2020-07-15T12:59:00-05:00 2019-06-30 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2018-07-01 721495500 OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL % AMANDA HYMEL OURL 2257657709 5000 Hennesy Boulevard Baton Rouge LA 70808 JEFF LIMBOCKER CFO/EVP 2257656565 2020-06-25 true RYAN HOOKS P00746825 2253444000 2020-06-23 199.206.0.5 72049520201975000012 2020-07-15 P EB850E1BCF32CA73DDA849DEBA9ACC48FFFF1BCD 606B868638B351F0DD3B21299E8CEABE66140F96 2018 2020-09-23 17:36:50Z CHRISTINA HOCKADAY 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 8208381 false X N/A X 2001 LA THE PURPOSE OF THE HOSPITAL IS TO PROVIDE FOR THE CARE OF ILL, INJURED AND DISABLED PERSONS AND TO ENHANCE THE HEALTH OF THOSE IN THE COMMUNITY THROUGH RESEARCH AND EDUCATION. 7 3 59 4 0 0 14617 30000 7829587 6638912 474114 366139 28417 28417 8346735 7063468 4138 3018 0 0 3138779 3078768 0 0 0 3378242 3510949 6521159 6592735 1825576 470733 15092651 16049358 3977562 4645435 11115089 11403923 X SEE SCHEDULE O false false 5112253 3018 6638912 OUR LADY OF THE LAKE ASSUMPTION PROVIDES TWENTY-FOUR HOUR HEALTHCARE SERVICES FOR PATIENTS IN THE SURROUNDING RURAL COMMUNITIES. THE HOSPITAL HAD 5,917 EMERGENCY ROOM VISITS THIS YEAR. THE HOSPITAL'S EMERGENCY ROOM IS OPEN TO EVERYONE, REGARDLESS OF ABILITY TO PAY. THE HOSPITAL ALSO PROVIDED 25,390 LAB TESTS, OVER 3,000 OUTPATIENT CLINIC VISITS AND 110 INPATIENT DAYS DURING THE YEAR. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTHCARE NEEDS OF THE PEOPLE OF GOD, THE MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. 5112253 true true false false false false false false false false true true false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 17 0 true 59 true false false false false false false false false false false false false X 7 3 false false false false true true true true true false false true true true true false true true false false X AMANDA HYMEL 2257656565 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 X Jeffrey D Limbocker CFO 2.0 58.0 X X 0 696323 138768 Kenneth Wester Board Member 2.0 55.5 X 0 1115252 204346 John Selser chair 2.0 2.0 X X 0 0 0 William E Balhoff Chair 2.0 0.0 X X 0 0 0 Charles P Bolotte MD Board member 10.0 0.0 X 35698 0 0 Christy Hockaday CEO 2.0 48.0 X X 0 245030 28633 Yolanda Dixon Secretary 2.0 2.0 X X 0 0 0 Harry J Philips Jr Vice Chair 2.0 0.0 X X 0 0 0 Stephanie Manson Board Member 2.0 40.0 X 0 469495 68312 Brian F Tripode Supervisor-Pharmacy 40.0 0.0 X 159182 0 29270 Donna M Mullings Director - nursing 1 40.0 0.0 X 102333 0 41465 297213 2526100 510794 2 false true false OLOLRMC Laboratory Services 7777 Hennessy Blvd Suite 804 Baton Rouge LA 70898 Lab Services 1066081 Correct Care Inc 229 Saint John Lane COVINGTON LA 704333276 Director of ER Fees 1264787 FMOL HEALTH SYSTEM 4200 ESSEN LANE BATON ROUGE LA 70809 LAB MANAGEMENT FEES 111745 3 30000 30000 Patient Service Revenue 900099 6623529 6623529 Purchase Discounts 900099 3288 3288 Medical Records 900099 598 598 Outreach Lab 900099 5988 5988 All other Program Service Revenue 900099 5509 5509 6638912 58456 58456 0 0 28417 28417 0 28417 28417 1452596 1144913 307683 307683 307683 0 0 0 0 0 0 0 0 0 0 7063468 6667329 366139 X 3018 3018 0 0 0 0 0 2307893 1813942 493951 265470 208651 56819 348612 262047 86565 156793 124304 32489 1462685 1164013 298672 5450 5450 0 0 0 13743 13743 1085386 871944 213442 136 88 48 263029 97973 165056 40741 40741 0 235623 201624 33999 24290 16726 7564 0 0 0 0 189530 162182 27348 41578 41578 Medical Supplies Expense 146730 137648 9082 0 SALES TAX EXPENSE 2028 1902 126 