2011-02-03T17:50:00-07:00 2010-06-30 990 2009-07-01 920037099 SOUTH PENINSULA HOSPITAL INC SOUT 9072358101 4300 Bartlett Street Homer AK 99603 Robert Letson 9072350324 2011-02-03 2009 2016-02-24 21:20:13Z Robert F Letson 4300 Bartlett St Homer AK 99603 34615095 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 9 385 40 0 0 4273270 4138538 30418452 30465640 17929 10917 0 0 34709651 34615095 0 0 0 0 18155834 18576453 0 0 0 13625590 14677734 31781424 33254187 2928227 1360908 62191900 60883752 28553400 25884343 33638500 34999409 South Peninsula Hospital promotes community health and wellness by providing personalized, high quality, locally coordinated healthcare. 0 0 21584209 0 23967192 Our 22 bed hospital provided inpatient services to 883 patients for total patient days of 3,106 for the 2009 tax year. Total outpatient visits for the year were 30,748 and include 4,410 emergency department visits, 958 ambulatory surgery visits and 8,028 imaging visits. Other outpatient services include laboratory, physical therapy, occupational therapy, infusion and chemotherapy, and sleep lab. 2942994 0 5723610 Our 28 bed Long Term Care facility serviced 35 residents during the 2009 tax year with an average daily census of 24 and total resident days of 8,726. 711547 0 658571 Our community health services department provides home health care, chore and respite services, and other home care services to more than 130 local residents. 5,168 vists were made to client homes in the 2009 tax year. 0 0 116267 Other program services include revenue from cafeteria and vendings machines, medical record copies, and other program related sources. 0 0 116267 25238750 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 87 0 1 385 1 0 0 0 0 0 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 5 X 0 0 0 Vickey Hodnik 3 X 0 0 0 Kent Haina 3 X 0 0 0 Julie Woodworth 3 X 0 0 0 Nina Allen 3 X 0 0 0 Walter Partridge 4 X 0 0 0 Bernadette Wilson 3 X 0 0 0 Matthew North 2.5 X 0 0 0 Matthew Hambrick 3.00 X 0 0 0 Robert F Letson 50 X 123402 0 49361 Lori I Meyer 45 X 87665 0 35066 Larry R Tripp 40 X 205919 0 0 Michael J Toner 40 X 118396 0 47358 Diane G Peterson 40 X 106946 0 42778 Susan M Shover 40 X 100530 0 40212 Christine K Anderson 40 X 100018 0 40007 842876 0 254782 6 0 1 0 Eris Radiology LLC PO Box 2434 Homer AK 99603 Radiologists 402017 Jeffrey Quam PO Box 1592 Homer AK 99603 Radiologist 406563 The Owens Group LLC 3705 Artic Blvd suite 2717 Anchorage AK 99503 Consulting 250057 Raymond Fowler 40914 Crested Crane St Homer AK 99603 Anesthesiologist 249209 James Peterson PO Box 58 Homer AK 99603 Anesthesiologist 209335 11 0 0 0 0 4114402 24136 0 4138538 Hospital 622000 23967192 23967192 0 0 Long Term Care 623000 5723610 5723610 0 0 Home Health Care 621610 658571 658571 0 0 116267 116267 0 0 30465640 9689 0 0 9689 0 0 0 0 0 0 0 0 0 0 0 1228 0 0 0 1228 1228 0 0 1228 0 0 34615095 30465640 0 10917 0 0 0 0 0 0 0 0 297604 0 297604 0 0 0 0 0 12968738 9471823 3496915 0 371667 222054 149613 0 3908485 3229873 678612 0 1029959 858412 171547 0 0 0 0 0 39710 0 39710 0 21031 0 21031 0 0 0 0 0 0 0 0 0 0 0 4179482 3159147 1020335 0 70921 70921 0 4224813 3770998 453815 0 257337 229695 27642 0 0 0 0 0 1161858 62356 1099502 0 83033 49208 33825 0 0 0 0 0 145523 109053 36470 0 640015 639984 31 0 0 0 0 0 2479633 2479633 0 0 349901 349901 0 0 Repairs & maintenance 891280 574701 316579 0 Dues, books & subscriptions 133197 31912 101285 0 33254187 25238750 8015437 0 1655 1655 15218511 8910714 0 0 6365463 6162779 0 0 0 0 0 0 1216146 1199624 712190 1235533 68439869 25066422 38677935 43373447 0 0 0 0 0 0 0 62191900 60883752 4790056 3302534 0 0 638018 394540 23125326 22187269 0 0 0 0 0 0 0 0 0 0 28553400 25884343 X 33613214 34974123 25286 25286 0 0 33638500 34999409 62191900 60883752 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 3600579 3600579 0 43466634 8910302 34556332 0 52702 5414 47288 0 20741990 16150706 4591284 0 577964 0 577964 43373447 0 0 34615095 33254187 1360908 0 0 0 0 0 0 1360908 34615095 0 0 0 0 0 34615095 0 0 0 34615095 33254187 0 0 0 0 0 33254187 0 0 0 33254187 1 1 1 X 1 X 1 1 1 0 1 1 780343 0 780343 0.023 9263787 8405257 858530 0.026 0 0 0 0 0 0 10044130 8405257 1638873 0.049 101143 1547 99596 0.003 107225 0 107225 0.003 434195 405418 28777 0.0001 0 0 0 0 98987 0 98987 0.003 0 0 741550 406965 334585 0.0091 0 0 10785680 8812222 1973458 0.0581 1 1317911 131791 9251361 9614149 -362788 X 0 South Peninsula Hospital

