYMPTOMS. IN JANUARY 2021, COVID-19 VACCINE DEMANDS BEGAN. AN INFLUX OF PHONE CALLS FLOODED THE HOSPITAL AND CLINIC PHONE LINES. STAFF MEMBERS FROM BOTH FACILITIES HANDLED ALL THE QUESTIONS, PLACING PEOPLE ON CALLBACK WAITING LISTS TO SCHEDULE THEIR VACCINE APPOINTMENTS. THE CLINIC SCHEDULED A DAY TO GIVE 100 VACCINES TO HANDLE THE DEMAND. HOSPITAL STAFF WAS STAGED AT THE CLINIC TO ASSIST. TWICE A WEEK THE CLINIC CLEARED THE AFTERNOON SCHEDULES TO HANDLE THE VACCINE DEMAND. ACH WILL CONTINUE TO WORK WITH ITS COMMUNITY PARTNERS TO DEVELOP PROGRAMS THAT ADDRESS THE NEEDS OF THE PEOPLE OF ASSUMPTION PARISH, ESPECIALLY ITS VULNERABLE POPULATIONS, WITH THE GOAL OF BEING A PRIMARY ENTRY POINT FOR HEALTHCARE IN THE AREA. BECAUSE THE PANDEMIC TOOK PLACE DURING A SIGNIFICANT PART OF THE 2018 CHNA MEASUREMENT PERIOD, SOME OF THE INITIAL IMPLEMENTATION STRATEGY TARGETS WERE NOT ACHIEVED. HOWEVER, THERE WAS SIGNIFICANT WORK WITH THE COMMUNITY REGARDING COVID-19 AND MEETING THE NEEDS OF PEOPLE IN CRISIS. ACH ADMINISTERED MORE THAN 2,200 FIRST AND SECOND COVID-19 VACCINE DOSES TO COMMUNITY MEMBERS THROUGH THE ASSUMPTION PRIMARY CARE CLINIC AND PARTNERED WITH ASSUMPTION PARISH SCHOOLS, THIBODAUX REGIONAL FAMILY PRACTICE, AND THE ASSUMPTION PARISH OFFICE OF EMERGENCY PREPAREDNESS TO PROVIDE AND ADMINISTER MORE THAN 600 VACCINES TO THE FACULTY OF THE ASSUMPTION PARISH SCHOOL BOARD. THE INITIAL BEHAVIORAL HEALTH PROGRAM THAT WAS IMPLEMENTED DURING THE CHNA MEASUREMENT PERIOD DID NOT CONTINUE DUE TO PROVIDER CONSTRAINTS. A NEW PROGRAM WITH TWO PROVIDERS AND A LICENSED COUNSELOR WHO SEE PATIENTS IN PERSON AND THROUGH VIRTUAL VISITS HAS SINCE BEEN ESTABLISHED AT THE ASSUMPTION PRIMARY CLINIC. THE BEHAVIORAL HEALTH PROVIDER ALSO PROVIDES CONSULTATIONS WHEN ACH EMERGENCY DEPARTMENT HAS PHYSICIAN'S EMERGENCY CERTIFICATE (PEC) PATIENTS. DAILY, ACH COMMUNICATED AND WORKED WITH ASSUMPTION PARISH, REGION III, AND STATE EMERGENCY PREPAREDNESS AGENCIES. IN 2021, THERE WERE A RECORD NUMBER OF HURRICANES THAT THREATENED OUR AREA. WHEN THE HURRICANES THREATENED OUR AREA, ACH STAFF REMAINED ON CAMPUS EVEN THOUGH THE CODE GRAY WAS NOT CALLED BY FMOLHS. IN FEBRUARY, A MAJOR WINTER STORM CLOSED DOWN MOST OF THE STATE. ACH STAFF WORKED WITH LOCAL LEPC AND FMOLHS DURING THIS CODE GRAY EVENT.THE STATE'S EFS-8 PORTAL HAS BEEN USED TO SUBMIT THE HOSPITAL'S PREVIOUS DAY'S TOTALS. TOTALS SUCH AS COVID-19 NUMBERS, NUMBER OF ER PATIENTS, STAFFING OUTAGES, TOTAL OF PPE SUPPLIES, ETC. ARE REPORTED DAILY. |
| ASSUMPTION COMMUNITY HOSPITAL | PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY IS DETERMINED BASED ON INFORMATION THAT MAY BE OBTAINED FROM SOURCES OTHER THAN THE PATIENT, SUCH AS EVIDENCE THAT THE PATIENT IS PARTICIPATING IN ONE OR MORE OF THE FOLLOWING:1. STATE-FUNDING PRESCRIPTION PROGRAMS.2. LACHIP, SUBSIDIZED HOUSING, FREE OR REDUCED SCHOOL LUNCHES, ETC. FOR THE PATIENT'S/GUARANTOR'S CHILDREN.3. LOUISIANA FOOD STAMP PROGRAM.4. STATE MEDICARE PROGRAM. FOR PATIENTS WHO HAVE MEDICARE COVERAGE, THE FINANCIAL ASSISTANCE DETERMINATION WILL RELY ON INFORMATION FROM THE MEDICAID PROGRAM, INCLUDING EVIDENCE THAT:- PATIENT IS CURRENTLY ON MEDICAID, BUT HAS A PRIOR BALANCE WITHIN 12 MONTHS OF THE APPROVAL DATE- PATIENT CURRENTLY HAS MEDICAID WITH LIMITED BENEFITS (ONLY COVERS