2021-10-11T11:58:18-05:00 2020-12-31 721202445 POSTLETHWAITE & NETTERVILLE 8550 UNITED PLAZA BLVD SUITE 1001 BATON ROUGE LA 70809 990 2020-01-01 720551963 SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION D/B/A LAKE CHARLES MEMORIAL HOSPITAL SOUT 3374943202 1701 OAK PARK BOULEVARD LAKE CHARLES LA 70601 DEVIN HYDE PRESIDENT/CEO 3374943204 2021-10-06 1 DEVIN HYDE 999009999 BRANDON LAGARDE P01428217 2259224600 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DEVIN HYDE 1701 OAK PARK BOULEVARD LAKE CHARLES LA 70601 406939424 0 X WWW.LCMH.COM X 1952 LA PROVIDE HEALTHCARE SERVICES 13 7 3408 40 0 0 695537 3671737 368366892 401444141 913821 -13793620 1003233 803282 370979483 392125540 191379 254375 0 0 136794099 135550631 0 0 1070319 199294036 215481916 336279514 351286922 34699969 40838618 305890508 386653359 230376628 300006923 75513880 86646436 X THE MISSION OF LAKE CHARLES MEMORIAL HOSPITAL IS TO IDENTIFY AND IMPROVE THE HEALTH OF THE PEOPLE OF SOUTH LOUISIANA AND EAST TEXAS BY PROVIDING A FULL SPECTRUM OF INNOVATIVE SERVICES-INCLUDING HEALTH EDUCATION, DISEASE PREVENTION, AND DIAGNOSTIC AND TREATMENT OPTIONS-IN A PERSONALIZED, CARING AND SAFE MANNER THROUGHOUT THE REGION. 0 0 8474590 2134820 LAKE CHARLES MEMORIAL HOSPITAL (LCMH)2020 COMMUNITY BENEFITS SUMMARYI. INTRODUCTIONAS A COMMUNITY-BASED HOSPITAL, IT IS LCMH'S MISSION TO HELP IMPROVE THE HEALTH AND WELLNESS OF THE SOUTHWEST LOUISIANA COMMUNITY. WHILE IT IS OUR LEGAL RESPONSIBILITY TO PROVIDE MEDICAL CARE TO ANYONE IN NEED REGARDLESS OF HIS OR HER ABILITY TO PAY, LCMH ALSO PROVIDES A SIGNIFICANT AMOUNT OF COMMUNITY SERVICE PROGRAMS, INCLUDING EDUCATIONAL PROGRAMS AND HEALTH SCREENINGS, FREE OF CHARGE OR AT A GREATLY REDUCED COST TO THE CONSUMER. II. SPORTS MEDICINE, COMMUNITY EVENTS AND SEMINARSTHE SPORTS MEDICINE ALLIANCE PROVIDED PRE-PARTICIPATION PHYSICALS FOR AREA ATHLETES, ATHLETIC ASSESSMENTS, LECTURES, IN-SERVICES, WORKSHOPS, SPORTS CAMPS AND CLINICS, STUDENT TRAINER SCHOLARSHIPS, ATHLETIC TRAINER COVERAGE AT AREA SPORTING EVENTS, SPECIAL EVENTS AND MORE FREE OF CHARGE OR FOR A MINIMAL FEE TO THE PARTICIPANTS. COMMUNITY BENEFIT: $386,603.EACH YEAR, LCMH PROVIDES FREE HEALTH SCREENINGS, EDUCATIONAL SEMINARS AND INFORMATIONAL BOOTHS AT A VARIETY OF COMMUNITY EVENTS. THE HOSPITAL ALSO PROVIDES FREE SPEAKERS TO CIVIC GROUPS AND THEIR ORGANIZATIONS. THIS COMMITMENT TO HEALTH AND WELLNESS EDUCATION TAKES LCMH PROFESSIONALS INTO THE FIVE PARISH AREA TO STAFF INDUSTRIAL, CORPORATE, AND SCHOOL HEALTH FAIRS. LCMH CONTRIBUTED A NET $263 IN SPECIAL EVENTS AND SEMINARS. COMMUNITY BENEFIT: $263.III. HEALTH PROFESSIONALS EDUCATIONLCMH INVESTS IN MEDICAL EDUCATION IN AN EFFORT OF PROVIDE THE AREA WITH QUALIFIED PROFESSIONALS. IN 2020, LCMH SPENT $1,968,544 FOR THE LOUISIANA STATE UNIVERSITY HEALTH SERVICES CENTER-FAMILY PRACTICE RESIDENCY PROGRAM. COMMUNITY BENEFIT: $5,833,724.IV. CHARITABLE DONATIONSLCMH MAKES NUMEROUS MONETARY DONATIONS TO A VARIETY OF NON-PROFIT AGENCIES. COMMUNITY BENEFIT: $119,180.LCMH'S TOTAL 2020 NET COMMUNITY CONTRIBUTIONS: $6,339,770. 90043478 65958277 LCMH PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES THROUGH A 313 BED ADULT ACUTE CARE HOSPITAL, 38 BED WOMEN'S HOSPITAL WITH 23 NICU BEDS, 42 BED BEHAVIORAL HEALTH HOSPITAL, & THROUGH A JOINT VENTURE A 29 BED LONG TERM CARE FACILITY. ADDITIONALLY LCMH PROVIDES OUTPATIENT SERVICES THROUGH 19 OUTPATIENT LOCATIONS, INCLUDING THE MOSS CLINIC, A PUBLIC/PRIVATE PARTNERSHIP PROVIDING CARE TO THE UNDERSERVED IN THE COMMUNITY.CHARITY CARE - LCMH PROVIDES MEDICAL CARE TO MEDICAID AND INDIGENT RECIPIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN 2020, LCMH PROVIDED $19,190,590 IN UNREIMBURSED MEDICAID COSTS AND $4,894,611 IN UNREIMBURSED CHARITY CARE COSTS AS PROVIDED IN THE CEA WITH THE STATE AND LSU. COMMUNITY BENEFIT: $24,085,201. 