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KAPIOLANI MEDICAL SPECIALISTS: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
KAPIOLANI MEDICAL SPECIALISTS (EIN 99-0322406)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-09
IRS object ID
201321299349302882
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-09T20:42:22-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14370 LA JOLLA VILLAGE DR STE 500AddressLine1
CitySAN DIEGOCity
StateCAState
ZIP Code92122ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN990322406EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1KAPI'OLANI MEDICAL SPECIALISTSBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% DONNA MASUDA-KAMInCareOfName
Name ControlKAPINameControl
Phone8089838986Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line155 MERCHANT STREET 24TH FLOORAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96813ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEARL INOUYEName
TitleVICE PRESIDENTTitle
Date Signed2013-05-07DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone8585357200Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKENNETH NAKAMURA MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11319 PUNAHOU STREETAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96826ZIPCode
FieldValueIRS element (for citing)
Gross Receipts23190148GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HAWAIIPACIFICHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileHIStateLegalDomicile
Activity Or Mission DescriptionKAPI'OLANI MEDICAL SPECIALISTS IS A SPECIALTY PHYSICIAN GROUP DEDICATED TO PROVIDING WORLD-CLASS CARE FOR HAWAI'I'S WOMEN AND CHILDREN THROUGH ACADEMICS, RESEARCH, AND CLINICAL CARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members2NbrIndependentVotingMembers
Total Nbr Employees159TotalNbrEmployees
Total Nbr Volunteers2TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year112089ContributionsGrantsPriorYear
Contributions Grants Current Year71817ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21775603ProgramServiceRevenuePriorYear
Program Service Revenue CY23109729ProgramServiceRevenueCY
Investment Income Prior Year3661InvestmentIncomePriorYear
Investment Income Current Year8602InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year21891353TotalRevenuePriorYear
Total Revenue Current Year23190148TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year19826986SalariesEtcPriorYear
Salaries Etc Current Year21823961SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year7556214OtherExpensePriorYear
Other Expenses Current Year6533421OtherExpensesCurrentYear
Total Expenses Prior Year27383200TotalExpensesPriorYear
Total Expenses Current Year28357382TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-5491847RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-5167234RevenuesLessExpensesCY
Total Assets BOY4643083TotalAssetsBOY
Total Assets EOY4084175TotalAssetsEOY
Total Liabilities BOY3751823TotalLiabilitiesBOY
Total Liabilities EOY3205898TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY891260NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY878277NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE O.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense24621816Expense
Grants0Grants
Revenue23109729Revenue
DescriptionSEE SCHEDULE O.Description
Total Program Service Expense24621816TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109619NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees159NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members2NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledHIStatesWhereCopyOfReturnIsFiled
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDONNA MASUDA-KAMNamePerson
Telephone Number8085357355TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line155 MERCHANT STREET 24TH FLOORAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96813ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
MARTHA SMITH
BOARD OF DIRECTOR, CHAIR5.0XX0498306116318
RICHARD KASUYA MD
BOARD OF DIRECTOR0.2X000
KEITH MATSUMOTO MD
BOARD OF DIRECTOR0.2X000
CHARLES A STED
BOARD OF DIRECTOR2.0X01555410597643
ANTHONY GUERRERO MD
BOARD OF DIRECTOR8.0X5469001159
KENNETH B ROBBINS MD
BOARD OF DIRECTOR0.2X0684384203029
KENNETH T NAKAMURA MD
VICE CHAIR & CMO40.0X020432441725
CHERYL HETRICK
DIRECTOR OF OPERATIONS40.0X145296025178
MELINDA ASHTON MD
VP1.0X037969769014
WARREN CHAIKO
VP1.0X028063959425
CHARLES R CHING
EVP & SECRETARY3.0X0476486108462
EARL INOUYE
VP & SYSTEM CONTROLLER1.0X030082077938
GAIL LERCH
EVP1.0X0545501144607
SUSAN MASUMOTO-NONAKA
VP0.2X024274845576
DAVID OKABE
EVP, CFO & TREASURER1.0X0624519140845
KEALA PETERS
VP0.2X021658444780
VIRGINIA PRESSLER-FISHER MD
EVP0.2X0557313154090
STEVEN ROBERTSON
EVP & CIO1.0X0549278142203
KEKA SANBORN
VP0.2X025730034458
KATIE SHIGEMITSU
COMPLIANCE OFFICER0.8X016840238172
DAVID FOX
PRIVACY & INFORMATION SECURITY0.4X011237034869
JESSICA LEWIS
ASSISTANT CORPORATE SECRETARY1.3X011185621557
SIDNEY M JOHNSON MD
PHYSICIAN40.0678648075770X
DEVIN P PUAPONG MD
PHYSICIAN40.0587426045309X
ROBERT C DURKIN MD
PHYSICIAN40.0555944081247X
RUSSELL KY WOO MD
PHYSICIAN40.0526747044566X
