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KAUAI MEDICAL CLINIC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
KAUAI MEDICAL CLINIC (EIN 99-0326099)
Tax period
2020-07-01 to 2021-06-30
Filed
2022-05-12
IRS object ID
202241329349306994
Schema version
2020v4.1
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

FieldValueIRS element (for citing)
Return2022-05-12T15:48:49-05:00ReturnTs
Tax Period End2021-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line14365 EXECUTIVE DR STE 1600AddressLine1Txt
CitySAN DIEGOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP92121ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN990326099EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Kaua'i Medical ClinicBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% DEBRA TUQUEROInCareOfNm
Business Name ControlKAUABusinessNameControlTxt
Phone8082451500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line155 MERCHANT STREET 24TH FLOORAddressLine1Txt
CityHONOLULUCityNm
State AbbreviationHIStateAbbreviationCd
ZIP96813ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCARRIE ANN TSUTSUIPersonNm
Person TitleVP AND CONTROLLERPersonTitleTxt
Phone8082451500PhoneNum
Signature2022-05-10SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstCARRIE ANNPersonFirstNm
Person LastTSUTSUIPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOCELYNE C MILLERPreparerPersonNm
PTINP00634378PTIN
Phone8585357200PhoneNum
Preparation2022-05-05PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJENNIE CHAHANOVICHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line155 MERCHANT STREET 24TH FLOORAddressLine1Txt
CityHONOLULUCityNm
State AbbreviationHIStateAbbreviationCd
ZIP96813ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$63,113,020GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.hawaiipacifichealth.org/wilcoxWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1967FormationYr
Legal Domicile StateHILegalDomicileStateCd
Activity Or MissionKAUA'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 Body7VotingMembersGoverningBodyCnt
Voting Members Independent3VotingMembersIndependentCnt
Total Employee189TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$932,983PYContributionsGrantsAmt
CY Contributions Grants$5,846CYContributionsGrantsAmt
PY Program Service Revenue$51,970,360PYProgramServiceRevenueAmt
CY Program Service Revenue$63,106,352CYProgramServiceRevenueAmt
PY Investment Income-$19,896PYInvestmentIncomeAmt
CY Investment Income$822CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$52,883,447PYTotalRevenueAmt
CY Total Revenue$63,113,020CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$28,896,592PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,783,170CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$34,332,664PYOtherExpensesAmt
CY Other Expenses$52,479,850CYOtherExpensesAmt
PY Total Expenses$63,229,256PYTotalExpensesAmt
CY Total Expenses$63,263,020CYTotalExpensesAmt
PY Revenues Less Expenses-$10,345,809PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$150,000CYRevenuesLessExpensesAmt
Total Assets BOY$23,684,775TotalAssetsBOYAmt
Total Assets EOY$25,849,919TotalAssetsEOYAmt
Total Liabilities BOY$13,423,134TotalLiabilitiesBOYAmt
Total Liabilities EOY$13,717,672TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$10,261,641NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$12,132,247NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionKAUA'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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$61,993,372ExpenseAmt
Grant$0GrantAmt
Revenue$63,106,352RevenueAmt
DescSee schedule ODesc
Total Program Service Expenses$61,993,372TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtYes (true)CollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee189EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member3IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
