KAUAI MEDICAL CLINIC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- KAUAI MEDICAL CLINIC (EIN 99-0326099)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-16
- IRS object ID
- 202301359349319365
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-16T00:30:32+00:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 346565596 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4365 EXECUTIVE DRIVE SUITE 1600 | AddressLine1Txt |
| City | SAN DIEGO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92121 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 990326099 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kaua'i Medical Clinic | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KAUA | BusinessNameControlTxt |
| Phone | 8082451500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 MERCHANT STREET 24TH FLOOR | AddressLine1Txt |
| City | HONOLULU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96813 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIE CHAHANOVICH | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8082451500 | PhoneNum |
| Signature | 2023-05-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CARRIE ANN | PersonFirstNm |
| Person Last | TSUTSUI | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOCELYNE C MILLER | PreparerPersonNm |
| PTIN | P00634378 | PTIN |
| Phone | 8585357200 | PhoneNum |
| Preparation | 2023-05-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JENNIE CHAHANOVICH | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 MERCHANT STREET 24TH FLOOR | AddressLine1Txt |
| City | HONOLULU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96813 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $66,538,192 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HAWAIIPACIFICHEALTH.ORG/WILCOX | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1967 | FormationYr |
| Legal Domicile State | HI | LegalDomicileStateCd |
| Activity Or Mission | KAUA'I MEDICAL CLINIC IS AN AFFILIATE OF HAWAI'I PACIFIC HEALTH. IT IS A FIVE-LOCATION, MULTI-SPECIALTY CLINIC WHOSE NOT-FOR-PROFIT MISSION IS TO CREATE A HEALTHIER HAWAI'I. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 200 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,846 | PYContributionsGrantsAmt |
| CY Contributions Grants | $799,409 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $63,106,352 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $65,736,860 | CYProgramServiceRevenueAmt |
| PY Investment Income | $822 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,923 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $63,113,020 | PYTotalRevenueAmt |
| CY Total Revenue | $66,538,192 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,783,170 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,681,348 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $52,479,850 | PYOtherExpensesAmt |
| CY Other Expenses | $56,006,844 | CYOtherExpensesAmt |
| PY Total Expenses | $63,263,020 | PYTotalExpensesAmt |
| CY Total Expenses | $66,688,192 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$150,000 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$150,000 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,849,919 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,829,432 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,717,672 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,846,150 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,132,247 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,983,282 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE KAUA'I MEDICAL CLINIC IS A NOT-FOR-PROFIT MULTI-SPECIALTY CLINIC WHOSE MISSION IS TO CREATE A HEALTHIER HAWAI'I. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $65,455,689 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $65,736,860 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $65,455,689 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | Yes (true) | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 200 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | HI | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEBRA TUQUERO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8085357284 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 MERCHANT STREET 24TH FLOOR | AddressLine1Txt |
| City | HONOLULU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96813 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (42 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Jay Murphy MD | |||||||||
| Board of Director, Vice Chair | 40.0 | 0.0 | Yes (X) | Yes (X) | $0 | $388,719 | $34,040 | ||
| Raymond P Vara Jr | |||||||||
| Board of Director, President | 2.0 | 60.1 | Yes (X) | Yes (X) | $0 | $2,290,034 | $2,498,142 | ||
| Robert Wotring II MD | |||||||||
| Board of Director, Chair | 40.0 | 0 | Yes (X) | Yes (X) | $0 | $304,197 | $18,884 | ||
| Denise Roberts | |||||||||
| Board of Director | 0.2 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Eugene Tareshawty | |||||||||
| Board of Director | 40.0 | 0.0 | Yes (X) | $0 | $248,662 | $23,390 | |||
