2022-05-13T17:25:55-05:00 2021-06-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2020-07-01 463123178 OUR LADY OF THE ANGELS HOSPITAL INC OURL 9857306700 4200 ESSEN LANE BATON ROUGE LA 70809 LOWELL STANTON REGIONAL CFO 9857306700 2022-05-13 1 LOWELL STANTON XXX-XX-XXXX RYAN HOOKS P00746825 2253444000 2022-05-11 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z RENE RAGAS 4200 ESSEN LANE BATON ROUGE LA 70809 84960844 0 0928 X N/A X 2013 LA THE HOSPITAL'S PURPOSE IS TO PROVIDE CARE FOR THE ILL, INJURED, OR (SEE SCHEDULE O) DISABLED PERSONS & TO PROVIDE FOR RESEARCH, EDUCATION, & THE ENHANCEMENT OF HEALTH OF THOSE IN SOUTHEAST LOUISIANA. 11 9 560 9 0 0 242916 8081604 71301740 76842347 138027 36893 -7238 0 71675445 84960844 14000 2500 0 0 31625126 33627795 0 0 0 37259538 35509131 68898664 69139426 2776781 15821418 52943208 64080884 33634855 32582389 19308353 31498495 X SEE SCHEDULE O. 0 0 51914910 2500 76842347 OUR LADY OF THE ANGELS HOSPITAL, INC. PROVIDES QUALITY HOSPITAL AND MEDICAL SERVICES PRIMARILY TO RESIDENTS OF SOUTHEAST LOUISIANA. THE HOSPITAL IS AN ACTIVE, CARING MEMBER OF THE COMMUNITIES IT SERVES. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTHCARE NEEDS OF THE PEOPLE OF GOD, THE HOSPITAL HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. THE HOSPITAL PROVIDED 56 LICENSED BEDS, 10,115 INPATIENT DAYS AND 17,447 ER VISITS IN THE YEAR ENDED JUNE 30, 2021. 51914910 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 5 0 1 560 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 X AMANDA HYMEL 9857306700 5959 S SHERWOOD FOREST BLVD BATON ROUGE LA 70809 BERNIE CHASCIN BOARD MEMBER 2.00 0.00 X 0 0 0 CHRIS TREVINO MD BOARD MEMBER/PHYSICIAN 2.00 40.00 X 0 190662 8956 CRAIG ROBICHAUX CHAIR 2.00 0.00 X X 0 0 0 HENRY HARRISON BOARD MEMBER 2.00 0.00 X 0 0 0 JUDITH WAMSLEY SECRETARY 2.00 0.00 X X 0 0 0 LEO MICKENHEIM VICE CHAIR 2.00 0.00 X X 0 0 0 RENE RAGAS PRESIDENT AND CEO 2.00 51.00 X X 0 474302 133773 ROBERT BURGESS BOARD MEMBER 2.00 0.00 X 0 0 0 ROGER KEESE BOARD MEMBER 2.00 0.00 X 0 0 0 SR EILEEN ROWE BOARD MEMBER 2.00 2.50 X 0 0 0 WILLIAM WAINWRIGHT BOARD MEMBER 2.00 0.00 X 0 0 0 LOWELL STANTON REGIONAL CFO 2.00 52.50 X 0 561274 24388 DEBBIE WILLIAMS VP, OPERATIONS 40.00 0.00 X 174998 0 9038 RALPH SERPAS VP, CNO 40.00 0.00 X 200650 0 34386 CONSTANCE GISTAND HOSPITALIST 40.00 0.00 X 354543 0 21800 GOLAM NOAZ STAFF PHYSICIAN 40.00 0.00 X 317072 0 21364 HAMID HUSSAIN STAFF PHYSICIAN 40.00 0.00 X 594116 0 37010 MARIA CHRISTINA BUENAFLOR STAFF PHYSICIAN 40.00 0.00 X 304347 0 21861 STEVEN OGDEN STAFF PHYSICIAN 40.00 0.00 X 300948 0 13285 JEFFREY LIMBOCKER FORMER REGIONAL CFO 0.00 40.00 X 0 971153 196661 2246674 2197391 522522 33 1 1 0 FMOL HEALTH SYSTEM 4200 ESSEN LANE BATON ROUGE LA 70809 MANAGEMENT SERVICES 4646732 MERCY SPECIALIZED BILLING SVCS 655 MARYVILLE CENTRE ST LOUIS MO 63141 EPIC AND BILLING SERVICES 3135095 LSUHSC-NEW ORLEANS 433 BOLIVAR ST NEW ORLEANS LA 70112 PROF. MEDICAL