236392808 254375 333812161 LCMH PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES THROUGH A 313 BED ADULT ACUTE CARE HOSPITAL, 38 BED WOMEN'S HOSPITAL WITH 23 NICU BEDS, 42 BED BEHAVIORAL HEALTH HOSPITAL, & THROUGH A JOINT VENTURE A 29 BED LONG TERM CARE FACILITY. ADDITIONALLY LCMH PROVIDES OUTPATIENT SERVICES THROUGH 19 OUTPATIENT LOCATIONS, INCLUDING THE MOSS CLINIC, A PUBLIC/PRIVATE PARTNERSHIP PROVIDING CARE TO THE UNDERSERVED IN THE COMMUNITY. 334910876 1 1 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 1 0 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 0 1 0 1 342 0 1 3408 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 7 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X DAWN JOHNSON-HATCHER 3374942094 1701 OAK PARK BLVD LAKE CHARLES LA 706018911 CHRIS THOMPSON MD BOARD MEMBER 40.00 0.30 X 957600 0 8400 CHARLES P WHITSON TREASURER 40.00 1.30 X X 454013 0 27467 RICHARD MARTINEZ MD BOARD MEMBER 1.00 0.30 X 0 0 0 LOUIS M TODD SR BOARD MEMBER 1.00 1.30 X 0 0 0 JASON LANGHOFER DO MEDICAL STAFF PRESIDENT ELECT 40.00 0.30 X X 550516 0 25518 MITCH ADRIAN CHAIRMAN 1.00 0.30 X X 0 0 0 JUDGE ULYSSES G THIBODEAUX BOARD MEMBER 1.00 0.30 X 0 0 0 LARRY M GRAHAM PRESIDENT, CEO & ASSIST SECRETARY 40.00 1.30 X X 671494 0 34938 JOE MILLER JR PAST CHAIRMAN 1.00 0.30 X X 0 0 0 DENISE EMERSON RAU BOARD MEMBER 1.00 0.30 X 0 0 0 SETH BILLIODEAUX MEDICAL STAFF PAST PRESIDENT 40.00 0.30 X X 564729 0 33786 CLIFF COURVILLE MEDICAL STAFF PRESIDENT 40.00 0.30 X X 691440 0 24671 DR NEIL ASPINWALL CHAIRMAN-ELECT/VICE CHAIRMAN & SECRETARY 1.00 0.30 X X 0 0 0 WILLIAM RANDY CONDOS BOARD MEMBER 40.00 0.30 X 111484 0 0 GERALD BRYANT EXECUTIVE VP OF NURSING 40.00 X 367940 0 19067 DONNA SHIELDS VP OF PATIENT CARE SERVICES 40.00 X 276202 0 25568 JASON J RASHALL EXECUTIVE VP OF BUSINESS DEVELOPMENT 40.00 X 265811 0 32491 BERNITA BROWN VP OF SUPPORT SERVICES 40.00 X 227989 0 4530 ANNA CAZES EXECUTIVE VP OF OPERATIONS 40.00 X 379686 0 34938 DANIEL AGUILLARD VP OF SPECIALTY SERVICES 40.00 X 263771 0 20900 KATHLEEN DEROUEN SENIOR VP OF MARKETING 40.00 X 247054 0 16707 WENDY R FOURNET VP OF HUMAN RESOURCES 40.00 X 223393 0 13954 LEIF PEDERSEN VP OF PHILANTROPHY 40.00 1.00 X 228364 0 31738 DAWN HATCHER JOHNSON VP OF FINANCIAL SERVICES 40.00 X 240737 0 15326 MANLEY JORDAN CHIEF MEDICAL OFFICER 40.00 X 516174 0 26588 ROBBIN ODOM VP OF QUALITY MANAGEMENT 40.00 X 203551 0 703 BRETT CASCIO PHYSICIAN 40.00 X 2201413 0 34938 JEFFREY BALAZSY PHYSICIAN 40.00 X 1426440 0 18057 JOSEPH LUGO PHYSICIAN 40.00 X 1272752 0 20482 SARPREET BASRA PHYSICIAN 40.00 X 1068005 0 24419 KHALED NOUR PHYSICIAN 40.00 X 1052359 0 34938 MOHAMMED SARWAR MD PAST OFFICER 40.00 X 323626 0 34938 14786543 0 565062 236 1 1 0 LEWING CONSTRUCTION INC PO BOX 5216 LAKE CHARLES LA 706065216 CONSTRUCTION CONTRACTOR 7922102 LSU HEALTH SCIENCE CENTER 433 BOLIVAR ST NEW ORLEANS LA 70112 RESIDENCY PROGRAM 5685786 OLSON RESTORATION LLC 9085 MARSHALL COURT WESTIMINISTER CO 80031 REMEDIATION 5415515 HHS ENVIRONMENTAL SERVICES & HHS LLC PO BOX 826 SAN ANTONIO TX 782930826 JANITORIAL SERVICES 3117838 CALCASIEU MECHANICAL PO BOX 7728 LAKE CHARLES LA 706067728 HVAC SERVICES 1276040 226 133276 254375 3284086 54571 3671737 PATIENT SERVICE REVENUE 900099 396055092 396055092 MANAGEMENT FEES 900099 4174212 4174212 CAFETERIA 900099 1214837 1214837 401444141 225513 225513 342165 0 342165 342165 342165 794751 789160 14024724 5591 -14024724 -14019133 -14019133 INCOME (LOSS) FROM SECOND AVENUE 621990 469979 469979 INCOME (LOSS) FROM LA PET/CT IMAG 621990 80841 80841 INCOME (LOSS) FROM SHAREPORT SUB 621990 -21702 -21702 -68001 -68001 461117 392125540 401905258 0 -13451455 254375 254375 7441948 2604682 4316330 520936 106536773 104938721 1598052 