MARCO ISLAND HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MARCO ISLAND HOSPITAL INC (EIN 59-2315435)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-14
- IRS object ID
- 202342269349300524
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-14T11:00:39-05:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 30 SOUTH WACKER DR SUITE 3300 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606063392 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 592315435 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARCO ISLAND HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MARC | BusinessNameControlTxt |
| Phone | 2396246338 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 40 S HEATHWOOD DRIVE | AddressLine1Txt |
| City | MARCO ISLAND | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34145 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NOBLE ARRINGTON | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 2396246338 | PhoneNum |
| Signature | 2023-08-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | NOBLE | PersonFirstNm |
| Person Last | ARRINGTON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | REBEKUH ELEY | PreparerPersonNm |
| PTIN | P01247672 | PTIN |
| Phone | 3126343400 | PhoneNum |
| Preparation | 2023-08-08 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARCO HEALTHCARE CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PAUL HILTZ | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 413029 | AddressLine1Txt |
| City | NAPLES | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 341013029 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,983,926 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NCHMD.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE.OUR VISION IS TO BE A WORLD-CLASS LEADER OF EXCELLENCE INHEALTHCARE AND TO PROVIDE EXCELLENCE IN EVERY PATIENT EXPERIENCE.MARCO ISLAND HOSPITAL, INC. OPERATES AN URGENT CARE CENTER ANDMEDICAL OFFICE BUILDING TO SERVE THE NEEDS OF THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 41 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,765,524 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,859,481 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,984,974 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $86,428 | PYOtherRevenueAmt |
| CY Other Revenue | $109,695 | CYOtherRevenueAmt |
| PY Total Revenue | $7,836,926 | PYTotalRevenueAmt |
| CY Total Revenue | $3,969,176 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,129,749 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,302,556 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,004,720 | PYOtherExpensesAmt |
| CY Other Expenses | $1,012,446 | CYOtherExpensesAmt |
| PY Total Expenses | $3,134,469 | PYTotalExpensesAmt |
| CY Total Expenses | $3,315,002 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,702,457 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $654,174 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,377,535 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,805,833 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $378,998 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $255,431 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,998,537 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,550,402 | NetAssetsOrFundBalancesEOYAmt |
| Mission | HELPING EVERYONE LIVE A LONGER, HAPPIER, AND HEALTHIER LIFE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,703,039 | ExpenseAmt |
| Revenue | $3,870,124 | RevenueAmt |
| Desc | MARCO ISLAND HOSPITAL, OPERATES A 11 1/2 HOUR/ 7 DAYS A WEEK URGENT CARE FACILITY AND SERVICES PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. DURING FYE 9/30/22, 8,517 PATIENTS WERE TREATED. OF THESE PATIENTS, 8.97% ARE CLASSIFIED AS MEDICAID, CHARITY OR BAD DEBTS. | Desc |
| Total Program Service Expenses | $2,703,039 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 41 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | FL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOBLE ARRINGTON CHIEF FINANCIAL OFFICER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2396246338 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 350 7TH STREET NORTH | AddressLine1Txt |
| City | NAPLES | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34102 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| PAUL HILTZ | |||||||||
| PRESIDENT/CEO/TRUSTEE | 1.00 | 44.00 | Yes (X) | Yes (X) | $0 | $1,353,470 | $34,580 | ||
| PHILLIP DUTCHER TERM 0721 | |||||||||
| FORMER CHIEF OPERATING OFFICER | 0.00 | 0.00 | $0 | $924,440 | $13,802 | Yes (X) | |||
| RICK WYLES | |||||||||
| CFO/ASSISTANT TREASURER | 1.00 | 44.00 | Yes (X) | $0 | $721,538 | $35,521 | |||
| KRISTIN MASCOTTI MD | |||||||||
| CHIEF MEDICAL OFFICER | 1.00 | 44.00 | Yes (X) | $0 | $657,719 | $76,334 | |||
| JONATHAN KLING | |||||||||
| CHIEF OPERATING OFFICER SYSTEM | 1.00 | 44.00 | Yes (X) | $0 | $555,965 | $71,841 | |||
| CARLOS B QUINTERO MD | |||||||||
| CHIEF QUALITY OFFICER | 1.00 | 44.00 | Yes (X) | $0 | $561,965 | $44,463 | |||
| JIM MAHON | |||||||||
| SENIOR VICE PRESIDENT | 1.00 | 44.00 | Yes (X) | $0 | $546,695 | $12,327 | |||
| RENEE M THIGPEN | |||||||||
| CHIEF HR OFFICER | 1.00 | 44.00 | Yes (X) | $0 | $485,952 | $30,767 | |||
| PAMELA ZIPPERER-DAVIS TRM 0321 | |||||||||
| FORMER CHIEF ADMINISTRATIVE OFFICER | 0.00 | 0.00 | $0 | $468,442 | $19,661 | Yes (X) | |||
| MICHAEL RILEY | |||||||||
| FORMER CHIEF STRATEGY OFFICER | 0.00 | 0.00 | $0 | $383,519 | $26,237 | Yes (X) | |||
| ANDREW COOPER START 0822 | |||||||||
| CHIEF INFORMATION OFFICER | 1.00 | 44.00 | Yes (X) | $0 | $244,206 | $19,961 | |||
| GINA TEEGARDEN RN | |||||||||
| CHIEF NURSING EXECUTIVE | 1.00 | 44.00 | Yes (X) | $0 | $242,211 | $18,105 | |||
| ILIA ECHEVARRIA START 0122 | |||||||||
| CHIEF NURSING OFFICER NNH | 1.00 | 44.00 | Yes (X) | $0 | $235,078 | $21,598 | |||
| MATTHEW STACELL START 0622 | |||||||||
| CHIEF PERFORMANCE MANAGEMENT OFFICER | 1.00 | 44.00 | Yes (X) | $0 | $187,079 | $32,986 | |||
| LINDA ROEBACK TERM 0520 | |||||||||
| FORMER CHIEF COUNSEL | 0.00 | 0.00 | $0 | $191,807 | $5,400 | Yes (X) | |||
| THOMAS THORNTON TERM 1121 | |||||||||
| CHIEF ADMIN. OFFICER | 1.00 | 44.00 | Yes (X) | $0 | $176,542 | $4,879 | |||
| ZACHARY BOSTOCK TERM 0320 | |||||||||
