2022-05-16T16:13:50-05:00 2021-06-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2020-07-01 720423635 OUR LADY OF LOURDES REGIONAL MEDICAL CENTER INC OURL 2259232701 4200 ESSEN LANE BATON ROUGE LA 70809 KATHLEEN HEALY-COLLIER CEO & MARKET PRESIDENT 2259232701 2022-05-16 1 KATHLEEN HEALY-COLLIER 999009999 MAXWELL BARLOW P01959439 2253444000 2022-05-15 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z KATHLEEN HEALY-COLLIER 4200 ESSEN LANE BATON ROUGE LA 70809 548382432 0 X LOURDESRMC.COM X 1957 LA TO PROVIDE FOR THE CARE OF THE ILL, INJURED, OR DISABLED PERSONS AND TO PROVIDE FOR RESEARCH, EDUCATION, AND THE ENHANCEMENT OF THOSE IN THE COMMUNITY. 18 17 3358 160 380955 0 9159761 15588421 402518366 494007411 3966886 1484213 3631413 33008909 419276426 544088954 1497818 819806 0 0 171163969 190117295 0 0 0 254319145 252758460 426980932 443695561 -7704506 100393393 491856825 576116813 453733840 440358431 38122985 135758382 X SEE SCHEDULE O. 0 0 301150707 819806 489891329 OUR LADY OF LOURDES REGIONAL MEDICAL CENTER PROVIDES QUALITY HOSPITAL AND MEDICAL SERVICES PRIMARILY TO RESIDENTS OF SOUTH LOUISIANA. THE MEDICAL CENTER 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 MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. THE MEDICAL CENTER PROVIDED SERVICES FOR 100,083 PATIENT DAYS, 17,285 INPATIENT DISCHARGES, AND 79,072 EMERGENCY ROOM VISITS IN THE YEAR ENDED JUNE 30, 2021. SEE SCHEDULE O FOR FURTHER EXPLANATION. 39243211 33164572 OUR LADY OF LOURDES RMC'S PHYSICIAN PRACTICE PROVIDES CARE TO THE NEEDY MEMBERS OF ITS COMMUNITIES. 340393918 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 1 1 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 33 0 1 3358 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 18 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 0 1 1 X AMANDA HYMEL 2257658496 5959 SSHERWOOD FOREST BLVD BATON ROUGE LA 70809 KELLY T CAHILL BOARD MEMBER/PHYSICIAN 40.00 0.00 X 514842 0 34970 CHRISTA V BILLEAUD SECRETARY 0.50 0.00 X X 0 0 0 FR JAMES BRADY BOARD MEMBER 0.50 0.00 X 0 0 0 MATTHEW MD BOUDREAUX BOARD MEMBER 0.50 0.00 X 0 0 0 STEPHEN J DELATTE BOARD MEMBER 0.50 0.00 X 0 0 0 JULIE DRONET BOARD MEMBER 0.50 0.00 X 0 0 0 ANITA M FONTENOT BOARD MEMBER 0.50 0.00 X 0 0 0 BRYAN HANKS CHAIR 0.50 0.00 X X 0 0 0 KATHLEEN HEALY-COLLIER CEO & MARKET PRESIDENT (PART YEAR) 40.00 0.50 X X 0 0 0 EDWARD J KRAMPE III SECRETARY & TREASURER 0.50 0.00 X 0 0 0 IAN MACDONALD BOARD MEMBER 0.50 0.00 X 0 0 0 MICHAEL P MARAIST BOARD MEMBER 0.50 0.00 X 0 0 0 MIKE MONCLA BOARD MEMBER 0.50 0.00 X 0 0 0 ANGELA MORRISON BOARD MEMBER 0.50 0.00 X 0 0 0 SR ANN CATHERINE NGUYEN BOARD MEMBER 0.50 1.00 X 0 0 0 LOUIS PERRET BOARD MEMBER 0.50 0.00 X 0 0 0 SR MARGARIDA VASQUES BOARD MEMBER 0.50 0.00 X 0 0 0 DR THOMAS MONTGOMERY BOARD MEMBER 0.50 0.00 X 0 0 0 JENNIFER J CLOWERS CFO & VP OF FINANCE 0.00 40.00 X 0 326407 40024 JEFFREY D LIMBOCKER EVP/CFO FMOLHS 2.00 58.50 X 0 971153 196661 DANNA M CRAIN HEART SERVICE/COO HHL 40.00 0.00 X 273891 0 110053 TRACY DELHOMME VP ONCOLOGY 40.00 0.00 X 180485 0 34038 GILBERT HUMBERT CNO 40.00 0.00 X 314267 0 35490 DONNA F LANDRY COO 40.00 0.00 X 412698 0 22451 DUKE WALKER VP ORTHO/NEURO SVCS 40.00 0.00 X 202249 0 31717 CARRIE TEMPLETON VP OF WCC 40.00 0.00 X 263014 0 26474 KENNETH W FALTERMAN STAFF PHYSICIAN 40.00 0.00 X 780681 0 39283 ANN MARIE FLANNERY STAFF PHYSICIAN 40.00 0.00 X 615257 0 35921 DEIADRA J GARRETT STAFF PHYSICIAN 40.00 0.00 X 806228 0 21882 RYAN FARMER STAFF PHYSICIAN 40.00 0.00 X 521310 0 26610 GABRIEL DERSAM STAFF PHYSICIAN 40.00 0.00 X 513552 0 2646 W BRYAN LEE FORMER CEO/PRESIDENT 0.00 40.00 X 0 595667 105281 5398474 1893227 763501 209 1 1 0 FMOL HEALTH SYSTEM 4200 ESSEN LANE BATON ROUGE LA 70809 MANAGEMENT SERVICES 47985584 TRIMEDX INC 5451 LAKEVIEW PKWY S DRIVE INDIANAPOLIS IN 46268 BIOMED SERVICES 6296265 THE LEMOINE COMPANY LLC 1906 ERASTE LANDRY ROAD STE 200 LAFAYETTE LA 70506 CONSTRUCTION SERVICE 1783567 CVT SURGICAL CENTER 7777 HENNESSY BLVD STE 1008 BATON ROUGE LA 70808 PHYSICIAN SERVICES 1528881 CARDIAC AND THORACIC SURGERY 25787 ADAMS LANE JACKSON LA 70748 SURGERY SERVICE 1320664 67 15088849 499572 15588421 PATIENT SERVICE REVENUE 622110 475032765 475032765 OTHER REVENUE 900099 8661660 8661660 REV-MGT CONS - LOURDES 622110 3641234 3641234 INCOME