990 Return ofOrganization ExemptFromIncomeTax990s.foundationcenter.org/990_pdf_archive/721/721479692/721479… · 2 Check this box Of- if the organization discontinued its operations

l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93493341001122

Form990 Return of Organization Exempt From Income Tax OMB No 1545-0047

Under section 501 (c), 527, or 4947( a)(1) of the Internal Revenue Code ( except black lung2011benefit trust or private foundation)

Department of the Treasury • . -

Internal Revenue Service -The organization may have to use a copy of this return to satisfy state reporting requirements

A For the 2011 calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011

B Check if applicableC Name of organizationSPRINGHILL MEDICAL SERVICES INC

fl Address change DBA SPRINGHILL MEDICAL CENTER

Doing Business AsName change

1 Initial return Number and street (or P 0 box if mail is not delivered to street address ) Room/suite

F_ Terminated2001 DOCTORS DRIVE

F-Amended return City or town, state or country, and ZIP + 4SPRINGHILL, LA 71075

F_ Application pending

F Name and address of principal officer

I Tax - exempt status F 501(c)(3) 1 501( c) ( ) -4 (insert no ) 1 4947(a)(1) or F_ 527

3 Website:1- N/A

D Employer identification number

72-1479692

E Telephone number

(318) 539-1001

G Gross receipts $ 19,227,696

H(a) Is this a group return for

affiliates? F-Yes F No

H(b) Are all affiliates included ? fl Yes F No

If"No," attach a list (see instructions)

H(c) Group exemption number 0-

K Form of organization F Corporation 1 Trust F_ Association 1 Other 1- L Year of formation 2000 M State of legal domicile LA

Summary

1 Briefly describe the organization's mission or most significant activitiesTO PROVIDE A HEALTHCARE EXPERIENCE THAT EXCEEDS THE EXPECTATIONS OF THE LIVES WE TOUCH EVERY DAY

2 Check this box Of- if the organization discontinued its operations or disposed of more than 25% of its net assets

3 Number of voting members of the governing body (Part VI, line la) . 3 12

r;} 4 Number of independent voting members of the governing body (Part VI, line 1b) 4 0

5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) 5 251

6 Total number of volunteers (estimate if necessary) . 6

7aTotal unrelated business revenue from Part VIII, column (C), line 12 7a 0

b Net unrelated business taxable income from Form 990-T, line 34 7b

Prior Year Current Year

8 Contributions and grants (Part VIII, line 1h) . 176,049 2,321,369

9 Program service revenue (Part VIII, line 2g) . 16,946,326 16,294,290

13-10 Investment income (Part VIII, column (A), lines 3, 4, and 7d . 417,446 329,321

11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 188,304 282,716

12 Total revenue-add lines 8 through 11 (must equal Part VIII, column (A), line

12) . . . . . . . . . . . . . . . . . . . 17,728,125 19,227,696

13 Grants and similar amounts paid (Part IX, column (A), lines 1-3 . 0

14 Benefits paid to or for members (Part IX, column (A), line 4) . 0

15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-

10) 9,691,891 10,003,264

16a Professional fundraising fees (Part IX, column (A), line 11e) . 0

b Total fundraising expenses (Part IX, column (D), line 25) 0-0

17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) . 7,400,720 7,601,853

18 Total expenses Add lines 13-17 (must equal Part IX, column (A), line 25) 17,092,611 17,605,117

19 Revenue less expenses Subtract line 18 from line 12 635,514 1,622,579

Beginning of CurrentEnd of Year

YeaYear

ED20 Total assets (Part X, line 16) . 9,022,491 11,679,770

21 Total liabilities (Part X, line 26) 6,889,192 7,923,892

ZLL 22 Net assets or fund balances Subtract line 21 from line 20 2,133,299 3,755,878

Signature Block

Under penalties of perjury, I declare that I have examined this return , including accoknowledge and belief, it is true, correct, and complete . Declaration of preparer (otheknowledge.

SignSignature of officer

Here TOMMY BOGGS BOARD MEMBERType or print name and title

Preparer's Date

Paidsignature CHRIS A KOHLENBERG CPA

Preparers Firm's name (or yours Langlinais Broussard & Kohlenberg

Use Only if self-employed),address, and ZIP + 4 PO Box 1123

Abbeville, LA 705111123

May the IRS discuss this return with the preparer shown above? (see instructs

Form 990 ( 2011) Page 2

1:M-600 Statement of Program Service AccomplishmentsCheck if Schedule 0 contains a response to any question in this Part III F

1 Briefly describe the organization 's mission

TO PROVIDE A HEALTHCARE EXPERIENCE THAT EXCEEDS THE EXPECTATIONS OF THE LIVES WE TOUCH EVERY DAY

2 Did the organization undertake any significant program services during the year which were not listed on

the prior Form 990 or 990 -EZ'' . . . . . . . . . . . . . . . . . . . . fl Yes F No

If "Yes," describe these new services on Schedule 0

3 Did the organization cease conducting , or make significant changes in how it conducts , any program

services ? . . . . . . . . . . . . . . . . . . . . . . . . . . F Yes F No

If "Yes," describe these changes on Schedule 0

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 and section 4947( a)(1) trusts 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 $ 14,904,008 including grants of $ ) (Revenue $

SMS OPERATES A 60 BED ACUTE CARE HOSPITAL WITH MEDICAL, SURGICAL, DIAGNOSTIC, AND EMERGENCY SERVICES IT OPERATES ONE CLINIC IN SPRINGHILL,AND TWO OTHER CLINICS IN OUTLYING COMMUNITIES TO PROVIDE EASIER ACCESS TO HEALTH CARE THE HOSPITAL PROVIDED 3,838 INPATIENT DAYS OF CARE(MEDICARE DAYS-2,552) SMS, INC MAKES AVAILABLE FREE MEETING SPACE TO NONPROFIT ORGANIZATIONS SUCH AS THE LOCAL LIONS CLUB, AMERICANCANCER SOCIETY, AND MINISTERIAL ALLIANCE SOME OF THESE GROUPS MEET WEEKLY, WHILE OTHERS MEET MONTHLY SMS, INC IS VERY ACTIVE WITH THELOCAL SCHOOLS IN THE SURROUNDING PARISHES STAFF FROM THE HEALTH SYSTEM'S CLINICS PERFORM PHYSICALS FOR THE AREA SCHOOLS SPORTS TEAMSTHE HEALTH SYSTEM PROVIDES SHADOW OPPORTUNITIES FOR AREA HIGH SCHOOL STUDENTS TO LEARN MORE ABOUT MEDICAL PROFESSIONS THE HEALTHSYSTEM PARTICIPATES IN THE AHEC PROGRAM, WHICH IS A SIX WEEK PROGRAM FOR AREA HIGH SCHOOL JUNIORS AND SENIORS TO OBSERVE AND ASSIST INAREAS OF INTEREST AS THEY PREPARE FOR COLLEGE CAREERS SMS, INC IS ALSO VERY ACTIVE IN THE COMMUNITY THE HEALTH SYSTEM HOSTS A NUMBER OFHEALTH FAIRS FOR THE COMMUNITY THE HEALTH FAIRS OFFER THE COMMUNITY ACCESS TO A NUMBER OF FREE HEALTH SCREENINGS, ACCESS TO VENDORS OFINTEREST FOR THEIR HEALTH AND A COMPLETE CHEMISTRY PROFILE AT A REDUCED PRICE SMS, INC ALSO CO-SPONSORS A COMMUNITY HEALTH WALK WITHTHE PROCEEDS GOING TO THE AMERICAN HEART ASSOCIATION THE HOSPITAL PROVIDES EMPLOYEES TO SPEAK TO LOCAL CLUBS AND ORGANIZATIONS

4b (Code ) (Expenses $ including grants of $ ) (Revenue $

4c (Code ) (Expenses $ including grants of $ ) (Revenue $

4d Other program services (Describe in Schedule 0 )

(Expenses $ including grants of $ ) (Revenue $

4e Total program service expenses $ 14,904,008

Form 990 (2011)

Form 990 (2011) Page 3

Li^ Checklist of Required Schedules

Yes No

1 Is the organization described in section 501(c)(3) or4947(a)(1) (other than a private foundation)? If "Yes," Yes

complete Schedule As . . . . . . . . . . . . . . . . . . . . . ^ 1

2 Is the organization required to complete Schedule B, Schedule of Contnbutors(see instructions)? 2 No

3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to Nocandidates for public office? If "Yes,"complete Schedule C, Part I . . . . . . . . . . 3

4 Section 501(c)(3) organizations . Did the organization engage in lobbying activities, or have a section 501(h) No

election in effect during the tax year? If "Yes,"complete Schedule C, Part II . 4

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

III . . . . . . . . . . . . . . . . . . . . . . . . 5 No

6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have theright to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes,"complete

Schedule D, Part Is . . . . . . . . . . . . . . . . . . . 6 N o

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 II^ 7No

8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"

complete Schedule D, Part III . . . . . . . . . . . . . . . . . . . . 8 N o

9 Did the organization report an amount in Part X, line 21, 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 IV . . . . . . . . . . . . . . . . . . 9 N o

10 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, 10 Nopermanent endowments, or quasi-endowments? If "Yes,"complete Schedule D, Part V

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, linelO? If "Yes,"complete

Schedule D, Part VI.95 lla 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 VII. llb 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 VIII. llc 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 IX.^ lid No

e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes,"complete Schedule D, PartX.95lie Yes

f Did the organization's separate or consolidated financial statements for the tax year include a footnote thataddresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes,"complete llf NoSchedule D, Part X.95

12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes,"complete

Schedule D, Parts XI, XII, and XIII INI 12a Yes

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, XII, and XIII is optional 12b N o

13 Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes, "complete Schedule E13 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, Part I 14b No

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 U S ? If "Yes, "complete Schedule F, Part II and IV . . 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 U S ? If "Yes,"complete Schedule F, Part III and IV . . 16 No

17 Did the organization report a total of more than $15,000, of expenses for professional fundraising services on 17 No

Part IX, column (A), lines 6 and 11e? If "Yes,"complete Schedule G, Part I

18 Did the organization report more than $15,000 total offundraising 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 19 No

"Yes," complete Schedule G, Part III .

20a Did the organization operate one or more hospitals? If "Yes,"complete Schedule H . 20a Yes

b If "Yes" to line 20a, did the organization attach its audited financial statement to this return? Note . All Form 990

G9 .filers that operated one or more hospitals must attach audited financial statements 20b Yes

Form 990 (2011)

Form 990 (2011) Page 4

Checklist of Required Schedules (continued)

21 Did the organization report more than $5,000 of grants and other assistance to governments and organizations in 21the United States on Part IX, column (A), line 1'' If "Yes,"complete Schedule I, Parts I and II . .

22 Did the organization report more than $5,000 of grants and other assistance to individuals in the United States 22on Part IX, column (A), line 2'' If "Yes,"complete Schedule I, Parts I and III . .

23 Did the organization answer "Yes" to Part VII, Section A, questions 3, 4, or 5, about compensation of the

organization's current and former officers, directors, trustees, key employees, and highest compensated 23

employees? If "Yes,"complete ScheduleI . IN I

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, 20027 If "Yes," answer questions 24b-24d and

complete Schedule K. If "No,"go to line 25 . . . . . . . . . . . . . . . 24a

b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? . 24b

c Did the organization maintain an escrow account other than a refunding escrow at any time during the yearto defease any tax-exempt bonds? . 24c

d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? 24d

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

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prioryear, and that the transaction has not been reported on any of the organization 's prior Forms 990 or 990 - EZ7 If 25b

"Yes," complete Schedule L, Part I .

26 Was a loan to or by a current or former officer, director , trustee, key employee, highly compensated employee, ordisqualified person outstanding as of the end of the organization 's tax year? If "Yes," complete Schedule L, 26Part II .

27 Did the organization provide a grant or other assistance to an officer , director, trustee , key employee , substantialcontributor , or a grant selection committee member, or to a person related to such an individual ? If "Yes," 27

complete Schedule L, Part III .

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, PartIV

28a

b A family member of a current or former officer, director, trustee, or key employee? If "Yes,"complete Schedule L, Part IV . 28b

c A n entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) wasan officer, director, trustee, or owner? If "Yes,"complete Schedule L, Part IV . . 28c

29 Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M 29

30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualifiedconservation contributions? If "Yes,"complete Schedule M . . . . . . . . . . . 30

31 Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes,"complete Schedule N,Part I . 31

32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes,"completeSchedule N, Part II . 32

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 . . . . . . . 33

34 Was the organization related to any tax-exempt or taxable entity? If "Yes,"complete Schedule R, Parts II, III, IV,

and V, line 1 . 34

35a Is any related organization a controlled entity of the filing organization within the meaning of section 512(b)(13)735a

b Did the organization receive any payment from or engage in any transaction with a controlled entity within themeaning of section 512(b)(13)? If "Yes,"complete Schedule R, Part V, line 2 . . . 35b

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 . . . . . . . . . . 36

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organizationand that is treated as a partnership for federal income tax purposes? If "Yes,"complete Schedule R, Part VI 37

38 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 and 197

Note . All Form 990 filers are required to complete Schedule 0 38

No

No

Yes

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

Yes

Form 990 (2011)

Form 990 (2011) Page 5

Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule 0 contains a response to any question in this Part V

Yes No

la Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable

la 36

b Enter the number of Forms W-2G included in line la Enter -0- if not applicablelb 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 thisreturn . . . . . . . . . . . . . . . . . . . . 2a 251

b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

2b Yes

Note . Ifthe sum of lines la and 2a is greater than 250, you may be required toe-file (see instructions)

3a Did the organization have unrelated business gross income of $1,000 or more during theyear? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a N o

b I f "Yes," has i t filed a Form 990-T for this year? If "No,"provide an explanation in Schedule O . . . . 3b N o

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 or securitiesaccount)? . . . . . . . . . . . . . . . . . . . . . . . 4a No

b If "Yes," enter the name of the foreign country 0-

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'' No

Sc

6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the 6a No

organization solicit any contributions that were not tax deductible?

b If "Yes," did the organization include with every solicitation an express statement that such contributions or giftswere not tax deductible? . 6b No

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 7a No

services provided to the payor7 .

b If "Yes," did the organization notify the donor of the value of the goods or services provided? . 7b No

c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required tofile Form 82827 . 7c No

d If "Yes," indicate the number of Forms 8282 filed during the year 7d 0

e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefitcontract? . 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 No

h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a

Form 1098-C7 7h No

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 excessbusiness 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 49667 . 9a No

b Did the organization make a distribution to a donor, donor advisor, or related person? . 9b No

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 10b

facilities

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 othersources 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 No

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 . All 501(c)(29) organizations must list in Schedule 0 each state in which they are licensed to issuequalified health plans, the amount of reserves required by each state, and the amount of reserves the organizationallocated to each state 13a No

b Enter the aggregate 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 aggregate amount of reserves on hand13c

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 0 . 14b No

Form 990 (2011)

Form 990 ( 2011) Page 6

Lamm Governance , Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and fora "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule0. See instructions.Check if Schedule 0 contains a response to any question in this Part VI .F

Section A . Governin g Bod y and Mana gement

Yes No

la Enter the number of voting members of the governing body at the end of the taxyear . . . . . . . . . . . . . la 12

b Enter the number of voting members included in line la, above, who areindependent . . . . . . . . . . . . . . . . lb 0

2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with anyother officer, director, trustee, or key employee? 2 No

3 Did the organization delegate control over management duties customarily performed by or under the directsupervision 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 No

7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one ormore members of the governing body? 7a No

b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, 7b Yesor persons other than the governing body?

