TY 2012 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) CHARLES FREEBURGH........................................................................ BOARD MEMBER - CHAIR	2.0 .......................4.0	X	X	0	0	0
(2) DONALD DAIGLE........................................................................ BOARD MEMBER - CHAIR	2.0 .......................2.0	X	X	0	0	0
(3) DANIEL MONTELARO........................................................................ BOARD MEMBER - VICE CHAIR	2.0 .......................2.0	X	X	0	0	0
(4) TIMOTHY ANDRUS MD........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(5) WALTER BRINGAZE III MD........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(6) RENEE FURR........................................................................ BOARD MEMBER - SECRETARY	2.0 .......................0.0	X	X	0	0	0
(7) SR LILLIAN LYNCH OSF........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(8) VAN MAYHALL JR........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(9) JOHN MCCLELLAND MD........................................................................ BOARD MEMBER	42.0 .......................0.0	X		530,130	0	25,316
(10) DAVID POPE MD........................................................................ CHIEF OF STAFF/BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(11) SR EILEEN ROWE OSF........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(12) ELIZABETH SEITER MD........................................................................ CHIEF OF STAFF/BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(13) JOEL SILVERBERG MD........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(14) KAREN WILLIAMS MD........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(15) KENNETH WESTER........................................................................ CEO	2.0 .......................58.0	X	X	0	647,415	92,415
(16) JAMES CRAVEN MD........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(17) LUTHER KISSAM........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
FMOL HEALTH SYSTEM, 4200 ESSEN LANEBATON ROUGELA70809	MANAGEMENT SERVICES	49,341,456
ANESTHESIOLOGY GROUP, 8212 SUMMA AVENUEBATON ROUGELA70809	PHYSICIAN SERVICES	8,227,929
CROTHALL HEALTHCARE INC, 5000 HENNESSY BLVDBATON ROUGELA70809	HEALTHCARE SERVICES	7,296,087
LOUISIANA STATE UNIVERSITY, 204 THOMAS BOYD HALLBATON ROUGELA70803	MEDICAL SERVICES	8,281,243
CARDIOVASCULAR SYSTEMS LLC, 7777 HENNESSY BLVD SUITE 1000BATON ROUGELA70808	CONSULTING SERVICES	4,716,149
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 152

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	10,058,596	10,058,596
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	56,888	56,888
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	12,000	12,000
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	4,582,299	1,816,707	2,765,592
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	248,680,211	212,227,102	36,453,109
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	26,232,820	19,970,742	6,262,078
9	Other employee benefits .......	25,148,148	22,370,512	2,777,636
10	Payroll taxes ...........	16,434,044	13,642,185	2,791,859
11	Fees for services (non-employees):
a	Management ......	13,037,566	6,467,672	6,569,894
b	Legal .........	1,780,761	2,077	1,778,684
c	Accounting ...........	3,855,580	15,498	3,840,082
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	1,121,672		1,121,672
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	19,834,720	16,871,088	2,963,632
12	Advertising and promotion ....	2,962,455	502,324	2,460,131
13	Office expenses .......	29,460,710	23,380,839	6,079,871
14	Information technology ......	863,656	350,040	513,616
15	Royalties ..	0
16	Occupancy ...........	8,716,149	7,147,242	1,568,907
17	Travel ............	226,116	175,121	50,995
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	889,689	535,923	353,766
20	Interest ...........	10,174,037	8,342,710	1,831,327
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	29,248,139	24,055,073	5,193,066
23	Insurance ..............	6,731,063	3,284,160	3,446,903
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	133,027,327	133,027,327
b	PURCHASED SERVICES	120,481,646	41,380,718	79,100,928	0
c	EQUIPMENT AND MAINTENANCE	14,658,918	10,631,452	4,027,466
d	OTHER EXPENSE	65,900	65,900
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	728,341,110	556,389,896	171,951,214	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	53,927,784	1	51,211,713
2	Savings and temporary cash investments .........	81,641,790	2	71,117,095
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	101,485,562	4	145,949,083
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 .............	0	7	0
8	Inventories for sale or use ..............	10,629,346	8	14,389,326
9	Prepaid expenses and deferred charges ..........	11,926,438	9	14,659,880
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	943,769,371
b	Less: accumulated depreciation .....	10b	360,812,529	467,132,763	10c	582,956,842
11	Investments—publicly traded securities ..........	158,534,638	11	220,486,055
12	Investments—other securities. See Part IV, line 11 .....	281,105,013	12	281,775,375
13	Investments—program-related. See Part IV, line 11 .....	33,611,922	13	42,096,434
14	Intangible assets ...............	3,498,629	14	11,950,328
15	Other assets. See Part IV, line 11 ...........	46,667,576	15	61,777,937
16	Total assets. Add lines 1 through 15 (must equal line 34)......	1,250,161,461	16	1,498,370,068
	17	Accounts payable and accrued expenses .........	119,870,069	17	166,841,123
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	202,632,986	20	300,832,430
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....................	211,728,816	25	192,765,440
26	Total liabilities. Add lines 17 through 25.........	534,231,871	26	660,438,993
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	707,726,529	27	825,226,388
28	Temporarily restricted net assets ...........	8,203,061	28	12,704,687
29	Permanently restricted net assets ...........	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	715,929,590	33	837,931,075
34	Total liabilities and net assets/fund balances ........	1,250,161,461	34	1,498,370,068

- TIN:

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.

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

OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


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

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)		(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)		(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).

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

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)		(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)		(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.)..

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

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

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:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... 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 OUR LADY OF THE LAKE HOSPITAL INC

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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (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 OUR LADY OF THE LAKE HOSPITAL INC

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
OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

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

(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

(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

(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

(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:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

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)? .......................................

Yes No

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.

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.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

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 .................	0	73,035,268		73,035,268
b	Buildings ................	0	568,208,468	163,272,737	404,935,731
c	Leasehold improvements ............	0	3,078,646	1,161,023	1,917,623
d	Equipment ................	0	278,420,448	186,495,736	91,924,712
e	Other .................	0	21,026,541	9,883,033	11,143,508
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					582,956,842

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther 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
(3)Other (A) FIXED INCOME SECURITIES	100,670,535	F
(B) ALTERNATIVE INVESTMENTS	181,104,841	F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	281,775,376

Part VIII

InvestmentsProgram 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.)

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.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
OTHER LIABILITIES		36,478,623
ACCRUED PENSION COST		156,286,817







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		192,765,440
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

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
FIN 48 (ASC 740 FOOTNOTE)	Schedule D	The Medical Center recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. No reserves for uncertain tax positions have been recorded.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization
OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

Part I

General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.

For grantmakers. 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? ...................................

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in region
	Central America and the Caribbean	Investments	149,634,650
















3a	Sub-total .....		149,634,650
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)		149,634,650

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012

Schedule F (Form 990) 2012

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement
Central America and the Caribbean	HAITI MISSION	12,000	CHECK

Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .... MediumBullet

Enter total number of other organizations or entities ....................... MediumBullet

Schedule F (Form 990) 2012

Schedule F (Form 990) 2012Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2012

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2012

Page 5

Part V

Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

Identifier	ReturnReference	Explanation

Schedule F (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: .........

Yes

200% 250% 300% 350% 400% Other %

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.

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"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

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? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) ..	3,915,961		3,915,961	0.540 %
b	Medicaid (from Worksheet 3, column a) ....	106,657,210	65,511,872	41,145,338	5.650 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	110,573,171	65,511,872	45,061,299	6.190 %
Other Benefits		3,055,349	1,016,624	2,038,726	0.280 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	3,055,349	1,016,624	2,038,726	0.280 %
f	Health professions education (from Worksheet 5) ..	15,696,368	5,997,924	9,698,443	1.330 %
g	Subsidized health services (from Worksheet 6) ..	13,407,161	2,341,312	11,065,850	1.520 %
h	Research (from Worksheet 7)	348,215	95,407	252,808	0.030 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	1,086,520		1,086,520	0.150 %
j	Total. Other Benefits ..	33,593,613	9,451,267	24,142,347	3.310 %
k	Total. Add lines 7d and 7j .	144,166,784	74,963,139	69,203,646	9.500 %

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
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

100,696,819

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

126,673,221

Enter Medicare allowable costs of care relating to payments on line 5.....

137,973,843

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-11,300,622

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

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 %
1PERKINS PLAZA IMAGIN	REAL ESTATE	62.565 %	0.513 %	33.333 %
2PERKINS PLAZA MAD	REAL ESTATE	52.041 %	0.510 %	36.224 %
3NUCLEAR IMAGING	IMAGING SERVICES	66.670 %		33.330 %
4CONVENIENT CARE	URGENT CARE CLINIC	50.000 %		50.000 %
5SURGICAL SPECIALTY	SURGERY CENTER	49.000 %		51.000 %
6PERKINS PLAZA ASC	AMBULATORY SURGERY CENTER	46.000 %		27.000 %
7REGIONAL EYE SURGERY	IMAGING SERVICES	12.750 %		87.250 %
8
9
10
11
12
13

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
1	OUR LADY OF THE LAKE HOSPITAL 5000 HENNESSY BOULEVARD BATON ROUGE,LA70808 WWW.FMOLHS.ORG/OLOLRMC	X	X	X	X
2	SURGICAL SPECIALTY CTR OF BATON ROUGE 8080 BLUEBONNET BLVD BATON ROUGE,LA70810 WWW.SSCBR.COM	X	X

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)

	OUR LADY OF THE LAKE HOSPITAL
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

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

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....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

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 ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

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 ........

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)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

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

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: 150.% 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: 400.% 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	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
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	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
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	Yes
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

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? ............................

Yes

If “Yes,” explain in Part VI.

