2015-05-12T16:22:48-05:00 2014-06-30 ERNST & YOUNG US LLP 2901 DOUGLAS BLVD SUITE 300 ROSEVILLE CA 95661 990 2013-07-01 990246364 Kapi'olani Health Foundation % Ann Ho KAPI 8085357100 55 Merchant Street 24TH floor Suite Honolulu HI 96813 EARL INOUYE VICE PRESIDENT 2015-05-12 CINDY WHITE P01396368 2013 2016-02-25 16:41:14Z Michael Robinson 55 Merchant Street 26TH floor Honolulu HI 96813 34326564 false X www.kapiolanigift.org X 1986 HI TO IMPROVE THE HEALTH OF HAWAI'I'S PEOPLE THROUGH FUNDING OF MEDICAL THROUGH FUNDING OF MEDICAL CARE, EQUIPMENT, HEALTH EDUCATION AND RESEARCH AT KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN. 22 20 0 20 0 13104576 10440469 0 0 2480565 3395378 11412 8467 15596553 13844314 1839647 1783592 0 0 0 0 125520 62022 2282219 3604638 4031792 5569805 5877406 10026748 7966908 79724192 92478456 1130646 2060111 78593546 90418345 X TO IMPROVE THE HEALTH OF HAWAI'I'S PEOPLE THROUGH FUNDING OF MEDICAL CARE, EQUIPMENT, HEALTH EDUCATION AND RESEARCH AT KAPI'OLANI MEDICAL 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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 MARCUS MERNER Board of Director 0.2 0.0 X 0 0 0 FRED M NOA Board of Director 0.2 0.0 X 0 0 0 MICHAEL O'MALLEY ESQ Board of Director, Chair 0.2 0.0 X X 0 0 0 ALANA PAKKALA Board of Director 0.2 0.0 X 0 0 0 VIRGINIA PRESSLER-FISHER MD Board of Director, VP 4.0 55.0 X X 0 586997 184338 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 65.0 X 0 1490728 393474 EILEEN WACKER Board of Director 0.2 0.0 X 0 0 0 JOHN C WALKER JR 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 BRAD TOTHEROW Board of Director (PART YEAR) 0.2 0.0 X 0 0 0 MICHAEL ROBINSON President 20.0 20.0 X 0 208380 22142 DAVID OKABE Treasurer 1.0 53.0 X 0 783672 175363 EARL INOUYE Assistant Treasurer 0.2 54.0 X 0 317690 79385 CHARLES R CHING 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990, Schedule D, Part IV TRUST, ESCROW, AND CUSTODIAL ARRANGEMENTS 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 ENDOWMENT ESTABLISHED IN 2001 IN HONOR OF DR. CAL SIA, PEDIATRICIAN, EDUCATOR, ADMINISTRATOR AND ADVOCATE FOR HAWAII'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. CHAN FAMILY FUND ESTABLISHED IN 1999 TO PROVIDE ASSISTANCE TO FAMILIES OF CHILDREN WITH CANCER. 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. RICHARD DAVI SCHOLARSHIP FUND ESTABLISHED TO PROVIDE SCHOLARSHIPS FOR CONTINUING MEDICAL EDUCATION. THE WILLIAM 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 KMCWC. PAMELA ANN SHIGEZAWA MEDICAL LIBRARY ESTABLISHED FOR THE USE AND BENEFIT OF THE KAPI'OLANI HOSPITAL MEDICAL LIBRARY. X X X X X true Marts and Lundy 1200 Wall Street West Lyndhurst NJ 07071 Public Relations false 62022 -62022 62022 -62022 HI GOLF TOURNAMENT 29870 1850 28020 20244 0 29870 1850 28020 20244 20244 7776 true Kapi'olani Medical Center for Women & Children 55 Merchant Street 24th Floor Honolulu HI 96813 990177350 501(c)(3) 1629863 50158 FMV Gift-in-kind GENERAL SUPPORT Hawai'i Pacific Health 55 Merchant Street 24th Floor Honolulu HI 96813 990246363 501(c)(3) 11009 0 GENERAL SUPPORT Kapi'olani Medical Specialist 55 Merchant Street 24th Floor Honolulu HI 96813 990322406 501(c)(3) 92562 0 GENERAL SUPPORT 3 FORM 990, SCHEDULE I 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 VIRGINIA PRESSLER-FISHER MD Board of Director, VP 0 332773 0 137886 0 116338 0 19716 0 164622 0 771335 0 116500 MICHAEL ROBINSON President 0 186726 0 18572 0 3082 0 6986 0 15156 0 230522 0 0 RAYMOND P VARA JR Board of Director 0 780906 0 445327 0 264495 0 20970 0 372504 0 1884202 0 267684 DAVID OKABE Treasurer 0 429188 0 177313 0 177171 0 13890 0 161473 0 959035 0 131479 EARL INOUYE Assistant Treasurer 0 236093 0 41827 0 39770 0 19987 0 59398 0 397075 0 25156 CHARLES R CHING Secretary 0 325455 0 173692 0 160676 0 5082 0 155468 0 820373 0 103184 BETTY KANESHIRO FORMER OFFICER 0 101699 0 0 0 0 0 13108 0 20530 0 135337 0 0 Form 990, Schedule J, Part I, Line 3 SUPPLEMENTAL COMPENSATION INFORMATION 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 15B FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. 