2015-05-06T16:45:48-05:00 2014-06-30 ERNST & YOUNG US LLP 4370 LA JOLLA VILLAGE DR SUITE 500 SAN DIEGO CA 92122 990 2013-07-01 990251372 MOLOKAI GENERAL HOSPITAL % Zessica Apiki MOLO 8085533125 PO BOX 408 Suite KAUNAKAKAI MOLOKAI HI 96748 Clinton Yee Treasurer 8085533125 2015-05-04 DEBRA HEISKALA P00649485 8085533125 2013 2016-02-25 16:41:14Z JANICE KALANIHUIA PO BOX 408 KAUNAKAKAI MOLOKAI HI 96748 14056295 false X www.molokaigeneralhospital.org X 1987 HI TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE ISLAND OF MOLOKAI. 8 5 95 47 3354 2289524 2113825 10351595 11084844 403365 113119 362743 400960 13407227 13712748 0 0 0 0 5905405 6059540 0 0 0 6408779 6947205 12314184 13006745 1093043 706003 20389734 21774950 3044464 3177224 17345270 18597726 X TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE ISLAND OF MOLOKAI. false false 9213819 11314865 MOLOKAI GENERAL HOSPITAL (MGH) IS A RURAL HEALTH CARE FACILITY WITH A CRITICAL ACCESS HOSPITAL DESIGNATION. IT PROVIDES THE ONLY EMERGENCY ROOM SERVICES FOR RESIDENTS AND VISITORS ON THE ISLAND OF MOLOKAI, AND PROVIDES ACUTE CARE, INPATIENT HOSPICE, SKILLED NURSING, AND LOW-RISK OBSTETRICAL SERVICES. MGH ALSO OFFERS CHEMOTHERAPY, LIMITED SPECIAL PROCEDURES, DIABETES MANAGEMENT, PREVENTIVE HEALTH SERVICES, HIGH-RISK WEIGHT MANAGEMENT, MIDWIFERY, FAMILY PLANNING, AND PRIMARY CARE IN ITS RURAL HEALTH CLINIC. SEE SCHEDULE O FOR MORE INFORMATION. 9213819 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 43 0 true 95 true true true false false false false false false false false false X 8 5 false false false false true true true true true false false true false false false false false false X Zessica Apiki 8085533125 PO Box 408 Kaunakakai HI 96748 Paul Stevens MD Trustee 1.0 0.0 X Ernest Fukeda Jr Trustee 1.0 3.0 X Eric Yeaman Trustee 1.0 7.0 X Arthur A Ushijima Chair/Trustee 1.0 64.0 X X 0 5075790 172084 Lance Dunbar Vice Chair/Trustee 1.0 2.0 X X 0 0 0 Richard Keene Treasurer - Part Year 2.0 53.0 X 0 607025 42893 Randy Lite Vice President 55.0 0.0 X 99850 23922 Punahele Alcon Secretary 40.0 0.0 X 80541 15491 Robert K Nobriga Treasurer 1.0 4.0 X 0 0 0 William L Thomas Jr MD Internal Medicine 50.0 0.0 X 251724 0 27639 Sandra Brazzel MD Internal Medicine 50.0 0.0 X 106558 17266 Dino Akai Director of Nursing 40.0 0.0 X 159620 0 16524 Gary Massengill RAD TECH 40.0 0.0 X 103054 18013 801347 5682815 333832 4 false true false 0 2046742 67083 0 2113825 PATIENT SERVICE REVENUE 623000 11075216 11075216 0 0 INTERCO PURCHASED 561000 9628 9628 0 0 11084844 30087 3354 26733 0 0 170939 170939 0 170939 170939 424796 1783 343547 81249 1783 83032 83032 0 0 0 CAFETERIA SALES 624200 131334 131334 0 0 ALL OTHER REVENUE 900099 98687 98687 0 0 230021 13712748 11314865 3354 280704 X 0 0 0 0 0 0 0 0 494122 0 494122 0 0 0 0 0 4224571 2967599 1256972 0 263752 232724 31028 0 757781 430186 327595 0 319314 205097 114217 0 0 0 0 0 0 0 0 0 43415 0 43415 0 759 0 759 0 0 0 0 0 0 0 2329664 1792112 537552 0 15710 7361 8349 0 337300 107862 229438 0 26071 0 26071 0 0 0 0 0 435411 37017 398394 0 124308 81358 42950 0 0 0 0 0 6319 3422 2897 0 0 0 0 0 0 0 0 0 1305574 1246332 59242 0 158256 158256 0 0 INTERCOMPANY CHARGES 1187602 1034041 153561 0 MEDICAL SUPPLIES 659050 659050 0 0 PROVIDER TAX 46560 46560 0 0 GRANT FUNDED EXPENSES 188588 122224 66364 0 82618 82618 13006745 9213819 3792926 0 0 650 650 3295995 4448966 0 0 1135317 1716760 0 0 0 0 0 0 98725 102845 78141 67617 24325416 12821816 12402686 