2012-08-14T11:27:24-07:00 2011-09-30 990 2010-10-01 593234721 Baptist Medical Center of Nassau Inc BAPT 9042021797 3563 Philips Hwy Bldg F Ste 608 Attn Mike Lee Jacksonville FL 32207 Mike Lukaszewski 9042022852 2012-08-14 2010 2016-02-24 21:20:13Z X BMC Nassau A Hugh Greene 800 Prudential Dr Jacksonville FL 32207 62151965 0 X e-baptisthealth.com X 1994 FL Continue the healing ministry of Christ by providing accessible, quality healthcare services at a reasonable cost in an atmosphere that fosters respect and compassion. 13 9 448 186 8696 0 101626 222309 61478251 61301964 427634 49602 496977 572195 62504488 62146070 25849 49188 0 0 24490706 24116143 0 0 0 29210477 30636715 53727032 54802046 8777456 7344024 75882547 81302502 12445873 11112180 63436674 70190322 Continue the healing ministry of Christ by providing accessible, quality healthcare services at a reasonable cost in an atmosphere that fosters respect and compassion. 0 0 47343936 49188 61301964 Baptist Medical Center of Nassau, Inc. (BMCN) is a highly advanced, extremely well-equipped community hospital on Amelia Island that provides a full spectrum of inpatient and outpatient services and 24-hour emergency care to coastal communities in northeast Florida and southeast Georgia. BMCN is an Accredited Chest Pain Center, has earned Magnet recognition for excellence in patient care, and offers many advanced services and technologies not typically seen in a community hospital, including 64-slice CT, digital mammography and a full-time hospitalist program. BMCN was one of the first community hospitals in the nation to convert to an electronic medical record system. All patients are cared for in the state-of-the-art Berkman Building, which offers 48 private patient suites including intensive care. BMCN has a busy maternity department, delivering over 450 babies per year. Inpatient pediatric care is provided by Wolfson Children's Hospital in Jacksonville, our sister hospital in Baptist Health System (BHS), and the only pediatric specialty hospital in the area. The medical staff includes highly trained physicians in 24 different specialties who practice locally, and as part of BHS, BMCN has access to many additional specialized physicians, services, and resources when needed. During the fiscal year, there were 2,981 admissions accounting for 9,839 patient days, and there were 24,710 emergency room visits. As part of BHS, the region's only community-owned, faith-based healthcare system, BMCN is committed to improving the health of everyone in its community, regardless of their ability to pay. BMCN provided the following Uncompensated Care and Community Benefit for the fiscal year ended September 30, 2011: (1) Charity Care, $2.6 million (2) Unreimbursed Medicaid Costs, $1.2 million (3) Unreimbursed Medicare Costs, $4.0 million (4) Specific Community Programs, $43 thousand, and (5) Unreimbursed Bad Debt Expense, $1.2 million, for a total of $9.1 million of uncompensated care and community benefit. BMCN's primary focus is addressing unmet health needs, particularly among vulnerable populations who have limited resources and access to health care. BMCN has gone beyond the delivery of essential health care to improve the lives of individuals and the overall quality of life in our region. Baptist Health's Community Health Committee guides the community health efforts. This committee provides strategic direction related to community health activities and ensures focus on key priorities that align with Baptist Health's mission. A cornerstone of our commitment to the community is caring for the health of vulnerable, uninsured and underserved people among us. One of BMCN's guiding principles of community health is to collaborate with other local organizations to leverage our collective expertise and strength for the health benefits of the community. This collaborative approach helps ensure efficiency and avoids duplication of effort, resulting in enhancement of the lives of area residents at every life stage and income level. BMCN community health priorities currently include: (1) increasing access to care for medically underserved people, (2) preventing and managing chronic diseases, (3) assisting victims of domestic violence, and (4) helping our children and youth. BMCN provided the following charitable donations to the Nassau County community: $15 thousand dollars in assistance to the Barnabus Center, a clinic for the underserved, $6 thousand dollars for Micah's Place, a shelter for women and children of domestic violence, $10 thousand for the Nassau Boys and Girls Club, which assists the youth of the local community, and $18 thousand dollars to various civic and charitable organizations. 