SVCS 2360222 WASHINGTON PARISH EMERGENCY 5000 AMBASSADOR CAFFERY PKWY BLDG LAFAYETTE LA 70508 CONTRACT PROF. SVCS 2033548 REGIONAL RADIOLOGY LLC PO BOX 1089 COVINGTON LA 70434 DIAGNOSTIC RADIOLOGY 1296917 27 8081604 8081604 PATIENT SERVICE REVENUE 622110 74944215 74944215 PHARMACY 622110 1044219 1044219 OTHER INCOME 900099 646489 646489 CAFETERIA SALES 622110 162325 162325 PURCHASE DISCOUNTS 622110 42383 42383 2716 2716 76842347 36893 36893 84960844 76842347 0 36893 2500 2500 385161 289862 95299 27931154 21020242 6910912 481710 361650 120060 2921695 2193713 727982 1908075 1432513 475562 11726003 9002715 2723288 81901 81901 6821200 2857330 3963870 56604 23613 32991 3388837 3613344 -224507 122839 51244 71595 6483520 6422278 61242 26413 11019 15394 12843 5358 7485 -3737 422 -4159 712325 619722 92603 909364 71856 837508 MEDICAL SUPPLIES EXPENS 4236492 3128449 1108043 REPAIRS & MAINTENANCE 934527 807080 127447 69139426 51914910 17224516 0 41073735 32512308 50230 -3120082 557879 560158 5641360 5547537 21196809 1821395 5613202 19375414 6802 9205549 52943208 64080884 23010713 14752933 11079593 5013202 -455451 12816254 33634855 32582389 X 19308353 31498495 19308353 31498495 52943208 64080884 X 15821418 -2076 -3629200 X 0 1 X 1 0 X 125000 125000 5099525 1065132 4034393 2991770 756263 2235507 12980514 12980514 19375414 DUE TO/FROM AFFILIATES 9205549 9205549 CAPITAL LEASES 12296029 DEFERRED TAX LIABILITY 520225 12816254 X PART X, LINE 2: 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. 1 1 1 X 250.000000000000 0 1 1 1 0 1 1 1562015 1562015 24134061 24134061 25696076 25696076 0 0.00000 6857187 64130 6793057 0.09830 6857187 64130 6793057 0.09830 32553263 25760206 6793057 0.09830 0 4711092 10014853 10562568 -547715 X 1 1 1 1 OUR LADY OF THE ANGELS HOSPITAL INC 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 WWW.OLOAH.ORG 2203781960 X X X X OUR LADY OF THE ANGELS HOSPITAL INC 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V SECTION B X X 1 18 0 1 0 1 X 250.000000000000 0.000000000000 X X X X X 1 1 X X X 1 X SEE SUPPLEMENT AT PART V X SEE SUPPLEMENT AT PART V X SEE SUPPLEMENT AT PART V X X X X X X X 1 X 0 X X X X 1 X 0 0 OUR LADY OF THE ANGELS HOSPITAL, INC. PART V, SECTION B, LINE 5: THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM THE COMMUNITY BY CONDUCTING TWO FOCUS GROUP SESSIONS WITH INDIVIDUALS REPRESENTING COMMUNITY AND FAITH BASED ORGANIZATIONS ACTIVE IN THE COMMUNITY. THE HOSPITAL ALSO ADMINISTERED A SURVEY THAT HAS 115 COMMUNITY MEMBER RESPONSES. THE HOSPITAL CONDUCTED ONE-ON-ONE INTERVIEWS WHICH INCLUDED DR. GINA LAGRADE, REGIONAL MEDICAL DIRECTOR, OFFICE OF PUBLIC HEALTH, REGION IX, DEPARTMENT OF HEALTH & HOSPITALS, WHO HAS A SPECIALIZED KNOWLEDGE IN PUBLIC HEALTH. OUR LADY OF THE ANGELS HOSPITAL, INC. PART V, SECTION B, LINE 11: OUR LADY OF THE ANGELS HOSPITAL (OLOAH), A MEMBER OF THE FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM (FMOLHS), CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2018. THE