MOLOKAI GENERAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MOLOKAI GENERAL HOSPITAL (EIN 99-0251372)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-09
- IRS object ID
- 201341299349303104
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
- Affiliated Group Attachment
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-09T20:34:09-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4370 LA JOLLA VILLAGE DR STE 500 | AddressLine1 |
| City | SAN DIEGO | City |
| State | CA | State |
| ZIP Code | 92122 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 990251372 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOLOKAI GENERAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % ZESSICA APIKI | InCareOfName |
| Name Control | MOLO | NameControl |
| Phone | 8085533125 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 408 | AddressLine1 |
| City | KAUNAKAKAI MOLOKAI | City |
| State | HI | State |
| ZIP Code | 96748 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RICHARD KEENE | Name |
| Title | TREASURER | Title |
| Date Signed | 2013-05-07 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8585357200 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Janice Kalanihuia | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 408 | AddressLine1 |
| City | KAUNAKAKAI MOLOKAI | City |
| State | HI | State |
| ZIP Code | 96748 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 11010772 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.molokaigeneralhospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1987 | YearFormation |
| State Legal Domicile | HI | StateLegalDomicile |
| Activity Or Mission Description | To provide quality healthcare services to the island of Molokai. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 102 | TotalNbrEmployees |
| Total Nbr Volunteers | 121 | TotalNbrVolunteers |
| Total Gross UBI | -2088 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -2398 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 4228503 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2460646 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7370473 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 7823430 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 15434 | InvestmentIncomePriorYear |
| Investment Income Current Year | 99569 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 506841 | OtherRevenuePriorYear |
| Other Revenue Current Year | 590292 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12121251 | TotalRevenuePriorYear |
| Total Revenue Current Year | 10973937 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5769055 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5716662 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6400710 | OtherExpensePriorYear |
| Other Expenses Current Year | 6525720 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12169765 | TotalExpensesPriorYear |
| Total Expenses Current Year | 12242382 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -48514 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1268445 | RevenuesLessExpensesCY |
| Total Assets BOY | 20778135 | TotalAssetsBOY |
| Total Assets EOY | 19322477 | TotalAssetsEOY |
| Total Liabilities BOY | 2684188 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2930807 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 18093947 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 16391670 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | To provide quality healthcare services to the island of Molokai. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 8150101 | Expense |
| Revenue | 7986423 | Revenue |
| Description | 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. | Description |
| Total Program Service Expense | 8150101 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 40 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 102 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicy |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | false | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ZESSICA APIKI | NamePerson |
| Telephone Number | 8085533125 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 408 | AddressLine1 |
| City | KAUNAKAKAI | City |
| State | HI | State |
| ZIP Code | 96748 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ARTHUR A USHIJIMA | |||||||
| CHAIR/TRUSTEE | 1.0 | X | X | 0 | 835524 | 621099 | |
| LANCE DUNBAR | |||||||
| VICE CHAIR/TRUSTEE | 1.0 | X | X | 0 | 0 | 0 | |
| NEIL J HANNAHS | |||||||
| TRUSTEE | 1.0 | X | 0 | 0 | 0 | ||
| STEPHEN PETRO | |||||||
| TRUSTEE | 1.0 | X | 0 | 0 | 0 | ||
| PAUL STEVENS MD | |||||||
| TRUSTEE | 1.0 | X | 0 | 0 | 0 | ||
| NALEEN N ANDRADE MD | |||||||
| TRUSTEE - PART YEAR | 1.0 | X | 0 | 0 | 0 | ||
| JUDY EGUSA | |||||||
| TRUSTEE - PART YEAR | 1.0 | X | 0 | 0 | 0 | ||
| ERIC YEAMAN | |||||||
| TRUSTEE | 1.0 | X | 0 | 0 | 0 | ||
| PUNAHELE ALCON | |||||||
| ADMIN ASSISTANT/SECRETARY | 40.0 | X | 66534 | 0 | 13993 | ||
| JANICE KALANIHUIA | |||||||
| PRESIDENT | 54.0 | X | 0 | 223211 | 53563 | ||
| RANDY LITE | |||||||
| VICE PRESIDENT | 55.0 | X | 90018 | 0 | 24479 | ||
| RICHARD C KEENE | |||||||
