2019-04-18T17:29:53-07:00 2018-06-30 990 2017-07-01 920077523 CENTRAL PENINSULA GENERAL HOSPITAL INC CENT 9077144404 250 Hospital Place Soldotna AK 99669 Lance Spindler CFO 9077144722 2019-04-18 107.77.205.13 2017 2019-02-21 02:37:17Z Central Peninsula Hospital Rick Davis 250 Hospital Place Soldotna AK 99669 361189266 0 X www.cpgh.org X 1994 AK We are a community initiated and community nurtured organization dedicated to promoting wellness and providing high quality health care that ensures the confidence and loyalty of our patients. We strive to improve individual and community health and achieve national standards of excellence. 11 10 1019 195 0 0 1435192 2293293 299302632 353751803 44845 319536 4051309 3706679 304833978 360071311 214739 106967 0 0 89599715 94672527 0 0 0 214467872 257281285 304282326 352060779 551652 8010532 226141503 262953280 73142827 101944072 152998676 161009208 We are a community initiated and community nurtured organization dedicated to promoting wellness and providing high quality health care that ensures the confidence and loyalty of our patients. We strive to improve individual and community health and achieve national standards of excellence. We are dedicated to providing the highest quality patient and resident centered care in a healing environment. 0 0 317553269 321303712 Our 49 bed hospital provided patient and ancillary services to 2,704 inpatients and 133,194 outpatients during the 2017 tax year. The hospital provides emergency medical services regardless of ability to pay. Emergency medical services were provided to 16,811 individuals, and 1,748 of those individuals were admitted to the hospital. 4,395 surgical procedures were performed in the hospital during the tax year. The imaging department performed 48,108 procedures. 63,185 physical therapy 15-minute procedures were provided to area residents. During the 2017 tax year, free medical services in the amount of $3,375,097 (gross charges) were provided to patients eligible for charity care. 11698885 11000031 Skilled nursing and long term care services were provided by our 60 bed skilled nursing facility. Heritage Place provides healing and compassionate residential care in a home like setting. Total admissions for the 2017 tax year were 137 and total resident days of care were 18,606. An average of 51 residents per day were provided long term care and nursing. Ancillary services for residents included 7,249 physical therapy treatments, while outpatients received 1,017 therapy treatments. 20929346 21448060 The hospital operates 10 family and specialty physician services clinics providing care in the following areas: Family Medicine, Pediatrics, Neurology, Pain Management, Surgery, Urology, Podiatry, Internal Medicine, Women's Health, and Orthopedics. Other outpatient clinics include Wound care, Sleep studies, and the provision of Durable medical equipment. During the 2017 tax year physician and specialty services were provided for 28,446 visits. 6,062 wound care procedures and 185 sleep studies were performed. 0 0 0 350181500 1 1 0 1 0 0 1 0 0 0 1 0 0 1 1 0 1 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 1 0 1 147 0 1 1019 1 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Central Peninsula Hospital Finance Department 9077144525 250 Hospital Place Soldotna AK 99669 Silverio Mattero Board Member 4 X 4350 0 0 Trena Richardson President 8 X 13750 0 0 Gregg Motonaga Anesthesia MD/Board Member 44 X X 716229 0 38126 Mark Dixson Board Member 4 X 4400 0 0 Mark Premo Board Member 4 X 3300 0 0 Steven Manley Board Member 4 X 0 0 0 James McHale Vice President 4 X 4350 0 0 Debra Shuey Board Member 4 X 3850 0 0 John Bramante Board Member 4 X 2600 0 0 Irv Carlisle Sec/Treasurer 6 X 2750 0 0 Lynda Columbia Board Member 4 X 3650 0 0 Matthew Dammeyer COO 40 X 320114 0 32427 Richard Davis CEO 40 X 520615 0 34677 Lance Spindler CFO 40 X 262744 0 31103 Karen Scoggins CNO 40 X 220101 0 25110 David S Innes Orthopedic Surgeon 40 X 874301 0 0 Robert Cadoff Urologist 40 X 1260009 0 31763 Jason Lattin Surgeon 40 X 886161 0 49549 Aaron Wonnacott MD 40 X 758635 0 35593 5861909 0 278348 119 0 1 0 C&A Industries dba Focus One Solutions PO Box 3037 Omaha NE 68103 Contract Labor Provider 1596286 Alaska Hospitalist Group LLC 4300 B Street Suite 200 Anchorage AK 99503 Physician Services 750875 Roger Brecheen dba Wilson Gynecolog PO Box 243 Wilson WY 83014 OBGYN Locums Physician 371570 Curtis Buchholz 44455 Sterling Hwy Soldotna AK 996697936 Pathology services 320178 QCentrix Dept CH19901 Palatine IL 60055 Quality Improvement 254341 10 0 0 0 14374 1962802 316117 13592 2293293 Hospital service revenue 622000 321303712 321303712 0 0 Skilled nursing revenue 623000 11000031 11000031 0 0 Outpatient Physician clinic revenue 