Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
Our Lady of Lourdes Regional Medical
Center Inc
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
4801 ambassador caffery parkway
 
Room/suite
City or town, state or country, and ZIP + 4
Lafayette, LA70508
D Employer identification number

72-0423635
E Telephone number

G Gross receipts $ 190,572,492
F Name and address of principal officer:
WILLIAM BARROW
4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE,LA70508
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.LOURDES.NET
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1957
M State of legal domicile: LA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: The purpose of the hospital is to provide for the care of the ill, injured, or disabled persons and to provide for research, education, and for the enhancement of health of those in the community.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 19
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 13
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 1,564
6 Total number of volunteers (estimate if necessary) .... 6 75
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 1,590,217
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 66,056
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 675,869 724,539
9 Program service revenue (Part VIII, line 2g) ......... 147,104,911 184,348,384
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 12,203,330 3,539,972
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 20,860,796 910,723
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 180,844,906 189,523,618
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 261,905 306,528
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 68,439,070 71,548,833
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 93,680,400 142,570,865
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 162,381,375 214,426,226
19 Revenue less expenses. Subtract line 18 from line 12....... 18,463,531 -24,902,608
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 371,525,480 384,051,471
21 Total liabilities (Part X, line 26)............. 254,541,033 262,344,329
22 Net assets or fund balances. Subtract line 21 from line 20..... 116,984,447 121,707,142
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: INSPIRED BY THE VISION OF ST. FRANCIS OF ASSISI AND IN THE TRADITION OF THE ROMAN CATHOLIC CHURCH, OUR LADY OF LOURDES REGIONAL MEDICAL CENTER, INC. EXTENDS THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. OUR LADY OF LOURDES REGIONAL MEDICAL CENTER, INC. CALLS FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING-WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 169,020,997 including grants of $ 306,528 ) (Revenue $ 182,752,204 )
OUR LADY OF LOURDES REGIONAL MEDICAL CENTER PROVIDES QUALITY HOSPITAL AND MEDICAL SERVICES PRIMARILY TO RESIDENTS OF SOUTH LOUISIANA. THE MEDICAL CENTER IS AN ACTIVE, CARING MEMBER OF THE COMMUNITIES IT SERVES. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTHCARE NEEDS OF THE PEOPLE OF GOD, THE MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. THE MEDICAL CENTER PROVIDED SERVICES FOR 47,473 PATIENT DAYS IN THE YEAR ENDED JUNE 30, 2012. SEE SCHEDULE O FOR FURTHER EXPLANATION.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 169,020,997
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
Yes
 
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
218
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,564
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
19
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
13
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
 
No
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
RONALD E HOGAN
4801 AMBASSADOR CAFFERY PARKWAY
LAFAYETTE,LA70508
(337) 470-2947
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) WF BUD BARROW
CEO
 .5 X   X       0 502,799 60,881
(2) GERALD R BOUDREAUX
CHAIRMAN
 .5 X   X       0 0 0
(3) RICHARD K BROUSSARD MD
BOARD MEMBER
 .5 X           0 0 0
(4) KEMP COREIL MD
BOARD MEMBER
 .5 X           4,203 0 0
(5) D WAYNE ELMORE
SECRETARY
 .5 X   X       0 0 0
(6) CHARLES T GOODSON
BOARD MEMBER
 .5 X           0 0 0
(7) JOHN L INDEST
BOARD MEMBER
 .5 X           0 0 0
(8) HENRY J KAUFMAN MD
BOARD MEMBER
 .5 X           23,000 0 0
(9) SR VERNOLA LYONS
BOARD MEMBER
 .5 X           0 0 0
(10) SR BETTY LYONS
BOARD MEMBER
 .5 X           0 0 0
(11) KEVIN MOODY
BOARD MEMBER
 .5 X           0 0 0
(12) KENNETH L ODINET MD
BOARD MEMBER
 .5 X           50,500 0 0
(13) JERRY REAUX
VICE CHAIRMAN
 .5 X   X       0 0 0
(14) GAIL ROMERO
BOARD MEMBER
 .5 X           0 0 0
(15) MICHAEL H VANDERLICK
BOARD MEMBER
 .5 X           21,956 0 0
(16) STEVE P LANDRY PHD
BOARD MEMBER
 .5 X           0 0 0
(17) HENRY C PERRET JR
BOARD MEMBER
 .5 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) WILLIAM W RUCKS IV
BOARD MEMBER
 .5 X           0 0 0
(19) JOHN P SCHUTTE MD
BOARD MEMBER
 .5 X           10,000 0 0
(20) KENNETH L HIX
BOARD MEMBER
 .5 X           0 0 0
(21) ROBERT A MAHTOOK JR
BOARD MEMBER
 .5 X           0 0 0
(22) CLINTON YOUNG MD
BOARD MEMBER
 .5 X           0 0 0
(23) FR CHESTER ARCENEAUX
BOARD MEMBER
 .5 X           0 0 0
(24) DAVID G BAKER
BOARD MEMBER
 .5 X           0 0 0
(25) KAREN O WYBLE
VP CARDIOVASCULAR SERVICES
 60.0     X       241,945 0 31,783
(26) KIM L HEBERT
CFO, VP OF FINANCE
 50.0     X       208,990 0 45,868
(27) BARBARA FESKE
VP MANAGEMENT & SUPPORT SVCS
 60.0     X       195,214 0 53,825
(28) MONTE A WILSON
COO
 40.0     X       196,976 0 7,526
(29) DANNA M CRAIN
CNO
 40.0     X       177,516 0 47,234
(30) KEVIN J DOMINGUE
VP TALENT MANAGEMENT
 60.0     X       175,406 0 35,558
(31) DONNA F LANDRY
VP CORP DEVELOPMENT
 60.0     X       57,021 0 4,784
(32) ANDRE E MOREAU
VP CORP DEVELOPMENT
 60.0     X       139,818 0 31,364
(33) WILLIAM R GUILLORY
STAFF PHYSICIAN
 40.0         X   409,527 0 17,307
(34) STEVEN J SNATIC
STAFF NEUROLOGIST
 40.0         X   306,388 0 27,689
(35) DANIEL C DUNLAP
STAFF NEUROLOGIST
 40.0         X   305,560 0 17,351
(36) JAMES M MWATIBO
STAFF PHYSICIAN
 40.0         X   281,506 0 24,220
(37) JOHN C DUGAL
STAFF PHYSICIAN
 40.0         X   277,447 0 31,804
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,082,973 502,799 437,194
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet35
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
FMOL HEALTH SYSTEM INC
4200 ESSEN LANE
BATON ROUGE,LA70809 		ADMINISTRATIVE SERV 13,560,072
ACADIANA ACUTE CARE ASSOC
4906 AMBASSADOR CAFFERY 350
LAFAYETTE,LA70508 		ER PHYSICIANS 2,822,500
SOUTHERN LITHOTRIPSY LLC
PO BOX 52014
LAFAYETTE,LA70505 		CONSULTING 984,000
COL MANAGEMENT
PO BOX 2207
LAKE CHARLES,LA70602 		MGMT FEE- IMAGING 911,225
HOSPITALIST MEDICINE PHYSICIAN
4801 AMBASSADOR CAFFERY
LAFAYETTE,LA70508 		PHYSICIANS 826,806
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet158
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 500,693
e Government grants (contributions)1e 138,370
f All other contributions, gifts, grants, and
similar amounts not included above1f 		85,476
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 724,539
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 900,099 173,312,909 173,312,909    
b OUTREACH LAB REVENUE 900,099 4,476,599 2,880,419 1,596,180  
c INCOME FROM EQUITY INVESTEES   3,131,790 3,131,790    
d HEART HOSPITAL MANAGEMENT FEE 900,099 1,376,772 1,376,772    
e FOOD SERVICE REVENUE 900,099 873,089 873,089    
f All other program service revenue . 1,177,225 1,177,225    
g Total. Add lines 2a–2f........MediumBullet 184,348,384
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 4,038,266   -6,760 4,045,026
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 1,125,528  
b Less: rental expenses 214,805  
c Rental income or (loss) 910,723  
d Net rental income or (loss).......MediumBullet 910,723 380,146   530,577
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 330,775 5,000
b Less: cost or other basis and sales expenses 261,125 572,944
c Gain or (loss) 69,650 -567,944
d Net gain or (loss)..........MediumBullet -498,294   797 -499,091
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 0
12 Total revenue. See Instructions....MediumBullet 189,523,618 183,132,350 1,590,217 4,076,512
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 294,528 294,528
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 12,000 12,000
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 4,803,973 3,891,218 912,755  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 53,963,010 43,710,038 10,252,972  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,598,368 2,842,711 755,657  
9 Other employee benefits ....... 5,111,093 4,139,985 971,108  
10 Payroll taxes ........... 4,072,389 3,298,635 773,754  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 352,194   352,194  
c Accounting ........... 220,869   220,869  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 39,856,119 29,653,901 10,202,218  
12 Advertising and promotion .... 859,819 343,928 515,891  
13 Office expenses ....... 6,429,577 3,791,118 2,638,459  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 8,642,541 4,580,547 4,061,994  
17 Travel ............ 114,658 90,580 24,078  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 143,645 51,712 91,933  
20 Interest ........... 8,001,986 4,081,013 3,920,973  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 14,186,928 10,640,196 3,546,732  
23 Insurance .............. 1,445,970 1,142,316 303,654  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES EXPENSE 34,271,404 34,271,404 0 0
b ACCRUED PENSION 27,904,703 22,044,715 5,859,988  
c TAXES 133,846 133,846    
d OTHER EXPENSE 6,606 6,606    
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 214,426,226 169,020,997 45,405,229 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 26,832,749 1 3,035,076
2 Savings and temporary cash investments ....... 4,423,714 2 7,006,720
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 25,606,651 4 34,292,090
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 1,796,675 7 6,039,528
8 Inventories for sale or use .............. 3,901,208 8 4,080,639
9 Prepaid expenses and deferred charges ............ 1,631,890 9 1,618,468
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 413,605,786
b Less: accumulated depreciation. ..... 10b 152,390,057 274,259,018 10c 261,215,729
11 Investments—publicly traded securities .......... 4,841,166 11 9,666,102
12 Investments—other securities. See Part IV, line 11 ...... 7,541,163 12 8,321,047
13 Investments—program-related. See Part IV, line 11 .. 4,882,542 13 26,189,044
14 Intangible assets ......... 12,022,577 14 20,572,163
15 Other assets. See Part IV, line 11 ........... 3,786,127 15 2,014,865
16 Total assets. Add lines 1 through 15 (must equal line 34)... 371,525,480 16 384,051,471
Liabilities 17 Accounts payable and accrued expenses . 62,657,350 17 44,814,212
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 151,381,883 20 149,124,946
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 40,501,800 25 68,405,171
26 Total liabilities. Add lines 17 through 25..... 254,541,033 26 262,344,329
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 116,984,447 27 121,707,142
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 116,984,447 33 121,707,142
34 Total liabilities and net assets/fund balances ..... 371,525,480 34 384,051,471
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
189,523,618
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
214,426,226
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
-24,902,608
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
116,984,447
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
29,625,303
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
121,707,142
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number