| Helen Cox | |||||||||
| Board of Director | 0.2 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Mike Murakoshi | |||||||||
| Board of Director | 0.2 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Alan Ito | |||||||||
| Information Security Officer (part year) | 0.1 | 39.9 | Yes (X) | $0 | $201,298 | $32,431 | |||
| Arthur Gladstone | |||||||||
| EVP & CSO | 0.0 | 55.0 | Yes (X) | $0 | $906,835 | $317,125 | |||
| Brandon Wong | |||||||||
| VP | 0.0 | 47.0 | Yes (X) | $0 | $185,663 | $55,129 | |||
| Carrie Ann Tsutsui | |||||||||
| VP & SYSTEM CONTROLLER | 0.1 | 47.9 | Yes (X) | $0 | $278,287 | $78,811 | |||
| Charles R Ching | |||||||||
| EVP, General Counsel & Secretary | 0.5 | 39.5 | Yes (X) | $0 | $959,131 | $268,655 | |||
| David Okabe | |||||||||
| EVP, CFO & Treasurer | 1.0 | 49.0 | Yes (X) | $0 | $953,161 | $392,126 | |||
| David Stumbaugh | |||||||||
| VP | 1.5 | 38.5 | Yes (X) | $0 | $271,257 | $85,843 | |||
| Dawn Dunbar | |||||||||
| SVP | 0.0 | 45.0 | Yes (X) | $0 | $403,265 | $118,270 | |||
| Dean Tateyama | |||||||||
| VP | 1.0 | 39.0 | Yes (X) | $0 | $201,171 | $40,804 | |||
| Douglas Kwock MD | |||||||||
| VP | 1.0 | 39.0 | Yes (X) | $0 | $507,996 | $119,013 | |||
| Gerard Livaudais MD | |||||||||
| EVP (part year) | 0.1 | 49.9 | Yes (X) | $0 | $570,789 | $181,478 | |||
| James Lin MD | |||||||||
| VP | 0.1 | 47.5 | Yes (X) | $0 | $335,132 | $97,482 | |||
| Jennie Chahanovich | |||||||||
| CEO | 10.0 | 46.5 | Yes (X) | $0 | $681,179 | $231,860 | |||
| Jessica Lewis | |||||||||
| Assistant Corporate Secretary | 2.5 | 37.5 | Yes (X) | $0 | $168,040 | $40,849 | |||
| John McNamara | |||||||||
| SVP & CMO | 2.0 | 38.0 | Yes (X) | $0 | $47,283 | $1,584 | |||
| Katie Shigemitsu | |||||||||
| Compliance Officer | 0.5 | 39.5 | Yes (X) | $0 | $223,318 | $32,225 | |||
| Leslie Chun MD | |||||||||
| EVP | 1.0 | 59.0 | Yes (X) | $0 | $785,845 | $225,311 | |||
| Lorrie-Ann Luke | |||||||||
| VP | 0.5 | 41.0 | Yes (X) | $0 | $270,752 | $88,451 | |||
| Louise Fukumoto | |||||||||
| VP | 0.0 | 40.0 | Yes (X) | $0 | $199,148 | $35,921 | |||
| Melinda Ashton MD | |||||||||
| EVP & CHIEF QUALITY OFFICER | 0.1 | 49.2 | Yes (X) | $0 | $788,781 | $260,505 | |||
| Michael Robinson | |||||||||
| VP | 0.2 | 49.8 | Yes (X) | $0 | $337,891 | $85,823 | |||
| Peter Lewis | |||||||||
| VP & Chief Information Security Officer | 0.1 | 39.9 | Yes (X) | $0 | $135,377 | $330 | |||
| Reina (France) Graves | |||||||||
| Privacy Officer | 1.5 | 38.5 | Yes (X) | $0 | $250,059 | $34,768 | |||
| Shilpa Patel MD | |||||||||
| Associate CQO | 0.8 | 39.2 | Yes (X) | $0 | $316,795 | $45,382 | |||
| Steven Robertson | |||||||||
| EVP & CIO | 0.0 | 53.0 | Yes (X) | $0 | $787,444 | $299,769 | |||
| Sunshine Topping | |||||||||
| SVP | 0.5 | 49.5 | Yes (X) | $0 | $379,753 | $113,698 | |||
| Susan Masumoto-Nonaka | |||||||||
| VP (part year) | 0.5 | 39.5 | Yes (X) | $0 | $522,308 | $82,373 | |||
| Troy Branstetter | |||||||||
| VP | 1.0 | 57.0 | Yes (X) | $0 | $230,736 | $37,114 | |||
| Warren Chaiko | |||||||||
| SVP | 1.0 | 39.0 | Yes (X) | $0 | $767,486 | $120,610 | |||
| William Burke | |||||||||
| VP | 0.0 | 54.0 | Yes (X) | $0 | $302,321 | $88,324 | |||
| Amber Elkington | |||||||||
| MANAGER | 40.0 | 0 | $123,192 | $0 | $32,370 | Yes (X) | |||
| Brandt Farias | |||||||||
| Former Officer | 0.1 | 62.9 | $0 | $204,094 | $80,106 | Yes (X) | |||
| Gail Lerch | |||||||||
| Former Officer | 0.5 | 50.5 | $0 | $486,260 | $98,582 | Yes (X) | |||
| Geri Young MD | |||||||||
| Former Officer | 20.0 | 5.3 | $0 | $467,081 | $22,025 | Yes (X) | |||
| Kenneth B Robbins MD | |||||||||
| Former Officer | 6.5 | 48.5 | $0 | $236,663 | $100,651 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $123,192 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $17,594,211 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $6,520,254 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| SHIOI CONSTRUCTION INC | ||||||
| 4011 HALAU ST | LIHUE | HI | 96766 | CONSTRUCTION SERVICES | $209,753 | |
| CLINICAL LABORATORIES OF HAWAI'I LLP | ||||||
| PO BOX 1300 | HONOLULU | HI | 968071300 | MEDICAL SERVICES | $176,760 | MAILCODE NUMBER 60300 |
| NRC HEALTH | ||||||
| 1245 Q ST | LINCOLN | NE | 68508 | PATIENT RELATIONS | $101,097 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $799,409 | GovernmentGrantsAmt |
| Total Contributions | $799,409 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 622110 | $36,822,867 | $36,822,867 |
| PREMIUM REVENUE | 622110 | $9,876,067 | $9,876,067 |
| INTER-ENTITY SERVICE REVENUE | 622110 | $17,364,114 | $17,364,114 |
| OTHER HEALTH CARE REVENUE | 622110 | $1,479,467 | $1,479,467 |
| RENTAL INCOME | 900099 | $150,888 | $150,888 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,457 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $43,457 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $65,736,860 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,923 | TotalRevenueColumnAmt |