621110 21448060 21448060 0 0 0 0 0 0 353751803 316549 0 0 316549 0 0 0 0 0 0 0 0 734045 0 976992 0 -242947 0 -242947 -242947 0 0 0 2987 0 0 0 2987 2987 2987 0 0 0 0 0 0 0 0 0 0 0 0 0 0 559390 140963 418427 418427 0 0 Property tax revenue 622000 43918 43918 0 0 USAC telephone subsidy 622000 1363606 1363606 0 0 Electronic Health Records incentives 622000 249530 249530 0 0 1874145 1874145 0 0 3531199 360071311 357461469 0 316549 106967 106967 0 0 0 0 0 0 5826234 4218481 1607753 0 0 0 0 0 60205221 60205221 0 0 1879491 1879491 0 0 22519818 22519818 0 0 4241763 4241763 0 0 0 0 0 0 212528 0 212528 0 38483 0 38483 0 20515 0 20515 0 0 0 0 0 0 0 6156762 6156762 0 0 298501 298501 0 0 25239103 25239103 0 0 7031113 7031113 0 0 0 0 0 0 2547205 2547205 0 0 337481 337481 0 0 0 0 0 0 362805 362805 0 0 1899679 1899679 0 0 0 0 0 0 14496331 14496331 0 0 1034237 1034237 0 0 Medicare Deductions from Revenue 93310400 93310400 0 0 Medicaid Deductions from Revenue 55345784 55345784 0 0 Commercial, Gov't and Other Deductions from Revenue 36332607 36332607 0 0 Uncompensated Care (Bad Debt & Charity) 9874204 9874204 0 0 2743547 2743547 0 0 352060779 350181500 1879279 0 35482840 40477767 4957556 4960629 326591 199953 29807497 29552245 0 0 0 0 0 0 5778418 6278415 1795376 2239425 173086826 65537730 111211292 107549096 0 0 500000 500000 0 0 1301191 869045 34980742 70326705 226141503 262953280 14935395 17412202 0 0 12245 12653 58145490 83513417 0 0 0 0 0 0 0 0 49697 1005800 73142827 101944072 X 146099651 122430538 6899025 38578670 0 0 152998676 161009208 226141503 262953280 8010532 0 0 0 0 0 X 0 1 X 1 1 1 X 0 1 0 0 0 0 1 12050 0 1 8465 20515 0 Schedule C, Part II-B, Line 1 Line 1(g) consists of travel expenses and compensation of employees for 2 trips to Washington D.C. to meet with federal legislators regarding Medicaid expansion and continuation of the Medicare Rural Community Hospital Demonstration Project. Line 1(i) consists of the portion of membership dues paid to organizations that were spent on lobbying activities. These outside organizations include the American Hospital Association and the Alaska Hospital and Nursing Home Association. X 1 40 0 0 0 1 0 0 0 0 2452117 0 2452117 89548658 0 32510894 57037764 622459 0 470647 151812 71565720 0 31475268 40090452 8897872 0 1080921 7816951 107549096 Plant replacement and expansion fund 32703493 Bond proceeds reserved for capital projects 29217909 Debt service reserve fund 7637498 Deferred loss on 2011 bond refunding 767805 70326705 0 Other Liabilities - cash held for others 42437 Other Liabilities - due to/from third party payors 963363 1005800 172171574 0 0 0 464151 464151 171707423 0 188363888 188363888 360071311 164167558 0 0 0 470667 470667 163696891 0 188363888 188363888 352060779 Schedule D, Part II, Line 9 In 2008 the Hospital purchased a building which resides on 40 acres of land subject to a perpetual covenant for the benefit of all Alaska residents, restricting the use of the land for agricultural purposes pursuant to AK Statute 38.05.321. The building on this property is used by the Hospital's chemical dependency unit. There is no value placed on the easement itself and therefore it does not appear on the Financial Statements or footnotes. However, the cost of the real property is recorded in the Hospital's Balance Sheet at its net book value. Schedule D, Part XI, Line 2d Cost of Goods sold in the amount of $140,963 reported in Part Viii line 10b are reported as expenses on the audited financial statements. Revenue from Central Peninsula Health Foundation in the amount of $323,188 are included in the audited financial statements, however they are excluded from the 990 Part VIII. The Foundation is a separate legal entity and although it is reported as a blended component unit of the Hospital's financials, it files its own Form 990. Schedule D, Part XI, Line 4b Deductions from revenue in the amount of $188,363,888 are reported as expenses in Part IX, line 24 a-d on the 990, however they are reported net of revenue on the audited financial statements. Schedule D, Part XII, Line 2d Cost of Goods sold in the amount of $140,963 reported in Part VIII line 10b are reported as expenses on the audited financial statements. Expenses of Central Peninsula Health Foundation in the amount of $329,704 are included in the audited financial statements, however they are excluded from the 990 Part VIII. The Foundation is a separate legal entity and although it is reported as a blended component unit of the Hospital's financials, it files its own Form 990. Schedule D, Part XII, Line 4b Deductions from revenue in the amount of $188,363,888 are reported as expenses in Part IX, line 24 a-d on the 990, however they are reported net of revenue on the audited financial statements. 