72-0423635
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number

72-0423635
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Our Lady of Lourdes Regional Medical
Center Inc 		Employer identification number

72-0423635
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Our Lady of Lourdes Regional Medical
Center Inc 		Employer identification number

72-0423635
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Our Lady of Lourdes Regional Medical
Center Inc 		Employer identification number

72-0423635
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number

72-0423635
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   26,757,745 26,757,745
b Buildings ................   192,173,626 10,428,513 181,745,113
c Leasehold improvements ............   5,828,538 2,259,428 3,569,110
d Equipment ................   85,790,123 51,086,077 34,704,046
e Other .................   103,055,754 88,616,039 14,439,715
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 261,215,729
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) INVESTMENT IN PARK PLACE 5,052,080 F
(2) INVESTMENT IN LHC GROUP 329,628 F
(3) INVEST IN LOURDES AFTER HOURS 513,670 F
(4) INVESTMENT IN HHL 19,933,283 F
(5) INVESTMENT IN LID 360,383 F




Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 26,189,044
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
PROF. & GENERAL LIABILITY 812,102
ACCRUED PENSION COST 67,387,585
BOND DISCOUNT 205,484






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 68,405,171
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
FIN 48 FOOTNOTE (ASC 740) SCHEDULE D, PART XIV THE MEDICAL CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. NO RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number

72-0423635
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean     Investments   3,161,370
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....     3,161,370
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     3,161,370
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
Cent. America/Caribbean HAITI MISSION DONATIONS 12,000 CHECK      
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
1
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number

72-0423635
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
 
No
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    1,389,594   1,389,594 0.580 %
b Medicaid (from Worksheet 3, column a) .....     13,698,146 5,319,473 8,378,673 3.470 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     2,338,103 1,488,205 849,898 0.350 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    17,425,843 6,807,678 10,618,165 4.400 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    557,911 188,557 369,354 0.150 %
f Health professions education
(from Worksheet 5) .. 		    130,158   130,158 0.050 %
g Subsidized health services
(from Worksheet 6) .. 		    1,786,986 258,863 1,528,123 0.630 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     417,775 45,537 372,238 0.150 %
jTotal Other Benefits ...     2,892,830 492,957 2,399,873 0.980 %
kTotal. Add lines 7d and 7j. ..     20,318,673 7,300,635 13,018,038 5.380 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
7,353,814
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
 