States Where Copy Of Return Is FldHIStatesWhereCopyOfReturnIsFldCd
Own WebsiteYes (X)OwnWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonDEBRA TUQUEROPersonNm
Phone8085357284PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line155 MERCHANT STREET 24TH FLOORAddressLine1Txt
CityHONOLULUCityNm
State AbbreviationHIStateAbbreviationCd
ZIP96813ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (40 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
RAYMOND P VARA JR
BOARD OF DIRECTOR, PRESIDENT2.060.1Yes (X)Yes (X)$0$2,201,810$2,584,503
DAVID OKABE
EVP, CFO & TREASURER1.049.0Yes (X)$0$946,332$377,896
ARTHUR GLADSTONE
EVP & CSO0.255.6Yes (X)$0$816,310$309,387
CHARLES R CHING
EVP, GEN COUNSEL & SECRETARY0.539.5Yes (X)$0$770,901$282,179
GAIL LERCH
FORMER OFFICER0.550.5$0$742,339$304,514Yes (X)
STEVEN ROBERTSON
EVP & CIO0.053.0Yes (X)$0$746,792$292,161
MELINDA ASHTON MD
EVP & CHIEF QUALITY OFFICER0.149.2Yes (X)$0$720,839$248,689
JENNIE CHAHANOVICH
CEO10.046.5Yes (X)$0$660,280$228,096
LESLIE CHUN MD
EVP1.059.0Yes (X)$0$664,477$114,056
GERARD LIVAUDAIS MD
EVP0.149.9Yes (X)$0$523,145$123,914
DOUGLAS KWOCK MD
VP1.039.0Yes (X)$0$492,064$95,971
KENNETH B ROBBINS MD
FORMER OFFICER6.548.5$0$346,070$178,446Yes (X)
DAWN DUNBAR
SVP0.045.0Yes (X)$0$393,438$104,947
WARREN CHAIKO
SVP1.039.0Yes (X)$0$375,732$110,606
Susan Matsumoto-Nonaka
VP0.539.5Yes (X)$0$364,629$81,441
GERI YOUNG MD
CMO (PART YEAR)20.025.3Yes (X)$0$407,043$37,407
JAY MURPHY MD
BOARD OF DIRECTOR40.00.0Yes (X)$0$399,952$32,931
BRANDT FARIAS
SVP (PART YEAR)0.162.9Yes (X)$0$327,384$85,944
MICHAEL ROBINSON
VP0.249.8Yes (X)$0$327,479$74,190
JAMES LIN MD
VP0.147.5Yes (X)$0$313,223$66,003
EARL INOUYE
FORMER OFFICER1.047.0$0$285,145$69,530Yes (X)
DAVID STUMBAUGH
VP1.538.5Yes (X)$0$266,339$79,167
LORRIE-ANN LUKE
VP0.541.5Yes (X)$0$259,855$82,613
WILLIAM BURKE
VP0.054.0Yes (X)$0$277,031$60,631
ROBERT WOTRING II MD
BOARD OF DIRECTOR, CHAIR40.00.0Yes (X)Yes (X)$0$311,587$18,715
SUNSHINE TOPPING
SVP0.549.5Yes (X)$0$289,279$21,615
THOMAS HEMINGWAY
BOARD OF DIRECTOR (PART YEAR)40.00.0Yes (X)$0$257,706$27,305
CARRIE ANN TSUTSUI
VP & CONTROLLER0.147.9Yes (X)$0$230,878$53,413
KATIE SHIGEMITSU
COMPLIANCE OFFICER0.539.5Yes (X)$0$224,686$38,125
EUGENE TARESHAWTY
BOARD OF DIRECTOR40.00.0Yes (X)$0$237,307$9,563
ALAN ITO
INFORMATION SECURITY OFFICER0.139.9Yes (X)$0$200,273$35,376
JESSICA LEWIS
ASSISTANT CORPORATE SECRETARY2.537.5Yes (X)$0$170,876$40,404
DAVID FOX
PRIVACY OFFICER (PART YEAR)1.538.5Yes (X)$0$163,615$32,106
FRANCE GRAVES
PRIVACY OFFICER1.538.5Yes (X)$0$108,993$33,530
DONNA WICHIMAI
MANAGER40.00.0$109,477$0$22,348Yes (X)
AMBER ELKINGTON
MANAGER40.00.0$101,819$0$29,033Yes (X)
HELEN COX
BOARD OF DIRECTOR0.20.0Yes (X)$0$0$0
SANDI KATO-KLUTKE
BOD, VICE CHAIR (PART YEAR)0.20.0Yes (X)Yes (X)$0$0$0
MIKE MURAKOSHI
BOARD OF DIRECTOR0.20.0Yes (X)$0$0$0
DENISE ROBERTS
BOARD OF DIRECTOR0.20.0Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$13,940,196TotReportableCompRltdOrgAmt
Total Other Compensation$6,043,937TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PHILIPS HEALTH CARE
3000 MINUTEMAN RD TAX DEPARTMENTANDOVERMA01810MEDICAL SERVICES$179,000
OAHU AIR CONDITIONING SERVICE
PO BOX 17010HONOLULUHI96817Maintenance Services$120,973
SHIOI CONSTRUCTION INC
PO BOX 963KILAUEAHI96754CONSTRUCTION SVCS.$107,087
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$5,846GovernmentGrantsAmt
Total Contributions$5,846TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT REVENUE622110$34,383,769$34,383,769
PREMIUM REVENUE622110$9,648,598$9,648,598
INTER-ENTITY SERVICE REVENUE622110$17,283,187$17,283,187
OTHER HEALTH CARE REVENUE622110$1,409,582$1,409,582
RENTAL INCOME900099$146,476$146,476

