2012-05-07T12:56:28-05:00 2011-09-30 COLE EVANS & PETERSON POST OFFICE DRAWER 1768 SHREVEPORT LA 711661768 990 2010-10-01 720400933 WILLIS-KNIGHTON MEDICAL CENTER WILL 3182124000 POST OFFICE BOX 32600 SHREVEPORT LA 711302600 ROBERT D HUIE 3182124000 2012-05-04 1 C WILLIAM GERARDY JR 3182228367 2010 2016-02-24 21:20:13Z ROBERT D HUIE POST OFFICE BOX 32600 SHREVEPORT LA 711302600 822393296 0 X WWW.WKHS.COM X 1949 LA THE MEDICAL CENTER PROVIDES A FULL-RANGE OF HEALTH CARE SERVICES TO THE GENERAL PUBLIC. 12 10 6600 195 1488814 0 40505 4944 819408120 801935730 2823330 1730606 -3361508 3673880 818910447 807345160 2099791 1797776 0 0 319436029 333959691 0 0 0 449700782 395476199 771236602 731233666 47673845 76111494 814894488 888515990 339366527 364310630 475527961 524205360 X TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE WE SERVE. 1 0 610714083 1466627 803155625 WILLIS-KNIGHTON MEDICAL CENTER STRIVES TO PROVIDE HIGH QUALITY, COST-EFFECTIVE MEDICAL CARE TO THE COMMUNITIES OF NORTHWEST LOUISIANA, NORTHEAST TEXAS, AND SOUTHWEST ARKANSAS. THE MEDICAL CENTER OFFERS SOPHISTICATED TECHNOLOGY AND PROCEDURES THAT MAKE IT A TERTIARY CARE REFERRAL CENTER. GENERAL THE MEDICAL CENTER PROVIDES 24-HOUR EMERGENCY CARE, REGARDLESS OF THE PATIENT'S ABILITY TO PAY, AT ITS FOUR HOSPITALS. THE MEDICAL CENTER PROVIDES AN ORGAN TRANSPLANT PROGRAM, FERTILITY AND REPRODUCTIVE HEALTH CLINIC, OBSTETRICS, COMPREHENSIVE HEART AND CANCER PROGRAMS, EXTENSIVE SURGICAL OPTIONS, LEADING-EDGE DIAGNOSTICS AS WELL AS A BROAD NETWORK OF PHYSICIANS ENCOMPASSING MOST SPECIALTIES AND SUBSPECIALTIES. THE MEDICAL CENTER PROVIDES THESE SERVICES REGARDLESS OF RACE, COLOR, CREED, RELIGION, GENDER, NATIONAL ORIGIN, DISABILITY OR AGE. THE MEDICAL CENTER HAD 51,109 ADMITTANCES DURING THE YEAR ENDED SEPTEMBER 30, 2011 WITH A TOTAL OF 206,940 PATIENT DAYS AND 3,962 BIRTHS. THE MEDICAL CENTER PARTICIPATES IN THE MEDICAID PROGRAM AND ADMINISTERS A CHARITY CARE POLICY WHEREBY FREE OR DISCOUNTED SERVICES ARE AVAILABLE TO QUALIFIED INDIVIDUALS WITH LIMITED FINANCIAL MEANS. DURING THE YEAR ENDED SEPTEMBER 30, 2011, THE MEDICAL CENTER PROVIDED AN ESTIMATED $12,500,000 IN UNREIMBURSED COSTS ATTRIBUTABLE TO CHARITY CARE (EXCLUDING PROJECT NEIGHBORHEALTH) AND AN ESTIMATED $17,000,000 IN UNREIMBURSED COSTS ATTRIBUTABLE TO MEDICAID PATIENTS. THESE ESTIMATES ARE BASED ON THE MEDICAL CENTER'S OVERALL COST-TO-CHARGE RATIO. IN ADDITION TO THESE SERVICES, WILLIS-KNIGHTON PROJECT NEIGHBORHEALTH OPERATES FOUR CLINICS IN COMMUNITIES THAT ARE ECONOMICALLY DISTRESSED AND/OR DESIGNATED AS MEDICALLY UNDER-SERVED AREAS WITH HEALTH PROFESSIONAL SHORTAGES. SEE SCHEDULE H FOR DETAILED INFORMATION REGARDING PROJECT NEIGHBORHEALTH. REGIONAL TRANSPLANT CENTER THE MEDICAL CENTER, IN CONJUNCTION WITH LSU HEALTH SCIENCES CENTER (A PUBLIC TEACHING AND INDIGENT CARE FACILITY), OPERATES A REGIONAL TRANSPLANT CENTER (WILLIS-KNIGHTON/LSUHSC REGIONAL TRANSPLANT CENTER) AT WILLIS-KNIGHTON MEDICAL CENTER. ALL TRANSPLANT PATIENTS RECEIVE TRANSPLANTS WITHOUT REGARD TO THEIR ECONOMIC STATUS. THE REGIONAL TRANSPLANT CENTER PROVIDES KIDNEY, PANCREAS, AND LIVER TRANSPLANTS. SUBSTANTIALLY ALL THE COSTS OF OPERATING THE REGIONAL TRANSPLANT CENTER ARE BORNE BY WILLIS-KNIGHTON MEDICAL CENTER. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2011, 19 PATIENTS RECEIVED ORGAN TRANSPLANTS, CONSISTING OF 13 KIDNEYS (1 OF THOSE PATIENTS ALSO HAD A PANCREAS TRANSPLANT) AND 6 LIVERS. OF THE 19 TRANSPLANT SURGERIES PERFORMED AT THE MEDICAL CENTER DURING THE YEAR ENDED SEPTEMBER 30, 2011, 13 PATIENTS WERE BENEFICIARIES OF THE MEDICARE PROGRAM AND 1 PATIENT WAS A BENEFICIARY OF THE MEDICAID PROGRAM. AS SUCH, THESE TRANSPLANTS WERE PERFORMED AT VERY LITTLE, IF ANY, COST TO THE PATIENTS.EMERGENCY CARE THE MEDICAL CENTER PROVIDES EMERGENCY SERVICES AT FOUR LOCATIONS ON A 24-HOUR BASIS STAFFED BY FULL-TIME EMERGENCY ROOM PHYSICIANS. EMERGENCY PATIENTS ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY. DURING THE YEAR ENDED SEPTEMBER 30, 2011, THE MEDICAL CENTER'S EMERGENCY ROOMS WERE VISITED BY 144,890 PATIENTS, OF WHOM 19,832 WERE ADMITTED TO THE HOSPITAL FOR FURTHER TREATMENT.WOMEN AND CHILDREN'S HEALTH SERVICES THE MEDICAL CENTER PROVIDES A VARIETY OF MEDICAL SERVICES FOR WOMEN AND CHILDREN, INCLUDING OBSTETRICS, GYNECOLOGY, AND NEONATOLOGY. THESE SERVICES INCLUDE BOTH HIGH-RISK AND LOW-RISK OBSTETRICS. MATERNAL TRANSPORTS ARE ACCEPTED. THE LABOR AND DELIVERY (L&D) UNITS ARE DIRECTED BY BOARD CERTIFIED OB-GYN PHYSICIANS AND THE MAJORITY OF THE NURSES ARE CERTIFIED BY THE ASSOCIATION OF WOMEN'S HEALTH, OBSTETRIC & NEONATAL NURSES (AWHON). THERE WERE 3,962 BIRTHS; 10,476 OBSTETRICAL VISITS TO THE L&D UNITS; AND 4,141 OBSTETRICAL AND GYNECOLOGICAL INPATIENTS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2011.HEALTH AND WELLNESS CENTERS THE MEDICAL CENTER HAS SIX MEDICALLY-SUPERVISED HEALTH AND WELLNESS CENTERS DEDICATED TO THE PREVENTION OF HEALTH PROBLEMS, FOUR IN SHREVEPORT, ONE IN BOSSIER CITY, AND ONE IN HOMER WITH A TOTAL MEMBER ENROLLMENT AT SEPTEMBER 30, 2011 OF 6,551. THE CENTERS ARE LOCATED ON EACH OF THE FOUR HOSPITAL CAMPUSES, IN THE WK PIERRE AVENUE COMMUNITY CENTER, AND IN THE WK CLAIBORNE REGIONAL HEALTH CENTER. A MEDICAL EVALUATION, INCLUDING A BLOOD CHEMISTRY WORK-UP, IS REQUIRED FOR MEMBERSHIP. THE CENTERS SERVE PULMONARY AND CARDIAC REHABILITATION PATIENTS AND PROVIDE HEALTH AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE LOCATED. NEONATAL INTENSIVE CARE UNIT WILLIS-KNIGHTON'S CENTER FOR WOMEN'S HEALTH HOUSES A 42-BED LEVEL III NICU. THIS UNIT ACCEPTS REFERRALS FROM THE ARK-LA-TEX AREA AND IS SERVICED BY BOTH AIR AND GROUND EMERGENCY TRANSPORT ON A 24-HOUR BASIS. THIS UNIT IS DIRECTED BY A BOARD CERTIFIED NEONATOLOGIST. THE MAJORITY OF THE NURSING STAFF IS CERTIFIED BY AWHON. THE AVERAGE LENGTH OF STAY PER ADMIT IS 19.4 DAYS.HOSPICE HOSPICE OF LOUISIANA IS A DEPARTMENT OF WILLIS-KNIGHTON MEDICAL CENTER THAT PROVIDES COMPREHENSIVE END-OF-LIFE CARE INCLUDING SKILLED AND SUPPORTIVE SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. THE HOSPICE TEAM, UNDER THE GUIDANCE OF THE ATTENDING PHYSICIAN, FOCUSES ON THE ALLEVIATION OF THE PAIN AND DISCOMFORT CONNECTED WITH LIFE-ENDING ILLNESS. QUALITY OF LIFE, EMOTIONAL AND SPIRITUAL BALANCE, SYMPTOM MANAGEMENT, AND PAIN CONTROL ARE THE GOALS THAT TEAM MEMBERS STRIVE FOR AS THEY ASSIST DYING PATIENTS AND THEIR FAMILIES. BEREAVEMENT SUPPORT FOR THE IMMEDIATE FAMILY AND COMPANIONS IS PROVIDED FOR AT LEAST ONE YEAR FOLLOWING THE PATIENT'S DEATH. FOR THE YEAR ENDED SEPTEMBER 30, 