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
49,503,709
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
54,090,608
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-4,586,899
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1LOURDES IMAGING DEV
  		LEASOR OF IMAGING PROP & EQUI 22.691 % 5.391 % 71.918 %
2HEART HOSP OF LAFAYE
  		SPECIALTY HOSPITAL 60.000 % 0 % 33.240 %
3PARK PLACE SURGICAL
  		AMBULATORY SURGICAL CENTER 45.000 % 5.070 % 36.910 %
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?3
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 OUR LADY OF LOURDES RMC
4801 AMBASSADOR CAFFERY PARKWAY
LAFAYETTE,LA70508 		X X         X    
2 HEART HOSPITAL OF ACADIANA LLC
1105 KALISTE SALOOM ROAD
LAFAYETTE,LA70508 		X X         X    
3 PARK PLACE SURGERY CENTER LLC
901 WILSON STREET
LAFAYETTE,LA70503 		  X             SURGERY CENTER
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
OUR LADY OF LOURDES RMC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 361.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20 Yes  
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
HEART HOSPITAL OF ACADIANA LLC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 185.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 371.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
PARK PLACE SURGERY CENTER LLC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 264.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address Type of Facility (describe)
1 LOURDES IMAGING NETWORK LLC
4809 AMBASSADOR CAFFERY SUITE 350
LAFAYETTE,LA70506 		IMAGING CENTER
2 LOURDES AFTER HOURS LLC
2130 KALISTE SALOOM ROAD
LAFAYETTE,LA70508 		HEALTHCARE CLINIC
3 LHCG-XIII LLC
601 WEST ST MARY BLVD SUITE 309
LAFAYETTE,LA70506 		HOME HEALTH AGENCY
4
5
6
7
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I LINE 3C   OUR LADY OF THE LOURDES REGIONAL MEDICAL CENTER USES INFORMATION OBTAINED RELATED TO INCOME LEVELS, ETC. TO DETERMINE ELIGIBILITY FOR CHARITY AND DISCOUNTED CARE. ALL SELF PAY ACCOUNTS GET AN AUTOMATIC 25% DISCOUNT.
PART I LINE 7G   THE MEDICAL CENTER PROVIDES SUBSIDIZED HEALTH SERVICES. THE DISCOUNT PROVIDED BRINGS CHARGES DOWN TO COST FOR ALL PATIENTS WHO HAVE NO FORM OF INSURANCE COVERAGE. PROGRAMS SUCH AS SCOTT FAMILY CLINIC, WHICH SERVES THE UNDERINSURED OR UNINSURED AND ST. BERNADETTE'S CLINIC, WHICH PROVIDES FREE MEDICAL CARE TO THE HOMELESS AND UNINSURED POPULATION ARE ALSO INCLUDED. THE COSTING METHODOLOGY USED FOR SUBSIDIZED HEALTH SERVICES WAS ACTUAL EXPENSES INCURRED IN PROVIDING THE SERVICES LESS DIRECT OFFSETTING REVENUE.
PART I LINE 7   THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINES 7A-7D AND IS BASED ON IRS WORKSHEET 2. FOR PART I LINES 7E, 7F, 7G, AND 7I, IRS WORKSHEETS 4-8 WERE USED. DIRECT COSTS WERE CAPTURED FROM THE THE HOSPITAL'S AUDITED FINANCIAL STATEMENT AND THE MEDICARE COST REPORT WHERE APPLICABLE. FOR PART I LINE 7G THE FOLLOWING METHODOLOGY WAS USED DUE TO THE FACT THAT MANY OF THE DEPARTMENTS INCLUDED IN SUBSIDIZED HEALTH SERVICES HAVE NO CHARGES. THEREFORE, THE COST TO CHARGE RATIO COULD NOT BE UTILIZED. COST FIGURES FOR THESE WERE CALCULATED FROM DIRECT DEPARTMENTAL COSTS PLUS AN OVERHEAD ALLOCATION (AS REFLECTED ON THE MEDICARE COST REPORT) LESS DIRECT OFFSETTING REVENUE.
PART III LINE 4   THE MEDICAL CENTER'S AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A FOOTNOTE FOR BAD DEBT EXPENSE. HOWEVER, BAD DEBTS ARE BASED ON THE AGING OF THE ACCOUNTS AND ALSO THE HISTORICAL COLLECTION HISTORY ASSOCIATED WITH THE DIFFERENT AGING CATEGORIES I.E. 0-30, 30-60, ETC. FURTHER ANALYSES ARE DONE PERIODICALLY TO DETERMINE THE APPROPRIATE COLLECTION PERCENTAGE TO USE IN ESTIMATING THE BAD DEBT EXPENSE. COST TO CHARGE RATIO WAS USED TO DETERMINE THE COST OF BAD DEBT EXPENSE REPORTED IN PART III LINE 2. BAD DEBT EXPENSE DOES NOT INCLUDE DISCOUNTS THAT ARE PROVIDED, NOR ARE AMOUNTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE INCLUDED. ANY AMOUNTS (PAYMENTS) RECEIVED ON ACCOUNTS AFTER THEY HAVE BEEN DEEMED TO BE UNCOLLECTIBLE (BAD DEBT) ARE RECORDED AS A RECOVERY (REDUCTION) OF BAD DEBT EXPENSE.
PART III LINE 8   THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENT AND GUIDELINES. THE MEDICARE COST REPORT (MCR) IS AN ANNUAL REPORT REQUIRED OF ALL INSTITUTIONS PARTICIPATING IN THE MEDICARE PROGRAM. THE MCR RECORDS EACH INSTITUTION'S TOTAL COSTS AND CHARGES ASSOCIATED WITH PROVIDING SERVICES TO ALL PATIENTS, THE PORTION OF THOSE COSTS AND CHARGES ALLOCATED TO MEDICARE PATIENTS, AND THE MEDICARE PAYMENTS RECEIVED.
PART III LINE 9B   OUR LADY OF LOURDES RECOGNIZES ITS OBLIGATION TO PROVIDE QUALITY HEALTHCARE TO THOSE WHO ARE UNABLE TO PAY. THE HOSPITAL ALSO RECOGNIZES THAT IT HAS AN OBLIGATION TO MAINTAIN LONG-TERM FINANCIAL STABILITY AND VIABILITY. BASED ON OUR VALUES, THE HOSPITAL IS COMMITTED TO PROVIDING SERVICES AT NO CHARGE OR AT REDUCED RATES TO THOSE PATIENTS WHO MEET PRE-DETERMINED FINANCIAL AND MEDICAL QUALIFICATIONS. PATIENTS WHO QUALIFY FOR CHARITY CARE SHOULD BE IDENTIFIED PRIOR TO, OR AT TIME OF ADMISSION. THE HOSPITAL WILL CONTINUE TO REVIEW A PATIENTS' ABILITY TO PAY AFTER DISCHARGE AS APPROPRIATE. FINANCIAL ASSISTANCE IS BASED ON THE PATIENT'S INCOME LEVEL AS DICTATED IN THE FINANCIAL ASSISTANCE POLICY. THE PATIENT'S ACCOUNT IS WRITTEN OFF TO CHARITY WHEN IT IS DETERMINED THAT THEY QUALIFY FOR FINANCIAL ASSISTANCE. THE ACCOUNT IS ALSO REMOVED FROM THE COLLECTION PROCESS AT THAT TIME. ALL REQUESTS FOR ASSISTANCE WILL REMAIN CONFIDENTIAL, AND THE HOSPITAL WILL NOT DISCRIMINATE IN THE APPLICATION OF ITS CHARITY POLICY BASED UPON RACE, CREED, COLOR, SEX OR NATIONAL ORIGIN.
