2021-05-14T17:18:16-05:00 2020-06-30 ERNST & YOUNG US LLP 4365 EXECUTIVE DR STE 1600 SAN DIEGO CA 92121 990 2019-07-01 990322406 Kapi'olani Medical Specialists % DONNA MASUDA-KAM KAPI 8089838986 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 CARRIE ANN TSUTSUI vice president 8089838986 2021-05-14 true JOCELYNE MILLER P00634378 8585357200 2019 2022-09-23 18:48:47Z Hawai'i Pacific Health Medical Group LESLIE CHUN MD CEO 1100 WARD STREET STE 1130 HONOLULU HI 96814 146245757 false X WWW.HAWAIIPACIFICHEALTH.ORG X 1995 HI SEE SCHEDULE O 9 5 281 5 0 0 275782 3593511 37486286 142645267 1117 6979 0 0 37763185 146245757 0 0 0 0 40656823 126194493 0 0 0 13576773 86851308 54233596 213045801 -16470411 -66800044 8640582 50715377 9196409 55466019 -555827 -4750642 X SEE SCHEDULE O true false 202822844 0 142645267 SEE SCHEDULE O. 202822844 true true false false false false false false false false true false false true true false false true false false false false false false false false false false 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THE COMPANY'S 2016 THROUGH 2019 TAX YEARS REMAIN SUBJECT TO EXAMINATION FOR FEDERAL INCOME TAX PURPOSES, WHEREAS THE 2015 THROUGH 2019 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 0 1033137 0 1243254 0 449629 0 783086 0 25984 0 3535090 0 1164033 DAVID OKABE EVP, CFO & Treasurer 0 520205 0 406003 0 211759 0 309351 0 14764 0 1462082 0 413043 KENNETH B ROBBINS MD Board of Director (PART YEAR) 0 477249 0 357670 0 198029 0 301237 0 15544 0 1349729 0 396604 MARTHA SMITH BOD, CHAIR (PART YEAR) 0 477372 0 341791 0 145695 0 262403 0 15564 0 1242825 0 361169 STEVEN ROBERTSON EVP & CIO 0 422759 0 339367 0 152984 0 246776 0 15564 0 1177450 0 328662 GAIL LERCH EVP 0 421695 0 308486 0 162489 0 250310 0 10139 0 1153119 0 334634 CHARLES R CHING EVP, GEN COUNSEL & SECRETARY 0 409868 0 297161 0 175709 0 236489 0 22978 0 1142205 0 306902 MELINDA ASHTON MD EVP & CQO 0 439151 0 287410 0 125499 0 230179 0 15493 0 1097732 0 138152 SIDNEY JOHNSON MD Physician 706769 0 6737 0 35427 0 11200 0 23361 0 783494 0 0 0 DEVIN PUAPONG MD Physician 622833 0 1347 0 33591 0 11200 0 23361 0 692332 0 0 0 RUSSELL WOO MD Physician 620819 0 3368 0 31818 0 11200 0 24552 0 691757 0 0 0 PATRICK O'DONNELL MD Board of Director 576263 0 1347 0 18390 0 11200 0 26465 0 633665 0 0 0 ROBERT DURKIN MD Physician 561651 0 1347 0 36446 0 11200 0 22439 0 633083 0 0 0 SUSAN TAN MD Physician 581462 0 1347 0 327 0 11200 0 17051 0 611387 0 0 0 DAVID CHO MD Board of Director 529943 0 5367 0 20725 0 11200 0 23639 0 590874 0 0 0 WARREN CHAIKO SVP 0 253695 0 80480 0 52310 0 89168 0 25984 0 501637 0 67479 DAWN DUNBAR SVP 0 281633 0 71604 0 33610 0 86358 0 23493 0 496698 0 55170 EARL INOUYE VP & System Cntrlr (part year) 0 268741 0 51409 0 42082 0 76325 0 15279 0 453836 0 51704 SUSAN MASUMOTO-NONAKA VP 0 263169 0 49921 0 44839 0 74967 0 9932 0 442828 0 49726 BRANDT FARIAS SVP & Chief Marketing Officer 0 225772 0 55675 0 29288 0 77419 0 9763 0 397917 0 53601 MICHAEL ROBINSON VP 0 241022 0 48215 0 21434 0 70610 0 9768 0 391049 0 41364 ANNE DEMPSEY MD Board of Director 0 308426 0 1347 0 26510 0 11200 0 21139 0 368622 0 0 LORRIE-ANN LUKE VP 0 197053 0 37827 0 15752 0 59354 0 24795 0 334781 0 37320 DAVID STUMBAUGH VP 0 200279 0 38164 0 16207 0 57649 0 22225 0 334524 0 25102 KENNETH T NAKAMURA MD Vice Chair & CMO 0 153763 0 24434 0 41495 0 41088 0 12544 0 273324 0 27386 KATIE SHIGEMITSU Compliance Officer 0 207349 0 0 0 6321 0 21837 0 14431 0 249938 0 0 ALAN ITO Information Security