2020-04-30T13:51:27-07:00 2019-06-30 990 2018-07-01 920077523 CENTRAL PENINSULA GENERAL HOSPITAL INC CENT 9077144404 250 Hospital Place Soldotna AK 99669 Paul Morris CFO 9077144722 2020-04-30 216.67.112.2 2018 2020-09-23 17:36:50Z Central Peninsula Hospital Rick Davis 250 Hospital Place Soldotna AK 99669 384726577 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 1025 202 0 0 2293293 2150211 353751803 377679563 319536 873990 3706679 2953699 360071311 383657463 106967 120903 0 0 94672527 90709146 0 0 0 257281285 284694849 352060779 375524898 8010532 8132565 262953280 266081604 101944072 96939831 161009208 169141773 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 336896150 0 340745985 Our 49 bed hospital provided patient and ancillary services to 2,525 inpatients and 133,287 outpatients during the 2018 tax year. The hospital provides emergency medical services regardless of ability to pay. Emergency medical services were provided to 15,887 individuals, and 1,788 of those individuals were admitted to the hospital. 4,054 surgical procedures were performed in the hospital during the tax year. The imaging department performed 45,663 procedures. 66,803 physical therapy 15-minute procedures were provided to area residents. During the 2018 tax year, free medical services in the amount of $4,280,050 (gross charges) were provided to patients eligible for charity care. 12222065 0 11845372 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 2018 tax year were 151 and total resident days of care were 19,223. An average of 53 residents per day were provided long term care and nursing. Ancillary services for residents included 5,560 physical therapy treatments, while outpatients received 660 therapy treatments. 24513162 0 25088206 The hospital operates 11 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 and outpatient substance abuse treatment. During the 2018 tax year physician and specialty services were provided for 28,519 visits. 0 0 0 373631377 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 1 149 0 1 1025 1 0 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 9077144525 250 Hospital Place Soldotna AK 99669 James McHale Board President 8 X 3000 0 0 Steve Horn Board Vice President 8 X 0 0 0 Irv Carlisle Board Secretary/Treasurer 8 X 3600 0 0 Trena Richardson Board President (former) 4.0 X X 15000 0 0 Silverio Mattero Board Member 4 X 2600 0 0 Mark Dixson Board Member 4 X 3150 0 0 Mark Premo Board Member 4 X 2200 0 0 Steven Manley Board Member 4 X 0 0 0 Debra Shuey Board Member 4 X 2900 0 0 John Bramante Board Member 4 X 2400 0 0 Lynda Columbia Board Member 4 X 3500 0 0 Gregg Motonaga Anesthesia MD/Board Member 44 X X 751603 0 39016 Richard Davis CEO 40 X 609111 0 36296 Matthew Dammeyer COO 40 X 350973 0 39790 Lance Spindler CFO 40 X 281887 0 31818 Karen Scoggins CNO 40 X 234803 0 27984 Robert Cadoff Urologist 40 X 1502936 0 32695 Jason Lattin Surgeon 40 X 1158094 0 51757 Michael Reyes Orthopedic Surgeon 40 X 935431 0 18049 Darren Mullins Oncologist 40 X 785110 0 36904 6648298 0 314309 107 1 1 0 C&A Industries dba Focus One Solutions PO Box 3037 Omaha NE 68103 Contract Labor Provider 864655 Alaska Hospitalist Group LLC 4300 B Street Suite 200 Anchorage AK 99503 Physician Services 756875 Curtis Buchholz 44455 Sterling Hwy Soldotna AK 996697936 Pathology services 316754 Legacy Electric 46113 Sather Ct Soldotna AK 99669 Electrical contracting services 197263 Alaska Monitoring Associates PO Box 220304 Anchorage AK 99522 Neuromonitoring services 150100 10 0 0 0 122970 2027241 0 82905 2150211 Hospital service revenue 622000 340745985 340745985 0 0 Skilled nursing revenue 623000 11845372 11845372 0 0 Outpatient Physician clinic revenue 621110 25088206 25088206 0 0 0 0 0 0 377679563 873990 873990 0 0 0 0 0 0 0 0 0 0 641755 0 912896 0 -271141 0 -271141 -271141 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 732819 156218 576601 576601 0 0 Property tax revenue 622000 55539 55539 0 0 USAC telephone subsidy 622000 689044 689044 0 0 340b pharmacy rebate program 622000 693850 693850 0 0 1209806 1209806 0 0 2648239 383657463 381507252 0 0 120903 120903 0 0 0 0 0 0 7014368 5428417 1585951 0 0 0 0 63291558 63291558 0 0 2005925 2005925 0 0 14006781 14006781 0 0 4390514 4390514 0 0 0 0 0 0 182280 0 182280 0 105365 0 105365 0 19925 0 19925 0 0 0 0 0 0 0 7874296 7874296 0 0 320307 320307 0 0 1954775 1954775 0 0 7430179 7430179 0 0 0 0 0 0 3203643 3203643 0 0 312379 312379 0 0 0 0 0 0 367521 367521 0 0 1992709 1992709 0 0 0 0 0 0 13717851 13717851 0 0 1337298 1337298 0 0 Medicare deductions 103975608 103975608 0 0 Medicaid deductions 56197885 56197885 0 0 All other payor deductions 41373942 41373942 0 0 Charity & Bad Debt expense 10305853 10305853 0 0 34023033 34023033 375524898 373631377 1893521 0 40477767 34989644 4960629 4727809 199953 299315 29552245 28220841 0 0 0 0 0 0 