2018-02-06T15:32:57-07:00 2017-06-30 990 2016-07-01 920077523 CENTRAL PENINSULA GENERAL HOSPITAL INC CENT 9077144404 250 Hospital Place Soldotna AK 99669 Lance Spindler CFO 9077144722 2018-02-06 216.67.112.2 2016 2021-01-29 14:40:06Z Central Peninsula Hospital Rick Davis 250 Hospital Place Soldotna AK 99669 305919647 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 9 997 230 0 0 1323581 1435192 305468571 299302632 554917 44845 4398828 4051309 311745897 304833978 137919 214739 0 0 77486796 89599715 0 0 0 210085444 214467872 287710159 304282326 24035738 551652 230377060 226141503 77930036 73142827 152447024 152998676 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 271031543 268022592 Our 49 bed hospital provided patient and ancillary services to 2,449 inpatients and 97,864 outpatients during the 2016 tax year. The hospital provides emergency medical services regardless of ability to pay. Emergency medical services were provided to 16,933 individuals, and 1,796 of those individuals were admitted to the hospital. 4,098 surgical procedures were performed in the hospital during the tax year. The imaging department performed 39,109 procedures. Over 78,673 physical therapy 15-minute procedures were provided to area residents. During the 2016 tax year, free medical services in the amount of $3,637,642 (gross charges) were provided to patients eligible for charity care. 11352901 10685874 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 2016 tax year were 151 and total resident days of care were 18,975. An average of 52 residents per day were provided long term care and nursing. Ancillary services for residents included 11,233 physical therapy treatments, while outpatients received 2,596 therapy treatments. 20073390 20594166 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, Forensic services, and the provision of Durable medical equipment. During the 2016 tax year physician and specialty services were provided for 29,856 patients. Over 4,573 wound care procedures, 104 forensic exams, and 202 sleep studies were also performed. 0 0 0 302457834 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 1 1 0 0 0 0 0 1 0 1 0 1 164 0 1 997 1 0 0 0 0 0 0 X 11 9 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 0 X 3700 0 0 Trena Richardson President 8 0 X 11250 0 0 Gregg Motonaga Anesthesia MD/Board Member 44 0 X X 731944 0 0 Mark Dixson Board Member 4 0 X 3500 0 0 Mark Premo Board Member 4 0 X 2550 0 0 Steven Manley Board Member 4 0 X 0 0 0 Stephen Horn Board Member 4 0 X 2450 0 0 James McHale Vice President 4 0 X 3400 0 0 Debra Shuey Board Member 4 0 X 3650 0 0 John Bramante Board Member 4 0 X 2500 0 0 Irv Carlisle Sec/Treasurer 6 0 X 2950 0 0 Lynda Columbia Board Member 4 0 X 0 0 0 Matthew Dammeyer COO 40 0 X 281644 0 36463 Richard Davis CEO 40 0 X 493587 0 33449 Lance Spindler CFO 40 0 X 262669 0 35636 Karen Scoggins CNO 40 0 X 209433 0 27756 Danny Romman Foot Surgeon, MD 40 0 X 695994 0 18334 David S Innes Orthopedic Surgeon 40 0 X 1621345 0 43345 Robert Cadoff Urologist 40 0 X 1239820 0 30202 Jason Lattin Surgeon 40 0 X 853575 0 43345 6425961 0 268530 111 0 1 0 C&A Industries dba Focus One Solutions PO Box 3037 Omaha NE 68103 Contract Labor Provider 1937366 Alaska Hospitalist Group LLC 4300 B Street Suite 200 Anchorage AK 99503 Physician Services 759237 Himagine PO Box 743505 Atlanta GA 303743505 Medical Coding Provider 592138 Integrity Networks 2220 Lind Ave SW 106 Renton WA 98057 Information Services contract labor 350495 Curtis Buchholz 44455 Sterling Hwy Soldotna AK 996697936 Pathology services 292636 16 0 0 0 46805 1181785 206602 59432 1435192 Hospital Service Revenue 622000 268022592 268022592 0 0 Skilled Nursing/Longterm 623000 10685874 10685874 0 0 Outpatient Physician Clinics 621110 20594166 20594166 0 0 0 0 0 0 299302632 43349 0 0 43349 0 0 0 0 0 0 0 0 583729 0 951473 0 -367744 0 -367744 -367744 0 0 0 1496 0 0 0 1496 1496 1496 0 0 0 441873 134196 307677 307677 0 0 Property Tax Revenue 622000 55422 55422 0 0 USAC Telephone Subsidy 622000 1331319 1331319 0 0 Electronic Health Record Incentives 622000 375379 375379 0 0 2349256 2349256 0 0 4111376 304833978 303355437 0 43349 214739 214739 0 0 0 0 0 0 6572836 5034895 1537941 0 0 0 0 0 55460930 55460930 0 0 1798211 1798211 0 0 21622796 21622796 0 0 4144942 4144942 0 0 0 0 0 0 193039 0 193039 0 77291 0 77291 0 16221 0 16221 0 0 0 0 0 