2023-05-11T18:10:40-05:00 2022-06-30 ERNST & YOUNG US LLP 370 17TH STREET SUITE 4800 DENVER CO 80202 990 2021-07-01 990251372 MOLOKAI GENERAL HOSPITAL % ZESSICA APIKI MOLO 8085533125 PO BOX 408 KAUNAKAKAI MOLOKAI HI 96748 CLINTON YEE TREASURER 8085533125 2023-05-08 true CLINTON YEE 999009999 ANDREW JAMESON P01894820 7209314000 2023-05-05 3 2021 2023-04-26 12:10:37Z JANICE KALANIHUIA PO BOX 408 KAUNAKAKAI HI 96748 27468938 false X www.queens.org/locations/hospitals/molokai X 1987 HI TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE ISLAND OF MOLOKAI. 7 4 117 0 6561 0 1910539 2051338 17079993 17629035 403773 418858 603604 693420 19997909 20792651 3000 0 0 0 8569830 9039318 0 0 4905 8432100 9455916 17004930 18495234 2992979 2297417 24888533 26444076 3634791 3791683 21253742 22652393 X TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE ISLAND OF MOLOKAI. false false 14274856 0 18177659 MOLOKAI GENERAL HOSPITAL (MGH) IS A RURAL HEALTH CARE FACILITY WITH A CRITICAL ACCESS HOSPITAL DESIGNATION. IT PROVIDES THE ONLY EMERGENCY ROOM SERVICES FOR RESIDENTS AND VISITORS ON THE ISLAND OF MOLOKAI, AND PROVIDES ACUTE CARE, INPATIENT HOSPICE, SKILLED NURSING, AND LOW-RISK OBSTETRICAL SERVICES. MGH ALSO OFFERS CHEMOTHERAPY, LIMITED SPECIAL PROCEDURES, DIABETES MANAGEMENT, MIDWIFERY, FAMILY PLANNING, AND PRIMARY CARE IN ITS RURAL HEALTH CLINIC(LOCATED ON HOSPITAL GROUNDS). SEE SCHEDULE O FOR MORE INFORMATION. 14274856 true true false true false false false false false false true true false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 0 0 true 117 true false false false false false false false false false false false false X 7 4 false false false false true true true true true false false true false false false false false false X ZESSICA APIKI 8085533125 PO BOX 408 KAUNAKAKAI HI 96748 JILL HOGGARD GREEN TRUSTEE/CHAIR 1.0 64.0 X X 0 1520980 270173 JASON CHANG TRUSTEE 1.0 54.0 X 0 947366 146632 JANICE KALANIHUIA PRESIDENT 54.0 1.0 X X 0 324054 56632 WILLIAM THOMAS JR MD PHYSICIAN 40.0 0.0 X 286579 0 44102 BRYN CHOWCHUVECH MD PHYSICIAN 40.0 0.0 X 287652 0 36682 CLINTON YEE TREASURER 2.0 53.0 X 0 219833 50649 JENNIFER NGUYEN MD PHYSICIAN 40.0 0.0 X 235048 0 16379 MICHAEL MULLEN DIRECTOR OF NURSING 40.0 0.0 X 140968 0 34493 PUNAHELE ALCON VICE PRESIDENT 50.0 0.0 X 145127 0 27172 BRIANNA MULLEN NURSE PRACTITIONER 40.0 0.0 X 145508 0 12067 MARINA LAFAELE SECRETARY 40.0 0.0 X 47325 0 25157 DONNA HAYTKO-PAOA TRUSTEE 1.0 0.0 X 0 0 0 JENAI WALL TRUSTEE 1.0 7.0 X 0 0 0 LANCE DUNBAR VICE CHAIR/TRUSTEE 1.0 0.0 X X 0 0 0 AARON BOSWELL TRUSTEE 1.0 0.0 X 0 0 0 1288207 3012233 720138 17 false true false 0 2026906 24432 2051338 NET PATIENT SERVICE REVENUE 623000 16492024 16492024 SUSTAINABILITY FEE 623000 1040889 1040889 INTERCOMPANY REVENUE 900099 96122 96122 17629035 77590 6561 71029 0 0 144796 144796 0 144796 144796 7012205 5350 6676287 335918 5350 341268 341268 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 624200 274130 274130 QUALITY PAYMENT 900099 44553 44553 MEANINGFUL USE PAYMENT 900099 218375 218375 11566 11566 548624 20792651 18177659 6561 557093 X 0 0 0 0 208872 208872 0 6936409 5262284 1674125 457246 309679 147567 951985 559927 392058 484806 344916 139890 0 578565 578565 15804 15804 1806 1806 0 4768 4768 3398715 3382602 16113 35689 28532 7157 340076 67227 272849 57611 1852 55759 0 480362 10756 469606 83646 42279 41367 0 16599 5485 11114 0 0 800569 742108 58461 222408 221164 1244 INTERCOMPANY CHARGES 1676880 1671975 4905 MEDICAL SUPPLIES 1149273 1149273 REPAIRS & MAINTENANCE 270541 189166 81375 PROVIDER TAX 201743 201743 120861 83888 36973 18495234 14274856 4215473 4905 700 800 7403982 9486440 0 0 1796270 1560882 0 0 0 0 0 0 94031 96216 65001 91557 29605460 20745832 8301248 8859628 4196897 3835494 2819082 2512602 0 0 0 0 211322 457 24888533 26444076 2139523 2119113 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1495268 1672570 3634791 3791683 X 21253742 22652393 0 0 21253742 22652393 24888533 26444076 X 2297417 -1061786 163020 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 1806 194808 1806 