| FORMER CHIEF ADMIN. OFFICER | 0.00 | 0.00 | $0 | $145,718 | $5,232 | Yes (X) | |||
| HETTY TOMS | |||||||||
| OP REHAB MANAGER | 40.00 | 0.00 | $110,842 | $0 | $25,573 | Yes (X) | |||
| GARY TOMCIK TERM 0420 | |||||||||
| FORMER CHIEF EXPERIENCE OFFICER | 0.00 | 0.00 | $0 | $122,410 | $8,384 | Yes (X) | |||
| MARGARET DIAMOND START 1221 | |||||||||
| CHIEF ADMINISTRATIVE OFFICER | 1.00 | 44.00 | Yes (X) | $0 | $91,138 | $431 | |||
| KEVIN M FITZGERALD | |||||||||
| CHAIRMAN | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOHN L JACK PATTERSON | |||||||||
| 1ST VICE CHAIRMAN | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| RICHARD ADAMS | |||||||||
| 2ND VICE CHAIRMAN/TREASURER | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LISA GANDY | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID CARUSO | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DIANNA DOHM | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| PATRICIA KAUFMAN | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SANDRA MONSON | |||||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $110,842 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $8,295,894 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $508,082 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CHANCEY DESIGN PARTNERSHIP INC | |||||
| 1228 E 7TH AVE | TAMPA | FL | 33605 | ARCHITECTURAL SERVICES | $181,547 |
| SODEXO INC AND AFFILIATES | |||||
| PO BOX 360170 | PITTSBURGH | PA | 152516170 | FACILITIES MANAGEMENT | $135,262 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SVC REV | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $3,859,481 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,859,481 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,859,481 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $113,802 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $14,750 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $99,052 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $99,052 | TotalRevenueColumnAmt |
| Exclusion | $99,052 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MIH PULMONARY REHAB | 621990 | $10,514 | $10,514 |
| OTHER INCOME | 522100 | $129 | $129 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $10,643 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,969,176 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,870,124 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $99,052 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,903,324 | TotalAmt |
| Program Services | $1,533,508 | ProgramServicesAmt |
| Management And General | $369,816 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,316 | TotalAmt |
| Program Services | $48,597 | ProgramServicesAmt |
| Management And General | $11,719 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,949 | TotalAmt |
| Program Services | $157,070 | ProgramServicesAmt |
| Management And General | $37,879 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,967 | TotalAmt |
| Program Services | $115,994 | ProgramServicesAmt |
| Management And General | $27,973 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,700 | TotalAmt |
| Program Services | $152,841 | ProgramServicesAmt |
| Management And General | $36,859 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $231,731 | TotalAmt |
| Program Services | $186,706 | ProgramServicesAmt |
| Management And General | $45,025 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,641 | TotalAmt |
| Program Services | $100,423 | ProgramServicesAmt |
| Management And General | $24,218 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $211 | TotalAmt |
| Program Services | $170 | ProgramServicesAmt |
| Management And General | $41 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $233,779 | TotalAmt |
| Program Services | $188,356 | ProgramServicesAmt |
| Management And General | $45,423 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,959 | TotalAmt |
| Program Services | $53,949 | ProgramServicesAmt |
| Management And General | $13,010 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $165,245 | $165,245 |
| BAD DEBT EXPENSE | $180 | $180 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,315,002 | TotalAmt |
| Program Services | $2,703,039 | ProgramServicesAmt |
| Management And General | $611,963 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,030 | BOYAmt |
| EOY | $3,653 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $557,367 | BOYAmt |
| EOY | $641,103 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,860,098 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,700,236 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,815,923 | BOYAmt |
| EOY | $4,159,862 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,215 | BOYAmt |
| EOY | $1,215 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,377,535 | BOYAmt |
| EOY | $4,805,833 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $339,920 | BOYAmt |
| EOY | $211,518 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,078 | BOYAmt |
| EOY | $43,913 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $378,998 | BOYAmt |
| EOY | $255,431 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,998,537 | BOYAmt |
| EOY | $4,550,402 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,998,537 | BOYAmt |
| EOY | $4,550,402 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,377,535 | BOYAmt |
| EOY | $4,805,833 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $654,174 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$102,309 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $997,275 | OtherCostOrOtherBasisAmt |
| Book Value | $997,275 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,197,614 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,407,227 | DepreciationAmt |
| Book Value | $2,790,387 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,251,200 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,879,000 | DepreciationAmt |
| Book Value | $372,200 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $414,009 | OtherCostOrOtherBasisAmt |
| Depreciation | $414,009 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,159,862 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED EXP-PROF/GEN LIAB INSURANCE | $35,467 |
