2015-01-30T12:21:50-07:00 2014-06-30 990 2013-07-01 920037099 SOUTH PENINSULA HOSPITAL INC SOUT 9072358101 4300 Bartlett Street Homer AK 99603 Robert Letson CEO 9072350324 2015-01-30 2013 2016-02-25 16:41:14Z South Peninsula Hospital Inc 4300 Bartlett St Homer AK 99603 54972418 0 X www.sphosp.org X 1969 AK South Peninsula Hospital promotes community health and wellness by providing personalized, high quality, locally coordinated healthcare. 10 10 438 40 0 0 4643740 4864841 46171122 50097257 20790 10320 0 0 50835652 54972418 0 0 0 0 30165231 33999714 0 0 0 19285368 20195284 49450599 54194998 1385053 777420 63920463 65102426 25573531 25978074 38346932 39124352 South Peninsula Hospital promotes community health and wellness by providing personalized, high quality, locally coordinated healthcare. 0 0 27454446 0 34420753 Our 22 bed hospital provided inpatient services to 977 patients for total patient days of 3,340 for the 2013 tax year. Total outpatient visits for the year were 40,080 and include 4,757 emergency department visits, 1,044 ambulatory surgery visits, and 5,935 imaging visits. Other outpatient services include laboratory, physical therapy, occupational therapy, infusion and chemotherapy, and sleep lab. 5242242 0 7468444 Our Long Term Care facility served 35 residents during the 2013 tax year with an average daily census of 26 and total resident days of 9,517. 7248294 0 7122972 The hospital acquired an established family practice clinic during the 2012 tax year adding to the provider-based clinics established in 2011. The clinics had 18,890 patient visits during the 2013 tax year. 1408261 0 811986 Our community health services department provides home health care, chore and respite services, and other home care services to more than 250 local residents. 3,149 visits were made to client homes in the 2013 yax year. Other program services include revenue from cafeteria and vendings machines, medical record copies, and other program related sources. 1408261 0 811986 41353243 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 125 0 1 438 1 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 0 X South Peninsula Hospital 9072358101 4300 Bartlett Street Homer AK 99603 Julie Woodworth Director 3 X 1550 0 0 Kelly Cooper Director 2.5 0 X 1200 0 0 Clyde Boyer Director 1.5 0 X 600 0 0 Thomas Clark Director 5.00 0 X 1350 0 0 Susan Drathman Director 2 0 X 1200 0 0 Matthew Hambrick Director 2 0 X 1200 0 0 Vickey Hodnick Director 2 0 X 1200 0 0 Matthew North Director 2 0 X 1200 0 0 Bernadette Wilson Director 3.5 0 X 1200 0 0 M Todd Boling DO Director 3.00 0 X 1200 0 0 Robert F Letson Chief Executive Officer 50 0 X 199249 0 46040 Lori Meyer Chief Financial Officer 40 0 X 137715 0 42057 Brent Adcox Medical Doctor 40 0 X 1005877 0 46040 Gregory Hough Medical Doctor 40 0 X 573234 0 46040 Larry R Tripp CRNA 40 0 X 359033 0 15000 Carl Seger Medical Doctor 40 0 X 345727 0 46040 Hillary Seger Medical Doctor 40 0 X 300840 0 15000 2933575 0 256217 23 0 1 0 Peak Imaging 4438 Towne Heights Ln Homer AK 99603 Radiologist 970764 Eris Radiology LLC PO Box 2434 Homer AK 99603 Radiologists 436457 Raymond Fowler 40914 Crested Crane St Homer AK 99603 Anesthesiologist 329228 James Peterson PO Box 58 Homer AK 99603 Anesthesiologist 206459 Paul Raymond 4201 Bartlett St Unit 2 Homer AK 99603 Emergency Physician 182704 12 0 0 0 0 4533308 331533 0 4864841 Hospital 622000 34420754 34420754 0 0 Long Term Care 623000 7468444 7468444 0 0 Physician Clinics 621111 7122972 7122972 0 0 Home Health Services 621610 811986 811986 0 0 273101 273101 0 0 50097257 10206 10206 0 0 0 0 0 0 0 0 0 0 0 0 0 114 0 0 0 114 114 114 0 0 0 0 54972418 50107577 0 0 X 350841 0 350841 0 0 0 0 0 22782923 18022494 4760429 0 1412225 1114589 297636 0 7846403 5472009 2374394 1607322 1179616 427706 0 69995 69995 0 0 364376 0 364376 0 30052 0 30052 0 0 0 0 0 0 0 0 0 0 0 5982684 5087020 895664 0 105223 0 105223 0 4924514 4281656 642858 0 725621 95289 630332 0 0 0 0 0 1714831 341535 1373296 0 160806 106779 54027 0 0 0 0 0 177282 118592 58690 0 822385 821570 815 0 0 0 0 0 3060120 3060120 0 0 744621 744621 