194808 14273050 1789824557 14274856 1790019365 863743 1000000 215936 250000 1000000 1000000 1000000 863943 3863943 5795915 160095 141608 166517 194808 663028 250000 250000 250000 215936 965936 1448904 0 0 19217802 13842224 5375578 8245705 6903608 1342097 2141953 2141953 8859628 POOLED INVESTMENTS - NONPUBLIC 2512602 F 2512602 0 DUE TO AFFILIATES 674973 GEN & PROFESSIONAL TAIL LIABILITY 84174 LONG TERM PENSION LIABILITY 883 DUE TO GOVERNMENT REIMBURSEMENT 912540 1672570 X SCHEDULE D, PART X, LINE 2 FIN 48(ASC 740) FOOTNOTE QHS EVALUATES ITS UNCERTAIN TAX POSITIONS AND HAS NO MATERIAL UNRECOGNIZED TAX POSITIONS AS OF JUNE 30, 2022. true true X true X 250. true X true true true false true true 229974 229974 0.01240 5225971 6584433 5455945 6584433 229974 0.01240 8135 8135 0.00040 250174 125087 125087 0.00680 258309 125087 133222 0.00720 5714254 6709520 363196 0.01960 true 205495 205495 7786473 3971101 3815372 X true true 1 1 MOLOKAI GENERAL HOSPITAL 280 HOME OLU PLACE KAUNAKAKAI MOLOKAI HI 96748 queens.org/locations/hospitals/molokai 18-H X X X X MOLOKAI GENERAL HOSPITAL 1 false false true X X X X X X X X X 21 true true true true X SEE PART V, SECTION C X true 21 true SEE PART V, SECTION C false true X 250. 400. X X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE SECTION C X X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3E THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM COMMUNITY REPRESENTATIVES Community Meetings - Organizations throughout the state, called "community connectors", helped to reach individuals from key communities for group talk story sessions. These organizations were invaluable partners, each trusted and recognized within their target communities, and willing both to provide input from their own work as well as create space and encourage their clients, partners, staff, and stakeholders to participate. Each meeting focused on both a geographic region and either an ethnic community or a vulnerable population. Key Informant Interviews - The Ward Team conducted 80 key informant interviews with individuals in key stakeholder positions able to provide input and insight on behalf of a target population. These tended to be organizational leaders serving stakeholder communities versus members of those actual populations that joined community meetings. Interviews were typically one on one between an interviewer and a key informant, lasting anywhere from 45 to 90 minutes. Small Groups - The Ward Team also held a series of private small group meetings with key leaders in three of these areas (food security, mental health, and housing). (Note that two of these necessitated additional one-on-one interviews, rather than small groups, given scheduling difficulties and the desire to speak with key individuals). These interviews followed the completion of most of the key informant interviews and community meetings and benefitted from that learning to date. The focus of discussion was around identifying COVID-19 adaptation strategies that worked and how that learning can be carried forward and built upon. Much of this discussion has augmented the Best Practice strategies highlighted in the report. Community Advisory Committee - In 2021, the Community Advisory Committee (CAC) was composed of community leaders serving various target communities. CAC members were especially generous with their time, input, and expertise throughout the process. In addition to being key informants, they also participated in meetings during the last phase of the assessment and report and helped to make critical connections where there were gaps, ensure that things were ground-truthed with what they saw in their communities, and provided input as to how the priorities could be helpful both within the clinical and community-based contexts. SCHEDULE H, PART V, SECTION B, LINE 6A CHNA HOSPITAL FACILITIES NINETEEN HEALTHCARE ASSOCIATION OF HAWAII (HAH) MEMBER HOSPITALS CONTRIBUTED TO THE PRODUCTION OF THIS CHNA: ADVENTIST HEALTH CASTLE KAHUKU MEDICAL CENTER KAISER FOUNDATION HOSPITAL - HONOLULU KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN KUAKINI MEDICAL CENTER KULA HOSPITAL LANA'I COMMUNITY HOSPITAL MAUI MEMORIAL MEDICAL CENTER MOLOKAI GENERAL HOSPITAL QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL PALI MOMI MEDICAL CENTER THE QUEEN'S MEDICAL CENTER THE QUEEN'S MEDICAL CENTER - WEST O'AHU REHABILITATION HOSPITAL OF THE PACIFIC SHRINERS HOSPITALS FOR CHILDREN - HONOLULU STRAUB MEDICAL CENTER SUTTER HEALTH KAHI MOHALA WAHIAWA GENERAL HOSPITAL WILCOX MEDICAL CENTER SCHEDULE H, PART V, SECTION B, LINE 6B CHNA OTHER THAN HOSPITAL FACILITIES THE HEALTHCARE ASSOCIATION OF HAWAII PARTNERED WITH SOLUTIONS PACIFIC AND WARD RESEARCH TO CONDUCT A CHNA FOR THE STATE OF HAWAII. IN ADDITION, THE REPORT INVOLVED NUMEROUS OTHER HEALTH CARE FACILITIES AND RESOURCES WITHIN THE COMMUNITY THAT WERE ABLE TO RESPOND TO THE HEALTHCARE NEEDS IN THE COMMUNITY. THESE RESOURCES ARE LISTED ON PAGE 94 OF THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 7A AND 10A WEBSITE WHERE THE MOLOKAI GENERAL HOSPITAL FACILITY'S CHNA AND IMPLEMENTATION PLAN CAN BE ACCESSED: https://www.queens.org/about/community-benefit-qhs/ SCHEDULE H, PART V, SECTION B, LINE 11 SIGNIFICANT NEEDS AND NEEDS NOT ASSESSED TOGETHER, THE HEALTHCARE ASSOCIATION OF HAWAII (HAH) MEMBER HOSPITALS PRIORITIZED THE AREAS OF NEED FOR THE STATE. THE TOP RANKED GOALS WERE: . Financial Security . Food Security . Mental and Behavioral Health . Housing . Trust and Equitable Access IN ADDITION, THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED: . Work together for equity and justice . Strengthen safe families . Prepare for emergencies . Restore environment and sense of place . Shift kupuna care away from "sick care" . Nurture community identity and cohesiveness . Invest in teenagers and healthy starts SENIOR MANAGEMENT OF THE QUEEN'S HEALTH SYSTEMS (QUEEN'S), THE NONPROFIT PARENT COMPANY OF A FAMILY OF HEALTH CARE-RELATED COMPANIES THAT INCLUDES THE QUEEN'S MEDICAL CENTER (QMC), QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL (NHCH) AND MOLOKAI GENERAL HOSPITAL (MGH), DISCUSSED THE COMMUNITY HEALTH NEEDS AND AGREED TO ADDRESS THE FOLLOWING PRIORITIES FOR THE SYSTEM: . Financial Security . Food Security . Mental and Behavioral Health . Housing . Trust and Equitable Access As the primary resource on Molokai for COVID testing and vaccinations, MGH administered a total of 4,054 COVID vaccinations and an estimated 315 flu shots. The addition of internist Dr. Randi Olds has increased access to primary care on Molokai. . Though only practicing for two months in FY22, Dr. Olds served 123 patients, 57% of whom identified as Native Hawaiian/Pacific Islander. . All total for FY22, Dr. Olds had 140 face-face encounters (including inpatient visits), and 64% of those encounters were with patients who identified as Native Hawaiian/Pacific Islander. Providing 803 visits for wound care in which 98 patients were served, 56% of whom identified as Native Hawaiian/Pacific Islander. Additionally, MGH's Rural Health Clinic achieved the following in FY22*: . 7,338 face-face provider visits (includes inpatients) . 7,247 face-face provider visits (does not include inpatients) . 9,373 total visits, including nurse visits . 62% of the total visits were with patients who identified as Native Hawaiian/Pacific Islander. *Please note that these outcomes do not include the Emergency Department, imaging or any other part of MGH. FOR OTHER AREAS NOT DIRECTLY ADDRESSED, MOLOKAI GENERAL HOSPITAL RECOGNIZES THE IMPORTANCE OF THESE NEEDS AND HAS SUPPORTED EFFORTS TO ADDRESS MANY OF THEM. ALTHOUGH MGH WILL NOT DIRECTLY BE ADDRESSING ALL AREAS OF NEED, WE HAVE SUPPORTED AND PARTNERED WITH OTHERS TO ADDRESS SEVERAL OF THEM AND WILL CONTINUE TO SUPPORT OPPORTUNITIES TO ADDRESS COMMUNITY HEALTH NEEDS IN COLLABORATION WITH OTHERS. SCHEDULE H, PART V, SECTION B, LINE 13B INCOME LEVEL OTHER THAN FPG FOR CITIZENS OF FOREIGN COUNTRIES, THE INCOME QUALIFYING LEVEL IS BASED ON THE RESIDENT'S COUNTRY'S MINIMUM WAGE. SCHEDULE H, PART V, SECTION B, LINE 13H OTHER ELIGIBILITY CRITERIA MEDICARE OR