| ACCRUED EXP-WORKER'S COMP | $8,446 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $43,913 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE SYSTEM AND ALL OF ITS NOT-FOR-PROFIT SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE (THE CODE). THE SYSTEM AND ALL OF ITS NOT-FOR-PROFIT SUBSIDIARIES DO NOT HAVE SIGNIFICANT UNRELATED BUSINESS INCOME; HOWEVER, SUCH STATUS IS SUBJECT TO FINAL DETERMINATION UPON EXAMINATION OF THE RELATED INCOME TAX RETURNS BY THE APPROPRIATE TAXING AUTHORITIES. THE SYSTEM IS GENERALLY NO LONGER SUBJECT TO TAX EXAMINATIONS IN THE MAJOR U.S. TAXING JURISDICTIONS IN WHICH THEY OPERATE FOR TAX YEARS PRIOR TO 2018. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 8517 | PersonsServedCnt |
| Total Community Benefit Expns | $1,230 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,230 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $49,287 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $45,118 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,169 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 8517 | PersonsServedCnt |
| Total Community Benefit Expns | $50,517 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $45,118 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,399 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $1,174 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,174 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,174 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,174 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 8517 | PersonsServedCnt |
| Total Community Benefit Expns | $51,691 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $45,118 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,573 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $180 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $30 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $1,472,330 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,148,441 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$676,111 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARCO ISLAND HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 40 S HEATHWOOD DRIVE | AddressLine1Txt |
| City | MARCO ISLAND | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34145 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.NCHMD.ORG | WebsiteAddressTxt |
| State License | LICENSE #4113 | StateLicenseNum |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Other | URGENT CARE FACILITY 11 1/2 HOURS/7 DAYS A WEEK | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARCO ISLAND HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.NCHMD.ORG/ABOUT-US/ANNUAL-REPORTS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.NCHMD.ORG/ABOUT-US/ANNUAL-REPORTS | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.NCHMD.ORG/PATIENTS-AND-VISITORS/BILLING-INFO | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.NCHMD.ORG/PATIENTS-AND-VISITORS/BILLING-INFO | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.NCHMD.ORG/PATIENTS-AND-VISITORS/BILLING-INFO | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MARCO ISLAND HOSPITAL, INC. | PART V, SECTION B, LINE 5: CHNA TAKING INTO ACCOUNT INPUT FROM THE COMMUNITYTHE NCH LEADERSHIP TEAM IS ACTIVELY INVOLVED AND PARTICIPATES IN MANY COMMUNITY RELATED ORGANIZATIONS AND GROUPS THAT ARE CONTINUALLY ASSESSING UNMET NEEDS WITHIN COLLIER COUNTY. NCH HAS HISTORICALLY WORKED WITH OUR BOARD OF TRUSTEES, COLLIER COUNTY CHILDREN'S ALLIANCE, COLLIER COUNTY PUBLIC SCHOOLS, BLUE ZONES PROJECT OF SWFL AND OTHER AGENCIES THROUGHOUT THE COMMUNITY IN ASSESSING AND COLLABORATING IN EFFORTS TO IMPROVE THE HEALTH OF OUR COMMUNITY.NCH WORKS COLLABORATIVELY WITH THE FLORIDA DEPARTMENT OF HEALTH IN COLLIER COUNTY, THE COUNTY AND CITY GOVERNMENT, THE NAPLES AREA CHAMBER OF COMMERCE AND SEVERAL OTHER COMMUNITY GROUPS TO FORM THE COMMUNITY ASSESSMENT DESIGN GROUP. THE PURPOSE IS TO ASSESS THE COMMUNITY'S STRENGTHS AND OPPORTUNITIES. A NEW COMMUNITY HEALTH ASSESSMENT WAS COMPLETED IN 2022. THE 2020-2023 COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) PRIORITIES WERE ESTABLISHED IN 2020 BY THE HEALTHY COLLIER EXECUTIVE COMMITTEE BASED ON THE RESULTS FROM THE 2019 CHA. DOH-COLLIER FACILITATED THE CHIP PROCESS BY USING THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) STRATEGIC PLANNING MODEL. USING THE MOBILIZING FOR ACTION THROUGH THE PLANNING AND PARTNERSHIP (MAPP) FRAMEWORK, THE LEADERSHIP FOR COMMUNITY HEALTH IMPROVEMENT PLANNING (LCHIP) COMMITTEE REVIEWED THE 2019 COMMUNITY HEALTH ASSESSMENT (CHA) AND HELD DISCUSSIONS REGARDING GROUP PRIORITIES AND OBJECTIVES GOING FORWARD. THE COMMITTEE AGREED THAT THE RESULTS STRONGLY CORROBORATED THE RESULTS OF OTHER RECENT COMMUNITY ASSESSMENTS AND ACCURATELY REFLECT THE NEEDS OF COLLIER COUNTY.THE 2020-2023 CHIP WAS THEN SHAPED USING THE FIVE HIGHEST RANKED HEALTH PRIORITY AREAS FROM THE CHA RESULTS. THEY INCLUDE MENTAL HEALTH, CHRONIC DISEASES, ACCESS TO CARE, ALCOHOL AND DRUG USE, AND HEALTH OF OLDER ADULTS. MENTAL HEALTH AND ALCOHOL & DRUG USE WERE COMBINED INTO THE MENTAL HEALTH & SUBSTANCE ABUSE WORKGROUP. IN FEBRUARY AND MARCH OF 2020, THE DOH-COLLIER FACILITATORS CONVENED THE HEALTH PRIORITY WOKGROUPS TO FINALIZE THE GOALS, STRATEGIES, AND OBJECTIVES THAT EACH GROUP WILL WORK ON FOR THE NEXT THREE YEARS.HEALTH PRIORITY: MENTAL HEALTH AND SUBSTANCE ABUSEGOAL: IMPROVE IDENTIFICATION AND TREATMENT OF MENTAL HEALTH AND SUBSTANCE USE DISORDERS.OBJECTIVES:1. INCREASE THE COMBINED (HCN AND DLC) PERCENTAGE OF REFERRAL STATUS UPDATES GIVEN TO MEDICAL PROVIDERS WHO REFERRED PATIENTS FOR MENTAL HEALTH SERVICES FROM 47% IN 2021 TO 55% BY DECEMBER 2022. PROGRESS: AT THE END OF 2022, THE PERCENTAGE DECREASED TO 41.07%.2. INCREASE THE NUMBER OF INDIVIDUALS TRAINED PER YEAR IN YOUTH AND ADULT MENTAL HEALTH FIRST AID FROM 1060 IN 2019 TO 1500 BY DECEMBER 2022. PROGRESS: THE NUMBER OF INDIVIDUALS TRAINED IN 2022 WERE 2,937.HEALTH PRIORITY: CHRONIC DISEASESGOAL: DELIVER CULTURALLY RELEVANT HEALTH EDUCATION TO COLLIER COUNTY RESIDENTS IN POPULATIONS WITH DISPARITIES IN HEALTH OUTCOMES.OBJECTIVES:1. INCREASE THE NUMBER OF BLUE ZONES APPROVED WORKSITES FROM 49 IN 2019 TO 85 BY DECEMBER 2022. PROGRESS: TWENTY-ONE NEWLY APPROVED WORKSITES WERE ADDED IN 2022 WHICH RESULTED IN A TOTAL OF 87 APPROVED WORKSITES.2. INCREASE THE NUMBER OF EARLY CARE AND EDUCATION (ECE) SITES TO COMPLETE THE GO NUTRITION AND PHYSICAL ACTIVITY SELF-ASSESSMENT FOR CHILD CARE (GO NAPSACC) FROM 0 IN 2021 TO FIVE BY DECEMBER 2022. PROGRESS: THERE WERE NO NEW ECE SITES TO COMPLETE THE ASSESSMENT IN 2022. DOH-COLLIER'S RESPONSE TO THE COVID-19 PANDEMIC SLOWED PROGRAM DEVELOPMENT AND ONBOARDING.3. REACH A MINIMUM OF 2000 UNDUPLICATED SNAP-ELIGIBLE YOUTH THROUGH NUTRITION EDUCATION BY DECEMBER 2022. PROGRESS: THIS PROGRAM EXCEEDED ITS 2022 TARGET WITH 2,655 SNAP-ELIGIBLE YOUTH. 