PART VI LINE 2 NEEDS ASSESSMENT THE COMMUNITY SERVICES DEPARTMENT AT OUR LADY OF LOURDES REGIONAL MEDICAL CENTER WAS FORMED NEARLY 10 YEARS AGO TO ASSESS THE COMMUNITY NEEDS. IT HAS GROWN INTO 5 DISTINCT SERVICE AREAS WHICH PROVIDES HEALTHCARE TO NEEDY RESIDENTS IN THE ACADIANA AREA. IN TAKING "HEALTHCARE TO THE HIGHEST POWER", THE DEPARTMENT REACHES OUT TO THOSE MOST IN NEED, SPECIFICALLY, THE UNINSURED AND UNDERINSURED. IN PURSUING THE MISSION TO IMPROVE THE HEALTH STATUS OF ACADIANA'S POOREST RESIDENTS, THE DEPARTMENT HAS STRATEGICALLY PLACED ACCESSIBLE SERVICES THROUGHOUT THE COMMUNITY. COMMUNITY SERVICES' CATHOLIC IDENTITY IS MADE TANGIBLE IN THE COMMUNITY THROUGH THESE UNIQUE SERVICES. THE DEPARTMENT STEWARDS ITS RESOURCES BY ENGAGING COMMUNITY MEMBERS, FORMING PARTNERSHIPS, AND ESTABLISHING COLLABORATIVE RELATIONSHIPS. THESE UNIQUE SERVICES CLEARLY DISTINGUISH OUR LADY OF LOURDES FROM OTHER HEALTHCARE FACILITIES IN ACADIANA. THE MEDICAL CENTER DOES EXTENSIVE RESEARCH REGARDING COMMUNITY ISSUES AND NEEDS WITHIN ITS SERVICE AREAS. THE RESEARCH IS CONDUCTED IN AN EFFORT TO DETERMINE IF ITS COMMUNITY BENEFIT PROGRAMS ARE STILL APPROPRIATE AND TO DETERMINE IF OTHER PROGRAMS ARE NEEDED. THE SENIOR EXECUTIVE TEAM DETERMINES THE FOCUS GROUPS TO BETTER UNDERSTAND WHAT THE PEOPLE WITHIN THE REGION CONSIDER TO BE THE MAJOR COMMUNITY NEEDS. THE FOCUS GROUP INCLUDES COMMUNITY LEADERS, RELIGIOUS LEADERS, COMMUNITY SERVICE EMPLOYEES, LOW WAGE EMPLOYEES AND CLIENTS FROM CLINICS. SOME OF THE RESULTS OF THE MEDICAL CENTER'S NEEDS ASSESSMENT INCLUDE: ST. CLARE'S CLINIC ST. BERNADETTE'S COMMUNITY CLINIC NORTHSIDE HIGH SCHOOL BASED HEALTH CENTER SCOTT FAMILY CLINIC CONGREGATIONAL HEALTH SERVICES
PART VI LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PATIENTS ARE GIVEN THE MEDICAL CENTER'S PATIENT HANDBOOK WHERE THEY ARE REFERRED TO THE SECTION ENTITLED "FINANCIAL INFORMATION - WHAT TO EXPECT". FINANCIAL COUNSELORS ALSO MEET WITH THE PATIENTS AND EDUCATE THEM ABOUT THE ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND ALSO THE ORGANIZATION'S FINANCIAL ASSISTANCE (CHARITY) PROGRAM. FOR THE CONVENIENCE OF THE PATIENTS, THE MEDICAL CENTER ALSO OPERATES A MEDICAID ENROLLMENT CENTER TO ASSIST PATIENTS INTERESTED IN APPLYING FOR MEDICAID BENEFITS. THIS OFFICE IS OPEN MONDAY - FRIDAY FROM 8:00 A.M. - 4:00 P.M. A TELEPHONE NUMBER IS ALSO PROVIDED IN THE HANDBOOK.
PART VI LINE 4 COMMUNITY INFORMATION THE MEDICAL CENTER IS AN ACTIVE, CARING MEMBER OF THE COMMUNITIES IT SERVES. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTH NEEDS OF THE PEOPLE OF GOD, THE BOARD OF DIRECTORS HAVE ESTABLISHED A POLICY UNDER WHICH THE MEDICAL CENTER PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. THE MEDICAL CENTER SERVES LAFAYETTE PARISH AND ITS SURROUNDING AREAS. APPROXIMATELY 222,000 PEOPLE LIVE IN LAFAYETTE PARISH AND 445,0000+ IN THE TOTAL SERVICE AREA WITH EXPECTED GROWTH IN THE NEXT FEW YEARS.
PART VI LINE 5 PROMOTION OF COMMUNITY HEALTH SEE THE QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT REPORT ON SCHEDULE O.
PART VI LINE 6 AFFILIATED HEALTH CARE SYSTEM OUR LADY OF LOURDES REGIONAL MEDICAL CENTER IS NOT-FOR-PROFIT, NON-STOCK, MEMBER CORPORATION OF WHICH FRANCISCAN MISSIONAIRIES OF OUR LADY HEALTH SYSTEM, INC. IS THE SOLE MEMBER. FRANCISCAN MISSIONAIRIES OF OUR LADY HEALTH SYSTEM, INC. ALSO INCLUDES SEVERAL OTHER HOSPITALS IN LOUISIANA: OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER ST. FRANCIS MEDICAL CENTER ST. ELIZABETH HOSPITAL
PART V LINE 13 OUR LADY OF LOURDES RMC, HEART HOSPITAL OF ACADIANA, & PARK PLACE SURGERY: Registration personnel refer patients that may have difficulty paying for their medical care to financial counselors to discuss qualification for free or discounted care.
PART V LINE 19 OUR LADY OF LOURDES RMC, HEART HOSPITAL OF ACADIANA, & PARK PLACE SURGERY: The hospital offers various levels of discounts which are based on a sliding scale using federal poverty guideline family income levels and other factors. Such other factors include asset levels, medical indigency and a patient's qualification for Medicare or Medicaid. Together these criteria are used to set the maximum amount charged.
PART V LINE 20 OUR LADY OF LOURDES RMC In an effort to provide assistance to both uninsured and underinsured patients, the organization has two policies - a financial assistance policy (FAP) and a self-pay policy. The average amounts charged to patients who were eligible for assistance under the hospital facility's FAP are less than amounts generally billed to patients who have insurance covering such care. This is accomplished through use of discounts applied on a sliding scale based on federal poverty guideline family income levels. Discounts used on the sliding scale are 25%, 50%, 75% and 100% (or free care). The majority of FAP-eligible patients qualify for either the 75% or 100% discount. A smaller population of patients qualify for the 50% discount. Less than 1% of the FAP-eligible patients qualified for teh 25% charity discount. This discount category is equivalent to the 25% self-pay discount offered to all self-pay patients regardless of income level. It is in this small population of patients where expected payment may have exceeded amounts generally billed to patients with insurance covering such care. The organization and its board are currently working to address this issue for this small number of patients.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number
72-0423635
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) LOURDES FOUNDATION4801 AMBASSADOR CAFFERY
LAFAYETTE,LA70508 		72-0513639 501(c)(3) 52,721       GENERAL SUPPORT
(2) LAFAYETTE COMMUNITY HEALTHCARE CLINIC1317 JEFFERSON ST
LAFAYETTE,LA70501 		72-1221982 501(C)(3) 111,475       GENERAL SUPPORT
(3) UNITED WAY OF ACADIANA215 E PINHOOK ROAD
LAFAYETTE,LA70501 		72-0513639 501(C)(3) 48,849       COMMUNITY PROG. SUPP.
(4) THE LOUISIANA OPEN INC124 HEYMANN BLVD STE 105
LAFAYETTE,LA70503 		72-1043611 501(C)(3) 7,500       GENERAL SUPPORT
(5) FIBERCORPS100 PETROLEUM DRIVE
LAFAYETTE,LA70508 		20-8233506 501(C)(6) 16,666       SEE PART IV
(6) LSU EUNICEPO BOX 1129
EUNICE,LA70535 		72-6000848 GOVT. 7,700       DMS PROGRAM FUNDING
(7) SOUTHWEST LA EDUCATION AND REFERRAL CENTER INC1005 JEFFERSON STREET
LAFAYETTE,LA70501 		72-0628109 501(C)(3) 20,000       GENERAL SUPPORT