MEDICAID/QUEST ELIGIBILITY SCHEDULE H, PART V, LINES 16A, 16B & 16C THE FINANCIAL ASSISTANCE POLICY AND PLAIN LANGUAGE SUMMARY ARE WIDELY AVAILABLE ON MOLOKAI GENERAL HOSPITAL'S WEBSITE AT: https://www.queens.org/locations/hospitals/molokai/pay-your-bill/ THE FINANCIAL ASSISTANCE POLICY'S APPLICATION FORM AND TRANSLATIONS ARE WIDELY AVAILABLE ON MOLOKAI GENERAL HOSPITAL'S WEBSITE AT: https://www.queens.org/locations/hospitals/molokai/pay-your-bill/financial assistance/ SCHEDULE H, PART V, SECTION B, LINE 16J OTHER METHOD FOR PUBLICIZING POLICIES NOTICES THAT FINANCIAL ASSISTANCE IS AVAILABLE ARE POSTED IN ALL PATIENT REGISTRATION, BILLING OFFICE AND EMERGENCY DEPARTMENT AREAS. THESE NOTICES DO NOT CONTAIN THE FULL DETAILED TEXT OF THE POLICY. REGISTRATION PERSONNEL ARE KNOWLEDGEABLE TO ASSIST PATIENTS WITH QUESTIONS AND ARE ABLE TO GIVE THEM THE FINANCIAL ASSISTANCE APPLICATION. SCHEDULE H, PART I, LINE 6A COMMUNITY BENEFIT REPORT - RELATED ORGANIZATION COMMUNITY BENEFITS ARE REPORTED ANNUALLY AS PART OF THE FORM 990. THIS IS NOT SEPARATELY AVAILABLE TO THE PUBLIC. A FORMAL REPORT ISSUED BY THE PARENT COMPANY, THE QUEEN'S HEALTH SYSTEMS, INCLUDES THE COMMUNITY BENEFITS OF THE MOLOKAI GENERAL HOSPITAL. THIS REPORT IS PUBLISHED PERIODICALLY AND IS SEPARATELY AVAILABLE TO THE PUBLIC. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY CONSIDERS ALL PATIENT SEGMENTS. AMOUNTS REPRESENT THE NET COSTS FOR THE VARIOUS PROGRAMS AND OPERATIONS, CONSIDERING ACTUAL AMOUNTS INCURRED AND CALCULATED BENEFITS BASED ON COST-TO-CHARGE RATIOS AND AVERAGE RATES (I.E. WAGE RATES). SCHEDULE H, PART III, LINE 2 MGH PROVIDES AN ALLOWANCE AGAINST ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE BY ESTABLISHING AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. MGH ESTIMATES THE ALLOWANCE BASED ON THE AGING OF THE ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE BY PAYOR AND OTHER RELEVANT FACTORS. MGH PROVIDES MEDICAL SERVICES TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY (PATIENTS ARE NOT BILLED - CHARITY CARE) AND PATIENTS WHO REFUSE TO PAY (BAD DEBTS). THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER MGH'S FINANCIAL ASSISTANCE POLICY IS CALCULATED BASED ON THE COST-TO-CHARGE RATIO. THE HOSPITAL ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD'S ACCOUNTING STANDARDS UPDATE 2014-09 TOPIC 606 (ASU 606) EFFECTIVE JULY 1, 2018. ASU 606 AND THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA) DIFFERENTIATE BAD DEBT FROM IMPLICIT PRICE CONCESSIONS. THE HOSPITAL MAKES A DETERMINATION REGARDING A PRICE CONCESSION TO STANDARD PRICING ON A PORTFOLIO BASIS PRIOR TO ASSESSING THE CREDIT RISK OF INDIVIDUALS WITHIN THE PORTFOLIO. PATIENT SERVICE REVENUE IS RECORDED NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS, INCLUDING AN ESTIMATE FOR IMPLICIT PRICE CONCESSIONS. BAD DEBT IS RECORDED AS AN OPERATING EXPENSE AND RESULTS WHEN A PATIENT, DETERMINED TO HAVE THE FINANCIAL CAPACITY TO PAY FOR HEALTHCARE SERVICES, IS UNWILLING TO DO SO. THE AMOUNT SHOWN ON PART III, LINE 2 IS THE PRICE CONCESSION AMOUNT FOR THE TAX YEAR ENDED JUNE 30, 2022. SCHEDULE H, PART III, LINE 3 BAD DEBT AS COMMUNITY BENEFIT THE PORTION OF THE BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS CALCULATED BY APPLYING THE COST TO CHARGE RATIO TO THE TOTAL BAD DEBT EXPENSE. BAD DEBT PERTAINING TO PATIENT CARE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE, CONSISTENT WITH MGH'S MISSION, PATIENTS RECEIVE CARE REGARDLESS OF WHETHER MGH COLLECTS PAYMENT FOR SERVICES PERFORMED. FOR FY2022, MGH REPORTED BAD DEBT EXPENSE OF $205,495. SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE FOOTNOTE THE AUDITED FINANCIAL STATEMENTS DO NOT DESCRIBE BAD DEBT EXPENSE. THE AUDITED FINANCIAL STATEMENTS DO DESCRIBE THE RECEIVABLES FOR PATIENT SERVICES. "ACCOUNTS RECEIVABLE PRIMARILY COMPRISE AMOUNTS DUE FOR HEALTHCARE SERVICES FROM PATIENTS AND THIRD-PARTY PAYORS AND ARE RECORDED NET OF AMOUNTS FOR CONTRACTUAL ADJUSTMENTS, IMPLICIT PRICE CONCESSIONS AND BAD DEBTS." SCHEDULE H, PART III, LINE 8 TREATMENT OF MEDICARE