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 990246364 Kapi'olani Health Foundation % DONNA MASUDA-KAM KAPI 8085357100 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 CARRIE-ANN TSUTSUI vice president 2021-05-14 true JOCELYNE MILLER P00634378 8585357200 2019 2022-09-23 18:48:47Z DAWN DUNBAR 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 27473389 false X https://giving.hawaiipacifichealth.org X 1986 HI THE MISSION OF KAPI'OLANI HEALTH FOUNDATION IS TO CREATE A HEALTHIER HAWAI'I. 26 24 0 48 0 0 6594376 7829532 0 0 1114087 -1074716 537248 674 8245711 6755490 3158784 3031378 0 0 0 0 0 0 886195 1814540 4356793 4973324 7388171 3272387 -632681 90409866 92196378 2705875 1754095 87703991 90442283 X THE MISSION OF KAPI'OLANI HEALTH FOUNDATION IS TO CREATE A HEALTHIER HAWAI'I. false false 5924474 3031378 0 SEE SCHEDULE O 5924474 true true false false false false false false true true true true false false true false false 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Board of Director, Chair 0.2 0.0 X X 0 0 0 NATALIE BANACH Board of Director 0.2 0.0 X 0 0 0 KATHY CARR Board of Director 0.2 0.0 X 0 0 0 MEREDITH CHING Board of Director 0.2 0.0 X 0 0 0 SHELLEY CRAMER Board of Director 0.2 0.0 X 0 0 0 SARA DUDGEON Board of Director 0.2 0.0 X 0 0 0 MATTHEW EMERSON Board of Director 0.2 0.0 X 0 0 0 STEPHANIE GAMBETTA Board of Director 0.2 0.0 X 0 0 0 KIM HEHIR Board of Director 0.2 0.0 X 0 0 0 DAVID HUDSON Board of Director (PART YR) 0.2 0.0 X 0 0 0 THOMAS KOSASA MD Board of Director 0.2 0.0 X 0 0 0 NEDRA MANSON Board of Director 0.2 0.0 X 0 0 0 PAUL MARX Board of Director, Vice Chair 0.2 0.0 X X 0 0 0 MARCUS MERNER Board of Director 0.2 0.0 X 0 0 0 RALPH MESICK Board of Director 0.2 0.0 X 0 0 0 RUTH MILLS Board of Director 0.2 0.0 X 0 0 0 BRAD NICOLAI Board of Director 0.2 0.0 X 0 0 0 PAIGE PAHLMEYER Board of Director 0.2 0.0 X 0 0 0 KAREN T POLIVKA Board of Director 0.2 0.0 X 0 0 0 PATRICIA W SHEEHAN Board of Director 0.2 0.0 X 0 0 0 CHYNNA STONE Board of Director 0.2 0.0 X 0 0 0 KELLY SUEDA Board of Director 0.2 0.0 X 0 0 0 EILEEN WACKER Board of Director 0.2 0.0 X 0 0 0 SHELLEY WILSON Board of Director 0.2 0.0 X 0 0 0 LINDA WOO Board of Director 0.2 0.0 X 0 0 0 0 6158952 1742052 0 true true false 0 7829532 68565 7829532 0 1027353 1027353 0 0 0 0 0 18615830 20717899 -2102069 -2102069 -2102069 0 0 0 0 0 0 0 0 0 All other revenue 900099 674 0 0 674 674 6755490 0 0 -1074042 X 3031378 3031378 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13899 0 13899 0 0 0 0 0 0 0 190019 0 190019 0 868092 0 250661 617431 23917 0 0 23917 47237 0 24458 22779 0 0 0 0 0 0 0 0 39710 0 0 39710 13779 0 0 13779 0 0 0 0 531 0 0 531 0 0 0 0 0 0 0 0 1935 0 0 1935 14427 0 14427 0 PROGRAM EXPENDITURES 2937389 2877660 0 59729 PRINTING & DESIGN SVCS 100181 0 0 100181 CORPORATE ALLOCATION 84038 0 84038 0 OTHER EXPENSES 21639 15436 0 6203 7388171 5924474 577502 886195 0 0 0 2562998 2946840 2459749 2240767 2722803 1995884 0 0 0 0 0 0 0 0 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INVESTMENT POOL 48573557 F 48573557 0 DUE TO AFFILIATES 1249227 DUE TO HAWAI'I PACIFIC HEALTH 144913 DUE TO