2013-01-28T19:36:00-07:00 2012-06-30 990 2011-07-01 920037099 SOUTH PENINSULA HOSPITAL INC SOUT 9072358101 4300 Bartlett Street Homer AK 99603 Robert Letson 9072350324 2013-01-24 2011 2016-02-25 16:41:14Z South Peninsula Hospital 4300 Bartlett St Homer AK 99603 43058454 0 X www.sphosp.org X 1969 AK South Peninsula Hospital promotes community health and wellness by providing personalized, high quality, locally coordinated healthcare. 9 9 372 40 0 0 3826627 3750708 34374543 39302350 -29364 669 0 0 38171806 43053727 0 0 0 0 22178537 23461645 0 0 0 16198707 17352512 38377244 40814157 -205438 2239570 59764131 61723129 24970160 24689588 34793971 37033541 X South Peninsula Hospital promotes community health and wellness by providing personalized, high quality, locally coordinated healthcare. 1 0 24068070 0 30584371 Our 22 bed hospital provided inpatient services to 951 patients for total patient days of 3045 for the 2011 tax year. Total outpatient visits for the year were 27,045 and include, 4,490 emergency department visits, 982 ambulatory surgery visits, and 9,964 imaging visits. Other outpatient services include laboratory, physical therapy, occupational therapy, infusion and chemotherapy, and sleep lab. 4014224 0 6238816 Our Long Term care facility served 39 residents during the 2011 tax year with an average daily census of 25 and total resident days of 9,276. 1591045 0 1676765 The hospital opened its first provider-based clinic during the 2011 tax year. The clinic had 1,191 patient visits during the year. 900001 0 802398 Our community health services department provides home health care, chore and respite services, and other home care services to more than 300 local residents. 3,200 visits were made to client homes in the 2011 yax year. Other program services include revenue from cafeteria and vendings machines, medical record copies, and other program related sources. 900001 0 802398 30573340 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 0 0 0 0 0 0 1 0 0 0 0 1 97 0 1 372 1 0 0 0 0 0 0 X 9 9 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 0 0 0 Kelly Cooper 2.5 X 0 0 0 Clyde Boyer 3.5 X 0 0 0 Thomas Clark 2 X 0 0 0 Susan Drathman 7.5 X 0 0 0 Matthew Hambrick 2 X 0 0 0 Vickey Hodnick 3 X 0 0 0 Matthew North 2 X 0 0 0 Bernadette Wilson 3 X 0 0 0 Robert F Letson 50 X 147571 0 60504 Robert A Barnes 40 X 130947 0 53668 Brent Adcox 40 X 300949 0 123389 Larry R Tripp 40 X 260012 0 15601 Douglas Westphal 40 X 109583 0 44929 Lisa Mangum 40 X 109068 0 44718 Deanna Graham 40 X 105868 0 43406 1163998 0 386215 9 0 1 0 Peak Imaging 4438 towne Heights Ln Homer AK 99603 Radiologist 723960 Raymond Fowler 40914 Crested Crane St Homer AK 99603 Anesthesiologist 339384 Eris Radiology LLC PO Box 2434 Homer AK 99603 Radiologists 335319 James Peterson PO Box 58 Homer AK 99603 Anesthesiologist 246115 Paul Raymond 4201 Bartlett St Unit 2 Homer AK 99603 Emergency Physician 188442 10 0 0 0 0 3688934 61774 0 3750708 Hospital 622000 30584371 30584371 0 0 Long Term Care 623000 6238816 6238816 0 0 Physician Clinic 621111 1676765 1676765 0 0 Community Health Services 621610 634156 634156 0 0 168242 168242 0 0 39302350 4994 4994 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 402 0 4727 0 -4325 -4325 -4325 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 43053727 39303019 0 0 0 0 0 0 0 0 0 0 292303 0 292303 0 0 0 0 0 16331078 12435582 3895496 0 631352 473514 157838 0 4895710 3629561 1266149 0 1311202 983402 327800 0 146759 146759 0 0 230850 0 230850 0 20984 0 20984 0 0 0 0 0 0 0 0 0 0 0 5315909 4355380 960529 0 101002 0 101002 0 3913076 3450947 462129 0 469985 55363 414622 0 0 0 0 0 1674578 171517 1503061 0 115115 55650 59465 0 0 0 0 0 121689 70084 51605 0 801276 799762 1514 0 0 0 0 0 2915639 2915639 0 0 478800 478800 0 0 Maintenance & Repair 836042 519314 316728 0 Dues Books Subscriptions 210808 32066 178742 0 40814157 30573340 10240817 0 1605 2104 6052721 7923929 0 0 6774323 7784191 0 0 0 0 0 0 1160194 1213604 1111326 1065947 73651937 29918583 44663962 43733354 0 0 0 0 0 0 0 0 0 0 59764131 61723129 3104838 3864475 0 0 370714 405518 21237144 20221532 0 0 0 0 0 0 0 0 257464 198063 24970160 24689588 X 34768685 37008255 25286 25286 0 0 34793971 37033541 59764131 61723129 2239570 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 188508 188508 0 45149380 10232795 34916585 0 80470 17005 63465 0 24602618 18670361 5932257 0 3630961 998422 2632539 43733354 0 Payable to related third party 198063 198063 43053727 40814157 2239570 0 0 0 0 0 0 2239570 43053727 0 0 0 0 0 43053727 0 0 0 43053727 40814157 0 0 0 0 0 40814157 0 0 0 40814157 1 1 1 X 1 X 1 1 1 0 0 666623 0 666623 0.02 8120565 4990206 3130359 0.07 0 0 0 0 0 0 8787188 4990206 3796982 0.09 98742 7682 91060 0.002 109932 0 109932 0.003 653919 564746 89173 0.002 0 0 0 0 56000 0 56000 0.001 0 0 918593 572428 346165 0.008 0 0 9705781 5562634 4143147 0.098 0 1307608 130761 8404845 7740865 663980 X 0 1 1 South Peninsula Hospital Inc