1 1 X 1 X 1 X 1 1 0 0 1 1424 1372345 0 1372341 0.0087 1 18000 32248437 27588489 4659948 0.0296 0 0 0 0 0 0 2 19424 33620782 27588489 6032289 0.0383 432 9920 885449 94292 791157 0.005 113 181 71259 8410 62849 0.0004 17 36360 16063107 7910888 8152219 0.0519 4 92 7978 300 7678 0 1037 135 160891 0 160891 0.001 1603 46688 17188684 8013890 9174794 0.0583 1605 66112 50809466 35602379 15207083 0.0966 0 0 0 0 0 0 9 90 2541 0 2541 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 90 2541 0 2541 0 0 2727791 1909453 39348369 46041915 -6693546 X 1 1 1 1 Central Peninsula Hospital 250 Hospital Place Soldotna AK 99669 www.cpgh.org X X X Central Peninsula Hospital 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X http://www.cpgh.org/workfiles/CPH%202016%20Community%20Health%20Needs%20Assessment.pdf X 1 18 0 1 0 1 X 200 300 X 1 1 X X 1 X www.cpgh.org/Patient Financial Services X www.cpgh.org/PatientFinancialServices X www.cpgh.org/PatientFinancialServices X X X X X X 1 X 1 X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-Central Peninsula Hospital The 2016 Community Health Needs Assessment (CHNA) was prepared by an independent contractor who conducted phone interviews with a broad cross section of the local community through randomly selected landlines for 600 respondents (14.7% of total landlines). The contractor also used 2014 US Census Bureau estimates, 2015 AK Department of Labor statistics, and health data for the community, state, and nation in the needs assessment. Hospital management provides additional information for the report through its partnerships and collaboration with other healthcare entities throughout the state. Other sources of data include the Alaska Hospital Nursing Home Association, Rural Healthcare and Small Hospital Association, the Kenai Peninsula Borough Assembly, and the Hospital Patient Advisory Committee. Schedule H, Part V, Section B, Line 5-Central Peninsula Hospital In addition to the CHNA, the Hospital collaborates with local area medical providers, patients, hospital associations, and the local government to determine whether community health needs are being met, and where unmet opportunities exist. Schedule H, Part V, Section B, Line 7d-Central Peninsula Hospital The most recently published CHNA identified the top ten community health needs as follows: 1) Alzheimer's services, 2) Alcohol and drug abuse treatment services, 3) Cardiology services, 4) Mental health services, 5) Assisted living services, 6) Wellness services, 7) Pulmonary services, 8) End of life care services, 9) Dialysis services, and 10) Primary care services. Of these ten identified needs, the Hospital's Board and Executive Team have prioritized the top health initiatives to be addressed and has designed an Implementation Plan to outline those needs and track progress in meeting initiatives. The Implementation Plan lists the Hospital's priorities as follows: Priority #1) Cardiovascular Health, Priority #2) Substance abuse and mental health services, Priority #3) End of life services, Priority #4) Primary Care access, Priority #5) Wellness services for kids and adults, and Priority #6) Alzheimer's care. While the Hospital recognizes the importance of the remaining health needs identified in the CHNA, these needs either cannot be achieved by the Hospital in the near future, or are being addressed by an outside organization. Dialysis services are currently offered in the service area by another non-hospital owned organization. No inpatient dialysis services are provided at the Hospital due to the absence of physicians specializing in kidney care. Currently, the volume of pulmonary patients in the service area does not support the recruitment of a full-time Pulmonologist; these services are provided in Anchorage. Preventative care and wellness services are being provided by the Hospital in order to reduce the need for these services. In recent years, approximately 100 assisted living beds have been added to the service area by local for profit entities. The Hospital believes these entities, along with Home Health Care entities, will continue to meet community needs. Schedule H, Part V, Section B, Line 11-Central Peninsula Hospital Every three years, the Hospital produces a Community Health Needs Assessment (CHNA) providing an analysis of the health needs facing our community. This report is made available to the public, and can be used by community members to better understand the present state of the region and to make decisions and plans for the future. The last CHNA was completed in July 2016. Each year, the Hospital prioritizes and updates its Implementation Plan. The following describes updates to the Plan as of the December 2018 update. Priority #1) Cardiovascular Health - In order to