FROM EQUITY INVESTEES 622110 2575512 2235520 339992 RELATED RENTS 531120 2064135 2064135 2032105 1991142 40963 494007411 289939 289939 -2322 -2322 3579464 0 3579464 3579464 3579464 4955749 534325 4181815 111663 773934 422662 1196596 1196596 PENSION RELATED CHANGES 900099 29429445 29429445 29429445 544088954 523055901 380955 5063677 819806 819806 2219224 1988668 230556 159225983 142683927 16542056 2847343 2513570 333773 14628137 12922298 1705839 11196608 9884113 1312495 80064424 37919946 42144478 55374 55374 54447 54447 7898566 2710700 5187866 865716 209249 656467 21450638 8957152 12493486 315109 76164 238945 15632084 13599913 2032171 143979 34801 109178 55700 13463 42237 8044325 88479 7955846 14430943 12505295 1925648 4781790 555852 4225938 MEDICAL SUPPLIES EXPENS 94677908 88833290 5844618 OTHER EXPENSE 4287457 4022785 264672 443695561 340393918 103301643 0 116149693 169220537 8210237 4905762 43951204 50912048 465135 227625 8448923 9115188 2786670 14514412 427521463 167642560 254523114 259878903 100000 100000 20443121 26728633 -989169 2598311 20572162 20572162 17195735 17343232 491856825 576116813 61908717 70891025 40505506 32997119 223540713 222351203 127778904 114119084 453733840 440358431 X 28509465 130578251 9613520 5180131 38122985 135758382 491856825 576116813 X 100393393 5527805 -8285801 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 38497132 38497132 231070927 59723074 171347853 5061647 3685433 1376214 114178191 68650418 45527773 38713566 35583635 3129931 259878903 ACCRUED PENSION COST 87584385 OTHER LONG TERM LIABILITIES 18719775 DUE TO/FROM AFFILIATES 7814924 114119084 X PART X, LINE 2: FIN 48 FOOTNOTE (ASC 740) THE MEDICAL CENTER 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 JUDGEMENT OCCURS. NO RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. 1 CENTRAL AMERICA AND THE CARIBBEAN 0 0 GRANTMAKING 12000 0 0 0 0 0 0 12000 0 12000 CENT. AMERICA/CARRIBBEAN HAITI MISSION 12000 CHECK 1 0 0 0 0 0 0 PART I, LINE 2: THE HOSPITAL GIVES GRANTS TO ORGANIZATIONS WITH WHICH IT HAS A HISTORY OF GIVING. THE HOSPITAL FOLLOWS UP WITH GRANT RECIPIENTS IF THERE IS AN INDICATION OR POTENTIAL THAT THE FUNDS ARE NOT BEING USED FOR CHARITABLE PURPOSES. PART III ACCOUNTING METHOD: 1 1 X 1 X 250.000000000000 0 1 1 1 0 1 1 1004116 1004116 108459780 87575349 20884431 0.04710 109463896 88579465 20884431 0.04710 990460 35757 954703 0.00220 65270 65270 0.00010 857291 501283 356008 0.00080 142419 142419 0.00030 2055440 537040 1518400 0.00340 111519336 89116505 22402831 0.05050 79608 79608 0.00020 79608 79608 0.00020 1 3652414 106103030 111128976 -5025946 X 1 1 1 LOURDES IMAGING DEV LEASOR OF IMAGING PROP & EQUIPMENT 0.63170 0.04170 0.36820 3 PARK PLACE SURGICAL SPECIALTY SURGERY CENTER 0.45000 0.04650 0.50350 4 LAFAYETTE SURGICARE AMBULATORY SURGERY CENTER 0.59420 0.40580 5 HEART HOSPITAL OF LAFAYETTE SPECIALTY HOSPITAL 0.60000 0.20520 3 1 OUR LADY OF LOURDES RMC 4801 AMBASSADOR CAFFERY PARKWAY LAFAYETTE LA 70508 WWW.LOURDESRMC.COM X X X 2 HEART HOSPITAL OF ACADIANA LLC 1105 KALISTE SALOOM ROAD LAFAYETTE LA 70508 WWW.HEARTHOSPITALLAF.NET X X X 3 PARK PLACE SURGICAL HOSPITAL 4811 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 WWW.PARKPLACESURGERY.COM X X SURGERY CENTER OUR LADY OF LOURDES RMC 1 0 0 1 X X X X X X X X X 18 1 1 0 1 X SEE PART V SECTION C X X 1 18 0 1 0 1 X 250.000000000000 X X X X X 1 1 X X X 1 X SEE PART V SECTION C X SEE PART V SECTION C X SEE PART V SECTION C X X X X X X X 1 X 0 X X X X 1 X 0 0 HEART HOSPITAL OF ACADIANA LLC 2 0 0 1 X X X X X X X X X 18 1 1 0 1 X SEE PART V SECTION C X SEE PART V SECTION C X X 1 18 0 1 0 1 X 250.000000000000 X X X X X 1 1 X X X 1 X SEE PART V SECTION C X SEE PART V SECTION C X SEE PART V SECTION C X X X X X X X 1 X 0 X X X X 1 X 0 0 PARK PLACE SURGERY CENTER LLC 3 0 0 1 X X X X X X X X X 18 1 1 0 1 X SEE PART V SECTION C X SEE PART V SECTION C X X 1 19 0 1 0 1 X 250.000000000000 X X X X 1 1 X X X 1 X SEE PART V SECTION C X SEE PART V SECTION C X SEE PART V SECTION C X X X X X X X 1 X 0 X X X X 1 X 0 0 OUR LADY OF LOURDES RMC PART V, SECTION B, LINE 7D: THE CHNA CAN BE FOUND ATLOURDESRMC.COM/ABOUT-US/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT HEART HOSPITAL OF ACADIANA, LLC PART V, SECTION B, LINE 7D: THE CHNA CAN BE FOUND