2241923 2115342 116334 10247 12381058 11682015 642456 56587 6948929 6556588 360581 31760 1180500 1142724 34825 2951 202297 195823 5968 506 6979193 6755859 205886 17448 673505 559009 60616 53880 1465150 1418265 39559 7326 156391 151386 4223 782 6006157 5765911 240246 13520804 12574348 946456 3259560 3031391 228169 SUPPLIES 74616374 72228650 2201183 186541 PURCHASED SERVICES 52694427 51008205 1554486 131736 BAD DEBT 25635234 23840768 1794466 CONTRACT LABOR 7716343 7562016 154327 21375981 20524798 801564 49619 351286922 334910876 15305727 1070319 32023807 142110729 14051764 20092199 31249827 24159422 7073569 7123013 3921256 5015848 396774112 260541508 145868232 136232604 15026306 4863553 56675747 47055991 305890508 386653359 80175223 152316201 119186737 117710406 23800706 22278054 7213962 7702262 230376628 300006923 X 75513880 86646436 75513880 86646436 305890508 386653359 X 40838618 159891 -29865953 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6063815 6063815 185556960 102314510 83242450 715541 649911 65630 191477889 146529450 44948439 12959907 11047637 1912270 136232604 INTERCOMPANY RECEIVABLES 3141857 ASSETS WHOSE USE IS LIMITED 18246773 OTHER RECEIVABLES 4360574 RIGHT OF USE ASSETS 21306787 47055991 INVESTMENT - AMRI 7702262 7702262 X PART X, LINE 2: THE SYSTEM APPLIES THE ACCOUNTING GUIDANCE RELATED TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, WHICH SETS OUT A CONSISTENT FRAMEWORK TO DETERMINE THE APPROPRIATE LEVEL OF TAX RESERVES TO MAINTAIN FOR UNCERTAIN TAX POSITIOINS. THE SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE RECORDED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN THE RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE SYSTEM HAS EVALUATED ITS POSITION REGARDING THE ACCOUNTING FOR UNCERTAIN INCOME TAX POSITIONS AND DOES NOT BELIEVE THAT IT HAS ANY MATERIAL UNCERTAIN TAX POSITIONS. 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 12159126 7264515 4894611 0.01390 77884352 58693762 19190590 0.05460 90043478 65958277 24085201 0.06850 7968544 2134820 5833724 0.01660 506046 506046 0.00140 8474590 2134820 6339770 0.01800 98518068 68093097 30424971 0.08650 1 8813318 2392992 84271397 97641513 -13370116 X 1 1 1 SECOND AVENUE MRI LLC IMAGING 0.51000 0.49000 2 LA PET IMAGING IMAGING 0.33000 3 MEMORIAL TOXICOLOGY LAB SERVICES LLC LAB SERVICES 0.51000 4 CHG SULPHUR HOSPITAL LLC LONG TERM ACUTE CARE 0.49000 5 SHAREPORT LLC MEDICAL WASTE 0.18600 1 1 LAKE CHARLES MEMORIAL HOSPITAL 1701 OAK PARK BLVD LAKE CHARLES LA 70601 HO0001606 X X X X LAKE CHARLES MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X HTTP://WWW.LCMH.COM/CHNA X 1 19 1 HTTP://WWW.LCMH.COM/CHNA 0 1 X 200.000000000000 500.000000000000 X X X X X X X 1 1 X X X 1 X WWW.LCMH.COM X WWW.LCMH.COM X X 1 X 0 X X X 1 X 0 1 LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: IN 2019, OVER SEVERAL WEEKS, LAKE CHARLES MEMORIAL HEALTH SYSTEM (WHICH INCLUDES LAKE CHARLES MEMORIAL HOSPITAL, LAKE CHARLES MEMORIAL WOMEN'S HOSPITAL & LAKE CHARLES MEMORIAL CANCER CENTER AND BEHAVIORAL HEALTH FOR THE PURPOSE OF OUR CHNA) CONDUCTED ITS THIRD COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AS A FOLLOW-UP TO ITS CHNA IN 2016. LAKE CHARLES MEMORIAL HEALTH SYSTEM WORKED CLOSELY WITH MULTIPLE COMMUNITY ORGANIZATIONS AND INSTITUTIONS TO ESTABLISH, EVALUATE, AND UNDERSTAND THE REGION'S COMMUNITY HEALTH NEEDS, BASED UPON THEIR COLLECTIVE INTERESTS IN THE HEALTH AND WELL-BEING OF RESIDENTS IN THEIR COMMUNITY. THE CHNA PROCESS INVOLVED PUBLIC AND PRIVATE ORGANIZATIONS, SUCH AS FAITH-BASED ORGANIZATIONS, EDUCATIONAL SYSTEMS, AND HEALTH AND HUMAN SERVICE ENTITIES TO ASSESS THE NEEDS OF THE COMMUNITY. THE PRIMARY DATA COLLECTION INVOLVED: COMMUNITY STAKEHOLDER INTERVIEWS, HAND-DISTRIBUTED SURVEYS, PROVIDER HEALTH INVENTORY, PUBLIC