Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | |||||
| 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 | 70,037,535 | 92,597,150 | 162,634,685 | |||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 0 | 0 | 0 | 70,037,535 | 92,597,150 | 162,634,685 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | 0 | 0 | 0 | 0 | 0 |
| 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. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public support. (Subtract line 7c from line 6.) | 162,634,685 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 0 | 0 | 0 | 70,037,535 | 92,597,150 | 162,634,685 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 0 | 0 | 0 | 0 | 0 | 0 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | 0 | 0 | 0 | 0 | 0 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 0 | 0 | 0 | 70,037,535 | 92,597,150 | 162,634,685 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2018 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 18007697 |
| Software Version: | 2018v3.1 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 3 Delegation of management duties | Ochsner Clinic Foundation entered into a management agreement to provide management services, billing and collection services and administrative support for certain hospital and healthcare operations in Shreveport and Monroe. Also, Ochsner acquired the Electronic Health Records licenses and fully manages the Information Services function. The Directors appointed to the board that are employed as Executives and Physicians by Ochsner Clinic Foundation did not receive any additional compensation by the management company for their duties. The following individuals were compensated as executives and physicians by the management company: 1. PETER NOVEMBER - $0 2. VINCENT ADOLPH MD - $0 3. SHELLEY SULLIVAN TYNAN - $0 4. CHARLES DAIGLE - $459,317 5. VERNON MOORE - $0 6. STEPHEN RANDALL - $282,730 |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | Below is a summary of the Significant Changes: a. Composition of Board - The board is made of the Joint Management Committee, 4 LSU Designated Directors & 4 Ochsner Designated Directors, with the Chair of the Board changing every 2 years between the LSU & Ochsner Designated Directors. All directors serve an indefinite term. b. Officers - Appointed by the CEO instead of by the Board, apart from the CEO who is appointed by the Chancellor of LSU Health Sciences Center. Also, the CEO must be a Physician at LSU Health Sciences Center - Shreveport. c. Stockholders - Sole owned by OLHS-NL d. Amend Documents/Bylaws - The bylaws were amended after the acquisition by OLHS-NL on October 1, 2018. e. Voting Approval Requirement - A 2/3 Majority of Each of the Designated Director Groups. In The event of a deadlock, the subject being voted upon will be brought before the Member, OLHS-NL, and its board to final determination on the matter. f. Policies - The Board adopted a Conflicts of Interest Policy in the updated bylaws. g. Committee - Since the corporation is solely owned by OLHS-NL, then it is under the authority of their Audit Committee. At a future time, the corporation may elect to have committees, but at this time does not have any. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | LSU-Health Sciences Center- Shreveport Faculty Group Practice is a wholly owned subsidiary of Ochsner LSU Health System of North Louisiana, a related 501(c)(3) organization, and a supported organization. LSU-Health Sciences Center- Shreveport Faculty Group Practice is organized on a non-stock membership basis, and as of October 1, 2018 the sole Member of the Corporation is Ochsner LSU Health System of North Louisiana. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | In the event of a final vote that results in a deadlock, the Directors may bring the matter before the Member and the board of directors of the Member will make the final determination on the matter, consistent with Section 4.14N of these Bylaws. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE ORGANIZATION PROVIDES A COPY OF THE FORM 990 TO THE FULL BOARD OF DIRECTORS ONCE REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM, ERNST & YOUNG U.S. LLP |
| Form 990, Part VI, Line 12c Conflict of interest policy | OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES OF OCHSNER LSU HEALTH SYSTEM OF NORTH LOUISIANA AND ITS SUBSIDIARIES AND AFFILIATES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY, OR WITHIN 40 DAYS OF BECOMING AN EMPLOYEE, OR IF A CURRENT EMPLOYEE HAS A CHANGE IN BUSINESS CIRCUMSTANCES NOT PREVIOUSLY DISCLOSED. THE CONFLICT OF INTEREST PROGRAM ADMINISTRATOR REVIEWS DISCLOSURES AND DETERMINES WHETHER ACTION IS NECESSARY OR IF THE DISCLOSURE NEEDS TO BE REVIEWED BY THE CONFLICT OF INTEREST STEERING COMMITTEE. THE CONFLICT OF INTEREST PROGRAM ADMINISTRATOR, IN CONJUNCTION WITH THE CONFLICT OF INTEREST STEERING COMMITTEE, WILL MAKE MITIGATION RECOMMENDATIONS, INCLUDING, BUT NOT LIMITED TO, DIVESTITURE AND TERMINATION OF BUSINESS RELATIONSHIPS. OCHSNER LSU HEALTH SYSTEM OF NORTH LOUISIANA REQUIRES ANNUAL CERTIFICATION THAT THE RELATIONSHIPS DISCLOSED DURING A PRECEDING CALENDAR YEAR ARE COMPLETE AND ACCURATE. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | ALL OCHSNER LSU HEALTH SYSTEM OF NORTH LOUISIANA CEO AND OFFICER COMPENSATION AND BENEFITS ARRANGEMENTS, INCLUDING SALARY AND BONUS INCENTIVE PLANS, ARE REVIEWED BY OCHSNER CLINIC FOUNDATION'S EXECUTIVE TEAM UNDER ITS AGREEMENT TO PROVIDE MANAGEMENT SERVICES. OCHSNER CLINIC FOUNDATION'S EXECUTIVE TEAM IS WITHOUT CONFLICTS OF INTEREST AND USES AN INDEPENDENT EXTERNAL CONSULTANT. APPROPRIATE DATA IS APPLIED TO DETERMINE THE COMPARABILITY OF FAIR MARKET VALUE PAY AND ALL ACTIONS ARE APPROPRIATELY DOCUMENTED. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | Management jobs are assigned to pay ranges where the midpoint is aligned to the 50th percentile of salary survey data. Upon hire, management salaries are based upon applicable skills and experience relevant to the job and pay range. Merit increases are awarded annually thereafter based upon performance. Off-cycle adjustments may be provided due to market movement to ensure alignment with the competitive market. |
| Form 990, Part VI, Line 19 Required documents available to the public | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST |
| Form 990, Part XII, Line 2c Change in Oversight Process or Selection Process | The organization became a wholly owned subsidiary of OLHS-NL, and is included in the Consolidated Audit. The oversight process of these financial statement is the Audit Committee of OLHS-NL. This change in the oversight process resulted in the change of the Auditor of the Financial Statements and Reviewer of the Tax Return from Carr Riggs & Ingram LLC to Ernst & Young U.S. LLP. |
| Software ID: | 18007697 |
| Software Version: | 2018v3.1 |