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: $47,557 - VIRGINIA PRESSLER-FISHER, M.D. $70,020 - RAYMOND P. VARA JR. $42,822 - DAVID OKABE $ 4,242 - EARL INOUYE $36,337 - 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: $137,886 - VIRGINIA PRESSLER-FISHER, M.D. $395,327 - RAYMOND P. VARA JR. $177,313 - DAVID OKABE $ 41,827 - EARL INOUYE $133,692 - CHARLES R. CHING X 16 353978 cost/selling price X MISCELLANEOUS DONATIONS 0 50158 cost/selling price false true true Schedule M, Part I, Line 32b SOLICITATION, PROCESSING, OR NONCASH CONTRIBUTIONS FINANCIAL INSTITUTIONS ARE USED TO ASSIST IN THE SELLING OF NON-CASH CONTRIBUTIONS. NUMBERS OF ITEMS DONATED NOT AVAILABLE FOR ALL CONTRIBUTIONS. 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 IMPROVE THE HEALTH OF HAWAI'I'S FAMILIES THROUGH THE FUNDING OF MEDICAL CARE, EQUIPMENT, HEALTH EDUCATION, CAPITAL INFRASTRUCTURE AND RESEARCH AT KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN (KAPI'OLANI). KAPI'OLANI IS HAWAI'I'S ONLY MATERNITY, NEWBORN AND PEDIATRIC SPECIALTY HOSPITAL. KAPI'OLANI IS A NOT-FOR-PROFIT HOSPITAL AND AN AFFILIATE OF HAWAI'I PACIFIC HEALTH, THE STATE'S LARGEST HEALTH CARE PROVIDER. SERVICES INCLUDE: - INTENSIVE CARE FOR INFANTS AND CHILDREN - 24-HOUR EMERGENCY PEDIATRIC CARE - AIR TRANSPORT - MATERNAL-FETAL MEDICINE - HIGH-RISK PERINATAL CARE - THE STATE'S FIRST BREAST HEALTH AND GYNECOLOGICAL CANCER CENTERS AS A NOT-FOR-PROFIT HOSPITAL, 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 HOSPITAL PROVIDE EXCEPTIONAL MEDICAL CARE FOR HAWAI'I'S WOMEN AND CHILDREN, PARTICULARLY THE MOST CRITICALLY ILL. OUR GENEROUS DONORS HELP THE HOSPITAL CONTINUE PROVIDING EXCEPTIONAL MEDICAL CARE TO HAWAII'S WOMEN AND CHILDREN, INCLUDING THE CRITICALLY ILL, IN FOUR KEY AREAS: PATIENT CARE, CAPITAL IMPROVEMENTS, EDUCATION AND RESEARCH, AND UNCOMPENSATED CARE CAPITAL IMPROVEMENTS RESEARCH SHOWS THAT PATIENTS HEAL BETTER AND FASTER WHEN FAMILIES ARE INVOLVED WITH THEIR CARE. THE BUILDING DESIGN FOLLOWS THIS CONCEPT 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 HAWAII'S FAMILIES DESERVE, KAPIOLANI HAS EMBARKED ON A MAJOR RENOVATION AND REBUILD OF THE HOSPITAL. PHASE 1 WILL HELP KAPIOLANI REACH THE FOLLOWING GOALS: 1. CREATE FAMILY-CENTERED SPACE TO DELIVER FAMILY-CENTERED CARE, A CONCEPT AT THE CENTER OF HOSPITAL REBUILDS NATIONWIDE; 2. MEET THE CRITICAL CARE NEEDS OF HAWAII'S CHILDREN, AS THE PACIFIC REGION'S SOLE TERTIARY REFERRAL CENTER AND LEVEL III-B NEONATAL INTENSIVE CARE UNIT; AND 3. ENSURE ADEQUATE EDUCATIONAL CONFERENCE ROOMS AND SPACES ARE AVAILABLE AS HAWAII'S PEDIATRIC TEACHING HOSPITAL. SPECIALIZED PEDIATRIC CARE GIFTS TO THE FOUNDATION ENABLE KAPI'OLANI TO PROVIDE A FULL BREADTH OF SPECIALIZED PEDIATRIC 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 TRANSPORT TEAM THE KAPI'OLANI NEONATAL-PEDIATRIC 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 650 PATIENTS TO O'AHU AND THE MAINLAND IN FISCAL YEAR 2014. 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 AND LUCILE PACKARD CHILDREN'S HOSPITAL, WORK ALONGSIDE THE PEDIATRIC CARDIOLOGISTS AND SURGEONS FROM KAPI'OLANI AND STRAUB CLINIC & HOSPITAL. THEY PERFORM A WIDE RANGE OF SURGERIES AND TREATMENTS ON PATIENTS WHOSE SURVIVAL IS UNLIKELY IF LEFT UNTREATED. KAPI'OLANI CLEFT AND CRANIOFACIAL CENTER DONORS ALSO SUPPORTED 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 VI, LINE 2 DESCRIPTION OF BUSINESS RELATIONSHIPS ALANA KOBAYASHI PAKKALA & JEFFREY ARCE HAVE A BUSINESS RELATIONSHIP. KOBAYASHI GROUP PROVIDES CERTAIN CONSULTING SERVICES TO RAYMOND VARA, WARREN CHAIKO, AND MARTHA SMITH. 