2017-04-28T17:15:36-05:00 2016-06-30 ERNST & YOUNG US LLP 370 17TH ST 3300 DENVER CO 80202 990 2015-07-01 990246364 Kapi'olani Health Foundation % Donna Masuda-Kam KAPI 8085357100 55 Merchant Street 24th Floor Honolulu HI 96813 EARL INOUYE VICE PRESIDENT 8085357100 2017-04-28 true KELLEY SIMON P00791436 7209314000 2015 2017-02-10 21:41:12Z Thomas Mundell 55 Merchant Street 26th Floor Honolulu HI 96813 38244861 false X www.kapiolanigift.org X 1986 HI THE MISSION OF KAPI'OLANI HEALTH FOUNDATION IS TO CREATE A HEALTHIER HAWAI'I. 20 19 0 21 0 3483583 5044427 0 0 2229277 -1274674 9483 367923 5722343 4137676 2020966 2444616 0 0 0 0 114348 59606 1258699 2780232 2512683 4915546 5016905 806797 -879229 88652469 87743680 1686782 1981119 86965687 85762561 X THE MISSION OF KAPI'OLANI HEALTH FOUNDATION IS TO CREATE A HEALTHIER HAWAI'I. false false 3143945 2444616 0 SEE SCHEDULE O 3143945 true true false false false false false false true true true true false false true false false true false false false false false true true false false true false true false false false false false false false false true false false false false true true true false false true X 0 0 0 false false false false false true true false false false false X 20 19 true false false false true true true true true false false true true true true true true false false false HI X X Donna Masuda-Kam 8085272520 55 Merchant Street 24th Floor Honolulu HI 96813 JEFFREY A ARCE Board of Director, Chair 0.2 0.0 X X 0 0 0 MEREDITH CHING Board of Director 0.2 0.0 X 0 0 0 KIMBERLY W DEY Board of Director, Vice Chair 0.2 0.0 X X 0 0 0 SARA DUDGEON Board of Director 0.2 0.0 X 0 0 0 STEPHANIE GAMBETTA Board of Director 0.2 0.0 X 0 0 0 KIM HEHIR Board of Director 0.2 0.0 X 0 0 0 MICHELLE HO Board of Director 0.2 0.0 X 0 0 0 DAVID HUDSON Board of Director 0.2 0.0 X 0 0 0 THOMAS KOSASA MD Board of Director 0.2 0.0 X 0 0 0 LORI L MCCARNEY Board of Director 0.2 0.0 X 0 0 0 PAUL MARX Board of Director 0.2 0.0 X 0 0 0 MARCUS MERNER Board of Director 0.2 0.0 X 0 0 0 RALPH MESICK Board of Director 0.2 0.0 X 0 0 0 ALANA PAKKALA Board of Director 0.2 0.0 X 0 0 0 ANGELA PRATT Board of Director 0.2 0.0 X 0 0 0 ABELINA SHAW Board of Director 0.2 0.0 X 0 0 0 PATRICIA W SHEEHAN Board of Director 0.2 0.0 X 0 0 0 RAYMOND P VARA JR Board of Director 0.2 61.9 X 0 1619202 657628 EILEEN WACKER Board of Director 0.2 0.0 X 0 0 0 GREGORY K YIM MD Board of Director 0.2 0.0 X 0 0 0 SACHI BRADEN Board of Director (part year) 0.2 0.0 X 0 0 0 FRED M NOA Board of Director (part year) 0.2 0.0 X 0 0 0 THOMAS MUNDELL PRESIDENT 6.0 56.0 X 0 319598 78217 DAVID OKABE Treasurer 0.1 55.3 X 0 727747 271732 EARL INOUYE Assistant Treasurer 0.2 50.8 X 0 323923 66330 CHARLES R CHING Secretary 0.1 57.4 X 0 613655 218402 JESSICA LEWIS Assistant Treasurer 1.0 39.0 X 0 128274 25615 MICHAEL ROBINSON Former Officer 0.0 53.0 X 0 216195 39408 0 3948594 1357332 0 true true false 0 20000 5024427 572787 5044427 0 773404 773404 0 0 0 0 0 31919527 33967605 -2048078 -2048078 -2048078 506855 20000 139580 367275 367275 0 0 ALL OTHER REVENUE 648 0 0 648 648 4137676 0 0 -906751 X 2444616 2444616 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4208 0 4208 0 0 0 0 59606 59606 192976 192976 0 901370 310568 590802 131238 0 0 131238 94246 0 33640 60606 64914 0 0 64914 0 0 0 0 35967 0 0 35967 42490 0 0 42490 0 0 0 0 5976 0 0 5976 0 0 0 0 0 0 0 10244 0 0 10244 13321 0 13321 0 Program Expenditures 699329 699329 0 0 OTHER PURCHASES 256078 256078 CORPORATE ALLOCATION 59548 59548 ALL OTHER EXPENSES 778 778 5016905 3143945 614261 1258699 0 0 0 10618497 17198585 11786857 8776320 851515 654029 0 0 0 0 0 0 0 0 0 0 327970 304831 33383 23139 