2012-03-01T12:30:29-07:00 2011-06-30 990 2010-07-01 920037099 SOUTH PENINSULA HOSPITAL INC SOUT 9072358101 4300 Bartlett Street Homer AK 99603 Robert Letson 9072350324 2011-11-15 2010 2016-02-24 21:20:13Z Robert F Letson 4300 Bartlett St Homer AK 99603 38207127 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 9 382 40 0 0 4138538 3826627 30465640 34374543 10917 -29364 0 0 34615095 38171806 0 0 0 0 18576453 22178537 0 0 0 14677734 16198707 33254187 38377244 1360908 -205438 60883752 59764131 25884343 24970160 34999409 34793971 South Peninsula Hospital promotes community health and wellness by providing personalized, high quality, locally coordinated healthcare. 0 0 23870004 0 27868901 Our 22 bed hospital provided inpatient services to 966 patients for total patient days of 3,302 for the 2010 tax year. Total outpatient visits for the year were 29,607 and include 4,495 emergency department visits, 960 ambulatory surgery visits, and 9,625 imaging visits. Other outpaient services included laboratory, physical therapy, occupational therapy, speech therapy, infusion and chemo therapy, and sleep lab. 4189411 0 5780547 Our 38 bed Long Term Care facility served 35 resident during the 2010 tax year with an average daily census of 25 and total resident days of 9,295. 926242 0 598452 Our community health services department provides home health care, chire and respite services, and other home care serrvices to more than 300 local residents. 4,532 visits were made to clinet homes in the 2010 tax year. 0 0 126637 Other program services include revenue from cafeteria and vendings machines, medical record copies, and other program related sources. 0 0 126637 28985657 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 95 0 1 382 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 Kelly Cooper 2.5 X 0 0 0 Vickey Hodnik 3 X 0 0 0 Kent Haina 3 X 0 0 0 Julie Woodworth 5 X 0 0 0 Nina Allen 1.5 X 0 0 0 Bernadette Wilson 4 X 0 0 0 Matthew North 2 X 0 0 0 Matthew Hambrick 3 X 0 0 0 Clyde Boyer 3 X 0 0 0 Walter Partridge 3.75 X 0 0 0 Robert F Letson 50 X 126958 0 52619 Robert A Barnes 45.00 X 38137 0 15806 Lori I Meyer 45 X 106794 0 44262 Larry R Tripp 40 X 280562 0 0 Diane G Peterson 40 X 126323 0 52356 Christine K Anderson 40 X 120981 0 50142 Douglas J Westphal 40 X 107337 0 44487 Michael J Toner 40 X 107134 0 44403 1014226 0 304075 8 0 1 0 Eris Radiology LLC PO Box 2434 Homer AK 99603 Radiologists 441182 Raymond Fowler 40914 Crested Crane St Homer AK 99603 Anesthesiologist 287886 Jeffrey Quam PO Box 1592 Homer AK 99603 Radiologist 264484 James Peterson PO Box 58 Homer AK 99603 Anesthesiologist 179884 The Owens Group LLC 3705 Artic Blvd suite 2717 Anchorage AK 99503 Consulting 145904 13 0 0 0 0 3821365 5262 0 3826627 Hospital 622000 27868907 27868907 0 0 Long Term Care 623000 5780547 5780547 0 0 Community Health Services 621610 598452 598452 0 0 126637 126637 0 0 34374543 5957 0 0 5957 0 0 0 0 0 0 0 0 0 0 0 0 0 35321 0 -35321 -35321 0 0 -35321 0 0 38171806 34374543 0 -29364 0 0 0 0 0 0 0 0 376951 0 376951 0 0 0 0 0 15330329 11530925 3799404 0 682553 513392 169161 0 4591154 3432626 1158528 0 1197550 898163 299387 0 116360 116360 0 0 302874 0 302874 0 22060 0 22060 0 0 0 0 0 0 0 0 0 0 0 4626978 3802882 824096 0 88716 0 88716 0 3743938 3300197 443741 0 496195 437385 58810 0 0 0 0 0 1389976 81253 1308723 0 112648 50733 61915 0 0 0 0 0 106457 60578 45879 0 940582 940010 572 0 0 0 0 0 2738347 2738347 0 0 387311 387311 0 0 Repairs & Maintenance 942139 658212 283927 0 Dues, Books & Subscriptions 184126 37283 146843 0 38377244 28985657 9391587 0 1655 1605 8910714 6052721 0 0 6162779 6774323 0 0 0 0 0 0 1199624 1160194 1235533 1111326 71959779 27295817 43373447 44663962 0 0 60883752 59764131 3302534 3104838 0 0 394540 370714 22187269 21237144 0 0 0 0 0 0 0 0 0 257464 25884343 24970160 X 34974123 34768685 25286 25286 0 0 34999409 34793971 60883752 59764131 -205438 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 188508 188508 0 47742303 9822989 37919314 0 58662 10459 48203 0 23342783 17462369 5880414 0 627523 0 627523 44663962 0 Note Payable to Kenai Peninsula Borough 257464 257464 38171806 38377244 -205438 0 0 0 0 0 0 -205438 38171806 0 0 0 0 0 38171806 0 0 0 38171806 38377244 0 0 0 0 0 38377244 0 0 0 38377244 1 1 1 X 1 X 1 1 0 0 623959 0 623959 0.016 10438694 9503258 935436 0.024 983443 521630 461813 0.011 0 0 12046096 10024888 2021208 0.051 96168 2241 93927 0.002 111311 0 111311 0.003 977547 598452 379095 0.01 0 0 0 0 105013 0 105013 0.003 0 0 1290039 600693 689346 0.018 0 0 13336135 10625581 2710554 0.069 0 1292944 129294 10734673 12415518 -1680845 X 0 1 1 South Peninsula Hospital Inc