| Exclusion | $1,923 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $66,538,192 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $65,736,860 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,923 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,051,667 | TotalAmt |
| Program Services | $7,554,394 | ProgramServicesAmt |
| Management And General | $497,273 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $505,542 | TotalAmt |
| Program Services | $485,658 | ProgramServicesAmt |
| Management And General | $19,884 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,527,595 | TotalAmt |
| Program Services | $1,227,725 | ProgramServicesAmt |
| Management And General | $299,870 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $596,544 | TotalAmt |
| Program Services | $560,139 | ProgramServicesAmt |
| Management And General | $36,405 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,112 | TotalAmt |
| Management And General | $33,112 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $686,845 | TotalAmt |
| Program Services | $551,722 | ProgramServicesAmt |
| Management And General | $135,123 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $217,622 | TotalAmt |
| Program Services | $170,893 | ProgramServicesAmt |
| Management And General | $46,729 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,745 | TotalAmt |
| Program Services | $91,607 | ProgramServicesAmt |
| Management And General | $138 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,284,307 | TotalAmt |
| Program Services | $1,190,411 | ProgramServicesAmt |
| Management And General | $93,896 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,768 | TotalAmt |
| Program Services | $4,617 | ProgramServicesAmt |
| Management And General | $1,151 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,350 | TotalAmt |
| Program Services | $14,350 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,014,202 | TotalAmt |
| Program Services | $1,014,202 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,252 | TotalAmt |
| Management And General | $42,252 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| INTER ENTITY PURCHASED SVCS. | $49,359,535 | $49,359,535 | |
| MEDICAL SUPPLIES | $3,197,061 | $3,192,695 | $4,366 |
| MEMBERSHIP DUES | $1,765 | $1,765 | |
| GENERAL EXCISE TAX | $7,666 | $1,951 | $5,715 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,614 | TotalAmt |
| Program Services | $34,025 | ProgramServicesAmt |
| Management And General | $16,589 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,688,192 | TotalAmt |
| Program Services | $65,455,689 | ProgramServicesAmt |
| Management And General | $1,232,503 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,147,897 | BOYAmt |
| EOY | $1,225,967 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,327,913 | BOYAmt |
| EOY | $2,882,134 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,969,833 | BOYAmt |
| EOY | $3,076,915 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,688 | BOYAmt |
| EOY | $57,567 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,217,725 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,050,677 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,270,065 | BOYAmt |
| EOY | $10,167,048 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,068,523 | BOYAmt |
| EOY | $6,419,801 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,849,919 | BOYAmt |
| EOY | $23,829,432 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,761,363 | BOYAmt |
| EOY | $1,869,506 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,956,309 | BOYAmt |
| EOY | $9,976,644 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,717,672 | BOYAmt |
| EOY | $11,846,150 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,132,247 | BOYAmt |
| EOY | $11,983,282 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,132,247 | BOYAmt |
| EOY | $11,983,282 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,849,919 | BOYAmt |
| EOY | $23,829,432 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$150,000 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $0 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $0 | DonatedServicesAndUseFcltsAmt |
| Investment Expense | $0 | InvestmentExpenseAmt |
| Prior Period Adjustments | $0 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $1,035 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Art Public Exhibition Amounts ArtPublicExhibitionAmountsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Included | $45,768 | AssetsIncludedAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Collection Used Pub Exhibition | Yes (X) | CollectionUsedPubExhibitionInd |
| Solicited Assets Sale | false | SolicitedAssetsSaleInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $634,097 | OtherCostOrOtherBasisAmt |
| Book Value | $634,097 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,641,750 | OtherCostOrOtherBasisAmt |
| Depreciation | $601,471 | DepreciationAmt |
| Book Value | $2,040,279 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,945,100 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,993,139 | DepreciationAmt |