KAPI'OLANI CTR WOMEN & CHILDREN 82003 DUE TO WILCOX MEMORIAL HOSPITAL 41433 DUE TO KAPI'OLANI MEDICAL SPECIALISTS 15000 DUE TO WILCOX HEALTH FOUNDATION 13005 DUE TO HPH RSRCH INSTITUTE 12677 DUE TO PALI MOMI FOUNDATION 6757 DUE TO STRAUB MEDICAL CENTER 5011 1570026 FORM 990, SCHEDULE D, PART IV, LINE 2B ESCROW OR CUSTODIAL ACCOUNT LIABILITY ESCROW LIABILITIES REPRESENT AMOUNTS DUE TO INDIVIDUALS UNDER CHARITABLE REMAINDER TRUST AGREEMENTS. FORM 990, SCHEDULE D, PART V, LINE 4 DESCRIPTION OF INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS ENDOWMENT FUNDS ARE MANAGED TO ENSURE THAT THE RETURNS SUPPORT THE MEDICAL CENTER'S OPERATIONS; HIRING OF STAFF; IMPLEMENTATION OF PROGRAMS; RESEARCH AND EDUCATION; AND PROVIDE QUALITY CARE FOR PATIENTS, ALL IN ACCORDANCE WITH THE DONOR'S INTENT AND THE ORGANIZATION'S MISSION. true HAWAI'I PACIFIC HEALTH 55 MERCHANT ST 24TH FL HONOLULU HI 96813 990246363 501(c)(3) 15013 0 RESEARCH INSTITUTE SUPPORT KAPI'OLANI MEDICAL SPECIALISTS 55 MERCHANT ST 24TH FL HONOLULU HI 96813 990322406 501(c)(3) 196612 GENERAL SUPPORT KAPI'OLANI MED CENTER FOR WOMEN & CHILDREN 55 MERCHANT ST 24TH FL HONOLULU HI 96813 990177350 501(c)(3) 2819753 GENERAL SUPPORT 3 FORM 990, SCHEDULE I, part II DESCR OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS TEMPORARILY RESTRICTED FUNDS RELEASED (& GRANTED) TO THE AFFILIATED ORGANIZATIONS ARE RELEASED AFTER THE SPECIFIC PURPOSE OF THE FUND HAS BEEN MET. ONCE THE AFFILIATED ORGANIZATION COMMUNICATES THE EXPENSE AND SATISFIES THE SUBSTANTIATION OF THE EXPENSE FOR THE PURPOSE THAT THE FUNDS WERE CONTRIBUTED FOR, THE FOUNDATION RELEASES THE RESTRICTION AND RECORDS THE GRANT TO THE AFFILIATED ORGANIZATION. NO FURTHER MONITORING OF THE FUNDS AFTER DISTRIBUTION IS NECESSARY. 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 Treasurer 0 520205 0 406003 0 211759 0 309351 0 14764 0 1462082 0 413043 CHARLES R CHING Secretary 0 409868 0 297161 0 175709 0 236489 0 22978 0 1142205 0 306902 DAWN DUNBAR President 0 281633 0 71604 0 33610 0 86358 0 23493 0 496698 0 55170 EARL INOUYE Assistant Treasurer (PART YR) 0 268741 0 51409 0 42082 0 76325 0 15279 0 453836 0 51704 MICHAEL ROBINSON FORMER OFFICER 0 241022 0 48215 0 21434 0 70610 0 9768 0 391049 0 41364 JESSICA LEWIS Assistant Secretary 0 160085 0 0 0 0 0 13865 0 24832 0 198782 0 0 CARRIE ANN TSUTSUI Assistant Treasurer 0 155055 0 13337 0 0 0 0 0 11084 0 179476 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S PRESIDENT 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 DAVID OKABE - $72,787 CHARLES R. CHING - $44,640 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 DAVID OKABE - $381,003 EARL INOUYE - $51,409 CHARLES R. CHING - $297,161 MICHAEL ROBINSON - $48,215 DAWN DUNBAR - $71,604 X 8646 COST/SELLING X 9 10951 COST/SELLING X 2 2693 COST/SELLING X 4 20444 COST/SELLING X PREPAID GIFTCARD 2 80 COST/SELLING X MISC-TOYS 16 25751 COST/SELLING 1 false true false Schedule M, Part I, COLUMN B COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART III, LINE 4 PROGRAM SERVICE ACCOMPLISHMENTS THE MISSION OF KAPI'OLANI HEALTH FOUNDATION (THE FOUNDATION) IS TO CREATE A HEALTHIER