0 0 8109502 8109502 0 0 288131 288131 0 0 21852155 21852155 0 0 5943402 5943402 0 0 0 0 0 0 2526279 2526279 0 0 352227 352227 0 0 0 0 0 0 336157 336157 0 0 1672223 1672223 0 0 0 0 0 0 13680869 13680869 0 0 1413549 1413549 0 0 Medicare Patient Deductions 69645938 69645938 0 0 Medicaid Patient Deductions 45714652 45714652 0 0 Commercial, Governemnt, Other Patient Deduct 31090328 31090328 0 0 Uncompensated Care (Charity + Bad Debt) 9728787 9728787 0 0 1827122 1827122 0 0 304282326 302457834 1824492 0 32654348 35482840 4394414 4957556 80710 326591 30397574 29807497 0 0 0 0 0 0 5837172 5778418 1967254 1795376 183578811 72367519 109253168 111211292 0 0 500000 500000 0 0 1772446 1301191 43519974 34980742 230377060 226141503 13919812 14935395 0 0 12906 12245 63767341 58145490 0 0 0 0 27993 0 0 0 201984 49697 77930036 73142827 X 144322706 146099651 8124318 6899025 0 0 152447024 152998676 230377060 226141503 551652 0 0 0 0 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 8089 0 1 8132 16221 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 2400217 0 2400217 103279904 0 43746892 59533012 562002 0 399387 162615 72767949 0 27188657 45579292 4568739 0 1032583 3536156 111211292 Plant replacement and expansion fund 28890928 Debt service reserve fund 4876535 Bond proceeds reservd for capital projects 299226 Deferred loss on 2011 bond refunding 914053 34980742 0 Cash Held for Others 49697 49697 155478188 0 0 0 732770 732770 154745418 0 150088560 150088560 304833978 154576576 0 0 0 382810 382810 154193766 0 150088560 150088560 304282326 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 use by the Hospital's chemical dependency unit. There is no value placed upon 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 Good sold in the amount of $134,196 reported in Part VIII line 10b are reported as expenses on the audited financial statements. Revenues from Central Peninsula Health Foundation in the amount of $598,574 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 $150,088,560 are reported as expenses in Part IX, line 24 a-d on the 990, however they are reported net of revenues on the Audited financial statements. Schedule D, Part XII, Line 2d Cost of Goods sold in the amount of $134,196 are required to be reported net of associated revenue for durable medical equipment on the 990, Part VIII line 10b. COGS is reported as an expense on the audited financial statements. Expenses of Central Peninsula Health Foundation in the amount of $248,614 are reported as a reduction of other non-operating revenues on the Audited financial statements. The Foundation is a blended component unit and a supporting organization of the Hospital. These expenses are not reported on the 990 because the Foundation is required to file its own Form 990. Schedule D, Part XII, Line 4b Deductions from Revenue in the amount of $150,088,560 are reported as Expenses in Part IX of the Form 990, while they are reported net of revenues on the Audited financial statements in accordance with Generally Accepted Accounting principles. These deductions include unpaid write-offs from Medicare, Medicaid, and other third party payors. 1 1 X 1 X 1 X 1 1 0 0 1 1535 1645873 0 1645873 0.0111 1 13000 22489531 24993090 -2503559 0 0 0 0 0 0 0 2 14535 24135404 24993090 -857686 0.0111 416 9865 854230 100761 753469 0.0051 105 791 55671 6255 49416 0.0003 14 33384 10220718 4457100 5763618 0.039 10 128 12619 900 11719 0.0001 1083 1113 285858 0 285858 0.0019 1628 45281 11429096 4565016 6864080 0.0464 1630 59816 35564500 29558106 6006394 0.0575 0 0 0 0 0 0 10 100 3165 0 3165 0 1 0 102 0 102 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 6 68077 0 68077 0.0005 0 0 0 0 0 0 20 106 71344 0 71344 0.0005 0 3123539 2186477 32840222 42344994 -9504772 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 15 1 0 0 1 X http://www.cpgh.org/workfiles/CPH%202016%20Community%20Health%20Needs%20Assessment.pdf X 1 16 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 During preparation of the Community Health Needs Assessment (CHNA), an independent contractor conducted phone interviews with a broad cross section of the local community through randomly selecting land-lines for 600 respondents (14.7% of total land lines). The contractor also used US Census bureau estimates (2014), Ak Department of Labor Research (2015) 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 