8 Did the organization contemporaneously document the meetings held or written actions undertaken during theyear 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 theorganization's mailing address? If"Yes," provide the names and addresses in Schedule 0 9 No

Section B. Policies (This Section B requests information about policies not required by the InternalRevenue 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 exemptpurposes?

bOb No

11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filingthe form? 11a Yes

b Describe in Schedule 0 the process, if any, used by the organization to review the 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 0 how this was done . . . . . . . . . . . . . . . . . . . 12c Yes

13 Did the organization have a written whistleblower policy? 13 Yes

14 Did the organization have a written document retention and destruction policy? 14 Yes

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 0 (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 Yes

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 theorganization's exempt status with respect to such arrangements? 16b No

Section C. Disclosure

17 List the States with which a copy of this Form 990 is required to be filed-

18 Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (50 1(c)

(3)s only) available for public inspection Indicate how you made these available Check all that apply

fl Own website fl Another's website F Upon request

19 Describe in Schedule 0 whether (and if so, how), the organization made its governing documents, conflict ofinterest policy, and financial statements available to the public See Additional Data Table

20 State the name, physical address, and telephone number of the person who possesses the books and records of the organization -

SPRINGHILL MEDICAL CENTER

2001 DOCTORS DRIVE

SPRINGHILL,LA 71075

(318) 539-1001

Form 990 (2011)

Form 990 (2011) Page 7

1:M.lkvh$ Compensation of Officers , Directors ,Trustees, Key Employees, Highest Compensated

Employees, and Independent ContractorsCheck if Schedule 0 contains a response to any question in this Part VII (-

Section A. Officers, Directors, Trustees, Kev Employees, and Highest Compensated Employees

la 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

* List all of the organization' s current officers, directors, trustees (whether individuals or organizations), regardless of amount

of compensation, and current key employees Enter -0- in columns (D), (E), and (F) if no compensation was paid

* List all of the organization 's current key employees, if any See instructions for definition of "key employee "

* 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

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

6 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, highestcompensated employees, and former such persons

1 Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee

(A) (B) (C) (D ) ( E) (F)

Name and Title Average Position (do not check Reportable Reportable Estimatedhours more than one box, compensation compensation amount of otherper unless person is both from the from related compensationweek an officer and a organization (W- organizations from the

(describe director/trustee) 2/1099-MISC) (W- 2/1099- organization and

hours ,o = MISC) relatedfor (o organizations

related fD 0 IDorganizations -

- {),o

fD

TO

Schedule0)

3 m

t 1

(1) MICHELLE PARDUE MD0 00 0 0 0

CHIEF OF MED ST

(2) MARILYN MOW40 00 86,262 0 7,702

ASST ADMINISTRA

(3) DANA JONES40 00 87,068 0 7,880

CNO

(4) LAYLA CHASE40 00 96,914 0 468

CFO

(5) LTODD EPPLER40 00 0 0 0

CEO

(6) DIANNE STEPHENS0 00 0 0 0

Vice President

(7) GARY TORRENCE1 00 X 0 0 0

ADVISORY

(8) MARY ARMWOOD1 00 X 0 0 0

BOARD MEMBER

(9) SS HOLLIDAY JR MD1 00 X 0 0 0

ADVISORY

(10) WAYNE MCMAHEN DVM1 00 X X 0 0 0

BOARD MEMBER

(11) DON TEAGUE1 00 X X 0 0 0

Treasurer

(12) RAYMOND ROBERTSON1 00 X 0 0 0

BOARD MEMBER

(13) JOHN D HERRINGTON1 00 X 0 0 0

BOARD MEMBER

(14) ROBERT GARLAND1 00 X 0 0 0

BOARD MEMBER

(15) ROBERT A COLVIN1 00 X X 0 0 0

Secretary

(16) ROBERT BUSH1 00 X 0 0 0

President

(17) TOMMY BOGGS1 00 X X 0 0 0

BOARD MEMBER

Form 990 (2011)

Form 990 (2011) Page 8

Ulj= Section A. Officers, Directors , Trustees , Key Employees, and Highest Compensated Employees (continued)

(A) (B) (C) (D ) ( E) (F)

Name and Title Average Position (do not check Reportable Reportable Estimatedhours more than one box , compensation compensation amount of otherper unless person is both from the from related compensationweek an officer and a organization ( W- organizations from the

(describe director/trustee ) 2/1099-MISC) (W- 2/1099- organization and

hours ,o = MISC) relatedfor (o organizations

related -D 0 'Dorganizations rt ,o

^D

T

OC: C^Schedule0)

^

m

T.,tT1

q31

(18) ROBERT EDWARDS40 00 X 149,999 0 10,571

MD-RADIOLOGY

(19) DAVID W LAW40 00 X 266,547 0 7,838

MD-FAMILY PRACTICE

(20) MICHELLE PARDUE40 00 X 209,105 0 7,682

MD-FAMILY PRACTICE

(21) JERRY WAYNE SESSIONS40 00 X 190,042 0 8,139

MD-FAMILY PRACTICE

(22) LEAMON G TORRENCE40 00 X 141,682 0 12,139

MD-INTERNAL MEDICI

lb Sub-Total . . . . . . . . . . . . . . . 0-

c Total from continuation sheets to Part VII, Section A . . . . 0-

d Total ( add lines lb and 1c ) . . . . . . . . . . . . 0- 1,227,619 62,419

Total number of individuals (including but not limited to those listed above) who received more than

$100,000 of reportable compensation from the organization-5

No

Did the organization list any former officer, director or trustee, key employee, or highest compensated employee

on line la's If"Yes,"complete Schedule] forsuch individual . . . . . . . . . . . . 3 No

For any individual listed on line la, is the sum of reportable compensation and other compensation from the

organization and related organizations greater than $150,000' If"Yes,"complete Schedule] forsuch

individual . . . . . . . . . . . . . . . . . . . . . . . . . . .

Did any person listed on line la receive or accrue compensation from any unrelated organization or individual for

services rendered to the organization ? If "Yes, "complete ScheduleI 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) (B) (C)Name and business address Description of services Compensation

WILLIS KNIGHTON HEALTH SYSTEMPO BOX 32600 CONTRACT LABOR-CEO 179,226SHREVEPORT, LA 71130

SPRINGHILL EMERGENCY GROUP LLCPO BOX 82368 EMERGENCY ROOM COVER 456,500LAFAYETTE, LA 705982368

NEW DIRECTIONS B & B504 TEXAS STREET STE 200 MANAGEMENT SERVICE 540,112SHREVEPORT, LA 71101

J STEPHENS MAYHUGH ASSOCIATES INCPO BOX 77458 CRNA SERVICES 135,489BATON ROUGE, LA 70879

CPSIPO BOX 850309 INFORMATION SYSTEMS 347,399MOBILE, AL 36685

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 0-5

Form 990 (2011)

Form 990 (2011) Page 9

1:M.WJ004 Statement of Revenue

(A) (B) (C) (D)

Total revenue Related or Unrelated Revenueexempt business excluded fromfunction revenue tax underrevenue sections

512, 513, or

514

la Federated campaigns . la

b Membership dues . . . . lbm°

c Fundraising events . 1c0 {G

d Related organizations . . . ld

e Government grants (contributions) le 2,311,369

i f All other contributions, gifts, grants, and if 10,000similar amounts not included above

g Noncash contributions included in

lines la-1f $

h Total. Add lines la-1f . 2,321,369

a, Business Code

2a PATIENT SERVICE REVENUE 621500 16,294,290 16,294,290

b

c

dU7

e

f All other program service revenue

g Total . Add lines 2a-2f . . . . . . . . 16,294,290

3 Investment income (including dividends, interest

and other similar amounts) 329,321 329,321

4 Income from investment of tax-exempt bond proceeds 0

5 Royalties . . . . . . . . . . . . 0

(i) Real (ii) Personal

6a Gross rents 37,576

b Less rentalexpenses

c Rental income 37,576or (loss)

d Net rental inco me or (loss) . . 0- 37,576 37,576

(i) Securities (ii) Other

7a Gross amountfrom sales ofassets otherthan inventory

b Less cost orother basis andsales expenses

c Gain or (loss)

d Net gain or (los s) . . . . . . . . . . 0

8a Gross income from fundraisingQo events (not including3 $

of contributions reported on line 1c)See Part IV, line 18 .

a

b Less direct expenses . b

c Net income or (loss) from fundraising events . 0

9a Gross income from gaming activities

See Part IV, line 19 . .

a

b Less direct expenses . b

c Net income or (loss) from gaming activities . 0

10a Gross sales of inventory, less

returns and allowances .

a

b Less cost of goods sold . b

c Net income or (loss) from sales of inventory . 0- 0

Miscellaneous Revenue Business Code

11a MISCELLANEOUS INCOME 180,764 180,764

b CAFETERIA 722210 64,376 64,376

C

d All other revenue . .

e Total .Add lines 11a-11d245,140

12 Total revenue . See Instructions19, 227, 696 16, 331, 866 574, 461

Form 990 (2011)

Form 990 (2011) Page 10

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns

All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D)Check if Schedule 0 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 andgeneral expenses

(D)Fundraisingexpenses

1 Grants and other assistance to governments and organizations

in the United States See Part IV, line 21 0

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 270,244 270,244

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 8,250,484 8,250,484

8 Pension plan contributions ( include section 401(k) and section

40 3(b) employer contributions ) 206,107 206,107

9 Other employee benefits 674,517 674,517

10 Payroll taxes 601,912 601,912

11 Fees for services ( non-employees)

a Management . 0

b Legal 857 857

c Accounting 46,785 46,785

d Lobbying 0

e Professional fundraising See Part IV, line 17 0

f Investment management fees 0

g Other 0

12 Advertising and promotion 50,856 50,856

13 Office expenses 0

14 Information technology 3,259 3,259

15 Royalties 0

16 Occupancy 299,371 299,371

17 Travel 68 ,250 68,250

18 Payments of travel or entertainment expenses for any federal,state, or local public officials 0

19 Conferences , conventions , and meetings 0

20 Interest 313,268 313,268

21 Payments to affiliates 0

22 Depreciation, depletion, and amortization 597,314 597,314

23 Insurance 365,259 365,259

24 Other expenses Itemize expenses not covered above (List

miscellaneous expenses in line 24f If line 24f amount exceeds 10% of

line 25, column ( A) amount, list line 24f expenses on Schedule 0

a TAXES & LICENSES 241,391 241,391

b SUPPLIES 1,525,750 1,525,750

c RENTALS & MAINTENANCE 233,061 233,061

d OUTSIDE SERVICES 2,771,829 2,771,829

e COMM &STAFF 641,716 641,716

f All other expenses 442,887 442,887

25 Total functional expenses . Add lines 1 through 24f 17,605,117 14,904,008 2,701,109 0

26 Joint costs. Check here F- if following

SOP 98-2 (ASC 958-720) Complete this line only if the

organization reported in column ( B) joint costs from a

combined educational campaign and fundraising solicitation

Form 990 (2011)

Form 990 (2011) Page 11

IMEM Balance Sheet

(A) (B)Beginning of year End of year

1 Cash-non-interest-bearing 1,973,793 1 3,547,432

2 Savings and temporary cash investments 2 0

3 Pledges and grants receivable, net 3 0

4 Accounts receivable, net 2,466,517 4 1,992,133

5 Receivables from current and former officers, directors, trustees, key employees, andhighest compensated employees Complete Part II of

Schedule L 5 0

6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) andpersons described in section 4958(c)(3)(B) Complete Part II of

