2013-05-09T20:42:22-05:00 2012-06-30 ERNST & YOUNG US LLP 4370 LA JOLLA VILLAGE DR STE 500 SAN DIEGO CA 92122 990 2011-07-01 990322406 KAPI'OLANI MEDICAL SPECIALISTS % DONNA MASUDA-KAM KAPI 8089838986 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 EARL INOUYE 2013-05-07 8585357200 2011 2016-02-25 16:41:14Z KENNETH NAKAMURA MD 1319 PUNAHOU STREET HONOLULU HI 96826 23190148 false X WWW.HAWAIIPACIFICHEALTH.ORG X 1995 HI KAPI'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. 6 2 159 2 0 112089 71817 21775603 23109729 3661 8602 0 0 21891353 23190148 0 0 0 0 19826986 21823961 0 0 0 7556214 6533421 27383200 28357382 -5491847 -5167234 4643083 4084175 3751823 3205898 891260 878277 X SEE SCHEDULE O. false false 24621816 0 23109729 SEE SCHEDULE O. 24621816 true true false false false false false false false false true false false true true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false false true 19 0 true 159 true false false false false false false false false false false X 6 2 false false false false true false true true true false false true true true true true true false true false HI X X DONNA MASUDA-KAM 8085357355 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 X MARTHA SMITH 5.0 X X 0 498306 116318 RICHARD KASUYA MD 0.2 X 0 0 0 KEITH MATSUMOTO MD 0.2 X 0 0 0 CHARLES A STED 2.0 X 0 1555410 597643 ANTHONY GUERRERO MD 8.0 X 54690 0 1159 KENNETH B ROBBINS MD 0.2 X 0 684384 203029 KENNETH T NAKAMURA MD 40.0 X 0 204324 41725 CHERYL HETRICK 40.0 X 145296 0 25178 MELINDA ASHTON MD 1.0 X 0 379697 69014 WARREN CHAIKO 1.0 X 0 280639 59425 CHARLES R CHING 3.0 X 0 476486 108462 EARL INOUYE 1.0 X 0 300820 77938 GAIL LERCH 1.0 X 0 545501 144607 SUSAN MASUMOTO-NONAKA 0.2 X 0 242748 45576 DAVID OKABE 1.0 X 0 624519 140845 KEALA PETERS 0.2 X 0 216584 44780 VIRGINIA PRESSLER-FISHER MD 0.2 X 0 557313 154090 STEVEN ROBERTSON 1.0 X 0 549278 142203 KEKA SANBORN 0.2 X 0 257300 34458 KATIE SHIGEMITSU 0.8 X 0 168402 38172 DAVID FOX 0.4 X 0 112370 34869 JESSICA LEWIS 1.3 X 0 111856 21557 SIDNEY M JOHNSON MD 40.0 X 678648 0 75770 DEVIN P PUAPONG MD 40.0 X 587426 0 45309 ROBERT C DURKIN MD 40.0 X 555944 0 81247 RUSSELL KY WOO MD 40.0 X 526747 0 44566 WILLIAM ELY BURKHALTER MD 40.0 X 455259 0 54804 TERRY LONG X 0 144440 2528 3004010 7910377 2405272 6 true true false UNIVERSITY OF HAWAI'I 2530 DOLE STREET HONOLULU HI 96822 Physician Services 1299361 COMPHEALTH INC PO BOX 972651 DALLAS TX 753972651 HLTH CARE STAFFING 116479 2 71817 71817 NET PATIENT SERVICE REVENUE 900099 13835648 13835648 SERVICE CONTRACTS 900099 9274081 9274081 23109729 2854 2854 0 0 5748 0 5748 5748 5748 0 0 0 0 23190148 23109729 8602 0 0 0 0 179192 179192 0 18457190 18306597 150593 1259519 1200237 59282 943836 886632 57204 984224 957420 26804 0 5019 5019 147013 147013 0 0 0 2842558 1616706 1225852 26873 26873 139758 123551 16207 0 0 380348 361610 18738 65216 60117 5099 0 0 0 0 160999 154315 6684 496209 480344 15865 BAD DEBT 267880 267880 CORPORATE ALLOCATION 1836732 1836732 OTHER PURCHASES 30612 9931 20681 PROGRAM SERVICE EXPENDITURES 12351 12351 121853 4933 116920 28357382 24621816 3735566 0 0 0 556683 19236 0 0 1245415 1209542 0 0 0 0 0 0 0 0 54388 41162 2102860 1568435 609366 534425 0 0 0 0 0 0 0 0 2177231 2279810 4643083 