2011, HOSPICE OF LOUISIANA SERVED 206 PATIENTS AND THEIR FAMILIES AS DIRECT ADMITS, NOT INCLUDING VISITATION AND COUNSELING PROVIDED THROUGH PRE-ADMIT AND/OR BEREAVEMENT SERVICES. THE TEAM INCLUDES: REGISTERED NURSES, CERTIFIED NURSING ASSISTANTS, SOCIAL WORKERS, CHAPLAINS, VOLUNTEERS, ATTENDING PHYSICIANS, AND MEDICAL DIRECTOR.BEHAVIORAL MEDICINE CENTER THE BEHAVIORAL MEDICINE CENTER AT WILLIS-KNIGHTON MEDICAL CENTER OFFERS INPATIENT AND OUTPATIENT SERVICES TO INDIVIDUALS IN NEED OF MENTAL HEALTH CARE. DURING THE YEAR ENDED SEPTEMBER 30, 2011, THE BEHAVIORAL MEDICINE CENTER SPONSORED NUMEROUS INFORMATION SESSIONS FOR VARIOUS GROUPS IN THE SHREVEPORT/BOSSIER AND NORTHWEST LOUISIANA AREAS. SUCH SESSIONS AMOUNTED TO APPROXIMATELY 460 HOURS AND WERE ATTENDED BY APPROXIMATELY 4,000 PEOPLE. TOPICS INCLUDED:MARRIAGE/FAMILY - DEVELOPMENT OF SKILLS TO ENRICH MARRIAGE AND FAMILY LIFE.SELF-ESTEEM - CONCENTRATES ON HOW GOOD SELF-ESTEEM CAN ENHANCE AN INDIVIDUAL'S QUALITY OF LIFE. PARENTING - FOCUSES ON APPROPRIATE PARENTING SKILLS AT VARIOUS DEVELOPMENTAL STAGES. STRESS MANAGEMENT - DEVELOPING SKILLS TO COPE WITH EVERYDAY STRESSES IN LIFE.PERSONAL ENRICHMENT - EMPOWERING OURSELVES TO REACH MAXIMUM POTENTIAL.MOTIVATION/ATTITUDE - HOW ATTITUDE AFFECTS OUR MENTAL AND PHYSICAL HEALTH.COUNSELING ISSUES/TECHNIQUES - ISSUES CONCERNING PROFESSIONAL DEVELOPMENT FOR COUNSELORS/THERAPISTS.AGING - DEVELOPMENT OF A POSITIVE ATTITUDE TO DEAL WITH ISSUES OF AGING.DEPRESSION/SUICIDE - ASSESSMENT OF DEPRESSION AND SUICIDE, AND LEGAL AND ETHICAL ISSUES SURROUNDING SUICIDE. 7735406 1094959 THE MEDICAL CENTER PROVIDES HOUSING, HEALTHCARE, AND RELATED SERVICES TO THE ELDERLY THROUGH THE OAKS OF LOUISIANA. THE OAKS OF LOUISIANA IS A RESIDENTIAL COMMUNITY DESIGNED SPECIFICALLY FOR ADULTS AGED 55 AND OVER. THIS RESIDENTIAL COMMUNITY PROVIDES SECURE, MAINTENANCE-FREE LIVING AND PROMOTES AN ACTIVE, HEALTHY LIFESTYLE. THE CAMPUS OF THE OAKS OF LOUISIANA INCLUDES THE TOWER AT THE OAKS, A RESIDENTIAL COMMUNITY AND SAVANNAH AT THE OAKS, AN ASSISTED LIVING FACILITY. 618449489 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 1 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 434 0 1 6600 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 10 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X X ROBERT D HUIE 3182124000 2611 GREENWOOD ROAD SHREVEPORT LA 711033908 JAMES K ELROD 53.00 X X 1218922 6000 6401 PIERRE V BLANCHARDIV MD 40.00 X 206058 0 7901 RAY P ODEN JR 4.00 X 0 0 0 PHILLIP A ROZEMAN MD 4.00 X 0 0 0 TIGNER A WALKER 4.00 X 0 0 0 FRANK B HUGHES MD 4.00 X 0 0 0 RAND H FALBAUM 4.00 X 0 0 0 TWAIN K GIDDENS 4.00 X 0 0 0 WILLIS L MEADOWS JR 4.00 X 0 0 0 JESSE C DEEN 4.00 X 0 0 0 SAM J TALBOT 4.00 X 0 0 0 BENDEL JOHNSON MD 4.00 X 0 0 0 ROBERT D HUIE 52.00 X 1062365 0 18953 NILA C WILLHOITE 40.00 X 237524 0 18497 CHARLES D DAIGLE 40.00 X 394430 0 24990 STEPHEN R RANDALL 40.00 X 291857 0 24512 MARGARET G ELROD 40.00 X 166001 0 9120 JERRY A FIELDER II 40.00 X 152627 0 28977 CLIFFORD M BROUSSARD 40.00 X 162500 0 16624 JANET K ELROD 40.00 X 164373 0 10510 IRA L MOSS 40.00 X 191458 0 19414 JILL K ELROD 40.00 X 209810 0 12632 PEGGY J GAVIN 40.00 X 167213 0 10563 GAYE E DEAN 40.00 X 132590 0 9518 DEBORAH D OLDS 40.00 X 125640 0 18013 RAMONA D FRYER 40.00 X 171119 0 18699 DANIEL J MOLLER JR MD 40.00 X 318417 0 16393 CHARLES A POWERS MD 40.00 X 315251 0 17025 RANDALL P BREWER MD 40.00 X 2089795 0 28000 MILAN G MODY MD 40.00 X 1328404 0 22987 CHRISTIAN M BRIERY MD 40.00 X 1189484 0 21130 MATTHEW S MOSURA MD 40.00 X 1010496 0 22981 AMIT AHUJA MD 40.00 X 824781 0 22987 12131115 6000 406827 421 0 1 0 LSU HEALTH SCIENCES CENTER PO BOX 33932 SHREVEPORT LA 71130 MEDICAL STAFFING 4280817 RED RIVER CARDIOVASCULAR SURGEONS 2751 ALBERT BICKNELL DR SUITE 5C SHREVEPORT LA 71103 PHYSICIAN SERVICES 2233000 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY TESTING SERVICES 2129050 COLE EVANS & PETERSON 624 TRAVIS STREET SHREVEPORT LA 71101 PAYROLL EE BENEFIT, ACCT/CONSULTANT SVCS 1376750 ESTOPINAL GROUP 903 SPRING STREET JEFFERSONVILLE IN 47130 ARCHITECTURAL FEES 1202449 102 4944 4944 HOSPITAL SERVICES 900099 800840771 800814420 26351 RESIDENTIAL COMMUNITY 900099 1094959 1094959 801935730 1600818 1600818 14581768 596156 14560085 488051 21683 108105 129788 129788 INCOME(LOSS) FROM SUBS 524114 1387515 1387515 LABORATORY REVENUE 621500 604720 604720 (LOSS) FROM SUBSIDIARY 623000 223097 223097 1458548 600805 857743 3673880 807345160 804250584 1488814 1600818 1755961 1755961 41815 41815 6395172 6395172 247043872 217503988 29539884 13540763 11620822 1919941 46209540 39657501 6552039 20770344 17825322 2945022 1629969 1629969 1575989 1575989 2335726 797050 1538676 6670126 6670126 1272893 1272893 44395962 21724089 22671873 6230492 6230492 DIRECT DEPARTMENTAL EXP 305867097 305867097 TAXES & LICENSES 6632313 6632313 BUSINESS OFFICE 3989579 3989579 14876053 1655844 13220209 731233666 618449489 112784177 0 2735472 23704709 103237689 98199847 109956151 113588257 1864914 8723990 21069958 21265155 3385735 2964420 953558385 465075604 469393930 488482781 78952214 110549292 21302078 18291146 2090110 1864249 906237 882144 814894488 888515990 76109762 78546392 583334 190496279 184320743 72177152 101443495 339366527 364310630 X 475527961 524205360 475527961 524205360 814894488 888515990 X 76111494 -27434095 X X 0 1 1 X 0 X 0 0 0 0 0 0 0 0 1 63207 63207 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: DURING THE YEAR ENDED SEPTEMBER 30, 2011, THE MEDICAL CENTER PAID DUES TOTALING $42,800 TO THE LOUISIANA STATE MEDICAL SOCIETY ON BEHALF OF DOCTORS IN THE MEDICAL CENTER'S PHYSICIAN NETWORK, WHICH CONSISTS OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEDICAL CENTER. A PORTION OF THE DUES, $8,988 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2011, THE MEDICAL CENTER PAID DUES TOTALING $6,300 TO THE AMERICAN MEDICAL ASSOCIATION ON BEHALF OF DOCTORS IN THE MEDICAL CENTER'S PHYSICIAN NETWORK, WHICH CONSISTS OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEDICAL CENTER. A PORTION OF THE DUES, $3,780 WAS RELATED TO LOBBYING ACTIVITIES. DURING THE YEAR ENDED SEPTEMBER 30, 2011, THE MEDICAL CENTER PAID DUES TOTALING $240,184 TO THE LOUISIANA HOSPITAL ASSOCIATION FOR THE MEDICAL CENTER'S MEMBERSHIP IN THE ASSOCIATION AND ON BEHALF OF DOCTORS IN THE MEDICAL CENTER'S PHYSICIAN NETWORK, WHICH CONSISTS OF PHYSICIANS EMPLOYED BY OR UNDER CONTRACT WITH THE MEDICAL CENTER. A PORTION OF THE DUES, $50,439 WAS RELATED TO LOBBYING ACTIVITIES. HEALTHCARE POLICY IS CRITICAL TO THE MISSION OF THE MEDICAL CENTER, AND ITS MANAGEMENT BELIEVES THAT HEALTHCARE PROVIDERS SHOULD PARTICIPATE IN FORMING HEALTHCARE POLICY BY INTERACTING WITH NATIONAL, STATE, AND LOCAL REPRESENTATIVES AND THEIR STAFFS, WHEN POSSIBLE, TO HELP THEM BETTER UNDERSTAND THE COMPLEXITIES AND RAMIFICATIONS OF KEY HEALTHCARE ISSUES. THE MEDICAL CENTER'S MANAGEMENT IS AVAILABLE TO LAWMAKERS, GOVERNMENT OFFICIALS, AND THEIR STAFF MEMBERS, FOR INFORMATION AND OCCASIONALLY RESPONDS TO QUESTIONS AND INITIATES COMMUNICATIONS ABOUT HOW PROPOSED LAWS, POLICIES, REGULATIONS, ETC. MIGHT AFFECT THE MEDICAL CENTER'S ABILITY TO DELIVER COST-EFFECTIVE, QUALITY HEALTHCARE. THE AMOUNT OF TIME AND MONEY RESOURCES INVOLVED IN THESE ACTIVITIES IS INSUBSTANTIAL. THE MEDICAL CENTER HAS NOT AND DOES NOT INTERVENE IN ANY POLITICAL CAMPAIGN. 