2011-08-11T12:04:24-07:00 2010-09-30 990 2009-10-01 593234721 BAPTIST MEDICAL CENTER OF NASSAU INC BAPT 9042021797 3563 Philips Hwy Bldg A Ste 106 Attn Mike Lee Jacksonville FL 32207 Mike Lukaszewski 9042022852 2011-08-11 2009 2016-02-24 21:20:13Z BMC Nassau A Hugh Greene 800 Prudential Dr Jacksonville FL 32207 62521309 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. 15 12 544 185 12891 0 3776 101626 54849407 61478251 333827 427634 271837 496977 55458847 62504488 15241 25849 0 0 22455711 24490706 0 0 0 22850275 29210477 45321227 53727032 10137620 8777456 69024180 75882547 13588210 12445873 55435970 63436674 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 46984907 25849 62504488 Health Care Delivery & Management: 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. BMCN has earned Magnet recognition for excellence in patient care. BMCN offers many advanced services and technologies not typically seen in a community hospital, including 64-slice CT, digital mammography and 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 501(c)(3) affiliated hospital, 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 the Baptist Health System, BMCN has access to many additional specialized physicians, services, and resources when needed. During the fiscal year, there were 2,920 admissions (7.9% increase over prior year) accounting for 10,785 patient days, and 24,121 emergency room visits (2.4% over prior year). Uncompensated Care and Community Benefit: Baptist Medical Center of Nassau, Inc. (BMCN) is part of Baptist Health System, Inc. (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 ending September 30, 2010: (1) Charity care - $2.5 million (2) Unreimbursed Medicaid Cost - $0.7 million (3) Unreimbursed Medicare Cost - $2.9 million, (4) Specific Community Programs - $26 thousand, (5) Unreimbursed Bad Debt Expense - $1.0 million, for a total of $7.1 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. Through its affiliated hospital, Southern Baptist Hospital of Florida, the following charitable donations were provided to the BMCN 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, and $5 thousand dollars for the Nassau Boys and Girls Club, which assists the youth of the local community. $26 thousand dollars were also donated to various civic and charitable organizations within the Nassau community directly by BMCN. 0 0 0 n/a 0 0 0 n/a 0 0 0 46984907 1 1 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 1 59 0 544 1 0 0 0 0 0 0 0 0 0 15 12 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Scott Finnegan 9042023270 3563 Philips Hwy Bld A Ste 608 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 Marshall Wood 2 X 0 0 0 Terrell J Powell 2 X 0 0 0 Jack B Healan Jr 2 X 0 0 0 William H Gower 2 X 0 0 0 Gerald R Burford MD 2 X 0 0 0 Michael M Bell 2 X 0 0 0 Katharine Monahan 2 X 0 0 0 A Hugh Greene 0 X X 0 1061640 312797 John F Wilbanks 0 X 0 597690 132026 Harvey Granger 0 X 0 479343 129232 Jim L Mayo 40 X 209552 0 33758 Michael Lukaszewski 0 X 0 3798767 39987 Denise S McClure-Drabick 40 X 363048 0 35006 Mary Ann Justyn 40 X 277445 0 31889 Brandi Durrence-Perkins 40 X 220960 0 22890 Barbara S Gingher 40 X 145123 0 22045 Kristin K Certain 40 X 136911 0 16510 1353039 5937440 776140 10 0 1 0 Lighthouse Anesthia LLC 6605 Abercorn St Ste 108 Savannah GA 31405 Anesthesia services 624197 Sodexho Inc & Affiliates PO Box 536922 Atlanta GA 303536922 Restaurant/housekeeping 242667 Emergency Resources Group 820 Prudential Dr Ste 713 Jax FL 32207 Physician services 147044 3 0 0 0 101626 0 0 0 101626 Net patient service revenues 622000 61465360 61465360 0 0 Reference lab 621500 12891 0 12891 0 0 0 0 0 61478251 418671 0 0 418671 0 0 0 0 0 0 0 0 177286 0 10274 0 167012 0 167012 0 0 167012 0 15510 0 6547 0 8963 8963 0 0 8963 0 Cafeteria revenues 722100 214540 0 0 214540 Record duplication revenues 561439 46131 0 0 46131 Reference lab revenues 621500 40756 0 0 40756 28538 0 0 28538 329965 62504488 61465360 12891 924611 25849 25849 0 0 0 0 0 0 228349 0 228349 0 0 0 0 0 17608314 17016995 591319 0 1442466 1378679 63787 0 3893925 3774106 119819 0 1317652 1276510 41142 0 254808 127404 127404 0 19079 9540 9539 0 13280 6640 6640 0 0 0 0 0 0 0 0 0 0 0 2300636 763432 1537204 0 137482 68741 68741 0 8682359 8415811 266548 0 38231 37019 1212 0 0 0 0 0 1559856 1510409 49447 0 64819 58898 5921 0 0 0 0 0 85837 2668 83169 0 47217 45328 1889 0 0 0 0 0 3459976 3321577 138399 0 289960 278362 11598 0 Bad debt expense 7815345 7815345 0 0 System functions allocation 3386880 0 3386880 0 AHCA fees 585905 585905 0 0 Interest rate swap expense & nonoperating losses 424629 424629 0 0 NICA fees 37942 37942 0 0 6236 3118 3118 0 53727032 46984907 6742125 0 800 800 0 0 0 0 7088687 7132192 0 0 0 0 0 0 918331 878725 587892 880063 65583708 22933045 41301727 42650663 6346054 6764736 0 0 0 0 12780689 17575368 69024180 75882547 6206103 5269379 0 0 0 0 6231229 5878023 0 0 0 0 0 0 0 0 1150878 1298471 13588210 12445873 X 54917107 63364880 518863 71794 0 0 55435970 63436674 69024180 75882547 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 66966 