2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
6
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
1
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Schedule I, Part I, Line 2   A compliance report is submitted by the organization receiving the grant at the end of the grant period.
SCHEDULE I, PART II, LINE 5   LAFAYETTE HEALTHCARE COALITION
Schedule I (Form 990) 2011


Additional Data


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number

72-0423635
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) WILLIAM R GUILLORY (i)
(ii)		 406,947
0 		2,580
0 		0
0 		9,800
0 		7,507
0 		426,834
0 		0
0
(2) STEVEN J SNATIC (i)
(ii)		 306,308
0 		80
0 		0
0 		9,800
0 		17,889
0 		334,077
0 		0
0
(3) DANIEL C DUNLAP (i)
(ii)		 305,480
0 		80
0 		0
0 		9,800
0 		7,551
0 		322,911
0 		0
0
(4) JAMES M MWATIBO (i)
(ii)		 268,151
0 		13,355
0 		0
0 		9,800
0 		14,420
0 		305,726
0 		0
0
(5) JOHN C DUGAL (i)
(ii)		 242,687
0 		34,760
0 		0
0 		9,800
0 		22,004
0 		309,251
0 		0
0
(6) KAREN O WYBLE (i)
(ii)		 190,130
0 		38,887
0 		12,928
0 		9,582
0 		22,201
0 		273,728
0 		0
0
(7) KIM L HEBERT (i)
(ii)		 169,321
0 		26,542
0 		13,127
0 		21,754
0 		24,114
0 		254,858
0 		0
0
(8) BARBARA FESKE (i)
(ii)		 157,078
0 		24,984
0 		13,152
0 		33,183
0 		20,642
0 		249,039
0 		0
0
(9) MONTE A WILSON (i)
(ii)		 149,970
0 		15,040
0 		31,966
0 		6,691
0 		835
0 		204,502
0 		0
0
(10) DANNA M CRAIN (i)
(ii)		 140,044
0 		30,303
0 		7,169
0 		21,133
0 		26,101
0 		224,750
0 		0
0
(11) KEVIN J DOMINGUE (i)
(ii)		 147,170
0 		21,196
0 		7,040
0 		12,571
0 		22,987
0 		210,964
0 		0
0
(12) ANDRE E MOREAU (i)
(ii)		 117,077
0 		13,542
0 		9,199
0 		15,432
0 		15,932
0 		171,182
0 		0
0
(13) WF BUD BARROW (i)
(ii)		 0
367,005 		0
82,987 		0
52,807 		0
40,025 		0
20,856 		0
563,680 		0
0



Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE J, PART I, LINE 4B   FMOL HEALTH SYSTEM, A RELATED TAX EXEMPT ORGANIZATION, MAINTAINS AN UNFUNDED DEFERRED COMPENSATION PLAN WHICH MEETS THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLAN PROVIDES FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURANCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH, OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLAN IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. NO ONE LISTED IN PART VII, SECTION A RECEIVED A PAYMENT FORM THE PLAN IN THE CURRENT YEAR.
SCHEDULE J, PART I, LINE 7   DISCRETIONARY BONUSES WERE PAID WITH REGARD TO PERSONS LISTED ON PART VII, SECTION A, LINE 1A. SUCH BONUSES WERE APPROVED BY THE CEO.
SCHEDULE J, PART I, LINE 4A   THE CEO IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS BASE SALARY AND AN ANNUAL INCENTIVE AT TARGET AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD RANGES FROM 18 TO 36 MONTHS DEPENDING ON THE EXECUTIVE AND THE LENGTH OF SERVICE. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. OTHER PERSONS LISTED ON PART VII, SECTION A ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT DUE TO REORGANIZATION OF HOSPITAL DEPARTMENTS, HOSPITAL FUNCTIONS OR DOWNSIZING ACTIVITY. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS OR HER BASE SALARY AND MEDICAL/DENTAL BENEFITS FOR THE ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD RANGES FROM 3 WEEKS TO 12 MONTHS DEPENDING ON THE LENGTH OF SERVICE AND THE LEVEL OF SUCH EMPLOYEE. NO PAYMENTS TO INDIVIDUALS LISTED IN PART VII, SECTION A WERE MADE UNDER THE PLAN IN THE CURRENT YEAR.
SCHEDULE J, PART I, LINE 3   THE CEO IS PAID BY FMOL HEALTH SYSTEM, A RELATED TAX EXEMPT ORGANIZATION. THE FMOLHS BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE CEO'S COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION STUDY/SURVEY FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE.
Schedule J (Form 990) 2011

Additional Data


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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number

72-0423635
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) LOUISIANA PHYSICIAN CORPORATION BD MEMBER IS PART OWNER 391,469 MED BILLING SVCS TO LOURDES RM Yes  
(2) LHC GROUP BD MEMBER IS A BD MEMBER 114,732 JOINT VENTURE   No
(3) MICHAEL H VANDERLICK APMC BD MEMBER IS OWNER 166,811 PHYSICIAN SERVICES   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number

