2024-05-14T15:29:19-07:00 2023-06-30 990 2022-07-01 920077523 CENTRAL PENINSULA GENERAL HOSPITAL INC CENT 9077144404 250 Hospital Place Soldotna AK 99669 Michael Haggerty CFO 9077144722 2024-05-14 Michael Haggerty 999009999 1 1 11 1 AAL2 2022 2023-04-26 12:10:37Z Central Peninsula Hospital Shaun Keef 250 Hospital Place Soldotna AK 99669 606922638 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 1306 57 0 0 10124702 2841792 527906761 597617379 191332 1856232 4725227 3894443 542948022 606209846 94600 98245 0 0 116490870 123972966 0 0 0 403934445 460163046 520519915 584234257 22428107 21975589 290881736 308441653 79702584 75286912 211179152 233154741 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 500942946 510883849 Our 49 bed hospital provided patient and ancillary services to 2,631 inpatients and 178,343 outpatients during the 2022 tax year. The hospital provides emergency medical services regardless of ability to pay. Emergency medical services were provided to 17,044 individuals, and 2,057 of those individuals were admitted to the hospital. 5,095 surgical procedures were performed in the hospital during the tax year. The imaging department performed 57,350 procedures. 76,658 physical medicine 15-minute procedures were provided to area residents. During the 2022 tax year, free medical services in the amount of $7,943,977 (gross charges) were provided to patients eligible for charity care. 14454654 13925892 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 resident days of care for the 2022 tax year were 18,403 days. An average of 50 residents per day were provided long term care and nursing. Ancillary services for residents included 4,548 therapy treatments. 65221163 72807638 The hospital operates 13 family and specialty physician services clinics providing care in the following areas: Family Medicine, Pediatrics, Neurology, Surgery, Urology, Podiatry, Internal Medicine, Women's Health, Orthopedics, Oncology, Pain Management, Spine, and outpatient substance abuse treatment. During the 2022 tax year physician and specialty services were provided for 46,244 visits. The Urgent Care clinic which began operations in tax year 2020 to provide for emergent care visits outside of the hospital had 6,807 visits during the year. 0 0 0 580618763 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 0 0 0 0 0 0 1 0 1 0 1 111 0 1 1306 1 1 1 0 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 9077144627 250 Hospital Place Soldotna AK 99669 Michael Reyes Orthopedic Surgeon 40 0 X X 1366948 0 28941 Robert Cadoff Urologist 40 0 X 1129149 0 17393 Darren Mullins Oncologist 40 0 X 1104606 0 28941 Herbert Bote Orthopedic Surgeon 40 0 X 1103786 0 27554 Jason Lattin Surgeon 40 0 X X 806565 0 78872 David King Surgeon 40 0 X 839687 0 28941 Gregg Motonaga Anesthesiologist/Board Member 40 0 X X X 827886 0 25084 Gregory Hough Surgeon 40 0 X X 810133 0 39646 Aaron Wonnacott Emergency Physician 40.00 0 X X 681078 0 35913 Rick Davis CEO 40 0 X 616246 0 41284 John Bramante Physician/Board Member 40 0 X X 465328 0 38213 Shaun Keef COO/CEO 40 0 X 411634 0 47980 Karen Scoggins CNO/COO 40 0 X 307044 0 35204 Michael Haggerty CFO 40 0 X 280797 0 23036 James McHale Board President 8 0 X 13750 0 0 Silverio Mattero Board Member 4 0 X 2600 0 2600 Trena Richardson Board Member 4 0 X 4100 0 0 Jay Rohloff Board Member 4 0 X 3600 0 0 Steve Horn Board Vice President 4 0 X 3550 0 0 Maxwell Best Board Member 4 0 X 2900 0 0 Lynda Columbia Board Member 4 0 X 2750 0 0 Carrie Couey Board Secretary/Treasurer 4 0 X 2550 0 0 Paul Ostrander Board Member 4 0 X 2350 0 0 Jesse Kincaid Board Member 4 0 X 2150 0 0 10791187 0 499602 204 1 1 0 Medical Solutions LLC dba Focusone Solutions LLC 1010 N 102nd St Ste 300 Omaha NE 68114 Contract Labor Provider 6180194 Alaska Hospitalist Group LLC 4300 B Street Suite 200 Anchorage AK 99503 Physician Services - Hospitalist 1355400 Heath Systems Informatics PO Box 10388 Bainbridge Island WA 98110 Healthcare Consulting Services 1684025 Himagine Solutions LLC PO Box 743505 Atlanta GA 30374 Medical Coding Contractor 743782 Blazy Construction Inc 36130 Kenai Spur Hwy Soldotna AK 99669 Construction Contractor 645479 25 0 0 0 80987 2760805 0 47673 2841792 Hospital Service Revenue 622000 510883849 510883849 0 0 Skilled Nursing Revenue 623000 13925892 13925892 0 0 Outpatient Physician Clinic Revenue 621110 72807638 72807638 0 0 0 0 0 0 597617379 1856232 1856232 0 0 0 0 0 0 0 0 0 0 437126 0 502614 0 -65488 0 -65488 -65488 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1210309 210178 1000131 1000131 0 0 USAC Telephone Subsidy 622000 949128 949128 0 0 340b Pharmacy Rebate Program 