2014-05-14T16:29:43-05:00 2013-06-30 135381590 BDO USA LLP 3601 C STREET SUITE 600 ANCHORAGE AK 99503 990 2012-07-01 926001607 PETERSBURG MEDICAL CENTER PETE 9077724291 PO BOX 589 PETERSBURG AK 99833 ELIZABETH WOODYARD 9077724291 2014-05-14 1 KEY E GETTY CPA P00121200 9072788878 2014-05-14 2012 2015-11-30 17:44:51Z ELIZABETH WOODYARD PO BOX 589 PETERSBURG AK 99833 15074272 0 X WWW.PMC-HEALTH.COM X COMPONENT UNIT OF PETERSBURG BOROUGH, AK 1993 AK OUR MISSION IS TO PROVIDE EXCELLENT HEALTHCARE AND TO PROMOTE WELLNESS IN OUR COMMUNITY. 7 7 138 13 0 0 910405 1098094 11439560 12948321 205447 97972 183536 130899 12738948 14275286 0 0 0 0 7105180 8925363 0 0 0 4812914 4651493 11918094 13576856 820854 698430 12282231 13725987 2323859 2844115 9958372 10881872 X OUR MISSION IS TO PROVIDE EXCELLENT HEALTHCARE AND TO PROMOTE WELLNESS IN OUR COMMUNITY. 0 0 2309185 2549125 NURSING SERVICES PROVIDED IN ACUTE CARE, INTENSIVE CARE, SWING BED, EMERGENCY ROOM, OPERATING ROOM AND HOME HEALTH SETTINGS. THESE SERVICES ARE PROVIDED IN A SEMI REMOTE RURAL AREA OF ALASKA. ACCESS TO THE AREA IS BY AIR OR WATER ONLY. 2890045 5368847 OTHER HEALTHCARE SERVICES. THESE SERVICES ARE PROVIDED IN A SEMI-REMOTE AREA OF RURAL ALASKA. ACCESS TO THE AREA IS BY AIR OR WATER ONLY. THE SERVICES INCLUDE LABORATORY, IMAGING AND PHYSICAL THERAPY. 2097551 1888958 CLINIC. WE PROVIDE CLINIC SERVICES TO A SEMI REMOTE AREA OF RURAL ALASKA. ACCESS TO THE AREA IS BY AIR OR WATER ONLY. 1652242 3141391 NURSING HOME. WE PROVIDE NURSING HOME SERVICES IN A SEMI REMOTE AREA OF RURAL ALASKA. ACCESS TO THE AREA IS BY AIR OR WATER ONLY. 1652242 3141391 8949023 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 53 0 1 138 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 1 0 X YING SCHWARTE 9077724291 PO BOX 589 PETERSBURG AK 99833 TOM ABBOTT 4.00 X X 0 0 0 JEANETTE NESS 2.00 X X 0 0 0 DARCY JUDY 2.00 X 0 0 0 TIM KOENEMAN 2.00 X 0 0 0 KRIS KISSINGER 2.00 X 0 0 0 DARLENE WHITETHORN 2.00 X 0 0 0 KRIS NOROSZ 2.00 X 0 0 0 KEN HILL 2.00 X 0 0 0 PHIL BEARDSLEY 2.00 X 0 0 0 ROCIO TEJERA 2.00 X 0 0 0 ELIZABETH WOODYARD 40.00 1.00 X 175588 0 12235 LEON WALSH 40.00 X 122107 0 12533 JENNIFER BRYNER 40.00 X 126370 0 42908 YING SCHWARTE 40.00 X 35848 0 8628 ALICE HULEBAK 40.00 X 170979 0 23277 JENNIFER HYER 40.00 X 170838 0 28149 MARK TUCILLO 40.00 X 172223 0 42389 ELIZABETH BACOM 43.00 X 107121 0 30403 1081074 0 200522 7 0 1 0 INNOVATIVE EMPLOYEE SOLUTIONS 9665 GRANITE RIDGE 420 SAN DIEGO CA 92123 TRAVELER NURSES 297251 DELTA HEALTHCARE PLACEMENT PO BOX 202940 DALLAS TX 753202056 RECRUITMENT 273267 COMP HEALTH PO BOX 972651 DALLAS TX 753972651 PHYSICIAN STAFFING 131366 CARDINAL HEALTH PO BOX 100316 PASADENA CA 911890316 ADMINISTRATIVE SERVICES 109484 QUEST DIAGNOSTICS FILE 91514 LOS ANGELES CA 90074 DIAGNOSTIC SERVICES 106686 7 1097994 100 1098094 PATIENT SERVICES 624100 12948321 12948321 12948321 54769 54769 42279 0 42279 42279 42279 842189 798986 43203 43203 43203 OTHER OPERATING REVENUE 