SIGNIFICANT HEALTH NEEDS/PRIORITY AREAS IDENTIFIED DURING THE 2018 CHNA PROCESS WERE:1. BEHAVIORAL HEALTH2. BARRIERS TO HEALTHY CHOICES. OLOAH'S 2018 CHNA IDENTIFIED TWO PRIORITY AREAS BEHAVIORAL HEALTH, AND BARRIERS TO HEALTHY CHOICES, WHICH WERE THE AREAS OLOAH SOUGHT TO ADDRESS IN 2021 AS IT WENT THROUGH THE PROCESS OF THE 2021 CHNA. WHILE OLOAH HAS BEEN ACTIVELY WORKING TO FIGHT COVID-19 FOR THE MAJORITY OF THE PREVIOUS CHNA MEASUREMENT PERIOD, IT HAS REMAINED AS ACTIVE AS POSSIBLE IN THE COMMUNITY/SERVICE AREA WHILE PROTECTING THE SAFETY OF THE RESIDENTS AND OLOAH TEAM MEMBERS DURING THE 2021 FISCAL YEAR. HONORING ITS ROLE AS AN ANCHOR INSTITUTION WITHIN THE WASHINGTON PARISH COMMUNITY, AND ITS COMMITMENT TO SERVE AT-RISK POPULATIONS ACROSS THE REGION, OLOAH INSTITUTED A COMMUNITY COVID-19 VACCINATION PROGRAM AIMED AT HELPING TO MAXIMIZE THE IMMUNIZATION RATE FOR REGION 9 OF SOUTHEAST LOUISIANA. TO DO SO, OLOAH PARTNERED WITH LOCAL CHURCHES, SCHOOLS, AND BUSINESSES AND PROVIDED VACCINATION CLINICS STAFFED BY OLOAH'S EMPLOYEES. THESE EVENTS CAME AT NO-COST TO THE ORGANIZATIONS, AND LED TO A TOTAL OF 963 FULL VACCINATION REGIMENS COMPLETED BY OLOAH IN REGION 9. OLOAH ALSO ESTABLISHED AND STAFFED A VACCINE CLINIC TO ADDRESS THE COVID-19 IMMUNIZATION NEEDS FOR WASHINGTON PARISH, AND ACT AS A CENTRALIZED LOCATION FOR THE COMMUNITY TO BE VACCINATED. BEGINNING IN JANUARY OF 2021, THE CLINIC ADMINISTERED A TOTAL OF 4,417 VACCINES, AND ALSO ACTED AS A DRIVE-THROUGH COVID TESTING SITE FOR THE COMMUNITY DURING THE COVID-19 SURGES EXPERIENCED THROUGHOUT THE YEAR. IN 2017, OUR LADY OF THE ANGELS HELPED ESTABLISH A HEALTHY COMMUNITIES COALITION FOR WASHINGTON PARISH. A STRATEGIC DECISION BASED ON THE RESULTS OF THE 2016 CHNA, THIS MULTI-SECTOR COLLABORATIVE PARTNERSHIP LAUNCHED SEVERAL INITIATIVES AIMED AT IMPROVING HEALTH OUTCOMES, HEALTH ACCESS AWARENESS, HEALTHCARE CONFIDENCE AND THE OVERALL STANDARD OF LIVING FOR THE PEOPLE OF WASHINGTON PARISH. AS A RESULT OF THESE COLLABORATIVE EFFORTS, THE LOCAL COMMUNITY CONTINUES TO WITNESS A GROUNDSWELL OF POSITIVE CHANGE AND COMMUNITY ENGAGEMENT. THIS COALITION UNDER THE UMBRELLA ORGANIZATIONS "BOGALUSA STRONG AND "FOCUS FRANKLINTON" IS CURRENTLY COMPRISED OF MEMBER ORGANIZATIONS SUCH AS LSU AGRICULTURAL CENTER, THE TOWN OF FRANKLINTON AND THE CITY OF BOGALUSA, THE MAYOR OF BOGALUSA, AND MORE THAN 85 COMMUNITY PARTNERS. THROUGHOUT 2021, OLOAH MAINTAINED A MONTHLY CADENCE OF COALITION MEETINGS AND ACTIVELY PARTICIPATED IN COMMUNITY PROJECTS INCLUDING: THE BOGALUSA UNITY INITIATIVE, EXPANDED PAINTED PLAYGROUND PROJECTS, COMMUNITY GARDENS, BREAST CANCER SUPPORT GROUP, LOCAL PARK REFURBISHMENT, AND THE EXPANSION OF AN ECUMENICAL PASTORAL ALLIANCE.IN ADDITION TO ITS COALITION BUILDING AND SUPPORT, OLOAH CONTINUED SERVICES AND HEALTH EDUCATION FOR THE WASHINGTON PARISH. OLOAH ENGAGED IN SENIOR EDUCATION WITH MONTHLY EDUCATION PROGRAMS AND HEALTH SCREENINGS AT