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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
Christus Health Northern Louisiana
 
Doing Business As
SEE SCHEDULE O
 
Number and street (or P.O. box if mail is not delivered to street address)
One St Mary Place
Suite
Room/suite
City or town, state or country, and ZIP + 4
Shreveport, LA71101
D Employer identification number

72-0408982
E Telephone number

G Gross receipts $ 230,264,603
F Name and address of principal officer:
Stephen F Wright
One St Mary Place
Shreveport,LA71101
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.christusschumpert.org
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: 1913
M State of legal domicile: LA
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: SUPPORTING THE HEALTH CARE MINISTRIES OF THE SPONSORING CONGREGATIONS IN EXTENDING THE HEALING MINISTRY OF JESUS CHRIST IN CONFORMITY WITH THE ETHICAL AND MORAL TEACHINGS OF THE ROMAN CATHOLIC CHURCH.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 17
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 2,185
6 Total number of volunteers (estimate if necessary) ............. 6 465
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 184,438
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,076,175 735,933
9 Program service revenue (Part VIII, line 2g) ......... 230,080,641 225,173,337
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,072,555 25,375
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,355,763 3,151,769
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 236,585,134 229,086,414
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,847,385 3,520,362
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) 93,911,516 87,933,519
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet137,521    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 140,375,588 207,739,955
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 236,134,489 299,193,836
19 Revenue less expenses. Subtract line 18 from line 12....... 450,645 -70,107,422
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 210,706,894 140,720,054
21 Total liabilities (Part X, line 26)............. 91,032,864 90,105,382
22 Net assets or fund balances. Subtract line 21 from line 20..... 119,674,030 50,614,672
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 MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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: THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC, EDUCATIONAL AND RELIGIOUS PURPOSES OF ADVANCING, PROMOTING AND SUPPORTING THE HEALTH CARE MINISTRIES OF THE SPONSORING CONGREGATIONS WHICH OPERATE AND ARE CONTROLLED IN CONFORMITY WITH THE ETHICAL AND MORAL TEACHINGS OF THE ROMAN CATHOLIC CHURCH, AND PROMOTING EFFICIENT GOVERNANCE AND MANAGEMENT, COOPERATIVE PLANNING AND THE SHARING OF RESOURCES AMONG SUCH HEALTH CARE MINISTRIES. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, THE CORPORATION'S MISSION SHALL BE TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST, AND CONSISTENT THEREWITH, SHALL OPERATE ACCORDING TO THE DOCTRINES, RESOLUTIONS, DECREES AND ETHICAL PRINCIPLES OF THE SPONSORING CONGREGATIONS, AND THE ETHICAL AND RELIGIOUS DIRECTORS FOR CATHOLIC HEALTH CARE SERVICES AS PROMULGATED OR AMENDED FROM TIME TO TIME BY THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS. IT IS ALSO A PURPOSE OF THE CORPORATION TO AID, LEND FINANCIAL SUPPORT AND AS
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 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 $ 152,656,426 including grants of $ 0 ) (Revenue $ 109,302,469 )
COMMITMENT TO BENEFITING OUR COMMUNITIES - PATIENT CARE SERVICES CHRISTUS HEALTH NORTHERN LOUISIANA IS PART OF CHRISTUS HEALTH, FORMED IN 1999 TO STRENGTHEN THE 148-YEAR-OLD, FAITH-BASED HEALTH CARE MINISTRIES OF THE CONGREGATIONS OF THE SISTERS OF CHARITY OF THE INCARNATE WORD OF HOUSTON AND SAN ANTONIO. FOUNDED ON THE MISSION "TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST," CHRISTUS IS CHALLENGED TO REACH OUT TO, AND BEYOND, THE MORE THAN 60 COMMUNITIES WE SERVE TO HELP THOSE IN NEED. THE VISION OF CHRISTUS HEALTH AS A CATHOLIC, FAITH-BASED MINISTRY, IS TO BE A LEADER, A PARTNER AND AN ADVOCATE IN THE CREATION OF INNOVATIVE HEALTH AND WELLNESS SOLUTIONS THAT IMPROVE THE LIVES OF INDIVIDUALS AND OF LOCAL AND GLOBAL COMMUNITIES SO THAT ALL MAY EXPERIENCE GOD'S HEALING PRESENCE AND LOVE. CHRISTUS HEALTH NORTHERN LOUISIANA RESPONDS TO HEALTH CARE NEEDS THROUGH SERVICES PROVIDED AT CHRISTUS SCHUMPERT HEALTH SYSTEM, A 490-BED INTEGRATED HEALTH SYSTEM WITH A TERTIARY HOSPITAL LOCATED IN DOWNTOWN SHREVEPORT AND A GENERAL ACUTE CARE HOSPITAL IN SOUTHEAST SHREVEPORT. THE SYSTEM ALSO INCLUDES THE 80-BED CHRISTUS SCHUMPERT SUTTON CHILDREN'S MEDICAL CENTER FOR SPECIALIZED CHILDREN'S CARE. EACH OF THE FACILITIES OF CHRISTUS HEALTH NORTHERN LOUISIANA SHARES ONE OBJECTIVE -- TO LEAD THE WAY TO A HEALTHIER COMMUNITY. CHRISTUS HEALTH NORTHERN LOUISIANA IS LOCATED IN SHREVEPORT, LOUISIANA, WHICH IS IN THE NORTHWESTERN CORNER OF THE STATE. ITS SERVICE AREA EXTENDS TO NORTHEAST TEXAS AND SOUTHERN ARKANSAS, WHICH INCLUDES A POPULATION OF MORE THAN 1.1 MILLION INDIVIDUALS. IN FISCAL YEAR 2013, WE SERVED HUNDREDS OF THOUSANDS OF INDIVIDUALS IN VARIOUS WAYS INCLUDING 60,246 VISITS TO OUR EMERGENCY DEPARTMENTS, 2,942 INPATIENT SURGERY PROCEDURES, 5,512 OUTPATIENT SURGERY PROCEDURES, 11,472 PATIENTS WHO WERE ADMITTED TO OUR HOSPITALS FOR CARE AND 179,927 PATIENTS WHO RECEIVED OUTPATIENT CARE AT OUR FACILITIES. TOUCHING THE LIVES OF THE PEOPLE AROUND US IS WHAT MAKES CHRISTUS HEALTH NORTHERN LOUISIANA STAND APART. INTERACTING WITH COMMUNITY ORGANIZATIONS, INDIVIDUAL PATIENTS AND CLIENTS GIVES US A VISION FOR THE MEDICALLY NEEDY IN EACH OF THE COMMUNITIES WE SERVE. WHETHER IT IS THE LIFE OF A CHILD EXPECTING A FUTURE FILLED WITH MIRACLES, THE LIFE OF A MAN IN NEED OF A CRITICAL HEART SURGERY, OR THE LIFE OF A WOMAN ABOUT TO GIVE BIRTH TO HER FIRST CHILD, CHRISTUS HEALTH NORTHERN LOUISIANA'S HEALTH CARE SERVICES WORK TO PROVIDE THE BEST CARE POSSIBLE REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. BY COLLABORATING WITH COMMUNITY ORGANIZATIONS, CHURCHES, BUSINESSES, AND OTHER HEALTH CARE ORGANIZATIONS, CHRISTUS HEALTH NORTHERN LOUISIANA'S VARIOUS ENTITIES HAVE STRENGTHENED THEIR ROLES AS MAJOR PROVIDERS OF COMPREHENSIVE, ACCESSIBLE HEALTH CARE SERVICES. THESE PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS HAVE ASSISTED CHRISTUS HEALTH NORTHERN LOUISIANA TO FURTHER CARE FOR THOSE IN NEED. FURTHERMORE, INVESTMENT IN COMMUNITY SERVICES WOULD NOT BE POSSIBLE WITHOUT DEDICATED EMPLOYEES AND VOLUNTEERS. THEY HELP TO BUILD STRONG RELATIONSHIPS AMONG THE HOSPITALS, OTHER HEALTH CARE MINISTRIES AND THE COMMUNITIES, NURTURING CHRISTUS HEALTH'S MISSION TO MEET THE NEEDS AND MAKE A DIFFERENCE IN THE LIVES OF OTHERS. CHRISTUS ASSOCIATES WORK BOTH INSIDE AND OUTSIDE THE WALLS OF OUR HEALTH CARE FACILITIES AND ARE COMMITTED TO HELPING OUR COMMUNITIES MAINTAIN GOOD HEALTH. UNDERSTANDING THE NEED TO PROVIDE ACCESS TO HEALTH CARE TO AS MANY PEOPLE AS POSSIBLE, CHRISTUS HEALTH PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS, INCLUDING MEDICAID, MEDICARE, CHAMPUS, TRICARE AND OTHERS. IN ADDITION, CHRISTUS HEALTH NORTHERN LOUISIANA OFFERS SPECIFIC PROGRAMS WHICH PROVIDE DISCOUNT SERVICES TO THOSE IN NEED WHO DO NOT HAVE MEDICAL INSURANCE OR WHO DO NOT PARTICIPATE IN GOVERNMENT-SPONSORED PROGRAMS. CHRISTUS HEALTH NORTHERN LOUISIANA ALSO CONTRACTS WITH A COMPANY TO SCREEN INDIVIDUALS FOR GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICAID AND LACHIP. CHRISTUS HEALTH NORTHERN LOUISIANA PROVIDES A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES TO THE PEOPLE FROM THE COMMUNITIES IT SERVES. IT CONDUCTS ITS ACTIVITIES AND SERVES ITS HEALTH CARE PURPOSE WITHOUT REGARD TO RACE, COLOR, CREED, RELIGION, GENDER, ORIENTATION, DISABILITY, AGE OR NATIONAL ORIGIN. CHRISTUS HEALTH NORTHERN LOUISIANA OFFERS A BROAD SPECTRUM OF ADULT AND PEDIATRIC MEDICAL AND SURGICAL CARE SERVICES WITH THE LATEST TECHNOLOGY. THESE SERVICES INCLUDE COMPREHENSIVE CANCER TREATMENT, PEDIATRIC SERVICES INCLUDING INTENSIVE CARE, NEONATAL INTENSIVE CARE, PEDIATRIC INTENSIVE CARE, INPATIENT AND OUTPATIENT DIAGNOSTIC AND SURGERY SERVICES, WELLNESS CENTERS, AND AMBULANCE TRANSPORTATION SERVICES SERVING RURAL COMMUNITIES AROUND SHREVEPORT. BOTH HOSPITALS OF CHRISTUS HEALTH NORTHERN LOUISIANA PROVIDE A 24-HOUR EMERGENCY ROOM THAT SERVES ALL THOSE IN NEED OF EMERGENT CARE, REGARDLESS OF THEIR ABILITY TO PAY. CHRISTUS HEALTH NORTHERN LOUISIANA ALSO SUPPORTS MANY LOCAL COMMUNITY HEALTH SERVICES, INCLUDING THE CARA CENTER FOR SUSPECTED VICTIMS OF CHILD ABUSE AND/OR NEGLECT AND VARIOUS HEALTH SPECIALTY PROGRAMS IN COLLABORATION WITH THE LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER, SUCH AS GRADUATE MEDICAL EDUCATION AND ALLIED HEALTH EDUCATION. CHRISTUS HEALTH NORTHERN LOUISIANA OPERATES THREE SCHOOL-BASED HEALTH CENTERS. THE FIRST CENTER OPENED AT LINWOOD PUBLIC CHARTER SCHOOL IN 1996; THE SECOND CENTER OPENED AT ATKINS ELEMENTARY IN AUGUST OF 1998; AND THE THIRD FACILITY BEGAN OPERATIONS IN SEPTEMBER, 2007 AT WOODLAWN HIGH SCHOOL. SINCE THEIR INCEPTION, THESE CENTERS HAVE HAD APPROXIMATELY 91,000 STUDENT VISITS. SERVICES OFFERED INCLUDE TREATMENT FOR MINOR ILLNESSES/INJURIES; ROUTINE PHYSICAL AND/OR ATHLETIC EXAMINATIONS; IMMUNIZATIONS; INCREASED ACCESS TO PRIMARY CARE; SPECIAL AWARENESS OF STD AND TEEN PREGNANCY FOR HIGH SCHOOL STUDENTS; OBESITY REDUCTION; SCREENING TESTS FOR HEARING, VISION, SCOLIOSIS, ETC.; REFERRAL AND FOLLOW-UP FOR ACUTE AND CHRONIC ILLNESSES (EX. DIABETES, ASTHMA); AND MENTAL HEALTH SERVICES, SUCH AS CRISIS, INDIVIDUAL, FAMILY AND/OR GROUP COUNSELING. THE OPERATION OF THE SCHOOL-BASED HEALTH CENTERS IS ENHANCED BY COLLABORATIVE PARTNERSHIPS WITH THE NORTHWESTERN STATE UNIVERSITY SCHOOL OF NURSING AND THE PEDIATRIC MEDICAL RESIDENCY PROGRAM AT LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER. AS A NOT-FOR-PROFIT ORGANIZATION AND AS PART OF CHRISTUS HEALTH, A REGIONAL GOVERNING BOARD COMPRISED LARGELY OF INDEPENDENT COMMUNITY MEMBERS REPRESENTING THE AREA WE SERVE GUIDES CHRISTUS HEALTH NORTHERN LOUISIANA. CHRISTUS HEALTH NORTHERN LOUISIANA IS PRIVILEGED TO HAVE AN OPEN MEDICAL STAFF COMPRISED OF QUALIFIED PHYSICIANS WHO PROVIDE CARE WITHIN OUR LOCAL COMMUNITIES. ALL QUALIFIED PHYSICIANS ARE GRANTED PRIVILEGES TO SERVE WITHIN CHRISTUS SCHUMPERT HOSPITALS AFTER UNDERGOING A THOROUGH AND COMPREHENSIVE CREDENTIALING PROCESS.
4b (Code:   ) (Expenses $ 36,909,882 including grants of $ 0 ) (Revenue $ 30,922,400 )
COMMUNITY BENEFIT REPORTING - CHARITY CARE AND MEDICAID CHRISTUS ADHERES TO THE CATHOLIC HEALTH ASSOCIATION'S GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT (2012), AND COMPLIES WITH THE STATE OF TEXAS REQUIREMENTS FOR REPORTING. COMMUNITY BENEFIT, REPORTED AS UNPAID COSTS, INCLUDES BOTH CHARITY CARE AND COMMUNITY SERVICES. TO THE LIMITS OF ITS RESOURCES, CHRISTUS HEALTH IS AN INSTITUTION OF PURELY PUBLIC CHARITY; THUS, THE MOST TANGIBLE EXPRESSION OF CHRISTUS HEALTH'S CHARITABLE PURPOSE IS THE PROVISION OF HEALTH CARE SERVICES TO THOSE PERSONS WHO ARE UNABLE TO PAY. CHARITY CARE FALLS INTO TWO CATEGORIES: CHARITY CARE AND UNPAID GOVERNMENT INDIGENT CARE. IN KEEPING WITH ITS MISSION, VALUES AND VISION, CHRISTUS HEALTH PROVIDES CHARITY CARE SERVICES IN A MANNER THAT RESPECTS THE DIGNITY OF THE PATIENTS AND THEIR FAMILIES. CHARITY CARE IS PROVIDED WITHOUT CHARGE OR AT A CHARGE THAT IS LESS THAN THE USUAL CHARGE FOR SUCH SERVICES. THE DETERMINATION AS TO THE AMOUNT TO BE CHARGED, IF ANY, IS MADE ACCORDING TO A PATIENT'S ABILITY TO PAY AS DETERMINED BY THE ESTABLISHED ELIGIBILITY CRITERIA. FOR UNINSURED PATIENTS WHOSE ECONOMIC CIRCUMSTANCES PLACE THEM AT OR UNDER 200 PERCENT OF THE FEDERAL POVERTY LEVEL (FPL), SERVICES ARE PROVIDED WITHOUT ANY EXPECTATION OF PAYMENT. UNINSURED PATIENTS WHOSE ECONOMIC CIRCUMSTANCES PLACE THEM BETWEEN 200 AND 400 PERCENT OF FPL ARE CHARGED BASED ON A SLIDING SCALE, AND THOSE ABOVE 400 PERCENT RECEIVE DISCOUNTS BASED ON THE UNINSURED FEE SCHEDULE. NO PATIENT IS REFUSED NECESSARY MEDICAL CARE DUE TO HIS OR HER INABILITY TO PAY. CHRISTUS HEALTH IS AN ACTIVE PARTICIPANT IN THE STATES OF TEXAS AND LOUISIANA MEDICAID PROGRAMS. THOSE PROGRAMS SEEK TO PROVIDE PAYMENT FOR HEALTH CARE SERVICES TO INDIVIDUALS WHO MEET CERTAIN FINANCIAL AND OTHER REQUIREMENTS. FINANCIAL REQUIREMENTS INCLUDE EVALUATION OF BOTH ASSETS AND INCOME.
4c (Code:   ) (Expenses $ 90,911,067 including grants of $ 0 ) (Revenue $ 84,948,468 )
OTHER GOVERNMENT SPONSORED PROGRAMS IN ADDITION TO THE PROVISION OF CHARITY CARE AND OTHER COMMUNITY SERVICES, CHRISTUS HEALTH PROVIDES SERVICES TO PERSONS COVERED UNDER GOVERNMENT-SPONSORED PROGRAMS, INCLUDING MEDICARE AND TRICARE. THE UNREIMBURSED COSTS OF THESE SERVICES ARE NOT INCLUDED IN REPORTS PREPARED FOLLOWING CATHOLIC HEALTH ASSOCIATION GUIDELINES. CHRISTUS HEALTH PROVIDES SERVICES TO PERSONS COVERED UNDER THE FEDERAL MEDICARE PROGRAM, AND IN FACT, THIS IS THE LARGEST SINGLE PAYOR CLASSIFICATION OF PATIENTS SERVED BY THIS HEALTH SYSTEM. THE PAYMENT RATE FOR INPATIENT SERVICES IS ON A PER-CASE RATE, CALCULATED BASED ON THE DIAGNOSTIC-RELATED GROUP (DRG) INTO WHICH THE PATIENT IS CATEGORIZED. OUTPATIENT SERVICES ARE REIMBURSED BY MEDICARE BASED ON ITS FEE SCHEDULE.
4d Other program services (Describe in Schedule O.)
(Expenses $ 1,557,627 including grants of $ 3,520,362 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet282,035,002
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? 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 IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
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
Click to see attachment............................
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 for escrow or custodial account liability; 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, line 10?
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 VIIClick 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 VIIIClick to see attachment.......
11c
 