| Book Value | $4,951,961 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,427,638 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,449,851 | DepreciationAmt |
| Book Value | $1,977,787 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $569,140 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,216 | DepreciationAmt |
| Book Value | $562,924 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,167,048 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (9 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OPERATING LEASE | $5,913,869 |
| DUE FROM GOVERNMENT AGENCIES | $132,209 |
| OTHER RECEIVABLES | $158,239 |
| DUE FROM PROVIDERS INSR. CORP. | $110,905 |
| DEPOSITS AND OTHER NON-CURRENT | $51,130 |
| DECORATIVE ARTWORK | $45,768 |
| DUE FROM HPH RSRCH. INSTITUTE | $7,681 |
| DUE FROM HPH RSRCH. INSTITUTE | |
| DUE FROM PALI MOMI MED. CENTER |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,419,801 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (15 entries)
| DescDesc | AmtAmt |
|---|---|
| LT OPERATING LEASE LIABILITY | $6,065,658 |
| ST OPERATING LEASE LIABILITY | $597,559 |
| ESCHEAT LIABILITY | $9,595 |
| DUE TO HPH MEDICAL GROUP | $2,507,216 |
| DUE TO HAWAI'I PACIFIC HEALTH | $590,956 |
| DUE TO WILCOX MEMORIAL HOSPITAL | $91,683 |
| DUE TO STRAUB CLINIC & HOSPITAL | $84,640 |
| DUE TO KAPI'OLANI MEDICAL CENTER WOMEN AND CHILDREN | $7,883 |
| DUE TO KAPI'OLANI MEDICAL SPECIALISTS | $388 |
| DUE TO KAPI'OLANI HEALTH FOUNDATION | $8,909 |
| DUE TO PALI MOMI FOUNDATION | $9 |
| DUE TO STRAUB FOUNDATION | $188 |
| DUE TO PALI MOMI MEDICAL CENTER | $11,960 |
| DEFERRED PAYROLL TAX | |
| DUE TO CMS (COVID PAYMENT) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,976,644 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part III, Line 4 Collections of art - description of collections | KAUA'I MEDICAL CLINIC'S (KMC) COLLECTION OF ARTWORK INCLUDES PAINTINGS AND SIMILAR WORKS THAT ARE DISPLAYED IN PUBLIC WAITING/HALLWAY AREAS TO IMPROVE PATIENT EXPERIENCE IN KMC'S FACILITIES. |
| Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | THE COMPANY HAS NOT RECORDED ANY EXPENSE OR ACCRUED FOR ANY RELATED EXPENSE FOR ANY UNCERTAIN TAX POSITIONS. THE COMPANY'S 2017 THROUGH 2020 TAX YEARS REMAIN SUBJECT TO EXAMINATION FOR FEDERAL INCOME TAX PURPOSES, WHEREAS THE 2016 THROUGH 2020 TAX YEARS REMAIN SUBJECT TO EXAMINATION FOR STATE TAXING JURISDICTIONS IN WHICH THE COMPANY OPERATES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (37 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jay Murphy MD | ||||||||||||||
| Board of Director, Vice Chair | $0 | $359,622 | $0 | $4,818 | $0 | $24,279 | $0 | $11,600 | $0 | $22,440 | $0 | $422,759 | $0 | $0 |
| Raymond P Vara Jr | ||||||||||||||
| Board of Director, President | $0 | $1,088,746 | $0 | $579,773 | $0 | $621,515 | $0 | $2,470,732 | $0 | $27,410 | $0 | $4,788,176 | $0 | $615,303 |
| Robert Wotring II MD | ||||||||||||||
| Board of Director, Chair | $0 | $262,322 | $0 | $4,613 | $0 | $37,262 | $0 | $11,600 | $0 | $7,284 | $0 | $323,081 | $0 | $0 |
| Eugene Tareshawty | ||||||||||||||
| Board of Director | $0 | $234,866 | $0 | $2,682 | $0 | $11,114 | $0 | $9,604 | $0 | $13,786 | $0 | $272,052 | $0 | $0 |
| Brandt Farias | ||||||||||||||
| Former Officer | $0 | $121,482 | $0 | $61,243 | $0 | $21,369 | $0 | $74,371 | $0 | $5,735 | $0 | $284,200 | $0 | $49,137 |
| Gail Lerch | ||||||||||||||
| Former Officer | $0 | $433,599 | $0 | $0 | $0 | $52,661 | $0 | $91,102 | $0 | $7,480 | $0 | $584,842 | $0 | $176,018 |
| Kenneth B Robbins MD | ||||||||||||||
| Former Officer | $0 | $236,663 | $0 | $0 | $0 | $0 | $0 | $86,322 | $0 | $14,329 | $0 | $337,314 | $0 | $78,909 |
| Geri Young MD | ||||||||||||||
| Former Officer | $0 | $165,538 | $0 | $27,657 | $0 | $273,886 | $0 | $8,653 | $0 | $13,372 | $0 | $489,106 | $0 | $0 |
| Melinda Ashton MD | ||||||||||||||
| EVP & CHIEF QUALITY OFFICER | $0 | $455,308 | $0 | $194,229 | $0 | $139,244 | $0 | $244,499 | $0 | $16,006 | $0 | $1,049,286 | $0 | $168,964 |
| Troy Branstetter | ||||||||||||||
| VP | $0 | $188,888 | $0 | $13,431 | $0 | $28,417 | $0 | $29,634 | $0 | $7,480 | $0 | $267,850 | $0 | $0 |
| William Burke | ||||||||||||||
| VP | $0 | $231,178 | $0 | $44,764 | $0 | $26,379 | $0 | $71,139 | $0 | $17,185 | $0 | $390,645 | $0 | $16,974 |
| Jennie Chahanovich | ||||||||||||||
| CEO | $0 | $372,818 | $0 | $148,018 | $0 | $160,343 | $0 | $218,488 | $0 | $13,372 | $0 | $913,039 | $0 | $143,838 |
| Warren Chaiko | ||||||||||||||
| SVP | $0 | $259,893 | $0 | $67,444 | $0 | $440,149 | $0 | $92,906 | $0 | $27,704 | $0 | $888,096 | $0 | $54,113 |
| Charles R Ching | ||||||||||||||
| EVP, General Counsel & Secretary | $0 | $431,400 | $0 | $135,036 | $0 | $392,695 | $0 | $252,886 | $0 | $15,769 | $0 | $1,227,786 | $0 | $185,998 |
| Leslie Chun MD | ||||||||||||||
| EVP | $0 | $519,567 | $0 | $180,626 | $0 | $85,652 | $0 | $200,623 | $0 | $24,688 | $0 | $1,011,156 | $0 | $86,619 |
| Dawn Dunbar | ||||||||||||||
| SVP | $0 | $290,624 | $0 | $74,468 | $0 | $38,173 | $0 | $93,610 | $0 | $24,660 | $0 | $521,535 | $0 | $59,749 |
| Louise Fukumoto | ||||||||||||||