4. REACH A MINIMUM OF 150 UNDUPLICATED SNAP-ELIGIBLE ADULTS THROUGH NUTRITION EDUCATION BY DECEMBER 2022. PROGRESS: IN 2022, 315 SNAP-ELIGIBLE ADULTS PARTICIPATED IN THE PROGRAM. 5. INCREASE THE NUMBER OF PARTICIPANTS THAT COMPLETE THE HEALTHY FOR GOOD PROGRAM FROM 100 IN 2021 TO 160 BY DECEMBER 31, 2022. PROGRESS: FOR 2022, THERE WERE NO ADDITIONAL PARTICPANTS IN THIS PROGRAM.6. INCREASE THE NUMBER OF STUDENTS IMPACTED BY THE SMARTER LUNCHROOM PSE CHANGES AT SNAP ELIGIBLE SCHOOLS IN COLLIER COUNTY FROM 0 TO 25,000 BY DECEMBER 2022. PROGRESS: RESULT OF THIS OBJECTIVE WAS NOT REPORTED FOR 2022.7. INCREASE THE ANNUAL NUMBER OF REFERRALS TO THE CHILDHOOD OBESITY PROGRAM FROM THE 34142, 34116, AND 34112 ZIP CODES FROM 16 IN 2021 TO 60 BY DECEMBER 2022. PROGRESS: BY THE END OF 2022, THE NUMBER OF REFERRALS INCREASED TO 72.HEALTH PRIORITY: ACCESS TO CAREGOAL: INCREASE ACCESS TO BLOOD PRESSURE SCREENING SERVICES FOR UNINSURED COLLIER COUNTY RESIDENTS.OBJECTIVE:1. INCREASE THE NUMBER OF UNINSURED RESIDENTS PER YEAR IN COLLIER COUNTY WHO RECEIVED A BLOOD PRESSURE SCREENING FROM 12,404 IN 2019 TO 14,000 IN 2022, AN INCREASE OF ABOUT 5% PER YEAR. PROGRESS: WHILE COVID-19 TESTING DROVE PATIENTS TO THE CLINICS IN 2020, WORKGROUP MEMBERS CONCLUDED THAT MASK AND VACCINE REQUIREMENTS CONTINUED TO KEEP SOME AWAY IN 2022. THIS RESULTED IN 10,761 UNINSURED RESIDENTS RECEIVING BLOOD PRESSURE SCREENINGS.HEALTH PRIORITY: HEALTH OF OLDER ADULTSGOAL: INCREASE CAPACITY FOR OLDER ADULTS (AGE 60+) TO COMFORTABLY AND SAFELY AGE IN PLACE WITH APPROPRIATE RESOURCES IN A LIVABLE COMMUNITY.OBJECTIVES:1. INCREASE THE PERCENTAGE OF STEPS COMPLETED TO PRODUCE THE COLLIER COUNTY AGE-FRIENDLY ACTION PLAN FROM 0% IN 2021 TO 100% BY DECEMBER 2022. PROGRESS: 100% OF THE PROJECT WAS COMPLETED BY THE END OF 2022.2. INCREASE THE ANNUAL NUMBER OF COMMUNITY TOUCHPOINTS REGARDING DEMENTIA PRESENTATIONS, OUTREACH, TRAININGS, AND EVENTS FROM 83 IN 2021 TO 100 BY DECEMBER 2022. PROGRESS: AT THE END OF 2022, 78 COMMUNITY TOUCHPOINTS WERE MADE. THE CHIP SERVES AS A ROADMAP FOR CONTINUOUS IMPROVEMENT. THE CHIP WILL CONTINUE TO EVALUATE THE NEEDS OF THE COMMUNITY AND BY WORKING TOGETHER, WE CAN HAVE A SIGNIFICANT IMPACT ON COLLIER COUNTY'S HEALTH AND WELL-BEING AWARENESS. |
| MARCO ISLAND HOSPITAL, INC. | PART V, SECTION B, LINE 6A: CHNA CONDUCTED WITH ONE OR MORE HOSPITAL FACILITIESAS PART OF AN INTEGRATED HEALTHCARE SYSTEM, THE CHNA FOR NAPLES COMMUNITY HOSPITAL AND MARCO ISLAND HOSPITAL WAS PREPARED JOINTLY. |
| MARCO ISLAND HOSPITAL, INC. | PART V, SECTION B, LINE 11: ADDRESSING THE NEEDS IDENTIFIED IN THE CHNATHE CHNA IDENTIFIED PROBLEM AREAS THAT NEEDED TO BE ADDRESSED. THESE INCLUDE SUFFICIENT JOB EMPLOYMENT, ECONOMIC OPPORTUNITIES, ACCESS TO AFFORDABLE HOUSING, DRUG AND ALCOHOL ABUSE, SAFE ROADWAYS FOR BICYCLIST AND PEDESTRIANS, PRIMARY CARE RESOURCES, ACCESS TO AFFORDABLE HEALTHY FOOD, ACCESS TO LONG TERM CARE NEEDS, COMMUNICABLE DISEASE, OBESITY, CHRONIC DISEASE, MENTAL HEALTH, DENTAL HEALTH, ACCESS TO CARE, DISABILITIES AND UNINTENTIONAL INJURIES.UPON REVIEW OF THE FINDINGS OF THE CHNA, THE NCH LEADERSHIP TEAM CAME UP WITH FIVE KEY AREAS TO FOCUS ON WHICH INCLUDED MENTAL HEALTH, CHRONIC DISEASE (ONCOLOGY), MATERNAL AND INFANT HEALTH, HEALTH OF THE OLDER POPULATION AND HEALTH BEHAVIORS AND OUTCOMES. BELOW IS A SUMMARY OF ACTIVITIES AND INITIATIVES NCH ACHIEVED IN THE PAST THREE YEARS IN THESE SPECIFIC KEY AREAS.MENTAL HEALTHIN AN EFFORT TO EXPAND ACCESS OF OUTPATIENT BEHAVIORAL HEALTH SERVICE NCH CO-LOCATED PHYSICIAN PRACTICES AND NCH HAS BEEN PARTICIPATING IN THE COLLIER COUNTY COMMISSIONERS AD HOC TASK FORCE ON MENTAL HEALTH AND ADDICTION NEEDS IN COLLIER COUNTY. THE COMMITTEE SPONSORED A ONE-CENT SALES TAX, WHICH WAS APPROVED FOR $25 MILLION FOR IMPROVING MENTAL HEALTH IN COLLIER. IN RESPONSE TO MANAGING HIGH-RISK PSYCHIATRIC PATIENTS, NCH HAS PLACED CASE MANAGERS IN NCH EMERGENCY DEPARTMENTS TO WORK WITH FREQUENT USERS OF ED AND INPATIENT SERVICES.IN ORDER TO TARGET SEVERE DEPRESSION NCH WILL SOON BE IMPLEMENTING AN ELECTRO CONVULSIVE THERAPY PROGRAM (ECT) AND A TRANS MAGNETIC SIMULATION PROGRAM (TMS), AS WELL AS IV KETAMINE AND INTRA NASAL KETAMINE PROGRAMS WHEN APPROVED BY THE FDA.CHRONIC DISEASE (ONCOLOGY)MAMMOGRAM SCREENINGS ARE OFFERED AND PROVIDED TO UNINSURED AND UNDERINSURED PATIENTS. IN ADDITION, A COMMUNITY FAIR IS SCHEDULED EACH YEAR AT LOCAL CHURCHES, CP-3 SCREENINGS AND AN AMERICAN CANCER ASSOCIATION STUDY HAS ALSO BEEN COMPLETED.NCH HIRED CARDIO THORACIC SURGEONS WHO DEVELOPED A COMPREHENSIVE LUNG CANCER PROGRAM FOCUSING ON SCREENING, NAVIGATION, SURVIVORSHIP AND SURGICAL INTERVENTION.NCH EXPANDED ITS NURSE NAVIGATION PROGRAM WITH FOCUS ON FOLLOWING ONCOLOGY PATIENTS THROUGHOUT THE CONTINUUM OF CARE WITH SPECIAL EMPHASIS ON BREAST AND LUNG PATIENTS AS WELL AS SCREENING ACTIVITIES.MATERNAL AND INFANT HEALTHNCH'S INITIAL LATCH MEASUREMENT IS 86%. NCH IS IMPLEMENTING SKIN TO SKIN IN THE DELIVERY ROOM. THE SKIN TO SKIN RATE IS 94%. ALL REGISTERED NURSES IN LABOR AND DELIVERY, MOTHER/BABY, NEONATAL INTENSIVE CARE UNIT, PEDIATRICS AND PEDIATRICS ED ARE EDUCATED IN BREASTFEEDING. NCH MAINTAINS A BREASTFEEDING RATE OF 56%. NCH EMPLOYS 1 FULL-TIME AND 1 PART-TIME EQUIVALENT LACTATION CONSULTANTS WHICH ARE AVAILABLE 7 DAYS A WEEK 16 HOURS PER DAY. NCH ALSO HOSTS THE COLLIER COUNTY BREASTFEEDING COALITION WITH AN OVERALL GOAL TO INCREASE BREASTFEEDING RATES IN COLLIER COUNTY.NCH IS A HOST MEMBER OF A SUBSTANCE ABUSE COALITION AND SPONSORS REGULAR MEETINGS HELD AT NCH. THE COALITION REPORTS DATA TO THE STATE AND ALSO SUPPORTS NURSE EDUCATIONAL PROGRAMS FOR PARENTS ON THE DETRIMENTAL EFFECTS OF SUBSTANCE ABUSE FOR NEWBORNS. ALL PATIENTS AND PARENTS ARE OFFERED TDAP IMMUNIZATION AND CURRENTLY ON WOMEN AND CHILDREN'S AND PEDIATRIC NURSING UNITS A STANDING