2023-05-16T00:03:25+00:00 2022-06-30 346565596 ERNST & YOUNG US LLP 4365 EXECUTIVE DRIVE SUITE 1600 SAN DIEGO CA 92121 990 2021-07-01 990322406 Kapi'olani Medical Specialists KAPI 8089838986 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 LESLIE CHUN MD CEO 2023-05-16 true CARRIE ANN TSUTSUI 999009999 JOCELYNE C MILLER P00634378 8585357200 2023-05-12 2021 2023-04-26 12:10:37Z HAWAI'I PACIFIC HEALTH MEDICAL GROUP LESLIE CHUN MD 1100 WARD STREET STE 1130 HONOLULU HI 96814 329136889 false X WWW.HAWAIIPACIFICHEALTH.ORG X 1995 HI SEE SCHEDULE O 9 5 1017 5 0 0 4973962 19157086 292692717 309962519 16410 17284 0 297683089 329136889 1000 5500 0 217941170 237203675 0 0 169734772 171980012 387676942 409189187 -89993853 -80052298 66271257 78117233 69591766 64704583 -3320509 13412650 SEE SCHEDULE O false false 388024955 5500 309962519 SEE SCHEDULE O 388024955 true false false true false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false false true false false false false false false true true true false false true X 0 0 1017 true false false false false false false false false false false false false X 9 5 true false false false true true true true true false false true true true true true true false true false CA HI X X JESSICA LI 8085357434 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 Gordon Hammond Board of Director, Chair 0.2 0 X X 0 0 0 Raymond P Vara Jr BOARD OF DIRECTOR & PRESIDENT 0.2 61.9 X X 0 2290034 2498142 Andrew Kawano Board of Director 0.2 0 X 0 0 0 Anne Dempsey MD Board of Director 0.2 40.0 X 325181 0 25149 Chris Eldridge Board of Director 0.2 0 X 0 0 0 David Cho MD Board of Director 0.2 40.0 X 552034 0 34040 Patrick O'Donnell MD Board of Director 40.0 0.3 X 591063 0 35040 Wayne Katayama Board of Director 0.2 0 X 0 0 0 Willow Morton Board of Director 0.2 0 X 0 0 0 Alan Ito Information Security Officer - part year 0.1 39.9 X 0 201298 32431 Arthur Gladstone EVP & CSO 0.0 55.0 X 0 906835 317125 Brandon Wong VP 0.0 47.0 X 0 185663 55129 Carrie Ann Tsutsui Vice President & System Controller 12.1 35.9 X 0 278287 78811 Charles R Ching EVP, General Counsel & Secretary 0.5 39.5 X 0 959131 268655 David Okabe EVP, CFO & Treasurer 3.0 47.0 X 0 953161 392126 David Stumbaugh VP 1.5 38.5 X 0 271257 85843 Dawn Dunbar SVP 0.1 44.9 X 0 403265 118270 Dean Tateyama VP 1.0 39.0 X 0 201171 40804 Douglas Kwock MD VP 1.0 39.0 X 0 507996 119013 Gerard Livaudais MD EVP (part year) 0.0 50.0 X 0 570789 181478 James Lin MD VP 2.0 45.6 X 0 335132 97482 Jennifer Jones VP 60.0 0 X 239100 0 74652 Jessica Lewis Assistant Corporate Secretary 2.5 37.5 X 0 168040 40849 John McNamara SVP & CMO 2.0 38.0 X 0 47283 1584 Katie Shigemitsu Compliance Officer 5.0 35.0 X 0 223318 32225 Leslie Chun MD CEO 45.0 15.0 X 0 785845 225311 Lorrie-Ann Luke VP 1.5 40.0 X 0 270752 88451 Louise Fukumoto VP 4.0 36.0 X 0 199148 35921 Melinda Ashton MD EVP & CQO 0.1 49.2 X 0 788781 260505 Michael Robinson VP 0.1 49.9 X 0 337891 85823 Peter Lewis VP & Chief Information Security Officer 0.1 39.9 X 0 135377 330 Reina (France) Graves Privacy Officer 1.2 38.8 X 0 250059 34768 Shilpa Patel MD Associate CQO 8.5 31.5 X 107179 209616 45382 Steven Robertson EVP & CIO 10.0 43.0 X 0 787444 299769 Sunshine Topping SVP 3.0 47.0 X 0 379753 113698 Susan Masumoto-Nonaka VP (part year) 0.1 39.9 X 0 522308 82373 Terence Young VP 38.0 22.0 X 0 282371 64220 Troy Branstetter VP 5.0 53.0 X 0 230736 37114 Warren Chaiko SVP 10.0 30.0 X 0 767486 120610 William Burke VP 12.0 42.0 X 0 302321 88324 Cass Nakasone MD PHYSICIAN 40.0 0 X 1532613 0 34040 Daniel Judd MD PHYSICIAN 40.0 0 X 888898 0 25734 Gregory Chow MD PHYSICIAN 40.0 0 X 1111680 0 27799 Mark Gerber MD PHYSICIAN 40.0 0 X 908445 0 20080 Sidney Johnson MD PHYSICIAN 40.0 0 X 860418 0 36425 Brandt Farias Former Officer 10.0 53.0 X 0 204094 80106 Gail Lerch Former Officer 3.0 48.0 X 0 486260 98582 Kenneth T Nakamura MD Former Officer 28.0 2.5 X 418723 0 21689 Martha Smith Former Officer 2.0 58.0 X 0 421044 263816 7535334 15863946 6719718 635 true true false UNIVERSITY OF HAWAI'I 2440 CAMPUS RD BOX 368 HONOLULU HI 96822 PHYSICIAN SERVICES 1533184 COMPHEALTH INC PO BOX 972651 DALLAS TX 753972651 PHYSICIAN SERVICES 867904 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SERVICES 622536 MITSUBISHI ELECTRIC US INC 5900-A KATELLA AVE CYPRESS CA 90630 MAINTENANCE SERVICES 591836 ERNST AND YOUNG LLP 1003 BISHOP ST STE 2600 HONOLULU HI 96813 ACCOUNTING SERVICES 212772 8 19157086 19157086 PATIENT SERVICE REVENUE 622110 30208613 30208613 SERVICE CONTRACTS 900099 6731526 6731526 INTER-ENTITY SERVICE REVENUE 622110 273022380 273022380 0 0 0 0 309962519 17284 17284 0 0 0 0 0 0 0 0 0 329136889 309962519 0 17284 5500 5500 1517065 1517065 429130 206257 222873 203697537 199326649 4370888 6267161 6101556 165605 15447299 8985882 6461417 9845483 9565049 280434 897834 897834 24377 24377 32687362 27011332 5676030 0 345 345 181968 132577 49391 335677 176645 159032 2929233 2765200 164033 918535 886985 31550 6535 3441 3094 237496 237496 374596 374596 14795498 14713216 82282 CONTRACT SERVICE HPHMG 115011044 115011044 OTHER PURCHASES 1733554 543282 1190272 MOVING EXPENSE 902827 902827 MEDICAL SUPPLIES 717750 375267 342483 225381 61539 163842 0 409189187 388024955 21164232 0 0 0 10134607 19828870 0 0 2450611 3845307 0 0 0 0 0 0 0 0 1730253 1606522 4301392 2672177 944147 1629215 0 0 1480023 1549309 0 0 0 49531616 49658010 66271257 78117233 26713971 23453157 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42877795 41251426 69591766 64704583 X -3345187 13387972 24678 24678 0 0 0 0 0 0 -3320509 13412650 66271257 78117233 X -80052298 0 0 0 0 96785457 X false true X true false X false false false false false false false false true 24377 24377 false Schedule C, Part II-B LOBBYING EXPENDITURES LOBBYING EXPENSES ARE THE PORTION OF AMOUNTS PAID TO HEALTHCARE ASSOCIATIONS THAT ENGAGED IN LEGISLATIVE LOBBYING ON BEHALF OF ITS MEMBERS. 