| VP | $0 | $176,638 | $0 | $17,733 | $0 | $4,777 | $0 | $20,815 | $0 | $15,106 | $0 | $235,069 | $0 | $0 |
| Arthur Gladstone | ||||||||||||||
| EVP & CSO | $0 | $503,226 | $0 | $189,772 | $0 | $213,837 | $0 | $292,071 | $0 | $25,054 | $0 | $1,223,960 | $0 | $199,456 |
| Reina (France) Graves | ||||||||||||||
| Privacy Officer | $0 | $248,960 | $0 | $0 | $0 | $1,099 | $0 | $12,228 | $0 | $22,540 | $0 | $284,827 | $0 | $0 |
| Alan Ito | ||||||||||||||
| Information Security Officer (part year) | $0 | $144,850 | $0 | $18,144 | $0 | $38,304 | $0 | $17,782 | $0 | $14,649 | $0 | $233,729 | $0 | $0 |
| Douglas Kwock MD | ||||||||||||||
| VP | $0 | $392,692 | $0 | $75,632 | $0 | $39,672 | $0 | $94,688 | $0 | $24,325 | $0 | $627,009 | $0 | $49,637 |
| Jessica Lewis | ||||||||||||||
| Assistant Corporate Secretary | $0 | $167,315 | $0 | $0 | $0 | $725 | $0 | $14,873 | $0 | $25,976 | $0 | $208,889 | $0 | $0 |
| James Lin MD | ||||||||||||||
| VP | $0 | $256,939 | $0 | $52,655 | $0 | $25,538 | $0 | $73,078 | $0 | $24,404 | $0 | $432,614 | $0 | $19,200 |
| Gerard Livaudais MD | ||||||||||||||
| EVP (part year) | $0 | $374,236 | $0 | $126,878 | $0 | $69,675 | $0 | $172,318 | $0 | $9,160 | $0 | $752,267 | $0 | $81,450 |
| Lorrie-Ann Luke | ||||||||||||||
| VP | $0 | $207,351 | $0 | $39,718 | $0 | $23,683 | $0 | $63,397 | $0 | $25,054 | $0 | $359,203 | $0 | $31,859 |
| Susan Masumoto-Nonaka | ||||||||||||||
| VP (part year) | $0 | $207,594 | $0 | $51,419 | $0 | $263,295 | $0 | $74,942 | $0 | $7,431 | $0 | $604,681 | $0 | $41,245 |
| David Okabe | ||||||||||||||
| EVP, CFO & Treasurer | $0 | $546,669 | $0 | $170,726 | $0 | $235,766 | $0 | $376,357 | $0 | $15,769 | $0 | $1,345,287 | $0 | $226,880 |
| Shilpa Patel MD | ||||||||||||||
| Associate CQO | $0 | $150,284 | $0 | $991 | $0 | $165,520 | $0 | $22,942 | $0 | $22,440 | $0 | $362,177 | $0 | $0 |
| Steven Robertson | ||||||||||||||
| EVP & CIO | $0 | $444,593 | $0 | $169,121 | $0 | $173,730 | $0 | $284,000 | $0 | $15,769 | $0 | $1,087,213 | $0 | $177,390 |
| Michael Robinson | ||||||||||||||
| VP | $0 | $260,167 | $0 | $49,180 | $0 | $28,544 | $0 | $75,992 | $0 | $9,831 | $0 | $423,714 | $0 | $39,448 |
| Katie Shigemitsu | ||||||||||||||
| Compliance Officer | $0 | $183,738 | $0 | $0 | $0 | $39,580 | $0 | $23,057 | $0 | $9,168 | $0 | $255,543 | $0 | $0 |
| David Stumbaugh | ||||||||||||||
| VP | $0 | $212,851 | $0 | $40,836 | $0 | $17,570 | $0 | $62,403 | $0 | $23,440 | $0 | $357,100 | $0 | $32,756 |
| Dean Tateyama | ||||||||||||||
| VP | $0 | $181,497 | $0 | $18,285 | $0 | $1,389 | $0 | $21,464 | $0 | $19,340 | $0 | $241,975 | $0 | $0 |
| Sunshine Topping | ||||||||||||||
| SVP | $0 | $280,785 | $0 | $68,850 | $0 | $30,118 | $0 | $89,038 | $0 | $24,660 | $0 | $493,451 | $0 | $0 |
| Carrie Ann Tsutsui | ||||||||||||||
| VP & SYSTEM CONTROLLER | $0 | $214,570 | $0 | $41,321 | $0 | $22,396 | $0 | $65,763 | $0 | $13,048 | $0 | $357,098 | $0 | $18,347 |
| Brandon Wong | ||||||||||||||
| VP | $0 | $169,022 | $0 | $15,905 | $0 | $736 | $0 | $32,689 | $0 | $22,440 | $0 | $240,792 | $0 | $0 |
| Amber Elkington | ||||||||||||||
| MANAGER | $114,159 | $0 | $8,791 | $0 | $242 | $0 | $9,536 | $0 | $22,834 | $0 | $155,562 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation | THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, HAWAI'I PACIFIC HEALTH ('HPH'), AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, FORM 990, PART VI, SECTION B, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERNAL REVENUE CODE ON COMPENSATION CONSIDERED UNDER SUCH PLANS. AMOUNTS PAID OUT DURING THE YEAR BY THE ORGANIZATION: RAYMOND P. VARA JR. - $193,418 DAVID OKABE - $72,983 GAIL LERCH - $7,785 STEVEN ROBERTSON - $49,068 CHARLES R. CHING - $44,495 ARTHUR GLADSTONE - $50,298 JENNIE CHAHANOVICH - $27,896 MELINDA ASHTON, M.D. - $41,256 GERARD F. LIVAUDIS - $26,186 LESLIE CHUN, M.D. - $33,229 ANNUAL INCENTIVE PLAN THE ANNUAL INCENTIVE PLAN IS AFFORDED TO EXECUTIVES BASED ON ANNUAL SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. AMOUNTS PAID OUT DURING THE YEAR BY THE ORGANIZATION: RAYMOND P. VARA JR. - $479,773 DAVID OKABE - $170,726 STEVEN ROBERTSON - $139,121 CHARLES R. CHING - $135,036 ARTHUR GLADSTONE - $159,772 MELINDA ASHTON, M.D. - $144,229 LESLIE CHUN, M.D. - $155,626 GERARD LIVAUDAIS, M.D. - $126,564 DAWN DUNBAR - $74,468 WARREN CHAIKO - $67,444 DOUGLAS KWOCK, M.D. - $75,632 SUSAN MASUMOTO NONAKA - $51,419 MICHAEL ROBINSON - $49,180 DAVID STUMBAUGH - $40,836 LORRIE-ANN LUKE - $39,718 JAMES LIN, M.D. - $49,164 CARRIE ANN TSUTSUI - $41,321 WILLIAM BURKE - $44,764 SUNSHINE TOPPING - $68,850 TROY BRANSTETTER - $13,431 BRANDON WONG - $15,905 JENNIE CHAHANOVICH - $123,018 BRANDT FARIAS - $61,243 RETENTION INCENTIVE PLAN THE RETENTION INCENTIVE PLAN WAS DESIGNED TO ENCOURAGE CONTINUED INTEREST IN THE SUCCESS OF THE ORGANIZATION AND PROVIDE COMPETITIVE RETIREMENT BENEFITS. THE SOLE PLAN PARTICIPANT IS HAWAI'I PACIFIC HEALTH'S CHIEF EXECUTIVE OFFICER, RAYMOND P. VARA JR. THE PLAN DOES NOT REPLACE THE ANNUAL AND LONG-TERM INCENTIVE PLAN NOR THE SERP RESTORATION