11503600 3378220 3934512 0 0 0 0 0 0 0 0 20389734 21774950 823370 1239063 0 0 67360 71747 0 0 0 0 0 0 0 0 0 0 2153734 1866414 3044464 3177224 X 17345270 18597726 0 0 0 0 17345270 18597726 20389734 21774950 X 706003 449214 97239 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 759 116026 759 116026 9213819 874689950 9214578 874805976 610729 1000000 152682 250000 false 1000000 1000000 1000000 1000000 4000000 6000000 46088 55188 113796 116026 331098 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 17287611 7804133 9483478 6535659 4704969 1830690 502146 312714 189432 11503600 0 DUE TO QUEEN'S MEDICAL CENTER 1240 DUE TO QUEEN'S HEALTH SYSTEMS 270273 GENERAL AND PROFESSIONAL TAIL LIABILITY 64795 DUE TO QIE 49248 DUE TO GOVERNMENT REIMB PROGRAM 567996 LONG TERM PENSION LIABILITY 914818 DUE TO DLS -1956 1866414 X SCHEDULE D, PART X, LINE 2 FIN 48(ASC 740) Footnote MGH EVALUATES ITS UNCERTAIN TAX POSITIONS AND HAS NO MATERIAL UNRECOGNIZED TAX BENEFITS AS OF JUNE 30,2014. true true X true X true X true true true false true true 61252 0 61252 0.00470 4312149 4656279 -344130 0 0 0 0.00000 4373401 4656279 -282878 0.00470 19985 660 19325 0.00150 19985 660 19325 0.00150 4393386 4656939 -263553 0.00620 true 149865 130383 1494169 1988761 -494592 X true true 1 1 MOLOKAI GENERAL HOSPITAL 280 HOMEOLU STREET KAUNAKAKAI HI 96748 www.molokaigeneralhospital.org 18-H X X X X MOLOKAI GENERAL HOSPITAL 1 true X X X X X X X X X 12 true true true X http://www.molokaigeneralhospital.org X X X X X false false true true 100 true 250. true X true true X true false X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3 INPUT FROM COMMUNITY REPRESENTATIVES FOR MAUI COUNTY, 11 KEY INFORMANTS WERE INTERVIEWED FOR THEIR SPECIFIC KNOWLEDGE OF THE HEALTH NEEDS WITHIN THE COUNTY; FOUR OF THESE INFORMANTS REPRESENTED MOLOKAI. THE INFORMATION OBTAINED FROM THESE INTERVIEWS WAS INCORPORATED INTO THE REPORT IN THREE WAYS. A SUMMARY QUALITATIVE ANALYSIS TOOL CALLED A "WORD CLOUD" WAS PRODUCED USING TAGCROWD.COM TO IDENTIFY THE MOST COMMON THEMES AND TOPICS. WORDS OR PHRASES THAT WERE MENTIONED MOST OFTEN DISPLAY IN THE WORD CLOUD IN THE LARGEST AND DARKEST FONT. NEXT, INPUT FROM THE KEY INFORMANTS WAS INCLUDED IN EACH RELEVANT TOPIC AREA IN SECTION 3.2 OF THE CHNA. IF AVAILABLE, INFORMATION SPECIFIC TO THE HEALTH OF MOLOKAI RESIDENTS IS LISTED IN THE FIRST SECTION OF EACH INTERVIEW SUMMARY TABLE; INFORMATION GATHERED ON THE GENERAL POPULATION OF HAWAII FOR EACH TOPIC AREA IS ALSO PRESENTED IN THE TABLES. ANY RECOMMENDED COMMUNITY PROGRAMS OR RESOURCES ARE INCLUDED IN THE LAST COLUMN TITLED "OPPORTUNITIES/STRENGTHS." SCHEDULE H, PART V, SECTION B, LINE 4 CHNA HOSPITAL FACILITIES THE HEALTHCARE ASSOCIATION OF HAWAII PARTNERED WITH HEALTHY COMMUNITIES INSTITUTE TO CONDUCT A CHNA FOR MAUI COUNTY. AS A SUBSET OF THE LARGER PROJECT, DATA RELEVANT TO MOLOKAI WAS ASSESSED SEPARATELY, IN ORDER TO BETTER UNDERSTAND THE UNIQUE NEEDS AND CONCERNS OF THE ISLAND. SCHEDULE H, PART V, SECTION B, LINE 7 NEEDS NOT ADDRESSED THE CHNA IDENTIFIED 20 AREAS OF COMMUNITY HEALTH NEEDS. THE MOLOKAI GENERAL HOSPITAL (MGH) RECOGNIZES THE IMPORTANCE OF THESE NEEDS AND HAS SUPPORTED EFFORTS TO ADDRESS MANY OF THEM, IT IS ALSO RECOGNIZED THAT THERE ARE HEALTH NEEDS THAT MGH WILL NOT DIRECTLY BE ADDRESSING FOR VARIOUS REASONS. AS PART OF THE PROCESS TO SELECT MGH'S PRIORITY AREA, EACH OF THE 20 IDENTIFIED AREAS OF NEED WERE MAPPED TO THREE CORE NEEDS TO BE ADDRESSED TO