ATLOURDESRMC.COM/ABOUT-US/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PARK PLACE SURGERY CENTER LLC PART V, SECTION B, LINE 7D: THE CHNA CAN BE FOUND ATLOURDESRMC.COM/ABOUT-US/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 5: OUR LADY OF LOURDES RMC, HEART HOSPITAL OF ACADIANA & PARK PLACE SURGERY: THE HOSPITALS GATHERED INFORMATION BY CONDUCTING 45 INTERVIEWS WITH INDIVIDUALS REPRESENTING COMMUNITY HEALTH AND PUBLIC SERVICE ORGANIZATION, MEDICAL PROFESSIONALS, HOSPITAL ADMINISTRATION AND OTHER HOSPITAL STAFF MEMBERS. INTERVIEWEES REPRESENTED NUMEROUS ORGANIZATIONS IN THE COMMUNITY INCLUDING LAFAYETTE GENERAL HEALTH, OUR LADY OF LOURDES, THE DIOCESE OF LAFAYETTE, MILES PERRET CANCER SERVICES, LOUISIANA DEPARTMENT OF HEALTH AND THE REGIONAL MEDICAL DIRECTOR OF REGION 4 OFFICE OF PUBLIC HEALTH. THE HOSPITAL ALSO HELD 5 FOCUS GROUPS THROUGHOUT THE SERVICE AREA AND RECEIVED 363 PAPER SURVEYS COMPLETED BY COMMUNITY MEMBERS WITHIN THE SERVICE AREA. PART V, SECTION B, LINE 6A: OUR LADY OF LOURDES RMC, HEART HOSPITAL OF ACADIANA & PARK PLACE SURGERY: LOURDES REGIONAL MEDICAL CENTER ADOPTED A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WITH HEART HOSPITAL OF LAFAYETTE AND PARK PLACE SURGICAL HOSPITAL. PART V, SECTION B, LINE 11 DURING THE CURRENT YEAR, OUR LADY OF LOURDES REGIONAL MEDICAL CENTER (INCLUDES LOURDES WOMEN'S AND CHILDREN'S HOSPITAL, HEART HOSPITAL OF LAFAYETTE AND PARK PLACE SURGICAL HOSPITAL) WORKED TO CONDUCT AN UPDATED JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WHICH IDENTIFIED NINE SIGNIFICANT HEALTH NEEDS: ACCESS TO CARE, CANCER, HEALTH LITERACY, HEART DISEASE & STROKE, NUTRITION & WEIGHT STATUS, MENTAL HEALTH/BEHAVIORAL HEALTH, PHYSICAL ACTIVITY, MATERNAL & CHILD HEALTH, AND DIABETES. THE HOSPITALS DECIDED THEY WOULD ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS IDENTIFIED DURING THE CURRENT CHNA: MENTAL HEALTH, CANCER, HEART DISEASE, ACCESS TO HEALTH CARE, NUTRITION & WEIGHT STATUS, MATERNAL & CHILD HEALTH. LOURDES CHOSE NOT TO ADDRESS HEALTH LITERACY, PHYSICAL ACTIVITY & DIABETES SINCE THESE COMMUNITY NEEDS WILL BE ADDRESSED THROUGH COMMUNITY PARTNERSHIPS OR INDIRECTLY THROUGH OTHER COMMUNITY HEALTH NEEDS THAT WILL BE ADDRESSED (NURTRITION & WEIGHT STATUS, HEART DISEASE, ETC.).OUR LADY OF LOURDES REGIONAL MEDICAL DURING THE CURRENT YEAR TO ADDRESS THE SIGNIFICANT COMMUNITY HEALTH NEEDS OF HEART DISEASE & STROKE, CANCER, MENTAL/BEHAVIORAL HEALTH, ACCESS TO HEALTH CARE, NUTRITION & WEIGHT STATUS AND MATERNAL & CHILD HEALTH, THE HOSPITALS DID THE FOLLOWING:HEART DISEASE & STROKELOURDES' ST. BERNADETTE'S CLINIC (SBC)FOR THE HOMELESS AND UNINSURED, AS PART OF THE TRIAGE OF NEW PATIENTS, CONTINUED TO SCREEN OVER 50% OF ALL PATIENTS FOR ABNORMAL GLUCOSE AND CHOLESTEROL LEVELS. HIGH RISK PATIENTS WERE REFERRED TO THEIR PRIMARY CARE PHYSICIAN.OUR LADY OF LOURDES HEART HOSPITAL (HHL)CONTINUED TO OFFER FREE OR DISCOUNTED CARDIAC SCREENINGS FOR 50-75 LOW-INCOME, UNINSURED, OR MEDICAID PATIENTS ANNUALLY. HHL AND SBC CONTINUED THEIR PARTNERSHIP AND OFFERED (20) FREE CAROTID SCREENINGS QUARTERLY TO THE UNINSURED/UNDER-INSURED POPULATION WE SERVE.PARK PLACE SURGICAL HOSPITAL(PPSH)CONTINUED TO FUND A FULL-TIME NURSE PRACTITIONER AT SBC WHO PROVIDES SERVICE TO THE INDIGENT, UNINSURED AND UNDER-RESOURCED POPULATION. SBC PROVIDED OVER 1,500 MEDICAL VISITS FOR FISCAL YEAR. MANY OF OUR HOMELESS PATIENTS WERE HOUSED IN HOTELS SINCE THEY COULD NOT BE HOUSED AT THE SHALTERS ADJACENT TO SBC DUE TO COVID 19 (SOCIAL DISTANCING GUIDELINES).CANCERLOURDES HOSPITALTHE LOURDES CANCER NETWORK OFFERS A FULL RANGE OF ONCOLOGY SERVICES AND IS ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS' COMMISSION ON CANCER. OLOL PROVIDES PERSONALIZED NURSE NAVIGATION, SURGICAL ONCOLOGY PROCEDURES, AND AN ON-SITE INFUSION CENTER. FREE OR LOW-COST CANCER SCREENINGS ARE PROVIDED THROUGH LOURDES' VARIOUS OUTREACH PROGRAMS EMBEDDED WITHIN THE COMMUNITY. THE LOURDES CLINIC ALSO HAS A SURVIVORSHIP PROGRAM FOR PATIENTS IN REMISSION.LOURDES PARTNERS WITH MILES PERRET CANCER SERVICES THAT OFFERS A COMPREHENSIVE RESOURCE CENTER HELPING THOSE IN ACADIANA FIGHT, SURVIVE, AND LIVE WITH CANCER. COMMUNITY LEADERS INDICATED THAT THE MILES PERRET MOBILE MILES PROGRAM AND WELLNESS CENTER ARE A STRENGTH OF THE COMMUNITY. A RECENT PARTNERSHIP WITH