PLAN. AMOUNTS PAID OUT DURING THE YEAR BY THE ORGANIZATION: RAYMOND P. VARA JR. - $1,015,000 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS | ESTABLISHED IN 1967, KAUA'I MEDICAL CLINIC HAS PROVIDED THE RESIDENTS AND VISITORS OF KAUA'I WITH PRIMARY AND SPECIALTY CARE FOR MORE THAN 50 YEARS. KAUA'I MEDICAL CLINIC PARTNERS WITH WILCOX MEDICAL CENTER AS PART OF WILCOX HEALTH. KAUA'I MEDICAL CLINIC OFFERS MORE THAN 30 SPECIALTIES AT FIVE LOCATIONS: THE MAIN CLINIC IN LIHU'E, KAUA'I URGENT CARE CLINIC IN LIHU'E, AND THREE SATELLITE CLINICS IN KAPA'A, KOLOA AND ELE'ELE. KAUA'I MEDICAL CLINIC HAS 172 EMPLOYEES AND 95 PHYSICIANS. IN FISCAL YEAR 2022, TOTAL CLINIC ENCOUNTERS WERE 312,256. SPECIALTY UNITS KAUA'I MEDICAL CLINIC IS KAUA'I'S ONLY MULTI-SPECIALTY GROUP. IT PROVIDES CARE IN CARDIOLOGY, FAMILY MEDICINE, GASTROENTEROLOGY, GENERAL MEDICINE, GENERAL SURGERY, HEMATOLOGY, INFECTIOUS DISEASES, INTERNAL MEDICINE, NEUROLOGY, OBSTETRICS AND GYNECOLOGY, ONCOLOGY, ORTHOPEDIC SURGERY, OTOLARYNGOLOGY, PEDIATRICS, PHYSIATRY, PODIATRY AND UROLOGY. THIS RANGE OF SPECIALTIES, MULTIPLE LOCATIONS, AND AFFILIATION WITH HAWAI'I PACIFIC HEALTH SIGNIFICANTLY INCREASES ACCESS TO CARE FOR KAUA'I RESIDENTS AND VISITORS. KAUA'I MEDICAL CLINIC PATIENTS ENJOY EASY APPOINTMENT SCHEDULING, URGENT CARE SERVICES, CHRONIC DISEASE MANAGEMENT, DIABETES CONSULTATION AND EDUCATION, DIAGNOSTIC IMAGING AND FINANCIAL COUNSELING. COMMUNITY KAUA'I MEDICAL CLINIC IS AN ACTIVE COMMUNITY PARTNER. KAUA'I MEDICAL CLINIC ALSO COLLABORATES WITH THE HAWAI'I STATE DEPARTMENT OF HEALTH, HEALTHCARE ASSOCIATION OF HAWAI'I AND OTHER HEALTH CARE PROVIDERS TO PROVIDE A COHESIVE PUBLIC HEALTH RESPONSE. KAUA'I MEDICAL CLINIC TREATS ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THUS SERVING (WITH WILCOX MEMORIAL HOSPITAL) AS ONE OF THE COMMUNITY'S SAFETY NET PROVIDERS OF HEALTH CARE. IN FISCAL YEAR 2022, KAUA'I MEDICAL CLINIC PROVIDED $461,238 WORTH OF CARE TO PATIENTS WHO WERE UNINSURED OR UNABLE TO PAY FOR THEIR CARE, AS WELL AS OTHER COMMUNITY BENEFITS. |
| Form 990, Part V, Line 1a FORM 1096 REPORTING | HAWAI'I PACIFIC HEALTH (HPH), THE ORGANIZATION'S TAX EXEMPT PARENT, PAYS ALL VENDORS. THEREFORE, HPH ISSUES FORMS 1099 UNDER ITS TAX ID. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | PETER LEWIS AND JESSICA LEWIS - Family relationship |
| Form 990, Part VI, Line 6 Classes of members or stockholders | HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO ELECT THE MEMBERS OF THE GOVERNING BODY AND/OR APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER AND HAS THE POWER TO APPROVE THE ELECTION OF MEMBERS OF THE GOVERNING BODY. HAWAI'I PACIFIC HEALTH, AS MEMBER, ALSO HAS THE POWER TO ELECT ONE OR MORE EX-OFFICIO VOTING MEMBERS OF THE GOVERNING BODY. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | THE MEMBER SHALL HAVE THE EXCLUSIVE POWER TO TAKE AND DIRECT THE FOLLOWING ACTIONS OF THE CORPORATION: (1) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE PRESIDENT/CHIEF EXECUTIVE OFFICER, TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, OTHER EXECUTIVE VICE-PRESIDENTS, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE OPERATING UNIT VICE-PRESIDENTS, AS SUCH TERM IS DEFINED IN THE BYLAWS; (2) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER BOARD; (3) AMEND THE BYLAWS; (4) DETERMINE AND EFFECT THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1)YEAR AND/OR FOR ONE MILLION DOLLARS ($1,000,000) OR MORE; (5) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (6) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (7) EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (8) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S PHYSICIAN AND EXECUTIVE COMPENSATION AND BENEFIT PLANS; (9) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, OR PARTNERSHIP OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (10) EXCEPT AS OTHERWISE PROVIDED IN THE BYLAWS OR AS REQUIRED BY THE LAW OF THE STATE OF HAWAI'I, SELL, LEASE OR OTHERWISE TRANSFER FIFTY PERCENT (50%) OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY WILCOX MEMORIAL HOSPITAL, KAUA'I MEDICAL CLINIC AND WILCOX HEALTH FOUNDATION (THE WILCOX AFFILIATES); (11) EXCEPT AS PROVIDED IN THE BYLAWS OR AS REQUIRED BY THE LAWS OF THE STATE OF HAWAI'I, SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE WILCOX AFFILIATES WHICH GENERATE FIFTY PERCENT (50%) OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE WILCOX AFFILIATES DURING THE PRIOR FISCAL YEAR; (12) CLOSE THE CLINICAL FACILITIES OWNED AND OPERATED BY THE CORPORATION; PROVIDED, THAT, AFTER THE EFFECTIVE DATE OF THE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORPORATION MUST ALSO BE APPROVED BY THE BOARD; (13) CONVERT THE CLINIC OWNED AND OPERATED BY THE CORPORATION INTO A FACILITY NO LONGER OFFERING MEDICAL SERVICES; PROVIDED, THAT, AFTER THE EFFECTIVE DATE OF THE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORPORATION MUST ALSO BE APPROVED BY THE BOARD; (14) AFTER CONSULTING WITH THE BOARD, REMOVE THE PRESIDENT/CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, TREASURER, SECRETARY, OTHER