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$234,740TotalRevenueColumnAmt
Related Or Exempt Func Income$234,740RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$63,106,352TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$822TotalRevenueColumnAmt
Exclusion$822ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$63,113,020TotalRevenueColumnAmt
Related Or Exempt Func Income$63,106,352RelatedOrExemptFuncIncomeAmt
Exclusion$822ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,016,410TotalAmt
Program Services$7,534,896ProgramServicesAmt
Management And General$481,514ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$568,416TotalAmt
Program Services$547,222ProgramServicesAmt
Management And General$21,194ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,606,458TotalAmt
Program Services$1,252,064ProgramServicesAmt
Management And General$354,394ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$591,886TotalAmt
Program Services$556,982ProgramServicesAmt
Management And General$34,904ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$23,787TotalAmt
Management And General$23,787ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$852,197TotalAmt
Program Services$686,706ProgramServicesAmt
Management And General$165,491ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$157TotalAmt
Program Services$157ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$205,257TotalAmt
Program Services$167,217ProgramServicesAmt
Management And General$38,040ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$60,581TotalAmt
Program Services$60,443ProgramServicesAmt
Management And General$138ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,287,971TotalAmt
Program Services$1,186,351ProgramServicesAmt
Management And General$101,620ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$3,468TotalAmt
Program Services$2,338ProgramServicesAmt
Management And General$1,130ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$11,900TotalAmt
Program Services$11,900ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,082,562TotalAmt
Program Services$1,082,562ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$20,714TotalAmt
Management And General$20,714ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
INTER ENTITY PURCHASED SVCS.$45,808,364$45,808,364
MEDICAL SUPPLIES$3,071,236$3,063,291$7,945
MEMBERSHIP DUES$5,307$5,307
GENERAL EXCISE TAX$9,362$3,532$5,830

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$36,987TotalAmt
Program Services$24,040ProgramServicesAmt
Management And General$12,947ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$63,263,020TotalAmt
Program Services$61,993,372ProgramServicesAmt
Management And General$1,269,648ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,152,341BOYAmt
EOY$1,147,897EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$2,472,985BOYAmt
EOY$4,327,913EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,246,475BOYAmt
EOY$2,969,833EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$21,624,395LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$11,354,330LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$10,622,797BOYAmt
EOY$10,270,065EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$7,190,177BOYAmt
EOY$7,134,211EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$23,684,775BOYAmt
EOY$25,849,919EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,591,405BOYAmt
EOY$1,761,363EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$11,831,729BOYAmt
EOY$11,956,309EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,423,134BOYAmt
EOY$13,717,672EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$10,261,641BOYAmt
EOY$12,132,247EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$10,261,641BOYAmt
EOY$12,132,247EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$23,684,775BOYAmt
EOY$25,849,919EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$150,000ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$2,020,606OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