72-0423635
Identifier Return Reference Explanation
PART VI, SECTION A, QUESTION 11   AFTER PREPARATION AND REVIEW BY KPMG LLP, THE FORM 990 IS REVIEWED BY ONE OR MORE MEMBERS OF SENIOR MANAGEMENT. A COPY OF THE FORM 990 IS PRESENTED TO THE FINANCE COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT DIRECTORS, AND COMMENTS ARE SOLICITED. A COPY OF THE FORM 990 IS ALSO PROVIDED TO THE MEDICAL CENTER'S GOVERNING BODY BEFORE IT IS FILED WITH THE IRS.
PART VI, SECTION B, QUESTION 12C   OUR LADY OF LOURDES REGIONAL MEDICAL CENTER HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY THAT REQUIRES EACH OFFICER, TRUSTEE, BOARD COMMITTEE MEMBER AND EMPLOYEE TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. COMPLETED DISCLOSURE FORMS ARE REVIEWED AND MAINTAINED BY THE CHIEF COMPLIANCE OFFICER. IF ANY TRUSTEE, BOARD COMMITTEE MEMBER OR SENIOR MANAGER HAS A POTENTIAL CONFLICT, THE EXECUTIVE COMMITTEE OF THE BOARD DETERMINES WHETHER ACTION NEEDS TO BE TAKEN AND COMMUNICATES ANY SUCH ACTION TO THE INDIVIDUAL. A POTENTIAL CONFLICT OF ANY OTHER EMPLOYEE IS REVIEWED BY THE CEO OR HIS DESIGNEE. THE EXECUTIVE COMMITTEE, CEO OR DESIGNEE, AS APPLICABLE, DETERMINES IF A CONFLICT OF INTEREST EXISTS OR CREATES THE APPEARANCE OF IMPROPRIETY. IF SUCH A DETERMINATION IS MADE, THE INDIVIDUAL WILL BE EXCUSED FROM PARTICIPATING IN THE BUSINESS DECISION. DURING THE YEAR, ANY CHANGE TO THE INFORMATION IN THE DISCLOSURE STATEMENT MUST BE DISCLOSED PROMPTLY TO THE CHIEF COMPLIANCE OFFICER, WHO TAKES APPROPRIATE ACTION. THE PROCESS ALSO REQUIRES AFFIRMATION FROM EACH INDIVIDUAL THAT HE OR SHE (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) HAS AGREED TO COMPLY WITH THE POLICY; AND (D) UNDERSTANDS THAT OUR LADY OF LOURDES REGIONAL MEDICAL CENTER IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OUR LADY OF LOURDES REGIONAL MEDICAL CENTER PROVIDES MECHANISMS FOR CONFIDENTIAL REPORTING OF COMPLIANCE ISSUES. THESE MECHANISMS INCLUDE AN ANONYMOUS HOTLINE AND WEB SITE WHERE INDIVIDUALS MAY RAISE ISSUES, SEEK CLARIFICATION, AND REPORT POSSIBLE CONFLICTS OF INTEREST OR OTHER CONCERNS. THESE REPORTS OF POSSIBLE CONFLICTS OF INTERESTS ARE REVIEWED AND INVESTIGATED BY THE CORPORATE COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN.
PART VI, SECTION C, QUESTION 19   THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
PART VI, SECTION A, QUESTION 7a   FMOL HEALTH SYSTEM INC., AS THE SOLE MEMBER OF THE MEDICAL CENTER, RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF OUR LADY OF LOURDES REGIONAL MEDICAL CENTER.
PART VI, SECTION B, QUESTION 15A & 15B   THE PRESIDENT AND CEO OF OUR LADY OF LOURDES REGIONAL MEDICAL CENTER IS AN EMPLOYEE OF FMOL HEALTH SYSTEM (A RELATED TAX-EXEMPT ORGANIZATION) WHOSE SALARY IS DETERMINED BY THE PAY PRACTICES OF THAT ORGANIZATION. SUCH PAY PRACTICES INCLUDE THE USE OF AN INDEPENDENT BOARD COMMITTEE WHICH REVIEWS COMPENSATION ANNUALLY AFTER OBTAINING AND RELYING UPON INDUSTRY-WIDE COMPENSATION INFORMATION FROM AN OUTSIDE CONSULTING FIRM. THE BOARD COMMITTEE APPROPRIATELY DOCUMENTS ITS DECISIONS. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS REVIEWED ANNUALLY BY THE CEO AND AN EXECUTIVE COMMITTEE. THE CEO AND EXECUTIVE COMMITTEE IS PROVIDED COMPENSATION RANGES DEVELOPED BY FMOL HEALTH SYSTEM FROM INDUSTRY-WIDE DATA. THE CEO AND EXECUTIVE COMMITTEE THEN USES THAT DATA TO DETERMINE THE APPROPRIATE COMPENSATION FOR OFFICERS AND KEY EMPLOYEES AND DOCUMENTS THE HUMAN RESOURCE FILES. ALL DELIBERATIONS AND DECISIONS WILL BE PROPERLY DOCUMENTED IN THE FUTURE.
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990 PART III OUR LADY OF LOURDES REGIONAL MEDICAL CENTER SERVICE TO THE COMMUNITY - JUNE 30, 2012 THE MEDICAL CENTER IS AN ACTIVE, CARING MEMBER OF THE COMMUNITIES IT SERVES. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTH NEEDS OF THE PEOPLE OF GOD, THE BOARD OF DIRECTORS HAS ESTABLISHED A POLICY UNDER WHICH THE MEDICAL CENTER PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. THE MEDICAL CENTER ALSO PARTICIPATES IN GOVERNMENT PROGRAMS INCLUDING MEDICARE, MEDICAID, AND THE TRICARE PROGRAM. UNDER THESE PROGRAMS, THE MEDICAL CENTER PROVIDES CARE TO PATIENTS AT PAYMENT RATES WHICH ARE DETERMINED BY THE FEDERAL AND STATE GOVERNMENTS, REGARDLESS OF ACTUAL COST. IN SOME CASES, THESE PROGRAMS PAY THE MEDICAL CENTER AT AMOUNTS WHICH ARE LESS THAN ITS COST OF PROVIDING SERVICES. THE FOLLOWING TABLE SUMMARIZES THE CHARITY CARE AND MEANS-TESTED PROGRAMS FOR THE YEAR ENDED JUNE 30, 2012. THIS TABLE DOES NOT INCLUDE DISCOUNTS OFFERED BY THE MEDICAL CENTER UNDER MANAGED CARE AND OTHER SUCH AGREEMENTS. THE BELOW FIGURES USE SLIGHTLY DIFFERENT ASSUMPTIONS FROM SCHEDULE H AND THEREFORE AMOUNTS MAY VARY. 2012 CHARGES FOREGONE MEDICARE $160,135,292 MEDICAID 31,739,431 TRICARE 2,767,418 CHARITY 3,778,000 TOTAL 198,420,141 ESTIMATED UNREIMBURSED COSTS MEDICARE $31,008,064 MEDICAID 10,907,501 TRICARE 1,205,337 CHARITY 1,645,492 TOTAL 44,766,394 IN ADDITION TO COMMUNITY SERVICES DIRECTLY ASSOCIATED WITH PROVIDING HOSPITAL-BASED CARE, THE MEDICAL CENTER SERVES THE COMMUNITY IN NUMEROUS OTHER WAYS. FOR EXAMPLE: THE MEDICAL CENTER SPONSORS THE ST. BERNADETTE'S CLINIC. ST. BERNADETTE'S PROVIDES FREE MEDICAL CARE TO THE HOMELESS AND UNINSURED POPULATION IN THE ACADIANA AREA. LOURDES PROVIDES THE SERVICES OF A NURSE PRACTITIONER AND REGISTERED NURSE. THE COST ASSOCIATED WITH THE CLINIC APPROXIMATED $640,498 FOR THE YEAR ENDED JUNE 30, 2012. DURING 1996, THE MEDICAL CENTER BEGAN OPERATING THE NORTHSIDE HIGH SCHOOL HEALTH CENTER. THE CENTER IS COMMITTED TO PROVIDING EXEMPLARY COMPREHENSIVE HEALTH CARE TO THE STUDENTS AT NORTHSIDE