HAWAI'I. KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN (KAPI'OLANI) IS A NOT-FOR-PROFIT MEDICAL CENTER LOCATED IN HONOLULU THAT IS DEDICATED TO THE HEALTH AND WELL BEING OF ALL HAWAI'I RESIDENTS. KAPI'OLANI IS HAWAI'I'S ONLY MATERNITY, NEWBORN AND PEDIATRIC SPECIALTY HOSPITAL. KAPI'OLANI IS PART OF THE HAWAI'I PACIFIC HEALTH SYSTEM, ONE OF THE STATE'S LARGEST HEALTH CARE PROVIDERS. AS A NOT-FOR-PROFIT MEDICAL CENTER, KAPI'OLANI RELIES ON PHILANTHROPIC SUPPORT FROM THE COMMUNITY TO FULFILL ITS MISSION AND CARE FOR ITS PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. CONTRIBUTIONS, BOTH UNRESTRICTED AND DESIGNATED, HELP THE MEDICAL CENTER PROVIDE EXCEPTIONAL MEDICAL CARE IN HAWAI'I. GENEROUS DONATIONS ASSIST, BUT ARE NOT LIMITED TO, THESE AREAS: PATIENT AND SPECIALITY CARE, CAPITAL IMPROVEMENTS, EDUCATION AND RESEARCH, COMMUNITY HEALTH AND UNCOMPENSATED CARE. SERVICES INCLUDE: PATIENT AND SPECIALITY CARE PEDIATRIC HEART CENTER THE KAPI'OLANI HEALTH FOUNDATION WANTS TO TAKE THE NEXT STEP IN IMPROVING PEDIATRIC CARDIAC CARE AND HAS A CAMPAIGN UNDERWAY TO BUILD HAWAI'I'S FIRST AND ONLY PEDIATRIC HEART CENTER. PHASE ONE IS TO BUILD A CATHETERIZATION LAB THAT WILL SERVE BOTH CHILDREN AND WOMEN. BY CREATING A PERMANENT PEDIATRIC HEART CENTER AND STATE-OF-THE-ART PROGRAM IT WILL REDUCE THE RISK, EXPENSE AND STRESS OF TRAVEL. CAPITAL IMPROVEMENTS THE FOUNDATION IS ALSO SUPPORTING THE FUNDING THE CONSTRUCTION OF A NEW DINING ROOM AND KITCHEN WITHIN THE DIAMOND HEAD TOWER. THIS FACILITY UPGRADE WAS COMPLETED IN THE WINTER OF 2019. COMMUNITY HEALTH AND UNCOMPENSATED CARE CHILD LIFE SERVICES KAPI'OLANI'S CHILD LIFE PROGRAM WAS ESTABLISHED TO HELP YOUNG PATIENTS AND THEIR FAMILIES COPE WITH HOSPITALIZATION TREATMENT. DONATIONS SUPPORT ALL OF THE EFFORTS OF THE CHILD LIFE PROGRAM INCLUDING THE SALARIES OF CHILD LIFE SPECIALISTS, CLASSROOM ACTIVITIES AND SUPPLIES OF THE EDUCATION LIAISON, AROMATHERAPY STAFFING AND PROGRAMS AND THE MEDICAL CENTER'S THERAPY DOG VISITS. PATIENT ASSISTANCE FUND: FAMILY FUND THE PURPOSE OF THE PATIENT ASSISTANCE FUND IS TO ASSIST MEDICAL CENTER PATIENTS AND/OR THEIR SUPPORT SYSTEM RECEIVING SERVICES, INCLUDING EMERGENCY ROOM AND OUTPATIENT SERVICES AT THIS FACILITY. THE MANAGEMENT AND DISBURSEMENT OF THE PATIENT ASSISTANCE FUND OR FAMILY FUND IS LEFT TO THE DISCRETION OF THIS FACILITY TO MEET SPECIFIC PATIENT CARE NEEDS. THE FUNDS MAY BE USED FOR PATIENTS AND/OR THEIR SUPPORT SYSTEM THAT HAVE FINANCIAL BARRIERS AND NEED CONTINUED MEDICAL OR PSYCHOSOCIAL SUPPORT OR TO FACILITATE DISCHARGE. NEARLY HALF OF KAPI'OLANI'S PATIENTS COME FROM UNINSURED OR UNDERINSURED FAMILIES. 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 2 DESCRIPTION OF BUSINESS RELATIONSHIPS JEFFREY ARCE AND RAYMOND VARA HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, LINE 6 MEMBERS 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 BOARD. FORM 990, PART VI, LINE 7A DESCRIPTION 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, LINE 7B DESCRIPTION OF CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS EXCLUSIVE POWER TO TAKE AND DIRECT THE FOLLOWING ACTIONS OF THE