2015-02-05T14:29:35-07:00 2014-06-30 990 2013-07-01 920077523 CENTRAL PENINSULA GENERAL HOSPITAL INC CENT 9077144404 250 Hospital Place Soldotna AK 99669 Lance Spindler CFO 9077144722 2015-02-05 2013 2016-04-25 22:37:26Z Central Peninsula Hospital Richard Davis CEO 250 Hospital Place Soldotna AK 99669 235291769 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 10 925 245 44444 90412 2802938 690205 215314333 229904499 45397 259080 2849386 3844998 221012054 234698782 182869 151055 0 0 67730487 69552860 0 0 0 138890586 151767800 206803942 221471715 14208112 13227067 146313507 191966077 48306258 80731761 98007249 111234316 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 196167123 202817980 Our 49 bed hospital provided patient and ancillary services to 2,563 inpatients and 86,256 outpatients during the 2013 tax year. The hospital provides emergency medical services regardless of ability to pay. Emergency medical services were provided to 15,409 individuals, and 1,502 of those individuals were admitted to the hospital. 4,117 surgical procedures were performed in the hospital during the tax year. The imaging department performed 39,916 procedures. Over 66,026 physical therapy 15-minute procedures were provided to area residents. During the 2013 tax year, free medical services in the amount of $8,880,963 (gross charges) were provided to patients eligible for charity care. 10787655 12446953 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 2013 tax year were 69 and total resident days of care were 19,673. An average of 54 residents per day were provided long term care and nursing. Ancillary services for residents included 15,563 physical therapy treatments, while outpatients received 2,842 therapy treatments. 12868057 14639566 The hospital operates 6 family and specialty physician services clinics providing care in the following areas: Family medicine, Pediatrics, Neurology, Pain Management, Surgery, and Orthopedics. Other outpatient clinics include Wound care, Sleep studies, Forensic services, and the provision of Durable medical equipment. During the 2013 tax year physician and specialty services were provided for 21,582 patients. Over 3,324 wound care procedures, 139 forensic exams, and 138 sleep studies were also performed. 0 0 0 219822835 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 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 113 0 1 925 1 1 1 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 X Central Peninsula Hospital Finance Department 9077144525 250 Hospital Place Soldotna AK 99669 Silverio Mattero Board Member 4 X 4525 0 0 Judith Salo Board Member (former) 4 0 X 3200 0 0 Alyson Stogsdill President (former) 6 0 X 14075 0 0 Trena Richardson President 6 0 X 4575 0 0 Loren Wiemer Board Member (former) 4 0 X 6525 0 0 Irving Carlisle Secretary/Treasurer 6 0 X 3925 0 0 Henry Peter Sprague Vice President 6 0 X 4275 0 0 Gregg Motonaga Anesthesia MD/Board Member 44 0 X X 609423 0 22032 Mark Dixson Board Member 4 0 X 3575 0 0 Mark Premo Board Member 4 0 X 3075 0 0 Joseph Bujak Board Member 4 0 X 2000 0 0 Andrea D Posey CNO (former) 40 0 X 176820 0 37800 Johnny L Dodd VP of Human Resources 40 0 X 164083 0 28403 Matthew Dammeyer Chief Operating Officer 40 0 X 222930 0 38629 Richard Davis CEO 40 0 X 393703 0 31902 Shaun Keef Chief Financial Officer (former) 40 0 X 237157 0 35569 David S Innes Orthopedic Surgeon 40 0 X 1519082 0 34805 Cynthia Kahn Pain Management Physician 40 0 X 547506 0 15162 Justin Evans Anethesia MD 40 0 X 522771 0 52305 Jason Lattin Surgeon 40 0 X 659041 0 34805 Steven Manley Board Member 4 0 X 0 0 0 Stephen Horn Board Member 4 0 X 0 0 0 James McHale Board Member 4 0 X 0 0 0 Debra Shuey Board Member 4 0 X 0 0 0 5102266 0 331412 73 0 1 0 South Sound Inpatient Physicians PO Box 742936 Los Angeles CA 900742936 Physician Services 824129 C&A Industries Aureus PO Box 3037 Omaha NE 68103 Contract Labor Provider 593023 Alaska Hospitalist Group LLC 4300 B Street Suite 200 Anchorage AK 99503 Physician Services 293667 Molloy Schmidt LLC 110 South Willow St Suite 101 Kenai AK 99611 Attorney Services 282748 Curtis Buccholz 44455 Sterling Hwy Soldotna AK 996697936 Pathology services 250371 10 0 0 0 104931 550630 34644 14644 690205 Hospital Service Revenue 622000 202817980 202817980 0 0 Nursing Home Revenue 623000 12446953 12446953 0 0 Physician Clinic Revenue 621110 14639566 14639566 0 0 0 0 0 0 229904499 256616 0 0 256616 0 0 0 0 0 0 0 0 414460 0 370016 0 44444 0 44444 0 44444 0 0 2464 0 0 0 2464 2464 2464 0 0 0 440323 222971 217352 217352 0 0 Property tax revenue 900099 96342 96342 0 0 USAC Telephone Grant Revenue 900099 481191 481191 0 0 3005669 