2017-01-30T13:36:53-07:00 2016-06-30 990 2015-07-01 920077523 CENTRAL PENINSULA GENERAL HOSPITAL INC CENT 9077144404 250 Hospital Place Soldotna AK 99669 Lance Spindler CFO 9077144722 2017-01-30 2015 2021-01-29 14:40:06Z Central Peninsula Hospital Richard Davis 250 Hospital Place Soldotna AK 99669 312430431 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 9 942 256 0 0 599171 1323581 268614128 305468571 249248 554917 5396380 4398828 274858927 311745897 205388 137919 0 0 76976428 77486796 0 0 0 180500141 210085444 257681957 287710159 17176970 24035738 212108821 230377060 83697535 77930036 128411286 152447024 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 257057629 273948766 Our 49 bed hospital provided patient and ancillary services to 2575 inpatients and 102,921 outpatients during the 2015 tax year. The hospital provides emergency medical services regardless of ability to pay. Emergency medical services were provided to 17,883 individuals, and 1,708 of those individuals were admitted to the hospital. 4,505 surgical procedures were performed in the hospital during the tax year. The imaging department performed 47,967 procedures. Over 75,709 physical therapy 15-minute procedures were provided to area residents. During the 2015 tax year, free medical services in the amount of $5,924,413 (gross charges) were provided to patients eligible for charity care. 11563463 12336198 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 2015 tax year were 169 and total resident days of care were 18,658. An average of 51 residents per day were provided long term care and nursing. Ancillary services for residents included 18,658 physical therapy treatments, while outpatients received 6,893 therapy treatments. 17460148 19183607 The hospital operates 11 family and specialty physician services clinics providing care in the following areas: Family medicine, Pediatrics, Neurology, Pain Management, Surgery, Urology, Podiatry, Internal Medicine, Womens Health, and Orthopedics. Other outpatient clinics include Wound care, Sleep studies, Forensic services, and the provision of Durable medical equipment. During the 2015 tax year physician and specialty services were provided for 29,278patients. Over 3,422 wound care procedures, 85 forensic exams, and 233 sleep studies were also performed. 0 0 0 286081240 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 1 127 0 1 942 1 1 1 0 0 0 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 X 2525 0 0 Trena Richardson President 8 0 X 12525 0 0 Gregg Motonaga Anesthesia MD/Board Member 44.00 0 X X 684614 0 41841 Mark Dixson Board Member 4 X 3625 0 0 Mark Premo Board Member 4 X 2775 0 0 Steven Manley Board Member 4 0 X 0 0 0 Stephen Horn Board Member 4 X 3075 0 0 James McHale Board Member 4 0 X 3325 0 0 Debra Shuey Board Member 4 0 X 3925 0 0 John Bramante Board Member 4 0 X 2625 0 0 Irv Carlisle Sec/Treasurer 40 0 X 3475 0 0 Matthew Dammeyer COO 40 0 X 299752 0 37053 Richard Davis CEO 40 0 X 445989 0 31489 Lance Spindler CFO 40 0 X 246471 0 35614 Karen Scoggins CNO 40 0 X 190418 0 24768 Justin Evans Anethesia MD 40 0 X 594068 0 55141 David S Innes Orthopedic Surgeon 40 0 X 2239156 0 37141 Robert Cadoff Urologist 40 0 X 799526 0 26588 Jason Lattin Surgeon 40 0 X 831535 0 37141 6369404 0 326776 100 0 1 0 C&A Industries dba Focus One Solutions PO Box 3037 Omaha NE 68103 Contract Labor Provider 1035450 Alaska Hospitalist Group LLC 4300 B Street Suite 200 Anchorage AK 99503 Physician Services 748007 Curtis Buchholz 44455 Sterling Hwy Soldotna AK 996697936 Pathology services 287333 Derek Leichliter 46113 Sather Ct Soldotna AK 99669 Electrical Contractor 274591 Talos Practice Services PO Box 96024 Las Vegas NV 89193 Surgical professional svcs 207463 9 0 0 0 3963 1318618 1000 7925 1323581 Hospital service revenue 622000 273948766 273948766 0 0 Skilled Nursing Revenue 623000 12336198 12336198 0 0 Physician Clinic revenue 621110 19183607 19183607 0 0 0 0 0 0 305468571 553256 0 0 553256 0 0 0 0 0 0 0 0 440765 0 535280 0 -94515 0 -94515 -94515 0 0 0 1661 0 0 0 1661 1661 1661 0 0 0 425797 149254 276543 276543 0 0 Property tax 900099 51278 51278 0 0 USAC Telephone grant 900099 597570 597570 0 0 EHR Incentive payments 900099 589444 589444 0 0 2978508 2978508 0 0 4216800 311745897 309869060 0 553256 137919 137919 0 0 0 0 0 0 7206323 5812914 1393409 0 0 0 0 0 51150893 51150893 0 0 1617583 1617583 0 0 13822693 13822693 0 0 3689304 3689304 0 0 0 0 0 0 171786 0 171786 0 38924 0 38924 0 24800 0 24800 0 0 0 0 0 0 0 4813531 4813531 0 0 294617 294617 0 0 25651449 25651449 0 0 4731999 4731999 0 0 0 0 0 0 2892618 2892618 0 0 328385 328385 0 0 0 0 0 0 351321 351321 0 0 1205993 1205993 0 0 0 0 0 0 10152657 10152657 0 0 1466731 1466731 0 0 Medicare deductions 74032765 