HOSPICE OF ACADIANA HAS ENABLED MILES PERRET TO PROVIDE A TRANSITION PROGRAM THAT HELPS FAMILIES ESTABLISH RAPPORT WITH HOSPICE PROVIDERS. KOMEN ACADIANA PROMOTES AWARENESS AND ALSO REGULARLY AWARDS LOCAL GRANTS TO SUPPORT BREAST CANCER SCREENINGS, PATIENT EDUCATION, AND PATIENT NAVIGATION SERVICES FOR MEDICAID AND MEDICARE PATIENTS WITHIN THE COMMUNITY. WITH OUR PARTNERSHIP WITH LEVY CANCER FOUNDATION, WE SERVE PATIENTS PRIMARILY IN RURAL VERMILION PARISH STRUGGLING WITH CANCER DIAGNOSES. THE LEUKEMIA AND LYMPHOMA SOCIETY WHICH WE SUPPORT ALSO OFFERS SERVICES TO PATIENTS WITH THOSE DIAGNOSES. LOURDES ALSO SUPPORTS THE LOUISIANA CAMPAIGN FOR TOBACCO-FREE LIVING AND CONTINUES TO WORK ON LOCAL HEALTH POLICIES ACROSS THE REGION. THE CAMPAIGN ALSO PROVIDES LOCAL RESIDENTS ACCESS TO TOBACCO CESSATION SUPPORT.LOURDES'SBC TO PROVIDE EARLY DETECTION, SBC SCREENED FOR CANCER AND PROVIDED TOBACCO SCREENINGS TO OVER 90% OF ALL PATIENTS. ANTI-CRAVING MEDICATIONS WERE PROVIDED TO 90% OF THOSE PATIENTS THAT WERE NOT REFERRED TO A SMOKING CESSATION PROGRAM. SBC ALSO DID TB SKIN TEST AND PROVIDED MAMMOGRAMS AND PAP SMEARS TO HOMELESS WOMEN, SOME OF WHICH HAD NEVER HAD THESE SERVCIES. OUR LADY OF LOURDES HEART HOSPITALPATIENTS WERE REFERRED TO LOURDES HEART HOSPITAL'S SMOKING CESSATION PROGRAMNUTRITION & WEIGHT STATUSLOURDES'SBC REFERRED 50% OF ALL IDENTIFIED PATIENTS WITH A BMI OF 30 AND ABOVE TO OUR NUTRITIONIST FOR COUNSELING AND EDUCATION. THE REFERRALS FOR THOSE PATIENTS WERE NOTED IN THE PATIENTS' CHARTS AT SBC. EVERY PATIENT AT LOURDES' NORTHSIDE SCHOOL- BASED HEALTH CENTER (NSBHC) WAS SCREENED FOR BMI IDENTIFYING THOSE STUDENTS WITH A BMI AT OR ABOVE THE 90TH PERCENTILE OF THE SAME AGE AND SEX; THOSE STUDENTS WERE ALSO REFERRED TO THE COMMUNITY SERVICES DIETITIAN AT SBC FOR WEIGHT COUNSELING. NSBHC CONTINUED EDUCATION AND COUNSELING TO 100% OF ALL STUDENTS IDENTIFIED AT OR ABOVE THE 90TH PERCENTILE OF BMI FOR THE SAME AGE AND SEX. THE KID'S HEALTHY HEART PROGRAM WAS CONTINUED AT ONE CHURCH PARTNER THAT EMPHASIZES THE 3-E'S (EXERCISE, EDUCATION, AND EATING HABITS), SERVING AN AVERAGE OF 50-75 YOUTHS (VIRTUALLY DUE TO COVID). MENTAL/BEHAVIORAL HEALTH:LOURDES' SBC COMMUNITY PARTNERSHIPS WITH 232-HELP AND THE FAMILY TREE TO CREATE COMMUNITY CRISIS CONNECTION (CCC) TO PROVIDE TELEPHONIC AND IN-PERSON MENTAL AND BEHAVIORAL HEALTH SERVICES TO THE HOMELESS AND UNINSURED POPULATION THROUGH AN FMF GRANT. SBC APPLIED AND RECEIVED A GRANT FROM THE FRANCISCAN MISSIONARY FUND TO PROVIDE MENTAL/BEHAVIORAL HEALTH SERVICE TO THE PATIENTS THAT WERE SCREENED AND REFERRED FOR SERVICES. THESE SERVICES AT SBC ARE PROVIDED BY A NURSE PRACTITIONER WHO IS CERTIFIED IN PSYCH AND UNDER THE SUPERVISION OF A PSYCHIATRIST. NSBHCAT LOURDES'NSBHC, THE SCHOOL'S SOCIAL WORKER CONDUCTED OVER 25 GROUP SESSIONS/PRESENTATIONS (MANY VIRTUALLY DUE TO COVID) DURING THE SCHOOL YEAR ON WARNING SIGNS AND CRISIS INTERVENTIONS TO HELP A PERSON AT RISK. ALSO, AS PART OF OFFICE OF PUBLIC HEALTH (OPH)REQUIREMENTS, ALL STUDENTS SEEN AT THE NHS HEALTH CENTER HAD A RISK ASSESSMENT DONE BY NURSING PERSONNEL AND WERE REFERRED TO NSBHC'S LICENSED CLINICAL SOCIAL WORKER.MATERNAL & CHILD HEALTHOUR LADY OF LOURDES - WOMEN'S & CHILDREN'S HOSPITAL (WCC)THERE IS STRONG EVIDENCE THAT BREASTFEEDING PROMOTION PROGRAMS INCREASE INITIATION, DURATION AND EXCLUSIVITY OF BREASTFEEDING. WCC PROMOTED AND FACILITATED BREASTFEEDING PROMOTTION PROGRAMS TO THE COMMUNITY AND TO THEIR PATIENTS, MANY OF WHOM ARE LOW-INCOME AND ARE 80% MEDICAID. WITHIN THIS POPULATION, HIGH RISK INDIVIDUALS AT BOTH THE MATERNAL AND NEONATAL/PEDIACTRIC POPULATION EXIST. UNDERSERVED CHILDREN, INCLUDING UNDER-REPRESENTED MINORITIES, ARE MORE LIKELY TO EXPERIENCE HIGH INTENSITY END OF LIFE CARE, INCLUDING IN-HOSPITAL DEATH. WCC INDENTIFIED A NEED FOR A PEDIACTRIC PALLIATIVE NURSE PRACTITIONER (NP)TO ASSIST PARENTS AND SIBLINGS WITH RESOURCES, EDUCATION AND SUPPORT IN HELPING WITH POTENTIAL DEATH OR LONG-TERM CARE DECISIONS. WCC APPLIED AND RECEIVED A FMF GRANT TO FUND A PEDIACTRIC PALLIALTIVE NURSE PRACTITIONER TO HELP THESE LOW-INCOME FAMILIES WITH THE BENEFIT OF PALLIATIVE CARE TO THESE FAMILIES WITH INDIVIDUALIZED SYMPTOM MANAGEMENT, IMPROVED COMMUNICATION AND SUPPORT IN MAKING THESE DIFFICULT DECISIONS.WCC ALSO PROVIDED