KAUAI MEDICAL CLINIC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- KAUAI MEDICAL CLINIC (EIN 99-0326099)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-04-28
- IRS object ID
- 201701189349301105
- Schema version
- 2015v3.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-04-28T17:15:29-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 370 17TH ST 3300 | AddressLine1Txt |
| City | DENVER | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 990326099 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kaua'i Medical Clinic | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % DEBRA TUQUERO | InCareOfNm |
| Business Name Control | KAUA | BusinessNameControlTxt |
| Phone | 8082451500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 MERCHANT STREET 24TH FLOOR | AddressLine1Txt |
| City | HONOLULU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96813 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | EARL INOUYE | PersonNm |
| Person Title | VICE PRESIDENT | PersonTitleTxt |
| Phone | 8082451500 | PhoneNum |
| Signature | 2017-04-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kelley Simon | PreparerPersonNm |
| PTIN | P00791436 | PTIN |
| Phone | 7209314000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEN CHAHANOVICH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 MERCHANT STREET | AddressLine1Txt |
| City | HONOLULU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96813 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $42,733,455 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.hawaiipacifichealth.org/wilcox | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1967 | FormationYr |
| Legal Domicile State | HI | LegalDomicileStateCd |
| Activity Or Mission | THE KAUA'I MEDICAL CLINIC IS A NOT-FOR-PROFIT MULTI-SPECIALTY CLINIC WHOSE MISSION IS TO CREATE A HEALTHIER HAWAI'I. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 265 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $210,050 | PYContributionsGrantsAmt |
| CY Contributions Grants | $49,821 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $40,389,824 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $42,682,774 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$512 | PYInvestmentIncomeAmt |
| CY Investment Income | -$4,425 | CYInvestmentIncomeAmt |
| PY Other Revenue | $468 | PYOtherRevenueAmt |
| CY Other Revenue | $48 | CYOtherRevenueAmt |
| PY Total Revenue | $40,599,830 | PYTotalRevenueAmt |
| CY Total Revenue | $42,728,218 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $36,456,615 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $39,227,415 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $16,825,318 | PYOtherExpensesAmt |
| CY Other Expenses | $18,745,028 | CYOtherExpensesAmt |
| PY Total Expenses | $53,281,933 | PYTotalExpensesAmt |
| CY Total Expenses | $57,972,443 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$12,682,103 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$15,244,225 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,424,440 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,915,878 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,714,820 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,383,089 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,709,620 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,532,789 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | KAUA'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 Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $50,481,933 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $42,677,585 | RevenueAmt |
| Desc | See schedule O | Desc |