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? .........................

If “Yes,” explain in Part VI.

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)

	SURGICAL SPECIALTY CTR OF BATON ROUGE
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

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

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....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

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)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

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

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: 150.% 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: 150.% 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	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
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	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
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	Yes
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
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	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

Yes

If “Yes,” explain in Part VI.

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? .........................

If “Yes,” explain in Part VI.

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?8
Name and address		Type of Facility (describe)
1	REGIONAL EYE SURGERY CENTER 4950 ESSEN LANE BATON ROUGE,LA708093739	SURGERY CENTER
2	PERKINS PLAZA AMB SURGERY CENTER 7145 PERKINS ROAD BATON ROUGE,LA708084322	SURGERY CENTER
3	PERKINS PLAZA IMAGING CENTER 5000 HENNESSY BOULEVARD BATON ROUGE,LA70808	IMAGING
4	NUCLEAR IMAGING 5000 HENNESSY BOULEVARD BATON ROUGE,LA70808	IMAGING
5	CONVENIENT CARE LLC 7777 HENNESSY BOULEVARD BATON ROUGE,LA70808	URGENT CARE
6	BRPT-LAKE REHABILITATION CENTERS LLC 530 SHADOWS LANE BATON ROUGE,LA70806	REHABILITATION
7	OLOL PONCHARTRAIN SURGERY CENTER LLC 15305 DALLAS PKWYSTE 1600 LB 28 ADDISON,TX75001	SURGERY CENTER
8	LAKE URGENT CARE ASCENSION LLC 10319 JEFFERSON HIGHWAY BATON ROUGE,LA70809	URGENT CARE
9
10