THE NECESSITY SPECIAL FORMULA SUPPORT AND SPECIALIZED TRANSPORTATION BEDS; WHEN OTHER OPTIONS ARE UNAVAILABLE OR NOT IN PLACE AT TIME OF DISCHARGE IT IS DETRIMENTAL TO THE OVERALL HEALTH AND WELFARE OF THE NEONATE/INFANT/CHILD. LACK OF PROPER NUTRITION AND APPROPRIATE SPECIALIZED EQUIPMENT UTILIZED FOR TRANSPORTATION FOR THE NEONATE/INFANT INCREASES THE RISK OF MALNUTRITION, FUTURE HEALTH ISSUES AND POSSIBLY DEATH. SPECIALIZED CAR BEDS FOR NEWBORNS ARE UTILIZED WHEN THEY CANNOT TOLERATE A CAR SEAT UPON DISCHARGE AND CAN CAUSE AN INCREASED RISK OF SUFFOCATION. IN FY 2021, WCC ASSISTED OVER 400 NEWBORNS AND THEIR FAMILIES (OFTEN FROM DISCHARGE TO WIC APPOINTMENTS FOR THEIR SUPPORT). 1,000 CANS OF FORMULA WERE ALSO DISTRIBUTED AND 150 OF THE SPECIALIZED TRANSPORTATION BEDS WERE GIVEN OUT TO LOW-INCOME FAMILIES. PART V, SECTION B, LINE 11 CONTINUED : ACCESS TO HEALTH CAREOUR LADY OF LOURDES RMC PARTNERED LAFAYETTE CONSOLIDATED GOVERNMENT-LCG (MAYOR'S OFFICE) TO ESTABLISH A COMMUNITY COVID-19 SCREENING/VACCINE CLINIC TO GIVE THE COMMUNITY EASY ACCESS TO COVID-19 TESTING AND VACCINES. LOURDES DIRECTOR OF COMMUNITY SERVICES WAS SELECTED AND CURRENTLY SERVES AS A MEMBER OF THE LCG HEALTH EQUITY TASK FORCE TO CONTINUE TO PROVIDE COVID-19 TESTING/VACCINE SITES IN THE COMMUNITY, STUDY THE ADVERSE EFFECTS OF THE CORONAVIRUS ON LOW-INCOME/MINORITY POPULATIONS AND TO LOOK INTO THE SOCIAL DETERMINANTS OF HEALTH (SDOH)AFFECTING POOR HEALTH OUTCOMES IN TARGETED LOW-INCOME POPULATIONS IN THE COMMUNITY.LOURDES PHYSICIAN GROUP (LPG)LOURDES PHYSICIAN GROUP IS COMPRISED OF 46 DEDICATED PHYSICIANS AND NURSE PRACTITIONERS PRACTICING IN OVER 16 LOCATIONS THROUGHOUT LAFAYETTE, LA AND THE SURROUNDING AREAS INCLUDING RURAL AREAS SUCH AS ERATH AND BREAUX BRIDGE, LA. TELEHEALTH/VIDEO VISITS ARE PERFORMED BY LOCAL, BOARD-CERTIFIED LOURDES PHYSICIAN GROUP PROVIDERS, WHICH HAS GIVEN THE COMMUNITY ADDITIONAL OPPORTUNITIES TO GET PCP SERVICES. ANY NECESSARY FOLLOW-UP CAN BE DONE LOCALLY AND PROVIDERS WILL DETERMINE IF ADDITIONAL IN-PERSON TESTING IS NEEDED.NSBHCLOURDES ALSO OPERATES A SCHOOL BASED HEALTH CENTER OF THE CAMPUS OF NORTHSIDE HIGH SCHOOL WHERE THEY OFFER THE FOLLOWING:O WELL-CARE /PREVENTIVE-CAREO SICK VISITSO IMMUNIZATIONSO DISEASE PREVENTIONO HEALTH EDUCATIONO BEHAVIORAL HEALTH COUNSELING O NUTRITION COUNSELINGO COVID 19 VACCINE SITELOURDES SBC APPLIED AND BECAME A MEDICAID ENROLLMENT CENTER FOR EASIER ACCESS TO MEDICAID APPLICATIONS FOR THE LOW-INCOME POPULATION NEAR THE CLINIC WITH LITTLE MEANS OF TRANSPORTATION. LOURDES SBC BECAME A COVID-19 TESTING/VACCINE SITE TO SERVE AS A CENTRAL LOCATION FOR THE HOMELESS POPULATION AND THOSE WITH LITTLE OR NO ACCESS TO TRANSPORTATION. CITY BUS PASSES ARE PROVIDED TO THE HOMELESS PATIENTS TO GET TO/FROM CLINIC, GET THEIR MEDICATIONS AND GET TO OTHER MEDICAL APPOINTMENTS. A MEN'S VETERAN HOMELESS SHELTER IS ADJACENT TO THE SBC THAT USES THE CLINIC FOR THEIR HEALTH NEEDS (MEDICAL, VISION, DENTAL EXTRACTIONS, DENTURES). HOWEVER, THESE PATIENTS WERE HOUSED IN HOTELS DUE TO COVID RESTRICTIONS OF SOCIAL DISTANCING. SBC DOES NOT BILL FOR ANY OF THEIR SERVICES TO THE HOMELESS, UNINSURED, UNDER-RESOURCED POPULATION. PART V, SECTION B, LINE 16A,B&C OUR LADY OF LOURDES RMC: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/PARK PLACE SURGERY:THE FINANCIAL ASSISTANCE POLICY (FAP), FAP APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY OF THE FAP ARE AVAILABLE AT: HTTPS://WWW.PARKPLACESURGERY.COM/FOR-PATIENTS/FINANCIAL-ASSISTANCEHEART HOSPITAL OF LAFAYETTE: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/ PART V, SECTION B, LINE 16J: OUR LADY OF LOURDES RMC, HEART HOSPITAL OF ACADIANA & PARK PLACE SURGERY: REGISTRATION PERSONNEL REFER UNINSURED, UNDERINSURED, AND LOW-INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, LINE 13H: FULLY DISCOUNTED CARE IS ALSO AVAILABLE WHERE THE PATIENT OR OTHER SOURCES CAN PROVIDE SUFFICIENT EVIDENCE OF PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1) 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) PATIENT'S 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. 