2013-02-14T19:42:00-07:00 2012-06-30 990 2011-07-01 920077523 CENTRAL PENINSULA GENERAL HOSPITAL INC CENT 9077144404 250 Hospital Place Soldotna AK 99669 Shaun Keef 9077144722 2013-02-15 2011 2016-03-07 17:11:31Z Central Peninsula Hospital Richard Davis CEO 250 Hospital Place Soldotna AK 99669 199479298 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 9 867 246 1020 34894 1164424 1122562 160821053 196563665 280501 267126 671090 1305676 162937068 199259029 139192 179256 0 0 59648477 67350906 0 0 0 97675498 122895004 157463167 190425166 5473901 8833863 121920884 132450612 46955610 48651475 74965274 83799137 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 170708016 169281220 Our 49 bed hospital provided patient and ancillary services to 2,387 inpatients and 82,310 outpatients during the 2011 tax year. The hospital provides emergency medical services regardless of ability to pay. Emergency medical services were provided to 16,770 individuals, and 1,389 of those individuals were admitted to the hospital. 3,900 surgical procedures were performed in the hospital during the tax year. The imaging department performed 38,699 procedures. Over 57,000 physical therapy procedures were provided to area residents. During the 2011 tax year, free medical services in the amount of $7,050,090 were provided to patients eligible for charity care. 10651180 11456333 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 2011 tax year were 37 and total resident days of care were 20,449. An average of 56 residents per day were provided long term care and nursing. Ancillary services for residents included 10,971 physical therapy treatments, while outpatients received 3,431 therapy treatments. 6681218 13975958 The Hospital operates 9 family and specialty physician services clinics providing care in the following areas: Family medicine, Women's health, 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 2011 tax year, physician and specialty services were provided for 22,682 patient visits. Over 2,700 wound care procedures, 145 forensic exams, and 215 sleep studies were also performed. 0 0 0 188040414 1 1 0 1 0 0 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 1 0 1 116 0 1 867 1 1 1 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Central Peninsula Hospital Finance Department 9077144525 250 Hospital Place Soldotna AK 99669 Henry Krull 4 X 2125 0 0 Michael Navarre 4 X 2000 0 0 John Hoyt 4 X 3200 0 0 Silverio Mattero 4 X 3125 0 0 Russell Peterson 4 X 0 0 0 Richard Ross 4 X 3425 0 0 Judith Salo 4 X 3475 0 0 Alyson Stogsdill 6 X 3425 0 0 Trena Richardson 6 X 4375 0 0 John Torgerson 4 X 2075 0 0 Loren Wiemer 6 X 12575 0 0 Irving Carlisle 4 X 0 0 0 Henry Peter Sprague 4 X 0 0 0 Stephen Craig Humphreys 4 X 0 0 0 Ryan K Smith 40 X 420049 34506 0 Jason D Paret 40 X 162455 27955 0 Andrea D Posey 40 X 160859 36806 0 Johnny L Dodd 40 X 132713 24695 0 Matthew Dammeyer 40 X 153374 35083 0 Michael Haggerty 40 X 144895 17348 0 Richard Davis 40 X 109931 7480 0 Gregg Motonaga 40 X 571622 37796 0 Charles C Mickelson 28 X 517710 33543 0 David S Innes 40 X 1214672 33543 0 Cynthia Kahn 40 X 534712 14555 0 Ned Magen 33 X 465902 33543 0 4628694 336853 0 68 0 1 0 Molloy Schmidt LLC 110 South Willow St Suite 101 Kenai AK 99611 Attorney Services 435148 Sound Physicians 1123 Pacific Avenue Tacoma WA 98402 Physician Services 849555 C&A Industries Aureus PO Box 3037 Omaha NE 68103 Contract Labor Provider 304878 Wash Doctor PO Box 3781 Soldotna AK 99669 Laundry Services 162040 Curtis Buchholz 44455 Sterling Hwy Soldotna AK 99669 Pathology Services 105200 0 0 0 240848 860922 20792 792 1122562 Hospital Service Revenue 622000 169218220 169218220 0 0 Nursing Home Revenue 623000 11456333 11456333 0 0 Physician clinic revenue 621110 13975958 13975958 0 0 1913154 1913154 0 0 196563665 266277 0 0 266277 0 0 0 0 0 0 0 0 102091 0 101071 0 1020 0 1020 0 1020 0 0 849 0 0 0 849 849 849 0 0 0 364884 119198 245686 245686 0 0 Property tax revenue 900099 91686 91686 0 0 USAC Telephone Svc rev 900099 518300 518300 0 0 Medicaid EHR subsidy 