74032765 0 0 Medicaid deductions 32174022 32174022 0 0 Uncompensated care 15861460 15861460 0 0 Commercial deductions 28696074 28696074 0 0 7196312 7196312 0 0 287710159 286081240 1628919 0 31905467 32654348 5732944 4394414 49290 80710 28938252 30397574 0 0 0 0 0 0 5169890 5837172 1409211 1967254 175526071 66272903 93151047 109253168 0 0 500000 500000 0 0 2169698 1772446 43083022 43519974 212108821 230377060 16817431 13919812 0 0 11005 12906 65878691 63767341 0 0 0 0 89411 27993 0 0 900997 201984 83697535 77930036 X 122377174 144322706 6034112 8124318 0 0 128411286 152447024 212108821 230377060 24035738 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 14933 0 1 9867 24800 0 Schedule C, Part II-B, Line 1 Line 1 g consist of travel expenses and compensation of employees for three trips to Juneau, AK to meet with state legislators regarding Medicaid expansion and two trips to Washington DC to meet with federal legislators regarding continuation of the Rural community hospital demonstration project. Line 1i consists of the portion of dues paid to outside organizations that were spent on lobbying. 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 100134816 0 41104626 59030190 562002 0 347019 214983 63646379 0 23836365 39810014 8782657 0 984893 7797764 109253168 Plant replacement and expansion fund 36058619 Debt service reserve fund 4725834 Bond proceeds reserved for capital projects 1675220 Deferred loss on 2011 bond refunding 1060301 43519974 0 Amounts due to Medicare program 150000 Other current liabilities 51984 201984 171067876 0 0 0 149254 149254 170918622 0 140827275 140827275 311745897 147032138 0 0 0 149254 149254 146882884 0 140827275 140827275 287710159 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 purposed pursuant to AK statute 38.05.321. The building on the 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 Hospital Financial statements or footnotes. However, the cost of the real property is recorded on the Hospital's balance sheet at its net book value. Schedule D, Part XI, Line 2d On IRS Form 990, expenses related to cost of goods sold for inventory are reported in Part VIII as a reduction of revenue. For financial statement purposes, these expenses are reported in operating expenses. Schedule D, Part XI, Line 4b On IRS Form 990, all Hospital revenues are reported gross and related deductions from third party payers such as Medicare, Medicaid, VA, and uncompensated care such as Charity and Bad debt are reported as expenses in Part IX. However, in accordance with General accepted accounting principles all revenues on the audited financial statements are reported net of these deductions. Schedule D, Part XII, Line 2d On IRS Form 990 expenses related to cost of goods sold for inventory sales are reported as a reduction of revenues in Part VIII whereas these costs are reported as operating expenses on the audited financial statements. Schedule D, Part XII, Line 4b On IRS Form 990 all uncompensated care and unpaid deductions from revenue from third party payers such as Medicare, Medicaid, and others are reported in Part IX on the statement of functional expenses. However on our audited financial statements, deductions are reported net of patient revenues in accordance with Generally Accepted Accounting principles. 1 1 X 1 X 1 X 1 1 0 0 1 3527 2312186 0 2312186 0.0171 1 19638 17783836 21240961 -3457125 0 1 102 22615 16107 6508 0 3 23267 20118637 21257068 -1138431 0.0171 422 10655 711653 87124 624528 0.0046 119 425 60892 8565 52327 0.0004 16 26916 11987511 6813214 5174297 0.0382 4 63 11467 1050 10417 0.0001 1051 519 203443 0 203443 0.0015 1612 38578 12974966 6909953 6065012 0.0448 1615 61845 33093603 28167021 4926581 0.0619 0 0 0 0 0 0 0 0 0 0 0 0 1 0 108 0 108 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 14 195 63383 0 63383 0.0005 0 0 0 0 0 0 15 195 63491 0 63491 0.0005 0 4043163 2830209 32047904 38216765 -6168861 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 X 15 1 0 0 1 X www.cpgh.org X 1 15 1 www.cpgh.org/2016CommunityHealthNeedsAssessment 0 0 1 X 200 300 X 1 1 X X 1 X http://www.cpgh.org/PatientFinancialServices X http://www.cpgh.org/PatientFinancialServices X http: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 Central Peninsula Hospital - in conducting a community health needs assessment (CHNA), an independent contractor reached out to a broad cross section of the local community in order to gather health data through phone interviews. The contractor also used published census and health data for the community, state, and nation in the needs assessment. Hospital management supplements health information provided in the CHNHA by partnerships and collaborations around the state and the nations through involvement in the