No
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 IXClick 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 XClick 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 XClick 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 and XII 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 and XII 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, Parts I and IV.........
14b
 
No
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 United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
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 United States? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions)....
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 hospital facilities? 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 statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
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, line 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 lines 24b through 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, highest 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 direct or indirect 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
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part 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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
250
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
2,185
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, securities account, or other financial 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 as charitable contributions?...
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.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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 .....................
1a
18
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
17
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 this 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
Yes
 
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
Yes
 
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
 
No
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
 
 
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:
MediumBulletSCOTT MERRYMAN3330 MASONIC DRIVEALEXANDRIALA71301 (318) 466-6000
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(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) Gregory J Barro........................................................................
Director
1.0
.......................0.0
X                
(2) Mark F Brown MD........................................................................
Director
1.0
.......................0.0
X                
(3) Charles C Campbell........................................................................
Director
1.0
.......................0.0
X                
(4) Philip A Cole MD........................................................................
Director
1.0
.......................0.0
X                
(5) John C Crosby........................................................................
Director
1.0
.......................0.0
X                
(6) Stephanie D Edmiston........................................................................
Director
1.0
.......................0.0
X                
(7) Jerry M France........................................................................
Director (Term 12/31/12)
1.0
.......................0.0
X                
(8) William H Gallmann MD........................................................................
Chairperson
1.0
.......................0.0
X   X            
(9) John Mark Garrett........................................................................
Director (Effective 01/01/13)
1.0
.......................0.0
X                
(10) Raymond A Hicks........................................................................
Director
1.0
.......................0.0
X                
(11) Sister Rosita Hyland........................................................................
Director
1.0
.......................0.0
X                
(12) Bernard S Johnson........................................................................
Director
1.0
.......................0.0
X                
(13) Walter R Lamb........................................................................
Director
1.0
.......................0.0
X                
(14) Thomas E Tem McElroy........................................................................
Director
1.0
.......................0.0
X                
(15) Sister Miriam T Miller........................................................................
Director
1.0
.......................0.0
X                
(16) Suzanne H Stinson........................................................................
Director (Effective 01/01/13)
1.0
.......................0.0
X                
(17) Arthur L Walker........................................................................
Director (Term 12/31/12)
1.0
.......................0.0
X                
Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line)
(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) Willie C White III........................................................................
Director (Effective 01/01/13)
1.0
.......................0.0
X                
(19) Susan A Wood........................................................................
Director
1.0
.......................0.0
X                
(20) Stephen F Wright........................................................................
President/CEO
16.0
.......................24.0
X   X       373,332 559,998 162,316
(21) Scott Merryman........................................................................
CFO
16.0
.......................24.0
    X       191,906 287,859 82,855
(22) Kim M Kelsch........................................................................
Secretary
40.0
.......................0.0
    X       63,786 0 6,165
(23) William W Lunn MD........................................................................
Regional COO & Ministry Admin
1.0
.......................0.0
      X     589,504 0 124,114
(24) Charlotte A Knoll........................................................................
Chief Nurse Executive
40.0
.......................0.0
      X     217,573 0 55,264
(25) Diedre Barfield MD........................................................................
CHIEF MEDICAL OFFICER
40.0
.......................0.0
      X     373,753 0 82,624
(26) Nancy R Hellyer........................................................................
Chief Administrative Officer
16.0
.......................24.0
      X     157,892 236,836 99,881
(27) CORINNE R FRANCIS........................................................................
VP, MISSION FOR CHRISTUS HLTH
16.0
.......................24.0
      X     65,480 98,221 24,980
(28) JOHN R GILCHRIST JR........................................................................
CHIEF PHILANTHROPY OFFICER
16.0
.......................24.0
      X     71,643 107,465 9,055
(29) SUSAN V TUDOR........................................................................
REG VP, STRATEGY, BUS. DEVELOP
16.0
.......................24.0
      X     103,792 155,690 55,342
(30) WENDY WHITE........................................................................
VP, HUMAN RESOURCES
16.0
.......................24.0
      X     108,139 162,208 49,570
(31) DOROTHY J TRAVIS........................................................................
VP FINANCE
40.0
.......................0.0
      X     78,664 0 8,976
(32) PAUL A FOSTER........................................................................
VP FINANCE
40.0
.......................0.0
      X     50,210 0 3,809
(33) John R Stephenson........................................................................
CRNA
40.0
.......................0.0
        X   202,472 0 11,219
(34) Curtis Ardoin........................................................................
CRNA
40.0
.......................0.0
        X   200,551 0 12,930
(35) David J Doucet........................................................................
CRNA
40.0
.......................0.0
        X   196,222 0 15,534
(36) William H Vander Wall........................................................................
Medical Physicist
40.0
.......................0.0
        X   193,780 0 16,989
(37) PETER A CERNIGLIARO........................................................................
CRNA
40.0
.......................0.0
        X   191,957 0 2,179
(38) Jason Rounds........................................................................
Chief Administrator
0.0
.......................40.0
          X 0 335,930 68,792
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,430,656 1,944,207 892,594
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet43
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
Yes
 
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
Cardinal Health, 21377 Network PlaceCHICAGOIL60673 pharmacy services 15,193,630
Omega Diagnostics LLC, 2915 Missouri AveSHREVEPORTLA71109 LABORATORY SERVICES 8,616,567
GE Medical Systems Information, 5517 Collections Center DriveCHICAGOIL60693 MED EQUIP SVCS 2,023,197
LSU Health Sciences Center Shrevepo, PO BOX 33932SHREVEPORTLA71130 PHYSICIAN SERVICES 2,003,055
Lifeshare Blood Centers, PO Box 65270SHREVEPORTLA71136 BLOOD PRODUCTS/SVCS 1,993,316
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet47
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 23,037
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 204,925
e Government grants (contributions)1e 472,611
f All other contributions, gifts, grants, and
similar amounts not included above
1f
35,360
g Noncash contributions included in lines
1a-1f:$
 
h Total. Add lines 1a-1f.......MediumBullet 735,933
 Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 621990 217,279,749 217,279,749    
b RENT RELATED TO EXEMPT FUNCTION 531120 4,915,612 4,915,612    
c WELLNESS CENTER 713940 2,096,610 2,096,610    
d PHARMACY 621990 865,201 774,275 90,926  
e PHYSICIAN NOTE INTEREST INCOME 900099 14,475 14,475    
f All other program service revenue . 1,690 1,690    
g Total. Add lines 2a–2f........MediumBullet 225,173,337
 Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 62,838     62,838
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 14,408     14,408
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   1,140,726
b Less: cost or other basis and sales expenses   1,178,189
c Gain or (loss)   -37,463
d Net gain or (loss)..........MediumBullet -37,463     -37,463
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 DIETARY SERVICE REVENUE 722320 1,432,008   93,512 1,338,496
b RADIOLOGY NONPATIENT BILLING REVENUE 900099 910,833     910,833
c OTHER OPERATING REVENUE 900099 546,009     546,009
d All other revenue .... 248,511     248,511
e Total. Add lines 11a–11d ...... MediumBullet 3,137,361
12 Total revenue. See Instructions......MediumBullet 229,086,414 225,082,411 184,438 3,083,632
Form 990 (2012)
Form 990 (2012)
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).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 3,520,362 3,520,362
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 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 2,866,369 2,632,932 229,424 4,013
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 67,093,900 61,627,102 5,370,225 96,573
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 4,562,876 4,562,876    
9 Other employee benefits ....... 8,837,508 8,203,835 633,673  
10 Payroll taxes ........... 4,572,866 4,293,931 263,319 15,616
11 Fees for services (non-employees):        
a Management ...... 111,858 110,138 1,720  
b Legal ......... 705,078 9,744 695,334  
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 15,345,152 11,493,269 3,846,831 5,052
12 Advertising and promotion .... 704,849 682 702,903 1,264
13 Office expenses ....... 23,771,148 19,002,896 4,754,578 13,674
14 Information technology ...... 9,493,701 9,493,701    
15 Royalties .. 0      
16 Occupancy ........... 4,895,150 4,755,337 139,813  
17 Travel ............ 98,384 52,010 45,619 755
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 1,222,283 1,186,342 35,941  
20 Interest ........... 5,301,440 5,301,440    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 92,293,304 92,293,304    
23 Insurance .............. 2,751,634 2,751,634    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 38,213,823 38,151,950 61,873  
b PROVISION FOR UNCOLLECTIBLE AC 10,441,959 10,441,959    
c SALES & USE TAX 2,001,760 2,001,760    
d INCOME TAX 4,962 4,962    
e All other expenses 383,470 142,836 240,060 574
25 Total functional expenses. Add lines 1 through 24e 299,193,836 282,035,002 17,021,313 137,521
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 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 16,537,647 1 30,648,539
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 29,065,033 4 30,052,734
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 472,414 7 569,504
8 Inventories for sale or use .............. 9,697,876 8 7,554,056
9 Prepaid expenses and deferred charges .......... 1,554,171 9 2,002,282
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 493,225,741
b Less: accumulated depreciation ..... 10b 424,317,295 152,449,467 10c 68,908,447
11 Investments—publicly traded securities .......... 391,872 11 412,666
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 14,524 13 14,524
14 Intangible assets ............... 417,701 14 154,320
15 Other assets. See Part IV, line 11 ........... 106,189 15 402,983
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 210,706,894 16 140,720,054
Liabilities 17 Accounts payable and accrued expenses ......... 12,269,447 17 14,872,306
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 413,786 19 370,384
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other 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.................... 78,349,631 25 74,862,692
26 Total liabilities. Add lines 17 through 25......... 91,032,864 26 90,105,382
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 119,203,189 27 50,095,208
28 Temporarily restricted net assets ........... 470,841 28 519,464
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 119,674,030 33 50,614,672
34 Total liabilities and net assets/fund balances ........ 210,706,894 34 140,720,054
Form 990 (2012)
Form 990 (2012)
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
229,086,414
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
299,193,836
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-70,107,422
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
119,674,030
5
Net unrealized gains (losses) on investments ...............
5
20,794
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
1,027,270
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
50,614,672
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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
Yes
 
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
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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
2012
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
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) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in)
(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e))
         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))
         
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
702
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
702
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
FORM 990, SCHEDULE C, PART II-B LOBBYING DESCRIPTION HEALTHCARE POLICY IS CRITICAL TO ALL AMERICANS AND CHRISTUS HEALTH NORTHERN LOUISIANA BELIEVES THAT HEALTH CARE PROVIDERS MUST PARTICIPATE IN FORMING HEALTH CARE POLICY BY INTERACTING WITH NATIONAL, STATE AND LOCAL REPRESENTATIVES AND THEIR STAFF MEMBERS TO HELP THEM BETTER UNDERSTAND THE COMPLEXITIES AND RAMIFICATIONS OF KEY HEALTH CARE POLICIES.
Form 990, Schedule C, Part II-b, line 1g   DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY CHRISTUS HEALTH NORTHERN LOUISIANA HAD DIRECT CONTACT WITH THE U.S. HOUSE OF REPRESENTATIVES REGARDING THE IMPORTANCE OF MAINTAINING FINANCIALLY SOUND MEDICARE AND MEDICAID PROGRAMS AND THE NUMBER OF PERSONS POTENTIALLY IMPACTED BY THE PROPOSED REDUCTIONS IN GOVERNMENT HEALTH PROGRAMS. CHRISTUS HEALTH NORTHERN LOUISIANA HAD DIRECT CONTACT THROUGH TWO MEETINGS WITH VARIOUS MEMBERS OF THE LOUISIANA STATE LEGISLATURE TO SUPPORT LOUISIANA HB1 AND IN AN EFFORT TO RECEIVE BETTER FUNDING FOR HEALTH CARE AND TO PREVENT FURTHER REDUCTIONS IN FUNDING FOR HEALTH CARE. THE REPORTED EXPENSES ASSOCIATED WITH THESE ACTIVITIES INCLUDE STAFF COMPENSATION AND RELATED ALLOCABLE OVERHEAD. Met with Governor Jindal and Senator Gerald Long as well as attended LHA Legislative reception. Huey P Long Hospital Privitization SCR25 was discussed. Stephen also met with Sen. David Vitter, Rep. Charles Boustany, Rep. John Fleming, Rep. Bill Cassidy and Chris Hodgson, LA to Rep. Steve Scalice to discuss the Rural Hospital Act of 2013 (HR1787/S842) Medical Dependent Home and Low Volume Hospital Payment Adjustment Issue.
Schedule C (Form 990 or 990EZ) 2012