0 6500 0 1672 0 71794 76002 0 -1385 0 7651 0 66966 1.00 0 0 0 1 1 0 477107 477107 0 39283502 8304919 30978583 0 37471 37471 0 0 24414753 13843455 10571298 0 1370875 747200 623675 42650663 Advances to affiliated organizations 14896207 Interest in net assets of Baptist Health System Foundation Inc 1687893 Long-term guarantee receivables 975814 Cost of issuance, long-term bonds 15454 17575368 0 Bond swap market values 695143 Estimated third party settlements 570728 Long term physician guarantees 32600 1298471 62504488 53727032 8777456 0 0 0 770540 -1547292 -776752 8000704 62514762 0 0 0 0 0 62514762 0 -10274 -10274 62504488 53737306 0 0 0 10274 10274 53727032 0 0 0 53727032 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 affiliate, Baptist Health System Foundation, Inc. Annually, 5% of the combined endowment corpus and accumulated earnings are available for spending on capital projects of BMCN. SchD_P10_S00_L00 Schedule D, Part X 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, BHS adopted ASC 740-10. The impact of the adoption of ASC 740-10 on these financial statements was not significant. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 (1) Unrestricted transfers to affiliated organizations ($1,501,720) (2) Unrestricted contributions for the purchase of property, plant, and equipment ($153,365) (3) Unrestricted net assets released from restrictions used for purchase of property, plant, and equipment $554,859 (4) Restricted contributions $99,954 (5) Investment gains on restricted net assets $6,500 (6) Restricted net assets released from restrictions ($553,520). SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Rental expenses of $10,274 are included in Part VIII, 6b, but are included in expenses and not revenues per the organization's audited financial statements. SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Rent expenses reported on Form 990, Part VIII, Line 6b, as rental expenses are $10,274. 1 1 X 1 X 1 X 1 1 1 0 1 1 2535380 0 2535380 0.0552 695229 695229 0.0151 0 0 0 0.00 0 0 3230609 0 3230609 0.0703 0 0 0 0.00 0 0 0 0 0 0 0 0 0 0 0 0 25849 0 25849 0.0006 0 0 25849 0 25849 0.0006 0 0 3256458 0 3256458 0.0709 0 1002454 0 16120474 18965144 -2844670 X 1 1 Baptist Medical Center of Nassau Inc

1250 S 18th St Fernandina Beach FL 32034

X X X Southern Baptist Hospital of Florida Inc Expenses for each category of community benefit are determined by using a cost-to-charge ratio specific to that category, determined using our cost accounting system. n/a $7,815,345 was the amount of bad debt expense reported in Form 990, Part IX, Column (A). All of this amount was removed from the denominator prior to calculating the percentages in Schedule H, Part I, 7(f) per the instructions for Form 990, Schedule H. The provision for bad debts is based upon management's assessment 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 Medical Centers' 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. Medicare allowable costs of care based on cost to charge ratio and cost accounting system of the organization. The written debt collection policy does not specifically address those patients who qualify for charity care, or have applied for charity care, as the organization does not bill these patients. The organization's cost accounting system identifies all patients that 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 non-compliant. Part VI - Line 8 - Baptist Health System, Inc. (BHS), parent affiliate of Baptist Medical Center of Nassau, Inc., and its related affiliates are all located within the Northeast Florida quadrant. An annual Community Benefit Report is published and available on the e-baptisthealth.com website. 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. The organization has partnered with the Duval County Health Department in its regional health assessment (MAPP). BHS also performed, in conjunction with the Health Planning Council, a "porch-to-porch" assessment in the New Town subdivision of Health Zone 1. This zone represents the greatest number of health disparities for the region and the lowest social-economic indicators. The organization also relies on a number of statistical reports provided by the Duval County Health Department on a variety of health care needs in the community. BHS has a dedicated community health board that focuses solely on the health needs of the community. BHS is an organizing member of a committee comprised of several non-profit hospitals and other health care agencies that focus on health care needs. 