900099 448984 448984 0 0 0 0 0 0 1058970 199259029 197869170 1020 266277 179256 179256 0 0 0 0 5052012 3531523 1520489 0 0 0 0 0 41310081 41310081 0 0 1428342 1428342 0 0 16463307 16463307 0 0 3097164 3097164 0 0 0 0 0 0 795891 0 795891 0 55316 0 55316 0 13056 0 13056 0 0 0 0 0 0 0 2713410 2713410 0 0 563745 563745 0 0 17725726 17725726 0 0 3366289 3366289 0 0 0 0 0 0 2350382 2350382 0 0 331129 331129 0 0 0 0 0 0 270281 270281 0 0 1103590 1103590 0 0 0 0 0 0 7977536 7977536 0 0 973887 973887 0 0 Medicare Deductions from revenue 34948132 34948132 0 0 Medicaid deductions from revenue 17842691 17842691 0 0 Charity care write-offs 7050090 7050090 0 0 Commercial, govmt, and other deductions from rev 13063444 13063444 0 0 11750409 11750409 0 0 190425166 188040414 2384752 0 0 0 21281704 27803487 200722 128492 15114899 19371223 0 322465 0 0 0 0 3133692 3539385 715429 1341753 113121143 48267250 67835573 64853893 0 0 500000 500000 0 0 0 0 13138865 14589914 121920884 132450612 8708436 12807111 0 0 12136 14194 38235038 35830170 0 46955610 48651475 X 74465274 83299137 500000 500000 0 0 74965274 83799137 121920884 132450612 8833863 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 3272 0 1 9785 13057 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 The Hospital engages in very little lobbying on an ongoing basis. However, educational discussions with lawmakers and general support of healthcare legislation do occur on occasion. Lobbying expenses for tax year 2011 consisted of one trip to the US Capitol, and one trip to the State Capitol to meet with legislators ($3,272). Other lobbying expenses consist of the % of dues paid to the American Hospital Association and the Alaska State Hospital and Nursing Home Association which were reportedly used for lobbying expenses ($9,785). X 1 40 0 0 0 1 0 0 0 0 1825517 0 1825517 70354228 0 31578316 38775912 625797 0 206955 418842 37735616 0 15832922 21902694 2579985 0 649057 1930928 64853893 Plant replacement fund 11421461 Longterm investment (Certificate of Deposit) 3034960 Bond issuance costs (refunding bonds) 133493 14589914 199259029 190425166 8833863 0 0 0 0 0 0 8833863 126354672 0 0 0 0 0 126354672 0 72904357 72904357 199259029 117520809 0 0 0 0 0 117520809 0 72904357 72904357 190425166 SchD_P02_S00_L09 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 AK residents, restricting the use of the land for agricultural purposes pursuant to AK statute 38.05.321. The building is used by the hospital's chemical dependency dept. There is no value placed on the easement itself and therefore it does not appear on the hospital financial statements or footnotes. However the cost of the real property is recorded as an asset on the balance sheet. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Amounts reported on line 1 are net of certain allowances and deductions for third party payors such as Medicare, Medicaid, VA, Charity Care, and Other insurance classes. SchD_P13_S00_L04b Schedule D, Part XIII, Line 4b Amounts reported on line 1 are not inclusive of certain allowances and deductions from revenue which are reported in Part IX line 25 expenses. These allowances and deductions represent amounts charged to payers which must be written off. They include Medicare, Medicaid, VA, Charity care, and other insurance classes. 1 1 X 1 X 1 X 1 1 1 0 0 1 6382 3640751 0 3640751 0.0339 1 22557 19572217 17966444 1605773 0.015 1 198 27002 15216 11786 0.0001 3 29137 23239970 17981660 5258310 0.0490 479 22393 657404 70267 587138 0.0055 100 764 99534 62944 36590 0.0003 9 9720 2563343 872205 1691138 0.0158 0 0 0 0 0 0 286 1908 184388 0 184388 0.0017 874 34785 3504669 1005416 2499254 0.0233 877 63922 26744639 18987076 7757564 0.0723 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 0 0 0 0 0 0 0 0 0 0 0 1 0 300 0 300 0 0 0 0 0 0 0 1 0 300 0 300 0 0 4696386 3626138 26096414 27440839 -1344425 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 X X X X X X X 0 1 1 200 1 400 1 X X X X X 1 1 X X X X 1 X 1 X X X X 1 X 0 0 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