meet the needs of an aging population, the Hospital has increased ICU/cardiovascular capability of nursing staff and Hospitalists by having a full-time Cardiologist on staff and working with the Alaska Heart Institute to recruit a second. We have also added a swing shift Hospitalist for additional coverage and hired a new ICU Director, who is implementing a more intensive education program. The Hospital is building a new Cath Lab that is on track for a November 2019 opening. Other efforts to address community health needs such as obesity and cholesterol management are ongoing. Priority #2) Substance Abuse and Mental Health Services - we have opened a new transitional housing facility that is up and running with good success. We are addressing the need to promote Primary Care Medical Home models with behavioral health integration by developing a value based program for our employee health plan. Priority #3) End of Life Services - a Palliative Care Committee has been formalized and continues to meet to address the issue of a lack of robust Hospice or Palliative Care programs, which results in high readmission rates and less than favorable utilization of hospital beds. Priority #4) Primary Care Access - Steps are being taken in order to address the lack of primary care access that results in inappropriate Emergency Department utilization and poor care coordination. We have actively supported recruitment of new providers, increased access within our primary clinics by implementing 10 hour scheduling, and are working on developing a Primary Care Medical Home model to provide more coordinated care from the primary care level. Priority #5) Wellness Services for kids and adults - we are working to increase early wellness education and lifestyle changes by supporting wellness activities in our community, such as Safe Kids, health fairs, and sponsorship of community activities that promote exercise, such as little league baseball and local runs. Priority #6) Alzheimer's Care - we are working to coordinate services that are already available by conducting surveys and promoting better coordination of community resources and sponsoring programs for family education and coping mechanisms. Schedule H, Part V, Section B, Line 16j-Central Peninsula Hospital Hospital admissions staff attempt to provide a financial assistance brochure to every patient during the admission or discharge process. The brochure is also available in hard copy at each hospital entrance, upon request, and on the Hospital's public website. It is also published in the local newspaper, at least quarterly, and reported in each Hospital report to the local governing body's public assembly meetings. Financial counselors personally contact all patients with past due balances and explain the financial assistance policy. They offer assistance with filling out the application, and also set up monthly payment plans for patients who do not qualify for 100% assistance. The Hospital employs 5 financial counselors that meet personally with patients to review their bills, set up payment arrangements, and assist with the financial assistance application process. The policy and assistance opportunities are published in the local newspaper, along with contact information for the Hospital's counselors. 21 Heritage Place 232 Rockwell Ave Soldotna AK 99669 Skilled nursing facility, longterm care Serenity House 47480 Kristina Way Soldotna AK 99669 Chemical dependency treatment center Central Peninsula Neurology 262 N Binkley Street Soldotna AK 99669 Neurology clinic Central Peninsula Family Practice Kenai 506 Lake Street Kenai AK 99611 Family practice clinic Kenai Physical Medicine 260 Caviar St Kenai AK 99611 Physical therapy clinic Soldotna Physical Medicine 245 N Binkley Soldotna AK 99669 Physical Therapy clinic Kenai Health Center 630 Barnacle Way Kenai AK 99611 Diagnostic imaging, lab, and domestic violence services Central Peninsula Family & Pediatrics 245 N Binkley St Suite 101 Soldotna AK 99669 Family practice clinic Central Peninsula Specialty Physician Building 240 Hospital Place Soldotna AK 99669 Specialty Physician Offices, Oncology, Imaging, Physical Therapy and leased Medical office space Serenity House intake office 245 N Binkley Street Suite 203 Soldotna AK 99669 Chemical dependency intake, behavioral health clinic Peninsula Medical Center 265 N Binkley Street Soldotna AK 99669 Owned medical office building Central Peninsula Medical Center 245 N Binkley Street Soldotna AK 99669 Owned medical office building CP Maintenance & Plant Ops 158 Corral Street Soldotna AK 99669 Maintenance and plant ops Foundation & Marketing 166 W Corral Street Soldotna AK 99669 Foundation and marketing offices Central Peninsula Internal Medicine 108 E Corral