Agenda 01/27/2009 Item #16F 4
/\genda Item r1o. 16F4
January 27, 2009
?a;i8 1 of 22
EXECUTIVE SUMMARY
Recommendation to approve a Certificate of Public Convenicnce and Necessity for
Nell IIcalthcare System for non-cmcrgency ambulance service and approve a
Bndget Amendment recognizing and appropriating the $250 annual rcnewal fee.
OBJECTIVE: Board of County Conmlissioners approval of a Certificate of Public
Convenience and Necessity for NCH Healthcare System, authorization for the Chainnan
to execute [he same and approval of a Budget Amendment [0 recognize and appropriate
the $250 annual renewal fee.
eONSIDERA nONS: NCH Healthcare Systems currently operates non-emergency
ambulance transp0l1 undcr a CerIilieate of Public Convenience and Necessity. Collier
County Ordinance No. 2004-12, as amended requires that NCH Healthcare Systems
annually renew its original Certificate of Puhlic Convenience and Necessity and pay a
$250 fee. Further, the renewal cC11ificate may be approved routinely by the Board of
County Commissioners upon advice of the Administrator. The Administrator
recommends renewal of the Certificate of Public Convenience and Necessity.
FISCAL IMPAeT: $250 to be recognized and appropriated by Budget Amendment to
Emergency Medical Services Fund 490 for FY09.
LEGAL CONSIDERA nONS: This item is legally sutlicicnt for Board action. This
item is not quasi-judicial and as such, ex p:uie disclosure is not required. This items
requires majority vote only. - JAB
GROWTH MANAGEMENT IMPACT: There IS no Growth Management Impact
associated with this action.
RECOMMENDA TION: That the Board of County Commissioners:
1. Approve the CeI1ificate of Public Convenience and Necessity for the NCH
Healthcare System;
2. Authorize the Chaimlan to execute the same: and.
3. Approve a Budget Amendment to reeogmze and appropriate the S250 annual
renewal fee.
PREP ARED BY: AIiie Bay, Supervisor - Accounting, Emergency Medical Services
Page I of I
Agenda Item ~'O. 16F4
January 27, 2009
Page 2 of 22
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
Item Number:
16F4
Item Summary:
Recommendation to approve a Certificate of Public Convenience and Necessity for NCH
Healthcare System for non-emergency ambulance service and approve a Budget
Amendment recognizing and appropriating the $250 annual renewal fee.
Meeting Date:
1/27/200990000 AM
Prepan'd By
A-"'_,",_..
MILIt: !;.>ay
SeniOl Ac.lininisil'dlive Assisiani
Date
Bureau of Emergency
Services
EMS
1/9/20099:19:55 AM
Approved R)'
.Jeff Page
EMS Chief
Date
Bureau of Emergency
Services
EMS
1/141200911:23 AM
Approved By
Jennifer A, Belpedio
,lI.ssistant County Attorney
Date
County Attorney
County Att~rney Office
1115/20099:57 AM
Approved By
Jeff Klatzkow
,b,ssf~tant :::ounty Attorney
I"'._~~
U<HI::
County Attorney
County Attorney Office
1115/::0091 :09 PM
Approved By
Dan :.:.. Summe~s
8ureau of :::mergency Services Director
Date
COUilty Manager's Office
Bureau of Emergency Services
1/15/20094:31 PM
Approved By
Sherry Pryor
i\~anagement & Budget Analyst
Offi::e of f~l.an<lgement g 8udget
Date
County ri:anager's Office
1/15/20095:20 PM
Approved Hy
James V, Mudd
COU:lty Mcnager
Date
Board of County
Cornm:ssionNs
County 1\%nagGr's Office
1!1512009 7:16 PM
fi le:IIC:\A"endaTest\Fxn0l1\ 122-.lanuarv%2027. %202009\ 1 Ii o;',?OCONSFNT%?OAr. FND
I/? 1 /?009
Agenda Item No. 16F4
January 27,2009
Page 3 of 22
COLLIER COmiTY FLORIDA
Renewal of Class "B" COPCN
Name of Service: NCH Ambulance Services
Name of Owner: NCH Healthcare System
Principle Address of Service: 2157 Pine Rid2e Road. Naples. Florida
Business Telephone: (239) 513-7080
Description of Service: Imrafacility_and out 01' county tramport for tbe ~CH Healthcan:
System
Number of Ambulances: 3 Ground Units: NCH will operate no less than one (I) and UP
to thrce (3) Ground Units on immediate call at all times.
