2019-05-22T14:17:07-05:00 2018-06-30 721396621 CARR RIGGS & INGRAM LLC 1117 BOLL WEEVIL CIRCLE ENTERPRISE AL 36330 990 2017-07-01 590914771 FISHERMEN'S HOSPITAL INC FISH 3057435533 3301 OVERSEAS HIGHWAY MARATHON FL 33050 DANIEL SAMESS CHAIRMAN 3057435417 2019-05-22 1 ASHLEY H STAFFORD P00248001 3343470088 2019-05-22 198.73.26.130 2019-05-22 11:00:15 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4815D86FBD379E0D2576E3DF5FFF015EDF8990DB 2017 2019-02-21 02:37:17Z DANIEL SAMESS 3301 OVERSEAS HIGHWAY MARATHON FL 33050 11005416 0 X HTTPS://BAPTISTHEALTH.NET/EN/FACILITIES/FISHERMEN X 1957 FL TO PROVIDE EXCELLENCE IN HEALTH CARE.TO PROMOTE PATIENT, PHYSICIAN AND STAFF SATISFACTION AND CONFIDENCE.TO ENSURE PATIENT RIGHTS ARE PROTECTED AND RESPECTED.TO IMPROVE THE QUALITY OF MEDICAL SERVICES CONSISTENT WITH TECHNOLOGICAL AND SYSTEMS DEVELOPMENT.TO SEEK OUT THE MEDICAL NEEDS OF THE COMMUNITY WE SERVE AND TO MEET THOSE NEEDS IN A TIMELY AND COST EFFECTIVE MANNER.TO PROTECT OUR ENVIRONMENT IN EVERY TASK WE UNDERTAKE.TO PROVIDE OPPORTUNITIES TO OUR STAFF FOR THEIR PERSONAL AND PROFESSIONAL DEVELOPMENT.TO COMMUNICATE THE POSITIVE AND EFFECTIVE ROLE PLAYED BY FISHERMEN'S COMMUNITY HOSPITAL IN OUR COMMUNITY.TO PERFORM OUR MISSION AT THE HIGHEST LEVEL OF ETHICAL EXPECTATIONS. 6 6 238 0 0 0 261046 0 29496813 0 12318 11005416 0 0 29770177 11005416 637159 0 0 0 13959220 808105 0 0 0 22147274 3309155 36743653 4117260 -6973476 6888156 12602735 1709381 18700625 919115 -6097890 790266 X TO PROVIDE EXCELLENCE IN HEALTH CARE.TO PROMOTE PATIENT, PHYSICIAN AND STAFF SATISFACTION AND CONFIDENCE.TO ENSURE PATIENT RIGHTS ARE PROTECTED AND RESPECTED.TO IMPROVE THE QUALITY OF MEDICAL SERVICES CONSISTENT WITH TECHNOLOGICAL AND SYSTEMS DEVELOPMENT.TO SEEK OUT THE MEDICAL NEEDS OF THE COMMUNITY WE SERVE AND TO MEET THOSE NEEDS IN A TIMELY AND COST EFFECTIVE MANNER.TO PROTECT OUR ENVIRONMENT IN EVERY TASK WE UNDERTAKE.TO PROVIDE OPPORTUNITIES TO OUR STAFF FOR THEIR PERSONAL AND PROFESSIONAL DEVELOPMENT.TO COMMUNICATE THE POSITIVE AND EFFECTIVE ROLE PLAYED BY FISHERMEN'S COMMUNITY HOSPITAL IN OUR COMMUNITY.TO PERFORM OUR MISSION AT THE HIGHEST LEVEL OF ETHICAL EXPECTATIONS. 0 0 4117260 THE HOSPITAL WAS LICENSED DURING THE FISCAL YEAR ENDED JUNE 30, 2017 BY THE STATE OF FLORIDA TO OPERATE 25 BEDS, INCLUDING 12 SWING BEDS, AS A CRITICAL ACCESS HOSPITAL. THE HOSPITAL PROVIDED ACUTE INPATIENT CARE AND OUTPATIENT SERVICES, PRIMARILY TO PATIENTS IN THE LOWER AND MIDDLE FLORIDA KEYS. THE HOSPITAL FACILITY WAS SOLD TO BAPTIST HEALTH SOUTH FLORIDA ON JULY 1, 2017. 4117260 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 59 0 1 238 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 FL X DANIEL SAMESS 3057435417 3301 OVERSEAS HIGHWAY MARATHON FL 33050 X PETER CHAPMAN MEMBER 4.00 X 0 0 0 BARBARA WRIGHT VICE CHAIR 4.00 X 0 0 0 JEFF COLDREN SECRETARY 4.00 X 0 0 0 DANIEL SAMESS CHAIR/TREASURER 4.00 X 0 0 0 RICH MALAFY MEMBER 4.00 X 0 0 0 CHRISTOPHER WALDERA MEMBER 4.00 X 0 0 0 TERESA CONDAS MEMBER 4.00 X 0 0 0 LYNN W MAUCK FORMER COO/CNO 40.00 X 156961 0 4992 STEVEN J SMITH PHYSICIAN 40.00 X 371290 0 5367 EDWARD