Officer 0 176197 0 13027 0 2549 0 18050 0 14096 0 223919 0 0 JESSICA LEWIS Assistant Corporate Secretary 0 160085 0 0 0 0 0 13865 0 24832 0 198782 0 0 DAVID FOX Privacy Officer 0 152341 0 0 0 4682 0 16130 0 15574 0 188727 0 0 JENNIFER JONES Director of Operations 0 136255 0 12136 0 0 0 12902 0 25564 0 186857 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S CHAIR 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, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. FORM 990, 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. AMOUNT PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $173,419 KENNETH B. ROBBINS, MD - $77,851 DAVID OKABE - $72,787 MARTHA SMITH - $50,243 GAIL LERCH - $53,324 CHARLES R. CHING - $44,640 STEVEN ROBERTSON - $49,104 MELINDA ASHTON - $41,490 ANNUAL AND LONG TERM INCENTIVE PLAN THE ANNUAL AND LONG TERM INCENTIVE PLANS ARE AFFORDED TO EXECUTIVES BASED ON ANNUAL AND LONG TERM SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. AMOUNT PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $1,093,254 KENNETH B. ROBBINS, M.D. - $357,670 DAVID OKABE - $381,003 GAIL LERCH - $308,486 CHARLES R. CHING - $297,161 STEVEN ROBERTSON - $309,367 MARTHA SMITH - $341,791 MELINDA ASHTON, M.D. - $262,410 EARL INOUYE - $51,409 SUSAN NONAKA - $49,921 WARREN CHAIKO - $65,480 KENNETH T. NAKAMURA, M.D. - $24,434 MICHAEL ROBINSON - $48,215 BRANDT FARIAS - $55,675 LORRIE-ANN LUKE - $37,827 DAVID STUMBAUGH - $38,164 DAWN DUNBAR - $71,604 JANNY CHEN SEE PART V 94249 PHYSICIAN COMPENSATION false Susan Lin SEE PART V 59625 DIRECTOR COMPENSATION false FORM 990, SCHEDULE L, PART IV, COLUMN B JANNY CHEN IS A FAMILY MEMBER OF DAVID CHO, MD CURRENT BOARD OF DIRECTOR. SUSAN LIN IS A FAMILY MEMBER OF LESLIE CHUN, MD , CEO. FORM 990, PART I, LINE 1 MISSION STATEMENT KAPI'OLANI MEDICAL SPECIALISTS (DBA HAWAI'I PACIFIC HEALTH MEDICAL GROUP), AN AFFILIATE OF HAWAI'I PACIFIC HEALTH, IS A SPECIALTY PHYSICIAN GROUP THAT SERVES WOMEN AND CHILDREN THROUGH ACADEMICS, RESEARCH AND CLINICAL CARE, IN PARTNERSHIP WITH KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN. IN DECEMBER 2019, THE EMPLOYED PROVIDER GROUPS AT STRAUB MEDICAL CENTER, PALI MOMI MEDICAL CENTER AND WILCOX MEDICAL CENTER JOINED KAPIOLANI MEDICAL SPECIALISTS TO BECOME THE HAWAI'I PACIFIC HEALTH MEDICAL GROUP. FORM 990, PART III, LINE 1 MISSION STATEMENT 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, STRAUB MEDICAL CENTER, PALI MOMI MEDICAL CENTER AND WILCOX MEDICAL CENTER THE GROUP'S MISSION IS CARING FOR THE COMMUNITY THROUGH MEDICAL AND ACADEMIC EXCELLENCE, AND COMMUNITY PARTNERSHIPS TO CREATE A HEALTHIER HAWAII. FORM 990, PART III, LINE 2 IN DECEMBER 2019, THE EMPLOYED PROVIDER GROUPS AT STRAUB MEDICAL CENTER, PALI MOMI MEDICAL CENTER AND WILCOX MEDICAL CENTER JOINED KAPI'OLANI MEDICAL SPECIALISTS TO BECOME THE HAWAI'I PACIFIC HEALTH MEDICAL GROUP. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS KAPI'OLANI MEDICAL SPECIALISTS (DBA HAWAI'I PACIFIC HEALTH MEDICAL GROUP)HAS 742 PROVIDERS IN SPECIALTIES SUCH AS EMERGENCY MEDICINE, RADIOLOGY, CARDIOLOGY, GERIATRICS, NEUROLOGY, SPORTS MEDICINE,DERMATOLOGY, ENDOCRINOLOGY, PULMONOLOGY, RHEUMATOLOGY,OCCUPATIONAL HEALTH, ALLERGY, INFECTIOUS DISEASE, INTERNAL MEDICINE, FAMILY MEDICINE, ANESTHESIOLOGY,VASCULAR SURGERY, GENERAL SURGERY, OPHTHALMOLOGY, ORTHOPEDIC SURGERY, PLASTIC SURGERY, UROLOGY, PEDIATRIC INTENSIVE CARE, NEONATOLOGY, PEDIATRIC RHEUMATOLOGY, PSYCHIATRY/COUNSELING, BEHAVIORAL HEALTH SERVICES, MEDICAL GENETICS, GYNECOLOGY-ONCOLOGY, ADULT AND PEDIATRIC HEMATOLOGY-ONCOLOGY, RESEARCH, PEDIATRIC HOSPITALISTS, ADULT HOSPITALISTS (INTERNAL MEDICINE), PEDIATRIC SURGERY, PEDIATRIC UROLOGY, PEDIATRIC ORTHOPEDICS AND SPORTS MEDICINE, PEDIATRIC ENDOCRINOLOGY, PEDIATRIC NEUROLOGY, PEDIATRIC GASTROENTEROLOGY, PEDIATRIC SEDATION, PEDIATRIC NEPHROLOGY, NEUROSURGERY, OTOLARYNGOLOGY, ADOLESCENT MEDICINE, AND PALLIATIVE CARE. IN FISCAL YEAR 2020, KAPI'OLANI MEDICAL SPECIALISTS (DBA HAWAI'I PACIFIC HEALTH MEDICAL GROUP) HAD 803,900 OUTPATIENT VISITS. 