COMMENTARY SURVEYS, AND A COMMUNITY FORUM. HUNDREDS OF COMMUNITY RESIDENTS, ORGANIZATIONS AND COMMUNITY LEADERS PARTICIPATED AND CONTRIBUTED TO THE CHNA PROCESS. THE PREVIOUSLY COMPLETED CHNAS IN 2013 AND 2016 SERVED AS A BASELINE TO PROVIDE ADDITIONAL INFORMATION AND A DEEPER UNDERSTANDING OF THE HEALTH AND SOCIOECONOMIC NEEDS OF THE COMMUNITY. TRIPP UMBACH COLLECTED AND ANALYZED THE RESULTS OF THE CHNA PROCESS. PRIMARY AND SECONDARY DATA IDENTIFIED KEY COMMUNITY HEALTH PRIORITIES IN THE REGION. WORKING CLOSELY WITH THE WORKING GROUP OF LAKE CHARLES MEMORIAL HOSPITAL, THE RESULTS WERE REVIEWED AND DISCUSSED, CONCLUDING IN THE IDENTIFICATION AND PRIORITIZATION OF THE COMMUNITY'S NEEDS AT THE REGIONAL LEVEL. AN INTERNAL HOSPITAL REPORTING FORUM WAS HELD AT LAKE CHARLES MEMORIAL HOSPITAL ON AUGUST 6, 2019, AS PART OF THE CHNA PROCESS. THE COMMUNITY PLANNING FORUM INVOLVED 16 COMMUNITY LEADERS REPRESENTING VARIOUS COMMUNITY ORGANIZATIONS, HEALTH AND HUMAN SERVICES AGENCIES, HEALTH INSTITUTIONS, AND ADDITIONAL COMMUNITY AGENCIES. MOST IMPORTANTLY, FORUM PARTICIPANTS PROVIDED CRITICAL FEEDBACK AND PRIORITIZED KEY NEED AREAS FOR THE CHNA.GOALS, OBJECTIVES AND STRATEGIES WERE EXAMINED AND AN IMPLEMENTATION PLAN DEVELOPED; IDENTIFYING WAYS LAKE CHARLES MEMORIAL WILL MEET THE NEEDS OF THE COMMUNITIES THEY SERVE. THE PRIORITIZED NEEDS IDENTIFIED IN THE SURVEY WERE: BEHAVIORAL HEALTH, HEALTH BEHAVIORS, AND HEALTH OUTCOMES. A RESOURCE INVENTORY WAS MADE AVAILABLE. THE RESOURCE INVENTORY HIGHLIGHTS PROGRAMS AND SERVICES IN THE REGION. THE INVENTORY IDENTIFIES ORGANIZATIONS AND AGENCIES IN THE COMMUNITY THAT ARE SERVING THE VARIOUS TARGET POPULATIONS. THE RESOURCE INVENTORY PROVIDES A LISTING OF AVAILABLE PROGRAMS AND CONTACT INFORMATION AS A MEANS TO CREATE THE POTENTIAL FOR COMMUNITY COORDINATION AND LINKAGES AMONG LOCAL ORGANIZATIONS.THE ASSESSMENTS, IMPLEMENTATION PLANS AND RESOURCE GUIDES WERE DISSEMINATED TO HOSPITAL SERVICE AREAS AND POSTED ON OUR WEBSITE FOR COMMUNITY ACCESS. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: CANCER AND HOUSING WERE ADDITIONAL THEMES THAT WERE IDENTIFIED. LAKE CHARLES MEMORIAL HEALTH SYSTEM'S CANCER CENTER WILL DIRECTLY ADDRESS THE NEEDS OF THE COMMUNITY RELATED TO CANCER AND THE ISSUES SURROUNDING THE DISEASE. THE INTERNAL WORKING GROUP AGREED THAT TRANSPORTATION WOULD NOT BE ADDRESSED IN THE IMPLEMENTATION AND PLANNING PHASES WITHIN LAKE CHARLES MEMORIAL HEALTH SYSTEM DUE TO THE SIGNIFICANT FUNDING REQUIREMENTS AND STRUCTURAL CHANGES NEEDED AT THE STATE AND LOCAL LEVEL TO ADDRESS THE HOUSING AND TRANSPORTATION INFRASTRUCTURE. HOWEVER, TRANSPORTATION WILL BE ADDRESSED WITHIN LAKE CHARLES MEMORIAL'S CANCER CENTER. THE TRANSPORTATION NEEDS OF CANCER PATIENTS ARE STILL A LARGE CONCERN AND THE CANCER CENTER WILL CONTINUE TO WORK TO ADDRESS AND IDENTIFY METHODS WHICH WILL ASSIST THIS PATIENT POPULATION. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS OFFERED BY FINANCIAL COUNSELORS. REFERENCES TO THE POLICY ARE INCLUDED ON ALL BILLINGS AND ARE POSTED ON OUR WEBSITE @ LCMH.COM. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE SAME. AMOUNTS GENERALLY BILLED ARE CALCULATED BASED ON OUR FINANCIAL ASSISTANCE POLICY. PART I, LINE 3C: LCMH USES AN ASSET TEST MANDATED FOR MEDICARE PATIENTS. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 4: THE FOLLOWING FOOTNOTE REGARDING BAD DEBT EXPENSE IS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS: "THE SYSTEM MAINTAINS ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS, DOUBTFUL ACCOUNTS, AND CHARITY CARE BASED ON MANAGEMENT'S ASSESSMENT OF COLLECTIBILITY, CURRENT ECONOMIC CONDITIONS, AND PRIOR EXPERIENCE. THE SYSTEM DETERMINES IF PATIENT ACCOUNTS RECEIVABLE ARE PAST-DUE BASED ON THE DISCHARGE DATE; HOWEVER, THE SYSTEM DOES NOT CHARGE INTEREST ON PAST-DUE ACCOUNTS. THE SYSTEM CHARGES OFF PATIENT ACCOUNTS RECEIVABLE IF MANAGEMENT CONSIDERS THE COLLECTON OF THE OUTSTANDING BALANCES TO BE DOUBTFUL."COSTING METHODOLOGY IS OPERATING EXPENSE TIMES PAYOR MIX TIMES ALLOWABLE PERCENT. THE SHORTFALL AS RELATES TO THIS QUESTION SHOULD BE TREATED AS A COMMUNITY BENEFIT IN THAT CARE IS PROVIDED TO MEMBERS OF OUR COMMUNITY AT LESS THAN THE ALLOWABLE COST. PART III, LINE 8: COSTING METHODOLOGY USED FOR LINE 6 IS OPERATING EXPENSES TIMES PAYOR MIX TIMES 89% ALLOWABLE. THE SHORTFALL AS RELATES TO THIS QUESTION SHOULD BE TREATED AS A COMMUNITY BENEFIT IN THAT CARE IS PROVIDED TO MEMBERS OF OUR COMMUNITY AT LESS THAN THE ALLOWABLE COST. PART III, LINE 9B: THE COLLECTION POLICY IS THE SAME AS FOR THOSE WHO DON'T QUALIFY. THOSE ENTITLED TO FREE CARE HAVE NO COLLECTION ACTIVITY AS THERE IS NO REIMBURSEMENT EXPECTED FOR THEIR CARE. THOSE WHO QUALIFY FOR DISCOUNTED CARE WILL BE TREATED AS ANY OTHER PATIENT WHO HAS A BALANCE DUE THE HOSPITAL, JUST THAT THE BALANCE DUE WILL BE AT THE DISCOUNTED RATE FOR WHICH THEY QUALIFY. PART VI, LINE 2: LCMH PROVIDES PROGRAMS & ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH & HEALING. THESE SCREENINGS, SEMINARS, CLASSES, ETC. RESPOND TO THE NEEDS OF PERSONS LIVING IN OUR COMMUNITY AND IMPROVES OVERALL COMMUNITY HEALTH. MEMORIAL HOSPITAL PROVIDES COMMUNITY HEALTH EDUCATION, COMMUNITY-BASED CLINICAL SERVICES, SUCH AS HEALTH SCREENINGS, SUPPORT GROUPS, SELF-HELP PROGRAMS, SUCH AS SMOKING CESSATION AND WEIGHT LOSS PROGRAMS, PASTORAL OUTREACH PROGRAMS AND SPIRITUAL CARE FOR THE WELL BEING OF OUR COMMUNITY. SEE 2016 ACTIVITIES AND 2013-2016 IMPLEMENTATION PLAN ACTIVITIES/RESULTS POSTED ON THE WEBSITE. PART VI, LINE 3: LCMH'S FINANCIAL ASSISTANCE POLICY IS AVAILABLE ONLINE AND MAY BE REQUESTED BY PHONE, EMAIL, AND ON SITE REQUEST. PATIENTS ARE PROVIDED BROCHURE AT ADMITTING EDUCATING THEM ABOUT THE AVAILABILTIY OF FINANCIAL ASSISTANCE AND HOW TO APPLY. PART VI, LINE 4: THE HOSPITAL IS LOCATED IN THE CITY OF LAKE CHARLES, LOUISIANA IN CALCASIEU PARISH. THE CITY OF LAKE CHARLES IN CONVENIENTLY LOCATED OFF INTERSTATE 10 BETWEEN HOUSTON, TX AND NEW ORLEANS, LA AND IS 30 MILES UPSTREAM FROM THE GULF OF MEXICO. LAKE CHARLES IS CONNECTED TO THE GULF BY MEANS OF A DEEP-WATER SHIP CHANNEL AND IS THE SEAT AND PORT OF ENTRY OF CALCASIEU PARISH. LAKE CHARLES IS THE FIFTH-LARGEST INCORPORATED CITY IN LOUISIANA, LOCATED ON LAKE CHARLES, PRIEN LAKE AND THE CALCASIEU RIVER. LAKE CHARLES IS A CULTURAL, INDUSTRIAL AND EDUCATIONAL CENTER IN THE SOUTHWEST REGION OF THE STATE. IT IS CONSIDERED A MAJOR CENTER OF PETROCHEMICAL REFINING, TOURISM, GAMING AND EDUCATION, WITH MCNEESE STATE UNIVERSITY AND SOWELA TECHNICAL COMMUNITY COLLEGE. BECAUSE OF THE LAKES AND WATERWAYS THROUGHOUT THE CITY, METROPOLITAN LAKE CHARLES IS OFTEN REFERRED TO AS THE LAKE AREA.THE LAKE AREA POPULATION IS APPROXIMATELY 200,000 WITH APPROXIMATELY 15% OF THE POPULATION BEING 65 OR OLDER. THE LAKE AREA RACIAL MAKEUP IS 70% WHITE, 25% BLACK, AND 5% OTHER. THE MEDIAN INCOME FOR THE AREA IS APPROXIMATELY $49,000 AND THE POVERTY RATE IS 14.9%. PART VI, LINE 5: N/A FORM 990 SCHEDULE H PART V SECTION B BASED ON CURRENT LITERATURE AND OTHER GUIDANCE FROM THE TREASURY AND THE IRS, THE FOLLOWING STEPS WERE CONDUCTED AS PART OF LAKE CHARLES MEMORIAL HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT:* THE 'COMMUNITY' SERVED BY THE HOSPITAL WAS DEFINED BY UTILIZING INPATIENT AND OUTPATIENT DATA REGARDING PATIENT ORIGIN. THIS PROCESS IS FURTHER DESCRIBED IN COMMUNITY SERVED BY THE HOSPITAL.