299341 174607 124734 3061305 1660745 1400560 940746 836825 103921 1629215 VARIOUS DEFERRED CHARGES 27512183 DUE FROM STRAUB CLINIC & HOSP. 9011874 OPERATING LEASE 6166231 DUE FROM KAUA'I MEDICAL CLINIC 2507605 OTHER RECEIVABLES 1487940 DUE FROM KMCWC 1481309 DUE FROM HAWAI'I HLTH. PTNRS. 790826 DUE FROM WILCOX MEMORIAL HOSP. 392106 DUE FROM HPHRI 125963 DUE FROM STRAUB FOUNDATION 84412 DUE FROM PALI MOMI MED. CTR. 54915 DUE FROM PROVIDERS INS. CORP. 40414 ESCHEAT LIABILITY 1215 DUE TO CMS COVID PAYMENT 1017 49658010 457B LIABILITY 27364220 DUE TO HAWAI'I PACIFIC HEALTH 6876669 LONG-TERM OPERATING LEASE LIABILITY 5749550 SHORT-TERM OPERATING LEASE 1221455 DUE TO KAPI'OLANI HEALTH FOUNDATION 26304 DEFERRED TENANT IMPROVE ALLOW LESSEE 6545 CAPITAL ACCUMULATION LIABILITY 4631 DUE TO HONOLULU IMAGING CENTER 1866 DUE TO PALI MOMI FOUNDATION 100 DUE FROM THIRD PARTY 74 DUE TO WILCOX HEALTH FOUNDATION 12 DEFERRED PAYROLL TAX LIABILITY DUE TO CMS COVID PAYMENT DUE TO HONOLULU SURGERY CENTER ESCHEAT LIABILITY 41251426 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote UNCERTAIN TAX POSITIONS AUDITED FINANCIAL STATEMENT FOOTNOTE THE COMPANY HAS NOT RECORDED ANY EXPENSE OR ACCRUED FOR ANY RELATED EXPENSE FOR ANY UNCERTAIN TAX POSITIONS. THE COMPANY'S 2018 THROUGH 2021 TAX YEARS REMAIN SUBJECT TO EXAMINATION FOR FEDERAL INCOME TAX PURPOSES, WHEREAS THE 2017 THROUGH 2021 TAX YEARS REMAIN SUBJECT TO EXAMINATION FOR STATE TAXING JURISDICTIONS IN WHICH THE COMPANY OPERATES. false true false false false false false false false Raymond P Vara Jr BOARD OF DIRECTOR & PRESIDENT 0 1088746 0 579773 0 621515 0 2470732 0 27410 0 4788176 0 615303 David Cho MD Board of Director 513626 0 15773 0 22635 0 11600 0 22440 0 586074 0 0 0 Anne Dempsey MD Board of Director 287128 0 7297 0 30756 0 11600 0 13549 0 350330 0 0 0 Patrick O'Donnell MD Board of Director 557044 0 2957 0 31062 0 11600 0 23440 0 626103 0 0 0 Brandt Farias Former Officer 0 121482 0 61243 0 21369 0 74371 0 5735 0 284200 0 49137 Gail Lerch Former Officer 0 433599 0 0 0 52661 0 91102 0 7480 0 584842 0 176018 Kenneth T Nakamura MD Former Officer 162508 0 28457 0 227758 0 8140 0 13549 0 440412 0 0 0 Martha Smith Former Officer 0 146322 0 124419 0 150303 0 258378 0 5438 0 684860 0 207350 Melinda Ashton MD EVP & CQO 0 455308 0 194229 0 139244 0 244499 0 16006 0 1049286 0 168964 Troy Branstetter VP 0 188888 0 13431 0 28417 0 29634 0 7480 0 267850 0 0 William Burke VP 0 231178 0 44764 0 26379 0 71139 0 17185 0 390645 0 16974 Warren Chaiko SVP 0 259893 0 67444 0 440149 0 92906 0 27704 0 888096 0 54113 Charles R Ching EVP, General Counsel & Secretary 0 431400 0 135036 0 392695 0 252886 0 15769 0 1227786 0 185998 Leslie Chun MD CEO 0 