Art Public Exhibition Amounts ArtPublicExhibitionAmountsGrp

FieldValueIRS element (for citing)
Assets Included$45,768AssetsIncludedAmt
FieldValueIRS element (for citing)
Held Works ArtHeldWorksArtGrp
Collection Used Pub ExhibitionYes (X)CollectionUsedPubExhibitionInd
Solicited Assets SalefalseSolicitedAssetsSaleInd
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$634,097OtherCostOrOtherBasisAmt
Book Value$634,097BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,514,768OtherCostOrOtherBasisAmt
Depreciation$479,568DepreciationAmt
Book Value$2,035,200BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,919,446OtherCostOrOtherBasisAmt
Depreciation$3,534,050DepreciationAmt
Book Value$5,385,396BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,431,928OtherCostOrOtherBasisAmt
Depreciation$7,335,609DepreciationAmt
Book Value$2,096,319BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$124,156OtherCostOrOtherBasisAmt
Depreciation$5,103DepreciationAmt
Book Value$119,053BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$10,270,065TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (10 entries)

DescDescBook ValueBookValueAmt
OPERATING LEASE$6,480,144
DUE FROM GOVERNMENT AGENCIES$218,213
OTHER RECEIVABLES$144,211
DUE FROM PROVIDERS INSR. CORP.$90,577
PREPAID & OTHER CURRENT ASSETS$65,688
DEPOSITS AND OTHER NON-CURRENT$51,130
DECORATIVE ARTWORK$45,768
DUE FROM HHP$28,543
DUE FROM HPH RSRCH. INSTITUTE$7,809
DUE FROM PALI MOMI MED. CENTER$2,128
FieldValueIRS element (for citing)
Total Book Value Other Assets$7,134,211TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (14 entries)

DescDescAmtAmt
LT OPERATING LEASE LIABILITY$6,663,217
ST OPERATING LEASE LIABILITY$577,167
DEFERRED PAYROLL TAX$144,643
ESCHEAT LIABILITY$9,819
DUE TO HPH MEDICAL GROUP$2,690,594
DUE TO CMS (COVID PAYMENT)$1,029,878
DUE TO HAWAI'I PACIFIC HEALTH$615,573
DUE TO WILCOX MEMORIAL HOSPITAL$122,053
DUE TO STRAUB CLINIC & HOSPITAL$49,715
DUE TO KAPI'OLANI MEDICAL CENTER WOMEN AND CHILDREN$42,095
DUE TO KAPI'OLANI MEDICAL SPECIALISTS$2,399
DUE TO KAPI'OLANI HEALTH FOUNDATION$8,959
DUE TO PALI MOMI FOUNDATION$9
DUE TO STRAUB FOUNDATION$188
FieldValueIRS element (for citing)
Total Liability$11,956,309TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART III, LINE 4ORGANIZATION'S ART COLLECTION 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 2Uncertain 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 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