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
2012
Open to Public Inspection
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (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 current year end balance (line 1g, column (a)) 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 XIII 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 .................   13,545,223 13,545,223
b Buildings ................   274,866,838 235,685,848 39,180,990
c Leasehold improvements ............   5,431,300 4,906,197 525,103
d Equipment ................   196,110,407 182,118,655 13,991,752
e Other .................   3,271,973 1,606,595 1,665,378
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 68,908,446
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
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
DUE TO CHRISTUS HEALTH BOND FUND 68,288,940
DUE TO RELATED ORGANIZATIONS 6,411,072
SALES TAX PAYABLE 162,680






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 74,862,692
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI 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 XIII.) ............ 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 XIII.) ........... 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 XII 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 XIII.) ............ 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 XIII.) ............ 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 XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
CASH - NON-BEARING INTEREST FORM 990, PART X, LINE 1 CHRISTUS HEALTH SYSTEM MAINTAINS A CENTRALIZED CASH MANAGEMENT SYSTEM. THIS CASH MANAGEMENT SYSTEM (CMS) INCLUDES A CONCENTRATION ACCOUNT WHEREIN DEPOSITS AND DISBURSEMENTS FOR RELATED CHRISTUS EXEMPT ORGANIZATIONS FLOW THROUGH THIS ACCOUNT AND OVER TO THE MANAGED INVESTMENT ACCOUNTS. EACH PARTICIPATING ORGANIZATION REPORTS A BALANCE IN THE CMS REFLECTIVE OF ITS CUMULATIVE CASH ACTIVITY. CASH BALANCES FOR EACH CHRISTUS ORGANIZATION ARE REPORTED ON FORM 990 IN ACCORDANCE WITH FINANCIAL STATEMENT REPORTING. CMS OWNERSHIP IS MAINTAINED BY CHRISTUS HEALTH (EIN 76-0590551) AND ALL ASSOCIATED INVESTMENT INCOME IS PROPERLY REPORTED ON THE CHRISTUS HEALTH FORM 990.
UNCERTAIN TAX POSITIONS UNDER ASC 740 FORM 990, SCHEDULE D, PART X, LINE 2 PER FOOTNOTE 3 IN THE CONSOLIDATED FINANCIAL STATEMENTS, THERE ARE NO MATERIAL UNRECORDED TAX LIABILITIES AS OF JUNE 30, 2013 AND 2012.
Schedule D (Form 990) 2012

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
2012
Open to Public Inspection
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
Part I
Financial Assistance 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) as a factor in determining 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 as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining 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, as a factor in determining 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) ..
    4,971,287   4,971,287 1.720 %
b Medicaid (from Worksheet 3,
column a) ....
    51,712,798 30,922,400 20,790,398 7.200 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
           
d Total Financial Assistance
and Means-Tested
Government Programs .
    56,684,085 30,922,400 25,761,685 8.920 %
Other Benefits
18 15,399 362,794   362,794 0.130 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
4 233 137,718 53,184 84,534 0.030 %
g Subsidized health services
(from Worksheet 6) ..
           
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
15 277,496 1,074,337   1,074,337 0.370 %
j Total. Other Benefits .. 37 293,128 1,574,849 53,184 1,521,665 0.530 %
k Total. Add lines 7d and 7j . 37 293,128 58,258,934 30,975,584 27,283,350 9.450 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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 1 3,420,030 3,987   3,987  
3 Community support 1 10,065 2,443   2,443  
4 Environmental improvements            
5 Leadership development and training for community members 1 800 8,793   8,793  
6 Coalition building            
7 Community health improvement advocacy 1   20,536   20,536 0.010 %
8 Workforce development 1 100 203   203  
9 Other            
10 Total 5 3,430,995 35,962   35,962 0.010 %
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. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
10,441,959
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
395,750
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
60,186,875
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
57,097,251
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
3,089,624
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(owned 10% or more by officers, directors, trustees, key employees, and physicians—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 %
1Omega Diagnostics
 
