2012-11-14T15:06:01-06:00 2011-12-31 721088864 LAPORTE APAC 111 VETERANS MEMORIAL BLVD SUITE 60 METAIRIE LA 700054958 990 2011-01-01 720417281 AMERICAN LEGION HOSPITAL AMER 3377833222 1305 CROWLEY-RAYNE HWY CROWLEY LA 70526 CHARMAINE VIDRINE 3377886406 2012-11-13 1 BONNIE M WYLLIE JD LLM P00540011 5048355522 2011 2016-02-24 21:20:13Z TERRY OSBORNE 1305 CROWLEY-RAYNE HWY CROWLEY LA 70526 32109227 0 X WWW.ALH.ORG X 1951 LA PROVIDES INPATIENT, OUTPATIENT, EMERGENCY, AND CHARITY HEALTHCARE SERVICES FOR RESIDENTS OF ACADIA PARISH AND THE SURROUNDING AREA. 7 4 549 48 0 0 26442 29346 34039503 31248575 339091 358654 197585 196942 34602621 31833517 0 0 0 0 17806258 16963392 0 0 0 18345991 16442616 36152249 33406008 -1549628 -1572491 36764277 35855406 6867390 7473804 29896887 28381602 X THE MISSION OF AMERICAN LEGION HOSPITAL IS TO BE A COMMUNITY HEALTH CENTER PROVIDING A SPECTRUM OF HIGH QUALITY HEALTH SERVICES, PROMOTING EDUCATION WITHIN THE ORGANIZATION, EMPHASIZING SERVICE AND EXCELLENCE,AND CONTINUALLY IMPROVING THE QUALITY MANAGEMENT SYSTEM. 0 0 28872575 31331194 THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF ACADIA PARISH AND THE SURROUNDING AREA. TOTAL HOSPITAL (ACUTE & ICU) PATIENT DAYS TOTALLED 12,929; AVERAGE LENGTH OF STAY WAS 3.82 DAYS; TOTAL PSYCHIATRIC DAYS TOTALLED 7,718; AVERAGE LENGTH OF STAY WAS 12.31 DAYS. OUTPATIENT REGISTRATIONS TOTALLED 38,566 FOR THE YEAR. CARE PROVIDED TO MEDICARE AND MEDICAID BENEFICIARIES TOTALLED 45% AND 25%, RESPECTIVELY, OF TOTAL GROSS REVENUE. THE HOSPITAL PARTICIPATED IN SEVERAL HEALTHCARE CAREER PROGRAMS WITH LOCAL SCHOOLS AND ORGANIZATIONS. THE HOSPITAL PARTICIPATED IN A LOCAL EVENT WHEREBY HEALTH INFORMATION WAS DISCUSSED. THE HOSPITAL SPONSORED TWENTY-THREE BIWEEKLY COMMUNITY BLOOD DRIVES AND ONE EMPLOYEE BLOOD DRIVE WITH A TOTAL OF 321 PARTICIPANTS. THE HOSPITAL ALSO PARTICIPATED WITH A LOCAL MOBILE OUTREACH PROGRAM FOR CANCER PATIENTS. DURING THE YEAR, THE MOBILE OUTREACH VISITED THE HOSPITAL ON TWENTY FOUR OCCASIONS, WITH 123 VISITS, WITH 90 PATIENTS PARTAKING OF THEIR BROAD SCOPE OF SERVICES, INCLUDING COUNSELING FOR PATIENTS AND THEIR FAMILIES. THE HOSPITAL ALSO PARTICIPATED AS A CLINICAL OBSERVATION SITE WITH SEVERAL LOCAL COLLEGES AND UNIVERSITIES AS WELL AS A TEXAS-BASED UNIVERSITY FOR NURSE ANESTHETISTS. THE HOSPITAL ALSO PARTICIPATED IN A CHRISTMAS CARD RECYCLING PROJECT. 28872575 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 50 0 1 549 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 4 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X JACKIE VALDETERO 3377886404 1305 CROWLEY-RAYNE HWY CROWLEY LA 70526 J ANDRUS BAROUSSE 0.50 X 0 0 0 BC DELAHOUSSAYE MD 0.50 X 0 0 0 MICHAEL MCBRIDE 0.50 X 0 0 0 RALPH COWEN 0.50 X 0 0 0 LAWRENCE HABETZ 0.50 X 0 0 0 STEPHEN STEFANSKI 0.50 X 0 0 0 P DALE LELEUX JR MD 0.50 X 0 0 0 TERRY OSBORNE 40.00 X 232780 0 10165 CHARMAINE VIDRINE 40.00 X 158041 0 10631 SATINDER SAINI MD 40.00 X 161067 0 10783 JAMES ROTEFF 40.00 X 133968 0 10440 GLENN DAILEY 40.00 X 105109 0 10631 J CRAIG BRIGNAC 40.00 X 105000 0 9822 HOPE ROSINSKI 40.00 X 101278 0 9802 997243 0 72274 9 0 1 0 PROFESSIONAL ANESTHESIA SERVICES OF SWLA 1309 HILLCROFT DR LAKE CHARLES LA 70605 ANESTHESIA SERVICES 1220000 ARSHAVIR MICHAEL APMC PO BOX 2403 CROWLEY LA 705272403 ANESTHESIA SERVICES 470000 MCKESSON TECHNOLOGIES INC PO BOX 98347 CHICAGO IL 606938347 COMPUTER SERVICES 337523 ACADIA EMERGENCY GROUP LLC PO BOX 82368 LAFAYETTE LA 705982368 ER PHYSICIAN SERVICES 318458 ELITE MEDICAL STAFFING DBA TOTAL SUPPORT 201 W VERMILION ST LAFAYETTE LA 70501 CONTRACT NURSING SERVICES 306980 16 29346 29346 PATIENT SERVICES 621990 31248575 31248575 31248575 270885 270885 160421 121379 39042 39042 39042 242100 154331 87769 87769 87769 CAFETERIA REVENUE 722210 159018 159018 JOINT VENTURE-OPEN AIR 621400 17876 17876 JOINT VENTURE-C. CARDI 621400 -23026 -23026 4032 4032 157900 31833517 31331194 0 472977 409521 409521 14633793 12773030 1860763 788227 669993 118234 1131851 962073 169778 232403 232403 56223 56223 4572946 4142665 430281 28491 28491 5988018 5695417 292601 294424 250307 44117 698418 537782 160636 22488 12778 9710 8631 3908 4723 180827 180746 81 2784811 2144304 640507 350566 