2014-11-13T15:10:34-06:00 2013-12-31 721202445 POSTLETHWAITE & NETTERVILLE 8550 UNITED PLAZA BLVD SUITE 1001 BATON ROUGE LA 70809 990 2013-01-01 720551963 SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION D/B/A LAKE CHARLES MEMORIAL HOSPITAL SOUT 3374943202 1701 OAK PARK BOULEVARD LAKE CHARLES LA 70601 LARRY GRAHAM PRESIDENT AND CEO 3374943204 2014-11-13 1 GAIL H PITTMAN P01429086 2259224600 2013 2015-11-30 17:44:51Z LARRY GRAHAM 1701 OAK PARK BOULEVARD LAKE CHARLES LA 70601 243819471 0 X WWW.LCMH.COM X 1952 LA PROVIDE HEALTHCARE SERVICES 13 9 2578 57 0 0 218807 276969 217788512 242258807 468351 297668 1201947 986027 219677617 243819471 35000 35000 0 0 87652049 92271844 0 0 1324365 110942088 131783298 198629137 224090142 21048480 19729329 186931118 220431868 118337597 146389848 68593521 74042020 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 5568984 2006847 LAKE CHARLES MEMORIAL HOSPITAL2013 COMMUNITY BENEFITS SUMMARYI. INTRODUCTIONAS A COMMUNITY-BASED HOSPITAL, IT IS LAKE CHARLES MEMORIAL HOSPITAL'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, MEMORIAL 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. CHARITY CAREMEMORIAL PROVIDES MEDICAL CARE TO MEDICAID INDIGENT RECIPIENTS REGARDLESS OF THEIR ABILITY TO PAY, AND REGARDLESS OF MEDICAID REIMBURSEMENT. IN 2013, MEMORIAL HOSPITAL PROVIDED $14,411,532 IN UN-REIMBURSED MEDICAID COSTS AND $1,465,580 IN CHARITY CARE COSTS. COMMUNITY BENEFIT-$15,877,111SPORTS MEDICINE, COMMUNITY EVENTS AND SEMINARSTHE SPORTS MEDICINE ALLIANCE PROVIDED $403,452 IN 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:$403,452EACH YEAR, LCMH PROVIDES FREE HEALTH SCREENINGS, EDUCATIONAL SEMINARS AND INFORMATIONAL BOOTHS AT A VARIETY OF COMMUNTIY EVENTS. THE HOSPITAL ALSO PROVIDES FREE SPEAKERS TO CIVIC GROUPS AND THER ORGANIZATIONS. THIS COMMITMENT TO HEALTH AND WELLNESS EDUCATION TAKES MEMORIAL PROFESSIONALS INTO THE FIVE PARISH AREA TO STAFF INDUSTRIAL, CORPORATE AND SCHOOL HEALTH FAIRS. THE HOSPITAL CONTRIBUTED $54,151 IN SPECIAL EVENTS AND SEMINARS.COMMUNITY BENEFIT: $54,151III. HEALTH PROFESSIONALS EDUCATIONLAKE CHARLES MEMORIAL INVESTS IN MEDICAL EDUCATION IN AN EFFORT OF PROVIDE THE AREA WITH QUALIFIED PROFESSIONALS. IN 2013, LCMH SPENT $3,108,170 FOR THE LOUISIANA STATE UNIVERSITY HEALTH SERVICES CENTER-FAMILY PRACTICE RESIDENCY PROGRAM.COMMUNITY BENEFIT:$3,108,170CHARITABLE DONATIONSLCMH MAKES NUMEROUS MONETARY DONATIONS TO A VARIETY OF NON-PROFIT AGENCIES.COMMUNITY BENEFIT:$50,515MEMORIAL'S TOTAL 2013 NET COMMUNITY CONTRIBUTIONS - $19,439,248 59515632 43638521 THE HOSPITAL PROVIDES A WIDE RANGE OF INPATIENT AND OUT- PATIENT SERVICES THROUGH A 29-BED LONG-TERM CARE FACILITY, A 339-BED ACUTE CARE FACILITY AND SEVERAL OUTPATIENT CLINICS. DURING 2013 LAKE CHARLES MEMORIAL HOSPITAL TOOK OVER THE OPERATIONS OF THE PREVIOUSLY STATE OPERATED W.O. MOSS REGIONAL HOSPITAL, WHICH WAS CLOSED. LCMH MOVED THE INPATIENT SURGERY AND EMERGENCY SERVICES TO OUR ACUTE CARE HOSPITAL. W.O. MOSS EMERGENCY ROOM WAS CONVERTED TO AN URGENT CARE CLINIC. LCMH MAINTAINED THE OUTPATIENT CLINICS AT THAT SITE AND ARE CURRENTLY OPERATED AS PROVIDER-BASED CLINICS UNDER THE NAME OF W.O. MOSS MEMORIAL HEALTH CLINIC. W.O. MOSS MEMORIAL HEALTH CLINIC AND LAKE CHARLES MEMORIAL HOSPITAL SIGNIFICANTLY EXPANDED SPECIALTY SERVICES IN ORDER TO ENHANCE THE SCOPE AND QUALITY OF HEALTHCARE TO THE UNDERSERVED IN THE SWLA COMMUNITY. 