Schedule L 6 0

7 Notes and loans receivable, net 122,008 7 212,941

8 Inventories for sale or use 380,665 8 369,149

9 Prepaid expenses and deferred charges 89,811 9 76,036

10a Land, buildings, and equipment cost or other basis Complete 11,096,063

Part VI of Schedule D 10a

b Less accumulated depreciation 10b 5 ,680,984 3,922,697 10c 5,415,079

11 Investments-publicly traded securities 11 0

12 Investments-other securities See Part IV, line 11 67,000 12 67,000

13 Investments-program-related See Part IV, line 11 13 0

14 Intangible assets 14 0

15 Other assets See Part IV, line 11 15 0

16 Total assets . Add lines 1 through 15 (must equal line 34) . 9,022,491 16 11,679,770

17 Accounts payable and accrued expenses 1,092,308 17 1,372,631

18 Grants payable 18

19 Deferred revenue 19

20 Tax-exempt bond liabilities 20

21 Escrow or custodial account liability Complete Part IVof Schedule D . 21

22 Payables to current and former officers, directors, trustees, keyemployees, highest compensated employees, and disqualified

persons Complete Part II of Schedule L . 22

23 Secured mortgages and notes payable to unrelated third parties 5,177,631 23 6,035,988

24 Unsecured notes and loans payable to unrelated third parties 24

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 ScheduleD . 619,253 25 515,273

26 Total liabilities . Add lines 17 through 25 . 6,889,192 26 7,923,892

Organizations that follow SFAS 117, check here F and complete lines 27

through 29, and lines 33 and 34.c3

1527 Unrestricted net assets 2,133,299 27 3,755,878

28 Temporarily restricted net assets 28

29 Permanently restricted net assets 29

Organizations that do not follow SFAS 117 check here - fl and completeLL. ,

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 2,133,299 33 3,755,878

34 Total liabilities and net assets/fund balances 9,022,491 34 11,679,770

Form 990 (2011)

Form 990 (2011) Page 12

1 :M.WO Reconcilliation of Net AssetsCheck if Schedule 0 contains a response to any question in this Part XI F

1 Total revenue (must equal Part VIII, column (A), line 12)1 19,227,696

2 Total expenses (must equal Part IX, column (A), line 25)2 17,605,117

3 Revenue less expenses Subtract line 2 from line 1 .3 1,622,579

4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A))4 2,133,299

5 Other changes in net assets or fund balances (explain in Schedule 0) .5

6 Net assets or fund balances at end of year Combine lines 3, 4, and 5 (must equal Part X, line 33, column(B))

-6 3,755,878

Financial Statements and ReportingGMEffCheck if Schedule 0 contains a response to any question in this Part XII F

Yes No

1 Accounting method used to prepare the Form 990 p Cash F Accrual F-Other

If the organization changed its method of accounting from a prior year or checked " Other," explain inSchedule 0

2a Were the organization 's financial statements compiled or reviewed by an independent accountant 's 2a No

b Were the organization 's financial statements audited by an independent accountant? . 2b Yes

c If"Yes, " to 2a or 2b , does the organization have a committee that assumes responsibility for oversight of theaudit, review, or compilation of its financial statements and selection of an independent accountant?If the organization changed either its oversight process or selection process during the tax year, explain inSchedule 0 2c Yes

d If "Yes " to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued

on a separate basis, consolidated basis, or both

F Separate basis fl Consolidated basis fl Both consolidated and separated basis

3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in theSingle Audit Act and 0MB 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 3b No

audit or audits , explain why in Schedule 0 and describe any steps taken to undergo such audits .

Form 990 (2011)


SCHEDULE A Public Charity Status and Public SupportOMB No 1545-0047

(Form 990 orComplete if the organization is a section 501(c)( 3) organization or a section 2011990EZ)

4947( a) (1) nonexempt charitable trust.

Department of the Treasury

Internal Revenue Service

Name of the organizationSPRINGHILL MEDICAL SERVICES INCDBA SPRINGHILL MEDICAL CENTER

Employer identification number

72-1479692

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

2 1 A school described in section 170 (b)(1)(A)(ii). (Attach Schedule E )

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

4 1 A medical research organization operated in conjunction with a hospital described in section 170 (b)(1)(A)(iii). Enter the

hospital's name, city, and state

5 1 A n organization operated for the benefit of a college or university owned or operated by a governmental unit described in

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

6 1 A federal, state, or local government or governmental unit described in section 170 ( b)(1)(A)(v).

7 1 An organization that normally receives a substantial part of its support from a governmental unit or from the general publicdescribed insection 170 ( b)(1)(A)(vi ) (Complete Part II )

8 1 A community trust described in section 170 ( b)(1)(A)(vi ) (Complete Part II )

9 1 An organization that normally receives (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions-subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975 See section 509(a)(2). (Complete Part III )

10 1 An organization organized and operated exclusively to test for public safety Seesection 509(a)(4).

11 1 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of

one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2) See section 509(a)(3). Check

the box that describes the type of supporting organization and complete lines 11e through 11h

a 1 Type I b 1 Type II c 1 Type III - Functionally integrated d 1 Type III - Other

e F By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons

other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or

section 509(a)(2)

f If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization,

check this box F

g Since August 17, 2006, has the organization accepted any gift or contribution from any of the

following persons?(i) a person who directly or indirectly controls, either alone or together with persons described in (ii) Yes No

and (iii) below, the governing body of the the supported organization? 11g(i)

(ii) a family member of a person described in (i) above? 11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above ? llg(iii)

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

)Name of

supported

organization

ii)EIN

(iii)Type of

organization

(described onlines 1- 9 above

or IRC section

(see

I (nIs th eorganization in

col ( i) listed inyour governing

document?

(v)

Didyou notify the

organization incol (i) of your

support?

(vi)

Is theorganization in

col ( i) organized

in the U S 7

ii

Amount ofsupport?

instructions)) Yes No Yes No Yes No

Total

► Attach to Form 990 or Form 990-EZ. ► See separate instructions.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 Cat No 11285F Schedule A (Form 990 or 990-EZ) 2011

Schedule A (Form 990 or 990-EZ) 2011 Page 2

Support Schedule for Organizations Described in IRC 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 qualifyunder Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A . Public SupportCalendar year (or fiscal year beginning (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total

in)1 Gifts, grants, contributions, and

membership fees received (Do notinclude any "unusualgrants ")

2 Tax revenues levied for theorganization's benefit and eitherpaid to or expended on itsbehalf

3 The value of services or facilitiesfurnished by a governmental unit tothe organization without charge

4 Total . Add lines 1 through 3

5 The portion of total contributions byeach person (other than agovernmental unit or publiclysupported organization) included online 1 that exceeds 2% of theamount shown on line 11, column

(f)6 Public Support . Subtract line 5 from

line 4

Section B. Total Su pportCalendar year (or fiscal year beginning (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total

in)

7 Amounts from line 4

8 Gross income from interest,

dividends, payments received on

securities loans, rents, royalties

and income from similar

10

11

12

13

sourcesNet income from unrelatedbusiness activities, whether ornot the business is regularlycarried onOther income (Explain in Part

IV ) Do not include gain or loss

from the sale of capital assets

Total support (Add lines 7

through 10)

Gross receipts from related activities, etc (See instructions 12

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,

check this box and stop here lik^F-

Section C. Com p utation of Public Su pport Percenta g e14 Public Support Percentage for 2011 (line 6 column (f) divided by line 11 column (f)) 14

15 Public Support Percentage for 2010 Schedule A, Part II, line 14 15

16a 33 1 / 3%support test - 2011 . Ifthe organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box

and stop here . The organization qualifies as a publicly supported organization

b 33 1 / 3% support test -2010 . If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this

box and stop here . The organization qualifies as a publicly supported organization

17a 10%-facts-and -circumstances test - 2011 . If the organization did not check a box on line 13, 16a, or 16b and line 14

is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here . Explainin Part IV how the organization meets the "facts and circumstances" test The organization qualifies as a publicly supported

organization

b 10%-facts -and-circumstances test - 2010 . If the organization did not check a box on line 13, 16a, 16b, or 17a and line

15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.

Explain in Part IV how the organization meets the "facts and circumstances" test The organization qualifies as a publicly

supported organization

18 Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and seeinstructions

Schedule A (Form 990 or 990-EZ) 2011


IMMOTM Support Schedule for Organizations Described in IRC 509(a)(2)

(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify underPart II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A . Public SupportCalendar year (or fiscal year beginning (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total

in)1 Gifts, grants, contributions, and

membership fees received (Do notinclude any "unusual grants ")

2 Gross receipts from admissions,

merchandise sold or servicesperformed, or facilities furnished inany activity that is related to theorganization's tax-exempt

purpose

3 Gross receipts from activities that

are not an unrelated trade orbusiness under section 513

4 Tax revenues levied for theorganization's benefit and eitherpaid to or expended on itsbehalf

5 The value of services or facilitiesfurnished by a governmental unit tothe organization without charge

6 Total . Add lines 1 through 5

7a Amounts included on lines 1, 2,and 3 received from disqualifiedpersons

b Amounts included on lines 2 and 3received from other thandisqualified persons that exceedthe 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 beginningin)

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 unrelatedbusiness activities not includedin line 10b, whether or not thebusiness 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 First Five Years If the Form 990

check this box and stop here

(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total

is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,

Section C. Com p utation of Public Su pport Percenta g e15 Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) 15

16 Public support percentage from 2010 Schedule A, Part III, line 15 16

Section D . Com p utation of Investment Income Percenta g e

17 Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) 17

18 Investment income percentage from 2010 Schedule A, Part III, line 17 18

19a 33 1 / 3% support tests-2011 . If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not

more than 33 1/3%, check this box and stop here . The organization qualifies as a publicly supported organization

b 33 1 / 3%support tests-2010 . If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line

18 is not more than 33 1/3%, check this box and stop here . The organization qualifies as a publicly supported organization20 Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions



MOW^ Supplemental Information . Supplemental Information. Complete this part to provide the explanation

required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for anyadditional information. (See instructions).

Facts And Circumstances Test

Explanation


lefile GRAPHIC print - DO NOT PROCESS I As Filed Data - I DLN: 934933410011221

SCHEDULE D(Form 990) Supplemental Financial Statements

- Complete if the organization answered "Yes," to Form 990,

MB No 1545-0047

20 1 1Department of the Treasury Part IV, line 6, 7, 9, 10, 11a 11b 11c 11d 11e 11f 12a , or 12b • ' ' 1 'Internal Revenue Service 1 0- Attach to Form 990 . 1- See separate instructions.

Name of the organization Employer identification numberSPRINGHILL MEDICAL SERVICES INCDBA SPRINGHILL MEDICAL CENTER 72- 1479692

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts . Complete if theoraanization answered "Yes" to Form 990. Part IV. line 6.

(a) Donor advised funds I (b) Funds and other accounts

1 Total number at end of year

2 Aggregate contributions to (during year)

3 Aggregate grants from (during year)

4 Aggregate value at end of year

Did the organization inform all donors and donor advisors in writing that the assets held in donor advisedfunds are the organization ' s property , subject to the organization ' s exclusive legal control ? 1 Yes 1 No

6 Did the organization inform all grantees , donors, and donor advisors in writing that grant funds may beused only for charitable purposes and not for the benefit of the donor or donor advisor , or for any other purposeconferring impermissible private benefit 1 Yes 1 No

MrSTI-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)

1 Preservation of land for public use ( e g , recreation or pleasure ) 1 Preservation of an historically importantly land area

1 Protection of natural habitat 1 Preservation of a certified historic structure

1 Preservation of open space

Complete lines 2a-2d if the organization held a qualified conservation contribution in the form of a conservationeasement 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 N umber of conservation easements included in (c) acquired after 8/17/06 2d

N umber of conservation easements modified, transferred, released, extinguished, or terminated by the organization during

the taxable year 0-

Number of states where property subject to conservation easement is located

Does the organization have a written policy regarding the periodic monitoring , inspection, handling of violations, andenforcement of the conservation easements it holds ? fl Yes fl No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year 0-

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

0- $Does each conservation easement reported on line 2(d) above satisfy the requirements of section170(h)(4)(B)(i) and 170(h)(4)(B)(ii)'' fl Yes fl No

9 In Part XIV, 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

Organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets.ComDlete if the oraanization answered "Yes" to Form 990. Part IV. line 8.

la If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works ofart, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,provide, in Part XIV, the text of the footnote to its financial statements that describes these items

b If the organization elected, as permitted under SFAS 116, 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 $

00 Assets included in Form 990, Part X $

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 relating to these items

a Revenues included in Form 990, Part VIII, line 1 $

b Assets included in Form 990, Part X $

For Privacy Act and Paperwork Reduction Act Notice , see the Intructions for Form 990 Cat No 52283D Schedule D (Form 990) 2011

Schedule D (Form 990) 2011 Page 2

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

3 Using the organization's accession and other records, check any of the following that are a significant use of its collectionitems (check all that apply)

a F_ Public exhibition d 1 Loan or exchange programs

b 1 Scholarly research e F Other

c F Preservation for future generations

4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in

Part XIV

5 During the year, did the organization solicit or receive donations of art, historical treasures or other similarassets to be sold to raise funds rather than to be maintained as part of the organization's collection? 1 Yes 1 No

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.

la Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets notincluded on Form 990, Part X'' 1 Yes fl No

b If "Yes," explain the arrangement in Part XIV and complete the following table

c Beginning balance

d Additions during the year

e Distributions during the year

f Ending balance

2a Did the organization include an amount on Form 990, Part X, line 21''

b If "Yes, " explain the arrangement in Part XIV

MrIM-Endowment Funds . Com p lete If the org anization answered "Yes" to Form 990, Part IV , line 10.

la Beginning of year balance

b Contributions .

c Investment earnings or losses

d Grants or scholarships . .

e Other expenditures for facilities

and programs

f Administrative expenses

g End of year balance .

(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back

2 Provide the estimated percentage of the year end balance held as

a Board designated or quasi-endowment 0-

b Permanent endowment 0-

c Term endowment 0-

3a Are there endowment funds not in the possession of the organization that are held and administered for theorganization 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'' . . I 3b

4 Describe in Part XIV the intended uses of the organization's endowment funds

1:M.lkvJd Land . Buildinas . and Eauioment . See Form 990. Part X. line 10.