EXECUTIVE VICE-PRESIDENTS, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE OPERATING UNIT VICE-PRESIDENTS; PROVIDED, HOWEVER, THAT TO REMOVE OR TERMINATE THE PRESIDENT/CHIEF EXECUTIVE OFFICER WILL REQUIRE THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE MEMBER TO FULLY COLLABORATE AND CONSULT WITH THE BOARD AND SEEK THE BOARD'S ADVANCE CONSENT FOR SUCH REMOVAL OR TERMINATION. IF THE BOARD DOES NOT CONCUR WITH THE PROPOSED REMOVAL OR TERMINATION OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER, SUCH REMOVAL OR TERMINATION WILL REQUIRE THE APPROVAL OF A MAJORITY OF THE MEMBERS ON THE MEMBER BOARD; (15) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORPORATE GOALS AND THE LONG RANGE AND STRATEGIC PLANS OF THE CORPORATION; AND (16) AFTER CONSULTING WITH THE BOARD, DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. THE CORPORATION SHALL NOT TAKE THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING MEMBER BOARD APPROVAL: (1) ADD ANY DIRECTOR TO THE BOARD; (2) REMOVE ANY DIRECTOR FROM THE BOARD; (3) AMEND THE ARTICLES; (4) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS ON BEHALF OF THE CORPORATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (5) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000); (6) ACQUIRE SHARES IN ANOTHER CORPORATION; (7) SELL, LEASE OR OTHERWISE TRANSFER FIFTY PERCENT (50%) OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY THE WILCOX AFFILIATES; (8) SELL, LEASE, EXCHANGE OR DISPOSE OF FIFTY PERCENT (50%) OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION TO ANY ENTITY THAT IS NOT AN AFFILIATE; (9) SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE WILCOX AFFILIATES WHICH GENERATE FIFTY PERCENT (50%) OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE WILCOX AFFILIATES DURING THE PRIOR FISCAL YEAR; (10) MERGE THE CORPORATION WITH ANY ENTITY; (11) DISSOLVE OR LIQUIDATE THE CORPORATION; (12) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (13) FORM A JOINT VENTURE OR OTHER BUSINESS RELATIONSHIP (OTHER THAN THE ORDINARY COURSE OF BUSINESS CONTRACTS) BETWEEN THE CORPORATION AND ANY PERSON OR ENTITY; AND (14) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | VARIOUS SCHEDULES OF THE FORM 990 ARE PREPARED PRIMARILY BY STAFF WITHIN THE ACCOUNTING AREA OF THE ORGANIZATION WORKING WITH VARIOUS OTHER AREAS OF THE ORGANIZATION SUCH AS MANAGEMENT OF THE OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPILED INTERNALLY BASED ON INPUT AND DISCUSSION WITH FINANCIAL ANALYSTS AND THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF THE REPORTING ENTITY. THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF EACH REPORTING ENTITY REVIEWS AND APPROVES THE DISCLOSURE NARRATIVES WHICH DESCRIBES THE MISSION/PURPOSE AND PROGRAM ACCOMPLISHMENTS OF THEIR ORGANIZATION. SENIOR MANAGEMENT OF THE HEALTH CARE SYSTEM REVIEWS THE FORMS 990 OF EACH FILING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE FORMS 990 ARE THEN PROVIDED TO THE GOVERNANCE AND NOMINATING COMMITTEE OF THE HEALTH CARE SYSTEM'S BOARD OF DIRECTORS FOR THEIR REVIEW. THE GOVERNANCE AND NOMINATING COMMITTEE OF THE PARENT'S ENTITY (HAWAI'I PACIFIC HEALTH "HPH") BOARD PROVIDES OVERSIGHT FOR THE FORM 990 REPORTING AND REVIEWS THE FORM 990 FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE FORM 990 FOR EACH ENTITY IS MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND THE HPH BOARD OF DIRECTORS THROUGH A BOARD MEMBER PORTAL FOR REVIEW PRIOR TO THE FILING OF THE FORM 990. THE FORMS 990 WILL BE POSTED TO HPH'S WEBSITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURNS WITH THE IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | ANNUALLY, EACH DIRECTOR, OFFICER, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) RECEIVED A COPY OF THE CONFLICT OF INTEREST ("COI") POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, THE ORGANIZATION MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. THE IN-HOUSE LEGAL DEPARTMENT DISTRIBUTES THE STATEMENT REQUEST AND REVIEWS THE COI STATEMENTS RETURNED. IDENTIFIED CONFLICTS OF INTEREST ARE PRESENTED TO THE BOARD FOR REVIEW, DELIBERATION AND CONFIRMATION/REFUTATION THAT A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST HAS BEEN FOUND, THE INDIVIDUAL MAY ADDRESS THE BOARD AND EXPLAIN THE TRANSACTION OR ARRANGEMENT CAUSING THE CONFLICT. AFTER THE PRESENTATION, THE INDIVIDUAL IS EXCUSED FROM THE MEETING AND SHALL NOT PARTICIPATE WITH ANY DISCUSSION OR VOTE ON MATTERS PERTAINING TO THE TRANSACTION OR ARRANGEMENT. IN MEETINGS WHERE APPLICATION OF THE COI POLICY OCCURS, THE MEETING MINUTES INCLUDE NATURE OF THE FINANCIAL INTEREST/CONFLICT, NAME(S) OF THE PERSON(S) WITH THE POTENTIAL OR ACTUAL CONFLICT, ANY ACTION TAKEN TO ASSIST IN THE DETERMINATION OF WHETHER A CONFLICT EXISTED, INCLUDING ANY DISCUSSION OF ALTERNATIVE ARRANGEMENTS, THE BOARD'S DECISION(S) REGARDING THE CONFLICT AND NAMES OF PERSON PRESENT IN THE DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | THE CEO OF THE ORGANIZATION IS NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER BY THE