FAMILY PLANNING). -PATIENT IS IN A HOSPICE AND HAS MEDICAID ONLY-PATIENT HAS MEDICAID THROUGH A NON-CONTRACTED STATE-PATIENT QUALIFIES FOR MEDICAID WITH A "SPEND-DOWN REQUIREMENT"-PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (I.E. MEDICAID SPEND-DOWN)-PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY OR ESTATE. THE DUE DILIGENCE EFFORTS TO VERIFY THE ESTATE ARE TO BE DOCUMENTED VIA THE HOSPITAL APPROVED WEBSITE.ADDITIONALLY, A PATIENT MAY BE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THERE IS AN INDEPENDENT, QUALIFIED ATTESTATION THAT THE PATIENT IS HOMELESS. |
| ASSUMPTION COMMUNITY HOSPITAL | PART V, SECTION B, LINE 16J: REGISTRATION PERSONNEL AND FINANCIAL COUNSELORS REFER PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE TO FINANCIAL COUNSELORS TO DISCUSS QUALIFICATION FOR FULLY-DISCOUNTED CARE UNDER THE FINANCIAL ASSISTANCE POLICY. THE POLICY IS ALSO POSTED AT THE HOSPITAL BUSINESS OFFICE AND AT ALL REGISTRATION LOCATIONS. |
| PART V, SECTION B, QUESTION 16A, B, & C | THE FINANCIAL ASSISTANCE POLICY (FAP), FAP APPLICATION FORM, AND A PLAIN-LANGUAGE SUMMARY OF THE FAP ARE AVAILABLE AT: HTTPS://FMOLHS.ORG/FINANCIAL-ASSISTANCE-POLICY/ |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C | FINANCIAL ASSISTANCE IS AVAILABLE FOR INDIVIDUALS WHO ARE INSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. FULLY-DISCOUNTED CARE IS AVAILABLE IF INCOME AND ASSETS MEET CERTAIN FEDERAL POVERTY GUIDELINE LEVELS. FULLY-DISCOUNTED CARE IS ALSO AVAILABLE FOR THOSE PATIENTS WITH CATASTROPHIC MEDICAL BILLS WHERE MEDICAL BILLS EXCEED A CERTAIN PERCENTAGE OF INCOME AND ASSETS. FULLY DISCOUNTED CARE IS ALSO AVAILABLE WHERE THE PATIENT OR OTHER SOURCES CAN PROVIDE SUFFICIENT EVIDENCE OF PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY IS DETERMINED BASED ON INFORMATION THAT MAY BE OBTAINED FROM SOURCES OTHER THAN THE PATIENT, SUCH AS EVIDENCE THAT THE PATIENT IS PARTICIPATING IN ONE OR MORE OF THE FOLLOWING:1. STATE-FUNDED PRESCRIPTION PROGRAMS;2. LACHIP, SUBSIDIZED HOUSING, FREE OR REDUCED SCHOOL LUNCHES, ETC. FOR THE PATIENT/GUARANTOR'S CHILDREN;3. LOUISIANA FOOD STAMP PROGRAM;4. STATE MEDICAID PROGRAM. FOR PATIENTS THAT HAVE MEDICAID COVERAGE, THE FINANCIAL ASSISTANCE DETERMINATION WILL RELY ON INFORMATION FROM THE MEDICAID PROGRAM, INCLUDING EVIDENCE THAT: - PATIENT IS CURRENTLY ON MEDICAID, BUT HAS A PRIOR BALANCE WITHIN 12 MONTHS OF THE APPROVAL DATE - PATIENT CURRENTLY HAS MEDICAID WITH LIMITED BENEFITS (ONLY COVERS FAMILY PLANNING) - PATIENT IS IN A HOSPICE AND HAS MEDICAID ONLY - PATIENT HAS MEDICAID THROUGH A NON-CONTRACTED STATE - PATIENT QUALIFIES FOR MEDICAID WITH A "SPEND-DOWN REQUIREMENT" - PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (I.E., MEDICAID SPEND-DOWN); - PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY OR ESTATE. THE DUE DILIGENCE EFFORTS TO VERIFY THE ESTATE ASSETS ARE TO BE DOCUMENTED VIA THE HOSPITAL APPROVED WEBSITE.ADDITIONALLY, A PATIENT MAY BE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THERE IS AN INDEPENDENT, QUALIFIED ATTESTATION THAT THE PATIENT IS HOMELESS. |
