2014-09-10T18:10:06-07:00 2013-06-30 990 2012-07-01 920037099 SOUTH PENINSULA HOSPITAL INC SOUT 9072358101 4300 Bartlett Street Homer AK 99603 Robert Letson 9072350324 2014-01-08 2012 2015-11-30 17:44:51Z X South Peninsula Hospital 4300 Bartlett St Homer AK 99603 50840652 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 10 412 40 0 0 3750708 4643740 39302350 46171122 669 20790 0 0 43053727 50835652 0 0 0 0 23461645 30165231 0 0 0 17352512 19285368 40814157 49450599 2239570 1385053 62058947 63920463 25097068 25573531 36961879 38346932 X South Peninsula Hospital promotes community health and wellness by providing personalized, high quality, locally coordinated healthcare. 1 0 26652661 0 32490497 Our 22 bed hospital provided inpatient services to 1034 patients for total patient days of 3,349 for the 2012 tax year. Total outpatient visits for the year were 19,113 and include 6,690 emergency department visits, 1,240 ambulatory surgery visits, and 4,582 imaging visits. Other outpatient services include laboratory, physical therapy, occupational therapy, infusion and chemotherapy, and sleep lab. 4236001 0 6863599 Our Long Term Care facility served 34 residents during the 2012 tax year with an average daily census of 26 and total resident days of 9,348. 6564876 0 5901532 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 17,629 patient visits during the 1021 tax year. 1136097 0 915494 Our community health services department provides home health care, chore and respite services, and other home care services to more than 300 local residents. 3,276 visits were made to client homes in the 2012 yax year. Other program services include revenue from cafeteria and vendings machines, medical record copies, and other program related sources. 1136097 0 915494 38589635 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 0 1 0 0 0 0 0 1 0 0 0 1 114 0 1 412 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 3 X 1800 0 0 Kelly Cooper 2.5 X 1200 0 0 Clyde Boyer 3 X 1200 0 0 Thomas Clark 3 X 1200 0 0 Susan Drathman 2 X 1200 0 0 Matthew Hambrick 2 X 1200 0 0 Vickey Hodnick 6 X 1200 0 0 Matthew North 2 X 1200 0 0 Bernadette Wilson 3.5 X 1200 0 0 M Todd Boling DO 2.5 X 0 0 0 Robert F Letson 50 0 X 158565 0 48813 Lori Meyer 45 X 123025 0 51194 Brent Adcox 40 X 861003 0 99317 Larry R Tripp 40 X 294649 0 34865 Gregory Hough 40 X 253154 0 35993 Shara Sutherlin 40 X 146798 0 34906 Douglas Duncan 40 X 146139 0 48764 1994733 0 353852 19 0 1 0 Peak Imaging 4438 Towne Heights Ln Homer AK 99603 Radiologist 946414 Eris Radiology LLC PO Box 2434 Homer AK 99603 Radiologists 348479 James Peterson PO Box 58 Homer AK 99603 Anesthesiologist 295066 Raymond Fowler 40914 Crested Crane St Homer AK 99603 Anesthesiologist 271984 Paul Raymond 4201 Bartlett St Unit 2 Homer AK 99603 Emergency Physician 235058 12 0 0 0 0 4532213 111527 0 4643740 Hospital 622000 32490497 32490497 0 0 Long Term Care 623000 6863599 6863599 0 0 Physician Clinics 621111 5901532 5901532 0 0 Community Health Services 621610 683443 683443 0 0 232051 232051 0 0 46171122 10790 10790 0 0 0 0 0 0 0 0 0 0 0 0 0 15000 0 5000 0 10000 10000 10000 0 0 0 0 50835652 46191912 0 0 X 0 0 0 0 0 0 0 0 318693 0 318693 0 0 0 0 0 21232522 17109109 4123413 0 1276473 1021178 255295 5799073 4595569 1203504 0 1538470 1230776 307694 0 90164 90164 0 0 309837 0 309837 0 40467 0 40467 0 0 0 0 0 0 0 0 0 0 0 5852720 4783257 1069463 0 138344 0 138344 0 4681897 4142885 539012 0 552140 140278 411862 0 0 0 0 0 1852973 336048 1516925 0 190930 110478 80452 0 0 0 0 0 186120 132183 53937 0 816777 816504 273 0 0 0 0 0 2709036 2709036 0 0 564806 564806 0 0 Repairs and Maintenance 1088171 766125 322046 0 Dues Books Subscriptions 210986 41239 169747 0 49450599 38589635 10860964 0 2104 2104 7923929 6541240 0 0 7712530 11359519 0 0 0 0 0 0 1213604 1484407 1065947 1020856 75772199 32627619 43733354 43144580 0 0 0 0 0 0 0 0 407479 367757 62058947 63920463 5261363 6957606 0 0 298655 286112 19338987 18194344 0 0 0 0 0 0 0 0 198063 135469 25097068 25573531 X 36936593 38321646 25286 25286 0 0 36961879 38346932 62058947 63920463 1385053 0 0 0 0 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 188508 188508 0 56712410 19625385 37087025 0 80470 23641 56829 0 17835660 12978593 4857067 0 955151 0 955151 43144580 0 DUE TO KENAI PENINSULA BOROUGH 135469 135469 50835652 0 0 0 0 0 50835652 0 0 0 50835652 49450599 0 0 0 0 0 49450599 0 0 0 49450599 1 1 1 X 1 X 1 1 1 0 0 924676 0 924676 0.019 12374778 12817393 -442615 0 0 0 0 0 0 0 13299454 12817393 482061 0.019 104339 20709 83549 0.002 186120 0 186120 0.003 617648 543168 74480 0.0015 0 0 0 0 18908 0 18908 0.0003 0 0 927015 563877 363057 0.0068 0 0 14226469 13381270 845118 0.0258 0 1746190 174619 8568195 13749778 -5181583 X 0 1 1 South Peninsula Hospital Inc

4300 Bartlett St Homer AK 99603

X X X X South Peninsula Hospital Inc 1 1 X X X X X X X X X 09 1 0 1 X 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 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. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Used worksheets provided in the instructions afor Schedule H andd cost to charge ratio. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f No bad debt expense is included in Form 990, Part IX, line 25. SchH_P01_S00_L07g Schedule H, Part I, Line 7g Subsidized health services do not include any costs attributable to a physician clinic. SchH_P03_S0A_L04 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 18). Line 2 is calculated by bad debt expense time cost to charge ratio. Line 3 is estimated at ten percent of bad debt cost. SchH_P03_S0B_L08 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. SchH_P05_S0B_L01 Schedule H, Part V, Section B, Line 1 Yes, our hospital is the sponsoring 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, one in 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 System. The 2012 assessment included only the first three since the changes in the facilities and resources within the community had not changed significantly outside the scope of hospital services. SchH_P05_S0B_L03 Schedule H, Part V, Section B, Line 3 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. Representatives from the FQHC, public health, community mental health, city government, substance abuse agency, local college, comminuty hospital and family planning clinic all serve on the steering committee. Community surveys - 1,212 surveys were completed via hard copy and online. Questions were similar if not exact to the CHNA of 2009 so responses could be compared, and were both multiple choice and free responses. Surveys were distributed at the local health fair, both weekly newspapers, on www.mappofskp.net, in organization waiting room, in line at the food bank, at city hall, the public library and the hardware store. The survey remained open until the committee was certain that, based on US census data for our area, a proportionate range of income levels, ages and location of residence were represented. Key Informants - a key information survey was sent to more than 100 community leaders representing the broad community health perspectives of: physical, mental, spiritual, environmental, education, economic and cultural prespectives. MAPP Steering Committee members contacted via telephone all of these key informants in advvance of sending the survey. Anonimity was promised, however sector was tracked as best as possible. 86 key informants participated, and the following representation was confirmed: alternative healthcare - 1, arts -3, clergy - 1, education - 6, environment - 4, environmental edication - 2, government - 4, law enforcement - 2, healthcare -4, military - 2, senior - 1, social services - 10, and youth -2. It is uncertain exactly what sector the remaining 44 represented out of our definition of health. Both open-ended input was solcitied, as well as specific follow up questions from the prior assessment. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 Available at public meetings. SchH_P05_S0B_L07 Schedule H, Part V, Section B, Line 7 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 clinic, and adding an obstetrician/gynocologist to our primary care practice. However, the hospital is not able to address all of the needs from the assessment 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. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 All patient are charged at gross charges. Discounts are applied to gross charges for all patients. SchH_P05_S0B_L22 Schedule H, Part V, Section B, Line 22 All patients are charges at gross charges. Discounts are applied to gross charges for all patients. SchH_P06_S00_L02 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 Srvices. MAPP uses four types of assessments to establish the overall community assessment: 1) community data (reportable statistics from numersous 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 found at www.mappofskp.net. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 During patient registration, each private pay patient is offered a Financial Assistance packet and business card for the financial counselor. The financial counselor assists any interested parties with Medicaid applications and/or the hospital's internal financial assistance application. SchH_P06_S00_L04 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 13,136 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 next closest hospital is Central Peninsula Hospital in Soldotna, 76 miles morth 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 area 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 13,987. X 1 1 X X X 0 0 0 1 0 1 0 0 0 Robert F Letson 157565 0 1000 0 0 0 9514 0 64599 0 232678 0 0 Lori Meyer 122025 0 1000 0 0 0 7382 0 45923 0 176330 0 0 0 Brent Adcox 779939 0 81064 0 0 0 15000 0 179080 0 1055083 0 0 Larry R Tripp 148999 0 145650 0 0 0 15000 0 48748 0 358397 0 0 Gregory Hough 219110 0 34044 0 0 0 15000 0 15262 0 283416 0 0 0 Shara Sutherlin 145798 0 1000 0 0 0 8808 0 43068 0 198674 0 0 0 Douglas Duncan 145139 0 1000 0 0 0 8768 0 72875 0 227782 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Reimbursement of health club dues at 50% of cost up to a maximum of $500 per year. SchJ_P01_S00_L03 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 management 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 and salary survey data. SchJ_P01_S00_L05 Schedule J, Part I, Line 5 The CRNA may receive a bonus based on revenue generated from his services. SchJ_P01_S00_L06 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 A 1 B 1 C 1 Woodworth Electric Family member of current director 122161 Electrical Contracting Services 0 F990_P00_S00_L0B Form 990, Header, Line B Schedule J Part II Colunm J had incorrect information reported. F990_P03_S00_L02 Form 990, Part III, Line 2 Acquisition of a family practice physician clinic. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b Form 990 is prepared by the organization Chief Financial Officer with input from other members of hte organization. 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. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c All employees 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. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 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 the questions being asked. The entire board of directors and senior managment 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. F990_P06_S0C_L19 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. F990_P09_S00_L11g 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 3744093