* POPULATION DEMOGRAPHICS AND SOCIOECONOMIC CHARACTERISTICS OF THE COMMUNITY WERE GATHERED AND REPORTED UTILIZING VARIOUS THIRD PARTY DATA SOURCES AS DESCRIBED IN CHNA (SEE IN APPENDICES). THE HEALTH STATUS OF THE COMMUNITY WAS THEN REVIEWED. INFORMATION ON THE LEADING CAUSES OF ILLNESS AND DEATH WAS ANALYZED IN CONJUNCTION WITH HEALTH OUTCOMES AND FACTORS REPORTED FOR THE COMMUNITY BY COUNTYHEALTHRANKINGS.ORG. HEALTH FACTORS WITH SIGNIFICANT OPPORTUNITY FOR IMPROVEMENT WERE NOTED.* AN INVENTORY OF HEALTH CARE FACILITIES AND RESOURCES WAS PREPARED AND POSTED ON LCMH.COM.* COMMUNITY INPUT WAS PROVIDED THROUGH KEY INFORMANT INTERVIEWS OF 16 STAKEHOLDERS AND A COMMUNITY HEALTH SURVEY WAS WIDELY DISTRIBUTED. THE COMMUNITY HEALTH SURVEY WAS COMPLETED BY 100 INDIVIDUALS. RESULTS AND FINDINGS ARE DESCRIBED IN THE KEY INFORMANT AND COMMUNITY HEALTH SURVEY OF THIS REPORT.*INFORMATION GATHERED IN THE STEPS ABOVE WAS ANALYZED AND REVIEWED TO IDENTIFY HEALTH ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS AND MINORITY GROUPS AND THE COMMUNITY AS A WHOLE. HEALTH NEEDS WERE RANKED UTILIZING A WEIGHTING METHOD THAT WEIGHS (1) THE SIZE OF THE PROBLEM, (2) THE SERIOUSNESS OF THE PROBLEM (3) THE PREVALENCE OF COMMON THEMES, (4) THE IMPACT OF THE PROBLEM ON VULNERABLE POPULATIONS, (5) HOW IMPORTANT THE PROBLEM IS TO THE COMMUNITY AND (6) WHETHER OR NOT THE HOSPITAL HAS EXISTING PROGRAMS WHICH RESPOND TO THE IDENTIFIED NEED.* RECOMMENDATIONS BASED ON THIS ASSESSMENT WERE COMMUNICATED TO THE HOSPITAL AND AN IMPLEMENTATION PLAN TO ADDRESS KEY HEALTH NEEDS WAS DEVELOPED. SUPPLEMENTAL INFORMATION: PROMOTION OF COMMUNITY HEALTH PRIORITY: CHRONIC DISEASED PREVENTION AND MANAGEMENTGOAL 1: DECREASE POPULATION RISK FACTORS THROUGH CULTURALLY APPROPRIATE SUPPORT FOR HEALTHY LIFESTYLES. STRATEGIES: A. PROMOTE EDUCATION AND SCREENING OPPORTUNITIES THAT SUPPORT AWARENESS OF HEART DISEASE, DIABETES, AND CANCER, I.E. HEALTHY EATING, INCREASED PHYSICAL ACTIVITY, TOBACCO-FREE LIFESTYLE AND MODERATE ALCOHOL USE. B. ACTIVELY PARTICIPATE IN COMMUNITY PARTNERSHIPS WHEREBY THE HOSPITALS CAN REACH OUT TO UNDERSERVED POPULATIONS THROUGH SCREENINGS AND HEALTH EDUCATION. C. IDENTIFY THOSE WHO WORK WITH UNDERSERVED, LOW-INCOME AND RACIAL/ETHNIC GROUPS AND PARTNER WITH THEM TO DEVELOP CULTUALLY APPROPRIATE STRATEGIES TO MONITOR PREVENTION INITIATIVES.GOAL 2: ENHANCE COMMUNITY EDUCATION ABOUT EARLY IDENTIFICATION AND INTERVENTION FOR CANCER WITH A GOAL OF REDUCING LATE-STAGE DIAGNOSES AND IMPROVING OUTCOMES AND SURVIVAL RATES. STRATEGIES: A. PROVIDE ANNUAL COLON CANCER SCREENINGS AND BREAST MAMMOGRAPHY EDUCATION. B. COORDINATE MONTHLY CANCER SUPPORT/EDUCATION GROUPS C. OFFER SMOKING CESSATION CLASSES AND EDUCATION ON LOUISIANA'S TOBACCO FREE PROGRAM. D. INCREASE THE NUMBER OF CERTIFIED SMOKING CESSATION INSTRUCTORS ON STAFF. E. IMPLEMENT A CANCER PATIENT NAVIGATOR POSITION.GOAL 3: ENHANCE COMMUNITY EDUCATION ABOUT PREVENTION, DETECTION AND MANAGING CHRONIC DISEASES. STRATEGIES: A. PROMOTE HEALTH RELATED ACTIVITIES, SUCH AS SCREENINGS, EXERCISE, HEALTHY EATING CHOICES AND EDUCATION, IN NON-TRADITIONAL SETTINGS (E.G. SHOPPING MALLS, FAITH-BASED ORGANIZATIONS, HIGH SCHOOLS) B. COORDINATE MONTHLY SEMINARS AND SUPPORT/EDUCATION GROUPS ON DIABETES, CANCER, AND HEART DISEASE. C. IMPLEMENT WELLNESS PROGRAMS FOR EMPLOYEES AND COMMUNITY EMPLOYERS THAT ENCOURAGE WORKSITES TO EDUCATE THEIR EMPLOYEES ABOUT THEIR BENEFIT PACKAGE, INCLUDING PREVENTIVE AND ANNUAL WELLNESS VISITS, SMOKING CESSATION, HEALTHY EATING CHOICES, SCREENINGS AND PHYSICAL SERVICES. D. OFFER SMOKING CESSATION CLASSES AND EDUCATION ON LOUISIANA'S TOBACCO FREE PROGRAM IN PARTNERSHIP WITH LOUISIANA TOBACCO FREE LIVING PROGRAM AND LSUHSC SMOKING CESSATION PROGRAM.PRIORITY: TEEN PREGNANCY EDUCATION AND MANAGEMENTGOAL 1: EDUCATE COMMUNITY AND SCHOOLS ABOUT TEEN PREGNANCY AND IMPORTANCE OF EARLY PREGNANCY MANAGEMENT TO IMPROVE LOW BIRTH WEIGHTS AND REDUCE TEEN PREGNANCY. STRATEGIES: A. WORK WITH COMMUNITY ORGANIZATIONS