| Total Program Service Expenses | $50,481,933 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 265 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | HI | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DEBRA TUQUERO | PersonNm |
| Phone | 8085357284 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 MERCHANT STREET 24TH FLOOR | AddressLine1Txt |
| City | HONOLULU | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96813 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| THOMAS HEMINGWAY | |||||||||
| Board of Director | 40.0 | 0.0 | Yes (X) | $506,384 | $0 | $16,232 | |||
| SANDI KATO-KLUTKE | |||||||||
| Board of Director, Vice Chair | 0.2 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MARK MAGELSSEN MD | |||||||||
| Board of Director, Chair | 40.0 | 0.0 | Yes (X) | $311,347 | $0 | $12,035 | Yes (X) | ||
| MIKE MURAKOSHI | |||||||||
| Board of Director | 0.2 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| SUSAN TAI | |||||||||
| Board of Director | 0.2 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| RAYMOND P VARA JR | |||||||||
| Board of Director & president | 2.0 | 60.1 | Yes (X) | $0 | $1,619,202 | $657,628 | Yes (X) | ||
| ROBERT WOTRING II MD | |||||||||
| Board of Director | 40.0 | 0.0 | Yes (X) | $340,426 | $0 | $10,966 | |||
| JEN CHAHANOVICH | |||||||||
| CEO | 20.0 | 42.0 | $0 | $505,647 | $124,158 | Yes (X) | |||
| GERI YOUNG MD | |||||||||
| CMO | 40.0 | 11.5 | $0 | $430,718 | $59,195 | Yes (X) | |||
| DAVID OKABE | |||||||||
| EVP, CFO & Treasurer | 1.0 | 54.4 | $0 | $727,747 | $271,732 | Yes (X) | |||
| KENNETH B ROBBINS MD | |||||||||
| EVP | 5.0 | 51.0 | $0 | $732,193 | $274,111 | Yes (X) | |||
| GAIL LERCH | |||||||||
| EVP | 1.0 | 54.4 | $0 | $683,748 | $220,054 | Yes (X) | |||
| CHARLES R CHING | |||||||||
| EVP, GEN COUNSEL & SECRETARY | 4.0 | 53.5 | $0 | $613,655 | $218,402 | Yes (X) | |||
| MELINDA ASHTON MD | |||||||||
| SVP & CQO | 1.0 | 49.1 | $0 | $510,699 | $105,148 | Yes (X) | |||
| THOMAS MUNDELL | |||||||||
| SVP | 0.2 | 61.8 | $0 | $319,598 | $78,217 | Yes (X) | |||
| EARL INOUYE | |||||||||
| VP & System Controller | 1.0 | 50.0 | $0 | $323,923 | $66,330 | Yes (X) | |||
| ARTHUR GLADSTONE | |||||||||
| VP & CNE | 0.2 | 55.0 | $0 | $613,451 | $153,514 | Yes (X) | |||
| SUSAN MASUMOTO-NONAKA | |||||||||
| VP | 1.0 | 52.1 | $0 | $297,153 | $67,431 | Yes (X) | |||
| WARREN CHAIKO | |||||||||
| VP | 5.0 | 45.0 | $0 | $307,709 | $71,951 | Yes (X) | |||
| MICHAEL ROBINSON | |||||||||
| VP | 0.2 | 52.8 | $0 | $216,195 | $39,408 | Yes (X) | |||
| KATIE SHIGEMITSU | |||||||||
| Compliance Officer | 0.2 | 44.0 | $0 | $178,214 | $22,615 | Yes (X) | |||
| DAVID FOX | |||||||||
| Privacy Officer | 1.0 | 39.0 | $0 | $142,843 | $25,167 | Yes (X) | |||
| ALAN ITO | |||||||||
| Information Security Officer | 1.0 | 39.0 | $0 | $153,291 | $25,158 | Yes (X) | |||
| JESSICA LEWIS | |||||||||
| Assistant Corporate Secretary | 2.5 | 37.5 | $0 | $128,274 | $25,615 | Yes (X) | |||
| LORRIE-ANN LUKE | |||||||||
| VP | 0.2 | 47.8 | $0 | $157,671 | $53,818 | Yes (X) | |||
| BRANDT FARIAS | |||||||||
| VP | 0.2 | 54.8 | $0 | $77,243 | $29,911 | Yes (X) | |||
| STEVEN ROBERTSON | |||||||||
| EVP & CIO | 0.5 | 53.0 | $0 | $601,130 | $226,186 | Yes (X) | |||
| SURENDRA D RAO MD | |||||||||
| Physician | 40.0 | 0.0 | $718,796 | $0 | $28,035 | Yes (X) | |||
| JOSEPH M MURRAY MD | |||||||||
| Physician | 40.0 | 0.0 | $615,113 | $0 | $29,007 | Yes (X) | |||
| ANDREW SO MD | |||||||||
| Physician | 40.0 | 0.0 | $565,875 | $0 | $23,100 | Yes (X) | |||
| DEREK S JOHNSON DO | |||||||||
| Physician | 40.0 | 0.0 | $540,918 | $0 | $29,134 | Yes (X) | |||
| ELLIOT M MORRIS MD | |||||||||