35089843 35517752 27895498 23206980 2218318 2218319 0 0 158558 148556 88652469 87743680 120068 108017 0 0 0 0 0 0 160722 153221 0 0 0 0 0 0 1405992 1719881 1686782 1981119 X 46687688 43449003 37989063 39898867 2288936 2414691 86965687 85762561 88652469 87743680 X -879229 -117619 0 0 -206278 X false true X true false X 8081042 13104576 10440469 3483583 5044427 40154097 0 0 8081042 13104576 10440469 3483583 5044427 40154097 7747593 32406504 896809 945661 1007105 1072788 773404 4695767 0 571 691 488 648 2398 44852262 0.72252 0.70803 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true X 66720120 125755 -1382870 84637 65378368 68635843 102429 -1899330 118822 66720120 61397833 15361 7313112 90463 68635843 55489203 34773 5973274 99417 61397833 56726543 15932 -1160109 93163 55489203 0.96000 0.01000 0.03000 false false 0 0 56667 56667 268942 248164 20778 2361 0 2361 23139 COMBINED INVESTMENT POOL 23206980 F 23206980 0 Due to Aflliates 1719881 1719881 Form 990, Schedule d, Part iv, line 2b Trust, Escrow and custodial arrrengements Escrow liabilities represent amounts due to individuals under charitable remainder trust agreements. FORM 990, SCHEDULE D, PART V, LINE 4 DESCRIPTION OF INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS CALVIN C.J. SIA, MD ENDOWMNET. ESTABLISHED IN 2001 IN HONOR OF DR. CAL SIA, PEDIATRICIAN, EDUCATOR, ADMINISTRATOR AND ADVOCATE FOR HAWAI'I'S KEIKI. THE PURPOSE OF THIS FUND IS TO PROMOTE OPTIMAL HEALTH AND DEVELOPMENT OF ALL CHILDREN. CECIL MARSHALL ENDOWMENT ESTABLISHED IN 2001 TO SUPPORT THE MISSION OF THE KAPI'OLANI HEALTH FOUNDATION. DAVID & DORIS CROWELL ENDOWMENT ESTABLISHED IN 2000 TO PROVIDE MEDICAL CARE FOR ECONOMICALLY DISADVANTAGED CHILDREN AT KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN. FLANDERS ENDOWMENT FUND ESTABLISHED BY MURIEL MACFARLANE FLANDERS IN MEMORY OF HER TWO GRANDMOTHERS, EMELIE HEDEMANN MACFARLANE AND ABIGAIL KUAIHELANI CAMPBELL. THE HARRY & JEANETTE WEINBERG FOUNDATION ENDOWMENT ESTABLISHED TO PROVIDE ONGOING SUPPORT TO KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN'S EMERGENCY ROOM AND PEDIATRIC INTENSIVE CARE UNIT (PICU). MARJORIE BOOTH STEPHENS FUND ESTABLISHED TO PROVIDE MEDICAL CARE TO ALL WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THE WILIAM SAUNDERS ENDOWMENT ESTABLISHED IN HONOR OF CECIL A. SAUNDERS, MD, A PEDIATRICIAN WHO ESTABLISHED BABY CLINICS IN THE 1920S, THIS FUND SUPPORTS PEDIATRIC PROGRAMS AT KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN. SASHA FRANZEL LIFE PERMANENT ENDOWMENT ESTABLISHED IN 2011 FOR THE PURPOSE OF PROVIDING SUPPORT TO THE KAPI'OLANI CLEFT & CRANIOFACIAL CENTER (KCCC). MILLARD HENLEIN AND FRANKIE HENLEIN CHILDREN'S FUND ESTABLISHED IN 1992 FOR THE PURPOSE OF PROVIDING DIRECT MEDICAL SERVICES TO NEEDY CHILDREN AT THE KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN. PAMELA ANN SHIGEZAWA MEDICAL LIBRARY ESTABLISHED FOR THE USE AND BENEFIT OF THE KAPI'OLANI HOSPITAL MEDICAL LIBRARY. KAPI'OLANI PEDIATRIC ENDOWMENT FUND THE FUND SHALL BE USED TO SUPPORT THE PEDIATRIC PROGRAM AT KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN. ABBIE VARA ENDOWMENT THE FUND SHALL SUPPORT THE KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN PEDIATRIC REHABILITATION SERVICES PROGRAM AND/OR OTHER PROGRAMS OR SERVICES OF KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN. X X X X X X true MARTS LUNDY PUBLIC Relations false 59606 -59606 59606 -59606 GOLF TOURNAMENT 526855 20000 506855 14981 11725 885 111989 0 526855 20000 506855 14981 11725 885 111989 139580 367275 true Kapi'olani Med Center for Women & Children 55 MERCHANT ST 24TH FL Honolulu HI 96813 990177350 501(c)(3) 2251288 