0 0 Maintenance & Repairs 1112071 797293 314778 Dues, Books & Subscriptions 200703 40065 160638 54194998 41353243 12841755 0 2104 2429 6541240 7692665 0 0 11359519 12870008 0 0 0 0 0 0 1484407 1451479 1020856 1084885 77376414 35703489 43144580 41672925 0 0 0 0 0 0 0 0 367757 328035 63920463 65102426 6957606 8482048 0 0 286112 338301 18194344 17088217 0 0 0 0 0 0 0 0 135469 69508 25573531 25978074 X 38321646 39099066 25286 25286 0 0 38346932 39124352 63920463 65102426 777420 0 0 0 0 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3704067 0 3704067 54154892 0 20944229 33210663 80470 0 30278 50192 18794060 0 14728982 4065078 642925 0 0 642925 41672925 Note payable to Kenai Peninsula Borough 69508 69508 54972303 0 0 0 0 0 54972303 0 115 115 54972418 54194884 0 0 0 -114 -114 54194998 0 0 0 54194998 Schedule D, Part XI, Line 4b Gain on sale of assets netted against other expense on audited financials. Schedule D, Part XII, Line 2d Gain on sale of assets netted in other expense on audited financials. 1 1 1 X 1 X 1 1 0 0 897765 0 897765 0.017 11565731 10088307 1477424 0.027 0 0 0 0 0 0 12463496 10088307 2375189 0.044 101264 68036 33228 0.0006 513604 4811 508793 0.009 1054451 447648 606803 0.011 0 0 0 0 46463 0 46463 0.0008 0 0 1715782 520495 1195287 0.0214 0 0 14179278 10608802 3570476 0.0654 1764 0 1764 0 0 0 1764 0 1764 0 0 2921369 292137 11419569 15816083 -4396514 X 0 1 1 South Peninsula Hospital Inc 4300 Bartlett St Homer AK 99603 www.sphosp.org GACH-010 X X X X South Peninsula Hospital Inc 1 1 X X X X X X X X X 09 1 0 1 X www.sphosp.org X X X X X X X X X X 0 0 1 1 100 1 300 1 X X X 1 1 X 1 0 X X X X 1 X 0 1 Schedule H, Part V, Section B, Line 1-South Peninsula Hospital Inc Our hospital is the sponsorping agency of the Southern Kenai Peninsula MAPP (Mobilizing to Action for Planning and Partnerships). MAPP is a framework for community health needs assessment and planning developed by the Centers for Disease Control and Prevention for the National Association of City and County Health Officials. We have conducted two health needs assessments using this framework, on ein 2009 and one in 2012. MAPP utilizes four individual assessments to make up one complete assessment: Community Health Status; Community Themes and Strengths; Forces of Change, and; Local Public Health Syste, The 2012 assessment included on the first three since the changes in the facilities and resources within the community had not changed significantly outside the scope of hospital services. Schedule H, Part V, Section B, Line 3-South Peninsula Hospital Inc Deliberate effort was made to be sure the assessment reflected all areas of the community, including income levels, ages and area of residence. Steering Committee Representation - our project's steering committee represents a significant portion of the community. Representative from the FQHC, public health, community mental health, city government, substance abuse agency, local college, community hospital and family planning clinic all serve on the steering committee. Community surveys - 1,212 surveys were completed via hard copy and online. Schedule H, Part V, Section B, Line 5-South Peninsula Hospital Inc Available at public meetings. Schedule H, Part V, Section B, Line 7-South Peninsula Hospital Inc Where possible, the hospital did take action to address specific needs. Some examples include: better publicizing our patient discount and financial aid programs, adding a lipidologist to our visiting specialist clinis, and adding an obstetrician/gynocologist to oru primary care practice. However, the hospital is not able to address all of the needs from the asessment as many are beyond a hospital's scope of services. Community groups were formed to address the significant findings of the assessment that fall beyond the scope of just one agency or organization, and hospital representatives serve on such workgroups. Schedule H, Part V, Section B, Line 20-South Peninsula Hospital Inc All patients are charged at gross charges. Discounts are applied to gross charges for all patients. Schedule H, Part V, Section B, Line 22-South Peninsula Hospital Inc All patients are charged at gross charges. Discounts are applied to gross charges for all patients. 