198 West Corral Soldotna AK 99669

Neurology clinic Central Peninsula Family Practice Kenai

506 Lake Street Kenai AK 99611

Family practice clinic Kenai Physical Medicine

130 Willow Street Unit 1 Kenai AK 99611

Physical therapy clinic Soldotna Physical Medicine

35551 Kenai Spur Hwy 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 Practice Kobuk

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 Central Peninsula Family Practice Fireweed

245 N Binkley Street Suite 101 Soldotna AK 99669

Family practice 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 Vacant building

166 W Corral Street Soldotna AK 99669

Vacant building for remodel SchH_P01_S00_L07 Schedule H, Part I, Line 7 In activities where costs were reasonably able to be compiled, we used actual costs. For activities such as charity care, and the cost to provide such care, we used the cost to charge ratio as calculated by our most current medicare cost report figures. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f Total bad debt (at gross charges) reported were $9,094,261. However applying a cost to charge ratio of 51.7% we reduced bad debt to $4,696,386 to report the 'cost' to the organization for unpaid accounts. Of this balance approximately 73% is estimated to be attributable to patients who may be eligible for free or discounted care under the organizations charity care policy. SchH_P02_S00_L00 Schedule H, Part II The Hospital performs most of its community building activities through monetary support to local non-profits reported in another section of the Schedule H. SchH_P03_S0A_L04 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 financially 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 accounts receivable payor composition and aging, and historical write-off experience by payor category. The amount reported on line 1 is based on total gross charges written off to bad debt ($9,094,261) times the cost to charge ratio, to arrive at Cost of services written off to bad debt. The amount reported on line 2 is based on an estimated 73% of bad debts which may be attributable to patients that qualify for a discount or free care under our financial assistance policy. Because bad debts are primarily related to uninsured and underinsured patients to which services are provided despite the ability to pay, we believe that bad debts are also considered a community benefit. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The cost to charge ratio has been calculated based on current charges and costs reported on our 2012 Medicare Cost Report. The ratio is slightly lower than that reported due to the removal of community benefit expenses from the total 'costs' (for the purposes of the 990 Sch H). It is the position of management that virtually all of the shortfall of medicare costs vs reimbursement are considered a community benefit. The reason for this stance is that the hospital is required to write off contractual allowances for medicare patients regardless of the shortfall created to provide those services. The hospital may only collect the portion which is patient co-pay or deductible and may not engage in collection efforts for the remainder. SchH_P03_S0C_L09b 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 may request financial assistance based on either financial or medical indigence. The collection policy refers the collector first to the charity care policy for instruction on determining eligibility. As noted in Part I, the charity care policy is based on FPG which is 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. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 In addition to the above methods of disbursement, the Health Needs Assessment was also provided via email to Administrators, Hospital Board members, and supervisory staff of Central Peninsula Hospital. SchH_P05_S0B_L06 Schedule H, Part V, Section B, Line 6 Hospital management and the board of directors address the needs assessment findings through frequent strategic planning and the implementation of new services whenever financially viable. Additionally, the hospital supports the provision of health services by community health partners when it cannot supply those needs itself. SchH_P05_S0B_L07 Schedule H, Part V, Section B, Line 7 Four of the health findings require long-term planning to reach the intended goal, they are: 1. Smoking rates of Central