2018-05-15T11:01:58-05:00 2017-06-30 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2016-07-01 720780429 Ollie Steele Burden Manor INC % AMANDA HYMEL OLLI 2257657709 4250 ESSEN LANE BATON ROUGE LA 70809 JEFF LIMBOCKER REGIONAL CFO 2257656565 2018-05-14 true Ryan Hooks P00746825 2253444000 2018-05-08 2016 2022-09-23 18:48:47Z KAREN ALLEN 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 22078012 false 0928 X N/A X 1963 LA The purpose of the hospital is to provide CARE FOR THE ill INJURED OR DISABLED PERSONS,ESPECIALLY THE ELDERLY AND FOR THE ENHANCEMENT OF HEALTH OF THE ELDERLY IN THE COMMUNITY 11 9 558 125 0 5701 157034 21279670 21917813 2150 3165 0 0 21287521 22078012 0 0 0 0 15258346 15367537 0 0 0 7550131 7744046 22808477 23111583 -1520956 -1033571 18860830 18323998 15274007 15760988 3586823 2563010 X See Schedule O false false 18298445 21917813 OLLIE STEELE BURDEN MANOR OPERATES TWO NURSING HOME FACILITIES specially designed to provide the highest level of care for those suffering with complex physical health issues including Alzheimer's disease and dementia. The nursing homes provide 24 hour nursing care in a rehabilitative setting that ministers to the needs of the whole person. The nursing home provided care and housing for 99,954 resident days. 18298445 true true false false false false false false false false true false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 18 0 true 558 true false false false false false false false false false false X 11 9 false false false false true true true true true false false true false false false false false false X AMANDA HYMEL 2259232701 5959 S SHERWOOD FOREST BLVD BATON ROUGE LA 70809 X Karen B Allen President of SSD 12.5 37.5 X X 0 259020 73265 KENNETH SCOTT WESTER Board Member 1.0 56.5 X 0 758992 197955 Mary Tauzin Board Member 1.0 0.0 X 0 0 0 James W Firnberg Sr Board Member 1.0 0.0 X 0 0 0 Kevin Curry Board Member 1.0 0.0 X 0 0 0 Arthur Landry Chairman 1.0 0.0 X X 0 0 0 Jayne Apple Board Member 1.0 0.0 X 0 0 0 SR Ann Catherine Nguyen Board Member 1.0 0.5 X 0 0 0 JEFF KUEHNY MD BOARD MEMBER 1.0 0.0 X 0 0 0 Robert Kuhn Board Member 1.0 0.0 X 0 0 0 Dr Lisa Perez Board Member 1.0 0.0 X 0 0 0 JEFFREY D LIMBOCKER CFO 1.0 59.0 X 0 515326 127559 STACEY FONTENOT CLINICAL DIRECTOR OF OPERATION 40.0 0.0 X 106831 0 26548 106831 1533338 425327 1 false true false TRITON HEALTHCARE 8128 FLORIDA BLVD DENHAM SPRINGS LA 70726 THERAPY SERVICES 322428 ADVANTAGE MEDICAL PROFESSIONALS 3340 SERVERN AVE SUITE 320 METARIE LA 700027410 STAFFING SERVICES 152254 SOUTHERN MEDICAL STAFFING 1305 METRO DRIVE SUITE 6 ALEXANDRIA LA 71301 STAFFING SERVICES 433098 AEGIS THERAPIES INC 7160 North Dallas Parkway Suite 40 PLANO TX 72902 THERAPY SERVICES 636027 LOUISIANA PATIENT'S COMPENSATION FU 627 N FOURTH ST STE 2-300 BATON ROUGE LA 70802 INSURANCE 112134 5 136000 9690 11344 157034 PATIENT REVENUE 900099 21887344 21887344 BEAUTY/BARBER SERVICES 900099 12392 12392 Miscellaneous Revenue 900099 1155 1155 FRANCISCAN SISTER SERVICES 900099 9600 9600 VENDING REVENUE 900099 6868 6868 454 454 21917813 3165 3165 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22078012 21917813 3165 0 0 0 0 0 0 11262342 8851899 2410443 1036604 814740 221864 2271070 1707131 563939 797521 632269 165252 54211 44611 9600 21546 21546 0 0 0 0 2103388 1893049 210339 7964 5177 2787 1006778 375003 631775 106469 98029 8440 0 800216 754684 45532 2204 1518 686 0 6419 6419 45502 45502 0 962934 908143 54791 151186 151186 MEDICAL SUPPLIES EXPENSE 438800 411640 27160 PROVIDER FEES 1170927 1170927 RECRUITMENT 9624 6256 3368 Other Expenes - RAW FOOD 855878 556321 299557 23111583 18298445 4813138 0 0 0 1340019 1663582 0 0 1229180 1168099 0 0 0 0 0 0 51407 50250 112134 106362 30908790 15879121 15806293 15029669 0 0 155797 164036 0 0 166000 142000 0 0 18860830 18323998 2295570 4682615 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12978437 11078373 15274007 15760988 X 3580823 2546515 6000 16495 0 0 3586823 2563010 18860830 18323998 -1033571 9758 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 905168 905168 23396348 11213983 12182365 873448 476635 396813 5733826 4188503 1545323 15029669 0 DUE TO AFFILIATES 6676849 DEPOSITS 2200 ACCRUED PENSION COSTS 4399324 11078373 X FIN 48 (ASC 740) FOOTNOTE SCHEDULE D 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 judgement occurs. No reserves for uncertain tax positions have been recorded. false true false false false false false false false Karen B Allen President of SSD 0 193214 0 46791 0 19015 0 49837 0 23428 0 332285 0 0 KENNETH SCOTT WESTER Board Member 0 579161 0 161056 0 18775 0 170152 0 27803 0 956947 0 0 JEFFREY D LIMBOCKER CFO 0 402952 0 93599 0 18775 0 103542 0 24017 0 642885 0 0 PART I QUESTION 3 THE PRESIDENT 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 PRESIDENT'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 DETERMINATION IS THEN DOCUMENTED BY THE COMPENSATION COMMITTEE. 