144033777 35000 197420361 THE HOSPITAL PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES THROUGH A 29-BED LONG-TERM ACUTE CARE FACILITY, A 339-BED ACUTE CARE FACILITY AND SATELLITE LOCATIONS. ADDITIONALLY, DURING 2013 LAKE CHARLES MEMORIAL HOSPITAL TOOK OVER THE OPERATIONS OF THE PREVIOUSLY STATE-OPERATED W O MOSS REGIONAL HOSPITAL. LCMH MOVED THE INPATIENT, SURGERY AND EMERGENCY SERVICES TO OUR ACUTE CARE HOSPITAL. W O MOSS EMERGENCY ROOM WAS CONVERTED TO AN URGENT CARE CLINIC. LCMH MAINTAINED THE OUTPATIENT CLINICS AT W O MOSS MEMORIAL HEALTH CLINIC AND SIGNIFICANTLY EXPANDED SPECIALTY SERVICES IN ORDER TO ENHANCE THE SCOPE AND QUALITY OF HEALTHCARE TO THE UNDERSERVED IN THE SWLA COMMUNITY. 209118393 1 1 0 1 0 0 0 0 0 0 1 1 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 0 0 0 0 0 1 1 1 1 0 1 312 0 1 2578 1 0 0 0 0 0 0 0 0 0 0 X 13 9 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X CHARLES WHITSON CHIEF FINANCIAL OF 3374943202 1701 OAK PARK BLVD LAKE CHARLES LA 706018911 CHRISTOPHER THOMPSON PHYSICIAN / MEDICAL STAFF 40.00 0.30 X 808801 0 7650 ULYSSES GENE THIBODEAUX CHAIRMAN 1.00 0.30 X X 0 0 0 LOUIS M TODD SR ACTIVE TRUSTEE 1.00 1.30 X 0 0 0 DAVID WALLACE MD ACTIVE TRUSTEE 1.00 0.30 X 0 0 0 CHARLES WHITSON CPA SR.VICE PRESIDENT OF FINAN 40.00 1.30 X X 290059 0 26345 LARRY GRAHAM PRESIDENT/CEO & ASST SECRE 40.00 1.30 X X 684234 0 18956 DENISE EMERSON RAU CHAIRMAN-ELECT/VICE CHAIR/ 1.00 0.30 X X 0 0 0 THOMAS SHEARMAN ACTIVE TRUSTEE 1.00 0.30 X 0 0 0 BEN THOMPSON PHYSICIAN / MEDICAL STAFF 40.00 0.30 X 483281 0 21286 JOE MILLER ACTIVE TRUSTEE 1.00 0.30 X 0 0 0 GERALD W MOUTON ACTIVE TRUSTEE 40.00 0.30 X 300920 0 21286 BRYAN BAROOTES MD PHYSICIAN/MED STAFF PRESID 1.00 0.30 X 0 0 0 S MARK MCMURRY ACTIVE TRUSTEE 1.00 0.30 X 0 0 0 MARK ABRAHAM ACTIVE TRUSTEE 1.00 0.30 X 0 0 0 MARILYN MCSWAIN RN SR.VICE PRESIDENT OF NURSI 40.00 X 221760 0 19285 BERNITA BROWN VICE PRES OF SUPPORT SERVI 40.00 X 156286 0 17864 TIM COFFEY SR.VICE PRES OF OPERATIONS 40.00 X 285468 0 15229 DONNA SHIELDS ASST VICE PRES NURSING 40.00 X 211955 0 19184 TODD DELAHOUSSAYE SR.VICE PRES OF PHYSICIAN 40.00 X 191005 0 13046 KATHLEEN DEROUEN SR.VICE PRES OF MARKETING 40.00 X 165077 0 15796 LEIF PEDERSEN VICE PRES OF PHILANTHROPHY 40.00 1.00 X 154766 0 23029 NATHAN COHEN PHYSICIAN 40.00 X 950019 0 21285 BRETT CASCIO PHYSICIAN 40.00 X 1768362 0 26648 MICHAEL BROUSSARD MD PHYSICIAN 40.00 X 899652 0 7650 FRANCISCO MARERRO PHYSICIAN 40.00 X 964655 0 26648 JEAN KING WHITE PHYSICIAN 40.00 X 1049433 0 21285 MANLEY M JORDAN MD ACTIVE TRUSTEE (FORMER) 40.00 X 431824 0 26648 THOMAS C STRONG MD ACTIVE TRUSTEE (FORMER) 40.00 X 431193 0 15634 BRIAN CLEMENTS MD ACTIVE TRUSTEE (FORMER) 40.00 X 485592 0 26648 KEVIN MOCKLIN ACTIVE TRUSTEE (FORMER) 40.00 X 241697 0 19987 LUCIEN K MOSS ACTIVE TRUSTEE (FORMER) 40.00 X 358483 0 26648 11534522 0 438037 105 1 1 0 LEWING CONSTRUCTION INC PO BOX 5216 LAKE