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
PART I, LINE 3C:		ELIGIBILITY FOR CHARITY IS BASED ON AN INDIVIDUALIZED DETERMINATION OF FINANCIAL NEED, AND SHALL NOT TAKE INTO ACCOUNT AGE, GENDER, RACE SOCIAL OR IMMIGRANT STATUS, SEXUAL ORIENTATION OR RELIGIOUS AFFILIATION. DISCOUNTED CARE IS BASED UPON CURRENT FEDERAL POVERTY LEVELS (FPL) WITH THOSE AT 200% OR BELOW ELIGIBLE FOR FREE CARE, AND THOSE ABOVE 200% RECEIVE DISCOUNTED CARE ON A SLIDING SCALE, UP TO BUT NOT MORE THAN 400% OF FPL.
PART I, LINE 7G:		OUR LADY OF THE LAKE INCLUDES THE COST OF SEVERAL PHYSICIAN CLINICS IN SUBSIDIZED HEALTH SERVICES INCLUDING THOSE THAT PROVIDE SPECIALIZED PEDIATRIC SERVICES, PSYCHIATRIC SERVICES, RURAL HEALTH CLINICS AND HOSPITAL MEDICINE PHYSICIANS THAT HANDLE THE PLAN OF CARE FOR PATIENTS WITHOUT PERSONAL PHYSICIANS AS RELATED TO EMERGENCY ROOM VISITS.
PART I, LINE 7F:		FOR THE PURPOSE OF CALCULATING THE PERCENTAGE IN PART I, LINE 7, COLUMN F, FUNCTIONAL EXPENSES WERE USED WHICH DID NOT INCLUDE BAD DEBT EXPENSE.
PART I, LINE 7:		THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINES 7A-7D AND IS BASED ON IRS WORKSHEET 2. FOR PART I LINES 7E, 7F, 7H AND 7I, DIRECT COSTS WERE CAPTURED FROM THE HOSPITAL'S AUDITED FINANCIAL STATEMENT AND THE MEDICARE COST REPORT WHERE APPLICABLE. FOR PART I LINE 7G, THE FOLLOWING METHODOLOGY WAS USED DUE TO THE FACT THAT MANY OF THE DEPARTMENTS INCLUDED IN SUBSIDIZED HEALTH SERVICES HAVE NO CHARGES. THEREFORE, THE COST TO CHARGE RATIO COULD NOT BE UTILIZED. COST FIGURES FOR THESE WERE CALCULATED FROM DIRECT DEPARTMENTAL COSTS PLUS AN OVERHEAD ALLOCATION (AS REFLECTED ON THE MEDICARE COST REPORT) LESS DIRECT OFFSETTING REVENUE.
PART III, LINE 4:		THE BAD DEBT FOOTNOTE IS ON PAGE 16 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8:		THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. THE AMOUNT ON PART III, LINE 6 REPRESENTS MEDICARE ALLOWABLE COSTS FROM THE COST REPORT AS ADJUSTED FOR AMOUNTS ALREADY INCLUDED ON SCHEDULE H, LINE 7 RELATED TO SUBSIDIZED HEALTH SERVICES AND HEALTH PROFESSIONS EDUCATION.
PART III, LINE 9B:		PATIENTS WITH NO MEANS OF PAYMENTS MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS MAY ALSO BE WRITTEN OFF TO CHARITY BASED ON THE INFORMATION PROVIDED BY CREDIT BUREAUS, THROUGH THE SYSTEMS AND TOOLS UTILIZED AS WELL AS THE PATIENT'S MEDICAL EXPENSE. IF IT IS DETERMINED THAT A PATIENT QUALIFIES FOR CHARITY CARE AFTER THE INDIVIDUAL'S ACCOUNT HAS BEEN SENT TO COLLECTIONS, THE ACCOUNT IS IMMEDIATELY REMOVED FROM THE COLLECTIONS PROCESS. TO THE EXTENT APPROPRIATE AND PERMITTED BY LAW, FINANCIAL COUNSELING AND SCREENINGS ARE CONDUCTED AT THE TIME OF ENCOUNTER TO ASSIST IN IDENTIFYING PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY.
NEEDS ASSESSMENT	PART VI, LINE 2:	RESPONDING TO THE HEALTH NEEDS OF OUR COMMUNITY, ESPECIALLY TO THOSE MOST IN NEED, IS PRIMARY TO THE HOSPITAL'S MISSION. OUR LADY OF THE LAKE HOSPITAL WORKS TO CONDUCT HEALTH CARE NEEDS ASSESSMENTS. THEY WORK CLOSELY WITH UNITED WAY, PUBLIC HEALTH, AMERICAN HEART ASSOCIATION, ST. VINCENT de PAUL AND MANY OTHER ORGANIZATIONS TO DEFINE COMMUNITY NEEDS AND TO CONSOLIDATE EFFORTS TO MEET THOSE COMMUNITY NEEDS. FOR EXAMPLE, PARISH NURSING, HEALTH SCREENING FOR DIABETES, SKIN CANCER, PROSTRATE CANCER AND BREAST CANCER ARE PROMOTED IN VARIOUS COMMUNITY SETTINGS TO IMPROVE OVERALL COMMUNITY HEALTH. OUR LADY OF THE LAKE HOSPITAL CONDUCTED A CHNA IN COLLABORATION WITH OTHER ORGANIZATIONS AND AGENCIES IN BATON ROUGE THROUGH THE MAYOR'S HEALTHY CITY INITIATIVE.
PATIENT EDUCATION OF ELIGIBILITY OF ASSISTANCE	PART VI, LINE 3	INDIVIDUALS ARE EDUCATED ABOUT ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE HOSPITAL'S CHARITY CARE POLICY AT VARIOUS STAGES OF THE ENCOUNTER WITH OUR LADY OF THE LAKE HOSPITAL. PATIENTS ARE INFORMED THROUGH A PATIENT HANDBOOK THAT CONTAINS INFORMATION ON THE FINANCIAL POLICIES OF THE HOSPITAL. ADDITIONALLY, SYSTEMS AND TOOLS ARE UTILIZED TO CONDUCT HIGH LEVEL FINANCIAL SCREENING TO ASSIST IN IDENTIFYING PATIENTS ELIGIBLE FOR CHARITY CARE, FINANCIAL ASSISTANCE, AND SELF PAY DISCOUNTS. WHEN AND WHERE APPROPRIATE, FINANCIAL COUNSELORS VISIT PATIENTS AT THE TIME OF THE ENCOUNTER AND EXPLAIN THE ASSISTANCE OPTIONS AVAILABLE. FINANCIAL COUNSELORS WORK WITH PATIENTS TO ASSIST WITH ENROLLMENT FOR MEDICAID FOR THOSE WHO ARE ELIGIBLE AS WELL AS TO ASSIST THOSE WHO QUALIFY FOR CHARITY CARE.
COMMUNITY INFORMATION	PART VI, LINE 4	OUR LADY OF THE LAKE HOSPITAL (OLOL) IS A COMMUNITY-BASED, NOT-FOR-PROFIT HOSPITAL LOCATED IN BATON ROUGE, LOUISIANA THAT SERVES EAST BATON ROUGE PARISH AND PORTIONS OF THE SURROUNDING PARISHES. OLOL'S PRIMARY SERVICE AREA HAS A POPULATION OF 692,769 AND 263,676 HOUSEHOLDS. THE MEDIAN AGE IS 35 YEARS, THE SENIOR POLULATION COMPRISES ABOUT 11.7% OF THE TOTAL POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $49,769, 25.6% HOUSEHOLDS HAVE INCOMES BELOW $25,000, PER CAPITA INCOME IS $24,673 AND UNEMPLOYMENT RATE IS 4.8%. OLOL'S PRIMARY SERVICE AREA INCLUDES THE FOLLOWING PARISHES: EAST BATON ROUGE PARISH LIVINGSTON PARISH ASCENSION PARISH OLOL'S SECONDARY SERVICE AREA INCLUDES THE FOLLOWING PARISHES: ASSUMPTION PARISH EAST FELICIANA PARISH IBERVILLE PARISH POINTE COUPEE PARISH ST. HELENA PARISH ST. JAMES PARISH WEST BATON ROUGE PARISH WEST FELICIANA PARISH
PROMOTION OF COMMUNITY HEALTH	PART VI, LINE 5	OUR LADY OF THE LAKE HOSPITAL PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES BECAUSE IT UNDERSTANDS THAT IMPROVEMENTS TO A COMMUNITY HAVE A DIRECT LINK TO THE IMPROVED HEALTH OF COMMUNITY RESIDENTS. COMMUNITY BUILDING ACTIVITIES INCLUDE THE FOLLOWING: OUR LADY OF THE LAKE ESTABLISHED CLINICS LOCATED IN AREAS WITHIN UNDER-INSURED/LOW INCOME AREAS. THIS ALLOWS INDIVIDUALS TO ACCESS HEALTH CARE SERVICE THAT WOULD BE FOREGONE OR POSTPONED THEREBY CREATING A COMMUNITY AREA WITH MORE INTENSE HEALTH ISSUES/PROBLEMS. OUR LADY OF THE LAKE PROVIDES OVERSIGHT OF COMMUNITY PROGRAMS AND ACTIVITIES AND COORDINATED HEALTH CARE SCREENING FOR VARIOUS HEALTH ISSUES. AFTER HURRICANE KATRINA, OUR LADY OF THE LAKE BECAME A TEACHING HOSPITAL THROUGH AFFILIATION WITH LOUISIANA STATE UNIVERSITY MEDICAL SCHOOL TO INSURE THE STATE OF LOUISIANA MAINTAIN AN ADEQUATE SUPPLY OF PHYSICIANS. IN 2011 OUR LADY OF THE LAKE RECEIVED ACCREDITATION APPROVAL FOR A PEDIATRIC GRADUATE MEDICAL EDUCATION PROGRAM. THE STATE CHARITY HOSPITAL WILL CLOSE THE INPATIENT PORTION OF THE STATE FACILITY SHIFTING THOSE HEALTH CARE SERVICES TO OUR LADY OF THE LAKE HOSPITAL. THE OUTPATIENT COMPONENT OF THE STATE CHARITY HOSPITAL WILL BE EXPANDED THROUGH THE OPENING OF A 24/7 URGENT CARE CLINIC IN AN AREA WITH A LARGE UNDER-INSURED/UNINSURED POPULATION. THE MAJORITY OF THE GOVERNING BODY OF OUR LADY OF THE LAKE IS COMPRISED OF INDIVIDUALS FROM A BROAD CROSS-SECTION OF THE COMMUNITY WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. OLOL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF THE HOSPITAL DEPARTMENTS AS NEEDED. SURPLUS FUNDS ARE APPLIED TO IMPROVEMENT IN PATIENT CARE AREAS THROUGH THE INVESTMENT IN CLINICAL TECHNOLOGY. MEDICAL INFORMATION TECHNOLOGY, AND CONTINUED TRAINING OF CLINICAL STAFF.
AFFILIATED HEALTH CARE SYSTEM ROLES	PART VI, LINE 6	OUR LADY OF THE LAKE HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL, NON-STOCK, MEMBER CORPORATION OF WHICH FRANCISCIAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC. (FMOL HEALTH SYSTEM) IS THE SOLE MEMBER. OUR LADY OF THE LAKE HOSPITAL IS PART OF THE FMOL HEALTH SYSTEM WHICH INCLUDES SEVERAL HOSPITALS AND TAX-EXEMPT AFFILIATES THROUGHOUT THE STATE OF LOUISIANA. OUR LADY OF THE LAKE HOSPITAL SERVES THE COMMUNITY IN EAST BATON ROUGE PARISH AND SURROUNDING PARISHES. OTHER RELATED HOSPITALS IN LOUISIANA INCLUDE: OUR LADY OF LOURDES REGIONAL MEDICAL CENTER ST. FRANCIS MEDICAL CENTER ST. ELIZABETH HOSPITAL OUR LADY OF THE LAKE ASSUMPTION HOSPITAL
PART V, LINE 13G:	OUR LADY OF THE LAKE HOSPITAL	REGISTRATION PERSONNEL REFER PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE TO FINANCIAL COUNSELORS TO DISCUSS QUALIFICATION FOR FREE OR DISCOUNTED CARE. THE POLICY IS ALSO POSTED AT THE HOSPITAL BUSINESS OFFICES AND AT URGENT CARE CENTERS.
PART V, LINE 13G:	SURGICAL SPECIALTY CENTER OF BATON ROUGE	FOR PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE, FINANCIAL COUNSELORS ARE AVAILABLE TO DISCUSS QUALIFICATION FOR FREE OR DISCOUNTED CARE.
PART V, QUESTION 20:	OUR LADY OF THE LAKE HOSPITAL	THE HOSPITAL FACILITY HAS CALCULATED THE AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE AT APPROXIMATELY A 30% DISCOUNT FROM CHARGE MASTER RATES. UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP), MULTIPLE LEVELS OF DISCOUNTS ARE PROVIDED FOR. THE MAJORITY OF FAP ELIGIBLE PATIENTS FALL IN THE 50%, 75%, AND 100% DISCOUNT LEVELS. THERE IS HOWEVER A 25% DISCOUNT LEVEL. THE HOSPITAL ALSO OFFERS A 25% SELF-PAY DISCOUNT. SO FOR UNINSURED FAP PATIENTS, MULTIPLE DISCOUNTS MAY APPLY. IT IS POSSIBLE, HOWEVER, THAT AN UNDERINSURED PATIENT WITHIN CERTAIN INCOME LEVELS WOULD BE OFFERED ONLY THE 25% CHARITY DISCOUNT. THE NUMBER OF PATIENTS IN THIS SCENARIO WOULD BE EXTREMELY SMALL, IF ANY, BUT IT IS POSSIBLE THAT THIS CATEGORY OF PATIENT MAY HAVE BEEN CHARGED MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE. IN ADDITION, THERE IS LOW PROBABILITY THAT ANY PATIENT IN THIS 25% CHARITY DISCOUNT CATEGORY ACTUALLY PAID MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE. THE HOSPITAL ADOPTED A NEW FAP POLICY AS OF JUNE 2013 THAT WILL ENSURE THAT FAP-ELIGIBLE PATIENTS ARE NOT BILLED MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE.
PART V, QUESTION 20:	SURGICAL SPECIALTY CENTER OF BATON ROUGE	UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP), MULTIPLE LEVELS OF DISCOUNTS ARE PROVIDED FOR. THE MAJORITY OF FAP ELIGIBLE PATIENTS FALL IN THE 50%, 75%, AND 100% DISCOUNT LEVELS. THERE IS HOWEVER A 25% DISCOUNT LEVEL. THE HOSPITAL ALSO OFFERS A 25% SELF-PAY DISCOUNT. SO FOR UNINSURED FAP PATIENTS, MULTIPLE DISCOUNTS MAY APPLY. IT IS POSSIBLE, HOWEVER, THAT AN UNDERINSURED PATIENT WITHIN CERTAIN INCOME LEVELS WOULD BE OFFERED ONLY THE 25% CHARITY DISCOUNT. THE NUMBER OF PATIENTS IN THIS SCENARIO WOULD BE EXTREMELY SMALL, IF ANY, BUT IT IS POSSIBLE THAT THIS CATEGORY OF PATIENT MAY HAVE BEEN CHARGED MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE. IN ADDITION, THERE IS LOW PROBABILITY THAT ANY PATIENT IN THIS 25% CHARITY DISCOUNT CATEGORY ACTUALLY PAID MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE COVERING SUCH CARE. THE HOSPITAL FACILITY IS CURRENTLY WORKING TO CORRECT THIS SITUATION FOR THIS SMALL NUMBER OF PATIENTS.
PART V, QUESTION 19D:	OUR LADY OF THE LAKE HOSPITAL AND SURGICAL SPECIALTY CENTER OF BATON ROUGE	THE HOSPITAL OFFERS VARIOUS LEVELS OF DISCOUNTS WHICH ARE BASED ON A SLIDING SCALE USING THE FEDERAL POVERTY GUIDELINE FAMILY INCOME LEVELS AND OTHER FACTORS. SUCH OTHER FACTORS INCLUDE ASSET LEVELS, MEDICAL INDIGENCY, AND A PATIENT'S QUALIFICATION FOR MEDICARE OR MEDICAID. TOGETHER THESE CRITERIA ARE USED TO SET THE MAXIMUM AMOUNT CHARGED. ALSO, A 25% SELF-PAY DISCOUNT IS GIVEN IN ADDITION TO THE CHARITY DISCOUNTS DESCRIBED ABOVE.
PART III, SECTION A, QUESTION 2		THE HOSPITAL ACCOUNTS FOR BAD DEBTS BASED ON THE AGING OF THE ACCOUNTS AND BASED ON HISTORICAL COLLECTION HISOTRY ASSOCIATED WITH THE VARIOUS AGING CATEGORIES. ON A PERIODIC BASIS, THE ORGANIZATION CONDUCTS A RETROSPECTIVE REVIEW TO DETERMINE THE APPROPRIATENESS OF THE COLLECTION PERCENTAGES UTILIZED IN ESTIMATED BAD DEBT EXPENSE. CHARITY AND DISCOUNTS ARE NOT INCLUDED IN BAD DEBT EXPENSE. PAYMENTS RECEIVED ON ACCOUNTS SUBSEQUENT TO BEING CONSIDERED BAD DEBT ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE.
PART V, SECTION B, QUESTION 3	OUR LADY OF THE LAKE HOSPITAL AND SURGICAL SPECIALTY CENTER OF BATON ROUGE	OLOL JOINED THE MAYOR'S HEALTHY CITY INITIATIVE AND SITS AMONG OTHER LOCAL AREA HOSPITALS IN AN OPEN COLLABORATIVE EFFORT TO IMPROVE THE HEALTH OF THE BATON ROUGE COMMUNITY. THE MAYOR'S HEALTHY CITY INITIATIVE WORKED WITH HEALTHYBR AND MEDBR TO COMPLETE THE COMMUNITY NEEDS ASSESSMENT. AMONG THESE THREE GROUPS, THERE WERE REPRESENTATIVES FROM NUMEROUS BUSINESSES, HOSPITALS, GOVERNMENT ORGANIZATIONS, NONPROFIT ORGANIZATIONS AND SCHOOLS. THE LOCAL HOSPITALS PARTICIPATING WERE WOMAN'S HOSPITAL, BATON ROUGE GENERAL, OCHSNER MEDICAL CENTER, LSU HEALTH SCIENCES, LANE REGIONAL MEDICAL CENTER, AND EARL K. LONG/LSU HEALTH. THE REPRESENTATIVES ALSO INCLUDED INDIVIDUALS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THESE INDIVIDUALS WERE JIMMY GUIDRY, MD, STATE HEALTH OFFICER OF LOUISIANA AND DHH'S MEDICAL DIRECTOR; PAM ROMERO, RD, LDN, CDE, REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR; AND MARILYN REYNAUD, MD, MPH, REGIONAL ADMINISTRATOR/MEDICAL DIRECTOR FOR THE DEPARTMENT OF HEALTH AND HOSPITALS, REGION 2 OFFICE OF PUBLIC HEALTH. DEPARTMENT OF HEALTH AND HOSPITALS, REGION 2 OFFICE OF PUBLIC HEALTH.
PART V, SECTION B, QUESTION 4		OUR LADY OF THE LAKE HOSPITAL: THE CHNA WAS CONDUCTED IN COLLABORATION WITH WOMAN'S HOSPITAL, BATON ROUGE GENERAL MEDICAL CENTER, LANE REGIONAL MEDICAL CENTER, AND LSU HEALTH/EARL K. LONG MEDICAL CENTER THROUGHTHE MAYOR'S HEALTHY CITY INITIATIVE. SURGICAL SPECIALTY CENTER OF BATON ROUGE: SURGICAL SPECIALTY CENTER OF BATON ROUGE FORMALLY ADOPTED THE COMMUNITY HEALTH NEEDS ASSESSMENT OF OUR LADY OF THE LAKE HOSPITAL , AN AFFILIATED ENTITY. SSC AND OLOL SHARE THE SAME DEMOGRAPHIC COMMUNITY SO SSC FELT THAT THE NEEDS IDENTIFIED BY THE MAYOR'S HEALTHY CITY INITIATIVE WERE REPRESENTATIVE OF ITS COMMUNITY'S NEEDS AS WELL.
PART V, SECTION B, Q5		OUR LADY OF THE LAKE HOSPITAL: THE CHNA CAN BE FOUND AT HTTPS://FMOLHS.ORG/OLOLRMC/PAGES/QUALITY/COMMUNITY-HEALTH-ASSESSMENT.ASPX SURGICAL SPECIALTY CENTER OF BATON ROUGE: THE CHNA CAN BE FOUND AT WWW.SSCBR.COM.
PART V, SECTION B, QUESTION 7		OUR LADY OF THE LAKE HOSPITAL (OLOL): OLOL DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA. OLOL (AND THE MAYOR'S HEALTHY CITY INITIATIVE AS A WHOLE) AGREED THAT THE COMMUNITY SHOULD WORK ON THE TOP FOUR IDENTIFIED PRIORITIES SINCE THEY POSE THE HIGHEST RISK TO THE COMMUNITY. AS SUCH, OLOL CHOSE NOT TO FOCUS ON THE FOLLOWING: HEART DISEASE/HIGH BLOOD PRESSURE/STROKE; CANCER; DIABETES; CHILD AND ADOLESCENT HEALTH; LIFESTYLE ISSUES; AND BARRIERS. HOWEVER OLOL CURRENTLY CONDUCTS AND WILL CONTINUE TO CONDUCT PROGRAMS AND/OR PROVIDE SERVICES THAT HELP ADDRESS THESE NEEDS. SURGICAL SPECIALTY CENTER OF BATON ROUGE: SURGICAL SPECIALTY CENTER OF BATON ROUGE (SSC) DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA. IT CHOSE NOT TO ADDRESS OBESITY, HIV/AIDS, CHILDREN & ADOLESCENT HEALTH, HEART DISEASE/HIGH BLOOD PRESSURE/STROKE BECAUSE OUR LADY OF THE LAKE HOSPITAL (AN AFFILIATED ENTITY) AND OTHERS HAVE SELECTED THESE ISSUES TO ADDRESS. SSC WILL ASSIST OTHER LOCAL HOSPITALS AND ORGANIZATIONS IN THE COMMUNITY IF REQUESTED AND WHERE APPROPRIATE. SSC ALSO CHOSE NOT TO ADDRESS MENTAL AND BEHAVIORAL HEALTH, HIV/AIDS, AND OVER UTILIZATION OF EMERGENCY DEPARTMENT BECAUSE SSC IS A SPECIALTY HOSPITAL NOT EQUIPT TO ADDRESS SUCH ISSUES.