1328030 45404332 46732362 9106646 559057856 246369708 321794794 1896537 1088466 808071 280158201 204552366 75605835 56606783 13065064 43541719 488482781 CAPITAL LEASE OBLIGATIONS 3802279 INVESTMENT IN SUB. - VIRGINIA HALL, INC. 3634932 LIABILITY FOR PENSION BENEFITS 94006284 101443495 807345160 731233666 76111494 -176843 -27257252 -27434095 48677399 817410678 -176843 -176843 817587521 -10242361 -10242361 807345160 768733279 37499613 37499613 731233666 0 731233666 PART XII, LINE 4B UNRELATED BUSINESS INCOME 857,743 SUBSIDIARIES EXPENSES (11,100,104) TOTAL (10,242,361) PART XIII, LINE 2D UNRELATED BUSINESS INCOME (857,743) SUBSIDIARIES EXPENSES 11,100,104 PENSION RELATED CHANGES 27,257,252 TOTAL 37,499,613 PART XI, LINE 8 PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS - THIS COST IS PRIMARILY ATTRIBUTABLE TO THE EFFECTS OF CHANGES IN FINANCIAL MARKETS ON BOTH INVESTED PLAN ASSETS AND ASSUMED DISCOUNT RATES USED IN THE CALCULATION OF THE PLAN'S FUNDED STATUS. 0 0 0 0 0 0 0 RUSSIA & THE NEWLY INDEPENDENT STATES PROVIDE MEDICAL SUPPLIES AND DOCTORS' TRAVEL EXPENSES FOR MEDICAL MISSION TRIP TO THE UKRAINE 15000 CHECK 26815 MEDICAL SUPPLIES AND TRAVEL EXPENSES BOOK 1 0 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 1 0 0 12301555 12301555 0.01680 69482922 53681385 15801537 0.02160 81784477 53681385 28103092 0.03840 1922529 1922529 0.00260 5461127 5461127 0.00750 4 10234 2272480 601618 1670862 0.00230 2090294 2090294 0.00290 4 10234 11746430 601618 11144812 0.01530 4 10234 93530907 54283003 39247904 0.05370 0 18232199 0 210413293 221982377 -11569084 X 1 1 4 1 WILLIS-KNIGHTON MEDICAL CENTER

2600 GREENWOOD ROAD SHREVEPORT LA 71103

X X X X REHAB CTR, SNF, PHYSICIAN CLINICS 2 WK PIERREMONT HEALTH CENTER

8001 YOUREE DRIVE SHREVEPORT LA 71115

X X X X PHYSICIAN CLINICS 3 WK BOSSIER HEALTH CENTER

2400 HOSPITAL DRIVE BOSSIER CITY LA 71111

X X X PHYSICIAN CLINICS 4 WILLIS-KNIGHTON SOUTH

2510 BERT KOUNS INDUSTRIAL LOOP SHREVEPORT LA 71118

X X X X PHYSICIAN CLINICS NOT REQUIRED 1 PART I, LINE 7: ALL ITEMS IN THE TABLE, EXCEPT FOR LINE 7G, USE THE COST-TO-CHARGE RATIO COSTING METHOD. PROJECT NEIGHBORHEALTH, WHICH IS INCLUDED ON LINE 7G, USES THE ACTUAL COST METHOD. PART III, LINE 4: THE MEDICAL CENTER MAINTAINS AN ALLOWANCE FOR DOUBTFUL PATIENT ACCOUNTS RECEIVABLE BASED ON MANAGEMENTS ASSESSMENT OF COLLECTABILITY, CURRENT ECONOMIC CONDITIONS, AND PRIOR EXPERIENCE. AS MANAGEMENT DETERMINES THE COLLECTION OF SPECIFIC PATIENT ACCOUNTS TO BE DOUBTFUL, SUCH ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE. BASED ON THIS ANALYSIS, BAD DEBT EXPENSE AS A PERCENTAGE OF GROSS PATIENT BILLINGS (EXCLUDING MEDICARE CHARGES, MEDICAID CHARGES, AND CHARITY CARE) WAS 6.2 PERCENT AND 6.1 PERCENT FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND SEPTEMBER 30, 2010, RESPECTIVELY. 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. PART III, LINE 9B: MONTHLY STATEMENTS ARE GENERATED AND MAILED BY THE MEDICAL CENTER TO KEEP PATIENTS/GUARANTORS INFORMED OF OUTSTANDING ACCOUNT BALANCES. STATEMENT MESSAGES ARE GENERATED FOR EACH ACCOUNT THAT LET THE PATIENT/GUARANTOR KNOW IF THE BALANCE IS PENDING PAYMENT FROM THEIR INSURANCE CARRIER OR DEEMED TO BE THE PATIENT'S RESPONSIBILITY.THE IN-HOUSE COLLECTIONS DEPARTMENT IS RESPONSIBLE FOR SELF-PAY COLLECTIONS. THIS INCLUDES COLLECTION OF BALANCES AFTER ALL INSURANCE HAS PAID AND COLLECTION OF BALANCES FROM PATIENTS WHO HAVE NO INSURANCE. THE MEDICAL CENTER UTILIZES SELF PAY COMPASS (A COMPANY THAT SPECIALIZES IN ESTIMATING INDIVIDUAL'S INCOME AND FINANCIAL RESOURCES) TO IDENTIFY ACCOUNTS THAT HAVE A HIGH PROBABILITY FOR PAYMENT. THE PROBABILITY OF PAYMENT REPORT GENERATED BY SELF PAY COMPASS IS BASED ON OUTSIDE INFORMATION SOURCES THAT PROVIDE A PERSON'S CREDIT HISTORY, ESTIMATED HOUSEHOLD INCOME, MEDICAL BILL PAYMENT HISTORY, ETC. REPORTS ARE GENERATED FROM SELF PAY COMPASS ON A WEEKLY BASIS FOR ALL ACCOUNTS WITH A SELF-PAY BALANCE AND CALCULATED PROBABILITY OF PAYMENT GREATER THAN 70%. ACCOUNTS FROM THESE REPORTS ARE THEN PROCESSED BY MEDITECH (THE MEDICAL CENTER'S CORE SOFTWARE) TO DETERMINE IF THE GUARANTOR HAS ADDITIONAL SELF-PAY BALANCES. IF THE GUARANTOR IS CURRENTLY PAYING ON ANOTHER ACCOUNT(S), THE ACCOUNT FROM THE REPORT IS COMBINED WITH THE OTHER ACCOUNT(S) SO THE GUARANTOR RECEIVES ONE STATEMENT OR COLLECTION LETTER EACH MONTH. IF THE GUARANTOR HAS NO OTHER ACCOUNTS ON WHICH THEY ARE PAYING, A PHONE CALL IS MADE. A REPORT IS GENERATED FROM SELF PAY COMPASS ON A MONTHLY BASIS TO DETERMINE ACCOUNTS WITH BALANCES LESS THAN $100 THAT ARE DELINQUENT. THESE ACCOUNTS ARE IMPORTED INTO MEDITECH TO RECEIVE A COLLECTION LETTER WHEN APPROPRIATE. A REPORT IS GENERATED FROM MEDITECH ON A MONTHLY BASIS TO IDENTIFY ACCOUNTS WITH BALANCES OVER $10,000. THE IN-HOUSE COLLECTOR REVIEWS THE COLLECTION ACTIVITY AND FOLLOWS UP WITH THE APPROPRIATE ACTION WHICH MAY INCLUDE PHONE CALLS, ASSISTING THE PATIENT WITH APPLYING FOR CHARITY CARE, ESTABLISHING A PAYMENT ARRANGEMENT OR RECOMMENDING THAT THE ACCOUNT BE REFERRED FOR OUTSIDE COLLECTIONS. OTHER REPORTS ARE GENERATED FROM MEDITECH AND SELF PAY COMPASS ON AN AS-NEEDED BASIS TO IDENTIFY OTHER ACCOUNTS REQUIRING COLLECTION ACTIVITY. PART VI, LINE 2: WILLIS-KNIGHTON MEDICAL CENTER OPERATES THROUGHOUT SHREVEPORT, BOSSIER CITY AND NEARBY PARISHES AND PROVIDES FOUR HOSPITALS, NUMEROUS SATELLITE CLINICS, A SKILLED NURSING FACILITY, A RETIREMENT COMMUNITY, AND AN ASSISTED LIVING FACILITY. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT IT SERVES BY STAYING INFORMED ABOUT THE RELEVANT TRENDS OCCURRING IN THE AREAS IN WHICH IT OPERATES. PART VI, LINE 3: WILLIS-KNIGHTON HEALTH SYSTEM IS COMMITTED TO PROVIDING CHARITY CARE TO PERSONS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE. CONSISTENT WITH ITS MISSION TO DELIVER COMPASSIONATE, HIGH QUALITY, AFFORDABLE HEALTHCARE SERVICES AND TO BE AN ADVOCATE FOR THOSE WHO ARE MOST IN NEED, WILLIS-KNIGHTON HEALTH SYSTEM STRIVES TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING CARE. PATIENTS ARE EXPECTED TO COOPERATE WITH WILLIS-KNIGHTON HEALTH SYSTEM'S PROCEDURES FOR OBTAINING CHARITY OR OTHER FORMS OF PAYMENT OR FINANCIAL ASSISTANCE, AND TO CONTRIBUTE TO THE COST OF THEIR CARE BASED ON THEIR INDIVIDUAL ABILITY TO PAY.PATIENTS OF THE MEDICAL CENTER ARE INFORMED OF THEIR ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE ORGANIZATION'S CHARITY CARE POLICY IN THE FOLLOWING MANNERS:1)IF THE PATIENT DOES NOT HAVE INSURANCE, THEN THE MEDICAL CENTER WILL ASSIST THEM IN DETERMINING WHETHER OR NOT THEY QUALIFY FOR MEDICAID.2)INFORMATION CONCERNING THE MEDICAL CENTER'S CHARITY CARE PROGRAM IS AVAILABLE ON THE MEDICAL CENTER'S WESITE, WWW.WKHS.COM.3)ONCE A PATIENT HAS BEEN ADMITTED INTO THE HOSPITAL, AND IT IS DETERMINED THAT THEY DO NOT HAVE INSURANCE, THEN A MEDICAL CENTER EMPLOYEE IS RESPONSIBLE FOR REQUESTING A DEPOSIT FROM THE PATIENT. IF THE PATIENT IS NOT ABLE TO PAY, THEN THE PATIENT IS GIVEN AN APPLICATION FOR THE CHARITY CARE PROGRAM AT THAT TIME.4)IN THE EVENT THERE IS NO WRITTEN DOCUMENTATION TO SUPPORT A PATIENT'S ELIGIBILITY FOR CHARITY CARE, THE MEDICAL CENTER UTILIZES SELF PAY COMPASS (A COMPANY THAT SPECIALIZES IN ESTIMATING AN INDIVIDUAL'S INCOME AND FINANCIAL RESOURCES) TO DETERMINE CHARITY CARE ELIGIBILITY. THE MEDICAL CENTER RELIES ON SELF PAY COMPASS TO ESTIMATE INCOME AND FINANCIAL RESOURCES ONLY FOR THOSE INDIVIDUALS WHOSE INCOME IS ESTIMATED TO BE 150% OR LESS OF THE FEDERAL POVERTY LEVEL. REPORTS ARE GENERATED ON A QUARTERLY BASIS TO IDENTIFY ACCOUNTS THAT MEET THIS CRITERION, AND CHARITY CARE ADJUSTMENTS ARE APPLIED, IF APPLICABLE. PART VI, LINE 4: WILLIS-KNIGHTON'S PRIMARY SERVICE AREA COVERS AN APPROXIMATE 35 MILE RADIUS OF SHREVEPORT, COVERING THE LOUISIANA PARISHES OF CADDO, BOSSIER, WEBSTER, CLAIBORNE, RED RIVER, DESOTO AND BIENVILLE, AND WHICH HAD A 2010 ESTIMATED POPULATION OF APPROXIMATELY 453,794 PERSONS. THE MEDIAN HOUSEHOLD INCOME ACCORDING TO THE 2010 U.S. CENSUS DATA FOR SHREVEPORT IS $38,095. THE MEDIAN HOUSEHOLD INCOME ACCORDING TO THE 2010 U.S. CENSUS DATA FOR BOSSIER PARISH IS $49,053. PART VI, LINE 6: OTHER COMMUNITY BENEFITS:PROJECT NEIGHBORHEALTH - OVERVIEWDURING 1995, THE MEDICAL CENTER BEGAN A PROGRAM KNOWN AS "PROJECT NEIGHBORHEALTH." THE PROGRAM'S PURPOSE IS TO PROMOTE HEALTH AND WELL-BEING IN COMMUNITIES THAT ARE ECONOMICALLY DISTRESSED AND/OR DESIGNATED AS MEDICALLY UNDER-SERVED, HEALTH-PROFESSIONAL-SHORTAGE AREAS. THE PROGRAM PROVIDES FREE COMMUNITY PROGRAMS INCLUDING ANTI-DRUG/GANG PROGRAMS, LIFE SKILLS TRAINING, MENTORING PROGRAMS, NUTRITIONAL COUNSELING, POLICE COMMUNITY FORUMS, AND OTHER COMMUNITY-RELATED PROGRAMS. AS PART OF PROJECT NEIGHBORHEALTH, THE MEDICAL CENTER OPERATES THE FOLLOWING CLINICS: WK COMMUNITY HEALTH AND EDUCATION CENTER - MLK CLINIC, WK PIERRE AVENUE HEALTH & WELLNESS CENTER, WK BRADLEY MEDICAL CLINIC, AND THE CHILDREN'S DENTAL CLINIC AND WK COMMUNITY EDUCATION CENTER.WK COMMUNITY HEALTH AND EDUCATION CENTER - MLK CLINICPROJECT NEIGHBORHEALTH: ON SEPTEMBER 1, 1995, AT A COST OF APPROXIMATELY $1,300,000, THE MEDICAL CENTER OPENED A 6,463 SQUARE FOOT, FEDERALLY DESIGNATED INDIGENT CARE MEDICAL CLINIC AND A 3,914 SQUARE FOOT COMMUNITY EDUCATION BUILDING ON SHREVEPORT-BLANCHARD ROAD AT DR. MARTIN LUTHER KING DRIVE IN SHREVEPORT, LOUISIANA. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THESE FACILITIES ARE CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. SERVICES ARE PROVIDED WITHOUT REGARD TO THE PATIENTS' ABILITY TO PAY. THE LOCATION OF THE CLINIC (CENSUS TRACT 246 IN THE MARTIN LUTHER KING DRIVE AREA IN CADDO PARISH) WAS DESIGNATED BY THE DEPARTMENT OF HEALTH AND HOSPITALS AS A HEALTH-PROFESSIONAL-SHORTAGE AREA AND AS A MEDICALLY UNDER-SERVED AREA. PRIOR TO THE CLINIC'S OPENING, THIS AREA WAS THE SECOND LARGEST CONTIGUOUS POPULATION OF MEDICALLY UNDER-SERVED PEOPLE IN THE UNITED STATES. THE CLINIC HAS AN EMERGENCY AND SPECIAL PROCEDURES ROOM, AN X-RAY DEPARTMENT, AND A FULLY EQUIPPED LABORATORY AND DENTAL FACILITY. PREVENTATIVE CARE PROGRAMS INCLUDE BLOOD PRESSURE CHECKS, HEALTH SCREENINGS, IMMUNIZATIONS, AND DIABETES COUNSELING. THE CLINIC'S STAFF INCLUDES 1 FAMILY PRACTICE PHYSICIAN, A DENTIST, AND SUPPORT STAFF. THE CLINIC HAD 3,168 MEDICAL PATIENT VISITS AND 144 DENTAL PATIENT VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2011. THE EDUCATION FACILITY HOUSES CLASSROOMS, AN AUDITORIUM, A NURSERY, A CONFERENCE ROOM, AND A LIBRARY WITH STUDY AREAS.WK PIERRE AVENUE COMMUNITY HEALTH & WELLNESS CENTERPROJECT NEIGHBORHEALTH: ON AUGUST 1, 1998, THE MEDICAL CENTER OPENED A 15,062 SQUARE FOOT MEDICAL CLINIC KNOWN AS THE "WK PIERRE AVENUE COMMUNITY CENTER" ON PIERRE AVENUE IN SHREVEPORT AT A COST OF APPROXIMATELY $1,375,000. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THIS FACILITY IS CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. THIS FACILITY ALSO CONTAINS A HEALTH AND FITNESS CENTER. THE MEDICAL CENTER PROVIDES EQUIPMENT AND MEDICAL STAFF FOR THE CLINIC. THE CLINIC'S STAFF INCLUDES A FAMILY PRACTICE PHYSICIAN AND SUPPORT STAFF. THE CLINIC HAD 3,348 MEDICAL PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2011. WK BRADLEY MEDICAL CLINIC ON AUGUST 24, 1998, THE MEDICAL CENTER OPENED A 3,915 SQUARE FOOT MEDICAL CLINIC KNOWN AS THE "WK BRADLEY MEDICAL CLINIC" IN BRADLEY, ARKANSAS AT A COST OF APPROXIMATELY $140,000. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THIS FACILITY IS CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. THE MEDICAL CENTER PROVIDES EQUIPMENT AND MEDICAL STAFF FOR THE CLINIC. THE CLINIC'S STAFF INCLUDES A NURSE PRACTITIONER AND VARIOUS SUPPORT STAFF. THE CLINIC HAD 2,522 MEDICAL PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2011. THE CHILDREN'S DENTAL CLINIC AND WK COMMUNITY EDUCATION CENTERPROJECT NEIGHBORHEALTH: ON OCTOBER 15, 2001, THE MEDICAL CENTER OPENED A 3,049 SQUARE FOOT MEDICAL CLINIC KNOWN AS THE "THE CHILDREN'S DENTAL CLINIC AND WK COMMUNITY EDUCATION CENTER" ON SOUTHERN AVENUE IN SHREVEPORT. THE MEDICAL CLINIC IS HOUSED IN A DONATED BUILDING THAT THE MEDICAL CENTER RENOVATED AT A COST OF APPROXIMATELY $162,000. LOCATED IN AN ECONOMICALLY DISTRESSED COMMUNITY, THIS FACILITY IS CONVENIENT TO AND PRIMARILY FOR THE BENEFIT OF THE PEOPLE IN THAT COMMUNITY. THE MEDICAL CENTER PROVIDES EQUIPMENT AND MEDICAL STAFF FOR THE CLINIC. THE CLINIC'S STAFF INCLUDES A FULL-TIME OFFICE MANAGER AND 53 DENTISTS FROM THE NORTHWEST LOUISIANA DENTAL VOLUNTEERS, WHO EACH DONATE ONE-THIRD DAY PER MONTH TO THE CLINIC. THE CLINIC HAD 1,052 PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2011. DURING THE YEAR ENDED SEPTEMBER 30, 2011, UNDER PROJECT NEIGHBORHEALTH, THE MEDICAL CENTER PROVIDED OVER 15,000 HOURS TO COMMUNITY SERVICES/PROJECTS AT NO COST TO THE RECIPIENTS BY 3 FULL-TIME EMPLOYEES, 2 PART-TIME EMPLOYEES, AND VOLUNTEERS IN ADDITION TO HOURS PROVIDED BY VARIOUS DEPARTMENTS WITHIN THE MEDICAL CENTER.OTHER COMMUNITY SERVICESTHE MEDICAL CENTER MAKES AVAILABLE, FREE-OF-CHARGE, MEETING SPACE TO OUTSIDE COMMUNITY OUTREACH ORGANIZATIONS SUCH AS QUEENSBOROUGH NEIGHBORHOOD ASSOCIATION, ALLIANCE FOR EDUCATION, BOSSIER MEDICAL SOCIETY, CADDO PARISH SHERIFF'S OFFICE, ICE (INNER CITY ENTREPRENEUR), NORTH LOUISIANA AHEC, LIFESHARE BLOOD CENTER, LSU PSYCHIATRY PROGRAM, TEXAS WESLEYAN UNIVERSITY CRNA PROGRAM, NORTHWEST LOUISIANA COALITION FOR WOMEN AND CHILDREN, NORTHWEST LOUISIANA INTERFAITH PHARMACY, VOLUNTEERS FOR YOUTH JUSTICE AND OTHER CHARITABLE AND GOVERNMENTAL ORGANIZATIONS. ROOMS ARE ALSO PROVIDED FOR OFF CAMPUS CLASSES TAUGHT BY BPCC AND LSUS AT THE WK CAREER INSTITUTE.THE MEDICAL CENTER OFFERS EXTENSIVE ONLINE HEALTH INFORMATION ON ITS WEB SITE. FREE HEALTH INFORMATION IS AVAILABLE, TARGETED TO BOTH ADULTS AND CHILDREN. INFORMATION FOR ADULTS INCLUDES A HEALTH LIBRARY, DRUG INTERACTION CHECKER, NUTRITION AND WELLNESS INFORMATION AND DESCRIPTION OF PROCEDURES, WRITTEN BY HEALTH PROFESSIONALS AND REVIEWED AND UPDATED REGULARLY. THE MEDICAL CENTER ALSO PARTNERS WITH THE NEMOURS FOUNDATION TO OFFER KIDSHEALTH, A HEALTH AND WELLNESS INFORMATION SITE TARGETED TO CHILDREN, TEENS AND THEIR PARENTS. THE WILLIS-KNIGHTON CANCER CENTER WEB SITE OFFERS INFORMATION ON VARIOUS TYPES OF CANCER AND TREATMENTS AS WELL AS AN UPDATED LIST OF CLINICAL TRIALS. DURING THE PAST YEAR THE MEDICAL CENTER'S ON-LINE HEALTH LIBRARY ATTRACTED 153,809 VISITORS. KIDSHEALTH ATTRACTED OVER 150,000 VISITORS.IMMUNIZATIONS FOR CHILDREN WILLIS-KNIGHTON PROVIDES A MOBILE UNIT THAT OFFERS "SHOTS FOR TOTS". USING ITS MOBILE VAN AND STAFF, VACCINES ARE TAKEN TO VARIOUS NEIGHBORHOODS TO MAKE THEM CONVENIENT FOR PARENTS. UNDER THIS PROGRAM, ANY CHILD MAY RECEIVE IMMUNIZATION SHOTS, FREE OF CHARGE, FOR MEASLES, MUMPS, RUBELLA, DIPHTHERIA, PERTUSSIS, TETANUS, HEPATITIS B, POLIO, MENINGITIS, FLU, AND CHICKEN POX. THE MEDICAL CENTER SUBSIDIZES ALL EXPENSES OF THE PROGRAM EXCEPT THE VACCINE, WHICH IS PROVIDED BY THE LOUISIANA DEPARTMENT OF PUBLIC HEALTH. DURING THE YEAR ENDED SEPTEMBER 30, 2011, THE MEDICAL CENTER IMMUNIZED 3,084 PATIENTS UNDER THIS PROGRAM.HEALTH PROFESSIONS EDUCATIONTHE MEDICAL CENTER PROVIDES VARIOUS EDUCATION PROGRAMS THAT RESULT IN HEALTH CARE PROFESSIONALS RECEIVING DEGREES, CERTIFICATES OR TRAINING THAT IS NECESSARY TO BE LICENSED TO PRACTICE AS HEALTH CARE PROFESSIONALS. WHILE THE MEDICAL CENTER ALSO PROVIDES A VARIETY OF EDUCATION, TRAINING AND STIPEND PROGRAMS THAT ARE EXCLUSIVE TO THE MEDICAL CENTER'S EMPLOYEES AND MEDICAL STAFF, THOSE COSTS ARE NOT INCLUDED IN THIS CATEGORY. THE MEDICAL CENTER MAINTAINS AN ASSOCIATION WITH LSU HEALTH SCIENCES CENTER (A PUBLIC TEACHING, RESEARCH, AND INDIGENT CARE FACILITY) BY PROVIDING GRANTS, ASSISTANCE WITH RESIDENTS AND FELLOWS, ALONG WITH UNDERWRITING THE COST OF CLINICAL SETTINGS FOR TRAINING AND INTERSHIPS FOR A VARIETY OF OTHER HEALTH PROFESSIONALS.SPORTS MEDICINESPORTS MEDICINE EXPERTS AT WILLIS-KNIGHTON SPORTS MEDICINE WORK WITH ATHLETES ON THE PREVENTION AND TREATMENT OF SPORTS-RELATED INJURIES, HELPING THEM TO MAINTAIN A HEALTHY LIFESTYLE. THIS SERVICE IS OFFERED TO VARIOUS SCHOOLS AND PROGRAMS THROUGHOUT THE LOCAL AREA. 1 ALLIANCE FOR EDUCATION 820 JORDAN STREET SHREVEPORT LA 71101 721466587 501(C)(3) 75000 DONATION FOR PATHWAY TO EXCELLENCE AMERICAN CANCER SOCIETY 920 PIERREMONT SUITE 300 SHREVEPORT LA 71106 237040934 501(C)(3) 15000 DONATION FOR RESEARCH AMERICAN HEART ASSOCIATION PO BOX 37388 SHREVEPORT LA 71133 135613797 501(C)(3) 45000 DONATION FOR OPERATIONS CADDO BOSSIER SOCCER ASSOCIATION 1780 EAST BERT KOUNS SUITE 901 SHREVEPORT LA 71105 581652966 501(C)(3) 21470 SPONSORSHIP CHILDREN AND ARTHRITIS 2751 ALBERT BICKNELL DRIVE SUITE 2E 2E SHREVEPORT LA 71103 721170530 501(C)(3) 15000 DONATION FOR OPERATIONS DESOTO REGIONAL HEALTH SYSTEM PO BOX 1636 MANSFIELD LA 71052 721491325 501(C)(3) 47803 DONATION FOR OPERATIONS EVERGREEN FOUNDATION 2101 HIGHWAY 80 HAUGHTON LA 71037 237089068 501(C)(3) 25000 DONATION TO BETTER HEALTH BETTER LIVES CAMPAIGN FOR THE HANDICAPPED INDEPENDENCE BOWL FOUNDATION PO BOX 1723 SHREVEPORT LA 71166 720297228 501(C)(3) 32000 SPONSORSHIP JUNIOR ACHIEVEMENT 3003 KNIGHT STREET SHREVEPORT LA 71105 720595081 501(C)(3) 20000 DONATION FOR OPERATIONS LOUISIANA TECH UNIVERSITY FOUNDATION PO BOX 3046 RUSTON LA 71272 726021176 501(C)(3) 71000 SPONSORSHIP LSUHSC PO BOX 31650 SHREVEPORT LA 71130 721402222 GOVERNMENT 140000 TRAUMA CENTER DONATION LSU-SHREVEPORT FOUNDATION ONE UNIVERSITY PLACE SHREVEPORT LA 71115 721031108 501(C)(3) 46000 2011 RIVER BEND REVUE SPONSOR, INDIA NIGHT SPONSOR, DONATION FOR OPERATIONS MARCH OF DIMES FOUNDATION 1120 SOUTH POINTE PARKWAY BLDG D SHREVEPORT LA 71105 131846366 501(C)(3) 10000 DONATION FOR OPERATIONS NORTHWEST LOUISIANA ECONOMIC 400 EDWARDS STREET SHREVEPORT LA 71101 720936419 501(C)(3) 40000 PLEDGE FOR OPERATIONS NORTHWEST LOUISIANA FOOD BANK 2307 TEXAS AVENUE SHREVEPORT LA 71103 721328890 501(C)(3) 25000 DONATION TO FUND THE FOOD BANK PROGRAM PUBLIC AFFAIRS RESEARCH COUNCIL OF LA PO BOX 14776 BATON ROUGE LA 70898 720436118 501(C)(3) 25000 DONATION TO CAPITAL CAMPAIGN RED RIVER REVEL ARTS FESTIVAL 101 CROCKET STREET SUITE C SHREVEPORT LA 71101 720953274 501(C)(3) 25000 SPONSORSHIP OF REGIONAL CULTURAL EVENT RED RIVER RADIO PUBLIC BROADCASTING PO BOX 5250 SHREVEPORT LA 71135 720702001 501(C)(3) 20500 DONATION FOR OPERATIONS OF COMMUNITY BROADCAST NETWORK AFRICAN-AMERICAN CHAMBER OF COMMERCE 1315 MILAM STREET SHREVEPORT LA 71101 726028366 501(C)(3) 8100 SPONSORSHIP SHREVEPORT-BOSSIER RESCUE MISSION 2033 TEXAS AVENUE SHREVEPORT LA 71103 237050551 501(C)(3) 123826 HEALTH INSURANCE FOR RESCUE MISSION EMPLOYEES AND DONATION FOR OPERATIONS SHREVEPORT SYMPHONY 619 LOUISIANA AVENUE SHREVEPORT LA 71101 726001334 501(C)(3) 62200 CONCERT SPONSOR AND DONATION FOR OPERATIONS SOUTHERN UNIVERSITY 610 TEXAS STREET SUITE 400 SHREVEPORT LA 71101 721454141 501(C)(3) 55000 DONATION FOR ALLIED HEALTH AND NURSING SCHOLARSHIPS