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KAUAI MEDICAL CLINIC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
KAUAI MEDICAL CLINIC (EIN 99-0326099)
Tax period
2017-07-01 to 2018-06-30
Filed
2019-05-13
IRS object ID
201901339349304735
Schema version
2017v2.3
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)
Return2019-05-13T13:26:48-05:00ReturnTs
Tax Period End2018-06-30TaxPeriodEndDt

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 Begin2017-07-01TaxPeriodBeginDt

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)
PersonEARL INOUYEPersonNm
Person Titlevice presidentPersonTitleTxt
Phone8082451500PhoneNum
Signature2019-05-09SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOCELYNE MILLERPreparerPersonNm
PTINP00634378PTIN
Phone8585357200PhoneNum
Preparation2019-05-09PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address190.2.10.9IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id33008120191335000004FederalOriginalSubmissionId
Federal Original Submission Id2019-05-13FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdB26A0E7ADF3B9DE143B5ECD047BF97D8CB3915A7AtSubmissionCreationDeviceId
At Submission Filing Device Id537EC6986AB1F8F0FDE33F35764D968E98BC4D64AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

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$46,967,396GrossReceiptsAmt
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 Employee296TotalEmployeeCnt
Total Volunteers3TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,335PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$44,092,741PYProgramServiceRevenueAmt
CY Program Service Revenue$46,960,821CYProgramServiceRevenueAmt
PY Investment Income$872PYInvestmentIncomeAmt
CY Investment Income$6,575CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$44,095,948PYTotalRevenueAmt
CY Total Revenue$46,967,396CYTotalRevenueAmt
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$41,186,294PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$43,978,816CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$19,286,426PYOtherExpensesAmt
CY Other Expenses$20,182,978CYOtherExpensesAmt
PY Total Expenses$60,472,720PYTotalExpensesAmt
CY Total Expenses$64,161,794CYTotalExpensesAmt
PY Revenues Less Expenses-$16,376,772PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$17,194,398CYRevenuesLessExpensesAmt
Total Assets BOY$14,788,260TotalAssetsBOYAmt
Total Assets EOY$15,750,780TotalAssetsEOYAmt
Total Liabilities BOY$8,502,179TotalLiabilitiesBOYAmt
Total Liabilities EOY$9,973,306TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,286,081NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$5,777,474NetAssetsOrFundBalancesEOYAmt
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$55,373,138ExpenseAmt
Grant$0GrantAmt
Revenue$46,960,821RevenueAmt
DescSee schedule ODesc
Total Program Service Expenses$55,373,138TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
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 FootnotefalseIncludeFIN48FootnoteInd
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 With Officer EntfalseBusinessRlnWithOfficerEntInd
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
Employee296EmployeeCnt
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
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 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

Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
THOMAS HEMINGWAY
Board of Director40.00.0Yes (X)$443,727$0$31,240
SANDI KATO-KLUTKE
Board of Director, Vice Chair0.20.0Yes (X)$0$0$0Yes (X)
MIKE MURAKOSHI
Board of Director0.20.0Yes (X)$0$0$0
JAY MURPHY
Board of Director40.00.0Yes (X)$400,388$0$30,742
SUSAN TAI
Board of Director0.20.0Yes (X)$0$0$0
RAYMOND P VARA JR
Board of Director, President2.060.1Yes (X)$0$2,029,978$874,907Yes (X)
ROBERT WOTRING II MD
Board of Director, Chair40.00.0Yes (X)$290,159$0$17,701Yes (X)
MELINDA ASHTON MD
EVP & Chief Quality Officer0.149.2$0$585,804$129,787Yes (X)
JENNIE CHAHANOVICH
CEO25.031.5$0$564,557$194,002Yes (X)
WARREN CHAIKO
VP1.044.0$0$330,980$93,204Yes (X)
CHARLES R CHING
EVP, Gen Counsel & Secretary0.539.5$0$677,419$251,375Yes (X)
PAULA DIAS
VP (PART YEAR)0.250.8$0$345,992$82,214Yes (X)
DAWN DUNBAR
SVP0.145.0$0$52,816$3,841Yes (X)
BRANDT FARIAS
SVP & Chief Marketing Officer1.054.0$0$265,836$60,185Yes (X)
DAVID FOX
Privacy Officer1.438.6$0$148,299$31,417Yes (X)
ARTHUR GLADSTONE
VP & CNE0.255.2$0$785,819$279,189Yes (X)
EARL INOUYE
VP & System Controller1.047.0$0$341,558$86,237Yes (X)
ALAN ITO
Information Security Officer0.139.9$0$174,922$37,605Yes (X)
GAIL LERCH
EVP0.550.0$0$713,515$279,569Yes (X)
JESSICA LEWIS
Assistant Corporate Secretary2.537.5$0$138,454$37,263Yes (X)
LORRIE-ANN LUKE
VP0.250.5$0$222,650$74,131Yes (X)
SUSAN MASUMOTO-NONAKA
VP0.539.5$0$339,685$85,692Yes (X)
DAVID OKABE
EVP, CFO & Treasurer1.049.0$0$835,619$339,264Yes (X)
KENNETH B ROBBINS MD
EVP6.548.7$0$793,702$312,183Yes (X)
STEVEN ROBERTSON
EVP & CIO0.150.6$0$699,378$262,517Yes (X)
MICHAEL ROBINSON
VP0.249.8$0$261,111$64,808Yes (X)
KATIE SHIGEMITSU
Compliance Officer1.039.0$0$193,030$33,703Yes (X)
DAVID STUMBAUGH
VP1.538.5$0$158,699$39,353Yes (X)
GERI YOUNG MD
CMO40.010.5$0$599,843$82,800Yes (X)
ALYSSA A CARNEGIE
Physician40.00.0$586,250$0$16,121Yes (X)
DEREK S JOHNSON
Physician40.00.0$715,628$0$30,742Yes (X)
DANIEL B JUDD
Physician40.00.0$818,788$0$22,640Yes (X)
JOSEPH M MURRAY
Physician40.00.0$588,497$0$24,087Yes (X)
SURENDRA D RAO
Physician40.00.0$732,740$0$30,740Yes (X)
THOMAS MUNDELL
Former Officer0.00.0$0$427,274$37,658Yes (X)
THERESA RAMEY
Former Officer0.040.0$0$128,197$19,967Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$4,576,177TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$11,815,137TotReportableCompRltdOrgAmt
Total Other Compensation$3,996,884TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K88IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
SHIOI CONSTRUCTION INC
98-724 KUAHAO PLPEARL CITYHI96782CONSTRUCTION SVCS$438,198
VIRTUAL RADIOLOGIC CORPORATION
25983 NETWORK PLACECHICAGOIL606731259RADIOLOGY$152,501
BARTON ASSOCIATES INC
PO BOX 417844BOSTONMA022417844HEALTH CARE STAFFING$152,175
PRESS GANEY ASSOC INC
ONE NORTH FRANKLIN STE 300CHICAGOIL606063494HEALTH CARE SURVEY$108,087
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Fundraising$0FundraisingAmt
Noncash Contributions$0NoncashContributionsAmt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
NET PATIENT REVENUE622110$36,377,642$36,377,642$0$0
PREMIUM REVENUE622110$7,834,881$7,834,881$0$0
INTER-ENTITY SERVICE REV622110$1,559,216$1,559,216$0$0
OTHER HEALTH CARE REVENUE622110$970,679$970,679$0$0
RENTAL INCOME900099$126,397$126,397$0$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$92,006TotalRevenueColumnAmt
Related Or Exempt Func Income$92,006RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$46,960,821TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,575TotalRevenueColumnAmt
Exclusion$6,575ExclusionAmt