SHORTFALL COMMUNITY BENEFIT FOR THE FISCAL YEAR ENDED JUNE 30, 2022, MOLOKAI GENERAL HOSPITAL HAD A MEDICARE SURPLUS. AS SUCH, MEDICARE SHORTFALL WAS NOT REPORTED AS A COMMUNITY BENEFIT. MEDICARE COSTING METHODOLOGY THE MEDICARE AMOUNTS ABOVE ARE CALCULATED WITH DATA FROM THE JUNE 30, 2022 COST REPORT, BASED ON A RATIO OF TOTAL PATIENT REVENUES TO TOTAL PATIENT COSTS CALCULATED BY COST CENTERS. MGH IS THE ISLAND OF MOLOKAI'S ONLY HOSPITAL, PROVIDING 24 HOUR SERVICE TO ALL MEMBERS OF THE PUBLIC. SCHEDULE H, PART III, LINE 9B APPLICATION OF THE COLLECTION PRACTICES TO THOSE QUALIFYING FOR FINANCIAL ASSISTANCE MGH PROVIDES FULL OR PARTIAL DISCOUNTS FOR ELIGIBLE PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. ELIGIBILITY CONTINUES FOR SIX MONTHS OR UPON CHANGE IN PATIENT'S INCOME AND ASSETS PER GUIDELINES. PATIENTS MAY RECERTIFY EVERY SIX MONTHS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT EVALUATION AND SURVEYS ARE COMPLETED AS NEEDED BY COST CENTERS OR DEPARTMENTS. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE MGH HAS AN ON-STAFF SOCIAL WORKER WHO ASSISTS PATIENTS AND THEIR FAMILIES BY PROVIDING EDUCATION AND ASSISTANCE IN APPLYING FOR ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, INCLUDING MGH'S CHARITY CARE POLICY. ADDITIONALLY, THE REGISTRATION STAFF AND BUSINESS OFFICE STAFF PROVIDE WRITTEN AND VERBAL INFORMATION REGARDING THE HOSPITAL'S CHARITY CARE POLICIES DURING INTAKE AND DISCHARGE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION MGH, PART OF THE QUEEN'S HEALTH SYSTEMS, IS THE ONLY HOSPITAL ON THE ISLAND OF MOLOKA'I, PROVIDING 24-HOUR CARE SERVICES FOR A POPULATION OF 7,400. MOLOKA'I IS DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA IN PRIMARY CARE, DENTAL AND MENTAL HEALTH SERVICES. ADDITIONALLY, THE ISLAND IS LISTED AS A FEDERAL MEDICALLY UNDERSERVED AREA (MUA). THE AVERAGE HOUSEHOLD INCOME IS $46,000 WITH 63% OF THE POPULATION REPORTING THEY ARE OF NATIVE HAWAIIAN ANCESTRY (MULTIPLE RACE) IN 2010. ON AVERAGE, THIRTY PERCENT OF FAMILY HOUSEHOLDS REPORT RECEIVING SOME FORM OF GOVERNMENT ASSISTANCE. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH THE AMOUNTS MENTIONED IN PART I OF SCHEDULE H REPRESENT COSTS INCURRED TO ENSURE CONTINUED OPERATIONS THAT BENEFIT THE COMMUNITY. TO SUPPORT MGH'S MISSION AND TO FULFILL THE TAX-EXEMPT PURPOSE AS A CHARITABLE HOSPITAL, MGH PROVIDES A NUMBER OF COMMUNITY BENEFITS. THIS INCLUDES UNCOMPENSATED CARE, WHERE MGH PROVIDES MEDICAL SERVICES TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY (PATIENTS ARE NOT BILLED - CHARITY CARE) AND PATIENTS WHO REFUSE TO PAY (BAD DEBT). MGH ALSO IS HOME TO AN OUTPATIENT CLINIC, WHERE MGH PROVIDES OUTPATIENT SERVICES TO INDIGENT PATIENTS. IN ADDITION, MGH PROVIDES MANY FREE INFORMATIONAL SEMINARS AND EDUCATIONAL OPPORTUNITIES TO THE PUBLIC TO PROMOTE THE HEALTH OF THE COMMUNITY. THESE PROGRAMS ARE SPECIFICALLY DIRECTED TO ADDRESS HEALTH ISSUES WITHIN THE COMMUNITY INCLUDING DIABETES, CANCER AND WOMEN'S HEALTH ISSUES. MGH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS AND IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND PROVIDES FREE FLU CLINICS IN AREAS OUTSIDE THE MAIN TOWN. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM MGH IS A MEMBER OF THE QUEEN'S HEALTH SYSTEMS (QHS) AFFILIATED GROUP. THE GROUP INCLUDES QUEEN'S MEDICAL CENTER (QMC), QUEEN EMMA LAND COMPANY (QEL), QUEEN'S INSURANCE EXCHANGE (QIE), QUEEN'S DEVELOPMENT CORPORATION (QDC), QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL (NHCH) AND QUEEN'S UNIVERSITY MEDICAL GROUP (QUMG). QHS PROVIDED LEGAL, ACCOUNTING AND ADMINISTRATIVE SUPPORT SERVICES TO MGH AND QIE PROVIDED MEDICAL MALPRACTICE INSURANCE TO MGH. IN RETURN, MGH ASSISTED QMC IN FULFILLING ITS MISSION TO PROVIDE IN PERPETUITY QUALITY HEALTH CARE SERVICES TO IMPROVE THE WELL-BEING OF NATIVE HAWAIIANS AND ALL THE PEOPLE OF HAWAII. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT N/A false false false false false false false true false JILL HOGGARD GREEN TRUSTEE/CHAIR 0 1012265 0 501851 0 6864 0 253215 0 16958 0 1791153 JASON CHANG TRUSTEE 0 673130 0 273696 0 540 0 122534 0 24098 0 1093998 JANICE KALANIHUIA PRESIDENT 0 244039 0 70762 0 9253 0 39939 0 16693 0 380686 WILLIAM THOMAS JR MD PHYSICIAN 236135 0 47098 0 3346 0 35380 0 8722 0 330681 0 BRYN CHOWCHUVECH MD PHYSICIAN 218336 0 68846 0 470 0 20536 0 16146 0 324334 0 CLINTON YEE TREASURER 0 197489 0 20480 0 1864 0 24863 0 25786 0 270482 JENNIFER NGUYEN MD PHYSICIAN 200183 0 34547 0 318 0 15714 0 665 0 251427 0 MICHAEL MULLEN DIRECTOR OF NURSING 126208 0 14760 0 0 0 11108 0 23385 0 175461 0 PUNAHELE ALCON VICE PRESIDENT 131516 0 13350 0 261 0 11019 0 16153 0 172299 0 BRIANNA MULLEN NURSE PRACTITIONER 142659 0 1000 0 1849 0 11486 0 581 0 157575 0 SCHEDULE J, PART I, LINE 3 THE ORGANIZATION RELIED ON THE QUEEN'S HEALTH SYSTEMS ("QHS", PARENT COMPANY) TO DETERMINE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL. QHS USED A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY AND STUDY, FORM 990 OF OTHER ORGANIZATIONS AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SCHEDULE J, PART I, LINE 7 OTHER NON-FIXED PAYMENTS RECOGNITION AWARDS WERE PAID TO ALL EMPLOYEES BASED ON ACCOMPLISHMENTS OF PREDETERMINED GOALS SET FORTH IN THE INCENTIVE AND STRATEGIC PLANS AND DEFINED ELIGIBILITY OF THE EMPLOYEE. RECOGNITION AWARDS ARE DISCRETIONARY AND CONSIDER QUALITY THRESHOLDS WHICH INCLUDE ANNUAL ACCREDITATION AND MINIMUM OPERATING INCOME LEVEL CRITERIA. IN ADDITION, EXECUTIVE AWARDS ARE WEIGHTED BASED ON INDIVIDUAL GOALS ESTABLISHED FOR EACH EXECUTIVE. SCHEDULE J, PART II & FORM 990, PART VII COMPENSATION PAID FOR SERVICES JILL HOGGARD GREEN MS. HOGGARD GREEN SERVES AS A TRUSTEE FOR THE QUEEN'S HEALTH SYSTEMS AND SEVERAL OTHER QUEEN'S RELATED AFFILIATES. MS. HOGGARD GREEN ALSO SERVES AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE QUEEN'S HEALTH SYSTEMS ("QHS", PARENT COMPANY) AND CHAIR OF MGH, NHCH AND QEL. SHE IS A VOLUNTEER TRUSTEE AND IS NOT COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR HER VARIOUS SERVICES. JANICE KALANIHUIA MS. KALANIHUIA SERVES AS VICE PRESIDENT FOR THE QUEEN'S HEALTH SYSTEMS AND PRESIDENT OF MGH. SHE IS NOT SEPARATELY COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR ALL SERVICES. JASON CHANG MR. CHANG SERVES AS COO AND EVP OF QHS, PRESIDENT AND TRUSTEE OF QMC AND TRUSTEE OF QEL, MGH AND QNHCH. HE IS NOT SEPARATELY COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL SERVICES. PUNAHELE ALCON MS. ALCON SERVES AS VICE PRESIDENT AND DIRECTOR OF OUTPATIENT AND BUSINESS SERVICES OF MGH. SHE IS NOT SEPARATELY COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR ALL SERVICES. CLINTON YEE MR. YEE SERVES AS CORPORATE CONTROLLER OF QUEEN'S HEALTH SYSTEMS, ASSISTANT TREASURER OF QMC AND QHS AND TREASURER OF MGH. HE IS NOT SEPARATELY COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL SERVICES. FORM 990, PART III, LINE 4A TO SUPPORT THE MGH'S MISSION AND TO FULFILL THE TAX EXEMPT PURPOSE AS A CHARITABLE HOSPITAL, MGH PROVIDED THE FOLLOWING COMMUNITY BENEFITS, TOTALING $568,691 FOR THE YEAR ENDED JUNE 30, 2022. 1. UNCOMPENSATED CARE - MGH PROVIDES MEDICAL SERVICES TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY (CHARITY CARE) AND PATIENTS WHO REFUSE TO PAY/ARE ELIGIBLE FOR FINANCIAL ASSISTANCE (BAD DEBTS). FOR THE YEAR ENDED JUNE 30, 2022 THE ESTIMATED COST OF PROVIDING CHARITY CARE WAS $229,974 AND THE ESTIMATED COST OF BAD DEBT WAS $205,495. 2. COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS - MGH PROVIDES HEALTH AND WELLNESS EDUCATION TO THE COMMUNITY IN AN EFFORT TO PROMOTE HEALTHY LIFESTYLES AND MADE ENVIRONMENTAL IMPROVEMENTS TO ITS FACILITIES. FOR THE YEAR ENDED JUNE 30, 2022, THE COST OF COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS WAS $8,135. 