64355 FMV GIFTS-IN-KIND GENERAL SUPPORT Kapi'olani Medical Specialists 55 Merchant St 24th Fl Honolulu HI 96813 990322406 501(c)(3) 94962 0 GENERAL SUPPORT Hawai'i Pacific Health 55 Merchant St 24th Fl Honolulu HI 96813 990246363 501(c)(3) 13355 0 GENERAL SUPPORT 3 FORM 990, SCHEDULE I, part II DESCR OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS TEMPORARILY RESTRICTED FUNDS RELEASED (& GRANTED) TO THE AFFILIATED ORGANIZATIONS ARE RELEASED AFTER THE SPECIFIC PURPOSE OF THE FUND HAS BEEN MET. ONCE THE AFFILIATED ORGANIZATION COMMUNICATES THE EXPENSE AND SATISFIES THE SUBSTANTIATION OF THE EXPENSE FOR THE PURPOSE THAT THE FUNDS WERE CONTRIBUTED FOR, THE FOUNDATION RELEASES THE RESTRICTION AND RECORDS THE GRANT TO THE AFFILIATED ORGANIZATION. NO FURTHER MONITORING OF THE FUNDS AFTER DISTRIBUTION IS NECESSARY. false true false false false false false false false THOMAS MUNDELL PRESIDENT 0 225815 0 45416 0 48367 0 64643 0 13574 0 397815 0 0 RAYMOND P VARA JR Board of Director 0 893498 0 388324 0 337380 0 634530 0 23098 0 2276830 0 296712 DAVID OKABE Treasurer 0 450780 0 152265 0 124702 0 257404 0 14328 0 999479 0 94882 EARL INOUYE Assistant Treasurer 0 246127 0 38502 0 39294 0 51458 0 14872 0 390253 0 19251 CHARLES R CHING Secretary 0 338812 0 123416 0 151427 0 198040 0 20362 0 832057 0 89031 JESSICA LEWIS Assistant Treasurer 0 127774 0 500 0 0 0 6349 0 19266 0 153889 0 0 MICHAEL ROBINSON Former Officer 0 193143 0 19823 0 3229 0 35572 0 3836 0 255603 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S PRESIDENT IS PAID BY ITS TAX EXEMPT PARENT, HAWAI'I PACIFIC HEALTH ('HPH'), AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O FORM 990 PART VI, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. FORM 990, SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERNAL REVENUE CODE ON COMPENSATION CONSIDERED UNDER SUCH PLANS. 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. AMOUNT PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: $132,595 - RAYMOND P. VARA JR. $36249 - DAVID OKABE $44,823 - CHARLES R. CHING 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. AMOUNT PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: $328,234 - RAYMOND P. VARA JR. $117,265 - DAVID OKABE $38,502 - EARL INOUYE $88,416 - CHARLES R. CHING X 7 422062 cost/selling price X gifts in kind 45 150725 cost/selling price false true false Schedule M, Part I, COLUMN B COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART III, LINE 4 PROGRAM SERVICE ACCOMPLISHMENTS The mission of kapi'olani health foundation The mission of kapi'olani health foundation (the foundation) is to create a healthier Hawai'i. Kapi'olani Medical Center for Women & Children (Kapi'olani) is a not for profit medical center located in Honolulu and dedicated to the health and well being of all Hawai'i residents. Kapi'olani is Hawai'i's only maternity, newborn and pediatric specialty hospital. Kapi'olani is part of the Hawai'i Pacific Health System, one of the state's largest health care providers. Services include: - intensive care for infants and children - 24-hour emergency pediatric and adult care - critical care transport - maternal-fetal medicine - the state's first breast health and gynecological cancer centers - the sex abuse treatment center - obstetrics & gynecology - pediatric care - children's specialty clinics As a not-for-profit medical center, kapi'olani relies on philanthropic support from the community to fulfill its mission of serving its patients, regardless of their ability to pay. Contributions, both unrestricted and designated, help the medical center provide exceptional medical care for hawai'i's women and