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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
FMOL HEALTH SYSTEM INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
4200 ESSEN LANE
Suite
Room/suite
City or town, state or country, and ZIP + 4
BATON ROUGE, LA708092158
D Employer identification number

72-1028323
E Telephone number

G Gross receipts $ 102,564,367
F Name and address of principal officer:
JOHN FINAN
4200 ESSEN LANE
BATON ROUGE,LA70809
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.FMOLHS.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1984
M State of legal domicile: LA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: FMOL Health System manages an integrated health system to make a difference in our communities through Catholic Health Services by calling forth all who serve in the healthcare ministry.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 13
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 12
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 580
6 Total number of volunteers (estimate if necessary) ............. 6 13
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 591,635
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 90,000
9 Program service revenue (Part VIII, line 2g) ......... 86,359,969 92,687,223
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 21,631 9,230,584
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 954,836 517,113
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 87,336,436 102,524,920
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 741,200 144,754
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) 45,119,210 47,004,201
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 72,370,733 63,098,460
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 118,231,143 110,247,415
19 Revenue less expenses. Subtract line 18 from line 12....... -30,894,707 -7,722,495
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 72,379,045 86,556,648
21 Total liabilities (Part X, line 26)............. 52,620,498 47,546,583
22 Net assets or fund balances. Subtract line 21 from line 20..... 19,758,547 39,010,065
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: INSPIRED BY THE VISION OF ST. FRANCIS AND IN THE TRADITION OF THE ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING - WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMILITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILEGED TO SERVE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $   including grants of $   ) (Revenue $ 102,887 )
FMOL HEALTH SYSTEM INCLUDES CALAIS HEALTH, LLC, WHICH PROVIDES OCCUPATIONAL MEDICINE AND BEHAVORIAL HEALTH TO LOUISIANA RESIDENTS.
4b (Code:   ) (Expenses $ 144,754 including grants of $ 144,754 ) (Revenue $   )
GRANTS ARE MADE TO CHARITABLE ORGANIZATIONS IN ORDER TO SUPPORT THE CHARITABLE MISSION OF FMOL HEALTH SYSTEMS, INC.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet144,754
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
51
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
580
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
 
No
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletROBERT D RAMSEY4200 ESSEN LANEBATON ROUGELA70809 (225) 923-2701
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) JOHN J FINAN JR........................................................................
PRESIDENT/CEO
 50.0
.......................2.0 		X   X       1,181,275 0 84,177
(2) C STEVEN CLARK........................................................................
BOARD MEMBER
 1.0
.......................0.0 		X                
(3) JOHN S LORE........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(4) ARCHBISHOP GREGORY AYMOND........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(5) MR CLAUDE HARBARGER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(6) JAMES W MOORE JR........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(7) CW LOVELL II MD........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 1,600 0
(8) RICHARD M DEARMAN MD........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(9) SR BRENDAN MARY RONAYNEOSF........................................................................
BOARD MEMBER
 1.0
.......................3.0 		X           0 0 0
(10) SR LILIAN LYNCH OSF........................................................................
BOARD MEMBER
 1.0
.......................0.0 		X                
(11) DR WILLIAM JENKINS........................................................................
BOARD MEMBER
 1.0
.......................0.0 		X                
(12) Mr JIM PRINCE........................................................................
BOARD MEMBER - CHAIRMAN
 1.0
.......................1.0 		X   X       0 0 0
(13) KEVIN SCHEXNAYDER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(14) SR BARBARA ARCENEAUX OSF........................................................................
BOARD MEMBER
 1.0
.......................0.0 		X                
(15) SR KATHLEEN CAIN OSF........................................................................
BOARD MEMBER
 1.0
.......................0.0 		X                
(16) SR MARGARIDA VASQUESOSF........................................................................
BOARD MEMBER
 1.0
.......................0.0 		X                
(17) SR MARTHA ANN ABSHIRE OSF........................................................................
BOARD MEMBER
 1.0
.......................0.0 		X                
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) HOWARD L HARVILL........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(19) Dr Karen Williams........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(20) STEVEN R NATHANSON........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(21) JOLEE H BOLLINGER ESQ........................................................................
GENERAL COUNSEL
 50.0
.......................1.0 		    X       415,218 0 59,449
(22) ROBERT D RAMSEY JR........................................................................
CHIEF FINANCIAL OFFICER
 50.0
.......................3.0 		    X       560,813 0 143,082
(23) WILLIAM BARROW........................................................................
PRESIDENT / CEO LOURDES
 50.0
.......................1.0 		      X     505,704 0 106,415
(24) LAURA T MARTIN........................................................................
VP OF HEALTHCARE REFORM
 50.0
.......................   		      X     261,646 0 59,875
(25) DAVID E WENDT........................................................................
CHIEF INFORMATION OFFICER
 50.0
.......................   		      X     219,323 0 17,086
(26) WILSON J GORDON III........................................................................
VP OF STRATEGY
 50.0
.......................   		      X     451,044 0 104,311
(27) STEPHANIE A MILLS MD........................................................................
PRESIDENT/CEO FHWS
 50.0
.......................2.0 		      X     532,300 0 86,390
(28) REDFIELD E BRYAN MD........................................................................
MD CONSULTANT
 20.0
.......................4.0 		      X     194,076 0 24,035
(29) LOUIS BREMER........................................................................
PRESIDENT/CEO ST. FRANCIS
 50.0
.......................4.0 		      X     501,979 0 22,718
(30) KENNETH SCOTT WESTER........................................................................
President/CFO OLOL
 50.0
.......................10.0 		      X     647,415 0 92,415
(31) ROBERT BURGESS........................................................................
PRESIDENT & CEO -ST. ELIZABETH
 0.0
.......................50.0 		      X     137,089 0 13,967
(32) PAMELA B SHOWS........................................................................
ACCOUNT EXECUTIVE
 50.0
.......................   		        X   255,447 0 73,646
(33) VINDELL WASHINGTON........................................................................
VP PERF EXCELLENCE & TECH
 50.0
.......................   		        X   464,377 0 34,128
(34) WILLIAM P MOSSER........................................................................
VP OF MATERIALS MANAGEMENT
 50.0
.......................   		        X   253,474 0 29,343
(35) PETER F GUARISCO JR........................................................................
VP OF MISSION
 50.0
.......................   		        X   227,625 0 51,588
(36) KAREN B ALLEN........................................................................
PRESIDENT/CEO SR. SVCS
 25.0
.......................25.0 		        X   249,557 0 55,112
(37) DOLORES LEJEUNE........................................................................
PAST KEY EMPLOYEE/RETIRED 6/12
 0.0
.......................0.0 		          X 370,673 0 59,572
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 7,429,035 1,600 1,117,309
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet59
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CERNER CORPORATION, PO Box 412702KANSAS CITYMO641412702 CONSULTING & SERVICE 17,389,329
CDW Government LLC, 230 N Milwaukee AveVERNON HILLSIL600611577 CONSULTING & SERVICE 4,500,274
SHI INTERNATIONAL CORP, 33 Nightsbridge RoadPISCATAWAYNJ08854 CONSULTING & SERVICE 3,480,197
Mainline Information Systems, 1700 Summit Lake DrTALLAHASSEEFL32317 Consulting & service 3,403,184
CATHOLIC HEALTHCARE AUDIT, 231 S BEMISTON SUITE 300CLAYTONMO63105 AUDIT SERVICES 1,493,974
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet62
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 90,000
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 90,000
Program Service Revenue Business Code
2a MANAGEMENT FEES 900099 92,316,762 92,316,762    
b PURCHASED DISCOUNT 900099 181,786 181,786    
c MEDICAL RECORDS REVENUE 900099 188,675 188,675    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 92,687,223
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 9,270,031   177,409 9,092,622
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses   39,447
c Gain or (loss)   -39,447
d Net gain or (loss)..........MediumBullet -39,447 0 0 -39,447
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CONSULTING REVENUE 900099 414,226   414,226  
b DISCONTINUED OPERATIONS 900099 102,887 102,887    
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 517,113
12 Total revenue. See Instructions......MediumBullet 102,524,920 92,790,110 591,635 9,053,175
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 144,754 144,754
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 3,660,464   3,660,464  
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 33,011,505   33,011,505  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 4,335,380   4,335,380  
9 Other employee benefits ....... 3,696,114   3,696,114  
10 Payroll taxes ........... 2,300,738   2,300,738  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 255,412   255,412  
c Accounting ........... 111,602   111,602  
d Lobbying ........... 90,835   90,835  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 35,816,739   35,816,739  
12 Advertising and promotion .... 350,829   350,829  
13 Office expenses ....... 1,605,136   1,605,136  
14 Information technology ...... 370   370  
15 Royalties .. 0      
16 Occupancy ........... 2,384,268   2,384,268  
17 Travel ............ 1,301,428   1,301,428 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 636,593   636,593  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 19,223,621   19,223,621  
23 Insurance .............. 821,576   821,576  
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 EXPENSE 16,662   16,662  
b BAD DEBT 483,389   483,389  
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 110,247,415 144,754 110,102,661 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 11,487,964 1 10,355,686
2 Savings and temporary cash investments ......... 2,149,908 2 2,519,442
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 1,334,018 4 619,560
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 .............. 0 8 0
9 Prepaid expenses and deferred charges .......... 7,208,381 9 8,374,818
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 126,335,970
b Less: accumulated depreciation ..... 10b 77,641,412 46,890,748 10c 48,694,558
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... -720 12 -896,557
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 359,629
15 Other assets. See Part IV, line 11 ........... 3,308,746 15 16,529,512
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 72,379,045 16 86,556,648
Liabilities 17 Accounts payable and accrued expenses ......... 20,505,880 17 15,996,284
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 170,000 20 170,000
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.................... 31,944,618 25 31,380,299
26 Total liabilities. Add lines 17 through 25......... 52,620,498 26 47,546,583
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 19,758,547 27 39,010,065
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 19,758,547 33 39,010,065
34 Total liabilities and net assets/fund balances ........ 72,379,045 34 86,556,648
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
102,524,920
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
110,247,415
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-7,722,495
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
19,758,547
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
26,974,013
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
39,010,065
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