IMPROVE COMMUNITY HEALTH: PRIMARY HEALTH CARE NEEDS, SECONDARY HEALTH CARE NEEDS AND SOCIETAL NEEDS. THIS MAPPING ALLOWED MGH TO FOCUS ON ADDRESSING NEEDS WITHIN THE SCOPE OF ITS CORE COMPETENCIES. AS AN ACUTE CARE TERTIARY/QUATERNARY HOSPITAL, MGH'S CORE COMPETENCIES ARE IN THE PRIMARY HEALTH CARE NEEDS CATEGORY. COMMUNITY HEALTH NEEDS IN THE SECONDARY HEALTH CARE NEEDS AND SOCIETAL NEEDS CATEGORIES ARE BEING ADDRESSED THROUGH THE LEADERSHIP OF OTHER ORGANIZATIONS WHOSE MISSIONS, CORE COMPETENCIES AND EXPERTISE MEET THOSE NEEDS. THOSE ARE: - DISABILITIES - ECONOMY - EDUCATION - ENVIRONMENT - EXERCISE, NUTRITION AND WEIGHT - FAMILY PLANNING - INJURY PREVENTION AND SAFETY - ORAL HEALTH - SOCIAL ENVIRONMENT - SUBSTANCE ABUSE AND LIFESTYLE - TRANSPORTATION ALTHOUGH MGH WILL NOT DIRECTLY BE ADDRESSING THESE AREAS OF NEED, WE HAVE SUPPORTED AND PARTNERED WITH OTHERS TO ADDRESS SEVERAL OF THEM AND WILL CONTINUE TO SUPPORT OPPORTUNITIES TO ADDRESS COMMUNITY HEALTH NEEDS IN COLLABORATION WITH OTHERS. OF THE AREAS MAPPED TO THE PRIMARY HEALTH CARE NEEDS CATEGORY, MGH SELECTED DIABETES AS ITS PRIORITY AREA. FOR THE OTHER AREAS, MGH CURRENTLY PROVIDES MANY SERVICES AND PROGRAMS TO ADDRESS THESE NEEDS. THESE SERVICES AND PROGRAMS ARE OFFERED IN/AT THE HOSPITAL, IN CONJUNCTION WITH PARTNERS, AND THROUGH OUTREACH TO THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 14G OTHER METHOD FOR PUBLICIZING POLICIES A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WAS ATTACHED TO BILLING INVOICES, PROVIDED IN WRITING TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY AND AVAILABLE UPON REQUEST. THE FULL POLICY IS PROVIDED TO MGH CLINIC PATIENTS DURING THE APPLICATION PROCESS. SCHEDULE H, PART I, LINE 6A COMMUNITY BENEFIT REPORT - RELATED ORGANIZATION COMMUNITY BENEFITS ARE REPORTED ANNUALLY AS PART OF FORM 990. THIS IS NOT SEPARATELY AVAILABLE TO THE PUBLIC. A FORMAL REPORT ISSUED BY THE PARENT COMPANY, THE QUEEN'S HEALTH SYSTEMS, INCLUDES THE COMMUNITY BENEFITS OF MOLOKAI GENERAL HOSPITAL (MGH). THIS REPORT IS PUBLISHED PERIODICALLY AND IS SEPARATELY AVAILABLE TO THE PUBLIC. SCHEDULE H, PART I, LINE 7G THE COSTING METHODOLOGY CONSIDERS ALL PATIENT SEGMENTS. AMOUNTS REPRESENT THE NET COSTS FOR THE VARIOUS PROGRAMS AND OPERATIONS, CONSIDERING ACTUAL AMOUNTS INCURRED AND CALCULATED BENEFITS BASED ON COST-TO-CHARGE RATIOS AND AVERAGE RATES (I.E. WAGE RATES). SCHEDULE H, PART III, LINE 2 MGH PROVIDES FOR AN ALLOWANCE AGAINST ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE BY ESTABLISHING AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. MGH ESTIMATES THE ALLOWANCE BASED ON THE AGING OF THE ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE BY PAYOR, AND OTHER RELEVANT FACTORS. MGH PROVIDES MEDICAL SERVICES TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY (PATIENTS ARE NOT BILLED - CHARITY CARE) AND PATIENTS WHO REFUSE TO PAY (BAD DEBTS). THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER MGH'S FINANCIAL ASSISTANCE POLICY IS CALCULATED BASED ON THE COST-TO-CHARGE RATIO. SCHEDULE H, PART III, LINE 3 BAD DEBT AS COMMUNITY BENEFIT THE PORTION OF THE BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS CALCULATED BY APPLYING THE COST TO CHARGE RATIO TO TOTAL BAD DEBT EXPENSE. BAD DEBT PERTAINING TO PATIENT CARE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE, CONSISTENT WITH MGH'S MISSION, PATIENTS RECEIVE CARE REGARDLESS OF WHETHER MGH COLLECTS PAYMENT FOR SERVICES PERFORMED. SCHEDULE