children, particularly the most critically ill. Our generous donors help the medical center in four key areas: patient care, capital improvements, education and research, community health and uncompensated care. Capital improvements Research shows that patients heal better and faster when families are involved with their care. As Kapi'olani continues to expand and renovate the facility, the intent is to build around the concept of family-centered care by providing ample space to accommodate new technology and to allow parents and caregivers to stay overnight. Rapidly emerging technologies have fundamentally changed the care delivery process for patients. To continue to deliver the level and comfort that hawai'i's families deserve, kapi'olani has embarked on a long term plan to rebuild the medical center. Phase 1 has been completed with the opening of the diamond head tower. The new structure offers: 1. Family-centered space to deliver family-centered care, a concept at the center of hospital rebuilds nationwide; 2. Services that meet the critical care needs of hawai'i's children, as the pacific region's sole tertiary referral center for pediatric, neonatal and maternal care; and 3. Adequate educational conference rooms and spaces that are available foster Hawai'i's pediatric teaching hospital. Specialized pediatric care Gifts to the foundation enable kapi'olani to provide a full breadth of specialized pediatric care, from general pediatrics to multi specialty care. not typically available to populations the size of hawai'i's, which is 1.4 million. Children with cancer, blood disorders, autoimmune deficiencies and other diseases need follow-up care beyond their inpatient stay. The road to recovery can include years of outpatient treatment. For kids in hawai'i, this means regular trips to kapi'olani's pediatric ambulatory unit, the only facility of its kind in the pacific region. Neonatal-pediatric critical care transport team The kapi'olani neonatal-pediatric critical care transport team is the only one like it in the state and donor-supported. Specially trained staff provide 24/7 lifesaving care to the state's most critically ill newborns and children, regardless of where they are located throughout the islands. Kapi'olani transported more than 572 patients on o'ahu, from neighbor islands and to the mainland in fiscal year 2015. Many of them would not have survived without the immediate medical attention they received from the team. Heart week Since many children in hawai'i with serious heart conditions are not well enough to fly to the mainland for open-heart surgery, donor support allows kapi'olani to bring the surgeons to them for heart week. For one week, multiple times per year, some of the nation's finest specialists from hospitals, such as rady children's hospital san diego, work alongside the pediatric cardiologists and surgeons from kapi'olani. They perform a wide range of surgeries and procedures on patients who are unlikely to survive if their condition is left untreated. Kapi'olani cleft and craniofacial center Donors also support kapi'olani's pediatric specialty clinics, including the kapi'olani cleft and craniofacial center. Cleft lip and cleft palate are complex conditions. They require multidisciplinary therapies from birth through young adulthood by a coordinated team of medical specialists. The center is the only one of its kind in the state, and gathers the essential mix of dedicated specialists in pediatrics, audiology, ear/nose/throat, occupational therapy, dentistry, orthodontics, oral and maxillofacial surgery, plastic surgery, ophthalmology and genetics in one place to serve patients and their