Kenai Peninsula residents remain elevated (although a non-smoking hospital campus has been revived, and smoking cessation methods are provided to patients --community wide initiated have yet to be planned and implemented) 2. Cancer risks on the Central Kenai Peninsula are elevated, requiring the promotion of screening (The construction of a radiation oncology center is underway for patients in need of cancer treatment, however detection and prevention efforts require additional attention) 3. Mental Health Needs are an issue on the Central Kenai Peninsula due to elevated depression/anxiety (Continued program expansion and funding for women's and children's behavioral health needs have been achieved - however additional mental health providers are needed to meet the demand) 4. Barriers to oral health care due to cost exists for a large number of residents (The hospital has not yet developed a solution for reducing the cost of oral health care for area residents. Currently Peninsula Community Health services is meeting this need through the provision of dental care through means based programs) SchH_P05_S0B_L13 Schedule H, Part V, Section B, Line 13 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. SchH_P05_S0B_L17 Schedule H, Part V, Section B, Line 17 Our financial counselors make every effort to contact patients via phone and mail to communicate the various options for either payment arrangements or financial assistance prior to sending an account to collections. SchH_P05_S0B_L19 Schedule H, Part V, Section B, Line 19 The hospital offers all self pay patients a prompt pay discount of 25% on hospital charges. Additionally, those patients which are uninsured, underinsuraed, or medically indigent may qualify for either free care or discounted care. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 In addition to the Health Needs Assessment report, the Hospital also determines health needs of the community through a variety of ways. A patient advisory committee comprised of area residents and hospital representatives assists in determining the adequacy of facilities and services to meet health needs of the community. The Hospital periodically employs consultants to determine the physician and specialty physician needs of the community to direct physician recruiting and strategic planning. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The hospital attempts to provide a financial assistance program brochure to every patient during discharge. The brochure is also available on our website under Patient Financial Services. Additionally, the hospital's Financial counselors personally contact patients and explain the financial assistance policy, assist with the completion of the application, or set up payment plans if necessary. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The area served by the the hospital is comprised of 13 Census designated places or towns and has a total population of approximately 35,000 residents according to the 2008 census. The geographic region is in the Central Kenai Peninsula in the state of Alaska. Based on the 2000 Census, approximately 7 percent of the population is age 65 or older, 25 percent are between 45 and 64, and 37 percent are between ages 18 and 44. Basic social and economic characteristics of the region indicate high unemployment and uninsured rates, nearly 3 percent higher than the US average and 2 percent higher than the state average. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The hospital engages in numerous community efforts to improve the health of the region served. Monetary and personnel support of local non-profits, public service announcements, healthy choice advertising campaigns, child safety programs, low cost health fairs, physician speakers bureaus, community health newsletters, and many other programs and initiatives. 