WILLIAM ELY BURKHALTER MD
PHYSICIAN40.0455259054804X
TERRY LONG
Former Officer01444402528X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3004010TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs7910377TotalReportableCompFrmRltdOrgs
Total Other Compensation2405272TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
UNIVERSITY OF HAWAI'I
2530 DOLE STREETHONOLULUHI96822Physician Services1299361
COMPHEALTH INC
PO BOX 972651DALLASTX753972651HLTH CARE STAFFING116479
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Related Organizations71817RelatedOrganizations
Total Contributions71817TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE9000991383564813835648
SERVICE CONTRACTS90009992740819274081
FieldValueIRS element (for citing)
Total Program Service Revenue23109729TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2854TotalRevenueColumn
Exclusion$2,854ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other5748Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other5748Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column5748TotalRevenueColumn
Exclusion$5,748ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column23190148TotalRevenueColumn
Related Or Exempt Function Income23109729RelatedOrExemptFunctionIncome
Exclusion$8,602ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total179192Total
Program Services179192ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total18457190Total
Program Services18306597ProgramServices
Management And General150593ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1259519Total
Program Services1200237ProgramServices
Management And General59282ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total943836Total
Program Services886632ProgramServices
Management And General57204ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total984224Total
Program Services957420ProgramServices
Management And General26804ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total5019Total
Management And General5019ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total147013Total
Management And General147013ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2842558Total
Program Services1616706ProgramServices
Management And General1225852ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total26873Total
Management And General26873ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total139758Total
Program Services123551ProgramServices
Management And General16207ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total380348Total
Program Services361610ProgramServices
Management And General18738ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total65216Total
Program Services60117ProgramServices
Management And General5099ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total160999Total
Program Services154315ProgramServices
Management And General6684ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total496209Total
Program Services480344ProgramServices
Management And General15865ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT267880267880
CORPORATE ALLOCATION18367321836732
OTHER PURCHASES30612993120681
PROGRAM SERVICE EXPENDITURES1235112351

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total121853Total
Program Services4933ProgramServices
Management And General116920ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total28357382Total
Program Services24621816ProgramServices
Management And General3735566ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY556683BOY
EOY19236EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1245415BOY
EOY1209542EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY54388BOY
EOY41162EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2102860LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1568435LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY609366BOY
EOY534425EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2177231BOY
EOY2279810EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4643083BOY
EOY4084175EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2852272BOY
EOY2213987EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY899551BOY
EOY991911EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3751823BOY
EOY3205898EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY841264BOY
EOY837048EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY49996BOY
EOY41229EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY891260BOY
EOY878277EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4643083BOY
EOY4084175EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-5167234ReconcilationRevenueExpenses
Reconcilation Other Changes5154251ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years125521CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year112089CurrentTaxYearMinus1Year
Current Tax Year71817CurrentTaxYear
Total309427Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16789539CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20360418CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years21244574CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21775603CurrentTaxYearMinus1Year
Current Tax Year23115477CurrentTaxYear