Pathology Services 40.000 %   46.670 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?2
Name, address, and primary website address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 CHRISTUS SCHUMPERT HEALTH SYSTEM
ONE SAINT MARY PLACE
SHREVEPORT,LA71101
X X X       X      
2 CHRISTUS SCHUMPERT HIGHLAND
1453 EAST BERT KOUNS LOOP
SHREVEPORT,LA71105
X X         X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
CHRISTUS SCHUMPERT HEALTH SYSTEM
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 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.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15   No
16 Check all of the following 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
b
c
d
e
17 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
CHRISTUS SCHUMPERT HIGHLAND
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 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.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15   No
16 Check all of the following 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
b
c
d
e
17 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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?2
Name and address Type of Facility (describe)
1 Omega Diagnostics LLC
PO Box 37589
Shreveport,LA71133
Pathology Clinic
2 Bossier Specialty Hospital LLC
PO Box 53045
Shreveport,LA71135
Short Term Acute Care
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
Budgeted Charity Care Part I, Line 5 The organization budgets charity care for internal financial review purposes only. The provision of charity care is not limited to amounts established for budgetary purposes.
Annual Community Benefit Report Part I, Line 6a A REPORT OF COMMUNITY BENEFIT IS INCLUDED IN A WRITTEN ANNUAL REPORT FOR CHRISTUS HEALTH, THE ORGANIZATION'S PARENT COMPANY. CHRISTUS HEALTH IS AN INTERNATIONAL, CATHOLIC, FAITH BASED, NONPROFIT HEALTH SYSTEM FORMED IN 1999 WITH A MISSION "TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST." THE ANNUAL COMMUNITY BENEFIT REPORT SUMMARIZES ACTIVITIES AND PROGRAMS CONDUCTED DURING THE PAST YEAR TO IMPROVE HEALTH INCLUDING PROACTIVE COMMUNITY HEALTH SERVICES. HOWEVER, THE ANNUAL REPORT IS ONLY A SNAPSHOT OF HOW THE ORGANIZATION DISTINGUISHES ITSELF IN ITS VISION TO BE A LEADER, A PARTNER, AND AN ADVOCATE IN CREATING INNOVATIVE HEALTH AND WELLNESS SOLUTIONS THAT IMPROVE THE LIVES OF INDIVIDUALS AND COMMUNITIES.
Percent of Total Expense Part I, Line 7, column (f) TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) IS $299,193,836. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS $10,441,959. THIS LEAVES A TOTAL EXPENSE OF $288,751,877 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). Description of Financial Assistance and Other Community Benefits as Percentage of Total Costs Part I, Line 7, Column (f) The organization's total community benefit expense as reported on Part I, Line 7k, Column (c) as a percentage of total expense is 20.18%, which exceeds the amount reported on Part I, Line 7k Column (f) which is computed using net community benefit expense.
CASH AND IN-KIND CONTRIBUTIONS Part I, Line 7I CHRISTUS HEALTH NOTHERN LOUISIANA MADE OVER $1,074,000 IN CASH AND IN KIND CONTRIBUTIONS DURING FISCAL YEAR 2013. THE AFOREMENTIONED AMOUNT IS DETERMINED IN ACCORDANCE WITH REPORTING RULES FOR SCHEDULE H, WORKSHEET 8. AS SUCH THIS AMOUNT DIFFERS FROM GRANTS REPORTED AT FORM 990, SCHEDULE I, GRANTS AND OTHER ASSISTANCE TO ORGANIZATIONS, GOVERNMENTS, AND INDIVIDUALS AND PART IX, LINES 1 THROUGH 3 GRANTS AND OTHER ASSISTANCE. CHRISTUS HEALTH ESTABLISHED THE CHRISTUS FUND, A GRANT FUND TO PROVIDE RESOURCES TO NOT FOR PROFIT AGENCIES AND GROUPS WHOSE VISION, MISSION, AND GOALS ARE CONSISTENT WITH CHRISTUS HEALTH'S MISSION, VALUES AND PHILOSOPHY OF A HEALTHY COMMUNITY. CHRISTUS FUND GRANTS TOTALING $61,560 WERE DONATED BY CHRISTUS HEALTH TO NONPROFIT ORGANIZATIONS LOCATED IN THE COMMUNITY SERVED BY CHRISTUS HEALTH NORTHERN LOUISIANA. THE GRANT DOLLARS WERE USED BY CHRISTUS HEALTH NORTHERN LOUISIANA TO SUPPORT PROGRAMS THAT PROMOTE THE HEALTH OF THE COMMUNITY THAT CHRISTUS HEALTH NORTHERN LOUISIANA SERVES, SUCH AS THE PROVISION OF SUPPORT TO A FREE CLINIC AND PHARMACY THAT PROVIDES HEALTHCARE SERVICES TO THE UNINSURED. ALL GRANTS MADE TO OUTSIDE ORGANIZATIONS THROUGH THE CHRISTUS FUND ARE MADE TO NONPROFIT ORGANIZATIONS THAT USE THE GRANT MONEY TO SUPPORT THE HEALTH OF THE COMMUNITY. THESE GRANT DOLLARS ARE NOT INCLUDED ON SCHEDULE H, PART I, LINE 7(I). INDIGENT FUNDING EXPENSE OF $1,386,000 IS INCLUDED IN SCHEDULE H, PART I, LINE 7(I).
Part I, Line 7   Line 7a: Ratio of patient care cost to charges based on Schedule H, worksheet 2 Line 7b: Ratio of patient care cost to charges based on Schedule H, worksheet 2 Line 7e: Actual expenses less any direct offsetting revenue Line 7f: Actual expenses less any direct offsetting revenue Line 7i: Actual expense of the contributions
Community Building Activities Part II AMOUNTS REPORTED AT SCHEDULE H, PART II, COMMUNITY BUILDING ACTIVITIES, INCLUDE PHYSICAL IMPROVEMENTS AND HOUSING, ECONOMIC DEVELOPMENT, COMMUNITY SUPPORT, LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, COMMUNITY HEALTH IMPROVEMENT ADVOCACY, AND WORKFORCE DEVELOPMENT. THE CHRISTUS HEALTH BOARD OF DIRECTORS APPROVED FUNDING OF A COMMUNITY DIRECT INVESTMENT (CDI) LOAN PROGRAM TO ENSURE THAT THE WORK OF SOCIAL ACCOUNTABILITY AND MORAL AND ETHICAL STEWARDSHIP CONTINUES IN SPITE OF CHALLENGING FISCAL CONDITIONS FACED BY LOCAL OPERATING ENTITIES. THE PURPOSE OF THE CDI PROGRAM IS TO SUPPORT COMMUNITY DRIVEN INITIATIVES, PRIMARILY AFFORDABLE HOUSING AND ECONOMIC DEVELOPMENT BY PROVIDING FINANCING AT BELOW-MARKET INTEREST RATES TO NOT FOR PROFIT ORGANIZATIONS AT TERMS NOT EXCEEDING MORE THAN FIVE YEARS. REPORTED AT SCHEDULE H, PART II, LINE 3 "COMMUNITY SUPPORT" IS THE INCOME EARNED AT THE MARKET RATE LESS OUR LOAN RATE (FOREGONE INCOME), WHICH IS CONSIDERED A COMMUNITY BENEFIT FOR REPORTING PURPOSES. THOUGH OUTSTANDING LOAN BALANCES VARY THROUGHOUT THE YEAR, THE OUTSTANDING LOAN BALANCE AT THE END OF FISCAL YEAR 2013 WAS $1,631,224. THE FOREGONE INTEREST FOR CHRISTUS HEALTH NORTHERN LOUISIANA IN FISCAL YEAR ENDING JUNE 30, 2013 WAS $44,856. THE CHRISTUS HEALTH ADVOCACY DEPARTMENT IS WORKING IN PARTNERSHIP WITH LOCAL, STATE AND FEDERAL POLICY MAKERS TO ENSURE ACTIVITIES AND PROGRAMS ARE IN PLACE THAT WILL ENHANCE PUBLIC HEALTH AND ADVANCE GENERAL KNOWLEDGE. ADVOCACY EFFORTS FOCUS ON THE NEEDS OF CHILDREN, INCLUDING SCHOOL-BASED HEALTH CENTERS AND SENIORS, AS WELL AS OTHER VULNERABLE POPULATIONS. THE EFFORTS ARE PROMOTING PROGRAMS SUCH AS HEALTH SCREENINGS AND EDUCATION FOR EARLY DETECTION OF CANCER AND HEART DISEASE, DIABETES AND IMMUNIZATIONS.
Bad Debt Reporting in Accordance with HFMA Statement 15 Part III, Section A, Line 1 CHRISTUS Health follows in principle Healthcare Financial Management Association Statement No. 15. The system has adopted an uncompensated care policy where revenue from services provided to the uninsured is recognized at the time of payment, rather than at the time of service. This policy is the result of a lack of reasonable assurance of collection for services provided to the uninsured due to the system's historically low collection rate. Management has estimated that the difference between recording revenue from the uninsured on a cash basis, rather than the accrual basis, is immaterial. Accordingly, all accounts receivable from the uninsured have been fully reserved in the allowance for uncompensated care.
Methodology Used in Determining Bad Debt Part III, Section A, Line 2 The organization's total bad debt expense (total of all hospital facilities) is in accordance with the organization's financial statements, which is computed as bad debt net of contractual allowance, payments received and recoveries of bad debt previously written off.
Estimate of Bad Debt Expense Attributable to Patients Eligible Under Organization's Charity Care Policy Part III, Section A, Line 3 The filing organization recognizes that some patients are unable or unwilling to seek financial assistance due to barriers such as educational level, literacy, documentation requirements, or being intimidated by the application process. In order to estimate the amount of the organization's bad debt expense attributable to patients who may be eligible for financial assistance but have not submitted an application, the organization engaged PARO Decision Support, LLC. PARO Charity Score is designed to identify patients that likely qualify for financial assistance based on a predictive model and other financial and asset estimates for the patient derived from public record sources. In order to assess the bad debt accounts that would likely qualify for charity care, the following criteria were established based on an analysis of historical data of Christus Health and its related organizations: 1.PARO Score of less than or equal to 586, which is a predictor defining the likely socioeconomic conditions for the patient; 2.Estimated Federal Poverty Level of less than or equal to 226%, which is based on estimated household size and household estimated income; and 3.Third party data available on patient accounts which indicate that the patient is not a homeowner or a probable homeowner. For the fiscal year ending June 30, 2011, the organization reported that 30% of bad debt expenses were attributable to patients who may have been eligible for financial assistance but were not responsive to the application process existing at that time. This figure was based on the PARO analysis and estimates of patients' financial needs that examined whether patients were characteristic of others who historically qualified for assistance under the traditional application process. The presumptive charity care analysis performed for the prior fiscal year determined a benchmark of bad debt accounts in the Christus Health System that lacked the information to qualify for charity care under the filing organization's customary process but would have likely qualified for assistance. During the fiscal year ending June 30, 2013, the organization utilized the PARO score to identify the accounts of individual patients that were likely eligible for financial assistance despite having not completed an application, and such analysis determined that 26.21% of such accounts were likely eligible for financial assistance. The organization granted presumptive eligibility for these accounts and they were reclassified under our financial assistance policy. These amounts were not reported as bad debt. The amount reported on Schedule H, Part III, Line 3 is the difference between the presumptive charity care benchmark established in the fiscal year ending June 30, 2011 and the aggregate of individual accounts for which the organization granted presumptive eligibility in the fiscal year ending June 30, 2013. Thus, the organization estimates that only 30% of the bad debt expenses in fiscal year ending June 30, 2013 are attributable to patients who would likely have qualified for financial assistance. It is important to note that the figure calculated for fiscal year ending June 30, 2011 was estimated and not exact, and therefore the difference between the amounts qualified as presumptive charity care in any fiscal year may vary from the benchmark established in fiscal year ending June 30, 2011.
Bad Debt Expense Footnote Part III, Section A, Line 4 The footnote to the CHRISTUS Health consolidated financial statements says, "The preparation of the accompanying consolidated financial statements in conformity with accounting principles generally accepted in the United States requires management of the system to make assumptions, estimates, and judgments that affect the amounts reported in the financial statements, including the notes thereto, and related disclosures of commitments and contingencies, if any. The system considers critical accounting policies to be those that require more significant judgments and estimates in the preparation of its financial statements, including the following: recognition of net patient revenues, which include contractual allowances; provisions for bad debt; reserves for losses and expenses related to health care professional and general liabilities; determination of fair values of certain financial instruments; determination of fair value of certain goodwill and long-lived assets; and risks and assumptions for measurement of pension and retiree medical liabilities. Management relies on historical experience and on other assumptions believed to be reasonable under the circumstances in making its judgment and estimates. Actual results could differ materially from these estimates."
Extent to which shortfall should be treated as community benefit Costing Methodology Part III, Section B, Line 8 The amount on Schedule H, Part III, Line 6 is determined by calculating Medicare Allowable Costs using worksheet A of the Medicare Cost Report. Worksheet A of the Medicare Cost Report requires the organization to remove non-allowable expenses from total expenses via the adjustments to expenses worksheets within the Medicare Cost Report. The amount reported on Schedule H, Part III, Line 6 does not take into account all costs incurred by the filing organization associated with the filing organization's provisions of services to Medicare patients. Schedule H, Part III, Line 7 would equal a shortfall of ($3,089,624) if total expenses allocable to Medicare services were substituted on Schedule H, Part III, Line 6.
Collection Policy Part III, Section C, Line 9b It is the policy of the organization to pursue collections of patient balances from patients who have the ability to pay for these services. CHRISTUS Health applies its collection efforts consistently and fairly to all patients regardless of insurance. If a patient does not have the financial resources to pay their outstanding balances, the goal of the organization is to qualify these patients through the organization's charity policy or screen the patients through organization's presumptive charity tests. If the patient qualifies under either policy the account will be written off based upon level of qualification. These policies support the mission and vision of the organization and are approved by senior leadership. Input for persons who represent the community Part V, Section B, Line 3 CHRISTUS HEALTH NORTHERN LOUISIANA COLLABORATED WITH COMMUNITY ORGANIZATIONS, CHURCHES, BUSINESSES, AGENCIES, LOCAL COLLEGES AND UNIVERSITIES, STATE INDIGENT PROGRAMS, THE COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF NORTHWEST LOUISIANA, UNITED WAY, FOOD BANK OF NORTHERN LOUISIANA, COMMUNITY RENEWAL, CATHOLIC CHARITIES, LOCAL PHARMACIES, THE NORTH LOUISIANA AREA HEALTH EDUCATION CENTER, AND VARIOUS OTHER ORGANIZATIONS TO ESTABLISH A CHRISTUS HEALTH NORTHERN LOUISIANA ADVISORY COUNCIL TO DETERMINE THE COMMUNITY HEALTH NEEDS OF NORTHERN LOUISIANA. THE ADVISORY COUNCIL IDENTIFIED THE GAPS IN SERVICES ACROSS MULTIPLE COMMUNITIES TO INCLUDE: INADEQUATE HEALTH LITERACY; INADEQUATE HEALTH LITERATURE DISSEMINATION MECHANISMS TO AT-RISK POPULATIONS; AND AN INADEQUATE AMOUNT OF PRIMARY MEDICAL AND MENTAL HEALTH CARE PROVIDERS TO RURAL COMMUNITIES, AMONG SEVERAL OTHER NEEDS ALL SPECIFICALLY IDENTIFIED IN THE CHRISTUS HEALTH NORTHERN LOUISIANA COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). WORKING INTERNALLY AND WITH OUR COMMUNITY PARTNERS, THE RESULTS OF THE NEEDS ASSESSMENT WERE ANALYZED AND PRIORITIZED. EFFECTIVE PLANS AND STRATEGIES TO ADDRESS THOSE NEEDS WERE DESIGNED AND/OR CONTINUED. THE IDENTIFIED COMMUNITY HEALTH NEEDS WERE INCORPORATED INTO THE STRATEGIC GOALS OF CHRISTUS HEALTH NORTHERN LOUISIANA
Determination of eligibility for discounted care Part V, Section B, Line 11 The hospital facility provides discounted care to all uninsured patients. In order to determine discounts for uninsured patients, the facility utilizes a sliding scale based on federal poverty guidelines and other criteria applied to a uniform fee schedule. The facility has implemented a 3 tier uninsured fee schedule wherein individuals between 201-300% of the Federal Poverty Level receive a specific discount percentage off of the uninsured discounted price; individuals between 301%-400% of the Federal Poverty Level receive a specific discount percentage off of the uninsured discounted price; and individuals above 401% of the Federal Poverty Level receive no additional discount off of the uninsured discounted price. There is no Federal Poverty Limit for the uninsured population to receive discounted care because all charges by the facility are based on the uninsured discounted price. The uninsured discounted price is based on the FY 2009 managed care average reimbursement rate, excluding implant and drug contribution dollars.
How the hospital facility publicizes the financial assistance policy Part V, Section B, Lines 14 & 14g The hospital facility's complete financial assistance policy is not posted in the facility's emergency rooms, waiting rooms or admissions offices; however, a notice that the financial assistance policy is available at the business office, online and is posted in the facility's emergency rooms, waiting rooms and admission offices. Part V, Section B, Line 15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained action the hospital facility may take upon non-payment? The organization does not have a policy that addresses actions in the event of non-payment. The organization does not pursue any of the listed actions at lines 16 or 17 in pursuit of collections from individuals prior to making a reasonable effort to determine the patient's eligibility for financial assistance under CHRISTUS Health Management Directive 11.
Determine the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care Part V, Section B, Line 20D The hospital facility used the average managed care reimbursement rate from the fiscal year ending 6-30-09 in order to determine the maximum amounts that can be charged to FAP-eligible patients. The average managed care rate is the average reimbursement received for specific categories of services from the collective group of private insurers that reimburse all hospital facilities within the Christus Health System except St. Vincent Hospital and Christus Continuing Care.