519567 0 180626 0 85652 0 200623 0 24688 0 1011156 0 86619 Dawn Dunbar SVP 0 290624 0 74468 0 38173 0 93610 0 24660 0 521535 0 59749 Louise Fukumoto VP 0 176638 0 17733 0 4777 0 20815 0 15106 0 235069 0 0 Arthur Gladstone EVP & CSO 0 503226 0 189772 0 213837 0 292071 0 25054 0 1223960 0 199456 Reina (France) Graves Privacy Officer 0 248960 0 0 0 1099 0 12228 0 22540 0 284827 0 0 Alan Ito Information Security Officer - part year 0 144850 0 18144 0 38304 0 17782 0 14649 0 233729 0 0 Jennifer Jones VP 186362 0 33649 0 19089 0 49592 0 25060 0 313752 0 12372 0 Douglas Kwock MD VP 0 392692 0 75632 0 39672 0 94688 0 24325 0 627009 0 49637 Jessica Lewis Assistant Corporate Secretary 0 167315 0 0 0 725 0 14873 0 25976 0 208889 0 0 James Lin MD VP 0 256939 0 52655 0 25538 0 73078 0 24404 0 432614 0 19200 Gerard Livaudais MD EVP (part year) 0 374236 0 126878 0 69675 0 172318 0 9160 0 752267 0 81450 Lorrie-Ann Luke VP 0 207351 0 39718 0 23683 0 63397 0 25054 0 359203 0 31859 Susan Masumoto-Nonaka VP (part year) 0 207594 0 51419 0 263295 0 74942 0 7431 0 604681 0 41245 David Okabe EVP, CFO & Treasurer 0 546669 0 170726 0 235766 0 376357 0 15769 0 1345287 0 226880 Shilpa Patel MD Associate CQO 21271 129013 0 991 85908 79612 6006 16936 13090 9350 126275 235902 0 0 Steven Robertson EVP & CIO 0 444593 0 169121 0 173730 0 284000 0 15769 0 1087213 0 177390 Michael Robinson VP 0 260167 0 49180 0 28544 0 75992 0 9831 0 423714 0 39448 Katie Shigemitsu Compliance Officer 0 183738 0 0 0 39580 0 23057 0 9168 0 255543 0 0 David Stumbaugh VP 0 212851 0 40836 0 17570 0 62403 0 23440 0 357100 0 32756 Dean Tateyama VP 0 181497 0 18285 0 1389 0 21464 0 19340 0 241975 0 0 Sunshine Topping SVP 0 280785 0 68850 0 30118 0 89038 0 24660 0 493451 0 0 Carrie Ann Tsutsui Vice President & System Controller 0 214570 0 41321 0 22396 0 65763 0 13048 0 357098 0 18347 Brandon Wong VP 0 169022 0 15905 0 736 0 32689 0 22440 0 240792 0 0 Terence Young VP 0 222718 0 40284 0 19369 0 54856 0 9364 0 346591 0 12298 Gregory Chow MD PHYSICIAN 1006800 0 2658 0 102222 0 11600 0 16199 0 1139479 0 0 0 Mark Gerber MD PHYSICIAN 853882 0 2501 0 52062 0 11600 0 8480 0 928525 0 0 0 Sidney Johnson MD PHYSICIAN 721464 0 29134 0 109820 0 11600 0 24825 0 896843 0 0 0 Daniel Judd MD PHYSICIAN 846373 0 2343 0 40182 0 2900 0 22834 0 914632 0 0 0 Cass Nakasone MD PHYSICIAN 1245888 0 1714 0 285011 0 11600 0 22440 0 1566653 0 0 0 Schedule J, Part I, Line 3 SUPPLEMENTAL COMPENSATION INFORMATION 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 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 MARTHA SMITH - $58,273 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 MARTHA SMITH - $124,419 BRANDT FARIAS - $61,243 JENNIFER JONES - $32,649 TERENCE YOUNG - $37,784 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 JANNY CHEN MD SEE PART V 203387 PHYSICIAN COMPENSATION false SUSAN LIN