1 City of Soldotna 117 North Birch Soldotna AK 99669 920030328 RR 78-276, 1978 10000 0 Contribution toward community library expansion. Kenai Peninsula Borough North Peninsula Recreation Service Area PO Box 7116 Nikiski AK 99635 920030894 RR 78-276, 1978 15000 Contribution toward construction of Nikiski Community Playground. Southcentral Foundation 4501 Diplomacy Drivie Anchorage AK 99508 920086076 501(c)3 7500 Sponsorship for the All Alaska Pediatric Partnership. Kenai River Professional Guide association PO Box 3674 Soldotna AK 99669 920162358 501(c)3 10000 Sponsorship for the Wounded Warrior progam. Kenai Peninsula Food Bank 33955 Community College Dr Soldotna AK 99669 943112445 501(c)3 10500 The Food Bank provides low-cost or free food to families with financial need. This contribution supports the provision of nutritional help to area residents. Hospice of the Central Peninsula PO Box 2584 Soldotna AK 99669 920118694 501(c)3 28350 Funding for the Hospice Bereavement Program, and general contributions. Boys and Girls Club 705 Frontage Rd Suite B Kenai AK 99611 943067142 501(c)3 20550 Contribution to support the provision of safe after-school programs and healthy activities for Peninsula children. Kenai Peninsula Youth Foundation Kenai River Brown Bears PO Box 2605 Soldotna AK 99669 262580744 501(c)3 7500 2011/2012 Season sponsor. The Kenai Peninsula Youth Foundation is an organization dedicated to providing developmental programs for aspiring student athletes. This contribution was made to Kenai River Brown Bears to support their Breast Cancer Awareness sporting event. 36 16 SchI_P01_S00_L02 Schedule I, Part I, Line 2 The hospital does not provide 'grants' but cash contributions to local organizations which support community initiatives and healthy living on the Kenai Peninsula. The hospital provides funding to organizations in good community standing. Hospital officers are responsible for approving all assistance payments to organizations, and do so with discretion. X X 0 1 X X X X X 0 1 0 1 0 1 0 0 0 Gregg Motonaga 544633 0 27277 0 1837 0 21783 0 21251 0 616781 0 0 Charles C Mickelson 519559 0 60 0 1230 0 5283 0 31401 0 557533 0 0 David S Innes 773386 0 378957 0 65469 0 5283 0 31401 0 1254496 0 0 Ned Magen 466083 0 60 0 2899 0 5283 0 31401 0 505726 0 0 Ryan K Smith 213241 0 127477 0 82209 0 11722 0 28784 0 463433 0 0 Richard Davis 82434 0 22817 0 5388 0 1105 0 7084 0 118828 0 0 Jason D Paret 99467 0 13124 0 52218 0 7937 0 22373 0 195119 0 0 Michael Haggerty 113424 0 4502 0 27999 0 8076 0 10303 0 164304 0 0 Andrea D Posey 132511 0 12092 0 19396 0 8545 0 31401 0 203945 0 0 Johnny L Dodd 116758 0 4882 0 13197 0 5570 0 21251 0 161658 0 0 Cynthia Kahn 427523 0 61646 0 46573 0 5283 0 10303 0 551328 0 0 Matthew Dammeyer 108737 0 15575 0 32202 0 6822 0 31401 0 194737 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Gross up payments are made for certain taxable fringe benefits and for 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. The employee is responsible for federal income taxes. Also among the fringe benefits offered to employees are health club discounts. The hospital pays for one-half of gym membership fees to promote the health and welfare of its employees and their family members. SchJ_P01_S00_L01b 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 of the hospital and is not governed by written policy. The hospital maintains that at some future date, employees may be required to pay their own FICA taxes on fringe benefits. Similarly, payment of one-half of gym membership fees is not a written policy. Although the hospital currently extends this benefit to employees, it may not always do so. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The hospital contracts with an independent consultant to perform a review of executive wages and benefits using comparable studies. The resulting report is provided to the Board of Directors for review. The Board sets compensation levels for the CEO through a written employment contract with the organization. The CEO is responsible for hiring the remainder of the Hospital's executive staff. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The hospital provides a 457 Top Hat plan to certain key employees and executives. The following individuals 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 ($17,228), Ryan Smith ($3,846), Richard Davis ($3,181), Jason Paret ($1,017), Michael Haggerty ($3,226), Andrea Posey ($3,423), Johnny Dodd ($2,909), and Matthew Dammeyer ($1,588). SchJ_P01_S00_L05 Schedule J, Part I, Line 5 In accordance with their employment contract, Emergency Room Physicians receive a percentage of their professional physician fees billed. This compensation is not based on the entity's overall revenue. SchJ_P01_S00_L06 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 incentive plan bonus payment. The remaining measures are 1)patient satisfaction, 2)quality, and 