St Soldotna AK 99669 Internal Medicine Physician Offices Radiation Oncology Building 240 Hospital Place Soldotna AK 99669 Radiation Oncology Building - leased to RBS Evolution Central Peninsula Billing Office 198 W Corral Soldotna AK 99669 Office space for Physician Clinic billing Accounting 146 W Corral Street Soldotna AK 99669 Accounting offices Central Peninsula Hospital 262 N Binkley St Soldotna AK 99669 Vacant Physician Office space Central Peninsula Hospital Transitional Living Ctr 362 Tyee Street Soldotna AK 99669 Transitional Living Center Central Peninsula Care Transitions 354 Tyee St Soldotna AK 99669 Detox Center - Undergoing remodel during tax year 2016 CP Womens Health 289 N Fireweed Street Suite C/D Soldotna AK 99669 OB/Gyn Physician Medical Office Patient Financial Services 254 N Binkley Street Soldotna AK 99669 Patient Financial Services Schedule H, Part I, Line 7 In most cases, the costs listed in Line 7 are actual costs associated with these programs. In cases where the costs for certain activities is too cumbersome to compile, the cost to charge ratio from the most recently filed Medicare Cost Report (FY2018) was used. Schedule H, Part I, Line 7, Column f Bad debt expense of $6,499,107 were reported gross in Part IX, line 25 functional expenses. However, they were reported at cost in Schedule H based on the cost to charge ratio. Schedule H, Part I, Line 7g The Hospital did include losses from certain subsidized Physician Clinics in Part I. line 7g for both family practice and specialty physician practices. These losses are as follows: Soldotna Family Practice and Pediatrics ($967,410), Neurology ($169,943), Women's Health ($644,692), Foot & Ankle ($456,183), Internal Medicine ($770,404), and Kenai Family Practice ($291,363). Schedule H, Part II The Hospital supports local educational and workforce institutions through monetary donations, job fairs, job shadowing programs, internships, community partnerships, coalitions, and skills training. Community workforce development and health education improves the quality of life and the health of the community by fostering positive activities for area residents and engaging the community in health initiatives. Schedule H, Part III, Section A, Line 4 Bad debt provisions are made for the amount of revenue that will not be collected from patients to whom services were billed but not paid. The Hospital has determined these patients are neither medically nor financially indigent and do not qualify for the Hospital's charity care program. Bad debt provisions are determined by Management's assessment with consideration of business and economic conditions, changes and trends in the healthcare coverage, and other collection indicators. The adequacy of this provision is periodically reviewed and further modified based upon the accounts receivable payor mix and aging, and historical write-off trends by payor class. Schedule H, Part III amounts are based on the combined Medicare and Medicaid cost to charge ratio for tax year 2017 per our filed cost report. The amount which may be attributable to patients who qualify for charitable assistance or free care is estimated to be about 70% of the total. These are accounts which our financial counselors have made every effort to contact and assist patients with financial assistance applications, but the patient refused to apply. It is our belief that all of these bad debts should be considered community benefit because they provide a necessary and vital health benefit to community members regardless of ability to pay. Schedule H, Part III, Section B, Line 8 It is our belief that the shortfall in actual receipts from Medicare compared to the cost to provide care to Medicare patients should be considered a community benefit. The reason for this stance is that the Hospital is required to write off all contractual allowances for Medicare patients regardless of the amount of the shortfall. The Hospital may only collect the portion which is a patient's co-pay or deductible and may not engage in collection efforts for the remainder. Medicare patients comprise a significant percentage of our community members, and our community Hospital must provide needed medical services to this population irrespective of the payments received. Costs included within this Schedule H are based on the as filed 2018 Medicare cost report (tax year 2017). Schedule H, Part III, Section C, Line 9b The Hospital's collection policy PFS-546 addresses private pay patients and defines the individuals which are eligible to receive financial assistance based on either financial or medical indigence. The collection policy refers to the charity care policy for instructions for determining eligibility. As noted in Part I, the charity