Alaska State Hospital and Nursing Home Association, Rural Healthcare and Small Hospital Association, and also on a local level with the Kenai Peninsula Borough, the Patient Advisory committee, and the Borough Assembly. Schedule H, Part V, Section B, Line 5-Central Peninsula Hospital In addition to the CHNA, the Hospital also confers with local medical staff, patients, hospital associations, and the local government to ascertain community health needs. Schedule H, Part V, Section B, Line 7d-Central Peninsula Hospital In addition to the above methods of disbursement, the CHNA was also provided through email to all Hospital Administrators, Board members, and supervisory staff. Schedule H, Part V, Section B, Line 11-Central Peninsula Hospital The most recently published CHNA identified the top ten community health needs as follows: Access to primary care physicians, Alcohol and drug abuse treatment, Mental health services, Alzheimer services, Cardiology services, Assisted living services, Pulmonary services, Dialysis services, Wellness services, and End of life care. Of these 10 identified needs, the Hospital Board has prioritized the top 7 Community health initiatives which will help to be address these needs. time. Those initiatives are as follows: 1)Cardiovascular health, 2)Substance abuse, 3)Mental health services, 4)End of life services, 5)Primary care physician access, 6)Wellness services, and 7)Alzheimers care. Although the Hospital recognized the importance of all needs identified by the CHNA, three needs cannot be addressed at this time due to various reasons. These three items are: 1)Dialysis services - No nephrology physicians are currently working full time in the service area with which to collaborate to cover this need. Nephrology and dialysis are currently supported by physicians in Anchorage which come to the peninsula monthly to see patients at the local outpatient dialysis center. 2)Assisted living - in recent months approximately 100 assisted living beds have been added to the service area which are managed my private entities. The Hospital believes this will meet the community needs. 3)Pulmonary services - currently the volume of pulmonary patients residing in the service area are not sufficient to support a full-term Pulmonologist and therefore this service is not able to be addressed at this time. 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 displayed 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 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. 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 501r, 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 Surgical Services 289 N Fireweed St Unit B Soldotna AK 99669 Surgical clinic 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 Kenai Spine Ctr 108 E Corral St Soldotna AK 99669 Medical office building partly leased to Kenai Spine, CP Radiology and Physical medicine Radiation Oncology Building 240 Hospital Place Soldotna AK 99669 Radiation Oncology Building - leased to RBS Evolution CP Foot & Ankle Clinic 198 W Corral Soldotna AK 99669 Hospital owned physician clinic Serenity House transitional housing II 146 W Corral Street Soldotna AK 99669 Residential building providing transitional housing to patients leaving chemical dependency CP Urology Clinic 262 N Binkley St Soldotna AK 99669 Urology Physician clinic Central Peninsula Hospital Transitional Living Ctr 362 Tyee Street Soldotna AK 99669 Transitional Living Center 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 cost for certain activities is too cumbersome to compile, the cost to charge ratio from the most recently filed Medicare Cost Report (FY2016) was used. Schedule H, Part I, Line 7g The Hospital did include costs from Physician clinics in Part I, line 7g for both family practice and specialized physician services. These costs are as follows; Womens Health clinic -$375,929, Family and Pediatrics -$286,936, Internal medicine -$113,333, Pain Management -$238,641, Orthopaedics -$332,110, and Urology -$332,477. 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 and by 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, changes and trends in healthcare coverage, and other collection indicators. The adequacy of this provision is periodically reviewed and further modified based upon the accounts receibable payor composition and aging, and historical writeoff experience by payor class. Schedule H, Part III is based on the estimated cost to provide care for individuals whose accounts were classified as bad debt during the year. The amount which may be attributable to patients who qualify for charitable assistance or free care is estimated at approximately 73% of that total. These are accounts which our financial counselors made every effort to contact and assist patients to apply for financial assistance, but the patient refused to do so. 