See attachment for description of vehicles.
This permit, as provided hy Ordinance No. 2004-12, as amended shall allow the above
named Ambulance Service to operation intrafacility and out of county transports for a fee
or charge for the following area(s): Collier County until the expiration date hereon,
except that this permit may be revoked by the Board of Courty Commissioners of Collier
County at any time the service named herein shall fail 10 comply with any local, state or
federal laws or regulation application to the provisions of Emergency Medical Services.
Issued and approved this _.'
day of
.2009
ATTEST:
DWIGHT E. BROCK, CLERK
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
Deputy Clerk
Donna Fiala, Chairman
Approved as to form and legal sufficiency:
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Agenda item ~~o. 16F4
January 27, 2009
Page 5 of 22
Naph!.s Campus
3SOSeventh Street N.
Naples, Florida 14 t 02
(239) '36.\000
NCH
North Colli@r Campus
11190 He-i1lthpad: Boulevard
Naples. Florida 341,a
1239) m.7OOO
".':i:l:-- ...............
Healthcare
System
December 29, 2008
Dan Summers, Direclor
Bureau of Emergency Services
Collier County, Florida
Mr. Summers,
Pursuant to Collier County Ordinance 2004-12, please accept the following ,nformatlon for the renewal
of the required certificate for 2009.
1- NCH Ambulance Services is operated by NCH Healthcare Systems, 350 7'" Street North, Naples,
Florida, 34101
2- NCH Ambulance Services provides the NCH Hea~hcare System with interfacility, and out of county
ambulance transport.
3- NCH Ambulance Services operates up to 3, and no less than 1, State Licensed ALS Ambulances,
for 24 hours a day, and 7 days a' week.
4- NCH Ambulance Services is located at 2157 P,ne Ridge Road, Naples, Florida.
5- Schedule of attachments:
A- NCH Certificate of Liability Insurance.
s- FlOrida Department of Health, Advanced Life Support License.
C- List of permitted ALS Ambulances.
D- Schedule of Rates
I
E- list of Officers and Trustees of the NCH Healthcare System.
G- Check for $250.00 renewal fee.
Thank You for your attention to this matter. I am always available if you need further information, or
clarification on th is renewal.
Sincerely,
David Mennini. Director
NCH Am bulance Services
www.NCHmd.org
.l\genda Item No. 15F4
January 27, 2009
Page 6 of 22
Attachment A
Dr;,-r. 7 f "0
-.
ACORD,. CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 I - DATE
10/02/2008
PRODUCER B77-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ON~Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willi. North America, lnc. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
26 Century Blvd. A~ TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 31i5191
Nashville. l'lf 372305191 INSURERS AFFORDING COVERAGE NAIC'
INSURE!) -...- ---..
NC'B B.al thc:.r. Sy.tlll_llI, lne. INSURER A: Th. Charter _Oak Pire rnaur.uc. Comoanv 25615MOD1
PO Box 4130B INSURER B:
Attn: Seth Martin ,
Napl.., PL 34101 INSURER C: . I
IINSlJR.ERD: , _.