THE COUNCIL ON AGING AND WESTMINSTER WOODS APARTMENTS. OLOAH STAFF MADE 30 HOME VISITS WITH BOTH NURSE PRACTITIONERS AND FAMILY MEDICINE RESIDENTS FROM THE LSU RURAL FAMILY MEDICINE RESIDENCY PROGRAM. TOGETHER WITH THE LSU RURAL FAMILY MEDICINE RESIDENCY PROGRAM LOCATED ON-SITE, OLOAH PERFORMED MORE THAN 500 PRO-BONO STUDENT ATHLETE SPORTS PHYSICALS FOR THE LOCAL PUBLIC SCHOOLS. OLOAH ALSO CONTINUED TO HOST A TOBACCO CESSATION PROGRAM THROUGH ITS CONTRACT WITH AN LSU NEW ORLEANS TOBACCO CESSATION SPECIALIST, AND COLLABORATED WITH LOCAL, STATE AND COMMUNITY PARTNERS IN ORDER TO STUDY AND RESPOND TO THE OPIOID EPIDEMIC AND SUBSTANCE ABUSE ISSUES IN WASHINGTON PARISH, PARTICULARLY THROUGH OLOAH'S PARTICIPATION IN A NOWS (NEONATAL OPIOID WITHDRAWAL SYNDROME) GRANT AND PROGRAM.AS A PART OF OLOAH'S EFFORTS TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH, AND THUS DECREASE THE BARRIERS TO HEALTHY LIVING, A CONCERTED EFFORT WAS MADE TO ADDRESS THE ISSUES AND SITUATIONS THAT HAVE HISTORICALLY PREVENTED THE LOCAL POPULATION FROM RECEIVED NECESSARY CARE. THIS INCLUDED BUT IS NOT LIMITED TO: PAYING FOR $14,030 WORTH OF POST-DISCHARGE TRANSPORTATION COSTS FOR PATIENTS WITHOUT RELIABLE TRANSPORTATION, AND COVERING THE COST OF AT HOME OXYGEN TREATMENTS FOR A TOTAL OF $3,080. IN ADDITION, OLOAH SOCIAL SERVICES DEPARTMENT ENGAGED THE COMMUNITY THROUGH ONE-ON-ONE AND GROUP EDUCATION CONCERNING BEHAVIORAL HEALTH AND SUBSTANCE ABUSE. IN 2021, THIS AMOUNTED TO A TOTAL OF 2,769 ENCOUNTERS.AS A PART OF ITS 2021 APPROACH TO COMMUNITY BENEFIT, OLOAH ESTABLISHED A COMMUNITY BENEFIT WORKGROUP, COMPOSED ENTIRELY OF EMPLOYEE VOLUNTEERS, THAT MET QUARTERLY DURING WORK HOURS TO SERVE AS AN ADVISORY COUNCIL FOR THE OLOAH'S COMMUNITY BENEFIT EFFORTS. THE GOAL OF THE WORKGROUP IS TO TAKE REGULAR INVENTORY OF OLOAH'S COMMUNITY BENEFIT PROGRAMS TO MAKE RECOMMENDATIONS FOR THE MAXIMIZING OF THE PROGRAM'S EFFECTIVENESS, WITH A FOCUS TOWARDS AT-RISK, MARGINALIZED, AND MINORITY POPULATIONS. OUR LADY OF THE ANGELS HOSPITAL, INC. PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: 1. THE PATIENT RECEIVING FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOSPITAL; 2. STATE-FUNDED PRESCRIPTION PROGRAMS; 3. HOMELESS, INDIGENT, OR HOMELESS CLINIC PATIENT; 4. PATIENTS' CHILDREN WHO QUALIFY FOR OTHER FINANCIAL ASSISTANCE PROGRAMS; 5. PATIENT ELIGIBLE FOR FOOD STAMPS; 6. MEDICAID ELIGIBLE PATIENT; 7. PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY; 8. PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY OUR LADY OF THE ANGELS HOSPITAL, INC. PART V, SECTION B, LINE 16J: REGISTRATION PERSONNEL REFER UNINSURED AND/OR LOW-INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, 16A, B, & C THE FINANCIAL ASSISTANCE POLICY (FAP), FAP APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY OF THE FAP WERE ALL AVAILABLE AT: HTTPS://FMOLHS.ORG/FINANCIAL-ASSISTANCE-POLICY/ PART V, SECTION B, LINE 7A THE CHNA CAN BE LOCATED AT