4300 Bartlett St Homer AK 99603

X X X X South Peninsula Hospital Inc 1 0 1 1 100 1 300 1 X X X 1 1 X 1 X 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 Orthopedic Clinic

4300 Bartlett St Homer AK 99603

Provider based physician clinic. 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 for Schedule H and 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 debts and charity care are subtracted from patient service revenue to arrive at net patient service revenue. Line 2 is calculated by bad debt expense times cost to charge ratio. Line 3 is estimated at ten percent of bad debt cost. The cost of providing uncompensated care should be treated as community benefit because it costs the hospital that amount to provide care to patients unwilling or unable to pay for treatment. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 No shortfall reported. SchH_P05_S0B_L19 Schedule H, Part V, Section B, Line 19 Hospital provides individuals with no insurance with a self pay discount. SchH_P05_S0B_L21 Schedule H, Part V, Section B, Line 21 All patients are charged 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 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 found at www.skpcommunitiesproject.net. In addition, the hospital conducts its own satisfaction surveys with patients which asks for input on needed services, does monthly community outreach forums where we also solicit input, and take input from local physicians and providers. 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 with in 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 12,472 and covers 8317.66 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 north of South Peninsula Hiospital 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 a vast Service Area encompassing 8,317 square miles and 491 miles of built roads. 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 attacts over 100,000 visitors each year. According to Alaska Department of Labor the estimated population in 2007 of the SPHSA was 12,719. The primary and secondary Service Area combined, including Nanwalek (217), Port Graham (134) and Seldovia (429) is estimated at 13,499. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The governing body of South Peninsula Hospital is comprised of persons who reside in the hospital service area who are neither employees nor independent contractors, nor family members of the hospital. South Peninsula Hospital extends medical staff privileges to all qualified physicians in its community. South Peninsula Hospital is committed to applying surplus funds to improvements in patient care. X 1 1 X X X 0 0 0 1 0 0 0 0 0 Robert F Letson 141571 0 6000 0 0 0 8854 0 51650 0 208075 0 0 0 Robert A Barnes 129963 0 984 0 0 0 7857 0 45811 0 184615 0 0 0 Brent Adcox 270949 0 30000 0 0 0 18057 0 105332 0 424338 0 0 0 Larry R Tripp 147834 0 112178 0 0 0 15601 0 0 0 275613 0 0 0 Douglas Westphal 100342 0 9241 0 0 0 6575 0 38354 0 154512 0 0 0 Lisa Mangum 107347 0 1721 0 0 0 6544 0 38174 0 153786 0 0 0 Deanna Graham 104868 0 1000 0 0 0 6352 0 37054 0 149274 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 subcommittee 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 team are asked to do a confidential evaluation as well as having the CEO complete a self evaluation. The CEO's compensation is review 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 receives a bonus based on revenue generated from his services. Kenai Peninsula Borough 920030894 2003-09-30 10621278 Hospital Expansion 0 0 0 Kenai Peninsula Borough 920030894 2007-04-05 3086211 Hospital Expansion 0 0 0 Kenai Peninsula Borough 920030894 2007-08-28 14703525 Hospital Expansion 0 0 0 Kenai Peninsula Borough 920030894 2011-09-01 3285000 Retire oustanding debt 0 0 0 3365000 0 0 0 0 0 0 0 0 0 0 0 2007 0 0 1 1 0 0 1 1 1 0 0 0 1 1 0 0 3285000 0 0 0 32976 0 0 0 0 0 2011 1 0 1 1 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 F990_P03_S00_L02 Form 990, Part III, Line 2 South Peninsula Hospital opened its first provider based physician clinic during the 2011 tax year. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b Form 990 is prepared by the organization's controller with input from other members of the 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 of interest 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 for and make any necessary adjustments to the format and content of the questions 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. 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. 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 1 0 0 0 0 0 0 0 0 Kenai Peninsula Borough c 3631204