care policy is based on FPG which is the basis for a sliding scale between 200 and 300% of those guidelines. Applicants on the upper end of the scale are eligible for a discount on their bills, while those on the lower end of the scale are eligible for free care. Schedule H, Part VI, Line 2 In addition to the Community Health Needs Assessment and strategic plan, the Hospital also determines health deficiencies in the community through a variety of other means. Hospital Administrators round on patients and meet regularly with an advisory committee comprised of area residents and former patients to determine the physician and specialty services necessary to meet the health concerns of the community. The Hospital also peridoically hires consultants to determine the physician and specialty service needs in the community and to assist with physician recruiting. Lastly, an open dialogue exists between Hospital management, community leaders, the local governing body, patients, staff and medical providers. This community engagement is another source of identifying community health needs. Schedule H, Part VI, Line 3 Hospital admissions staff attempt to provide a financial assistance brochure to every patient during the admission or discharge process. The brochure is also available in hard copy at each hospital entrance, upon request, and on the Hospital's public website. It is also published in the local newspaper, at least quarterly, and reported in each Hospital report to the local governing body's public assembly meetings. Financial counselors personally contact all patients with past due balances and explain the financial assistance policy. They offer assistance with filling out the application, and also set up monthly payment plans for patients who do not qualify for 100% assistance. The Hospital employs 5 financial counselors that meet personally with patients to review their bills, set up payment arrangements, and assist with the financial assistance application process. The policy and assistance opportunities are published in the local newspaper, along with contact information for the Hospital's counselors. Schedule H, Part VI, Line 4 The area served by the Hospital is located on the Kenai Peninsula in South central Alaska. The service area if comprised of 13 towns, and contains 65% of the population of the Kenai Peninsula Borough. According to the 2015 AK Department of Labor estimates, nearly 38,000 residents live in the geographic area serviced by the Hospital. According to the most recently completed CHNA (2016), the number of uninsured individuals between the ages of 18 and 64 has dropped from 22% in 2012 to 12% in 2016 as a result of Medicaid expansion and the Healthcare exchange. Schedule H, Part VI, Line 5 The Hospital engages in numerous community initiatives year-round to improve health and awareness and education in our service area. It also makes monetary donations to support healthcare efforts, healthy living programs, personnel support to local non-profits such as Hospice, makes public service announcements on important healthcare issues, provides health professional education, holds health fairs, immunization clinics, publishes community health newsletters, and provides meeting space for health and community activities. 1 Kenai River Brown Bears PO Box 2613 Kenai AK 99611 262580744 501c3 20000 0 Actual monetary donation 2017/2018 season sponsorship for local athletes. Kenai Peninsula Boys and Girls Club 227 Caviar Street Kenai AK 99611 943067142 501c3 15000 0 Actual monetary donation This cash donation supports the operations of the Kenai Peninsula Boys and Girls Club, a local nonprofit dedicated to providing safe after school activities for area children. Kenai River Foundation PO Box 3944 Soldotna AK 99669 271570362 501c3 12000 0 Actual monetary donation Sponsorship of the Wounded Heroes event. Kenai Peninsula Food Bank 33955 Community College Drive Soldotna AK 99669 943112445 501c3 5000 7121 Actual monetary donation Actual cost of donated hams and turkeys Soup supper fundraiser donation and donation of hams and turkeys for local residents and customers of the food bank. Bridges Community Resource Network PO Box 1612 Soldotna AK 99669 920151271 501c4 7500 0 Actual monetary donation Imagination library program sponsorship. 