3005669 0 0 3583202 234698782 233707517 44444 256616 151055 151055 0 0 0 0 0 0 5425483 4113091 1312392 0 0 0 0 0 45177880 45177880 0 0 1561659 1561659 0 0 14057437 14057437 0 0 3330401 3330401 0 0 0 0 0 0 242505 0 242505 0 74252 0 74252 0 19731 0 19731 0 0 0 0 0 0 0 3463568 3463568 0 0 265859 265859 0 0 20383839 20383839 0 0 4072985 4072985 0 0 0 0 0 0 2290727 2290727 0 0 324367 324367 0 0 0 0 0 0 317297 317297 0 0 961727 961727 0 0 0 0 0 0 7845261 7845261 0 0 977197 977197 0 0 Medicare program deductions 50779904 50779904 0 0 Medicaid program deductions 18684098 18684098 0 0 Uncompensated care program deductions 20478365 20478365 0 0 Commercial, governtment, other program deductions 18268091 18268091 0 0 2318027 2318027 0 0 221471715 219822835 1648880 0 0 30230384 35197813 5278059 31686 94772 22175972 24663984 0 0 0 0 0 0 4247583 4488685 1219529 1555004 125816880 54428890 69429959 71387990 0 0 500000 500000 0 0 0 497662 13510965 53269537 146313507 191966077 13438967 12401135 0 0 14006 9676 34853285 67333899 0 0 153953 0 833098 48306258 80731761 X 97507249 106540914 500000 4693402 0 0 98007249 111234316 146313507 191966077 13227067 0 0 0 0 0 X 0 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 10177 0 1 9554 19731 0 Schedule C, Part II-B, Line 1 The Hospital engages in very little lobbying. Educational discussions with lawmakers and general support of healthcare legislation does occur on occasion. Total labor and travel expenses for the tax year amounted to $10,177. This represents the labor and travel expenses for two trips to Juneau, the capital of Alaska and two trips to Washington DC. Certain organization to which Central Peninsula Hospital pays membership dues, engage in lobbying activities. The amount reported for other activities represents the % of those membership dues which were reportedly spent on lobbying type activities. Total Hospital dues spent on lobbying activities by other organizations was $9,554. X 1 40 0 0 0 1 0 0 0 0 2150517 0 2150517 77392636 0 36111569 41281067 545822 0 246327 299495 38090926 0 17176208 20914718 7636979 0 894786 6742193 71387990 Plant replacement and expansion funds 16447887 Bond debt service reserve funds 4193402 Bond proceeds reserved for construction project 31275450 Deferred loss on bond refunding 1352798 53269537 0 Reserves payable to third party payors 791371 Other current liabilities 41727 833098 138678714 0 0 0 592987 592987 138085727 0 96613055 96613055 234698782 125451647 0 0 0 592987 592987 124858660 0 96613055 96613055 221471715 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 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. The cost of the real property and land is recorded on the Hospital's balance sheet at its net book value. Schedule D, Part XI, Line 2d Part VIII revenues are reported net of certain items which appear as expenses in the audited financial statements. These items are Cost of goods sold on durable medical equipment ($222,971) and expenses pertaining to unrelated business income ($370,016). Schedule D, Part XI, Line 4b These expenses represent the total deductions from revenue for third party payors (Medicare, Medicaid, VA, etc) and the amount of charity care discounts provided to patients. The audited financials report revenue net of contractual allowances, rather than gross. Schedule D, Part XII, Line 2d Certain reclassifications of expenses are required on the 990 Part VIII which are reported as reductions of revenue. These expenses include rental real estate expenses report on line 6b of the 990 Part VIII in the amount of $370,016. Additionally, cost of goods sold are reported on line 10b of 990 Part VIII in the amount of $222,971. Both items are reported as expenses in the audited financial statements rather than reductions of revenue. Schedule D, Part XII, Line 4b Certain expenses on the audited financial statements are reported net of revenues however those revenues are reported as gross on the 990 Part XIII. These expenses include charity care write-offs of $8,880,963 and third party payer deductions from revenue of $87,732,092. 