327873 22693 REPAIRS AND MAINTENANCE 960078 910907 49171 PHYSICIAN RECRUITMENT 189555 189555 COLLECTION EXPENSES 71237 71237 3500 3500 33406008 28872575 4533433 0 1725 1825 3907774 2521232 6302129 6735053 1183120 1300187 1046108 875191 34869544 21211071 12939965 13658473 1006850 1022974 262279 398212 305124 205159 9809203 9137100 36764277 35855406 2275330 2715043 4592060 4758761 6867390 7473804 X 29624239 28108455 272648 273147 29896887 28381602 36764277 35855406 X -1572491 57206 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 82773 540653 623426 1183113 11354600 8929545 3608168 41567 21031147 11738612 9334102 62878 572813 542914 92777 13658473 RESTRICTED CASH AND INVESTMENTS 6075237 DEPOSITS FOR HEALTH INSURANCE ADMINISTRATOR 2395884 TRUST INVESTMENT 273147 COST REPORT SETTLEMENT RECEIVABLE 392832 9137100 31833517 33406008 -1572491 57206 57206 -1515285 32664297 810412 810412 31853885 -20368 -20368 31833517 34221143 693756 693756 33527387 -121379 -121379 33406008 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: TEXT FROM FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS. UNCERTAINTY IN INCOME TAXES: THE AUTHORITATIVE GUIDANCE IN ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES, CREATES A SINGLE MODEL TO ADDRESS UNCERTAINTY IN TAX POSITIONS AND CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING THE MINIMUM RECOGNITION THRESHOLD A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER THE REQUIREMENTS OF THIS GUIDANCE, TAX-EXEMPT ORGANIZATIONS COULD BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS. THERE ARE NO MATERIAL UNRECORDED TAX LIABILITIES AS OF DECEMBER 31, 2011 AND 2010. PART XII, LINE 2D - OTHER ADJUSTMENTS: SUBSIDIARY INCOME $ 810,412 -- AUDITED FINANCIAL STMTS WERE CONSOLIDATED PART XII, LINE 4B - OTHER ADJUSTMENTS: DIVIDEND FROM SUBSIDIARY $106,161 RENTAL EXPENSES REPORTED IN PART VIII, LINE 6B -- $(121,379) JOINT VENTURE INCOME -- OPEN AIR MRI, LLC $17,876 JOINT VENTURE LOSS -- CROWLEY CARDIAC WELLNESS $(23,026) PART XIII, LINE 2D - OTHER ADJUSTMENTS: SUBSIDIARY EXPENSE $693,756 (AUDITED FINANCIAL STMTS WERE CONSOLIDATED) PART XIII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES REPORTED IN PART VIII, LINE 6B -- $121,379 1 1 X 1 X 1 X 1 0 0 115692 115692 0.00350 8656281 6573142 2083139 0.06230 8771973 6573142 2198831 0.06580 1774 1774 0.00010 3500 3500 0.00010 5274 5274 0.00020 8777247 6573142 2204105 0.06600 195238 195238 0.00580 195238 195238 0.00580 0 1707858 674604 15489319 13132830 2356489 X 1 1 1 OPEN AIR MRI PROVIDE OPEN AIR MRI 0.51000 2 OF ACADIANA LLC SERVICES TO RESIDENTS 3 OF ACADIA PARISH AND 4 SURROUNDING AREA 6 ALH HEALTH PARTIAL OWNER OF 1.00000 7 VENTURES LLC CROWLEY CARDIAC 8 WELLNESS, LLC 9 CROWLEY CARDIAC PROVIDE CARDIAC 0.30000 0.10000 0.30000 10 WELLNESS LLC SCREENING SERVICES 11 TO RESIDENTS OF 12 ACADIA PARISH AND 13 SURROUNDING AREA 1 1 AMERICAN LEGION HOSPITAL

1305 CROWLEY-RAYNE HWY CROWLEY LA 70526

X X X INCLUDES OFFSITE PSYCHIATRIC CAMPUS AMERICAN LEGION HOSPITAL 1 1 1 100.000000000000 1 200.000000000000 1 X 1 1 X X X 1 0 X 1 X 0 0 2 OPEN AIR MRI OF ACADIANA LLC

1305 CROWLEY-RAYNE HWY SUITE A CROWLEY LA 70526

PROVIDES OPEN AIR MRI SERVICES CROWLEY CARDIAC WELLNESS LLC

1113 EAST NORTHERN AVENUE CROWLEY LA 70526

PROVIDES CARDIAC SCREENING SERVICES PART I, LINE 7: PERCENT OF TOTAL COMMUNITY BENEFIT EXPENSE TO TOTAL EXPENSE IS 26.27% THE HOSPITAL USED TOTAL COMMUNITY BENEFIT EXPENSE (8,777,247) OVER TOTAL EXPENSES FROM PART IX ($33,406,008) TO COMPUTE THIS PERCENTAGE. PART II: LINE 8 COMMUNITY BUILDING ACTIVITIES: OUR AREA FALLS INTO THE HEALTHCARE PHYSICIAN SHORTAGE AREA (HPSA); AS A RESULT, OUR HOSPITAL HAS TO RECRUIT PHYSICIANS TO OUR AREA TO ENSURE A FULL ARRAY OF PHYSICIAN SERVICES ARE AVAILABLE FOR THE RESIDENTS OF OUR PARISH AND SURROUNDING AREA. PHYSICIAN RECRUITMENT IN THE CURRENT YEAR AMOUNTED TO $189,556. WE ALSO OFFERED AN ONGOING INCENTIVE FOR OUR CURRENT NURSING STAFF FOR REIMBURSEMENT OF STUDENT LOANS; THIS INCENTIVE WAS MADE TO COMPETE WITH OTHER HOSPITALS IN THE AREA. THIS AMOUNT TO $5,682 IN THE CURRENT YEAR. THE HOSPITAL STRIVES TO MAINTAIN A COMPETENT WORKFORCE TO PROVIDE HIGH QUALITY SERVICES TO OUR PATIENTS. PART