ST JUDE'S CHILDREN'S RESEARCH HOSPITAL PO BOX 810 MEMPHIS TN 38101 620646012 501(C)(3) 25000 SPONSORSHIP AND DONATION TO ST. JUDE'S DREAM HOME THE ODYSSEY FOUNDATION 401 TEXAS STREET SHREVEPORT LA 71101 331055253 501(C)(6) 10000 DONATION TO WALKING THE WALK FUNDRAISER YMCA 400 MCNEIL SHREVEPORT LA 71101 720408997 501(C)(3) 40800 SPONSORSHIP INNER CITY ENTREPRENEUR INSTITUTE 820 JORDAN STREET SUITE 360 SHREVEPORT LA 71101 721418314 501(C)(3) 10000 BIZCAMP SPONSOR BOOKER T WASHINGTON HIGH SCHOOL 204 MILAM STREET SHREVEPORT LA 71103 726000224 GOVERNMENT 5022 PURCHASED SCHOOL SIGNDONATION FOR OPERATIONS BOSSIER CHAMBER OF COMMERCE 710 BENTON ROAD BOSSIER CITY LA 71111 720382231 501(C)(6) 11000 DONATION TO SUPPORT RENOVATION OF THE 8TH AF MUSEUM AND A NIGHT OF STARS CADDO COUNCIL ON AGING 1700 BUCKNER SQUARE SUITE 240 SHREVEPORT LA 71101 720715821 501(C)(3) 10100 DONATION FOR OPERATIONS CADDO PARISH SHERIFF'S DEPARTMENT 505 TRAVIS STREET 7TH FLOOR SHREVEPORT LA 71101 726000179 GOVERNMENT 6873 DONATION FOR OPERATIONS BETTY & LEONARD PHILLIPS DEAF ACTION CENTER OF NORTHWEST LA INC 330 MARSHALL STREET SUITE 300 SHREVEPORT LA 71101 720934321 501(C)(3) 6000 DONATION FOR OPERATIONS FRIENDS OF THE STATE EXHIBIT MUSEUM PO BOX 78208 SHREVEPORT LA 71107 720960820 501(C)(3) 15000 DONATION FOR OPERATIONS GINGERBREAD HOUSE BOSSIERCADDO CHILDREN'S ADVOCACY CENTER 1700 BUCKNER STREET SUITE 101 SHREVEPORT LA 71101 721390471 501(C)(3) 6000 DONATION FOR OPERATIONS GRAMBLING STATE UNIVERSITY PO BOX 913 GRAMBLING LA 71245 581736948 GOVERNMENT 10000 DONATION FOR OPERATIONS HOLY ANGELS RESIDENTIAL FACILITY INC 10450 ELLERBE ROAD SHREVEPORT LA 71106 720628035 501(C)(3) 30000 41893 FMV DONATION FOR OPERATIONS, DONATION OF FURNITURE NORTHWESTERN FOUNDATION UNIVERSITY PARKWAY NATCHITOCHES LA 71497 726021495 501(C)(3) 180000 NURSING PROGRAM DONATION PROVIDENCE HOUSE 814 COTTON STREET SHREVEPORT LA 71101 721205164 501(C)(3) 25000 DONATION FOR OPERATIONS QUEENSBOROUGH NEIGHBORHOOD ASSOCIATION PO BOX 38234 SHREVEPORT LA 71133 721232716 501(C)(3) 10000 DONATION FOR OPERATIONS SAMARITAN COUNSELING CENTER 1525 STEPHENS AVENUE SHREVEPORT LA 71101 721014069 501(C)(3) 5800 DONATION FOR OPERATIONS SHREVEPORT OPERA 212 TEXAS STREET NO 1 SHREVEPORT LA 71101 726021455 501(C)(3) 12500 DONATION FOR OPERATIONS VOLUNTEERS FOR YOUTH JUSTICE 900 JORDAN STREET SHREVEPORT LA 71101 721057695 501(C)(3) 5000 DONATION FOR OPERATIONS VOLUNTEERS OF AMERICA 360 JORDAN STREET SHREVEPORT LA 71101 720506820 501(C)(3) 8000 DONATION FOR OPERATIONS CITY OF BOSSIER CITY 620 BENTON ROAD BOSSIER CITY LA 71171 726000179 GOVERNMENT 233000 BOOK DONATION OF LAND TO DEVELOP NEW FIRE DEPARTMENT NORTH LOUISIANA AREA HEALTH EDUCATION CENTER 1513 DOCTORS DRIVE BOSSIER CITY LA 71111 721149280 501(C)(3) 5315 BOOK DONATION OF FOOD NORTH CADDO MEDICAL CENTER 1000 SPRUCE STREET VIVIAN LA 71082 720594537 501(C)(3) 9125 BOOK DONATION OF EQUIPMENT 43 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE MEDICAL CENTER HAS A CONTRIBUTION COMMITTEE THAT APPROVES SUBSTANTIALLY ALL CONTRIBUTIONS. THE CONTRIBUTION COMMITTEE REQUESTS THAT THE ORGANIZATION REQUESTING THE DONATION COMPLETE A CONTRIBUTION REQUEST FORM THAT IS AVAILABLE ON THE MEDICAL CENTER'S WEBSITE. BEFORE THE MEDICAL CENTER'S CONTRIBUTION COMMITTEE WILL APPROVE THE CONTRIBUTIONS THE PURPOSE OF THE CONTRIBUTION MUST BE STATED ON THE CONTRIBUTION REQUEST FORM. X 0 1 X X X X X 0 1 0 1 0 0 0 0 0 JAMES K ELROD 1031593 6000 0 0 187329 0 0 0 6401 0 1225323 6000 0 0 PIERRE V BLANCHARDIV MD 200000 0 0 0 6058 0 1953 0 5948 0 213959 0 0 0 ROBERT D HUIE 560825 0 0 0 501540 0 2441 0 16512 0 1081318 0 0 0 NILA C WILLHOITE 210366 0 0 0 27158 0 2606 0 15891 0 256021 0 0 0 CHARLES D DAIGLE 371875 0 0 0 22555 0 1685 0 23305 0 419420 0 0 0 STEPHEN R RANDALL 270980 0 0 0 20877 0 1707 0 22805 0 316369 0 0 0 MARGARET G ELROD 141049 0 0 0 24952 0 3344 0 5776 0 175121 0 0 0 JERRY A FIELDER II 151964 0 0 0 663 0 4802 0 24175 0 181604 0 0 0 CLIFFORD M BROUSSARD 158164 0 0 0 4336 0 1649 0 14975 0 179124 0 0 0 JANET K ELROD 142616 0 0 0 21757 0 4088 0 6422 0 174883 0 0 0 IRA L MOSS 168648 0 0 0 22810 0 3196 0 16218 0 210872 0 0 0 JILL K ELROD 188369 0 0 0 21441 0 1728 0 10904 0 222442 0 0 0 PEGGY J GAVIN 140431 0 0 0 26782 0 4288 0 6275 0 177776 0 0 0 RAMONA D FRYER 153494 0 0 0 17625 0 1728 0 16971 0 189818 0 0 0 DANIEL J MOLLER JR MD 296685 0 0 0 21732 0 1875 0 14518 0 334810 0 0 0 CHARLES A POWERS MD 295000 0 0 0 20251 0 1875 0 15150 0 332276 0 0 0 RANDALL P BREWER MD 2097315 0 0 0 -7520 0 1695 0 26305 0 2117795 0 0 0 MILAN G MODY MD 1330449 0 0 0 -2045 0 1682 0 21305 0 1351391 0 0 0 CHRISTIAN M BRIERY MD 1191928 0 0 0 -2444 0 0 0 21130 0 1210614 0 0 0 MATTHEW S MOSURA MD 1013790 0 0 0 -3294 0 1676 0 21305 0 1033477 0 0 0 AMIT AHUJA MD 826823 0 0 0 -2042 0 1682 0 21305 0 847768 0 0 0 PART I, LINE 1A THE VALUE OF EACH PERSON'S FREE MEMBERSHIP IN THE MEDICAL CENTER'S HEALTH & WELLNESS CENTERS IS ADDED TO THE EMPLOYEE'S W-2 WAGES. PART I, LINE 4B PHYSICIANS INCLUDED IN FORM 990, PART VII, SECTION A, LINE 1A, ARE COMPENSATED BASED ON THEIR OWN PERSONAL PRODUCTIVITY. THE PHYSICIANS ARE PAID A PERCENTAGE OF THEIR INDIVIDUAL COLLECTIONS BASED ON THE CONDITIONS OF EACH PHYSICIAN CONTACT. SUPPLEMENTAL INFORMATION PART III EXPLANATION OF PART II, COLUMN (B)(III) OTHER COMPENSATION JAMES K. ELROD UNUSED VACATION PAY-$122,998 UNUSED SICK PAY-$23,806 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$1,472 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$21,555 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(953) GIFT CERTIFICATE-$1,000 PERSONAL USE OF EMPLOYER VEHICLES-$751 TOTAL--$187,329 ROBERT D. HUIE NONQUALIFIED DEFERRED COMPENSATION PLAN-$429,468 (SEE EXPLANATION BELOW) UNUSED VACATION PAY-$35,950 UNUSED SICK PAY-$12,942 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR COMPUTER USAGE-$200 VALUE ADDED FOR CELL PHONE USAGE-$844 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$5,176 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,999) GIFT CERTIFICATE-$125 PERSONAL TRAVEL-$3,134 TOTAL--$501,540 NILA C. WILLHOITE UNUSED SICK PAY-$4,854 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,554 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$6,007 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,824) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$742 TOTAL--$27,158 CHARLES D. DAIGLE UNUSED SICK PAY-$9,062 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$908 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$504 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,744) GIFT