TO EDUCATE HIGH SCHOOL TEENS ABOUT PREGNANCY RISKS. B. EDUCATE COMMUNITY HEALTH ORGANIZATIONS ABOUT OUR OBCARE PROGRAM WHICH PROVIDES OB SERVICES TO UNINSUED AND UNDERINSURED. C. PROVIDE PREGNANCY EDUCATION TO EXPECTANT MOTHERS AND FATHERS. SUPPLEMENTAL INFORMATION: STATE FILING OF COMMUNITY BENEFIT REPORT LOUISIANA: SEE ACTIVITIES AND RESULTS OF CHNA IMPLEMENTATION PLAN ON WEBSITE LCMH.COM 1 SWLA HOSPITAL FOUNDATION 1701 OAK PARK BLVD LAKE CHARLES LA 70601 270833927 501(C)(3) 100000 SPONSORSHIP LOCAL HEART FOUNDATION 1919B SOUTHWOOD DRIVE LAKE CHARLES LA 70605 822809813 501(C)(3) 5000 SPONSORSHIP 2 PART I, LINE 2: RECONCILIATION OF GRANTS ARE MONITORED MONTHLY BY AN ACCOUNTANT IN THE ACCOUNTING OFFICE AND REVEIWED BY THE CONTROLLER AND VICE PRESIDENT. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 BRETT CASCIO PHYSICIAN 934632 0 1266781 0 0 0 8400 0 26538 0 2236351 0 0 0 JEFFREY BALAZSY PHYSICIAN 531250 0 895190 0 0 0 8400 0 9657 0 1444497 0 0 0 JOSEPH LUGO PHYSICIAN 910026 0 362726 0 0 0 8400 0 12082 0 1293234 0 0 0 SARPREET BASRA PHYSICIAN 530442 0 537563 0 0 0 8400 0 16019 0 1092424 0 0 0 KHALED NOUR PHYSICIAN 623905 0 428454 0 0 0 8400 0 26538 0 1087297 0 0 0 CHRIS THOMPSON MD BOARD MEMBER 726927 0 230673 0 0 0 8400 0 0 0 966000 0 0 0 CLIFF COURVILLE MEDICAL STAFF PRESIDENT 467316 0 224124 0 0 0 8400 0 16271 0 716111 0 0 0 LARRY M GRAHAM PRESIDENT, CEO & ASSIST SECRETARY 671494 0 0 0 0 0 8400 0 26538 0 706432 0 0 0 SETH BILLIODEAUX MEDICAL STAFF PAST PRESIDENT 467316 0 97413 0 0 0 8400 0 25386 0 598515 0 0 0 JASON LANGHOFER DO MEDICAL STAFF PRESIDENT ELECT 525516 0 25000 0 0 0 0 0 25518 0 576034 0 0 0 MANLEY JORDAN CHIEF MEDICAL OFFICER 491174 0 25000 0 0 0 8400 0 18188 0 542762 0 0 0 CHARLES P WHITSON TREASURER 429013 0 25000 0 0 0 8400 0 19067 0 481480 0 0 0 ANNA CAZES EXECUTIVE VP OF OPERATIONS 354686 0 25000 0 0 0 8400 0 26538 0 414624 0 0 0 GERALD BRYANT EXECUTIVE VP OF NURSING 347940 0 20000 0 0 0 0 0 19067 0 387007 0 0 0 MOHAMMED SARWAR MD PAST OFFICER 323626 0 0 0 0 0 8400 0 26538 0 358564 0 0 0 DONNA SHIELDS VP OF PATIENT CARE SERVICES 261202 0 15000 0 0 0 6501 0 19067 0 301770 0 0 0 JASON J RASHALL EXECUTIVE VP OF BUSINESS DEVELOPMENT 240811 0 25000 0 0 0 5953 0 26538 0 298302 0 0 0 DANIEL AGUILLARD VP OF SPECIALTY SERVICES 243771 0 20000 0 0 0 0 0 20900 0 284671 0 0 0 KATHLEEN DEROUEN SENIOR VP OF MARKETING 222054 0 25000 0 0 0 5419 0 11288 0 263761 0 0 0 LEIF PEDERSEN VP OF PHILANTROPHY 213364 0 15000 0 0 0 5200 0 26538 0 260102 0 0 0 DAWN HATCHER JOHNSON VP OF FINANCIAL SERVICES 220737 0 20000 0 0 0 0 0 15326 0 256063 0 0 0 WENDY R FOURNET VP OF HUMAN RESOURCES 208393 0 15000 0 0 0 2666 0 11288 0 237347 0 0 0 BERNITA BROWN VP OF SUPPORT SERVICES 212989 0 15000 0 0 0 4310 0 220 0 232519 0 0 0 ROBBIN ODOM VP OF QUALITY MANAGEMENT 193551 0 10000 0 0 0 0 0 703 0 204254 0 0 0 PART I, LINE 1A THE HOSPITAL PAYS ANNUAL DUES TO THE PIONEER CLUB, A SOCIAL CLUB, FOR LARRY GRAHAM, PRESIDENT AND CEO IN THE AMOUNT OF $4,761 PER YEAR. ANY NONBUSINESS USE OF THE CLUB IS ACCOUNTED FOR AND INCLUDED AS COMPENSATION IN THE CEO W-2. A LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 546395D84 2007-11-01 69371392 REVENUE AND REFUNDING BOND 0 0 0 B CALCASIEU PARISH PUBLIC TRUST AUTHORITY 521333467 NONEAVAIL 2013-10-10 6275000 CURRENT BOND REFUNDING 0 0 0 C CALCASIEU PARISH PUBLIC TRUST AUTHORITY 521333467 NONEAVAIL 2014-01-07 10000000 CONSTRUCTION 0 0 0 D CALCASIEU PARISH PUBLIC TRUST AUTHORITY 521333467 NONEAVAIL 2015-02-04 10000000 CONSTRUCTION 0 0 0 A 69371392 6780514 1363176 2007 1 1 1 1 B 6275000 89494 2013 1 0 1 1 C 10000000 10000000 2015 0 0 1 1 D 10000000 141275 9858725 2016 0 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 C 0 0 1 1 1 0 0 0 1 D 0 0 1 1 0 0 0 1 A 0 0 0 1 0 0 1 NATIXIS FUNDING CORP 