for kids and adults, 7)Pulmonary services, 8)End of life care services, 9)Dialysis services, 10)Primary care providers Of these 10 identified needs, the Hospital's Board and Executive team have prioritized the top 7 Health initiatives which can be immediately addressed and designed an Implementation Plan to respond to those needs. The Implementation Plan addresses: 1)Cardiovascular Health, 2)Substance abuse 3)Mental health, 4)End of Life services, 5)Primary Care access, 6)Wellness services for adults and children, and 7)Alzheimer's Care. Although the Hospital recognizes the importance of the remaining health needs identified in the CHNA, 3 needs either cannot be achieved by the Hospital in the near future, or are being addressed by an outside organization. Those needs are 1)Dialysis services - outpatient dialysis services are currently offered in the service area by another organization. No inpatient dialysis services are provided at the Hospital due to the absence of physicians specializing in kidney care. Kidney Physician's from Anchorage to come to the Kenai peninsula once each month to see local patients. 2) Pulmonary services - currently the volume of pulmonary patients in the service area would not support the recruitment of a full-time Pulmonologist, therefore services are being provided from Anchorage. Preventative care, and wellness services are being provided by the Hospital in order to reduce the need for pulmonary services. 3) Assisted living - 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, in addition to Home Health care entities will meet the community need. Schedule H, Part V, Section B, Line 11-Central Peninsula Hospital In the most recently published CHNA, an independent consultant identified the top 10 community health needs: 1)Alzheimers services, 2)Alcohol and drug abuse treatment, 3)Cardiology services, 4)Mental health services, 5)Assisted living services, 6)Wellness services for kids and adults, 7)Pulmonary Services, 8)End of life services, 9)Dialysis Services, and 10)Primary care providers. The Hospital has developed an implementation strategy to meet 7 of these 10 needs. The remaining 3 are being addressed by other entities within the community, or are unable to be addressed at this time due to the lack of specialty providers. Seven of the health concerns identified above are being met by the Hospital implementation plan in the following ways: 1)Alzheimers - Education and training for key individuals in Long-term care, and Hospital nursing through the Alzheimer's association has begun, along with collaboration with Cindy Harris, Alaska's Alzheimer's Ambassador. Partnering with local providers to obtain Alzheimer's education from a neuropsychologist. 2)Drug abuse treatment - Applied for and received a $2.5M grant to develop and open a 6-bed withdrawal management detox center to provide intensive outpatient detoxification in the local community. The detox center opened it's doors in August 2017. A 16-bed transitional housing facility will open in December 2017 to provide continuing outpatient care to area residents who still require outpatient services after initial treatment. Developed a large community collaborative called Change for the Kenai (C4K) to address the opioid crisis, and lack of housing resources. 3)Cardiology - Received approval from the State of Alaska to build a cardiac catheterization lab on the Hospital campus. Revenue bonds will be sold in December 2017 to fund the project, which will be completed by 2020. Lease medical clinic space to Alaska Heart institute for local cardiology care, and assisting in the recruitment of two more cardiologists. 4)Mental Health service -The Behavioral health department continues to provide comprehensive mental health services to the community in collaboration with Peninsula Community Health Services (PCHS). Currently the Hospital does not employ a psychiatrist, however PCHS does. 5)Wellness services for kids and adults - currently the Hospital supports local non-profits such as the Boys and Girls club, and Kenai River Brown Bears which provide healthy activities for local kids. Further, Health fairs are provide to the general public enabling them to participate in numerous lab and other health diagnostics to gauge 6)End of life care services - developed a multidisciplinary Palliative Care committee to improve partnership among entities providing end of life care. Provided $30,000 in support for local Hospice entity providing end of life and bereavement services. 