0 6592735 5112253 1480482 0 7119523 8327145 6488 0 12550 265779 802508 499527 0 0 0 0 0 0 0 0 14673 14702 3963037 2921357 1194448 1041680 0 0 5730042 5900525 0 0 0 0 212419 0 15092651 16049358 2573770 2908032 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1403792 1737403 3977562 4645435 X 11109251 11403923 5838 0 0 0 11115089 11403923 15092651 16049358 470733 -181899 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 55461 55461 855835 666505 189330 82115 44845 37270 2969626 2210007 759619 1041680 0 0 RETIREMENT PAYABLE LONG TERM 1366941 DUE TO/FROM RELATED ENTITIES 370462 1737403 X FIN 48 (ASC 740) FOOTNOTE FMOLHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. NO RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. true true true X 250. false true true true false true true 175763 175763 0.03460 2634639 2634639 0.00000 2810402 2634639 175763 0.03460 35255 35255 35255 35255 2845657 2634639 211018 0.03460 true 64827 1788282 1812543 -24261 X true true 1 1 Assumption Community Hospital 135 HIGHWAY 402 NAPOLEONVILLE LA 70390 X X X X Rural Health Clinic Assumption Community Hospital 1 false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C X true 18 false true false true X 250. 0. X X X X X true true X X X true 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 true X false X X X X true X false false PART V, SECTION B, LINE 5 THE HOSPITAL HELD A FOCUS GROUP DISCUSSION WITH VARIOUS COMMUNITY GROUPS IN ORDER TO DISCUSS AND VALIDATE STATISTICAL DATA OBTAINED FROM THE HEALTH COMMUNITIES INSTITUTE. THE FOCUS GROUP WAS ABLE TO HELP IDENTIFY THE COMMUNITY'S CHALLENGES AND THE ISSUES WITH THE GREATEST POTENTIAL FOR SUCCESS. IT MET WITH REPRESENTATIVES FROM ASSUMPTION PARISH COUNCIL ON AGING, ASSUMPTION PARISH LIBRARY, ASSUMPTION PARISH SCHOOLS, ASSUMPTION PARISH HEAD START, ACADIAN AMBULANCE SERVICE, LSU AG CENTER, ASSUMPTION HEALTHCARE AND REHAB, ASSUMPTION ASSOCIATION FOR RETARDED CITIZENS, OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER, ASSUMPTION PRIMARY CARE, ASSUMPTION PARISH SHERIFF'S OFFICE, ASSUMPTION PARISH POLICE JURY, AND REGION III OFFICE OF EMERGENCY PREPAREDNESS. ONE PARTICIPANT WITH SPECIALIZED KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH WAS DEBRA GONZALES, DHH/OFFICE OF PUBLIC HEALTH FOR REGION III. PART V, SECTION B, QUESTION 7 THE CHNA CAN BE FOUND AT HTTPS://OLOLRMC.COM/PAGES/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX PART V, SECTION B, QUESTION 11 Assumption Community Hospital (ACH), a critical access hospital, an affiliate of Our Lady of the Lake Hospital and a member of the Franciscan Missionaries of Our Lady Health System, conducted a new community health needs assessment in 2018. The significant health needs identified during the 2018 community health needs assessment were: mental health services, obesity, diabetes, and access to cancer screening. The significant community health needs identified during the previous community health needs assessment in 2015 were Access to primary care, childhood obesity, diabetes, and health education for seniors. During the 2018-2019 fiscal year, ACH served over 2,000 parishioners. ACH partnered with Assumption's Council of Aging for The Council of Aging Community Health Fair which targeted senior citizen audience of Assumption Parish. ACH administered free flu vaccines, blood pressure and glucose screenings, cholesterol screenings, and weight and BMI checks. ACH purchased healthy snacks that were distributed to the seniors. There were approximately 125 attendees at the Fair. ACH participated in the Assumption Head