Needs Assessment Part VI, Line 2 CHRISTUS HEALTH NORTHERN LOUISIANA COLLABORATED WITH COMMUNITY ORGANIZATIONS, CHURCHES, BUSINESSES, AGENCIES, LOCAL COLLEGES AND UNIVERSITIES, STATE INDIGENT PROGRAMS, THE COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF NORTHWEST LOUISIANA, UNITED WAY, FOOD BANK OF NORTHERN LOUISIANA, COMMUNITY RENEWAL, CATHOLIC CHARITIES, LOCAL PHARMACIES, THE NORTH LOUISIANA AREA HEALTH EDUCATION CENTER, AND VARIOUS OTHER ORGANIZATIONS TO ESTABLISH A CHRISTUS HEALTH NORTHERN LOUISIANA ADVISORY COUNCIL TO DETERMINE THE COMMUNITY HEALTH NEEDS OF NORTHERN LOUISIANA. THE ADVISORY COUNCIL IDENTIFIED THE GAPS IN SERVICES ACROSS MULTIPLE COMMUNITIES TO INCLUDE: INADEQUATE HEALTH LITERACY; INADEQUATE HEALTH LITERATURE DISSEMINATION MECHANISMS TO AT-RISK POPULATIONS; AND AN INADEQUATE AMOUNT OF PRIMARY MEDICAL AND MENTAL HEALTH CARE PROVIDERS TO RURAL COMMUNITIES, AMONG SEVERAL OTHER NEEDS ALL SPECIFICALLY IDENTIFIED IN THE CHRISTUS HEALTH NORTHERN LOUISIANA COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). WORKING INTERNALLY AND WITH OUR COMMUNITY PARTNERS, THE RESULTS OF THE NEEDS ASSESSMENT WERE ANALYZED AND PRIORITIZED. EFFECTIVE PLANS AND STRATEGIES TO ADDRESS THOSE NEEDS WERE DESIGNED AND/OR CONTINUED. THE IDENTIFIED COMMUNITY HEALTH NEEDS WERE INCORPORATED INTO THE STRATEGIC GOALS OF CHRISTUS HEALTH NORTHERN LOUISIANA.
Patient education of eligibility for assistance Part VI, Line 3 CHRISTUS Health Northern Louisiana makes every effort to educate patients on its Charity and Discount Policy and about their eligibility for assistance under federal, state, or local government programs during registration, pre-registration (for scheduled tests and surgeries), post registration (during their hospitalization) and following discharge (telephone or written inquiry) in languages appropriate for the population being served. Patients are given information and forms by a financial counselor who helps them complete the forms during their inpatient and outpatient visits. Patients are asked to bring or mail supporting documentation to determine income, assets and household expenses. The Business Office reviews the application based on the information provided by the patient. If the patient qualifies for charity care or a discount, a new bill is generated. Patients who do not provide the required documentation are considered ineligible and are billed accordingly. If the documentation is provided at a later time, the patient may then be determined to be eligible for charity care or a discount. Documentation is retained by the billing office for seven years. A public notice regarding the charity care policy is posted in prominent places throughout the hospitals, including but not limited to the emergency room waiting areas and the admissions office waiting areas, as required by both the State of Texas Community Benefit Standard (which addresses the duties and responsibilities of nonprofit hospitals) and CHRISTUS Health Community Benefit Guidelines #050. In addition, a public notice regarding the charity care policy and information on financial assistance are also posted on the CHRISTUS HEALTH website. The information on financial assistance includes explanations on the availability of financial assistance, who qualifies, and how to apply for financial assistance.
Community Information Part VI, Line 4 CHRISTUS HEALTH NORTHERN LOUISIANA IS LOCATED IN SHREVEPORT, LOUISIANA, WHICH IS IN THE NORTHWESTERN CORNER OF THE STATE. ITS SERVICE AREA EXTENDS TO NORTHEAST TEXAS AND SOUTHERN ARKANSAS, WHICH INCLUDES A POPULATION OF MORE THAN 1.1 MILLION PEOPLE. THE POPULATION IN THE ORGANIZATION'S SERVICE AREA, CONSISTENT WITH NATIONAL TRENDS, IS ANTICIPATING ITS LARGEST GROWTH IN ITS POPULATION OF PERSONS AGE 65 AND OLDER. THE SERVICE AREA'S POVERTY RATE IS 22 PERCENT, AND THE UNEMPLOYMENT RATE IS APPROXIMATELY AT 11.7 PERCENT. ROUGHLY 57 PERCENT OF HOUSEHOLDS IN THE SERVICE AREA ARE AT/BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL.
Promotion of Community Health Part VI, Line 5 CHRISTUS HEALTH NORTHERN LOUISIANA RESPONDS TO THE HEALTH CARE NEEDS OF ITS COMMUNITY THROUGH SERVICES PROVIDED AT CHRISTUS SCHUMPERT HEALTH SYSTEM, A 490-BED INTEGRATED HEALTH SYSTEM WITH A TERTIARY HOSPITAL LOCATED IN DOWNTOWN SHREVEPORT AND A GENERAL ACUTE CARE HOSPITAL IN SOUTHEAST SHREVEPORT. CHRISTUS HIGHLAND MEDICAL CENTER IS A 160-BED ACUTE CARE HOSPITAL THAT INCLUDES BIRTHING SUITES, MEDICAL AND SURGICAL CARE, A REHABILITATION UNIT, SKILLED NURSING, COMPREHENSIVE CORONARY CARE, ORTHOPEDICS AND EMERGENCY SERVICES. THE SYSTEM ALSO INCLUDES THE 80-BED CHRISTUS SCHUMPERT SUTTON CHILDREN'S MEDICAL CENTER FOR SPECIALIZED CHILDREN'S CARE. EACH OF THE FACILITIES OF CHRISTUS HEALTH NORTHERN LOUISIANA SHARE ONE OBJECTIVE, WHICH IS TO LEAD THE WAY TO A HEALTHIER COMMUNITY. BOTH HOSPITALS IN THE CHRISTUS HEALTH NORTHERN LOUISIANA REGION PROVIDE A 24 HOUR EMERGENCY ROOM THAT IS OPEN TO SERVE ALL THOSE IN NEED OF EMERGENT CARE, REGARDLESS OF THEIR ABILITY TO PAY. CHRISTUS HEALTH NORTHERN LOUISIANA HAS PART OWNERSHIP IN ONE DIAGNOSTIC SERVICE PROVIDER - OMEGA DIAGNOSTICS, L.L.C. CHRISTUS HEALTH NORTHERN LOUISIANA PROVIDES A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES TO THE PEOPLE FROM THE COMMUNITIES IT SERVES. IT CONDUCTS ITS ACTIVITIES AND SERVES ITS HEALTH CARE PURPOSE WITHOUT REGARD TO RACE, COLOR, CREED, RELIGION, GENDER, ORIENTATION, DISABILITY, AGE OR NATIONAL ORIGIN. CHRISTUS HEALTH NORTHERN LOUISIANA WORKS TO PROVIDE THE BEST CARE POSSIBLE REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. BY COLLABORATING WITH COMMUNITY ORGANIZATIONS, CHURCHES, BUSINESSES, AND OTHER HEALTH CARE ORGANIZATIONS, CHRISTUS HEALTH NORTHERN LOUISIANA HAS STRENGTHENED ITS ROLE AS A MAJOR PROVIDER OF COMPREHENSIVE ACCESSIBLE HEALTH CARE SERVICES. THESE PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS HAVE SERVED TO ASSIST CHRISTUS HEALTH NORTHERN LOUISIANA TO CARE FOR THOSE IN NEED AND FOCUS ON ADDRESSING THE NEED FOR ACCESS TO HEALTH SERVICES, IN ADDITION TO ASSURING HEALTH IMPROVEMENT THROUGH HEALTH PROMOTION AND DISEASE PREVENTION. CHRISTUS HEALTH IS DEEPLY COMMITTED TO PROACTIVELY IMPROVING THE HEALTH OF INDIVIDUALS AND COMMUNITIES AND PARTICULARLY THE LARGE NUMBER OF UNINSURED AND UNDERINSURED PEOPLE. EVIDENCE FROM HUNDREDS OF COMMUNITIES AROUND THE COUNTRY DEMONSTRATES THE EFFECTIVENESS OF ENGAGING THE ENTIRE COMMUNITY IN EFFORTS TO EXPAND ACCESS TO HEALTH CARE. THEREFORE, CHRISTUS HEALTH STRIVES TO COLLABORATE WITH COMMUNITY PARTNERS. BY WORKING WITH AND/OR INITIATING COMMUNITY LED PARTNERSHIPS IN ALL THE COMMUNITIES SERVED BY CHRISTUS HEALTH, WE CAN ACHIEVE MEASURABLE AND SUSTAINABLE IMPROVEMENT IN OUR WELL BEING. CHRISTUS HEALTH NORTHERN LOUISIANA SUPPORTS MANY LOCAL COMMUNITY HEALTH SERVICES, INCLUDING THE CARA CENTER FOR VICTIMS OF CHILD ABUSE AND/OR NEGLECT AND VARIOUS SPECIALTY HEALTH PROGRAMS IN COLLABORATION WITH THE LOCAL UNIVERSITY HEALTH SCIENCE CENTER. CHRISTUS HEALTH NORTHERN LOUISIANA ALSO OPERATES THREE SCHOOL-BASED HEALTH CENTERS. "COMMUNITY SERVICES FOR A BROADER COMMUNITY" IS ALSO A PART OF CHRISTUS HEALTH NORTHERN LOUISIANA'S OVERALL COMMUNITY BENEFIT. CHRISTUS HEALTH NORTHERN LOUISIANA USED CASH DONATIONS AS A VEHICLE TO HELP OUR COMMUNITIES. WE MADE CASH DONATIONS, IN ADDITION TO GRANTS AWARDED THROUGH THE CHRISTUS FUND, TO SUPPORT CAUSES LIKE THE FIGHT AGAINST CANCER, DIABETES, HEART DISEASE, PROVISION OF A CONTINUUM OF CARE FOR OUR ELDERLY, THOSE SUFFERING FROM HIV/AIDS, AND FOR MANY OTHER EQUALLY WORTHY PURPOSES. CHRISTUS HEALTH NORTHERN LOUISIANA OPERATES THREE SCHOOL BASED HEALTH CENTERS WHICH PROVIDE SERVICES INCLUDING TREATMENT FOR MINOR ILLNESSES/INJURIES, ROUTINE PHYSICALS, ATHLETIC EXAMINATIONS, IMMUNIZATIONS, SCREENINGS FOR HEARING, VISION, SCOLIOSIS, REFERRALS AND FOLLOW UP FOR ACUTE AND CHRONIC ILLNESSES SUCH AS DIABETES AND ASTHMA, AND MENTAL HEALTH SERVICES SUCH AS COUNSELING FOR CRISIS FOR INDIVIDUALS AND FAMILIES. MORE THAN 2,000 STUDENTS (ELEMENTARY, MIDDLE AND HIGH SCHOOLS) ARE SERVED DURING THE SCHOOL YEAR. CHRISTUS HEALTH'S HEALTHY COMMUNITIES MODEL INCORPORATES THESE KEY PRINCIPLES: (1) COMMUNITY OWNERSHIP: SUCCESSFUL INITIATIVES BRING TOGETHER BUSINESS, GOVERNMENT, NONPROFIT, HEALTHCARE, FAITH COMMUNITIES AND CITIZEN LEADERS TO ADDRESS COMMUNITY ISSUES. EVERYONE SHOULD FEEL EMPOWERED. (2) WELL BEING OF THE COMMUNITY: THE UNIVERSAL DEFINITION OF HEALTH AND WHOLENESS EMBRACES THE PHYSICAL, EMOTIONAL, MENTAL AND SPIRITUAL DIMENSIONS OF LIFE. (3) GOALS AND MEASURES: USE BENCHMARKS AND MEASURE PROGRESS AND OUTCOMES. (4) PARTNERSHIPS AND COLLABORATIONS: BUILDING CAPACITY USING EXISTING COMMUNITY ASSETS HELPS TO MAGNIFY THE RESOURCES AVAILABLE. SOME OF THE MAIN COMMUNITY BUILDING ACTIVITIES IN WHICH CHRISTUS HEALTH NORTHERN LOUISIANA PARTICIPATES TO IMPROVE ACCESS TO HEALTH SERVICES, ENHANCES PUBLIC HEALTH, AND ADVANCE KNOWLEDGE INCLUDE: (1) PROMOTE HEALTHY LIVING TO STUDENTS AND FACULTY MEMBERS IN LOCAL SCHOOL DISTRICTS (PROJECT 5210 FOR OBESE CHILDREN PROGRAM IN THREE SCHOOLS TO PROVIDE FREE NUTRITIONAL EDUCATION AND SUPPORT). (2) DEVELOP PARTNERSHIPS AND OPPORTUNITIES FOR COLLABORATION WITH NONPROFIT AND RELIGIOUS ORGANIZATIONS, PARISH AND CIVIC OFFICES, INDUSTRIES AND BUSINESSES, PRIVATE AND PUBLIC SCHOOL SYSTEMS, HEALTH CARE PROVIDERS, AND SOCIAL SERVICE AGENCIES IN THE PROMOTION OF HEALTHY LIFESTYLES AND THE EXPLORATION OF HEALTH NEEDS WITHIN THE COMMUNITY. (3) PROMOTE AWARENESS AND UNDERSTANDING OF LACHIP THROUGH THE SCHOOL BASED HEALTH CLINICS AND OTHER HOSPITALS, THEREBY INCREASING THE ENROLLMENT OF ALL ELIGIBLE CHILDREN. (4) PROVIDE SUPPORT TO THE COMMUNITY HEALTH WORKER PROGRAM, A PARTNERSHIP BETWEEN CHRISTUS HEALTH AND THE MARTIN LUTHER KING HEALTH CLINIC, IN THE PROMOTION OF SELF-CARE MANAGEMENT OF HIGH RISK PATIENTS. (5) PROMOTE COLLABORATION AMONG LOCAL CHILD ABUSE AGENCIES BY HOUSING THESE GROUPS IN A SINGLE DWELLING (CARA CENTER AND GINGERBREAD HOUSE). THE CARA CENTER IS A PARTNERSHIP BETWEEN CHRISTUS HEALTH NORTHERN LOUISIANA AND LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER WHICH PROVIDES MEDICAL EXAMINATIONS FOR SUSPECTED CASES OF CHILD ABUSE AND NEGLECT. CHRISTUS HEALTH NORTHERN LOUISIANA REINVESTS ALL SURPLUS FUNDS BACK IN TO THE COMMUNITIES IT SERVES THROUGH EXPANDED HEALTH SERVICES, NEW TECHNOLOGIES, AND BETTER FACILITIES. AS A NOT FOR PROFIT ORGANIZATION AND AS A PART OF CHRISTUS HEALTH, A REGIONAL GOVERNING BOARD COMPRISED LARGELY OF INDEPENDENT COMMUNITY MEMBERS REPRESENTING THE MAKEUP OF THE AREA WE SERVE GUIDES CHRISTUS HEALTH NORTHERN LOUISIANA. WE ARE PRIVILEGED TO HAVE AN OPEN MEDICAL STAFF COMPRISED OF QUALIFIED PHYSICIANS WHO WORK WITH US TO PROVIDE CARE TO OUR COMMUNITIES. ALL QUALIFIED PHYSICIANS WHO ARE GRANTED PRIVILEGES TO SERVE WITH US IN OUR HOSPITALS MUST UNDERGO A THOROUGH AND COMPREHENSIVE CREDENTIALING AND ORIENTATION PROCESS. ALL PERSONS EMPLOYED AND AFFILIATED WITH CHRISTUS HEALTH NORTHERN LOUISIANA ARE REQUIRED TO COMPLETE ANNUAL CONFLICT OF INTEREST STATEMENTS.
Affiliated health care system Part VI, Line 6 CHRISTUS Health Northern Louisiana is part of CHRISTUS Health, an international, Catholic, faith based, nonprofit health system comprised of almost 350 services and facilities including more than 60 hospitals and long term care facilities, 175 clinics and outpatient centers, and other community health ministries and community development ventures. CHRISTUS services can be found in: Arkansas, Georgia, Iowa, Louisiana, Missouri, New Mexico, Texas, and in six provinces of Mexico. A common mission, core values, and vision unite the health system. Each region, including CHRISTUS Health Northern Louisiana, develops five-year and ten-year strategic plans that help set the yearly operational plans and budgets. Regional strategic goals are set in collaboration with CHRISTUS Health and include metrics that will be used to measure community benefit, clinical outcomes, patient satisfaction, and Associate engagement. CHRISTUS Health provides updated market, demographics, and health indicator data on an annual basis. The data supplied from CHRISTUS Health along with the system wide strategic initiatives are consistent with the community needs assessment of the region. CHRISTUS Health Northern Louisiana, in turn, partners with other nonprofit groups (churches, health care providers, and government agencies) to create collaborations where health needs can be addressed and the general health of individuals and the community is improved.
Community Benefit Report Part VI, Line 7 All CHRISTUS Health entities including facilities located in states that do not require annual community benefit reporting (i.e., Louisiana and New Mexico), follow the same reporting rules as outlined in the Catholic Health Association Guide to Planning and Reporting Community Benefit, copyright 2008. Total community benefit for CHRISTUS Health is also reported in the annual report prepared and distributed by the system office. Christus Health's non-profit hospitals located in Texas file a community benefit report in the state of Texas. The Annual Statement of Community Benefits Standard (ASCBS) form and an annual report of the Community Benefits Plan are filed with the Texas Department of State Health Services (DSHS), as required by the Health and Safety Code, Sections 311.045 and 311.046. The 2013 ASCBS form is expanded to collect the information on charity care policies and community benefits in a standardized format. State Filing of Community Benefit Report: TX
FACILITY REPORTING GROUP(S) PART VI, LINE 8 The narrative information provided for the applciable lines in Part VI, Line 1 applies to all hospital facilities within the legal entity.
Schedule H (Form 990) 2012
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
2012
Open to Public
Inspection
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number
72-0408982
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. Part II can be duplicated if additional space is needed.
(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) LSU Health Sciences Foundation
920 Pierremont Rd
Shreveport,LA71106
72-1402222 501(C)(3) 16,000       RESEARCH AND EVENT SPONSOR
(2) LSU in Shreveport Foundation
920 Pierremont RD
Shreveport,LA71106
72-1031108 501(C)(3) 23,000       RESEARCH AND PUBLIC AWARENESS
(3) Martin Luther King Health Center
827 Margaret PL
Shreveport,LA71101
72-1079721 501(C)(3) 85,000       research
(4) Louisiana Public Health Institute
1515 Poydras St
New Orleans,LA70112
72-1379921 501(C)(3) 13,600       COMMUNITY HEALTH NEEDS
(5) American Heart Association Inc
745 Olive Street
Shreveport,LA71104
13-5613797 501(C)(3) 30,000       HEALTHY HEART SUPPORT
(6) Biomedical Research Foundation of NW LA
PO Box 38050
Shreveport,LA71133
58-1711612 501(C)(3) 105,000       SUPPORT SURGERY PROGRAMS
(7) American Cancer Society
920 Pierremont Road
Shreveport,LA71106
64-0329009 501(C)(3) 12,125       CANCER RESEARCH SUPPORT
(8) North Louisiana Economic Partnership
One Texas Center
Shreveport,LA71101
72-0936419 501(C)(3) 10,000       ECONOMIC DEVELOPMENT
(9) Susan G Komen Breast Cancer Foundation
PO Box 4269
Shreveport,LA71134
75-1835298 501(C)(3) 6,000        
(10) Purchased-Not For Sale
605 Cotton Street
Shreveport,LA71101
26-4794709 501(C)(3) 15,500       COMBASS COMM, DOCOTOR'S DAY
(11) LOUISIANA CLINICAL SERVICES
3330 MASONIC DRIVE
ALEXANDRIA,LA71301
27-4193861 501(C)(3) 2,046,000       INDIGENT CARE FUNDING
(12) JEFFERSON CLINICAL SERVICES
3330 MASONIC DRIVE
ALEXANDRIA,LA71301
45-2183224 501(C)(3) 426,000       INDIGENT CARE FUNDING
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
12
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
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.
Part III can be duplicated 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, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Form 990, Schedule I, PART I, LINE 2 Description of Organization's Procedures for Monitoring the Use of Grants THE ORGANIZATION FOLLOWS CHRISTUS HEALTH MANAGEMENT DIRECTIVE NO. 0006, "CONTRIBUTIONS/DONATIONS TO OTHER ORGANIZATIONS". BEFORE ANY DONATION IS MADE, TWO CRITERIA ARE ADDRESSED: (1) ORGANIZATION TEST AND (2) IRS TEST. THE ORGANIZATION TEST ENSURES THAT DONATIONS ARE EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC, EDUCATIONAL, AND RELIGIOUS PURPOSES, AND IN FURTHERANCE OF OUR PURPOSE OF SUPPORTING THE HEALING MINISTRY OF JESUS CHRIST AND ADVANCING, PROMOTING, AND SUPPORTING THE HEALTHCARE MINISTRIES OF THE SPONSORING CONGREGATIONS. CONTRIBUTIONS CAN BE MADE TO SUPPORT CHRISTUS SYSTEM MEMBERS AND TO OTHER QUALIFYING TAX-EXEMPT ORGANIZATIONS, PARTICULARLY THOSE DESIGNED TO SUPPORT AND BENEFIT THE POOR AND UNDERSERVED. THE ORGANIZATION CONSIDERED FOR DONATIONS MUST BE AN IRS SECTION 501(C)(3) ORGANIZATION AND DOCUMENTATION TO THAT EFFECT OBTAINED. TO SATISFY THE IRS TEST CONTRIBUTIONS GIVEN MUST BE DEDICATED TO ACHIEVING CHARITABLE PURPOSES NOT FOR PERSONAL BENEFIT BUT FOR PUBLIC BENEFIT. CONTRIBUTIONS ARE PROHIBITED TO ORGANIZATIONS THAT CONTRIBUTE TO POLITICAL CAMPAIGNS, CANDIDATES FOR OFFICE, OR CONDUCT MORE THAN INCIDENTAL LOBBYING. DOCUMENTATION MUST SUPPORT HOW THE DONATION MEETS ORGANIZATIONAL PURPOSES AND FURTHERANCE OF MISSION. DONATIONS SHOULD BE MODEST IN SCOPE. THE FILING ORGANIZATION PROVIDES INDIGENT FUNDING GRANTS TO THE COUNTIES IN WHICH CHRISTUS HEALTH SYSTEM HOSPITALS SERVE VIA GRANTS PAID TO OTHER HOSPITALS AND HEALTHCARE ORGANIZATIONS LOCATED WITHIN SUCH COUNTIES. THIS CHARITABLE DONATION HELPS RELIEVE THE ADDITIONAL EXPENSE OF HEALTHCARE FOR THE INDIGENT POPULATION WITHIN OUR COMMUNITIES THAT THE FILING ORGANIZATION MAY NOT DIRECTLY SERVE IN ONE OF ITS HOSPITALS. THIS IS A RESULT OF OUR MISSION TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST, ESPECIALLY TO THE POOR AND UNDERSERVED.
Schedule I (Form 990) 2012