H, PART III, LINE 4 TEXT OF BAD DEBT EXPENSE FOOTNOTE THERE IS NO FOOTNOTE CONTAINED IN THE FINANCIAL STATEMENTS FOR BAD DEBT EXPENSE. PURSUANT TO ASU 2011-07, MGH REPORTS ITS PROVISION FOR BAD DEBTS RELATED TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM REVENUE, SIMILAR TO CONTRACTUAL DISCOUNTS. SCHEDULE H, PART III, LINE 8 TREATMENT OF MEDICARE SHORTFALL AS COMMUNITY BENEFIT THE HOSPITAL MUST TREAT PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE GOVERNMENT SETS NON-NEGOTIABLE MEDICARE RATES AND THE REIMBURSEMENT HAS NOT KEPT PACE WITH THE RISING COSTS OF PROVIDING THOSE SERVICES. DUE TO THE REQUIREMENT TO PROVIDE CARE AND THE INABILITY OF THE MEDICARE REIMBURSEMENT TO KEEP PACE WITH THE COST OF PROVIDING SERVICES, WE FEEL THAT THE LOSS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES IS PART MGH'S MISSION AND IS A BENEFIT TO THE COMMUNITY. MEDICARE COSTING METHODOLOGY THE MEDICARE AMOUNTS ABOVE ARE CALCULATED WITH DATA FROM THE JUNE 30, 2014 COST REPORT, BASED ON A RATIO OF TOTAL PATIENT REVENUES TO TOTAL PATIENT COSTS CALCULATED BY COST CENTERS. MGH IS THE ISLAND OF MOLOKAI'S ONLY HOSPITAL, PROVIDING 24 HOUR SERVICE TO ALL MEMBERS OF THE PUBLIC. ONLY HOSPITAL, PROVIDING 24 HOUR SERVICE TO ALL MEMBERS OF THE PUBLIC. SCHEDULE H, PART III, LINE 9b APPLICATION OF COLLECTION PRACTICES TO THOSE QUALIFYING FOR FINANCIAL ASSISTANCE MGH PROVIDES FULL OR PARTIAL DISCOUNTS FOR ELIGIBLE PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. ELIGIBILITY CONTINUES FOR SIX MONTHS OR UPON CHANGE IN PATIENT'S INCOME AND ASSETS PER GUIDELINES. PATIENTS MAY RECERTIFY EVERY SIX MONTHS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT EVALUATION AND SURVEYS ARE COMPLETED AS NEEDED BY COST CENTERS OR DEPARTMENTS. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE MGH HAS AN ON-STAFF SOCIAL WORKER WHO ASSISTS PATIENTS AND THEIR FAMILIES BY PROVIDING EDUCATION AND ASSISTANCE IN APPLYING FOR ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, INCLUDING MGH'S CHARITY CARE POLICY. ADDITIONALLY, THE REGISTRATION STAFF AND BUSINESS OFFICE STAFF PROVIDE WRITTEN AND VERBAL INFORMATION REGARDING THE HOSPITAL'S CHARITY CARE POLICIES DURING INTAKE AND DISCHARGE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION MGH, PART OF THE QUEEN'S HEALTH SYSTEMS, IS THE ONLY HOSPITAL ON THE ISLAND OF MOLOKA'I, PROVIDING 24-HOUR CARE SERVICES FOR A POPULATION OF 7,400. MOLOKA'I IS DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA IN PRIMARY CARE, DENTAL AND MENTAL HEALTH SERVICES. ADDITIONALLY, THE ISLAND IS LISTED AS A FEDERAL MEDICALLY UNDER-SERVED AREA (MUA). THE AVERAGE HOUSEHOLD INCOME IS $46,000 WITH 63% OF THE POPULATION REPORTING THEY ARE OF NATIVE HAWAIIAN ANCESTRY (MULTIPLE RACE) IN 2010. ON AVERAGE, THIRTY PERCENT (30%) OF FAMILY HOUSEHOLDS REPORT RECEIVING SOME FORM OF GOVERNMENT ASSISTANCE. MGH SPONSORS AN ANNUAL HEALTH FAIR(S) AND OTHER HEALTH-RELATED EVENTS FOR THE COMMUNITY'S BENEFIT. MGH PROVIDES FREE FLU CLINICS IN AREAS OUTSIDE OF THE MAIN TOWN. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH THE AMOUNTS MENTIONED IN PART II OF SCHEDULE H REPRESENT COSTS INCURRED TO ENSURE CONTINUED OPERATIONS THAT BENEFIT THE COMMUNITY. TO SUPPORT MGH'S MISSION AND TO FULFILL THE TAX-EXEMPT PURPOSE AS A CHARITABLE HOSPITAL, MGH PROVIDES A NUMBER OF COMMUNITY BENEFITS. THIS INCLUDES UNCOMPENSATED CARE, WHERE MGH PROVIDES MEDICAL SERVICES TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY (PATIENTS ARE NOT BILLED; CHARITY CARE) AND PATIENTS WHO REFUSE TO PAY (BAD DEBTS). MGH ALSO IS HOME TO AN OUTPATIENT CLINIC, WHERE MGH PROVIDES OUTPATIENT SERVICES TO INDIGENT PATIENTS. IN ADDITION, MGH PROVIDES MANY FREE INFORMATIONAL SEMINARS AND EDUCATIONAL OPPORTUNITIES TO THE PUBLIC TO PROMOTE THE HEALTH OF COMMUNITY. THESE PROGRAMS ARE SPECIFICALLY DIRECTED TO ADDRESS HEALTH ISSUES WITHIN THE COMMUNITY INCLUDING DIABETES, CANCER AND WOMEN'S HEALTH ISSUES. MGH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS AND IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM MGH IS A MEMBER OF THE QUEEN'S HEALTH SYSTEMS ("QHS") AFFILIATED GROUP. THE GROUP INCLUDES QUEEN'S MEDICAL CENTER ("QMC"), QUEEN EMMA LAND COMPANY ("QEL"), QUEEN'S INSURANCE EXCHANGE ("QIE"), QUEEN'S DEVELOPMENT CORPORATION ("QDC"), AND NORTH HAWAII COMMUNITY HOSPITAL ("NHCH"). QHS PROVIDED LEGAL, ACCOUNTING AND ADMINISTRATIVE SUPPORT SERVICES TO MGH AND QIE PROVIDED MEDICAL MALPRACTICE INSURANCE TO MGH. IN RETURN, MGH ASSISTED QMC IN FULFILLING ITS MISSION TO PROVIDE IN PERPETUITY QUALITY HEALTH CARE SERVICES TO IMPROVE THE WELL-BEING OF NATIVE HAWAIIANS AND ALL OF THE PEOPLE OF HAWAII. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT N/A false true false false false false false true false Richard Keene Treasurer - Part Year 0 462096 0 126401 0 18528 0 30073 0 12820 0 649918 0 0 Arthur A Ushijima Chair/Trustee 0 1004241 0 1033483 0 3038066 0 159429 0 12655 0 5247874 0 3630766 William L Thomas Jr MD Internal Medicine 250482 0 0 0 1242 0 21252 0 6387 0 279363 0 0 0 Dino Akai Director of Nursing 154100 0 0 0 5520 0 0 0 16524 0 176144 0 0 0 SCHEDULE J, PART I, LINE 3 METHOD USED TO ESTABLISH COMPENSATION THE ORGANIZATION RELIED ON THE QUEEN'S HEALTH SYSTEM (QHS) TO DETERMINE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL. QHS USED A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, FORM 990 OF OTHER ORGANIZATIONS, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SCHEDULE J, PART I, LINE 4B PARTICIPATE IN, OR RECEIVE PAYMENT FROM, A SUPPLEMENTAL NONQUALIFIED RETIREMENT THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) PROVIDES FOR AN UMBRELLA BENEFIT EQUAL TO A LIFE ANNUITY OF 60% OF FINAL AVERAGE SALARY AT NORMAL RETIREMENT AGE (WHICH BENEFIT IS OFFSET HOWEVER BY THE BENEFIT PROVIDED TO THE CEO UNDER THE QHS PENSION PLAN, THE QHS 401(K) PLAN FOR MATCHING CONTRIBUTIONS ONLY, THE QHS PENSION RESTORATION PLAN, AND 50% OF ESTIMATED SOCIAL SECURITY RETIREMENT BENEFITS.) NORMAL RETIREMENT AGE IS DEFINED AS 65 AND THE BENEFIT VESTS AND IS PAID OUT AS A LUMP SUM AT THAT POINT REGARDLESS IF EMPLOYMENT IS CONTINUED PAST AGE 65. THE FOLLOWING PAYOUTS WERE MADE DURING 2013: ARTHUR A. USHIJIMA - $2,965,859. OTHER REPORTABLE COMPENSATION REFLECTS VESTED PAYMENTS IN TWO NONQUALIFIED RETIREMENT PLANS. THE FIRST PLAN IS A DEFINED BENEFIT SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) THAT PROVIDED AN INCOME REPLACEMENT EQUAL TO 60% OF MR. USHIJIMA'S FINAL THREE-YEAR AVERAGE BASE SALARY AT AGE 65, OFFSET BY ALL OTHER FORMS OF EMPLOYER-PROVIDED RETIREMENT (INCLUDING 50% OF SOCIAL SECURITY). MR. USHIJIMA'S SERP WAS A GRANDFATHERED RETIREMENT PLAN THAT PROVIDED RETIREMENT BENEFITS IN LINE WITH INDUSTRY NORMS FOR OTHER HEALTH SYSTEM CEOS. UNLIKE SOME OTHER SERP DESIGNS THAT PROVIDE PARTIAL VESTING WITH CASH PAYMENTS EVERY FEW YEARS, 100% OF MR. USHIJIMA'S SERP VESTED UPON ATTAINMENT OF AGE 65, WHICH OCCURRED IN 2013. THE $2,965,859 SERP PAYMENT REFLECTS HIS 24 YEARS OF SERVICE AS OF 2013 AND IS SUBJECT TO ALL APPLICABLE STATE AND FEDERAL TAXES. THE SERP CEASED UPON VESTING, AND NO FURTHER PAYMENTS WILL BE MADE UNDER THIS PLAN. THE SECOND NONQUALIFIED RETIREMENT PLAN IS A PENSION RESTORATION BENEFIT, WHICH IS PROVIDED TO ALL ELIGIBLE EMPLOYEES, INCLUDING MR. USHIJIMA, AND WHICH APPLIES THE SAME BENEFIT FORMULA AS THE ALL-EMPLOYEE QUALIFIED CASH BALANCE PENSION PLAN TO THE PORTION OF SALARY THAT EXCEEDS LEGISLATIVE CAPS ON PAY FOR QUALIFIED PLANS. THE PENSION RESTORATION PLAN IS ALSO 100% VESTED AT AGE 65, AND THE BALANCE OF THIS ACCOUNT, WHICH WAS $664,907 FOR MR. USHIJIMA, WAS PAID TO HIM IN 2013, SUBJECT TO ALL APPLICABLE STATE AND FEDERAL TAXES. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS RECOGNITION AWARDS WERE PAID TO ALL EMPLOYEES BASED ON ACCOMPLISHMENTS OF PREDETERMINED GOALS AND OBJECTIVES SET FORTH IN THE INCENTIVE AND STRATEGIC PLANS AND DEFINED ELIGIBILITY OF THE EMPLOYEE. RECOGNITION AWARDS ARE DISCRETIONARY AND CONSIDER QUALITY THRESHOLDS WHICH INCLUDE ANNUAL ACCREDITATION AND MINIMUM OPERATING INCOME LEVEL CRITERIA. IN ADDITION, EXECUTIVE AWARDS ARE WEIGHTED BASED ON INDIVIDUAL GOALS ESTABLISHED FOR EACH EXECUTIVE. SCHEDULE J, PART II COMPENSATION PAID FOR SERVICES JANICE KALANIHUIA MS. KALANIHUIA SERVES AS VP FOR THE QUEEN'S HEALTH SYSTEMS (PARENT COMPANY) AND PRESIDENT OF MGH. SHE IS NOT SEPARATELY COMPENSATED FOR THESE VARIOUS SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR ALL HER SERVICES. ARTHUR A. USHIJIMA MR. USHIJIMA SERVES AS A TRUSTEE FOR THE QUEEN'S HEALTH SYSTEMS AND SEVERAL OTHER QUEEN'S RELATED AFFILIATES. HE IS A VOLUNTEER TRUSTEE AND IS NOT COMPENSATED FOR THESE SERVICES. HIS HOURS SERVED AS A TRUSTEE FOR MGH IS 1 HOUR PER WEEK. MR. USHIJIMA ALSO SERVES AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE QUEEN'S HEALTH SYSTEMS (PARENT COMPANY) AND AS PRESIDENT OF QMC. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL HIS SERVICES. RICHARD C. KEENE MR. KEENE SERVED AS QMC TREASURER, SVP/CFO AND TREASURER FOR THE QUEEN'S HEALTH SYSTEMS (PARENT COMPANY), TREASURER OF QEL AND TREASURER OF MGH. HE IS NOT SEPARATELY COMPENSATED FOR THESE VARIOUS SERVICES. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL HIS SERVICES. FORM 990, PART III, LINE 4A TO SUPPORT MGH'S MISSION AND TO FULFILL ITS TAX EXEMPT PURPOSE AS A CHARITABLE HOSPITAL, MGH PROVIDED COMMUNITY BENEFITS TOTALING APPROXIMATELY $705,552 FOR THE YEAR ENDED JUNE 30, 2014. 1. UNCOMPENSATED CARE - MGH PROVIDES MEDICAL SERVICES TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY (CHARITY CARE) AND PATIENTS WHO REFUSE TO PAY (BAD DEBTS). FOR THE YEAR ENDED JUNE 30, 2014, THE ESTIMATED LOSSES FROM PROVIDING CHARITY CARE, AS WELL AS THE ESTIMATE OF CHARITY CARE CURRENTLY CLASSIFIED AS BAD DEBTS WAS $61,252 AND $130,383 RESPECTIVELY. 2. HEALTH AND WELLNESS EDUCATION - MGH PROVIDES HEALTH AND WELLNESS EDUCATION TO THE COMMUNITY IN AN EFFORT TO PROMOTE HEALTHY LIFESTYLES. FOR THE YEAR ENDED JUNE 30, 2014, LOSSES RELATED TO PROVIDING HEALTH AND WELLNESS EDUCATION WAS $19,325. 