3. SUBSIDIZED HEALTH SERVICES - MGH IS THE ONLY FACILITY ON THE ISLAND OF MOLOKAI TO PROVIDE CHEMOTHERAPY TO CANCER PATIENTS. IN ADDITION, MGH PROVIDED OBSTETRICS AND MIDWIFERY SERVICES TO THE RESIDENTS OF MOLOKAI. RELATED TO THESE SERVICES, MGH INCURRED COSTS IN EXCESS OF REIMBURSEMENT OF APPROXIMATELY $125,087 DURING THE YEAR ENDED JUNE 30, 2022. FORM 990, PART VI, LINE 6 MEMBERS OR STOCKHOLDERS MGH HAS A SOLE MEMBER, WHICH IS THE QUEEN'S HEALTH SYSTEMS (QHS), A HAWAII NONPROFIT CORPORATION. FORM 990, PART VI, LINE 7A POWER TO ELECT OR APPOINT BOARD MEMBERS QHS ELECTS ALL OF THE BOARD MEMBERS OF THE MGH BOARD OF TRUSTEES. FORM 990, PART VI, LINE 7B DESCRIPTION OF CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS CERTAIN MAJOR DECISIONS APPROVED BY THE MGH BOARD OF TRUSTEES MUST ALSO BE APPROVED BY QHS. SUCH DECISIONS INCLUDE: 1. A CHANGE TO THE PURPOSE OF THE COMPANY; 2. A FINANCING TRANSACTION IN EXCESS OF $500,000; 3. A LEASE TRANSACTION THAT HAS A TERM THAT IS LONGER THAN 3 YEARS OR HAS A RENT OBLIGATION IN EXCESS OF $1,000,000 OVER THE LEASE TERM; 4. A TRANSACTION INVOLVING THE SALE, LEASE, DISPOSITION OR HYPOTHECATION OF REAL PROPERTY; 5. ANNUAL OPERATIONAL AND CAPITAL BUDGETS; 6. STRATEGIC PLANS; 7. MERGER OR MAJOR ACQUISITIONS; 8. CREATION OF A NEW ENTITY OR JOINT VENTURE; 9. SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS; 10. DISSOLUTION; 11. AMENDMENT OF BYLAWS; 12. ADOPTION, AMENDMENT OR RESCISSION OF A BOARD POLICY; 13. CAPITAL EXPENDITURES IN EXCESS OF $1,000,000 FOR MGH. FORM 990, PART VI, SECTION B, LINE 11B PROCESS USED TO REVIEW THE FORM 990 THE FORM 990 FOR THE QUEEN'S HEALTH SYSTEMS (QHS) AND THE SEPARATE FORMS FOR EACH OF THE NOT-FOR-PROFIT SUBSIDIARIES OF QHS WERE REVIEWED BY THE GOVERNING BODY PRIOR TO THE FILING OF THE TAX RETURN. THE QHS RISK MANAGEMENT COMMITTEE, WHICH IS COMPRISED OF MEMBERS OF THE QHS BOARD OF TRUSTEES, WAS DELEGATED THE RESPONSIBILITY TO REVIEW THE RETURNS PRIOR TO THEIR FILING. THE RETURNS WERE PRESENTED TO THE COMMITTEE BY MANAGEMENT AND BY THE INDEPENDENT PUBLIC ACCOUNTING FIRM THAT REVIEWED THE RETURNS. IN ADDITION, COMPENSATION RELATED DISCLOSURES IN THE RETURNS WERE REVIEWED BY THE CHAIRPERSON OF THE COMPENSATION COMMITTEE PRIOR TO FILING THE RETURNS. ALSO, A COPY OF THE MOLOKAI GENERAL HOSPITAL (MGH) RETURN WAS MADE AVAILABLE TO EACH OF THE MEMBERS OF THE MGH BOARD OF TRUSTEES PRIOR TO THE RETURNS BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12, 13 AND 14 APPROVED POLICIES THE CONFLICT OF INTEREST, WHISTLEBLOWER AND DOCUMENT RETENTION POLICIES HAVE BEEN APPROVED BY QHS ON BEHALF OF THE MGH BOARD OF TRUSTEES BUT HAVE NOT BEEN SEPARATELY APPROVED BY THE MGH BOARD. AS SUCH, LINES 12, 13 AND 14 HAVE BEEN CHECKED 'NO'. FORM 990, PART VI, SECTION B, LINE 12C MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY ALL QHS COMPANIES ARE SUBJECT TO A WRITTEN CONFLICT OF INTEREST POLICY. ALL TRUSTEES, OFFICERS, DESIGNATED EMPLOYEES AND CONTRACTORS ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE FORM. THE DESIGNATED EMPLOYEES ARE THOSE SELECTED BY EXECUTIVES IN THE ORGANIZATION WHO IDENTIFY THOSE EMPLOYEES (TYPICALLY MANAGER LEVEL AND ABOVE) WHO MAY BE IN A POSITION TO SELECT OR INFLUENCE THE SELECTION OF A VENDOR. DISCLOSURES ARE SUMMARIZED AND MAINTAINED BY EACH COMPANY'S CORPORATE SECRETARY. THE CONTRACTS MANAGEMENT DEPARTMENT AND LEGAL DEPARTMENT HAVE THE CONFLICT OF INTEREST SUMMARIES AND CHECK FOR CONFLICTS OF INTEREST AT THE BEGINNING OF THE CONTRACT PROCESS. ANY CONFLICT OF INTEREST INVOLVING A TRUSTEE IS PRESENTED TO THE BOARD OF TRUSTEES. ANY CONFLICT OF INTEREST INVOLVING A DISQUALIFIED PERSON IS SUBJECT TO THE PROCESS OF ESTABLISHING A REBUTTABLE PRESUMPTION OF REASONABLENESS. ANY TRUSTEE WITH A CONFLICT OF INTEREST IS EXCUSED FOR THE PORTION OF THE MEETING WHERE THE SUBJECT MATTER IS DISCUSSED AND VOTED ON. FORM 990, PART VI, SECTION B, LINES 15A AND 15B PROCESS USED FOR DETERMINING COMPENSATION ALTHOUGH NOT COMPENSATED BY MOLOKAI GENERAL HOSPITAL, A RELATED ORGANIZATION, THE QUEEN'S HEALTH SYSTEMS GOES THROUGH THE FOLLOWING PROCEDURES FOR DETERMINING THE CEO'S COMPENSATION. A COMMITTEE OF THE BOARD OF TRUSTEES CALLED THE COMPENSATION COMMITTEE MEETS REGULARLY TO REVIEW THE COMPENSATION OF ALL EXECUTIVES OF ALL COMPANIES WITHIN QHS. MGH'S EXECUTIVE COMPENSATION IS REVIEWED ANNUALLY FOR ITS PRESIDENT. ALL DECISIONS REGARDING EXECUTIVE COMPENSATION ARE MADE IN