| Physician | 40.0 | 0.0 | $488,046 | $0 | $24,606 | Yes (X) | |||
| KATHLEEN A CLARK | |||||||||
| FORMER OFFICER | 0.0 | 40.0 | $0 | $288,616 | $10,565 | Yes (X) | |||
| THERESA L RAMEY | |||||||||
| FORMER OFFICER | 0.0 | 40.0 | $0 | $122,360 | $18,217 | Yes (X) | |||
| JOHN LA FORGIA | |||||||||
| FORMER OFFICER | 0.0 | 0.0 | $0 | $402,813 | $5,653 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,086,905 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $10,154,093 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $3,023,299 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 78 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SHIOI CONSTRUCTION INC | |||||
| 4023 HALAU ST | LIHUE | HI | 96766 | CONSTRUCTION SVCS | $1,019,785 |
| COMPHEALTH INC | |||||
| PO BOX 972651 | DALLAS | TX | 753972651 | HEALTHCARE STAFFING | $463,413 |
| VRP OF CAPA | |||||
| 25983 NETWORK PLACE | CHICAGO | IL | 606731259 | PATIENT CARE | $149,620 |
| CDW GOVERNMENT INC | |||||
| 75 REMITTANCE DRIVE STE 1515 | CHICAGO | IL | 606751515 | IT SERVICES | $142,500 |
| CARDINAL HEALTH | |||||
| PO BOX 100316 | PASADENA | CA | 911890316 | HEALTHCARE SVCS | $124,529 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $0 | FundraisingAmt |
| Related Organizations | $49,821 | RelatedOrganizationsAmt |
| All Other Contributions | $0 | AllOtherContributionsAmt |
| Noncash Contributions | $0 | NoncashContributionsAmt |
| Total Contributions | $49,821 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| NET PATIENT REVENUE | 622110 | $35,817,105 | $35,817,105 | $0 | $0 |
| PREMIUM REVENUE | 622110 | $4,722,953 | $4,722,953 | $0 | $0 |
| OTHER HEALTH CARE REVENUE | 622110 | $530,118 | $530,118 | $0 | $0 |
| RENTAL INCOME | 900099 | $101,397 | $101,397 | $0 | $0 |
| INTER-ENTITY SERVICE REV | 622110 | $1,478,234 | $1,478,234 | $0 | $0 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,967 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $32,967 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $42,682,774 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $812 | TotalRevenueColumnAmt |
| Exclusion | $812 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $5,237 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$5,237 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,237 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$5,237 | RelatedOrExemptFuncIncomeAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | COOKBOOK SALES | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $48 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $48 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $48 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,728,218 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $42,677,585 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $812 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,167,649 | TotalAmt |
| Program Services | $1,167,649 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,336,627 | TotalAmt |
| Program Services | $31,794,178 | ProgramServicesAmt |
| Management And General | $542,449 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $941,796 | TotalAmt |
| Program Services | $938,313 | ProgramServicesAmt |
| Management And General | $3,483 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,248,364 | TotalAmt |
| Program Services | $2,250,686 | ProgramServicesAmt |
| Management And General | $997,678 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,532,979 | TotalAmt |
| Program Services | $1,498,713 | ProgramServicesAmt |
| Management And General | $34,266 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $272,647 | TotalAmt |