MD SEE PART V 263201 PHYSICIAN COMPENSATION false CAMNHUNG NGUYEN MD SEE PART V 164848 PHYSICIAN COMPENSATION false Schedule L, Part IV, Column (b) JANNY CHEN, M.D. IS A FAMILY MEMBER OF DAVID CHO, M.D., A CURRENT MEMBER OF THE BOARD OF DIRECTORS. SUSAN LIN, M.D. IS A FAMILY MEMBER OF LESLIE CHUN, M.D., CHIEF EXECUTIVE OFFICER. CAMNHUNG NGUYEN, M.D. IS A FAMILY MEMBER OF JAMES LIN, M.D., VICE PRESIDENT, INFORMATION TECHNOLOGY. Form 990, Part I, Line 1 brief mission KAPI'OLANI MEDICAL SPECIALISTS, AN AFFILIATE OF HAWAI'I PACIFIC HEALTH, IS A PROVIDER GROUP THAT SERVES HAWAI'I PACIFIC HEALTH THROUGH ACADEMICS, RESEARCH AND CLINICAL CARE, IN PARTNERSHIP WITH KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN, PALI MOMI MEDICAL CENTER, STRAUB MEDICAL CENTER, AND WILCOX HEALTH. Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION KAPI'OLANI MEDICAL SPECIALISTS (DBA HAWAI'I PACIFIC HEALTH MEDICAL GROUP) HAS OVER 658 EMPLOYED FTE PROVIDERS AND IS ORGANIZED BY THE FOLLOWING SPECIALTIES: PRIMARY CARE, MEDICAL SUBSPECIALTIES, SURGERY, WOMEN'S HEALTH, HOSPITAL BASED MEDICINE, AND PEDIATRICS. IN FISCAL YEAR 2022, KAPI'OLANI MEDICAL SPECIALISTS (DBA HAWAI'I PACIFIC HEALTH MEDICAL GROUP) HAD 1,642,072 PATIENT ENCOUNTERS. KAPI'OLANI MEDICAL SPECIALISTS (DBA HAWAI'I PACIFIC HEALTH MEDICAL GROUP) ALLIES WITH THE UNIVERSITY OF HAWAI'I JOHN A. BURNS SCHOOL OF MEDICINE, IN ADHERENCE TO ITS CORE VALUES OF WORLD-CLASS HEALTH CARE, PHYSICIAN TRAINING, AND MEDICAL RESEARCH. THIS PARTNERSHIP PROVIDES A UNIQUE ACADEMIC AFFILIATION FOR HAWAI'I PACIFIC HEALTH AND FURTHERS ITS COMMITMENT TO EFFECTIVE HEALTH CARE THROUGH MEDICAL RESEARCH AND BY TRAINING TOMORROW'S HEALTH CARE PROVIDERS. KAPI'OLANI MEDICAL SPECIALISTS (DBA HAWAI'I PACIFIC HEALTH MEDICAL GROUP) HAS DEVELOPED A VARIETY OF WAYS TO IDENTIFY AND MEET THE UNIQUE HEALTH CARE NEEDS OF HAWAI'I. KAPI'OLANI MEDICAL SPECIALISTS RECRUITS PHYSICIANS FROM THROUGHOUT THE NATION WHO DESIRE EMPLOYMENT IN A GROUP PRACTICE SETTING WITH HAWAI'I'S LEADING HEALTH CARE SYSTEM, ESPECIALLY SUB-SPECIALISTS IN SHORT SUPPLY, YET HIGH DEMAND. KAPI'OLANI MEDICAL SPECIALISTS PHYSICIANS PROVIDE ESSENTIAL SERVICES AT OTHER HOSPITALS IN THE STATE OF HAWAI'I, I.E., NEONATAL SERVICES AT THE QUEEN'S MEDICAL CENTER, CLINICS AT TRIPLER ARMY MEDICAL CENTER, AND SPECIALTY SERVICES AT KAISER PEMANENTE LOCATIONS. ADDITIONALLY, THEY PROVIDE PATIENT CARE AT OUTREACH CLINICS AND COMMUNITY HEALTH CENTERS THROUGHOUT HAWAI'I, PROMOTE LESSER-KNOWN SERVICES TO PATIENTS WITH SPECIAL NEEDS, PROVIDE HEALTH EDUCATION ON THE NEIGHBOR ISLANDS AND HEALTH CARE TRAINING TO THE COMMUNITY AND OTHER PROVIDERS, AND SERVE AS MEDICAL DIRECTORS ON VARIOUS COMMUNITY BOARDS. CARING FOR THE UNDERSERVED, A LONG-STANDING TRADITION OF ACADEMIC MEDICAL CENTERS THROUGHOUT THE NATION, CONTINUES TO BE A MAJOR FOCUS OF KAPI'OLANI MEDICAL SPECIALISTS. IN