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

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number

72-1028323
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
No
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
No
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
(A) FRANCISCAN MISSIONARIES OF OUR LADY NORTH AMERICAN PROVINCE
  		720958584 01 Yes   Yes   Yes   110,247,415
Total                 110,247,415

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number

72-1028323
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
FMOL HEALTH SYSTEM INC
  		Employer identification number

72-1028323
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
FMOL HEALTH SYSTEM INC
  		Employer identification number

72-1028323
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
FMOL HEALTH SYSTEM INC
  		Employer identification number

72-1028323
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


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

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

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

72-1028323
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

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

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

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










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

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

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


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
90,835
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
90,835
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number

72-1028323
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............   286,416 113,333 173,083
d Equipment ................   122,792,720 77,528,079 45,264,641
e Other .................   3,256,834   3,256,834
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 48,694,558
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM AFFILIATES 15,031,545
(2) SELF INSURANCE RECEIVABLE 1,199,518
(3) OTHER 298,449






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 16,529,512
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
ACCRUED NON-QUALIFIED DEFERRED COMPENSATION LIABILITY 1,702,454
OTHER LIABILITIES 1,000,000
CAPITAL LEASE - CERNER 7,946,780
SELF INSURANCE LIAB-L.T. 1,171,963
INTEREST RATE SWAP 10,088,711
DUE TO AFFLIATES 9,470,391



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 31,380,299
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
FIN 48 (ASC 740) FOOTNOTE   "FMOLHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. NO RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED."
Schedule D (Form 990) 2012

Additional Data


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SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number

72-1028323
Part I
General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total expenditures
for and investments
in region
Central America and the Caribbean     Investments   130,000
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....     130,000
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     130,000
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.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
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
Schedule F (Form 990) 2012
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
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).......................................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................
Schedule F (Form 990) 2012
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


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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
FMOL HEALTH SYSTEM INC
 
Employer identification number
72-1028323
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) OUR LADY OF THE LAKE RMC
5000 HENNESSY BLVD
BATON ROUGE,LA70808 		72-0423651 501(C)(3) 17,500       GENERAL PURPOSE
(2) VHA Health Foundation Inc
220 E LAS COLINAS BLVD
IRVING,TX75039 		22-2710552 501(C)(3) 10,000       Hurricane Relief
(3) Sisters of St Joseph
6400 Minnesota Avenue
St Louis,MT63111 		53-0196617 501(c)(3) 25,000       Hurricane Relief


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
3
3
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

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
SCHEDULE I, PART 1, LINE 2   ACCORDING TO THE LEVELS OF AUTHORIZATION'S POLICIES AND PROCEDURES, ALL CHARITABLE CONTRIBUTIONS ARE APPROVED BY THE CEO OF THE FMOL HEALTH SYSTEM.
Schedule I (Form 990) 2012