622000 1922269 1922269 0 0 Property Tax Revenue 622000 88403 88403 0 0 0 0 0 0 2959800 606209846 603368054 0 0 98245 98245 9225925 5952271 3273654 89142217 89142217 2640489 2640489 16634402 16634402 6329933 6329933 171133 171133 155542 155542 15165 15165 17632285 17632285 247128 247128 2014296 2014296 9566122 9566122 3984560 3984560 175956 175956 243405 243405 1851913 1851913 13581735 13581735 1179564 1179564 Medicare deductions 180399734 180399734 0 0 Medicaid Deductions 83417555 83417555 0 0 All other deductions 77120660 77120660 0 0 Charity & Bad Debt 17876644 17876644 0 0 50529649 50529649 584234257 580618763 3615494 0 45854334 56248801 4179194 6507397 207870 452654 32913299 38521664 0 0 0 0 0 0 9082783 8893820 2630874 2886578 244437792 131102449 110463270 113335343 0 0 500000 0 0 0 0 1177000 85050112 80418396 290881736 308441653 20431738 23595370 0 0 2583500 4797186 52448023 44507236 0 0 0 0 0 0 0 0 4239323 2387120 79702584 75286912 X 211179152 233154741 0 0 211179152 233154741 290881736 308441653 21975589 0 0 0 0 X 0 1 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 1305 0 1 13860 15165 0 Schedule C, Part II-B, Line 1 Line 1(g) consists of compensation for employees to meet with representatives regarding Medicaid expansion and 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 organizations were the Alaska Hospital Healthcare Association and the American Hospital Association. X 1 40 0 0 0 1 0 0 0 0 6992060 0 6992060 115534945 0 58966817 56568128 2828054 0 671383 2156671 104936542 0 64975247 39961295 14146191 0 6489002 7657189 113335343 Plant Replacement Fund 66251079 Debt Service Account 6396482 Goodwill 4722357 Bond reserve held in escrow 1977167 Cash from bond proceeds 964751 Deferred loss on bond refunding 106560 80418396 0 Due to third parties 2387120 2387120 258601969 0 0 0 1776665 1776665 256825304 0 349384542 349384542 606209846 235994326 0 0 0 641997 641997 235352329 0 348881928 348881928 584234257 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 the 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. 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 Cost of goods sold in the amount of $210,178 are required to be reported at net for durable medical equipment on the 990 Part VIII line 10b. COGS is reported as an expense on the audited financial statements. Revenue from the Foundation in the amount of $1,566,487 is also included on the audited financial statements, however they are excluded from the Part VIII totals. The Foundation is a separate legal entity and although it is reported in consolidated statements with the Hospital, it files its own 990. Schedule D, Part XI, Line 4b Deductions from revenue in the amount of $348,881,928 are reported as expenses in Part IX lines 24a-d on the 990, however they are reported net of revenue on the audited financial statements. Rental Expenses of $502,614 are deducted from Revenue in Part VIII. Rental expenses are recorded as an expense on the audited financial statements. Schedule D, Part XII, Line 2d Cost of goods sold in the amount of $210,178 are required to be reported at net for durable medical equipment on the 990, Part VIII line 10b. COGS is reported as an expense on the audited financial statements. Expenses from the Foundation in the amount of $431,819 are also included in the audited financial statements, however they are excluded from the Part VIII totals. The Foundation is a separate legal entity and although it is reported in consolidated statements with the hospital, it files its own 990. Schedule D, Part XII, Line 4b Deductions from revenue in the amount of $348,881,928 are reported as expenses in Part IX lines 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 1 0 0 0 672 2184324 0 2184316 0.0098 1 0 38922254 43435529 0 0 0 0 0 0 0 0 1 672 41106578 43435529 2184316 0.0098 230 52300 907770 44467 863304 0.0039 47 715 60357 6570 53787 0.0002 18 0 28794890 17386589 11408301 0.0514 4 119 16577 1510 15067 0.0001 180 2370 279997 300 279697 0.0013 479 55504 30059591 17439436 12620156 0.0569 480 56176 71166169 60874965 14804472 0.0667 1 9932667 2513152 56552984 66955052 -10402068 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 23 1 0 0 1 X www.cpgh.org 1 23 0 1 0 1 X 200 300 X X X X X 1 1 X 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 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Central Peninsula Hospital Every three years, the Hospital conducts a Community Health Needs Assessment to evaluate the needs of the community. This report is prepared by an independent contractor who conducts surveys and interviews community members. The most recent report was prepared for