| PART I, LINE 7 | THE OPERATION OF OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS A COMMUNITY BENEFIT IN ITSELF. OUR LADY OF THE LAKE ASSUMPTION IS LOCATED IN AN UNDER-INSURED/LOW INCOME AREA. THE HOSPITAL IS THE ONLY SOURCE OF EMERGENCY HEALTH SERVICES AVAILABLE IN THE IMMEDIATE AREA. THE HOSPITAL DOES NOT HAVE A FORMAL COMMUNITY BENEFIT REPORT BUT IS CONSOLIDATED WITH THE SOLE MEMBER, OUR LADY OF THE LAKE HOSPITAL, INC.PART I, LINE 7, COLUMN FFOR THE PURPOSE OF CALCULATING THE PERCENTAGE IN PART I, LINE 7, COLUMN F, FUNCTIONAL EXPENSES WERE USED WHICH DID NOT INCLUDE BAD DEBT EXPENSE.PART I, LINE 7THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINES 7A-D AND IS BASED ON THE COST ACCOUNTING SYSTEM OF THE ORGANIZATION. FOR PART I LINES 7E, 7F, 7H AND 7I, DIRECT COSTS WERE CAPTURED FROM THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND THE MEDICARE COST REPORT WHERE APPLICABLE. FOR PART I LINE 7G, COST FIGURES WERE CALCULATED FROM DEPARTMENTAL COSTS LESS DIRECT OFFSETTING REVENUE. |
| PART III, LINE 2 | AMOUNT REPRESENTS THE ACTUAL CUSTOMER AMOUNTS DUE TO OUR LADY OF THE LAKE ASSUMPTION THAT WERE WRITTEN OFF BECAUSE THEY WERE UNCOLLECTIBLE. |
| PART III, LINE 4 | THE BAD DEBT FOOTNOTE IS ON PAGE 17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| 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. THE AMOUNT ON PART III, LINE 6 REPRESENTS MEDICARE ALLOWABLE COSTS FROM THE COST REPORT. |
| PART III, LINE 9B | PATIENTS WITH NO MEANS OF PAYMENT MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME, ASSETS, AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS MAY ALSO BE FULLY DISCOUNTED BASED ON A PRESUMPTIVE CHARITY SCORING SYSTEM WHICH IS SIMILAR TO CREDIT SCORING. TO THE EXTENT APPROPRIATE AND PERMITTED BY LAW, FINANCIAL COUNSELING AND SCREENINGS ARE CONDUCTED AT THE TIME OF ENCOUNTER TO ASSIST IN IDENTIFYING PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S POLICY. THESE PROCESSES HELP IDENTIFY (EARLY IN THE PROCESS) PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. THIS HELPS KEEP QUALIFYING PATIENTS OUT OF THE HOSPITAL'S COLLECTION PROCESSES BECAUSE AMOUNTS COVERED BY FINANCIAL ASSISTANCE ARE NOT SUBJECT TO THE HOSPITAL'S COLLECTION PRACTICES. HOWEVER, IF IT IS DETERMINED THAT A PATIENT QUALIFIES FOR DISCOUNTED CARE AFTER THE INDIVIDUAL'S ACCOUNT HAS BEEN SENT TO COLLECTIONS, THE DISCOUNTED AMOUNT IS IMMEDIATELY REMOVED FROM THE COLLECTIONS PROCESS. |
| PART VI, LINE 2 | NEEDS ASSESSMENT THE HOSPITAL WORKED WITH THE ASSUMPTION RURAL HEALTH CLINIC COMMUNITY, THE ASSUMPTION COUNCIL ON AGING, THE ASSUMPTION PARISH SCHOOL NURSES, DEPARTMENT OF HEALTH AND HOSPITALS/OFFICE OF PUBLIC HEALTH, AND OTHER COMMUNITY AND BUSINESS LEADERS TO IDENTIFY THE COMMUNITY'S HEALTH CARE NEEDS. THE IDENTIFIED NEEDS WILL CONTINUE TO BE ADDRESSED THROUGH CONTINUED DIALOGUE AND COLLABORATION WITH SPECIFIC GROUPS IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. IN ADDITION TO WORKING WITH SPECIFIC GROUPS TO ADDRESS THE COMMUNITY'S HEALTH CARE NEEDS, THE HOSPITAL AND THE RURAL HEALTH CARE CLINIC PROVIDE VARIOUS OUTREACH PROGRAMS SUCH AS AN ANNUAL HEALTH FAIR, PERIODIC SMOKING CESSATION CLASSES, AND PERIODIC DIABETES EDUCATION PROGRAMS. |