Additional Data


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number

72-1028323
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
No
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)JOHN J FINAN JRPRESIDENT/CEO (i)
(ii)		 809,368
0 		349,809
0 		22,098
0 		47,974
0 		36,203
0 		1,265,452
0 		0
0
(2)WILLIAM BARROWPRESIDENT / CEO LOURDES (i)
(ii)		 389,012
0 		112,500
0 		4,192
0 		96,486
0 		9,929
0 		612,119
0 		0
0
(3)DOLORES LEJEUNEPAST KEY EMPLOYEE/RETIRED 6/12 (i)
(ii)		 257,665
0 		109,900
0 		3,108
0 		53,435
0 		6,137
0 		430,245
0 		0
0
(4)PAMELA B SHOWSACCOUNT EXECUTIVE (i)
(ii)		 186,231
0 		3,625
0 		65,591
0 		47,972
0 		25,674
0 		329,093
0 		0
0
(5)LAURA T MARTINVP OF HEALTHCARE REFORM (i)
(ii)		 195,298
0 		65,058
0 		1,290
0 		51,916
0 		7,959
0 		321,521
0 		0
0
(6)DAVID E WENDTCHIEF INFORMATION OFFICER (i)
(ii)		 184,665
0 		23,753
0 		10,905
0 		0
0 		17,086
0 		236,409
0 		0
0
(7)VINDELL WASHINGTONVP PERF EXCELLENCE & TECH (i)
(ii)		 335,795
0 		111,825
0 		16,757
0 		10,000
0 		24,128
0 		498,505
0 		0
0
(8)WILLIAM P MOSSERVP OF MATERIALS MANAGEMENT (i)
(ii)		 208,895
0 		30,125
0 		14,454
0 		9,765
0 		19,578
0 		282,817
0 		0
0
(9)PETER F GUARISCO JRVP OF MISSION (i)
(ii)		 158,934
0 		52,069
0 		16,622
0 		27,348
0 		24,240
0 		279,213
0 		0
0
(10)JOLEE H BOLLINGER ESQGENERAL COUNSEL (i)
(ii)		 317,218
0 		97,700
0 		300
0 		45,000
0 		14,449
0 		474,667
0 		0
0
(11)WILSON J GORDON IIIVP OF STRATEGY (i)
(ii)		 340,964
0 		108,100
0 		1,980
0 		92,814
0 		11,497
0 		555,355
0 		0
0
(12)STEPHANIE A MILLS MDPRESIDENT/CEO FHWS (i)
(ii)		 354,518
0 		150,025
0 		27,757
0 		55,349
0 		31,041
0 		618,690
0 		0
0
(13)REDFIELD E BRYAN MDMD CONSULTANT (i)
(ii)		 130,000
0 		40,000
0 		24,076
0 		0
0 		24,035
0 		218,111
0 		0
0
(14)LOUIS BREMERPRESIDENT/CEO ST. FRANCIS (i)
(ii)		 370,799
0 		129,200
0 		1,980
0 		10,000
0 		12,718
0 		524,697
0 		0
0
(15)ROBERT D RAMSEY JRCHIEF FINANCIAL OFFICER (i)
(ii)		 399,933
0 		145,225
0 		15,655
0 		103,675
0 		39,407
0 		703,895
0 		0
0
(16)KAREN B ALLENPRESIDENT/CEO SR. SVCS (i)
(ii)		 170,426
0 		59,025
0 		20,106
0 		30,737
0 		24,375
0 		304,669
0 		0
0
(17)KENNETH SCOTT WESTERPresident/CFO OLOL (i)
(ii)		 481,556
0 		147,200
0 		18,659
0 		78,953
0 		13,462
0 		739,830
0 		0
0
(18)ROBERT BURGESSPRESIDENT & CEO -ST. ELIZABETH (i)
(ii)		 130,652
0 		0
0 		6,437
0 		5,305
0 		8,662
0 		151,056
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE J, PART I, LINE 1A   LOUIS BREMER RECEIVED A HOUSING ALLOWANCE. THESE EXPENSES WERE TREATED AS TAXABLE COMPENSATION TO THE LISTED PERSON. WILLIAM BARROW RECEIVED REIMBURSEMENT FOR SOCIAL CLUB DUES. THESE EXPENSES WERE TREATED AS TAXABLE COMPENSATION TO THE LISTED PERSON. DOLORES LEJEUNE RECEIVED PAYMENT FOR A TRAVEL COMPANION. THESE EXPENSES WERE TREATED AS TAXABLE COMPENSATION TO THE LISTED PERSON.
SCHEDULE J, PART I, LINE 1B   HUMAN RESOURCES IS INVOLVED IN THE DECISION-MAKING PROCESS IN DETERMINING THAT THE ORGANIZATION WOULD PROVIDE HOUSING ALLOWANCES, SOCIAL CLUB DUES, AND TRAVEL COMPANION PAYMENTS.
SCHEDULE J, PART I, LINE 4A   THE CFO, GENERAL COUNSEL, AND TWO KEY EMPLOYEES ARE 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 A GOOD REASON. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS/HER 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. THE CEO IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR TERMINATION OF EMPLOYMENT WITHOUT CAUSE. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID 75% OF HIS BASE SALARY AND 75% OF HIS INCENTIVE PAYMENT DETERMINED 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. ONE KEY EMPLOYEE IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR TERMINATION OF EMPLOYMENT WITHOUT CAUSE. IF TRIGGERED, THE EXECUTIVE WOULD BE PAID HIS/HER BASE SALARY AND AN ANNUAL INCENTIVE AT TARGET AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD RANGES FROM 18 TO 36 MONTHS DEPENDING ON THE EXECUTIVE AND THE LENGTH OF SERVICE. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. CURRENT YEAR.
SCHEDULE J, PART I, LINE 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.
SCHEDULE J, PART I, LINE 7   DISCRETIONARY BONUSES WERE PAID WITH REGARD TO PERSONS LISTED ON PART VII, SECTION A, LINE 1A. SUCH BONUSES WERE APPROVED BY THE CEO OR THE COMPENSATION COMMITTEE DEPENDING ON THE INDIVIDUAL'S JOB LEVEL.
Schedule J (Form 990) 2012