Total103285611Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16789539CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20360418CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years21370095CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21887692CurrentTaxYearMinus1Year
Current Tax Year23187294CurrentTaxYear
Total103595038Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year726199CurrentTaxYearMinus1Year
Current Tax Year834750CurrentTaxYear
Total1560949Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year726199CurrentTaxYearMinus1Year
Current Tax Year834750CurrentTaxYear
Total1560949Total
FieldValueIRS element (for citing)
Public Support Total509102034089PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6139CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13916CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4893CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3661CurrentTaxYearMinus1Year
Current Tax Year2854CurrentTaxYear
Total31463Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6139CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13916CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4893CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3661CurrentTaxYearMinus1Year
Current Tax Year2854CurrentTaxYear
Total31463Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16795678CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20374334CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years21374988CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21891353CurrentTaxYearMinus1Year
Current Tax Year23190148CurrentTaxYear
Total103626501Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98463PublicSupportPercentage509
Prior Year Support Percentage0.98220PriorYearSupportPercentage
Investment Income Percentage0.00030InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00043PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
LandLand
BuildingsBuildings

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis15705OtherCostOrOtherBasis
Depreciation5844Depreciation
Book Value9861BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis780259OtherCostOrOtherBasis
Depreciation634604Depreciation
Book Value145655BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1306896OtherCostOrOtherBasis
Depreciation927987Depreciation
Book Value378909BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings534425TotalOfBookValueLandBuildings

Other Assets OtherAssets (10 entries)

DescriptionDescriptionBook ValueBookValue
VARIOUS DEFERRED CHARGES115193
OTHER RECEIVABLES305508
LIFE INSURANCE - CSV918545
GOVERNMENT AGENCIES28400
KAPI'OLANI WOMEN773007
PROVIDERS INSURANCE27068
HAWAI'I PACIFIC HEALTH RSRCH43432
KAPI'OLANI HEALTH FOUNDATION27404
STRAUB FOUNDATION40414
WILCOX MEMORIAL HOSPITAL839
FieldValueIRS element (for citing)
Total Book Value Other Assets2279810TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (9 entries)

DescriptionDescriptionAmountAmount
LONG TERM LIAB - CAPITAL ACCUMULATION$58,426
LONG TERM LIAB - MCGF INS ADV$337,692
LONG TERM LIAB - ESCHEAT LIAB$104
HAWAI'I PACIFIC HEALTH$473,081
PALI MOMI FOUNDATION$100
PALI MOMI MEDICAL CENTER$47,692
STRAUB CLINIC & HOSPITAL$35,057
WILCOX HEALTH FOUNDATION$12
KAUA'I MEDICAL CENTER$39,747
FieldValueIRS element (for citing)
Total Of Amounts991911TotalOfAmounts

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (23 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARTHA SMITH
032516006341801097280978080185100614624074802
CHARLES A STED
0761348036462304294390580822016821021530530379514
KENNETH B ROBBINS MD
041043801332150140731018298702004208874130105027
KENNETH T NAKAMURA MD
01431290343450268500272350144900246049011692
CHERYL HETRICK
142616025000180023447017310170474000
MELINDA ASHTON MD
02992840422480381650477540212600448711014412
WARREN CHAIKO
0209882037492033265037603021822034006404264
CHARLES R CHING
032298301026810508220105967024950584948069790
EARL INOUYE
0230688035169034963056567021371037875807137
GAIL LERCH
03168850107318012129801266570179500690108065499
SUSAN MASUMOTO-NONAKA
020056802717301500702545202012402883240927
DAVID OKABE
042459601387550611680133328075170765364088765
KEALA PETERS
0168717027117020750024396020384026136400
VIRGINIA PRESSLER-FISHER MD
0345564098374011337501329100211800711403087201
STEVEN ROBERTSON
0345271011306909093801205230216800691481070437
KEKA SANBORN
0207841024234025225014448020010029175800
KATIE SHIGEMITSU
01650740332800025035013137020657400
SIDNEY M JOHNSON MD
5447330001339150538030219670754418000
DEVIN P PUAPONG MD
4274030001600230281380171710632735000
ROBERT C DURKIN MD
3894210001665230564730247740637191000
RUSSELL KY WOO MD
429678000970690281380164280571313000
WILLIAM ELY BURKHALTER MD
390509000647500371040177000510063000
TERRY LONG
014444000000252800014696800

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SUPPLEMENTAL COMPENSATION INFORMATIONSCHEDULE J, PART I, QUESTION 3THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, HAWAII PACIFIC HEALTH, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O FOR 990 PART VI, LINE 15A FOR THE PROCESS USED BY HAWAII PACIFIC HEALTH TO DETERMINE COMPENSATION.