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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
OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number
72-0423651

Part I

General Information on Grants and Assistance

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? ....................................

Yes No

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	(h) Purpose of grant or assistance
(1) BATON ROUGE AREA CHAMBER 564 LAUREL STREET BATON ROUGE,LA70801	72-0126959	501(C)(6)	76,308	GENERAL SUPPORT
(2) GENERAL GROWTH PROPERTIES 6401 BLUEBONNET BLVD STE 5050 BATON ROUGE,LA70836	30-0247204		88,000	PLAYGROUND EQUIPMENT
(3) CARDIOVASCULAR RESEARCH 7777 HENNESSY BLVD BATON ROUGE,LA70808	72-1490943	501(C)(3)	100,000	GENERAL SUPPORT
(4) BATON ROUGE SPEECH AND HEARING FOUNDATION 535 W ROOSEVELT ST BATON ROUGE,LA70802	72-0542134	501(C)(3)	45,500	GENERAL SUPPORT
(5) LOUISIANA PEDIATRIC CARDIOLOGY FOUNDATION 2137A QUAIL RUN STE B BATON ROUGE,LA70808	72-1476551	501(C)(3)	30,000	GENERAL SUPPORT
(6) ARTHRITIS ASSOCIATION OF LA 4939 JAMESTOWN AVE STE 104-A BATON ROUGE,LA70809	76-0750333	501(C)(3)	25,000	GENERAL SUPPORT
(7) CANCER SERVICES OF BATON ROUGE 550 LOBDELL AVENUE BATON ROUGE,LA70806	72-0517180	501(C)(3)	21,250	GENERAL SUPPORT
(8) VOLUNTEER HEALTH CORPS 4655 SHERWOOD COMMON BLVD BATON ROUGE,LA70816	20-4852337	501(C)(3)	20,000	GENERAL SUPPORT
(9) MARY BIRD PERKINS CANCER P O BOX 11407 DEPT 1299 BIRMINGHAM,AL352461299	23-7010520	501(C)(3)	16,250	GENERAL SUPPORT community
(10) BATON ROUGE SYMPHONY ORCHESTRA 2354 S ACADIAN THRUWAY STE A BATON ROUGE,LA70808	72-6001959	501(C)(3)	10,000	GENERAL SUPPORT
(11) INTERNATIONAL RETT SYNDROME FOUNDATION 4600 DEVITT DR CINCINNATI,OH45246	31-1682518	501(C)(3)	10,000	GENERAL SUPPORT
(12) SOUTHERN UNIVERSITY SYSTEM P O BOX 9270 BATON ROUGE,LA70813	23-7052911	501(C)(3)	10,000	GENERAL SUPPORT
(13) BOYS & GIRLS CLUB 8281 GOODWOOD BLVD STE H BATON ROUGE,LA70806	72-0928014	501(C)(3)	6,000	GENERAL SUPPORT
(14) FAMILIES HELPING FAMILIES 2356 DRUSILLA LANE BATON ROUGE,LA70809	72-1406289	501(C)(3)	7,500	GENERAL SUPPORT
(15) ISTROUMA AREA COUNCIL P O BOX 66676 BATON ROUGE,LA70896	72-0411324	501(C)(3)	7,500	GENERAL SUPPORT
(16) SHAQUILLE O'NEAL CHAMPSLIFE SKILLS 107 GYM ARMORY BATON ROUGE,LA70803	72-1004960	501(C)(3)	8,500	GENERAL SUPPORT
(17) PENNINGTON BIOMEDICAL RESEARCH FOUNDATION 6400 PERKINS ROAD BATON ROUGE,LA708084124	58-1767810	501(C)(3)	6,500	GENERAL SUPPORT
(18) ALLIANCE SAFETY COUNCIL 10099 NORTH REIGRE ROAD BATON ROUGE,LA70809	72-0702946	501(c)(3)	30,000	GENERAL SUPPORT
(19) AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS,TX752314596	13-5613797	501(C)(3)	80,000	GENERAL SUPPORT
(20) BR ECONOMIC & AGRICULTURAL DEVELOPMENT ALLIANCE PO BOX 3976 BATON ROUGE,LA70821	72-1332566	501(C)(3)	10,000	GENERAL SUPPORT
(21) CATHOLIC DIOCESE OF BATON ROUGE 18000 S ACADIAN THRUWAY BATON ROUGE,LA70806	72-0550127	501(C)(3)	7,500	GENERAL SUPPORT
(22) ARTS COUNCIL OF GREATER BATON ROUGE 427 LAUREL STREET BATON ROUGE,LA70802	72-0735814	501(C)(3)	6,000	GENERAL SUPPORT
(23) MCMAINS CHILDREN'S DEVELOPMENTAL CENTER 1805 COLLEGE DRIVE BATON ROUGE,LA70808	72-0459036	501(C)(3)	35,967	GENERAL SUPPORT
(24) JUNIOR ACHIEVEMENT 7809 JEFFERSON HWY STE D-4 BATON ROUGE,LA70809	72-0485727	501(C)(3)	11,000	GENERAL SUPPORT
(25) LOUISIANA 4-H FOUNDATION PO BOX 25100 BATON ROUGE,LA70894	72-1367519	501(C)(3)	10,000	GENERAL SUPPORT
(26) LOUISIANA STATE UNIVERSITY- OFFICE OF ACCTG SVCS 204 THOMAS BOYD HALL BATON ROUGE,LA708032901	72-6000848	GOVT	2,148,011	GENERAL SUPPORT
(27) LOURDES FOUNDATION PO BOX 4027 LAFAYETTE,LA70502	72-1494532	501(C)(3)	10,000	GENERAL SUPPORT
(28) LSUHSC CLINICS EARL K LONG MEDICAL CENTER 5825 AIRLINE HWY BATON ROUGE,LA70805	72-1304948	501(C)(3)	833,909	GENERAL SUPPORT
(29) LSUHSC-NEW ORLEANS 1901 PERDIDO STREET BOX P3-1 NEW ORLEANS,LA70112	72-6087770	501(C)(3)	360,433	GENERAL SUPPORT
(30) ST ELIZABETH HOSPITAL 1125 WEST HWY 30 GONZALES,LA70737	72-1470744	501(C)(3)	10,354	GENERAL SUPPORT
(31) OUR LADY OF THE LAKE COLLEGE 5000 HENNESSY BLVD BATON ROUGE,LA70808	72-1173156	501(C)(3)	2,929,167	GENERAL SUPPORT
(32) CITY YEAR INC 287 COLUMBUS AVENUE BOSTON,MA02116	22-2882549	501(C)(3)	7,500	GENERAL SUPPORT
(33) NATIONAL INFUSION SERVICES 5344 BRITTANY DRIVE BATON ROUGE,LA70808	72-1508782		18,130	INFUSION THERAPY
(34) F JEFFERSON LINER JR MD & DOROTHY A LEWIS PTRS PO BOX 2308 HAMMOND,LA70404	72-0955002		157,714	SEE PART IV
(35) BATON ROUGE RADIOLOGY GROUP 7887 PICARDY AVENUE BATON ROUGE,LA70809	72-0692720		1,514,302	SVCS FOR INDIGENT PATIENTS