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$46,967,396TotalRevenueColumnAmt
Related Or Exempt Func Income$46,960,821RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$6,575ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,473,392TotalAmt
Program Services$1,473,392ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$35,923,559TotalAmt
Program Services$35,397,436ProgramServicesAmt
Management And General$526,123ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,243,826TotalAmt
Program Services$1,240,562ProgramServicesAmt
Management And General$3,264ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$3,582,627TotalAmt
Program Services$2,444,035ProgramServicesAmt
Management And General$1,138,592ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,755,412TotalAmt
Program Services$1,716,051ProgramServicesAmt
Management And General$39,361ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$248,929TotalAmt
Program Services$0ProgramServicesAmt
Management And General$248,929ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt
Fundraising$0FundraisingAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$7,944,742TotalAmt
Program Services$5,956,111ProgramServicesAmt
Management And General$1,988,631ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,445,665TotalAmt
Program Services$3,394,221ProgramServicesAmt
Management And General$51,444ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$78,824TotalAmt
Program Services$159ProgramServicesAmt
Management And General$78,665ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,395,731TotalAmt
Program Services$1,249,266ProgramServicesAmt
Management And General$146,465ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$222,966TotalAmt
Program Services$206,448ProgramServicesAmt
Management And General$16,518ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$38,437TotalAmt
Program Services$38,437ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$767,995TotalAmt
Program Services$767,995ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,423,791TotalAmt
Program Services$1,377,039ProgramServicesAmt
Management And General$46,752ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
CORPORATE ALLOCATION$4,332,247$0$4,332,247$0
OTHER PURCHASES$102,839$37,459$65,380$0
DUES$59,680$59,680$0$0
PHYSICIAN MOVING EXPENSES$48,907$0$48,907$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$72,225TotalAmt
Program Services$14,847ProgramServicesAmt
Management And General$57,378ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$64,161,794TotalAmt
Program Services$55,373,138ProgramServicesAmt
Management And General$8,788,656ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Joint Costs TotalJointCostsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$152,650BOYAmt
EOY$149,531EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$145,976BOYAmt
EOY$227,200EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

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

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,148,357BOYAmt
EOY$3,238,732EOYAmt

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$15,940,206LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$8,879,382LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$7,346,455BOYAmt
EOY$7,060,824EOYAmt

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$3,994,822BOYAmt
EOY$5,074,493EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$14,788,260BOYAmt
EOY$15,750,780EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,698,888BOYAmt
EOY$5,172,621EOYAmt

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$3,803,291BOYAmt
EOY$4,800,685EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,502,179BOYAmt
EOY$9,973,306EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,286,081BOYAmt
EOY$5,777,474EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

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

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

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

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,286,081BOYAmt
EOY$5,777,474EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,788,260BOYAmt
EOY$15,750,780EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$17,194,398ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$0NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts$0DonatedServicesAndUseFcltsAmt
Investment Expense$0InvestmentExpenseAmt
Prior Period Adjustments$0PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$16,685,791OtherChangesInNetAssetsAmt
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

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
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$1,336,994OtherCostOrOtherBasisAmt
Depreciation$164,109DepreciationAmt
Book Value$1,172,885BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,670,410OtherCostOrOtherBasisAmt
Depreciation$2,401,687DepreciationAmt
Book Value$3,268,723BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,527,379OtherCostOrOtherBasisAmt
Depreciation$6,313,586DepreciationAmt
Book Value$1,213,793BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$771,326OtherCostOrOtherBasisAmt
Book Value$771,326BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$7,060,824TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (9 entries)

DescDescBook ValueBookValueAmt
DEPOSITS & OTHER NON-CURRENT$3,990,196
PREPAID & OTHER CURRENT ASSETS$279,238
DUE FROM GOVERNMENT AGENCIES$240,758
OTHER RECEIVABLES$140,317
DUE FROM HAWAI'I HEALTH PTNRS$336,217
DUE FROM WILCOX HEALTH FNDN$41,432
DUE FROM HPH RSRCH INSTITUTE$24,974
DUE FROM KMS$11,811
DUE FROM PROVIDERS INS. CORP$9,550
FieldValueIRS element (for citing)
Total Book Value Other Assets$5,074,493TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (10 entries)