6278415 6644838 2239425 3088504 195877625 72780281 107549096 123097344 0 0 500000 500000 0 0 869045 552520 70326705 63960789 262953280 266081604 17412202 19890945 0 0 12653 13742 83513417 76447711 0 0 0 0 0 0 0 0 1005800 587433 101944072 96939831 X 122430538 150661988 38578670 18479785 0 0 161009208 169141773 262953280 266081604 8132565 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 10680 0 1 9245 19925 0 Schedule C, Part II-B, Line 1 Line 1(g) consists of travel expenses and compensation for employees for two trips to meet with representatives regarding Medicaid expansion and the Medicare Rural Community Hospital Demonstration project. There was also a trip to the AHA Annual Meeting in Washington DC. Line 1(i) consists of the portion of membership dues paid to organizations that were spent on lobbying activities. These 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 4971116 0 4971116 89138222 0 36529183 52609039 304105 0 210522 93583 69890978 0 34775029 35115949 31573204 0 1265547 30307657 123097344 Plant replacement fund 46408939 Cash from bond proceeds 9046778 Bond reserve held in escrow 1589638 Debt service account 6120105 Deferred loss on 2011 bond refunding 621556 KPB adjustment for bond payment 173773 63960789 0 Due to third parties 587433 587433 178517076 0 0 0 687097 687097 177829979 0 205827484 205827484 383657463 170314773 0 0 0 617359 617359 169697414 0 205827484 205827484 375524898 Schedule D, Part II, Line 9 In 2008 the Hospital purchased a building which resides on 40 acres of land subject to a perpetual covenant for the benefit of all Alaska residents, restricting the use of the land for agricultural purposes pursuant to AK Statute 38.05.321. The building on this property is used by the Hospital's chemical dependency unit. There is no value placed on the easement itself and therefore it does not appear on the Financial Statements. 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 $156,218 reported in Part VIII line 10b are reported as expenses on the audited financial statements. Revenue from the Foundation in the amount of $530,879 is 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 XI, Line 4b Deductions from revenue in the amount of $205,827,484 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. Schedule D, Part XII, Line 2d Cost of goods sold in the amount of $156,218 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 $461,141 is 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 $205,827,484 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 1 1806 1714494 0 1714494 0.0105 1 0 33343926 31948472 1395454 0.0085 0 0 0 0 0 0 2 1806 35058420 31948472 3109948 0.0190 237 8484 1009569 34581 974988 0.006 77 63 83465 11635 71832 0.0004 17 40407 16201176 9731575 6469601 0.0395 6 77 8498 425 8073 0 958 390 238510 0 238510 0.0015 1295 49421 17541218 9778216 7763004 0.0474 1297 51227 52599638 41726688 10872952 0.0664 0 0 0 0 0 0 9 90 3225 0 3225 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 35733 0 35733 0.0002 0 0 0 0 0 0 18 90 38958 0 38958 0.0002 1 6025803 1928257 42337748 49859918 -7522170 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 0 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 X 1 X 0 0 Schedule H, Part V, Section B, Line 11-Central Peninsula Hospital At the time of filing this 990, a Community Health Needs Assessment (CHNA) is being prepared by an independent contractor who conducted surveys and interviews with community members. 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. The Hospital continues to address the needs presented in the previous report completed in 2016. We have expanded our mental health and substance abuse services to include transitional housing and an outpatient clinic. We are planning to open an urgent care facility in Kenai in the upcoming year. We are also in the process of opening a brand new Cath Lab to provide services not previously available on the Kenai Peninsula. 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 if needed. 24 Heritage Place 232 Rockwell Ave Soldotna AK 99669 Skilled nursing facility, longterm care Serenity House 47480 Kristina Way Soldotna AK 99669 Chemical dependency treatment center Central Peninsula Neurology 262 N Binkley Street Soldotna AK 99669 Neurology clinic Central Peninsula Family Practice Kenai 506 Lake Street Kenai AK 99611 Family practice clinic Kenai Physical Medicine 260 Caviar St Kenai AK 99611 Physical therapy clinic Soldotna Physical Medicine 245 N Binkley Soldotna AK 99669 Physical Therapy clinic Kenai Health Center 630 Barnacle Way Kenai AK 99611 Diagnostic imaging, lab, and domestic violence services Central Peninsula Family & Pediatrics 245 N Binkley St Suite 101 Soldotna AK 99669 Family practice clinic Central Peninsula Specialty Physician Building 240 Hospital Place Soldotna AK 99669 Specialty Physician