HTTPS://OLOAH.ORG/ABOUT-US/COMMUNITY-BENEFITS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART I, LINE 3C FINANCIAL ASSISTANCE IS AVAILABLE FOR INDIVIDUALS WHO ARE UNINSURED, 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. PART I, LINE 7F FOR 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 7 THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINE 7A-7D AND WAS OBTAINED FROM THE HOSPITAL'S MEDICARE COST REPORT. PART III, LINE 2: AMOUNT REPRESENTS THE ACTUAL CUSTOMER AMOUNTS DUE TO OUR LADY OF THE ANGELS HOSPITAL THAT WERE WRITTEN OFF BECAUSE THEY WERE UNCOLLECTIBLE. PART III, LINE 4: THE BAD DEBT FOOTNOTE IS ON PAGE 18 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. PART III, LINE 9B: PATIENTS WITH NO MEANS OF PAYMENT MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME, ASSETS, RESIDENCY, AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. 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: RESPONDING TO THE HEALTH NEEDS OF OUR COMMUNITY, ESPECIALLY TO THOSE MOST IN NEED, IS PRIMARY TO THE HOSPITAL'S MISSION. AS SUCH, OUR LADY OF THE ANGELS HOSPITAL WORKS CLOSELY WITH CHARITABLE ORGANIZATIONS TO DEFINE COMMUNITY NEEDS AND CONSOLIDATE EFFORTS TO MEET THOSE COMMUNITY NEEDS. OUR LADY OF THE ANGELS ADOPTED A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT BY JUNE 30, 2019 AND WILL CONTINUE TO USE COMMUNITY BASED DATA TO SUPPORT DECISIONS FOR OUTREACH IN THE COMMUNITY. PART VI, LINE 3: 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 ANGELS HOSPITAL. PATIENTS ARE INFORMED THROUGH A PATIENT HANDBOOK THAT CONTAINS INFORMATION ON THE FINANCIAL POLICIES OF THE HOSPITAL. 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 4: OUR LADY OF THE ANGELS HOSPITAL IS A COMMUNITY-BASED, NOT-FOR-PROFIT HOSPITAL LOCATED IN BOGALUSA, LOUISIANA, THAT SERVES WASHINGTON PARISH AND PORTIONS OF THE SURROUNDING PARISHES. THE HOSPITAL'S PRIMARY SERVICE AREA IS WASHINGTON PARISH. BASED ON THE MOST RECENT CHNA, WASHINGTON PARISH HAS A POPULATION OF APPROXIMATELY 46,371, AND THE SENIOR POPULATION COMPRISES ABOUT 17% OF THE TOTAL POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $30,705, WHICH IS SIGNIFICANTLY LOWER THAN BOTH THE STATE AND NATIONAL AVERAGE. THE PERCENTAGE OF INDIVIDUALS RECEIVING SUPPLEMENTAL NUTRITIONAL ASSISTANCE PROGRAM (SNAP) BENEFITS IS 29% WHICH IS NEARLY DOUBLE THE STATE (16%) AND NATIONAL (13%) AVERAGES. PART VI, LINE 5: OUR LADY OF THE ANGELS HOSPITAL PARTICIPATES IN COMMUNITY IMPROVEMENT ACTIVITIES BECAUSE IT UNDERSTANDS THAT IMPROVEMENTS TO A COMMUNITY HAVE A DIRECT LINK TO THE IMPROVED HEALTH OF COMMUNITY RESIDENTS. COMMUNITY IMPROVEMENT ACTIVITIES INCLUDE THE FOLLOWING: OUR LADY OF THE ANGELS ESTABLISHED CLINICS LOCATED IN AREAS WITHIN UNDER-INSURED/LOW INCOME AREAS. THIS ALLOWS INDIVIDUALS TO ACCESS HEALTH CARE SERVICE THAT MAY BE FOREGONE OR POSTPONED RESULTING IN MORE INTENSE HEALTH ISSUES/PROBLEMS. OUR LADY OF THE ANGELS PROVIDES OVERSIGHT OF COMMUNITY PROGRAMS AND