| Management And General | $272,647 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,047,431 | TotalAmt |
| Program Services | $5,336,064 | ProgramServicesAmt |
| Management And General | $1,711,367 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $32 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,284,963 | TotalAmt |
| Program Services | $3,198,529 | ProgramServicesAmt |
| Management And General | $86,434 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,765 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $92,765 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,352,820 | TotalAmt |
| Program Services | $1,224,138 | ProgramServicesAmt |
| Management And General | $128,682 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,403 | TotalAmt |
| Program Services | $161,606 | ProgramServicesAmt |
| Management And General | $40,797 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,532 | TotalAmt |
| Program Services | $932 | ProgramServicesAmt |
| Management And General | $600 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $784,144 | TotalAmt |
| Program Services | $784,144 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,083,391 | TotalAmt |
| Program Services | $2,053,973 | ProgramServicesAmt |
| Management And General | $29,418 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| CORPORATE ALLOCATION | $3,412,027 | $0 | $3,412,027 | $0 |
| OTHER PURCHASES | $131,550 | $73,107 | $58,443 | $0 |
| OTHER EXPENSES | $79,323 | -$99 | $79,422 | $0 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,972,443 | TotalAmt |
| Program Services | $50,481,933 | ProgramServicesAmt |
| Management And General | $7,490,510 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Joint Costs TotalJointCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $266,932 | BOYAmt |
| EOY | -$219,815 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $418,911 | BOYAmt |
| EOY | $302,118 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,814,134 | BOYAmt |
| EOY | $3,400,625 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,405,890 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,373,855 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,122,628 | BOYAmt |
| EOY | $7,032,035 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,801,835 | BOYAmt |
| EOY | $3,400,915 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,424,440 | BOYAmt |
| EOY | $13,915,878 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,537,165 | BOYAmt |
| EOY | $5,218,041 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,177,655 | BOYAmt |
| EOY | $3,165,048 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,714,820 | BOYAmt |
| EOY | $8,383,089 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,709,620 | BOYAmt |
| EOY | $5,532,789 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,709,620 | BOYAmt |
| EOY | $5,532,789 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,424,440 | BOYAmt |
| EOY | $13,915,878 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$15,244,225 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $0 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $0 | DonatedServicesAndUseFcltsAmt |
| Investment Expense | $0 | InvestmentExpenseAmt |
| Prior Period Adjustments | $0 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $16,067,394 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $634,097 | OtherCostOrOtherBasisAmt |
| Book Value | $634,097 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $1,177,609 | OtherCostOrOtherBasisAmt |
| Depreciation | $71,147 | DepreciationAmt |
| Book Value | $1,106,462 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $4,793,566 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,631,360 | DepreciationAmt |