7)Primary care providers - The Hospital hired an Internal medicine provider to improve access to care for this specialty. The Hospital is currently recruiting two more Family medicine providers to the community. Operates two Family medicine clinics, one in Soldotna and one in Kenai which provide affordable primary care to area residents regardless of their insurance payor. Currently, there are three health needs which the Hospital is not addressing. Here are the reasons why: 1)Assisted living services - in recent years, nearly 100 additional beds were created through local non-profit and for-profit entities. It is believed that this additional capacity will meet the community need. 2)Pulmonary services - currently the number of pulmonary patients is not sufficient to recruit a full-time pulmonologist to the service area. This need will continue to be reviewed in coming years. Instead, the Hospital has focused on preventative care provided through Community wellness education, support of adolescent programs, and Health fairs. 3)Dialysis services - Outpatient dialysis services are being provided in the community through Fresenius, however no inpatient dialysis services exists due to the lack of a Kidney specialist. Currently there is not adequate need to recruit a full-time nephrologist to the area and so residents are being cared for by a single kidney physician who holds clinics in the Soldotna area once per month. Schedule H, Part V, Section B, Line 16i-Central Peninsula Hospital The Hospital makes its financial assistance policy widely available to the public and to its patients through various means. Financial assistance brochures are available in hard copy at each of the main entrances to the Hospital as well as in the Emergency Department waiting area. During the discharge process, admissions staff attempt to provide a copy o the financial assistance policy to every patient. Additionally, the financial counselors contact patients about their bills and discuss the financial assistance with them over the phone and in person. Counselors also offer personal assistance with completing the application if needed. The Financial assistance policy is posted on our website at www.cpgh.org and is reported in quarterly public meetings of the local governing body. Finally, the policy is advertised in the local newspaper to the general public, along with instructions for how to contact a financial counselor. Schedule H, Part V, Section B, Line 16j-Central Peninsula Hospital The Hospital makes its financial assistance policy widely available to the public and its patients through various means. Financial assistance brochures are located at each of the main entrances to the Hospital as well as in the Emergency Department waiting area. During the discharge process, Hospital Admissions staff attempt to provide a copy of the financial assistance policy to every patient. Additionally, financial counselors contact patients about their bills and discuss the financial assistance policy with them over the phone or in person. They also offer assistance in completing the applications with the patient. Additionally, the financial assistance policy is posted on our website at www.cpgh.org and is reported quarterly at meetings of the local governing body. Finally, the policy is advertised in the local newspaper to the general public, along with instructions for how to contact a financial counselor. Schedule H, Part V, Section B, Line 22d-Central Peninsula Hospital In accordance with IRC 501(r), the Hospital uses a blend of the Medicare rates and the most advantageous commercial rates to determine the maximum amount that can be charged to FAP-eligible individuals. 