Description of property(a) Cost or otherbasis (investment)

(b)Cost or otherbasis (other)

(c) Accumulateddepreciation

(d) Book value

la Land

b Buildings 11 ,096,063 5,680,984 5,415,079

c Leasehold improvements

d Equipment

e Other

Total . Add lines la-1e (Column (d) should equal Form 990, Part X, column (B), line 10(c).) . 5,415,079

Schedule D (Form 990) 2011

fl Yes l No


Investments -Other Securities . See Form 990 , Part X , line 12.

(a) Description of security or category(b)Book value

(c) Method of valuation(including name of security) Cost or end-of-year market value

(1)Financial derivatives

(2)Closely-held equity interests

Other

Total . (Column (b) should equal Form 990, Part X, col (B) line 12 ) 011

Investments- Pro ram Related . See Form 990 , Part X , line 13.

I I(b) Book value

(c) Method of valuation(a) Description of investment type

Cost or end-of-vear market value

Total . (Column (b) should equal Form 990, Part X, col (B) line 13 ) 01 1

Other Assets . See Form 990 , Part X line 15.

(a) DescriDtion (b) Book value

Total . (Column (b) should equal Form 990, Part X, col.(B) line 15.)

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

1 (a) Description of Liability ( b) Amount

Federal Income Taxes

RURAL HOSPITAL UCC-DEFERRED REVENUE 465,426

Rounding 1

DUE TO MEDICARE 49.846

Total . (Column (b) should equal Form 990, Part X, col (B) line 25) P. I 51 5,27 3

2. Fin 48 (ASC 740) Footnote In Part XIV, 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 (ASC740)



Reconciliation of Chan g e in Net Assets from Form 990 to Financial Statements

1 Total revenue (Form 990, Part VIII, column (A), line 12) 1 19,227,696

2 Total expenses (Form 990, Part IX, column (A), line 25) 2 17,605,117

3 Excess or (deficit) for the year Subtract line 2 from line 1 3 1,622,579

4 Net unrealized gains (losses) on investments 4

5 Donated services and use of facilities 5

6 Investment expenses 6

7 Prior period adjustments 7

8 Other (Describe in Part XIV) 8

9 Total adjustments (net) Add lines 4 - 8 9

10 Excess or (deficit) for the year per financial statements Combine lines 3 and 9 10 1,622,579

Reconciliation of Revenue per Audited Financial Statements With Revenue per Return

1 Total revenue, gains, and other support per audited financial statements . 1 19,227,696

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 XIV) 2d

e Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . 2e

3 Subtract line 2e from line 1 . . . . . . . . . . . . . . . . . . . . 3 19,227,696

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 XIV) 4b

c Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . c

5 Total Revenue Add lines 3 and 4c. (This should equal Form 990, Part I, line 12 . 5 19,227,696

Reconciliation of Ex penses per Audited Financial Statements With Ex pense s per Return

1 Total expenses and losses per audited financial

statements 1

17,605,117

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 XIV) 2d

e Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . 2e

3 Subtract line 2e from line 1 . . . . . . . . . . . . . . . . . . . . 3 17,605,117

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 XIV) 4b

c Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . c

5 Total expenses Add lines 3 and 4c. (This should equal Form 990, Part I, line 18 . 5 17,605,117

Su pp lemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9, Part III, lines la and 4, Part IV, lines lb and 2b,

Part V, line 4, Part X, Part XI, line 8, Part XII, lines 2d and 4b, and Part XIII, lines 2d and 4b Also complete this part to provide any

additional information

Identifier Ret urn Reference Explanat ion


l efile GRAPHIC print - DO NOT PROCESS As Filed Data - DLN: 93493341001122

SCHEDULE H HospitalsOMB No 1545-0047

(Form 990) 20111110- Complete if the organization answered "Yes" to Form 990, Part IV , question 20.Department of the Treasury 1110- Attach to Form 990 . 1- See separate instructions. Open to PublicInternal Revenue Service

I Inspect ion

Name of the organization Employer identification numberSPRINGHILL MEDICAL SERVICES INCDBA SPRINGHILL MEDICAL CENTER

-

72- 1479692

Charity Care and Certain Other Community Benefits at CostEVINW

Yes No

la Did the organization have a charity care policy ? If "No," skip to question 6a . la Yes

b If "Yes," is it a written policy ? . . . . . . . . . . . . . . . . . . . . . lb Yes

2 If the organization had multiple hospitals, indicate which of the following best describes application of the charitycare policy to the various hospitals

F Applied uniformly to all hospitals F Applied uniformly to most hospitals

F Generally tailored to individual hospitals

3 A nswer the following based on the charity care eligibility criteria that applies to the largest number of theorganization ' s patients during the tax year

a Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care 3a Yes

F 100% F 150% F 200% F Other %

b Did the organization use FPG to determine eligibility for providing discounted care? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care 3b Yes

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

c If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria fordetermining eligibility for free or discounted care Include in the description whether the organization uses an assettest or other threshold, regardless of income, to determine eligibility for free or discounted care

4 Did the organization's policy provide free or discounted care to the "medically indigent"? . 4 Yes

5a Did the organization budget amounts for free or discounted care provided under its financial assistance policy duringthe tax year? 5a Yes

b If "Yes," did the organization's charity care expenses exceed the budgeted amount? . 5b No

c If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . Sc No

6a Did the organization prepare a community benefit reportduring the tax year? 6a No

6b If "Yes," did the organization make it available to the public? 6b No

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

7 Charity Care and Certain Other Community Benefits at Cost

Charity Care and (a) Number of (b) Persons (c) Total community (d) Direct offsetting (e) Net community benefit (f) Percent of

Means-Tested Governmentactivities or served benefit expense revenue expense total expense

Programsprograms(optional)

(optional)

a Charity care at cost (fromWorksheet 1) . . 92,016 92,016 0 520 %

b Medicaid (from Worksheet 3,column a) . . . . 2,758,564 465,426 2,293,138 13 030 %

c Costs of other means-testedgovernment programs (fromWorksheet 3, column b)

d Total Charity Care andMeans-Tested GovernmentPrograms 2,850,580 465,426 2,385,154 13 550 %

Other Benefitse Community health improvement

services and communitybenefit operations (from(Worksheet 4) . . . 68,575 8,258 60,317 0 340 %

f Health professions education(from Worksheet 5) .

g Subsidized health services(from Worksheet 6) 1,982,478 774,998 1,207,480 6 860 %

h Research (from Worksheet 7)

i Cash and in-kind contributionsfor community benefit (fromWorksheet 8) . .

j Total Other Benefits . . . 2,051,053 783,256 1,267,797 7 200 %

k Total . Add lines 7d and 7j 4,901,633 , 1,248,682 , 3,652,951 , 20 750 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 . Cat N o 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011 Page 2

Community Building Activities Complete this table if the organization conducted any community building

activities.(a) Number ofactivities orprograms(optional)

(b) Personsserved (optional)

(c) Total communitybuilding expense

(d) Direct offsettingrevenue

(e) Net communitybuilding expense

(f) Percent oftotal expense

1 Physical improvements and housing

2 Economic development

3 Community support

4 Environmental improvements 743 743

5 Leadership development and trainingfor community members

6 Coalition building

7 Community health improvementadvocacy

8 Workforce development

9 Other

10 Total 743 743

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense Yes No

1 Did the organization report bad debt expense in accordance with Heathcare Financial Management Association

Statement No 157 1 Yes

2 Enter the amount of the organization's bad debt expense . 2 1,839,720

3 Enter the estimated amount of the organization's bad debt expense attributable topatients eligible under the organization's charity care policy 3 459,848

4 Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense

In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and

rationale for including a portion of bad debt amounts as community benefit

Section B. Medicare

5 Enter total revenue received from Medicare (including DSH and IM E) . 5 6,125,863

6 Enter Medicare allowable costs of care relating to payments on line 5 . 6 6,076,017

7 Subtract line 6 from line 5 This is the surplus or (shortfall) . 7 49,846

8 Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit

Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6Check the box that describes the method used

I' Cost accounting system Cost to charge ratio Other

Section C . Collection Practices

9a Did the organization have a written debt collection policy during the tax year? . 9a Yes

b If "Yes," did the organization's collection policy that applied to the largest number of its patients during the tax yearcontain provisions on the collection practices to be followed for patients who are known to qualify for financialassistance? Describe in Part VI 9b No

URVI-mananernent Companies and Joint Ventures (see instructions)

(a) Name of entity (b) Description of primaryactivity of entity

(c) Organization'sprofit % or stockownership %

(d) Officers, directors,trustees, or key

employees' profit %or stock ownership%

(e) Physicians'profit % or stockownership

1 SPRINGHILL HOME CARE HOME HEALTH SERVICES 33 000 %

2

3

4

5

6

7

8

9

10

11

12

13

Schedule H (Form 990) 2011


Facility Information

Section A . Hospital Facilities

list in order of size from largest to smallest)

ow many hospital facilities did the organization operate duringthe tax year? 5

r

C

O+k

i

Cp

D

t

p

P13

P

--1CD{3

E

'0Cu13

0

f}

n{6(P(P

a

j0ryC6

{]

m

N

0

a(P

m

p_

S-

e3 P-na

Name and address

Other (Describe)

5 SPRINGHILL HOMECARE

1112 DOCTORS DRIVE JOINT VENTURE

SPRINGHILL,LA 71075

4 PLAIN DEALING RURAL HEALTH CLI PROVIDER BASED

110 FOREST LANE RURAL HEALTH

PLAIN DEALING, LA 71064 CLINIC

3 NORTH WEBSTER MEDICAL CLINIC PROVIDER BASED

106 TRI STATE DRIVE RURAL HEALTH

SAREPTA,LA 71071 CLINIC

2 SMC DOCTORS CLINIC PROVIDER BASED

401 11TH ST NE RURAL HEALTH

SPRINGHILL,LA 71071 CLINIC

1 SPRINGHILL MEDICAL CENTER

2001 DOCTORS DRIVE X X X

SPRINGHILL,LA 71075



Facility Information (continued)

Section B. Facility Policies and Practices.(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

SPRINGHILL HOMECARE

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A): 5

Community Health Needs Assessment (Lines 1 through 7 are optional for 2011

Yes I No

1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment("Needs Assessment ") ? If "No, " skip to question 8 . . . . . . . . . . . . . . . . . . . . . 1 No

If "Yes," indicate what the Needs Assessment describes ( check all that apply)

a F A definition of the community served by the hospital facility

b F Demographics of the community

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

needs of the community

d F How data was obtained

e F The health needs of the community

f F Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and

minority groups

g F The process for identifying and prioritizing community health needs and services to meet those needs

h F The process for consulting with persons representing the community's interests

i F Information gaps that limit the hospital facility's ability to assess the community 's health needs

i F Other ( describe in Part VI)

2 Indicate the tax year the hospital facility last conducted a Needs Assessment 20

3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons whorepresent the community served by the hospital facility? If "Yes," describe in Part VI how the hospital facility took intoaccount input from persons who represent the community, and identify the persons the hospital facility consulted 3

4 Was the hospital facility's Needs Assessment conducted with one or more other hospital facilities? If "Yes," list theother hospital facilities in Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Did the hospital facility make its Needs Assessment widely available to the public? . . . . . . . . . . . 5

If "Yes," indicate how the Needs Assessment was made widely available (check all that apply)

a 1 Hospital facility's website

b F Available upon request from the hospital facility

c r Other (describe in Part VI)

6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how(check all that apply)

a F Adoption of an implementation strategy to address the health needs of the hospital facility's community

b F Execution of the implementation strategy

c F Development of a community-wide community benefit plan for the facility

d F Participation in community-wide community benefit plan

e F Inclusion of a community benefit section in operational plans

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

g F Prioritization of health needs in the community

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

i F Other (describe in Part VI)

7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If "No,"explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs 7

Financial Assistance Policy

Did the hospital facility have in place during the tax year a written financial assistance policy that

8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 No

9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care? . . . . . . . . . . . 9 No

If "Yes," indicate the FPG family income limit for eligibility for free care _%

If "No," explain in Part VI the criteria the hospital facility used



Facility Information (contin

10 Used FPG to determine eligibility for providing discounted care ? . . . . . . . . . . .

If "Yes," indicate the FPG family income limit for eligibility for discounted care _%


11 Explained the basis for calculating amounts charged to patients ? . . . . . . . . . . .

If"Yes, " indicate the factors used in determining such amounts ( check all that apply)

a F_ Income level

b F Asset level

c F Medical indigency

d F Insurance status

e F_ Uninsured discount

f I Medicaid/ Medicare

g F State regulation

h F_ Other ( describe in Part VI)

12 Explained the method for applying for financial assistance ? . . . . . . . . . . . . .

13 Included measures to publicize the policy within the community served by the hospital facility?

If"Yes," indicate how the hospital facility publicized the policy (check all that apply)

a F The policy was posted at all times on the hospital facility's web site

b F The policy was attached to all billing invoices

c F The policy was posted in the hospital facility's emergency rooms or waiting rooms

d F The policy was posted in the hospital facility's admissions offices

e F The policy was provided , in writing, to patients upon admission to the hospital facility

f F The policy was available upon request

g F Other ( describe in Part VI)

Yes No

10 No

1 11 I I No

. . . . . . 12 No

. . . . . . 13 No

Billing and Collections

14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financialassistance policy (FA P) that explained actions the hospital facility may take upon non-payment? . . . . . . . 14 No

15 Check all of the following collection actions against an individual that were permitted under the hospital facility's

policies during the tax year before making reasonable efforts to determine the patient's eligibility under the facility's

FA P

a 1 Reporting to credit agency

b F Lawsuits

c F_ Liens on residences

d 1 Body attachments or arrests

e FO ther similar actions (describe in Part VI)

16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year beforemaking reasonable efforts to determine the patient's eligibility under the facility's FA P7 . . . . . . . . . . 16 No