Additional Data


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Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number
72-1028323
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A LOUISIANA PUBLIC FACILITIES AUTHORITY 05A 05D
  		72-0895871 546395B78 10-25-2005 170,286,095 CAPITAL, REFUND PRIOR ISSUES 7/23/   X   X   X
B LA PUBLIC FACILITIES AUTHORITY O5B 05C
  		72-0895871 546394D92 05-28-2008 100,000,000 CAPITAL, REFUND PRIOR ISSUE 10/04/   X   X   X
C LA PUBLIC FACILITIES AUTHORITY 2005D
  		72-0895871 546395C28 07-21-2008 88,325,000 REOFFERED 05D,REFUND PART 98A&98C   X   X   X
D LA PUBLIC FACILITIES AUTHORITY 98B 08A
  		72-0895871 546395E83 08-07-2008 82,485,000 REOFFER 98B REFUND 98A, 98C   X   X   X
LA PUBLIC FACILITIES AUTHORITY 2009A
  		72-0895871 546395H72 07-23-2009 202,528,691 CAPITAL, REOFFER '98   X   X   X
Louisiana Public Facilities Authority 2012B
  		72-0895871 546395J88 11-01-2012 104,972,722 Capital Expenditures   X   X   X
Louisiana Public Facilities Authority
  		72-0895871   10-03-2012 56,530,000 REFUND 2005C Bonds   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 86,933,548      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 1,683,949      
8 Credit enhancement from proceeds . . . . . . . . . . . 1,675,000      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 83,547,599      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . . X              
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X              
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . . 20.5      
d Was the hedge superintegrated? . . . . . .   X            
e Was a hedge terminated? . . . . . . .   X            
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X              
b Name of provider . . . . . . . . . HYPO RE BANK
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 3.5      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X              
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
PART II, LINE 3 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE INTEREST EARNINGS WERE SPENT ON CAPITAL EXPENDITURES.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUE 10/04/05: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 3C 0 REOFFERED 05D, REFUND PART 98A & 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
PART IV, LINE 3C 0 REOFFER 98B REFUND 98A, 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number
72-1028323
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A LOUISIANA PUBLIC FACILITIES AUTHORITY 05A 05D
  		72-0895871 546395B78 10-25-2005 170,286,095 CAPITAL, REFUND PRIOR ISSUES 7/23/   X   X   X
B LA PUBLIC FACILITIES AUTHORITY O5B 05C
  		72-0895871 546394D92 05-28-2008 100,000,000 CAPITAL, REFUND PRIOR ISSUE 10/04/   X   X   X
C LA PUBLIC FACILITIES AUTHORITY 2005D
  		72-0895871 546395C28 07-21-2008 88,325,000 REOFFERED 05D,REFUND PART 98A&98C   X   X   X
D LA PUBLIC FACILITIES AUTHORITY 98B 08A
  		72-0895871 546395E83 08-07-2008 82,485,000 REOFFER 98B REFUND 98A, 98C   X   X   X
LA PUBLIC FACILITIES AUTHORITY 2009A
  		72-0895871 546395H72 07-23-2009 202,528,691 CAPITAL, REOFFER '98   X   X   X
Louisiana Public Facilities Authority 2012B
  		72-0895871 546395J88 11-01-2012 104,972,722 Capital Expenditures   X   X   X
Louisiana Public Facilities Authority
  		72-0895871   10-03-2012 56,530,000 REFUND 2005C Bonds   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 86,933,548      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 1,683,949      
8 Credit enhancement from proceeds . . . . . . . . . . . 1,675,000      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 83,547,599      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . . X              
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X              
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . . 20.5      
d Was the hedge superintegrated? . . . . . .   X            
e Was a hedge terminated? . . . . . . .   X            
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X              
b Name of provider . . . . . . . . . HYPO RE BANK
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 3.5      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X              
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
PART II, LINE 3 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE INTEREST EARNINGS WERE SPENT ON CAPITAL EXPENDITURES.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUE 10/04/05: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 3C 0 REOFFERED 05D, REFUND PART 98A & 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
PART IV, LINE 3C 0 REOFFER 98B REFUND 98A, 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number
72-1028323
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A LOUISIANA PUBLIC FACILITIES AUTHORITY 05A 05D
  		72-0895871 546395B78 10-25-2005 170,286,095 CAPITAL, REFUND PRIOR ISSUES 7/23/   X   X   X
B LA PUBLIC FACILITIES AUTHORITY O5B 05C
  		72-0895871 546394D92 05-28-2008 100,000,000 CAPITAL, REFUND PRIOR ISSUE 10/04/   X   X   X
C LA PUBLIC FACILITIES AUTHORITY 2005D
  		72-0895871 546395C28 07-21-2008 88,325,000 REOFFERED 05D,REFUND PART 98A&98C   X   X   X
D LA PUBLIC FACILITIES AUTHORITY 98B 08A
  		72-0895871 546395E83 08-07-2008 82,485,000 REOFFER 98B REFUND 98A, 98C   X   X   X
LA PUBLIC FACILITIES AUTHORITY 2009A
  		72-0895871 546395H72 07-23-2009 202,528,691 CAPITAL, REOFFER '98   X   X   X
Louisiana Public Facilities Authority 2012B
  		72-0895871 546395J88 11-01-2012 104,972,722 Capital Expenditures   X   X   X
Louisiana Public Facilities Authority
  		72-0895871   10-03-2012 56,530,000 REFUND 2005C Bonds   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 86,933,548      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 1,683,949      
8 Credit enhancement from proceeds . . . . . . . . . . . 1,675,000      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 83,547,599      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . . X              
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X              
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . . 20.5      
d Was the hedge superintegrated? . . . . . .   X            
e Was a hedge terminated? . . . . . . .   X            
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X              
b Name of provider . . . . . . . . . HYPO RE BANK
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 3.5      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X              
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
PART II, LINE 3 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE INTEREST EARNINGS WERE SPENT ON CAPITAL EXPENDITURES.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUE 10/04/05: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 3C 0 REOFFERED 05D, REFUND PART 98A & 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
PART IV, LINE 3C 0 REOFFER 98B REFUND 98A, 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number
72-1028323
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A LOUISIANA PUBLIC FACILITIES AUTHORITY 05A 05D
  		72-0895871 546395B78 10-25-2005 170,286,095 CAPITAL, REFUND PRIOR ISSUES 7/23/   X   X   X
B LA PUBLIC FACILITIES AUTHORITY O5B 05C
  		72-0895871 546394D92 05-28-2008 100,000,000 CAPITAL, REFUND PRIOR ISSUE 10/04/   X   X   X
C LA PUBLIC FACILITIES AUTHORITY 2005D
  		72-0895871 546395C28 07-21-2008 88,325,000 REOFFERED 05D,REFUND PART 98A&98C   X   X   X
D LA PUBLIC FACILITIES AUTHORITY 98B 08A
  		72-0895871 546395E83 08-07-2008 82,485,000 REOFFER 98B REFUND 98A, 98C   X   X   X
LA PUBLIC FACILITIES AUTHORITY 2009A
  		72-0895871 546395H72 07-23-2009 202,528,691 CAPITAL, REOFFER '98   X   X   X
Louisiana Public Facilities Authority 2012B
  		72-0895871 546395J88 11-01-2012 104,972,722 Capital Expenditures   X   X   X
Louisiana Public Facilities Authority
  		72-0895871   10-03-2012 56,530,000 REFUND 2005C Bonds   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 86,933,548      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 1,683,949      
8 Credit enhancement from proceeds . . . . . . . . . . . 1,675,000      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 83,547,599      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . . X              