ORDER FOR TDAP ADMINISTRATION IF STATUS IS UNKNOWN. IN ADDITION, IN WOMEN AND CHILDREN'S AND PEDIATRIC NURSING UNITS ALL NCH STAFF HAVE RECEIVED THE TDAP VACCINE AS WELL AS ANY NEW STAFF.HEALTH OF THE OLDER POPULATIONNCH HAS EXPANDED GERIATRIC MEDICINE TO MULTIPLE NCH PHYSICIAN PRACTICES.TWO NCH PHYSICIANS ARE MEDICAL DIRECTORS OF TWO SKILLED NURSING FACILITIES IN COLLIER COUNTY.DIABETES MANAGEMENTNCH HEALTHCARE SYSTEM'S VON ARX DIABETES CENTER HAS TWO RECOGNIZED AMERICAN DIABETES PROGRAMS THAT MAINTAIN DATA COLLECTION AND REPORTING REQUIREMENTS. DIABETES SUPPORT GROUPS ARE PROVIDED TO THE COMMUNITY. ALSO, FREE PRE-DIABETES SEMINARS AND COMMUNITY LECTURES ARE OFFERED THROUGHOUT THE YEAR. PHILANTHROPIC FUNDS HAVE BEEN ALLOCATED FOR PEDIATRICS TO ASSURE THEY HAVE APPOINTMENTS SCHEDULED WITH REGISTERED DIETICIANS OR NURSES FOR UNDERINSURED OR UNINSURED CHILDREN. PHILANTHROPIC FUNDS ARE ALSO USED FOR GESTATIONAL PATIENTS PROVIDING EDUCATIONAL CLASSES, AND SUPPLIES. OUR RESULTS INCLUDE 80% OF WOMEN ACHIEVED TARGET RANGES FOR BLOOD GLUCOSE LEVELS AND 85% OF BABIES BORN MET BIRTH WEIGHT GOALS (<9 LBS.).ACCOMPLISHMENTS FOR 2021 INCLUDE, BUT ARE NOT LIMITED TO: I. THE VON ARX DIABETES CENTER SERVED 5,644 OUTPATIENT VISITS; II. SERVICES WERE EXPANDED TO MARCO ISLAND AND BONITA SPRINGS; III. EXPANDED GROCERY STORE TOURS; IV. MAINTAINED ACCREDITATION WITH THE AMERICAN DIABETES ASSOCIATION NCH WORKING WITH THE FLORIDA DEPARTMENT OF HEALTH - COLLIER COUNTY PARTICIPATED AGAIN IN THE COLLIER COUNTY COMMUNITY ASSESSMENT DESIGN GROUP. THE SCOPE OF THE GROUP IS TO DESIGN A COMMUNITY STRENGTHS/OPPORTUNITIES SURVEY. A SURVEY WAS PREPARED AND SENT OUT TO THE HEALTH CARE LEADERS, COMMUNITY FOCUS GROUPS AND HEALTH CARE STAFF. IDENTIFIED PROBLEM AREAS INCLUDED THE FOLLOWING:CHRONIC DISEASE AND MORTALITYINFECTIOUS DISEASEMATERNAL AND INFANT HEALTHINJURIESACCESS TO HEALTHCAREHEALTH BEHAVIORS AND HEALTH STATUSMENTAL HEALTHORAL HEALTHTHE HEALTH OF THE OLDER POPULATIONSUBSEQUENTLY, THE LEADERSHIP FOCUS GROUP MET TO DISCUSS BOTH THE POSITIVE AND NEGATIVE FACTORS THAT INFLUENCED THESE AREAS.THE NEXT STEP IN THE PROCESS WAS TO CONDUCT GEOGRAPHICAL AREA COMMUNITY FOCUS GROUPS. THESE GROUPS WERE CHOSEN TO REFLECT AND INCLUDE THE DIVERSITY OF COMMUNITY LOCATIONS, ETHNICITY, AND SOCIO-ECONOMIC FACTORS. THE DISTINCT AREAS OF THE COUNTY REPRESENTED UNIQUE DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS. THE DIFFERENCES WERE VALUABLE AND USEFUL FOR ASSESSING AND PRIORITIZING HEALTHCARE NEEDS WITHIN OUR COMMUNITY. IN ADDITION, WE PROVIDED INPUT INTO THE ANALYSIS ON VARIOUS HEALTH INDICATORS WHICH INCLUDED THE FOLLOWING: POPULATION SOCIOECONOMIC CHARACTERISTICS INFECTIOUS DISEASE HEALTH BEHAVIORS AND HEALTH STATUS MORTALITY INDICATORS MATERNAL AND INFANT HEALTH HEALTH OF THE OLDER POPULATIONUPON REVIEW OF THE FINDINGS OF THE (CHNA) THE NCH LEADERSHIP TEAM REVIEWED THE FINDINGS. A PRIORITIZATION SESSION WAS COMPLETED WHICH WAS BASED ON THE MISSION, VISION AND CORE VALUES OF THE NCH HEALTHCARE SYSTEM WITH A PRIMARY FOCUS ON THE GOAL OF COLLIER COUNTY BECOMING THE HEALTHIEST COUNTY IN THE UNITED STATES. UPON MUCH DISCUSSION THE TEAM CAME UP WITH FOUR KEY AREAS OF FOCUS WHICH INCLUDE: MENTAL HEALTH ACCESS TO CARE CHRONIC DISEASE HEALTH OF OLDER ADULTSUNADDRESSED IDENTIFIED NEEDSALTHOUGH SEVERAL COMMUNITY NEEDS WERE IDENTIFIED, NCH MUST FOCUS OUR EXISTING CLINICAL STRENGTHS AND INFRASTRUCTURE WHERE WE CAN MAXIMIZE OUR RESOURCES TO BENEFIT THE GREATEST NUMBER OF PEOPLE IN THE COMMUNITY. NCH WILL CONTINUE TO RE-EVALUATE THE UNADDRESSED IDENTIFIED NEEDS AND PURSUE ACTION WHEN AND WHERE RESOURCES ALLOW. |
| MARCO ISLAND HOSPITAL, INC. | PART V, SECTION B, LINE 13B: NCH HEALTHCARE SYSTEM, INC., WHICH INCLUDES MIH, HAS A POLICY THAT ALLOWS A DISCOUNT FOR SELF-PAY UNINSURED OR UNDERINSURED PATIENTS WITH INCOME AND ASSETS GREATER THAN 200% OF FPG WHEN THE FAP APPPLICATION AND SUPPORTING DOCUMENTATION IS PROVIDED.MIH RETAINS DISCRETION TO PROVIDE FINANCIAL ASSISTANCE TO PATIENTS WHO FALL OUTSIDE THE FPG INCOME GUIDELINES. OTHER CONSIDERATIONS TO INCOME LEVEL ARE PERCENTAGE OF TOTAL AMOUNT CHARGED BASED ON SERVICES PROVIDED TO THE PATIENT COMPARED TO PATIENTS INCOME. |
| MARCO ISLAND HOSPITAL, INC. | PART V, SECTION B, LINE 13H: MIHBASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS.OTHER CRITERIA USED TO DETERMINE ELIGIBILITY ARE PATIENTS WHO ARE ELIGIBLE TO RECEIVE BENEFITS FROM A GOVERNMENTAL AGENCY AS THE VICTIM OF A VIOLENT CRIME OR SEXUAL ASSAULT AND THE TREATMENT IS RELATED TO THE VIOLENT CRIME OR SEXUAL ASSAULT. |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | FORM 990 SCHEDULE HMIH USES OTHER FACTORS OTHER THAN FPG TO DETERMINE ELIGIBILTY FOR PROVIDING FREE OR DISCOUNTED CARE AS DESCRIBED BELOW.PRESUMPTIVE ELIGIBILITYPATIENTS MAY BE ELIGIBLE FOR A DISCOUNT OF THE FULL UNPAID BALANCE IN THE ABSENCE OF A COMPLETED FINANCIAL ASSISTANCE APPLICATION FORM IF THE PATIENT MEETS ONE OF THE FOLLOWING:1. IS HOMELESS2. IS DECEASED AND HAS NO KNOWN ESTATE AVAILABLE TO PAY MEDICAL BILLS3. IS CURRENTLY ELIGIBLE FOR MEDICAID (AS PRIMARY INSURANCE) BUT WAS NOT AT DATE OF SERVICE OR MEDICAID BENEFITS ARE EXHAUSTED.4. IS ELIGIBLE TO RECEIVE BENEFITS FROM A GOVERNMENTAL AGENCY AS THE VICTIM OF A VIOLENT CRIME OR SEXUAL ASSAULT AND THE TREATMENT IS RELATED TO THE VIOLENT CRIME OR SEXUAL ASSAULT.5. A DEMONSTRATED INABILITY TO PAY FOR SERVICES BASED ON ALL AVAILABLE ASSETS. PATIENTS RECEIVING CARE IN OR FROM THE EMERGENCY DEPARTMENT WHO ARE WITHOUT FINANCIAL RESOURCES MAY BE ELIGIBLE FOR THE FAP IF THEY ARE UNEMPLOYED OR SELF-EMPLOYED AND CANNOT PROVIDE INCOME AN INCOME TAX STATEMENT, ARE INDIGENT WITHOUT ACCESS TO THE REQUIRED APPLICATION DOCUMENTATION MAY STILL BE ELIGIBLE FOR FINANCIAL ASSISTANCE. |
| PART I, LINE 6A: | RELATED PARTY DISCLOSURESMARCO ISLAND HOSPITAL, INC. ("MIH") IS AN AFFILIATE OF NCH HEALTHCARE SYSTEM, INC.("NCHS"). NCHS PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND INCLUDES THIS REPORT WITH ITS FORM 990 TAX RETURN FILING.THE COMMUNITY BENEFIT REPORT PREPARED INCLUDES ALL ORGANIZATIONS OF THE SYSTEM, INCLUDING MARCO ISLAND HOSPITAL, INC. |