families. FORM 990, PART V, LINE 1A HAWAI'I PACIFIC HEALTH (HPH), THE ORGANIZATION'S TAX EXEMPT PARENT, PAYS ALL VENDORS. THEREFORE, HPH ISSUES FORM 1099S UNDER ITS TAX ID. FORM 990, PART VI, LINE 2 DESCRIPTION OF BUSINESS RELATIONSHIPS ALANA PAKKALA, MARTHA SMITH AND RAYMOND VARA HAVE A BUSINESS RELATIONSHIP. JEFFREY ARCE, RAYMOND VARA, WARREN CHAIKO AND MARTHA SMITH HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, LINE 6 MEMBERS AND RIGHTS HAWAI'I PACTIFIC HEALTH IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO ELECT THE MEMBERS OF THE GOVERNING BODY AND/OR APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BOARD. FORM 990, PART VI, LINE 7A DESCRIPTION CLASSES OF PERSON AND THE NATURE OF THEIR RIGHTS HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER, AND HAS THE POWER TO APPROVE THE ELECTION OF MEMBERS OF THE GOVERNING BODY. HAWAI'I PACIFIC HEALTH, AS MEMBER, ALSO HAS THE POWER TO ELECT ONE OR MORE EX OFFICIO VOTING MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, LINE 7B DESCR CLASSES OF PERSONS, DECISIONS REQ APPR & TYPE OF VOTING RIGHTS HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS EXCLUSIVE POWER TO TAKE AND DIRECT THE FOLLOWING ACTIONS OF THE CORPORATION: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: PRESIDENT, VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE CHAIR AND VICE-CHAIR OF THE BOARD; (II) AFTER CONSULTATION WITH THE BOARD, REMOVE THE PRESIDENT, VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE CHAIR AND VICE-CHAIR; (III) REMOVE A DIRECTOR FROM THE BOARD; (IV) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER; (V) AMEND THESE BYLAWS; (VI) CAUSE THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1) YEAR AND/OR ONE MILLION DOLLARS ($1,000,000) OR MORE; (VII) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (VIII) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE, AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (IX) DETERMINE AND EFFECT INTER-CORPORATE FUND TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (X) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S EXECUTIVE COMPENSATION AND BENEFIT PLANS; (XI) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (XII) DEVELOP AND PROMULGATE OVERALL CORPORATE GOALS AND THE LONG-RANGE AND STRATEGIC PLAN OF THE CORPORATION; AND (XIII) DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. THE CORPORATION SHALL NOT TAKE THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING MEMBER APPROVAL: (I) ELECT ANY DIRECTOR TO THE BOARD; (II) AMEND THE ARTICLES; (III) MERGE THE CORPORATION WITH ANY ENTITY; (IV) DISSOLVE THE CORPORATION; (V) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS BY OR ON BEHALF OF THE CORPORATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (VI) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000) EXCEPT FOR THOSE ASSETS ACQUIRED BY GIFTS, GRANT, OR DONATION; (VII) ACQUIRE SHARES IN ANOTHER CORPORATION; (VIII) SELL, LEASE, EXCHANGE, ENCUMBER OR DISPOSE OF TWENTY-FIVE PERCENT (25%) OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION TO ANY ENTITY THAT IS NOT AN AFFILIATE; (IX) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (X) FORM A JOINT VENTURE OR OTHER BUSINESS RELATIONSHIP (OTHER THAN THE ORDINARY COURSE OF BUSINESS CONTRACTS) BETWEEN THE CORPORATION AND ANY PERSON OR ENTITY; AND (XI) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE. FORM 990, PART VI, LINE 11B REVIEW OF THE 990 BY THE ORGANIZATION'S GOVERNING BODY VARIOUS SCHEDULES OF THE 990 ARE PREPARED PRIMARILY BY STAFF WITHIN THE ACCOUNTING AREA OF THE ORGANIZATION WORKING WITH VARIOUS OTHER AREAS OF THE ORGANIZATION SUCH AS MANAGEMENT OF OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPLETED INTERNALLY BASED ON INPUT AND DISCUSSION WITH FINANCIAL ANALYSTS AND THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF THE REPORTING ENTITY. THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF EACH REPORTING ENTITY REVIEWS AND APPROVES THE DISCLOSURE NARRATIVES WHICH DESCRIBE THE MISSION/PURPOSE AND PROGRAM ACCOMPLISHMENTS OF THEIR ORGANIZATION. SENIOR MANAGEMENT OF THE HEALTH CARE SYSTEM REVIEWS THE 990S OF EACH FILING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE 990S ARE THEN PROVIDED TO THE GOVERNANCE AND NOMINATING COMMITTEE OF THE HEALTH CARE SYSTEM'S BOARD OF DIRECTORS FOR THEIR REVIEW. THE GOVERNANCE AND NOMINATING COMMITTEE OF THE PARENT ENTITY'S (HAWAI'I PACIFIC HEALTH "HPH") BOARD PROVIDES OVERSIGHT FOR THE 990 REPORTING AND REVIEWS THE 990S FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE 990S FOR EACH ENTITY ARE MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND THE HPH BOARD OF DIRECTORS THROUGH A BOARD MEMBER PORTAL FOR REVIEW PRIOR TO THE FILING OF THE 990. THE 990 WILL BE POSTED TO HPH'S WEBSITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURN WITH THE IRS. FORM 990, PART VI, LINE 12C ANNUALLY, EACH DIRECTOR, OFFICER, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) RECEIVED A COPY OF THE CONFLICT OF INTEREST ("COI") POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; 4) HAS DISCLOSED ANY CONFLICTS OR POTENTIAL CONFLICTS OR ECONOMIC INTERESTS AS REQUIRED; AND 5) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION, AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, THE ORGANIZATION MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. THE IN-HOUSE LEGAL DEPARTMENT DISTRIBUTES THE STATEMENT REQUEST AND REVIEWS THE COI STATEMENTS RETURNED. IDENTIFIED CONFLICTS OF INTEREST ARE PRESENTED TO THE BOARD FOR REVIEW, DELIBERATION AND CONFIRMATION/REFUTATION THAT A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST HAS BEEN FOUND, THE INDIVIDUAL MAY ADDRESS THE BOARD AND EXPLAIN THE TRANSACTION OR ARRANGEMENT CAUSING THE CONFLICT. AFTER THE PRESENTATION, THE INDIVIDUAL IS EXCUSED FROM THE MEETING AND SHALL NOT PARTICIPATE WITH ANY DISCUSSION OR VOTE ON MATTERS PERTAINING TO THE TRANSACTION OR ARRANGEMENT. IN MEETINGS WHERE APPLICATION OF THE COI POLICY OCCURS, THE MEETING MINUTES INCLUDE NATURE OF THE FINANCIAL INTEREST/CONFLICT, NAME(S) OF THE PERSON(S) WITH THE POTENTIAL OR ACTUAL CONFLICT, ANY ACTION TAKEN TO ASSIST IN THE DETERMINATION OF WHETHER A CONFLICT EXISTED, INCLUDING ANY DISCUSSION OF ALTERNATIVE ARRANGEMENTS, THE BOARD'S DECISION(S) REGARDING THE CONFLICT AND NAMES OF PERSON PRESENT IN THE DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT. BOARD'S DECISION(S) REGARDING THE CONFLICT AND NAMES OF PERSON PRESENT IN THE DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, LINES 15A & 15B PROCESS FOR DETERMINING COMPENSATION THE PRESIDENT, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER THE TAX-EXEMPT PARENT, HPH. FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE PRESIDENT, OFFICERS AND KEY EMPLOYEES' COMPENSATION. COMPENSATION FOR HAWAI'I PACIFIC HEALTH ("HPH") EXECUTIVES (VICE PRESIDENT AND ABOVE) IS SET BY THE HPH COMPENSATION COMMITTEE, WHICH IS COMPOSED SOLELY OF INDEPENDENT, COMMUNITY-BASED MEMBERS OF THE HPH BOARD OF DIRECTORS. ON AN ANNUAL BASIS THE HPH BOARD CHAIRPERSON (WHO IS INDEPENDENT) SELECTS A NEUTRAL THIRD PARTY EXECUTIVE COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVES' COMPENSATION AND BENEFITS. THE CONSULTANT PROVIDES A WRITTEN REPORT TO THE COMPENSATION COMMITTEE AT ITS ANNUAL MEETING. INCLUDED IN THE REPORT IS MARKET BASED DATA FROM