FY2023-FY2025 and indicates that the categories showing the largest increase in perceived need from the prior reporting period were Mental Health & Substance Abuse Services, Nutrition and Obesity, Cardiovascular Health, Access to Health Care Services, and Cancer Care. In response to these findings, the Hospital has plans to open a Mental Wellness Clinic staffed with two Psych Nurse Practitioners in November 2023. The Hospital is also actively recruiting for a staff Psychiatrist. The Care Transitions Detox Center has increased bed capacity from 7 beds to 10 beds. Two Interventional Pain Physicians were added to focus on Chronic Pain. As of 6/30/23, a lease agreement was signed which will allow us offer additional diabetes care services, with a clinic scheduled to open in October 2023. The Hospital has added several community health education activities such as a Women and Babies Health Fair, and partners with other local organizations to promote outdoor activities. To address access to Health Care Services, the Hospital signed an agreement in April 2023 with the University of Washington to implement an Internal Medicine Residency Program. Two Physician extenders have been added to the Family Practice Clinic, and is actively recruiting for three Family Practice Physicians, and three Internal Medicine Physicians. As of 6/30/23, the Hospital was actively recruiting two Hematology/Oncology Physicians, both dual Board Certified in Hematology and Oncology, and both signed employment agreements in July 2023. In addition, the Hospital continues to collaborate with local area medical providers, patients, hospital associations and local governments to determine whether community health needs are being met and where opportunities for improvement may exist. Schedule H, Part V, Section B, Line 11-Central Peninsula Hospital Every three years, the Hospital conducts a Community Health Needs Assessment to evaluate the needs of the community. This report is prepared by an independent contractor who conducts surveys and interviews community members. The most recent report was prepared for FY2023-FY2025 and indicates that the categories showing the largest increase in perceived need from the prior reporting period were Mental Health & Substance Abuse Services, Nutrition and Obesity, Cardiovascular Health, Access to Health Care Services, and Cancer Care. In response to these findings, the Hospital has plans to open a Mental Wellness Clinic staffed with two Psych Nurse Practitioners in November 2023. The Hospital is also actively recruiting for a staff Psychiatrist. The Care Transitions Detox Center has increased bed capacity from 7 beds to 10 beds. Two Interventional Pain Physicians were added to focus on Chronic Pain. As of 6/30/23, a lease agreement was signed which will allow us offer additional diabetes care services, with a clinic scheduled to open in October 2023. The Hospital has added several community health education activities such as a Women and Babies Health Fair, and partners with other local organizations to promote outdoor activities. To address access to Health Care Services, the Hospital signed an agreement in April 2023 with the University of Washington to implement an Internal Medicine Residency Program. Two Physician extenders have been added to the Family Practice Clinic, and is actively recruiting for three Family Practice Physicians, and three Internal Medicine Physicians. As of 6/30/23, the Hospital was actively recruiting two Hematology/Oncology Physicians, both dual Board Certified in Hematology and Oncology, and both signed employment agreements in July 2023. In addition, the Hospital continues to collaborate with local area medical providers, patients, hospital associations and local governments to determine whether community health needs are being met and where opportunities for improvement may exist. Schedule H, Part V, Section B, Line 13h-Central Peninsula Hospital Employment status, family size, and catastrophic circumstances. Schedule H, Part V, Section B, Line 16j-Central Peninsula Hospital Hospital admissions staff attempt to provide a financial assistance brochure to each patient during admission or discharge. The brochure is also available in hard copy at Hospital entrances and in the various departments and clinics. It is also available on our website. Financial counselors personally contact all patients with past due balances to explain the policy and their options. They offer assistance with filling out the application and are able to set up monthly payments plans as needed. 