0 0 0 47343936 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 1 55 0 1 448 1 1 1 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X X Scott Finnegan 9042023270 841 Prudential Dr Aetna Bldg Suite 1602 Jacksonville FL 32207 James M Townsend 2 X X 0 0 0 Rick Keffer 2 X X 0 0 0 Christina Bryan 2 X X 0 0 0 Willie J Scott 2 X 0 0 0 Gregory N Smith MD 2 X 0 0 0 Jon C Lasserre 2 X 0 0 0 Donna Lynn VanPuymbrouck 2 X 0 0 0 Katharine Monahan 2 X 0 0 0 Michael M Bell 2 X 0 0 0 Jack B Healan Jr 2 X 0 0 0 Gerald R Burford MD 2 X 0 0 0 William H Gower 2 X 0 0 0 Terrell J Powell 2 X 0 0 0 Marshall Wood 2 X 0 0 0 A Hugh Greene 0 X X 0 935923 406991 John F Wilbanks 0 X 0 520205 182738 Harvey Granger 0 X 0 441702 171606 Jim L Mayo 40 X 202167 0 39757 Michael Lukaszewski 0 X 0 504752 47190 Jane Herzog 40 X 171729 0 11905 Barbara S Gingher 40 X 141919 0 27167 Kristin K Certain 40 X 130488 0 21944 Stephen Bean 40 X 125088 0 28488 Wanda Linton 40 X 120913 0 13082 892304 2402582 950868 12 0 1 0 Lighthouse Anesthia LLC 6605 Abercorn St Ste 108 Savannah GA 31405 Anesthesia services 535422 Sodexho Inc & Affiliates PO Box 536922 Atlanta GA 303536922 Restaurant/housekeeping 185293 2 0 0 0 221339 0 970 0 222309 Net patient service revenues 622000 61301964 61301964 0 0 0 0 0 0 61301964 49602 0 0 49602 0 0 0 0 0 0 0 0 168002 0 5895 0 162107 0 162107 162107 0 0 0 0 0 Restaurant revenue 722212 222258 0 0 222258 Record duplication revenue 561439 47720 0 0 47720 Reference lab revenues 621500 27723 0 8696 19027 112387 0 0 112387 410088 62146070 61464071 8696 450994 49188 49188 0 0 0 0 0 0 241924 0 241924 0 0 0 0 0 16558512 16002146 556366 0 1623360 1551607 71753 0 4436096 4299464 136632 0 1256251 1217056 39195 0 235283 117641 117642 0 47811 23906 23905 0 9912 4956 4956 0 0 0 0 0 0 0 0 0 0 0 2032855 674501 1358354 0 110168 55084 55084 0 8268277 8069172 199105 0 38323 37112 1211 0 0 0 0 0 1754357 1698744 55613 0 60053 54570 5483 0 0 0 0 0 91197 2836 88361 0 53168 51041 2127 0 0 0 0 0 3687328 3539835 147493 0 -50079 -48076 -2003 0 Bad debt expense 9137967 9137967 0 0 System functions allocations 4343928 0 4343928 0 AHCA & NICA assessments 618794 618794 0 0 Bonds interest rate swap expense 175412 175412 0 0 Other administrative and general expense 21961 10980 10981 0 54802046 47343936 7458110 0 800 600 0 0 0 0 7132192 7216969 0 0 0 0 0 0 878725 745105 880063 700890 65939647 25499948 42650663 40439699 6764736 6814338 0 0 0 0 0 0 17575368 25384901 75882547 81302502 5269379 4872372 0 0 0 0 5878023 5500323 0 0 0 0 0 0 0 0 1298471 739485 12445873 11112180 X 63364880 70047201 71794 106935 0 36186 63436674 70190322 75882547 81302502 X 7344024 -590376 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 71794 36186 286 1100 0 0 107166 66966 0 6500 1672 0 0 71794 76002 0 -1385 1597 6054 0 66966 0.662 0.338 0 0 1 1 0 477107 477107 0 39811416 9475166 30336250 0 0 0 0 0 24607234 15293055 9314179 0 1043890 731727 312163 40439699 Advances to affiliated organizations 24138339 Interest in net assets of Baptist Health System Foundation, Inc. 544338 Long term guarantee receivables 688906 Bonds prepaid cost of issuance 13318 25384901 0 Bond swap market values 739485 739485 62146070 54802046 7344024 0 0 0 0 -590376 -590376 6753648 62150995 0 0 0 0 0 62150995 0 -4925 -4925 62146070 54807941 0 0 0 5895 5895 54802046 0 0 0 54802046 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Baptist Medical Center of Nassau, Inc. (BMCN) has two temporarily restricted quasi-endowments that are held by its related fundraising affiliate, Baptist Health System Foundation, Inc. Annually, 5 per cent of the combined endowment corpus and accumulated earnings are available for spending on capital projects of BMCN. SchD_P10_S00_L02 Schedule D, Part X, Line 