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'S POPULATION. KAPI'OLANI MEDICAL SPECIALISTS RECRUITS PHYSICIANS FROM THROUGHOUT THE NATION WHO DESIRE EMPLOYMENT IN A GROUP PRACTICE SETTING WITH HAWAI'I'S LEADING PEDIATRIC HOSPITAL AND ADULT HOSPITALS THAT SERVE POPULATIONS THROUGHOUT THE ISLANDS VIA HAWAI'I PACIFIC HEALTH HOSPITAL BASED AND SATELLITE CLINICS. PRIMARY CARE ACCESS FOR ALL SOCIODEMOGRAPHICS ALONG WITH SUB-SPECIALISTS IN SHORT SUPPLY, YET HIGH DEMAND ARE RECRUITED TO MEET COMMUNITY NEEDS. KAPI'OLANI MEDICAL SPECIALISTS DOCTORS ALSO PROVIDE ESSENTIAL SERVICES AT OTHER HOSPITALS IN THE STATE OF HAWAI'I, I.E., AT THE QUEEN'S MEDICAL CENTER, TRIPLER ARMY MEDICAL CENTER, AND 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 AFFILIATION WITH THE JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAII. IN FISCAL YEAR 2020, THE GROUP PROVIDED $5,227,641 IN MEDICAL CARE TO PATIENTS WHO WERE UNINSURED OR UNABLE TO PAY FOR THEIR CARE. FORM 990,PART V, LINE 1A HAWAI'I PACIFIC HEALTH (HPH), THE ORGANIZATION'S TAX EXEMPT PARENT, PAYS ALL VENDORS. THEREFORE, HPH ISSUES FORM 1099S UNDER ITS TAX ID. FORM 990, PART VI, LINE 6 MEMBERS/STOCKHOLDERS AND THEIR RIGHTS 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 POWER TO ELECT OR APPOINT MEMBERS HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER AND HAS THE POWER TO APPROVE THE ELECTION OF MEMBERS OF THE ORGANIZATION'S 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 DESCR CLASSES OF PERSONS, DECISIONS REQ APPR & TYPE OF VOTING RIGHTS HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS THE FOLLOWING RESERVED POWERS: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, TREASURER, SECRETARY, EXEC VP/CFO, OTHER EXCUTIVE VP'S, SENIOR VP, ASST. SECRETARIES, AND ALL VP'S; (II) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORP IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER BOARD; (III) AMEND THE BYLAWS; (IV) CAUSE THE CORP'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 CORP 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 CORP, LIMITED LIABILITY COMPANY, OR PARTNERSHIP OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORP; (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 CORP WHICH GENERATE 50% OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE CORP DURING THE PRIOR FISCAL YEAR; (XII) AFTER CONSULTING WITH THE BOARD, REMOVE THE CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, EXECUTIVE VP/CFO, TREASURER, SECRETARY, OTHER EXCUTIVE VP'S, SENIOR VP'S, ASST SECRETARIES, AND ALL VP'S; (XIII) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORP GOALS AND THE LONG RANGE AND STRATEGIC PLANS OF THE CORP; AND (XIV) 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 CORP EXCEEDING $1,000,000 IN VALUE; (V) ACQUIRE ASSETS WORTH OVER $1,000,000; (VI) AQUIRE SHARES IN ANOTHER CORP; (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 CORP; (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 THE 990 BY THE ORGANIZATION'S GOVERNING BODY VARIOUS