Start Health Fair. ACH administered free flu vaccines, blood pressure and glucose screenings, and weight and BMI checks. ACH purchased Healthy Food Choices coloring books and crayons that were given to the parents and grandparents to take home for their children and grandchildren. Approximately 30 people attended. ACH representatives also attended 3 parent meetings to introduce the Get Fit Program. ACH administered flu vaccines to the Assumption Retarded Center citizens and their staff. Assumption Parish Sheriff's Department held an in-house health fair. ACH offered blood pressure screenings and BMI screenings to all of their employees. ACH performed a full-scale exercise for Active Shooter which involved our parish sheriff's department, our volunteer fire department, Acadian, Policy Jury and Nursing Home. This exercise provided education and confidence to our parishioners that ACH would be prepared for an active shooter in addition to showing that agencies can work together for the safety of the parish. A Nutritional Program was offered through our clinic to teach children about healthier food choices. Recognizing the program could be expanded and enhanced, ACH reached out to the public school nurses for their suggestions. ACH was then introduced to the LSU Ag Center Agent. After months of sharing suggestions and planning ACH created the Get-Fit-Ba-You program. Assumption collaborated with the parish LSU Ag Center to begin the Get-Fit-Ba-You program which was taught to 1100 5th - 8th graders in our parish public school system. LSU Ag Center, with the help of LSU, designed a nutritional three week program. This introduced students to healthy choices they can make for themselves. ACH provides the staff to cook food tasting samples for the 1100 students. Through a series of pre and post tests given to the students that participated through their physical education classes, ACH determined that there was a 35% increase in knowledge of nutrition because of the program. ACH created a walking path under four beautiful oak trees. Benches, planters and trashcans were added to continue to add to the beauty of the walking path. ACH estimates that 25 to 30 parishioners a day use our walking path. Mary Bird Perkins and Woman's Hospital Mobile Unit have partnered with us to provide breast exams and skin and prostate cancer screenings between three to four times a year, completing 88 breast exams. PART V, SECTION B, QUESTION 13H PRESUMPTIVE ELIGIBILITY IS DETERMINED BASED ON INFORMATION THAT MAY BE OBTAINED FROM SOURCES OTHER THAN THE PATIENT, SUCH AS EVIDENCE THAT THE PATIENT IS PARTICIPATING IN ONE OR MORE OF THE FOLLOWING: 1. STATE-FUNDED PRESCRIPTION PROGRAMS; 2. LACHIP, SUBSIDIZED HOUSING, FREE OR REDUCED SCHOOL LUNCHES, ETC. FOR THE PATIENT/GUARANTOR'S CHILDREN; 3. LOUISIANA FOOD STAMP PROGRAM; 4. STATE MEDICAID PROGRAM. FOR PATIENTS THAT HAVE MEDICAID COVERAGE, THE FINANCIAL ASSITANCE DETERMINATION WILL RELY ON INFORMATION FROM THE MEDICAID PROGRAM, INCLUDING EVIDENCE THAT: - PATIENT IS CURRENTLY ON MEDICAID, BUT HAS A PRIOR BALANCE WITHIN 12 MONTHS OF THE APPROVAL DATE - PATIENT CURRENTLY HAS MEDICAID WITH LIMITED BENEFITS (ONLY COVERS FAMILY PLANNING) - PATIENT IS IN A HOSPICE AND HAS MEDICAID ONLY - PATIENT HAS MEDICAID THROUGH A NON-CONTRACTED STATE - PATIENT QUALIFIES FOR MEDICAID WITH A "SPEND-DOWN REQUIREMENT" - PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (I.E., MEDICAID SPEND-DOWN); - PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY OR ESTATE. THE DUE DILIGENCE EFFORTS TO VERIFY THE ESTATE ASSETS ARE