Additional Data


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Software Version:  


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
2012
Open to Public Inspection
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
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 of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
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
Yes
 
3
Indicate which, if any, of the following the filing organization used 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
Yes
 
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
 
No
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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 (E) amounts for that individual.
(A) Name and Title (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)Stephen F WrightPresident/CEO (i)
(ii)
203,087
304,630
72,612
108,918
97,633
146,450
54,326
81,490
10,600
15,900
438,258
657,388
81,099
121,649
(2)William W Lunn MDRegional COO & Ministry Admin (i)
(ii)
387,410
0
115,258
0
86,836
0
103,460
0
20,654
0
713,618
0
64,284
0
(3)Scott MerrymanCFO (i)
(ii)
120,004
180,006
35,770
53,655
36,132
54,198
29,074
43,611
4,068
6,102
225,048
337,572
20,078
30,118
(4)Charlotte A KnollChief Nurse Executive (i)
(ii)
168,785
0
48,469
0
319
0
51,676
0
3,588
0
272,837
0
0
0
(5)Diedre Barfield MDCHIEF MEDICAL OFFICER (i)
(ii)
283,432
0
82,321
0
8,000
0
68,814
0
13,810
0
456,377
0
0
0
(6)Nancy R HellyerChief Administrative Officer (i)
(ii)
121,232
181,848
36,022
54,032
638
956
30,371
45,557
9,581
14,372
197,844
296,765
0
0
(7)Jason RoundsChief Administrator (i)
(ii)
0
235,934
0
64,090
0
35,906
0
47,768
0
21,024
0
404,722
0
14,821
(8)John R StephensonCRNA (i)
(ii)
202,372
0
100
0
0
0
0
0
11,219
0
213,691
0
0
0
(9)Curtis ArdoinCRNA (i)
(ii)
200,451
0
100
0
0
0
0
0
12,930
0
213,481
0
0
0
(10)David J DoucetCRNA (i)
(ii)
194,775
0
100
0
1,347
0
0
0
15,534
0
211,756
0
0
0
(11)William H Vander WallMedical Physicist (i)
(ii)
188,885
0
1,050
0
3,845
0
0
0
16,989
0
210,769
0
0
0
(12)PETER A CERNIGLIAROCRNA (i)
(ii)
191,857
0
100
0
0
0
0
0
2,179
0
194,136
0
0
0
(13)CORINNE R FRANCISVP, MISSION FOR CHRISTUS HLTH (i)
(ii)
47,630
71,446
8,000
12,000
9,850
14,775
7,991
11,987
2,001
3,001
75,472
113,209
0
0
(14)JOHN R GILCHRIST JRCHIEF PHILANTHROPY OFFICER (i)
(ii)
60,850
91,275
10,505
15,758
288
432
0
0
3,622
5,433
75,265
112,898
0
0
(15)SUSAN V TUDORREG VP, STRATEGY, BUS. DEVELOP (i)
(ii)
79,971
119,957
18,638
27,958
5,183
7,775
19,541
29,311
2,596
3,894
125,929
188,895
0
0
(16)WENDY WHITEVP, HUMAN RESOURCES (i)
(ii)
75,766
113,649
18,537
27,806
13,836
20,753
16,953
25,430
2,875
4,312
127,967
191,950
9,486
14,230
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Supplemental Compensation Information   FORM 990, PART VII, LINE 1A AND SCHEDULE J, PART II DIRECTORS AND EX-OFFICIO DIRECTORS PROVIDE THEIR SERVICES AS MEMBERS OF THE BOARD WITHOUT COMPENSATION OR BENEFITS. ANY COMPENSATION AND BENEFITS DISCLOSED FOR SUCH PERSONS IS EARNED IN THE RESPECTIVE INDIVIDUAL'S ROLE AS AN OFFICER OR EMPLOYEE OF THE ORGANIZATION, NOT FOR THE INDIVIDUAL'S ROLE AS A BOARD MEMBER OR DIRECTOR. OFFICERS, KEY EMPLOYEES AND HIGHEST PAID EMPLOYEES ARE FULL-TIME EMPLOYEES. BOARD MEMBERS SPEND TIME AS NEEDED FOR BOARD MEETINGS AND FUNCTIONS. FORM 990, SCHEDULE J, PART I, LINE 1A TAXABLE COMPENSATION WAS REPORTED TO VARIOUS OFFICERS AND BOARD MEMBERS RELATED TO COMPANION TRAVEL TO CHRISTUS MEETINGS. RELATED ORG DETERMINING CEO/EXECUTIVE DIRECTOR'S COMPENSATION FORM 990, SCHEDULE J, PART I, QUESTION 3 THE FILING ORGANIZATION'S CEO/EXECUTIVE DIRECTOR IS AN EMPLOYEE OF CHRISTUS HEALTH, A RELATED ORGANIZATION. AS A RESULT, COMPENSATION IS ESTABLISHED AT THE CHRISTUS HEALTH LEVEL AND THE FILING ORGANIZATION DOES NOT HAVE A ROLE IN IMPLEMENTING THE METHODS USED TO ESTABLISH COMPENSATION OR IN DETERMINING CEO/EXECUTIVE DIRECTOR COMPENSATION. CHRISTUS HEALTH USES AN EXECUTIVE COMPENSATION COMMITTEE TO ESTABLISH AND APPROVE THE COMPENSATION OF THE FILING ORGANIZATION'S CEO/EXECUTIVE DIRECTOR. THIS COMMITTEE USES AN INDEPENDENT COMPENSATION CONSULTANT WHO PERFORMS BI-ANNUAL COMPENSATION SURVEY. SEVERANCE PAYMENT FORM 990, SCHEDULE J, PART I, QUESTION 4A UNDER THE SEVERANCE PLAN, ALL OR A PORTION OF THE BASE SALARY OF A PARTICIPATING EXECUTIVE WILL CONTINUE TO BE PAID TO THE EXECUTIVE FOR A LIMITED PERIOD OF TIME IF THE EXECUTIVE'S EMPLOYMENT WITH CHRISTUS AND ITS AFFILIATES IS INVOLUNTARILY TERMINATED. CAROLYN MOORE RECEIVED $34,259 IN SEVERANCE PAYMENT DURING CALENDAR YEAR 2012. BONNIE BURNETT RECEIVED $47,216 IN SEVERANCE PAYMENT DURING CALENDAR YEAR 2012. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FORM 990, SCHEDULE J, PART I, QUESTION 4B DEFERRED COMPENSATION INCLUDES EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, AND PENSION RESTORATION PLAN. ESTIMATED PENSION BENEFITS WERE CALCULATED BASED ON THE PROVISIONS OF THE CURRENT PENSION RESTORATION PLAN AT 6% OF PENSIONABLE EARNINGS WHICH ARE OVER THE IRS LEGISLATIVE COMPENSATION LIMIT. SOME ASSOCIATES ARE GRANDFATHERED UNDER AN EARLIER LEGACY PENSION PLAN. IF A PARTICIPANT HAS PROTECTED PENSION BENEFITS UNDER SUCH LEGACY PLANS, HIS/HER PERCENTAGE IS ZERO UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, AS THE PROTECTED BENEFIT IS ALREADY EQUAL TO OR BETTER THAN CURRENT MARKET. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENT FORM 990, SCHEDULE J, PART I, QUESTION 4B AND FORM 990, SCHEDULE J, PART II, COLUMN (F) COMPENSATION REPORTED AS DEFERRED IN PRIOR FORM 990 STEPHEN WRIGHT WAS PAID $202,748 DURING CALENDAR YEAR 2012 UNDER A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. Scott Merryman WAS PAID $50,196 DURING CALENDAR YEAR 2012 UNDER A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. Wendy White WAS PAID $23,716 DURING CALENDAR YEAR 2012 UNDER A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. William Lunn WAS PAID $64,284 DURING CALENDAR YEAR 2012 UNDER A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. Jason Rounds WAS PAID $14,821 DURING CALENDAR YEAR 2012 UNDER A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. SUPPLEMENTAL COMPENSATION INFORMATION FORM 990, SCHEDULE J, PART II W-2 COMPENSATION MAY INCLUDE PAYMENTS RELATED TO COMPENSATION DEFERRED IN PRIOR YEARS. DEFERRED COMPENSATION MAY INCLUDE DEFERRALS OF CURRENT YEAR COMPENSATION UNDER EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN AND PENSION RESTORATION PLAN. DEFERRED COMPENSATION FORM 990, SCHEDULE J, PART II, COLUMN C DEFERRED COMPENSATION INCLUDES EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, EMPLOYER CONTRIBUTION TO 403(B) MATCHED SAVINGS PLAN, PENSION RESTORATION PLAN AND ESTIMATED PENSION BENEFITS UNDER CHRISTUS HEALTH CASH BALANCE PLAN. ESTIMATED PENSION BENEFITS WERE CALCULATED BASED ON THE PROVISIONS OF THE CURRENT CASH BALANCE PLAN AT 6% OF PENSIONABLE EARNINGS. SOME ASSOCIATES ARE GRANDFATHERED UNDER AN EARLIER PENSION PLAN. THESE GRANDFATHERED PARTICIPANTS, BASED ON COMPUTATION AT THE TIME OF THEIR RETIREMENT, WILL RECEIVE THE LARGER OF THE RETIREMENT BENEFIT COMPUTED UNDER THE CASH BALANCE PLAN COMPARED TO THE PREVIOUS PENSION PLAN. DUE TO THE COMPLEXITY OF CALCULATING AN ACCURATE BENEFIT COST FOR GRANDFATHERED PARTICIPANTS, THE FORM 990 REPORTS AS PENSION BENEFITS THEIR ANNUAL ESTIMATED CASH BALANCE PLAN ACCRUAL. SUPPLEMENTAL COMPENSATION INFORMATION FORM 990, SCHEDULE J, PART II, COLUMN B(II) BONUS AND INCENTIVE COMPENSATION MAY INCLUDE AMOUNTS THAT WERE DEFERRED IN A PRIOR YEAR BUT PAID OUT IN CALENDAR YEAR 2012. SUPPLEMENTAL COMPENSATION INFORMATION FORM 990, PART VII, SECTION A AND SCHEDULE J, PART II PAID TO THE FOLLOWING PERSONS BY CHRISTUS HEALTH, A RELATED ORGANIZATION OF THE FILING ENTITY: STEPHEN WRIGHT, SCOTT MERRYMAN, CHARLOTTE KNOLL, PAUL FOSTER, DOROTHY TRAVIS, AND WILLIAM LUNN, MD.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
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, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
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) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by 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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)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 assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
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) OMEGA DIAGNOSTICS LLC SEE PART V 254,749 Leases & Salary Reimbursement   No
(2) OMEGA DIAGNOSTICS LLC SEE PART V 7,044,374 LAB SERVICES TO NOLA   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
DESCRIPTION OF ACTIVITY PART IV, LINE 1, COLUMN B STEPHEN WRIGHT, OFFICER OF CHRISTUS HEALTH NORTHERN LOUISIANA AND OFFICER OF SCH MANAGEMENT SOLUTIONS, INC., IS A MEMBER OF THE MANAGEMENT COMMITTEE OF OMEGA DIAGNOSTICS, LLC. SCH MANAGEMENT SOLUTIONS, INC. OWNS 40% OF OMEGA DIAGNOSTICS, LLC. SCOTT MERRYMAN, OFFICER OF CHRISTUS HEALTH NORTHERN LOUISIANA AND OFFICER OF SCH MANAGEMENT SOLUTIONS INC., IS A MEMBER OF THE MANAGEMENT COMMITTEE OF OMEGA DIAGNOSTICS, LLC. SCH MANAGEMENT SOLUTIONS, INC. OWNS 40% OF OMEGA DIAGNOSTICS, LLC. WILLIAM LUNN, MD, KEY EMPLOYEE OF CHRISTUS HEALTH NORTHERN LOUISIANA, IS A MEMBER OF THE MANAGEMENT COMMITTEE OF OMEGA DIAGNOSTICS, LLC.
DESCRIPTION OF ACTIVITY PART IV, LINE 2, COLUMN B STEPHEN WRIGHT, OFFICER OF CHRISTUS HEALTH NORTHERN LOUISIANA AND OFFICER OF SCH MANAGEMENT SOLUTIONS, INC., IS A MEMBER OF THE MANAGEMENT COMMITTEE OF OMEGA DIAGNOSTICS, LLC. SCH MANAGEMENT SOLUTIONS, INC. OWNS 40% OF OMEGA DIAGNOSTICS, LLC. SCOTT MERRYMAN, OFFICER OF CHRISTUS HEALTH NORTHERN LOUISIANA AND BOARD MEMBER OF SCH MANAGEMENT SOLUTIONS INC., IS A MEMBER OF THE MANAGEMENT COMMITTEE OF OMEGA DIAGNOSTICS, LLC. SCH MANAGEMENT SOLUTIONS, INC. OWNS 40% OF OMEGA DIAGNOSTICS, LLC. WILLIAM LUNN, MD, KEY EMPLOYEE OF CHRISTUS HEALTH NORTHERN LOUISIANA, IS A MEMBER OF THE MANAGEMENT COMMITTEE OF OMEGA DIAGNOSTICS, LLC.
Schedule L (Form 990 or 990-EZ) 2012