CHARLES LA 706065216 CONTRUCTION/CONTRACTOR 3539120 LSU HEALTH CARE SERVICES DIVISION PO BOX 91308 BATON ROUGE LA 70821 PROFESSIONAL FEES 2621011 LSU HEALTH SCIENCE CENTER 433 BOLIVAR STREET NEW ORLEANS LA 70112 RESIDENCY PROGRAM 2143051 INSTITUTE FOR NEUROPSYCHIATRY APMC 2829 4TH AVENUE LAKE CHARLES LA 70601 PSYCH SERVICES 1286600 LA COMMERCIAL LAUNDRY PO BOX 503 SCOTT LA 705830503 LAUNDRY/LINEN SERVICES 1261829 158 245239 31730 276969 PATIENT SERVICE REVENUE 900099 238429347 238429347 CAFETERIA 900099 2322517 2322517 MANAGEMENT FEES 900099 1506943 1506943 242258807 288432 288432 188341 0 188341 188341 188341 9236 0 9236 9236 9236 INCOME FROM SECOND AVENUE MRI, LL 621990 795379 795379 INCOME FROM LA PET/CT IMAGING LAK 621990 29310 29310 NET INCOME FROM GIFT SHOP 453220 -27003 -27003 797686 243819471 243065729 0 476773 35000 35000 11534522 4037082 6690023 807417 62987793 62042976 944817 1364381 1209818 139781 14782 11483553 10182640 1176494 124419 4901595 4346318 502170 53107 1073958 1039591 31682 2685 381691 369477 11260 954 8021016 7764343 236620 20053 1211987 1005949 109079 96959 1347666 1304541 36387 6738 259369 251069 7003 1297 5793702 5561954 231748 11590276 10778957 811319 3522130 3275581 246549 SUPPLIES 50793561 49168167 1498410 126984 PURCHASED SERVICES 19126802 18514744 564241 47817 BAD DEBT 15266622 15266622 CONTRACT LABOR 4422250 4333805 88445 8972268 8629759 321356 21153 224090142 209118393 13647384 1324365 10578185 18213237 14862985 31700928 24207133 30008661 4156378 4847852 2617752 7172331 280290617 207519546 69391203 72771071 43797209 40672591 17320273 15045197 186931118 220431868 27579755 56722961 84520000 81305000 3065397 4595516 3172445 3766371 118337597 146389848 X 68593521 74042020 68593521 74042020 186931118 220431868 X 19729329 -14280830 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 84000 0 0 84000 0 PART II-B, LINE 1: THE HOSPITAL UTILIZED A LOBBYING FIRM TO ASSIST IN EDUCATING LEGISLATORS REGARDING THE PROPOSED CLOSURE OF W.O. MOSS REGIONAL HOSPITAL (MOSS), A STATE RUN CHARITY HOSPITAL, AND THE PROPOSED COOPERATIVE ENDEAVOR AGREEMENT BETWEEN THE STATE OF LOUISIANA (STATE), LOUISIANA STATE UNIVERSITY (LSU) AND LAKE CHARLES MEMORIAL HOSPITAL (LCMH) WHEREBY LCMH WOULD LEASE THE ENTIRE MOSS FACILITY FROM LSU AND CONTINUE THE OPERATIONS OF THE EXISTING AMBULATORY CLINICS AT THAT SITE. 5193286 5193286 133044674 96857526 36187148 1322877 1322877 0 128907997 101193235 27714762 11821783 8145908 3675875 72771071 40366214 C INVESTMENT - LA PET IMAGING 174091 C INVESTMENT-CORPORATE SHARE LCCC 12000 C INVESTMENTS-VHA-E 82786 C INVESTMENTS-LAKE CHARLES HEALTH PLANS 37500 C 40672591 INTERCOMPANY RECEIVABLES 1838333 ASSETS WHOSE USE IS LIMITED 10851078 DEFERRED FINANCING COSTS 1768452 OTHER RECEIVABLES 484829 OTHER ASSET-MSO 102505 15045197 BOND PREMIUM 27371 INVESTMENT-AMRI 3739000 3766371 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. WITH FEW EXCEPTIONS, THE SYSTEM IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS ENDED BEFORE DECEMBER 31, 2010. 