22 River Tower Outpatient Imaging 240 Hospital Place Suite 102 Soldotna AK 99669 Outpatient imaging services Central Peninsula Bone & Joint Center 240 Hospital Place Suite 204 Soldotna AK 99669 Orthopedic clinic Heritage Place 232 Rockwell Ave Soldotna AK 99669 Skilled nursing facility, longterm care Central Peninsula Surgical Associates 240 Hospital Place Suite 305 Soldotna AK 99669 Surgical clinic Kenai Spine 240 Hospital Place Suite 104 Soldotna AK 99669 Spine clinic Central Peninsula Internal Medicine 247 N Fireweed St Suite A Soldotna AK 99669 Internal Medicine physicians Central Peninsula Urology 240 Hospital Place Suite 303 Soldotna AK 99669 Urology clinic Soldotna Physical Medicine 245 N Binkley Soldotna AK 99669 Physical Therapy clinic Serenity House 47480 Kristina Way Soldotna AK 99669 Chemical dependency treatment center Kenai Physical Medicine 260 Caviar St Kenai AK 99611 Physical therapy clinic Central Peninsula Women's Health 108 E Corral St Soldotna AK 99669 OB/Gyn Physician Medical Office Central Peninsula Neurology 262 N Binkley Street Soldotna AK 99669 Neurology clinic Central Peninsula Foot & Ankle 240 Hospital Place Suite 203 Soldotna AK 99669 Podiatry clinic Central Peninsula Urgent Care 10128 Kenai Spur Hwy Kenai AK 99611 Urgent Care clinic Central Peninsula Hospital Transitional Living Ctr 362 Tyee Street Soldotna AK 99669 Transitional Living Center Central Peninsula Family & Pediatrics 245 N Binkley St Suite 101 Soldotna AK 99669 Family practice clinic Central Peninsula Care Transitions 354 Tyee St Soldotna AK 99669 Detox Center River Tower Oncology 240 Hospital Place Suite 301 Soldotna AK 99669 Oncology services Central Peninsula Family Practice Kenai 506 Lake Street Kenai AK 99611 Family practice clinic Serenity House Medical Clinic 245 N Binkley St Soldotna AK 99669 Outpatient substance abuse treatment Surgery Center 100 Trading Bay Road Kenai AK 99611 Outpatient surgery center Kenai Health Center 630 Barnacle Way Kenai AK 99611 Diagnostic imaging, lab, and domestic violence services Schedule H, Part I, Line 7 In most cases, the costs listed in Line 7 are the 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 was used. Schedule H, Part I, Line 7, Column f Bad debt expense of $9,932,667 was reported in Part IX, line 25 functional expenses. However, they were reported at cost in Schedule H based on cost to charge ratio. Schedule H, Part I, Line 7g The Hospital included losses from subsidized Physician Clinics in Part I, Line 7(g) for family practice and specialty physician practices. Losses are included as follows: Oncology ($922,015), Urgent Care ($1,062,535), Serenity House Detox Center ($315,195), Serenity House Medical Center ($90,859), Surgical Services ($156,205), Surgery Center ($81,944), Internal Medicine ($1,231,999), Neurology ($473,266), Soldotna Family & Pediatrics ($1,352,826), Kenai Family Practice ($1,029,043), Women's Health ($295,325), Foot & Ankle ($363,785). 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 or 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 receivable payor composition and aging, and historical write-off experience by payor category. Schedule H, Part III amounts are based on the combined Medicare and Medicaid cost to charge ratio per our most recently filed cost report. It is our belief that all of these bad debts should be considered a community benefit because they provide a necessary and vital health benefit to the community members we serve, 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 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 copay or deductible and may not engage in collection efforts on the remainder. Medicare patients comprise a significant percentage of our community members, and we must provide needed medical services to this population irrespective of the amount of payment we will receive. Schedule H, Part III, Section C, Line 9b The Hospital's collection policy addresses private pay patients and defines the individuals who are eligible to receive financial assistance based on either financial or medical indigence. The collection policy refers to the charity care policy for instruction 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 at the upper end of the scale are eligible for a discount on their bill, 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 in other ways. Hospital Administrators round on patients and meet regularly with an advisory committee comprised of area residents and former patients to determine the needs of the community. An open dialogue exists between Hospital management, community leaders, local governing bodies, patients, staff and medical providers. This community engagement fosters trust in addition to