III, LINE 4: FOOTNOTE IN FINANCIAL STATEMENTS FOR BAD DEBTS AND COSTING METHODOLOGIESFROM NOTE 1 OF NOTES TO CONSOLIDATED FINANCIAL STATEMENTS:PATIENT ACCOUNTS RECEIVABLES ARE CARRIED AT THE ORIGINAL BILLED AMOUNT LESS DEDUCTIONS FOR CONTRACTUALS AND OTHER DISCOUNTS AS WELL AS AN ESTIMATE FOR UNCOLLECTIBLE ACCOUNTS BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PATIENT ACCOUNTS RECEIVABLES ARE WRITTEN-OFF WHEN DEEMED UNCOLLECTIBLE WHICH OCCURS AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS. RECOVERIES OF PATIENT ACCOUNTS RECEIVABLES PREVIOUSLY WRITTEN-OFF ARE RECORDED WHEN RECEIVED. THE HOSPITAL DOES NOT HAVE A POLICY OF CHARGING INTEREST ON PAST DUE BALANCES IN PATIENT ACCOUNTS RECEIVABLE.FROM NOTE 1 OF NOTES TO CONSOLIDATED FINANCIAL STATEMENTS:IN JULY 2011, THE FASB ISSUES ASU NO. 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES. UNDER ASU NO. 2011-07, CERTAIN HEALTH CARE ENTITIES THAT RECOGNIZE SIGNIFICANT AMOUNTS OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED WITHOUT ASSESSING THE PATIENT'S ABILITY TO PAY ARE REQUIRED TO CHANGE THE PRESENTATION OF THEIR STATEMENT OF OPERATIONS BY RECLASSIFYING THE PROVISION FOR BAD DEBTS ASSOCIATED WITH PATIENT SERVICE REVENUE FROM AN OPERATING EXPENSE TO A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS). ADDITIONALLY, THOSE HEALTH CARE ENTITIES ARE REQUIRED TO PROVIDE ENHANCED DISCLOSURE ABOUT THEIR POLICIES FOR RECOGNIZING REVENUE AND ASSESSING BAD DEBTS, AS WELL AS QUALITATIVE AND QUANTITATIVE INFORMATION ABOUT CHANGES IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE GUIDANCE IS EFFECTIVE FOR THE HOSPITAL FOR FISCAL YEARS, AND INTERIM PERIODS WITHIN THOSE YEARS, BEGINNING AFTER DECEMBER 15, 2011, WITH EARLY ADOPTION PERMITTED. THE HOSPITAL HAS ELECTED TO EARLY ADOPT ASU NO. 2011-07 AND HAS APPLIED ITS PROVISIONS TO THE CONSOLIDATED FINANCIAL STATEMENTS.FROM NOTE 2 OF NOTES TO THE CONSOLIDATED FINANCIALS STATEMENTS:ACCOUNTS RECEIVABLE ARE ALSO REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLES AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARY COVERAGE EXISTS FOR PART OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN DISCOUNTED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS TOTALED $2,831 AND $3,032 AT DECEMBER 31, 2011 AND 2010, RESPECTIVELY. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS APPROXIMATELY 47% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2011 AND 2010. OVERALL, THE TOTAL OF SELF-PAY DISCOUNTS AND WRITE-OFFS HAS NOT CHANGED SIGNIFICANTLY FOR THE YEAR ENDED DECEMBER 31, 2011. THE HOSPITAL HAS NOT EXPERIENCED SIGNIFICANT CHANGE IN WRITE-OFF TRENDS EVEN THOUGH THE HOSPITAL HAS CHANGED ITS CHARITY CARE POLICY EFFECTIVE FOR 2011 TO COMPLY WITH THE AFFORDABLE CARE ACT AND INTERNAL REVENUE CODE SECTION 501(R)(5) WHICH LIMITS THE AMOUNTS CHARGED TO THOSE WHO QUALIFY FOR FINANCIAL ASSISTANCE TO THE BEST INSURANCE RATE OR MEDICARE RATE FOR SERVICE.THE HOSPITAL USED THE SAME COSTING METHODOLOGY USED AND RECOMMENDED IN THE IRS WORKSHEET 2 FOR SCHEDULE H, RATIO OF PATIENT CARE COST TO CHARGES FOR PART III, LINES 2 AND 3. FOR LINE 3, THE HOSPITAL ANALYZED ITS BAD DEBT POPULATION AND ITS CHARITY POPULATION. APPROXIMATELY FIFTY-EIGHT PERCENT OF OUR BAD DEBTS WERE UNINSURED. THUS, THE HOSPITAL ASSUMED THAT FIFTY PERCENT OF THOSE WOULD PROBABLY QUALIFY FOR CHARITY BUT FAILED TO PROVIDE THE APPROPRIATE DOCUMENTATION. FOR THE OTHER FORTY-TWO PERCENT OF OUR BAD DEBT POPULATION AN ASSUMPTION WAS MADE THAT A FOURTH OF THOSE WOULD QUALIFY BUT DID NOT PRESENT THE APPROPRIATE DOCUMENTATION. THE HOSPITAL DID NOT INCLUDE ANY BAD DEBTS IN OUR COMMUNITY BENEFIT CALCULATIONS. PART III, LINE 8: THE COSTING METHODOLOGY USED FOR LINE 6 IS THE STANDARD MEDICARE COST REPORT COSTING SYSTEM. THE AMOUNTS WERE RECAPPED FROM THE HOSPITAL'S FILED 2011 COST REPORT; THE CORRESPONDING REVENUE AMOUNTS WERE INCLUDED ON LINE 5. THE AMOUNTS REPORTED INCLUDE THOSE RELATED TO MEDICARE PART A INPATIENT SERVICES (BOTH ACUTE AND PSYCHIATRIC) AND MEDICARE PART B HOSPITAL-RELATED OUTPATIENT SERVICES; IT EXCLUDES THE MEDICARE HOSPITAL OUTPATIENT LABORATORY CHARGES WHICH WERE REIMBURSED ON A FEE SCHEDULE AND, THUS, NOT REQUIRED TO BE REPORTED ON THE COST REPORT. ADDITIONALLY, THESE AMOUNTS EXCLUDE THE REIMBURSEMENT AND COSTS ASSOCIATED WITH OUR ANESTHESIA HOSPITAL BASED PRACTICE AS WELL AS OUR PHYSICIAN OFFICE. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY ADDRESSES THOSE WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. OUR PRACTICE IS TO SEND A LETTER OFFERING A CHARITY CARE APPLICATION TO THOSE UNINSURED PATIENTS ALONG WITH A DETAILED BILL WITHIN SEVEN DAYS OF DISCHARGE. OUR HOSPITAL PRACTICE ALSO INCLUDES SENDING STATEMENTS WITH GRADUATED MESSAGES TO PATIENTS BEFORE THEY ARE WRITTEN OFF TO BAD DEBT; AT THIS TIME, THEY ARE INFORMED OF THE FINANCIAL ASSISTANCE PRACTICE AND ARE ENCOURAGED TO CONTACT THE HOSPITAL IF THEY FEEL THAT THEY WOULD QUALIFY. AT ANY TIME, ANY PATIENT MAY REQUEST A CHARITY CARE APPLICATION FORM. AMERICAN LEGION HOSPITAL PART V, SECTION B, LINE 11H: ALL PATIENTS, REGARDLESS OF FINANCIAL CLASS, ARE CHARGED THE SAME PRICE ACROSS THE BOARD. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE HAVE THEIR CHARGES REDUCED TO THE MEDICARE REIMBURSABLE RATE. AMERICAN LEGION HOSPITAL PART V, SECTION B, LINE 13G: THE HOSPITAL INCLUDES ON ALL INVOICE STATEMENTS A MESSAGE ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. IT INFORMS PATIENTS TO CONTACT A CUSTOMER SERVICE REPRESENTATIVE TO REQUEST AN APPLICATION. AMERICAN LEGION HOSPITAL PART V, SECTION B, LINE 17E: THE HOSPITAL NOTIFIES PATIENTS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSION AND IN COMMUNICATIONS WITH PATIENTS REGARDING THE PATIENTS' BILLS. THIS IS DONE BEFORE MAKING ANY REASONABLE COLLECTION EFFORTS. PART VI, LINE 2: NEEDS ASSESSMENTAMERICAN LEGION HOSPITAL(ALH) IS THE ONLY ACUTE CARE HOSPITAL IN ACADIA PARISH AND THE SURROUNDING AREA, AND IT MAINTAINS AN EMERGENCY ROOM OPEN TO ALL PEOPLE REQUIRING EMERGENCY CARE, WITHOUT REGARD TO ABILITY TO PAY. THE HOSPITAL MAINTAINS A BOARD OF DIRECTORS DRAWN FROM THE COMMUNITY AND THEY ARE AWARE OF THE HEALTH NEEDS IN THE COMMUNITY. FOR THESE NEEDS IDENTIFIED BY THE BOARD AND MEDICAL STAFF ALH USES SURPLUS RECEIPTS OVER DISBURSEMENTS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE HOSPITAL COMPLIES WITH FEDERAL REQUIREMENTS OF NOTICES TO PATIENTS AS REQUIRED BY FEDERAL PROGRAMS, SUCH AS MEDICARE. IN THE ADMISSION PROCESS, THE HOSPITAL MAKES AVAILABLE SCREENING SERVICES ONSITE TO HELP INPATIENTS WHO QUALIFY FOR MEDICARE AND/ OR MEDICAID ASSISTANCE APPLY FOR BENEFITS. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS INCLUDED IN THE HANDBOOK PROVIDED TO PATIENTS UPON ADMISSION. ADDITIONALLY, UPON ORIGINAL BILL FOR SERVICES, ALL PATIENTS WITHOUT INSURANCE ARE REMINDED OF THE CHARITY DISCOUNT WITH INFORMATION ON HOW TO APPLY. A PROMPT PAY DISCOUNT IS OFFERED TO ALL PATIENTS WITHOUT INSURANCE. PART VI, LINE 4: COMMUNITY INFORMATIONTHE HOSPITAL SERVES THE RESIDENTS OF ACADIA PARISH AND THE SURROUNDING AREA. AS THE ONLY ACUTE HOSPITAL IN THE PARISH, THE HOSPITAL PROVIDES HEALTHCARE SERVICES TWENTY-FOUR HOURS A DAY. THE HOSPITAL STRIVES TO MAINTAIN A WELL CONDITIONED PLANT AND MODERN TECHNOLOGY TO BETTER SERVE THE CITIZENS OF OUR COMMUNITY; ADDITIONALLY, THE HOSPITAL STRIVES TO MAINTAIN A KNOWLEDGEABLE AND FRIENDLY STAFF TO PROVIDE PATIENT CARE TO THE RESIDENTS IN THE SURROUNDING AREA. ACADIA PARISH COVERS 655.12 SQUARE MILES IN SOUTHWEST LOUISIANA. THE ESTIMATED POPULATION FOR 2011 WAS AROUND 62,000 RESIDENTS. ACADIA PARISH'S POPULATION CONSISTS OF 13.0% OF PERSONS WHO ARE SIXTY-FIVE OR OLDER (SLIGHTLY HIGHER THAN THE STATE'S OVERALL PERCENTAGE OF 12.5%). ACCORDING TO THE 2009-2011 AMERICAN COMMUNITY SURVEY OF THE U.S. CENSUS BUREAU, THE MEDIAN HOUSEHOLD INCOME FOR ACADIA PARISH WAS $36,197 HOWEVER, FOR LOUISIANA IT WAS $43,484 AND FOR THE U.S. IT WAS $51,484. THIS SURVEY ALSO SHOWS THE PERCENT OF PEOPLE LIVING BELOW THE POVERTY LEVEL DURING 2009-2011 IN ACADIA PARISH TO BE 21.2%. HOWEVER, IN LOUISIANA IT WAS 18.7%, AND IN THE U.S. IT WAS 15.2%. THUS, ACADIA PARISH'S POPULATION IS POORER THAN THE REST OF LOUISIANA AND THE NATION. PART VI, LINE 5: THE HOSPITAL MAINTAINS AN EMERGENCY ROOM OPEN TO ALL PEOPLE REQUIRING EMERGENCY CARE, WITHOUT REGARD TO ABILITY TO PAY. THE HOSPITAL PROVIDES HOSPITAL CARE FOR ALL PERSONS IN THE