12.000000000000 1 1 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: LOUISIANA PUBLIC FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 05/14/2012 A MEMORIAL HOSPITAL SERVICE DISTRICT CALCASIEU PARISH LOUISIANA 521769984 NONEAVAIL 2015-10-01 10000000 CONSTRUCTION 0 0 0 B MEMORIAL HOSPITAL SERVICE DISTRICT CALCASIEU PARISH LOUISIANA 521769984 NONEAVAIL 2017-12-14 10000000 CONSTRUCTION 0 0 0 C MEMORIAL HOSPITAL SERVICE DISTRICT CALCASIEU PARISH LOUISIANA 521769984 NONEAVAIL 2020-07-24 104935000 HOSPITAL REVENUE AND REFUNDING BONDS 0 0 0 A 10000000 133775 9866225 2017 0 0 0 1 B 10000000 100555 9899445 2019 0 0 1 1 C 120288650 8718500 2019 1 0 0 1 A 0 0 1 1 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 1 1 B 0 1 0 0 0 0 0 1 1 C 0 0 0 1 0 0 0 0 0 A 1 B 1 C 0 RICHARD MARTINEZ RICHARD MARTINEZ IS A MEMBER OF THE BOARD OF BOTH ENTITIES 531408 PROVIDES ADVERTISING EMPLOYMENT FOR THE HOSPITAL 0 LOUIS TODD LOUIS TODD IS A MEMBER OF THE BOARD & IS SELF-EMPLOYED (TODD & ASSOCIATES) 1104481 LOUIS TODD, THROUGH TODD AND ASSOCIATES, IS THE HOSPITAL'S BROKER FOR MEDICAL MALPRACTICE INSURANCE COVERAGE AND IS PAID A COMMISSION DIRECLTY FROM LAMMICO. THIS COMMISSION HAS NO IMPACT ON THE AMOUNT OF COVERAGE OBTAINED BY THE HOSPITAL OR THE PREMIUM THAT IS PAID FOR THE COVERAGE. IN 2020, THE TOTAL PREMIUMS PAID BY THE HOSPITAL TO LAMMICO WERE $1,104,481. TODD AND ASSOCIATES IS PAID A COMMISSION FROM LAMMICO AT A SET CERTAIN PERCENTAGE OF THE PREMIUMS PAID. THIS PERCENTAGE IS SET INDEPENDENTLY BETWEEN TODD AND ASSOCIATES AND LAMMICO. THE HOSPITAL IS NOT INVOLVED IN SETTING THE COMMISSION RATE OR AMOUNT PAID TO TODD AND ASSOCIATES BY LAMMICO, NOR DOES IT PAY ANY COMMISSION TO LOUIS TODD OR TODD AND ASSOCIATES DIRECTLY. 0 X OFFICE FURNITURE 291 54571 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE EMERGENCY ROOM, PHARMACY, WOUND CARE AND MATERIALS MANAGEMENT HAVE BEEN OUTSOURCED TO MANAGEMENT COMPANIES. FORM 990, PART VI, SECTION A, LINE 6 THE ENTITY HAS BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THEY ELECT BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B BOARD MEMBERS WILL BE PROVIDED A COPY OF THE 990 FOR REVIEW PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE IS MONITORED THROUGHOUT THE YEAR VIA MANUAL SIGNATURES BEING REQUIRED ON ALL AP CHECKS EXCEPT SMALL BALANCE PATIENT REFUNDS. THESE CHECKS HAVE AUTOMATED SIGNATURES, BUT ARE REVIEWED BEFORE MAILING. IN ADDITION LARGE CONSTRUCTION JOBS ARE REQUIRED TO BE BID OUT AND BIDS ARE RETURNED SEALED TO OUR ATTORNEYS. RELATIONSHIPS SUCH AS BANKING, INSURANCE AND OTHERS THAT HAVE BEEN DISCLOSED BY BOARD MEMBERS ARE SUBJECT TO DISCUSSION AT BOARD MEETINGS AND GENERALLY THE BOARD MEMBER WITHIN THAT RELATIONSHIP WILL EXCLUDE THEMSELVES FROM THE MEETING. FORM 990, PART VI, SECTION B, LINE 15 COMPARISON WITH VHA GULF STATES GREATER NEW ORLEANS SOCIETY OF HUMAN RESOURCES ASSN AND LHA DATA WAS DONE BY THE SALARY COMMITTEE OF THE BOARD OF TRUSTEES. MINUTES OF THE SALARY COMMITTEE WERE MAINTAINED. FORM 990, PART VI, SECTION C, LINE 19 IN ADDITION TO THE DOCUMENTS THAT ARE ON FILE WITH THE SECRETARY OF STATE THAT WERE REQUIRED TO ESTABLISH THE LEGAL ENTITY, THE GOVERNING DOCUMENTS (INCLUDING THE CONFLICT OF INTEREST POLICY) WILL BE PROVIDED TO THE PUBLIC UPON REQUEST AND SUBJECT TO OUR LEGAL COUNSEL'S APROVAL. FORM 990, PART XI, LINE 9: BOOK/TAX DIFFERENCE - 2ND AVENUE MRI, LLC -469,979. BOOK/TAX DIFFERENCE - GIFT SHOP 68,001. BOOK/TAX DIFFERENCE - LA PET/CT IMAGING LAKE CHARLES LLC 28,666. GAAP ADJUSTMENT TO RECORD CY INCOME (LOSS) EQUITY IN SUBSIDIARIES -29,514,343. BOOK/TAX DIFFERENCE - SHAREPORT SUB 1 21,702. FORM 990 PART XII LINE 2C THE ORGANIZATION'S PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. 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