| TREASURER | 2.0 | X | 0 | 492932 | 65337 | ||
| WILLIAM L THOMAS JR MD | |||||||
| INTERNAL MEDICINE | 55.0 | 222448 | 0 | 24901 | X | ||
| SANDRA BRAZZEL MD | |||||||
| INTERNAL MEDICINE | 55.0 | 164166 | 0 | 26454 | X | ||
| DINO FONTES | |||||||
| DIRECTOR OF NURSING | 40.0 | 151724 | 0 | 21563 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 694890 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1551667 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 851389 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JT POWER MD | NamePerson |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 682 | AddressLine1 |
| City | KAPAA | City |
| State | HI | State |
| ZIP Code | 96755 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | EMERGENCY PHYSICIAN | DescriptionOfServices |
| Compensation | 107192 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Related Organizations | 322790 | RelatedOrganizations |
| Government Grants | 2085756 | GovernmentGrants |
| All Other Contributions | 52100 | AllOtherContributions |
| Total Contributions | 2460646 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUES | Description |
| Business Code | 623000 | BusinessCode |
| Total Revenue Column | 7823430 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7823430 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 7823430 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 55933 | TotalRevenueColumn |
| Unrelated Business Revenue | -2088 | UnrelatedBusinessRevenue |
| Exclusion | $58,021 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 156635 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 156635 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 156635 | TotalRevenueColumn |
| Exclusion | $156,635 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 77296 | Securities |
| Other | 3175 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 36835 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 40461 | Securities |
| Other | 3175 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 43636 | TotalRevenueColumn |
| Exclusion | $43,636 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| Cafeteria Revenue | 624200 | 73040 | $73,040 | |
| Meals on Wheels | 624200 | 109467 | 109467 | |
| Alu Like Program | 624200 | 53526 | 53526 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 197624 | TotalRevenueColumn |
| Exclusion | $197,624 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 433657 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10973937 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7986423 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -2088 | UnrelatedBusinessRevenue |
| Exclusion | $528,956 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 440168 | Total |
| Management And General | 440168 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4086823 | Total |
| Program Services | 2879118 | ProgramServices |
| Management And General | 1207705 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 235717 | Total |
| Program Services | 207586 | ProgramServices |
| Management And General | 28131 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 648709 | Total |
| Program Services | 330287 | ProgramServices |
| Management And General | 318422 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 305245 | Total |
| Program Services | 201224 | ProgramServices |
| Management And General | 104021 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 199031 | Total |
| Management And General | 199031 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25530 | Total |
| Management And General | 25530 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 549 | Total |
| Management And General | 549 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1456112 | Total |
| Program Services | 962070 | ProgramServices |
| Management And General | 494042 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11624 | Total |
| Program Services | 7876 | ProgramServices |
| Management And General | 3748 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 365158 | Total |
| Program Services | 165832 | ProgramServices |
| Management And General | 199326 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28211 | Total |
| Program Services | 6468 | ProgramServices |
| Management And General | 21743 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 434070 | Total |
| Program Services | 35991 | ProgramServices |
| Management And General | 398079 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 136178 | Total |
| Program Services | 99771 | ProgramServices |
| Management And General | 36407 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4238 | Total |
| Program Services | 267 | ProgramServices |
| Management And General | 3971 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1161563 | Total |
| Program Services | 1134975 | ProgramServices |
| Management And General | 26588 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153444 | Total |
| Program Services | 144986 | ProgramServices |
| Management And General | 8458 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| INTERCOMPANY CHARGES | 1345472 | 1340515 | 4957 |