CERTIFICATE-$125 TOTAL--$22,555 STEPHEN R. RANDALL UNUSED SICK PAY-$6,254 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,482 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$560 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,244) GIFT CERTIFICATE-$125 TOTAL--$20,877 MARGARET G. ELROD UNUSED SICK PAY-$3,255 VALUE ADDED FOR CELL PHONE USAGE-$2,390 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,400 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(952) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$1,234 TOTAL--$24,952 JERRY A. FIELDER,II UNUSED SICK PAY-$3,507 VALUE ADDED FOR CELL PHONE USAGE-$2,398 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$418 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(6,744) VALUE ADDED FOR CABLE/INTERNET- $959 GIFT CERTIFICATE-$125 TOTAL--$663 CLIFFORD M. BROUSSARD UNUSED SICK PAY-$3,702 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$853 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$1,795 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,799) GIFT CERTIFICATE-$125 TOTAL--$4,336 JANET K. ELROD UNUSED SICK PAY-$3,291 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$2,259 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$368 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,594) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$148 TOTAL--$21,757 IRA L. MOSS UNUSED SICK PAY-$3,892 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,774 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$3,025 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,005) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$299 TOTAL--$22,810 JILL K. ELROD UNUSED SICK PAY-$4,347 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$1,818 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$758 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(5,953) GIFT CERTIFICATE-$125 VALUE ADDED FOR CABLE/INTERNET- $960 PERSONAL USE OF EMPLOYER VEHICLES-$2,226 TOTAL--$21,441 PEGGY J. GAVIN UNUSED SICK PAY-$3,240 VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$3,023 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$2,392 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(1,453) GIFT CERTIFICATE-$125 PERSONAL USE OF EMPLOYER VEHICLES-$1,755 TOTAL--$26,782 RAMONA D. FRYER UNUSED SICK PAY-$3,542 VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$978 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$619 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(4,799) GIFT CERTIFICATE-$125 TOTAL--$17,625 DANIEL J. MOLLER, JR., M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 VALUE ADDED FOR CELL PHONE USAGE-$1,252 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$5,200 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,005) GIFT CERTIFICATE-$125 TOTAL--$21,732 CHARLES A. POWERS, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 VALUE ADDED FOR CELL PHONE USAGE-$1,311 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$4,039 SECTION 457(B) DEFERRED COMPENSATION PLAN-$16,500 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(2,799) TOTAL--$20,251 PIERRE V. BLANCHARD,IV, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$7,010 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(952) TOTAL--$6,058 RANDALL P. BREWER, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$564 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(8,744) TOTAL--($7,520) MATTHEW S. MOSURA, M.D. COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$449 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,743) TOTAL--($3,294) MILAN G. MODY, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$499 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,744) TOTAL--($2,045) CHRISTIAN M. BRIERY, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$660 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$464 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,568) TOTAL--($2,444) AMIT AHUJA, M.D. VALUE ADDED FOR HEALTH & FITNESS USAGE-$1,200 COST OF GROUP TERM LIFE INSURANCE IN EXCESS OF $50,000-$502 EMPLOYEE CAFETERIA PLAN CONTRIBUTIONS-$(3,744) TOTAL--($2,042) EXPLANATION OF PART II, COLUMN (B)(III) OTHER COMPENSATION THE AMOUNT CONTRIBUTED FOR THE CALENDAR YEAR 2010 FOR MR. HUIE'S SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IS INCLUDED IN THE DETAILS FOR PART II, COLUMN (B)(III). EXPLANATION OF PART II, COLUMN (C) DEFERRED COMPENSATION THIS EMPLOYEE PARTICIPATES IN A DEFINED BENEFIT PENSION PLAN, THE CONTRIBUTIONS TO WHICH ARE ACTUARIALLY DETERMINED. THE AMOUNT SHOWN IS THE INCREASE IN THE ANNUAL VESTED BENEFIT AT NORMAL RETIREMENT FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2010 (NOT DISCOUNTED TO PRESENT VALUE) (NORMAL RETIREMENT IS AGE 65 WITH 5 YEARS OF PARTICIPATION). MR. ELROD HAS REACHED THE MAXIMUM BENEFIT UNDER THE PLAN. EXPLANATION OF PART II, COLUMN (D) NONTAXABLE BENEFITS INCLUDED IN THIS COLUMN IS THE COST OF THE FOLLOWING NONTAXABLE BENEFITS: LONG-TERM DISABILITY INCOME INSURANCE PLAN, GROUP TERM-LIFE INSURANCE, AND THE ESTIMATED COST OF SELF-FUNDED HEALTH INSURANCE PLAN. FRANK B HUGHES MD TRUSTEE 124616 RENT-BUILDING 0 PHILLIP A ROZEMAN MD TRUSTEE 235072 RENT-BUILDING 0 TIMOTHY B WILLHOITE FAMILY MEMBER OF NILA WILLHOITE, OFFICER 47777 EMPLOYMENT 0 GREGORY J GAVIN FAMILY MEMBER OF PEGGY GAVIN, OFFICER 179566 EMPLOYMENT 0 KIMBERLY M MULLINS FAMILY MEMBER OF PEGGY GAVIN, OFFICER 48731 EMPLOYMENT 0 CHARLES E MULLINS FAMILY MEMBER OF PEGGY GAVIN, OFFICER 69814 EMPLOYMENT 0 SHARLENE ANN BROUSSARD FAMILY MEMBER OF CLIFFORD BROUSSARD, OFFICER 32312 EMPLOYMENT 0 WINSTON E MOORE III FAMILY MEMBER OF MARGARET ELROD, OFFICER 30798 EMPLOYMENT 0 TODD JUSTIN BLANCHARD FAMILY MEMBER OF PIERRE BLANCHARD, M.D., TRUSTEE 126539 EMPLOYMENT 0 PIERRE V BLANCHARD MD TRUSTEE 5034619 RENT-BUILDING, PURCHASED SERVICE AGREEMENT WITH LIFECARE HOSPITALS, INC., FOR WHICH PIERRE BLANCHARD, M.D. IS THE MEDICAL DIRECTOR 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 DURING THE YEAR, WILLIS-KNIGHTON MEDICAL CENTER COMPLETED CONSTRUCTION AND PLACED INTO SERVICE TWO PHASES OF THE OAKS OF LOUISIANA. PHASE 1, THE TOWER AT THE OAKS, PROVIDES SECURE, MAINTENANCE-FREE LIVING FOR ADULTS AGED 55 AND OVER. PHASE 2, THE SAVANNAH, PROVIDES ASSISTED LIVING. PLEASE SEE PART III, 4B FOR MORE INFORMATION. FORM 990, PART VI, SECTION A, LINE 2 1. FAMILY RELATIONSHIPS WITH JAMES K. ELROD - PRESIDENT, CEO, AND TRUSTEE MARGARET ELROD, SPOUSE - VP-MARKETING, LIVE OAK RETIREMENT COMMUNITY, QUICK CARE, OCCUPATIONAL MEDICINE, AND WELLNESS CENTERS JILL K. ELROD, DAUGHTER - VP OF LEGAL AFFAIRS JANET K. ELROD, DAUGHTER - VP AND ADMINISTRATOR OF WK SOUTH HOSPITAL FORM 990, PART VI, SECTION B, LINE 11 THE MEDICAL CENTER'S CPA FIRM PREPARES THE FORM 990 WITH THE ASSISTANCE OF SEVERAL OF THE MEDICAL CENTER'S EMPLOYEES. THE FORM 990 IS THEN REVIEWED BY THE MEDICAL CENTER'S PRESIDENT AND VICE-PRESIDENT. AFTER THIS REVIEW, A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD OF TRUSTEES, AND THE PRESIDENT, VICE-PRESIDENT AND CPA FIRM REVIEW AND DISCUSS THE FORM 990 WITH THE TRUSTEES BEFORE THE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICTS OF INTEREST POLICY COVERS ALL "INTERESTED PERSONS." AN "INTERESTED PERSON" IS DEFINED AS ANY TRUSTEE, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD DESIGNATED POWERS WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST IN AN ENTITY WITH WHICH THE MEDICAL CENTER HAS A TRANSACTION OR ARRANGEMENT; OR A COMPENSATION ARRANGEMENT WITH THE MEDICAL CENTER OR WITH ANY ENTITY OR INDIVIDUAL WITH WHICH THE MEDICAL CENTER HAS A TRANSACTION OR ARRANGEMENT; OR A POTENTIAL OWNERSHIP OR INVESTMENT INTEREST IN, OR COMPENSATION ARRANGEMENT WITH, ANY ENTITY OR INDIVIDUAL WITH WHICH THE MEDICAL CENTER IS NEGOTIATING A TRANSACTION OR ARRANGEMENT. INTERESTED PERSONS HAVE A DUTY TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST AND ALL MATERIAL FACTS RELATED TO THE PROPOSED TRANSACTION OR ARRANGEMENT TO THE TRUSTEES AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. THE INTERESTED PERSON IS ALLOWED TO MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION THE INTERESTED PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. IF THE BOARD OR COMMITTEE BELIEVES A MEMBER HAS VIOLATED THE CONFLICTS OF INTEREST POLICY, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE. IF THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS, IN FACT, FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. PERIODIC REVIEWS ARE CONDUCTED WHICH, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: 1. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULT OF ARM'S-LENGTH BARGAINING. 2. WHETHER ACQUISITIONS OF GOODS OR SERVICES RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. 3. WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS AND ARRANGEMENTS WITH MANAGEMENT SERVICE ORGANIZATIONS AND PHYSICIAN HOSPITAL ORGANIZATIONS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. 4. WHETHER AGREEMENTS TO PROVIDE HEALTH CARE AND AGREEMENTS WITH OTHER HEALTH CARE PROVIDERS, EMPLOYEES, AND THIRD PARTY PAYORS FURTHER THE CORPORATION'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES THE COMPENSATION OF THE TOP TWO EXECUTIVES (CEO AND CFO) OF THE MEDICAL CENTER. A SECOND COMPENSATION COMMITTEE, CONSISTING OF THE CEO AND CFO, DETERMINES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEES STUDY DATA FROM INDEPENDENT SALARY SURVEYS (SUCH AS "MANAGER AND EXECUTIVE COMPENSATION IN HOSPITALS AND HEALTH SYSTEMS," WHICH IS AN ANNUAL SURVEY PREPARED BY SULLIVAN COTTER) TO UNDERSTAND COMPENSATION PAID TO SIMILARLY QUALIFIED INDIVIDUALS IN COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THE COMPENSATION COMMITTEES ALSO COMPILE DATA FROM OTHER TAX-EXEMPT HEALTH SYSTEMS OF SIMILAR SIZE AND COMPLEXITY AND USE THAT INFORMATION AS COMPARATIVE COMPENSATION. THE COMMITTEES USE THE INFORMATION FROM THESE SOURCES AS BENCHMARKS IN DETERMINING OFFICER AND KEY EMPLOYEE COMPENSATION. THE COMMITTEES ALSO CONSIDER OTHER FACTORS IN DETERMINING OFFICER AND KEY EMPLOYEE COMPENSATION, SUCH AS LENGTH OF EMPLOYMENT AND THEIR RESPONSIBILITIES. THE EXECUTIVE COMPENSATION COMMITTEE PERIODICALLY HIRES INDEPENDENT CONSULTANTS FOR ANALYSIS OF THE COMPENSATION OF THE MEDICAL CENTER'S TOP TWO EXECUTIVES (CEO AND CFO). THE COMMITTEES MAINTAIN CONTEMPORANEOUS DOCUMENTATION OF THE BASIS FOR THEIR DECISIONS REGARDING COMPENSATION ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 WILLIS-KNIGHTON MEDICAL CENTER'S GOVERNING DOCUMENTS AND ITS CONFLICT OF INTEREST POLICY ARE AVAILABLE ON ITS WEBSITE: WWW.WKHS.COM. THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE FOLLOWING WEBSITE: HTTP://WWW.EMMA.MSRB.ORG. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -176,843. FASB ASC 715-30 PENSION -27,257,252. TOTAL TO FORM 990, PART XI, LINE 5: -27,434,095. FORM 990, PART XII, LINE 2C WILLIS-KNIGHTON MEDICAL CENTER DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DUING THE YEAR ENDED 9/30/11. VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER 2715 ALBERT BICKNELL DRIVE SHREVEPORT LA 711033925 721047744 NURSING CARE-SKILLED NURSING FACILITY FOR THE ELDERLY AND DISABLED LA 501(C)(3) 9 N/A 0 MULTI-FAITH RETIREMENT SERVICES DBA LIVE OAK RETIREMENT 600 E FLOURNOY LUCAS ROAD SHREVEPORT LA 711153855 720809402 PROVIDE HOUSING, HEALTHCARE AND RELATED SERVICES TO THE ELDERLY LA 501(C)(3) 9 N/A 0 SOUTH SHREVEPORT PHARMACY INC PO BOX 1768 SHREVEPORT LA 711661768 721131182 RETAIL SALES OF PHARMACEUTICAL PRODUCTS LA N/A C 2041 183385 1.00000 CLAIMS & BENEFITS ADMINISTRATORS OF LOUISIANA INC PO BOX 32600 SHREVEPORT LA 711302600 721296277 CLAIMS ADMINISTRATION LA N/A C 1.00000 WILLIS-KNIGHTON LAB AND X-RAY SERVICES INC PO BOX 32600 SHREVEPORT LA 711302600 721137503 INACTIVE LA N/A C 1.00000 HEALTH PLUS OF LOUISIANA INC 2219 LINE AVENUE SHREVEPORT LA 711042128 721264135 HEALTH MAINTENANCE ORGANIZATION LA N/A C 6223020 11249526 1.00000 HPL INSURANCE AGENCY INC PO BOX 32625 SHREVEPORT LA 711302625 202199735 HEALTH INSURANCE AGENT LA HEALTH PLUS OF LOUISIANA INC C 2779 38923 1.00000 1 0 0 1 0 0 0 0 1 1 1 1 0 1 1 0 0 1 VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER A 213111 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER J 328000 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER K 1097161 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC A 65000 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC K 9660721 FAIR MARKET VALUE MULTI-FAITH RETIREMENT SERVICES DBA LIVE OAK RETIREMENT COMMUNITY J 132000 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER N 1174811 FAIR MARKET VALUE MULTI-FAITH RETIREMENT SERVICES DBA LIVE OAK RETIREMENT COMMUNITY D 7000000 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER I 213111 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC I 65000 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC L 468231 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC O 21857278 FAIR MARKET VALUE VIRGINIA HALL NURSING HOME DBA PROGRESSIVE CARE CENTER B 172359 FAIR MARKET VALUE HEALTH PLUS OF LOUISIANA INC R 5000000 FAIR MARKET VALUE