SUPPLEMENTAL NON QUALIFIED RETIREMENT PLANSCHEDULE J, PART I, QUESTION 4BTHE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERANL 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 ORGANIZATION: MARTHA SMITH $74,802 KENNETH T. NAKAMURA $11,692 MELINDA ASHTON $14,412 WARREN CHAIKO $4,264 CHARLES CHING $41,641 EARL INOUYE $7,137 GAIL LERCH $36,407 SUSAN MASUMOTO-NONAKA $927 DAVID OKABE $51,432 VIRGINIA PRESSLER-FISHER $57,884 STEVEN ROBERTSON $40,015 KENNETH B. ROBBINS $67,793 CHARLES A. STED $277,790 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 ORGANIZATION: CHARLES A. STED $101,724 CHARLES CHING $28,149 VIRGINIA PRESSLER FISHER $29,317 GAIL LERCH $29,092 DAVID OKABE $37,333 KENNETH B. ROBBINS $37,234 STEVEN ROBERTSON $30,422

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF ORGANIZATION'S MISSIONFORM 990, PART III, LINE 1KAPI'OLANI MEDICAL SPECIALISTS (KMS) IS A SPECIALTY PHYSICIAN GROUP DEDICATED TO PROVIDING WORLD-CLASS CARE FOR HAWAII'S WOMEN AND CHILDREN THROUGH ACADEMICS, RESEARCH AND CLINICAL CARE. WORKING IN PARTNERSHIP WITH KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN, THE GROUP'S MISSION IS CARING FOR THE COMMUNITY THROUGH MEDICAL AND ACADEMIC EXCELLENCE.
PROGRAM SERVICE ACTIVITYFORM 990, PART III, LINE 4AKAPI'OLANI MEDICAL SPECIALISTS (KMS) HAS OVER 100 PEDIATRIC SPECIALISTS AND SUB-SPECIALISTS IN PEDIATRIC INTENSIVE CARE, PEDIATRIC EMERGENCY MEDICINE, NEONATOLOGY, PEDIATRIC RHEUMATOLOGY, PSYCHIATRY/COUNSELING, BEHAVIORAL HEALTH SERVICES, MEDICAL GENETICS, GYNECOLOGY-ONCOLOGY, PEDIATRIC HEMATOLOGY-ONCOLOGY, RESEARCH, PEDIATRIC HOSPITALISTS, ADULT HOSPITALISTS (INTERNAL MEDICINE), PEDIATRIC SURGERY, PEDIATRIC UROLOGY, PEDIATRIC ORTHOPEDICS AND SPORTS MEDICINE, PEDIATRIC GASTROENTEROLOGY, PEDIATRIC SEDATION, PEDIATRIC NEPHROLOGY, ADOLESCENT MEDICINE, AND PALLIATIVE CARE. IN FISCAL YEAR 2012, KMS HAD 72,110 PATIENT VISITS. KMS ALLIES WITH THE UNIVERSITY OF HAWAII JOHN A. BURNS SCHOOL OF MEDICINE, IN ADHERENCE TO ITS CORE VALUES OF WORLD-CLASS HEALTH CARE, PHYSICIAN TRAINING, AND MEDICAL RESEARCH. THIS PARTNERSHIP PROVIDES A UNIQUE ACADEMIC AFFILIATION FOR HAWAI'I PACIFIC HEALTH AND FURTHERS ITS COMMITMENT TO EFFECTIVE HEALTH CARE THROUGH MEDICAL RESEARCH AND BY TRAINING TOMORROW'S HEALTH CARE PROVIDERS. KMS HAS DEVELOPED A VARIETY OF WAYS TO IDENTIFY AND MEET THE UNIQUE HEALTH CARE NEEDS OF HAWAII'S WOMEN AND CHILDREN. KMS RECRUITS PHYSICIANS FROM THROUGHOUT THE NATION WHO DESIRE EMPLOYMENT IN A GROUP PRACTICE SETTING WITH HAWAII'S LEADING PEDIATRIC HOSPITAL, ESPECIALLY SUB-SPECIALISTS IN SHORT SUPPLY YET