4084175 2852272 2213987 0 0 0 0 0 0 0 0 0 0 0 0 0 0 899551 991911 3751823 3205898 X 841264 837048 49996 41229 0 0 891260 878277 4643083 4084175 X -5167234 5154251 X false true true X false X 0 0 125521 112089 71817 309427 16789539 20360418 21244574 21775603 23115477 103285611 16789539 20360418 21370095 21887692 23187294 103595038 726199 834750 1560949 726199 834750 1560949 102034089 6139 13916 4893 3661 2854 31463 6139 13916 4893 3661 2854 31463 16795678 20374334 21374988 21891353 23190148 103626501 0.98463 0.98220 0.00030 0.00043 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 15705 5844 9861 780259 634604 145655 1306896 927987 378909 534425 VARIOUS DEFERRED CHARGES 115193 OTHER RECEIVABLES 305508 LIFE INSURANCE - CSV 918545 GOVERNMENT AGENCIES 28400 KAPI'OLANI WOMEN 773007 PROVIDERS INSURANCE 27068 HAWAI'I PACIFIC HEALTH RSRCH 43432 KAPI'OLANI HEALTH FOUNDATION 27404 STRAUB FOUNDATION 40414 WILCOX MEMORIAL HOSPITAL 839 2279810 0 LONG TERM LIAB - CAPITAL ACCUMULATION 58426 LONG TERM LIAB - MCGF INS ADV 337692 LONG TERM LIAB - ESCHEAT LIAB 104 HAWAI'I PACIFIC HEALTH 473081 PALI MOMI FOUNDATION 100 PALI MOMI MEDICAL CENTER 47692 STRAUB CLINIC & HOSPITAL 35057 WILCOX HEALTH FOUNDATION 12 KAUA'I MEDICAL CENTER 39747 991911 false true false false false false false false false MARTHA SMITH 0 325160 0 63418 0 109728 0 97808 0 18510 0 614624 0 74802 CHARLES A STED 0 761348 0 364623 0 429439 0 580822 0 16821 0 2153053 0 379514 KENNETH B ROBBINS MD 0 410438 0 133215 0 140731 0 182987 0 20042 0 887413 0 105027 KENNETH T NAKAMURA MD 0 143129 0 34345 0 26850 0 27235 0 14490 0 246049 0 11692 CHERYL HETRICK 142616 0 2500 0 180 0 23447 0 1731 0 170474 0 0 0 MELINDA ASHTON MD 0 299284 0 42248 0 38165 0 47754 0 21260 0 448711 0 14412 WARREN CHAIKO 0 209882 0 37492 0 33265 0 37603 0 21822 0 340064 0 4264 CHARLES R CHING 0 322983 0 102681 0 50822 0 105967 0 2495 0 584948 0 69790 EARL INOUYE 0 230688 0 35169 0 34963 0 56567 0 21371 0 378758 0 7137 GAIL LERCH 0 316885 0 107318 0 121298 0 126657 0 17950 0 690108 0 65499 SUSAN MASUMOTO-NONAKA 0 200568 0 27173 0 15007 0 25452 0 20124 0 288324 0 927 DAVID OKABE 0 424596 0 138755 0 61168 0 133328 0 7517 0 765364 0 88765 KEALA PETERS 0 168717 0 27117 0 20750 0 24396 0 20384 0 261364 0 0 VIRGINIA PRESSLER-FISHER MD 0 345564 0 98374 0 113375 0 132910 0 21180 0 711403 0 87201 STEVEN ROBERTSON 0 345271 0 113069 0 90938 0 120523 0 21680 0 691481 0 70437 KEKA SANBORN 0 207841 0 24234 0 25225 0 14448 0 20010 0 291758 0 0 KATIE SHIGEMITSU 0 165074 0 3328 0 0 0 25035 0 13137 0 206574 0 0 SIDNEY M JOHNSON MD 544733 0 0 0 133915 0 53803 0 21967 0 754418 0 0 0 DEVIN P PUAPONG MD 427403 0 0 0 160023 0 28138 0 17171 0 632735 0 0 0 ROBERT C DURKIN MD 389421 0 0 0 166523 0 56473 0 24774 0 637191 0 0 0 RUSSELL KY WOO MD 429678 0 0 0 97069 0 28138 0 16428 0 571313 0 0 0 WILLIAM ELY BURKHALTER MD 390509 0 0 0 64750 0 37104 0 17700 0 510063 0 0 0 TERRY LONG 0 144440 0 0 0 0 0 2528 0 0 0 146968 0 0 SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, QUESTION 3 THE 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 PLAN SCHEDULE J, PART I, QUESTION 4B THE 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 DESCRIPTION OF ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 