| PART I, LINE 7: | COSTING METHOD USEDTHE COSTING METHODOLOGY USED IN CALCULATING THE AMOUNTS REPORTED ON THE LINE 7 TABLE ARE BASED ON A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS DERIVED FROM FORM 990, SCH. H, WORKSHEET 2. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSE INCLUDED FORM 990, PART IX, LINE 25THE BAD DEBT EXPENSE AMOUNT INCLUDED ON FORM 990, PART IX, LINE 25 WAS $180 FOR THE YEAR ENDED SEPTEMBER 30, 2022. THIS AMOUNT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES REPORTED ON THE SCHEDULE H, PART I, LINE 7 TABLE. |
| PART III, LINE 2: | BAD DEBT EXPENSE, COSTING METHODOLOGY USEDBAD DEBT EXPENSE IN THE FINANCIAL STATEMENTS IS DETERMINED BY PATIENTS THAT HAVE FILED FOR BANKRUPTCY AND/OR HAVE LOSS OF EMPLOYMENT AFTER THE DATE OF SERVICE. |
| PART III, LINE 3: | BAD DEBT EXPENSETHE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 2 IS BASED ON A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS DERIVED FROM FORM 990, SCH. H, WORKSHEET 2. |
| PART III, LINE 4: | BAD DEBT EXPENSE FOOTNOTEBAD DEBTS REPRESENT CHARGES DEEMED UNCOLLECTIBLE DUE TO EITHER: (A) A PATIENT'S INABILITY TO QUALIFY AS CHARITY, WELFARE, OR MEDICAID, YET CLEAR FINANCIAL INDICATIONS EXIST THAT DEMONSTRATE AN INABILITY TO PAY, OR (B) A PATIENT'S REFUSAL TO PAY FOR SERVICES PROVIDED AND THE SYSTEM'S DECISION TO CEASE FURTHER COLLECTION EFFORTS. BAD DEBT EXPENSE IN THE FINANCIAL STATEMENTS IS DETERMINED BY PATIENTS THAT HAVE FILED FOR BANKRUPTCY AND/OR HAVE LOSS OF EMPLOYMENT AFTER THE DATE OF SERVICE. THE BAD DEBT EXPENSE FOOTNOTE DISCLOSURE CAN BE FOUND ON PAGES 17 AND 18 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENTS FOR THE NCH HEALTHCARE SYSTEM, INC. AND SUBSIDIARIES. |
| PART III, LINE 8: | COSTING METHODOLOGY, MEDICARE SHORTFALLTHE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 6 IS BASED ON A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS DERIVED FROM FORM 990, SCHEDULE H, WORKSHEET 2. CONSISTENT WITH THE CHARITABLE HEALTHCARE MISSION OF MARCO ISLAND HOSPITAL, INC. AND THE COMMUNITY BENEFIT STANDARD SET FORTH IN IRS REVENUE RULING 69-545, THE HOSPITAL PROVIDES CARE FOR ALL PATIENTS COVERED BY MEDICARE SEEKING MEDICAL CARE. SUCH CARE IS PROVIDED REGARDLESS OF WHETHER THE REIMBURSEMENT PROVIDED FOR SUCH SERVICES MEETS OR EXCEEDS THE COSTS INCURRED BY THE HOSPITAL TO PROVIDE SUCH SERVICES. AS A RESULT, MARCO ISLAND HOSPITAL, INC. VIEWS ANY SHORTFALL REPORTED IN LINE 7 AS AN ADDITIONAL ITEM OF COMMUNITY BENEFIT PROVIDED BY THE ORGANIZATION. |
| PART III, LINE 9B: | COLLECTION PRACTICESMARCO ISLAND HOSPITAL, INC. PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET SPECIFIC CRITERIA UNDER THE STATE'S CHARITY CARE GUIDELINES. BECAUSE MARCO ISLAND HOSPITAL, INC. DOES NOT PURSUE COLLECTION OF ACCOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS REVENUE. |
| PART VI, LINE 2: | NEEDS ASSESSMENTTHE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES IN VARIOUS WAYS. OUR LEADERSHIP TEAM IS ACTIVELY INVOLVED AND PARTICIPATES IN MANY COMMUNITY RELATED ORGANIZATIONS AND GROUPS THAT ARE CONTINUALLY ASSESSING UNMET NEEDS WITHIN COLLIER COUNTY. WE HAVE HISTORICALLY WORKED WITH OUR BOARD OF TRUSTEES, COLLIER COUNTY CHILDREN'S ALLIANCE, COLLIER COUNTY PUBLIC SCHOOLS, THE IMMOKALEE FOUNDATION, CHILDREN'S MEDICAL SERVICES, AND OTHER AGENCIES THROUGHOUT OUR COMMUNITY IN ASSESSING AND COLLABORATING IN EFFORTS TO IMPROVE THE HEALTH OF OUR COMMUNITY. NCH PROVIDES MANY HEALTH-ENHANCING EDUCATIONAL PROGRAMS AND RESOURCES IN PROMOTING HEALTH TO THE COMMUNITY. THE CURRENT PROGRAMS AND RESOURCES PROVIDED TO THE COMMUNITY INCLUDE THE FOLLOWING: HEALTH SEMINARS, COMMUNITY HEALTH FAIRS, FREE DIAGNOSTIC AND SCREENING/TESTING, THE NEIGHBORHOOD HEALTH CLINIC, HEART PROGRAMS, CANCER SURVIVAL AWARENESS, PATIENT SUPPORT GROUPS, TWO WELLNESS CENTERS, VON ARX DIABETES CENTER, PASTORAL CARE SERVICES, AND SPONSOR AND SUPPORT CLINICAL NURSING SCHOOLS.IN ADDITION TO THE PROGRAMS LISTED, WE ARE ALSO WORKING WITH THE SAFE AND HEALTHY CHILDREN'S COALITION OF COLLIER COUNTY TO DEVELOP PROGRAMS FOR DROWNING PREVENTION, CHILDHOOD OBESITY, SAFE SLEEP EFFORTS, AND BREASTFEEDING PROGRAMS.DURING 2022, WE COMPLETED A COMMUNITY NEEDS ASSESSMENT REPORT AND HAVE POSTED THIS REPORT ON OUR WEBSITE (HTTP://WWW.NCHMD.ORG/ABOUT-US/ANNUAL-REPORTS). WE ARE COMMITTED TO PROMOTING EXISTING AND POTENTIAL NEW PROGRAMS TO THE COMMUNITY IN RESPONSE TO THE COMMUNITY HEALTH NEEDS ASSESSMENT. PLEASE REFER TO THIS REPORT AND DETAILED PLAN WHICH WAS REVIEWED BY THE NCH HEALTHCARE SYSTEM BOARD OF TRUSTEES AND APPROVED AT THE SEPTEMBER 27, 2022 BOARD OF TRUSTEES MEETING.INCLUDED IN THE 2022 REPORT IS THE BLUE ZONE PROJECT WHICH BEGAN IN 2015 AND IS SPONSORED BY NCH. THE BLUE ZONE PROJECT IS A COMPREHENSIVE WELL-BEING IMPROVEMENT INITIATIVE DESIGNED TO HELP PEOPLE LIVE LONGER AND BETTER BY BUILDING STRONG SOCIAL NETWORKS AND ENCOURAGING SUSTAINABLE CHANGES THROUGHOUT THE COMMUNITY THAT LEADS TO HEALTHIER CHOICES. |
| PART VI, LINE 3: | INFORMATION REGARDING PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEMARCO ISLAND HOSPITAL, INC. RECOGNIZES ITS RESPONSIBILITY TO COMMUNICATE ITS FINANCIAL POLICIES AND EXPECTATIONS TO PATIENTS. THE HOSPITAL INFORMS AND EDUCATES PATIENTS BY PROVIDING PATIENTS WITH THE NCH HEALTHCARE SYSTEM PATIENT RIGHTS AND RESPONSIBILITIES. INCLUDED IN THESE RIGHTS IS THE RIGHT TO BE GIVEN, UPON REQUEST, FULL MEDICAL INFORMATION AND FINANCIAL COUNSELING. IN ADDITION, A PATIENT REPRESENTATIVE WILL CONTACT PATIENTS PRIOR TO SERVICES TO EVALUATE THE PATIENT'S ABILITY TO PAY. THIS PROCESS INCLUDES OBTAINING THE PATIENT'S CURRENT FINANCIAL INFORMATION, OBTAINING A CREDIT REPORT, AND REVIEWING THE PATIENT'S PAYMENT HISTORY WITH MARCO ISLAND HOSPITAL, INC. PERSONS REQUIRING ASSISTANCE WITH THE UNFUNDED PORTION OF THEIR BILLS ARE ENCOURAGED TO REQUEST A CHARITY EVALUATION. MARCO ISLAND HOSPITAL, INC. ALSO PROVIDES ASSISTANCE FOR PATIENTS TO APPLY FOR MEDICAID COVERAGE OR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS WHICH MAY ASSIST WITH PAYMENT FOR MEDICAL SERVICES. |
| PART VI, LINE 4: | COMMUNITY INFORMATIONMARCO ISLAND HOSPITAL, INC. SERVES AN OLDER COMMUNITY. THE MEDIAN AGE IS 66.9. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IS $84,288. THE UNEMPLOYMENT RATE IS APPROXIMATELY 4.9%. THE PERCENTAGE OF RESIDENTS IN THE POVERTY LEVEL IS APPROXIMATELY 5.75%. |