6 2 Schedule I, Part I, Line 2 The Hospital provides cash contributions to local organizations which support community initiatives and healthy living on the Kenai Peninsula. Contributions are only made to organizations in good community standing. Hospital officials are responsible for approving all assistance to outside organizations and do so with discretion. X 0 1 X X X X X 0 1 0 1 0 1 0 0 0 Robert Cadoff Urologist 1240058 0 17572 0 2379 0 5996 0 31898 0 1297903 0 0 0 Jason Lattin Surgeon 885301 0 30 0 830 0 5996 0 47516 0 939673 0 0 0 David S Innes Orthopedic Surgeon 873958 0 20 0 323 0 5996 0 11897 0 892194 0 0 0 Aaron Wonnacott MD 748370 0 9728 0 527 0 5996 0 29323 0 793944 0 0 0 Gregg Motonaga Anesthesia MD/Board Member 682640 0 32734 0 856 0 20541 0 19845 0 756616 0 0 0 Richard Davis CEO 390243 0 64853 0 65520 0 16467 0 22419 0 559502 0 0 0 Matthew Dammeyer COO 240280 0 29371 0 50464 0 12461 0 29322 0 361898 0 0 0 Lance Spindler CFO 212930 0 28834 0 20980 0 11344 0 29448 0 303536 0 0 0 Karen Scoggins CNO 169977 0 24905 0 25219 0 10463 0 20720 0 251284 0 0 0 Schedule J, Part I, Line 1a Gross up payments are made for certain taxable fringe benefits including life insurance over $50,000. A year-end wage adjustment is made for all affected employees to include the gross up for fringe benefits and excess life insurance benefits. The Hospital has historically paid all social security and Medicare taxes on such benefits while the employee is responsible for federal income taxes. Schedule J, Part I, Line 1b The year end gross up adjustment for fringe benefits and life insurance over $50,000 is based on historical practice and is not based on written policy. The Hospital maintains that at some future date, employees may be required to pay their own FICA taxes on these benefits. Schedule J, Part I, Line 3 The Hospital contracts with an independent consultant every 3 years to perform a review of executive salaries and benefits. The most recent review was completed in August 2017. The resulting report is provided to the Board and Management for review. The Board then sets compensation levels for the CEO through a written employment contract or amendment. The CEO is responsible for hiring the remainder of the Hospital's executive team and for using comparable data studies to set their salaries. Schedule J, Part I, Line 4 The Hospital provides a 457 top hat plan to certain key employees and executives. The individuals listed on Schedule J participated in the plan and either deferred their own compensation or received hospital contributions into the plan during the tax year. Schedule J, Part I, Line 5 In accordance with their employment contracts, Emergency Room physicians and surgeons receive a percentage of their professional fees billed as compensation. The compensation is not based directly on the Hospital's overall revenue, but rather on the individual charges that are generated by the Physician. This compensation method is considered reasonable and customary for these employed physicians. Schedule J, Part I, Line 6 The Hospital pays an annual incentive plan bonus to all employees, supervisors, and executive staff based on a series of operational and quality measures in order to maintain the highest standard of patient care. One of the measures is meeting the Hospital's financial budget. There is a knock-out provision for the other measures if the financial budget is not met. The bonus is not calculated based on the Hospital's net earnings. Other measures are Quality of Care and Patient Satisfaction. A Kenai Peninsula Borough 920030894 01179PX51 2011-09-15 27905000 Refunding bonds - 2011 GO 0 0 1 B Kenai Peninsula Borough 920030894 01179RDP5 2014-02-20 32490000 2014 Medical Office Building construction bonds 0 0 1 C Kenai Peninsula Borough 920030894 001179RJV 2015-06-15 3200000 2015 Medical Office Building construction bonds 0 0 0 D Kenai Peninsula Borough 920030894 000000000 2016-06-09 3050000 2016 Medical Office Building construction bonds 0 0 0 A 0 0 32616814 0 0 0 201610 0 0 0 0 0 2008 0 1 1 1 B 0 0 34999563 3700147 1813599 996410 127595 0 0 35043223 0 0 2016 0 0 1 1 C 0 0 3200000 544993 35169 146736 22868 0 0 3200000 0 0 2016 0 0 1 1 D 0 0 3067913 563191 0 143621 17500 0 0 2799968 0 267944 2016 0 0 0 1 A 0 0 0 0 0 0 0 0 0 1 B 0 1 0 0 0.11 0 0.11 1 0 1 C 0 1 0 0 0.11 0 0.11 1 0 1 D 0 1 0 0 0.11 0 0.11 1 0 1 A 0 0 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A Kenai Peninsula Borough 920030894 01179RXH1 2017-11-29 28955000 2018 Cath Lab and OB construction bonds 0 0 1 A 0 0 29395334 2684471 0 614852 436394 0 0 445370 0 28949965 2019 0 0 0 1 A 0 1 0 0 0.11 0.11 1 0 1 A 0 1 0 0 1 0 0 0 1 A 1 Gregg Motonaga Dr. Motonaga is an employed physician and Board Member 775985 Total FY18 employee compensation and benefits 0 Irving Carlisle Board Member 2880 rent for storage space from a company for which he is a 50% owner 0 Form 990, Part VI, Section A, Line 7b Central Peninsula Hospital Inc. operates the Hospital through a lease and operating agreement with the Kenai Peninsula Borough. Hospital Board decisions regarding the acquisition of significant capital assets, or real property are subject to the approval of the Kenai Peninsula