| PART VI, LINE 3 | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: INDIVIDUALS ARE EDUCATED ABOUT ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AT VARIOUS STAGES OF THE ENCOUNTER WITH OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. PATIENTS ARE INFORMED THROUGH A PATIENT HANDBOOK THAT CONTAINS INFORMATION ON THE FINANCIAL POLICIES OF THE HOSPITAL. ADDITIONALLY, SYSTEMS AND TOOLS ARE UTILIZED TO CONDUCT HIGH LEVEL FINANCIAL SCREENING TO ASSIST IN IDENTIFYING PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. WHEN AND WHERE APPROPRIATE, FINANCIAL COUNSELORS VISIT PATIENTS AT THE TIME OF THE ENCOUNTER AND EXPLAIN THE ASSISTANCE OPTIONS AVAILABLE. FINANCIAL COUNSELORS WORK WITH PATIENTS TO ASSIST WITH ENROLLMENT FOR MEDICAID FOR THOSE WHO ARE ELIGIBLE AS WELL AS TO ASSIST THOSE WHO QUALIFY FOR HOSPITAL FINANCIAL ASSISTANCE.PART VI, LINE 4COMMUNITY INFORMATION ASSUMPTION PARISH IS A VERY RURAL AREA WITH ONLY ONE INCORPORATED COMMUNITY OF APPROXIMATELY 700 RESIDENTS KNOWN AS THE VILLAGE OF NAPOLEONVILLE. ASSUMPTION PARISH IS A COMMUNITY HEAVILY DEPENDENT ON AGRICULTURE (PRIMARILY SUGAR CANE PRODUCTION) AND HAS ONLY A FEW LARGE EMPLOYERS SUCH AS THE ASSUMPTION PARISH SCHOOL SYSTEM AND A LOCAL MARINE SHIPYARD. BASED ON THE MOST RECENT CHNA, THE MEDIAN HOUSEHOLD INCOME FOR THE PARISH FOR 2018 WAS $45,457. OTHER SMALL COMMUNITIES LOCATED IN THE PARISH INCLUDE, LABADIEVILLE, PAINCOURTVILLE, PLATTENVILLE, BERTRANDVILLE, BELLE ROSE, PIERRE PART AND BAYOU L'OURSE. 13.93% OF FAMILIES LIVE BELOW THE POVERTY LINE. 29% OF THE ASSUMPTION PARISH POPULATION DID NOT GRADUATE HIGH SCHOOL. THE MAJORITY OF ASSUMPTION PARISH SPEAKS ONLY ENGLISH, BUT 13% SPEAK INDO-EUROPEAN LANGUAGES.PART VI, LINE 5OTHER INFORMATIONTHE MAJORITY OF THE GOVERNING BODY OF OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS COMPRISED OF INDIVIDUALS WITH A BROAD CROSS-SECTION OF HEALTH CARE AND BUSINESS EXPERIENCE. OUR LADY OF THE LAKE ASSUMPTION HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF THE HOSPITAL DEPARTMENTS AS NEEDED. SURPLUS FUNDS ARE APPLIED TO IMPROVEMENTS IN PATIENT CARE AREAS THROUGH INVESTMENT IN CLINICAL TECHNOLOGY, MEDICAL INFORMATION TECHNOLOGY, AND CONTINUED TRAINING OF CLINICAL STAFF.PART VI, LINE 6AFFILIATED HEALTH CARE SYSTEM OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS A NOT-FOR-PROFIT, NON-STOCK, MEMBER CORPORATION OF WHICH OUR LADY OF THE LAKE HOSPITAL, INC. IS THE SOLE MEMBER. OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS PART OF THE FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC. WHICH INCLUDES SEVERAL HOSPITALS AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATE. OUR LADY OF THE LAKE ASSUMPTION SERVES THE COMMUNITY IN LOUISIANA'S ASSUMPTION PARISH AND SURROUNDING PARISHES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER OUR LADY OF LOURDES REGIONAL MEDICAL CENTERST. FRANCIS MEDICAL CENTER OUR LADY OF THE LAKE ASCENSIONOUR LADY OF THE ANGELS HOSPITAL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KENNETH WESTER | ||||||||||||||
| BOARD MEMBER | $0 | $663,937 | $0 | $210,990 | $0 | $171,813 | $0 | $228,388 | $0 | $29,747 | $0 | $1,304,875 | $0 | $124,160 |
| JEFF LIMBOCKER | ||||||||||||||
| FORMER CFO | $0 | $594,289 | $0 | $299,775 | $0 | $77,089 | $0 | $170,677 | $0 | $25,984 | $0 | $1,167,814 | $0 | $54,592 |
| STEPHANIE G MANSON | ||||||||||||||
| BOARD MEMBER | $0 | $380,045 | $0 | $120,580 | $0 | $1,835 | $0 | $61,009 | $0 | $26,103 | $0 | $589,572 | $0 | $0 |
| LOWELL E STANTON | ||||||||||||||