ACTIVITIES AND COORDINATED HEALTH CARE SCREENING FOR VARIOUS HEALTH ISSUES. THE MAJORITY OF THE GOVERNING BODY OF OUR LADY OF THE ANGELS HOSPITAL IS COMPRISED OF INDIVIDUALS FROM A BROAD CROSS-SECTION OF THE COMMUNITY WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. OUR LADY OF THE ANGELS HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL 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 6: OUR LADY OF THE ANGELS HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL, NON-STOCK, MEMBER CORPORATION OF WHICH FRANCISCIAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC. (FMOL HEALTH SYSTEM) IS THE SOLE MEMBER. OUR LADY OF THE ANGELS HOSPITAL IS PART OF THE FMOL HEALTH SYSTEM WHICH INCLUDES SEVERAL HOSPITALS AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATE OF LOUISIANA. OUR LADY OF THE ANGELS HOSPITAL SERVES THE COMMUNITY IN WASHINGTON PARISH AND SURROUNDING PARISHES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: - OUR LADY OF THE LAKE HOSPITAL- OUR LADY OF LOURDES REGIONAL MEDICAL CENTER- ST. FRANCIS MEDICAL CENTER- OUR LADY OF THE LAKE ASSUMPTION HOSPITAL 0 1 0 0 0 0 0 0 0 JEFFREY LIMBOCKER FORMER REGIONAL CFO 0 594289 0 299775 0 77089 0 170677 0 25984 0 1167814 0 54592 HAMID HUSSAIN STAFF PHYSICIAN 545238 0 46556 0 2322 0 11400 0 25610 0 631126 0 0 0 RENE RAGAS PRESIDENT AND CEO 0 352813 0 119654 0 1835 0 107590 0 26183 0 608075 0 0 LOWELL STANTON REGIONAL CFO 0 410291 0 136397 0 14586 0 0 0 24388 0 585662 0 0 CONSTANCE GISTAND HOSPITALIST 315688 0 37613 0 1242 0 11400 0 10400 0 376343 0 0 0 GOLAM NOAZ STAFF PHYSICIAN 237469 0 79171 0 432 0 11400 0 9964 0 338436 0 0 0 MARIA CHRISTINA BUENAFLOR STAFF PHYSICIAN 295469 0 8068 0 810 0 11400 0 10461 0 326208 0 0 0 STEVEN OGDEN STAFF PHYSICIAN 241990 0 58526 0 432 0 11400 0 1885 0 314233 0 0 0 RALPH SERPAS VP, CNO 160865 0 37950 0 1835 0 8338 0 26048 0 235036 0 0 0 CHRIS TREVINO MD BOARD MEMBER/PHYSICIAN 0 156355 0 33280 0 1027 0 7629 0 1327 0 199618 0 0 DEBBIE WILLIAMS VP, OPERATIONS 143322 0 29841 0 1835 0 6932 0 2106 0 184036 0 0 0 PART 1, QUESTION 3 THE CEO IS PAID BY FMOL HEALTH SYSTEM, A RELATED TAX EXEMPT ORGANIZATION. THE FMOLHS BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE CEO'S COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION STUDY/SURVEY FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE. PART 1, QUESTION 4A THE PRESIDENT AND REGIONAL CFO ARE 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 GENERALLY 18 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. THE FORMER REGIONAL CHO 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 GENERALLY 24 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. PART 1, 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 THE APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. JEFF LIMBOCKER RECEIVED A PAYMENT OF $74,342 FROM THE PLANS IN THE CURRENT YEAR. FORM 990, PART III, LINE 1 INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI AND IN THE