identifying community needs. Schedule H, Part VI, Line 3 Hospital admissions staff attempt to provide a financial assistance brochure to each patient during admission or discharge. The brochure is also available in hard copy at hospital entrances and in the various departments and clinics. It is also readily available on our website. Financial counselors personally contact all patients with past due balances to explain the policy and their options. They also offer assistance with filling out the application and can set up monthly payments as needed. Schedule H, Part VI, Line 4 The area served by the Hospital is located on the Kenai Peninsula in South Central Alaska. According to the Kenai Peninsula Borough's FY2023 budget, in 2022 the Kenai Peninsula Borough had a population of 58,957 residents. Schedule H, Part VI, Line 5 The Hospital engages in numerous community initiatives year-round to improve health and awareness in our service area. In addition to providing monetary donations, the Hospital makes public service announcements on important healthcare issues, provides health professional educational opportunities, holds health fairs and immunization clinics, publishes community health newsletters, and provides meeting space for health and community activities. 1 Hospice of the Central Peninsula Inc PO Box 2584 Soldotna AK 99669 920118643 501c3 35750 0 Actual monetary donation Bereavement Program and Annual Wine Event sponsorship Boys and Girls Club of the Kenai Peninsula 320 Spruce Street Kenai AK 99611 943067142 501c3 18300 0 Actual monetary donation Cornerstone Program contribution and Soccer Team Sponsorship Soldotna Chamber of Commerce 44790 Sterling Hwy Soldotna AK 99669 920061612 501c6 5500 0 Actual monetary donation Platinum level Community Parner sponsorship and Christmas in the Park AHHA 1049 W 5th Ave Suite 200 Anchorage AK 99501 920034538 501c6 7500 Actual monetary donation Conference sponsorship Kenai Peninsula Food Bank 33955 Community College Drive Soldotna AK 99669 943112445 501c3 20000 0 Actual monetary donation Sponsorship of Soup Supper, Spring Festival, and It's Scary to be Hungry Bridges Community Resource Network PO Box 1612 Soldotna AK 99669 920151271 501c4 5500 0 Actual Monetary Donation Imagination Library Program and Small Schools Basketball Tournament sponsorship Kenai River Youth Foundation dba Kenai River Brown Bears 3360 Echo Lake Rd Soldotna AK 99669 262580744 501c3 5695 0 Actual monetary donation Season sponsorship 4 3 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 management is responsible for authorizing any 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 1125392 0 30 0 3727 0 6527 0 16934 0 1152610 0 0 0 Herbert Bote Orthopedic Surgeon 883876 0 142838 0 77071 0 6527 0 32538 0 1142850 0 0 0 Michael Reyes Orthopedic Surgeon 1052725 0 198765 0 115458 0 6527 0 29519 0 1402994 0 0 0 Darren Mullins Oncologist 582130 0 416690 0 105786 0 6527 0 34169 0 1145302 0 0 0 David King Surgeon 647969 0 91186 0 100532 0 6527 0 26369 0 872583 0 0 0 Rick Davis CEO 387007 0 137258 0 91982 0 18871 0 27119 0 662237 0 0 0 Shaun Keef COO/CEO 314319 0 57880 0 39435 0 14861 0 38963 0 465458 0 0 0 Michael Haggerty CFO 206464 0 45337 0 28997 0 12170 0 13684 0 306652 0 0 0 Karen Scoggins CNO/COO 225374 0 55075 0 26595 0 12791 0 29044 0 348879 0 0 0 Gregg Motonaga Anesthesiologist/Board Member 772033 0 54503 0 1349 0 6527 0 29519 0 863931 0 0 0 John Bramante Physician/Board Member 302726 0 131726 0 30877 0 6527 0 37530 0 509386 0 0 0 Jason Lattin Surgeon 598265 0 98506 0 109794 0 6527 0 85623 0 898715 0 0 0 Gregory Hough Surgeon 647933 0 71869 0 90330 0 6527 0 45763 0 862422 0 0 0 Aaron Wonnacott Emergency Physician 649141 0 31030 0 907 0 6527 0 38963 0 726568 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 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 all 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. 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 January 2023. 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 agreement. The CEO is responsible for hiring the rest of the Hospital's executive team and for using comparable data studies to set competitive salary packages. 