TO BE DOCUMENTED VIA THE HOSPITAL APPROVED WEBSITE. ADDITIONALLY, A PATIENT MAY BE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THERE IS AN INDEPENDENT, QUALIFIED ATTESTATION THAT THE PATIENT IS HOMELESS. PART V, SECTION B, QUESTION 16J REGISTRATION PERSONNEL AND FINANCIAL COUNSELORS REFER PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE TO FINANCIAL COUNSELORS TO DISCUSS QUALIFICATION FOR FULLY-DISCOUNTED CARE UNDER THE FINANCIAL ASSITANCE POLICY. THE POLICY IS ALSO POSTED AT THE HOSPITAL BUSINESS OFFICE AND AT ALL REGISTRATION LOCATIONS. PART V, SECTION B, QUESTION 16A, B, & C The Financial Assistance Policy (FAP), FAP application form, and a plain-language summary of the FAP are available at: https://fmolhs.org/financial-assistance-policy/ PART I, LINE 3C FINANCIAL ASSISTANCE IS AVAILABLE FOR INDIVIDUALS WHO ARE INSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. FULLY-DISCOUNTED CARE IS AVAILABLE IF INCOME AND ASSETS MEET CERTAIN FEDERAL POVERTY GUIDELINE LEVELS. FULLY-DISCOUNTED CARE IS ALSO AVAILABLE FOR THOSE PATIENTS WITH CATASTROPHIC MEDICAL BILLS WHERE MEDICAL BILLS EXCEED A CERTAIN PERCENTAGE OF INCOME AND ASSETS. FULLY DISCOUNTED CARE IS ALSO AVAILABLE WHERE THE PATIENT OR OTHER SOURCES CAN PROVIDE SUFFICIENT EVIDENCE OF PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY IS DETERMINED BASED ON INFORMATION THAT MAY BE OBTAINED FROM SOURCES OTHER THAN THE PATIENT, SUCH AS EVIDENCE THAT THE PATIENT IS PARTICIPATING IN ONE OR MORE OF THE FOLLOWING: 1. STATE-FUNDED PRESCRIPTION PROGRAMS; 2. LACHIP, SUBSIDIZED HOUSING, FREE OR REDUCED SCHOOL LUNCHES, ETC. FOR THE PATIENT/GUARANTOR'S CHILDREN; 3. LOUISIANA FOOD STAMP PROGRAM; 4. STATE MEDICAID PROGRAM. FOR PATIENTS THAT HAVE MEDICAID COVERAGE, THE FINANCIAL ASSITANCE DETERMINATION WILL RELY ON INFORMATION FROM THE MEDICAID PROGRAM, INCLUDING EVIDENCE THAT: - PATIENT IS CURRENTLY ON MEDICAID, BUT HAS A PRIOR BALANCE WITHIN 12 MONTHS OF THE APPROVAL DATE - PATIENT CURRENTLY HAS MEDICAID WITH LIMITED BENEFITS (ONLY COVERS FAMILY PLANNING) - PATIENT IS IN A HOSPICE AND HAS MEDICAID ONLY - PATIENT HAS MEDICAID THROUGH A NON-CONTRACTED STATE - PATIENT QUALIFIES FOR MEDICAID WITH A "SPEND-DOWN REQUIREMENT" - PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (I.E., MEDICAID SPEND-DOWN); - PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY OR ESTATE. THE DUE DILIGENCE EFFORTS TO VERIFY THE ESTATE ASSETS ARE TO BE DOCUMENTED VIA THE HOSPITAL APPROVED WEBSITE. ADDITIONALLY, A PATIENT MAY BE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THERE IS AN INDEPENDENT, QUALIFIED ATTESTATION THAT THE PATIENT IS HOMELESS. PART I, LINE 7 THE OPERATION OF OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS A COMMUNITY BENEFIT IN ITSELF. OUR LADY OF THE LAKE ASSUMPTION IS LOCATED IN AN UNDER-INSURED/LOW INCOME AREA. THE HOSPITAL IS THE ONLY SOURCE OF EMERGENCY HEALTH SERVICES AVAILABLE IN THE IMMEDIATE AREA. THE HOSPITAL DOES NOT HAVE A FORMAL COMMUNITY BENEFIT REPORT BUT IS CONSOLIDATED WITH THE SOLE MEMBER, OUR LADY OF THE LAKE HOSPITAL, INC. PART I, LINE 7, COLUMN F 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 LINES 7A-D AND IS BASED ON IRS WORKSHEET 2. PART III, SECTION A, QUESTION 2 PART III, SECTION A, QUESTION 2 AMOUNT REPRESENTS THE ACTUAL CUSTOMER AMOUNTS DUE TO OUR LADY OF THE LAKE ASSUMPTION THAT WERE WRITTEN OFF BECAUSE THEY WERE UNCOLLECTIBLE. PART III, LINE 4 THE BAD DEBT FOOTNOTE IS ON PAGE 19 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. THE AMOUNT ON PART III, LINE 6 REPRESENTS MEDICARE ALLOWABLE COSTS FROM