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. Baptist Health System Inc. (BHS), the parent affiliate of Baptist Medical Center of Nassau, Inc., is a five-hospital system that covers both urban and rural areas. BHS covers a five-county area of Northeast Florida including downtown Jacksonville. BHS focuses its community health initiatives on lower income areas that also have high health needs. Much of this is provided through the churches in the area as well as the school systems. There is a heightened emphasis on cardiovascular diseases and asthma. The focus is on the uninsured and underserved groups consisting primarily of African-Americans with a smaller percentage of Caucasian, Hispanic and Asian populations. All Baptist Health System, Inc. (BHS) affiliates, including Baptist Medical Center of Nassau, Inc., maintain an open medical staff. BHS has a Community Health Board Committee that focuses on community health needs in the five-county area. BHS directly donates over a million dollars annually to several organizations that provide health services to the homeless, uninsured and underserved populations in the five-county area. Southern Baptist Hospital of Florida, Inc., d/b/a Baptist Medical Center, is the largest hospital in the Baptist Health System and coordinates the majority of community health initiatives for the hospital system. However, each affiliate hospital is involved in health initiatives in their immediate community. These initiatives consist primarily of direct health care services to low income adults and families. 1 X SchI_P01_S00_L02 Schedule I, Part I, Line 2 Our community health efforts are guided by the Community Health Committee, comprised of selected Baptist Health Board members from across the health system. The Committee provides strategic direction related to our community health activities and ensures we focus on key priorities that align with our organization's mission. X X X X 0 1 0 0 0 0 0 0 0 A Hugh Greene 0 705486 0 325000 0 31154 0 294876 0 17921 0 1374437 0 0 John F Wilbanks 0 416149 0 165964 0 15577 0 119121 0 12905 0 729716 0 0 Michael Lukaszewski 0 396129 0 133520 0 3269118 0 27154 0 12833 0 3838754 0 3151623 Harvey Granger 0 343476 0 120290 0 15577 0 111912 0 17320 0 608575 0 0 Jim L Mayo 166667 0 32500 0 10385 0 22512 0 11246 0 243310 0 0 0 Denise S McClure-Drabick 363048 0 0 0 0 0 25550 0 9456 0 398054 0 0 0 Mary Ann Justyn 277445 0 0 0 0 0 17846 0 14043 0 309334 0 0 0 Brandi Durrence-Perkins 220960 0 0 0 0 0 9270 0 13620 0 243850 0 0 0 Barbara S Gingher 130144 0 14979 0 0 0 15443 0 6602 0 167168 0 0 0 Kristin K Certain 127911 0 9000 0 0 0 6464 0 10046 0 153421 0 0 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Southern Baptist Hospital of Florida, 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 (Supplemental Vice-President Executive Retirement Plan). These SERPs are plans described in IRC 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 2009: A. Hugh Greene, $272,142, John F. Wilbanks, $100,597, and Harvey Granger, $90,141. These amounts were included in Schedule J, Part II, Column (c) for each of the listed individuals. During 2009, Michael Lukaszewski reached retirement age under the plan and his benefit of $2,856,831 (an amount accrued over his 22 years of service) vested. Because this vested amount became taxable upon Mr. Lukaszewski reaching retirement age, the plan distributed $1,033,344 to the IRS for associated income taxes and payroll taxes. The remainder will be distributed on a monthly basis over Mr. Lukaszewski's life expectancy. In addition to the SERP plans, Southern Baptist Hospital of Florida, Inc. had an inactive 457(f) nonqualified elective deferred compensation plan that was terminated on January 30, 2009. As a result of this termination, the accumulated values of the previously deferred employee contributions became vested and were distributed to participants. Amounts distributed included $396,711 to Michael Lukaszewski and $181 to Harvey Granger. These amounts were included on Schedule J, Part II, Column (B)(iii) for each individual. Jacksonville Health Facilities Authority Var Rate Hospital Rev Refunding Bonds Series 2007 CDE 469404UN5 2007-05-17 3264000 Refund Series 1997A bonds 0 0 3264000 0 3255494 0 8506 0 0 2007 1 0 1 1 0 0 0 0 1 0.00 0.00 0.00 1 0 1 1 UBS and Wells Fargo 16.1 0 0 0 Gregory N Smith MD Director of organiz. 100000 Medical Dir, Surgical Serv. 0 Amelia Internal Medicine PA Director - Gerald Burford, MD 103253 Rent paid to organization 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_L11 Form 990, Part VI, Section B, Line 11 11a. 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 15a & 15b. 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 minutes 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 Audited Financial Statements are on file with Florida's Agency for Health Care Administration. SchK_P01_S00_L00c Schedule K, Part I, Column c CUSIP #'s: (1) Series 2007C - 469404UN5, (2) Series 2007D - 469404UP0, and (3) Series 2007E - 469404UM7 Southern Baptist Hospital of Florida Inc 800 Prudential Dr Jacksonville FL 32207 590747311 Hospital FL 501(c)(3) 3 Baptist Health System Inc Baptist Health System Inc 800 Prudential Dr Jacksonville FL 32207 592487136 Mgt. assistance to affiliates FL 501(c)(3) 11a N/A 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 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 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 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 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 0 0 1 1 1 1 1 1 0 Baptist Health System Foundation Inc c 101626