2011-01-28T13:21:12-07:00 2010-06-30 990 2009-07-01 920077523 CENTRAL PENINSULA GENERAL HOSPITAL INC CENT 9077144404 250 Hospital Place Soldotna AK 99669 Jason Paret 9077144719 2011-01-28 2009 2016-02-24 21:20:13Z Central Peninsula Hospital Ryan K Smith CEO 250 HOSPITAL PLACE SOLDOTNA AK 99669 143398895 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 8 792 210 3488 2488 2199558 1086302 127001320 139479810 690647 349551 4031202 2458737 133922727 143374400 111950 122672 0 0 47241232 52650261 0 0 124343 84236916 87918395 131590098 140691328 2332629 2683072 120675626 121468958 53867326 51977585 66808300 69491373 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. 0 0 127339478 127255382 Our 49 bed hospital provided patient and ancillary services for 2156 inpatients and 70916 outpatients during the 2009 tax year. Emergency medical services were provided to 16358 individuals and 1284 of those patients were admitted. The surgery department performed over 3042 surgical cases. The imaging department performed 33506 procedures. Over 32000 physical therapy procedures were performed. The hospital provides emergency medical services regardless of ability to pay. Over 4.8 million in charity care services were provided to patients during the 2009 tax year. 8694610 0 8769126 Skilled nursing and longterm care services were provided by our 60 bed skilled nursing facility, Heritage Place. Total admissions for the 2009 tax year were 59 while total resident days for the year were 18964. An average of 52 residents per day were provided care. Ancillary services for residents included 2777 physical therapy treatments. Heritage Place provides healing and compassionate residential care in a home like setting. 2652497 0 3153358 Our newest service line, Family and Specialty physician clinics, were added to the array of healthcare services provided by the Hospital during the tax year 2009. A community healthcare need exists for general and specialty practitioners that provide medical services to patients who are financially indigent. During the tax year the Hospital added five Family and Specialty physician clinics. During the tax year 11,535 patients were provided care at the various medical clinics. 0 0 0 138686585 1 1 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 1 121 0 1 792 1 1 1 0 0 0 0 11 8 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 1 1 1 1 0 X X X Central Peninsula General Hospital Finance Department 9077144404 250 Hospital Place Soldotna AK 99669 John Bramante 4 X 2350 0 0 Thomas Boedeker 8.00 X 16250 0 0 Sue Carter 4 X 3800 0 0 Loretta Flanders 4.00 X 2250 0 0 John Hoyt 4.00 X 2900 0 0 Russell Peterson 4.00 X 0 0 0 Richard Ross 4.00 X 2800 0 0 Judith Salo 4.00 X 3100 0 0 Alyson Stogsdill 6.00 X 3950 0 0 John Torgerson 4.00 X 2550 0 0 Loren Weimer 6 X 4200 0 0 Silverio Mattero 4.00 X 0 0 0 Trena Richardson 4 X 150 0 0 Johnny Dodd 40 X 0 0 0 Ryan Smith 40.00 X 340307 0 34444 Jason Paret 40 X 183044 0 34672 Andrea Posey 40.00 X 161730 0 34371 Sally Walker 40.00 X 126274 0 9226 Matthew Dammeyer 40.00 X 171290 0 34449 Peter Brennan 40.00 X 89698 0 29565 Gregg Motonaga 40 X 548239 0 39226 Charles Mickelson 28.00 X 411047 0 31087 Robert Ledda 28.00 X 377635 0 31087 Ned Magen 33.00 X 418879 0 31087 Angus Warren 35.00 X 395499 0 13707 3267942 0 322921 47 0 1 0 Molloy Schmidt LLC 110 South Willow St Suite 101 Kenai AK 99611 Attorney Services 348798 Davis Wright Tremaine LLC 1201 Third Ave Suite 2200 Seattle WA 981013045 Attorney Services 257626 Wash Doctor PO Box 3781 Soldotna AK 99669 Laundry Services 150927 Booth's Landscaping PO Box 2878 Soldotna AK 99669 Landscaping and grounds maintenance 117443 Alaska Surgical Services 6339 E Speedway Blvd Ste 201 Tucson AZ 85710 Specialized Surgical Services 112316 7 0 0 0 319940 736362 30000 74418 1086302 Hospital Service Revenue 622000 127255382 127255382 0 0 Nursing Home Revenue 623000 8769126 8769126 0 0 Physician Clinic Revenue 621110 3153358 3153358 0 0 301944 301944 0 0 139479810 342720 0 0 342720 712 0 0 712 0 0 0 0 4800 0 1312 0 3488 0 3488 0 3488 0 0 6119 0 0 0 6119 6119 6119 0 0 0 133952 23183 110769 110769 0 0 Property Tax Revenue 900099 2135217 2135217 0 0 USAC telephone service grant 900099 209263 209263 