DescDescAmtAmt
457(B) LIABILITY$3,939,066
ESCHEAT LIABILITY$4,385
HAWAI'I PACIFIC HEALTH$609,641
WILCOX MEMORIAL HOSPITAL$98,052
STRAUB CLINIC & HOSPITAL$60,473
KAPI'OLANI MED CTR WOMEN & CHILDREN$54,730
PALI MOMI MEDICAL CENTER$25,182
KAPI'OLANI HEALTH FOUNDATION$8,959
STRAUB FOUNDATION$188
PALI MOMI FOUNDATION$9
FieldValueIRS element (for citing)
Total Liability$4,800,685TotalLiabilityAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
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 (32 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
THOMAS HEMINGWAY
Board of Director$345,521$0$6,666$0$91,540$0$10,800$0$20,440$0$474,967$0$0$0
JAY MURPHY
Board of Director$372,498$0$4,818$0$23,072$0$10,800$0$19,942$0$431,130$0$0$0
RAYMOND P VARA JR
Board of Director, President$0$948,892$0$497,727$0$583,359$0$851,629$0$23,278$0$2,904,885$0$389,984
ROBERT WOTRING II MD
Board of Director, Chair$265,586$0$2,792$0$21,781$0$10,800$0$6,901$0$307,860$0$0$0
MELINDA ASHTON MD
EVP & Chief Quality Officer$0$403,706$0$109,332$0$72,766$0$114,014$0$15,773$0$715,591$0$80,859
JENNIE CHAHANOVICH
CEO$0$335,722$0$107,085$0$121,750$0$180,963$0$13,039$0$758,559$0$105,277
WARREN CHAIKO
VP$0$239,729$0$44,681$0$46,570$0$68,926$0$24,278$0$424,184$0$38,768
CHARLES R CHING
EVP, Gen Counsel & Secretary$0$368,738$0$140,275$0$168,406$0$229,595$0$21,780$0$928,794$0$107,869
PAULA DIAS
VP (PART YEAR)$0$228,847$0$53,684$0$63,461$0$67,640$0$14,574$0$428,206$0$35,473
BRANDT FARIAS
SVP & Chief Marketing Officer$0$197,165$0$48,129$0$20,542$0$51,000$0$9,185$0$326,021$0$27,066
DAVID FOX
Privacy Officer$0$146,804$0$0$0$1,495$0$15,529$0$15,888$0$179,716$0$0
ARTHUR GLADSTONE
VP & CNE$0$455,088$0$180,230$0$150,501$0$257,118$0$22,071$0$1,065,008$0$124,936
EARL INOUYE
VP & System Controller$0$255,688$0$43,382$0$42,488$0$67,746$0$18,491$0$427,795$0$40,079
ALAN ITO
Information Security Officer$0$168,811$0$3,500$0$2,611$0$16,463$0$21,142$0$212,527$0$0
GAIL LERCH
EVP$0$394,947$0$148,419$0$170,149$0$270,029$0$9,540$0$993,084$0$117,325
JESSICA LEWIS
Assistant Corporate Secretary$0$138,454$0$0$0$0$0$12,067$0$25,196$0$175,717$0$0
LORRIE-ANN LUKE
VP$0$175,436$0$32,490$0$14,724$0$49,450$0$24,681$0$296,781$0$25,571
THOMAS MUNDELL
Former Officer$0$175,274$0$0$0$252,000$0$16,988$0$20,670$0$464,932$0$0
SUSAN MASUMOTO-NONAKA
VP$0$242,091$0$53,266$0$44,328$0$67,640$0$18,052$0$425,377$0$39,472
DAVID OKABE
EVP, CFO & Treasurer$0$485,359$0$181,256$0$169,004$0$324,005$0$15,259$0$1,174,883$0$143,406
THERESA RAMEY
Former Officer$0$126,233$0$0$0$1,964$0$13,254$0$6,713$0$148,164$0$0
KENNETH B ROBBINS MD
EVP$0$461,691$0$138,974$0$193,037$0$295,724$0$16,459$0$1,105,885$0$139,998
STEVEN ROBERTSON
EVP & CIO$0$391,948$0$143,046$0$164,384$0$246,258$0$16,259$0$961,895$0$116,758
MICHAEL ROBINSON
VP$0$204,754$0$37,673$0$18,684$0$55,605$0$9,203$0$325,919$0$32,835
KATIE SHIGEMITSU
Compliance Officer$0$191,175$0$0$0$1,855$0$18,484$0$15,219$0$226,733$0$0
DAVID STUMBAUGH
VP$0$149,738$0$8,961$0$0$0$15,319$0$24,034$0$198,052$0$0
GERI YOUNG MD
CMO$0$354,313$0$45,050$0$200,480$0$69,261$0$13,539$0$682,643$0$35,012
ALYSSA A CARNEGIE
Physician$543,437$0$400$0$42,413$0$2,700$0$13,421$0$602,371$0$0$0
DEREK S JOHNSON
Physician$657,712$0$3,365$0$54,551$0$10,800$0$19,942$0$746,370$0$0$0
DANIEL B JUDD
Physician$782,428$0$0$0$36,360$0$2,700$0$19,940$0$841,428$0$0$0
JOSEPH M MURRAY
Physician$570,203$0$0$0$18,294$0$10,800$0$13,287$0$612,584$0$0$0
SURENDRA D RAO
Physician$714,066$0$150$0$18,524$0$10,800$0$19,940$0$763,480$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Schedule J, Part I, Line 3THE 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, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION.
Form 990, Schedule J, Part I, Line 4aSEVERANCE PAY THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT DURING THE YEAR: THOMAS MUNDELL - $252,000
Form 990, Schedule J, Part I, Line 4bTHE 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 ORGANIZATION: RAYMOND P. VARA JR. - $ 193,669 DAVID OKABE - $ 75,026 KENNETH B. ROBBINS, M.D. - $ 79,809 GAIL LERCH - $ 64,691 CHARLES R. CHING - $ 55,730 STEVEN ROBERTSON - $ 63,844 ARTHUR GLADSTONE - $ 60,055 JENNIE CHAHANOVICH - $ 35,591 ANNUAL AND LONG TERM INCENTIVE PLAN THE ANNUAL AND LONG TERM INCENTIVE PLAN ARE AFFORDED TO EXECUTIVES BASED ON ANNUAL AND LONG TERM SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. AMOUNTS PAID OUT DURING THE YEAR BY RELATED ORGANIZATION: RAYMOND P. VARA JR. - $ 397,727 DAVID OKABE - $ 146,256 KENNETH B. ROBBINS, M.D. - $ 138,975 GAIL LERCH - $ 118,419 CHARLES R. CHING - $ 110,275 STEVEN ROBERTSON - $ 118,046 MELINDA ASHTON, M.D. - $ 94,332 EARL INOUYE - $ 43,382 ARTHUR GLADSTONE - $145,230 SUSAN MASUMOTO-NONAKA - $ 43,266 WARREN CHAIKO - $ 44,681 GERI YOUNG, M.D. - $ 45,050 JENNIE CHAHANOVICH - $ 107,085 MICHAEL ROBINSON - $37,673 BRANDT FARIAS - $ 33,129 LORRIE-ANN LUKE - $ 32,490