2 In July 2006, ASC 740-10-50-15, Income Taxes: Unrecognized Tax Benefit Related Disclosures was issued. ASC 740-10-50-15 creates a single model to address uncertain income tax positions and clarifies the accounting for income taxes by prescribing a "more likely than not" minimum recognition threshold that a tax position is required to meet before being recognized in the financial statements. Under the requirements of ASC 740-10, tax-exempt organizations may be required to record an obligation as the result of a tax position they have historically taken on various tax exposure items. Prior to ASC 740-10, the determination of when to record a liability for a tax exposure was based on whether a liability was considered probable and reasonably estimable in accordance with ASC 450, Contingencies. On January 1, 2008, Baptist Health System, Inc. adopted ASC 740-10. The impact of the adoption of ASC 740-10 on the financial statements of Baptist Medical Center of Nassau, Inc. was not significant. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Unrestricted: transfers to affiliated organizations ($865,902), contributions for the purchase of property, plant, and equipment $203,099; Restricted: contributions $72,427. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Rental expenses recorded as expenses per audited financial statements and as a reduction of gross rental revenues on Form 990, Part VIII, Line 6b, ($5,895); Contributions for the purchase of property, plant, and equipment recorded as an increase in unrestricted net assets per audited financial statements and as contributions on Form 990, Part VIII, Line 1, $970. SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Rent expense recorded as expenses per audited financial statements but recorded as a reduction of rent revenue on Form 990, Part VIII, Line 6b. 1 1 X 1 X 1 X 1 1 1 0 1 1 2587890 0 2587890 0.0567 1230364 0 1230364 0.0269 0 0 0 0 0 0 3818254 0 3818254 0.0836 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42896 0 42896 0.0009 0 0 42896 0 42896 0.0009 0 0 3861150 0 3861150 0.0845 0 1206066 0 15045765 19026152 -3980387 X 1 1 1 1 Baptist Medical Center of Nassau Inc

1250 S 18th St Fernandina Beach FL 32034

X X X Baptist Medical Center of Nassau Inc 1 0 1 1 200 1 400 1 X X X X X X X X 1 1 X 1 X X 1 X X X X X 1 X 1 0 SchH_P01_S00_L06a Schedule H, Part I, Line 6a Baptist Health System, Inc. (BHS), parent affiliate of Baptist Medical Center of Nassau, Inc. (BMCN), annually prepares a consolidated community benefit report inclusive of BMCN. SchH_P01_S00_L07 Schedule H, Part I, Line 7 The organization uses a cost-to-charge ratio based on its cost accounting system. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f Bad debt expense of $9,137,967 was included in Form 990, Part IX, Line 25, column (A), but was not included in the percentage calculations for Schedule H, Part I, Line 7, column (f), per the Form 990, Schedule H instructions. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 The provision for bad debts is based on management's assessments of historical and expected net collections considering business and economic conditions, trends in healthcare coverage and other collection indicators. Accounts receivable are written off after collection effort has been followed in accordance with the organization's policies. Accounts written off as uncollectible are deducted from the allowance for uncollectible patient accounts, and subsequent recoveries are added. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category. Bad debt expense at cost is determined by the organization's cost accounting system and cost-to-charge ratio. None of the bad debt expense at cost is included in Schedule H, Part I. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 Medicare allowable costs of care based on the organization's cost-to-charge ratio and cost accounting system are used to determine the amount reported on Line 6. None of the shortfall reported on Line 7 is included in Schedule H, Part I. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Yes, the organization does have a written debt collection policy. The policy does not specifically address those patients who are known to qualify or have applied for charity care as the organization does not bill these patients. The organization's cost accounting system identifies all patients who have a pending or approved charity application. The organization would only bill the patient if, after multiple attempts to obtain any needed documentation from the patient to complete the charity approval process, the patient was noncompliant. SchH_P05_S0B_L11 Schedule H, Part V, Section B, Line 11 Credit scores and existing credit delinquencies are also factors that are used. SchH_P05_S0B_L17 Schedule H, Part V, Section B, Line 17 At every patient access point, "Guidelines for Charity Care Eligibility" cards are provided that contain financial discount and charity care information. This includes a general chart of eligible income levels and encourages patients to speak with our patient financial advocates to arrange a financial evaluation. If seen by one of the organization's patient financial advocates, the patient is advised prior to discharge. All statements to patients provide a number to call if they need financial assistance. All applications for financial assistance are maintained whether or not the patient qualifies. SchH_P05_S0B_L19 Schedule H, Part V, Section B, Line 19 The hospital has an automatic 40% discount for all uninsured patients. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 The hospital has a minimum 40% discount, including those eligible for charity assistance, in addition to further discounts for patients qualified under our Charity Care Policy. On occasion, the net amount billed to such uninsured patients may exceed the net amount billed to insured patients. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Baptist Health System, Inc. (BHS) is the parent affiliate of Baptist Medical Center of Nassau, Inc. BHS uses a variety of sources to develop its assessment of community health needs. A health needs assessment was facilitated for 18 church partners located in the urban core to determine the health needs of the congregation and its surrounding community. The urban core is located in Health Zone 1 as identified by the Duval County Health Department. BHS assists each congregation with an anonymous assessment. The organization also retrieves data from the Northeast Florida Counts web site, which is a source of population data and development. Data is provided for Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia Counties. BHS continues to be an organizing member of a health needs committee comprised of three major non-profit hospitals in the area in addition to other health care agencies that focus on health care needs of the community. BHS is currently involved in a collaborative community health needs assessment with five hospitals and health care organizations that is expected to be completed in June, 2012. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 At every patient access point, "Guidelines for Charity Care Eligibility" cards are provided that contain financial discount and charity care information. This includes a general chart of eligible income levels and encourages patients to speak with one of our patient financial advocates to arrange a financial evaluation. The organization sends statements to patients who have applied for charity care but have not provided all the documentation that is required to make a determination; letters are sent by the organization requesting the information to complete their application. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Baptist Health System, Inc. (BHS), the parent affiliate of Baptist Medical Center of Nassau, Inc., includes four licensed hospitals as part of its health system that covers both urban and rural areas. BHS targets underserved and uninsured communities located in the urban core and rural areas to provide service. BHS covers Baker, Clay, Duval, Nassau and Flagler Counties. The population of the community served is largely made up of African Americans with a very small percentage of Caucasians, Hispanic, and Asian culture. The average annual income in an area of focus located in Health Zone 1 is $21,000. BHS works with community partners to create a safety net for at-risk children, adolescents, and adults by providing nursing care. BHS continues to provide health care services to low income areas through our partnerships with local churches. 