0 0 0 0 0 0 2344480 143374400 141941178 3488 343432 122672 122672 0 0 0 0 0 0 3560459 2327987 1108129 124343 0 0 0 0 35768110 35768110 0 0 1204967 1204967 0 0 9395133 9395133 0 0 2721592 2721592 0 0 0 0 0 0 688768 0 688768 0 51069 0 51069 0 32434 0 32434 0 0 0 0 0 0 0 2615236 2615236 0 0 200779 200779 0 0 13657483 13657483 0 0 1734717 1734717 0 0 0 0 0 0 2011525 2011525 0 0 304578 304578 0 0 0 0 0 0 292050 292050 0 0 1776297 1776297 0 0 0 0 0 0 8376945 8376945 0 0 812147 812147 0 0 Medicare patient deductions 22879662 22879662 0 0 Medicaid patient deductions 10444642 10444642 0 0 Charity care patient deductions 4875739 4875739 0 0 Commercial, government, other patient deductions 6994996 6994996 0 0 Bad debt expense 7064140 7064140 0 0 3105188 3105188 0 0 140691328 138686585 1880400 124343 0 0 25679283 23245962 337820 114102 13300497 14831114 0 0 0 0 0 0 2236763 2699469 379428 486090 113584493 45226987 72701706 68357506 0 500000 501471 0 5540129 11233244 120675626 121468958 11608226 11982197 0 291329 12642 41967771 39982746 0 0 0 0 53867326 51977585 X 66308300 68991373 500000 500000 0 0 66808300 69491373 120675626 121468958 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 6930 6930 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 The hospital engages in very little, if any lobbying on an ongoing basis. However, educational discussions and general support of the 2010 Healthcare Reform Act did occur during the tax year. Specifically the provision to extend the Medicare Demonstration Project for rural hospitals was of great importance to the continued mission of the Hospital in supporting community initiatives which would not otherwise be supported. X X 1 40 0 0 0 1 0 0 0 1 1412817 0 1412817 71997627 0 30908161 41089466 673731 0 110180 563551 37887712 0 13794052 24093660 1612606 0 414594 1198012 68357506 501471 F 501471 Plant replacement funds 10528599 Bond Proceeds 704645 11233244 143374400 140691328 2683072 0 0 0 0 -23315 -23315 2659757 143336283 0 0 0 0 0 143336283 0 38117 38117 143374400 140715820 0 0 0 24492 24492 140691328 0 0 0 140691328 SchD_P02_S00_L09 Schedule D, Part II, Line 9 In 2008 the Hospital purchased a building which resides on 40 acres of land which is subject to a 'perpetual covenant' for the benefit of all Alaska residents restricting the use of the land to agricultural purposes as defined in Alaska Statute 38.05.321. The building itself is used by the Hospital's chemical dependency department. There is no value placed upon the easement itself as either an asset or liability. However, the cost of the land and the cost of the building is recorded on the Hospital's balance sheet as its net book value. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 The Hospital's audited financial statements are consolidated with those of Central Peninsula Health Foundation, a related organization. This adjustment is the net loss for the tax year experienced by the Foundation, and must be subtracted in order to agree with the net income shown on the Hospital's audited financials. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Certain reclassifications of revenues and expenses are made for the 990 which remove items from expenses and or revenues and report them in a different manner than in the Hospital's audited financial statements. For example, rental revenues and expenses are shown in Part VIII of Form 990. Additionally, Inventory sales for Durable Medical Equipment are shown net of Cost of Goods sold in Part VIII of Form 990. SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Certain expenses are reclassified in the 990 under Part VIII Statement of Revenue, such as Rental expenses and Cost of goods sold for inventory. 1 1 1 X 1 X 1 1 1 0 1 1 1 6203 2929925 0 2929925 0.0334 1 10963 16374293 14744586 1629707 0.0186 1 282 95396 53594 41802 0.0005 3 17448 19399614 14798180 4601434 0.0525 642 29495 491125 100887 390238 0.0044 210 682 60271 17225 43046 0.015 9 12993 2004485 683977 1320508 0.015 0 0 0 0 0 0 136 2810 126660 0 126660 0.0014 997 45980 2682541 802089 1880452 0.0358 1000 63428 22082155 15600269 6481886 0.0883 21 7268 7268 0.0001 21 0 7268 0 7268 0.0001 0 4244976 3183732 17535925 23409968 -5874043 X 1 1 Central Peninsula Hospital