CONFORMITY WITH THE PROCEDURES REQUIRED TO ESTABLISH A REBUTTABLE PRESUMPTION OF REASONABLENESS. ANY ADJUSTMENT TO COMPENSATION IS SUBJECT TO THE PROCESS OF ANNUAL PERFORMANCE REVIEWS AND COMPARISON TO COMPARABLE COMPENSATION DATA PREPARED BY A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT. THE MOST RECENT REVIEW TOOK PLACE IN OCTOBER 2022. OUTSIDE COUNSEL ASSISTS WITH THE REVIEW PROCESS AND DOCUMENTS THE DECISIONS OF THE COMMITTEE. FORM 990, PART VI, LINE 19 AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, & FINANCIAL STATEMENTS TO THE PUBLIC MGH'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST AND THE QHS' CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THIS TAX RETURN, AS REQUIRED. MGH DOES NOT MAKE THE CONFLICT OF INTEREST POLICY THAT IT FOLLOWS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS MINIMUM PENSION LIABILITY $ 145,381 FUND TRANSFER $ 17,641 ROUNDING $ (2) ----------- TOTAL $ 163,020 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:1079581 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION SERVICES TOTAL FEES:795911 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING SERVICES TOTAL FEES:45855 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASE SERVICES TOTAL FEES:1471063 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER SERVICES TOTAL FEES:6305 THE QUEEN'S HEALTH SYSTEMS 1301 PUNCHBOWL STREET HONOLULU HI 96813 990238120 ADMIN SVCS HI 501(c)(3) 12c NA false THE QUEEN'S MEDICAL CENTER 1301 PUNCHBOWL STREET HONOLULU HI 96813 990073524 MEDICAL SVCS HI 501(c)(3) 3 QHS true QUEEN EMMA LAND COMPANY 1301 PUNCHBOWL STREET HONOLULU HI 96813 990183769 SUPPORT SVCS HI 501(c)(3) 12a QHS true QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 96743 990260423 MEDICAL SVCS HI 501(c)(3) 3 QHS true QUEEN'S UNIVERSITY MEDICAL GROUP 1301 PUNCHBOWL STREET HONOLULU HI 96813 880820406 MED SVCS HI 501(c)(3) 7 QHS true HAMAMATSUQUEEN'S PET IMAGING 1301 PUNCHBOWL STREET HONOLULU HI 96813 943266916 PET IMAGING HI NA N/A PRIMARY CARE PHYSICIAN ENT LLC 1301 PUNCHBOWL STREET HONOLULU HI 96813 834591861 MEDICAL SERVICES HI NA N/A QUEEN'S DEVELOPMENT CORPORATION 1301 PUNCHBOWL STREET HONOLULU HI 96813 990240109 DEVELOPMENT HI NA C Corp true QUEEN'S INSURANCE EXCHANGE 1301 PUNCHBOWL STREET HONOLULU HI 96813 911913839 INSURANCE HI NA C Corp true DIAGNOSTIC LABORATORY SERVICES INC 99-859 IWAIWA STREET AIEA HI 96701 990240499 MEDICAL LAB SVCS HI NA C Corp true false false false false false false false false false false false true true false false true true false false THE QUEEN'S MEDICAL CENTER m 76116 FMV DIAGNOSTIC LABORATORY SERVICES p 1073166 FMV SCHEDULE R, PART III IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP HAMAMATSU/QUEEN'S PET IMAGING CENTER, LLC EIN: 94-3266916 ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 PRIMARY CARE PHYSICIAN ENTERPRISE LLC EIN: 83-4591861 ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 NAME: QUEEN EMMA LAND COMPANY ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 EIN: 99-0183769 EXPENSES: $36,308,169 501(H) ELECTION: YES SHARE OF EXCESS LOBBYING EXPENDITURES: $0 NAME: THE QUEEN'S HEALTH SYSTEMS ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 EIN: 99-0238120 EXPENSES: $161,938,198 501(H) ELECTION: YES SHARE OF EXCESS LOBBYING EXPENDITURES: $0 NAME: THE QUEEN'S MEDICAL CENTER ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 EIN: 99-0073524 EXPENSES: $1,462,863,437 501(H) ELECTION: YES SHARE OF EXCESS LOBBYING EXPENDITURES: $0 NAME: MOLOKAI GENERAL HOSPITAL ADDRESS: P.O. BOX 408 KAUNAKAKAI MOLOKAI, HI 96748 EIN: 99-0251372 EXPENSES: $14,274,856 501(H) ELECTION: YES SHARE OF EXCESS LOBBYING EXPENDITURES: $0 NAME: QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL ADDRESS: 67-1125 MAMALAHOA HIGHWAY KAMUELA, HI 96743 EIN: 99-0260423 EXPENSES: $114,634,705 501(H) ELECTION: NO SHARE OF EXCESS LOBBYING EXPENDITURES: $0 NAME: QUEEN'S UNIVERSITY MEDICAL GROUP ADDRESS: 1301 PUNCHBOWL STREET, HONOLULU, HI 96813 EIN: 88-0820406 EXPENSES: $0 501(H) ELECTION: NO SHARE OF EXCESS LOBBYING EXPENDITURES: $0