HIGH DEMAND. KMS DOCTORS PROVIDE PATIENT CARE AT OUTREACH CLINICS AND COMMUNITY HEALTH CENTERS THROUGHOUT HAWAII, PROMOTE LESSER-KNOWN SERVICES TO PATIENTS WITH SPECIAL NEEDS, PROVIDE HEALTH EDUCATION ON THE NEIGHBOR ISLANDS AND HEALTH CARE TRAINING TO THE COMMUNITY AND OTHER PROVIDERS, AND SERVE AS MEDICAL DIRECTORS ON VARIOUS COMMUNITY BOARDS. CARING FOR THE UNDERSERVED, A LONG-STANDING TRADITION OF ACADEMIC MEDICAL CENTERS THROUGHOUT THE NATION, CONTINUES TO BE A MAJOR FOCUS OF KAPI'OLANI MEDICAL SPECIALISTS. IN FISCAL YEAR 2012, THE GROUP PROVIDED $4,405,000 IN MEDICAL CARE TO PATIENTS WHO WERE UNINSURED OR UNABLE TO PAY FOR THEIR CARE.
MEMBERS/STOCKHOLDERS AND THEIR RIGHTSFORM 990, PART VI, LINE 6HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTSFORM 990, PART VI, LINE 7BHAWAI'I PACIFIC HEALTH, AS MEMBER, HAS THE FOLLOWING RESERVED POWERS: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE CHIEF MEDICAL OFFICER, DIRECTOR OF OPERATIONS, TREASURER, SECRETARY, EXECUTIVE VICE PRESIDENT / CHIEF FINANCIAL OFFICER, OTHER EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, ASST. SECRETARIES, AND ALL VICE PRESIDENTS EXCEPT THE OPERATING UNIT VICE PRESIDENTS, AS SUCH TERMS ARE DEFINED IN THESE BYLAWS; (II) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION ("CORP") IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER BOARD; (III) AMEND THESE BYLAWS; (IV) THE CORP'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF 1 YEAR AND/OR FOR $1,000,000 OR MORE; (V) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORP'S FUNDS SHALL BE DEPOSITED; (VI) DIRECT, MANAGE AND CONTROL THE CUSTODY, THE ADVISORY SERVICE AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORP; (VII) EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORP AND ANY AFFILIATE; (VIII) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORP'S PHYSICIAN AND EXECUTIVE COMPENSATION AND BENEFIT PLANS; (IX) FORM A NEW CORP, LIMITED LIABILITY COMPANY, OR PARTNERSHIP OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORP; (X) EXCEPT AS PROVIDED IN SECTION 3.2(C) OF THE BYLAWS OR AS REQUIRED BY THE LAWS OF THE STATE OF HAWAII, SELL, LEASE OR OTHERWISE TRANSFER 50% OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY THE CORP; (XI) EXCEPT AS PROVIDED IN SECTION 3.2(C) OF THE BYLAWS OR AS REQUIRED BY THE LAWS OF THE STATE OF HAWAII, SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE CORP WHICH GENERATE 50% OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE CORP DURING THE PRIOR FISCAL YEAR; (XII) CLOSE THE CLINICAL FACILITIES OWNED AND OPERATED BY THE