3. MEDICARE SHORTFALL IN PAYMENTS - MGH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO MEDICARE PATIENTS IN THE STATE OF HAWAII. MGH INCURRED COSTS IN EXCESS OF REIMBURSEMENT OF APPROXIMATELY $494,592 DURING THE YEAR ENDED JUNE 30, 2014. FORM 990, PART VI, LINE 6 MEMBERS OR STOCKHOLDERS MGH HAS A SOLE MEMBER, WHICH IS THE QUEEN'S HEALTH SYSTEMS, A HAWAII NONPROFIT CORPORATION ("QHS"). FORM 990, PART VI, LINE 7A POWER TO ELECT OR APPOINT BOARD MEMBERS QHS ELECTS ALL OF THE BOARD MEMBERS OF THE MGH BOARD OF TRUSTEES. FORM 990, PART VI, LINE 7B DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS CERTAIN MAJOR DECISIONS APPROVED BY THE MGH BOARD OF TRUSTEES MUST ALSO BE APPROVED BY QHS. SUCH DECISIONS INCLUDE: 1. A CHANGE TO THE PURPOSE OF THE COMPANY; 2. A FINANCING TRANSACTION IN EXCESS OF $50,000; 3. A LEASE TRANSACTION THAT HAS A TERM THAT IS LONGER THAN 3 YEARS OR HAS A RENT OBLIGATION IN EXCESS OF $1,000,000 OVER THE LEASE TERM; 4. A TRANSACTION INVOLVING THE SALE, LEASE, DISPOSITION OR HYPOTHECATION OF REAL PROPERTY; 5. ANNUAL OPERATIONAL AND CAPITAL BUDGETS; 6. STRATEGIC PLANS; 7. MERGER OR MAJOR ACQUISITIONS; 8. CREATION OF A NEW ENTITY OR JOINT VENTURE; 9. SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS; 10. DISSOLUTION; 11. AMENDMENT OF BYLAWS; 12. ADOPTION, AMENDMENT OR RESCISSION OF A BOARD POLICY; 13. CAPITAL EXPENDITURES IN EXCESS OF $1,000,000 FOR MGH. FORM 990, PART VI, LINE 11B PROCESS USED TO REVIEW THE FORM 990 THE FORM 990 FOR THE QUEEN'S HEALTH SYSTEMS (QHS) AND THE SEPARATE FORMS FOR EACH OF THE NOT-FOR-PROFIT SUBSIDIARIES OF QHS WERE REVIEWED BY THE GOVERNING BODY OF QHS PRIOR TO THE FILING OF THE RETURNS. THE QHS FINANCE COMMITTEE, WHICH IS COMPRISED OF MEMBERS OF THE QHS BOARD OF TRUSTEES, WAS DELEGATED THE RESPONSIBILITY TO REVIEW THE RETURNS PRIOR TO THEIR FILING. THE RETURNS WERE PRESENTED TO THE COMMITTEE BY MANAGEMENT AND BY THE INDEPENDENT PUBLIC ACCOUNTING FIRM THAT PREPARED THE RETURNS. IN ADDITION, COMPENSATION RELATED DISCLOSURES IN THE RETURNS WERE REVIEWED BY THE CHAIRPERSON OF THE QHS COMPENSATION COMMITTEE PRIOR TO FILING THE RETURNS. ALSO, A COPY OF THE MOLOKAI GENERAL HOSPITAL (MGH) RETURNS WERE MADE AVAILABLE TO EACH OF THE MEMBERS OF THE MGH BOARD OF TRUSTEES PRIOR TO THE RETURNS BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINE 12, 13, & 14 APPROVED POLICIES THE CONFLICT OF INTEREST, WHISTLEBLOWER AND DOCUMENT RETENTION POLICIES HAVE BEEN APPROVED BY QHS ON BEHALF OF THE MGH BOARD BUT HAVE NOT BEEN SEPARATELY APPROVED BY THE MGH BOARD. AS SUCH, LINES 12, 13 AND 14 HAVE BEEN CHECKED 'NO'. FORM 990, PART VI, LINE 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST ALL QHS COMPANIES ARE SUBJECT TO A WRITTEN CONFLICT OF INTEREST POLICY. ALL TRUSTEES, OFFICERS, DESIGNATED EMPLOYEES AND CONTRACTORS ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE FORM. THE DESIGNATED EMPLOYEES ARE THOSE SELECTED BY EXECUTIVES IN THE ORGANIZATION WHO IDENTIFY THOSE EMPLOYEES (TYPICALLY MANAGER LEVEL OR ABOVE) WHO MAY BE IN A POSITION TO SELECT OR INFLUENCE THE SELECTION OF A VENDOR. DISCLOSURES ARE SUMMARIZED AND MAINTAINED BY EACH COMPANY'S CORPORATE SECRETARY. THE CONTRACT MANAGEMENT DIVISION AND LEGAL DEPARTMENT HAVE THE CONFLICT SUMMARIES AND CHECK FOR CONFLICTS OF INTEREST AT THE BEGINNING OF THE CONTRACT PROCESS. ANY CONFLICTS OF INTEREST INVOLVING A TRUSTEE IS PRESENTED TO THE BOARD OF TRUSTEES. ANY TRANSACTION INVOLVING A DISQUALIFIED PERSON IS SUBJECT TO THE PROCESS OF ESTABLISHING A REBUTTABLE PRESUMPTION OF REASONABLENESS. ANY TRUSTEE WITH A CONFLICT OF INTEREST IS EXCUSED FOR THE PORTION OF THE MEETING WHERE THE SUBJECT MATTER IS DISCUSSED AND VOTED ON. FORM 990, PART VI, LINES 15A AND 15B OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN A COMMITTEE OF THE BOARD OF