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 Pain Management 289 N Fireweed Unit C/D Soldotna AK 99669 Pain management clinic Central Peninsula Neurology 289 N Fireweed St Suite C/D 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 Vacant building 158 Corral Street Soldotna AK 99669 Vacant building for remodel Serenity House transitional housing 166 W Corral Street Soldotna AK 99669 Transitional housing for Serenity House clients 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 Serenity House transitional housing II 146 W Corral Street Soldotna AK 99669 Residential building providing transitional housing to patients leaving chemical dependency 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 254 N Binkley St Soldotna AK 99669 OB/Gyn Physician Medical Office 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 (FY2017) was used. Schedule H, Part I, Line 7, Column f Bad debt expenses of $6.091 million 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 costs from certain Physician clinics in Part I, line 7g for both family practice and specialty physician practices. These costs are as follows: Internal Medicine -$785,360, Pain Management -$76,501, Women's Health -$225,660, Family Medicine -$761,932, and Urology -$574,728. 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 areas residents and engaging the community in health initiatives. Schedule H, Part III, Section A, Line 4 Footnote: 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, charges and trends in healthcare coverage, and other collection indicators. The adequacy of this provision is periodically reviewed and further modified based upon the accounts receivable payor composition and aging, and historical write-off experience by payor class. Schedule H, Pt III amounts are based on the combined Medicare and Medicaid cost to charge ratio for tax year 2016 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 for 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 2017 Medicare cost report (tax year 2016) 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 on 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 (300%) are eligible for a discount on their bills, while those on the lower end (200%) are eligible for free care. Schedule H, Part VI, Line 2 In addition to the preparation of a Community Health Needs Assessment (CHNA) and a strategic plan to meet those needs, 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 periodically hires consultants to determine the physician and specialty service needs in the community and to assist with physician recruiting. Last, 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. Finally, it is 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 3 full time 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 is 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 individual between the age 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 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 building activities. 1 Kenai Peninsula Boys and Girls Club 227 Caviar Street Kenai AK 99611 943067142 501c3 35000 0 Actual monetary amount donated This cash donation supports the operations of the Kenai Peninsula Boys and Girls Club, a local nonprofit dedicated to providing safe afterschool activities for area children. Hospice of the Central Peninsula PO Box 2584 Soldotna AK 99669 920118694 501c3 30000 4000 Actual monetary donation Cost of catering and Food for event. Local bereavement program sponsorship and Hospice 30th Anniversary catered event costs. Kenai River Brown Bears PO Box 2605 Soldotna AK 99669 262580744 501c3 20000 0 Actual monetary donation Season sponsorship of the 2016/2017 season for local athletes, and Cancer awareness night sponsorship. Kenai Watershed Forum 44129 Sterling Highway Soldotna AK 99669 911829284 501c3 11000 0 Actual monetary donation 2016/2017 Salmon Run series sponsorship providing local environmental education. Kenai River Foundation PO Box 3944 Soldotna AK 99669 271570362 501c3 10000 0 Actual monetary donation Sponsorship of the Wounded Heroes Event. Kenai Peninsula United Way PO Box 2073 Kenai AK 99611 920111698 501c3 10000 0 Actual monetary donation Employee giving match contribution. Bridges Community Resource Network PO Box 1612 Soldotna AK 99669 920151271 501c4 10000 0 Actual monetary donation Imagination library program sponsorship. Kenai Peninsula Food Bank 33955 Community College Dr Soldotna AK 99669 943112445 501c3 5000 2678 Actual monetary donation Actual cost of hams and turkeys Soup supper fundraiser donation and donation of hams and turkeys for local residents and customers of the food bank. Alaska State Hospital and Nursing Home Association 1049 W 5th Ave Suite 100 Anchorage AK 99501 920034538 501c6 5400 0 Actual monetary donation Annual 2017 conference sponsorship to provide education to Alaska Hospital's and Nursing Homes. 