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 throughout the tax year. Schedule J, Part I, Line 5 In accordance with their employment agreements, Emergency Department physicians 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 individual charges that are generated by the Physician. The compensation method is considered reasonable and customary for these employed physicians. Schedule J, Part I, Line 6 The Hospital has an annual incentive plan for all employees. Incentive is 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. The incentive is not calculated based on actual earnings. Other measures include Quality of Care indicators 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 27905000 0 32616814 0 0 0 201600 0 0 0 32415205 0 1 1 1 B 17395000 0 34999563 3028236 1813599 1470824 127595 0 0 35212215 0 0 2016 0 0 1 1 C 3200000 0 3200000 0 35169 0 22868 0 0 3200000 5561 0 2016 0 0 1 1 D 3050000 0 3050000 0 33244 0 17500 0 0 3032500 0 0 2016 0 0 1 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 Schedule K, Part I, Column a-09/15/2011 27,905,000 Kenai Peninsula Borough Par amount of bond was $27,905,000 - lower than proceeds from issue. Schedule K, Part I, Column b-02/20/2014 32,490,000 Kenai Peninsula Borough Par amount of Bond was $32,490,000 - lower than proceeds from issue. A Kenai Peninsula Borough 920030894 01179RXH1 2017-11-29 28955000 2018 Cath Lab and OB construction bonds 0 0 1 B Kenai Peninsula Borough 920030894 000000000 2021-06-28 6335000 Refunding bonds - 2011 GO 0 0 1 A 4970000 0 29140645 1541107 762523 2062538 436394 0 0 29139606 29706 0 2020 0 0 0 1 B 3095000 0 6927370 0 0 0 26118 0 0 0 6901252 0 1 0 1 1 A 0 0 0 0 0 0 0 1 0 1 B 0 0 0 0 0 0 0 1 0 1 A 0 1 0 0 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 Schedule K, Part I, Column e-11/29/2017 28,955,000 Kenai Peninsula Borough The bond issued Par amount less than proceeds John Bramante Employee and Board Member 465328 Total compensation and benefits 0 Michael Reyes Employee and Board Member 1366948 Total compensation and benefits 0 Form 990, Part VI, Section A, Line 7b The Executive team and Board Members 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. Form 990, Part VI, Section B, Line 11b The 990 is prepared by the Hospital's accounting department, and reviewed by the Controller. It is submitted to Hospital Administration for review. Edits may be suggested and incorporated into the filing. Draft 990's and supporting schedules are then submitted to the Finance Committee and Board Members for review and comment before final filing. Form 990, Part VI, Section B, Line 12c The Executive team and Board Members 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 actions. If a conflict arises, the Board member in conflict will abstain from voting on the applicable resolution. 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 January 2023. These reports are submitted to the Board for review and are used to set the wage scale for the CEO. 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. Copies of the audited financial statements are supplied to the Executive team and Board Members, as well as the Kenai Peninsula Borough. The lead auditor presents a presentation to the Board discussing how the audit went and the overall results. The Hospital's 990 is widely available to the public on Guidstar.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 owns 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 80987 This amount represents total contributions received from the Foundation in payment for programs, capital, and grants to individuals for assistance. The Hospital pays these expenses and is then reimbursed by the Foundation. Central Peninsula Health Foundation j 14184 The Hospital provides office space to the Foundation Director for the cost of $1,182 per month. This includes all costs to maintain the space, such as utilities and janitorial services. Central Peninsula Health Foundation m 80987 The Foundation performs fundraising activities for which substantially all of the donations are intended to benefit the Hospital and its various programs. Central Peninsula Health Foundation n 14184 The Hospital provides office space to the Foundation Director for the cost of $1,182 per month. This includes all costs to maintain the space, such as utilities and janitorial services. Central Peninsula Health Foundation o 130681 The Hospital shares employees for Directorship and Accounting functions necessary to operate the Foundation. This amount represents associated salaries and benefits. Kenai Peninsula Borough k 1 The Hospital is operated by Central Peninsula General Hospital, Inc. through an operating agreement with the Kenai Peninsula Borough. The amount of the agreement is $1.00 per annum. Kenai Peninsula Borough p 9363487 During the tax year, the Hospital reimbursed the Kenai Peninsula Borough for bond debt service, insurance premiums, refuse, and sales tax payments. This amount represents those cash payments. Filed Form 8868 to extend due date to May 15, 2024. Received approval from IRS with notice date of September 4, 2023.