2016-05-16T10:18:01-05:00 2015-06-30 KPMG LLP 301 Main Street Suite 2150 Baton Rouge LA 70801 990 2014-07-01 721495500 OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL % JEFF LIMBOCKER OURL 2257657709 5000 Hennesy Boulevard Baton Rouge LA 70808 JEFF LIMBOCKER CFO 2257657709 2016-05-13 true RYAN HOOKS P00746825 2253444000 2016-05-13 2014 2016-08-17 19:52:53Z WAYNE M ARBONEAUX 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 7106510 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 4 64 7 0 26228 35455 7145316 7025036 32159 12824 23522 23480 7227225 7096795 0 0 0 0 2889138 2918733 0 0 0 3424183 3613337 6313321 6532070 913904 564725 11267247 13508974 4542350 6219682 6724897 7289292 X 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. false false 2898764 4624693 OUR LADY OF THE LAKE ASSUMPTION PROVIDES TWENTY-FOUR HOUR HEALTHCARE SERVICES FOR PATIENTS IN THE SURROUNDING RURAL COMMUNITIES. THE HOSPITAL HAD 7,013 EMERGENCY ROOM VISITS THIS YEAR. THE HOSPITAL'S EMERGENCY ROOM IS OPEN TO EVERYONE, REGARDLESS OF ABILITY TO PAY. 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 MEMEBERS OF ITS COMMUNITIES. 1017985 1584221 LABORATORY - PROVIDES PATIENTS WITH LABORATORY RESULTS. THE HOSPITAL PERFORMED 21,654 LAB TESTS DURING THE YEAR. 843379 176517 PATIENT CARE - THE HOSPITAL PROVIDED GENERAL MEDICAL AND SURGICAL SERVICE TO ITS PATIENTS FOR 202 INPATIENT DAYS. 277784 663085 5037912 true true false false false false false false false false true false false true 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 20 0 true 64 true false false false false false false false false false false X 7 4 false false false false true true true true true false false true true true true false true true false false X JEFF LIMBOCKER 2257656565 5000 HENNESSY BOULEVARD BATON ROUGE LA 70808 X Wayne M Arboneaux CEO 50.0 0.0 X X 214706 0 56732 Jeffery D Limbocker CFO & Treasurer 2.0 48.0 X X 0 474458 59003 Kenneth Wester Board Member 2.0 58.0 X 0 784733 64461 Daniel Montelaro Board Member- Chair 2.0 2.0 X X 0 0 0 John Selser Board Member- Vice Chair 2.0 0.0 X X 0 0 0 Donald Daigle Board Member- Secretary 2.0 2.0 X X 0 0 0 Charles P Bolotte MD Board Member 2.0 0.0 X 0 0 0 Brian F Tripode Supervisor-Pharmacy 40.0 0.0 X 142151 0 13434 356857 1259191 193630 2 false true false Correct Care Inc 17438 Hard Hat Drive COVINGTON LA 70435 Director of ER Fees 1083880 OLOLRMC Laboratory Services PO Box 14790 Baton Rouge LA 70898 Mngt Fees; Lab Serv 980037 Department of Health and Hospitals 628 North 4th Street Baton Rouge LA 70821 Contract Physicians 103464 3 14939 9191 11325 35455 Patient Service Revenue 900099 7011368 7011368 Miscellaneous Revenue 900099 10186 10186 Medical Records Revenue 900099 1687 1687 Vending Revenue 900099 1795 1795 7025036 16752 16752 0 0 27667 4187 23480 0 23480 23480 1600 5528 -3928 -3928 -3928 0 0 0 0 7096795 7048516 12824 X 0 0 0 0 208121 208121 0 1996508 1866639 129869 248264 196114 52150 321067 300182 20885 144773 113518 31255 1339236 1145499 193737 0 0 0 0 0 1159576 1064273 95303 17446 17446 415292 102189 313103 5 5 0 250216 38416 211800 12688 3602 9086 0 0 0 0 244179 80702 163477 50507 6583 43924 Medical Supplies Expense 124192 120195 3997 6532070 5037912 1494158 0 3655526 5765612 86275 60962 18455 17715 2217334 3111692 0 0 0 0 0 0 0 0 27522 20711 3675124 2234833 1451525 1440291 3810610 2392280 0 0 0 0 0 0 0 699711 11267247 13508974 3003702 3767086 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1538648 2452596 4542350 6219682 X 6706443 7271577 18454 17715 0 0 6724897 7289292 11267247 13508974 564725 -330 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 55461 55461 864918 584458 280460 50036 33731 16305 2704709 1616644 1088065 0 1440291 DUE TO/FROM OLOLPG 699711 699711 0 DUE TO AFFLILIATES 1085655 ACCRUED PENSION COSTS 1366941 2452596 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 true X true true true false true true 78173 78173 0.01200 78173 78173 0.01200 78173 78173 0.01200 false 2113160 1672667 1965577 -292910 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 12 true false false true X SEE PART V, SECTION C X true 12 false true false true X 200. 300. X X X true true X X true X X X X X true X false X X X X true X false false PART V QUESTION 13H 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. 8) PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY. PART V, QUESTION 22D THE HOSPITAL FACILITY DETERMINED THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE USING THE AVERAGE OF THE BOTTOM QUARTER LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES. PART V, LINE 5 THE HOSPITAL MET SEPARATELY WITH FOUR DIFFERENT COMMUNITY GROUPS IN ORDER TO GATHER INFORMATION DURING ITS CHNA PROCESS. IT MET WITH REPRESENTATIVES FROM PIERRE PART COMMUNITY DEVELOPMENT BOARD, ASSUMPTION RURAL HEALTH CLINIC COMMUNITY ADVISORY BOARD, ASSUMPTION PARISH COUNCIL ON AGING AND THE LOUISIANA OFFICE AND PUBLIC HEALTH AND DHH BUREAU OF PRIMARY CARE AND RURAL HEALTH. THE REPRESENTATIVES ALSO INCLUDED INDIVIDUALS WITH SPECIALIZED KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THESE INDIVIDUALS WERE MS. KAYLA GUERRERO, LMSW, MPH (DHH REGION 3 COORDINATOR, LOUISIANA OFFICE OF PUBLIC HEALTH) AND MS. BETH MILLET(PROGRAM MANAGER 2/ DIRECTOR OF HEATH SYSTEMS DEVELOPMENT, LOUISIANA BUREAU OF PRIMARY CARE AND RURAL HEALTH). PART V, QUESTION 16I REGISTRATION PERSONNEL AND FINANCIAL COUNSELORS REFER PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE TO FINANCIAL COUNSELORS TO DISCUSS QUALIFICATION FOR FREE OR DISCOUNTED CARE. THE POLICY IS ALSO POSTED AT THE HOSPITAL BUSINESS OFFICE AND AT ALL OUTPATIENT REGISTRATION LOCATIONS. PART V, QUESTION 7 THE CHNA CAN BE FOUND AT HTTPS://FMOLHS.ORG/OLOLRMC/PAGES/QUALITY/COMMUNITY-HEALTH-ASSESSMENT.ASPX PART V, SECTION B, QUESTION 11 Assumption Community Hospital, a Critical Access Hospital, an affiliate of Our Lady of the Lake Hospital and a member of the Franciscan Ministries of Our Lady Health System last conducted a Community Health Needs Assessment in 2012. As a result of this process, the needs of the parish were identified as Diabetes, Childhood Obesity, Adult Services and Access to Primary Health Care for the Uninsured/Underinsured. The focus of these objectives has relied heavily on the identification of those in need and the conveyance of education and information so that the patients and their caregivers are better prepared to make sound decisions. As a result of our Diabetes screenings, we managed to identify 173 diabetic patients that we are currently treating through the Rural Health Clinic. Our goal was to get an A1C level on each of these patients. We were able to meet that goal at 100%. We are working on a program that we can get the patient to pay closer attention to this number as an indicator of improved control. In addition, these patients are receiving diabetes education from the Nurse Practitioner's. Childhood obesity is an area that we are extremely interested in trying to make a positive impact. We feel that if we can influence the younger citizens of our area to make healthier choices and focus on making exercise part of their daily routine that this will catapult them to a healthier adult lifestyle. We monitored 501 of these patients. It was determined that 73 or 14.6% of them were in the obese category. The National Average according to the CDC is 18% and the Louisiana State average is 14%. In an effort to reinforce and reiterate good behaviors, we hold annual community events such as health fairs, head start parent education and educational events held at the local Council on Aging facility. We provide free testing and information to anyone that wishes to attend these events. We feel that this has connected the hospital and the staff to the public that we serve and we are proud to be affiliated with the other local organizations that participate in these events. We were able to provide testing and education to 193 people as a result of this community involvement. Assumption Parish is a very rural and the access to healthcare is limited to the citizens of this area. The Rural Health Clinic is staffed with 2 Nurse Practitioners with Physician oversight. Through this service, we were able to serve 1812 patients during FY2015. This practice is setup to focus on serving the Medicaid/Uninsured/Underinsured population. We feel that without this clinic in place this patient population would not seek the proper medical attention. The effort of every member of Assumption Hospital and Rural Health Clinic is greatly appreciated and shows the care and concern that the staff has for the people of this area. It is our intention to continue to grow and evolve the services that we are able to provide to the public. We will continue to strive to improve the health and wellbeing of the citizens that we serve. 