4300 Bartlett Street 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 0 1 1 100 1 300 1 X X X 1 0 1 X 1 X X X X X X 1 X 0 1 2 South Peninsula Hospital Long Term Care

4300 Bartlett Street Homer AK 99603

Long Term Care skilled nursing facility. South Peninsula Hospital Community Health Services

4300 Bartlett Street 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 revenue. Line 2 is calculated by bad debt expense times cost to charge ratio. Line 3 is estimated at ten percent of bad debt at cost. The cost of providing uncompensated care should be treated as community benefit because it cost 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 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. Worksheet B in the schedule H instructions and cost to charge ratio was used to determine the amount reported on line 6. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 The assessment process and tolls were made widely available via the community health fair, city hall, survey monkey, community meetings, hospital website and more. The assessment report continues to be available on the hospital website, numerous partner websites, and at our community MAPP website www.mappofskp.net. SchH_P05_S0B_L07 Schedule H, Part V, Section B, Line 7 Some of the priority needs are currently being addressed by the hospital or by community work grorups through the community health improvement plan (CHIP). Additional needs will be addressed by community workgroups in the furture. Specific needs for the hospital are being addressed by the hospital. 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 (Mobilzing 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 communnity 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 year-long 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 communnity assess and health improvement plan. A copy of the assessment can be found at www.skpcommunitiesproject.net. In addition, the hospital conducts its own satifaction surveys with patients which ask 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 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 12,472 and covers 8317.66 square miles. South Peninsula Hospital is locatted 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 Hospital but as many as 80-90 miles for many of the resident 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 neighbohoods 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 attracts over 100,000 visitors each year. According to Alaska Department of Labor the estimated population in 2007, based on the 2000 U.S. Census, 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 126958 0 0 0 0 0 5370 0 47249 0 179577 0 0 0 Robert A Barnes 38137 0 0 0 0 0 1613 0 14193 0 53943 0 0 0 Lori I Meyer 106794 0 0 0 0 0 4517 0 39745 0 151056 0 0 0 Larry R Tripp 156784 0 123778 0 0 0 0 0 0 0 280562 0 0 0 Diane G Peterson 126323 0 0 0 0 0 5343 0 47013 0 178679 0 0 0 Christine K Anderson 120981 0 0 0 0 0 5118 0 45024 0 171123 0 0 0 Douglas J Westphal 107337 0 0 0 0 0 4540 0 39946 0 151823 0 0 0 Michael J Toner 107134 0 0 0 0 0 4532 0 39871 0 151537 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 $400 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 reviewed annually and any increases are a board decision based on performance. SchJ_P01_S00_L05 Schedule J, Part I, Line 5 The CRNA receives a bonus based on revenue generated for 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 0 0 10552011 0 0 0 14255 0 0 10552011 0 55012 2007 0 0 1 1 0 0 3062070 0 0 0 24141 0 0 3062070 0 0 2007 0 1 1 1 0 0 14683525 0 0 0 20000 0 0 13580350 0 0 2010 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 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 0 0 0 F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a Form 990 is prepared by the organization's controller with input from other members of the organization. The form 990 is reviewed by the Finance Committee of the board of directors. The fifnal for 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. Officer, 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 In 2007 the board of directors reviewed Horty Springer website to verify salary range appropriate when searching for a new CEO. 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 evaulation. 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 1 0 0 0 0 1 0 0 0 0 0 0 0 0 Kenai Peninsula Borough c 3708764 Kenai Peninsula Borough e 313831