If"Yes," check all actions in which the hospital facility or a third party engaged


b F Lawsuits


d 1 Body attachments

e F-Other similar actions (describe in Part VI)

17 Indicate which efforts the hospital facility made before initiating any of the actions checked in question 16 (check all

that apply)

a F-Notified patients of the financial assistance policy upon admission

b F-Notified patients of the financial assistance policy prior to discharge

c F-Notified patients of the financial assistance policy in communications with the patients regarding the patients'

bills

d F-Documented its determination of whether patients were eligible for financial assistance under the hospital

facility's financial assistance policy

e FO ther (describe in Part VI)




Policy Relating to Emergency Medical Care

No

18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care thatrequires the hospital facility to provide, without discrimination, care for emergency medical conditions to individualsregardless of their eligibility under the hospital facility's financial assistance policy? . . . . . . . . . . 18 Yes

If"No," indicate why

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

b The hospital facility's policy was not in writing

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

VI)

d r- Other (describe in Part VI)

Individuals Eligible for Financial Assistance

19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FA P-eligible individuals for emergency or other medically necessary care

a r- The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum

amounts that can be charged

b 1 The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculate

the maximum amounts that can be charged

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

d Other ( describe in Part VI)

20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility's financialassistance policy, and to whom the hospital facility provided emergency or other medically necessary services, morethan the amounts generally billed to individuals who had insurance covering such care? . . . . . . . . . 20 No

If"Yes," explain in Part VI

21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for services

provided to that patient?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 N o






PLAIN DEALING RURAL HEALTH CLI




Yes I No

1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment("Needs Assessment ") ? If "No, " skip to question 8 . . . . . . . . . . . . . . . . . . . . . 1 No








f F Primary and chronic disease needs and other health issues of uninsured persons, low - income persons, and

minority groups


h F The process for consulting with persons representing the community 's interests
























8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes

9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care? . . . . . . . . . . . 9 Yes

If "Yes," indicate the FPG family income limit for eligibility for free care 100 0000 %






If "Yes," indicate the FPG family income limit for eligibility for discounted care 200 0000 %



If"Yes," indicate the factors used in determining such amounts ( check all that apply)

a F Income level

b F Asset level



e F Uninsured discount






If"Yes," indicate how the hospital facility publicized the policy ( check all that apply)

a F The policy was posted at all times on the hospital facility 's web site







Yes No

10 Yes

1 11 I Yes

. . . . . . 12 Yes

. . . . . . 13 Yes


14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financialassistance policy (FA P) that explained actions the hospital facility may take upon non-payment? . . . . . . . 14 Yes



FA P

a F Reporting to credit agency

b F Lawsuits

c F Liens on residences






b F Lawsuits





that apply)



c F Notified patients of the financial assistance policy in communications with the patients regarding the patients'

bills

d F Documented its determination of whether patients were eligible for financial assistance under the hospital







No






VI)



19 Indicate how the hospital facility determined , during the tax year, the maximum amounts that can be charged to FA P-eligible individuals for emergency or other medically necessary care











. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 N o






NORTH WEBSTER MEDICAL CLINIC




Yes I No

1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment("Needs Assessment")? If "No, " skip to question 8 . . . . . . . . . . . . . . . . . . . . . 1 No








f F Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and

minority groups






































a F Income level

b F Asset level













d F The policy was posted in the hospital facility 's admissions offices




Yes No

10 Yes

1 11 I Yes

. . . . . . 12 Yes

. . . . . . 13 Yes





FA P


b F Lawsuits







b F Lawsuits





that apply)




bills








No






VI)



19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FA P-eligible individuals for emergency or other medically necessary care











. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 N o






SMC DOCTORS CLINIC




Yes I No

1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment("Needs Assessment ")? If "No," skip to question 8 . . . . . . . . . . . . . . . . . . . . . 1 No









minority groups






































a F Income level

b F Asset level









If"Yes," indicate how the hospital facility publicized the policy ( check all that apply)








Yes No

10 Yes

1 11 I Yes

. . . . . . 12 Yes

. . . . . . 13 Yes





FA P


b F Lawsuits







b F Lawsuits





that apply)




bills








No






VI)














. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 N o










1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment

("Needs Assessment ")? If "No, " skip to question 8 . . . . . . . . . . . . . . . . . . . . .

If "Yes," indicate what the Needs Assessment describes (check all that apply)








minority groups


























Yes I No









If "Yes, " indicate the FPG family income limit for eligibility for discounted care 200 0000 %




a F Income level

b F Asset level










a F_ The policy was posted at all times on the hospital facility 's web site

b F_ The policy was attached to all billing invoices

c F The policy was posted in the hospital facility 's emergency rooms or waiting rooms

d F_ The policy was posted in the hospital facility's admissions offices




Yes No

10 Yes

1 11 I Yes

. . . . . . 12 Yes

. . . . . . 13 Yes





FA P


b F Lawsuits







b F Lawsuits





that apply)

a F Notified patients of the financial assistance policy upon admission

b F Notified patients of the financial assistance policy prior to discharge


bills








No






VI)









d Other (describe in Part VI)





. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 N o





Section C. Other Facilities That Are Not Licensed , Registered, or Similarly Recognized as a Hospital Facility

(list in order of size from largest to smallest)

How many non-hospital facilities did the organization operate during the tax year?

Name and address Type of Facility ( Describe )

1

2

3

4

5

6

7

8

9

10



Supplemental Information

Complete this part to provide the following information

1 Required descriptions . Provide the descriptions required for Part I, lines 3c, 6a, and 7, Part II, Part III, lines 4, 8, and 9b, and Part

V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21

2 Community health needs assessment . Describe how the organization assesses the health care needs of the communities it serves,in addition to any community health needs assessments reported in Part V, Section B

3 Patient education of eligibility for assistance . Describe how the organization informs and educates patients and persons who maybe billed for patient care about their eligibility for assistance under federal, state, or local government programs or under theorganization's financial assistance policy

4 Community information . Describe the community the organization serves, taking into account the geographic area and demographic

constituents it serves

5 Promotion of community health . Provide any other information important to describing how the organization's hospital facilities orother health care facilities further its exempt purpose by promoting the health of the community (e g , open medical staff, communityboard, use of surplus funds, etc )

6 Affiliated health care system . If the organization is part of an affiliated health care system, describe the respective roles of theorganization and its affiliates in promoting the health of the communities served

7 State filing of community benefit report . If applicable, identify all states with which the organization, or a related organization, filesa community benefit report

Identifier ReturnReference Explanation

Part VI - Additional Information PART III, LINE 8 SMC'S COSTING METHODOLOGY USED

TO DETERMINE MEDICARE ALLOWABLE COSTS REPORTED

IN THE COST REPORT IS CALCULATED BASED UPON COST

CENTER STATISTICAL DATA AND ALLOCATION BASED

UPON THE RATIO OF MEDICARE PATIENTS TO TOTAL

PATIENTS PART III, LINE 9b SMC GRANTS CHARITY

CARE/FINANCIAL ASSISTANCE TO PATIENTS FOR SIX

MONTHS AFTER BEING APPROVED PROVIDED THAT THE

PATIENT'S INCOME STATUS HAS NOT CHANGED

CAUSING THEM TO FALL BELOW 100% OF FEDERAL

POVERTY LEVEL GUIDELINES AFTER SIX MONTHS,THE

PATIENT MUST COMPLETE ANOTHER FINANCIAL

SSISTANCE APPLICATION




Part VI - Community Building THROUGH THE CLEANUP AND MAINTENANCE OF

Activities COMMUNITY PARKS, SMC MAKES ENVIRONMENTAL

IMPROVEMENTS BY REMOVING TRASH AS WELL AS

PROMOTES PHYSICAL ACTIVITY




Part VI - Community Information SMC SERVES THE RURAL COMMUNITY OF NORTH

WEBSTER PARISH IN LOUISIANA AND SOUTH COLUMBIA

COUNTY IN ARKANSAS THE RURAL COMMUNITY IS A

DESIGNATED HEALTHCARE PROFESSIONAL SHORTAGE

REA (HPSA) AND A DESIGNATED PHYSICIAN SCARCITY

REA (PSA) THE POPLATION OFTHE COMMUNITY IS

PPROXIMATELY 20,000 THE AVERAGE INCOME IS

PPROXIMATELY $24,000 PER YEAR AND ABOUT 12% OF

HE COMMUNITY HAS INCOME BELOW THE FEDERAL

POVERTY GUIDELINES THE PATIENT MIX OF UNINSURED

ND MEDICAID IS 12% AND 16%




Part VI - Patient Education of SMC STRIVES TO INFORM AND EDUCATE ALL OF OUR

Eligibility for Assistance UNINSURED PATIENTS THAT PRESENT TO OUR

FACILITIES ABOUT OUR FINANCIAL ASSISTANCE POLICY

UNINSURED PATIENTS ARE EDUCATED ON MEDICAID

ND OUR CHARITY CARE PRPGRAM WHEN THEY PRESENT

O OUR FACILITY AS EMERGENCY, OUTPATIENT, OR

INPATIENT WE HAVE SEVERAL MEDICAID APPLICATION

REPRESENTATIVES AT OUR FACILITY THAT CAN TAKE

APPLICATIONS FOR MEDICAID AND PATIENTS ARE GIVEN

INFORMATION ON HOWTO APPLY PATIENTS ARE ALSO

GIVEN A FINANCIAL ACCEPTANCE APPLICATION THAT

CONTAINS INSTRUCTIONS AND CONTACT INFORMATION

A LL O F OUR INITIAL BILLING STATEMENTS TELL THE

PATIENTS THAT IF THEY FEELTHAY MAY QUALIFY FOR

CHARITY CARE OR FINANCIAL ASSISTANCE TO CONTACT

HE BUSINESS OFFICE




Part VI - Needs Assessment SMC ASSESSES THE NEEDS OF THE COMMUNITY

THROUGH A COLLABORATION BETWEEN PHYSICIANS,

CASE MANAGERS,AND OUTREACH COORDINATORS WHO

SPEND TIME IN THE COMMUNITY PROVIDING

EDUCATION, WELLNESS TESTS, AND ASSESSMENTS OF

PATIENTS WITH CERTAIN DIAGNOSIS NEEDS

SSESSMENT IS ALSO ACCOMPLISHED THROUGH

PARTICIPATION IN SPRINGHILL COMMUNITY NETWORK

ND THE FRIENDS 50+ COMMUNITY GROUP




Part I, Line 7, Column F - Explanation SMC RECORDS BAD DEBT AT GROSS CHARGES LEFT

of Bad Debt Expense UNPAID AFTER REASONABLE COLLECTION EFFORTS

HAVE BEEN MADE THE COST OFTHE BAD DEBT

REPORTED WAS DETERMINED BASED UPON THE COST TO

CHARGE RATIO CALCULATED FROM WORSHEET 2 SMC

ESTIMATED THE AMOUNT OF BAD DEBT EXPENSE

TTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE

ORGANIZATION'S CHARITY CARE POLICY USING

STATISTICAL DATA COLLECTED OVER SIX MONTHS THAT

INCLUDED THE PERCENT OF APPROVED APPLICATIONS

O RETURNED APPLICATIONS THE FOOTNOTE TO THE

ORGANIZATION'S FINANCIAL STATEMENTS THAT IS

RELATED TO BAD DEBT STATES "TRADE RECEIVABLES

RE CARRIED AT THE ORIGINAL BILLED AMOUNT LESS AN

ESTIMATE MADE FOR UNCOLLECTIBLE ACCOUNTS BASED

ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A

MONTHLY BASIS MANAGEMENT DETERMINES THE

A LLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BY

IDENTIFYING TROUBLED ACCOUNTS AND BY USING

HISTORICAL EXPERIENCES APPLIED TO AN AGING OF

CCOUNTS TRADE RECEIVABLES ARE WRITTEN OFF

WHEN DEEMED UNCOLLECTIBLE THE RATIONALE FOR

INCLUDING ANY PORTION OF BAD DEBT AS COMMUNITY

BENEFIT IS PRIMARILY DUE TO SMCS RURAL LOCATION

ND PROVIDING ACCESS TO PATIENTS EVEN THOUGH

HEY ARE UNWILLING TO PAY OR IN THE EVENT THEY

RE UNABLE TO PAY BUT UNWILLING TO FOLLOW OUR

FINANCIAL ASSISTANCE PROGRAM BY NOT BLOCKING

CCESS TO CARE, SMC KEEPS THE COMMUNITY HEALTHY



Identifier Return Reference Explanation

Part I, Line 7 - Explanation of SPRINGHILL MEDICAL SERVICES INC (SMC) USED COST

Costing Methodology O CHARGE RATIO CALCULATED FOR (a) (b) (c) AND (g)

WE USED ACTUAL COST INCURRED FOR (e)AND (f),



Schedule J Compensation Information OMB No 1545-0047

(Form 990)For certain Officers, Directors, Trustees , Key Employees, and Highest

2011Compensated Employees

- Complete if the organization answered "Yes" to Form 990,Department of the Treasury Part IV, question 23. ' to Pu b lic

Internal Revenue Service Attach to Form 990 . 1- See separate instructions. Insp ecti o n

Name of the organization Employer identification numberSPRINGHILL MEDICAL SERVICES INCDBA SPRINGHILL MEDICAL CENTER 72- 1479692

llll^ Questions Regarding Compensation

la 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 la Complete Part III to provide any relevant information regarding these items

1 First-class or charter travel 1 Housing allowance or residence for personal use

fl Travel for companions fl Payments for business use of personal residence

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

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

Yes I No

b If any of the boxes in line la are checked, did the organization follow a written policy regarding payment orreimbursement orprovision of all the expenses described above? If "No," complete Part III to explain lb

2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by allofficers, 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 organization uses to establish the compensation of the

organization 's CEO/ Executive Director Check all that apply

fl Compensation committee F Written employment contract

fl Independent compensation consultant fl Compensation survey or study

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

4 During the year, did any person listed in Form 990, Part VII, Section A, line la 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 No