CORP; PROVIDED THAT AFTER THE EFFECTIVE DATE OF THESE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORP MUST ALSO BE APPROVED BY THE BOARD; (XIII) CONVERT THE CLINICAL FACILITIES OWNED AND OPERATED BY THE CORP INTO A FACILITY NO LONGER OFFERING MEDICAL SERVICES; PROVIDED THAT AFTER THE EFFECTIVE DATE OF THESE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORP MUST ALSO BE APPROVED BY THE BOARD; (XIV) AFTER CONSULTING WITH THE BOARD, REMOVE THE CHIEF MEDICAL OFFICER, DIRECTOR OF OPERATIONS, EXECUTIVE VICE PRESIDENT / CHIEF FINANCIAL OFFICER, TREASURER, SECRETARY, OTHER EXECUTIVE VICE PRESIDENT, SENIOR VICE PRESIDENTS, ASST SECRETARIES, AND ALL VICE PRESIDENTS EXCEPT THE OPERATING UNIT VICE PRESIDENTS; PROVIDED, HOWEVER, THAT TO REMOVE OR TERMINATE THE CHIEF MEDICAL OFFICER WILL REQUIRE THE CHIEF MEDICAL OFFICER OF THE MEMBER TO FULLY COLLABORATE AND CONSULT WITH THE BOARD AND SEEK THE BOARD'S ADVANCE CONSENT FOR SUCH REMOVAL OR TERMINATION. IF THE BOARD DOES NOT CONCUR WITH THE PROPOSED REMOVAL OR TERMINATION OF THE CHIEF MEDICAL OFFICER, SUCH REMOVAL OR TERMINATION WILL REQUIRE THE APPROVAL OF A MAJORITY OF THE MEMBERS ON THE MEMBER BOARD; (XV) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORP GOALS AND THE LONG RANGE AND STRATEGIC PLANS OF THE CORP; AND (XVI) AFTER CONSULTING WITH THE BOARD, DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. IN ADDITION, DECISIONS OF THE GOVERNING BODY REQUIRING THE APPROVAL OF HAWAI'I PACIFIC HEALTH, AS MEMBER, INCLUDE: (I) ADD ANY DIRECTOR TO THE BOARD; (II) REMOVE ANY DIRECTOR FROM THE BOARD; (III) AMEND THE ARTICLES; (IV) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS ON BEHALF OF THE CORP EXCEEDING $1,000,000 IN VALUE; (V) ACQUIRE ASSETS WORTH OVER $1,000,000; (VI) AQUIRE SHARES IN ANOTHER CORP; (VII) SELL, LEASE OR OTHERWISE TRANSFER 50% OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER THE GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY THE CORP; (VIII) SELL, LEASE, EXCHANGE OR DISPOSE OF 50% OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION; (IX) SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE CORPORATION WHICH GENERATE 50% OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE CORPORATION DURING THE PRIOR FISCAL YEAR; (X) MERGE THE CORP WITH ANY ENTITY; (XI) DISSOLVE OR LIQUIDATE THE CORP; (XII) ISSUE THE CORP'S MEMBERSHIP TO ANY OTHER THAN THE MEMBER; (XIII) FORM A JOINT VENTURE OR OTHER BUSINESS RELATIONASHIP (OTHER THAN THE ORDINARY COURSE OF BUSINESS CONTRACTS) BETWEEN THE CORP AND ANY PERSON OR ENTITY; AND (XIV) DEVELOP A NEW LINE OF BUSINESS.