3 South Peninsula Hospital Long Term Care 4300 Bartlett St Homer AK 99603 Long Term Care skilled nursing facility. South Peninsula Hospital Provider Based Clinics 4300 Bartlett St Homer AK 99603 Provider based physician clinics. South Peninsula Hospital Community Health Services 4300 Bartlett St Homer AK 99603 Home health care services. Schedule H, Part I, Line 7 Used worksheets provided in the instructions for Schedule H and cost to charge ratio. Schedule H, Part I, Line 7g Subsidized health services do not include any costs attributable to a physician clinic. Schedule H, Part II The hospital obtained Certified Application Counselor Facility status and trained several Certified Application Counselors. The hospital had counselors available to assist individuals to enroll in the health insurance marketplace on a daily basis and also sponsored several special enrollment days where counselors time was dedicated to enrollment. Schedule H, Part III, Section A, Line 4 Bad debt and charity care are subtracted from patient service revenue to arrive at net patient service revenue (as noted on page 16). Line 2 is calculated by bad debt expense times cost to charge ratio. Line 3 is estimated at ten percent of bad debt. Schedule H, Part III, Section B, Line 8 The shortfall should be treated as community benefit because it cost the hospital that amount to provide care to Medicare beneficiaries for which it was not compensated. The amount reported on Line 6 was calculated by multiplying the total allowable costs on the cost report by the Medicare payer mix. Schedule H, Part VI, Line 2 The hospital served as the lead organization in a community assessment utilizing MAPP (Mobilizing to Action through Planning and Partnership). MAPP is the community assessment model endorsed by the CDC and the State of Alaska Department of Health and Social Services. MAPP uses four types of assessments to establish the overall community assessment: 1) community data (reportable statistics from numerous groups and agencies) 2) community leader/public opinion (community surveys and interviews) 3) local public health assessment (CDC scoring of our local public health) and 4) forces of change (a look at local, state, national and international forces which impact the community). All of this is compiled into one community assessment. The multi-year process is coordinated by the hospital, but utilizes a steering committee made up of representatives from local partners in health and wellness. Over 50 partnering agencies are involved in our community assessment and health improvement plan. A copy of the assessment can be founs at www.mappofskp.net. Schedule H, Part VI, Line 3 During patient registration, each private pay patient is offered a Financial Assistance packet and business card for financial counselor, The financial counselor assists any interested parties with Medicaid applications and/or the hospital's internal financial assistance application. Schedule H, Part VI, Line 4 The South Peninsula Hospital Service Area (SPHSA) was formed in 1969 by the Kenai Peninsula Borough. It was determined that hospital services were needed within the South Peninsula area and that such services would be best provided by the establishment of a service area. The population of the SPHSA is 13,899 and covers 8,317 square miles. South Peninsula Hospital is located in Homer, Alaska, at the southern tip of the Kenai Peninsula and close to the westerly most highway point in the country. The nexst closest hospital is Central Peninsula Hospital in Soldotna, 76 miles north of South Peninsula Hospital but as many as 80-90 miles for many of the residents in the SPHSA. Close to half of the population is largely in or in close proximity to the City of Homer. The remaining half is scattered in small neighborhoods throughout the vast service area. Some of the communities in the SPHSA are accessible only by air and water. Homer is the commerce hub of the service area, and