Borough Assembly. Bonds, loans, and capital expenditures not funded from the Hospital's Plant Replacement Fund must be approved by a vote of the Borough's constituents if greater than $1.5 million. Form 990, Part VI, Section B, Line 11b The 990 is prepared by the Hospital's Finance Department and submitted to Hospital Administrators for review. Management then returns any edits to the Finance Department for preparation of a second draft. The second draft of the 990 and all schedules and statements are submitted to each member of the Board for review and comment. The Board proposes any edits to the Finance Department and gives authority to the CFO or Board President to sign and file the return. Form 990, Part VI, Section B, Line 12c Both senior leadership an members of the Board of Directors complete annual conflict of interest statements which are reviewed by management and the Finance team to assess independence. The Board reviews and discusses any conflicts of interest which arise throughout the year and takes appropriate action. If a conflict arises, the Board Member in conflict will abstain from voting on the applicable resolution at the Board Meeting. Form 990, Part VI, Section B, Line 15 An independent professional executive compensation study is performed every 3 years. The most recent study was completed in August 2017. These reports are submitted to the Board for review and used to set the wage scale for the CEO, CFO, CNO, COO and VP of Human Resources. Form 990, Part VI, Section C, Line 19 The Hospital makes its audited financial statements and governing documents available to the public for inspection upon request. Paper copies of the audited financial statements are supplied to the Board, Hospital Administrators, and the Kenai Peninsula Borough. The Hospital's 990 is widely available to the public on Guidestar.com and other websites. Central Peninsula Health Foundation 250 Hospital Place Soldotna AK 99669 202778670 To support quality healthcare activities AK 501(c)3 Public Charity N/A 0 Kenai Peninsula Borough 144 N Binkley Street Soldotna AK 99669 920030894 Local Government which owns the hospital assets. AK 115 N/A 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 0 1 0 Central Peninsula Health Foundation c 270528 This amount represents total contributions received from the Foundation in payment for programs, capital, and grants to individuals for assistance. The Hospital initially paid or each of these expenses, and the Foundation reimbursed the Hospital from either restricted or unrestricted funds depending on the expenditure type. Central Peninsula Health Foundation j 12789 The Hospital provides office space to the Foundation Director for the average monthly cost of $1,066 per month. This amount includes janitorial, rent, utilities, and overhead, and is based on the facility costs per the 2016 Medicare Cost Report. Kenai Peninsula Borough k 1 The Hospital is operated by Central Peninsula General Hospital, Inc. through a lease and operating agreement with the Kenai Peninsula Borough. The amount of the lease, as stated in that agreement is $1 per annum. Central Peninsula Health Foundation m 270528 The Foundation performs fundraising activities for which substantially all of the donations are intended for the Hospital and its programs. The value of those programs and services for which the Foundation transferred or solicited funds during the year was $270,528. Central Peninsula Health Foundation n 12789 The Hospital provides office space to the Foundation Director for the average monthly cost of $1,066 per month. This amount includes janitorial, rent, utilities, and overhead, and is based on the facility costs per the 2016 Medicare Cost Report. Central Peninsula Health Foundation o 70400 The Hospital shares certain paid employees for directorship and accounting functions necessary to operate the Foundation. This amount represents the salaries and benefits paid to those persons. Kenai Peninsula Borough p 6252707 During tax year 2017, the Hospital reimbursed the Kenai Peninsula Borough for bond debt service, refuse, insurance premiums, and sales tax. This amount represents the actual cash payments to the Borough for these expenses. Kenai Peninsula Borough r 12982780 Central Peninsula Hospital operates the Hospital on behalf of the Kenai Peninsula Borough through a lease and operating agreement. That agreement requires that all operating cash in excess of 90 days expenses at the end of each quarter be transferred to a Plant Replacement Fund held at the Borough. This is the total amount of cash transferred into that fund during the year. The annual audited financial statements of the Hospital were not completed in time to enable timely filing of the 990 informational return.