250 Hospital Place Soldotna AK 99669

X X X Heritage Place

232 Rockwell Ave Soldotna AK 99669

Skilled nursing facility, long term care Serenity House

47480 Kristina Way Soldotna AK 99669

Chemical dependency center Kenai Health Center

630 Barnacle Way Kenai AK 99611

Diagnostic imaging, lab, and sexual assault nursing services 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 Central Peninsula Family Practice Kobuk

431 S Kobuk Ave Suite B Soldotna AK 99669

Family practice clinic Central Peninsula Pediatrics

289 N Fireweed Unit C D Soldotna AK 99669

Pediatric clinic Central Peninsula Pain Management Clinic

289 N Fireweed Unit B Soldotna AK 99669

Pain management clinic Central Peninsula Neurology

198 West Corral St Soldotna AK 99669

Neurology clinic Serenity House Intake Office

245 N Binkley Street Suite 203 Soldotna AK 99669

Chemical dependency intake, counselling, behavioral health services The costing methodology for Line 7 a - d is based on a Cost-to-charge ratio using figures from the Medicare Cost Report for the same tax year. The Cost-to-charge ratio is slightly different from the cost report because it excludes nonpatient care activities and community building expenses. The costing methodology for Line 7 e - i is based on actual costs recorded per program or event. N/A. The amount of bad debt expense included in Form 990, Part IX, line 25 at gross charges is $7,064,140. The amount reported in Schedule H, Part III, line 2 (at cost) is $4,244,976 for a difference of $2,819,164. 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 assessed and further modified based upon the accounts receivable payor composition and aging, and historical write-off experience by payor category. It is the position of management that virtually all of the shortfall of medicare costs vs revenues be considered community benefit. The reason for this stance is that the organization 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. The costs reported on line 6 are the actual amounts reported on the Medicare Cost Report for the same year as this tax filing. 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 indigences. 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 the FPG which is the basis for a sliding scale between 200% and 400% of FPG. Applicants on the lower end of the scale (200%) are eligible for partial write-off, while those on the upper end (400%) are eligible for a full write-off. The Hospital engages an independent third party to prepare a Community Health Needs Assessment every three years (at a minimum). The most recently completed report was prepared by The Center for Health Policy, Planning and Research University of New England and is dated January 6, 2010. The resulting document, Central Kenai Peninsula Community Health Planning Report was reviewed by Management and the Board of Directors for strategic planning and development. The report is also available to the public on our website at http://www.cpgh.org/workfiles/CKP%20Health%20Assessment%202009%20-%20Final%20Report.pdf 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 has two financial counsellors who personally contact patients and explain the hospital's financial assistance policy, assist with the completion of the application, and set up payment plans if necessary. The area served by Central Peninsula Hospital is comprised of 13 Census Designated Places (CDPs) or towns with a total population of nearly 35,000 residents according to 2008 census estimates. The geographic region is in the Central Kenai Peninsula of the State of Alaska. Based on the 2000 census, approximately 7 percent of the population was age 65 or older, 25 percent were between ages 45 and 64, while 37 percent were between ages 18 and 44. Basic social and economic characteristics of the region indicate high unemployment and uninsured rates for the Central Kenai Peninsula. The hospital engages in numerous community coalition efforts to improve the health of the region served. The largest single community initiative activity performed during tax year 2009 was the planning and performance of community wide H1N1 vaccine distribution. Nursing