2024-05-15T17:38:28-05:00 2023-06-30 464570451 Jay M Johnson LLC 25 Jefferson Way Suite 202 Ketchikan AK 99901 990 2022-07-01 926001607 Petersburg Medical Center PETE 9077724291 PO Box 589 Petersburg AK 99833 Philip Hofstetter CEO 9077724291 2024-05-15 1 Philip Hofstetter 999009999 0 Jay M Johnson CPA P01316146 9072209970 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Philip Hofstetter PO BOX 589 Petersburg AK 99833 24474594 0 X WWW.PMCAK.ORG X Component unit of Petersburg Borough 1993 AK Our mission is to provide excellent healthcare and to promote wellness in our community. 7 7 0 0 95012 0 2821496 2834036 16703912 20190193 0 95012 685701 1355353 20211109 24474594 0 0 0 0 15637250 13899131 0 0 0 7885635 8433719 23522885 22332850 -3311776 2141744 30819911 26311595 30281643 23559828 538268 2751767 X Our mission is to provide excellent healthcare and to promote wellness in our community. 0 0 2906445 3092576 Petersburg Medical Center is a Critical Access Hospital located in a rural, island community that serves a population of 3,000. Access is by air or water only. The hospital provides in-patient, skilled nursing care, emergency department, chemotherapy services and out-patient surgical procedures. Ancillary departments that support the in-patient and skilled patient needs include clinical laboratory, diagnostic imaging, physical therapy, speech therapy, occupational therapy, dietary and dietician services. 8994382 13493668 Joy Janssen Clinic is staffed with four physicians, a mid-level practitioner, mental health specialist, chiropractor, and audiologist. Services include wellness and chronic disease monitoring (diabetes, hypertension, cardiac, stroke), medication assisted treatment, chiropractor, audiology, telemedicine services with ENT, psychiatry and dietician consultation. Besides family planning, infertility, pediatric care, and annual wellness exams, the practitioners also provide follow up care coordinated with offsite specialists for cardiac, stroke, bariatric surgery, and cancer care. Diagnostic imaging provides CT, ultrasound, DEXA scans and mammography. Laboratory is a moderate and high complex CLIA certified laboratory offering PCR testing for infectious diseases, microbiology, and transfusion services in addition to the traditional diagnostic capabilities. 1996385 3603949 The Long Term Care facility is a CMS certified facility providing advanced level of care to residents. Therapy support is provided by Physical Therapy, Occupational Therapy, Speech. Activity staff provide enrichment opportunities to engage residents and their visiting family and friends. A wheelchair van is used to take residents to events such as plays, community celebrations, and picnics. Visitors from the community regularly share their art and musical talent with the residents. 13897212 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 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 X Phil Hofstetter 9077724291 PO Box 589 Petersburg AK 99833 Jerod Cook President 2.00 0.25 X X 0 0 0 Marlene Cushing Secretary 2.00 0.25 X X 0 0 0 Joseph Stratman Board Member 2.00 0.25 X 0 0 0 Cindi Lagoudakis Board Member 2.00 0.25 X 0 0 0 Kim Simbahon Board Member 2.00 0.25 X 0 0 0 Heather Conn Board Member 2.00 0.25 X 0 0 0 Jim Roberts Board Member 2.00 0.25 X 0 0 0 Philip Hofstetter CEO 40.00 X 214529 0 0 Jennifer Bryner CNO 40.00 X 161512 0 0 Cortney Hess Chief Medical Officer 40.00 X 308811 0 0 Cynthia Newman Chief Human Resources Officer 40.00 X 153725 0 0 Jennifer Hyer Physician 40.00 X 298345 0 0 Selina Burt Physician 40.00 X 296378 0 0 Kaitlin Duross Physical Therapist 40.00 X 132991 0 0 Mark Tuccillo Physician 40.00 X 219458 0 0 Nancy Higgins Asst Lab Manager 40.00 X 142608 0 0 Violet Shimek Lab Manager 40.00 X 146431 0 0 Eric Hulebak Physician 40.00 X 145719 0 0 Angela Menish Physician 40.00 X 141529 0 0 Kelly Zweifel Clinic Manager 40.00 X 137738 0 0 Jill Dormer Chief IT Officer 