1 1 X 1 X 1 X 1 1 1 0 1 1 1 2301 3982330 3982330 0.0354 1 10878 20289323 18118268 2171055 0.0193 1 167 38341 24796 13545 0.0001 3 13346 24309994 18143064 6166930 0.0548 534 26648 679969 99799 580170 0.0052 113 335 70420 8810 61610 0.0005 9 12698 2572419 1115681 1456738 0.013 4 120 19849 0 19849 0.0002 981 3513 280305 0 280305 0.0025 1641 43314 3622962 1224290 2398672 0.0214 1644 56660 27932956 19367354 8565602 0.0762 0 0 0 0 0 0 0 0 0 0 0 0 2 0 204 0 204 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 300 0 300 0 0 0 0 0 0 0 1 199 66012 0 66012 0.0006 0 0 0 0 0 0 7 199 66516 0 66516 0.0006 0 5200414 4086588 27587893 30928532 -3340639 X 1 1 1 1 Central Peninsula Hospital 250 Hospital Place Soldotna AK 99669 X X X Central Peninsula Hospital 1 1 X X X X X X X X X 09 1 0 1 X www.cpgh.org X X X X X X X 0 0 1 1 200 1 400 1 X X X X X 1 1 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 In conducting the CHNA, the University of New England (UNE) reached out to a broad cross section of the local community in order to gather health data through phone interviews. The UNE also used published census and health data for the community, state, and nation in their needs assessment. Hospital management supplements health information provided in the CHNA through partnerships and collaborations around the state and the nation such as involvement in the Alaska State Hospital and Nursing Home Association, Rural Health Care and Small Hospital associations, and also on the local level with the Kenai Peninsula Borough, the Patient advisory committee, and the Service area board. Schedule H, Part V, Section B, Line 5-Central Peninsula Hospital In addition to the above methods of disbursement, the CHNA was also provided through email to Administrators, Hospital Board Members, and supervisory staff of the Hospital. Schedule H, Part V, Section B, Line 6-Central Peninsula Hospital Hospital Management collaborates with the Board of Directors to address the CHNA findings through frequent strategic planning and implementation of new services whenever financially viable. Additionally, the Hospital support the provision of health service by Community health partners when it cannot supply those needs itself. Schedule H, Part V, Section B, Line 7-Central Peninsula Hospital Two of the 2013 CHNA health findings require long-term planning or community collaboration to meet the health need: 1. Respiratory Health and COPD affect over 10% of the population surveyed. Although the service area reports lower rates of smoking than peer communities, COPD rates remain the same. Additional attention on smoking cessation is needed along with reduction of obesity rates. The Hospital does treat patients admitted for services with smoking cessation patches free of charge while they are inpatients. However, an external campaign to reduce smoking rates has no yet been developed and it is unclear at this time what community collaboration efforts would best serve this need. 2. Diabetes - nearly 10% of the population surveyed reported a diagnosis of diabetes. Age and obesity are major risk factors in developing diabetes, and nearly 68% of the population is either overweight or obese. The Hospital has therefore focused much of its attention not on diabetes itself but on prevention through one of its major risk factors, obesity. The Healthy Lifestyles department specifically targets healthy eating and healthy living habits which can help lower the occurrence of diabetes. Further, the diabetes education department offers education, counseling, and support groups to area residents that suffer from diabetes. Schedule H, Part V, Section B, Line 14-Central Peninsula Hospital The Hospital makes its financial assistance policy widely available to its patients and the public through various means. During the discharge process, admissions staff attempt to provide a copy of the financial assistant brochure to every patient. Additionally, financial counselors contact patients about their billings and discuss the financial assistance policy with them over the phone and in person and offer assistance with completion of applications. The policy is posted on our public website at www.cpgh.org and is reported quarterly in local area government assembly meetings during the Hospital's financial presentation. Finally, advertising space is purchased in our local newspaper to publicize the financial assistance policy to the general public along with instructions for how to contact a financial counselor. Schedule H, Part V, Section B, Line 20-Central Peninsula Hospital The Hospital offers all self pay patients (regardless of FAP eligibility) a 25% prompt pay discount on hospital charges. This discount is more advantageous than substantially all of our negotiated commercial rates. For those patients who are unable to pay because they are financially or medically indigent, they are provided an opportunity to enroll in our financial assistance program for a further discount or free care. 16 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 Medical Office Space - Spine Ctr 108 E Corral St Soldotna AK 99669 Medical office building purchased - leased to Kenai Spine 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 