2024-05-14T15:25:30-05:00 2023-06-30 346565596 ERNST & YOUNG US LLP 425 HOUSTON ST STE 600 FT WORTH TX 76102 990 2022-07-01 364774713 LSU HEALTH SCIENCES CENTER - SHREVEPORT FACULTY GROUP PRACTICE LSUH 3186758533 1541 KINGS HIGHWAY SHREVEPORT LA 71103 JOHN SHAUGHNESSY CFO 3186260990 2024-05-14 1 JOHN SHAUGHNESSY 999009999 0 MELVA SCOTT P01207335 8173351900 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z OCHSNER LSU PHYSICIAN GROUP CHARLES FOX III MD 1541 KINGS HIGHWAY SHREVEPORT LA 71103 207020717 0 X N/A X 2013 LA SEE SCHEDULE O FOR ORGANIZATION MISSION STATEMENT 8 5 0 0 0 0 1065702 0 184171414 207020717 0 0 0 0 185237116 207020717 200000 10000 0 0 780924 853562 0 0 0 170418027 184276683 171398951 185140245 13838165 21880472 63352059 219897114 20081081 154745664 43270978 65151450 X NO BOARD APPROVED MISSION STATEMENT 0 0 150395927 10000 207020717 LSU HEALTH SCIENCES CENTER-SHREVEPORT FACULTY GROUP PRACTICE (LSUHSC-S FGP) IS THE HEALTHCARE PROVIDER ORGANIZATION FOR THE PUBLIC-PRIVATE PARTNERSHIP BETWEEN THE STATE OF LOUISIANA, LSU HEALTH SCIENCES CENTER-SHREVEPORT (LSUHSC-S) AND OCHSNER HEALTH. LSUHSC-S FGP IS A PHYSICIAN-LED GROUP PRACTICE OF GREATER THAN 500 PROVIDERS COMPRISED OF MORE THAN 70 SPECIALTIES AND SUB-SPECIALTIES WORKING TO ADVANCE THE CLINICAL MISSION OF THE ACADEMIC MEDICAL CENTER, AND ITS PARTNER HOSPITALS AND CLINICS, WITH A FOCUS ON IMPROVING COMMUNITY HEALTH THROUGH ALIGNMENT OF CARE GOALS. LSUHSC-S FGP PROVIDES PROFESSIONAL HEALTHCARE SERVICES RANGING FROM DIGITAL AND TELEHEALTH TO COMPLEX TRAUMATIC INJURY SURGICAL CARE FOR PATIENTS OF OCHSNER LSU HEALTH SYSTEM OF NORTH LOUISIANA, WHICH REPRESENTS THE ONLY LEVEL I AND LEVEL III TRAUMA CENTERS IN THE ARK-LA-TEX REGION. LSUHSC-S FGP FACILITATES COLLABORATION AMONG CLINICAL DEPARTMENTS AND PROVIDERS SO THAT RESOURCES CAN BE DIRECTED TOWARD QUALITY OUTCOMES AND PATIENT SAFETY. 150395927 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 5 0 1 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JOHN SHAUGHNESSY 3186260990 1541 KINGS HIGHWAY SHREVEPORT LA 71103 CHARLES D DAIGLE DIRECTOR 1.00 49.00 X 0 0 0 CINDY RIVES DIRECTOR 1.00 5.00 X 0 0 0 KEITH WHITE DIRECTOR 1.00 5.00 X 0 0 0 CHARLES J FOX III MD CEO / BOARD CHAIR 10.00 40.00 X X 0 0 0 VINCENT ADOLPH MD DIRECTOR 1.00 0.00 X 0 0 0 DAVID GUZICK DIRECTOR 1.00 5.00 X 0 0 0 MIKE HULEFELD DIRECTOR 1.00 5.00 X 0 0 0 JEFF REYNOLDS INTERIM CFO 40.00 10.00 X X 0 0 0 DAVID F LEWIS MD MBA DIRECTOR (JMC TERM END 12/31/22) 1.00 49.00 X 0 0 0 PETER NOVEMBER DIRECTOR (JMC TERM END 11/8/22) 1.00 5.00 X 0 0 0 DAVID CALLECOD DIRECTOR (BEGIN 12/1/21-END 7/31/22) 1.00 49.00 X X 0 0 0 LEONARDO SEOANE INTERIM CEO (BEG 8/1/22-END 12/31/22) 40.00 10.00 X X 0 0 0 PATRICK BICKNELL EXECUTIVE DIRECTOR / VP 50.00 0.00 X 0 215914 51193 LAURI WALTON INTERIM CFO (END 12/31/22) 40.00 10.00 X 0 192559 57442 SHELLEY S TYNAN SECRETARY 1.00 5.00 X 0 0 0 STEPHEN RANDALL VICE PRESIDENT 10.00 40.00 X 0 0 0 SHANNON PHAGAN DIRECTOR OF FINANCIAL OPERATIONS 50.00 0.00 X 0 142451 41438 0 