, I INSURER E:
Jl.;encja item "0. 16F4
.bnuary 27. 2009
COVE RAG ES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ,"JlJY CONTRACT OR OTHER DOCUMHlT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED DR
MAY PERTAIN, THE INSURANCE AfFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSKJNS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHO'JI./N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I
TYPEOfINSURANCE
POUCY NUMBER
Ulml
GENERAL UABlUT'Y
COMMERCIAL GENEfVJ.. UASIUTY
: CL-'l.IMS MADE 0 OCCUR
EACHOCClJRRENCE
~~, ~ ~~
,MED EXP( one I
, PERSONAL 110 ADV INJURY
s
s
S
1
1
PRODUCTS - COMP/OF AGG ! ,
GENERAL AGGREGATE
GEN'lAGGREGATELlMlT APPLIES PER;
POUGY :---: )f8i i lOC
A I
AUTOMOBtlE UABlUTY
M1YAUTO
ALL OVVNED AU TOS
SCHEDIJcED AUTOS
IPB108241A934-COF-08
I
10/1/2008 ,10/1/2009
COMBINED SINGLE LIMIT
(EallCddenlj
1,000,000
,
L' HIRED AUTOS
JL NON.DWNEDALJTOS
BOOIL Y INJURY
I (p8fJl8l'SOl"l)
BOOl Y_INJURY
(Pef8CClOent)
f~OP~Rrnt~GE ; s
AtfY AUTO
,
i AtJTO OOL Y - EA ACCIDENT
,
, OTHER THMI
AUTO ONLY:
,S
,
EA.A.CC S
AGO 1
I EXCESS/UMBRELlA UABlllTY
=:J OCCUR [J C'.AIMS WIDE
. _EACH OCCURRENCE
'--,
, DEDUCTIBLE
, RETENTION $
WORKERS COMPENSAl1ON AND
EIlPLOVERS'lJABIUTY
A~ PROPRIETORlPAA,TNERlEXECUnvE
OfFlCERlt.E~EREXCLUDED'
, ~CI~~~;S:ONSbeiC"l'f
i Oll-lER
[l- I
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~ E,\.. EACH ACCIDENT $
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E.L. DISEASE POl...lCYLlMIT $
i AGGREGATE
I
0ESCRIPTl0N OF OPERA TJONSJLOCATIONSNEHIClESlEXCLUSIONS ADDED BY EHOORSEMENTI$PF;cw" PRO\/1S1ONS
CERTIFICATE HO~DER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRJElECPOUClES BE CANCEll.ED BEFORE TIiE EXARATlON
DATE lliEREOF, THE JSSUING INSURER wtlL ENDEAVOR TO MPJl ~ DAYS WRrTTEN
~OT1CE 10 T!'F- C!::P.'T!fr..ATe HOLD!:R pt.ll..l!ED TO T!1E: LEFT, BUT FJl.JLl'P.E TO 00 SO SHA!.l
IMPOSE NO OBUGAlKlN OR UABaJTY OF At('( KIND UPON THE INSURfR. ITS AGENTS OR
NeB Healthcare Systems. Inc.
Attn: ~8vin Coopar
P.O. Box 413029
Naplft8, FL 34101
ACORD 2S (2001108)
Co11,2495498 Tp1,S38852
@ACORDCORPORATION1988
Aaenda Item No. 16F4
~ .January 27, 2009
Q~-.", (';l
o
page 2 of 2
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
011 this certificate does not confer rights to the certificate holder in iieu or such endorsement(s).
If SUBROGATION is WAIVED, subject to the terms and oondltions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder In lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affinnalively or negatively amend, extend or alter the coverege afforded by the policies I isted thereon.
ACORD 25 (2001108)
Coll,2495498 Tpl,BJ8852 Cert,11461B08
Agenda item r~o. 1 GF4
January 27, 2009
Page 9 of 22
Attachment B
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,;;gsnca item ~~o. 16t=A
January 27,2009
Page 11 of 22
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Agenda 110m ~,O. 15F4
January 27, 2009
Page 130122
Attachment D
Agenda item ~~0. 15F4
January 27, 2009
Page 14 of 22
Oecember 2008.