40.00 X 134938 0 0 Kirsten Rioux-Testoni Home Health Manager 40.00 X 134592 0 0 Traci Vinson RN 40.00 X 129693 0 0 Sonja Paul Imaging Manager 40.00 X 129153 0 0 Laura Holder RN 40.00 X 120983 0 0 Amy Hollis RN 40.00 X 120557 0 0 Elizabeth Hart RN 40.00 X 119200 0 0 Tami Stone Radiology 40.00 X 118835 0 0 Elise Kubo Pharmacy Manager 40.00 X 118687 0 0 Helen Boggs RN 40.00 X 117690 0 0 Mary Kravitz RN 40.00 X 117227 0 0 Patrick Sessa Psychology 40.00 X 115161 0 0 Andrew Simmonds Physical Therapist 40.00 X 113619 0 0 Amanda Galaktionoff Physical Therapist 40.00 X 111901 0 0 Mamie Nilsen RN 40.00 X 111406 0 0 Rozanne Plew RN 40.00 X 108658 0 0 Margaret Agner RN 40.00 X 108041 0 0 Matthew Pawuk IT Manager 40.00 X 107623 0 0 Mike Boggs Facilities Manager 40.00 X 103147 0 0 Sarah Gundy Speech Therapist 40.00 X 103103 0 0 Lena Odegaard RN 40.00 X 102889 0 0 Jolyn Duddles RN 40.00 X 100098 0 0 Carolyn Kvernvik RN 40.00 X 100069 0 0 Alice Hulebak Physician 40.00 X 255712 0 0 5402756 0 0 37 0 1 0 Wainebrandt LLC 1509 W 9th Ave 301 Anchorage AK 99501 Accounting Firm 215000 1 2834036 2834036 Patient Services 624100 20190193 20190193 20190193 95012 95012 Non-Operating Revenue 900099 1128005 1128005 Unrealized Gains 523000 227348 227348 1355353 24474594 21545546 95012 0 11769316 9147395 2621921 2129815 1655343 474472 83519 83519 396228 396228 4000 4000 2159284 887995 1271289 1359104 188262 1170842 228922 228922 1128578 1128578 178388 178388 Supplies 1680427 1552213 128214 Repairs & Maintenance 588638 255707 332931 Dues & Fees 374457 117465 256992 Equipment 173343 42497 130846 78831 50335 28496 22332850 13897212 8435638 0 1700244 422952 2987828 4434720 356624 304713 111147 113382 29243946 21153009 8165962 8090937 5960175 3704480 11537931 9240411 30819911 26311595 5143963 3483361 402639 147863 24735041 19928604 30281643 23559828 X -4631284 -2417785 0 0 5169552 5169552 538268 2751767 30819911 26311595 2141744 71755 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4000 Part I-A, Line 1: Lobby for federal and state grants to help us fund the construction of a new hospital. 347945 347945 10613487 10112338 501149 12193736 6735689 5458047 6088778 4304982 1783796 8090937 Def Outflow Employer Contrib 2554803 Net OPEB Asset 6685608 9240411 Capital Lease 2783403 Net Pension Liability 16521607 Deferred Inflow-Pension Invest 623594 19928604 Part XI, Line 2d - Other Adjustments: Petersburg Medical Center Foundation Revenue Part XII, Line 2d - Other Adjustments: Petersburg Medical Center Foundation Expenses 1 1 1 X 175.000000000000 1 X 500.000000000000 1 1 0 0 1 1045535 7899165 8497984 -598819 X 1 1 1 1 Petersburg Medical Center 103 Fram St PO Box 589 Petersburg AK 99833 https://www.pmcak.org GACH-006 X Nursing Home and Outpatient Clinic Petersburg Medical Center 0 0 1 X X X X X X X X X 22 1 0 1 1 X www.pmcak.org X 1 22 1 www.pmcak.org 0 1 X 175.000000000000 500.000000000000 X X 1 1 X X X 1 X www.pmcak.org X www.pmcak.org X www.pmcak.org X X X X X X 1 X 0 X X X 1 X 0 0 Petersburg Medical Center Part V, Section B, Line 5: The hospital partnered with other entities in the community with particular expertise in public health through regular consultation, educational opportunities and joint training. These entities consisted of The Alaska Public Health Nurse, Petersburg EMS, Southeast Alaska Regional Health Consortium (SEARHC), and Petersburg Mental Health Petersburg Medical Center Part V, Section B, Line 6b: Petersburg Indian Association (PIA)Working Against Violence for Everyone (W.A.V.E.)Petersburg Parks and RecreationPetersburg Public SchoolsPetersburg Ministerial AssociationPetersburg Volunteer Fire DepartmentPetersburg Cancer Support GroupMountainview Manor Assisted LivingSupporting Health Awareness and Resiliency Education (SHARE) Program and CoalitionBorough of Petersburg Petersburg Medical Center Part V, Section B, Line 11: Aging community: Education on falls to improve outcomes on fall incidents