HIGH SCHOOL. PHYSICAL AND PSYCHOSOCIAL SERVICES ARE PROVIDED BY A DEDICATED STAFF IN AN INFORMAL AND CONFIDENTIAL ATMOSPHERE THAT IS EASILY ACCESSIBLE TO ALL STUDENTS. EMPHASIS IS PLACED ON WELLNESS, AVOIDING HIGH RISK BEHAVIORS, AND MEETING THE INDIVIDUAL MEDICAL, EMOTIONAL AND SOCIAL NEEDS OF ADOLESCENTS AT NO COST TO THE STUDENTS. THE ESTIMATED COSTS ASSOCIATED WITH THE HEALTH CENTER APPROXIMATED $335,010 FOR THE YEAR ENDED JUNE 30, 2012. CONGREGATIONAL HEALTH SERVICES BEGAN MARCH 2001 AT IMMACULATE HEART OF MARY CHURCH AND THEN EXPANDED TO PROGRESSIVE BAPTIST CHURCH, WHICH ARE CHURCHES IN THE LAFAYETTE AREA. CURRENTLY, THERE ARE TWO PART-TIME NURSES AND ONE NURSE PRACTITIONER WHO COORDINATE THE PROGRAM. THE NURSES HAVE SPECIALIZED TRAINING AS HEALTH EDUCATORS, REFERRAL SOURCES, HEALTH COUNSELORS, HEALTH ADVOCATES AND VOLUNTEER COORDINATORS. THE ESTIMATED COSTS ASSOCIATED WITH THESE ACTIVITIES APPROXIMATED $126,865 FOR THE YEAR ENDED JUNE 30, 2012. THE MEDICAL CENTER HAS PURCHASED THE "CAMP BLUEBIRD" FRANCHISE, A CAMP FOR ADULT CANCER PATIENTS, PROVIDING SUCH PATIENTS A SECURE AND MEDICALLY SUPERVISED ENVIRONMENT, AND OFFERING THERAPEUTIC SHARING OPPORTUNITIES AS WELL AS INFORMATION REGARDING THE EDUCATIONAL, MEDICAL AND PSYCHOLOGICAL CONCERNS OF THE CAMPERS. THE MEDICAL CENTER SPONSORS THE SCOTT FAMILY CENTER (THE CENTER), WHICH BEGAN IN 1998 AS A PEDIATRIC CLINIC AND KIDMED (A STATE-SPONSORED HEALTH PROGRAM) AND HAS NOW EVOLVED INTO A FAMILY CLINIC WITH KIDMED SERVICES. A PEDIATRIC NURSE PRACTITIONER, FAMILY NURSE PRACTITIONER AND CLERICAL STAFF OPERATE THE FACILITY. THE CENTER SERVES UNDERINSURED, UNINSURED, AND LACHIP (A STATE-SPONSORED HEALTH PROGRAM) ENROLLMENT. THE FACILITY IS A MAJOR PROVIDER OF IMMUNIZATIONS AS AN ALTERNATE SOURCE TO THE LAFAYETTE PARISH HEALTH UNIT. THE ESTIMATED COSTS ASSOCIATED WITH THESE ACTIVITIES APPROXIMATED $586,235 FOR THE YEAR ENDED JUNE 30, 2012. THE MEDICAL CENTER DONATES THE SERVICES OF ONE FULL-TIME REGISTERED NURSE TO THE LAFAYETTE COMMUNITY HEALTH CARE CLINIC (THE CLINIC). THE CLINIC TARGETS INDIVIDUALS AND FAMILIES WHO ARE EMPLOYED OR TEMPORARILY UNEMPLOYED AND UNINSURED. PHYSICIANS, DENTISTS, NURSES, AND PHARMACISTS ARE ON HAND TO TREAT PATIENTS. THE ESTIMATED COSTS ASSOCIATED WITH THE CLINIC APPROXIMATED $19,925 FOR THE YEAR ENDED JUNE 30, 2012. THE MEDICAL CENTER ALSO HAD ESTIMATED COSTS OF $22,443 ASSOCIATED WITH EMERGENCY PREPAREDNESS AND $130,158 ASSOCIATED WITH HEALTH PROFESSIONS EDUCATION FOR THE YEAR ENDED JUNE 30, 2012. THE FOLLOWING TABLE SUMMARIZES ESTIMATED COSTS OF THE COMMUNITY SERVICES NOTED ABOVE FOR THE YEAR ENDED JUNE 30, 2012: 2012 ST. BERNADETTE'S $640,498 NORTHSIDE HIGH SCHOOL HEALTH CENTER 335,010 CONGREGATIONAL HEALTH SERVICES 126,865 SCOTT FAMILY CENTER 586,235 LAFAYETTE COMMUNITY HEALTH CARE CLINIC 19,925 HEALTH PROFESSIONS EDUCATION 130,158 EMERGENCY PREPAREDNESS 22,443 ------------- TOTAL $1,861,134 ALTHOUGH THE MEDICAL CENTER HAS ESTIMATED THE COST OF THESE EFFORTS TO SERVE THE ACADIANA COMMUNITY, MANAGEMENT AND THE BOARD OF DIRECTORS BELIEVE THAT SUCH COSTS REPRESENT ONLY ONE FACET OF THE MANY WAYS THAT THE MEDICAL CENTER AND ITS RELATED ORGANIZATIONS SERVE THE ACADIANA AREA.
PART VI, SECTION A, QUESTION 7B   THE RESERVED POWERS TO FMOL HEALTH SYSTEM, INC. ARE AS FOLLOWS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES AND PURPOSES OF CORPORATION 2. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION 3. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION, OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES 5. TO DISSOLVE AND TO DISTRIBUTE ASSETS OF THE CORPORATION 6. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION 7. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF THE CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION 9. TO APPOINT THE FISCAL AUDITOR FOR THE CORPORATION 10. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHARGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION 11. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION 12. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION.
PART VI, SECTION A, QUESTION 6   FMOL HEALTH SYSTEM (AN IRC SECTION 501(C)(3) ORGANIZATION) IS THE SOLE MEMBER OF OUR LADY OF LOURDES REGIONAL MEDICAL CENTER.
PART VI, SECTION A, QUESTION 2   HENRY PERRET, JR. & KEVIN MOODY - BUSINESS RELATIONSHIP HENRY PERRET, JR. & WILLIAM W. RUCKS, IV - BUSINESS RELATIONSHIP KEVIN MOODY & WILLIAM W. RUCKS, IV - BUSINESS RELATIONSHIP CHARLES GOODSON & WILLIAM W. RUCKS, IV- BUSINESS RELATIONSHIP KEMP COREIL M.D. & MICHAEL H. VANDERLICK, M.D. - BUSINESS RELATIONSHIP JOHN L. INDEST & W.F. "BUD" BARROW - BUSINESS RELATIONSHIP
PART XI, LINE 5   UNREALIZED GAIN ON INVESTMENTS 263,804 UNREALIZED LOSS ON INVESTMENTS (99,104) CAPITAL TRANSFERS (5,782,608) CHANGE IN ACCOUNTING FOR EQUITY INVESTMENTS 35,243,211 TOTAL CHANGES TO FUND BALANCE 29,625,303
PART VI, SECTION B, QUESTION 16A & 16B   THROUGHOUT THE TAX YEAR, THE ORGANIZATION HAD A JOINT VENTURE POLICY IN PLACE ALTHOUGH IT WAS NOT APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE JUNE 30, 2012. THE ORGANIZATION INTENDS TO HAVE THE POLICIES APPROVED BY OUR LADY OF LOURDES REGIONAL MEDICAL CENTER'S BOARD OF DIRECTORS OR COMMITTEE THEREOF.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:W.F. "BUD" BARROW TITLE:CEO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SR. BETTY LYONS TITLE:BOARD MEMBER HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIM L HEBERT TITLE:CFO, VP OF FINANCE HOURS:1
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Our Lady of Lourdes Regional Medical
Center Inc
Employer identification number