| MEDICAL SUPPLIES | 406016 | 406016 | |
| BAD DEBT EXPENSE | 142145 | 142145 | |
| GRANT EXPENSE | 21135 | 21135 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 635244 | Total |
| Program Services | 63839 | ProgramServices |
| Management And General | 571405 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12242382 | Total |
| Program Services | 8150101 | ProgramServices |
| Management And General | 4092281 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 700 | BOY |
| EOY | 650 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3195754 | BOY |
| EOY | 1407222 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 911269 | BOY |
| EOY | 1192344 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 110195 | BOY |
| EOY | 101113 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78658 | BOY |
| EOY | 77355 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 23659420 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10226797 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13421326 | BOY |
| EOY | 13432623 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3060233 | BOY |
| EOY | 3111170 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20778135 | BOY |
| EOY | 19322477 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 805158 | BOY |
| EOY | 836353 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8712 | BOY |
| EOY | 39378 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1870318 | BOY |
| EOY | 2055076 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2684188 | BOY |
| EOY | 2930807 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18093947 | BOY |
| EOY | 16391670 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18093947 | BOY |
| EOY | 16391670 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20778135 | BOY |
| EOY | 19322477 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1268445 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -433832 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Belongs To Affiliated Group | X | OrgBelongsToAffiliatedGroup |
Total Grassroots Lobbying TotalGrassrootsLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 0 | FilingOrganizationsTotals |
| Affiliated Group Totals | 0 | AffiliatedGroupTotals |
Total Direct Lobbying TotalDirectLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 549 | FilingOrganizationsTotals |
| Affiliated Group Totals | 55188 | AffiliatedGroupTotals |
Total Lobbying Expenditures TotalLobbyingExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 549 | FilingOrganizationsTotals |
| Affiliated Group Totals | 55188 | AffiliatedGroupTotals |
Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 12241833 | FilingOrganizationsTotals |
| Affiliated Group Totals | 780940655 | AffiliatedGroupTotals |
Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 12242382 | FilingOrganizationsTotals |
| Affiliated Group Totals | 780995843 | AffiliatedGroupTotals |
Lobbying Nontaxable LobbyingNontaxableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 762119 | FilingOrganizationsTotals |
| Affiliated Group Totals | 1000000 | AffiliatedGroupTotals |
Grassroots Nontaxable GrassrootsNontaxableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 190530 | FilingOrganizationsTotals |
| Affiliated Group Totals | 250000 | AffiliatedGroupTotals |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Form4720 Filed | false | Form4720Filed |
Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 1000000 | CurrentYearMinus3 |
| Current Year Minus2 | 1000000 | CurrentYearMinus2 |
| Current Year Minus1 | 1000000 | CurrentYearMinus1 |
| Current Year | 1000000 | CurrentYear |
| Total | 4000000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Lobbying Ceiling | $6,000,000 | LobbyingCeilingAmount |
Total Lobbying Expenditures2 TotalLobbyingExpenditures2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 134730 | CurrentYearMinus3 |
| Current Year Minus2 | 31942 | CurrentYearMinus2 |
| Current Year Minus1 | 46088 | CurrentYearMinus1 |
| Current Year | 55188 | CurrentYear |
| Total | 267948 | Total |
Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 250000 | CurrentYearMinus3 |
| Current Year Minus2 | 250000 | CurrentYearMinus2 |
| Current Year Minus1 | 250000 | CurrentYearMinus1 |
| Current Year | 250000 | CurrentYear |
| Total | 1000000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grassroots Ceiling | $1,500,000 | GrassrootsCeilingAmount |
Grassroots Lobbying Expenditures GrassrootsLobbyingExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 0 | CurrentYearMinus3 |
| Current Year Minus2 | 0 | CurrentYearMinus2 |
| Current Year Minus1 | 0 | CurrentYearMinus1 |
| Current Year | 0 | CurrentYear |
| Total | 0 | Total |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Land | Land |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17240920 | OtherCostOrOtherBasis |
| Depreciation | 800818 | Depreciation |
| Book Value | 10958210 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5928305 | OtherCostOrOtherBasis |
| Depreciation | 320094 | Depreciation |
| Book Value | 2212062 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 490195 | OtherCostOrOtherBasis |