1 1 1 X 1 X 500.000000000000 1 1 1 0 1 1 20120932 18655352 1465580 0.00650 39394700 24983169 14411531 0.06430 59515632 43638521 15877111 0.07080 5115017 2006847 3108170 0.01390 453967 0 453967 0.00200 5568984 2006847 3562137 0.01590 65084616 45645368 19439248 0.08670 1 4848190 2908914 73022024 95022651 -22000627 X 1 1 1 SECOND AVENUE MRI LLC IMAGING 0.51000 0.49000 2 LA PET IMAGING IMAGING 0.24500 2 1 LAKE CHARLES MEMORIAL HOSPITAL 1701 OAK PARK BLVD LAKE CHARLES LA 70601 HO0001606 X X X X 2 LAKE CHARLES MEMORIAL SPECIALTY HOSPITAL 2837 ERNEST STREET BLDG B LAKE CHARLES LA 70601 H0000170 X LONG TERM ACUTE CARE LAKE CHARLES MEMORIAL HOSPITAL 1 1 X X X X X X X X 13 1 0 1 X WWW.LCMH.COM X X X X X X X X X 0 0 1 1 200.000000000000 1 500.000000000000 1 X X X X X X X X 1 1 X X X X X 1 X X X 1 X X X X X X X 1 X 0 1 LAKE CHARLES MEMORIAL SPECIALTY HOSPITAL 2 1 X X X X X X X X 13 1 0 1 X X X X X X X X X X 0 0 1 1 200.000000000000 1 500.000000000000 1 X X X X X X X X X 1 1 X X X X X 1 X X X 1 X X X X X X X 1 X 0 1 LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: INTERVIEWS WITH 28 KEY INFORMANTS WERE CONDUCTED OVER A TWO-DAY PERIOD IN SEPTEMBER 2012. INTERVIEWEES WERE DETERMINED BASED ON THEIR (A) SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, (B), THEIR AFFILIATION WITH LOCAL GOVERNMENT, SCHOOLS AND INDUSTRY OR (C) THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. THE KEY INFORMANTS WORKED FOR THE FOLLOWING TYPES OF ORGANIZATIONS AND AGENCIES: SOCIAL SERVICE AGENCIES, LOCAL SCHOOL SYSTEM AND COMMUNITY COLLEGE, LOCAL CITY AND COUNTY GOVERNMENT, PUBLIC HEALTH AGENCIES, INDUSTRY, FAITH COMMUNITY AND MEDICAL PROVIDERS. ALL INTERVIEWS WERE CONDUCTED USING A STANDARD QUESTIONNAIRE. RESPONSES FROM THE INTERVIEWEES WERE GROUPED INTO 4 MAJOR CATEGORIES FOR DICSUSSION--GENERAL OPINIONS REGARDING HEALTH AND QUALITY OF LIFE IN THE COMMUNITY, UNDERSERVED POPULATIONS AND COMMUNITIES OF NEED, BARRIERS TO HEALTH CARE, AND MOST IMPORTANT HEALTH AND QUALITY OF LIFE ISSUES. THE RESULTS OF THESE INTERVIEWS ARE SUMMARIZED IN THE CHNA AND ARE CONSIDERED IN THE REPORT RECOMMENDATIONS. ADDITIONALLY A COMMUNITY WEB BASED AND PAPER BASED SURVEY WAS CONDUCTED TO GATHER BROAD COMMUNITY INPUT REGARDING HEALTH ISSUES. THE SURVEY WAS LAUNCHED ON SEPTEMBER 11, 2012 AND CLOSED ON DECEMBER 5, 2012. THE SUVERY WAS INTENDED TO GATHER INFORMATION REGARDING THE OVERALL HEALTH OF THE COMMUNITY. THE RESULTS OF THE SURVEY YIELD INFORMATION ON DIFFERENT HEALTH AND COMMUNITY FACTORS. AREAS SURVEYED INCLUDED DEMOGRAPHICS AND SOCIOECONOMIC CHARACTERISTICS, BEHAVIORAL RISK FACTORS, HEALTH CONDITIONS AND ACCESS TO HEALTH RESOURCES. THE SURVEY WAS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AS WELL AS VARIOUS OTHER PUBLIC HEALTH SURVEYS AND CUSTOMIZED QUESTIONS. THE FINAL SURVEY INSTRUMENT WAS DEVELOPED BY LAKE CHARLES MEMORIAL HOSPTIAL REPRESENTATIVES IN CONJUNCTION WITH BKD. LAKE CHARLES MEMORIAL SPECIALTY HOSPITAL PART V, SECTION B, LINE 3: INTERVIEWS WITH 28 KEY INFORMANTS WERE CONDUCTED OVER A TWO-DAY PERIOD IN SEPTEMBER 2012. INTERVIEWEES WERE DETERMINED BASED ON THEIR (A) SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, (B), THEIR AFFILIATION WITH LOCAL GOVERNMENT, SCHOOLS AND INDUSTRY OR (C) THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. THE