TRUSTEES CALLED THE COMPENSATION COMMITTEE MEETS REGULARLY TO REVIEW THE COMPENSATION OF ALL COMPANIES WITHIN QHS. MGH'S EXECUTIVE COMPENSATION IS REVIEWED ANNUALLY FOR ITS PRESIDENT. ALL DECISIONS REGARDING EXECUTIVE COMPENSATION ARE MADE IN CONFORMITY WITH THE PROCEDURES REQUIRED TO ESTABLISH A REBUTTABLE PRESUMPTION OF REASONABLENESS. ANY ADJUSTMENT TO COMPENSATION IS SUBJECT TO THE PROCESS OF PERFORMANCE REVIEWS AND COMPARISON TO COMPARABLE COMPENSATION DATA PREPARED BY A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT. OUTSIDE COUNSEL ASSISTS WITH THE REVIEW PROCESS AND DOCUMENTS THE DECISIONS OF THE COMMITTEE. FORM 990, PART VI, LINE 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC MGH'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST AND THE QHS' CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THIS RETURN, AS REQUIRED. MGH DOES NOT MAKE ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES PROGRAM SERVICES: MEDICAL SERVICES 1,568,408 OTHER SERVICES 223,704 TOTAL 1,792,112 MANAGEMENT SERVICES: COLLECTION SERVICES 780,603 OTHER SERVICES (243,051) TOTAL 537,552 FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS MINIMUM PENSION LIABILITY $ 98,380 FUND TRANSFER $ (1,140) ROUNDING $ (1) --------- TOTAL $ 97,239 THE QUEEN'S HEALTH SYSTEMS 1301 PUNCHBOWL STREET HONOLULU HI 96813 990238120 ADMIN SERVICE HI 501(c)(3) 11b NA false THE QUEEN'S MEDICAL CENTER 1301 PUNCHBOWL STREET HONOLULU HI 96813 990073524 MEDICAL SVCS HI 501(c)(3) 3 QHS true QUEEN EMMA LAND COMPANY 1301 PUNCHBOWL STREET HONOLULU HI 96813 990183769 SUPPORT SVCS HI 501(c)(3) 11b QHS true NORTH HAWAII COMMUNITY HOSPITAL 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 990260423 MEDICAL SVCS HI 501(c)(3) 3 QHS true HAMAMATSUQUEEN'S PET IMAGING CENTER LL 1301 PUNCHBOWL STREET HONOLULU HI 96813 943266916 PET IMAGING HI NA THE QUEEN'S DEVELOPMENT CORPORATION 1301 PUNCHBOWL STREET HONOLULU HI 96813 990240109 DEVELOPMENT HI NA C Corp QUEEN'S INSURANCE EXCHANGE INC 1301 PUNCHBOWL STREET HONOLULU HI 96813 911913839 INSURANCE HI NA C Corp DIAGNOSTIC LABORATORY SERVICES INC 99-859 IWAIWA STREET AIEA HI 96701 990240499 MEDICAL LAB SVCS HI NA C Corp false false false false false false false false false false false false true false false true false false false DIAGNOSTIC LABORATORY SERVICES INC p 582586 FMV THE QUEEN'S MEDICAL CENTER m 198093 FMV SCHEDULE R, PART III IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP HAMAMATSU/QUEEN'S PET IMAGING CENTER, LLC EIN: 94-3266916 ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 NAME: QUEEN EMMA LAND COMPANY ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 EIN: 99-0183769 EXPENSES: $27,589,120 501(H) ELECTION: YES SHARE OF EXCESS LOBBYING EXPENDITURES: $0 NAME: THE QUEEN'S HEALTH SYSTEMS ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 EIN: 99-0238120 EXPENSES: $26,784,452 501(H) ELECTION: YES SHARE OF EXCESS LOBBYING EXPENDITURES: $0 NAME: THE QUEEN'S MEDICAL CENTER ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 EIN: 99-0073524 EXPENSES: $792,649,588 501(H) ELECTION: YES SHARE OF EXCESS LOBBYING EXPENDITURES: $0 NAME: MOLOKAI GENERAL HOSPITAL ADDRESS: P.O. BOX 408 KAUNAKAKAI, HI 96748 EIN: 99-0251372 EXPENSES: $9,213,819 501(H) ELECTION: YES SHARE OF EXCESS LOBBYING EXPENDITURES: $0 NAME: NORTH HAWAII COMMUNITY HOSPITAL ADDRESS: 67-1125 MAMALAHOA HIGHWAY EIN: 99-0260423 EXPENSES: $18,452,971 501(H) ELECTION: YES SHARE OF EXCESS LOBBYING EXPENDITURES: $0