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 la, 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 la, 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 la, did the organization provide any non-fixed

payments not described in lines 5 and 67 If "Yes," describe in Part III 7 No

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 Regs section 53 4958-4(a)(3)7 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 No

For Privacy Act and Paperwork Reduction Act Notice , see the Intructions for Form 990 Cat No 50053T Schedule 3 ( Form 990) 2011

Schedule J (Form 990) 2011 Page 2

OTITFI-Officers , Directors , Trustees , Key Employees, and Highest Compensated Employees . Use Schedule 3-1 if additional space 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 la, columns (D) and (E) for that individual

(A) Name ( B) Breakdown of W-2 and/or 1099-MISC compensation ( C) Retirement and (D) Nontaxable (E) Total of columns (F) Compensation

(i) Basecompensation

(ii) Bonus &incentive

compensation

(iii) Otherreportable

compensation

other deferred

compensation

benefits ( B)(i)-(D) reported in prior

Form 990 or

Form 990-EZ

(1) ROBERT EDWARDS (1) 149,999 10,571 160,570

(2) MICHELLE

PA RDU E

(i)

(ii)

209,105 7,682 216,787

(3) LEA MON G

TORRENCE

(i)

(ii)

141,682 12,139 153,821

(4) JERRY WAYNE

SESSIONS

(1)

(ii)

190,042 8,139 198,181

(5) DAVID W LAW (i) 266,547 7,838 274,385

Schedule 3 (Form 990) 2011

Schedule J (Form 990) 2011 Page 3

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines la, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8 Also complete this part for any additional information


Schedule 3 (Form 990) 2011


SCHEDULE 0OMB No 1545 0047

(Form 990 or 990 Supplemental Information to Form 990 or 990-EZ2011EZ) Complete to provide information for responses to specific questions on

Form 990 or to provide any additional information . Open to PublicDepartment of the Treasury 1- Attach to Form 990 or 990-EZ. Insp e ctionInternal Revenue Service

Name of the organizationSPRINGHILL MEDICAL SERVICES INCDBA SPRINGHILL MEDICAL CENTER

Employer identification number

72-1479692


Audited Financial Statements

Form 990, Part Form 990, Part V I, Line 19 Other Organization ALL GOVERNING DOCUMENTS AND WRITTEN POLICIES AREVI, Line 19 Documents Publicly Available AVAILABLE UPON REQUEST

Form 990, Part Form 990, Part V I, Line 15b Compensation Review COMPENSATION AND ADJUSTMENTS TO COMPENSATION OF TOPVI, Line 15b and Approval Process for Officers and Key MANAGEMENT AND PHYSICIANS MUST BE REVIEWED AND APPROVED

Employees BY THE BOARD

Form 990, Part Form 990, Part V I, Line 11 Form 990 Review THE BOARD REVIEWS THE 990 DRAFT COMPLETED BY THE CPA AND

VI, Line 11 Process MAKES ANY NECESSARY CHANGES BEFORE IT IS MAILED TO THEIRS

FXNANCIAL STATEMENTS

SPRINGHILL MEDICAL SERVICES, INC.

d/b/a


DECEMBER 31, 2011 AND 2010

FINANCIAL STATEMENTS

SPRINGHILL MEDICAL SERVICES, INC..

d/b/a SPRINGHILL MEDICAL CENTER

DECEMBER 31 2011 AND 2010

TABLE OF CONTENTS

STATEMENT PAGE

Independent Auditor's Report 1

Statement of Financial Position A 2 - 3

Statement of Activities B 4

Statement of Cash Flows C 5

Notes to the Financial Statements 6 - 14

SCHEDULE

Supplemental Information:

Patient Service Revenues 1 Z5

Other Operating Revenues 2 16

Salaries by Department 3 17

Employee Benefits 4 18

Purchased Service by Department 5 19

Supplies and Other Expenses by Department 6 20

LANGLIIVATSBROUSSARD dic Glen F. Lanylinnis, C.P.A.

MichaelP_ Braussard, C.P.A.<4l[RHLFIVBFRG ChrlsA. Kahlenb erg, C.P_A., M.B.A., M_H.A.

CAA Corporation of Certified Public Accountants 6ayla L . Falcon, C.P.A.

Patrltk f. Guidry, C.P.A.

Ashley V. Breaux, CRA-

Jonathan P. Prlmeaux, E-P_A-, M_B..A.

Kathryn N. Haag, C.P.A.

INDEPENDENT AUDITOR' S REPORT

Chairman and Board of DirectorsSpringhill Medical Services, Inc.d/b/a Springhill Medical Center

Springhill, Louisiana

We have audited the financial statements of Springhill Medical Services, Inc. (the

Hospital), as of and for the years ended December 31, 2011 and 2010. These financial

statements are the responsibility of the Hospital's management. Our responsibility is to

express an opinion on these financial statements based on our audit.

We conducted our audit in accordance with auditing standards generally accepted in the

United States of America. Those standards require that we plan and perform the audit to

obtain reasonable assurance about whether the financial statements are free of material

misstatement. An audit includes examining, on a test basis, evidence supporting the

amounts and disclosures in the financial statements. An audit also includes assessing the

accounting principles used and the significant estimates made by management, as well as

evaluating the overall financial statement presentation. We believe that our audit

provides a reasonable basis for our opinion.

In our opinion, the financial statements referred to above present fairly, in all material

respects, the financial position of Springhill Medical Services, Inc. as of December 31,

2011 and 2010, and the results of its operations, changes in net assets and cash flows for

the years then ended, in conformity with accounting principles generally accepted in the

United States of America.

Our audit was performed for the purpose of forming an opinion on the financial statements

taken as a whole. The supplementary information listed in the table of contents is

presented for purposes of additional analysis and is not a required part of the financial

statements. Such information has been subjected to the auditing procedures applied in the

audit of the financial statements taken as a whole.

LANGLINAIS USSARD & KOH ENBE G(A corporation of Certifie P lic Accountants)

June 27, 2012

2419 Veterans Memorial Drive • P.O. Box 1123 • Abbeville, Louisiana 70511-1123 - Telephone (3371893-6232 • Fax (337) 893-6249

SPRI GHILL MEDICAL, SERVI CES , INC .

Snrinahill, Louisiana

STATEMENT A

STATEMENTS OF FINANCIAL POSITION DECEMBER, 31

ASSET

2011 2010

CURRENT ASSETS:

Cash and cash equivalents

Accounts receivables, less allowance for doubtful

accounts of $ 4,699,472 and $ 5,614,183, respectively

Other Receivables

Inventories

Due from Third Party Payors

Prepaid expenses

Total Current Assets

OTHER ASSETS:

$ 2,942,642

1,691,798

212,941

369,149

350,322

76,036

5,642,888

$ 1,194,109

2,110,919

122,008

380,665

355,598

89,811

4,253,110

Assets limited as to use - cash

Assets limited as to use - investment

Investments

Total Other Assets

200,686

404,105

67,000

671,791

379,683

400,000

67,000

846,683

PROPERTY , PLANT AND EQUIPMENT:

Property, plant and equipment, cost 11,096,063 9,095,165

Less: accumulated depreciation 5,680,984 5 ,172,468

Total Property, Plant and Equipment 5,415,079 3,922,697

TOTAL ASSETS $ 11,729,758 $ 9,022,490

The accompanying notes are an integral part of these financial statements

2


Springhill. Louisiana

STATEMENTS OF FINANCIAL POSITION

STATEMENT A

DECEMBER, 31

LIABILITIES AND NET ASSETS

2011 2010

CURRENT LIABILITIES:

Current portion of long-term debt $ 506,079 $458,663

Short term debt 1,134,063 -

Accounts payable 636,505 466,835

Accrued salaries and related withholdings 675,284 542,198

Due to third party payors 99,834

Credit balances 58,927 81,108

Interest payable 14,810 14,810

Total Current Liabilities 3,125,502 1,563,614

LONG - TERM LIABILITIES:

Capital leases 376,937 66,878

Long-term debt 4,006,014 4,639,447

Total Long-Term Liabilities 4,382,951 4,706,325

OTHER LIABILITIES:

Deferred revenue 465,426 619,251

Total Other Liabilities 465,426 619.251

TOTAL LIABILITIES 7,973,879 6 ,889,190

NET ASSETS:

Invested in Capital Net of Related Debt 5,038,142 3,855,819

Restricted 671,791 846,683

Unrestricted (1,954,054 ) (2,569,202 )

TOTAL NET ASSETS 3,755,879 2,133,300

TOTAL LIABILITIES AND NET ASSETS $ 11,729,758 $ 9,022,490

The accompanying notes are an integral part of these financial statements.

3

SPRINGHILL MEDICAL SERVICES , INC.


STATEMENT OF ACTIVITIES

STATEMENT E

YEAR ENDED DECEMBER 31,

2011

OPERATING REVENUES:

Net Patient Service Revenues

Other operating Revenue

TOTAL OPERATING REVENUE

OPERATING EXPENSES:

Salaries

Employee Benefits

Purchased Services

Supplies and Other

Depreciation

Provision for Doubtful. Accounts

TOTAL OPERATING EXPENSES

INCOME (LOSS) FROM OPERATIONS

NON-OPERATING REVENUES (EXPENSES)

Interest Income

Interest Expense

TOTAL NON-OPERATING REVENUES

CHANGE IN NET ASSETS

TOTAL NET ASSETS, BEGINNING

TOTAL NET ASSETS, ENDING

2010

$ 18,866,638 $ 20,553,616

3,234,469 773,074

22,101,107 21,326,690

8,520,727 8,216,144

1,514,658 1,530,747

2,325,221 2,371,485

4,333,927 4,016,102

597,314 574,023

2,882,164 3,607,289

20,174,011 20,315,790

1,927,096 1,010,900

8,751 8,724

(313,268 ) (317,306 )

(304,517 ) (308,582 )

1,622,575 702,318

2,133,300 1,430,982

$ 3,755,879 $ 2,133,300


4



STATEMENT C

STATEMENTS OF CASH FLOWS YEAR ENDED DECEMBER 31,

CASH FLOWS FROM OPERATING ACTIVITIES:

Cash Received from Patients

Cash Payments to Suppliers for Goods and Services

Cash Payments to Employees for Services

Net Cash Flow Provided By Operating Activities

CASH FLOWS FROM CAPITAL AND RELATED FINANCING ACTIVITXES:

Interest paid on long-term debt

Proceeds from issuance of debt

Repayment of long-term debt

Net Cash Used In Capital and Related Financing Activities

CASH FLOWS FROM INVESTING ACTIVITIES:

Purchase of capital assets

Proceeds from disposition of assets

Investment income

Purchase of investment

Sale of investment

Net Cash Provided by Financing Activities

NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS

CASH AND CASH EQUIVALENTS AT BEGINNING OF YEAR INCLUDING $379,683

AND $16,612 LIMITED AS TO USE FOR 2011 AND 2010, RESPECTIVELY

CASH AND CASH EQUIVALENTS AT END OF YEAR INCLUDING $200,686

AM $379,683 LIMITED AS TO USE FOR 2011 AND 2010, RESPECTIVELY

CASH FLOWS FROM OPERATING ACTIVITIES:

Operating Income (Loss)

Adjustments to reconcile operating income to net cash

provided by operating activities:

Depreciation and Amortization

Provision for Doubtful Accounts

Gain on disposal of assets

Increase in receivables and due from third parties

Decrease in inventories and prepaid expenses

Increase in accounts payable and accrued expenses

Decrease in deferred revenue

NET CASH PROVIDED BY OPERATING ACTIVITIES

2011 2010

$ 24,219,849 $ 28,242,137

(13,363,053) (18,782,625)

(7,747,367 ) (8,296,021 )

3,109,429 1,163,491

(313,268) (317,306)

1,679,407 -

(821,302 ) (479,721 )

544,837 (797,027 )

(2,089,696) (432,308)

320 3,700

8,751 8,724

(4,105) -

- 111,640

(2,084,730 ) (308,244 )

1,569,536 58,220

1,573,792 1,515,572

$ 3,143,328 $ 1,573,792

1,927,096 1,010,900

597,314

2,882,164

(320)

(2,471,047)

25,291

302,756

(153,825 )

$ 3,109,429

574,023

3,607,289

(3,644)

(4,081,232)

68,845

22,495

(35, 185 )

$ 1,163,491


5


NOTES TO FINANCIAL STATEMENTS DECEMBER 31, 2011 AND 2010

NOTE 1: DESCRIPTION OF REPORTING ENTITY AND SUMMARY OF SIGNIFICANT ACCOUNTING

POLICIES

Legal organization . Springhill Medical Services, Inc., d/b/a Springhill Medical Center

(the "Hospital"), is a Louisiana nonprofit corporation which has received exemption

from income taxes as an organization described under Section 501(c) (3) of the Internal

Revenue Code, as amended. Springhill Medical Center is a sixty bed facility located in

rural northwest Louisiana on the Arkansas border. The current facility was built in

1975 with major expansions made in 1983, 1989 and 1994. On November 17, 2000,

Springhill Medical Services, Inc., purchased Springhill Medical Center and became a

locally-owned non-profit facility governed by a Board of Directors consisting of

fourteen members. The Hospital provides outpatient, emergency, inpatient acute

hospital, skilled nursing (through swing beds), geriatric psychiatric services, rural

health clinics, home health services (through "joint venture") as well as operates

physician clinics.

Basis of accounting . The accompanying basic financial statements of the Hospital have

been prepared in conformity with generally accepted accounting principles (GP.AP) in the

United States. Revenues and expenses are recognized on the accrual basis.Substantially all revenue and expenses are subject to accrual.