FISCAL YEAR 2022, THE GROUP PROVIDED $294,176,073 IN MEDICAL CARE TO PATIENTS IN NEED OF MEDICAL SERVICES. Form 990, Part III, Line 1 ORGANIZATION'S MISSION KAPI'OLANI MEDICAL SPECIALISTS (DBA HAWAI'I PACIFIC HEALTH MEDICAL GROUP) IS A MULTI-SPECIALTY PROVIDER GROUP DEDICATED TO PROVIDING WORLD-CLASS CARE FOR HAWAI'I'S ADULTS AND CHILDREN THROUGH ACADEMICS, RESEARCH AND CLINICAL CARE. WORKING IN PARTNERSHIP WITH KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN, PALI MOMI MEDICAL CENTER, STRAUB MEDICAL CENTER, AND WILCOX HEALTH, THE GROUP'S MISSION IS TO CREATE A HEALTHIER HAWAI'I. 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 JESSICA LEWIS AND PETER LEWIS - Family relationship Form 990, Part VI, Line 6 Classes of members or stockholders HAWAI'I PACIFIC HEALTH (HPH) IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO APPROVE CERTAIN 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 ELECT 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 HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS THE FOLLOWING RESERVED POWERS: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE CHIEF MEDICAL OFFICER, DIRECTOR OF OPERATIONS, TREASURER, SECRETARY, EXECUTIVE VP/CFO, OTHER EXCUTIVE VP'S, SENIOR VP, ASSISTANT SECRETARIES, AND ALL VP'S EXCEPT THE OPERATING UNIT VP'S, AS SUCH TERMS ARE DEFINED IN THESE BYLAWS; (II) 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; (III) AMEND THESE BYLAWS; (IV) THE CORPORATION'S PARTICIPATION IN ALL LONG-TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF 1 YEAR AND/OR FOR $1,000,000 OR MORE; (V) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (VI) DIRECT, MANAGE AND CONTROL THE CUSTODY, THE ADVISORY SERVICE AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (VII) EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (VIII) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S PHYSICIAN AND EXECUTIVE COMPENSATION AND BENEFIT PLANS; (IX) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, OR PARTNERSHIP OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (X) EXCEPT AS PROVIDED IN SECTION 3.2(C) OF THE BYLAWS OR AS REQUIRED BY THE LAWS OF THE STATE OF HAWAI'I, SELL, LEASE OR OTHERWISE TRANSFER 50 OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY THE CORP; (XI) EXCEPT AS PROVIDED IN SECTION 3.2(C) OF THE BYLAWS OR AS REQUIRED BY THE LAWS OF THE STATE OF HAWAI'I, SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE CORPORATION WHICH GENERATE 50 OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE CORPORATION DURING THE PRIOR FISCAL YEAR; (XII) CLOSE THE CLINICAL FACILITIES OWNED AND OPERATED BY THE CORPORATION; PROVIDED THAT AFTER THE EFFECTIVE DATE OF THESE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORP MUST ALSO BE APPROVED BY THE BOARD; (XIII) CONVERT THE CLINICAL FACILITIES OWNED AND OPERATED BY THE CORPORATION INTO A FACILITY NO