5 1 - LOURDES IMAGING NETWORK LLC 4809 AMBASSADOR CAFFERY SUITE 350 LAFAYETTE LA 70506 IMAGING CENTER 2 - LOURDES AFTER HOURS LLC 2130 KALISTE SALOOM ROAD LAFAYETTE LA 70508 HEALTHCARE CLINIC 3 - LHCG-XIII LLC 601 WEST ST MARY BLVD SUITE 309 LAFAYETTE LA 70506 HOME HEALTH AGENCY 4 - LHCG LXVII LLC 901 S HUGH WALLIS ROAD LAFAYETTE LA 70508 HOSPICE 5 - LAFAYETTE SURGICARE 4630 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 AMBULATORY SURGICAL FACILITY 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 IF 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 MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1) 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) PATIENT'S 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.PART I LINE 7THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINES 7A-7D AND IS BASED ON THE JUNE 30, 2021 MEDICARE COST REPORT DATA. 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 I LINE 7GOUR LADY OF LOURDES PROVIDES SUBSIDIZED HEALTH SERVICES INCLUDING HEALTH CARE CLINICS. ST. BERNADETTE'S CLINIC, WHICH PROVIDES FREE MEDICAL CARE TO THE HOMELESS AND UNINSURED POPULATION, IS INCLUDED. THE COSTING METHODOLOGY USED FOR SUBSIDIZED HEALTH SERVICES WAS ACTUAL EXPENSES INCURRED IN PROVIDING THE SERVICES LESS DIRECT OFFSETTING REVENUE. ST. BERNADETTE CLINIC $623195.PART I, LINE 7FFOR 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 III, SECTION A, LINE 2THIS AMOUNT REPRESENTS THE ACTUAL CUSTOMER AMOUNTS DUE TO OUR LADY OF LOURDES REGIONAL MEDICAL CENTER THAT WERE WRITTEN OFF BECAUSE THEY WERE UNCOLLECTIBLE.PART III, LINE 4:THE BAD DEBT FOOTNOTE IS ON PAGES 17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.PART III LINE 8THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENT AND GUIDELINES. THE MEDICARE COST REPORT (MCR) IS AN ANNUAL REPORT REQUIRED OF ALL INSTITUTIONS PARTICIPATING IN THE MEDICARE PROGRAM. THE MCR RECORDS EACH INSTITUTION'S TOTAL COSTS AND CHARGES ASSOCIATED WITHPROVIDING SERVICES TO ALL PATIENTS, THE PORTION OF THOSE COSTS AND CHARGES ALLOCATED TO MEDICARE PATIENTS, AND THE MEDICARE PAYMENTS RECEIVED. 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 CHARITY CARE AFTER THE INDIVIDUAL'S ACCOUNT HAS BEEN SENT TO COLLECTIONS, THE DISCOUNTED AMOUNT IS IMMEDIATELY REMOVED FROM THE COLLECTIONS PROCESS.PART VI LINE 3PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPATIENTS ARE GIVEN THE MEDICAL CENTER'S PATIENT HANDBOOK WHERE THEY ARE REFERRED TO THE SECTION ENTITLED "FINANCIAL INFORMATION - WHAT TO EXPECT". FINANCIAL COUNSELORS ALSO MEET WITH THE PATIENTS AND EDUCATE THEM ABOUT THE ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCALGOVERNMENT PROGRAMS AND ALSO THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM. FOR THE CONVENIENCE OF THE PATIENTS, THE MEDICAL CENTER ALSO OPERATES A MEDICAID ENROLLMENT CENTER TO ASSIST PATIENTS INTERESTED IN APPLYING FOR MEDICAID BENEFITS. THIS OFFICE IS OPEN MONDAY - FRIDAYFROM 8:00 A.M. - 4:00 P.M. A TELEPHONE NUMBER IS ALSO PROVIDED IN THE HANDBOOK.PART VI LINE 4COMMUNITY INFORMATIONOUR LADY OF LOURDES REGIONAL MEDICAL CENTER IS A COMMUNITY BASED, NOT-FOR-PROFIT HOSPITAL THAT TREATS PATIENTS FROM ACROSS THE ACADIANA REGION. PURSUANT TO THE HOSPITAL'S LAST CHNA, OUR LADY OF LOURDES' PRIMARY AND SECONDARY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 716,583. IT IS ESTIMATED THAT 18.1% OF THE POPULATION AND 21.6% OF THE CHILDREN OF LAFAYETTE PARISH (THE PRIMARY SERVICE AREA) IS LIVING IN POVERTY.THE PRIMARY SERVICE ARE INCLUDES THE FOLLOWING PARISH:LAFAYETTE PARISHTHE SECONDARY SERVICE AREA INCLUDES THE FOLLOWING PARISHES:ACADIA PARISHEVANGELINE PARISHIBERIA PARISHJEFFERSON DAVID PARISHST. LANDRY PARISHST. MARTIN PARISHST. MARY PARISHVERMILLION PARISHPART VI LINE 5PROMOTION OF COMMUNITY HEALTH:THE MAJORITY OF THE GOVERNING BODY OF OUR LADY OF LOURDES REGIONAL MEDICAL CENTER IS COMPRISED OF INDIVIDUALS WITH A BROAD CROSS-SECTION OF HEALTH CARE AND BUSINESS EXPERIENCE. OUR LADY OF LOURDES REGIONAL MEDICAL CENTER 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 LOURDES REGIONAL MEDICAL CENTER IS NOT-FOR-PROFIT, NON-STOCK, MEMBER CORPORATION OF WHICH FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC.(FMOL HEALTH SYSTEM)IS THE SOLE MEMBER. OUR LADY OF LOURDES IS PART OF THE FMOL HEALTH SYSTEM WHICH INCLUDES SEVERAL HOSPITALS AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATE OF LOUISIANA. OUR LADY OF LOURDES RMC SERVES THE COMMUNITY IN LAFAYETTE PARISH AND SURROUNDING PARISHES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER, ST. FRANCIS MEDICAL CENTER, ST. ELIZABETH HOSPITAL, OUR LADY OF THE LAKE ASSUMPTION HOSPITAL, AND OUR LADY OF THE ANGELS HOSPITAL. AS OF JULY 1, 2019, ST. DOMINIC JACKSON MEMORIAL HOSPITAL IN MISSISSIPPI IS ALSO A RELATED HOSPITAL, DUE TO A SHARED MISSION AGREEMENT BETWEEN FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM AND ST. DOMINIC HEALTH SYSTEM. PART VI LINE 2 NEEDS ASSESSMENTTHE COMMUNITY SERVICES DEPARTMENT AT OUR LADY OF LOURDES REGIONAL MEDICAL CENTER WAS FORMED NUMEROUS YEARS AGO TO ASSESS THE COMMUNITY NEEDS. IT HAS GROWN INTO 5 DISTINCT SERVICE AREAS WHICH PROVIDES HEALTHCARE TO NEEDY RESIDENTS IN THE ACADIANA AREA. IN TAKING "HEALTHCARE TO THE HIGHEST POWER", THE DEPARTMENT REACHES OUT TO THOSE MOST IN NEED, SPECIFICALLY, THE UNINSURED AND UNDERINSURED. IN PURSUING THE MISSION TO IMPROVE THE HEALTH STATUS OF ACADIANA'S POOREST RESIDENTS, THE DEPARTMENT HAS STRATEGICALLY PLACED ACCESSIBLE SERVICES THROUGHOUT THE COMMUNITY. COMMUNITY SERVICES' CATHOLIC IDENTITY IS MADE TANGIBLE IN THE COMMUNITY THROUGH THESE UNIQUE SERVICES. THE DEPARTMENT STEWARDS ITS RESOURCES BY ENGAGING COMMUNITY MEMBERS, FORMING PARTNERSHIPS, AND ESTABLISHING COLLABORATIVE RELATIONSHIPS. THESE UNIQUE SERVICES CLEARLY DISTINGUISH OUR LADY OF LOURDES FROM OTHER HEALTHCARE FACILITIES IN ACADIANA. THE MEDICAL CENTER DOES EXTENSIVE RESEARCH REGARDING COMMUNITY ISSUES AND NEEDS WITHIN ITS SERVICE AREAS. THE RESEARCH IS CONDUCTED IN AN EFFORT TO DETERMINE IF ITS COMMUNITY BENEFIT PROGRAMS ARE STILL APPROPRIATE AND TO DETERMINE IF OTHER PROGRAMS ARE NEEDED. THE SENIOR EXECUTIVE TEAM DETERMINES THE FOCUS GROUPS TO BETTER UNDERSTAND WHAT THE PEOPLE WITHIN THE REGION CONSIDER TO BE THE MAJOR COMMUNITY NEEDS. THE FOCUS GROUP INCLUDES COMMUNITY LEADERS, RELIGIOUS LEADERS, COMMUNITY SERVICE EMPLOYEES, LOW WAGE EMPLOYEES AND CLIENTS FROM CLINICS. SOME OF THERESULTS OF THE MEDICAL CENTER'S NEEDS ASSESSMENT INCLUDE:ST. CLARE'S CLINICST. BERNADETTE'S COMMUNITY CLINICNORTHSIDE HIGH SCHOOL BASED HEALTH CENTERCONGREGATIONAL HEALTH SERVICES 1 UL FOUNDATION 705 EAST ST MARY BLVD LAFAYETTE LA 70503 726023836 501(C)(3) 20000 GENERAL SUPPORT COMMUNITY FDN OF ACADIANA 1035 CAMILLA BLVD STE 100 LAFAYETTE LA 70508 721493023 501(C)(3) 115000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 110 VETERANS MEMORIAL BLVD SUITE 160 METAIRIE LA 70005 135613797 501(C)(3) 13300 GENERAL SUPPORT GREATER LAFAYETTE CHAMBER 804 EAST ST MARY BLVD LAFAYETTE LA 70503 720232780 501(C)(6) 38250 INVESTMENT IN ACADIANA ONE CAMPAIGN MILES PERRET CANCER SERVICES 230 KALISTE SALOOM STE 200 LAFAYETTE LA 70508 753023211 501(C)(3) 27911 FMV DONATION OF FOOD, FORGIVENESS OF RENT GENERAL SUPPORT TRIUMPHANT SERVICES OF LOUISIANA LLC 102 MARSH DRIVE LAFAYETTE LA 70507 843572998 168000 MENTAL HEALTH SERVICES 232-HELP PO BOX 52763 LAFAYETTE LA 70505 720628109 501(C)(3) 93097 GENERAL SUPPORT FRANCISCAN MISSIONARIES OF OUR LADY UNIVERSITY 5414 BRITTANY DRIVE BATON ROUGE LA 70808 721173156 501(C)(3) 10000 GENERAL SUPPORT DIOCESE OF LAFAYETTE 1408 CARMEL AVE LAFAYETTE LA 70501 720437696 501(C)(3) 13000 GENERAL SUPPORT BEACON COMMUNITY CONNECTIONS 2600 JOHNSTON ST 330 LAFAYETTE LA 70503 831455134 501(C)(3) 61250 GENERAL SUPPORT LITTLE LEAGUE BASEBALL INC 4400-A AMBASSADOR CAFFERY 316 LAFAYETTE LA 70508 720848707 501(C)(3) 12000 GENERAL SUPPORT LOUISIANA OPEN INC 124 HEYMANN BLVD SUITE 105 LAFAYETTE LA 70503 721043611 501(C)(3) 9000 GENERAL SUPPORT 11 1 PART I, LINE 2: MONITORING GRANTS FORMAL REQUESTS ARE RECEIVED BY THE BUSINESS PAYOR RELATIONS DEPARTMENT, ARE CHECKED FOR ALL APPROPRIATE INFORMATION, AND ARE PRESENTED TO THE EXECUTIVE ADMINISTRATION FOR APPROVAL. THE HOSPITAL GIVES GRANTS TO ORGANIZATIONS WELL-KNOWN IN THE COMMUNITY, OR WHICH IT HAS A HISTORY OF GIVING TO. THE HOSPITAL FOLLOWS UP WITH GRANT RECIPIENTS IF THERE IS AN INDICATION OF POTENTIAL THAT THE FUNDS ARE NOT BEING USED FOR CHARITABLE PURPOSES. 