3)utilitzation. Kenai Peninsula Borough 920030894 488530NF9 2003-12-18 47985000 Hospital expansion project 2003 GO bonds 0 0 0 Kenai Peninsula Borough 920030894 01179PX51 2011-09-15 27905000 Refunding bonds - 2011 GO 0 0 1 43635000 0 53963243 0 3376615 32472362 544896 0 0 53418347 0 0 2008 0 0 1 1 0 0 32616814 0 0 0 201610 0 0 0 0 0 2008 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 Charles Weimer Spouse of Board President 12000 Mr. Weimer Rents real estate at FMV to the hospital 0 Henry Krull Board member 125268 Mr. Krull is the majority shareholder in KRG Development which leases real estate at FMV to the hospital 0 S Craig Humphreys Board member 322465 Dr. Humphreys is currently repaying a physician guarantee loan arrangement to the hospital for practice start up expenses 0 F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b Central Peninsula General Hospital Inc. operates the Hospital through a lease and operating agreement (LOA) with the Kenai Peninsula Borough. CPGH Inc Board decisions regarding the acquisition of significant capital assets and plant expansion are subject to approval by the Borough Assembly. Bonds, loans, and capital expenditures not funded through the Hospital's plant replacement funds must be approved by a vote of Borough constituents if greater than $1.0 million. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The 990 is prepared by the Hospital Finance Department and submitted to management for review. Management then returns all edits to the Finance Committee for the 2nd draft. The 2nd Draft and all schedules and statements are then submitted to each Board Member for review and comment. Final edits are provided to the Finance Dept and made prior to electronic submission by the CFO or Board President. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Both senior leadership and members of the Board of Directors complete annual conflict of interest statements which are reviewed by the management and Finance teams. The board also reviews and discusses any conflicts of interest which arise throughout the year and appropriate action is taken. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 An independent professional Executive remuneration study was performed for 2012 by the HayGroup. Remuneration reports are submitted to the Board for review and used to set wage scales for the CEO, CFO, CNO, COO, and VP of Human Resources. Contemporaneous documentation exists for this study. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The Hospital publishes its 3 most recent 990s on its own website at www.cpgh.org. The 990 is also available at Guidestar.com. The Hospital provides its governing documents, conflict of interest policy, and audited financial statements in electronic format upon request. 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 1 0 1 1 1 0 1 1 0 Central Peninsula Health Foundation c 34706 Actual cash value of capital contributions received from Central Peninsula Health Foundation. Kenai Peninsula Borough j 1 Central Peninsula General Hospital Inc operates the Hospital through a lease and operating agreement with the Kenai Peninsula Borough. Ultimately the borough owns the hospital facility and all related assets under the agreement and leases them to CPGH Inc to operate on its behalf. The amount stated in the lease and operating agreement is $1 per annum. Central Peninsula Health Foundation m 15419 Central Peninsula Hospital provides office space to Central Peninsula Health Foundation. The value of that space is determined based on our most recently filed Medicare Cost Report (2011) expenses for facility, administration, support services allocated per square foot. Central Peninsula Health Foundation n 60463 Central Peninsula Hospital shares certain paid employees for the directorship, and accounting functions necessary to operate Central Peninsula Health Foundation. Central Peninsula Health Foundation p 48487 Actual expenses incurred by Central Peninsula Hospital are stated at the dollar value paid which is reimbursed at cost by Central Peninsula Health Foundation. Kenai Peninsula Borough q 7610126 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 Kenai Peninsula Borough. This is the total amount of cash transferred to that account during FY12. Extension was obtained because audited financial statements had not yet been issued as of the initial 990 reporting deadline.