KEY INFORMANTS WORKED FOR THE FOLLOWING TYPES OF ORGANIZATIONS AND AGENCIES: SOCIAL SERVICE AGENCIES, LOCAL SCHOOL SYSTEM AND COMMUNITY COLLEGE, LOCAL CITY AND COUNTY GOVERNMENT, PUBLIC HEALTH AGENCIES, INDUSTRY, FAITH COMMUNITY AND MEDICAL PROVIDERS. ALL INTERVIEWS WERE CONDUCTED USING A STANDARD QUESTIONNAIRE. RESPONSES FROM THE INTERVIEWEES WERE GROUPED INTO 4 MAJOR CATEGORIES FOR DISCUSSION--GENERAL OPINIONS REGARDING HEALTH AND QUALITY OF LIFE IN THE COMMUNITY, UNDERSERVED POPULATIONS AND COMMUNITIES OF NEED, BARRIERS TO HEALTH CARE, AND MOST IMPORTANT HEALTH AND QUALITY OF LIFE ISSUES. THE RESULTS OF THESE INTERVIEWS ARE SUMMARIZED IN THE CHNA AND ARE CONSIDERED IN THE REPORT RECOMMENDATIONS.ADDITIONALLY A COMMUNTIY WEB BASED AND PAPER BASED SURVEY WAS CONDUCTED TO GATHER BROAD COMMUNITY INPUT REGARDING HEALTH ISSUES. THE SURVEY WAS LAUNCHED ON SEPTEMBER 11, 2012 AND CLOSED ON DECEMBER 5, 2012. THE SURVEY WAS INTENDED TO GATHER INFORMATION REGARDING THE OVERALL HEALTH OF THE COMMUNITY. THE RESULTS OF THE SURVEY YIELD INFORMATION ON DIFFERENT HEALTH AND COMMUNTIY FACTORS. AREAS SURVEYED INCLUDED DEMOGRAPHICS AND SOCIOECONOMIC CHARACTERISTICS, BEHAVIORAL RISK FACTORS, HEALTH CONDITIONS AND ACCESS TO HEALTH RESOURCES. THE SURVEY WAS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AS WELL AS VARIOUS OTHER PUBLIC HEALTH SURVEYS AND CUSTOMIZED QUESTIONS. THE FINAL SURVEY INSTRUMENT WAS DEVELOPED BY LAKE CHARLES MEMORIAL HOSPITAL REPRESENTATIVES IN CONJUNCTION WITH BKD. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 7: THE FOLLOWING IDENTIFIED NEEDS WERE NOT ADDRESSED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AS THEY ARE ADDRESSED BY OTHERS IN DIFFERENT WAYS:1. DRUG ABUSE, EXCESSIVE DRINKING, CHILDREN IN POVERTY AND TRANSPORTATION--THERE ARE COMMUNITY AND STATE AGENCIES THAT HAVE GREATER EXPERTISE IN SUBSTANCE ABUSE, TRANSPORTATION AND IMPROVING POVERTY IN THE COMMUNITY. AT THE TIME THESE ISSUES ARE NOT INCORPORATED INTO THE COMMUNITY BENEFIT PLAN BECAUSE WE DO NOT HAVE THE INFRASTRUCTURE, EXPERTISE OR FUNDING NEEDED TO HAVE A SIGNIFICANT IMPACT IN THESE AREAS. 2. DENTAL CARE FOR UNINSURED CHILDREN WAS IDENTIFIED AS A NEED AND WE WILL BE PROVIDING DENTAL CARE THROUGH OUR MOSS MEMORIAL HEALTH CLINIC TO MEDICAID AND UNINSURED CHILDREN. 3. MENTAL HEALTH--WE DO CURRENTLY PROVIDE THE ONLY ADOLESCENT MENTAL HEALTH SERVICES IN SOUTHWEST LOUISIANA AND THE ONLY EMERGENCY PSYCHIATRIC TRIAGE PROGRAM TO ADDRESS EMERGENT MENTAL HEALTH ISSUES. LAKE CHARLES MEMORIAL SPECIALTY HOSPITAL PART V, SECTION B, LINE 7: THE FOLLOWING IDENTIFIED NEEDS WERE NOT ADDRESSED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AS THEY ARE ADDRESSED BY OTHERS IN DIFFERENT WAYS:1. DRUG ABUSE, EXCESSIVE DRINKING, CHILDREN IN POVERTY AND TRANSPORTATION--THERE ARE COMMUNITY AND STATE AGENCIES THAT HAVE GREATER EXPERTISE IN SUBSTANCE ABUSE, TRANSPORTATION AND IMPROVING POVERTY IN THE COMMUNITY. AT THE TIME THESE ISSUES ARE NOT INCORPORATED INTO THE COMMUNITY BENEFIT PLAN BECAUSE WE DO NOT HAVE THE INFRASTRUCTURE, EXPERTISE OR FUNDING NEEDED TO HAVE AN SIGNIFICANT IMPACT IN THESE AREAS.2. DENTAL CARE FOR UNINSURED CHILDREN WAS IDENTIFIED AS A NEED AND WE WILL BE PROVIDING DENTAL CARE THROUGH OUR MOSS MEMORIAL HEALTH CLINIC TO MEDICAID AND UNINSURED CHILDREN.3. MENTAL HEALTH-- WE DO CURRENTLY PROVIDE THE ONLY ADOLESCENT MENTAL HEALTH SERVICES IN SOUTHWEST LOUISIANA AND THE ONLY EMERGENCY PSYCHIATRIC TRIAGE PROGRAM TO ADDRESS EMERGENT MENTAL HEALTH ISSUES. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 12I: ALL PATIENTS ARE CHARGED THE SAME. AMOUNTS GENERALLY BILLED ARE CALCULATED BASED ON OUR FINANCIAL ASSISTANCE POLICY. LAKE CHARLES MEMORIAL SPECIALTY HOSPITAL PART V, SECTION B, LINE 12I: ALL PATIENTS ARE CHARGED THE SAME. AMOUNTS GENERALLY BILLED ARE CALCULATED BASED ON OUR FINANCIAL ASSISTANCE POLICY. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY IS OFFERED BY FINANCIAL COUNSELORS. REFERENCES TO THE POLICY ARE INCLUDED ON ALL BILLINGS. LAKE CHARLES MEMORIAL SPECIALTY HOSPITAL PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY IS OFFERED BY FINANCIAL COUNSELORS. REFERENCES TO THE POLICY ARE INCLUDED ON ALL BILLINGS. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 22: ALL PATIENTS ARE CHARGED THE SAME. AMOUNTS GENERALLY BILLED ARE CALCULATED BASED ON OUR FINANCIAL ASSISTANCE POLICY. LAKE CHARLES MEMORIAL SPECIALTY HOSPITAL PART V, SECTION B, LINE 22: ALL PATIENTS ARE CHARGED THE SAME. AMOUNTS GENERALLY BILLED ARE CALCULATED BASED ON OUR FINANCIAL ASSISTANCE POLICY. 5 PULMONARY ASSOCIATES 2770 3RD AVENUE SUITE 110 LAKE CHARLES LA 70601 PHYSICIAN CLINIC FAMILY MEDICINE SPECIALISTS - GAUTHIER 1890 WEST GAUTHIER SUITE 155 LAKE CHARLES LA 70605 PHYSICIAN CLINIC SURGICAL ASSOCIATES 2770 3RD AVENUE SUITE 120 LAKE CHARLES LA 70601 PHYSICIAN CLINIC MATTHEW SCROGGS MD 1890 WEST GAUTHIER SUITE 150 LAKE CHARLES LA 70605 PHYSICIAN CLINIC MATERNAL-FETAL MEDICINE 1900 WEST GAUTHIER LAKE CHARLES LA 70605 PHYSICIAN CLINIC 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 92% 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. 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 MCNESE 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 14% OF THE POPULATION BEING 65 OR OLDER. THE LAKE AREA RACIAL MAKEUP IS 61% WHITE, 33% BLACK, AND 6% OTHER. THE MEDIAN INCOME FOR THE AREA IS APPROXIMATELY $41,000 AND THE POVERTY RATE IS 17.6%. 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 PARTIES (SEE IN APPENDICES). THE HEALTH STATUS OF THE COMMUNITY WAS THEN REVIEWED. INFORMATION ON THE LEADING CAUSES OF DEATH AND MORBIDITY INFORMATION 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.* COMMUNITY INPUT WAS PROVIDED THROUGH KEY INFORMANT INTERVIEWS OF 27 STAKEHOLDERS AND A COMMUNITY HEALTH SURVEY WAS WIDELY DISTRIBUTED. THE COMMUNITY HEALTH SURVEY WAS COMPLETED BY 106 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 HAVE BEEN COMMUNICATED TO THE HOSPITAL. 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 ENVIRONMENTS THAT SUPPORT PREVENTION OF HEART DISEASE, DIABETES, RESPIRATORY DISEASE AND CANCER, I.E. HEALTHY EATING, INCREASED PHYSICAL ACTIVITY, TOBACCO-FREE LIFESTYLE AND MODERATE ALCOHOL USE. B. ACTIVELY PARTICIPATE IN THE PARTNERSHIP FOR A HEALTHIER SOUTHWEST LOUISIANA WHEREBY THE HOSPITALS IN CALCASIEU PARISH PARTNER ANNUALLY TO PROVIDE COMMUNITY 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. D. ESTABLISH A COMMUNITY WALKING AND HEALTHY EATING CHOICES PROGRAM IN CONJUNCTION WITH LOCAL MALL.