| Book Value | $3,162,206 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $7,114,903 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,671,348 | DepreciationAmt |
| Book Value | $1,443,555 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $685,715 | OtherCostOrOtherBasisAmt |
| Book Value | $685,715 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,032,035 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DEPOSITS & OTHER NON-CURRENT | $2,287,398 |
| DUE FROM HAWAI'I HLTH PARTNERS | $366,583 |
| DUE FROM GOVERNMENT AGENCIES | $246,139 |
| OTHER RECEIVABLES | $218,192 |
| PREPAID & OTHER CURRENT ASSETS | $192,981 |
| DUE FROM HPH RSRCH INSTITUTE | $48,190 |
| DUE FROM WILCOX HEALTH FND | $41,432 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,400,915 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (10 entries)
| DescDesc | AmtAmt |
|---|---|
| 457(B) LIABILITY | $2,236,268 |
| DUE TO HAWAI'I PACIFIC HEALTH | $599,541 |
| DUE TO WILCOX MEMORIAL HOSPITAL | $128,445 |
| DUE TO STRAUB CLINIC & HOSPITAL | $86,583 |
| DUE TO KAPI'OLANI WOMENS & CHILDREN | $50,879 |
| DUE TO PALI MOMI MEDICAL CENTER | $20,271 |
| ESCHEAT LIABILITY | $8,384 |
| DUE TO KAPI'OLANI MED SPECIALISTS | $924 |
| DUE TO PROVIDERS INSURANCE COMPANY | $23,603 |
| DUE TO FOUNDATIONS | $10,150 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,165,048 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (31 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEN CHAHANOVICH | ||||||||||||||
| CEO | $0 | $319,595 | $0 | $92,969 | $0 | $93,083 | $0 | $111,690 | $0 | $12,468 | $0 | $629,805 | $0 | $70,850 |
| THOMAS HEMINGWAY | ||||||||||||||
| Board of Director | $390,180 | $0 | $1,392 | $0 | $114,812 | $0 | $10,600 | $0 | $5,632 | $0 | $522,616 | $0 | $0 | $0 |
| GERI YOUNG MD | ||||||||||||||
| CMO | $0 | $340,611 | $0 | $33,670 | $0 | $56,437 | $0 | $46,543 | $0 | $12,652 | $0 | $489,913 | $0 | $16,835 |
| MARK MAGELSSEN MD | ||||||||||||||
| Board of Director, Chair | $294,334 | $0 | $1,392 | $0 | $15,621 | $0 | $10,600 | $0 | $1,435 | $0 | $323,382 | $0 | $0 | $0 |
| RAYMOND P VARA JR | ||||||||||||||
| Board of Director & president | $0 | $893,498 | $0 | $388,324 | $0 | $337,380 | $0 | $634,530 | $0 | $23,098 | $0 | $2,276,830 | $0 | $296,712 |
| ROBERT WOTRING II MD | ||||||||||||||
| Board of Director | $319,932 | $0 | $5,802 | $0 | $14,692 | $0 | $10,600 | $0 | $366 | $0 | $351,392 | $0 | $0 | $0 |
| DAVID OKABE | ||||||||||||||
| EVP, CFO & Treasurer | $0 | $450,780 | $0 | $152,265 | $0 | $124,702 | $0 | $257,404 | $0 | $14,328 | $0 | $999,479 | $0 | $94,882 |
| KENNETH B ROBBINS MD | ||||||||||||||
| EVP | $0 | $439,859 | $0 | $115,817 | $0 | $176,517 | $0 | $259,966 | $0 | $14,145 | $0 | $1,006,304 | $0 | $125,319 |
| GAIL LERCH | ||||||||||||||
| EVP | $0 | $367,240 | $0 | $130,858 | $0 | $185,650 | $0 | $210,958 | $0 | $9,096 | $0 | $903,802 | $0 | $95,902 |
| CHARLES R CHING | ||||||||||||||
| EVP, GEN COUNSEL & SECRETARY | $0 | $338,812 | $0 | $123,416 | $0 | $151,427 | $0 | $198,040 | $0 | $20,362 | $0 | $832,057 | $0 | $89,031 |
| MELINDA ASHTON MD | ||||||||||||||
| SVP & CQO | $0 | $361,811 | $0 | $81,977 | $0 | $66,911 | $0 | $91,008 | $0 | $14,140 | $0 | $615,847 | $0 | $40,989 |
| THOMAS MUNDELL | ||||||||||||||
| SVP | $0 | $225,815 | $0 | $45,416 | $0 | $48,367 | $0 | $64,643 | $0 | $13,574 | $0 | $397,815 | $0 | $0 |
| EARL INOUYE | ||||||||||||||
| VP & System Controller | $0 | $246,127 | $0 | $38,502 | $0 | $39,294 | $0 | $51,458 | $0 | $14,872 | $0 | $390,253 | $0 | $19,251 |
| ARTHUR GLADSTONE | ||||||||||||||