REVIEW OF THE 990S BY THE ORGANIZATION'S GOVERNING BODYFORM 990, PART VI, LINE 11BVARIOUS 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 THE OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPILED INTERNALLY BASED ON INPUT AND DISCUSSION WITH FINANCIAL ANALYSTS AND THE CHIEF OPERATING OFFICER / EXECUTIVE DIRECTOR OF THE REPORTING ENTITY. THE CHIEF OPERATING OFFICER / EXECUTIVE DIRECTOR OF EACH REPORTING ENTITY REVIEWS AND APPROVES THE DISCLOSURE NARRATIVES WHICH DESCRIBES THE MISSION / PURPOSE AND PROGRAM ACCOMPLISHMENTS OF THEIR ORGANIZATION. SENIOR MANAGEMENT OF THE HEALTH CARE SYTEM REVIEWS THE 990S OF EACH FILLING 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'S ENTITY (HAWAI'I PACIFIC HEALTH "HPH") BOARD PROVIDES OVERSIGHT FOR THE 990 REPORTING AND REVIEWS THE 990S FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE 990S FOR EACH ENTITY ARE MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND THE HPH BOARD OF DIRECTORS THROUGH A BOARD MEMBER PORTAL FOR REVIEW PRIOR TO THE FILING OF THE 990. THE 990S WILL BE POSTED TO HPH'S WEB SITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURNS WITH THE IRS.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTERESTFORM 990, PART VI, LINE 12CANNUALLY, EACH DIRECTOR, OFFICER, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: - RECEIVED A COPY OF THE CONFLICT OF INTEREST ("COI") POLICY; - HAS READ AND UNDERSTANDS THE POLICY; - AGREES TO COMPLY WITH THE POLICY; AND - UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, THE ORGANIZATION MUST ENGAGE PRIMARILY IN ACTIVITES 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.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED & YEAR PROCESS WAS LASTCOMPLETEDFORM 990, PART VI, LINE 15B THE CEO OF THE ORGANIZAITON IS NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER BY THE TAX-EXEMPT PARENT, HPH. FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE CEO'S COMPENSATION. COMPENSATION FOR HAWAI'I PACIFIC HEALTH (HPH) EXECUTIVES (VP AND ABOVE) IS SET BY THE INDEPENDENT BOARD MEMBERS WHO ARE MEMBERS OF THE HPH COMPENSATION COMMITTEE. ON AN ANNUAL BASIS THE HPH BOARD CHAIRPERSON (WHO IS INDEPENDENT) SELECTS A NEUTRAL THIRD PARTY EXECUTIVE COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVE'S 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. 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 FEBRUARY 24, 2012 TO REVIEW PHYSICIAN COMPENSATION, AND ON JULY 12, 2011 AND AUGUST 9, 2011 TO REVIEW EXECUTIVE COMPENSATION.
DISCLOSURE OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FINANCIAL STMTSFORM 990, PART VI, LINE 19THE CONFLICT OF INTEREST POLICY AND STANDARDS OF CONDUCT ARE AVAILABLE ON THE HAWAI'I PACIFIC HEALTH WEBSITE. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE VIA THE HAWAI'I PACIFIC HEALTH WEBSITE.
HOURS DEVOTED TO RELATED ORGANIZATIONSFORM 990, PART VIIINDIVIDUALS LISTED ON PART VII ALSO DEVOTE TIME TO THE FOLLOWING RELATED ORGANIZATIONS AS LISTED BELOW: KAPI'OLANI HEALTH FOUNDATION CHARLES A. STED 2 CHARLES R. CHING 0.1 DAVID OKABE 1 EARL INOUYE 0.2 JESSICA LEWIS 0.1 VIRGINIA PRESSLER-FISHER, M.D. 1 WILCOX HEALTH FOUNDATION CHARLES A. STED 1 CHARLES R. CHING 0.1 DAVID OKABE 0.1 EARL INOUYE 0.1 JESSICA LEWIS 0.2 VIRGINIA PRESSLER-FISHER, M.D. 1 STRAUB FOUNDATION CHARLES A. STED 1 CHARLES R. CHING 0.1 DAVID OKABE 0.1 EARL INOUYE 0.1 JESSICA LEWIS 0.1 KENNETH B. ROBBINS, M.D. 0.1 VIRGINIA PRESSLER-FISHER, M.D. 1 HAWAI'I PACIFIC HEALTH CHARLES A. STED 40 CHARLES R. CHING 30 DAVID FOX 2.4 DAVID