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X              
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . . 20.5      
d Was the hedge superintegrated? . . . . . .   X            
e Was a hedge terminated? . . . . . . .   X            
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X              
b Name of provider . . . . . . . . . HYPO RE BANK
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 3.5      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X              
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
PART II, LINE 3 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE INTEREST EARNINGS WERE SPENT ON CAPITAL EXPENDITURES.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUE 10/04/05: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 3C 0 REOFFERED 05D, REFUND PART 98A & 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
PART IV, LINE 3C 0 REOFFER 98B REFUND 98A, 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number
72-1028323
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A LOUISIANA PUBLIC FACILITIES AUTHORITY 05A 05D
  		72-0895871 546395B78 10-25-2005 170,286,095 CAPITAL, REFUND PRIOR ISSUES 7/23/   X   X   X
B LA PUBLIC FACILITIES AUTHORITY O5B 05C
  		72-0895871 546394D92 05-28-2008 100,000,000 CAPITAL, REFUND PRIOR ISSUE 10/04/   X   X   X
C LA PUBLIC FACILITIES AUTHORITY 2005D
  		72-0895871 546395C28 07-21-2008 88,325,000 REOFFERED 05D,REFUND PART 98A&98C   X   X   X
D LA PUBLIC FACILITIES AUTHORITY 98B 08A
  		72-0895871 546395E83 08-07-2008 82,485,000 REOFFER 98B REFUND 98A, 98C   X   X   X
LA PUBLIC FACILITIES AUTHORITY 2009A
  		72-0895871 546395H72 07-23-2009 202,528,691 CAPITAL, REOFFER '98   X   X   X
Louisiana Public Facilities Authority 2012B
  		72-0895871 546395J88 11-01-2012 104,972,722 Capital Expenditures   X   X   X
Louisiana Public Facilities Authority
  		72-0895871   10-03-2012 56,530,000 REFUND 2005C Bonds   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 86,933,548      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 1,683,949      
8 Credit enhancement from proceeds . . . . . . . . . . . 1,675,000      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 83,547,599      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . . X              
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X              
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . . 20.5      
d Was the hedge superintegrated? . . . . . .   X            
e Was a hedge terminated? . . . . . . .   X            
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X              
b Name of provider . . . . . . . . . HYPO RE BANK
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 3.5      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X              
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
PART II, LINE 3 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE INTEREST EARNINGS WERE SPENT ON CAPITAL EXPENDITURES.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUE 10/04/05: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 3C 0 REOFFERED 05D, REFUND PART 98A & 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
PART IV, LINE 3C 0 REOFFER 98B REFUND 98A, 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number
72-1028323
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A LOUISIANA PUBLIC FACILITIES AUTHORITY 05A 05D
  		72-0895871 546395B78 10-25-2005 170,286,095 CAPITAL, REFUND PRIOR ISSUES 7/23/   X   X   X
B LA PUBLIC FACILITIES AUTHORITY O5B 05C
  		72-0895871 546394D92 05-28-2008 100,000,000 CAPITAL, REFUND PRIOR ISSUE 10/04/   X   X   X
C LA PUBLIC FACILITIES AUTHORITY 2005D
  		72-0895871 546395C28 07-21-2008 88,325,000 REOFFERED 05D,REFUND PART 98A&98C   X   X   X
D LA PUBLIC FACILITIES AUTHORITY 98B 08A
  		72-0895871 546395E83 08-07-2008 82,485,000 REOFFER 98B REFUND 98A, 98C   X   X   X
LA PUBLIC FACILITIES AUTHORITY 2009A
  		72-0895871 546395H72 07-23-2009 202,528,691 CAPITAL, REOFFER '98   X   X   X
Louisiana Public Facilities Authority 2012B
  		72-0895871 546395J88 11-01-2012 104,972,722 Capital Expenditures   X   X   X
Louisiana Public Facilities Authority
  		72-0895871   10-03-2012 56,530,000 REFUND 2005C Bonds   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 86,933,548      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 1,683,949      
8 Credit enhancement from proceeds . . . . . . . . . . . 1,675,000      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 83,547,599      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . . X              
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X              
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . . 20.5      
d Was the hedge superintegrated? . . . . . .   X            
e Was a hedge terminated? . . . . . . .   X            
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X              
b Name of provider . . . . . . . . . HYPO RE BANK
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 3.5      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X              
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
PART II, LINE 3 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE INTEREST EARNINGS WERE SPENT ON CAPITAL EXPENDITURES.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUE 10/04/05: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 3C 0 REOFFERED 05D, REFUND PART 98A & 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
PART IV, LINE 3C 0 REOFFER 98B REFUND 98A, 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number
72-1028323
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A LOUISIANA PUBLIC FACILITIES AUTHORITY 05A 05D
  		72-0895871 546395B78 10-25-2005 170,286,095 CAPITAL, REFUND PRIOR ISSUES 7/23/   X   X   X
B LA PUBLIC FACILITIES AUTHORITY O5B 05C
  		72-0895871 546394D92 05-28-2008 100,000,000 CAPITAL, REFUND PRIOR ISSUE 10/04/   X   X   X
C LA PUBLIC FACILITIES AUTHORITY 2005D
  		72-0895871 546395C28 07-21-2008 88,325,000 REOFFERED 05D,REFUND PART 98A&98C   X   X   X
D LA PUBLIC FACILITIES AUTHORITY 98B 08A
  		72-0895871 546395E83 08-07-2008 82,485,000 REOFFER 98B REFUND 98A, 98C   X   X   X
LA PUBLIC FACILITIES AUTHORITY 2009A
  		72-0895871 546395H72 07-23-2009 202,528,691 CAPITAL, REOFFER '98   X   X   X
Louisiana Public Facilities Authority 2012B
  		72-0895871 546395J88 11-01-2012 104,972,722 Capital Expenditures   X   X   X
Louisiana Public Facilities Authority
  		72-0895871   10-03-2012 56,530,000 REFUND 2005C Bonds   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 86,933,548      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 1,683,949      
8 Credit enhancement from proceeds . . . . . . . . . . . 1,675,000      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 83,547,599      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . . X              
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0%   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X              
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
X              
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . . 20.5      
d Was the hedge superintegrated? . . . . . .   X            
e Was a hedge terminated? . . . . . . .   X            
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . . X              
b Name of provider . . . . . . . . . HYPO RE BANK
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 3.5      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . X              
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . . X              
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
PART II, LINE 3 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE INTEREST EARNINGS WERE SPENT ON CAPITAL EXPENDITURES.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUES 7/23/98: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 4C 0 CAPITAL, REFUND PRIOR ISSUE 10/04/05: THE GROSS PROCEEDS WERE INVESTED IN A GIC IN 2005 FOR 3 YEARS. NO PROCEEDS ARE CURRENTLY INVESTED IN A GIC.
PART IV, LINE 3C 0 REOFFERED 05D, REFUND PART 98A & 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
PART IV, LINE 3C 0 REOFFER 98B REFUND 98A, 98C: THE TERM ON THE HEDGE LISTED IS THE ENTIRE TERM. REMAINING TIME LEFT ON THE HEDGE DIFFERS BY BOND ISSUE.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number