| VP & CNE | $0 | $374,221 | $0 | $128,476 | $0 | $110,754 | $0 | $133,714 | $0 | $19,800 | $0 | $766,965 | $0 | $79,308 |
| SUSAN MASUMOTO-NONAKA | ||||||||||||||
| VP | $0 | $220,854 | $0 | $34,603 | $0 | $41,696 | $0 | $50,603 | $0 | $16,828 | $0 | $364,584 | $0 | $17,302 |
| WARREN CHAIKO | ||||||||||||||
| VP | $0 | $225,987 | $0 | $38,010 | $0 | $43,712 | $0 | $50,187 | $0 | $21,764 | $0 | $379,660 | $0 | $19,005 |
| MICHAEL ROBINSON | ||||||||||||||
| VP | $0 | $193,143 | $0 | $19,823 | $0 | $3,229 | $0 | $35,572 | $0 | $3,836 | $0 | $255,603 | $0 | $0 |
| KATIE SHIGEMITSU | ||||||||||||||
| Compliance Officer | $0 | $176,224 | $0 | $500 | $0 | $1,490 | $0 | $8,463 | $0 | $14,152 | $0 | $200,829 | $0 | $0 |
| DAVID FOX | ||||||||||||||
| Privacy Officer | $0 | $141,217 | $0 | $500 | $0 | $1,126 | $0 | $6,867 | $0 | $18,300 | $0 | $168,010 | $0 | $0 |
| ALAN ITO | ||||||||||||||
| Information Security Officer | $0 | $152,069 | $0 | $500 | $0 | $722 | $0 | $5,328 | $0 | $19,830 | $0 | $178,449 | $0 | $0 |
| JESSICA LEWIS | ||||||||||||||
| Assistant Corporate Secretary | $0 | $127,774 | $0 | $500 | $0 | $0 | $0 | $6,349 | $0 | $19,266 | $0 | $153,889 | $0 | $0 |
| LORRIE-ANN LUKE | ||||||||||||||
| VP | $0 | $133,999 | $0 | $7,951 | $0 | $15,721 | $0 | $32,517 | $0 | $21,301 | $0 | $211,489 | $0 | $0 |
| SURENDRA D RAO MD | ||||||||||||||
| Physician | $705,634 | $0 | $2,263 | $0 | $10,899 | $0 | $10,600 | $0 | $17,435 | $0 | $746,831 | $0 | $0 | $0 |
| JOSEPH M MURRAY MD | ||||||||||||||
| Physician | $557,471 | $0 | $10,684 | $0 | $46,958 | $0 | $10,600 | $0 | $18,407 | $0 | $644,120 | $0 | $0 | $0 |
| ANDREW SO MD | ||||||||||||||
| Physician | $466,708 | $0 | $32,873 | $0 | $66,294 | $0 | $10,600 | $0 | $12,500 | $0 | $588,975 | $0 | $0 | $0 |
| DEREK S JOHNSON DO | ||||||||||||||
| Physician | $497,931 | $0 | $12,899 | $0 | $30,088 | $0 | $10,600 | $0 | $18,534 | $0 | $570,052 | $0 | $0 | $0 |
| ELLIOT M MORRIS MD | ||||||||||||||
| Physician | $456,376 | $0 | $1,197 | $0 | $30,473 | $0 | $7,950 | $0 | $16,656 | $0 | $512,652 | $0 | $0 | $0 |
| STEVEN ROBERTSON | ||||||||||||||
| EVP & CIO | $0 | $365,310 | $0 | $95,556 | $0 | $140,264 | $0 | $14,828 | $0 | $211,358 | $0 | $827,316 | $0 | $93,921 |
| KATHLEEN A CLARK | ||||||||||||||
| FORMER OFFICER | $0 | $146,444 | $0 | $72,434 | $0 | $69,738 | $0 | $7,358 | $0 | $3,207 | $0 | $299,181 | $0 | $65,147 |
| THERESA L RAMEY | ||||||||||||||
| FORMER OFFICER | $0 | $120,093 | $0 | $500 | $0 | $1,767 | $0 | $5,796 | $0 | $12,421 | $0 | $140,577 | $0 | $0 |
| JOHN LA FORGIA | ||||||||||||||
| FORMER OFFICER | $0 | $57,466 | $0 | $0 | $0 | $345,347 | $0 | $2,145 | $0 | $3,508 | $0 | $408,466 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Schedule J, Part I, Line 3 | THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, HAWAI'I PACIFIC HEALTH ('HPH'), AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, FORM 990, PART VI, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. |
| Form 990, Schedule J, Part I, Line 4A | SEVERANCE PAY THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT FROM A RELATED ORGANIZATION: JOHN LA FORGIA - $303,035 |