Offices, Oncology, Imaging, Physical Therapy and leased Medical office space Serenity House intake office 245 N Binkley Street Suite 203 Soldotna AK 99669 Chemical dependency intake, behavioral health clinic Peninsula Medical Center 265 N Binkley Street Soldotna AK 99669 Owned medical office building Central Peninsula Medical Center 245 N Binkley Street Soldotna AK 99669 Owned medical office building CP Maintenance & Plant Ops 158 Corral Street Soldotna AK 99669 Maintenance and plant ops Foundation & Marketing 166 W Corral Street Soldotna AK 99669 Foundation and marketing offices Central Peninsula Internal Medicine 108 E Corral St Soldotna AK 99669 Internal Medicine Physician Offices Radiation Oncology Building 240 Hospital Place Soldotna AK 99669 Radiation Oncology Building - leased to RBS Evolution Central Peninsula Billing Office 198 W Corral Soldotna AK 99669 Office space for Physician Clinic billing Accounting 146 W Corral Street Soldotna AK 99669 Accounting offices Central Peninsula Hospital 262 N Binkley St Soldotna AK 99669 Vacant Physician Office space Central Peninsula Hospital Transitional Living Ctr 362 Tyee Street Soldotna AK 99669 Transitional Living Center Central Peninsula Care Transitions 354 Tyee St Soldotna AK 99669 Detox Center - Undergoing remodel during tax year 2016 CP Womens Health 289 N Fireweed Street Suite C/D Soldotna AK 99669 OB/Gyn Physician Medical Office Patient Financial Services 254 N Binkley Street Soldotna AK 99669 Patient Financial Services Serenity House Medical Clinic 245 N Binkley St Soldotna AK 99669 Outpatient substance abuse treatment 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 was used. Schedule H, Part I, Line 7, Column f Bad debt expense of $6,025,803 was reported gross in Part IX, line 25 functional expenses. However they were reported at cost in Schedule H based on the cost to charge ratio. Schedule H, Part I, Line 7g The Hospital did include losses from certain subsidized Physician Clinics in Part I, Line 7g for both family practice and specialty physician practices. These losses are as follows: Urology ($429,861), Orthopedics ($88,221), Soldotna Family & Peds ($1,035,202), Neurology ($162,925), Women's Health ($418,079), Foot & Ankle ($449,491), Internal Medicine ($816,036), and Kenai Family ($680,339). Schedule H, Part II The Hospital supports local educational and workforce institutions through monetary donations, job fairs, internships, community partnerships and skills training. Community workforce development and health education improves the quality of life and the health of the community by fostering positive activities for area residents and engaging the community in health initiatives. Schedule H, Part III, Section A, Line 4 Bad debt provisions are made for the amount of revenue that will not be collected from patients to whom services were billed but not paid. The Hospital has determined these patients are neither medically nor financially indigent and do not qualify for the Hospital's charity care program. Bad debt provisions are determined by management's assessment with consideration of business and economic conditions, changes and trends in 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 instructions for determining eligibility. As noted in Part I, the charity care policy is based on FPG which is the basis for a sliding scale between 200 and 300% of those guidelines. Applicants 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 physician and specialty service needs of the community. An open dialogue exists between Hospital management, community leaders, the 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 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 if 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 2015 AK Department of Labor estimates, nearly 38,000 residents live in the geographic area serviced by the Hospital. 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 35000 0 actual monetary donation Bereavement program sponsorship American Cancer Society Inc 3851 Piper St Ste U240 Anchorage AK 99508 131788491 501c3 20000 0 actual monetary donation Kenai Cheers for a Cure sponsorship and Hooked on a Cure sponsorship Boys and Girls Club 705 Frontage Rd Ste B Kenai AK 99611 943067142 501c3 15000 0 actual monetary donation Supports the operations of the Club, which is a local nonprofit dedicated to providing safe after school activities for children in the community. Kenai River Foundation PO Box 3944 Soldotna AK 99669 211570362 501c3 12000 0 Actual monetary donation Wounded Heroes event sponsorship Soldotna Chamber of Commerce 44790 Sterling Hwy Soldotna AK 99669 920061612 501c6 10000 0 actual monetary donation Community Partner sponsorships Kenai River Brown Bears PO Box 2613 Kenai AK 99611 262580744 501c3 7500 0 actual monetary donation 2019 season sponsorship for local athletes and Cancer