| PART VI, LINE 5: | INFORMATION REGARDING PROMOTION OF COMMUNITY HEALTHMARCO ISLAND HOSPITAL, INC. EMPLOYEES ARE INVOLVED IN A WIDE VARIETY OF ACTIVITIES AND ESSENTIAL SERVICES THAT ARE GEARED TOWARDS POSITIVELY AFFECTING OUR COMMUNITY'S HEALTH STATUS. THE FOLLOWING IS A SUMMARY OF TWO SUCH ACTIVITIES PROVIDED DURING THE YEAR:MARCO ISLAND HOSPITAL, INC. OFFERED FREE BLOOD PRESSURE CHECKS TO THE COMMUNITY MONDAY THROUGH FRIDAY FROM 9:00 AM TO 4:00 PM (9:00 AM TO NOON IN THE SUMMER MONTHS). FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2022, THERE WERE NO COMPLIMENTARY BLOOD PRESSURE CHECKS GIVEN TO THE PUBLIC. FREE BLOOD PRESSURE READINGS HALTED DUE TO COVID-19. |
| PART VI, LINE 6: | AFFILIATED HEALTHCARE SYSTEM INFORMATION MARCO ISLAND HOSPITAL, INC. IS AN AFFILIATE OF THE NCH HEALTHCARE SYSTEM, INC. THE NCH HEALTHCARE SYSTEM, INC. PROVIDES HEALTH-ENHANCING EDUCATIONAL PROGRAMS AND RESOURCES IN PROMOTING THE HEALTH OF OUR COMMUNITY. THE TYPES OF PROGRAMS/RESOURCES PROVIDED INCLUDE: HEALTH SEMINARS, COMMUNITY HEALTH FAIRS & TESTING, REGISTERED NURSES EDUCATING FUTURE PATIENTS, SUPPORTING THE NEIGHBORHOOD HEALTH CLINIC, PHYSICIAN LED ACCESS NETWORK OF COLLIER COUNTY, HEART PROGRAMS, CANCER SURVIVAL AWARENESS, SUPPORT OF PATIENT FAMILIES, DR. JOHN BRIGGS WELLNESS CENTER, AND SHARING OUR SPACE AT NO COST TO NEEDY, NOT-FOR-PROFIT ORGANIZATIONS. THE ORGANIZATION ALSO SPONSORS AND SUPPORTS THE CLINICAL NURSING SCHOOLS IN OUR COMMUNITY.THE ORGANIZATION'S CIVIC INVOLVEMENT INCLUDES MEMBERS OF NCH MANAGEMENT WHO SERVE ON COMMUNITY BOARDS IN VARIOUS CAPACITIES. THE HOSPITALS HAVE ALWAYS PROVIDED EXEMPLARY PASTORAL CARE SERVICES. NCH IS ENCOURAGING THEIR OWN HEALTHCARE PROFESSION BY SPONSORING CAREER DAYS, JOB SHADOWING, AND LECTURES AT LOCAL MIDDLE AND HIGH SCHOOLS ON THE MANY OPPORTUNITIES IN THE HEALTHCARE FIELD. IN ADDITION TO MARCO ISLAND HOSPITAL, INC., THE NCH HEALTHCARE SYSTEM ALSO INCLUDES THE FOLLOWING NON-PROFIT ORGANIZATIONS:>NAPLES COMMUNITY HOSPITAL IS LOCATED IN COLLIER COUNTY, FLORIDA. THE HOSPITAL CONSISTS OF NAPLES COMMUNITY HOSPITAL, A 391-BED ACUTE CARE FACILITY, AND NORTH NAPLES HOSPITAL, A 322-BED ACUTE CARE FACILITY. THE HOSPITAL ALSO HAS A BLOOD CENTER AND MAINTAINS VARIOUS OTHER OUTPATIENT CENTERS LOCATED THROUGHOUT THE COUNTY.>COLLIER HEALTH CARE, INC. OWNS AND LEASES HEALTHCARE FACILITIES IN NAPLES AND IMMOKALEE, FLORIDA.>NCHMD, INC. OWNS AND OPERATES PHYSICIAN MEDICAL PRACTICES AND OUTPATIENT RADIOLOGY SERVICES IN COLLIER AND LEE COUNTY, FLORIDA. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | FL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAUL HILTZ | ||||||||||||||
| PRESIDENT/CEO/TRUSTEE | $0 | $970,917 | $0 | $211,754 | $0 | $170,799 | $0 | $11,600 | $0 | $22,980 | $0 | $1,388,050 | $0 | $0 |
| PHILLIP DUTCHER TERM 0721 | ||||||||||||||
| FORMER CHIEF OPERATING OFFICER | $0 | $216,973 | $0 | $146,400 | $0 | $561,067 | $0 | $11,600 | $0 | $2,202 | $0 | $938,242 | $0 | $0 |
| RICK WYLES | ||||||||||||||
| CFO/ASSISTANT TREASURER | $0 | $504,131 | $0 | $114,408 | $0 | $102,999 | $0 | $11,600 | $0 | $23,921 | $0 | $757,059 | $0 | $0 |
| KRISTIN MASCOTTI MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $0 | $588,582 | $0 | $47,354 | $0 | $21,783 | $0 | $59,410 | $0 | $16,924 | $0 | $734,053 | $0 | $0 |
| JONATHAN KLING | ||||||||||||||
| CHIEF OPERATING OFFICER SYSTEM | $0 | $440,933 | $0 | $93,480 | $0 | $21,552 | $0 | $48,738 | $0 | $23,103 | $0 | $627,806 | $0 | $0 |
| CARLOS B QUINTERO MD | ||||||||||||||
| CHIEF QUALITY OFFICER | $0 | $525,327 | $0 | $16,642 | $0 | $19,996 | $0 | $19,203 | $0 | $25,260 | $0 | $606,428 | $0 | $0 |
| JIM MAHON | ||||||||||||||
| SENIOR VICE PRESIDENT | $0 | $374,637 | $0 | $81,333 | $0 | $90,725 | $0 | $11,600 | $0 | $727 | $0 | $559,022 | $0 | $0 |
| RENEE M THIGPEN | ||||||||||||||
| CHIEF HR OFFICER | $0 | $333,643 | $0 | $77,240 | $0 | $75,069 | $0 | $11,600 | $0 | $19,167 | $0 | $516,719 | $0 | $0 |
| PAMELA ZIPPERER-DAVIS TRM 0321 | ||||||||||||||
| FORMER CHIEF ADMINISTRATIVE OFFICER | $0 | $141,028 | $0 | $35,670 | $0 | $291,744 | $0 | $0 | $0 | $19,661 | $0 | $488,103 | $0 | $0 |
| MICHAEL RILEY | ||||||||||||||
| FORMER CHIEF STRATEGY OFFICER | $0 | $316,582 | $0 | $64,739 | $0 | $2,198 | $0 | $8,979 | $0 | $17,258 | $0 | $409,756 | $0 | $0 |
| ANDREW COOPER START 0822 | ||||||||||||||
| CHIEF INFORMATION OFFICER | $0 | $206,115 | $0 | $29,305 | $0 | $8,786 | $0 | $9,911 | $0 | $10,050 | $0 | $264,167 | $0 | $0 |
| GINA TEEGARDEN RN | ||||||||||||||
| CHIEF NURSING EXECUTIVE | $0 | $217,036 | $0 | $16,050 | $0 | $9,125 | $0 | $8,705 | $0 | $9,400 | $0 | $260,316 | $0 | $0 |
| ILIA ECHEVARRIA START 0122 | ||||||||||||||
| CHIEF NURSING OFFICER NNH | $0 | $211,173 | $0 | $15,754 | $0 | $8,151 | $0 | $9,484 | $0 | $12,114 | $0 | $256,676 | $0 | $0 |
| MATTHEW STACELL START 0622 | ||||||||||||||
| CHIEF PERFORMANCE MANAGEMENT OFFICER | $0 | $167,289 | $0 | $12,108 | $0 | $7,682 | $0 | $7,727 | $0 | $25,259 | $0 | $220,065 | $0 | $0 |
| LINDA ROEBACK TERM 0520 | ||||||||||||||
| FORMER CHIEF COUNSEL | $0 | $0 | $0 | $0 | $0 | $191,807 | $0 | $0 | $0 | $5,400 | $0 | $197,207 | $0 | $0 |
| THOMAS THORNTON TERM 1121 | ||||||||||||||
| CHIEF ADMIN. OFFICER | $0 | $67,778 | $0 | $70,000 | $0 | $38,764 | $0 | $0 | $0 | $4,879 | $0 | $181,421 | $0 | $0 |
| ZACHARY BOSTOCK TERM 0320 | ||||||||||||||
| FORMER CHIEF ADMIN. OFFICER | $0 | $0 | $0 | $0 | $0 | $145,718 | $0 | $0 | $0 | $5,232 | $0 | $150,950 | $0 | $0 |
| GARY TOMCIK TERM 0420 | ||||||||||||||
| FORMER CHIEF EXPERIENCE OFFICER | $0 | $0 | $0 | $0 | $0 | $122,410 | $0 | $0 | $0 | $8,384 | $0 | $130,794 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINES 4A-B | PART I, LINE 4A: CHIEF ADMINISTRATIVE OFFICER RESIGNED 03/20 AND RECEIVED A SEVERANCE PAYMENT OF $145,718 FOR CALENDAR YEAR 2021. GENERAL COUNSEL RESIGNED 05/20 AND RECEIVED A SEVERANCE PAYMENT OF $191,807 FOR CALENDAR YEAR 2021. CHIEF EXPERIENCE OFFICER RESIGNED 04/20 AND RECEIVED A SEVERANCE PAYMENT OF $122,410 FOR CALENDAR YEAR 2021. CHIEF OPERATING OFFICER RESIGNED 07/21 AND RECEIVED A SEVERANCE PAYMENT OF $436,519 FOR CALENDAR YEAR 2021. CHIEF ADMINISTRATIVE OFFICER RESIGNED 03/21 AND RECEIVED A SEVERANCE PAYMENT OF $282,056 FOR CALENDAR YEAR 2021. CHIEF ADMINISTRATIVE OFFICER RESIGNED 11/21 AND RECEIVED A SEVERANCE PAYMENT OF $33,889 FOR CALENDAR YEAR 2021. PART I, LINE 4B: THE FOLLOWING EXECUTIVES PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: PAUL HILTZ PRESIDENT AND CEO PHILLIP DUTCHER FORMER CHIEF OPERATING OFFICER RICK WYLES CHIEF FINANCIAL OFFICER KRISTIN MASCOTTI, M.D. CHIEF MEDICAL OFFICER JONATHAN KLING CHIEF OPERATING OFFICER JIM MAHON SENIOR VICE PRESIDENT RENEE THIGPEN CHIEF HR OFFICER CARLOS QUINTERO, M.D. CHIEF QUALITY OFFICER THE FOLLOWING EXECUTIVES RECEIVED A DISTRIBUTION FROM THE 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN IN CALENDAR YEAR 2021: PAUL HILTZ PRESIDENT AND CEO $144,750 PHILLIP DUTCHER FORMER CHIEF OPERATING OFFICER $ 91,500 RICK WYLES CHIEF FINANCIAL OFFICER $ 76,950 JIM MAHON SENIOR VICE PRESIDENT $ 56,250 RENEE THIGPEN CHIEF HR OFFICER $ 51,150 |