| Form 990, Schedule J, Part I, Line 4b | 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. THE CAPITAL ACCUMULATION ACCOUNT (CAA) IS A SECTION 457(F) PROGRAM THAT WAS PREVIOUSLY AFFORDED TO EXECUTIVE OFFICERS OF THE ORGANIZATION TO PROVIDE BENEFITS ON A TAX DEFERRED BASIS. AMOUNTS PAID OUT DURING THE YEAR BY RELATED ORGANIZATION: RAYMOND P. VARA JR. - $ 132,595 DAVID OKABE - $ 36,249 KENNETH B. ROBBINS, MD - $ 67,410 GAIL LERCH - $ 47,973 CHARLES R. CHING - $ 44,823 STEVEN ROBERTSON - $ 46,143 ARTHUR GLADSTONE - $ 32,570 JENNIE CHAHANOVICH - $ 24,365 KATHLEEN CLARK - $ 28,930 LONG TERM INCENTIVE PLAN THE LONG TERM INCENTIVE PLAN IS 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. - $ 328,234 DAVID OKABE - $ 117,265 KENNETH B. ROBBINS, MD - $ 115,817 GAIL LERCH - $ 95,858 CHARLES R. CHING - $ 88,416 STEVEN ROBERTSON - $ 95,556 MELINDA ASHTON, MD - $ 81,977 EARL INOUYE - $ 38,502 ARTHUR GLADSTONE - $ 93,476 SUSAN MASUMOTO-NONAKA - $ 34,603 WARREN CHAIKO - $ 38,010 GERI YOUNG, MD - $ 33,670 JENNIE CHAHANOVICH - $ 92,969 KATHLEEN CLARK - $ 72,434 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ESTABLISHED IN 1967, KAUA'I MEDICAL CLINIC HAS PROVIDED THE RESIDENTS AND VISITORS OF KAUA'I WITH PRIMARY AND SPECIALTY CARE FOR 49 YEARS. KAUA'I MEDICAL CLINIC PARTNERS WITH WILCOX MEMORIAL HOSPITAL 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 URGENT CARE CLINIC IN LIHU'E AND THREE SATELLITE CLINICS IN KAPA'A, KOLOA AND ELE'ELE. KAUA'I MEDICAL CLINIC EMPLOYS 89 PHYSICIANS AND 155 DIRECT SUPPORT STAFF. IN FISCAL YEAR 2016, TOTAL CLINIC ENCOUNTERS WERE 339,933. 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 2016, ITS HEALTH EDUCATION, PREVENTION PROGRAMS AND SUPPORT GROUPS FOCUSED ON DIABETES, HEART ATTACK/STROKE, SPORTS MEDICINE, WATER SAFETY, INJURY PREVENTION, AND HEALTH FAIRS. TOGETHER WITH WILCOX MEMORIAL HOSPITAL, 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 KEIKI RUN", SEVERAL PHYSICIAN-LED COMMUNITY WALKS, "KEIKI BIKE AND SAFETY DAY", "CANCER CARE VIDEO TELECONFERENCE", "WOMEN'S WAY TO HEALTH VIDEO TELECONFERENCE", "VALENTINE IN PARADISE VIDEO TELECONFERENCE", AND "OLD 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 2016, KAUA'I MEDICAL CLINIC PROVIDED $3,817,961 WORTH OF CARE TO PATIENTS WHO WERE UNINSURED OR UNABLE TO PAY FOR THEIR CARE, AS WELL AS OTHER COMMUNITY BENEFITS. |
| FORM 990, PART V, LINE 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 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 7A | POWER TO ELECT THE 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 7B | DESITIONS 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 CORPORATIONS 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 CORPORATIONS 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 CORPORATIONS 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, KAUAI 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 CORPORATIONS 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 11B | PROCESS USED TO REVIEW THE FORM 990 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 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 12C | MONITORING & 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; 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. |
| FORM 990, PART VI, LINE 15 | PROCESS 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 11, 2016 TO REVIEW PHYSICIAN COMPENSATION, AND ON AUGUST 24, 2016 TO REVIEW EXECUTIVE COMPENSATION. |
| FORM 990, PART VI, LINE 19 | PROCESS 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 11G | OTHER FEES EXCEEDING 10% OF TOTAL EXPENSE 3,535,720 - INTERNAL SERVICE PROVIDER 787,606 - PHYSICIAN SERVICES 587,344 - SERVICES PROVIDED BY WMH STAFF FOR ENVIRONMENTAL SERVICES, JANITORIAL, DISPOSAL SHREDDING, PEST CONTROL & CLEANING SERVICE 471,122 - SERVICES PROVIDED BY WMH STAFF FOR HEALTH INFO MGMT 350,316 - REPAIRS & MAINTENANCE 347,100 - VARIOUS SERVICES 242,266 - URGENT CARE STAFF HOURS 215,868 - COURIER SERVICES, PURCHASE TECH/CLERK HOURS, STERILE CLEANING SUPPLIES/INSPECT & PACKAGE SUPPLIES 211,302 - ELECTRICAL, SERVICES PROVIDED BY WMH STAFF FOR PLANT/GROUND MAINTENANCE, SECURITY SERVICES 108,172 - SERVICE EXCELLENCE 48,526 - COLLECTION FEES 42,625 - CONSULTING 42,453 - SERVICES CONTRACT RECURRING 39,700 - SERVICES TEMP LABOR OTHER 18,149 - LAUNDRY 650 - BUS PASS (329) - SERVICES MEDICAL (1,159) - EXPENSE RECOVERY --------------- 7,047,431 TOTAL |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS 16,067,394 - EQUITY TRANSFERS WITH HPH ----------- 16,067,394 TOTAL |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| KAPI'OLANI HEALTH FOUNDATION | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990246364 | FUNDRAISING | HI | 501(c)(3) | 7 | NA | Yes (true) |