550924 150073 0 0 1 0 0 PATIENT SERVICE REVENUE 621110 207020717 204952225 2068492 207020717 207020717 204952225 0 2068492 X 10000 10000 739522 739522 69065 69065 44975 44975 5123976 5123976 178106850 148486508 29620342 4644 4644 209768 209768 369725 369725 222395 222395 748 748 3138 3138 83299 83299 250 250 RECRUITING 130458 130458 MEMBERSHIPS & SUBSCRIPT 18024 18024 LICENSES AND TAXES 2510 2510 898 898 185140245 150395927 34744318 0 31924776 1191205 41276881 9308060 12746624 44447 0 854934 658966 279267 195968 21795509 164486436 63352059 219897114 1466725 1475454 2875 0 64314 65937 18547167 153204273 20081081 154745664 X 43270978 65151450 43270978 65151450 63352059 219897114 21880472 0 X X 0 1 X 1 1 1 X 1853443 1065702 2919145 92597150 103764401 141130722 184171414 207020717 728684404 92597150 105617844 141130722 185237116 207020717 731603549 0 0 0 731603549 91322 91322 91322 91322 92597150 105617844 141222044 185237116 207020717 731694871 0.99990 0.99980 0.00010 0.00020 X 551349 446894 104455 303585 212072 91513 195968 DUE FROM OLHSNL 164486436 164486436 DUE TO LSUHSC 153204273 153204273 X PART X, LINE 2: THE TEXT OF THE FOOTNOTE TO THE CONSOLIDATED FINANCIAL STATEMENTS THAT REPORTS THE LIABILITY FOR UNCERTAIN TAX POSITIONS IS AS FOLLOWS: OLHS-NL QUALIFIES AS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, EXCEPT FOR UNRELATED BUSINESS INCOME, IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. PURSUANT TO LOUISIANA LAW, THIS EXEMPTION ALSO APPLIES TO LOUISIANA STATE INCOME AND FRANCHISE TAXES. MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION ON THE ACCOMPANYING CONSOLIDATED BALANCE SHEET. 1 LSU HEALTH SCIENCES FOUNDATION SHREVEPORT 920 PIERREMONT ROAD NO 506 SHREVEPORT LA 71106 721402222 501(C)(3) 10000 0 GENERAL ASSISTANCE 1 PART I, LINE 2: PROCEDURES FOR MONITORING USE OF GRANT FUNDS: THE ORGANIZATION MAINTAINS RECORDS TO SUBSTANTIATE THE AMOUNT OF GRANTS AND ASSISTANCE THROUGH A GRANT APPLICATION PROCESS. GRANTEES' ABILITY TO PERFORM IS VOUCHED FOR AND CREDIT VOUCHERS OF PERFORMING PERSONS AT RESPECTIVE ORGANIZATIONS ARE OBTAINED. USE OF GRANT FUNDS IS MONITORED BY THE NORMAL ACCOUNTS PAYABLE PROCESS THAT THE ORGANIZATION HAS IN PLACE. ALL PAYMENTS MADE TO GRANTEES ARE APPROVED BY APPROPRIATE PERSONS ASSOCIATED WITH PRIMARY GRANT AWARDS WHO ARE KNOWLEDGEABLE OF WORK PRODUCT ON GRANTS. IN ADDITION TO THE APPROVAL PROCESS, THE ORGANIZATION HAS A PROCESS IN PLACE TO ENSURE THAT REQUESTED PAYMENTS ARE IN LINE WITH APPROVED BUDGETS SUBMITTED BY SUBRECIPIENTS. 0 0 0 0 0 0 0 0 0 PATRICK BICKNELL EXECUTIVE DIRECTOR / VP 0 191369 0 24005 0 540 0 17187 0 34006 0 267107 0 0 LAURI WALTON INTERIM CFO (END 12/31/22) 0 192559 0 0 0 0 0 31798 0 25644 0 250001 0 0 SHANNON PHAGAN DIRECTOR OF FINANCIAL OPERATIONS 0 142451 0 0 0 0 0 21989 0 19449 0 183889 0 0 SCH J, PT I, LN 3 - ARRANGEMENT USED TO ESTABLISH TOP MGMT OFFICIAL'S COMP ALL OCHSNER LSU HEALTH SYSTEM OF NORTH LOUISIANA'S 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. PART I, LINE 1 LSU HEALTH SCIENCES