| PART I, LINE 7 | PROVISION OF NON-FIXED PAYMENTS THIS ORGANIZATION IS AN AFFILIATE OF NCH HEALTHCARE SYSTEM, INC. ("THE SYSTEM"). THE SYSTEM MAY PROVIDE DISCRETIONARY BONUS AND/OR INCENTIVE COMPENSATION PAYMENTS TO ELIGIBLE EMPLOYEES. COMPENSATION PAYMENTS FOR ALL EMPLOYEES EXCLUDING THE CEO AND SENIOR LEADERSHIP TEAM IS DETERMINED BY THE SYSTEM BOARD OF TRUSTEES HUMAN RESOURCES COMMITTEE AND/OR CEO. COMPENSATION PAYMENTS MADE TO ANY DISQUALIFIED PERSON IS APPROVED BY THE SYSTEM THROUGH THE PROCESS DESCRIBED IN FORM 990, PART VI, SECTION B, LINE 15. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | GOVERNING BODY AND MANAGEMENT NCH HEALTHCARE SYSTEM,INC. IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | GOVERNING BODY AND MANAGEMENT NCH HEALTHCARE SYSTEM, INC. SOLE MEMBER OF THIS ORGANIZATION, ELECTS THIS ORGANIZATION'S DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | GOVERNING BODY AND MANAGEMENT ALL OF THE GOVERNANCE DECISIONS FOR MARCO ISLAND HOSPITAL, INC. ARE RESERVED TO THE GOVERNING BODY OF NCH HEALTHCARE SYSTEM, INC. |
| FORM 990, PART VI, SECTION B, LINE 11B | REVIEW PROCESS INFORMATION RELATED TO MARCO ISLAND HOSPITAL, INC.'S ("MIH") FORM 990 FILING IS GATHERED BY FINANCE STAFF AND PROVIDED TO RSM US LLP FOR REVIEW. AFTER THE REVIEW BY RSM US LLP, THE FORM 990 IS REVIEWED BY THE NCH HEALTHCARE SYSTEM CHIEF FINANCIAL OFFICER. THE FORM 990 IS THEN REVIEWED BY OUTSIDE COUNSEL FOR THE BOARD. PRIOR TO BOARD APPROVAL, THE FORM 990 IS PROVIDED TO ALL OF THE FINANCE COMMITTEE BOARD OF TRUSTEES FOR THEIR REVIEW VIA THE BOARD PORTAL. AT THE CONCLUSION OF THIS REVIEW PROCESS THE FORM 990 IS APPROVED BY THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST POLICY ANNUALLY, ALL NCH HEALTHCARE SYSTEM, INC. OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE INTERESTS THAT COULD POTENTIALLY GIVE RISE TO CONFLICTS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. MANAGEMENT SHALL DISCLOSE OTHER POTENTIAL CONFLICTS WITH THE COMPLIANCE OFFICER. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINED UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A GREATER THAN TWO-THIRDS VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. THE COMPLIANCE OFFICER WILL DETERMINE IF A MANAGEMENT TEAM MEMBER OR EMPLOYEE SHOULD BE EXCUSED FROM A DISCUSSION OR PARTICIPATE IN A DECISION IN WHICH THERE MAY BE A CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION PROCESS THIS ORGANIZATION IS AN AFFILIATE OF THE NCH HEALTHCARE SYSTEM, INC. ("THE SYSTEM"). COMPENSATION ARRANGEMENTS INVOLVING OUR CEO AND SENIOR LEADERSHIP TEAM ARE ESTABLISHED BY THE SYSTEM BOARD OF TRUSTEES COMPENSATION COMMITTEE PURSUANT TO A PROCESS THAT SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE AVAILABLE FOR SECTION 4958 EXCESS BENEFIT TRANSACTION TAX PURPOSES (WHICH REQUIRES A REVIEW OF COMPENSATION DETERMINATION BY DISINTERESTED PERSONS, USE OF APPROPRIATE COMPARABILITY DATA, AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS). |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS AVAILABLE TO THE PUBLIC THE FORMS 1023 AND 990, GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY OF NHSI ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO AVAILABLE VIA OUR WEBSITE: HTTP://WWW.NCHMD.ORG/ABOUT-US/ANNUAL-REPORTS. DOCUMENTS AVAILABLE FOR REQUEST ARE AVAILABLE PURSUANT TO THE PERIOD OF DISCLOSURE PROVIDED IN SECTION 6104(D). |
| FORM 990, PART XI, LINE 9: | TRANSFERS TO RELATED ORGANIZATIONS -102,309. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NCH HEALTHCARE SYSTEM INC | |||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 592314655 | HOLDING CO | FL | 501 (C) (3) | LINE 12B, II | N/A | 0 | |
| NAPLES COMMUNITY HOSPITAL INC | |||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 590694358 | HEALTHCARE | FL | 501 (C) (3) | LINE 3 | Yes (1) | NCH SYSTEM | |
| NCHMD INC | |||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 331075317 | HEALTHCARE | FL | 501 (C) (3) | LINE 10 | Yes (1) | NCH SYSTEM | |
| COMMUNITY HOME SERVICES INC | |||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 592440516 | SUPPORT ORG | FL | 501 (C) (3) | LINE 12B, II | Yes (1) | NCH SYSTEM | |
| COLLIER HEALTH CARE INC | |||||||||||
| PO BOX 413029 | NAPLES | FL | 34101 | 650244276 | HEALTHCARE | FL | 501 (C) (3) | LINE 3 | Yes (1) | NCH SYSTEM | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| PROSCAN NCH IMAGING LLC | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 861212843 | RADIOLOGY SERVICES | DE | N/A | 0 | 0 |
| NCH-VH JOINT VENTURE LLC | |||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 874042152 | SURGICAL SERVICES | KS | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|
| HEALTH RESOURCES CORPORATION | ||||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592568003 | HOLDING COMPANY | FL | NCH SYSTEM | C | Yes (1) | |
| AMBULATORY SURGICAL CARE CENTER INC | ||||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592568029 | OUTPATIENT SURGERY | FL | HRC | C | Yes (1) | |
| COMMUNITY HOME CARE INC | ||||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592372966 | HOME HEALTH | FL | HRC | C | Yes (1) | |
| COMMUNITY IMAGING INC | ||||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | 592446336 | RADIOLOGY LAB | FL | HRC | C | Yes (1) | |
| GREATER COLLIER INSURANCE LTD | ||||||||||
| 350 7TH STREET NORTH | NAPLES | FL | 34102 | INSURANCE | FL | C | 0 | N/A | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NAPLES COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | P | TransactionTypeTxt |
| Involved | $123,825 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |
Comments