LONGER OFFERING MEDICAL SERVICES; PROVIDED THAT AFTER THE EFFECTIVE DATE OF THESE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORPORATION MUST ALSO BE APPROVED BY THE BOARD; (XIV) AFTER CONSULTING WITH THE BOARD, REMOVE THE CHIEF MEDICAL OFFICER, DIRECTOR OF OPERATIONS, EXECUTIVE VP/CFO, TREASURER, SECRETARY, OTHER EXECUTIVE VP'S, SENIOR VP'S, ASSISTANT SECRETARIES, AND ALL VP'S EXCEPT THE OPERATING UNIT VP'S; PROVIDED, HOWEVER, THAT TO REMOVE OR TERMINATE THE CHIEF MEDICAL OFFICER WILL REQUIRE THE CHIEF MEDICAL 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 CHIEF MEDICAL OFFICER, SUCH REMOVAL OR TERMINATION WILL REQUIRE THE APPROVAL OF A MAJORITY OF THE MEMBERS ON THE MEMBER BOARD; (XV) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORPORATION GOALS AND THE LONG RANGE AND STRATEGIC PLANS OF THE CORPORATION; AND (XVI) AFTER CONSULTING WITH THE BOARD, DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. IN ADDITION, DECISIONS OF THE GOVERNING BODY REQUIRING THE APPROVAL OF HAWAI'I PACIFIC HEALTH, AS MEMBER, INCLUDE: (I) ADD ANY DIRECTOR TO THE BOARD; (II) REMOVE ANY DIRECTOR FROM THE BOARD; (III) AMEND THE ARTICLES; (IV) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS ON BEHALF OF THE CORPORATION EXCEEDING $1,000,000 IN VALUE; (V) ACQUIRE ASSETS WORTH OVER $1,000,000; (VI) AQUIRE SHARES IN ANOTHER CORPORATION; (VII) SELL, LEASE OR OTHERWISE TRANSFER 50 OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER THE GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY THE CORPORATION; (VIII) SELL, LEASE, EXCHANGE OR DISPOSE OF 50 OR MORE OF THE THEN PROPERTY AND ASSETS HELD BY THE CORPORATION; (IX) SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE CORPORATION WHICH GENERATE 50 OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE CORPORATION DURING THE PRIOR FISCAL YEAR; (X) MERGE THE CORPORATION WITH ANY ENTITY; (XI) DISSOLVE OR LIQUIDATE THE CORPORATION; (XII) ISSUE THE CORPORATION'S MEMBERSHIP TO ANY OTHER THAN THE MEMBER; (XIII) FORM A JOINT VENTURE OR OTHER BUSINESS RELATIONASHIP (OTHER THAN THE ORDINARY COURSE OF BUSINESS CONTRACTS) BETWEEN THE CORPORATION AND ANY PERSON OR ENTITY; AND (XIV) DEVELOP A NEW LINE OF BUSINESS 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 SYTEM REVIEWS THE FORM 990 OF EACH FILLING 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 HPH BOARD OF DIRECTORS THROUGH A BOARD PORTAL FOR REVIEW PRIOR TO THE FILING OF THE FORM 990. COPIES OF THE FORMS 990 ARE MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND IS PHYSICALLY LOCATED AT EACH FACILITY'S SITE FOR THE BOARD MEMBER TO REVIEW PRIOR TO FILING. 