in the home. Grow our physical therapy department as well as provide physical and occupational therapy in an outpatient setting. Nursing shortage: Partner with the University of Alaska to provide RN training program in Petersburg. Adult obesity rates: Provide education on healthy eating to the public as well as employees with the use of staff dieticians. Partner with other agencies to promote physical activity. Petersburg Medical Center Part V, Section B, Line 13b: Family size is another eligibility criteria that is considered. Part III, Line 2: Valuation of uncollectible amounts is based upon management's review and estimation of individual accounts it judges likely not to be paid. Part III, Line 4: Note 1 - Summary of Significant Accounting Policies, Patient Accounts Receivable Page 7. Note 2 - Net Patient Service Revenue, Page 10 Part III, Line 9b: Petersburg Medical Center has financial assistance guidelines for guarantors with limited means to pay. Financial service representatives will specifically notify self pay guarantors of the existence of the financial assistance guidelines in any instance where the guarantor states or implies a limited means to pay account balances. Part VI, Line 2: The organization's board maintains an awareness of the health care needs of the community and attempts to provide for those needs while remaining financially viable. Part VI, Line 3: The orginization's staff informs any patient for whom they become aware of possible eligibility for financial assistance of the existence of such assistance. The same applies to possible federal and state assistance. Part VI, Line 4: The organization operates on an island off the Southeast coast of Alaska. The Island is accessed only by air or water. The core population is 3,000. The primary industry is fishing. A once thriving timber industry has now ceased to exist. Part VI, Line 5: The organization operates under the direction of a board of locally elected citizens. The board is not compensated. They serve because they want to have the best possible health services within the community, given limited resources. The hospital conducts regular health fairs and distributes relevant health information to the community to keep its residents informed of the services available. Surplus funds are used to continually upgrade hospital equipment and facilities. X X X 0 0 0 0 0 0 0 0 0 Cortney Hess Chief Medical Officer 308811 0 0 0 0 0 0 0 0 0 308811 0 0 0 Jennifer Hyer Physician 298345 0 0 0 0 0 0 0 0 0 298345 0 0 0 Selina Burt Physician 296378 0 0 0 0 0 0 0 0 0 296378 0 0 0 Alice Hulebak Physician 255712 0 0 0 0 0 0 0 0 0 255712 0 0 0 Mark Tuccillo Physician 219458 0 0 0 0 0 0 0 0 0 219458 0 0 0 Philip Hofstetter CEO 214529 0 0 0 0 0 0 0 0 0 214529 0 0 0 Jennifer Bryner CNO 161512 0 0 0 0 0 0 0 0 0 161512 0 0 0 Cynthia Newman Chief Human Resources Officer 153725 0 0 0 0 0 0 0 0 0 153725 0 0 0 Form 990, Part VI, Section B, line 11b The Chief Financial Officer and the Chief Executive Officer will each review the completed return separately and then resolve any issues which arise prior to filing the return. Form 990, Part VI, Section B, line 15 The Chief Executive Officer's Salary is determined by the Board of Directors after reviewing salaries for similar positions in comparable organizations of the healthcare industry. A salary history of the position is part of the review. The compensation review is made in conjunction with the CEO's annual evaluation. Form 990, Part VI, Section C, line 19 Petersburg Medical Center makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Petersburg Medical Center Foundation PO Box 589 Petersburg AK 99833 920134279 Carry out fundraising & charity activities for Petersburg Medical Center AK 501(c)(3) Line 3 Petersburg Medical Center 1 Petersburg Borough PO Box 329 Petersburg AK 99833 926000142 Local Gov AK Sec 115 N/A N/A 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0