900099 85485 85485 OTHER NON-OPERATING REVENUE 900099 3135 3135 88620 14275286 12948321 0 228871 540436 172875 367561 8384927 6297690 2087237 18166 18166 643785 643785 59555 59555 ADMINISTRATIVE AND FISC 805760 805760 NURSING SERVICES 720770 720770 OTHER EXPENSE 661271 520742 140529 MAINTENANCE 505240 505240 1236946 1236946 13576856 8949023 4627833 0 1072395 95032 204477 7268 2161023 4720658 147085 188835 127682 90790 17542643 13068588 4964581 4474055 3533877 4035851 71111 113498 12282231 13725987 802750 1218060 1218996 1398367 302113 227688 2323859 2844115 X 5414585 6691170 0 0 4543787 4190702 9958372 10881872 12282231 13725987 698430 225070 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 347944 347944 12402414 9369883 3032531 125327 105312 20015 4666958 3593393 1073565 4474055 PAYABLE TO FOUNDATION 29204 CAPITAL LEASE 198484 227688 14482190 225070 225070 14257120 18166 18166 14275286 13558690 0 13558690 18166 18166 13576856 PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES RECLASSIFIED AS EXPENSE 18,166. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES RECLASSIFIED AS EXPENSE 18,166. 1 1 X 1 X 1 X 175.000000000000 1 1 1 0 0 231493 231493 0.01710 231493 231493 0.01710 231493 231493 0.01710 0 571581 2051868 2026199 25669 X 1 1 1 NONE 1 1 PETERSBURG MEDICAL CENTER

103 FRAM ST PETERSBURG AK 99833

X X X X NURSING HOME, OUTPATIENT CLINIC PETERSBURG MEDICAL CENTER 1 1 X X X X X X X 12 1 0 0 0 0 1 1 100.000000000000 1 175.000000000000 1 X X X X X 1 1 X X 1 0 X X 1 X 0 1 PART I, LINE 7: THE PERCENT OF FINANCIAL ASSISTANCE IS THE AMOUNT OF FINANCIAL ASSISTANCE AT COST ($231,493) DIVIDED BY TOTAL EXPENSES OF 13,576,856. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE IS THE NET DOLLAR AMOUNT OF PATIENT CHARGES TURNED OVER TO COLLECTION AGENCIES DURING THE YEAR. PART II: N/A PART III, LINE 4: THERE IS NO FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE. PART III, LINE 8: MEDICARE REVENUES EXCEED MEDICARE EXPENSES- THERE IS NO SHORTFALL. MEDICARE COSTS AND EXPENSES ARE FROM THE COST REPORT. PART III, LINE 9B: IF A PATIENT STATES OR IMPLIES HAVING A LIMITED MEANS TO PAY, BUSINESS OFFICE STAFF SPECIFICALLY NOTIFY THEM OF THE CHARITY POLICY. PETERSBURG MEDICAL CENTER PART V, SECTION B, LINE 1J: THE ORGANIZATION'S BOARD MAINTAINS AN AWARENESS OF THE HEALTH CARE NEEDS OF TEH COMMUNITY AND ATTEMPTS TO PROVIDE FOR THOSE NEEDS WHILE REMAINING FINANCIALLY VIABLE. PETERSBURG MEDICAL CENTER PART V, SECTION B, LINE 12H: AN ADDITIONAL FACTOR USED TO DETERMINE AMOUNTS CHARGED TO PATIENTS UNDER THE FINANCIAL ASSISTANCE POLICY IS FAMILY SIZE. PETERSBURG MEDICAL CENTER PART V, SECTION B, LINE 20D: PATIENTS WHO DO NOT HAVE INSURANCE COVERING EMERGENCY OR MEDICALLY NECESSARY CARE ARE BILLED THE RATES ESTABLISHED IN THE CHARGEMASTER FOR THE SERVICES PROVIDED. PETERSBURG MEDICAL CENTER PART V, SECTION B, LINE 22: THE ORGANIZATION CHARGES ALL PATIENTS THE GROSS CHARGE ESTABLISHED IN THE CHARGE MASTER FOR THE SERVICES