Schedule of rates for NCH ambulance transoort for 2009;
2R0020-9 NCH BlS -AO-429-SSS1.00
2R0030-R NCH ALS2-AO=4'B---Sfifil.00
2R0040-7 NCH AlSI-A0-426---SS77.00
2ROOSO-fi NCH AlSI-AO-427---S606.00
7ROO70-4 NCH BlSI-AO-428--5567.00
Agsnda Item r-.Jo. 1 CF4
January 27,2009
Page 15 of 22
Att~rhmpnt E
NCH
Agenda Item No. Pafid I of 4
Januacy 27, 20159
OUR MI~.5>ON IS TO RESTORE, Pft{)l"tOTE. AND PoIAINTAa,1 Ht9J..TH IN THE PEOPLE ..vE ~age 16 of 22
NCH Hcalthcarc - Officers & Trustees
P.O. BOX 413029, Noples FL 34101
TEL: 239,436.5000
I WEB: httpJ/woIw.ndllnd.org
_.,-~-
-
The NCH Healthcare System
. NCH Healthcare System
. NCH Naples Hospital Inc.
. NCH Marco Island Campus
t Ambulatory Surgical Care, Inc.
~ Community Home Care, Inc.
. Gulf Coast Linen Services, Inc,
. Health Resources Corporation
BOARD OF TRUSTEES 2007-2008
NCH HEAL THCARE SYSTEM, INC.
NCH NAPLES HOSPITAL, INC.
CORPORATE OFFICERS
,.
Carl E, Westman
Chairman
Joseph Perkovich
1st Vice Chairman
Stephen L. Schwartz
2nd Vice Chairman
Edwin Stedem
Secretary/Treasurer
~OARD OF TRUSTEES
n
! I
I
William Allyn
Jay H. Baker
William E. Bindley
Susan L. Dalton
.,.
r . \ "';;'
Paul Dernbach, M.D.
Alberto M. de la Rivaherrera, M.D.
Brian Doyle
Linda Flewelling
I""".
. . '''''':'~.
I
~.....
~
/r~
I
Thomas J. Gazdic
Daniel Gill
Ellin Goetz
Kay Gow
http://www .nchrnd.orgidefault.aspx1id=487 &Iink~navmenu&print= 1
12/29/2008
'--r---'
NCH Hcalthcarc - Officers & Trustees
~ I.....
F"-j'
Francis E. Harrington, M,D. Erika Hinson, R.N.
~
.
John Lewis, M.D.
Scott Lutgert
Wayne Mullican
Rabbi James H. Perman
,.
Stephen L. Schwartz
2nd Vice Chairman
Edwin Stedem
Secretary/Treasurer
STAFF OFFICERS
Allen S. Weiss, MD
President & CEO
Kevin D, Cooper
General Counsell
Chief of Staff
.-
~
AurOia Estevez, ~.1D
Chief Medical Officer
Linda Gipson
Chief Nursing Officer
I
Kim Ciccarelli Kantor
Gerri Moll
Joseph Perkovich
1st Vice Chairman
Norman Thomson, M.D.
Gail Dolan
COO, North Naples
Hospital Campus
Agen~a Item t"o. Ii>\if,,1. 2 of 4
"anuary 27, 20(j'g
p~ 7 f 2
Arnold Lerner
John M. Morrison
Scot C. Schuitz, M, 0,
Carl E, Westman
Chairman
Phillip Dutcher
COO, NCH Healthcare System,
Inc.