THE COST REPORT. PART III, LINE 9B PATIENTS WITH NO MEANS OF PAYMENT MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME, ASSETS, AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS MAY ALSO BE FULLY DISCOUNTED BASED ON A PRESUMPTIVE CHARITY SCORING SYSTEM WHICH IS SIMILAR TO CREDIT SCORING. TO THE EXTENT APPROPRIATE AND PERMITTED BY LAW, FINANCIAL COUNSELING AND SCREENINGS ARE CONDUCTED AT THE TIME OF ENCOUNTER TO ASSIST IN IDENTIFYING PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S POLICY. THESE PROCESSES HELP IDENTIFY (EARLY IN THE PROCESS) PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. THIS HELPS KEEP QUALIFYING PATIENTS OUT OF THE HOSPITAL'S COLLECTION PROCESSES BECAUSE AMOUNTS COVERED BY FINANCIAL ASSISTANCE ARE NOT SUBJECT TO THE HOSPITAL'S COLLECTION PRACTICES. HOWEVER, IF IT IS DETERMINED THAT A PATIENT QUALIFIES FOR DISCOUNTED CARE AFTER THE INDIVIDUAL'S ACCOUNT HAS BEEN SENT TO COLLECTIONS, THE DISCOUNTED AMOUNT IS IMMEDIATELY REMOVED FROM THE COLLECTIONS PROCESS. PART VI, LINE 2 NEEDS ASSESSMENT THE HOSPITAL WORKED WITH THE ASSUMPTION RURAL HEALTH CLINIC COMMUNITY, THE ASSUMPTION COUNCIL ON AGING, THE ASSUMPTION PARISH SCHOOL NURSES, DEPARTMENT OF HEALTH AND HOSPITALS/OFFICE OF PUBLIC HEALTH, AND OTHER COMMUNITY AND BUSINESS LEADERS TO IDENTIFY THE COMMUNITY'S HEALTH CARE NEEDS. THE IDENTIFIED NEEDS WILL CONTINUE TO BE ADDRESSED THROUGH CONTINUED DIALOGUE AND COLLABORATION WITH SPECIFIC GROUPS IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. IN ADDITION TO WORKING WITH SPECIFIC GROUPS TO ADDRESS THE COMMUNITY'S HEALTH CARE NEEDS, THE HOSPITAL AND THE RURAL HEALTH CARE CLINIC PROVIDE VARIOUS OUTREACH PROGRAMS SUCH AS AN ANNUAL HEALTH FAIR, PERIODIC SMOKING CESSATION CLASSES, AND PERIODIC DIABETES EDUCTION PROGRAMS. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: INDIVIDUALS ARE EDUCATED ABOUT ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AT VARIOUS STAGES OF THE ENCOUNTER WITH OUR LADY OF THE LAKE HOSPITAL. PATIENTS ARE INFORMED THROUGH A PATIENT HANDBOOK THAT CONTAINS INFORMATION ON THE FINANCIAL POLICIES OF THE HOSPITAL. ADDITIONALLY, SYSTEMS AND TOOLS ARE UTILIZED TO CONDUCT HIGH LEVEL FINANCIAL SCREENING TO ASSIST IN IDENTIFYING PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. WHEN AND WHERE APPROPRIATE, FINANCIAL COUNSELORS VISIT PATIENTS AT THE TIME OF THE ENCOUNTER AND EXPLAIN THE ASSISTANCE OPTIONS AVAILABLE. FINANCIAL COUNSELORS WORK WITH PATIENTS TO ASSIST WITH ENROLLMENT FOR MEDICAID FOR THOSE WHO ARE ELIGIBLE AS WELL AS TO ASSIST THOSE WHO QUALIFY FOR HOSPITAL FINANCIAL ASSISTANCE. PART VI, LINE 4 COMMUNITY INFORMATION Assumption Parish is a very rural area with only one incorporated community of approximately 700 residents known as the Village of Napoleonville. Assumption Parish is a community heavily dependent on agriculture (primarily sugar cane production) and has only a few large employers such as the Assumption Parish School system and a local marine shipyard. The median household income for the parish for 2018 was $45,457. Other small communities located in the parish include, Labadieville, Paincourtville, Plattenville, Bertrandville, Belle Rose, Pierre Part and Bayou L'Ourse. 