72-1028323
Identifier Return Reference Explanation
PART VI, SECTION A, QUESTION 6   THE ENTITY IS ORGANIZED AS A NON-PROFIT CORPORATION WITH MEMBERS. THE MEMBERS ARE THE PROVINCIAL OF THE FMOL NORTH AMERICAN PROVINCE AND THOSE PERSONS ARE MEMBERS OF THE PROVINCIAL COUNCIL OF FMOL NORTH AMERICAN PROVINCE.
PART VI, SECTION A, QUESTION 7A   THE MEMBERS RETAIN THE POWER TO APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF FMOL HEALTH SYSTEM.
PART VI, SECTION A, QUESTION 7B   THE RESERVED POWERS TO THE MEMBERS ARE AS FOLLOWS: 1. CHANGE PHILOSOPHY, OBJECTIVES, PURPOSES OF CORPORATION AND ANY CORPORATION IN WHICH FMOL HEALTH SYSTEM RETAINS VOTING RIGHTS 2. APPOINT AND REMOVE BOARD OF TRUSTEES AND OFFICERS OF FMOL HEALTH SYSTEM 3. ALTER ARTICLES OF INCORPORATION AND BYLAWS OF FMOL HEALTH SYSTEM AND ANY CORPORATION IN WHICH FMOL HEALTH SYSTEM RETAINS VOTING RIGHTS 4. AUTHORIZE MERGER, CONSOLIDATION OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES 5. DISSOLVE AND DISTRIBUTE ASSETS OF FMOL HEALTH SYSTEM OR ANY CORPORATION IN WHICH FMOL HEALTH SYSTEM RETAINS VOTING RIGHTS 6. APPOINT AND TERMINATE CEO OF FMOL HEALTH SYSTEM OR ANY CORPORATION IN WHICH FMOL HEALTH SYSTEM RETAINS VOTING RIGHTS 7. ACQUIRE, LEASE, ENCUMBER REAL ESTATE ON BEHALF OF FMOL HEALTH SYSTEM OR ANY CORPORATION IN WHICH FMOL HEALTH SYSTEM RETAINS VOTING RIGHTS 8. ADD TO OR INCUR LONG TERM DEBT IN EXCESS OF $5 MILLION BY FMOL HEALTH SYSTEM OR ANY CORPORATION IN WHICH FMOL HEALTH SYSTEM RETAINS VOTING RIGHTS
PART VI, SECTION A, QUESTION 11   AFTER PREPARATION AND REVIEW BY KPMG, LLP, MANAGEMENT WILL REVIEW THE FORM 990. A COPY OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED WITH THE IRS.
PART VI, SECTION B, QUESTION 12C   FMOL HEALTH SYSTEM 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 RESULTS IN CREATING 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 SHE OR HE (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 FMOL HEALTH SYSTEM IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION TO THE ABOVE, FMOL HEALTH SYSTEM 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 B, QUESTION 15A & 15B   OUR BOARD OF DIRECTORS DESIGNATES THE HUMAN RESOURCES AND COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT MEMBERS TO REVIEW AND SET THE COMPENSATION ANNUALLY OF OUR EXECUTIVES AND KEY EMPLOYEES. THE COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING INDUSTRY-WIDE COMPENSATION INFORMATION FROM AN OUTSIDE CONSULTING FIRM. THE COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR DETERMINATION IS THEN DOCUMENTED BY THE COMMITTEE.
PART VI, SECTION C, QUESTION 19   COPIES OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
PROGRAM SERVICE   THE FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM ("FMOLHS") WAS FORMED IN 1984 BY THE FRANCISCAN MISSIONARIES OF OUR LADY - NORTH AMERICAN PROVINCE, A RELIGIOUS COMMUNITY OF THE ROMAN CATHOLIC CHURCH, TO ENSURE THE PERPETUATION OF THEIR MISSION. THE HEALTH SYSTEM DELIVERS MEDICAL CARE AND COMMUNITY SERVICES THROUGH ITS SPONSORED HOSPITALS, SUBSIDIARIES AND AFFILIATES: OUR LADY OF THE LAKE HOSPITAL, INC. IN BATON ROUGE, LOUISIANA; ST. ELIZABETH HOSPITAL, IN GONZALES, LOUISIANA; OUR LADY OF LOURDES REGIONAL MEDICAL CENTER IN LAFAYETTE, LOUISIANA; AND ST. FRANCIS MEDICAL CENTER IN MONROE, LOUISIANA. CALAIS HEALTH, LLC, A WHOLLY OWNED CORPORATE HEALTH SERVICES SUBSIDIARY, AND FRANCISCAN PACE, INC., A WHOLLY OWNED CORPORATION FORMED FOR THE PURPOSE OF PERFORMING RELIGIOUS, BENEVOLENT, CHARITABLE, HEALTHCARE AND EDUCATIONAL ACTIVITIES, ARE BOTH HEADQUARTERED IN BATON ROUGE AND OPERATE THROUGHOUT LOUISIANA. LOUISE INSURANCE COMPANY SEEKS TO ASSURE BEST-COST LIABILITY COVERAGE FOR HEALTH SYSTEM-SPONSORED ORGANIZATIONS. THESE SPONSORED HOSPITALS, SUBSIDIARIES AND AFFILIATES ARE REFERRED TO HEREIN AS "FMOLHS AFFILIATES". FMOLHS SUPPORTS THE PURPOSE AND ACTIVITIES OF FMOLHS AFFILIATES AND ITS POWER MUST BE EXERCISED IN ACCORDANCE WITH THE TEACHINGS, TRADITIONS AND CANON LAW OF THE ROMAN CATHOLIC CHURCH AND THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH FACILITIES PROMULGATED BY THE NATIONAL CONFERENCE OF CATHOLIC BISHOPS OF THE UNITED STATES CATHOLIC CONFERENCE. FMOLHS SUPPORTS THE ACTIVITIES OF THE ENTIRE SYSTEM BY PROVIDING EXECUTIVE LEADERSHIP AND CENTRALIZED SUPPORT AND MANAGERIAL FUNCTIONS. SYSTEM-LEVEL ACTIVITIES INCLUDE STRATEGIC PLANNING, CAPITAL AND OPERATIONAL BUDGETING, HUMAN RESOURCES ADMINISTRATION, CENTRALIZED CASH MANAGEMENT AND TREASURY FUNCTIONS, INFORMATION TECHNOLOGY DEVELOPMENT AND SUPPORT, BUSINESS OFFICE, DECISION SUPPORT, AND OTHER SUPPORT AND MANAGEMENT FUNCTIONS. FMOLHS AND THE FMOLHS AFFILIATES ARE ACTIVE, CARING MEMBERS OF THE COMMUNITIES THEY SERVE. IN CARRYING OUT ITS MISSION OF MEETING THE HEALTH NEEDS OF THE PEOPLE OF GOD, THE BOARD OF DIRECTORS HAS ESTABLISHED A POLICY UNDER WHICH FMOLHS AFFILIATES PROVIDE CARE TO NEEDY MEMBERS OF THEIR COMMUNITIES. FOLLOWING THAT POLICY, HEALTH CARE SERVICES COSTING $13,734,000 WERE PROVIDED WITHOUT CHARGE DURING THE YEAR ENDED JUNE 30, 2013. CHARGES FOREGONE, BASED ON ESTABLISHED RATES, TOTALED $38,576,000 FOR THE YEAR ENDED JUNE 30, 2013. THE FMOLHS AFFILIATES ALSO PARTICIPATE IN GOVERNMENT PROGRAMS INCLUDING MEDICARE, MEDICAID, AND THE TRICARE PROGRAM. UNDER THESE PROGRAMS, THE FMOLHS AFFILIATES PROVIDE 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 FMOLHS AFFILIATES AT AMOUNTS WHICH ARE LESS THAN THEIR COST OF PROVIDING SERVICES. THE FOLLOWING TABLE SUMMARIZES THE AMOUNT OF CHARGES FOREGONE (I.E., CONTRACTUAL ADJUSTMENTS) AND THE ESTIMATED LOSSES INCURRED BY THE FMOLHS AFFILIATES DUE TO INADEQUATE PAYMENTS BY THESE PROGRAMS AND FOR CHARITY FOR THE YEAR ENDED JUNE 30, 2013: CHARGES FOREGONE ESTIMATED UNREIMBURSED COSTS MEDICARE $850,192,000 $72,837,000 MEDICAID $319,104,000 $66,635,000 OTHER $ 8,322,000 $ 2,332,000 CHARITY $ 38,576,000 $13,734,000 TOTALS 1,216,194,000 $155,538,000 IN ADDITION TO COMMUNITY SERVICES DIRECTLY ASSOCIATED WITH PROVIDING HOSPITAL BASED CARE, FMOLHS AFFILIATES SERVE THEIR COMMUNITIES IN NUMEROUS OTHER WAYS. ALTHOUGH THE FMOLHS AFFILIATES HAVE ESTIMATED THE COST OF EACH OF THESE EFFORTS TO SERVE THEIR COMMUNITIES, MANAGEMENT AND THE BOARDS OF DIRECTORS BELIEVE THAT SUCH COSTS REPRESENT ONLY SOME OF THE MANY WAYS FMOLHS AFFILIATES SERVE THEIR COMMUNITIES. THE ESTIMATED COSTS FOR THE YEAR ENDED JUNE 30, 2013 ARE AS FOLLOWS: NET COMMUNITY BENEFIT EXPENSE SUBSIDIZED HEALTH SERVICES 11,154,000 COMMUNITY HEALTH IMPROVEMENT SERVICES 2,590,000 HEALTH PROFESSIONS EDUCATION 6,849,000 COMMUNITY BUILDING ACTIVITIES 610,000 DONATIONS AND IN-KIND CONTRIBUTIONS 4,449,000 TOTAL 25,652,000 SUBSIDIZED HEALTH SERVICES-INCLUDES THE DISCOUNT PROVIDED, AT COST, TO ALL PATIENTS THAT HAVE NO FORM OF INSURANCE COVERAGE. PROGRAMS SUCH AS ST. ELIZABETH COMMUNITY CLINIC, SCOTT FAMILY CLINIC, ST. BERNADETTE'S CLINIC, WHICH SERVES THE UNDERINSURED AND UNINSURED. MENTAL HEALTH SERVICES AND PALLIATIVE CARE ARE ALSO PROVIDED TO THE COMMUNITY. COMMUNITY HEALTH IMPROVEMENT SERVICES - INCLUDES ACTIVITIES CARRIED OUT TO IMPROVE COMMUNITY HEALTH AND COSTS WHICH ARE UNDERWRITTEN BY FMOLHS AFFILIATES. THESE SERVICES INCLUDE CAMP BLUEBIRD, LAFAYETTE COMMUNITY HEALTHCARE CLINIC, A MEDICATION PROGRAM, CONGREGATIONAL HEALTH SERVICES, NORTHSIDE HIGH SCHOOL HEALTH CENTER, COMMUNITY SEMINARS, IMMUNOLOGICAL SUPPPORT, PARISH NURSE PROGRAM, LAKELINE DIRECT, ST. MARTHA ACTIVITY CENTER, ELDERLY SERVICES, AND ELDERLY HOUSING. HEALTH PROFESSIONS EDUCATION - INCLUDES ASSISTANCE TO FUTURE HEALTH CARE PROFESSIONALS, NURSING STUDENTS AND PHARMACY STUDENTS. CLINICAL SETTING FOR UNDERGRADUATE, VOCATIONAL TRAINING, INTERNSHIPS, CLERKSHIPS, AND RESIDENCIES. COLLABORATION WITH LOCAL COLLEGES FOR SUPERVISION AND CLINICAL TRAINING IN PHARMACY, RESPIRATORY THERAPY, HEALTH INFORMATION MANAGEMENT, AND MEDICAL TECHNOLOGY. REGISTERED NURSE RECRUITMENT ACTIVITIES, OLOL COLLEGE, AND PARTICIPATION IN MEDICARE'S GRADUATE MEDICAL EDUCATION THROUGH AFFILIATION WITH LOUISIANA MEDICAL SCHOOL AND MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS; WILL CONTINUE TO SUPPORT AVAILABILITY OF FUTURE HEALTH CARE PROFESSIONALS. COMMUNITY BUILDING ACTIVITIES- INCLUDES LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS SUCH AS EMERGENCY PREPAREDNESS PROGRAMS; COMMUNITY HEALTH EDUCATION SUCH AS CLASSES ON BREAST FEEDING, CHILDBIRTH BASICS, SIBLING CLASS, AND ABC'S OF CHILDCARE; COMMUNITY SUPPORT WITH MEALS ON WHEELS; COMMUNITY-BASED CLINICAL SERVICES, INCLUDING HEALTH SCREENINGS, DISCOUNTED SERVICES PROVIDED TO LOUISIANA BAPTIST CHILDREN'S HOME, VETERAN'S ADMINISTRATION, RURAL HOSPITALS, ULM ATHLETIC DEPARTMENT, MDA, WELLSPRING, AND HANDICAP CHILDREN; WORKFORCE DEVELOPMENT; AND PROVIDES COMMUNITY CLINICS, ST. VINCENT DEPAUL CHARITABLE PHARMACY AND MARY BIRD PERKINS USE OF LAND AND BUILDINGS. DONATIONS AND IN-KIND CONTRIBUTIONS - INCLUDES DONATIONS TO VARIOUS AREA COMMUNITY ORGANIZATIONS SUCH AS UNITED WAY, FAMILIES HELPING FAMILIES, CHILDREN'S COALITION, WELLSPRING, YMCA, HAITI PROJECT, PREVENT CHILD ABUSE, KOMEN FOUNDATION, ALZHEIMER'S FOUNDATION, MARCH OF DIMES, JUNIOR ACHIEVEMENT, CYSTIC FIBROSIS, COMMUNITY FUND FOR THE ARTS AND AMERICAN HEART ASSOCIATION. PROVIDES OFFICE SPACE FOR THE FAMILY TREE PARENTING CENTER, AS WELL AS EMPLOYEE COSTS ASSOCIATED WITH BOARD AND COMMUNITY INVOLVEMENT IN VARIOUS COMMUNITY ORGANIZATIONS.
PART XI, LINE 9   CAPITAL TRANSFERS $26,974,013
PART VI, SECTION A, QUESTION 2   CLAUDE HARBARGER & HOWARD L. HARVILL - 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:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FMOL HEALTH SYSTEM INC
 