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 without the expectation of compensation. 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 patients co-pay for deductible and may not engage in collection efforts for the remainder. As Medicare patients comprise a significant percentage of our community members, our community Hospital must provide needed medical services to this population irrespective of the payments received. The Medicare costs reported herein are based on the fiscal year 2016 Medicare cost report filed. 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 ways. 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 needs of the community. The Hospital periodically employs consultants to determine the physician and specialty services needed in the community for strategic planning and physician recruiting. Finally, an open dialogue exists between Hospital management and patients, staff, and area medical providers which is another source of identifying community health needs. Schedule H, Part VI, Line 3 Hospital staff attempt to provide a financial assistance brochure to every patient during the admission or discharge process. The brochure is also available at each entrance, upon request, on the Hospital's public website, and is published in the local newspaper. Financial counselors personally contact patients with past due balances and explain the financial assistance policy, assist with applications for assistance, and set up payment plans if necessary. The Hospital employs 3 full time financial counselors that meet personally with patients to review their bills, set up payment arrangements, explain the financial assistance policy, and assist with the application process. In addition, the Hospital purchases advertising space in the local newspaper to notify the public of it financial assistant program and explain how patients can contact a financial counselor to apply. Schedule H, Part VI, Line 4 The area served by the Hospital is comprised of 13 census designated places or towns and has a total population of 36,000 residents according to the 2010 census, approximately 11% of the population is 65 years or older, 32% are between 45 and 664, and 32% are between 19 and 44. Basic socioeconomic characteristics of the region indicate an 8.6% unemployment rate with a median household income of $60,378, while 8.9% of residents live below the federal poverty line. More than 22% of adults age 18 to 64 years are uninsured, just 1% higher than the National average. Schedule H, Part VI, Line 5 The Hospital engages in numerous community efforts year-round to improve health awareness and education in our service area. Monetary donations to local non-profits that support health initiatives, healthy living programs, personnel support to local non-profits, public service announcements, conference room space for community organizations and support groups, health speaker bureaus, child safety programs, health professions education, health fairs, immunization clinics, community health newsletters, and numerous other programs, initiatives and collaborations. 1 Kenai River Professional Guide Assn PO 3674 Soldotna AK 99669 920162358 501c3 10000 cash Wounded Heroes event sponsorship Kenai Peninsula Food Bank 33955 Community College Dr Soldotna AK 99669 943112445 501c3 5100 cash Soup Supper fundraiser donation and Gloria Wisecarver memorial donation Hospice of the Central Peninsula PO Box 2584 Soldotna AK 99669 920118694 501c3 31200 cash Bereavement program sponsorship, and annual fundraiser donation Kenai River Brown Bears PO Box 2605 Soldotna AK 99669 262580744 501c3 20000 cash 2015/2016 Season sponsorship and Cancer awareness night event Kenai Peninsula United Way 11355 Frontage Rd Kenai AK 99611 920111698 501c3 10000 cash Employer match of employee contributions. 5 0 Schedule I, Part I, Line 2 The Hospital provides cash contributions to local organization which support community initiatives and healthy living on the Kenai Peninsula. Contributions are only made to organization 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 Gregg Motonaga Anesthesia MD/Board Member 654320 0 31852 0 1222 0 23848 0 20774 0 732016 0 0 0 Justin Evans Anethesia MD 569587 0 29152 0 851 0 23848 0 36815 0 660253 0 0 0 David S Innes Orthopedic Surgeon 2245102 0 30 0 821 0 5848 0 36815 0 2288616 0 0 0 Jason Lattin Surgeon 836206 0 30 0 821 0 5848 0 36815 0 879720 0 0 0 Robert Cadoff Urologist 314836 0 62995 0 73925 0 13116 0 21616 0 486488 0 0 0 Richard Davis CEO 302446 0 32386 0 65625 0 12732 0 22962 0 436151 0 0 0 Lance Spindler CFO 201048 0 22795 0 28151 0 4321 0 36815 0 293130 0 0 0 Karen Scoggins CNO 162100 0 14738 0 18068 0 3591 0 24915 0 223412 0 0 0 Matthew Dammeyer COO 211182 0 31607 0 61072 0 10466 0 30696 0 345023 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 fringe 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 $18,773, Justin Evans $18,773, Richard Davis $7,374, Lance Spindler $4,369, Karen Scoggins $3,671, and Matthew Dammeyer $4,700. 