Awareness Kenai Peninsula Food Bank 33955 Community College Dr Soldotna AK 99669 943112445 501c3 7000 0 actual monetary donation Soup Supper fundraiser, Community BBQ picnic sponsorship, and donation of hams and turkeys for holidays Bridges Community Resource Network PO Box 1612 Soldotna AK 99669 920151271 501c4 7000 0 actual monetary donation Imagination Library Program sponsorship 8 0 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 1499276 0 10 0 3650 0 6026 0 34000 0 1542962 0 0 0 Jason Lattin Surgeon 1157254 0 10 0 830 0 6026 0 53800 0 1217920 0 0 0 Michael Reyes Orthopedic Surgeon 821816 0 112343 0 1272 0 0 0 21234 0 956665 0 0 0 Darren Mullins Oncologist 604865 0 83799 0 96445 0 6026 0 37841 0 828976 0 0 0 Gregg Motonaga Anesthesia MD/Board Member 719439 0 31335 0 829 0 20968 0 21498 0 794069 0 0 0 Richard Davis CEO 414554 0 92338 0 102219 0 18246 0 23859 0 651216 0 0 0 Matthew Dammeyer COO 282101 0 44077 0 24795 0 13120 0 31376 0 395469 0 0 0 Lance Spindler CFO 216687 0 33369 0 31831 0 11541 0 25155 0 318583 0 0 0 Karen Scoggins CNO 172324 0 29721 0 32758 0 23059 0 9935 0 267797 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 August 2017. The resulting report is provided to the Board and Management for review. The Board then sets compensation levels for the CEO through a written employment 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 during the tax year. Schedule J, Part I, Line 5 In accordance with their employment contracts, 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 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 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. There is a knock-out provision for the other measures if the financial budget is not met. 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 0 0 32616814 0 0 0 201610 0 0 0 0 0 2008 0 1 1 1 B 0 0 34999563 3700147 1813599 996347 12795 0 0 35043223 0 0 2016 0 0 1 1 C 0 0 3200000 544993 35169 146913 22868 0 0 3200000 0 0 2016 0 0 1 1 D 0 0 3067913 563191 0 157543 17500 0 0 2865230 0 267944 2016 0 0 0 1 A 0 0 0 0 0 0 0 0 0 1 B 0 1 0 0 0.11 0 0.11 1 0 1 C 0 1 0 0 0.11 0 0.11 1 0 1 D 0 1 0 0 0.11 0 0.11 1 0 1 A 0 0 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A Kenai Peninsula Borough 920030894 01179RXH1 2017-11-29 28955000 2018 Cath Lab and OB construction bonds 0 0 1 A 0 0 29395334 2684471 0 638253 436394 0 0 20221239 0 8844095 2020 0 0 0 1 A 0 1 0 0 0.11 0.11 1 0 1 A 0 1 0 0 1 0 0 0 1 A 1 Gregg Motonaga MD Employed physician and Board Member 804994 Total compensation and benefits 0 Irving Carlisle Board Member 2880 Rent for storage space in which he is a part owner 0 Form 990, Part VI, Section A, Line 7b Central Peninsula General Hospital, Inc. operates the Hospital through an 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. Form 990, Part VI, Section B, Line 11b The 990 is prepared by the Hospital's Finance department and submitted to Hospital Administration for review. Management suggests edits if required. Draft 990's and all 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 Both senior leadership 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 15 An independent professional executive compensation study is performed every 3 years. The most recent study was completed in August 2017. These reports are submitted to the Board for review and 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. Paper copies of the audited financial statements are supplied to Administrators and Board Members, as well as 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 155199 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 then is reimbursed by the Foundation. Central Peninsula Health Foundation j 12789 The Hospital provides office space to the Foundation Director for the cost of $1,066 per month. This amount includes janitorial services, utilities, etc. Central Peninsula Health Foundation m 155199 The Foundation performs fundraising activities for which substantially all of the donations are intended to benefit the Hospital and its programs. Central Peninsula Health Foundation n 12789 The Hospital provides office space to the Foundation Director for the cost of $1,066 per month. This amount includes janitorial services, utilities, etc. Central Peninsula Health Foundation o 111110 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 6550751 During the current tax year, the Hospital reimbursed the Kenai Peninsula Borough for bond debt service, refuse, and insurance expenses. This amount represents those cash payments. Kenai Peninsula Borough r 18744612 The Hospital's operating agreement with the Borough 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 by the Borough. This amount represents the amount of such transfers during the year. Filed Form 8868 to extend due date to May 15, 2020. Received approval from IRS with notice date of November 18, 2019.