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

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
(1) SCHOLARSHIP	1	3,438
(2) MEDICAL CARE FOR NEEDY INDIVIDUALS	6	53,450

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
Monitoring grants		FORMAL REQUESTS ARE RECEIVED BY THE BUSINESS PAYOR RELATIONS DEPARTMENT. THE REQUESTS ARE CHECKED FOR ALL APPROPRIATE INFORMATION AND DOCUMENTATION AND ARE PRESENTED TO EXECUTIVE ADMINISTRATION FOR APPROVAL. UPON APPROVAL THE REQUESTS ARE SUBMITTED TO ACCOUNTS PAYABLE FOR PAYMENT.
PART II, PAGE 3, LINE 10		THE PURPOSE OF THE GRANT TO F JEFFERSON LINER JR., MD AND DOROTHY A. LEWIS PTRS WAS FOR SURGICAL SERVICES PROVIDED TO CHARITY HOSPITAL.

Schedule I (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

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? .......

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

Yes

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable 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
(1)JOHN MCCLELLAND MDBOARD MEMBER	(i) (ii)	398,468 0	130,870 0	792 0	10,000 0	15,316 0	555,446 0	0 0
(2)KENNETH WESTERCEO	(i) (ii)	0 481,556	0 147,200	0 18,659	0 78,953	0 13,462	0 739,830	0 0
(3)JEFFERY LIMBOCKERCFO	(i) (ii)	298,157 0	60,125 0	11,989 0	28,981 0	28,131 0	427,383 0	0 0
(4)DENZIL MORAESSTAFF PHYSICIAN	(i) (ii)	770,773 0	345,370 0	44,696 0	10,000 0	24,261 0	1,195,100 0	0 0
(5)STEVEN GREMILLIONSTAFF PHYSICIAN	(i) (ii)	664,203 0	290,055 0	72,114 0	10,000 0	22,061 0	1,058,433 0	0 0
(6)KENNETH CIVELLOSTAFF PHYSICIAN	(i) (ii)	579,843 0	279,545 0	37,954 0	10,000 0	24,734 0	932,076 0	0 0
(7)PAUL GARRETTSTAFF PHYSICIAN	(i) (ii)	534,987 0	207,948 0	33,392 0	10,000 0	22,061 0	808,388 0	0 0
(8)JEFFREY HYDESTAFF PHYSICIAN	(i) (ii)	528,656 0	250,131 0	34,710 0	10,000 0	19,484 0	842,981 0	0 0

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
PART 1, QUESTION 4A		THE CEO IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE FOR GOOD REASON. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS BASE SALARY AND AN ANNUAL INCENTIVE AT TARGET AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 24 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR.
PART 1, QUESTION 4B		FMOLHS MAINTAINS AN UNFUNDED DEFERRED COMPENSATION PLAN WHICH MEETS THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLAN PROVIDES FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURRENCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLAN IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. NO ONE LISTED ON PART VII, SECTION A RECEIVED A PAYMENT FROM THE PLAN IN THE CURRENT YEAR.
PART 1, QUESTION 7		DISCRETIONARY BONUSES WERE PAID WITH REGARD TO PERSONS LISTED ON PART VII, SECTION A, LINE 1A. SUCH BONUSES WERE APPROVED BY THE CEO OR THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS.
PART 1, QUESTION 3		THE CEO IS PAID BY FMOL HEALTH SYSTEM, A RELATED TAX EXEMPT ORGANIZATION. THE FMOLHS BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET THE CEO'S COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION STUDY/SURVEY FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE.

Schedule J (Form 990) 2012

Additional Data

Software ID:
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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

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

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) SURGICAL MANAGEMENT SERVICES LLC	2 BM ARE OWNERS	2,003,294	PROVIDED MANAGEMENT SERVICES		No
(2) CVT VASCULAR LAB INC	2 BM ARE OWNERS	1,077,917	PROVIDED MEDICAL SERVICES		No
(3) CVT SURGICAL CENTER	2 BM ARE OWNERS	208,723	PROVIDED MEDICAL SERVICES		No
(4) BONE AND JOINT CLINIC	1 BOARD MEMBER IS OWNER	467,362	PROVIDED MEDICAL SERVICES		No