CORPORATION: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: PRESIDENT, VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE CHAIR AND VICE-CHAIR OF THE BOARD; (II) AFTER CONSULTATION WITH THE BOARD, REMOVE THE PRESIDENT, VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE CHAIR AND VICE-CHAIR; (III) REMOVE A DIRECTOR FROM THE BOARD; (IV) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER; (V) AMEND THESE BYLAWS; (VI) CAUSE THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1) YEAR AND/OR ONE MILLION DOLLARS ($1,000,000) OR MORE; (VII) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (VIII) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE, AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (IX) DETERMINE AND EFFECT INTER-CORPORATE FUND TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (X) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S EXECUTIVE COMPENSATION AND BENEFIT PLANS; (XI) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (XII) DEVELOP AND PROMULGATE OVERALL CORPORATE GOALS AND THE LONG-RANGE AND STRATEGIC PLAN OF THE CORPORATION; AND (XIII) DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. THE CORPORATION SHALL NOT TAKE THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING MEMBER APPROVAL: (I) ELECT ANY DIRECTOR TO THE BOARD; (II) AMEND THE ARTICLES; (III) MERGE THE CORPORATION WITH ANY ENTITY; (IV) DISSOLVE THE CORPORATION; (V) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS BY OR ON BEHALF OF THE CORPORATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (VI) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000) EXCEPT FOR THOSE ASSETS ACQUIRED BY GIFTS, GRANT, OR DONATION; (VII) ACQUIRE SHARES IN ANOTHER CORPORATION; (VIII) SELL, LEASE, EXCHANGE, ENCUMBER OR DISPOSE OF TWENTY-FIVE PERCENT (25%) OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION TO ANY ENTITY THAT IS NOT AN AFFILIATE; (IX) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (X) 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 (XI) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE. 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 THE STAFF WITHIN THE ACCOUNTING AREA OF THE ORGANIZATION WORKING WITH VARIOUS OTHER AREAS OF THE ORGANIZATION SUCH AS MANAGEMENT OF OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPLETED 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 DESCRIBE THE MISSION/PURPOSE AND PROGRAM ACCOMPLISHMENTS OF THEIR ORGANIZATION. SENIOR MANAGEMENT OF THE HEALTH CARE SYSTEM REVIEWS THE 990S OF EACH FILING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE 990S 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 ENTITY'S (HAWAI'I PACIFIC HEALTH "HPH") BOARD PROVIDES OVERSIGHT FOR THE 990 REPORTING AND REVIEWS THE 990S FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE 990S FOR EACH ENTITY ARE 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 990. THE 990 WILL BE POSTED TO HPH'S WEBSITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURN WITH THE IRS. FORM 990, PART VI, LINE 12C 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; 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 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. 