Attach to Form 990 or Form 990-EZ.
See separate instructions.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization in col. (i) listed in your governing document? | (v) Did you notify the organization in col. (i) of your support? | (vi) Is the organization in col. (i) organized in the U.S.? | (vii) Amount of monetary support | |||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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). | ||||||






Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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.).. | ||||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | TRUSTEES, CLAY ALLEN AND ROBERT GILES, ARE INVOLVED IN SEPARATE BUSINESS VENTURES TOGETHER THAT ARE WHOLLY UNRELATED TO THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION IS A NON-STOCK NOT-FOR-PROFIT CORPORATION WITH ONE CLASS OF MEMBERSHIP. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS RATIFY THE SELECTION OF THE INDIVIDUALS THAT SERVE ON THE BOARD OF TRUSTEES (GOVERNING BODY) AFTER THOSE INDIVIDUALS HAVE BEEN SELECTED AS A TRUSTEE BY THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | YES, THE INDIVIDUALS OF THE TRUSTEES (GOVERNING BODY) AND THE MEMBERS MUST BE APPROVED BY THE MEMBERSHIP BODY. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S ACCOUNTING STAFF AND A CPA FIRM. THE COMPLETED FORMS ARE REVIEWED BY THE OFFICERS AND THEN PRESENTED TO THE BOARD FOR REVIEW, COMMENT AND CORRECTIONS IF NEEDED BEFORE FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | AN ANNUAL SURVEY IS SENT TO THE BOARD MEMBERS AND OFFICERS REQUIRING THEM TO DISCLOSE CONFLICTS OF INTEREST. AFTER RECEIPT OF THESE SURVEYS, THE GOVERENCE COMMITTEE AND ITS CHAIRPERSON REVIEW ALL CONFLICTS AND REPORT ON SAME TO THE GOVERNANCE COMMITTEE. THEREAFTER THE CHAIRPERSON OF THE GOVERNANCE COMMITTEE AND THE ORGANIZATION'S GENERAL COUNCIL (WHO ATTENDS ALL BOARD MEETINGS) INSURES THAT ALL CONFLICTS ARE TIMELY DISCLOSED AND APPROPRIATE RECUSALS ARE MADE ON BUSINESS MATTERS THAT MAY BE RELATED TO THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | AN INDEPENDENT EXTERNAL CONSULTANT FIRM, SULLIVAN COTTER AND ASSOCIATES, IS ENGAGED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, WHICH IS COMPRISED OF DISINTERESTED DIRECTORS, TO PREPARE COMPENSATION SURVEY AND FAIR MARKET VALUE REPORT. THE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE MARKET COMPARABLES AND MAKES ADJUSTMENT THE PRESIDENT/CEOS COMPENSATION THEREAFTER. THIS SAME PROCESS IS FOLLOWED FOR THE FOLLOWING SENIOR EXECUTIVES OF THE ORGANIZATION: CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER AND GENERAL COUNSEL. |
| FORM 990, PART VI, SECTION C, LINE 19 | BASIC FINANCIAL INFORMATION IS MADE AVAILABLE AND SENT OUT TO THE COMMUNITY BY MEANS OF THE ORGANIZATION'S ANNUAL REPORT. OTHER DOCUMENTS AND MORE DETAILED FINANCIAL INFORMATION ARE AVAILABLE TO THE PUBLIC UPON REQUEST WITHIN THE PARAMETERS OF REGULATORY / LEGAL AUTHORITIES. |
| FORM 990, PART VII, SECTION A, LINE A | PAYMENTS TO THE PHYSICIANS THAT SERVE AS TRUSTEES WERE REPORTED ON 1099 MISC BOX 6. ALL SUCH PAYMENTS WERE IN CONSIDERATION FOR PROVIDING CALL COVERAGE IN OUR EMERGENCY ROOM, OR SERVING AS MEDICAL DIRECTORS FOR VARIOUS HOSPITAL DEPARTMENTS. NO PAYMENTS WERE MADE IN THEIR CAPACITY AS TRUSTEE. THE PAYMENTS TO THE PHYSICIAN SERVING AS CHIEF OF STAFF WERE FROM A RELATED ORGANIZATION AS AN EMPLOYED PHYSICIAN. |
| FORM 990, PART IX, LINE 24E | EQUIPMENT RENTAL AND MAINTENANCE: PROGRAM SERVICE EXPENSES 7,866,635. MANAGEMENT AND GENERAL EXPENSES 2,605,943. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,472,578. PHYSICIAN CLINICAL SERVICES: PROGRAM SERVICE EXPENSES 9,695,193. MANAGEMENT AND GENERAL EXPENSES 59,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,754,193. CLINICAL CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,621,489. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,621,489. MEDICAL DIRECTORSHIPS: PROGRAM SERVICE EXPENSES 3,053,322. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,053,322. FOOD SUPPLIES: PROGRAM SERVICE EXPENSES 2,575,111. MANAGEMENT AND GENERAL EXPENSES 58. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,575,169. OTHER COLLECTION SERVICE: PROGRAM SERVICE EXPENSES 2,442,414. MANAGEMENT AND GENERAL EXPENSES 8,117. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,450,531. OTHER NONCLINICAL SERVICES: PROGRAM SERVICE EXPENSES 1,724,880. MANAGEMENT AND GENERAL EXPENSES 143,495. FUNDRAISING EXPENSES 214,285. TOTAL EXPENSES 2,082,660. COMMUNITY PHYSICIAN RELATIONS: PROGRAM SERVICE EXPENSES 1,245,762. MANAGEMENT AND GENERAL EXPENSES 10,604. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,256,366. LAUNDRY: PROGRAM SERVICE EXPENSES 726,439. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 726,439. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 473,325. MANAGEMENT AND GENERAL EXPENSES 24,488. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 497,813. BANK CHARGES: PROGRAM SERVICE EXPENSES 157,425. MANAGEMENT AND GENERAL EXPENSES 30,942. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 188,367. TAXES & LICENSES: PROGRAM SERVICE EXPENSES 109,405. MANAGEMENT AND GENERAL EXPENSES 18,859. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 128,264. EMPLOYEE ACTIVITIES: PROGRAM SERVICE EXPENSES 83,548. MANAGEMENT AND GENERAL EXPENSES 21,010. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 104,558. TELEPHONE: PROGRAM SERVICE EXPENSES 72,010. MANAGEMENT AND GENERAL EXPENSES 22,627. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 94,637. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 38,353. MANAGEMENT AND GENERAL EXPENSES 11,297. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,650. RECRUITING: PROGRAM SERVICE EXPENSES 20,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,000. |
| FORM 990, PART XII, LINE 2C | THE PROCESS HAS NOT CHANED FROM THE PREVIOUS YEAR. |
| Software ID: | |
| Software Version: |
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Affiliated Group Business Name:
LAFAYETTE GENERAL MEDICAL CENTER Address. Either US or Foreign Type:
1214 COOLIDGE BOULEVARD
LAFAYETTE,
LA
705032621
EIN:
72-0535375 Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
297,068,790
Total Exempt Purpose Expenditures:
297,068,790
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
|
|
Affiliated Group Business Name:
ST MARTIN HOSPITAL Address. Either US or Foreign Type:
210 CHAMPAGNE BOULEVARD
BREAUX BRIDGE,
LA
70517
EIN:
26-4626264 Electing Organization Checkbox:
Total Grassroots Lobbying:
5,889
Total Direct Lobbying:
0
Total Lobbying Expenditures:
5,889
Other Exempt Purpose Expenditures:
15,227,902
Total Exempt Purpose Expenditures:
15,233,791
Lobbying Nontaxable Amount:
911,690
Grassroots Nontaxable Amount:
227,923
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
|
|
Affiliated Group Business Name:
UNIVERSITY HOSPITAL AND CLINICS INC Address. Either US or Foreign Type:
1214 COOLIDGE BOULEVARD
LAFAYETTE,
LA
705032621
EIN:
46-2605366 Electing Organization Checkbox:
Total Grassroots Lobbying:
7,246
Total Direct Lobbying:
0
Total Lobbying Expenditures:
7,246
Other Exempt Purpose Expenditures:
138,358,132
Total Exempt Purpose Expenditures:
138,365,378
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
|
|
Affiliated Group Business Name:
ACADIA GENERAL HOSPITAL INC Address. Either US or Foreign Type:
1305 CROWLEY RAYNE HWY
CROWLEY,
LA
70526
EIN:
46-4958152 Electing Organization Checkbox:
Total Grassroots Lobbying:
2,142
Total Direct Lobbying:
0
Total Lobbying Expenditures:
2,142
Other Exempt Purpose Expenditures:
11,655,391
Total Exempt Purpose Expenditures:
11,657,533
Lobbying Nontaxable Amount:
732,877
Grassroots Nontaxable Amount:
183,219
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
|
|
Affiliated Group Business Name:
LAFAYETTE GENERAL HEALTH SYSTEMS Address. Either US or Foreign Type:
1214 COOLIDGE BOULEVARD
LAFAYETTE,
LA
705032621
EIN:
38-3646817 Electing Organization Checkbox:
Total Grassroots Lobbying:
174,685
Total Direct Lobbying:
0
Total Lobbying Expenditures:
174,685
Other Exempt Purpose Expenditures:
88,430,939
Total Exempt Purpose Expenditures:
88,605,624
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
|