2014-05-13T17:28:30-05:00 2013-06-30 ERNST & YOUNG US LLP 4370 LA JOLLA VILLAGE DRIVE STE 500 SAN DIEGO CA 92122 990 2012-07-01 990251372 MOLOKAI GENERAL HOSPITAL % ZESSICA APIKI MOLO 8085533125 PO BOX 408 Suite KAUNAKAKAI MOLOKAI HI 96748 Robert Nobriga 2014-05-13 8585357200 2012 2015-11-30 17:44:51Z Janice Kalanihuia PO BOX 408 KAUNAKAKAI MOLOKAI HI 96748 15822596 false X www.molokaigeneralhospital.org X 1987 HI TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE ISLAND OF MOLOKAI. 6 4 99 50 6010 2460646 2289524 7823430 10351595 99569 403365 590292 362743 10973937 13407227 0 0 0 0 5716662 5905405 0 0 0 6525720 6408779 12242382 12314184 -1268445 1093043 19322477 20389734 2930807 3044464 16391670 17345270 X TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE ISLAND OF MOLOKAI. false false 8488690 0 10351595 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. 8488690 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 99 true true true false false false false false false false false false X 6 4 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 Lance Dunbar 1.0 2.0 X X 0 0 0 Neil Hannahs 1.0 2.0 X 0 0 0 Steven Petro 1.0 0.0 X 0 0 0 Paul Stevens MD 1.0 0.0 X 0 0 0 Eric Yeaman 1.0 6.0 X 0 0 0 Arthur A Ushijima 1.0 64.0 X X 0 1184114 449263 Janice Kalanihuia 54.0 1.0 X 0 243193 56516 Randy Lite 55.0 0.0 X 98993 0 28902 Punahele Alcon 40.0 0.0 X 77471 0 16339 Richard Keene 2.0 53.0 X 0 569831 70775 William L Thomas Jr MD 50.0 0.0 X 260775 0 29276 Sandra Brazzel MD 50.0 0.0 X 173723 0 29074 Dino Fontes 40.0 0.0 X 156777 0 25393 767739 1997138 705538 3 false true false Richard Wakiyama MD 4201 Greenvale Road FAIR OAKS CA 95628 EMERGENCY PHYSICIAN 121180 JT Power MD PO Box 198900-PMB233 HAWI HI 96719 EMERGENCY PHYSICIAN 101923 2 108595 2154752 26177 2289524 PATIENT SERVICE REVENUE 623000 10255464 10255464 INTERCO PURCHASED 561000 96131 96131 10351595 49616 6010 43606 0 0 157040 157040 0 157040 157040 2768321 797 2415369 352952 797 353749 353749 0 0 0 CAFETERIA SALES 624200 127093 127093 ALL OTHER REVENUE 78610 78610 205703 13407227 10351595 6010 760098 X 0 0 0 0 477482 477482 0 4022362 2836534 1185828 278178 247688 30490 817338 463644 353694 310045 201236 108809 0 949 949 40976 40976 0 0 0 1815651 942662 872989 14625 7589 7036 325385 139338 186047 41212 6817 34395 0 436540 35421 401119 145578 108558 37020 0 3453 166 3287 0 0 1289444 1262747 26697 133469 133469 Intercompany charges 1046086 1036778 9308 Medical supplies 616244 616244 Provider tax 330452 330452 Grant expense 70394 70394 98321 48953 49368 12314184 8488690 3825494 0 650 650 1407222 3295995 0 0 1192344 1135317 0 0 0 0 0 0 101113 98725 77355 78141 23918927 11516241 13432623 12402686 3111170 3378220 0 0 0 0 0 0 0 0 19322477 20389734 836353 823370 0 0 39378 67360 0 0 0 0 0 0 0 0 0 0 2055076 2153734 2930807 3044464 X 16391670 17345270 0 0 0 0 16391670 17345270 19322477 20389734 X 1093043 -134810 -4633 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 113796 113796 8488690 790087903 8488690 790201699 574435 1000000 143609 250000 false 1000000 1000000 1000000 1000000 4000000 6000000 31942 46088 55188 113796 247014 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 17279986 7053442 10226544 6173660 4192519 1981141 465281 270280 195001 12402686 0 Due to Queen's Medical Center 86238 Due to Queen's Health Systems 252769 General and professional tail liability 59198 Due to QIE 53304 Due to Government reimbursement program 756045 Long term pension liability 946180 2153734 X ASC 740 Footnote SCHEDULE D, PART X, LINE 2 MGH EVALUATES ITS UNCERTAIN TAX POSITIONS AND HAS NO MATERIAL UNRECOGNIZED TAX BENEFITS AS OF JUNE 30, 2013. true true X true X true X true true true false true true 65205 65205 0.00530 3839934 4455580 -615646 0.00000 3905139 4455580 -550441 0.00530 22578 22578 0.00180 329565 329221 344 0.00000 9200 9200 0.00070 361343 329221 32122 0.00250 4266482 4784801 -518319 0.00780 true 208347 1636132 1762572 -126440 X true true 1 1 MOLOKAI GENERAL HOSPITAL