Part V

Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

Identifier	Return Reference	Explanation
GOVERNING DOCUMENTS	PART VI, SECTION C, QUESTION 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST.
PART VI, SECTION A, QUESTION 6		FMOL HEALTH SYSTEM (AN IRC SECTION 501 (C)(3) ORGANIZATION) IS THE SOLE MEMBER OF OUR LADY OF THE LAKE HOSPITAL, INC.
MEMBERS	PART VI, SECTION A, QUESTION 7B	THE RESERVED POWERS TO THE MEMBER ARE AS FOLLOWS: 1. TO CHANGE PHILOSOPHY, OBJECTIVES AND PURPOSES OF CORPORATION 2. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION 3. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION 4. TO AUTHORIZE MERGER, CONSOLIDATION, OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES 5. TO DISSOLVE AND TO DISTRIBUTE ASSETS OF THE CORPORATION 6. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION 7. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF THE CORPORATION 8. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION 9. TO APPOINT THE FISCAL AUDITOR FOR THE CORPORATION 10. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHARGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION 11. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION AND 12. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION
CONFLICT OF INTEREST	PART VI, SECTION B, QUESTION 12C	OUR LADY OF THE LAKE HOSPITAL, INC. HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY THAT REQUIRES EACH OFFICER, TRUSTEE, BOARD COMMITTEE MEMBER AND EMPLOYEE TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. COMPLETED DISCLOSURE FORMS ARE REVIEWED AND MAINTAINED BY THE CHIEF COMPLIANCE OFFICER. IF ANY TRUSTEE, BOARD COMMITTEE MEMBER OR SENIOR MANAGER HAS A POTENTIAL CONFLICT, THE EXECUTIVE COMMITTEE OF THE BOARD DETERMINES WHETHER ACTION NEEDS TO BE TAKEN AND COMMUNICATES ANY SUCH ACTION TO THE INDIVIDUAL. A POTENTIAL CONFLICT OF ANY OTHER EMPLOYEE IS REVIEWED BY THE CEO OR HIS DESIGNEE. THE EXECUTIVE COMMITTEE, CEO OR DESIGNEE, AS APPLICABLE, DETERMINES IF A CONFLICT OF INTEREST EXISTS OR CREATES THE APPEARANCE OF IMPROPRIETY. IF SUCH A DETERMINATION IS MADE, THE INDIVIDUAL WILL BE EXCUSED FROM PARTICIPATING IN THE BUSINESS DECISION. DURING THE YEAR, ANY CHANGE TO THE INFORMATION IN THE DISCLOSURE STATEMENT MUST BE DISCLOSED PROMPTLY TO THE CHIEF COMPLIANCE OFFICER, WHO TAKES APPROPRIATE ACTION. THE PROCESS ALSO REQUIRES AFFIRMATION FROM EACH INDIVIDUAL THAT HE OR SHE (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) HAS AGREED TO COMPLY WITH THE POLICY AND (D) UNDERSTANDS THAT OUR LADY OF THE LAKE HOSPITAL IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, OUR LADY OF THE LAKE HOSPITAL, INC. PROVIDES MECHANISMS FOR CONFIDENTIAL REPORTING OF COMPLIANCE ISSUES. THESE MECHANISMS INCLUDE AN ANONYMOUS HOTLINE AND WEB SITE WHERE INDIVIDUALS MAY RAISE ISSUES, SEEK CLARIFICATION AND REPORT POSSIBLE CONFLICTS OF INTEREST OR OTHER CONCERNS. THESE REPORTS, INCLUDING REPORTS OF POSSIBLE CONFLICTS OF INTEREST ARE REVIEWED AND INVESTIGATED BY THE CORPORATE COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN.
PART VI, SECTION A, QUESTION 11		AFTER PREPARATION AND REVIEW OF THE FORM 990 BY KPMG, THE FORM 990 IS REVIEWED BY MANAGEMENT. A COPY OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED WITH THE IRS.
PART VI, SECTION A, QUESTION 7A		FMOL HEALTH SYSTEM, AS THE SOLE MEMBER OF OUR LADY OF THE LAKE HOSPITAL, INC. RETAINS THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF OUR LADY OF THE LAKE Hospital, Inc.
DETERMINING COMPENSATION	PART VI, SECTION B, QUESTION 15A & 15B	OUR BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE MADE UP OF INDEPENDENT BOARD MEMBERS TO REVIEW AND SET THE COMPENSATION ANNUALLY OF OUR OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION PROVIDED BY OUTSIDE SOURCES. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE COMPENSATION COMMITTEE. THE COMPENSATION FOR THE CEO OF OUR LADY OF THE LAKE HOSPITAL, INC. IS SET BY THE COMPENSATION COMMITTEE OF FMOL HEALTH SYSTEM (A RELATED TAX-EXEMPT ORGANIZATION) ACCORDING TO THEIR PAY PRACTICES WHICH ARE SIMILAR TO THOSE DESCRIBED ABOVE.
COMMUNITY BENEFIT STATEMENT	FORM 990 PART III	THE MEDICAL CENTER PARTICIPATES IN GOVERNMENT PROGRAMS, INCLUDING MEDICARE, MEDICAID, AND THE TRICARE PROGRAM. UNDER THESE PROGRAMS, THE MEDICAL CENTER PROVIDES CARE TO PATIENTS AT PAYMENT RATES THAT ARE DETERMINED BY THE FEDERAL AND STATE GOVERNMENTS, REGARDLESS OF ACTUAL COST. IN SOME CASES, THESE PROGRAMS PAY THE MEDICAL CENTER AT AMOUNTS THAT ARE LESS THAN ITS COST OF PROVIDING SERVICES. THE FOLLOWING TABLE SUMMARIZES THE AMOUNTS OF CHARGES FOREGONE (I.E., CONTRACTUAL ALLOWANCES) AND THE ESTIMATED LOSSES INCURRED BY THE MEDICAL CENTER DUE TO INADEQUATE PAYMENTS BY THESE PROGRAMS AND FOR CHARITY FOR THE YEAR END JUNE 30, 2013. THIS TABLE DOES NOT INCLUDE DISCOUNTS OFFERED BY THE MEDICAL CENTER UNDER MANAGED CARE OR OTHER SUCH ARRANGEMENTS. THE BELOW FIGURES USE A SLIGHTLY DIFFERENT ASSUMPTION FROM SCHEDULE H AND THEREFORE AMOUNTS MAY VARY. CHARITY CARE AND MEANS TESTED PROGRAMS: JUNE 30, 2013 CHARGES FOREGONE NET COMMUNITY BENEFIT EXPENSE CHARITY CARE $12,003,000 $4,354,000 UNREIMBURSED MEDICAID 146,088,000 29,889,000 UNREIMBURSED MEDICARE 296,872,000 23,933,000 TOTAL $454,963,000 $58,176,000 IN ADDITION TO COMMUNITY SERVICES DIRECTLY ASSOCIATED WITH PROVIDING HOSPITAL BASED CARE, THE MEDICAL CENTER SERVES THE COMMUNITY IN NUMEROUS OTHER WAYS. THE METHOD FOR ESTIMATING COSTS OF COMMUNITY SERVICES WAS REVISED FOR FISCAL YEAR 2013 TO REFLECT THE INTERNAL REVENUE SERVICE'S GUIDELINES FOR FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX. THE FOLLOWING TABLE FOR THE YEAR ENDED JUNE 30, 2013 SUMMARIZES ESTIMATED COSTS OF THE COMMUNITY SERVICES: COMMUNITY BENEFIT AT COST: COMMUNITY HEALTH IMPROVEMENT SERVICES: 1,949,000 HEALTH CARE PROFESSIONS EDUCATION: 5,858,000 SUBSIDIZED HEALTH SERVICES: 8,842,000 FINANCIAL CONTRIBUTION: 3,572,000 TOTAL $20,221,000 COMMUNITY HEALTH IMPROVEMENT SERVICES IMMUNOLOGICAL SUPPORT THE MEDICAL CENTER ORGANIZED, OWNS AND OPERATES A HOME WHICH IS DESIGNED TO HELP THE MEMBERS OF OUR COMMUNITY WHO HAVE CONTRACTED ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) TO DEAL WITH THE VERY DEBILITATING PHYSICAL, SOCIAL, AND PSYCHOLOGICAL PROBLEMS ASSOCIATED WITH THE DISEASE. PARISH NURSE PROGRAM TO ASSIST IN EDUCATING THE COMMUNITY REGARDING HEALTH RELATED ISSUES, THE MEDICAL CENTER PARTICIPATES IN NUMEROUS HEALTH FAIRS AND SPONSORS TALKS TO VARIOUS SCHOOLS AND INDUSTRY GROUPS REGARDING SUCH ISSUES AS DRUG ABUSE AND SAFETY IN THE WORKPLACE. LAKELINE DIRECT THE MEDICAL CENTER OPERATES A NURSE CALL CENTER, LAKELINE DIRECT, OFFERING COMPLIMENTARY 24 HOUR NURSE ADVICE, HEALTH INFORMATION AID, AND PHYSICIAN REFERRAL SERVICE TO THE COMMUNITY. ST. MARTHA ACTIVITY CENTER THE MEDICAL CENTER PROVIDES AN ACTIVITY CENTER LOCATED AT THE ELDERLY HOUSING FACILITY FOR THE RESIDENTS OF THE HOUSING FACILITY AS WELL AS OTHER ELDERLY COMMUNITY MEETINGS. ELDERLY SERVICES THE MEDICAL CENTER SPONSORS AND INCURS THE SALARY OF THE DIRECTOR OF THE HUD HOUSING FACILITY, PASTORAL CARE ASSOCIATE AND MEDICAL DIRECTOR OF ELDERLY SERVICES. ELDERLY HOUSING OLLIE STEELE BURDEN MANOR, A SUBSIDIARY OF THE MEDICAL CENTER, OPERATES ST. CLARE MANOR WHICH HAS 216 TOTAL BEDS, OF WHICH 120 ARE MEDICAID LICENSED. HEALTH CARE PROFESSIONAL'S EDUCATION OLOL COLLEGE IN AN EFFORT TO ENSURE THAT AN ADEQUATE SUPPLY OF NURSES ARE AVAILABLE FOR THE BATON ROUGE COMMUNITY, THE MEDICAL CENTER FOUNDED AND ORGANIZED OUR LADY OF THE LAKE COLLEGE, INC. THE MEDICAL CENTER SUBSIDIZES THE OPERATIONS OF THE COLLEGE WITH GRANTS. INTERNS AND RESIDENTS THE MEDICAL CENTER PARTICIPATES IN MEDICARE'S GRADUATE MEDICAL EDUCATION THROUGH AFFILIATION WITH LOUISIANA MEDICAL SCHOOL AND MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS TO CONTINUE TO SUPPORT AVAILABILITY OF PHYSICIANS IN FUTURE YEARS. SUBSIDIZED HEALTH SERVICES FAMILY EDUCATION THE MEDICAL CENTER PROMOTES A HEALTHY ENVIRONMENT FOR THE FAMILY THROUGH ITS PEDIATRIC PROGRAMS, WHICH INCLUDE KID-MED CLINIC, PEDIATRIC ASSESSMENT CENTER AND CHILD LIFE PROGRAMS. OLOL NEIGHBORHOOD CLINIC THE MEDICAL CENTER OPERATES A SCOTLANDVILLE CLINIC TO PROVIDE WALK IN CARE FOR MINOR ILLNESS AND INJURY DURING EVENINGS AND WEEKENDS. COPE THE MEDICAL CENTER PROVIDES CRISIS ORIENTED PSYCHIATRIC EVALUATION (COPE) TO THE COMMUNITY. PALLIATIVE CARE THE MEDICAL CENTER PROVIDES PALLIATIVE CARE SERVICE FOR PATIENTS IN THE FINAL STATE OF LIFE AND THEIR FAMILY MEMBERS. RESEARCH CLINICAL RESEARCH THE MEDICAL CENTER PARTICIPATES IN CLINICAL RESEARCH PROJECTS TO IMPROVE THE HEALTH AND CARE OF PATIENTS AND COMMUNITY MEMBERS. FINANCIAL CONTRIBUTIONS CASH CONTRIBUTIONS THE MEDICAL CENTER ALSO ORGANIZES EMPLOYEE PARTICIPATION IN FUND RAISING FOR ORGANIZATIONS SUCH AS CAPITAL AREA UNITED WAY, MARCH OF DIMES OF AMERICA, JUNIOR ACHIEVEMENT, CYSTIC FIBROSIS AND THE COMMUNITY FUND FOR THE ARTS. THE MEDICAL CENTER ALSO MAKES CORPORATE DONATIONS TO VARIOUS AREA COMMUNITY SERVICE ORGANIZATIONS. COMMUNITY BUILDING ACTIVITIES ELDERLY HOUSING COMPLEX THE MEDICAL CENTER OPERATES FOUR ELDERLY HOUSING PROJECTS: VILLA ST. FRANCIS, INC., ASSISI VILLAGE, INC., CALAIS HOUSE, INC., AND CHATEAU LOUISE, INC. THESE PROJECTS ARE DESIGNED TO PROMOTE THE HEALTH, SECURITY, AND HAPPINESS OF THE ELDERLY AND HANDICAPPED PERSONS OF THE GREATER BATON ROUGE AREA. MARY BIRD PERKINS THE MEDICAL CENTER ALSO SPONSORS THE CHARITABLE ACTIVITIES OF OTHER NOT-FOR-PROFIT ORGANIZATIONS IN BATON ROUGE. THE MEDICAL CENTER PROVIDES LAND ADJOINING THE MEDICAL CENTER TO THE MARY BIRD PERKINS CANCER CENTER FOR ITS OPERATIONS AND FORGOES ALL RENTAL INCOME FOR THE USE OF THIS LAND. COMMUNITY CLINIC THE MEDICAL CENTER PROVIDES A BUILDING THAT SPONSORS A COMMUNITY CLINIC AND FOREGOES ALL RENTAL INCOME RELATED TO THE USE OF THE BUILDING.
Part XI, Line 9		Other Changes in net assets or fund balances: Paid in Capital - PPASC 432,874 Capital Transfers FMOL 18,647,514 Total Other Adj. to FB 19,080,388
PART VI, SECTION A QUESTION 2		JAMES CRAVEN, M.D. AND WALTER BRINGAZE III, M.D. - BUSINESS RELATIONSHIP