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
2012
Open to Public
Inspection
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
Identifier Return Reference Explanation
DOING BUSINESS AS FORM 990, PAGE 1, ITEM C CHRISTUS HEALTH NORTHERN LOUISIANA IS DOING BUSINESS AS: CHRISTUS SCHUMPERT FIRST CARE BOSSIER CHRISTUS SCHUMPERT FIRST CARE SHREVEPORT CHRISTUS SCHUMPERT HEALTH SYSTEM CHRISTUS SCHUMPERT OCCUPATIONAL HEALTH SYSTEM CHRISTUS SCHUMPERT CHRISTUS HIGHLAND CHRISTUS BOSSIER CHRISTUS SCHUMPERT SCHOOL BASED HEALTH CENTER CHRISTUS SCHUMPERT HOSPITAL PHYSICIANS GRACE HOME CHRISTUS SCHUMPERT FIRST CARE BOSSIER CHRISTUS SCHUMPERT SPECIALTY FOR MEN AND WOMEN CHRISTUS SCHUMPERT WOMEN'S HEALTH CHRISTUS SCHUMPERT BREAST CENTER CHRISTUS HEALTH SHREVEPORT-BOSSIER CHRISTUS HIGHLAND MEDICAL CENTER CHRISTUS SCHUMPERT MEDICAL CENTER CHRISTUS SUTTON CHILDREN'S MEDICAL CENTER CHRISTUS LOUISIANA ATHLETIC CLUB - BOSSIER CHRISTUS LOUISIANA ATHLETIC CLUB - SHREVEPORT CHRISTUS LOUISIANA ATHLETIC CLUB - LAKE CHARLES CHRISTUS HEALTH SHREVEPORT-BOSSIER FOUNDATION CHRISTUS SCHUMPERT BREAST CENTER - SHREVEPORT CHRISTUS SCHUMPERT OUTPATIENT THERAPY SERVICES - SHREVEPORT CHRISTUS FOUNDATION SHREVEPORT-BOSSIER CHRISTUS PEDIATRIC ASSOCIATES SHREVEPORT-BOSSIER CHRISTUS LOUISIANA ATHLETIC CLUB SHREVEPORT-BOSSIER CHRISTUS WOUND & HYPERBARIC MEDICINE CENTER SHREVEPORT-BOSSIER
DESCRIPTION OF OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D COMMUNITY SERVICES FOR THE POOR AND UNDERSERVED ROOTED IN OUR MISSION AND TRADITION, FOUNDERS AND SPONSORS OF CHRISTUS HEALTH AND THOSE WHO CO-MINISTER WITH THEM SEEK NEW AND INNOVATIVE WAYS OF DELIVERING QUALITY HEALTH CARE THAT IS BOTH AFFORDABLE AND ACCESSIBLE TO ALL. TODAY, MORE THAN EVER, CHRISTUS HEALTH STRIVES TO IMPROVE THE TOTAL HEALTH STATUS OF THE COMMUNITY THROUGH PROGRAMS THAT PLACE SERVICES WHERE THEY ARE NEEDED THE MOST, WITH SPECIAL ATTENTION AND PREFERENCE GIVEN TO PROGRAMS THAT SUPPORT AND BENEFIT THE HEALTH AND WELFARE OF THE POOR AND UNDERSERVED. COMMUNITY SERVICES FOR THE POOR AND UNDERSERVED REPRESENT THE UNPAID COST OF SERVICES PROVIDED FOR WHICH A PATIENT IS NOT BILLED, OR FOR WHICH A FEE HAS BEEN ASSESSED THAT RECOVERS ONLY A PORTION OF THE COST OF THE RENDERED SERVICE. THIS CATEGORY INCLUDES INITIATIVES THAT REACH OUT TO THOSE IN NEED THROUGH COMMUNITY HEALTH AND SOCIAL PROGRAMS. THESE PROGRAMS SEEK JUSTICE FOR THE VULNERABLE AND WORK TO BRING ABOUT CHANGES IN OUR POLITICAL AND ECONOMIC SYSTEMS. THE PROGRAMS COVER A BROAD SPECTRUM OF SERVICES INCLUDING COMMUNITY CLINICS, EDUCATION AND WELLNESS FOR TEEN MOMS, MEALS ON WHEELS, RESCUE MISSION, BACK TO SCHOOL CHILDREN'S PROGRAM, COMMUNITY IMPROVEMENT, TRANSPORTATION SERVICES AND A VARIETY OF OTHER SOCIAL SERVICES. CHRISTUS HEALTH NORTHERN LOUISIANA OPENS ITS DOORS TO VARIOUS COMMUNITY ORGANIZATIONS, MEDICAL STUDENTS, GROUPS, CLUBS, STATE AGENCIES, AND SUPPORT GROUPS WHICH NEED MEETING AND/OR OFFICE SPACE. THIS SERVICE IS PROVIDED AT NO COST TO THESE COMMUNITY, NON-PROFIT ORGANIZATIONS OR STATE AGENCIES. CHRISTUS HEALTH NORTHERN LOUISIANA PROVIDES NEEDED OFFICE SPACE AT LITTLE TO NO EXPENSE TO VARIOUS NON-PROFIT ORGANIZATIONS. CHRISTUS HEALTH NORTHERN LOUISIANA PROVIDES MEALS FOR RESIDENTS OF RUTHERFORD HOUSE, A LOCAL RESIDENTIAL, REHABILITATIVE JUVENILE PROGRAM AND THE SHREVEPORT/BOSSIER RESCUE MISSION, A HOMELESS AND/OR DISPLACED SHELTER/HOUSING PROGRAM LOCATED IN SHREVEPORT, LOUISIANA. ONE EXAMPLE OF CHRISTUS HEALTH COMMUNITY BENEFITS ACCOUNTED FOR UNDER COMMUNITY SERVICES FOR THE POOR AND UNDERSERVED INCLUDE THE CHRISTUS COMMUNITY DIRECT INVESTMENT PROGRAM (CDI). THE CHRISTUS BOARD OF DIRECTORS APPROVED THE FUNDING OF A CDI LOAN PROGRAM TO ENSURE THAT THE WORK OF SOCIAL ACCOUNTABILITY AND MORAL AND ETHICAL STEWARDSHIP CONTINUES IN SPITE OF CHALLENGING FISCAL CONDITIONS FACED BY LOCAL OPERATING ENTITIES. THE PURPOSE OF THE CDI PROGRAM IS TO SUPPORT COMMUNITY-DRIVEN INITIATIVES PRIMARILY FOR AFFORDABLE HOUSING AND ECONOMIC DEVELOPMENT BY PROVIDING FINANCING AT BELOW-MARKET INTEREST RATES TO NOT-FOR-PROFIT ORGANIZATIONS AT TERMS NOT EXCEEDING MORE THAN FIVE YEARS. THE INCOME LOST FROM THE DIFFERENCE IN THE MARKET RATE LESS OUR LOAN RATE (FOREGONE INCOME) IS CONSIDERED A COMMUNITY BENEFIT FOR REPORTING PURPOSES. THE COST OF THESE INVESTMENTS IS NOT INCLUDED IN THE PROGRAM SERVICE EXPENSES OF CHRISTUS HEALTH NORTHERN LOUISIANA. THOUGH OUTSTANDING LOAN BALANCES VARY THROUGHOUT THE YEAR, THE OUTSTANDING LOAN BALANCE AT THE END OF FISCAL YEAR 2013 WAS $1,631,224. THE FOREGONE INTEREST FOR CHRISTUS HEALTH NORTHERN LOUISIANA IN FY2013 WAS $44,856. CHRISTUS HEALTH ESTABLISHED THE CHRISTUS FUND TO PROVIDE RESOURCES TO NOT-FOR-PROFIT AGENCIES AND GROUPS WHOSE VISION, MISSION AND GOALS ARE CONSISTENT WITH CHRISTUS HEALTH'S MISSION, VALUES AND PHILOSOPHY OF A HEALTHY COMMUNITY. WE BELIEVE THAT BY WORKING TOGETHER, WE CAN MAKE A PROFOUND DIFFERENCE IN THE QUALITY OF PEOPLES' LIVES AND CREATE SUSTAINABLE HEALTH IN OUR COMMUNITIES. DURING FY2013, THE TOTAL GRANT MONEY DISTRIBUTED BY CHRISTUS HEALTH TO THE NORTHERN LOUISIANA REGION WAS $66,559. THE COST OF THESE GRANTS IS NOT INCLUDED IN THE PROGRAM SERVICE EXPENSES OF CHRISTUS HEALTH NORTHERN LOUISIANA. PROGRAM SERVICE EXPENSES = $536,318 GRANTS = $383,373 PROGRAM SERVICE REVENUE = $ 0 PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4D COMMUNITY SERVICES FOR THE BROADER COMMUNITY THE GREATEST SHARE OF THESE EXPENSES IS FOR EDUCATING HEALTH PROFESSIONALS. HELPING TO PREPARE FUTURE HEALTH CARE PROFESSIONALS IS A DISTINGUISHING CHARACTERISTIC OF NOT-FOR-PROFIT HEALTH CARE AND CONSTITUTES A SIGNIFICANT COMMUNITY BENEFIT. CHRISTUS HEALTH ALSO USED CASH DONATIONS AS A VEHICLE TO HELP OUR COMMUNITIES. WE MADE CASH DONATIONS, IN ADDITION TO GRANTS AWARDED THROUGH THE CHRISTUS FUND, TO SUPPORT CAUSES LIKE LSU- EVENING FOR HEROES, NORTH LOUISIANA ECONOMIC PARTNERSHIP, AMERICAN HEART ASSOCIATION-GO RED FOR WOMEN,AMERICAN CANCER SOCIETY, MARCH OF DIMES, AND FOR MANY OTHER EQUALLY WORTHY PURPOSES. DURING FY2013, CHRISTUS HEALTH ADVOCATED FOR IMPROVING PUBLIC POLICIES, WORKING TO ESTABLISH, AND IN SOME INSTANCES AUGMENT, GRASSROOTS ADVOCACY AND GREATER ACCESS TO HEALTH CARE SERVICES FOR THE CONSTITUENTS WE SERVE. PROGRAM SERVICE EXPENSES = $1,021,309 GRANTS = $3,136,989 PROGRAM SERVICE REVENUE = $0
DESCRIPTION OF RELATIONSHIPS FORM 990, PART VI, QUESTION 2 OFFICER/DIRECTOR STEPHEN WRIGHT AND OFFICER SCOTT MERRYMAN HAVE A BUSINESS RELATIONSHIP AS BOTH SERVE AS OFFICERS OF SCH MANAGEMENT SOLUTIONS, INC. OFFICER SCOTT MERRYMAN AND KEY EMPLOYEE WILLIAM LUNN, MD HAVE A BUSINESS RELATIONSHIP AS BOTH SERVE AS MEMBERS OF THE MANAGEMENT COMMITTEE OF OMEGA DIAGNOSTICS, LLC.
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 CHRISTUS HEALTH IS THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, QUESTION 7A CHRISTUS HEALTH, THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION, HAS THE POWER TO APPOINT ALL MEMBERS OF THE FILING ORGANIZATION'S GOVERNING BODY.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, QUESTION 7B CHRISTUS HEALTH'S BOARD OF DIRECTORS HAS THE FOLLOWING POWERS: APPROVE, CHANGE AND/OR INTERPRET THE FILING ORGANIZATION'S PHILOSOPHY, MISSION AND VISION; APPROVE THE ADOPTION OR AMENDMENT OF THE FILING ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS; APPOINT AND REMOVE MEMBERS OF THE FILING ORGANIZATION'S BOARD OF DIRECTORS; APPOINT AND REMOVE THE FILING ORGANIZATION'S CHAIR OF THE BOARD OF DIRECTORS AND VICE CHAIRPERSON OF BOARD OF DIRECTORS; APPROVE INCURRENCE OF DEBT THAT EXCEEDS $5 MILLION PER INCURRENCE OR $25 MILLION ANNUALLY; APPROVE ANY MERGER, CONSOLIDATION, ACQUISITION, DISSOLUTION OR LIQUIDATION BY THE FILING ORGANIZATION; APPROVE THE IMPLEMENTATION OF SYSTEM-WIDE POLICIES FOR THE FILING ORGANIZATION; APPROVE SYSTEM-WIDE CONSOLIDATED BUDGET AND PERFORMANCE INDICATORS FOR THE FILING ORGANIZATION; APPROVE THE INDEPENDENT AUDIT REPORTS OF THE FILING ORGANIZATION; APPROVE CAPITAL PROJECTS GREATER THAN $10 MILLION FOR THE FILING ORGANIZATION; APPROVE ANY TRANSACTION BY THE FILING ORGANIZATION THE EFFECT OF WHICH IS TO CREATE A NEW LEGAL ENTITY OR JOINT VENTURE, ANY TRANSACTION INVOLVING A SYSTEM PARTICIPANT OR LOCAL ENTITY WHICH CREATES A NEW LEGAL ENTITY OR JOINT VENTURE, OR CHANGES IN BUSINESS PURPOSE OR RELATIONSHIP OF ANY LOCAL ENTITY; AND APPROVE AND AUTHORIZE ACTIONS RESERVED IN ORGANIZATION DOCUMENTS OR SIMILAR GOVERNANCE DOCUMENTS. THE CHRISTUS HEALTH CEO HAS THE FOLLOWING POWERS: POWER TO APPOINT AND REMOVE THE PRESIDENT OF THE FILING ORGANIZATION; APPROVE THE SALE, LEASE, MORTGAGE, TRANSFER, EASEMENT OR ENCUMBRANCE OF THE FILING ORGANIZATION'S REAL PROPERTY DESIGNATED AS NON-DESIGNATED MINISTRY PROPERTY UNDER $5 MILLION BUT MORE THAN $1 MILLION; APPROVE THE INCURRENCE OF DEBT UP TO A $5 MILLION CAP OR $25 MILLION ANNUALLY BY THE FILING ORGANIZATION; APPROVE STRATEGIC PLANS OF THE FILING ORGANIZATION; APPROVE THE FILING ORGANIZATION'S BUDGET; SET THE THRESHOLD OF CAPITAL PROJECTS LESS THAN $10 MILLION BY THE FILING ORGANIZATION; AND APPROVE MANAGEMENT DIRECTIVES FOR THE FILING ORGANIZATION. THE CHRISTUS HEALTH MEMBERS ARE THE CONGREGATION OF SISTERS OF CHARITY OF THE INCARNATE WORD, HOUSTON, TEXAS AND THE CONGREGATION OF SISTERS OF CHARITY OF THE INCARNATE WORD (OF SAN ANTONIO). THE CHRISTUS HEALTH MEMBERS HAVE THE FOLLOWING POWERS: APPROVE THE ADOPTION AND AMENDMENT OF ARTICLES OF INCORPORATION AND BYLAWS OF THE FILING ORGANIZATION IF THE CHANGE IS RELATED TO RESERVED POWERS OF MEMBERS; APPROVE THE SALE, LEASE, MORTGAGE, TRANSFER, EASEMENT OR ENCUMBRANCE OF REAL PROPERTY IN EXCESS OF A $5 MILLION THRESHOLD DOLLAR AMOUNT REQUIRED BY CANON LAW FOR THE FILING ORGANIZATION; APPROVE THE SALE, LEASE, MORTGAGE, TRANSFER, EASEMENT, OR ENCUMBRANCE OF REAL PROPERTY DESIGNATED AS DESIGNATED MINISTRY PROPERTY BY THE FILING ORGANIZATION, BUT NOT IN EXCESS OF $5 MILLION; APPROVE THE CHANGE OF OWNERSHIP, MANAGEMENT OR CONTROL, (EXCEPT IN THE ORDINARY COURSE OF BUSINESS OFFICE AND SPACE LEASES) THE FUNDAMENTAL USE BY CHANGE IN LICENSE THAT WOULD SIGNIFICANTLY CHANGE A FACILITY, OR THE ELIMINATION OF OB, PED, PSYCH OR EMERGENCY SERVICES ON REAL PROPERTY PROVIDED IN CONNECTION WITH DESIGNATED MINISTRY PROPERTY OWNED BY THE FILING ORGANIZATION; AND APPROVE THE MERGER, CONSOLIDATION, ACQUISITION, DISSOLUTION OR LIQUIDATION OF THE FILING ORGANIZATION IF IT OWNS DESIGNATED MINISTRY PROPERTY.
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, QUESTION 11B THE FORM 990 IS PREPARED AND REVIEWED BY THE ORGANIZATION'S EXTERNAL INDEPENDENT ACCOUNTANTS. THE CHRISTUS HEALTH ACCOUNTING DEPARTMENT WORKS WITH AN EXTERNAL ACCOUNTING FIRM IN PREPARATION AND REVIEW OF THE FORM 990. THE FILING ORGANIZATION'S CFO, OR OTHER DESIGNEE, REVIEWS THE FORM 990. THE FINAL FORM 990 THAT WILL BE FILED WITH THE IRS IS POSTED TO A SECURE INTERNET PORTAL FOR ALL MEMBERS OF THE BOARD OF DIRECTORS TO VIEW. REVIEW OF THE FINAL FORM 990 OCCURS PRIOR TO FILING WITH THE IRS IN THE SPRING OF 2014 VIA A WEB PORTAL POLLING TOOL BY THE RESPECTIVE CHRISTUS ORGANIZATION'S BOARD, BASED ON A SET OF SUGGESTED REVIEW PROCESSES DEVELOPED BY CHRISTUS HEALTH.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C AT THE END OF EACH CALENDAR YEAR, THE CHRISTUS HEALTH CORPORATE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE TO ALL OF THE ORGANIZATION'S BOARD AND COMMITTEE MEMBERS FOR COMPLETION PRIOR TO THE 1ST OF JANUARY IN THE NEXT YEAR. THE CORPORATE SECRETARY THOROUGHLY REVIEWS ALL COMPLETED AND EXECUTED CONFLICT OF INTEREST QUESTIONNAIRE FORMS TO ENSURE ACCURACY AND THAT NO POTENTIAL OR IDENTIFIED CONFLICT IS DISCLOSED OR EXISTS. THE ORGANIZATION'S BOARD OF DIRECTORS IS RESPONSIBLE FOR ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY OF THE ORGANIZATION.
COMPENSATION DETERMINATION PROCESS FORM 990, PART VI, QUESTIONS 15A & 15B THE EXECUTIVE COMPENSATION COMMITTEE OF CHRISTUS HEALTH DETERMINES THE COMPENSATION OF THE CEO, OFFICERS AND KEY EMPLOYEES OF CHRISTUS HEALTH AND CERTAIN OTHER OFFICERS AND KEY EMPLOYEES OF RELATED ORGANIZATIONS, INCLUDING CHRISTUS HEALTH NORTHERN LOUISIANA. THE EXECUTIVE COMPENSATION COMMITTEE IS COMPOSED OF INDIVIDUALS WHO HAVE NO CONFLICT OF INTEREST WITH THE COMPENSATION ARRANGEMENTS AT HAND. THE EXECUTIVE COMPENSATION COMMITTEE OF THE CHRISTUS HEALTH BOARD SELECTS AN INDEPENDENT EXTERNAL FIRM TO PERFORM AN INDEPENDENT COMPENSATION REVIEW, TO ENSURE THAT ALL COMPENSATION IS REASONABLE AND COMPARABLE TO OTHER SIMILARLY SITUATED ORGANIZATIONS, FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS, AND TO PROVIDE SUPPORTING INFORMATION OF COMPENSATION DECISIONS. ON AN ANNUAL BASIS THE EXTERNAL CONSULTANT: 1. DEVELOPS THE MERIT INCREASE RECOMMENDATIONS FOR ALL DESIGNATED SYSTEM EXECUTIVES BASED ON MARKET COMPARABILITY. 2. RECOMMENDS THE CHANGES IN THE COMPENSATION STRUCTURE (GRADES) BASED ON THE MARKET CHANGES. 3. COMPLETES A REVIEW AND EVALUATION OF NEWLY CREATED POSITIONS TO RECOMMEND A GRADE PLACEMENT TO THE COMMITTEE FOR ITS DISCUSSION AND APPROVAL. ON A BI-ANNUAL BASIS, THE EXTERNAL CONSULTANT COMPLETES A DETAILED REVIEW OF ALL OTHER DESIGNATED SYSTEM EXECUTIVES' COMPENSATION AND BENEFITS. THIS GROUP INCLUDES ALL TOP MANAGEMENT OFFICIALS, OTHER OFFICERS AND KEY LEADERS OF THE ORGANIZATION. THE REVIEW INCLUDES RECOMMENDATIONS TO THE COMMITTEE ON ANY CHANGES NECESSARY IN EITHER SPECIFIC COMPENSATION OR COMPENSATION STRUCTURE TO ENSURE MARKET COMPETITIVENESS, REASONABLENESS AND INTERNAL EQUITY. UPON RECOMMENDATIONS FROM THE INDEPENDENT EXTERNAL FIRM, THE EXECUTIVE COMPENSATION COMMITTEE MAKES FINAL COMPENSATION DECISIONS. ADDITIONALLY, THE EXECUTIVE COMPENSATION COMMITTEE REVIEWS ALL COMPENSATION PAYMENTS FOR EXCESS BENEFIT TRANSACTIONS. THE DISCUSSION AND DECISIONS OF THE COMMITTEE ARE DOCUMENTED AND FORMALIZED IN THE COMMITTEE MINUTES AND MAINTAINED ON RECORD. THE FILING ORGANIZATION DETERMINES THE COMPENSATION OF THE SECRETARY BY USE OF AN INDEPENDENT AND EXTERNAL CONSULTANT. THE CONSULTANT HELPS DETERMINE PAY RATES FOR THE ASSOCIATES OF THE FILING ORGANIZATION, TAKING INTO ACCOUNT MARKET DATA AND SHIFT DIFFERENTIAL. THE COMPENSATION RATES ARE APPROVED BY THE FILING ORGANIZATION. BASED THE AFOREMENTIONED PROCEDURE, THE SECRETARY'S COMPENSATION IS NOT REVIEWED BY A COMPENSATION COMMITTEE.
PUBLIC DISCLOSURE FORM 990, PART VI, QUESTION 18 CHRISTUS HEALTH AND MOST OF ITS AFFILIATED ENTITIES DO NOT HAVE FORMS 1023 BECAUSE OF THEIR INCLUSION IN THE IRS GROUP RULING WITH THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS, WHICH COVERS THE ORGANIZATION LISTED IN THE ANNUAL OFFICIAL CATHOLIC DIRECTORY. CHRISTUS HEALTH'S WEBSITE DISPLAYS THE IRS GROUP RULING AND RELEVANT ANNUAL OFFICIAL CATHOLIC DIRECTORY PAGES FOR THE ORGANIZATIONS RELATED TO CHRISTUS HEALTH. FORMS 990 AND 990-T ARE MADE AVAILABLE UPON REQUEST.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, QUESTION 19 THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CHRISTUS HEALTH ARE MADE AVAILABLE TO THE PUBLIC VIA THE CHRISTUS HEALTH WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC.
Other changes in net assets or fund balances Form 990, Part XI, Line 9 Pension Funding ($4,726,654) Pension Liability/Expense $4,441,490 Unrestr. Contribs $543,273 Contributed Capital $48,653 Distribution Corporate Retail $31,342 Temporary Restricted Contribs $984,426 Assets Released from Restriction ($948,114) Transfer of Restricted Donations $652,854 -------------- Total $1,027,270
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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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
2012
Open to Public Inspection
Name of the organization
Christus Health Northern Louisiana
 