OKABE 35 EARL INOUYE 30 GAIL LERCH 40 JESSICA LEWIS 0.6 KATIE SHIGEMITSU 0.1 KEKA SANBORN 50 KENNETH B. ROBBINS, M.D. 10 KENNETH T. NAKAMURA, M.D. 1 MARTHA SMITH 0.1 MELINDA ASHTON, M.D. 40 STEVEN ROBERTSON 15 SUSAN MASUMOTO-NONAKA 20 VIRGINIA PRESSLER-FISHER, M.D. 45 WARREN CHAIKO 15 KAUA'I MEDICAL CLINIC CHARLES A. STED 2 CHARLES R. CHING 4 DAVID FOX 4.8 DAVID OKABE 1 EARL INOUYE 1 GAIL LERCH 0.2 JESSICA LEWIS 2.4 KEKA SANBORN 0.2 KENNETH B. ROBBINS, M.D. 10 MELINDA ASHTON, M.D. 1 STEVEN ROBERTSON 1 SUSAN MASUMOTO-NONAKA 1 VIRGINIA PRESSLER-FISHER, M.D. 0.2 WARREN CHAIKO 1 PROVIDERS INSURANCE CORPORATION CHARLES A. STED 1 CHARLES R. CHING 2 DAVID OKABE 1 EARL INOUYE 0.5 JESSICA LEWIS 0.1 MELINDA ASHTON, M.D. 0.1 PALI MOMI FOUNDATION CHARLES A. STED 1 CHARLES R. CHING 0.1 DAVID OKABE 0.1 EARL INOUYE 0.1 JESSICA LEWIS 0.1 VIRGINIA PRESSLER-FISHER, M.D. 0.1 HAWAI'I PACIFIC HEALTH GROUP RETURN CHARLES A. STED 10 CHARLES R. CHING 13 DAVID FOX 30.8 DAVID OKABE 16 EARL INOUYE 10 GAIL LERCH 19 JESSICA LEWIS 36.3 KATIE SHIGEMITSU 36.8 KEITH MATSUMOTO, M.D. 0.3 KEKA SANBORN 8 KENNETH B. ROBBINS, M.D. 40 MARTHA SMITH 55 MELINDA ASHTON, M.D. 7 STEVEN ROBERTSON 43 SUSAN MASUMOTO-NONAKA 39 VIRGINIA PRESSLER-FISHER, M.D. 6 WARREN CHAIKO 35
OTHER CHANGES IN NET ASSETS OR FUND BALANCESFORM 990, PART XI, LINE 5$5,154,249 - EQUITY TRANSFER WITH HPH $ 2 - ROUNDING ---------- $5,154,251 - TOTAL

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
HAWAI'I PACIFIC HEALTH
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990246363HOLDING COHI501(C)(3)11B TYPE IINAfalse
KAPI'OLANI MEDICAL CENTER WOMEN CHILDREN
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990177350HOSPITALHI501(C)(3)3NAtrue
KAPI'OLANI HEALTH FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990246364FUNDRAISINGHI501(C)(3)7NAtrue
PALI MOMI MEDICAL CENTER
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990274038HOSPITALHI501(C)(3)3NAtrue
WILCOX MEMORIAL HOSPITAL
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990074365HOSPITALHI501(C)(3)3NAtrue
WILCOX HEALTH FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990204242FUNDRAISINGHI501(C)(3)7NAtrue
KAUA'I MEDICAL CLINIC
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990326099HOSPITALHI501(C)(3)3NAtrue
STRAUB CLINIC & HOSPITAL
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813912151670HOSPITALHI501(C)(3)3NAtrue
STRAUB FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990109350FUNDRAISINGHI501(C)(3)7NAtrue
PROVIDERS INSURANCE CORPORATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813710893000NFP INSURANCEHI501(C)(3)11B TYPE IINAtrue
PALI MOMI FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813383840327FUNDRAISINGHI501(C)(3)7NAtrue

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1HAWAI'I PACIFIC HEALTH PARTNERS INC &SUBBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line155 MERCHANT ST 24TH FLOORAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96813ZIPCode
FieldValueIRS element (for citing)
EIN990318588EIN
Primary ActivityHOLDING COPrimaryActivity
Legal Domicile StateHILegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CORPTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN
O7031829FMV
KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN
P324502FMV
KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN
Q407038FMV
KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN
R51600FMV
PROVIDERS INSURANCE COMPANY
Q734430FMV
STRAUB CLINIC & HOSPITAL
R81101FMV
KAPI'OLANI HEALTH FOUNDATION
C68234FMV