280 Homeolu Street Kaunakakai HI 96748

www.molokaigeneralhospital.org X X X X MOLOKAI GENERAL HOSPITAL true X X X X X X X X X 12 true true true X X X X X X false false true true 100 true 250. true X true true X X X true false X X true X false false SCHEDULE H, PART I, LINE 6A 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 7 THE COSTING METHODOLOGY USED INCLUDES ALL PATIENT SEGMENTS. THE COST TO CHARGE RATIO OF 92% WAS DERIVED FROM THE FISCAL YEAR ENDED JUNE 30, 2013 COST REPORT. SCHEDULE H, PART III, LINE 4 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). SCHEDULE H, PART III, LINE 8 THE MEDICARE AMOUNTS ABOVE ARE CALCULATED WITH DATA FROM THE JUNE 30, 2013 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. SCHEDULE H, PART III, LINE 9B 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 V, SECTION B, LINE 3 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 INTERVIEWS WERE WITH LORETTA FUDDY, HAWAII STATE DEPARTMENT OF HEALTH; DR. JOSH GREEN, STATE SENATOR & HAWAII INDEPENDENT PHYSICIANS ASSOCIATION; DONNA HAYTKO-PAOA, MAUI COLLEGE - MOLOKAI; LESLIE LAM, AMERICAN DIABETES ASSOCIATION HAWAII; KATHY MATAYOSHI, HAWAII STATE DEPARTMENT OF EDUCATION; DESIREE PUHI, MOLOKAI COMMUNITY HEALTH CENTER; LYNETTE SCHAEFER, MAUI POLICE DEPARTMENT AND MOLOKA'I HOSPICE; HARDY SPOEHR, PAPA OLA LOKAHI; DR. TRACI STEVENSON MOLOKAI COMMUNITY HEALTH CENTER; LORI SUAN, AMERICAN HEART ASSOCIATION, HAWAII CHAPTER; AND DR. JACKIE YOUNG, AMERICAN CANCER SOCIETY HAWAII SITE. 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 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 5A THE WEBSITE ADDRESS WHERE THE CHNA CAN BE ACCESSED IS: http://www.molokaigeneralhospital.org SCHEDULE H, PART V, SECTION B, LINE 7 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. FACILITY INFORMATION SCHEDULE H, PART V, SECTION B, LINE 14 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. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 EVALUATION AND SURVEYS ARE COMPLETED AS NEEDED BY COST CENTERS OR DEPARTMENTS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 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. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 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. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 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. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 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") AND QUEEN'S DEVELOPMENT CORPORATION ("QDC). THROUGH JUNE 30, 2013, QEL FUNDED MGH'S OPERATIONS AND CAPITAL EXPENSES. IN ADDITION, 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. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 N/A false true false false false false false true false Arthur A Ushijima 0 860163 0 264958 0 58993 0 436171 0 13092 0 1633377 0 0 Janice Kalanihuia 0 184279 0 44957 0 13957 0 43995 0 12521 0 299709 0 0 Richard Keene 0 439218 0 98654 0 31959 0 64154 0 6621 0 640606 0 0 William L Thomas Jr MD 259533 0 0 0 1242 0 22876 0 6400 0 290051 0 0 0 Sandra Brazzel MD 171585 0 0 0 2138 0 17491 0 11583 0 202797 0 0 0 Dino Fontes 151397 0 0 0 5380 0 8683 0 16710 0 182170 0 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 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. FORM 990, SCHEDULE J, PART I, LINE 4B 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 AGE 65 AND THE BENEFIT VESTS AND IS PAID OUT AS A LUMP SUM AT THAT POINT REGARDLESS IF EMPLOYMENT IS CONTINUED PAST AGE 65. THERE WERE NO PAYOUTS DURING FY2013. SCHEDULE J, PART I, LINE 7 SCHEDULE J, PART II & FORM 990, PART VII 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. COMPENSATION PAID FOR SERVICES SCHEDULE J, PART II 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 SERVES AS TREASURER OF QMC, QEL AND MGH, AND SVP/CFO AND TREASURER FOR THE QUEEN'S HEALTH SYSTEMS (PARENT COMPANY). HE IS NOT SEPARATELY COMPENSATED FOR THESE VARIOUS SERVICES. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL HIS SERVICES. HE IS NOT SEPARATELY COMPENSATED FOR THESE VARIOUS SERVICES. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL HIS SERVICES. PROGRAM SERVICE ACCOMPLISHMENTS 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 $432,000 FOR THE YEAR ENDED JUNE 30, 2013. 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, 2013, THE ESTIMATED LOSSES FROM PROVIDING CHARITY CARE, AS WELL AS THE ESTIMATE OF CHARITY CARE CURRENTLY CLASSIFIED AS BAD DEBTS WAS $65,205 AND $208,347 RESPECTIVELY. 2. WOMEN'S HEALTH CLINIC - MGH PROVIDES OUTPATIENT SERVICES TO INDIGENT PATIENTS AND OTHERS THROUGH THE WOMEN'S HEALTH CLINIC. SERVICES INCLUDE PERINATAL, OBSTETRICIAN AND MIDWIFERY. THE LOSSES FROM CLINIC OPERATIONS WERE APPROXIMATELY $344 FOR THE YEAR ENDED JUNE 30, 2013. 3. 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, 2013, LOSSES RELATED TO PROVIDING HEALTH AND WELLNESS EDUCATION WAS $22,578. 4. CHARITABLE CONTRIBUTIONS - MGH PROVIDED IN-KIND CONTRIBUTIONS (HOSPITAL SPACE) TO OUTSIDE CHARITABLE ORGANIZATIONS. FOR THE YEAR ENDED JUNE 30, 2013, THE FAIR MARKET VALUE OF RENT PROVIDED TO OUTSIDE CHARITABLE ORGANIZATIONS WAS $9,200. 6. 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 $126,440 DURING THE YEAR ENDED JUNE 30, 2013. DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, LINE 6 MGH HAS A SOLE MEMBER, WHICH IS THE QUEEN'S HEALTH SYSTEMS, A HAWAII NONPROFIT CORPORATION ("QHS"). DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, LINE 7A QHS ELECTS ALL OF THE BOARD MEMBERS OF THE MGH BOARD OF TRUSTEES. DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, LINE 7B 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. DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B 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. APPROVED POLICIES FORM 990, PART VI, LINE 12, 13, & 14 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'. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, LINE 12C 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. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, LINES 15A & 15B 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. AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, LINE 19 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. OTHER CHANGES IN NET ASSETS OR FUND BALANCES Form 990, Part XI, Line 9 FUND TRANSFER (4,633) OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:810404 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION SERVICES TOTAL FEES:757811 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:OTHER SERVICES TOTAL FEES:247436 The Queen's Health Systems 1301 Punchbowl Street Honolulu HI 96813 990238120 Admin Service HI 501(c)(3) 11 Type II 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) 11 Type II QHS true HamamatsuPET 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 true false false false false false false false false false false false false true false false false Diagnostic Laboratory Services Inc P 584509 FMV The Queen's Medical Center P 56795 FMV Queen Emma Land Company C 108595 FMV IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP SCHEDULE R, PART III 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: $34,234,175 Share of excess Lobbying Expenditures: $0 Name: The Queen's Health Systems Address: 1301 Punchbowl Street Honolulu, HI 96813 EIN: 99-0238120 Expenses: $24,583,081 Share of excess Lobbying Expenditures: $0 Name: The Queen's Medical Center Address: 1301 Punchbowl Street Honolulu, HI 96813 EIN: 99-0073524 Expenses: $722,895,753 Share of excess Lobbying Expenditures: $0 Name: Molokai General Hospital Address: P.O. Box 408 Kaunakakai, HI 96748 EIN: 99-0251372 Expenses: $8,488,690 Share of excess Lobbying Expenditures: $0