managers, infection control nurses, and emergency personnel were highly active in both the planning stages of rolling out the H1N1 vaccine and also in the actual distribution of the vaccine. The Hospital has an operating board comprised of Community members which are elected by the Board. Surplus earnings at year-end are re-invested into the hospital and into the community. Nearly all new capital acquisitions are funded with Hospital operating cash. 1 Kenai Peninsula Youth Foundation dba Kenai River Brown Bears PO Box 2605 Soldotna AK 99669 262580744 501(c)3 7500 The Kenai Peninsula Youth Foundation is an organization dedicated to providing developmental programs for aspiring student athletes. The cash grant was made to the youth foundation-owned Kenai River Brown Bears to support a Breast Cancer Awareness sporting event. All proceeds from the event were donated to the Breast Cancer fund of the Central Peninsula Health Foundation, a related organization. Kenai Peninsula United Way 11355 Frontage Road Benco Building Suite 101 Kenai AK 99611 920111698 501(c)3 20000 To support the United Way on the Kenai Peninsula which provides support to the financially indigent, and to other local non-profits. Boys & Girls Club of the Kenai Peninsula 705 Frontage Road Suite B Kenai AK 99611 943067142 501(c)3 11000 To support the provision of safe after-school programs and healthy activities and events for peninsula children. Kenai River Sportfishing Assn Corp 224 Kenai Ave Ste 102 Soldotna AK 99669 920142688 501(c)3 6000 To support the annual Kenai River Women's Classic a KRSA fundraising event dedicated to ensuring the sustainability of the Kenai River through programs focused on habitat, fishing management, research and education. Kenai River Professional Guide Association PO Box 3674 Soldotna AK 99669 920162358 501(c)6 10000 To support the Wounded Warrior program held by the Kenai River Professional Guide Association. Kenai Watershed Forum PO Box 2937 Soldotna AK 99669 911829284 501(c)3 6500 To support the mission of the Kenai Watershed Forum to provide for the healthy watersheds on the Kenai Peninsula. Soldotna Chamber of Commerce 44790 Sterling Hwy Soldotna AK 99669 920061612 501(c)6 8680 Support of the Soldotna Chamber of Commerce including several fundraising initiatives, funding scholarships for area teens, community partnership programs, and Toys for Tots. 5 2 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 of 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 523303 0 26251 0 630 0 21720 0 19451 0 591355 0 0 0 Charles Mickelson 413290 0 20 0 32600 0 5220 0 28741 0 479871 0 0 0 Robert Ledda 379877 0 20 0 28612 0 5220 0 28741 0 442470 0 0 0 Ned Magen 420794 0 20 0 37044 0 5220 0 28741 0 491819 0 0 0 Angus Warren 396139 0 20 0 12168 0 5220 0 9430 0 422977 0 0 0 Ryan Smith 216026 0 52933 0 82494 0 11869 0 28741 0 392063 0 0 0 Jason Paret 137639 0 25232 0 50487 0 8805 0 28741 0 250904 0 0 0 Andrea Posey 124265 0 23186 0 21385 0 8504 0 28741 0 206081 0 0 0 Sally Walker 97647 0 11560 0 34494 0 2184 0 7825 0 153710 0 0 0 Matthew Dammeyer 129973 0 23731 0 47578 0 8582 0 28741 0 238605 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Gross up payments are made for certain 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. Among the fringe benefits offered to employees are health club discounts. The hospital pays for one-half of gym membership fees. 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 a hospital 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 health club memberships is also not a written policy. Although the hospital currently extends this benefit to its employees, it may not always choose to do so. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The Hospital contracts with an independent consultant to perform a review of CEO wages and benefits using comparable data. The resulting report is provided to the Board of Directors for review. The Board then sets the compensation for the CEO. The CEO has a written employment contract with the organization. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The hospital provides a 457 Top hat plan to certain key employees and management. The following individuals on Schedule J participated in the 457 plan and either deferred their own compensation or received hospital contribution into the plan during the tax year: Gregg Motonaga $12,255, Charles Mickelson $15,600, Robert Ledda $14,000, Ned Magen $15,507, Ryan Smith $14,786, Jason Paret $15,725, Andrea Posey $3,340, John Dodd $725, Sally Walker $1,154, and Matthew Dammeyer $15,535. SchJ_P01_S00_L05 Schedule J, Part I, Line 5 In accordance with their employment contract, Emergency Room Physicians receive a percentage of their physician fees billed. However, physician compensation is not based on the entity's overall performance or revenues. SchJ_P01_S00_L06 Schedule J, Part I, Line 6 The Hospital pays an annual incentive plan bonus to all employees, supervisors, and officers based on a series of 4 operational quality measures. One of these 4 measures is based on the hospital meeting its 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 measures, and 3)utilization. Kenai Peninsula Borough Central Peninsula Hospital Service Area 920030894 488530NF9 2003-12-18 47985000 To expand the hospital building 0 0 53952406 518266 0 0 544896 0 52889244 2008 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 Dr John Bramante Board and Medical Staff member and part owner of Peninsula Internal Medicine 74434 The Hospital paid for medical services provided by Peninsula Internal Medicine 0 John Hoyt Mr. Hoyt is a member of the Wells Fargo management team 0 Wells Fargo is the Hospital's primary financial institution holding cash and investments 0 X 1 59543 Cost X 1 2500 FMV X Oncology Garden 1 12375 Actual Cost 0 0 0 0 F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b Central Peninsula General Hospital Inc. manages the hospital through a Lease and Operating Agreement with the Kenai Peninsula Borough. CPGH Inc Board decisions regarding significant capital purchases and plant expansion are subject to approval by the Kenai Peninsula Borough Assembly. Bonds, loans, and capital expenditures not funded through the hospital plant replacement funds must go to the voters if greater than $1.0 million. F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 The Finance Department prepares the first draft of Form 990 and submits it to management for review. Management edits are made to the 990. The second draft of Form 990 and all schedules and statements is then printed and provided to each Board Member for review and comment. Final edits are made to the 990 prior to online submission by the CFO. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Directors, officers and trustees annually complete a conflict of interest questionnaire. If any conflicts of interest are identified on the questionnaire they are reviewed by the board of directors. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The Hospital contracts with an independent consultant to review the wages and benefits of the CEO and other Officers using comparative data. This report is submitted to the Board of Directors for review and is used for setting the wage scale for the CEO, CFO, CNO, and Assistant Administrator. Contemporaneous documentation exists for this process. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The Hospital publishes the most recent 990 on it's website. The 990 is also available on Guidestar.com. The Hospital stores its governing documents, conflict of interest policy, and financial statements in electronic format. It provides these documents, upon request, to interested parties via email, fax, or in hard copy. Central Peninsula Health Foundation 250 Hospital Place Soldotna AK 99669 202778670 To support quality healthcare activities on the Kenai Peninsula. AK 501(c)3 Public Charity N/A Kenai Peninsula Borough 144 N Binkley St Soldotna AK 99669 920030894 Central Peninsula Hospital operates the hospital through a lease and operating agreement with KPB. AK 115 N/A 0 0 1 0 0 0 0 1 0 1 0 1 1 1 0 1 0 0 Central Peninsula Health Foundation c 319940 Central Peninsula Health Foundation h 71918 Kenai Peninsula Borough j 1 Central Peninsula Health Foundation n 124343 Central Peninsula Health Foundation p 51242