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

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

OUR LADY OF THE LAKE HOSPITAL INC

Employer identification number

72-0423651

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
(1) OUR LADY OF THE LAKE PHYSICIANS GROUP LL 5000 HENNESSY BLVD BATON ROUGE,LA70808 27-4026658	HEALTHCARE	LA	114,910,925	37,941,872	OLOL

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?
(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	Yes	No
(1) ST BERNARD HEALTH FUND 4200 ESSEN LANE BATON ROUGE,LA70809 20-4685614	HEALTHCARE	LA	501(c)(3)	11 TYPE 1	FMOL		No
(2) HEALTH PARTNERS NETWORK OF SOUTH LA 4801 AMBASSADOR CAFFERY PKWY LAFAYETTE,LA70508	HEALTHCARE	LA	501(c)(3)	3	LOURDES RMC	Yes
(3) HEALTH CARE CENTERS IN SCHOOLS 5000 HENNESSY BLVD BATON ROUGE,LA70808 72-1443935	HEALTHCARE	LA	501(c)(3)	7	OLOL	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) HEART HOSPITAL OF ACADIANA 1105 KALISTE SALOOM ROAD LAFAYETTE,LA70508 30-0442368	HEALTHCARE	LA	LOURDES	N/A				No		Yes
(2) PERKINS PLAZA MEDICAL ARTS DEVELOPMENT 5000 HENNESSY BOULEVARD BATON ROUGE,LA70808 45-0516574	REAL ESTATE	LA	OLOL	RELATED	259,855	2,914,222		No	0	Yes		52.040 %
(3) PERKINS PLAZA IMAGING DEVELOPMENT 5000 HENNESSY BOULEVARD BATON ROUGE,LA70808 20-3894521	REAL ESTATE	LA	OLOL	RELATED	149,092	3,124,782		No	0	Yes		62.560 %
(4) NUCLEAR IMAGING LLC 5000 HENNESSY BOULEVARD BATON ROUGE,LA70808 72-1470061	HEALTHCARE	LA	OLOL	RELATED	509,321	896,062		No	0	Yes		66.670 %
(5) P&S SURGERY CENTER LLC 312 GRAMMONT STREET MONROE,LA71201 72-1387870	HEALTHCARE	LA	ST FRANCIS	N/A				No		Yes
(6) LOURDES IMAGING DEVELOPMENT LLC 4801 AMBASSADOR CAFFERY PKWY LAFAYETTE,LA70508 20-8326287	REAL ESTATE	LA	LOURDES	N/A				No		Yes
(7) PARK PLACE SURGICAL CENTER 901 WILSON STREET LAFAYETTE,LA70503 72-1404092	HEALTHCARE	LA	LOURDES	N/A				No		Yes
(8) BRPT LAKE REHABILITATION CENTER 530 SHADOWS LANE BATON ROUGE,LA70806 72-1506100	HEALTHCARE	LA	OLOL	RELATED	110,023	707,884		No	0	Yes		33.000 %
(9) CONVENIENT CARE LLC 7777 HENNESSY BOULEVARD BATON ROUGE,LA70808 72-1439481	HEALTHCARE	LA	OLOL	RELATED	600,400	1,618,517		No	0	Yes		50.000 %
(10) PERKINS PLAZA AMBULATORY SURGERY CENTER 54 THE LEGENDS PARKWAY SUITE 159 EUREKA,MO630253803 48-1264699	HEALTHCARE	LA	OLOL	RELATED	99,713	1,496,934		No	0	Yes		70.000 %
(11) SURGICAL SPECIALTY CENTER OF BATON ROUGE 8080 BLUEBONNET BOULEVARD BATON ROUGE,LA70810 26-3160962	HEALTHCARE	LA	OLOL	RELATED	4,492,416	26,890,151		No	0	Yes		49.000 %
(12) ST ELIZABETH-MARY BIRD PERKINS CANCER 4950 ESSEN LANE BATON ROUGE,LA70809 26-0628752	HEALTHCARE	LA	STEH	N/A				No		Yes
(13) REGIONAL EYE SURGERY CENTER LLC 7777 HENNESSY BLVD SUITE 400 BATON ROUGE,LA70808 72-1484653	HEALTHCARE	LA	OLOL	RELATED	298,763	161,775		No	0	Yes		13.750 %
(14) ST MARYS IMAGING CENTER IILLC 4801 AMBASSADOR CAFFERY PKWY LAFAYETTE,LA70508	HEALTHCARE	LA	LOURDES IMAGING	N/A				No		Yes
(15) NORTHEAST LA CANCER INSTITUTE 141 DESIARD STREET SUITE 704 MONROE,LA71201 72-1329499	HEALTHCARE	LA	ST FRANCIS	N/A				No		Yes
(16) LHCG-XIII LLC 420 West Pinhook Road Suite A LAFAYETTE,LA70503 20-8068308	HEALTHCARE	LA	LOURDES	N/A				No		Yes
(17) LOURDES AFTER HOURS LLC 2130 KALISTE SALOOM RD LAFAYETTE,LA70508 20-1367299	HEALTHCARE	LA	LOURDES	N/A				No		Yes
(18) ST ELIZABETH IMAGING CENTER 1125 WEST HIGHWAY 30 Gonzales,LA70737 72-1470744	HEALTHCARE	LA	STEH	N/A				No		Yes
(19) CAPITAL AREA SHARED SERVICES ORGANIZATIO 5000 Hennessy Blvd Baton Rouge,LA70808 27-5173212	HEALTHCARE	LA	OLOL pg	RELATED	-334,931	714,345		No	0	Yes		48.000 %
(20) CAPITAL AREA SHARED SERVICES ORGANIZATIO 5000 Hennessy Blvd Baton Rouge,LA70808 27-5173212	HEALTHCARE	LA	STEP	N/A				No		Yes
(21) LAKE URGENT CARE ASCENSION LLC 10319 JEFFERSON HWY BATON ROUGE,LA70809 35-2463092	HEALTHCARE	LA	STEH	N/A				No		Yes
(22) OLOL PONTCHARTRAIN SURGERY CENTER 15305 DALLAS PKWY STE 1600 LB 28 ADDISON,TX75001 46-1379031	HEALTHCARE	TX	OLOLUSP	RELATED		124,456		No		Yes		55.000 %
(23) OLOLUSP SURGERY CENTER LLC 15305 DALLAS PKWY STE 1600 LB 28 ADDISON,TX75001 35-2457810	HEALTHCARE	LA	OLOL	RELATED		8,011,964		No		Yes		51.000 %
(24) LAKE URGENT CARE ASCENSION LLC 10319 JEFFERSON HWY BATON ROUGE,LA70809 35-2463092	HEALTHCARE	LA	OLOL	RELATED	-5	149,995		No		Yes		30.000 %

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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) ST FRANCIS INSURANCE AGENCY 309 JACKSON STREET MONROE,LA71201 72-1435136	INSURANCE	LA	ST FRANCIS	C CORP
(2) HOSPITAL ASSISTANCE SERVICES PO BOX 4027-C LAFAYETTE,LA70502 72-1073486	HEALTHCARE	LA	LOURDES	C CORP
(3) LOUISE INSURANCE COMPANY PO BOX 1051 KY1-1102 CJ	INSURANCE	CJ	FMOL	C CORP
(4) MONROE HEALTH SERVICES PO BOX 3187 MONROE,LA71210 72-1057820	HEALTHCARE	LA	AMBULATORY	C CORP
(5) NORTHEAST LA HEALTH NETWORK 309 JACKSON STREET MONROE,LA71201 72-1294587	HEALTHCARE	LA	AMBULATORY	C CORP
(6) CHARITABLE REMAINDER TRUST	INVESTMENT	LA	OLOL FOUNDATION	TRUST
(7) FRANCISCAN HEALTH & WELLNESS SERVICES I 4200 ESSEN LANE BATON ROUGE,LA70809 45-5492379	HEALTHCARE	LA	FMOL	C CORP
(8) FMOL HEALTH SYSTEM HOLDINGS INC 4200 ESSEN LANE BATON ROUGE,LA70809 45-4405024	INVESTMENT	LA	FMOL	C CORP