0 1 0 0 0 0 0 0 0 JEFFREY D LIMBOCKER EVP/CFO FMOLHS 0 594289 0 299775 0 77089 0 170677 0 25984 0 1167814 0 54592 DEIADRA J GARRETT STAFF PHYSICIAN 718376 0 86610 0 1242 0 11400 0 10482 0 828110 0 0 0 KENNETH W FALTERMAN STAFF PHYSICIAN 708687 0 67050 0 4944 0 11400 0 27883 0 819964 0 0 0 W BRYAN LEE FORMER CEO/PRESIDENT 0 447500 0 146902 0 1265 0 80105 0 25176 0 700948 0 0 ANN MARIE FLANNERY STAFF PHYSICIAN 610403 0 150 0 4704 0 11400 0 24521 0 651178 0 0 0 KELLY T CAHILL BOARD MEMBER/PHYSICIAN 367729 0 146573 0 540 0 11400 0 23570 0 549812 0 0 0 RYAN FARMER STAFF PHYSICIAN 470250 0 50250 0 810 0 0 0 26610 0 547920 0 0 0 GABRIEL DERSAM STAFF PHYSICIAN 511992 0 750 0 810 0 0 0 2646 0 516198 0 0 0 DONNA F LANDRY COO 302007 0 63987 0 46704 0 11400 0 11051 0 435149 0 27744 0 DANNA M CRAIN HEART SERVICE/COO HHL 220517 0 48347 0 5027 0 81868 0 28185 0 383944 0 0 0 JENNIFER J CLOWERS CFO & VP OF FINANCE 0 268771 0 56371 0 1265 0 11400 0 28624 0 366431 0 0 GILBERT HUMBERT CNO 257444 0 54988 0 1835 0 11400 0 24090 0 349757 0 0 0 CARRIE TEMPLETON VP OF WCC 214791 0 48098 0 125 0 2397 0 24077 0 289488 0 0 0 DUKE WALKER VP ORTHO/NEURO SVCS 164348 0 36066 0 1835 0 8267 0 23450 0 233966 0 0 0 TRACY DELHOMME VP ONCOLOGY 145706 0 32944 0 1835 0 7553 0 26485 0 214523 0 0 0 PART I, LINE 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 I, LINE 4B THE EXECUTIVE VICE PRESIDENT 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 EXECUTIVE WOULD BE PAID HIS/HER BASE SALARY AND AN ANNUAL INCENTIVE AT TARGET AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 24 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. 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, OR DUE TO A CHANGE OF CONTROL. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS GENERALLY 12 MONTHS. SCHEDULE J, PART I, LINE 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 OCCURANCE 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. JEFF LIMBOCKER RECEIVED A PAYMENT OF $74,342 FROM THE PLAN DURING THE YEAR. DONNA LANDRY RECEIVED A PAYMENT OF $39,056 FROM THE PLAN 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, OUR LADY OF LOURDES REGIONAL MEDICAL CENTER, INC. EXTENDS THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. OUR LADY OF LOURDES REGIONAL MEDICAL CENTER, INC. CALLS 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. 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 LOURDES REGIONAL MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A FMOL HEALTH SYSTEM INC., AS THE SOLE MEMBER OF THE MEDICAL CENTER, RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF OUR LADY OF LOURDES REGIONAL MEDICAL CENTER 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 OFFICE 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 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 AND REVIEW OF THE FORM 990 BY KPMG, THE FORM 990 IS REVIEWED BY MANAGEMENT. 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 LOURDES REGIONAL MEDICAL CENTER 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 OUR LADY OF LOURDES REGIONAL MEDICAL CENTER 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, OUR LADY OF LOURDES REGIONAL MEDICAL CENTER 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 OF POSSIBLE CONFLICTS OF INTERESTS ARE REVIEWED AND INVESTIGATED BY THE CORPORATE COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN. FORM 990, PART VI, SECTION B, LINE 15A THE PRESIDENT AND CEO OF OUR LADY OF LOURDES REGIONAL MEDICAL CENTER IS AN EMPLOYEE OF FMOL HEALTH SYSTEM (A RELATED TAX-EXEMPT ORGANIZATION) WHOSE SALARY IS 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 AN OUTSIDE CONSULTING FIRM. THE BOARD COMMITTEE APPROPRIATELY DOCUMENTS ITS DECISIONS. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS REVIEWED ANNUALLY BY THE CEO AND AN EXECUTIVE COMMITTEE. THE CEO AND EXECUTIVE COMMITTEE IS PROVIDED COMPENSATION RANGES DEVELOPED BY FMOL HEALTH SYSTEM FROM INDUSTRY-WIDE DATA. THE CEO AND EXECUTIVE COMMITTEE THEN USES THAT DATA TO DETERMINE THE APPROPRIATE COMPENSATION FOR OFFICERS AND KEY EMPLOYEES AND DOCUMENTS THE HUMAN RESOURCE FILES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CAPITAL TRANSFERS TO FMOL -8,285,801. ELECTIONS SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION OUR LADY OF LOURDES REGIONAL MEDICAL CENTER, INC. DOES HAVE APPLICABLE FINANCIAL STATEMENTS FOR THE YEAR OF THE ELECTION, AND INTEND TO APPLY THE DE MINIMIS 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 LOURDES REGIONAL MEDICAL CENTER, INC. IS MAKING THE ELECTION UNDER TREAS. 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