KAPI'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 ACTIVITY FORM 990, PART III, LINE 4A KAPI'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 RIGHTS FORM 990, PART VI, LINE 6 HAWAI'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 RIGHTS FORM 990, PART VI, LINE 7B HAWAI'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 BODY FORM 990, PART VI, LINE 11B VARIOUS SCHEDULES OF THE 990S ARE PREPARED PRIMARILY BY STAFF WITHIN THE ACCOUNTING AREA OF THE ORGANIZATION WORKING WITH VARIOUS OTHER AREAS OF THE ORGANIZATION SUCH AS MANAGEMENT OF 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 INTEREST FORM 990, PART VI, LINE 12C ANNUALLY, EACH DIRECTOR, OFFICER, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: - 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 LAST COMPLETED FORM 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 STMTS FORM 990, PART VI, LINE 19 THE CONFLICT OF INTEREST POLICY AND STANDARDS OF CONDUCT ARE AVAILABLE ON THE HAWAI'I PACIFIC HEALTH WEBSITE. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE VIA THE HAWAI'I PACIFIC HEALTH WEBSITE. HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII INDIVIDUALS 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 BALANCES FORM 990, PART XI, LINE 5 $5,154,249 - EQUITY TRANSFER WITH HPH $ 2 - ROUNDING ---------- $5,154,251 - TOTAL HAWAI'I PACIFIC HEALTH 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246363 HOLDING CO HI 501(C)(3) 11B TYPE II NA false KAPI'OLANI MEDICAL CENTER WOMEN CHILDREN 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990177350 HOSPITAL HI 501(C)(3) 3 NA true KAPI'OLANI HEALTH FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246364 FUNDRAISING HI 501(C)(3) 7 NA true PALI MOMI MEDICAL CENTER 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990274038 HOSPITAL HI 501(C)(3) 3 NA true WILCOX MEMORIAL HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990074365 HOSPITAL HI 501(C)(3) 3 NA true WILCOX HEALTH FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990204242 FUNDRAISING HI 501(C)(3) 7 NA true KAUA'I MEDICAL CLINIC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990326099 HOSPITAL HI 501(C)(3) 3 NA true STRAUB CLINIC & HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 912151670 HOSPITAL HI 501(C)(3) 3 NA true STRAUB FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990109350 FUNDRAISING HI 501(C)(3) 7 NA true PROVIDERS INSURANCE CORPORATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 NFP INSURANCE HI 501(C)(3) 11B TYPE II NA true PALI MOMI FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 383840327 FUNDRAISING HI 501(C)(3) 7 NA true HAWAI'I PACIFIC HEALTH PARTNERS INC &SUB 55 MERCHANT ST 24TH FLOOR HONOLULU HI 96813 990318588 HOLDING CO HI NA C CORP false false true false false false false false false false false false false false true true true true KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN O 7031829 FMV KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN P 324502 FMV KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN Q 407038 FMV KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN R 51600 FMV PROVIDERS INSURANCE COMPANY Q 734430 FMV STRAUB CLINIC & HOSPITAL R 81101 FMV KAPI'OLANI HEALTH FOUNDATION C 68234 FMV