1 Barnabus Center 11 S 11th St Fernandina Beach FL 32034 592920275 501(c)(3) 15000 0 book Donation to support organization's programs in Nassau County that provide families in distress and in need with shelter, food and basic necessities. Boys and Girls Club of Nassau County Foundation Inc P O Box 16003 Fernandina Beach FL 32035 593672345 501(c)(3) 10000 0 Cash Support charitable organization whose mission is to inspire and enable all young people, especially those from disadvantaged circumstances, to realize their full potential as productive, responsible and caring citizens. Micah's Place PO Box 16287 Fernandina Beach FL 32035 593675485 501(c)(3) 6000 0 book Spouse Abuse Shelter 3 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 Our community health efforts are guided by the organization's Community Health Committee, comprised of selected Baptist Health System, Inc. (BHS) board members. BHS is the parent affiliate of Baptist Medical Center of Nassau, Inc. The committee provides strategic direction related to our community health activities and ensures we focus on key priorities that align with our mission. X X X X 0 1 0 0 0 0 0 0 0 A Hugh Greene 0 635023 0 270900 0 30000 0 392827 0 14164 0 1342914 0 0 John F Wilbanks 0 367392 0 137813 0 15000 0 169216 0 13522 0 702943 0 0 Harvey Granger 0 327477 0 99225 0 15000 0 153278 0 18328 0 613308 0 0 Michael Lukaszewski 0 345772 0 143980 0 15000 0 33730 0 13460 0 551942 0 0 Jim L Mayo 162167 0 30000 0 10000 0 27839 0 11918 0 241924 0 0 0 Jane Herzog 171729 0 0 0 0 0 1459 0 10446 0 183634 0 0 0 Barbara S Gingher 127708 0 14211 0 0 0 20214 0 6953 0 169086 0 0 0 Stephen Bean 125088 0 0 0 0 0 13328 0 15160 0 153576 0 0 0 Kristin K Certain 121988 0 8500 0 0 0 10823 0 11121 0 152432 0 0 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Baptist Health System, Inc. (BHS), parent affiliate of Baptist Medical Center of Nassau, Inc., has two active Supplemental Nonqualified Retirement Plans (SERPs). One is for certain executives (Supplemental Executive Retirement Plan) and the other is for certain vice-presidents (Vice-President Supplemental Executive Retirement Plan). These SERPs are plans described in IRS Section 457(f). The benefits under these plans accrue during each executive's term of employment. These benefits are unvested and subject to forfeiture until the covered employee reaches retirement age. The following individuals accrued unvested benefits under these plans during 2011: A. Hugh Greene, $362,706, John F. Wilbanks, $140,879, and Harvey Granger, $124,136. These amounts were included in Schedule J, Part II, Column (c) for each of the listed individuals. Jacksonville Health Facilities Authority Var Rate Hospital Rev Refunding Bonds Series 2007 CDE 469404UN5 2007-05-17 3264000 Refund Series 1997A Bonds 0 0 0 550680 0 3264000 0 0 2713320 8506 0 0 0 0 0 2007 1 0 1 1 0 0 0 0 1 0 0 0 1 0 1 1 UBS and Wells Fargo 11.8 0 0 0 0 0 Gregory N Smith MD Director of organization 100000 Fees for services provided to organization as Medical Director, Surgical Services. 0 Amelia Internal Medicine PA Gerald Burford is a Director of the organiz. and officer of Amelia Internal Medicine PA. 103000 Rent of commercial property at market value from organization by interested person. 0 F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The organization has a sole corporate member, Baptist Health System, Inc., whose Board of Directors elects the members of the organization's governing body. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a The Board of Directors of Baptist Health System, Inc., the sole corporate member of the organization, elects the members of the governing body of the organization. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b While the organization's governing body did not review the Form 990, the Executive Committee of the Board of Directors of Baptist Health System, Inc., the sole corporate member of the organization, reviewed the organization's Form 990 prior to its filing. The Executive Committee of the Board of Baptist Health System, Inc. consists of seven (7) members of its Board of Directors and is authorized by its Bylaws to act on behalf of its Board of Directors. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The Board of the organization's sole member, Baptist Health System, Inc., has a Conflicts of Interest Committee which regularly reviews the required disclosures of potential conflicts of interest by the Directors and Officers of the organization and its affiliates and recommends any action to be taken with regard to such disclosures. In accordance with the Conflicts of Interest Policy, during meetings of the organization's governing body, a Director who may have a conflict of interest is excused from discussion by the governing body about any transaction or matter that may have given rise to the Director's actual or potential conflict of interest. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 In accordance with the Executive Compensation policy of Baptist Health System, Inc. (BHS), the organization's sole member, BHS's Compensation Committee (comprised of independent Directors of BHS) engages annually a third party compensation consultant who provides a database composed of current data regarding compensation paid for each executive position by similarly situated tax exempt health systems in the country. These health systems are generally the same size as BHS, considering revenue and other appropriate indicators. The group of comparator companies that is derived based on the above stated paramaters comprise the "Market". When the Committee meets with such consultant, the consultant provides to Committee members compensation target levels that are competitive with the Market. Generally, the median of the Market is targeted. The actual amount that health system executives receive as compensation may be higher or lower than the median, depending on the health system and the individual's performance. The objective is to have a strong link between health system and individual's performance and executive compensation such that if the health system and the individual perform at an optimal level, his or her compensation is in the higher range of the Market. Conversely, if either health system or individual performance is below expectation, compensation may be in the lower range of the Market. The nimutes of the annual Compensation Committee minutes are recorded by the Committee's compensation consultant and are approved promptly by the Chair of such Committee. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Upon receiving a request from anyone, the organization will supply a copy of its governing documents, Conflicts of Interest Policy, financial statements and its most recently filed Form 990. Copies of the organization's consolidated, independent Audited Financial Statements are on file with Florida's Agency for Health Care Administration. F990_P11_S00_L05 Form 990, Part XI, Line 5 Unrestricted: transfers to affiliates ($865,902), contributions for the purchase of property, plant, and equipment $203,099; Restricted: contributions $72,427. Southern Baptist Hospital of Florida Inc 800 Prudential Dr Jacksonville FL 32207 590747311 Hospital FL 501(c)(3) 3 Baptist Health System Inc 0 Baptist Health System Inc 800 Prudential Dr Jacksonville FL 32207 592487136 Mgt. assistance to affiliates FL 501(c)(3) 11a N/A 0 Baptist Medical Center of the Beaches Inc 1350 13th Ave S Jacksonville Beach FL 32250 592980620 Hospital FL 501(c)(3) 3 Baptist Health System Inc 0 Baptist Health System Foundation Inc 841 Prudential Dr Aetna Bldg 13th Flr Jacksonville FL 32207 592487135 Fundraising activities to support hospitals FL 501(c)(3) 7 Baptist Health System Inc 0 Baptist Health Properties Inc 3563 Philips Hwy Bldg A Ste 106 Jacksonville FL 32207 592487133 Real estate and property management FL 501(c)(3) 11a Baptist Health System Inc 0 Baptist Health Ambulatory Services Inc 3563 Philips Hwy Bldg A Ste 106 Jacksonville FL 32207 593410739 Cancer research & education FL 501(c)(3) 11a Baptist Health System Inc 0 Pavilion Health Services Inc 3563 Philips Hwy Bld A Ste 106 Jacksonville FL 32207 592059710 Physician practices/retail pharmacies FL N/A C 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 1