72-0423635
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) LOURDES IMAGING CENTER LLC
4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE,LA70508
 HEALTHCARE LA 0 0 LOURDES
 
(2) LOURDES PHYSICIAN GROUP LLC
4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE,LA70508
 HEALTHCARE LA 0 0 LOURDES
 








Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) St Bernard Health Fund

4200 Essen Lane

Baton Rouge,LA70809
20-4685614 		Healthcare LA 501(C)(3) 11 Type 1 FMOLHS
 
 
No
(2) Health Partners Network of South LA

4801 AMBASSADOR CAFFERY PKWY

Lafayette,LA70508
 Healthcare LA 501(C)(3) 3 LOURDES RMC
 
Yes
 
(3) HEALTH CARE CENTERS IN SCHOOLS

5000 HENNESSY BLVD

BATON ROUGE,LA70808
72-1443935 		HEALTHCARE LA 501(C)(3) 7 OLOL
 
Yes
 








For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Lourdes Imaging Center LLC

4801 AMBASSADOR CAFFERY PKWY
Lafayette,LA70508
20-8326214 		Healthcare LA LOURDES
  		RELATED 2,222,270 0   No 0 Yes   0 %
(2) Heart Hospital of Acadiana

1105 Kaliste Saloom Road
Lafayette,LA70508
30-0442368 		Healthcare LA LOURDES
  		RELATED 3,521,510 23,280,092   No 0 Yes   60.000 %
(3) Perkins Plaza Medical Arts Development

5000 Hennessy Boulevard
Baton Rouge,LA70808
45-0516574 		Real Estate LA OLOL
  		N/A       No   Yes    
(4) Perkins Plaza Imaging Center

5000 Hennessy Boulevard
Baton Rouge,LA70808
20-3697665 		Healthcare LA OLOL
  		N/A       No   Yes    
(5) Perkins Plaza Imaging Development

5000 Hennessy Boulevard
Baton Rouge,LA70808
20-3894521 		Real Estate LA OLOL
  		N/A       No   Yes    
(6) Nuclear Imaging LLC

5000 Hennessy Boulevard
Baton Rouge,LA70808
72-1470061 		Healthcare LA OLOL
  		N/A       No   Yes    
(7) P&S Surgery Center LLC

312 Grammont Street
Monroe,LA71201
72-1387870 		Healthcare LA St Francis
  		N/A       No   Yes    
(8) St Francis Pediatric After Hours LLC

Post Office 207
Monroe,LA71210
06-1782572 		Healthcare LA St Francis
  		N/A       No   Yes    
(9) Lourdes Imaging Development LLC

4801 AMBASSADOR CAFFERY PKWY
Lafayette,LA70508
20-8326287 		Real Estate LA LOURDES
  		RELATED -323,596 2,776,583   No 0 Yes   22.690 %
(10) Park Place Surgical Hospital

901 Wilson Street
Lafayette,LA70503
72-1404092 		Healthcare LA LOURDES
  		RELATED 3,784,125 15,654,532   No 0 Yes   70.240 %
(11) BRPT Lake Rehabilitation Centers LLC

530 Shadows Lane
Baton Rouge,LA70806
72-1506100 		Healthcare LA OLOL
  		N/A       No   Yes    
(12) Convenient Care LLC

7777 Hennessy Boulevard Suite 1004
Baton Rouge,LA70808
72-1439481 		Healthcare LA OLOL
  		N/A       No   Yes    
(13) Perkins Plaza Ambulatory Surgery Center

54 The Legends Parkway Suite 159
Eureka,MO63025
48-1264699 		Healthcare LA OLOL
  		N/A       No   Yes    
(14) Surgical Specialty Center of Baton Rouge

8080 Bluebonnet Boulevard
Baton Rouge,LA70810
23-3160962 		HEALTHCARE LA OLOL
  		N/A       No   Yes    
(15) St Elizabeth - Mary Bird Perkins

4950 Essen Lane
Baton Rouge,LA70809
26-0628752 		Healthcare LA STEH
  		N/A       No   Yes    
(16) Regional Eye Surgery Center LLC

7777 Hennessy Blvd Suite 4000
BATON ROUGE,LA70808
72-1484653 		Healthcare LA OLOL
  		N/A       No   Yes    
(17) St Mary's Imaging Center II LLC

4801 AMBASSADOR CAFFERY PKWY
Lafayette,LA70508
 Healthcare LA Lourdes Imaging
  		N/A       No   Yes    
(18) Northeast LA Cancer Institute

141 Destard Street Suite 704
Monroe,LA71201
72-1329499 		Healthcare LA St Francis
  		N/A       No   Yes    
(19) Lourdes After Hours LLC

2130 KALISTE SALOOM RD
LAFAYETTE,LA70508
20-1367299 		Healthcare LA LOURDES
  		RELATED 171,613 500,138   No 0 Yes   50.000 %
(20) LHCG-XIII LLC

420 West Pinhook Road Suite A
Lafayette,LA70503
20-8068308 		Healthcare LA LOURDES
  		RELATED 20,072 126,371   No 0 Yes   33.330 %
(21) ST ELIZABETH IMAGING CENTER

1125 WEST HIGHWAY 30
GONZALES,LA70737
36-4701565 		HEALTHCARE LA STEH
  		N/A       No   Yes    
(22) CAPITAL AREA SHARED SERVICES ORGANIZATIO

5000 HENNESSY BOULEVARD
BATON ROUGE,LA70808
27-5173212 		HEALTHCARE LA STEP
  		N/A       No   Yes    
(23) CAPITAL AREA SHARED SERVICES ORGANIZATIO

5000 HENNESSY BOULEVARD
BATON ROUGE,LA70808
27-5173212 		HEALTHCARE LA OLOL PG
  		N/A       No   Yes    
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) St Francis Insurance Agency
309 Jackson Street
Monroe,LA71201
72-1435136 		Insurance LA St Francis
  		C Corp      
(2) Hospital Assistance Services
PO Box 4027-C
Lafayette,LA70502
72-1073486 		Healthcare LA LOURDES
  		C Corp 0 0 100.000 %
(3) Louise Insurance Company
PO Box 1051
    KY1-1102
CJ
Insurance CJ FMOL
  		C Corp      
(4) Monroe Health Services
PO Box 3187
Monroe,LA71210
72-1057820 		Healthcare LA Ambulatory
  		C Corp      
(5) Northeast LA Health Network
309 Jackson Street
Monroe,LA71201
72-1294587 		Healthcare LA Ambulatory
  		C Corp      
(6) CHARITABLE REMAINDER TRUST
 
 
Investment LA OLOL Foundation
  		Trust      
(7) FRANCISCAN HEALTH & WELLNESS SERVICES I
4200 ESSEN LANE
BATON ROUGE,LA70809
45-5492379 		HEALTHCARE LA FMOL
  		C CORP      
(8) FMOL HEALTH SYSTEM HOLDINGS INC
4200 ESSEN LANE
BATON ROUGE,LA70809
45-4405024 		INVESTMENT LA FMOL
  		C CORP      
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) PARK PLACE SURGERY CENTER LLC

 R 3,116,864 FMV
(2) HEART HOSPITAL OF LAFAYETTE LLC

 N 258,414 FMV
(3) HEART HOSPITAL OF LAFAYETTE LLC

 K 1,379,772 FMV
(4) LOURDES AFTER HOURS LLC

 I 60,466 FMV
(5) FMOL HEALTH SYSTEM

 Q 20,951,883 FMV
(6) OUR LADY OF THE LAKE HOSPITAL

 K 4,476,599 FMV
(7) LOURDES IMAGING DEVELOPMENT

 J 1,449,489 FMV
(8) LOURDES IMAGING CENTER LLC

 R 2,692,650 FMV
(9) HEART HOSPITAL OF LAFAYETTE LLC

 R 3,150,000 FMV
(10) LOURDES FOUNDATION INC

 R 618,174 FMV
(11) LOURDES IMAGING DEVELOPMENT

 R 351,034 FMV
(12) LOURDES IMAGING CENTER

 A 25,200 FMV
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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