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. FULL AND PARTIAL DISCOUNTED CARE IS AVAILABLE IF INCOME AND ASSETS MEET CERTAIN FEDERAL POVERTY GUIDELINE LEVELS. DISCOUNTED CARE IS ALSO AVAILABLE FOR THOSE PATIENTS WITH CATASTROPHIC MEDICAL BILLS AND IS AVAILABLE 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 OLOL; 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. 8) PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY. PART I, LINE 6A 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, LINE 4 THE BAD DEBT FOOTNOTE IS ON PAGE 15 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 Responding to the health needs of our community, especially to those most in need, is primary to the Hospital's mission. Our Lady of the Lake Assumption Hospital is the only hospital located in Assumption Parish and is a federally designated 15 bed Critical Access Hospital. The hospital, along with its Provider Based Rural Health Clinic, provide important and needed services such as inpatient hospitalization, outpatient laboratory services, radiology imaging services, respiratory therapy services, and the vital provision of 24/7 emergency room services to the residents of Assumption Parish. The Hospital worked with the Pierre Part Medical Development Board, the Assumption Rural Health Clinic Community Advisory Board and the Assumption Council on Aging 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 Clinic provide various outreach programs such as an annual Health Fair, periodic Smoking Cessation classes, and periodic Diabetes Education. 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 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 income for the parish for 2011 was $20,603. Other small communities located in the parish include, Labadieville, Paincourtville, Plattenville, Bertrandville, Belle Rose, Pierre Part and Bayou L'Ourse. According to County Health Rankings, Assumption ranks 31 out of 64 parishes, with Louisiana ranking 49th in the nation. Assumption Parish residents have more than double the national benchmark in rates of low birth weight and nearly double the uninsured population rate. Although Assumption Parish ranks 17th out of the 64 Parishes overall in Louisiana in Clinical Care, there is a severe shortage of Primary Care Physicians. PART III, SECTION A, QUESTION 2 THE HOSPITAL ACCOUNTS FOR BAD DEBTS BASED ON THE AGING OF THE ACCOUNTS AND BASED ON THE HISTORICAL COLLECTION ASSOCIATED WITH THE VARIOUS AGING CATEGORIES. ON A PERIODIC BASIS, THE ORGANIZATION CONDUCTS A RETROSPECTIVE REVIEW TO DETERMINE THE APPROPRIATENESS OF THE COLLECTION PERCENTAGES UTILIZED IN ESTIMATED BAD DEBT EXPENSE. CHARITY AND DISCOUNTS ARE NOT INCLUDED IN BAD DEBT EXPENSE. PAYMENTS RECEIVED ON ACCOUNTS SUBSEQUENT TO BEING CONSIDERED BAD DEBT ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE. X X false true false false false false false true false Wayne M Arboneaux CEO 186500 0 27300 0 906 0 39920 0 16812 0 271438 0 0 0 Jeffery D Limbocker CFO & Treasurer 0 354015 0 103280 0 17163 0 35804 0 23199 0 533461 0 0 Kenneth Wester Board Member 0 583808 0 180278 0 20647 0 37476 0 26985 0 849194 0 0 Brian F Tripode Supervisor-Pharmacy 117795 0 24231 0 125 0 5801 0 7633 0 155585 0 0 0 PART I QUESTION 4A A BOARD MEMBER LISTED IN PART VII, WHO IS ALSO THE CEO OF A RELATED ORGANIZATION, 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. 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. An officer 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 base salary and provided retirement and welfare benefits for an entitlement period. The entitlement period is 12 months. No payments were made under the plan in the current year. the current year. PART I QUESTION 4B FMOLHS maintains two 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 7 DISCRETIONARY BONUSES WERE PAID WITH REGARD TO PERSONS LISTED ON PART VII, SECTION A, LINE 1A. SUCH BONUSES WERE APPROVED BY THE CEO/PRESIDENT OR THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. PART III, QUESTION 4D THE HOSPITAL PROVIDES VARIOUS OTHER PROGRAMS SUCH AS DIETARY, RESPIRATORY, PHARMACY AND SPECIAL PROCEDURES. 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, PURPOSES OF CORPORATION 2. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF CORPORATION 3. TO AUTHORIZE MERGER, CONSOLIDATION OR AFFILIATION, OR PARTICIPATION IN JOINT VENTURES 4. TO DISSOLVE AND DISTRIBUTE ASSETS OF THE CORPORATION 5. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION 6. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER IMMOVABLE PROPERTY ON BEHALF OF CORPORATION 7. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY CORPORATION 8. TO APPOINT FISCAL AUDITOR OF CORPORATION 9. 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 10. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF CORPORATION 11. TO APPROVE STRATEGIC BUSINESS PLANS OF CORPORATION 12. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD 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, 2015. 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 THE CEO'S COMPENSATION IS SET BY THE COMPENSATION COMMITTEE OF THE OUR LADY OF THE LAKE ASSUMPTION BOARD OF DIRECTORS. OTHER RELATED ORGANIZATIONS SET THE COMPENSATION AND PAY FOR OTHER PAID OFFICERS. EACH 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, 2015. 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 31, 2015. 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:4855 FORM 990 PART IX LINE 11G DESCRIPTION:Purchased Services TOTAL FEES:101742 FORM 990 PART IX LINE 11G DESCRIPTION:Medical Purchased SVC TOTAL FEES:1052229 FORM 990 PART IX LINE 11G DESCRIPTION:Consulting TOTAL FEES:750 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 true 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 BOULEVARD PLAZA 2 S BATON ROUGE LA 70808 203894521 REAL ESTATE LA OLOL N/A P&S SURGERY CENTER LLC 312 GRAMMONT STREET MONROE LA 71201 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 SURGICAL CENTER LLC 901 WILSON STREET LAFAYETTE LA 70503 721404092 HEALTHCARE LA LOURDES N/A BRPT LAKE REHABILITATION CENTER LLC 530 SHADOWS LANE BATON ROUGE LA 70806 721404092 HEALTHCARE LA OLOL N/A CONVENIENT CARE LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 721439481 HEALTHCARE LA OLOL N/A PERKINS PLAZA AMBULATORY SURGERY CENTER 1400 N PORTLAND AVENUE SUITE 200 OKLAHOMA CITY OK 73134 481264699 HEALTHCARE LA OLOL N/A SURGICAL SPECIALTY CENTER OF BATON ROUGE 8080 BLUEBONNET BLVD BATON ROUGE LA 70810 233160962 HEALTHCARE LA OLOL N/A ST ELIZABETH-MARY BIRD PERKINS CANCER C 4950 ESSEN LANE BATON ROUGE LA 70809 260628752 HEALTHCARE LA STEH N/A ST MARYS IMAGING CENTER II LLC 4801 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 HEALTHCARE LA LOURDES IMAGING N/A NORTHEAST LA CANCER INSTITUTE LLC 411 CALYPSO STREET MONROE LA 71201 721329499 HEALTHCARE LA SFMC N/A LHCG-XIII LLC 420 WEST PINHOOK ROAD SUITE A LAFAYETTE LA 70503 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 ST ELIZABETH IMAGING CENTER LLC 8080 BLUEBONNET BLVD STE 1000 BATON ROUGE LA 70810 271470744 HEALTHCARE LA STEH N/A CAPITAL AREA SHARED SERVICES ORGANIZATIO 4200 ESSEN LANE BATON ROUGE LA 70809 275173212 HEALTHCARE LA STEP N/A LAKE URGENT CARE ASCENSION LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 352463092 HEALTHCARE LA STEH N/A OLOLUSP SURGERY CENTER LLC 15305 DALLAS PKWY STE 1600 LB ADDISON TX 75001 352457810 HEALTHCARE TX OLOL N/A CAPITAL AREA SHARED SERVICES ORG LLC 4200 ESSEN LANE BATON ROUGE LA 70809 275173212 HEALTHCARE LA OLOL N/A LAKE URGENT CARE ASCENSION LLC 10319 JEFFERSON HIGHWAY BATON ROUGE LA 70809 352463092 HEALTHCARE LA OLOL N/A St Francis Urgent Care LLC 2600 Tower Dr 106 Monroe LA 71201 HEALTHCARE LA SFMC N/A FMOL HEALTH SYSTEM HOLDINGS INC 4200 ESSEN LANE ROUGE LA 70809 454405024 INVESTMENT LA FMOL C CORP ST FRANCIS INSURANCE AGENCY 309 JACKSON STREET MONROE LA 71201 721435136 INSURANCE LA SFMC C CORP HOSPITAL ASSISTANCE SERVICES PO BOX 4027-C LAFAYETTE LA 70502 721073486 HEALTHCARE LA LOURDES C CORP LOUISE INSURANCE COMPANY PO BOX 1051 KY1-1102 CJ 721057820 INSURANCE CJ FMOL C CORP MONROE HEALTH SERVICES PO BOX 3187 MONROE LA 71210 721057820 HEALTHCARE LA AMBULATORY C CORP NORTHEAST LA HEALTH NETWORK 309 JACKSON STREET MONROE LA 71201 721294587 HEALTHCARE LA AMBULATORY C CORP CHARITABLE REMAINDER TRUST INVESTMENT LA OLOL FOUNDATION TRUST FRANCISICAN HEALTH&WELLNESS SERVICES Inc 4200 ESSEN LANE ROUGE LA 70809 455492379 HEALTHCARE LA FMOL C CORP false false true false false false false false false false true false true false false true false false false