Use of estimates . The preparation of financial statements in conformity with generally

accepted accounting principles require management to make estimates and assumptionsthat affect the reported amounts of assets and liabilities and disclosure of contingentassets and liabilities at the date of the financial statements and the reported amountsof revenues and expenses during the reporting period. Actual results could differ fromthose estimates.

Inventory. Inventories are valued at the lower of cost or market value. Cost isdetermined by the first-in, first-out method.

Property, Plant and Equipment. Property, plant, and equipment is recorded at cost forpurchased assets or, if received as a donation, at fair market value on thedate of donation. The Hospital uses the straight-line method of calculatingdepreciation for all assets. The following estimated useful lives are generally used.

Land improvements 8 to 20 years

Buildings and improvements 10 to 40 years

Furniture and equipment 3 to 20 years

Expenditures for maintenance and repairs are charged to operations when incurred.Expenditures for betterments and major renewals are capitalized. The cost of assetsretired or otherwise disposed of and related accumulated depreciation are eliminatedfrom the accounts in the year of disposal. Gains or, losses resulting from propertydisposals are credited or charged to operations currently.

Grants and donations . Revenues from grants and donations (including capitalcontributions of assets) are recognized when all eligibility requirements, includingtime requirements, are met. Grants and donations may be restricted foreither specific operating purposes or for capital purposes. Amounts that areunrestricted or that are restricted to a specific purpose are reported after non-operating revenues and expense.


NOTES TO FINANCIAL STATEMENTS DECEMBER 31 , 2011 AND 2010

NOTE 1: DESCRIPTION OF REPORTING ENTITY AND SUMMARY OF SIGNIFICANT ACCOUNTING

POLICIES (cont)

Income taxes . The hospital is a nonprofit corporation and is exempt from income taxes

as'per section 501(c)(3) of the Internal Revenue Code.

Advertising. The Hospital expenses advertising cost as incurred.

Costs of borrowing. Except for capital assets acquired through gifts, contributions,

or capital grants, interest cost on borrowed funds during the period of construction of

capital assets is capitalized as a component of the cost of acquiring those assets.

None of the Hospital's interest cost was capitalized during the year ended December 31,

2011.

Cash and Cash Equivalents . Cash represents coin, currency, bank demand deposits andother negotiable instruments that are readily acceptable in lieu of currency. Cashequivalents are time deposits and certificates of deposits purchased with a maturity ofthree months or less. Cash and cash equivalents do not include amounts classified as

investments.

Trade receivables and allowance for uncollectible accounts . Trade receivables arecarried at the original billed amount less an estimate made for uncollectible accountsbased on a review of all outstanding amounts on a monthly basis- Management determinesthe allowance for uncollectible accounts by identifying troubled accounts and by usinghistorical experiences applied to an aging of accounts. Trade receivables-are writtenoff when deemed uncollectible. Recoveries of trade receivables previously written offare recorded when received.

Risk management . The Hospital is exposed to various risks of loss from torts; theftof, damage to, and destruction of assets; business interruptions; errors and omissions;employee injuries and illnesses; natural disasters; medical malpractice; and employeehealth, dental, and accident benefits. Commercial insurance coverage is purchased forclaims arising from such matters.

Restricted resources . When the Hospital has both restricted and unrestricted resourcesavailable to finance a particular program, it is the Hospital's policy to userestricted resources before unrestricted resources.

Environmental matters. Due to the nature of the Hospital's operations, materialshandled could lead to environmental concerns. However, at the time, management is notaware of any environmental matters which need to be considered.

Net patient service revenue . Patient service revenue is reported at the estimated netrealizable amounts from patients, third-party payors and others for services rendered,including estimated retroactive adjustments under reimbursement agreements with third-party payors. Retroactive adjustments are accrued on an estimated basis in the periodthe related services are rendered and adjusted in future periods as final settlementsare determined.

Signi ficant Concentration of Economic Dependence . The Hospital has an economicdependence on a small number of staff physicians who admit a majority of the Hospital'spatients. The Hospital also has an economic dependence on Medicare and Medicaid assources of payments. Accordingly, changes in federal or state legislation orinterpretations of rules have a significant impact on the Hospital.

Reclassifications . To be consistent with current year classifications , some items from

the previous year have been reclassified with no effect on net assets.

7

SPRZNGHILL MEDICAL SERVICES, INC.


NOTE 2: MAJOR SOURCE OF REVENUE

The Hospital participates in the Medicare and Medicaid programs as a provider of

medical services to program beneficiaries. The Hospital derived approximately 54%

and 52% of its gross patient service revenue from patients covered by the Medicare

and Medicaid programs for the years ended December 31, 2011 and 2010, respectively.

included in net patient service revenue for the years ended December 31, 2011 and

2010, is additional reimbursement for Medicaid Uncompensated Care Adjustments of

$1,084,678 and $1,273,689, respectively.

NOTE 3: PROPERTY, PLANT AND EQUIPMENT

Property, plant and equipment, by major category, is as follows at December 31,

2011:

BeginningBalance Additions

Land $ 71,308 $ -

EndingDeletions Balance

$ - $ 71,308

Buildings and Fixed Equipment 6,108,203 281,194 ( 335) 6,389,062

Movable Equipment 2,902,923 1,771,233 (88,462) 4,585,694

Construction in progress 12.731 50.000 (12.731) _____-5.0.00

Totals 9,095,165 2,102,427 (101,528) 11,096,064

Accumulated depreciation ( 5,172,468) (597,314) 88,797 (5,680,985)

Net Property, Plant, Equipment $3,922,697 $1, 5 0 5,113 $ (12,731) $5, 415,079

Depreciation expense for the years ended December 31, 2011 and 2010, amounted-,to

$597,314 and $574,023, respectively.

NOTE 4: LONG- TERM DEBT

Following is a summary of long-term debt at December 31, 2011 and 2010:

Note payable, due on November 15, 2030, plus interest

payable monthly at variable rates, 90 percent guaranteed

by the USDA, collateralized by the property and

improvements, rents and leases, present and future

accounts receivable, and deposit accounts of the Hospital $3,782,225 $ 3,977,324

Working' capital loan, due on November 15', 2018, plus557,222 990,556

interest at monthly variable rates

Capital lease obligations at imputed interest rates from4.00% to 14.54% collateralized by leased equipment 549,583 197,108

Total long-term debt

Less current portion

Long-term portion

4,889,030 5,164,988

506,079 _458,663

$4,382,951 $ 4,706,325

8



NOTE 4: LONG-TERM DEBT (cont)

A summary of long-term debt activity for the year ended is as follows:

Beginning EndingBalance Additions Reductions Balance

Note payable $ 3,977,324 $ - $ 200,100 $ 3,777,224

Working capital loan 990,556 - 433,333 557,223

Capital lease obligations 197,108 545,344 187,869 554,583

5,164 988 $ 545,344 $ 821,302 $ 4,889,030

Scheduled principal maturities on long-term debt and leases are as follows:

Long-term Long-term Capital

Year Ending December 31Debt

principalDebt Lease

Interest obligations

2012 $ 333,433 $ 279,549 $ 178,790

2013 333,433 259,198 118,312

2014 333,433 238,847 113,472

2015 thru 2019 1,457,721 896,272 147,240

2020 thru 2024 1,000,500 534,920 -

2025 thru 2029 875,927 218,149

$ . 4,334,447 $ 2,426,935 577,614

Less amounts representing interestunder capital lease obligations 23,031

Total $ _554,583

The Hospital leases equipment under various capital lease agreements with various

expiration dates until 2016. The assets and associated liabilities under the capital

leases are recorded at fair value of the assets. Capitalized assets are depreciated

over their estimated useful lives. Depreciation of assets under capital leases isincluded in depreciation expense.

NOTE 5: ASSETS LIMITED AS TO USE

The composition of assets limited as to use at December 31, 2011 and 2010 is set

forth in the following table.

Restricted access account required by bank as

security for loans and other obligations $604,791 $779,683

9



NOTE 6: INVESTMENTS

The Hospital purchased one class N unit (no par value) in a home health company for

$67,000 in August, 2004. Subsequently, they entered into an operating agreement with

the same company to provide home health services. The Hospital shares in thirty-three

percent (33%) of the profits and losses of the branch office located in Springhill,

Louisiana. The investment is accounted for using the cost method. Income reported as

other revenue was $320,572 and $408,721,for the years ended December 31, 2011 and.

2010, respectively.

NOTE 7: CONCENTRATION OF CREDIT RISK

The Hospital provides medical care primarily to Webster Parish residents and grants

credit to patients, substantially all of whom are local residents. Substantial

numbers of patients are insured through third-party payor agreements, predominately

Medicare and Medicaid. The Hospital's estimate of collectibility is based on an

analysis of aged accounts receivable to establish an allowance for uncollectible

accounts and allowances for contractual adjustments based upon agreements between the

Hospital and third-party payors. The mix of receivables (net of allowances) from

patients and third-party payors is as follows:

Medicare

Medicaid

Blue Cross

Commercial

Patient

Total

NOTE 8: OPERATING LEASES

39% 40

17°96 1896

5% BIr

16% 15%

24°% 19%

Leases that do not meet the criteria for capitalization are classified as operating

leases with related rental charged to operations as incurred.

NOTE 9: PATIENT SERVICE REVENUE

The Hospital has agreements with third-party payors that provide for payments to the

Hospital at amounts different from its established rates. A summary of the payment

arrangements with major third-party payors follows:

Medicare. Inpatient acute care services rendered to Medicare program beneficiaries

are paid at prospectively determined rates per discharge. These rates vary according

to a patient classification system that is based on clinical, diagnostic and other

factors. Certain outpatient services related to Medicare beneficiaries are paid

based on a set fee per diagnosis. Swing bed services are reimbursed at a

prospectively determined rate per patient day based on clinical, diagnostic and

other factors. Inpatient psychiatric services have been paid based on a cost

10

SPRINGHILL MEDICAL SERVICES, INC_


NOTE 9: PATIENT SERVICE REVENUE (coast)

reimbursement methodology, subject to a per discharge limitation. Effective January

1, 2005, a four (4) year transition began which moves from cost based to a

prospective system based upon diagnosis, length of stay, and other factors. The

transition is seventy-five percent (75%) cost in year one, fifty percent (50t) in

year two, twenty-five percent (25%) cost in year three, and after year three, zero

percent (0%) cost, with the balance paid each year upon the prospective rates. Rural

health clinic services are reimbursed based on cost per visit methodology.

The Hospital is reimbursed for cost reimbursable items at a tentative rate with

final settlements determined after submission of annual cost reports by the Hospital

and audits thereof by the Medicare fiscal intermediary. The Hospital's Medicare cost

reports have been finalized by the Medicare fiscal intermediary through December 31,

2008.

Medicaid . Inpatient acute care services are reimbursed based on a prospectively

determined per diem rate. Some outpatient services rendered to Medicare program

beneficiaries are reimbursed under a cost reimbursement methodology, while others

are paid prospectively based on a fee schedule. Rural health clinic services were

reimbursed based on a prospectively determined rate per visit until June 30, 2008,

when it changed to a cost based methodology. The Hospital is reimbursed at a

tentative rate for cost based services with final settlement determined after

submission of annual cost reports by the Hospital and audits thereof by the Medicaid

fiscal intermediary. The Hospital's Medicaid cost reports have been finalized by the

Medicaid fiscal intermediary through December 31, 2006.

Commercial. The Hospital has also entered into payment agreements with certain

commercial insurance carriers, health maintenance organizations, and preferred

provider organizations. The basis for payment to the Hospital under these agreements

include prospectively determined rates per discharge, discounts from established

charges, and prospectively determined daily rates.

Medicaid Uncompensated Cost . The Hospital received interim amounts of $1,084,67B and

$1,273,688, for Medicaid and self-pay uncompensated care services (UCC) for the

years ended December 31, 2011 and 2010, respectively, which represents 5.7. and 6.216

of net patient revenues. The interim amounts received are based upon uncompensated

cost incurred in previous years. Current regulations limit UCC to actual cost

incurred by the Hospital in each state fiscal year. Any overpayment will be recouped

by Medicaid after audit by Medicaid. Management contends interim payments reasonably

estimate final settlement. To the extent management's estimates differ from actual

results, the differences will be used to adjust income for the period when

differences arise.

11



NOTE 1D: COMPENSATED ABSENCES

Employees of the Hospital are entitled to paid vacation and paid sick days,

depending on job classification, length of service, and other factors. It is

impractical to estimate the amount of accrued compensation for future paid sick days

and, accordingly, no liability has been recorded for paid sick days in the

accompanying financial statements. However, vested vacation has been recorded as a

liability in the accompanying financial statements at employee rates in effect at

the balance sheet date.

NOTE 11: PENSION PLAN

The Hospital sponsors a defined contribution annuity pension plan. Under the

defined contribution annuity plan, the Hospital matches 100 %- of the employee's

contributions up to 50 of salaries. To participate in the plan, employees must be 18

years of age and must have completed one year of service. Employees are fully vested

in the Hospital's contributions after six years of service. The amount charged to

pension expense for the years ended December 31, 2011 and 2010, was $206,107 and

$213,482, respectively.

NOTE 12: - PROFESSIONAL LIABILITY RISK

The Hospital participates in the Louisiana Patients Compensation Fund established by

the State of Louisiana to provide medical professional liability coverage to health

care providers. The fund provides for $400,000 in coverage per occurrence above the

first $100,000 per occurrence for which the Hospital is at risk. The fund places no

limitation on the number of occurrences covered. In connection with the

establishment of the Patients Compensation Fund, the State of Louisiana enacted

legislation limiting the amount of settlement for professional liability to $500,000

per occurrence. Legal action in an attempt to overturn this legislation on

constitutional grounds is in process.

NOTE 13: WORKMEN'S COMPENSATION RISK

The Hospital participates in the Louisiana Workers Compensation Corporation. Should

the fund' s assets not be adequate to cover claims against it, the Hospital may be

assessed its pro rata share of the resulting deficit. it is not possible to estimate

the amount of additional assessments , if any.