LIKE ORGANIZATIONS. THE COMPENSATION COMMITTEE MAKES FINAL DECISIONS REGARDING COMPENSATION AND BENEFITS AT THE MEETING AFTER REVIEW AND DISCUSSION OF THE CONSULTANT'S REPORT, AND SUCH DECISIONS ARE DOCUMENTED IN THE COMPENSATION COMMITTEE MEETING MINUTES. COMMUNITY BASED DIRECTORS OF THE ORGANIZATION ARE NOT COMPENSATED. CERTAIN EMPLOYED PHYSICIANS MAY BE OFFICERS OR AN IDENTIFIED KEY EMPLOYEE OF THE REPORTING OR RELATED ORGANIZATION. PHYSICIAN COMPENSATION IS ALSO HANDLED IN THE SAME MANNER AS EXECUTIVE COMPENSATION, WITH THE HPH COMPENSATION COMMITTEE RECEIVING A REPORT FROM A NEUTRAL CONSULTANT AND FOLLOWING THE SAME PROCESS AS DESCRIBED ABOVE ON AN ANNUAL BASIS. THIS PROCESS WAS LAST COMPLETED ON MARCH 11, 2016 TO REVIEW PHYSICIAN COMPENSATION AND ON AUGUST 24, 2016 TO REVIEW EXECUTIVE COMPENSATION. FORM 990, PART VI, LINE 19 DISCLOSURE OF GOV DOCS, CONFLICT OF INTEREST POLICY & FINANCIAL STMTS THE CONFLICT OF INTEREST POLICY AND STANDARDS OF CONDUCT ARE AVAILABLE ON THE HAWAI'I PACIFIC HEALTH WEBSITE. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC VIA THE HAWAI'I PACIFIC HEALTH WEBSITE. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES $(101,026) - EQUITY TRANSFERS WITH HPH $ (10,614) - CHANGES IN SPLIT INTEREST AGREEMENTS $ (5,118) - OTHER CHANGES IN TR NET ASSETS $ (89,552) - TRANSFERS $ 2 - ROUNDING ------------ $ (120,645) - TOTAL FORM 990 PART IX LINE 11G DESCRIPTION:INTERNAL SVC PROVIDER EXPENSE TOTAL FEES:901370 Pali Momi Medical Center 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990274038 hospital HI 501(c)(3) 3 NA true STRAUB CLINIC & HOSPITAL 55 MERCHANT STREET 24TH FLOOR Honolulu HI 96813 912151670 hospital HI 501(c)(3) 3 NA true Kapi'OLANI MEDICAL CTR WOMEN & CHILDREN 55 MERCHANT STREET 24TH FLOOR Honolulu HI 96813 990177350 hospital HI 501(c)(3) 3 NA true Kapi'olani Medical Specialists 55 Merchant Street 24th Floor Honolulu HI 96813 990322406 healthcare HI 501(c)(3) 9 NA true Hawai'i Pacific Health 55 MERCHANT STREET 24TH FLOOR Honolulu HI 96813 990246363 HOLDING CO. HI 501(c)(3) 11B, III-FI NA false Wilcox Health Foundation 3-3420 KUHIO HIGHWAY Lihue HI 96766 990204242 fundraising HI 501(c)(3) 7 NA true Pali Momi Foundation 55 Merchant Street 24TH FLOOR Honolulu HI 96813 383840327 fundraising HI 501(c)(3) 7 NA true Straub Foundation 55 MERCHANT STREET 26TH FLOOR Honolulu HI 96813 990109350 FUNDRAISING HI 501(c)(3) 7 NA true Wilcox Memorial HOSPITAL 3-3420 Kuhio HIGHWAY Lihue HI 96766 990074365 hospital HI 501(c)(3) 3 NA true PROVIDERS INSURANCE CORPORATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 INSURANCE HI 501(C)(3) 11B, II NA true KAUA'I MEDICAL CLINIC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990326099 HOSPITAL HI 501(C)(3) 3 NA true ASC Pacific Ventures LLC 270540034 AMBU. SURG. CTR AL NA Straub Pharmacy INC 55 Merchant Street 24th Floor Honolulu HI 96813 990145107 INACTIVE HI NA C Corp Hicord Inc 55 Merchant Street 24th Floor Honolulu HI 96813 990251496 INVESTMENT HI NA C Corp Hawai'i Pacific Health Partners INC &SUB 55 Merchant Street 24th Floor Honolulu HI 96813 990318588 Holding COMPA HI NA C Corp false true false false false false false false false false false false false false true true true true true Kapi'olani Medical Specialists b 75000 FMV Kapi'olani Medical Ctr for Women & Children b 2054424 FMV Kapi'olani Medical Ctr for Women & Children s 209232 FMV Kapi'olani Medical Ctr for Women & Children r 209172 FMV Straub Foundation p 93364 FMV Pali Momi Foundation p 65421 FMV RELATED ORG. TAXABLE AS PARTNERSHIP SCHEDULE R, PART III ASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 3000 RIVERCHASE GALLERIA, STE 500 BIRMINGHAM, AL 35244