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (33 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
RAYMOND P VARA JR
BOARD OF DIRECTOR, PRESIDENT$0$1,110,173$0$372,487$0$719,150$0$2,558,309$0$26,194$0$4,786,313$0$593,274
DAVID OKABE
EVP, CFO & TREASURER$0$553,990$0$132,543$0$259,799$0$362,800$0$15,096$0$1,324,228$0$224,487
ARTHUR GLADSTONE
EVP & CSO$0$516,857$0$128,098$0$171,355$0$285,469$0$23,918$0$1,125,697$0$195,252
CHARLES R CHING
EVP, GEN COUNSEL & SECRETARY$0$436,925$0$104,835$0$229,141$0$262,171$0$20,008$0$1,053,080$0$164,297
GAIL LERCH
FORMER OFFICER$0$448,776$0$107,316$0$186,247$0$294,796$0$9,718$0$1,046,853$0$176,006
STEVEN ROBERTSON
EVP & CIO$0$450,338$0$108,006$0$188,448$0$276,365$0$15,796$0$1,038,953$0$172,460
MELINDA ASHTON MD
EVP & CHIEF QUALITY OFFICER$0$467,643$0$111,972$0$141,224$0$233,089$0$15,600$0$969,528$0$169,135
JENNIE CHAHANOVICH
CEO$0$381,818$0$99,404$0$179,058$0$215,398$0$12,698$0$888,376$0$133,412
LESLIE CHUN MD
EVP$0$532,633$0$83,827$0$48,017$0$90,427$0$23,629$0$778,533$0$0
GERARD LIVAUDAIS MD
EVP$0$410,238$0$78,825$0$34,082$0$108,525$0$15,389$0$647,059$0$71,310
DOUGLAS KWOCK MD
VP$0$407,043$0$48,037$0$36,984$0$73,862$0$22,109$0$588,035$0$45,958
KENNETH B ROBBINS MD
FORMER OFFICER$0$255,484$0$0$0$90,586$0$163,495$0$14,951$0$524,516$0$219,481
DAWN DUNBAR
SVP$0$299,741$0$57,822$0$35,875$0$81,124$0$23,823$0$498,385$0$65,358
WARREN CHAIKO
SVP$0$268,426$0$52,369$0$54,937$0$84,038$0$26,568$0$486,338$0$59,768
Susan Matsumoto-Nonaka
VP$0$278,475$0$39,915$0$46,239$0$71,170$0$10,271$0$446,070$0$45,567
GERI YOUNG MD
CMO (PART YEAR)$0$287,026$0$17,962$0$102,055$0$24,527$0$12,880$0$444,450$0$28,686
JAY MURPHY MD
BOARD OF DIRECTOR$0$368,876$0$4,034$0$27,042$0$11,400$0$21,531$0$432,883$0$0
BRANDT FARIAS
SVP (PART YEAR)$0$249,279$0$47,553$0$30,552$0$76,212$0$9,732$0$413,328$0$50,819
MICHAEL ROBINSON
VP$0$266,844$0$38,177$0$22,458$0$64,458$0$9,732$0$401,669$0$44,010
JAMES LIN MD
VP$0$262,146$0$18,953$0$32,124$0$42,220$0$23,783$0$379,226$0$0
EARL INOUYE
FORMER OFFICER$0$201,366$0$40,705$0$43,074$0$67,586$0$1,944$0$354,675$0$46,925
DAVID STUMBAUGH
VP$0$217,152$0$31,699$0$17,488$0$56,578$0$22,589$0$345,506$0$34,835
LORRIE-ANN LUKE
VP$0$211,025$0$30,832$0$17,998$0$57,437$0$25,176$0$342,468$0$34,527
WILLIAM BURKE
VP$0$237,450$0$16,427$0$23,154$0$43,960$0$16,671$0$337,662$0$0
ROBERT WOTRING II MD
BOARD OF DIRECTOR, CHAIR$0$291,778$0$1,772$0$18,037$0$11,400$0$7,315$0$330,302$0$0
SUNSHINE TOPPING
SVP$0$261,580$0$0$0$27,699$0$0$0$21,615$0$310,894$0$0
THOMAS HEMINGWAY
BOARD OF DIRECTOR (PART YEAR)$0$196,672$0$744$0$60,290$0$8,391$0$18,914$0$285,011$0$0
CARRIE ANN TSUTSUI
VP & CONTROLLER$0$195,857$0$17,756$0$17,265$0$41,055$0$12,358$0$284,291$0$0
KATIE SHIGEMITSU
COMPLIANCE OFFICER$0$221,265$0$0$0$3,421$0$23,435$0$14,690$0$262,811$0$0
EUGENE TARESHAWTY
BOARD OF DIRECTOR$0$233,316$0$0$0$3,991$0$1,731$0$7,832$0$246,870$0$0
ALAN ITO
INFORMATION SECURITY OFFICER$0$185,591$0$13,070$0$1,612$0$21,083$0$14,293$0$235,649$0$0
JESSICA LEWIS
ASSISTANT CORPORATE SECRETARY$0$170,876$0$0$0$0$0$15,118$0$25,286$0$211,280$0$0
DAVID FOX
PRIVACY OFFICER (PART YEAR)$0$160,526$0$0$0$3,089$0$16,325$0$15,781$0$195,721$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, SCHEDULE J, PART I, LINE 3SUPPLEMENTAL 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.
FORM 990, SCHEDULE J, PART I, LINE 4BSUPPLEMENTAL 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 RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $443,030 DAVID OKABE - $156,411 GAIL LERCH - $113,397 STEVEN ROBERTSON - $100,707 KENNETH B. ROBBINS, M.D. - $91,556 CHARLES R. CHING - $84,461 ARTHUR GLADSTONE - $77,843 MELINDA ASHTON, M.D. - $61,798 JENNIE CHAHANOVICH - $47,714 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 RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $372,488 DAVID OKABE - $132,543 GAIL LERCH - $107,316 STEVEN ROBERTSON - $108,006 CHARLES R. CHING - $104,835 ARTHUR GLADSTONE - $128,098 MELINDA ASHTON, M.D. - $111,972 JENNIE CHAHANOVICH - $99,404 LESLIE CHUN, M.D. - $83,827 GERARD LIVAUDAIS, M.D. $78,824 DAWN DUNBAR - $57,822 WARREN CHAIKO - $52,368 DOUGLAS KWOCK, M.D. - $48,037 BRANDT FARIAS - $47,553 EARL INOUYE - $40,705 SUSAN NONAKA - $39,915 MICHAEL ROBINSON - $38,177 DAVID STUMBAUGH - $31,700 LORRIE-ANN LUKE - $30,832 JAMES LIN, M.D. - $18,581 CARRIE ANN TSUTSUI - $17,756 WILLIAM BURKE - $16,427 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 a related organization: Raymond P. Vara JR - $1,015,000