SCHEDULES OF THE 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 990 OF EACH FILLING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE 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 (HPH) BOARD PROVIDES OVERSIGHT FOR THE 990 REPORTING AND REVIEWS THE 990 FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE 990 FOR EACH ENTITY IS MADE AVAILABLE TO THE BOARD MEMBERS OF THE ORGANIZATION AND THE HPH BOARD OF DIRECTORS THROUGH A BOARD PORTAL FOR REVIEW PRIOR TO THE FILING OF THE 990. THE 990 WILL BE POSTED TO HPH'S WEB SITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURNS WITH THE IRS. FORM 990, PART VI, LINE 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST 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; 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 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, LINES 15A & 15B PROCESS OF DETERMINING COMPENSATION 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, 2020 TO REVIEW PHYSICIAN COMPENSATION AND ON JULY 29, 2020 TO REVIEW EXECUTIVE COMPENSATION. FORM 990, PART VI, LINE 19 DISCLOSURE OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FINANCIAL STMTS THE CONFLICT OF INTEREST POLICY AND STANDARDS OF CONDUCT ARE AVAILABLE ON THE HAWAI'I PACIFIC HEALTH WEBSITE. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE VIA THE HAWAI'I PACIFIC HEALTH WEBSITE. FORM 990, PART XI, LINE 9 $ 62,605,229 - EQUITY TRANSFER WITH HPH __________________ $ 62,605,229 - TOTAL HAWAI'I PACIFIC HEALTH 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246363 ADMIN. SVCS HI 501(c)(3) 12B, 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 333840327 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 CORPORATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 INSURANCE HI 501(c)(3) 12B, 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 26TH 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 ASC PACIFIC VENTURES LLC 55 Merchant St 27th floor Honolulu HI 96813 270540034 AMBU. SURG. CTR HI NA HAWAI'I PACIFIC HEALTH PARTNERS INC 55 Merchant St 24th Floor Honolulu HI 96813 990318588 HOLDING COMPANY HI NA C Corp HICORD INC 55 Merchant St 24th Floor Honolulu HI 96813 990251496 INVESTMENT HI NA C Corp STRAUB PHARMACY INC 55 Merchant St 24th Floor Honolulu HI 96813 990145107 INACTIVE HI NA C Corp false false true false false false false false false false false false false false true true true true true KAPI'OLANI MED CENTR WOMEN & CHILDREN q 2588003 FMV KAPI'OLANI MED CENTR WOMEN & CHILDREN s 63302 FMV KAPI'OLANI MED CENTR WOMEN & CHILDREN p 14118805 FMV KAPI'OLANI MED CENTR WOMEN & CHILDREN r 50483 FMV PALI MOMI MEDICAL CENTER q 75939 FMV PALI MOMI MEDICAL CENTER s 238653 FMV PALI MOMI MEDICAL CENTER o 473954 FMV PALI MOMI MEDICAL CENTER p 1744015 FMV PALI MOMI MEDICAL CENTER r 444497 FMV STRAUB CLINIC & HOSPITAL q 5709349 FMV STRAUB CLINIC & HOSPITAL s 4332926 FMV STRAUB CLINIC & HOSPITAL o 4907961 FMV STRAUB CLINIC & HOSPITAL p 33948464 FMV STRAUB CLINIC & HOSPITAL r 9335167 FMV WILCOX MEMORIAL HOSPITAL q 1653370 FMV WILCOX MEMORIAL HOSPITAL o 57708 FMV WILCOX MEMORIAL HOSPITAL p 3654943 FMV KAUA'I MEDICAL CLINIC q 53858 FMV KAUA'I MEDICAL CLINIC o 1508439 FMV KAUA'I MEDICAL CLINIC p 12518933 FMV KAUA'I MEDICAL CLINIC r 1608882 FMV KAPI'OLANI HEALTH FOUNDATION c 195625 FMV PROVIDERS INSURANCE CORPORATION r 6532242 FMV SCHEDULE R, PART III RELATED ORG. TAXABLE AS PARTNERSHIP ASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 55 MERCHANT ST., 27TH FLOOR HONOLULU, HI 96813