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 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 20 SPECIALTIES AT FIVE LOCATIONS: THE MAIN CLINIC IN LIHU'E, KAUA'I URGET CARE CLINIC IN LIHU'E, AND THREE SATELLITE CLINICS IN KAPA'A, KOLOA AND ELE'ELE. KAUA'I MEDICAL CLINIC HAS 277 EMPLOYEES AND 94 PHYSICIANS. IN FISCAL YEAR 2018, TOTAL CLINIC ENCOUNTERS WERE 348,578. 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 IS AN ACTIVE COMMUNITY PARTNER. IN FISCAL 2018, ITS HEALTH EDUCATION, PREVENTION PROGRAMS AND SUPPORT GROUPS FOCUSED ON DIABETES, SPORTS MEDICINE, HEART ATTACK/STROKE, WATER SAFETY, INJURY PREVENTION AND HEALTH FAIRS. TOGETHER WITH WILCOX MEDICAL CENTER, THE CLINIC HOSTED OR SPONSORED A VARIETY OF COMMUNITY HEALTH EDUCATION EVENTS, AND STAFF SUPPORTED THEIR COMMUNITY BY PARTICIPATING IN ANNUAL CHARITABLE ENDEAVORS. THESE INCLUDED "KIDS SUMMER FEST," "KIDS FEST," "KAUA'I MARATHON," SEVERAL PHYSICIAN-LED COMMUNITY WALKS, "KEIKI BIKE AND SAFETY DAY," "DIABETES AWARENESS EXPO," "CANCER CARE VIDEO TELECONFERENCE," "GETTING A GRIP WITH ARTHRITIS VIDEO TELECONFERENCE," "VALENTINE IN PARADISE VIDEO TELECONFERENCE,"KOLOA SUGAR MILL RUN." 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 2018, KAUA'I MEDICAL CLINIC PROVIDED $5,954,892 WORTH OF CARE TO PATIENTS WHO WERE UNINSURED OR UNABLE TO PAY THEIR CARE, AS WELL AS OTHER COMMUNITY BENEFITS.
FORM 990, PART V, LINE 1AHAWAI'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 6MEMBERS OR STOCKHOLDERS 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, LINE 7APOWER TO ELECT AND TO APPOINT MEMBERS 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 7BDECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS 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 DOLLAR ($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 PROPERTY 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, LINE 11BPROCESS USED TO REVIEW THE FORM 990 VARIOUS SCHEDULES OF THE 990 ARE PREPARED PRIMARILY BY STAFF WITHIN THE ACCOUNTING AREA 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 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 990S WILL BE POSTED TO HPH'S WEB SITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURN WITH THE IRS.
FORM 990, PART VI, LINE 12CMonitoring & enforcement of compliance with 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, LINE 15PROCESS 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 16, 2018 TO REVIEW PHYSICIAN COMPENSATION, AND ON AUGUST 21, 2018 TO REVIEW EXECUTIVE COMPENSATION.
FORM 990, PART VI, LINE 19PROCESS OF MAKING DOCUMENTS AVAILABLE TO THE PUBLIC 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 TO THE PUBLIC VIA THE HAWAI'I PACIFIC HEALTH WEBSITE.
FORM 990, PART IX, LINE 11GOTHER FEES EXCEEDING 10% OF TOTAL EXPENSE $ 3,924,126 - INTERNAL SERVICE PROVIDER $ 647,658 - SERVICES PHYSICIAN $ 590,755 - SERVICES PROVIDED BY WMH STAFF FOR ENVIRONMENTAL SERVICES, JANITORIAL, DISPOSAL SHREDDING, PEST CONTROL & CLEANING SERVICES $ 482,813 - SERVICES PROVIDED BY WMH STAFF FOR HEALTH INFO MGMT $ 476,679 - VARIOUS SERVICES $ 277,879 - REPAIRS AND MAINTENANCE $ 246,558 - URGENT CARE STAFF HOURS $ 241,895 - ELECTRICAL SERVICES PROVIDED BY WMH STAFF FOR PLANT/GROUND MAINTENANCE, SECURITY SERVICES $ 204,926 - COURIER SERVICES, SPD STAFF HOURS $ 160,623 - ELEELE CLINIC $ 141,617 - KAPAA CLINIC $ 120,943 - PEDIATRIC CLINIC $ 118,840 - SERVICES EXCELLANCE $ 108,905 - FAMILY MEDICINE $ 55,983 - SERVICES CONSULTING $ 53,409 - COLLECTION FEES $ 39,909 - SERVICES CONTRACT RECURRING $ 29,090 - SERVICES LAUNDRY $ 23,407 - SERVICES MEDICAL $ 50 - BUS PASS $( 1,323) - EXPENSE RECOVERY ____________ $ 7,944,742 - TOTAL
FORM 990, PART XI, LINE 9OTHER CHANGES IN NET ASSETS $ 16,685,792 - EQUITY TRANSFERS WITH HPH $( 1) - ROUNDING _____________ $ 16,685,791 - TOTAL