TRADITION OF THE 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 PART VI, SECTION B, QUESTIONS 13 & 14: THROUGHOUT THE TAX YEAR, THE ORGANIZATION HAD A DOCUMENT RETENTION POLICY AND A WHISTLEBLOWER POLICY IN PLACE ALTHOUGH THEY WERE NOT APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS OR A COMMITTEE THEREOF BEFORE JUNE 30, 2021. FORM 990, PART VI, SECTION A, LINE 6 FMOL HEALTH SYSTEM (AN IRC SECTION 501(C)(3) ORGANIZATION) IS THE SOLE MEMBER OF OUR LADY OF THE ANGELS HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A FMOL HEALTH SYSTEM, AS THE SOLE MEMBER OF OUR LADY OF THE ANGELS HOSPITAL, INC., RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF OUR LADY OF THE ANGELS HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B THE RESERVED POWERS TO FMOL HEALTH SYSTEM, INC. ARE AS FOLLOWS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES AND PURPOSES OF CORPORATION 2. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION 3. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION, OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES 5. TO DISSOLVE AND TO 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 THE CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION 9. TO APPOINT THE FISCAL AUDITOR FOR THE CORPORATION 10. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHARGE 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 AND REVIEW BY KPMG, LLP, MANAGEMENT WILL REVIEW THE FORM 990. A COPY OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OUR LADY OF THE ANGELS HOSPITAL, INC. 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 MAINTAIN- ED 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 OUR LADY OF THE ANGELS HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OUR LADY OF THE ANGELS HOSPITAL, INC. 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. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT & CEO, AND REGIONAL CFO OF THIS ORGANIZATION ARE EMPLOYEES OF FMOL HEALTH SYSTEM, A RELATED TAX-EXEMPT ORGANIZATION, WHOSE SALARIES ARE DETERMINED BY THE PAY PRACTICES OF THAT ORGANIZATION. SUCH PAY PRACTICES INCLUDE THE USE OF AN INDEPENDENT BOARD COMMITTEE WHICH REVIEWS COMPENSATION ANNUALLY AFTER OBTAINING AND RELYING UPON INDUSTRY WIDE COMPENSATION INFORMATION FROM OUTSIDE SOURCES. THE BOARD COMMITTEE APPROPRIATELY DOCUMENTS ITS DECISIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CAPITAL TRANSFER -3,629,195. ROUNDING -5. SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION OUR LADY OF THE ANGELS HOSPITAL INC. DOES HAVE APPLICABLE FINANCIAL STATEMENTS FOR THE YEAR OF THE ELECTION, AND INTEND TO APPLY THE DEMINIMIS SAFE HARBOR 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)(II). SECTION 1.263(A)-3(N) ELECTION- BOOK CONFORMITY ELECTION OUR LADY OF THE ANGELS HOSPITAL INC. IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THOSE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2021. 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