| KAPI'OLANI MEDICAL CTR WOMEN & CHILDREN | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990177350 | HOSPITAL | HI | 501(c)(3) | 3 | NA | Yes (true) |
| KAPI'OLANI MEDICAL SPECIALISTS | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990322406 | HEALTH CARE | HI | 501(c)(3) | 9 | NA | Yes (true) |
| PALI MOMI FOUNDATION | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 383840327 | FUNDRAISING | HI | 501(c)(3) | 7 | NA | Yes (true) |
| PALI MOMI MEDICAL CENTER | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990274038 | HOSPITAL | HI | 501(c)(3) | 3 | NA | Yes (true) |
| PROVIDERS INSURANCE CORPORATION | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 710893000 | INSURANCE | HI | 501(c)(3) | 11B, II | NA | Yes (true) |
| STRAUB CLINIC & HOSPITAL | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULUL | HI | 96813 | 912151670 | HOSPITAL | HI | 501(c)(3) | 3 | NA | Yes (true) |
| STRAUB FOUNDATION | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990109350 | RESEARCH/EDUC | HI | 501(c)(3) | 7 | NA | Yes (true) |
| WILCOX HEALTH FOUNDATION | ||||||||||
| 3-3420 LIHUE HIGHWAY | LIHUE | HI | 96766 | 990204242 | FUNDRAISING | HI | 501(c)(3) | 7 | NA | Yes (true) |
| WILCOX MEMORIAL HOSPITAL | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990074365 | HOSPITAL | HI | 501(c)(3) | 3 | NA | Yes (true) |
| HAWAI'I PACIFIC HEALTH | ||||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990246363 | HOLDING COMP | HI | 501(c)(3) | 11b, III-FI | NA | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASC PACIFIC VENTURES LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3000 RIVERCHASE GALLERIA STE 500 | AddressLine1Txt |
| City | BIRMINGHAM | CityNm |
| State Abbreviation | AL | StateAbbreviationCd |
| ZIP | 35244 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 270540034 | EIN |
| Primary Activities | AMBU. SURG. CNTR. | PrimaryActivitiesTxt |
| Legal Domicile State | AL | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt |
|---|---|---|---|---|---|---|---|---|
| HAWAII PACIFIC HEALTH PARTNERS INC & SUB | ||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990318588 | HOLDING COMPANY | HI | NA | C Corp |
| HICORD INC | ||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990251496 | INVESTMENT | HI | NA | C Corp |
| STRAUB PHARMACY INC | ||||||||
| 55 MERCHANT STREET 24TH FLOOR | HONOLULU | HI | 96813 | 990145107 | INACTIVE | HI | NA | C Corp |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (7 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| STRAUB CLINIC & HOSPITAL | ||
| q | $61,387 | FMV |
| STRAUB CLINIC & HOSPITAL | ||
| r | $348,038 | FMV |
| STRAUB CLINIC & HOSPITAL | ||
| s | $292,246 | FMV |
| WILCOX MEMORIAL HOSPITAL | ||
| q | $1,581,252 | FMV |
| WILCOX MEMORIAL HOSPITAL | ||
| r | $55,549 | FMV |
| KAPIOLANI WOMEN & CHILDREN | ||
| q | $52,435 | FMV |
| PROVIDERS INSURANCE CORPORATION | ||
| r | $1,921,869 | FMV |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART III | FormAndLineReferenceDesc |
| Explanation | ASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 3000 RIVERCHASE GALLERIA, STE 500 BIRMINGHAM, AL 35244 | ExplanationTxt |