7 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 David S Innes Orthopedic Surgeon 1620792 0 0 0 553 0 5972 0 42213 0 1669530 0 0 0 Robert Cadoff Urologist 1199813 0 37629 0 2378 0 5972 0 30881 0 1276673 0 0 0 Jason Lattin Surgeon 852745 0 0 0 829 0 5972 0 40938 0 900484 0 0 0 Gregg Motonaga Anesthesia MD/Board Member 663844 0 67270 0 829 0 20618 0 19174 0 771735 0 0 0 Danny Romman Foot Surgeon, MD 679711 0 15867 0 416 0 5972 0 13433 0 715399 0 0 0 Richard Davis CEO 345552 0 71944 0 76091 0 15910 0 21724 0 531221 0 0 0 Matthew Dammeyer COO 223786 0 34133 0 23725 0 11680 0 28331 0 321655 0 0 0 Lance Spindler CFO 207765 0 31861 0 23043 0 11179 0 34482 0 308330 0 0 0 Karen Scoggins CNO 161577 0 28124 0 19732 0 9916 0 22848 0 242197 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 a 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 two years to perform a review of executive salaries and benefits. The most recent review was performed in October 2016. The resulting report is provided to the Board of Directors 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 staff 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 following individuals on Schedule J participated in the 457 plan and either deferred their own compensation or received hospital contributions into the plan during the tax year: Gregg Motonaga, David Innes, Richard Davis, Matthew Dammeyer, Karen Scoggins, and Lance Spindler. 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 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 4 operational and quality measures in order to maintain the highest standard of patient care. One of these 4 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. The remaining three measures are 1)Quality of Care, 2)Patient Satisfaction, and 3)Utilization. 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 993076 127595 0 0 35043226 0 0 2016 0 0 1 1 C 0 0 3200000 544993 35169 146524 22868 0 0 3200000 0 0 2016 0 0 1 1 D 0 0 3064374 563191 0 131793 17500 0 0 2765148 0 299226 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 Gregg Motonaga Dr Motonaga is an employed physician and board member 780796 Total FY17 employee compensation and benefits 0 John Bramante Dr. Bramante is a board member and employed by a vendor of CPH, Peninsula Internal Medicine 36572 Total FY17 invoices paid to vendor Peninsula Internal Medicine 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 proposed any edits to the Finance Department and give authority to the CFO or Board President to sign and file the return. Form 990, Part VI, Section B, Line 12c Both senior leadership and 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 remuneration study is performed every 2 to 3 years. The most recent study was performed in October 2016. Remuneration 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. Contemporaneous documentation exists for this study. 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 230533 This amount represents total contributions received from the Foundation in payment for programs, capital, and grants to individuals for assistance. The Hospital initially paid for each of these program expenses, capital, or grants, and the Foundation reimbursed the Hospital from either restricted or unrestricted fund 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 230533 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 tax year 2016 was $230,533. Central Peninsula Health Foundation n 12789 The Hospital provides office space to Central Peninsula Health Foundation, a supporting organization. The value is determined based on the most recently filed Medicare Cost report (2016) expenses for facility, admin, and support services per square foot. Central Peninsula Health Foundation o 67671 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 7825460 During tax year 2016, the Hospital reimbursed the Kenai Peninsula Borough for bond debts service, refuse, insurance premiums, and sales tax. This amount represents the actual cash payments to the borough for these expenses. Kenai Peninsula Borough r 6145982 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 Kenai Peninsula Borough. This is the total amount of cash transferred into that fund during tax year 2016. The annual audited financials statements of the entity were not completed in time to enable timely filing of the 990 information return.