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 SCREENING KITS DURING COLON CANCER AWARENESS MONTH IN MARCH. 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.F. SHOPPING MALLS, FAITH-BASED ORGANIZATIONS, HIGH SCHOOLS) B. COORDINATE MONTHLY SEMINARS AND SUPPORT/EDUCATION GROUPS ON DIABETES, CANCER, AND HEART DISEASE. C. PROMOTE THE IMPORTANCE OF CHECKUPS AND SREENINGS THROUGH OUR GET HEALTHY COMMUNITY PROGRAM. D. 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. E. IMPLEMENT A FREE ONLINE HEALTH RISK ASSESSMENT AND OFFER ASSISTANCE WITH PHYSICIAN REFERRAL. F. OFFER SMOKING CESSATION CLASSES AND EDUCATION ON LOUISIANA'S TOBACCO FREE 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. 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 1 REALLIETY ATHLETIC PRODUCTIONS 2023 CHARVAIS LAKE CHARLES LA 70601 461240215 N/A 10000 SPONSORSHIP SWLA CENTER FOR HEALTH SERVICES PO BOX 19010 LAKE CHARLES LA 706169010 721015384 501(C)(3) 10000 SPONSORSHIP LOUISIANA HIGH SCHOOL ATHLETIC ASSOCIATION 12720 OLD HAMMOND HIGHWAY BATON ROUGE LA 708161037 720513180 501(C)(3) 15000 SPONSORSHIP 2 1 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 1 0 0 0 1 1 1 0 CHRISTOPHER THOMPSON PHYSICIAN / MEDICAL STAFF 700003 0 108798 0 0 0 7650 0 0 0 816451 0 0 0 CHARLES WHITSON CPA SR.VICE PRESIDENT OF FINAN 280059 0 10000 0 0 0 7347 0 18998 0 316404 0 0 0 LARRY GRAHAM PRESIDENT/CEO & ASST SECRE 560370 0 116414 0 7450 0 7650 0 11306 0 703190 0 0 0 BEN THOMPSON PHYSICIAN / MEDICAL STAFF 429999 0 53282 0 0 0 7650 0 13636 0 504567 0 0 0 GERALD W MOUTON ACTIVE TRUSTEE 269000 0 31920 0 0 0 7650 0 13636 0 322206 0 0 0 MARILYN MCSWAIN RN SR.VICE PRESIDENT OF NURSI 221760 0 0 0 0 0 5650 0 13635 0 241045 0 0 0 BERNITA BROWN VICE PRES OF SUPPORT SERVI 156286 0 0 0 0 0 4228 0 13636 0 174150 0 0 0 TIM COFFEY SR.VICE PRES OF OPERATIONS 285468 0 0 0 0 0 7245 0 7984 0 300697 0 0 0 DONNA SHIELDS ASST VICE PRES NURSING 211955 0 0 0 0 0 5548 0 13636 0 231139 0 0 0 TODD DELAHOUSSAYE SR.VICE PRES OF PHYSICIAN 191005 0 0 0 0 0 5062 0 7984 0 204051 0 0 0 KATHLEEN DEROUEN SR.VICE PRES OF MARKETING 165077 0 0 0 0 0 4490 0 11306 0 180873 0 0 0 LEIF PEDERSEN VICE PRES OF PHILANTHROPHY 154766 0 0 0 0 0 4031 0 18998 0 177795 0 0 0 NATHAN COHEN PHYSICIAN 950019 0 0 0 0 0 7650 0 13635 0 971304 0 0 0 BRETT CASCIO PHYSICIAN 800782 0 967580 0 0 0 7650 0 18998 0 1795010 0 0 0 MICHAEL BROUSSARD MD PHYSICIAN 529391 0 370261 0 0 0 7650 0 0 0 907302 0 0 0 FRANCISCO MARERRO PHYSICIAN 600781 0 363874 0 0 0 7650 0 18998 0 991303 0 0 0 JEAN KING WHITE PHYSICIAN 700783 0 348650 0 0 0 7650 0 13635 0 1070718 0 0 0 MANLEY M JORDAN MD ACTIVE TRUSTEE (FORMER) 429998 0 1826 0 0 0 7650 0 18998 0 458472 0 0 0 THOMAS C STRONG MD ACTIVE TRUSTEE (FORMER) 372002 0 59191 0 0 0 7650 0 7984 0 446827 0 0 0 BRIAN CLEMENTS MD ACTIVE TRUSTEE (FORMER) 325780 0 159812 0 0 0 7650 0 18998 0 512240 0 0 0 KEVIN MOCKLIN ACTIVE TRUSTEE (FORMER) 241697 0 0 0 0 0 6351 0 13636 0 261684 0 0 0 LUCIEN K MOSS ACTIVE TRUSTEE (FORMER) 326000 0 32483 0 0 0 7650 0 18998 0 385131 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 $736.30 PER YEAR. ANY NONBUSINESS USE OF THE CLUB IS ACCOUNTED FOR AND INCLUDED AS COMPENSATION IN THE CEO W-2. PART I, LINE 6 BEN THOMPSON, M.D., LUCIEN K. MOSS M.D. AND MANLEY JORDAN, M.D. ARE SUBJECT TO A BONUS STRUCTURE OF COLLECTIONS MINUS EXPENSES. 