COMMUNITY OTHERWISE ABLE TO PAY THE COST OF MEDICAL SERVICES EITHER DIRECTLY OR THROUGH THIRD PARTY REIMBURSEMENT. THE HOSPITAL MAINTAINS A BOARD OF DIRECTORS DRAWN FROM THE COMMUNITY AND USES SURPLUS RECEIPTS OVER DISBURSEMENTS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS. ADDITIONALLY, THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF.BY MAINTAINING AN OPEN MEDICAL STAFF, THE HOSPITAL CAN OFFER A VARIETY OF SPECIALISTS TO AN OTHERWISE RURAL PARISH, THEREBY INCREASING AVAILABLE RESOURCES FOR THE BEST PATIENT CARE. THE HOSPITAL ALSO MAINTAINS A BOARD OF DIRECTORS COMPRISED OF MEMBERS FROM THE COMMUNITY; BY INCORPORATING MEMBERS OF THE COMMUNITY, THE BOARD CAN ENSURE THE LONG-TERM VIABILITY OF THE HOSPTIAL TO BE ABLE TO CONTINUE TO SERVE THE COMMUNITY FOR GENERATIONS TO COME. THE HOSPITAL DILIGENTLY STRIVES TO MAINTAIN A SURPLUS OF REVENUE OVER EXPENSES TO CONTINUE TO UPDATE THE HOSPITAL'S PLANT AND EQUIPMENT WITH THE RAPID CHANGING TECHNOLOGY IN TODAY'S MEDICAL WORLD TO BETTER MEET THE CHANGING NEEDS OF OUR COMMUNITY. IN THE CURRENT YEAR THE HOSPTIAL HAD A CAPITAL OUTLAY OF OVER $3,800,000, INCLUDING A DIVINCI ROBOT TO ASSIST IN SPECIALIZED SURGERIES, A FULL SERVICE GENERATOR, AND A NURSE CALL SYSTEM TOTALING OVER $2.5 MILLION.THE HOSPITAL IS THE SECOND LARGEST EMPLOYER IN THE PARISH, SECOND TO ONLY THE LOCAL SCHOOL BOARD. THE HOSPITAL IS A LARGE GENERATOR OF SALES TAX TO THE PARISH AS WELL. THE HOSPITAL CONTRIBUTED OVER $1,700,000 TO THE LOCAL ECONOMY IN ANNUAL EXPENDITURES. AS A RESULT, THE HOSPITAL'S PRESENCE SERVES AS A LARGE ECONOMIC FORCE IN OUR LOCAL COMMUNITY; TO ENSURE THAT WE CAN CONTINUE TO SERVE THE RESIDENTS OF OUR COMMUNITY, WE MUST CONTINUE TO MONITOR THE CURRENT CONDITIONS OF OUR WORKFORCE AND THE AVAILABILITY OF PHYSICIANS IN OUR AREA. THE HOSPITAL RECRUITS PHYSICIANS, INCLUDING SPECIALISTS, TO OUR AREA TO ENSURE THAT WE CAN CONTINUE TO BE THE HEALTHCARE PROVIDER OF THE FUTURE AS WELL. THE HOSPITAL ALSO JOINS FORCES WITH OTHER LOCAL ORGANIZATIONS AND COMPANIES TO PROVIDE HEALTHCARE SCREENINGS AT LOCAL EVENTS AS WELL AS PROVIDE INFORMATION TO PROMOTE A HEALTHIER, SAFER COMMUNITY. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMTHE HOSPITAL IS NOT AFFILIATED WITH ANY OTHER HEALTH CARE SYSTEM.PART VI LINE 7 COMMUNITY BENEFIT REPORTCURRENTLY, LOUISIANA DOES NOT REQUIRE THE HOSPITAL TO ISSUE A COMMUNITY BENEFIT REPORT; HOWEVER, THE LOCAL NEWSPAPER DOES ON OCCASION RUN AN ARTICLE ON THE HOSPITAL WHERE THE HOSPITAL DOES MAKE THE PUBLIC AWARE OF THE HUGE ECONOMIC IMPACT IT HAS ON THE LOCAL ECONOMY, BOTH AS AN EMPLOYER AS WELL AS A PURCHASER OF SUPPLIES WHICH GENERATES SALES TAXES FOR THE LOCAL ECONOMY. X X X 0 0 0 0 0 1 0 1 0 TERRY OSBORNE 215626 0 50 0 17104 0 0 0 10165 0 242945 0 0 0 CHARMAINE VIDRINE 157143 0 50 0 848 0 0 0 10631 0 168672 0 0 0 SATINDER SAINI MD 160276 0 50 0 741 0 0 0 10783 0 171850 0 0 0 PART I, LINE 3 THE PROCESS FOR DETERMINING COMPENSATION OF THE HOSPITAL'S CEO IS BASED ON SURVEY DATA OF HOSPITALS SIMILAR TO AMERICAN LEGION HOSPITAL IN RESPECT TO REVENUES, BEDS, REGION, AND FTES. ALL CONTRACTUAL CHANGES, INCLUDING INCREASES IN SALARY OF THE HOSPITAL'S CEO, ARE REVIEWED BY THE HOSPITAL'S AUDIT AND OVERSIGHT COMMITTEE. A RECOMMENDATION IS MADE FROM THE AUDIT AND OVERSIGHT COMMITTEE TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS APPROVES ALL CONTRACT CHANGES, INCLUDING INCREASES IN SALARY. THE HOSPITALS AUDIT AND OVERSIGHT COMMITTEE ALSO EVALUATES THE CEO'S PERFORMANCE ANNUALLY. PART I, LINE 6 THE HOSPITAL EMPLOYED ONE PHYSICIAN; THE CONTRACT STATES THAT HIS COMPENSATION SHALL CONSIST OF THE NET RECEIPTS OF HIS OFFICE PRACTICE LESS EXPENSES ASSOCIATED WITH RUNNING SUCH PRACTICE, INCLUDING PRACTICE-RELATED BAD DEBTS. THUS, HIS BASE COMPENSATION EQUALS HIS PRACTICE'S NET EARNINGS. HIS COMPENSATION IS NOT BASED ON ANY EARNINGS OF THE HOSPITAL AS A WHOLE. PART I, LINE 7 IN 2011, THE HOSPITAL BOARD APPROVED TO GIVE $50 TO EACH BENEFITED FULL-TIME EMPLOYEE AS OF DECEMBER 6, 2011. THUS, THE HOSPITAL'S THREE EMPLOYEES LISTED IN PART II EACH RECEIVED THIS $50 PAYMENT. MICHAEL MCBRIDE SEE PART V SEE PART V 0 0 0 STEPHEN STEFANSKI SEE PART V 254025 SEE PART V 0 0 P DALE LELEUX JR MD SEE PART V 182206 SEE PART V 0 FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: STEPHEN STEFANSKI (A) NAME OF PERSON: STEPHEN STEFANSKI(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BOARD MEMBER OF AMERICAN LEGION HOSPITAL (ALH) AND FATHER OF INSURANCE AGENT, STEPHEN STEFANSKI, JR., OF LOCAL INSURANCE COMPANY.