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 4ADESCRIPTION OF ORGANIZATION'S MISSION THE KAUA'I MEDICAL CLINIC IS A NOT-FOR-PROFIT MULTI-SPECIALTY CLINIC WHOSE MISSION IS TO CREATE A HEALTHIER HAWAI'I. DESCRIPTION OF PROGRAM SERVICES 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 163 EMPLOYEES AND 95 PHYSICIANS. IN FISCAL YEAR 2021, TOTAL CLINIC ENCOUNTERS WERE 261,667. 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 (KMC) IS AN ACTIVE COMMUNITY PARTNER. IN FISCAL YEAR 2021, MOST OF KMC'S EFFORTS WERE TO SERVE THE EVER-CHANGING MEDICAL NEEDS OF THE COMMUNITY IN RESPONSE TO THE PANDEMIC. COVID-19 INITIATIVES INCLUDED COMMUNITY VACCINE CLINICS, COMMUNITY TESTING SITES THAT WERE MOBILIZED THROUGHOUT KAUA'I, TELEHEALTH OPTIONS, AND COLLABORATING WITH THE HAWAI'I STATE DEPARTMENT OF HEALTH AND OTHER HEALTH CARE PROVIDERS TO PROVIDE A COHESIVE PUBLIC HEALTH RESPONSE. MOST OF THE SPONSORED EVENTS SUPPORTED BY KMC, IN PARTNERSHIP WITH WILCOX MEMORIAL HOSPITAL, WERE TRANSITIONED TO A SAFER AND PHYSICALLY DISTANCED FORMAT, INCLUDING THE "KAUA'I MARATHON" THAT WAS DONE AS THE VIRTUAL "KAUA'I 100 MILE CHALLENGETHE ANNUAL "BACK TO SCHOOL BASH" TURNED INTO A DRIVE-BY DISTRIBUTION OF 2,000 SCHOOL BAGS FOR CHILDREN. MANY HEALTH EDUCATION, PREVENTION PROGRAMS AND SUPPORT GROUPS FOCUSED ON DIABETES, SPORTS MEDICINE, HEART ATTACK/STROKE, WATER SAFETY, INJURY PREVENTION AND HEALTH FAIRS WERE ALSO PUT ON HOLD BECAUSE OF THE PANDEMIC. 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 2021, KAUA'I MEDICAL CLINIC PROVIDED $1,421,946 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 1Aform 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, SECTION A, LINE 6MEMBERS AND RIGHTS 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, SECTION A, LINE 7ADESCRIPTION OF CLASSES OF PERSON AND THE NATURE OF THEIR RIGHTS 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, SECTION A, LINE 7BDESCRIPTION OF CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS 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 ROPERTY 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, SECTION B, LINE 11BREVIEW OF FORM 990 BY THE ORGANIZATION'S 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 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 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, SECTION B, LINE 12CMONITORING & ENFORCEMENT OF 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, SECTION B, LINES 15a & 15bPROCESS OF DETERMINING COMPENSATION 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, 2021 TO REVIEW PHYSICIAN COMPENSATION, AND ON JULY 28, 2021 TO REVIEW EXECUTIVE COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS 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 9OTHER CHANGES IN NET ASSETS EQUITY TRANSFERS WITH HPH $ 2,010,328 TEMPORARILY RESTRICTED NET $ 10,278 ------------- TOTAL $ 2,020,606