Employer identification number

72-1028323
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) CALAIS HEALTH LLC
5745 ESSEN LANE
BATON ROUGE,LA70809
72-1470366 		HEALTHCARE LA 102,887 472,248 FMOL
 
(2) FMOL HEALTH SYSTEM MANAGMENT SERVICE LLC
4200 ESSEN LANE
BATON ROUGE,LA70809
30-0668218 		MGMT SERVICE LA   12,085 FMOL
 
(3) FMOLHS MGT SERVICES- NEW ORLEANS EAST LL
4200 ESSEN LANE
BATON ROUGE,LA70809
 MGMT SERVICE LA 405,458 196,491 FMOL MGT SVC
 
(4) FMOLHS MGT SERVICES- ST BERNARD LLC
4200 ESSEN LANE
BATON ROUGE,LA70809
30-0679332 		MGMT SERVICE LA 112,309 379,849 FMOL MGT SVC
 




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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) 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

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
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) HEART HOSPITAL OF ACADIANA

1105 KALISTE SALOOM ROAD
LAFAYETTE,LA70508
30-0442368 		HEALTHCARE LA LOURDES
  		N/A       No 0 Yes    
(2) PERKINS PLAZA MEDICAL ARTS DEVELOPMENT

5000 HENNESSY BOULEVARD
BATON ROUGE,LA70808
45-0516574 		REAL ESTATE LA OLOL
  		N/A       No 0 Yes    
(3) PERKINS PLAZA IMAGING DEVELOPMENT

5000 HENNESSY BOULEVARD
BATON ROUGE,LA70808
20-3894521 		REAL ESTATE LA OLOL
  		N/A       No   Yes    
(4) CAPITAL AREA SHARED SERVICES ORG LLC

5000 HENNESSY BOULEVARD
BATON ROUGE,LA70808
27-5173212 		HEALTHCARE LA OLOL
  		N/A       No   Yes    
(5) NUCLEAR IMAGING LLC

5000 HENNESSY BOULEVARD
BATON ROUGE,LA70808
72-1470061 		HEALTHCARE LA OLOL
  		N/A       No   Yes    
(6) P&S SURGERY CENTER LLC