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 I QUESTION 4A A BOARD MEMBER 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. Form 990, Part III, Question 1 INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI AND IN THE TRADITION OF THE ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING - WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. FORM 990, PART VI, QUESTION 6 OUR LADY OF THE LAKE HOSPITAL, INC.( AN IRC SECTION 501 (C)(3) ORGANIZATION) IS THE SOLE MEMBER OF OLLIE STEELE BURDEN MANOR, INC. FORM 990, PART VI, QUESTION 7A OUR LADY OF THE LAKE HOSPITAL INC., AS THE SOLE MEMBER OF OLLIE STEELE BURDEN MANOR, INC., RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF OLLIE STEELE BURDEN MANOR, INC. FORM 990, PART VI, QUESTION 7B OUR LADY OF THE LAKE HOSPITAL, AS THE SOLE MEMBER OF OLLIE STEELE BURDEN MANOR, INC. RESERVES THE FOLLOWING POWERS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES, 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 ARTICLES OF INCORPORATION AND BYLAWS OF CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION OR AFFILIATION, OR PARTICIPATE 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 IMMOVABLE PROPERTY ON BEHALF OF CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION 9. TO APPOINT FISCAL AUDITOR OF CORPORATION 10. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHARGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION 11. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION 12. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION FORM 990, PART VI, SECTION 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. FORM 990, PART VI, QUESTIONS 12-14 THROUGHOUT THE TAX YEAR, THE ORGANIZATION HAD A CONFLICT OF INTEREST POLICY, DOCUMENT RETENTION POLICY, AND A WHISTLEBLOWER POLICY IN PLACE ALTHOUGH THEY WERE NOT APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE JUNE 30, 2017. THE CONFLICT OF INTEREST POLICY AND THE DOCUMENT RETENTION POLICY HAVE, HOWEVER, BEEN APPROVED BY THE BOARD OF DIRECTORS OF OUR LADY OF THE LAKE HOSPITAL, INC. (THE ORGANIZATION'S SOLE-MEMBER). FORM 990, PART VI, QUESTION 12C OLLIE STEELE BURDEN MANOR 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 OLLIE STEELE BURDEN MANOR 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, OLLIE STEELE BURDEN MANOR PROVIDES MECHANISMS FOR CONFIDENTIAL REPORTING OF COMPLIANCE ISSUES. THESE MECHANISMS INCLUDE AN ANONYMOUS HOTLINE AND WEB SITE WHERE INDIVIDUALS MAY RAISE ISSUES, SEEK CLARIFICATION AND REPORT POSSIBLE CONFLICTS OF INTEREST OR OTHER CONCERNS. THESE REPORTS, INCLUDING REPORTS OF POSSIBLE CONFLICTS OF INTEREST ARE REVIEWED AND INVESTIGATED BY THE CORPORATE COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN. FORM 990 PART VI, SECTION B QUESTION 15A & 15B OTHER RELATED TAX EXEMPT ORGANIZATIONS SET THE COMPENSATION AND PAY THE EXECUTIVES. THAT BOARD OF DIRECTORS DESIGNATES THE COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE COMPENSATION ANNUALLY OF EXECUTIVES. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY OUTSIDE SOURCES. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, QUESTION 19 OLLIE STEELE BURDEN MANOR, INC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. Section 1.263(A)-3 (N) Election - BOOK CONFORMITY ELECTION OLLIE STEELE BURDEN MANOR, INC. IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THOSE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2017. Section 1.263(a)-1(f) ELECTION- DE MINIMIS SAFE HARBOR Ollie Steele Burden Manor, INC. 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, 2017. Taxpayer does have 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 $5000 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). 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