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
KAPI'OLANI MEDICAL CTR WOMEN & CHILDREN
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990177350HOSPITALHI501(c)(3)3NAYes (true)
KAPI'OLANI MEDICAL SPECIALISTS
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990322406HEALTH CAREHI501(c)(3)10NAYes (true)
PALI MOMI FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813383840327FUNDRAISINGHI501(c)(3)7NAYes (true)
PALI MOMI MEDICAL CENTER
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990274038HOSPITALHI501(c)(3)3NAYes (true)
PROVIDERS INSURANCE CORPORATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813710893000NFP INSURANCEHI501(c)(3)12b,IINAYes (true)
STRAUB CLINIC & HOSPITAL
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813912151670HOSPITALHI501(c)(3)3NAYes (true)
STRAUB FOUNDATION
55 MERCHANT STREET 26TH FLOORHONOLULUHI96813990109350RESEARCH/EDUCHI501(c)(3)7NAYes (true)
WILCOX HEALTH FOUNDATION
3-3420 KUHIO HIGHWAYLIHUEHI96766990204242FUNDRAISINGHI501(c)(3)7NAYes (true)
WILCOX MEMORIAL HOSPITAL
3-3420 KUHIO HIGHWAYLIHUEHI96766990074365HOSPITALHI501(c)(3)3NAYes (true)
HAWAI'I PACIFIC HEALTH
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990246363admin. svcsHI501(c)(3)12B,III-FINAfalse
KAPI'OLANI HEALTH FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990246364FUNDRAISINGHI501(c)(3)7NAYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