Schedule H, Part I, Line 6a The most recently completed Community Health Needs Assessment was published in January 2013, or the 2012 tax year. Schedule H, Part I, Line 7 In areas where costs were reasonably able to be compiled we used actual costs. For activities such as the cost of charity care, we used the cost to charge ratios as calculated by the figures reported on our most recently filed Medicare cost report. Schedule H, Part I, Line 7, Column f Bad debt was reported at gross charges in 990 Part IX, line 25 or $11,597,402 along with gross charity care of $8,880,963. However, for the purposes of this Schedule H, we have used the cost to charge ratio calculated herein (44.84%) to reduce our uncompensated care (bad debt plus charity) to the estimated cost to provide that care. ($5,200,414 in bad debt) Of this balance, approximately 73% is estimated to be attributable to patients who may have been eligible to receive free or discounted care under the Hospital's financial assistance policy but failed to apply for assistance. Schedule H, Part II The Hospital supports our local education and workforce establishments through monetary donations, job fairs, job shadowing, internships, community partnership and coalition building, and skills training. Community involvement, workforce development, and health education improves the quality of life, and health of the community through the fostering of positive relationships 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 financial 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 account receivable payor composition and aging, and historical write-off experience by payor category. The amount reported in Schedule H, Part III is based on the estimated cost to provide care for individual patient accounts which 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 benefits as they provide a necessary and vital health benefit to members of our service area free of charge. Schedule H, Part III, Section B, Line 8 It is our belief that all of 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 allowance for Medicare patients regardless of the amount of the shortfall. The Hospital may only collect the portion which is a patient's co-pay or deductible and may not engage in collection efforts for the remainder. The Medicare costs reported herein are based on the fiscal year 2014 Medicare cost report filed. Schedule H, Part III, Section C, Line 9b The Hospital's collection policy PFS-546 addresses the various classes of 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 are the basis for a sliding scale between 200% and 400% of those guidelines. Applicants on the upper end of the scale (400%) are eligible for partial write-off, 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 the identified needs, the Hospital also determines health deficits within the community through a variety of other ways. Hospital officials meet regularly with an advisory committee comprised of area residents and former patients to determine the adequacy of facilities and services to meet the health needs of the community. The hospital periodically employs consultants to determine the physician and specialty physician needs of the community in order to direct strategic planning and physician recruiting. Finally, an open dialogue between Hospital management and patients, staff, and area medical staff is another source of identifying community health needs which exist. Schedule H, Part VI, Line 3 Hospital staff attempt to provide a financial assistance program brochure to every patient during discharge. The brochure is also available upon request, on the Hospital's public website, and is published in the local newspaper. Financial counselors personally contact patients and explain the financial assistance policy, assist with completion of applications, and set up payment plans if necessary. The Hospital employs 2 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 financial assistance application process. In addition, the Hospital purchases advertising space in the local newspaper to notify the public of its financial assistance program and how patients can reach our financial counselors 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 approximately 36,000 residents according to the 2010 census. The geographic region is in the Central Kenai Peninsula in the state of Alaska. Based on the 2010 Census, approximately 11% of the population is age 65 or older, 32% are between 45 and 64, and 32% are between 19 and 44. Basic social and economic 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 US 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 and healthy living, personnel support of local non-profits, public service announcements, conference room space for community organizations and support groups, health speaker bureaus, child safety programs, health fairs, immunization clinics, community health newsletters, and numerous other programs, initiatives, and collaborations. 