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 FOR DETERMINING COMPENSATION THE PRESIDENT, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER THE TAX-EXEMPT PARENT, HPH. FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE PRESIDENT, OFFICERS AND KEY EMPLOYEES' 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 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 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 CHANGES IN TR NET ASSETS $ (14,021) EQUITY TRANSFERS WITH HPH $ (59,873) INTERCOMPANY TRANSFERS WITH FOUNDATIONS $ (238,127) ------------- TOTAL $ (312,021) FORM 990 PART IX LINE 11G DESCRIPTION:INTERNAL SVC PROVIDER EXPENSE TOTAL FEES:831662 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULT. SVCS FUNDR. STRATEGY TOTAL FEES:625 FORM 990 PART IX LINE 11G DESCRIPTION:MGR/DIR BONUS TOTAL FEES:35805 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 MEDICAL SPECIALISTS 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990322406 HEALTHCARE HI 501(c)(3) 10 HPH true KAPI'OLANI MEDICAL CTR WOMEN & CHILDREN 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990177350 HOSPITAL HI 501(c)(3) 3 HPH true PALI MOMI MEDICAL CENTER 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990274038 HOSPITAL HI 501(c)(3) 3 HPH true STRAUB CLINIC & HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 992151670 HOSPITAL HI 501(c)(3) 3 HPH true STRAUB FOUNDATION 55 MERCHANT STREET 24 TH FLOOR HONOLULU HI 96813 990109350 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 WILCOX HEALTH FOUNDATION 3-3420 KUHIO HIGHWAY LIHUE HI 96766 990204242 FUNDRAISING HI 501(c)(3) 7 HPH true PALI MOMI FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLUOLU HI 96813 383840327 FUNDRAISING HI 501(c)(3) 7 HPH true PROVIDERS INSURANCE CORPORATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 INSURANCE HI 501(c)(3) 12B, II HPH true KAUA'I MEDICAL CLINIC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990326099 HOSPITAL HI 501(c)(3) 3 HPH true ASC Pacific Ventures LLC 55 Merchant St 27th floor Honolulu HI 96813 270540034 AMBU. SURG. CTR AL NA Straub Pharmacy INC 55 Merchant Street 24th Floor Honolulu HI 96813 990145107 INACTIVE HI NA C Corp Hicord Inc 55 Merchant Street 24th Floor Honolulu HI 96813 990251496 INVESTMENT HI NA C Corp Hawai'i Pacific Health Partners INC 55 Merchant Street 24th Floor Honolulu HI 96813 990318588 Holding Company HI NA C Corp false true false false false false false false false false false false false false true true true true true KAPI'OLANI MEDICAL CTR FOR WOMEN & CHILDREN b 2659884 FMV KAPI'OLANI MEDICAL CTR FOR WOMEN & CHILDREN q 97770 FMV KAPI'OLANI MEDICAL CTR FOR WOMEN & CHILDREN r 631767 FMV KAPI'OLANI MEDICAL SPECIALISTS b 195625 FMV PALI MOMI FOUNDATION s 60381 FMV PALI MOMI FOUNDATION p 75588 FMV STRAUB FOUNDATION s 55638 FMV STRAUB FOUNDATION p 93103 FMV WILCOX HEALTH FOUNDATION s 121368 FMV WILCOX HEALTH FOUNDATION p 77340 FMV RELATED ORG. TAXABLE AS PARTNERSHIP SCHEDULE R, PART III ASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 55 MERCHANT ST., 27TH FLOOR HONOLULU, HI 96813