PROVIDED.IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UDNER THE FINANCIAL ASSISTANCE POLICY, THE CHARGES ARE REDUCED TO THE AMOUNTS PERMITTED BY THE POLICY. PART VI, LINE 2: THE ORGANIZATION'S STAFF AND BOARD OF DIRECTORS MAINTAINS AN AWARENESS OF THE GENERAL HEALTHCARE NEEDS OF THE COMMUNITY AND ATTEMPTS TO PROVIDE FOR THOSE NEEDS WHILE REMAINING FINANCIALLY VIABLE. PART VI, LINE 3: THE ORGANIZATION'S BUSINESS OFFICE STAFF INFORMS AND EDUCATES PATIENTS ABOUT THEIR ELIGIBILITY FOR GOVERNMENT PROGRAMS AND THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM AS PART OF THE COLLECTION PROCESS. PART VI, LINE 4: PETERSBURG MEDICAL CENTER OPERATES ON MITKOF ISLAND IN THE GULF OF ALASKA. MITKOF ISLAND IS ACCESSABLE ONLY BY AIR OR BOAT. PART VI, LINE 5: PETERSBURG MEDICAL CENTER IS OVERSEEN BY AN UNPAID SEVEN MEMBER BOARD OF DIRECTORS. THE ENTITY TAKES SERIOUSLY ITS MISSION OF PROMOTING WELLNESS IN THE COMMUNITY. ONE PROGRAM IS A HEALTH FAIR HELD BIANNUALLY WHERE RESIDENTS ARE ABLE TO OBTAIN CORE LAB TESTS AT A REDUCED COST TO HELP THEM MONITOR THEIR HEALTH STATUS. THE ORGANIZATION ALSO PARTICIPATES IN AND PROMOTES AN ANNUAL PHYSICAL ACTIVITY CHALLENGE AMONG AREA ENTITIES TO PROMOTE MORE HEALTHY LIVING. PART VI, LINE 6: N/A 1 X X X 0 0 0 0 0 0 0 0 0 ELIZABETH WOODYARD 175588 0 0 0 0 0 8779 0 3456 0 187823 0 0 0 JENNIFER BRYNER 126370 0 0 0 0 0 27801 0 15107 0 169278 0 0 0 ALICE HULEBAK 170979 0 0 0 0 0 8548 0 14729 0 194256 0 0 0 JENNIFER HYER 170838 0 0 0 0 0 8542 0 19607 0 198987 0 0 0 MARK TUCILLO 172223 0 0 0 0 0 37889 0 4500 0 214612 0 0 0 ELIZABETH HART SPOUSE OF BOARD PRESIDENT 92257 WAGES 0 FORM 990, PART VI, SECTION B, LINE 11 THE CHIEF FINANCIAL OFFICER AND THE CHIEF EXECUTIVE OFFICER WILL EACH REVIEW THE COMPLETED RETURN SEPARATELY AND THEN RESOLVE ANY ISSUES WHICH ARISE PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 15 THE CHIEF EXECUTIVE OFFICER'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS AFTER REVIEWING SALARIES FOR SIMILAR POSITIONS IN COMPARABLE ORGANIZATIONS OF THE HEALTHCARE INDUSTRY. A SALARY HISTORY OF THE POSITION IS PART OF THE REVIEW. THE COMPENSATION REVIEW IS MADE IN CONJUNCTION WITH THE CEO'S ANNUAL EVALUATION. THE CHIEF EXECUTIVE OFFICER'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS AFTER REVIEWING SALARIES FOR SIMILAR POSITIONS IN COMPARABLE ORGANIZATIONS OF THE HEALTHCARE INDUSTRY. A SALARY HISTORY OF THE POSITION IS PART OF THE REVIEW. THE COMPENSATION REVIEW IS MADE IN CONJUNCTION WITH THE CEO'S ANNUAL EVALUATION. FORM 990, PART VI, SECTION C, LINE 19 PETERSBURG MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART XII LINE 2C THERE HAS BEEN NO CHANGE IN THE AUDIT SELECTION OR OVERSIGHT PROCESS FROM THE PRIOR YEAR. PETERSBURG MEDICAL CENTER FOUNDATION PO BOX 589 PETERSBURG AK 99833 920134279 CARRY OUT FUNDRAISING & CHARITABLE ACTIVITIES FOR PETERSBURG MEDICAL CENTER AK 501(C)(3) 509(A)(3) PETERSBURG MEDICAL CENTER 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0