(C) AMOUNT OF TRANSACTION: $0(D) DESCRIPTION OF TRANSACTION: THE HOSPITAL PAID THE $168,698 FOR WORKERS COMPENSATION INSURANCE AND $118,089 FOR PROPERTY INSURANCE. THE COST OF THE INSURANCE POLICIES WAS THE LOWEST PROPOSAL RECEIVED FROM THE VARIOUS INSURANCE COMPANIES; THE BOARD DECIDED ON THESE PARTICULAR POLICIES. THE BOARD MEMBER AT ISSUE (FATHER) HAS REFRAINED FROM VOTING ON ANY RELATED ISSUES. NEITHER FATHER NOR SON WAS COMPENSATED BY THE HOSPITAL, AND THE SON IS NOT AN OWNER OF THE LOCAL INSURANCE COMPANY. FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: STEPHEN STEFANSKI (A) NAME OF PERSON: STEPHEN STEFANSKI(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BOARD MEMBER OF AMERICAN LEGION HOSPITAL (ALH) AND FATHER OF PARTIAL OWNER OF SECURITY COMPANY, BRETT STEFANSKI(C) AMOUNT OF TRANSACTION: $124,025(D) DESCRIPTION OF TRANSACTION: DURING 2011, THE HOSPITAL PAID $124,025 TO A LOCAL SECURITY COMPANY, WHICH IS PARTIALLY OWNED BY THE BOARD MEMBER'S SON. THE HOSPITAL HAS USED THE PARTICULAR SECURITY COMPANY FOR YEARS PRIOR TO HIS ACQUISITION. THE BOARD MEMBER HAS NOT VOTED ON ANY RELATED MATTER FOR THE SECURITY COMPANY SINCE THE BOARD MEMBER'S SON'S ACQUISITION. FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: MICHAEL MCBRIDE (A) NAME OF PERSON: MICHAEL MCBRIDE(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BOARD MEMBER OF AMERICAN LEGION HOSPITAL (ALH) AND REGIONAL PRESIDENT OF EVANGELINE BANK AND TRUST COMPANY(C) AMOUNT OF TRANSACTION : $0(D) DESCRIPTION OF TRANSACTION: AMERICAN LEGION HOSPITAL UTILIZES THE BANKING AND INVESTMENT MANAGEMENT SERVICES PROVIDED BY EVANGELINE BANK. MR. MCBRIDE IS NOT COMPENSATED BY AMERICAN LEGION HOSPITAL. THIS ARRANGEMENT WAS REVIEWED AND APPROVED BY THE BOARD OF AMERICAN LEGION HOSPITAL. THE SERVICES PROVIDED BY EVANGELINE BANK ARE COMPARABLE TO SERVICES AVAILABLE AT OTHER LOCAL FINANCIAL INSTITUTIONS. IN 2011, THE HOSPITAL HAD AN OUTSTANDING LOAN FROM THIS PARTICULAR FINANCIAL INSTITUTION. THE BOARD MEMBER REFRAINS FROM VOTING ON ANY RELATED BANKING ISSUES. FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: STEPHEN STEFANSKI (A) NAME OF PERSON: STEPHEN STEFANSKI(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BOARD MEMBER OF AMERICAN LEGION HOSPITAL (ALH) AND PARTIAL OWNER OF LAW FIRM.(C) AMOUNT OF TRANSACTION: $130,000(D) DESCRIPTION OF TRANSACTION: DURING THE YEAR, THE BOARD MEMBER'S LAW FIRM PURCHASED AN OFFICE BUILDING/LAND FROM AMERICAN LEGION HOSPITAL AND PAID THE APPRAISED VALUE. THE BOARD MEMBER ABSTAINED FROM THE DELIBERATION AND APPROVAL BY THE BOARD TO SELL THE PROPERTY AT THE APPRAISED VALUE OF $130,000. FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: P. DALE LELEUX, JR. MD (A) NAME OF PERSON: P. DALE LELEUX, JR. MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BOARD MEMBER OF AMERICAN LEGION HOSPITAL (ALH) AND PREVIOUSLY RECRUITED PHYSICIAN(C) AMOUNT OF TRANSACTION: $44,884(D) DESCRIPTION OF TRANSACTION: IN 2006 DR. LELEUX WAS RECRUITED TO WORK AT AMERICAN LEGION HOSPITAL IN CROWLEY, LA, WHICH IS AN AREA THAT QUALIFIES AS A HEALTH PROFESSIONAL SHORTAGE AREA. TO ENTICE HIM TO THIS AREA HE WAS OFFERED A PHYSICIAN RECRUITMENT PACKAGE. THE PURPOSE OF THIS WAS TO ASSIST HIM WITH THE START UP OF HIS PRACTICE. DURING THIS START-UP PERIOD WHEN HIS PRACTICE'S MONTHLY REVENUES DID NOT REACH A SET GOAL, ALH PAID HIM AN AMOUNT TO BRING HIS REVENUES TO THAT GOAL. HIS GUARANTEED INCOME PERIOD ENDED JULY 31, 2009. IF HE DISCONTINUED HIS FULL-TIME PRACTICE IN THIS COMMUNITY BEFORE A CERTAIN TIME, HE AGREED TO PAY BACK THESE ADVANCES. HOWEVER, IF HE CONTINUED HIS FULL-TIME PRACTICE IN THE COMMUNITY, HE WOULD NOT BE REQUIRED TO REPAY MOST OF THESE ADVANCES. FOR EACH YEAR HE REMAINED IN PRACTICE, THIS REPAYMENT AMOUNT DIMINISHED. WHEN HIS START-UP PERIOD ENDED ON 7/31/2009 THERE WAS A BALANCE THAT HE OWED ALH, WHICH WAS TO