| REGIONAL CFO | $0 | $410,291 | $0 | $136,397 | $0 | $14,586 | $0 | $0 | $0 | $24,388 | $0 | $585,662 | $0 | $0 |
| KEVIN GUIDRY | ||||||||||||||
| CEO | $0 | $221,437 | $0 | $44,580 | $0 | $125 | $0 | $77,955 | $0 | $15,656 | $0 | $359,753 | $0 | $0 |
| BRIAN F TRIPODE | ||||||||||||||
| SUPV PHARMACY | $178,530 | $0 | $1,000 | $0 | $125 | $0 | $7,406 | $0 | $15,143 | $0 | $202,204 | $0 | $0 | $0 |
| WENDY GAUDET | ||||||||||||||
| INTERIM CEO | $0 | $168,490 | $0 | $10,483 | $0 | $125 | $0 | $7,372 | $0 | $14,859 | $0 | $201,329 | $0 | $0 |
| DONNA M MULLINGS | ||||||||||||||
| DIR. NURSING | $104,450 | $0 | $6,005 | $0 | $125 | $0 | $30,180 | $0 | $20,011 | $0 | $160,771 | $0 | $0 | $0 |
| CHRISTINA HOCKADAY | ||||||||||||||
| FORMER CEO | $0 | $116,351 | $0 | $450 | $0 | $1,513 | $0 | $0 | $0 | $6,375 | $0 | $124,689 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I QUESTION 4A | THE CFO IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR TERMINATION OF EMPLOYMENT WITHOUT CAUSE FOR GOOD REASON AND FOR A CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 18 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. A BOARD MEMBER IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 12 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. A BOARD MEMBER AND THE FORMER CFO ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON, AND FOR A CHANGE OF CONTROL. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS/HER BASE SALARY AND AN ANNUAL INCENTIVE AT TARGET AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. TH ENTITLEMENT PERIOD IS 24 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. |
| PART I QUESTION 4B | FMOLHS MAINTAINS THREE UNFUNDED DEFERRED COMPENSATION PLANS WHICH MEET THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLANS PROVIDE FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURRENCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLANS IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. KENNETH SCOTT WESTER RECEIVED A PAYMENT OF $169,066 AND JEFFREY LIMBOCKER RECEIVED A PAYMENT OF $74,342 FROM THE PLANS IN THE CURRENT YEAR. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 1 | INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI AND IN THE TRADITION OF ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING- WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. |
| FORM 990, PART VI, SECTION A, LINE 6 | OUR LADY OF THE LAKE HOSPITAL (AN IRC SECTION 501 (C) (3) ORGANIZATION) IS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | OUR LADY OF THE LAKE HOSPITAL, AS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL, RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS AND THE OFFICERS OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7B | OUR LADY OF THE LAKE HOSPITAL, INC. AS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL CAN MAKE THE DECISIONS AS FOLLOWS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES, AND PURPOSES OF CORPORATION 2. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF THE CORPORATION. 3. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION OR AFFILIATION, OR PARTICIPATION IN JOINT VENTURES 5. TO DISSOLVE AND DISTRIBUTE ASSETS OF THE CORPORATION 6. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION 7. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY CORPORATION 9. TO APPOINT THE FISCAL AUDITOR OF THE CORPORATION 10. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHANGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION 11. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION 12. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION |
| FORM 990, PART VI, SECTION B, LINE 11B | AFTER PREPARATION OF THE FORM 990 BY KPMG LLP, MANAGEMENT REVIEWED THE FORM 990. A COPY OF THE FORM 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | OLOL ASSUMPTION COMMUNITY HOSPITAL HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY THAT REQUIRES EACH OFFICER, TRUSTEE, BOARD COMMITTEE MEMBER AND EMPLOYEE TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. COMPLETED DISCLOSURE FORMS ARE REVIEWED AND MAINTAINED BY THE CHIEF COMPLIANCE OFFICER. IF ANY TRUSTEE, BOARD COMMITTEE MEMBER OR SENIOR MANAGER HAS A POTENTIAL CONFLICT, THE EXECUTIVE COMMITTEE OF THE BOARD DETERMINES WHETHER ACTION NEEDS TO BE TAKEN AND COMMUNICATES ANY SUCH ACTION TO THE INDIVIDUAL. A POTENTIAL CONFLICT OF ANY OTHER EMPLOYEE IS REVIEWED BY THE CEO OR HIS DESIGNEE. THE EXECUTIVE COMMITTEE, CEO OR DESIGNEE, AS APPLICABLE, DETERMINES IF A CONFLICT OF INTEREST EXISTS OR CREATES THE APPEARANCE OF IMPROPRIETY. IF SUCH A DETERMINATION IS MADE, THE INDIVIDUAL WILL BE EXCUSED FROM PARTICIPATING IN THE BUSINESS DECISION. DURING THE YEAR, ANY CHANGE TO THE INFORMATION IN THE DISCLOSURE STATEMENT MUST BE DISCLOSED PROMPTLY TO THE CHIEF COMPLIANCE OFFICER, WHO TAKES APPROPRIATE ACTION. THE PROCESS ALSO REQUIRES AFFIRMATION FROM EACH INDIVIDUAL THAT HE OR SHE (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) HAS AGREED TO COMPLY WITH THE POLICY; AND (D) UNDERSTANDS THAT OLOL ASSUMPTION COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OLOL ASSUMPTION COMMUNITY HOSPITAL PROVIDES MECHANISMS FOR CONFIDENTIAL REPORTING OF COMPLIANCE ISSUES. THESE MECHANISMS INCLUDE AN ANONYMOUS HOTLINE AND WEB SITE WHERE INDIVIDUALS MAY RAISE ISSUES, SEEK CLARIFICATION, AND REPORT POSSIBLE CONFLICTS OF INTEREST OR OTHER CONCERNS. THESE REPORTS, INCLUDING REPORTS OF POSSIBLE CONFLICTS OF INTEREST, ARE REVIEWED AND INVESTIGATED BY THE CORPORATE COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN. PART VI, SECTION B QUESTION 13 THROUGHOUT THE TAX YEAR, THE ORGANIZATION HAD A WHISTLEBLOWER POLICY IN PLACE ALTHOUGH IT WAS NOT APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE JUNE 30, 2021. THE WHISTLEBLOWER POLICY HAS, HOWEVER, BEEN APPROVED BY THE BOARD OF DIRECTORS OF OUR LADY OF THE LAKE HOSPITAL, INC. (THE ORGANIZATION'S SOLE-MEMBER). |
| FORM 990, PART VI, SECTION B, LINE 15A | OTHER RELATED ORGANIZATIONS SET THE COMPENSATION AND PAY FOR THE EXECUTIVES. THAT BOARD OF DIRECTORS DESIGNATES THE COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY OUTSIDE SOURCES. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. SECTION 1.263(A)-3(N) ELECTION-BOOK CONFORMITY ELECTION OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2021. SECTION 1.263 (A)-1(F) - ELECTION- DE MINIMIS SAFE HARBOR ELECTION OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL HEREBY MAKES THE DE MINIMIS SAFE HARBOR ELECTION UNDER SECTION 1.263(A)-1(F) OF THE TREASURY REGULATIONS, EFFECTIVE ONLY FOR THE TAX YEAR ENDING JUNE 30, 2021. TAXPAYER HAS AN APPLICABLE FINANCIAL STATEMENT FOR THE YEAR OF THE ELECTION. THIS ELECTION PERMITS THE TAXPAYER TO DEDUCT FOR TAX PURPOSES ANY ITEM DEDUCTED UNDER ITS BOOK POLICY THAT DOES NOT EXCEED $5,000 PER INVOICE (OR PER ITEM, AS SUBSTANTIATED BY THE INVOICE) OR ITEMS HAVING AN ECONOMIC USEFUL LIFE OF TWELVE MONTHS OR LESS AS DESCRIBED IN SECTION 1.263(A)-1(F)(1)(I). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ST BERNARD HEALTH FUND | ||||||||||