TAX EXEMPT PARENT HAWAI'I PACIFIC HEALTH ("HPH"). FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE CEO'S COMPENSATION. COMPENSATION FOR HAWAI'I PACIFIC HEALTH ("HPH") EXECUTIVES (VICE PRESIDENT AND ABOVE) IS SET BY THE HPH COMPENSATION COMMITTEE, WHICH IS COMPOSED SOLELY OF INDEPENDENT, COMMUNITY-BASED MEMBERS OF THE HPH BOARD OF DIRECTORS. ON AN ANNUAL BASIS, THE HPH BOARD CHAIRPERSON (WHO IS INDEPENDENT) SELECTS A NEUTRAL THIRD PARTY EXECUTIVE COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVES' COMPENSATION AND BENEFITS. THE CONSULTANT PROVIDES A WRITTEN REPORT TO THE COMPENSATION COMMITTEE AT ITS ANNUAL MEETING. INCLUDED IN THE REPORT IS MARKET BASED DATA FROM LIKE ORGANIZATIONS. THE COMPENSATION COMMITTEE MAKES FINAL DECISIONS REGARDING COMPENSATION AND BENEFITS AT THE MEETING AFTER REVIEW AND DISCUSSION OF THE CONSULTANT'S REPORT, AND SUCH DECISIONS ARE DOCUMENTED IN THE COMPENSATION COMMITTEE MEETING MINUTES. COMMUNITY BASED DIRECTORS OF THE ORGANIZATION ARE NOT COMPENSATED. CERTAIN EMPLOYED PHYSICIANS MAY BE OFFICERS OR AN IDENTIFIED KEY EMPLOYEE OF THE REPORTING OR RELATED ORGANIZATION. PHYSICIAN COMPENSATION IS ALSO HANDLED IN THE SAME MANNER AS EXECUTIVE COMPENSATION, WITH THE HPH COMPENSATION COMMITTEE RECEIVING A REPORT FROM A NEUTRAL CONSULTANT AND FOLLOWING THE SAME PROCESS AS DESCRIBED ABOVE ON AN ANNUAL BASIS. THIS PROCESS WAS COMPLETED ON MARCH 09, 2022 TO REVIEW PHYSICIAN COMPENSATION, AND ON JULY 26, 2022 TO REVIEW EXECUTIVE COMPENSATION. |
| Form 990, Part VI, Line 19 Required documents available to the public | DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND STANDARDS OF CONDUCT ARE AVAILABLE ON THE HAWAI'I PACIFIC HEALTH WEBSITE. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC VIA THE HAWAI'I PACIFIC HEALTH WEBSITE. |
| Form 990, Part VIII, Line 2f Other Program Service Revenue | - Total Revenue: 43457, Related or Exempt Function Revenue: 43457, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | EQUITY TRANSFERS WITH HPH - 1035; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| HAWAI'I PACIFIC HEALTH | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990246363 | ADMIN SVCS. | HI | 501(c)(3) | Type III-FI | NA | false |
| KAPI'OLANI HEALTH FOUNDATION | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990246364 | FUNDRAISING | HI | 501(c)(3) | 7 | HPH | Yes (true) |
| KAPI'OLANI MED CTR FOR WOMEN & CHILDREN | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990177350 | HOSPITAL | HI | 501(c)(3) | 3 | HPH | Yes (true) |
| KAPI'OLANI MEDICAL SPECIALISTS | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990322406 | HEALTHCARE | HI | 501(c)(3) | 3 | HPH | Yes (true) |
| PALI MOMI FOUNDATION | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 383840327 | FUNDRAISING | HI | 501(c)(3) | 7 | HPH | Yes (true) |
| PALI MOMI MEDICAL CENTER | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990274038 | HOSPITAL | HI | 501(c)(3) | 3 | HPH | Yes (true) |
| PROVIDERS INSURANCE COMPANY | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 710893000 | INSURANCE | HI | 501(c)(3) | Type II | HPH | Yes (true) |
| STRAUB CLINIC & HOSPITAL | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 912151670 | HOSPITAL | HI | 501(c)(3) | 3 | HPH | Yes (true) |
| STRAUB FOUNDATION | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990109350 | FUNDRAISING | HI | 501(c)(3) | 7 | HPH | Yes (true) |
| WILCOX HEALTH FOUNDATION | ||||||||||
| 3-3420 KUHIO HIGHWAY | LIHUE | HI | 96766 | 990204242 | FUNDRAISING | HI | 501(c)(3) | 7 | HPH | Yes (true) |
| WILCOX MEMORIAL HOSPITAL | ||||||||||
| 3-3420 KUHIO HIGHWAY | LIHUE | HI | 96766 | 990074365 | HOSPITAL | HI | 501(c)(3) | 3 | HPH | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt |
|---|---|---|---|---|---|---|---|---|
| Honolulu Surgery Center LP | ||||||||
| 55 Merchant Street 24th Floor | HONOLULU | HI | 96813 | 621506645 | AMBU. SURG. CTR. | TN | NA | N/A |
| Specialty Surgical Suites LLC | ||||||||
| 1401 S Beretania St STE 750 | Honolulu | HI | 96814 | 461674512 | AMBU. SURG. CTR. | HI | NA | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt |
|---|---|---|---|---|---|---|---|---|
| HAWAI'I PACIFIC HEALTH PARTNERS INC | ||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990318588 | HOLDING COMPANY | HI | NA | C Corporation |
| STRAUB PHARMACY INC | ||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990145107 | INACTIVE | HI | NA | C Corporation |
| HICORD INC | ||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990251496 | INVESTMENT | HI | NA | C Corporation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (7 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| KAPI'OLANI MED CTR FOR WOMEN & CHILDREN | ||
| Q | $92,325 | FMV |
| STRAUB CLINIC & HOSPITAL | ||
| S | $642,221 | FMV |
| STRAUB CLINIC & HOSPITAL | ||
| P | $89,282 | FMV |
| WILCOX MEMORIAL HOSPITAL | ||
| Q | $645,660 | FMV |
| WILCOX MEMORIAL HOSPITAL | ||
| S | $365,051 | FMV |
| Kapiolani Medical Specialists | ||
| Q | $31,995,421 | FMV |
| KAPI'OLANI MEDICAL SPECIALISTS | ||
| R | $114,300 | FMV |