4300 Bartlett Street Homer AK 99603

X X X X ASHNHA Used worksheets provided in the instructions for Schedule H and cost to charge ratio. Subsidized health services do not include any costs attributable to a physician clinic. No bad debt expense is included in Form 990, Part IX, line 25. 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 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. None. South Peninsula Hospital serves 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 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 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 ask for input on needed services, does monthly community outreach forums where we also solicit input, and take input from local physicians and providers. 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 patients with Medicaid applications and/or the hospital's internal financial assistance (charity care) application. 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 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 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 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. The hospital leadership is from a community member board of directors, and an additional advisory board of elected members from the service area. Staff members serve on local community boards and committees, such as the recent H1N1 flu response team, the community emergency preparedness group, the Rotary, the Chamber of Commerce and more. We have a broad medical staff made up of physicians from the local and statewide healthcare community which is open to membership at different levels by application. Surplus foods and medical supplies are donated to local and international groups in needs. X 1 1 X X X 0 0 0 1 0 0 0 0 0 Robert F Letson 123402 0 0 0 0 0 4437 0 44924 0 172763 0 0 0 Lori I Meyer 87665 0 0 0 0 0 3364 0 31702 0 122731 0 0 0 Larry R Tripp 183178 0 22741 0 0 0 0 0 0 0 205919 0 0 0 Michael J Toner 118396 0 0 0 0 0 6572 0 40786 0 165754 0 0 0 Diane G Peterson 106946 0 0 0 0 0 1024 0 41754 0 149724 0 0 0 Susan M Shover 100530 0 0 0 0 0 0 0 40212 0 140742 0 0 0 Christine K Anderson 100018 0 0 0 0 0 1869 0 38138 0 140025 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_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 Kenai Peninsula Borough 920030894 2007-04-05 3086211 Hospital Expansion 0 0 Kenai Peninsula Borough 920030894 2007-08-28 14703525 Hospital Expansion 0 0 10552011 0 0 55012 14255 0 10552011 2007 0 0 1 1 3062070 0 0 0 24141 0 3062070 2007 0 1 1 1 14683525 0 0 0 20000 0 13580350 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_P04_S00_L12 Form 990, Part IV, Line 12 South Peninsula Hospital financial statements are audited on a separate basis, and consolidated with the Kenai Peninsula Borough's audited financial statements. South Peninsula Hospital is an enterprise fund of the Kenai Peninsula Borough. F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 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 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 questionairre annualy 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 borad of directors reveiwed Horty Springer website to verify salary range appropriate when searching for a new CEO. When the first annual review was completed, a committee comprised of board members reviewed various websites including Governance Institute as well as other hospital websites in the country to review existing evaluation tools and developed an evaluation that would accomodate South Peninsula Hospital's needs. 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 contect 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. 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 3819739