| 4200 ESSEN LANE | BATON ROUGE | LA | 70809 | 204685614 | HEALTHCARE | LA | 501(C)(3) | LINE 12A, I | FMOL | 0 |
| HEALTH CARE CENTERS IN SCHOOLS | ||||||||||
| 5000 HENNESSY BLVD | BATON ROUGE | LA | 70808 | 721443935 | HEALTHCARE | LA | 501(C)(3) | LINE 10 | OLOL | 0 |
| ST DOMINIC HEALTH SERVICES INC | ||||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 640714999 | HOLDING CO | MS | 501(C)(3) | LINE 12C, III-FI | FMOLHS | 0 |
| COMMUNITY HEALTH SERVICES - ST DOMINIC | ||||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 640884870 | HEALTH PROGRAM | MS | 501(C)(3) | LINE 10 | SDHS | 0 |
| ST DOMINIC - JACKSON MEMORIAL HOSPITAL | ||||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 640303091 | HOSPITAL | MS | 501(C)(3) | LINE 3 | SDHS | 0 |
| ST DOMINIC - HEALTH SERVICES FOUNDATION | ||||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 431992975 | FUNDRAISING | MS | 501(C)(3) | LINE 7 | SDHS | 0 |
| ST CATHERINE'S VILLAGE INC | ||||||||||
| 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 640714997 | RET HOME | MS | 501(C)(3) | LINE 10 | SDHS | 0 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (24 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| LOURDES IMAGING DEVELOPMENT LLC | ||||||||||
| 4801 AMBASSADOR CAFFERY PKWY | LAFAYETTE | LA | 70508 | 208326287 | REAL ESTATE | LA | N/A | N/A | 0 | 0 |
| PARK PLACE SURGERY CENTER LLC | ||||||||||
| 4811 AMBASSADOR CAFFERY PKWY | LAFAYETTE | LA | 70508 | 721404092 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| BRPT LAKE REHABILITATION CENTERS LLC | ||||||||||
| 175 S ENGLISH STATION RD STE 218 | LOUISVILLE | KY | 40245 | 721506100 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| CONVENIENT CARE LLC | ||||||||||
| 10319 JEFFERSON HIGHWAY | BATON ROUGE | LA | 70809 | 721439481 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| SURGICAL SPECIALTY CENTER OF BATON ROUGE LLC | ||||||||||
| 8080 BLUEBONNET BLVD | BATON ROUGE | LA | 70810 | 263120962 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| ST ELIZABETH-MARY BIRD PERKINS CANCER CENTER LLC | ||||||||||
| 4950 ESSEN LANE | BATON ROUGE | LA | 70809 | 260628752 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| NORTHEAST LA CANCER INSTITUTE LLC | ||||||||||
| 411 CALYPSO STREET | MONROE | LA | 71201 | 721329499 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LHCG-XIII LLC DBA LOURDES HOME HEALTH | ||||||||||
| 901 S HUGH WALLIS ROAD | LAFAYETTE | LA | 70508 | 208068308 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LOURDES AFTER HOURS LLC | ||||||||||
| 7777 HENNESSY BLVD SUITE 1004-202 | BATON ROUGE | LA | 70809 | 201367299 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LAKE URGENT CARE ASCENSION LLC | ||||||||||
| 10319 JEFFERSON HIGHWAY | BATON ROUGE | LA | 70809 | 352463092 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| OLOLUSP SURGERY CENTER LLC | ||||||||||