BE REPAID WITH INTEREST IN THE TIME FRAME OUTLINED IN THE RECRUITMENT PACKAGE. AS OF 1/1/2011 THE REMAINING PRINCIPAL AND INTEREST WAS $13,180, WHICH HE PAID IN FULL IN 2011.HIS RECRUITMENT PACKAGE ALSO INCLUDED MONTHLY STIPENDS TO REPAY HIS MEDICAL EDUCATION STUDENT LOANS. IN 2011 HE RECEIVED A TOTAL OF $31,704. THESE PAYMENTS ARE SCHEDULED TO END IN 2013.THIS PHYSICIAN RECRUITMENT PACKAGE WAS IN EFFECT BEFORE DR. LELEUX BECAME A BOARD MEMBER OF ALH IN 2011, AND HE CONTINUES TO TIMELY FULFILL HIS COMMITMENT ACCORDING TO THE TERMS OF THEIR AGREEMENT. FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: P. DALE LELEUX, JR. MD (A) NAME OF PERSON: P. DALE LELEUX, JR. MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BOARD MEMBER OF AMERICAN LEGION HOSPITAL (ALH) AND LESSEE(C) AMOUNT OF TRANSACTION: $30,322(D) DESCRIPTION OF TRANSACTION: THE PHYSICIAN LEASED TWO ADJACENT PROPERTIES FROM THE HOSPITAL AND PAID FAIR MARKET VALUE RENT. THESE LEASES WERE IN EFFECT PRIOR TO THE PHYSICIAN BECOMING A BOARD MEMBER. THE BOARD DID NOT VOTE ON ANY ISSUES RELATED TO THE LEASE IN THE CURRENT YEAR. FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: P. DALE LELEUX, JR. MD (A) NAME OF PERSON: P. DALE LELEUX, JR. MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: LLC OWNED BY BOARD MEMBER OF AMERICAN LEGION HOSPITAL PURCHASED HOSPITAL BUILDING AND LOTS.(C) AMOUNT OF TRANSACTION: $107,000(D) DESCRIPTION OF TRANSACTION: DURING THE YEAR, PATRICK DALE LELEUX, JR. MD, LLC PURCHASED AN OFFICE BUILDING AND LOTS FROM AMERICAN LEGION HOSPITAL AND PAID THE APPRAISED VALUE FOR IT. THIS LLC IS OWNED BY A BOARD MEMBER; THE PROPERTY PURCHASED WAS THE PRACTICE LOCATION FOR HIS PHYSICIAN PRACTICE WHICH HE WAS CURRENTLY LEASING FROM THE HOSPITAL. THE PHYSICIAN ABSTAINED FROM THE BOARD DELIBERATION AND APPROVAL TO SELL THE PROPERTY AT ITS APPRAISED VALUE OF $107,000. FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: P. DALE LELEUX, JR. MD (A) NAME OF PERSON: P. DALE LELEUX, JR. MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BOARD MEMBER OF AMERICAN LEGION HOSPITAL (ALH) AND PARTIAL OWNER OF JOINT VENTURE(C) AMOUNT OF TRANSACTION: $0(D) DESCRIPTION OF TRANSACTION: IN 2011, THE HOSPITAL FORMED A 100% OWNED SUBSIDIARY NAMED ALH HEALTH VENTURES, LLC. IN 2011, THE PHYSICIAN/BOARD MEMBER BECAME A PARTIAL OWNER OF LOUISIANA CARDIAC WELLNESS, LLC. BOTH OF THESE ENTITIES ARE MEMBERS OF CROWLEY CARDIAC WELLNESS, LLC. THE BOARD MEMBER ABSTAINS FROM VOTING ON ANY RELATED MATTERS. MANAGEMENT AND PROFIT/LOSS SHARING PERCENTAGES FOLLOW THE POLICIES AND PROCEDURES OUTLINED IN THE OPERATING AGREEMENT. FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: P. DALE LELEUX, JR. MD (A) NAME OF PERSON: P. DALE LELEUX, JR. MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BOARD MEMBER OF AMERICAN LEGION HOSPITAL (ALH) AND PARTIAL OWNER OF ENTITY CONTRACTING WITH HOSPITAL(C) AMOUNT OF TRANSACTION: $0(D) DESCRIPTION OF TRANSACTION: THE BOARD MEMBER IS A PARTIAL OWNER OF A LOCAL LONG-TERM ACUTE CARE HOSPITAL (LTAC) THAT CONTRACTED WITH AMERICAN LEGION HOSPITAL (ALH) TO HAVE A PHYSICIAN EMPLOYED BY ALH PROVIDE MEDICAL MANAGEMENT SERVICES FOR THE LTAC. THE CONTRACT ENDED DURING 2011.THE LTAC PAID FOR THE SERVICES THAT WERE RENDERED. THIS ARRANGEMENT WAS IN PLACE BEFORE THE BOARD MEMBER JOINED THE BOARD IN 2011. HE ABSTAINED FROM VOTING ON ANY MATTER RELATED TO THIS CONTRACT. FORM 990, SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NAME OF PERSON: P. DALE LELEUX, JR. MD (A) NAME OF PERSON: P. DALE LELEUX, JR. MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BOARD MEMBER OF AMERICAN LEGION HOSPITAL (ALH) AND INDEPENDENT CONTRACTOR OF EMERGENCY ROOM PHYSICIAN GROUPS(C) AMOUNT OF TRANSACTION: $0(D) DESCRIPTION OF TRANSACTION: THE PHYSICIAN/BOARD MEMBER WORKS FOR EMERGENCY ROOM (ER) PHYSICIAN GROUPS OCCASIONALLY IN ADDITION TO HIS FULLTIME PRACTICE. THE HOSPITAL CONTRACTED WITH ACADIA EMERGENCY GROUP, LLC THROUGH SEPTEMBER 25, 2011 AND WITH C&M MEDICAL SERVICES THEREAFTER (PAYMENTS RESPECTIVELY OF $318,458 AND $59,020, TOTAL OF 377,478). THE PHYSICIAN/BOARD MEMBER PERFORMED SERVICES FOR BOTH ER PHYSICIAN GROUPS. THE PHYSICIAN/BOARD MEMBER ABSTAINED FROM VOTING REGARDING THE ER CONTRACTS. THE BOARD MEMBER DOES NOT HAVE ANY OWNERSHIP IN EITHER ER PHYSICIAN GROUP BUT WAS COMPENSATED FOR THE SERVICES HE PROVIDED AS A PHYSICIAN BY THE RESPECTIVE ER PHYSICIAN GROUPS. HOWEVER, HE DID NOT RECEIVE ANY COMPENSATION FROM THE ER PHYSICIAN GROUPS FOR BEING A BOARD MEMBER OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 AMERICAN LEGION HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION. MEMBERS OF THE AMERICAN LEGION POST # 15 ARE AUTOMATICALLY MEMBERS OF THE AMERICAN LEGION HOSPITAL CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE AMERICAN LEGION HOSPITAL CORPORATION ELECT THE BOARD OF DIRECTORS OF THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY IS PRESENTED TO THE AUDIT AND OVERSIGHT COMMITTEE (WHICH CONSISTS OF FOUR OF THE SEVEN MEMBERS OF THE BOARD OF DIRECTORS). THE FORM AND ITS CONTENTS ARE DISCUSSED AND FULLY REVIEWED BY THE AUDIT AND OVERSIGHT COMMITTEE ALONG WITH THE HOSPITAL'S CEO AND CFO BEFORE FILING WITH THE IRS. WHEN ONLY REVIEWED BY THE AUDIT AND OVERSIGHT COMMITTEE BEFORE FILING, A COMPLETE COPY IS REVIEWED BY THE FULL BOARD AFTER ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE TRANSACTIONS ARE ALL ENTERED INTO AT FAIR MARKET VALUE WITH THE CORRESPONDING BOARD MEMBERS ABSTAINING FROM VOTING ON ITEMS FOR WHICH A CONFLICT OF INTEREST EXISTS. THE HOSPITAL'S ADMINISTRATION REVIEWS ALL TRANSACTIONS TO EVALUATE WHETHER CONFLICTS OF INTEREST EXIST AND TAKES APPROPRIATE ACTION WHEN NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE HOSPITAL'S CEO IS BASED ON SURVEY DATA OF HOSPITALS SIMILAR TO AMERICAN LEGION HOSPITAL IN RESPECT TO REVENUES, BEDS, REGION AND FTES. ALL CONTRACTUAL CHANGES, INCLUDING INCREASES IN SALARY OF THE HOSPITAL'S CEO, ARE REVIEWED BY THE HOSPITAL'S AUDIT & OVERSIGHT COMMITTEE. A RECOMMENDATION IS MADE FROM THE AUDIT & OVERSIGHT COMMITTEE TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS APPROVES ALL CONTRACT CHANGES, INCLUDING INCREASES IN SALARY. THE HOSPITAL'S AUDIT & OVERSIGHT COMMITTEE ALSO EVALUATES THE CEO'S PERFORMANCE ANNUALLY. LINE 15B: THE PROCESS FOR DETERMINING COMPENSATION OF THE HOSPITAL'S CFO IS BASED ON SURVEY DATA OF HOSPITALS SIMILAR TO AMERICAN LEGION HOSPITAL IN RESPECT TO REVENUES, BEDS, REGION AND FTES. ALL CONTRACT CHANGES, INCLUDING INCREASES IN SALARY OF THE HOSPITAL'S CFO, ARE INITIATED BY THE CEO AND REVIEWED BY THE HOSPITAL'S AUDIT & OVERSIGHT COMMITTEE. A RECOMMENDATION IS MADE FROM THE AUDIT & OVERSIGHT COMMITTEE TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS APPROVES ALL CONTRACT CHANGES, INCLUDING INCREASES IN SALARY. THE HOSPITAL'S CEO ALSO EVALUATES THE CFO'S PERFORMANCE ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL WILL MAKE AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO ANYONE WHO REQUESTS SUCH WITHIN THE TERMS OF THE LAW. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: 57,206. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ALH HEALTH VENTURES LLC 1113 EAST NORTHERN AVENUE CROWLEY LA 70526 352409152 PROV CARDIAC HLTH SCREENS LA -23118 65851 ALH OPEN AIR MRI OF ACADIANA LLC PO BOX 2207 LAKE CHARLES LA 706022207 721510626 OPEN AIR MRI SERVICES LA AMERICAN LEGION HOSPITAL RELATED HEALTHCARE 124037 75930 0 0 0.51000 PROFESSIONAL ARTS CENTER INC PO BOX 852 CROWLEY LA 705270852 720701822 RENTAL OF MEDICAL OFFICES LA N/A C 34790 111809 0.67000 CROWLEY PROFESSIONAL MED CORP 1305 CROWLEY-RAYNE HWY CROWLEY LA 70526 721142948 MAINTAIN MEDICAL OFFICE SPACE LA N/A C 2415 19325 0.48300 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 OPEN AIR MRI OF ACADIANA LLC A 32400 CASH OPEN AIR MRI OF ACADIANA LLC R 106161 CASH FORM 990, SCHEDULE R, PART V, LINE 1A: THE RENTAL TO OPEN AIR MRI OF ACADIANA, LLC IS SUBSTANTIALLY RELATED TO AMERICAN LEGION HOSPITAL'S EXEMPT PURPOSE OF PROVIDING MEDICAL CARE. IN ADDITION, THE RENTAL PAYMENTS (WHICH WERE ALSO QUALIFYING SPECIFIED PAYMENTS (SECTION 512(B)(13)(E)) RECEIVED FROM OPEN AIR MRI OF ACADIANA, LLC AND REPORTED ON SCHEDULE R, PART V, LINE 2) DID NOT EXCEED THE FAIR MARKET VALUE FOR THE PROPERTY BEING RENTED. AMERICAN LEGION HOSPITAL DOES NOT HAVE ANY UNRELATED TRADE OR BUSINESS INCOME TO REPORT ON FORM 990-T.