13.93% of families live below the poverty line. 29% of the Assumption Parish population did not graduate high school. The majority of Assumption Parish speaks only English, but 13% speak Indo-European languages. PART VI, LINE 5 OTHER INFORMATION THE MAJORITY OF THE GOVERNING BODY OF OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS COMPRISED OF INDIVIDUALS WITH A BROAD CROSS-SECTION OF HEALTH CARE AND BUSINESS EXPERIENCE. OUR LADY OF THE LAKE ASSUMPTION HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF THE HOSPITAL DEPARTMENTS AS NEEDED. SURPLUS FUNDS ARE APPLIED TO IMPROVEMENTS IN PATIENT CARE AREAS THROUGH INVESTMENT IN CLINICAL TECHNOLOGY, MEDICAL INFORMATION TECHNOLOGY, AND CONTINUED TRAINING OF CLINICAL STAFF. PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS A NOT-FOR-PROFIT, NON-STOCK, MEMBER CORPORATION OF WHICH OUR LADY OF THE LAKE HOSPITAL, INC. IS THE SOLE MEMBER. OUR LADY OF THE LAKE ASSUMPTION HOSPITAL IS PART OF THE FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC. WHICH INCLUDES SEVERAL HOSPITALS AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATE. OUR LADY OF THE LAKE ASSUMPTION SERVES THE COMMUNITY IN LOUISIANA'S ASSUMPTION PARISH AND SURROUNDING PARISHES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER OUR LADY OF LOURDES REGIONAL MEDICAL CENTER ST. FRANCIS MEDICAL CENTER ST. ELIZABETH HOSPITAL OUR LADY OF THE ANGELS HOSPITAL false true false false false false false false false Jeffrey D Limbocker CFO 0 535092 0 160416 0 815 0 114181 0 24587 0 835091 0 0 Kenneth Wester Board Member 0 741977 0 372460 0 815 0 175987 0 28359 0 1319598 0 0 Brian F Tripode Supervisor-Pharmacy 159057 0 0 125 0 6717 0 22553 0 188452 0 0 0 Christy Hockaday CEO 0 208231 0 35984 0 815 0 10039 0 18594 0 273663 0 0 Stephanie Manson Board Member 0 399671 0 69249 0 575 0 41046 0 27266 0 537807 0 0 PART I QUESTION 4A A BOARD MEMBER AND THE CFO LISTED IN PART VII ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR TERMINATION OF EMPLOYMENT WITHOUT CAUSE FOR GOOD REASON AND FOR A CHANGE OF CONTROL. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS/HER BASE SALARY AND AN ANNUAL INCENTIVE AT TARGET AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 24 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. THE CEO 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 12 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. PART I QUESTION 4B FMOLHS maintains three unfunded deferred compensation plans which meet the requirements of IRC Section 457(f) and IRC Section 409A. The plans provide for compensation to be deferred and paid upon the occurrence of certain events such as termination without cause, disability, death or attainment of a specific payment date. Participation in the plans is limited to certain executives and is subject to approval of FMOLHS board of directors or a designated committee of such board. No one listed on Part VII, Section A received a payment from the plans in the current year. PART III, QUESTION 1 - ORGANIZATION'S MISSION 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. PART VI, SECTION A, QUESTION 6 OUR LADY OF THE LAKE HOSPITAL (AN IRC SECTION 501 (C) (3) ORGANIZATION) IS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. PART VI, SECTION A, QUESTION 7A OUR LADY OF THE LAKE HOSPITAL, AS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL, RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS AND THE OFFICERS OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL. PART VI, SECTION A, QUESTION 7B OUR LADY OF THE LAKE HOSPITAL, INC. AS THE SOLE MEMBER OF OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL CAN MAKE THE DECISIONS AS FOLLOWS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES, AND PURPOSES OF CORPORATION 2. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF THE CORPORATION. 3. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION OR AFFILIATION, OR PARTICIPATION IN JOINT VENTURES 5. TO DISSOLVE AND DISTRIBUTE ASSETS OF THE CORPORATION 6. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION 7. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY CORPORATION 9. TO APPOINT THE FISCAL AUDITOR OF THE CORPORATION 10. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHANGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION 11. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION 12. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION PART VI, SECTION A, QUESTION 11 AFTER PREPARATION OF THE FORM 990 BY KPMG LLP, MANAGEMENT REVIEWED THE FORM 990. A COPY OF THE FORM 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. PART VI, SECTION B, QUESTION 12C OLOL ASSUMPTION COMMUNITY HOSPITAL HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY THAT REQUIRES EACH OFFICER, TRUSTEE, BOARD COMMITTEE MEMBER AND EMPLOYEE TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. COMPLETED DISCLOSURE FORMS ARE REVIEWED AND MAINTAINED BY THE CHIEF COMPLIANCE OFFICER. IF ANY TRUSTEE, BOARD COMMITTEE MEMBER OR SENIOR MANAGER HAS A POTENTIAL CONFLICT, THE EXECUTIVE COMMITTEE OF THE BOARD DETERMINES WHETHER ACTION NEEDS TO BE TAKEN AND COMMUNICATES ANY SUCH ACTION TO THE INDIVIDUAL. A POTENTIAL CONFLICT OF ANY OTHER EMPLOYEE IS REVIEWED BY THE CEO OR HIS DESIGNEE. THE EXECUTIVE COMMITTEE, CEO OR DESIGNEE, AS APPLICABLE, DETERMINES IF A CONFLICT OF INTEREST EXISTS OR CREATES THE APPEARANCE OF IMPROPRIETY. IF SUCH A DETERMINATION IS MADE, THE INDIVIDUAL WILL BE EXCUSED FROM PARTICIPATING IN THE BUSINESS DECISION. DURING THE YEAR, ANY CHANGE TO THE INFORMATION IN THE DISCLOSURE STATEMENT MUST BE DISCLOSED PROMPTLY TO THE CHIEF COMPLIANCE OFFICER, WHO TAKES APPROPRIATE ACTION. THE PROCESS ALSO REQUIRES AFFIRMATION FROM EACH INDIVIDUAL THAT HE OR SHE (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) HAS AGREED TO COMPLY WITH THE POLICY; AND (D) UNDERSTANDS THAT OLOL ASSUMPTION COMMUNITY HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OLOL ASSUMPTION COMMUNITY HOSPITAL PROVIDES MECHANISMS FOR CONFIDENTIAL REPORTING OF COMPLIANCE ISSUES. THESE MECHANISMS INCLUDE AN ANONYMOUS HOTLINE AND WEB SITE WHERE INDIVIDUALS MAY RAISE ISSUES, SEEK CLARIFICATION, AND REPORT POSSIBLE CONFLICTS OF INTEREST OR OTHER CONCERNS. THESE REPORTS, INCLUDING REPORTS OF POSSIBLE CONFLICTS OF INTEREST, ARE REVIEWED AND INVESTIGATED BY THE CORPORATE COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN. PART VI, SECTION B QUESTION 13 Throughout the tax year, the organization had a whistleblower policy in place although it was not approved by the organization's board of directors before June 30, 2019. The whistleblower policy has, however, been approved by the board of directors of Our Lady of the Lake Hospital, Inc. (the organization's sole-member). PART VI, SECTION B, QUESTION 15A & 15B OTHER RELATED ORGANIZATIONS SET THE COMPENSATION AND PAY FOR THE EXECUTIVES. THAT BOARD OF DIRECTORS DESIGNATES THE COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY OUTSIDE SOURCES. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE COMPENSATION COMMITTEE. PART VI, SECTION C, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. SECTION 1.263(A)-3(N) ELECTION-BOOK CONFORMITY ELECTION OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2019. SECTION 1.263 (A)-1(F) - ELECTION- DE MINIMIS SAFE HARBOR ELECTION OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL HEREBY MAKES THE DE MINIMIS SAFE HARBOR ELECTION UNDER SECTION 1.263(A)-1(F) OF THE TREASURY REGULATIONS, EFFECTIVE ONLY FOR THE TAX YEAR ENDING JUNE 30, 2019. TAXPAYER