NOTE 14: CONTINGENCIES

The Hospital evaluates contingencies based upon the best available evidence. The

Hospital believes that no allowances for loss contingencies are considered

12



NOTE 14: CONTINGENCIES (cont)

necessary. To the extent that resolution of contingencies results in amounts which

vary from the Hospital's estimates, future earnings will be charged or credited.

The principal contingencies are described below:

Governmental Third-Party Reimbursement Programs . Cost reimbursements and claims are

subject to examination by agencies administering the programs. The Hospital is

contingently liable for retroactive adjustments made by the Medicare and Medicaid

programs as the result of their examinations as well as retroactive changes in

interpretations applying statutes, regulations, and general instructions of those

programs. The amount of such adjustments cannot be determined.

The healthcare industry is subject to numerous laws and regulations of Federal,

State and local governments. These laws and regulations include, but are not

necessarily limited to, matters'such as licens=e., accreditation, privacy,

government healthcare program participating requirements, reimbursement for patient

services, and Medicare and Medicaid fraud and abuse. Recently, government activity

has increased with respect to investigations and allegations concerning possible

violations of fraud and abuse statutes and regulations by healthcare providers.

Violations of these laws and regulations could result in expulsion from government

healthcare programs together with the imposition of significant fines and penalties,

as well as significant repayment for patient services previously billed.

Management believes that the Hospital is in compliance with fraud and abuse statutes

as well as other applicable government law and regulations. Compliance with such

laws and regulations can be subject to future government review and interpretation

as well as regulatory actions unknown or unasserted at this time.

Medicare Wage Index . The Hospital was designated from "urban" to "rural" for

Medicare wage purposes effective October 1, 2004. Medicare provided a three year

grandfathering until September 30, 2007, to allow the Hospital to continue to

receive higher payments based on the urban wage index. The Hospital filed for and

received approval to continue using the urban wage index until September 30, 2010.

The Hospital filed for approval to continue using the urban wage index for services

after October 1, 2010, and was denied. Their classification for wage index purposes

will revert to "urban".

Professional Liability Risk. The Hospital is contingently liable for losses from

professional liability not underwritten by the Louisiana Patient Compensation Fund.

Litigation and Other Matters. Various claims in the ordinary course of business are

pending against the Hospital. In the opinion of management and counsel, insurance is

13


NOTES TO FINANCIAL STATEMENTS DECEMBER 31,- 2011-AND 2010

NOTE 14: CONTINGENCIES (coat)

sufficient to cover adverse legal determinations in those cases where a liability

can be measured.

NOTE 15: COMMITMENTS

Employment Contracts. The Hospital has employment contracts with eight physicians

for the year ended December 31, 2011, and nine physicians for the year ended

December 31, 2010. These contracts are for one year and are renewed on the contract

date. These physicians are paid according to a production based formula. Costs under

these contracts were $1,199,898 and $1,433,505, for the years ended December 31,

2011 and 2010, respectively.

NOTE 16: CHARITY CARE

The amount of charges foregone for services and supplies furnished under the

Hospital's charity care policy totaled $ 181,668, and $57,454 for the years ended

December 31, 2011 and 2010, respectively.

NOTE 17; SUBSEQUENT EVENTS

Management has evaluated subsequent events through the date the financial statements

were available to be issued, June 27, 2012, and determined that no events occurred

that require disclosure. No subsequent events occurring after this date have been

evaluated for inclusion in these financial statements.

NOTE 18 - RECENTLY ISSUED ACCOUNTING PRONOUNCEMENTS

In July 2011, the FASB issued ASU 2011-07, Health Care Entities (Topic 954)

Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and

the Allowance for Doubtful Accounts for Certain Health Care Entities. The

amendments to the codification will require certain health care entities to change

the presentation of their statement of operations by reclassifying the provision for

bad debts associated with patient service revenue from an operating expense to a

deduction from patient service revenue (net of contractual allowances and

discounts). Additionally those health care entities will be required to provide

enhanced disclosure about their policies for recognizing service revenue (net of

contractual allowances and discounts) as well as qualitative and quantitative

information about changes in the allowance for doubtful accounts. The Hospital will

be subject to these amendments for fiscal years ending after December 15, 2012, with

early adoption permitted. The amendments will be applied retrospectively for all

prior periods presented.

14



SCHEDULES OF PATIENT SERVICE REVENUES FOR THE YEARS ENDED DECEMBER 31,

2011

Routine Services

Adult and pediatric

Swing bed

Psychiatric Unit

Total routine services

Other Professional Services

Emergency service

Operating room

Recovery room

Observation

Intensive outpatient psych (IOP)

Laboratory and blood

Radiology

Pharmacy

Respiratory therapy

Physical and speech therapy

IV therapy

EKG and EEG

Central supply

Anesthesia

Wound Care

Doctor's Clinic rural health clinic

Plain Dealing rural health clinic

North Webster rural health clinic

Hospital based physicians

Total other professional services

GROSS PATIENT SERVICE REVENUE

Less: Contractual Adjustments

2010

$ 1,954,550 $ 2,053,928

44,616 65,340

1,998,071 2,035,128

3,997,237 4,154,396

3,022,876 2,947,676

1,140,062 974,587

74,256 71,768

370,640 213,680

1,908,920 2,195,055

6,367,534 6,530,298

4,876,746 5,203,529

3,335,631 3,433,133

566,570 592,916

393,306 457,587

932,504 770,616

603,522 694,252

713,437 817,282

137,900 -

309,827 -

3,370,408 5,062,822

42,988 186,880

763,165 993,725

1,016,420 -

29,948,912 31,145,806

33,946,149 35,300,202

16,164,189 16,020,274

Net Patient Service Revenue before Uncompensated Care

Medicaid Uncompensated Care

NET PATIENT SERVICE REVENUE

17,781,960 19,279,928

1,084,678 1,273,688

$ 16,866,638 $ 20,553,616

15

SPRINGHILL MEDICAL SERVICES, INC


SCHEDULES OF OTHER OPERATING REVENUES FOR THE YEARS ENDED DECEMBER 31,

2011 2010

Home Health joint venture $ 320,572 $ 408,721

Cafeteria sales 64,376 62,603

Vending revenue 4,297 4,000

Community care fees 6,899 12,622

Physician rent income 37,576 35,739

International Paper nurse 27,007 26,210

HPSA Income 369 100

Grant income 2,626,903 24,620

Gain (Loss) of disposal of assets 320 3,644

Miscellaneous revenue 146,150 194,615

Total Other Operating Revenue $ 3,234,469 $ 773,074

16

S PRINGHILL MEDICAL SERVICES. INC.

Springhill , Louisiana

SCHEDULE OF SALARIES FOR THE YEARS ENDED DECEMBER 31,

2011 2010

Administration

Plant operations and maintenance

Laundry and linen

Housekeeping

Dietary and cafeteria

Central supply

Nursing administration

Medical records

Nursing services

Reflections

Operating room

Radiology

Laboratory

Respiratory therapy

Physical therapy

Pharmacy


Emergency room


Doctors' Clinic rural health clinic


Senior friends

$ 972,796

135,791

22,433

164,055

164,497

93,494

455,829

260,316

1,178,954

597,342

243,728

535,524

394,048

167,747

146,043

254,181

21,538

595,843

34,803

1,595,544

370,467

15,754

$ 870,479

155,253

27,050

147,815

149,216

83,737

427,670

247,185

1,122,593

585,346

231,739

669,611

370,558

162,301

145,946

240,238

22,392

538,411

143,711

1,484,807

377,464

12,622

Total Salaries $ 8,520,727 $ 8,216,144

17


S»rincrhi l 1, Louia_iana

SCHEDULES OF EMPLOYEE BENEFITS

Payroll taxes

Retirement

Hospitalization insurance

Workers' compensation

Other

Total Employee Benefits

FOR THE YEARS ENDED DECEMBER 31,

2011

$ 599,687

206,107

579,259

59,913

69.692

$ 1,514,658

2010

$ 568,191

213,482

586,662

55,271

107,141

$ 1,530,747

18



SCHEDULES OF PURCHASED SERVICES FOR THE YEARS ENDED DECEZ-n3ER 31,

2011

Administration



Medical records

Nursing services

Reflections

Operating room

Anesthesiology

Radiology

Laboratory

Respiratory therapy

Therapy

Pharmacy

Intensive outpatient psych (lOP)

Emergency room




Total Purchased Services

$ 191,628

20,592

35,068

23,054

77,528

27,656

113,557

168,519

281, 614

J- 3.8, 689

24, 416

1, B26

2,368

592,265

504,545

1,674

139,190

1,032

2010

187,631

15,782

37,949

14,618

44,869

17,050

112,048

176,729

277,314

115,120

32,223

3,614

3,580

673,649

506,955

7,418

138,184

6.752

$ 2,325,221 $ 2,371,485

19

SPRINGHILL MEDICAL SERVICES INC.

Springhill. Louisiana

SCHEDULES OF SUPPLIES AND OTHER EXPENSES FOR THE YEARS ENDED DECEMBER 31,

2011 2010

Administration


Laundry and linen

Housekeeping


Central supply

Nursing administration

Medical records

Nursing services

Reflections

Operating room

Anesthesiology

Radiology

Laboratory

Respiratory therapy

Therapy

Pharmacy


Emergency room



North Webster doctors' clinic

Senior friends

Wound Care

Total Supplies and Other Expenses

$ 1,498,629 $ 1,347,291

388,314 386,392

47,424 32,597

40,031 36,986

214,758 197,723

253,505 216,328

2,245 2,946

38,694 36,317

39,991 52,418

120,362 123,960

127,082 126,701

6,462 6,910

226,338 253,146

332,785 316,806

14,101 9,097

3,742 9,261

495,925 466,402

9,808 14,530

31,619 34,514

13,001 62,626

194,855 143,608

139,144 133,799

6,161 5,744

88,951 -

$ 4,333,927 $ 4,016,102

20

LANGLIN4I5BROUS ARD&KOHLENBERGA Corporitlon of Certified Pubflc Accountants

Glen P. Lanylinals, C.P.A.

MichaelP_ Broua ard, C.P.A.

ChrisA. Kohlenhery, C.P.A., M_B.A_, M.H.A.

Gaya L_ Falcon, C.P.A.

Patrick M. C.P.A.

V. Breaux, C.P.A.

Jonathan P.. Primeaux, C.P.A_, M.B.A.

Kathryn S. Haag, C.P.A.

Communication of Significant Deficiencies and Material Weaknesses

To the Chairman and Board of Directorsand Management of Springhill Medical Services, Inc.

d/b/a Springhill Medical CenterSpringhill, Louisiana

In planning and performing our audit of the financial statements of Springhill

Medical Services, Inc. (the Hospital) as of and for the years ended December 31,

2011 and 2010, in accordance with auditing standards generally accepted in the

United States of America, we considered the Hospital's internal control over

financial reporting (internal control) as a basis for designing our auditing

procedures for the purpose of expressing our opinion on the financial statements,

but. not for the purpose of expressing an opinion on the effectiveness of the

Hospital's internal control. Accordingly, we do not express an opinion on the

effectiveness of the Hospital's internal control.

Our consideration of internal control was for the limited purpose described in the

preceding paragraph and was not designed to identify all deficiencies in internal

control that might be significant deficiencies or material weaknesses and therefore

there can be no assurance that all such deficiencies have been identified. However,

as discussed below, we identified certain deficiencies in internal control that we

consider to be material weaknesses and other deficiencies that we consider to be

significant deficiencies.

A deficiency in internal control exists when the design or operation of a control

does not allow management or employees, in the normal course of performing their

assigned functions, to prevent, or detect and correct misstatements on a timely

basis. A material weakness is a deficiency, or combination of deficiencies in

internal control, such that there is a reasonable possibility that a material

misstatement of the entity's financial statements will not be prevented, or

detected and corrected on a timely basis. We consider the following deficiencies in

the hospital's internal control to be material weaknesses:

2011-1 - SEGREGATION OF DUTIES

The hospital has several employees whose duties are not segregated.

2011-2 - FINANCIAL STATEMENT PREPARATION

The hospital relies on its outside auditors to assist in the preparation of

external financial statements and related disclosures. Under U.S. generally

accepted auditing principles, outside auditors cannot be considered part of the

Hospital's internal control structure, and, because of limitations of the

Hospital's small accounting staff, the design of the Hospital's internal control

structure does not otherwise include procedures to prevent or detect a material

misstatement in the external financial statements.

2011-3 - VACATIONS

Employees in key positions should be required to take continuous vacations and

backup personnel should be required to perform their duties while they are out.

2419 Veterans Memorial Drive • P0.11=1123 • Abbeville, Louisiana 70511-1123 • Telephone (337) 893-6232 • Fax(337)893-6249

PRIOR YEAR FINDINGS

2010-1 -- SEGREGATION OF DUTIES

Not Resolved. See 2011-1.

2010-2 - FINANCIAL STATEMENT PREPARATION

Not Resolved. See 2011-2.

2010-3 - VACATIONS

Not Resolved. See 2011-3

A significant deficiency is a deficiency, or a combination of deficiencies, in

internal control that is less severe than a material weakness, yet important enough

to merit attention by those charged with governance. We consider the above Findings

2011-1 through 2011-3 to be significant deficiencies.

This communication is intended solely for the information and use of management,

the Board of Directors, granting agencies and others within the organization, and

is not intended to be and should not be used by anyone other than these specified

parties.

LANGLINAL9^BROUSSARD & ?HL ERG

(A Corporation of Certi Public Accountants)

June 27, 2012

Additional Data

Software ID: 11000144

Software Version : 2011v1.2

EIN: 72 -1479692

Name : SPRINGHILL MEDICAL SERVICES INCDBA SPRINGHILL MEDICAL CENTER

Form 990, Special Condition Description:

Special Condition Description