85% OF THE EXCESS IS PAID TO THE PHYSICIAN, BUT NOT TO EXCEED 85% OF THE PHYSICIAN BASE. PHYSICIAN INCENTIVES ARE CALCULATED IN VARIOUS WAYS (I.E., CASH FLOW IN EXCESS OF EXPENSES, VALUE PER WRVU). AMOUNTS PAID TO THE PHYSICIANS ARE BASED ON THE FAIR MARKET VALUE OF THEIR PERSONALLY PERFORMED PROFESSIONAL SERVICES AND THEIR TOTAL COMPENSATION IS SUBJECT TO CERTAIN LIMITATIONS. IN NO INSTANCE DOES PHYSICIAN COMPENSATION VARY WITH OR TAKE INTO ACCOUNT THE VALUE OF OR VOLUME OF REFERRALS OR OTHER BUSINESS GENERATED BY THE PHYSICIANS FOR THE HOSPITAL. PART I, LINE 7 LARRY GRAHAM, PRESIDENT AND CEO, IS SUBJECT TO AN INCENTIVE PAY BASED ON EMPLOYEE SUCCESS IN ACHIEVING GOALS ESTABLISHED BY THE BOARD. THE MAXIMUM AMOUNT TO BE PAID IN ANY ONE YEAR IS 25% OF HIS BASE PAY. A CALCASIEU PARISH PUBLIC TRUST AUTHORITY 720895871 546395D84 2007-11-01 69371392 BOND REFUNDING, FACILITY AND EQUIPMENT UPGRADE AND RESERVES 0 0 0 B CALCASIEU PARISH PUBLIC TRUST AUTHORITY 521333467 NONEAVAIL 2013-10-10 6275000 CURRENT BOND REFUNDING 0 0 0 A 3550000 69371392 6641478 2007 1 1 1 1 B 6275000 89494 2013 1 0 1 1 A 0 0 0 0 0 0 0 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 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CALCASIEU PARISH PUBLIC TRUST AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 05/14/2012 THOMAS SHEARMAN THOMAS SHEARMAN IS A MEMBER OF THE BOARD & EMPLOYED BY LC AMERICAN PRESS 128083 LC AMERICAN PRESS PROVIDES ADVERTISING FOR THE HOSPITAL. 0 LOUIS TODD LOUIS TODD IS A MEMBER OF THE BOARD & IS SELF-EMPLOYED (TODD & ASSOCIATES) 1452329 TODD & ASSOCIATES PROVIDES BROKERAGE SERVICES FOR MEDICAL MALPRACTICE INSURANCE FOR THE HOSPITAL'S EMPLOYED PHYSICIANS THROUGH LAMMICO. LOUIS TODD RECEIVES A COMMISSION FROM THE PREMIUMS THAT THE HOSPITAL PAYS TO LAMMICO AND LOUISIANA PATIENTS COMPENSATION FUND. 0 DAVID WALLACE MD DAVID WALLACE IS A MEMBER OF THE BOARD, & A PHYSICIAN OF CHILDREN CLINIC 150744 CHILDREN CLINIC PROVIDES MEDICAL DIRECTORSHIP OF THE PEDIATRIC NURSERY, NEONATAL INTENSIVE CARE UNIT AND PEDIATRIC INTENSIVE CARE UNIT PROGRAMS AT THE HOSPITAL 0 FORM 990, PART VI, SECTION A, LINE 3 THE HOME HEALTH AGENCY, PHARMACY, AND PURCHASING 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 11 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 - LA PET/CT IMAGING LAKE CHARLES LLC -2,107. BOOK/TAX DIFFERENCE - GIFT SHOP 27,003. BOOK/TAX DIFFERENCE - 2ND AVENUE MRI, LLC -795,379. GAAP ADJUSTMENT TO RECORD NET TRANSFERS TO SUBSIDIARIES 41,846. ROUNDING -5. GAAP ADJUSTMENT TO RECORD CY INCOME (LOSS) EQUITY IN SUBSIDIARIES -13,552,188. FORM 990 PART XII LINE 2C THE ORGANIZATION'S PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. 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