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 990S BY THE ORGANIZATION'S GOVERNING BODY VARIOUS SCHEDULES OF THE 990S 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 990S 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; AND 4) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION, AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, THE ORGANIZATION MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. THE IN-HOUSE LEGAL DEPARTMENT DISTRIBUTES THE STATEMENT REQUEST AND REVIEWS THE COI STATEMENTS RETURNED. IDENTIFIED CONFLICTS OF INTEREST ARE PRESENTED TO THE BOARD FOR REVIEW, DELIBERATION AND CONFIRMATION /REFUTATION THAT A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST HAS BEEN FOUND, THE INDIVIDUAL MAY ADDRESS THE BOARD AND EXPLAIN THE TRANSACTION OR ARRANGEMENT CAUSING THE CONFLICT. AFTER THE PRESENTATION, THE INDIVIDUAL IS EXCUSED FROM THE MEETING AND SHALL NOT PARTICIPATE WITH ANY DISCUSSION OR VOTE ON MATTERS PERTAINING TO THE TRANSACTION OR ARRANGEMENT. IN MEETINGS WHERE APPLICATION OF THE COI POLICY OCCURS, THE MEETING MINUTES INCLUDE NATURE OF THE FINANCIAL INTEREST/CONFLICT, NAME(S) OF THE PERSON(S) WITH THE POTENTIAL OR ACTUAL CONFLICT, ANY ACTION TAKEN TO ASSIST IN THE DETERMINATION OF WHETHER A CONFLICT EXISTED, INCLUDING ANY DISCUSSION OF ALTERNATIVE ARRANGEMENTS, THE BOARD'S DECISION(S) REGARDING THE CONFLICT AND NAMES OF PERSON PRESENT IN THE DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT. 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 OFFICES & POSITIONS WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUN THE CEO, 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 CEO, 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 3, 2014 TO REVIEW PHYSICIAN COMPENSATION AND ON AUGUST 22, 2014 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 IX, LINE 11G OTHER FEES FOR SERVICES (NON-EMPLOYEE) $ 892,665 - INTERNAL SERVICE PROVIDED EXPENSE $ 248,584 - CONSULTING EXPENSE $ 407,652 - FUNDRAISING EXPENSE $ 20,939 - SERVICES OTHER $ 2,657 - REPAIR AND MAINTENANCE $ 45,240 - TEMP LABOR $ 8,695 - SERVICES CONTRACTS ----------- $ 1,626,432 - TOTAL FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES $ (114,969) - EQUITY TRANSFERS WITH HPH $ (127,601) - TRANSFERS $ ( 15,281) - OTHER CHANGES IN TR NET ASSETS $ ( 18,196) - CHANGE IN SPLIT INTEREST AGREEMENTS $ 1 - ROUNDING ------------ $ (276,046) - TOTAL Pali Momi Foundation 55 Merchant Street 24th Floor Honolulu HI 96813 383840327 fundraising HI 501(c)(3) 7 NA true Hawai'i Pacific Health 55 Merchant Street 24th Floor Honolulu HI 96813 990246363 holding co. HI 501(c)(3) 11b TYPE II NA false 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 Specialist 55 Merchant Street 24th Floor Honolulu HI 96813 990322406 healthcare HI 501(c)(3) 9 NA true 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 Straub Foundation 55 Merchant Street 24th Floor Honolulu HI 96813 990109350 FUNDRAISING HI 501(c)(3) 7 NA true Wilcox Memorial Hospital 55 Merchant Street 24th Floor Honolulu HI 96813 990074365 hospital HI 501(c)(3) 3 NA true Wilcox Health Foundation 55 Merchant Street 24th Floor Honolulu HI 96813 990204242 fundraising HI 501(c)(3) 7 NA true PROVIDERS INSURANCE CORPORATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 NFP INSURANCE HI 501(C)(3) 11B TYPE 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. CNTR AL NA N/A 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 COMPANY HI NA C Corp false true false false false false false false false false false false false false true false true false true Kapi'olani Medical Specialist b 87094 FMV Kapi'olani Medical CNTR for Women & Children b 1400483 FMV Hawai'i Pacific Health Research Institute s 196257 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