1 Kenai Peninsula Youth Foundation Kenai River Brown Bears PO Box 2605 Soldotna AK 99669 262580744 501(c)3 20300 Monetary support for the 2013-2014 youth hockey season. The Kenai Peninsula Youth Foundation is an organization dedicated to providing developmental programs for aspiring student athletes. Bridges Community Resource Network PO Box 1612 Soldotna AK 99669 920151271 501(c)3 11200 Monetary support for the Imagination Library, Cancer fundraisers, local arts and crafts guild, and school sports. City of Kenai 210 Fidalgo St Suite 200 Kenai AK 99611 926001599 170(c)1 10000 Monetary support for the construction of the Enchanted Forest Playground. Kenai Peninsula Food Bank 33955 Community College Dr Soldotna AK 99669 943112445 501(c)3 10000 Monetary support for the Food Bank which provides low-cost or free nutritious foods to families with financial need. Kenai Peninsula United Way 11355 Frontage Road Benco Building Suite 101 Kenai AK 99611 920111698 501(c)3 10000 Monetary support of United Way of the Kenai Peninsula, which promotes healthy living, financial stability, and educational improvement through its many community programs. Kenai River Foundation PO Box 3674 Soldotna AK 99669 271570362 501(c)3 10000 Monetary donation for the Wounded Heroes Event. Soldotna Chamber of Commerce 44790 Sterling Hwy Soldotna AK 99669 920061612 501(c)6 8035 Monetary support for the Community partnership, Progress Days, and the annual Pie Auction. American Cancer Society Inc 250 Williams St NW Suite 400 Atlanta GA 303031002 131788491 501(c)3 7000 Monetary support for the American Cancer Society Relay for life and Polar bear jump. The American Cancer society funds cancer research and education. Kenai Watershed Forum PO Box 2937 Soldotna AK 99669 911829284 501(c)3 6500 Monetary support for Kenai River conservation and education and for maintenance and support of the Tsalteshi trail system. Kachemak Bay Broadcasting Inc 3913 Kachemak Way Homer AK 99603 920060366 501(c)3 5200 Monetary Donation to public radio broadcasting for the Kenai Peninsula. 8 2 Schedule I, Part I, Line 2 The Hospital provides cash contributions to local organizations which support community initiatives and healthy living on the Kenai Peninsula. Contributions are only made to organizations in good community standing. Hospital officers 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 579577 0 30958 0 1063 0 23172 0 21748 0 656518 0 0 0 Justin Evans Anethesia MD 497469 0 28408 0 1029 0 23172 0 33268 0 583346 0 0 0 David S Innes Orthopedic Surgeon 1335617 0 155685 0 33164 0 5672 0 33268 0 1563406 0 0 0 Jason Lattin Surgeon 595672 0 37740 0 29764 0 5672 0 33267 0 702115 0 0 0 Cynthia Kahn Pain Management Physician 422089 0 74205 0 52267 0 5672 0 10544 0 564777 0 0 0 Richard Davis CEO 288847 0 49136 0 61018 0 12185 0 22514 0 433700 0 0 0 Shaun Keef Chief Financial Officer (former) 186523 0 25507 0 29261 0 6436 0 33268 0 280995 0 0 0 Andrea D Posey CNO (former) 139279 0 18937 0 21818 0 8878 0 32135 0 221047 0 0 0 Johnny L Dodd VP of Human Resources 137393 0 8133 0 22105 0 8687 0 22514 0 198832 0 0 0 Matthew Dammeyer Chief Operating Officer 183913 0 23830 0 18641 0 9708 0 32135 0 268227 0 0 0 Schedule J, Part I, Line 1a Gross up payments are made for certain taxable fringe benefits including the value of 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. In 2014 the hospital discontinued the payment of gym membership dues for employees. 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 governed by a written policy. The hospital maintains that at some future date, employees may be required to pay their own FICA taxes on fringe benefits. Similarly, the hospital decided not to continue paying for gym memberships during 2014. Schedule J, Part I, Line 3 The hospital contracts with an independent consultant every three years to perform a review of executive salaries and benefits. The most recent review was performed in October 2014. 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. 