CENTER-SHREVEPORT FACULTY GROUP PRACTICE (LSUHSC-S FGP) PROVIDES HEALTHCARE TO THE GENERAL PUBLIC, INCLUDING, BUT NOT LIMITED TO, THE DELIVERY OF PHYSICIAN MEDICAL SERVICES AND OTHER HEALTHCARE SERVICES TO INDIVIDUALS. LSUHSC-S FGP RECEIVES COMPENSATION FOR THESE SERVICES FROM THE MEDICARE AND MEDICAID PROGRAMS, CERTAIN COMMERCIAL INSURANCE CARRIERS, HEALTH MAINTENANCE ORGANIZATIONS, PREFERRED PROVIDER ORGANIZATIONS AND DIRECTLY FROM PATIENTS. FORM 990, PART VI, SECTION A, LINE 3 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 RECORD 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. MICHAEL HULEFELD - $0 2. PETER NOVEMBER - $0 3. LEONARDO SEOANE - $0 4. DAVID CALLECOD - $0 5. CHARLES DAIGLE - $196,255 6. SHELLEY SULLIVAN TYNAN - $0 7. VINCENT ADOLPH - $0 8. STEPHEN RANDALL - $393,737 9. JEFF REYNOLDS - $422,022 FORM 990, PART VI, SECTION A, LINE 6 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, SECTION A, LINE 7B 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, SECTION B, LINE 11B 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, SECTION B, LINE 12C 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, SECTION B, LINE 15 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. 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, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G PATIENT BILLING SERVICES: PROGRAM SERVICE EXPENSES 112. MANAGEMENT AND GENERAL EXPENSES 9,861,703. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,861,815. CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 214,273. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 214,273. PROG DIRECTOR ADMIN/PHYSICIAN SERV: PROGRAM SERVICE EXPENSES 148,464,173. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 148,464,173. MEDICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19,521,516. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,521,516. COLLECTION AGENCY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 627. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 627. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 22,223. MANAGEMENT AND GENERAL EXPENSES 22,223. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,446. FORM 990, PART XII, LINE 2C OVERSIGHT AND SELECTION PROCESS: THE PROCESS REGARDING THE COMMITTEE RESPONSIBLE FOR THE AUDIT, REVIEW, OR COMPILATION OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNT HAS NOT CHANGED FROM THE PRIOR YEAR. PART XII, LINE 3B THE 2023 SINGLE AUDIT FOR OCHSNER LSU HEALTH SHREVEPORT NORTH LOUISIANA AND OCHSNER LOUISIANA PHYSICIAN GROUP IS CURRENTLY UNDER WAY. OCHSNER LSU HEALTH SYSTEM OF NORTH LOUISIANA 1431 DALZELL STREET SHREVEPORT LA 71103 831605004 PATIENT CARE LA 501(C)(3) LINE 3 N/A 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 OCHSNER LSU HEALTH SYSTEM OF NORTH LOUISIANA D 24661338 INTERCOMPANY BILLINGS - MKT VALUE OCHSNER LSU HEALTH SYSTEM OF NORTH LOUISIANA M 19521516 INTERCOMPANY BILLINGS - MKT VALUE OCHSNER LSU HEALTH SYSTEM OF NORTH LOUISIANA L 35825754 INTERCOMPANY BILLINGS - MKT VALUE