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 Hospitals 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 989352 127595 0 0 35043226 0 0 2016 0 0 0 1 C 0 0 3200000 544993 35169 145714 22868 0 0 3200000 0 0 2016 0 0 0 1 D 0 0 3050000 563191 0 0 17500 0 0 0 0 1675220 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 Gregg Motonaga Dr. Motonaga is an employed physician and board member 732016 Total employee compensation and benefits 0 John Bramante Dr. Bramante is a board member, and an employed physician of Peninsula Internal Medicine 59081 Total invoices paid to Peninsula Internal Medicine during FY16 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. The CPGH Boards decisions regarding the acquisition of significant capital assets and plant expansion are subject to the approval of the Kenai Peninsula Borough assembly. Bonds, loans, and capital expenditures not funded through the Hospital's plant replacement fund must be approved by a vote of the Borough 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 then 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 and members of the Board of Directors complete an annual conflict of interest statement which is reviewed by management and the finance team. The board reviews and discusses any conflict of interests which arise throughout the year and takes appropriate action. If a conflict arises, the board member in conflict, will abstain from voting on the resolution at the board meeting. Form 990, Part VI, Section B, Line 15 An independent professional executive remuneration study is performed every 2-3 years. The most recently performed study was performed in October 2016. Remuneration reports are submitted to the Board for review and used to se 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 for inspection upon request. The Hospital's 990 is widely available 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 1 0 1 1 0 1 1 1 1 1 1 0 Central Peninsula Health Foundation c 194786 This represents the amount of 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 with either restricted or unrestricted funds depending on the expenditure type. Central Peninsula Health Foundation j 15036 The Hospital provides office space to the Foundation Director for the cost of $1,253 per month. This amount included janitorial services, and utilities. 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 194786 The Foundation performs fundraising for which a portion benefits the Hospital and its programs. The value of those programs for which the Foundation transferred solicited funds during tax year 2015 was $194,786. Central Peninsula Health Foundation n 15036 The Hospital provides office space to Central Peninsula Health Foundation. The value of the space is determined based on the most recently filed Medicare Cost report (2016)expenses for facility, admin, and support services per square foot. During the 2015 tax year, the Foundation began to pay for the portion of their operating expenses which exceeded $4,000 per month. The office space expense was included in that $4,000 donation to the Foundation. Central Peninsula Health Foundation o 72224 The Hospital shares certain paid employees for directorship and accounting functions necessary to operate the Foundation. The Foundation in return pays the Hospital for any operating, facility, or staff costs which exceed $4,000 per month. Kenai Peninsula Borough p 6721666 The Hospital reimbursed the Kenai Peninsula Borough for debt service, property insurance premiums, refuse, and sales tax. This amount represents the actual cash payments to the borough for these expenses. Central Peninsula Health Foundation q 70167 The Foundation is billed for operating expenses incurred by the Hospital which exceed $4,000 per month. This represents the actual cash value of those expenses which were billed to the Foundation and reimbursed to the Hospital. These expenses include facilities, staffing, supplies, and other operating expenses. Kenai Peninsula Borough r 22730784 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 into a Plant Replacement and Expansion fund at the Kenai Peninsula Borough. This is the total amount of cash transferred to the borough during FY2016. The audited financial statements were no issued by the filing deadline, so an extension was requested and granted.