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 individual 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 $17,499, Justin Evans $17,499, Richard Davis $6,609, Shaun Keef $3,584, Andrea Posey $1,648, Johnny Dodd $3,060, and Matthew Dammeyer $4,096. Schedule J, Part I, Line 5 In accordance with their employment contracts, Emergency room physicians and surgeons receive a percentage of their professional physician fees billed. This compensation is not based on the entity's overall revenue. Schedule J, Part I, Line 6 The hospital pays an annual incentive plan bonus to all employees, supervisors and executives based on a series of 4 operational and quality measures. One of these 4 measures is meeting the hospital's net earnings budget. This element comprises only one-fourth of the potential plan bonus payment and the bonus is not calculated based on the amount of the entity's earnings. The remaining measures are 1)patient satisfaction, 2)quality, and 3)utilization. A Kenai Peninsula Borough 920030894 488530NF9 2003-12-18 47985000 Hospital expansion project 2003 GO bonds 0 0 0 B Kenai Peninsula Borough 920030894 01179PX51 2011-09-15 27905000 Refunding bonds - 2011 GO 0 0 1 C Kenai Peninsula Borough 920030894 01179RDP5 2014-02-20 32490000 Medical Office Building construction project 0 0 1 A 43635000 0 53963243 0 3376615 32616814 544896 0 0 53418347 0 0 2008 0 0 1 1 B 0 0 32616814 0 0 0 201610 0 0 0 0 0 2008 0 1 1 1 C 0 0 34999563 2960067 347061 1233335 127595 0 0 3598902 0 31275450 2016 0 0 0 1 A 0 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 0 1 C 0 0 1 1 0 0 0 0 1 0 1 A 1 1 0 0 1 0 B 0 0 0 0 1 0 0 0 0 C 0 1 0 0 1 0 0 0 1 A 0 B 0 C 1 Charles Weimer Husband of former board member Loren Weimer 13000 Leased real estate to Hospital at FMV 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 Board's 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 $1.0 million. Form 990, Part VI, Section B, Line 11b The 990 is prepared by the Hospital's Finance Department and submitted to Hospital management for review. Management then returns any edits to the Finance Dept for preparation of a 2nd draft. The 2nd 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 dept 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 conflicts of interest which arise throughout the year and take appropriate action if needed. 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 by the Haygroup was executed in October 2014. Remuneration reports are submitted to the Board for review and used to set the wage scales for the CEO, CFO, CNO, COO, and VP of Human Resources. Contemporaneous documentation exists for this study. Form 990, Part VI, Section C, Line 18 The hospital published its 3 most recent 990s on its own website at www.cpgh.org. The Hospital's 990 is also published on Guidestar.com and is available upon request via email. Form 990, Part VI, Section C, Line 19 The Hospital makes its governing documents, conflict of interest policy, and audited financial statements available to the public upon request. The audit financial statements are also published on its website at www.cpgh.org. 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 0 1 0 1 1 1 1 1 1 0 Central Peninsula Health Foundation c 14644 Actual cost of capital assets provided to the Hospital. Central Peninsula Health Foundation q 62632 Actual expenses incurred by the Hospital are stated at the dollar value paid which is reimbursed at cost by the Foundation. Central Peninsula Health Foundation m 178919 The Foundation performs fundraising for which a portion benefits the Hospital and Hospital programs. The value of those programs for which the Foundation transferred solicited funds during 2014 was $178,919. Central Peninsula Health Foundation n 13829 The Hospital provides office space to Central Peninsula Health Foundation. The value of the space is determined based on our most recently filed Medicare Cost Report (2013) expenses for facility, administration, and support services allocated per square foot. Central Peninsula Health Foundation o 64348 The Hospital shares certain paid employees for directorship and accounting functions necessary to operate Central Peninsula Health Foundation. 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 stated in that agreement is $1 per annum. Kenai Peninsula Borough p 7990819 The Hospital reimburses the Kenai Peninsula Borough for expenses related to its debt service, property insurance premiums, refuse, and sales tax. This amount represents actual cash payments to the borough for these expenses. Kenai Peninsula Borough r 7730136 Per the lease and operating agreement with the Kenai Peninsula Borough, all cash >90 days operating must be transferred to an account held by the Borough for Plant replacement and expansion of facilities of the hospital. This is the total amount of cash transferred to the borough during FY2014. Extension was filed for 990 and accepted by the IRS. Extension deadline was met.