Employer identification number

72-0408982
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) 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











Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) CHRISTUS HEALTH ARK-LA-TEX

2600 ST MICHAEL DRIVE

TEXARKANA,TX75503
75-2796815
HLTHCARE SVCs TX 501(C)(3) 3 CH
 
Yes
 
(2) CHRISTUS CONTINUING CARE

1700 W LOOP SOUTH SUITE 1100

HOUSTON,TX77027
74-2898615
HLTHCARE SVCS TX 501(C)(3) 3 CH
 
Yes
 
(3) CH WILKINSON PHYSICIAN NETWORK

1700 WEST LOOP SOUTH STE 400B

HOUSTON,TX77027
76-0422435
HLTHCARE SVCS TX 501(C)(3) 11-TYPE 1 CH
 
Yes
 
(4) ST JOSEPH COMMUNITY FOUNDATION

2800 LAMAR AVE CAPITAL ONE 2ND F

PARIS,TX75460
42-1619230
SUPT HLTH SVC TX 501(C)(3) 11-TYPE 1 CH
 
Yes
 
(5) CHRISTUS STEHLIN FND FOR CANCER RESEARCH

10301 Stella Link Suite A

HOUSTON,TX77025
74-1622404
CANCER RESRCH TX 501(C)(3) 9 CH
 
Yes
 
(6) DUBUIS HEALTH SYSTEM INC

1700 West Loop South Ste 1100A

HOUSTON,TX77027
72-1270964
HLTHCARE SVCS TX 501(C)(3) 9 CH
 
Yes
 
(7) CHRISTUS HEALTH FOUNDATION

919 Hidden Ridge Drive

Irving,TX75038
61-1500100
Supt Hlth Svc TX 501(C)(3) 11-TYPE 1 CH
 
Yes
 
(8) CHRISTUS SCHUMPERT HEALTH SYSTEM FND

ONE ST MARY PLACE

SHREVEPORT,LA71101
72-1219280
HLTHCARE SVCS LA 501(C)(3) 7 CNLA
 
Yes
 
(9) CHRISTUS HEALTH CENTRAL LOUISIANA

3330 MASONIC DRIVE

ALEXANDRIA,LA71301
72-0408984
HLTHCARE SVCS LA 501(C)(3) 3 CH
 
Yes
 
(10) CHRISTUS HEALTH GULF COAST

PO BOX 922037

HOUSTON,TX77292
76-0591592
HLTHCARE SVCS TX 501(C)(3) 3 CH
 
Yes
 
(11) CHRISTUS HEALTH

919 Hidden Ridge Drive

Irving,TX75038
76-0590551
Supt Hlth Svc TX 501(C)(3) 9 NA
 
 
No
(12) Christus Spohn Health System Corporation

600 ELIZABETH STREET

CORPUS CHRISTI,TX78404
74-1109836
HLTHCARE SVCS TX 501(C)(3) 3 CH
 
Yes
 
(13) CHRISTUS HEALTH SOUTHEAST TEXAS

2830 Calder Street

BEAUMONT,TX77726
76-0591590
HLTHCARE SVCS TX 501(C)(3) 3 CH
 
Yes
 
(14) CHRISTUS HEALTH SOUTHWESTERN LOUISIANA

524 DR MICHAEL DEBAKEY DRIVE

LAKE CHARLES,LA70601
72-0411322
HLTHCARE SVCS LA 501(C)(3) 3 CH
 
Yes
 
(15) CHRISTUS SANTA ROSA HEALTH CARE CORP

333 N SANTA ROSA STREET

SAN ANTONIO,TX78207
74-1109665
HLTHCARE SVCS TX 501(C)(3) 3 CH
 
Yes
 
(16) CHRISTUS HEALTH UTAH

919 Hidden Ridge Drive

Irving,TX75038
87-0231682
HLTHCARE SVCS UT 501(C)(3) 9 CH
 
Yes
 
(17) CHRISTUS Health Liability Retention TrST

919 Hidden Ridge Drive

Irving,TX75038
76-0259623
INS TRST TX 501(C)(3) 11-TYPE 1 CH
 
Yes
 
(18) CHRISTUS HEALTH STRATEGIC GROWTH

919 HIDDEN RIDGE DRIVE

IRVING,TX75038
46-2798043
SUPT HLTH SVC TX 501(C)(3) 11-TYPE I CH
 
Yes
 
(19) CHRISTUS HEALTH INTERNATIONAL

919 HIDDEN RIDGE DRIVE

IRVING,TX75038
46-2811167
SUPT HLTH SVC TX 501(C)(3) 11-TYPE I CH
 
Yes
 
(20) CHRISTUS HEALTH LATIN AMERICA

919 HIDDEN RIDGE DRIVE

IRVING,TX75038
46-2816604
SUPT HLTH SVC TX 501(C)(3) 11-TYPE I CH
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) SCH MANAGEMENT SOLUTIONS INC

ONE ST MARY PLACE
SHREVEPORT,LA71101
72-1270625
MGMT HOSP JV LA CNLA
 
C CORP         No
(2) CHRISTUS Muguerza SAPI de CV

HIDALGO PTE 2525
Col. Obispado, Monterrey,N.L.64060
MX
HEALTHCARE SR MX CH
 
C Corp         No
(3) EMERALD ASSURANCE CAYMAN LTD

PO BOX 1051
GRAND CAYMAN   KY1-1102
CJ
98-0407545
INSURANCE CJ CH
 
C-CORP         No








Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
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-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) CH WILKINSON PHYSICIAN NETWORK

A(I) 1,153,576 ACCRUAL
(2) CH WILKINSON PHYSICIAN NETWORK

M 741,853 ACCRUAL
(3) CH WILKINSON PHYSICIAN NETWORK

O 248,895 ACCURAL
(4) CHRISTUS CONTINUING CARE

L 123,496 ACCRUAL
(5) CHRISTUS CONTINUING CARE

O 86,624 ACCRUAL
(6) CHRISTUS CONTINUING CARE

P 171,138 ACCRUAL
(7) CHRISTUS CONTINUING CARE

O 269,726 ACCRUAL
(8) CHRISTUS HEALTH CENTRAL LOUISIANA

M 1,865,373 ACCRUAL
(9) CHRISTUS HEALTH CENTRAL LOUISIANA

O 3,187,860 ACCRUAL
(10) CHRISTUS HEALTH CENTRAL LOUISIANA

Q 927,579 ACCRUAL
(11) CHRISTUS SCHUMPERT HEALTH SYSTEM FOUNDATION

C 194,718 ACCRUAL
(12) CHRISTUS SCHUMPERT HEALTH SYSTEM FOUNDATION

O 102,579 ACCRUAL
(13) CHRISTUS SCHUMPERT HEALTH SYSTEM FOUNDATION

Q 181,251 ACCRUAL
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 section 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) 2012
Schedule R (Form 990) 2012
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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