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 UNDERSTAND THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; 4) HAS DISCLOSED ANY CONFLICTS OR POTENTIAL CONFLICTS OR ECONOMIC INTERESTS AS REQUIRED; AND 5) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, THE ORGANIZATION MUST ENGAGE PRIMARILY IN ACTIVITES 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 TOP MANAGEMENT OFFICIALS OF THE ORGANIZATION ARE 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 TOP MANAGEMENT OFFICIAL'S COMPENSATION. COMPENSATION FOR HPH EXECUTIVES (VP AND ABOVE) IS SET BY THE INDEPENDENT BOARD MEMBERS WHO ARE MEMBERS OF THE HPH COMPENSATION COMMITTEE. ON AN ANNUAL BASIS, THE HPH BOARD CHAIRPERSON (WHO IS INDEPENDENT) SELECTS A NEUTRAL THIRD PARTY EXECUTIVE COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVE'S 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. 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 LAST 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 XI, Line 9 Other changes in net assets or fund balances EQUITY TRANSFER WITH HPH - 96785457; 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 true KAPI'OLANI MED CTR FOR WOMEN & CHILDREN 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990177350 HOSPITAL HI 501(c)(3) 3 HPH true KAUA'I MEDICAL CLINIC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990326099 HOSPITAL HI 501(c)(3) 3 HPH true PALI MOMI FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 383840327 FUNDRAISING HI 501(c)(3) 7 HPH true PALI MOMI MEDICAL CENTER 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990274038 HOSPITAL HI 501(c)(3) 3 HPH true PROVIDERS INSURANCE COMPANY 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 INSURANCE HI 501(c)(3) Type II HPH true STRAUB CLINIC & HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 912151670 HOSPITAL HI 501(c)(3) 3 HPH true STRAUB FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990109350 FUNDRAISING HI 501(c)(3) 7 HPH true WILCOX HEALTH FOUNDATION 3-3420 KUHIO HIGHWAY LIHUE HI 96766 990204242 FUNDRAISING HI 501(c)(3) 7 HPH true WILCOX MEMORIAL HOSPITAL 3-3420 KUHIO HIGHWAY LIHUE HI 96766 990074365 HOSPITAL HI 501(c)(3) 3 HPH true HONOLULU SURGERY CENTER LP 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 621506645 AMBU. SURG. CENTER TN NA N/A SPECIALTY SURGICAL SUITES LLC 1401 S BERETANIA STREET SUITE 750 HONOLULU HI 96814 461674512 AMBU. SURG. CENTER HI N/A 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 false false true false false false false false false false false false false false true true true true true KAPI'OLANI MED CTR FOR WOMEN & CHILDREN Q 4386063 FMV KAPI'OLANI MED CTR FOR WOMEN & CHILDREN P 19849180 FMV PALI MOMI MEDICAL CENTER Q 1299307 FMV PALI MOMI MEDICAL CENTER P 6426300 FMV STRAUB CLINIC & HOSPITAL Q 11025643 FMV STRAUB CLINIC & HOSPITAL S 128151 FMV STRAUB CLINIC & HOSPITAL P 108884102 FMV STRAUB CLINIC & HOSPITAL R 117508 FMV WILCOX MEMORIAL HOSPITAL Q 4146138 FMV WILCOX MEMORIAL HOSPITAL P 7735107 FMV KAUA'I MEDICAL CLINIC S 114300 FMV KAUA'I MEDICAL CLINIC P 31995421 FMV PROVIDERS INSURANCE CORPORATION R 13521775 FMV