HAS AN APPLICABLE FINANCIAL STATEMENT FOR THE YEAR OF THE ELECTION. THIS ELECTION PERMITS THE TAXPAYER TO DEDUCT FOR TAX PURPOSES ANY ITEM DEDUCTED UNDER ITS BOOK POLICY THAT DOES NOT EXCEED $5,000 PER INVOICE (OR PER ITEM, AS SUBSTANTIATED BY THE INVOICE) OR ITEMS HAVING AN ECONOMIC USEFUL LIFE OF TWELVE MONTHS OR LESS AS DESCRIBED IN SECTION 1.263(A)-1(F)(1)(I). FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:139587 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:141403 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PURCHASED SVC TOTAL FEES:802558 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:1838 ST BERNARD HEALTH FUND 4200 ESSEN LANE BATON ROUGE LA 70809 204685614 HEALTHCARE LA 501(C)(3) 11 TYPE 1 FMOL false HEALTH CARE CENTERS IN SCHOOLS 5000 HENNESSY BLVD BATON ROUGE LA 70808 721443935 HEALTHCARE LA 501(C)(3) 7 OLOL false HEART HOSPITAL OF ACADIANA LLC 1105 KALISTE SALOOM ROAD LAFAYETTE LA 70508 300442368 HEALTHCARE LA LOURDES N/A PERKINS PLAZA IMAGING DEVELOPMENT LLC 5000 HENNESSY BLVD PLAZA 2 SUITE BATON ROUGE LA 70808 203894521 REAL ESTATE LA OLOL N/A P&S SURGERY CENTER LLC 312 GRAMMONT STREET MONROE LA 71201 721387870 HEALTHCARE LA SFMC N/A LOURDES IMAGING DEVELOPMENT LLC 4801 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 208326287 REAL ESTATE LA LOURDES N/A PARK PLACE SURGERY CENTER LLC 4811 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 721404092 HEALTHCARE LA LOURDES N/A BRPT LAKE REHABILITATION CENTERS LLC 5222 BRITTANY DRIVE BATON ROUGE LA 70808 721506100 HEALTHCARE LA OLOL N/A CONVENIENT CARE LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 721439481 HEALTHCARE LA OLOL N/A SURGICAL SPECIALTY CENTER OF BATON ROUGE 8080 BLUEBONNET BLVD BATON ROUGE LA 70810 263160962 HEALTHCARE LA OLOL N/A ST ELIZABETH-MARY BIRD PERKINS CANCER C 4950 ESSEN LANE BATON ROUGE LA 70809 260628752 HEALTHCARE LA OLOL N/A NORTHEAST LA CANCER INSTITUTE LLC 411 CALYPSO STREET MONROE LA 71201 721329499 HEALTHCARE LA SFMC N/A LHCG-XIII LLC 901 S HUGH WALLIS ROAD LAFAYETTE LA 70508 208068308 HEALTHCARE LA LOURDES N/A LOURDES AFTER HOURS LLC 7777 HENNESSY BLVD SUITE 1004-202 BATON ROUGE LA 70809 201367299 HEALTHCARE LA LOURDES N/A LAKE URGENT CARE ASCENSION LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 352463092 HEALTHCARE LA OLOL N/A OLOLUSP SURGERY CENTER LLC 15305 DALLAS PKWY STE 1600 LB 28 ADDISON TX 75001 352457810 HEALTHCARE TX OLOL N/A ST FRANCIS URGENT CARE LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 474013731 HEALTHCARE LA SFMC N/A GAMMA KNIFE OF LOUISIANA LLC 4950 ESSEN LANE BATON ROUGE LA 70809 811827194 HEALTHCARE LA OLOL N/A LHCG LXVII LLC 901 S HUGH WALLIS ROAD LAFAYETTE LA 70508 474283509 HEALTHCARE LA LOURDES N/A PREMIER HEALTH HOLDINGS LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 472665226 HEALTHCARE LA OLOL N/A PINNACLE CARE HOLDINGS LLC 5627 S SHERWOOD FOREST BLVD BATON ROUGE LA 70816 720423651 HEALTHCARE LA OLOL N/A LAFAYETTE SURGERY CENTER LTD PSHIP C/O C T CORP SYSTEM 3867 PLAZA TOW BATON ROUGE LA 70816 HEALTHCARE LA LOURDES N/A HOSPITAL ASSISTANCE SERVICES PO BOX 4027-C LAFAYETTE LA 70502 721073486 HEALTHCARE LA LOURDES C CORP LOUISE INSURANCE COMPANY PO BOX 1051 KY1-1102 CAYMAN ISLANDS CJ INSURANCE CJ FMOL C CORP FRANCISICAN HEALTH & WELLNESS SERVICES 4200 ESSEN LANE BATON ROUGE LA 70809 455492379 HEALTHCARE LA FMOL C CORP FMOL HEALTH SYSTEM HOLDINGS INC 4200 ESSEN LANE BATON ROUGE LA 70809 454405024 INVESTMENT LA FMOL C CORP false false false false false false false false false false true false true false false false true true true