Vicki Hale
CFO IAssistant
Treasurer
http://www.nchmd.orgldefault.aspx?jd=487 &1 ink=navmenu&print= I
I
Beth r"iartln
Assistant Secretary
12/29/2008
Agenda Item No.l111h~ 3 of 4
January 27, 20'09
Page 18 of 22
NCH Hcalthcarc - Officers & Trustees
Brian Settle
Chief Human Resources
Officer
Susan Wolff
Chief Information
Officer
Return to Top
NCH MARCO ISLAND CAMPUS
eorporate Officers
John L Patterson, Chairman
James B, Kauffinan, Jr., 1st Vice Chairman
Allen W. Merriam, Ill, 2nd Vice Chairman
Al Diaz, 3rd Vice Chairman
Richard Adams, Secretary/Treasurer
L-ustees
hard Adams, SecretarylTreasurer
ElizabeIh Bozzo
Gail Cacciola, RN, EdD
Al Diaz, 3rd Vice Chairman
David Fenelon
Kevin Fitzgerald
J ud y Gewirtz
James B. Kauffinan, Jr.
Mary Ann Kline
Margaret L. Lanoix
Robert A. Marks
Allen W, Merriam, III, 2nd Vice Chairman
John L. Patterson, Chairman
Sal A. Saldano
Thomas Stolee, M.D.
Brooks CB. Wood
Staff Officers
Kevin D. Cooper, General Counsel/Chief of Staff
Gail Dolan, COO-North Naples Hospital Campus
Phil Dutcher, COO-NCH Healthcare SysIem
Aurora Estevez, M.D., Chief Medical Officer
~.uzanne Graziano, RN, Interim Chief Nursing Officer
'ki Hale, Chief Financial Ottlcer
~dan Settle, Chief Human Resources Officer
Pamela D. Wagner, Assistant Secretary
Allen S. Weiss, M.D., President & CEO
Susan Wolff, Cheiflnformation Officer
http://www .nchmd.org/default.aspx?id=487 &link=navmcnu&print= 1
12/29/2008
NCH Hcalthcarc - Officers & Trustees
Agenda Item No. Pa"d 4 of 4
January 27, 20D9
Page 19 of 22
Return to Top
HEALTH RESOURCES CORPORATION
AMBULATORY SURGICAL CARE, INC.
COMMUNITY HOME CARE, INC.
COMMUNITY IMAGING, INC.
GULF COAST LINEN SERVICE, INC.
Corporate Officers:
Carl E, Westman, Chairman
Stephen 1. Schwartz, 15t Vice Chairman
Joseph Perkovich, 2nd Vice Chairman
Edwin Stedem, Secretary/Treasurer
Directors:
Daniel Baer
Jay Baker
William Bindley
Richard Bodman
Paul Dernbach, M.D.
Linda Flewelling
Thomas Gazdic
Daniel Gill
Arnold Lerner
John Morrison
Joseph I. Perkovich, 2nd Vice Chairman
Stephen 1. Schwartz, I st Vice Chairman
Edwin Stedem, SecretarylTreasurer
Carl E. Westman, Chairman
Staff Officers
Kevin D. Cooper, General Counsel/Chief of Staff
Gail Dolan, COO-North Naples Hospital Campus
Phil Dutcher, COO-Downtown Hospital Campus
Vicki Hale, Chief Financial Officer
Beth Martin, Assistant Secretary
Brian Settle, Chief Human Resources Officer
Allen S. Weiss, M.D., President & CEO
Susan Wolff, Chief Information Officer
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http://www.nchmd.orgldefault.aspx'!id~48 7 &link~navmenu&print~ I
12/29/2008
I\genda Itel11 t'Jo. 16F4
January 27, 2009
Page 20 of 22
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References
Mr. Carl Westman
NCH Healthcare System
P.O. Box 413029
Naples, FL 34101-3029
Mr. Edwin Stedem
NCH Healthcare System
PO Rmc A.1~n?Q
Agenda Item No. 16F4
January 27,2009
Page 22 of 22
References
Mr. Cart Westman
NCH Healthcare System
P.O. Box 413029
Naples, FL 34101-3029
Mr. Edwin Stedem
NCH Healthcare System
P.O. Box 413029
Naples, FL 34101"3029
Mr. Joseph Perkovich
NCH Healthcare System
P.O. Box 413029
Naples, FL 34101-3029