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)

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HAWAI'I PACIFIC HEALTH
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990246363ADMIN SVCS.HI501(c)(3)12C, III-FINAfalse
KAPI'OLANI HEALTH FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990246364FUNDRAISINGHI501(c)(3)7HPHYes (true)
KAPI'OLANI MED CTR FOR WOMEN & CHILDREN
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990177350HOSPITALHI501(c)(3)3HPHYes (true)
KAPI'OLANI MEDICAL SPECIALISTS
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990322406HEALTHCAREHI501(c)(3)3HPHYes (true)
PALI MOMI FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813383840327FUNDRAISINGHI501(c)(3)7HPHYes (true)
PALI MOMI MEDICAL CENTER
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990274038HOSPITALHI501(c)(3)3HPHYes (true)
PROVIDERS INSURANCE CORPORATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813710893000INSURANCEHI501(c)(3)12B, IIHPHYes (true)
STRAUB CLINIC & HOSPITAL
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813912151670HOSPITALHI501(c)(3)3HPHYes (true)
STRAUB FOUNDATION
55 MERCHANT STREET 26TH FLOORHONOLULUHI96813990109350FUNDRAISINGHI501(c)(3)7HPHYes (true)
WILCOX HEALTH FOUNDATION
3-3420 KUHIO HIGHWAYLIHUEHI96766990204242FUNDRAISINGHI501(c)(3)7HPHYes (true)
WILCOX MEMORIAL HOSPITAL
3-3420 KUHIO HIGHWAYLIHUEHI96766990074365HOSPITALHI501(c)(3)3HPHYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

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FieldValueIRS element (for citing)
Business Name Line1ASC PACIFIC VENTURES LLCBusinessNameLine1Txt

US Address USAddress

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CityHonoluluCityNm
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EIN270540034EIN
Primary ActivitiesAMBU. SURG. CTR.PrimaryActivitiesTxt
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FieldValueIRS element (for citing)
Predominant Income TypeN/APredominantIncomeTypeTxt

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

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HAWAI'I PACIFIC HEALTH PARTNERS INC
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990318588HOLDING COMPANYHINAC CORP
STRAUB PHARMACY INC
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990145107INACTIVEHINAC CORP
HICORD INC
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990251496INVESTMENTHINAC CORP
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Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
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Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
KAPI'OLANI MED CTR FOR WOMEN & CHILDREN
q$103,599FMV
STRAUB CLINIC & HOSPITAL
s$332,684FMV
WILCOX MEMORIAL HOSPITAL
q$634,711FMV
WILCOX MEMORIAL HOSPITAL
s$304,874FMV
WILCOX MEMORIAL HOSPITAL
p$291,691FMV
KAPI'OLANI MEDICAL SPECIALISTS
q$28,525,227FMV
PROVIDERS INSURANCE CORPORATION
r$194,684FMV

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE R, PART IIIFormAndLineReferenceDesc
ExplanationRELATED ORGANITAZIONS TAXABLE AS A PARTNERSHIP: ASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 55 MERCHANT ST., 27 FLOOR, HONOLULU, HI 96813ExplanationTxt