| 15305 DALLAS PKWY STE 1600 LB 28 | ADDISON | TX | 75001 | 352457810 | HEALTHCARE | TX | N/A | N/A | 0 | 0 |
| ST FRANCIS URGENT CARE LLC | ||||||||||
| 10319 JEFFERSON HIGHWAY | BATON ROUGE | LA | 70809 | 474013731 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| GAMMA KNIFE OF LOUISIANA LLC | ||||||||||
| 4950 ESSEN LANE | BATON ROUGE | LA | 70809 | 811827194 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LHCG LXVII LLC | ||||||||||
| 901 S HUGH WALLIS ROAD | LAFAYETTE | LA | 70508 | 474283509 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| PREMIER HEALTH HOLDINGS LLC | ||||||||||
| 10319 JEFFERSON HIGHWAY | BATON ROUGE | LA | 70809 | 472665226 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| PINNACLE CARE HOLDINGS LLC | ||||||||||
| 5627 S SHERWOOD FOREST BLVD | BATON ROUGE | LA | 70816 | 821637627 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | ||||||||||
| C/O C T CORPORATION SYSTEM 3867 PLA | BATON ROUGE | LA | 70816 | 943419282 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| HIGHLAND MEDICAL ARTS LLC | ||||||||||
| PO BOX 55769 | JACKSON | MS | 39296 | 743073171 | MED BUILDING | MS | N/A | N/A | 0 | 0 |
| FREMAUX OFFICE MM LLC | ||||||||||
| 3500 NORTH CAUSEWAY BOULEVARD STE 6 | METAIRIE | LA | 70002 | 843084552 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| FREMAUX MOB LLC | ||||||||||
| 3500 NORTH CAUSEWAY BOULEVARD STE 6 | METAIRIE | LA | 70002 | MED BLDG | LA | N/A | N/A | 0 | 0 | |
| SHP MANAGING MEMBER LLC | ||||||||||
| 7015 HIGHWAY 190 E SERVICE ROAD STE | COVINGTON | LA | 70433 | 832168844 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| OLOL PONTCHARTRAIN SURGERY CENTER LLC | ||||||||||
| 4200 ESSEN LANE | BATON ROUGE | LA | 70809 | 461379031 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| LAKE SURGICAL HOSPITAL (SLIDELL) LLC | ||||||||||
| 1700 LINDBERG DR | SLIDELL | LA | 70458 | 474228147 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
| PREMIER HEALTH HOLDINGS LLC | ||||||||||
| 10319 JEFFERSON HIGHWAY | BATON ROUGE | LA | 70809 | 472665226 | HEALTHCARE | LA | N/A | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LOUISE INSURANCE COMPANY | |||||||||||||
| PO BOX 1051 KY1-1102 CAYMAN ISLANDS | CAYMAN ISLANDS | CJ | INSURANCE | CJ | N/A | C | 0 | ||||||
| FRANCISICAN HEALTH & WELLNESS SERVICES INC | |||||||||||||
| HEALTHCARE | N/A | C | 0 | 4200 ESSEN LANE | BATON ROUGE | LA | 70809 | 455492379 | LA | ||||
| FMOL HEALTH SYSTEM HOLDINGS INC | |||||||||||||
| INVESTMENT | N/A | C | 0 | 4200 ESSEN LANE | BATON ROUGE | LA | 70809 | 454405024 | LA | ||||
| ST DOMINIC MADISON HEALTH SERVICES INC | |||||||||||||
| HEALTHCARE | N/A | C | 0 | 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 202870254 | MS | ||||
| ST DOMINIC INTEGRATED SERVICES INC | |||||||||||||
| INVESTMENTS | N/A | C | 0 | 969 LAKELAND DRIVE | JACKSON | MS | 39216 | 271493623 | MS | ||||
| LAFAYETTE SURGICARE INC | |||||||||||||
| HEALTHCARE | N/A | C | 0 | C/O C T CORPORATION SYSTEM 3867 PLA | BATON ROUGE | LA | 70816 | 943419282 | LA | ||||
| FIRST INTERMED CORPORATION | |||||||||||||
| MEDICAL SERVICES | N/A | C | 0 | 308 CORPORATE DRIVE | RIDGELAND | MS | 39157 | 640824796 | MS | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |