2011-11-14T09:42:48-06:00 2010-12-31 POSTLETHWAITE & NETTERVILLE 8550 UNITED PLAZA BLVD SUITE 1001 BATON ROUGE LA 70809 990 2010-01-01 720551963 SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION D/B/A LAKE CHARLES MEMORIAL HOSPITAL SOUT 3374943202 1701 OAK PARK BOULEVARD LAKE CHARLES LA 70601 CHARLES WHITSON 3374943204 2011-11-14 1 2259224600 2010 2016-02-24 21:20:13Z LARRY GRAHAM 1701 OAK PARK BOULEVARD LAKE CHARLES LA 70601 197980383 0 X WWW.LCMH.COM X 1952 LA PROVIDE HEALTHCARE SERVICES 12 8 2066 63 0 0 1711833 1194764 177841048 193621946 725318 423389 2309318 2475437 182587517 197715536 50000 65000 0 0 70909201 73501805 0 0 479834 100412565 109112527 171371766 182679332 11215751 15036204 173916394 192852578 116656131 121040608 57260263 71811970 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 4238115 15000 1757340 LAKE CHARLES MEMORIAL HOSPITAL2010 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 RECIPIENTS REGARDLESS OF THEIR ABILITY TO PAY, AND REGARDLESS OF MEDICAID REIMBURSEMENT. IN 2010, MEMORIAL HOSPITAL PROVIDED $12,654,197 IN UN-REIMBURSED MEDICAID COSTS AND $3,963,424 IN CHARITY CARE COSTS. COMMUNITY BENEFIT-$16,617,622CANCER PREVENTIONTWO SCREENINGS WERE OFFERED TO THE COMMUNITY BY THE LSUHSC FAMILY PRACTICE RESIDENCY PROGRAM AT MEMORIAL AT NO CHARGE DURING 2010. THE SCREENINGS FOR COLORECTAL CANCER AND PROSTATE CANCER FOCUSED ON PREVALENT DIAGNOSIS AND RESULTED IN A COMMUNITY BENEFIT OF $15,057.COMMUNITY BENEFIT:$15,057SPORTS MEDICINETHE SPORTS MEDICINE ALLIANCE PROVIDED $217,301 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:$217,301III. HEALTH PROFESSIONALS EDUCATIONLAKE CHARLES MEMORIAL INVESTS IN MEDICAL EDUCATION IN AN EFFORT OF PROVIDE THE AREA WITH QUALIFIED PROFESSIONALS. IN 2010, LCMH SPENT $2,287,997 FOR THE LOUISIANA STATE UNIVERSITY HEALTH SERVICES CENTER-FAMILY PRACTICE RESIDENCY PROGRAM.COMMUNITY BENEFIT:$2,287,997CHARITABLE DONATIONSLCMH MAKES NUMEROUS MONETARY DONATIONS TO A VARIETY OF NON-PROFIT AGENCIES.COMMUNITY BENEFIT:$76,270COMMUNITY EVENTS AND SEMINARSEACH YEAR, LCMH PROVIDES FREE HEALTH SCREENINGS, EDUCATIONAL SEMINARS AND INFORMATIONAL BOOTHS AT A VARIETY OF COMMUNITY EVENTS. THE HOSPITAL ALSO PROVIDES FREE SPEAKERS TO CIVIC GROUPS AND OTHER ORGANIZATIONS. THIS COMMITMENT TO HEALTH AND WELLNESS EDUCATION TAKES MEMORIAL PROFESSIONALS INTO THE FIVE PARISH AREA TO STAFF INDUSTRIAL, CORPORATE AND SCHOOL HEALTH FAIRS. THROUGH THE LSUHSC FAMILY PRACTICE RESIDENCY PROGRAM, MEMORIAL CONTRIBUTED $13,000 TO THE COMMUNITY. THE HOSPITAL CONTRIBUTED $39,135 IN SPECIAL EVENTS AND SEMINARS.COMMUNITY BENEFIT:$52,135MEMORIAL'S TOTAL 2010 NET COMMUNITY CONTRIBUTIONS - $19,197,382 36330549 19712928 THE HOSPITAL PROVIDES A WIDE RANGE OF INPATIENT AND OUT- PATIENT SERVICES THROUGH A 29-BED LONG-TERM ACCUTE CARE FACILITY, A 324-BED ACUTE CARE FACILITY AND SATELLITE LOCATIONS. THE SYSTEM PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES WITHOUT CHARGE OR AT REDUCED RATES. 135307443 173930350 THE HOSPITAL PROVIDES A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES THROUGH A 29-BED LONG-TERM ACUTE CARE FACILITY, A 324-BED ACUTE CARE FACILITY AND SATELLITE LOCATIONS. 175876107 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 0 1 0 1 103 0 2066 1 0 0 0 0 0 0 0 0 0 0 X 12 8 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 LA X CHARLES WHITSON CHIEF FINANCIAL OF 3374943202 1701 OAK PARK BLVD LAKE CHARLES LA 706018911 GLENN PUMPELLY 1.00 X X 0 0 0 ULYSSES GENE THIBODEAUX 1.00 X X 0 0 0 LOUIS M TODD SR 1.00 X 0 0 0 DAVID WALLACE MD 1.00 X 0 0 0 CHARLES WHITSON CPA 40.00 X X X 220968 0 7034 PHILIP EARHART 1.00 X X 0 0 0 MANLEY M JORDAN MD 1.00 X 427020 0 0 LARRY GRAHAM 40.00 X X X 618238 0 16937 THOMAS C STRONG MD 40.00 X 359002 0 8354 DENISE EMERSON RAU 1.00 X 0 0 0 THOMAS SHEARMAN 1.00 X 0 0 0 BRIAN CLEMENTS MD 1.00 X 338545 0 8354 JOE MILLER 1.00 X 0 0 0 MARILYN MCSWAIN RN 40.00 X 186493 0 5895 DAVID B USHER 40.00 X 192317 0 6463 BERNITA BROWN 40.00 X 119766 0 3827 TIM COFFEY 40.00 X 220806 0 6990 DONNA SHIELDS 40.00 X 172949 0 2422 TODD DELAHOUSSAYE 40.00 X 152021 0 5085 KATHLEEN DEROUEN 40.00 X 152528 0 1838 JENNIFER CONSIGNEY 40.00 X 116783 0 2500 LEIF PEDERSEN 40.00 X 141086 0 0 CHRISTOPHER THOMPSON 40.00 X 830003 0 8354 NATHAN COHEN 40.00 X 929820 0 3675 DAVID DREZ 40.00 X 935748 0 3675 JAMES GAHARAN 40.00 X 823832 0 6939 BRET CASCIO 40.00 X 861096 0 3880 WILLIAM CONDOS 40.00 X 803146 0 3675 LEROY FREDERICKS 40.00 X 775639 0 6701 WILLIAM MOSS 40.00 X 411005 0 8752 BEN THOMPSON 40.00 X 492364 0 3675 GARY KOHLER 40.00 X 428149 0 10275 ROBERT BROUSSARD 40.00 X 425866 0 9736 DENNIS WALKER 40.00 X 626197 0 3675 11383752 0 142384 79 1 1 0 LEWING CONSTRUCTION INC PO BOX 5216 LAKE CHARLES LA 70606 CONTRUCTION/CONTRACTOR 2530585 LA COMMERCIAL LAUNDRY LLC PO BOX 503 SCOTT LA 70583 LAUNDRY/LINEN SERVICE 978469 EMERGENCY MEDICINE SPECIALIST APMC PO BOX 95385 NEW ORLEANS LA 70195 ER SERVICE 864318 INSTITUTE FOR NEUROPSYCHIATRY APMC 2829 4TH AVENUE LAKE CHARLES LA 70601 PSYCH SERVICES 859064 LC ANESTHESIOLOGY APMC 751 BAYOU PINES LAKE CHARLES LA 70601 ANESTHESIA SERVICE 696687 129 1188120 6644 1194764 PATIENT SERVICE REVENU 900099 188644369 188644369 MISC. PATIENT REVENUE 900099 3889861 3889861 CAFETERIA 900099 1087716 1087716 193621946 686803 686803 433351 433351 433351 433351 1433 264847 -263414 -263414 -263414 LITIGATION PROCEEDS 900099 1227946 1227946 INCOME FROM SECOND AVE 621990 575944 575944 INSURANCE PROCEEDS 900099 140606 140606 97590 97590 2042086 197715536 195400618 0 1120154 65000 65000 2469111 864189 1432084 172838 54651251 53831482 819769 1008951 966122 39776 3053 11915652 11409847 469750 36055 3456840 3310101 136279 10460 1047971 1014436 30915 2620 274165 265392 8088 685 3307212 3201381 97563 8268 1228682 1019806 110581 98295 118418 114629 3197 592 199094 192723 5376 995 6194873 5947078 247795 10910749 10146997 763752 3384673 3147746 236927 SUPPLIES 35026085 33905251 1033269 87565 BAD DEBT 17696769 17696769 PURCHASED SERVICES 15989212 15477557 471682 39973 CONTRACT LABOR 5719286 5604900 114386 SERVICE CONTRACTS 3698542 3580189 109107 9246 4316796 4114512 193095 9189 182679332 175876107 6323391 479834 416458 1443425 21973386 20227161 23115221 28868819 2673968 3254078 1745177 2251787 251699929 178633917 75328103 73066012 48664081 63741296 173916394 192852578 17706246 25301081 93045000 90375000 4733818 3752834 1171067 1611693 116656131 121040608 X 57260263 71811970 57260263 71811970 173916394 192852578 X 15036204 -484497 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3423429 3423429 124602149 89137893 35464256 1349935 1349935 0 110710125 81793039 28917086 11614291 6353050 5261241 73066012 INTERCOMPANY RECEIVABLES 49387450 ASSETS WHOSE USE IS LIMITED 11318774 DEFERRED FINANCING COSTS 2266472 OTHER RECEIVABLES 444169 OTHER ASSET-MSO 102505 INVESMENT-CORPORATE SHARE LCCC 12000 INVESTMENTS-VHA-E 82786 INVESTMENTS-LAKE CHARLES HEALTH PLANS 37500 INVESTMENT-LA PET IMAGING 89640 63741296 BOND PREMIUM 43793 INVESTMENT-AMRI 1567900 1611693 197715536 182679332 15036204 -484497 -484497 14551707 198677658 1635656 1635656 197042002 673534 673534 197715536 188519987 5840655 5840655 182679332 0 182679332 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE SYSTEM HAS EVALUATED ITS POSITION REGARDING THE ACCOUNTING FOR UNCERTAIN INCOME TAX POSITIONS. 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. PART XIII, LINE 2D: THE ENTITY ALLOCATES OVERHEAD TO ITS TAXABLE ENTITIES $4,294,801 EXPENSES REPORTED ON SOUTHWEST LA HOSPITAL FOUNDATION $ 311,871 INTERCOMPANY RENT INCOME OFFSET AGAINST RENT EXPENSES $1,233,982 TOTAL $5,840,655 PART XII, LINE 4B: BOOK/TAX DIFFERENCES INCLUDE: K-1 LA PET/CT IMAGING LAKE CHARLES $ 46,170 K-1 2ND AVENUE MRI $ 575,944 HOSPITAL AUXILIARY GIFT SHOP $ 51,420 TOTAL $ 673,534 PART XII, LINE 2D: BOOK/TAX DIFFERENCES INCLUDE: REVENUE REPORTED ON SOUTHWEST LA HOSPITAL FOUNDATION $ 255,615 DISTRIBUTION FROM GIFT SHOP AUXILIARY $ 100,000 BOOK INCOME-LA PET/CI IMAGING $ 46,059 INTERCOMPANY RENT INCOME OFFSET AGAINST RENT EXPENSE $1,233,982 TOTAL $1,635,656 1 1 1 X 1 X 1 1 1 0 1 1 6501953 2538529 3963424 0.01930 29828596 17174399 12654197 0.06160 36330549 19712928 16617621 0.08090 4030337 1742340 2287997 0.01110 207778 15000 192778 0.00090 4238115 1757340 2480775 0.01200 40568664 21470268 19098396 0.09290 1 4322394 2593436 48710237 77106796 -28396559 X 1 1 1 SECOND AVENUE MRI LLC IMAGING 0.51000 0.49000 2 LA PET IMAGING IMAGING 0.24500 1 1 LAKE CHARLES MEMORIAL HOSPITAL

1701 OAK PARK BLVD LAKE CHARLES LA 70601

X X X X LAKE CHARLES MEMORIAL HOSPITAL 1 1 1 150.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X X 1 X X X 1 X X X X X X 1 X 0 1 PART II: 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 (LESS BAD DEBT) 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 (LESS BAD DEBT) 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 CHARGE 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. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 11H: ALL PATIENTS ARE CHARGED THE SAME. THE DISCOUNT IS DETERMINED BASED ON THESE GUIDELINES. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 13G: THE FINANCIAL ASSISTANCE POLICY IS OFFERED BY FINANCIAL COUNSELORS. LAKE CHARLES MEMORIAL HOSPITAL PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE SAME. DISCOUNTS ARE CALCULATED BASED ON FINANCIAL ASSISTANCE POLICY. 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 UTILIZES FINANCIAL COUNSELORS TO APPRISE OUR PATIENTS OF PROGRAMS AVAILABLE TO ASSIST THEM WITH THE COSTS ASSOCIATED WITH THEIR CARE. PART VI, LINE 4: LCMH SERVICES A COMMUNITY WHICH IS APPROXIMATELY TWO HOURS EAST OF HOUSTON, TX AND TWO HOURS WEST OF BATON ROUGE, LA. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $44,826, WHICH IS SLIGHTLY ABOVE THE STATE AVERAGE. APPROXIMATELY 15.4% OF THE POPULATION LIVES BELOW THE POVERTY LEVEL, WHICH IS SLIGHTLY BELOW THE STATE AVERAGE. PART VI, LINE 6: N/A 1 MCNEESE STATE UNIVERSITY 300 BEAUREGARD DRIVE LAKE CHARLES LA 70605 726001688 55000 SPONSORSHIP NATIONAL LUNG CANCER PARTNERSHIP 222 NORTH MIDVALE BLVD 6 MADISON WI 53705 274734142 5000 SPONSORSHIP SWLA CENTER FOR HEALTH SERVICES PO BOX 19010 LAKE CHARLES LA 706169010 721015384 5000 SPONSORSHIP PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 X X 0 1 0 0 0 1 1 1 0 CHARLES WHITSON CPA 220968 0 0 0 0 0 7034 0 0 0 228002 0 0 0 MANLEY M JORDAN MD 427020 0 0 0 0 0 0 0 0 0 427020 0 0 0 LARRY GRAHAM 498288 0 112500 0 7450 0 16937 0 0 0 635175 0 0 0 THOMAS C STRONG MD 359002 0 0 0 0 0 8354 0 0 0 367356 0 0 0 BRIAN CLEMENTS MD 233545 0 105000 0 0 0 8354 0 0 0 346899 0 0 0 MARILYN MCSWAIN RN 186493 0 0 0 0 0 5895 0 0 0 192388 0 0 0 DAVID B USHER 192317 0 0 0 0 0 6463 0 0 0 198780 0 0 0 TIM COFFEY 220806 0 0 0 0 0 6990 0 0 0 227796 0 0 0 DONNA SHIELDS 172949 0 0 0 0 0 2422 0 0 0 175371 0 0 0 TODD DELAHOUSSAYE 152021 0 0 0 0 0 5085 0 0 0 157106 0 0 0 KATHLEEN DEROUEN 152528 0 0 0 0 0 1838 0 0 0 154366 0 0 0 CHRISTOPHER THOMPSON 830003 0 0 0 0 0 8354 0 0 0 838357 0 0 0 NATHAN COHEN 929820 0 0 0 0 0 3675 0 0 0 933495 0 0 0 DAVID DREZ 935748 0 0 0 0 0 3675 0 0 0 939423 0 0 0 JAMES GAHARAN 823832 0 0 0 0 0 6939 0 0 0 830771 0 0 0 BRET CASCIO 861096 0 0 0 0 0 3880 0 0 0 864976 0 0 0 WILLIAM CONDOS 803146 0 0 0 0 0 3675 0 0 0 806821 0 0 0 LEROY FREDERICKS 775639 0 0 0 0 0 6701 0 0 0 782340 0 0 0 WILLIAM MOSS 411005 0 0 0 0 0 8752 0 0 0 419757 0 0 0 BEN THOMPSON 492364 0 0 0 0 0 3675 0 0 0 496039 0 0 0 GARY KOHLER 428149 0 0 0 0 0 10275 0 0 0 438424 0 0 0 ROBERT BROUSSARD 425866 0 0 0 0 0 9736 0 0 0 435602 0 0 0 DENNIS WALKER 626197 0 0 0 0 0 3675 0 0 0 629872 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 WILLIAM MOSS, M.D., BEN THOMPSON, M.D., GARY KOHLER M.D., ROBERT BROUSSARD, 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. 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. LOUISIANA PUBLIC FACILITIES AUTHORITY 720895871 546395D84 2007-11-01 69199000 BOND REFUNDING, FACILITY AND EQUIPMENT UPGRADE AND RESERVES 0 0 0 69199000 6641478 59065216 1383980 2108326 2007 1 1 1 1 0 0 0 0 1 1 1 0 0 1 NATIXIS FUNDING CORP 12.000000000000 1 1 0 0 PHIL EARHART PHIL EARHART IS CHAIRMAN OF THE BOARD, & AN EMPLOYEE OF BUSINESS FIRST BANK 6297566 THE HOSPITAL HAS CASH AND INVESTMENT ACCOUNTS AT BUSINESS FIRST BANK 0 0 LOUIS TODD LOUIS TODD IS A MEMBER OF THE BOARD & IS SELF-EMPLOYED (TODD & ASSOCIATES) 1711602 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. 0 0 DAVID WALLACE MD DAVID WALLACE IS A MEMBER OF THE BOARD, & A PHYSICIAN OF CHILDREN CLINIC 150430 CHILDREN CLINIC PROVIDES MEDICAL DIRECTORSHIP OF THE PEDIATRIC NURSERY, NEONATAL INTENSIVE CARE UNIT AND PEDIATRIC INTENSIVE CARE UNIT PROGRAMS AT THE HOSPITAL 0 RICHARD MARTINEZ MD FORMER BD MEMBER, PARTNER SWLA IMAGING INVEST. WHICH OWNS 25% PET IMAGING 426381 THE HOSPITAL OWNS 24.5% OF PET IMAGING JOINT VENTURE 0 FORM 990, PART VI, SECTION A, LINE 3 THE HOME HEALTH AGENCY, PHARMACY, AND WOUND CARE FACILITY 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: BOOK/TAX DIFFERENCE - LA PET/CT IMAGING LAKE CHARLES LLC -111. BOOK/TAX DIFFERENCE - GIFT SHOP 48,580. BOOK/TAX DIFFERENCE - 2ND AVENUE MRI, LLC -575,944. PRIOR PERIOD ADJUSTMENT - SWLA HOSPITAL FOUNDATION 42,967. ROUNDING 11. TOTAL TO FORM 990, PART XI, LINE 5: -484,497. FORM 990 PART XII LINE 2C THE ORGANIZATION'S PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. SOUTHWEST LOUISIANA HEALTH CARE SYSTEM INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721103255 SUPPORT OF LAKE CHARLES MEMORIAL HOSPITAL LA 501(C)(3) PUBLIC CHARITY N/A 0 SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION FOUNDATION INC PO BOX 2900 LAKE CHARLES LA 70602 270833927 SUPPORT OF LAKE CHARLES MEMORIAL HOSPITAL LA 501(C)(3) PUBLIC CHARITY N/A 0 LAKE CHARLES MEDICAL PLAZA SOUTH 1701 OAK PARK BLVD LAKE CHARLES LA 70601 621447910 REAL ESTATE MANAGEMENT LA N/A 0.01000 SECOND AVENUE MRI LLC 2800 SECOND AVE SUITE C LAKE CHARLES LA 70601 202226374 IMAGING SERVICES LA SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION RELATED 575944 220516 0 0 0.51000 LA PETCT IMAGING LAKE CHARLES LLC 920 PIERREMONT ROAD SUITE 411 SHREVEPORT LA 71106 721474363 IMAGING SERVICES LA RELATED 46170 125399 0 0 0.25500 WLW PROPERTIES INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721023846 REAL ESTATE / EQUITY LA SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION C 95206 262220 1.00000 LAKE CHARLES MEDICAL SERVICES INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721285200 MEDICAL SERVICES LA SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION C 11308283 3145324 1.00000 SWLHS INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721103283 MEDICAL SERVICES LA N/A C SWLHS ONCOLOGY INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 201541727 MEDICAL SERVICES-ONCOLOGY LA N/A C LAKE CHARLES MEMORIAL HEART AND VASCULAR CENTER INC 1701 OAK PARK BLVD LAKE CHARLES LA 70601 721381266 MEDICAL SERVICES LA N/A C 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 1 1 LAKE CHARLES MEDICAL SERVICES INC P 1591304 CASH LAKE CHARLES HEART & VASCULAR INC P 559499 CASH SWLHS INC P 1125822 CASH SWLHS ONCOLOGY INC P 1018176 CASH SWLHS INC Q 1263282 CASH SWLHS ONCOLOGY INC Q 798235 CASH LAKE CHARLES MEDICAL SERVICES INC Q 4089782 CASH LAKE CHARLES HEART & VASCULAR INC Q 627163 CASH WLW PROPERTIES INC R 73155 CASH LAKE CHARLES MEDICAL PLAZA SOUTH Q 439208 CASH SECOND AVENUE MRI LLC R 56524 CASH LAKE CHARLES MEDICAL SERVICES INC A 245577 FAIR MARKET VALUE SWLHS INC A 185098 FAIR MARKET VALUE SWLHS ONCOLOGY INC A 76351 FAIR MARKET VALUE LAKE CHARLES HEART & VASCULAR INC A 139344 FAIR MARKET VALUE SECOND AVENUE MRI LLC P SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION FOUNDATION INC Q 156268 CASH WLW PROPERTIES INC J 34284 FAIR MARKET VALUE SWLHS INC I 228229 FAIR MARKET VALUE SWLHS ONCOLOGY INC I 33220 FAIR MARKET VALUE LAKE CHARLES HEART & VASCULAR INC I 109498 FAIR MARKET VALUE LAKE CHARLES MEDICAL SERVICES INC I 300993 FAIR MARKET VALUE SECOND AVENUE MRI LLC I 94203 FAIR MARKET VALUE SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION FOUNDATION INC N 142945 CASH SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION FOUNDATION INC M 43302 CASH SECOND AVENUE MRI LLC N