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

US Address USAddress

FieldValueIRS element (for citing)
Address Line13000 RIVERCHASE GALLERIA STE 500AddressLine1Txt
CityBIRMINGHAMCityNm
State AbbreviationALStateAbbreviationCd
ZIP35244ZIPCd
FieldValueIRS element (for citing)
EIN270540034EIN
Primary ActivitiesAMB. SURG. CTRPrimaryActivitiesTxt
Legal Domicile StateALLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxt
HAWAI'I PACIFIC HEALTH PARTNERS INC
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990318588HOLDING COMPANYHINAC Corp
HICORD INC
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990251496INVESTMENTHINAC Corp
STRAUB PHARMACY INC
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990145107INACTIVEHINAC Corp
FieldValueIRS element (for citing)
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
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (6 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
STRAUB CLINIC & HOSPITAL
s$272,571FMV
WILCOX MEMORIAL HOSPITAL
q$2,497,466FMV
WILCOX MEMORIAL HOSPITAL
p$979,047FMV
WILCOX MEMORIAL HOSPITAL
r$87,604FMV
KAPI'OLANI WOMEN & CHILDREN
q$78,377FMV
PROVIDERS INSURANCE CORPORATION
r$1,613,490FMV

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE R, PART IIIFormAndLineReferenceDesc
ExplanationASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 3000 RIVERCHASE GALLERIA, STE 500 BIRMINGHAM, AL 35244ExplanationTxt