312 GRAMMONT STREET
MONROE,LA71201
72-1387870 		HEALTHCARE LA SFMC
  		N/A       No   Yes    
(7) ST ELIZABETH - MARY BIRD PERKINS

4950 ESSEN LANE
BATON ROUGE,LA70809
26-0628752 		HEALTHCARE LA STEH
  		N/A       No   Yes    
(8) LOURDES IMAGING DEVELOPMENT LLC

4801 AMBASSADOR CAFFERY
LAFAYETTE,LA70508
20-8326287 		REAL ESTATE LA LOURDES
  		N/A       No   Yes    
(9) PARK PLACE SURGICAL HOSPITAL

901 WILSON STREET
LAFAYETTE,LA70503
72-1404092 		HEALTHCARE LA LOURDES
  		N/A       No   Yes    
(10) BRPT LAKE REHABILITAION CENTERES LLC

530 SHADOWS LANE
BATON ROUGE,LA70806
72-1404092 		HEALTHCARE LA OLOL
  		N/A       No   Yes    
(11) CONVENIENT CARE LLC

7777 HENNESSY BOULEVARD SUITE 1004
BATON ROUGE,LA70808
72-1439481 		HEALTHCARE LA OLOL
  		N/A       No   Yes    
(12) PERKINS PLAZA AMBULATORY SURGERY CENTER

54 THE LEDGENDS PARKWAY SUITE 159
EUREKA,MO63025
48-1264699 		HEALTHCARE LA OLOL
  		N/A       No   Yes    
(13) SURGICAL SPECIALTY CENTER OF BATON ROUGE

8080 BLUEBONNET BOULEVARD
BATON ROUGE,LA70810
26-3160962 		HEALTHCARE LA OLOL
  		N/A       No   Yes    
(14) ST ELIZABETH IMAGING CENTER

1125 HIGHWAY 30
GONZALES,LA70737
72-1470744 		HEALTHCARE LA STEH
  		N/A       No   Yes    
(15) REGIONAL EYE SURGERY CENTER LLC

7777 HENNESSY BLVD SUITE 4000
BATON ROUGE,LA70808
72-1484653 		HEALTHCARE LA OLOL
  		N/A       No   Yes    
(16) ST MARY'S IMAGING CENTER II LLC

4801 AMBASSADOR CAFFERY
LAFAYETTE,LA70508
72-1484653 		HEALTHCARE LA LOURDES IMAGING
  		N/A       No   Yes    
(17) NORTHEAST LA CANCER INSTITUTE

141 DESTARD STREET SUITE 704
MONROE,LA71201
72-1329499 		HEALTHCARE LA SFMC
  		N/A       No   Yes    
(18) LHCG-XIII LLC

420 WEST PINHOOK ROAD SUITE A
LAFAYETTE,LA70503
20-8068308 		HEALTHCARE LA LOURDES
  		N/A       No   Yes    
(19) LOURDES AFTER HOURS LLC

7777 HENNESSY BLVD SUITE 1004-202
BATON ROUGE,LA70808
20-1367299 		HEALTHCARE LA LOURDES
  		N/A       No   Yes    
(20) CAPITAL AREA SHARED SERVICES ORG LLC

5000 HENNESSY BOULEVARD
BATON ROUGE,LA70808
27-5173212 		HEALTHCARE LA STEH
  		N/A       No   Yes    
(21) LAKE URGENT CARE ASCENSION LLC

10319 Jefferson Highway
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 LA OLOLUSP
  		N/A       No   Yes    
(23) OLOLUSP SURGERY CENTER LLC

15305 Dallas Pkwy Ste 1600 LB 28
Addison,TX75001
35-2457810 		HEALTHCARE TX OLOL
  		N/A       No   Yes    
(24) LAKE URGENT CARE ASCENSION LLC

10319 Jefferson Highway
Baton Rouge,LA70809
35-2463092 		HEALTHCARE LA OLOL
  		N/A       No   Yes    
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) St Francis Insurance Agency

309 Jackson Street
Monroe,LA71201
72-1435136 		Insurance LA SFMC
  		C Corp       Yes  
(2) Hospital Assistance Services

PO Box 4027-C
Lafayette,LA70502
72-1073486 		Healthcare LA LOURDES
  		C Corp       Yes  
(3) Louise Insurance Company

PO BOX 1051
    KY1-1102
CJ
INSURANCE CJ FMOL
  		C Corp 6,831,488 35,642,526 100.000 % Yes  
(4) NORTHEAST LA HEALTH NETWORK

309 JACKSON STREET
Monroe,LA72101
72-1294587 		Healthcare LA AMBULATORY
  		C Corp       Yes  
(5) CHARITABLE REMAINDER TRUST

 
 
INVESTMENT LA OLOL FOUNDATION
  		TRUST          
(6) Monroe Health Services

PO BOX 3187
MONROE,LA72101
72-1057820 		Healthcare LA AMBULATORY
  		C Corp       Yes  
(7) FRANCISCAN HEALTH & WELLNESS SERVICES I

4200 ESSEN LANE
BATON ROUGE,LA70809
45-5492379 		HEALTHCARE LA FMOL
  		C Corp 3,363,675 3,204,548 100.000 % Yes  
(8) FMOL HEALTH SYSTEM HOLDINGS INC

4200 ESSEN LANE
BATON ROUGE,LA70809
45-4405024 		INVESTMENT LA FMOL
  		C CORP 1,058,453 6,089,694 100.000 % Yes  
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) OLOL Ascension Community Hospital

 s 2,121,686 FMV
(2) OLOL Ascension Community Hospital

 p 1,318,837 FMV
(3) OLOL Ascension Community Hospital

 l 3,374,115 FMV
(4) Franciscan Health & Wellness Services

 l 151,890 FMV
(5) Franciscan Health & Wellness Services

 q 4,344,450 FMV
(6) Our Lady of the Lake Hospital

 s 42,074,802 FMV
(7) Our Lady of the Lake Hospital

 k 1,161,741 FMV
(8) Our Lady of the Lake Hospital

 p 509,342 FMV
(9) Our Lady of the Lake Hospital

 q 10,604,555 FMV
(10) Our Lady of the Lake Hospital

 l 40,048,210 FMV
(11) Our Lady of Lourdes Regional Medical Center

 s 17,109,081 FMV
(12) Our Lady of Lourdes Regional Medical Center

 p 1,347,588 FMV
(13) Our Lady of Lourdes Regional Medical Center

 q 6,451,085 FMV
(14) Our Lady of Lourdes Regional Medical Center

 l 13,803,383 FMV
(15) St Francis Medical Center

 s 5,701,654 FMV
(16) St Francis Medical Center

 p 210,909 FMV
(17) St Francis Medical Center

 q 22,680,584 FMV
(18) St Francis Medical Center

 l 17,335,500 FMV
(19) Franciscan Pace Inc

 q 542,079 FMV
(20) Franciscan Pace Inc

 l 200,136 FMV
(21) Franciscan Missionaries of Our Lady

 k 350,680 FMV
(22) Louise Insurance Company

 r 6,448,266 FMV
(23) FMOL HEALTH SYSTEM HOLDINGS

 r 432,366 FMV
(24) FMOL HEALTH SYSTEM HOLDINGS

 q 522,990 FMV
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

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




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






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


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