the are attracts over 100,000 visitors each year. According to Alaska Department of Labor, the 2010 census of the primary service area is 13,136. The primary and secondary service area combined, including Nanwalek, Port Graham, and Seldovia is 13,899. X 1 1 X X X 0 0 0 1 0 1 0 0 0 Robert F Letson Chief Executive Officer 179752 0 19497 0 0 0 15000 0 31040 0 245289 0 0 0 Lori Meyer Chief Financial Officer 137715 0 0 0 0 0 11017 0 31040 0 179772 0 0 0 Brent Adcox Medical Doctor 832342 0 173535 0 0 0 15000 0 31040 0 1051917 0 0 0 Gregory Hough Medical Doctor 527659 0 45576 0 0 0 15000 0 31040 0 619275 0 0 0 Larry R Tripp CRNA 153770 0 205263 0 0 0 15000 0 0 0 374033 0 0 0 Carl Seger Medical Doctor 345727 0 0 0 0 0 15000 0 31040 0 391767 0 0 0 Hillary Seger Medical Doctor 300840 0 0 0 0 0 15000 0 0 0 315840 0 0 0 Schedule J, Part I, Line 1a Reimbursement of health club dues at 50% of cost up to a maximum of $500 per year. Schedule J, Part I, Line 3 Annually, an evaluation committee comprised of board members is appointed and they review the existing evaluation form and make any necessary adjustments to the format and content of questions asked. The entire board of directors and senior managment are asked to do a confidential evaluation as well as having the CEO complete a self-evaluation. The CEO's compensation is reviewed annualy and any increases are a board decision based on performance and salary survey data. Schedule J, Part I, Line 5 The CRNA may receive a bonus based on revenue generated from his services. Schedule J, Part I, Line 6 The medical doctors may receive a bonus based on net earnings of their clinic operations. A Kenai Peninsula Borough 920030894 2003-09-30 10621278 Hospital Expansion 0 0 0 B Kenai Peninsula Borough 920030894 2007-04-05 3086211 Hospital Expansion 0 0 0 C Kenai Peninsula Borough 920030894 2007-08-28 14703525 Hospital Expansion 0 0 0 D Kenai Peninsula Borough 920030894 2011-09-01 3285000 Retire oustanding debt 0 0 0 A 0 0 0 0 0 0 0 0 0 0 0 0 2007 0 0 1 1 B 0 0 0 0 0 0 0 0 0 0 0 0 2009 0 1 1 1 C 0 0 0 0 0 0 0 0 0 0 0 0 2009 0 0 1 1 D 0 0 0 0 0 0 0 0 0 0 0 0 2011 0 0 1 1 A 0 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 1 0 0 0 0 Woodworth Electric LLC Family member of current board member 81100 Electrical contracting servic3es 0 Form 990, Part VI, Section B, Line 11b Form 990 is prepared by the organization's Chief Financial Officer with input from other staff. The form is reviewed by the finance committee of the board of directors. The final form 990 is approved by the board of directors before submission to the internal revenue service. Form 990, Part VI, Section B, Line 12c All employee complete a conflict of interest questionnaire upon hire. Officers, directors, and managers complete a conflict of interest questionnaire annually each December. The possible existence of conflicts are required to be reported to the corporate compliance officer for investigation. Form 990, Part VI, Section B, Line 15 Annually, an evaluation committee comprised of board members is appointed and they review th4e existing evaluation form and make any necessary adjustments to the format and content of the questions being asked. The entire board of directors and senior management team are asked to do a confidential evaluation as well as having the CEO complete a self evaluation. The CEO's compensation is reviewed annually and any increases are a board decision based on performance. Form 990, Part VI, Section C, Line 19 All governing documents, conflict of interest policy, and financial statements are available to the public by providing copies upon request. Board of directors meeting minutes are available on the hospital website www.sphosp.org. Form 990, Part IX, Line 11g Physician and other professional fees for non-employees. Kenai Peninsula Borough 144 N Binkley Street Soldotna AK 99669 920030894 Local Government AK 115 N/A 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 Kenai Peninsula Borough c 3899763 Form 8868, Application for extension of time to file an exempt organization return, was filed and approved.