Schedule R (Form 990) 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

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 . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) Chateau Louise	q	36,120	FMV
(2) Calais House	q	45,194	FMV
(3) Our Lady of the Lake Foundation	B	8,288,470	FMV
(4) Our Lady of the Lake Foundation	C	1,785,898	FMV
(5) St Bernard Health Center	q	2,386	FMV
(6) Villa St Francis	q	85,348	FMV
(7) ASSISI VILLAGE	q	38,986	FMV
(8) ST ELIZABETH HOSPITAL	l	364,652	FMV
(9) ST CLARE MANOR	q	261,766	FMV
(10) OUR LADY OF THE LAKE ASSUMPTION	l	208,633	FMV
(11) REGIONAL EYE SURGERY CENTER LLC	s	206,250	FMV
(12) NUCLEAR IMAGING LLC	s	366,685	FMV
(13) PERKINS PLAZA MEDICAL ARTS DEVELOPMENT LLC	s	169,320	FMV
(14) PERKINS PLAZA IMAGING DEVELOPMENT LLC	s	91,078	FMV
(15) BRPT- LAKE REHABILITATION CENTERS LLC	s	62,919	FMV
(16) CONVENIENT CARE LLC	s	505,000	FMV
(17) PERKINS PLAZA AMBULATORY SURGERY CENTER LLC	s	116,000	FMV
(18) SURGICAL SPECIALTY CENTER OF BATON ROUGE LLC	s	4,249,757	FMV
(19) FMOL HEALTH SYSTEM	m	49,341,456	FMV
(20) OUR LADY OF THE LAKE COLLEGE	B	2,798,108	FMV
(21) OUR LADY OF LOURDES REGIONAL MEDICAL CENTER	l	4,791,911	FMV
(22) CAPITAL AREA SHARED SERVICES	r	2,220,000	FMV
(23) OLOLUSP SURGERY CENTERS LLC	b	7,948,491	FMV
(24) LAKE URGENT CARE ASCENSION LLC	b	150,000	FMV

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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: the purpose of the hospital is to provide for the care of the ill, injured, or disabled persons, and to provide for research, education, and for the enhancement of health of those in the community
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	6,438
6	Total number of volunteers (estimate if necessary) .............	6	190
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	7,014,471
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,408,607	7,712,549
9	Program service revenue (Part VIII, line 2g) .........	664,647,747	768,245,581
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	8,396,637	19,589,685
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-1,274,499	45,125,383
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	677,178,492	840,673,198
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	5,152,314	10,127,484
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)	284,957,317	321,077,522
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	434,889,017	397,136,104
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	724,998,648	728,341,110
19	Revenue less expenses. Subtract line 18 from line 12.......	-47,820,156	112,332,088
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,250,161,461	1,498,370,068
21	Total liabilities (Part X, line 26).............	534,231,871	660,438,993
22	Net assets or fund balances. Subtract line 21 from line 20.....	715,929,590	837,931,075

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 265,546,500 including grants of $ ) (Revenue $ 366,658,214 )
	THE MEDICAL CENTER PROVIDES QUALITY HOSPITAL AND MEDICAL SERVICES TO ITS PATIENTS. IN THE CURRENT YEAR, SERVICES WERE PROVIDED FOR 163,032 PATIENT DAYS. THE MEDICAL CENTER IS AN ACTIVE, CARING MEMBER OF THE COMMUNITIES IT SERVES. IN CARRYING OUT ITS MISSION, THE MEDICAL CENTER HAS ESTABLISHED A POLICY UNDER WHICH IT PROVIDES CARE TO NEEDY MEMBERS OF ITS COMMUNITIES. FOLLOWING THAT POLICY, HEALTH CARE SERVICES COSTING APPROXIMATELY $12,402,600 WERE PROVIDED WITHOUT CHARGE. ADDITIONAL COSTS WERE INCURRED FOR PARTICIPATION IN PROGRAMS WHICH, IN SOME CASES, PAY AMOUNTS LESS THAN THE COST OF PROVIDING SERVICES. SEE SCHEDULE O FOR FURTHER EXPLANATION.

4b	(Code: ) (Expenses $ 105,367,802 including grants of $ ) (Revenue $ 145,488,531 )
	THE MEDICAL CENTER PROVIDES PATIENTS WITH BOTH INPATIENT AND OUTPATIENT SURGICAL CARE. DURING THE YEAR, 19,575 SURGICAL PROCEDURES WERE PERFORMED

4c	(Code: ) (Expenses $ 40,410,404 including grants of $ ) (Revenue $ 55,797,409 )
	THE MEDICAL CENTER PROVIDES PATIENTS WITH PHARMACEUTICALS IN THE COURSE OF THEIR MEDICAL CARE. IN THE CURRENT YEAR, THE HOSPITAL DISPENSED 13,197,865 UNIT DOSES

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 145,065,190 including grants of $ 10,127,484 ) (Revenue $ 200,301,428 )
4e	Total program service expenses556,389,896

(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
(A) Name and Title
(18) JOHN SELSER........................................................................ BOARD MEMBER	2.0 .......................0.0	X			0	0	0
(19) JEFFERY LIMBOCKER........................................................................ CFO	52.0 .......................8.0		X		370,271	0	57,112
(20) DENZIL MORAES........................................................................ STAFF PHYSICIAN	60.0 .......................0.0			X	1,160,839	0	34,261
(21) STEVEN GREMILLION........................................................................ STAFF PHYSICIAN	60.0 .......................0.0			X	1,026,372	0	32,061
(22) KENNETH CIVELLO........................................................................ STAFF PHYSICIAN	60.0 .......................0.0			X	897,342	0	34,734
(23) PAUL GARRETT........................................................................ STAFF PHYSICIAN	60.0 .......................0.0			X	776,327	0	32,061
(24) JEFFREY HYDE........................................................................ STAFF PHYSICIAN	40.0 .......................0.0			X	813,497	0	29,484

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	5,574,778	647,415	337,444

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		5,711,823
e	Government grants (contributions)1e		837,973

f	All other contributions, gifts, grants, and similar amounts not included above1f		1,162,753

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			7,712,549
			Business Code
2a	PATIENT SVC REVENUE		621500	720,709,565	720,709,565
b	OUTREACH LABORATORY		900099	23,363,969	18,764,771	4,599,198
c	INCOME FROM EQUITY INVESTEES		900099	6,682,916	6,384,153	298,763
d	CAFETERIA SALES		900099	2,434,655	2,434,655
e	PHARMACY		900099	2,382,229	385,719	1,996,510
f	All other program service revenue .			12,672,247	12,672,247
g	Total. Add lines 2a–2f........			768,245,581
3	Investment income (including dividends, interest, and other similar amounts).......			5,877,012		62,667	5,814,345
4	Income from investment of tax-exempt bond proceeds..			48,202			48,202
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	10,516,657
b	Less: rental expenses	12,396,106
c	Rental income or (loss)	-1,879,449	0
d	Net rental income or (loss).......			-1,879,449	-1,879,449	0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	70,707,502	75,757
b	Less: cost or other basis and sales expenses	54,628,209	2,490,579
c	Gain or (loss)	16,079,293	-2,414,822
d	Net gain or (loss)..........			13,664,471		57,333	13,607,138
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..			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...			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..			0
Miscellaneous Revenue			Business Code
11a	INCREASE IN ACCRUED PENSION		900099	47,004,832	47,004,832
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			47,004,832
12	Total revenue. See Instructions......			840,673,198	806,476,493	7,014,471	19,469,685


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			53,927,784	1	51,211,713
2	Savings and temporary cash investments .........			81,641,790	2	71,117,095
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			101,485,562	4	145,949,083
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 .............			0	7	0
8	Inventories for sale or use ..............			10,629,346	8	14,389,326
9	Prepaid expenses and deferred charges ..........			11,926,438	9	14,659,880
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	943,769,371
b	Less: accumulated depreciation .....	10b	360,812,529	467,132,763	10c	582,956,842
11	Investments—publicly traded securities ..........			158,534,638	11	220,486,055
12	Investments—other securities. See Part IV, line 11 .....			281,105,013	12	281,775,375
13	Investments—program-related. See Part IV, line 11 .....			33,611,922	13	42,096,434
14	Intangible assets ...............			3,498,629	14	11,950,328
15	Other assets. See Part IV, line 11 ...........			46,667,576	15	61,777,937
16	Total assets. Add lines 1 through 15 (must equal line 34)......			1,250,161,461	16	1,498,370,068
17	Accounts payable and accrued expenses .........			119,870,069	17	166,841,123
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			202,632,986	20	300,832,430
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....................			211,728,816	25	192,765,440
26	Total liabilities. Add lines 17 through 25.........			534,231,871	26	660,438,993
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			707,726,529	27	825,226,388
28	Temporarily restricted net assets ...........			8,203,061	28	12,704,687
29	Permanently restricted net assets ...........			0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			715,929,590	33	837,931,075
34	Total liabilities and net assets/fund balances ........			1,250,161,461	34	1,498,370,068

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................	Yes	No