COLLINS PHYSICIAN 40.00 X 456245 0 7702 RONALD SAMESS PHYSICIAN 40.00 X 175702 0 5771 ALAN NETZMAN PHYSICIAN 40.00 X 127296 0 2928 CYNTHIA JOHNSTON PHYSICIAN 40.00 X 141520 0 2966 HENRY DEGROOT PHYSICIAN 40.00 X 137697 0 0 CECILE MUEHRCKE PHYSICIAN 40.00 X 128876 0 3365 1695587 0 33091 8 0 1 0 QUORUM HEALTH RESOURCES LLC 1573 MALLORY LANE SUITE 200 BRENTWOOD TN 37027 CONSULTING/MANAGEMENT SERVICES 700000 JAY A ZISKIND PA 3471 MAIN HIGHWAY STE 517 MIAMI FL 33133 LEGAL SERVICES 380000 PRIME RATE PREMIUM FINANCE CORPORATION I 2141 ENTERPRISE DR FLORENCE SC 295020507 INSURANCE PREMIUMS 221075 MEDHOST OF TENNESSEE INC 2739 MOMENTUM PLACE CHICAGO IL 606895327 SOFTWARE SERVICES 146651 MERITAIN HEALTH 300 CORPORATE PARKWAY AMHERST NY 14226 HEALTH INSURANCE PROVIDER 121382 6 11005416 0 11005416 11005416 11005416 11005416 11005416 0 0 X 808105 808105 1695534 1695534 104146 104146 47255 47255 OTHER OPERATING EXPENSE 725161 725161 PATIENT, PHARMACY AND O 459311 459311 TAXES 204180 204180 RENTS 72484 72484 1084 1084 4117260 4117260 0 0 4344146 1432662 2401730 276719 774939 508496 0 4470222 103202 0 12602735 1709381 5516343 919115 13184282 18700625 919115 X -6097890 790266 -6097890 790266 12602735 1709381 6888156 0 X 0 0 0 X 0 X PART X, LINE 2: THE HOSPITAL AND FOUNDATION HAVE BOTH BEEN GRANTED TAX-EXEMPT STATUS UNDER SECTION 501(A)(3) OF THE IRC AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) WHEREBY ONLY UNRELATED BUSINESS INCOME, AS DEFINED BY SECTION 512(A)(1) OF THE CODE, IS SUBJECT TO FEDERAL INCOME TAX. FISHERMEN'S HAD NO SIGNIFICANT UNRELATED BUSINESS TAXABLE INCOME; ACCORDINGLY, NO PROVISION OR BENEFIT FOR INCOME TAXES HAS BEEN INCLUDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. FISHERMEN'S APPLIES THE PROVISIONS OF FASB ASC 740, INCOME TAXES. THIS ASC REQUIRES THAT A TAX POSITION BE RECOGNIZED OR DERECOGNIZED BASED ON A "MORE-LIKELY-THAN-NOT" THRESHOLD. THIS APPLIES TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THIS ASC HAD NO IMPACT ON THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS OR STATEMENTS OF OPERATIONS. FISHERMEN'S DOES NOT BELIEVE ITS CONSOLIDATED FINANCIAL STATEMENTS INCLUDE ANY MATERIAL UNCERTAIN TAX POSITIONS. FISHERMEN'S POLICY IS TO RECORD INTEREST AND PENALTIES ASSOCIATED WITH TAXES IN "INTEREST" ON THE CONSOLIDATED STATEMENTS OF OPERATIONS. THE HOSPITAL AND FOUNDATION'S OPEN TAX YEARS THAT REMAIN SUBJECT TO AUDIT ARE FISCAL YEARS 2014 THROUGH 2017. 0 0 0 0 0 0 0 0 0 LYNN W MAUCK FORMER COO/CNO 156961 0 0 0 0 0 4992 0 0 0 161953 0 0 0 STEVEN J SMITH PHYSICIAN 371290 0 0 0 0 0 5367 0 0 0 376657 0 0 0 EDWARD COLLINS PHYSICIAN 456245 0 0 0 0 0 7702 0 0 0 463947 0 0 0 RONALD SAMESS PHYSICIAN 175702 0 0 0 0 0 5771 0 0 0 181473 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW PURPOSES. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO REPORT ANY CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST FORM 990, PART IX, LINE 11G PHYSICIAN FEES, MANAGEMENT FEES & PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,695,534. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,695,534. LATE FILED RETURN DUE TO CCH SOFTWARE OUTAGE