| Depreciation | 40651 | Depreciation |
| Book Value | 262351 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 13432623 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| LONG TERM PENSION LIABILITY | $950,198 |
| DUE TO GOVERNMENT REIMBURSEMENT PROGRAM | $831,682 |
| DUE TO QUEEN'S HEALTH SYSTEMS | $152,396 |
| GENERAL AND PROFESSIONAL TAIL LIABILITY | $55,276 |
| DUE TO QIE | $50,748 |
| DUE TO QUEEN'S MEDICAL CENTER | $14,776 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2055076 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ASC 740 Footnote | Identifier |
| Return Reference | SCHEDULE D, PART X, LINE 2 | ReturnReference |
| Explanation | MGH EVALUATES ITS UNCERTAIN TAX POSITIONS AND HAS NO MATERIAL UNRECOGNIZED TAX BENEFITS AS OF JUNE 30, 2012. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 75290 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 75290 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00620 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3568735 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1984386 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1584349 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13090 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3644025 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1984386 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1659639 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13710 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 27417 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 27417 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 441911 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 371547 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 70364 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00580 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 36000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 36000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00300 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 505328 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 371547 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 133781 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01110 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4149353 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2355933 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1793420 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.14820 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $139,302 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 1785444 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 1743961 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 41483 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOLOKAI GENERAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 280 HOMEOLU STREET | AddressLine1 |
| City | KAUNAKAKAI | City |
| State | HI | State |
| ZIP Code | 96748 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOLOKAI GENERAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 250. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | false | IncludesPublicityMeasures |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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, COLUMN (F) | BAD DEBT EXPENSE OF $142,145 WAS EXCLUDED FOR THE CALCULATION OF THE NET COMMUNITY BENEFIT PERCENTAGES IN PART I, LINE 7, COLUMN F. | |
| SCHEDULE H, PART I, LINE 7 | THE COSTING METHODOLOGY USED INCLUDES ALL PATIENT SEGMENTS. THE COST TO CHARGE RATIO OF .982% WAS DERIVED FROM THE FISCAL YEAR ENDED JUNE 30, 2012 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). The amount of bad debt expense attributable to patients eligible under MGH's financial assistance policy is calculated based on the cost-to-charge ratio. | |
| SCHEDULE H, PART III, LINE 8 | THE MEDICARE AMOUNTS ABOVE ARE CALCULATED WITH DATA FROM THE JUNE 30, 2012 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. | |
| NEEDS ASSESSMENT | EVALUATION AND SURVEYS ARE COMPLETED AS NEEDED BY COST CENTERS OR DEPARTMENTS. | SCHEDULE H, PART VI, LINE 2 |
| PATIENT EDUCATION AND ELIGIBILITY FOR ASSISTANCE | MGH HAS AN ON-STAFF SOCIAL WORKER WHO ASSISTS PATIENTS AND THEIR FAMILIES BY PROVIDING EDUCATION AND ASSISTANCE IN APPLYING FOR ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, INCLUDING MGH'S CHARITY CARE POLICY. ADDITIONALLY, THE REGISTRATION STAFF AND BUSINESS OFFICE STAFF PROVIDE WRITTEN AND VERBAL INFORMATION REGARDING THE HOSPITAL'S CHARITY CARE POLICIES DURING INTAKE AND DISCHARGE. | SCHEDULE H, PART VI, LINE 3 |
| COMMUNITY INFORMATION | MGH, PART OF THE QUEEN'S HEALTH SYSTEMS, IS THE ONLY HOSPITAL ON THE ISLAND OF MOLOKA'I, PROVIDING 24-HOUR CARE SERVICES FOR A POPULATION OF 7,400. MOLOKA'I IS DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA IN PRIMARY CARE, DENTAL AND MENTAL HEALTH SERVICES. ADDITIONALLY, THE ISLAND IS LISTED AS A FEDERAL MEDICALLY UNDER-SERVED AREA (MUA). THE AVERAGE HOUSEHOLD INCOME IS $46,000 WITH 63% OF THE POPULATION REPORTING THEY ARE OF NATIVE HAWAIIAN ANCESTRY (MULTIPLE RACE) IN 2010. ON AVERAGE, THIRTY PERCENT (30%) OF FAMILY HOUSEHOLDS REPORT RECEIVING SOME FORM OF GOVERNMENT ASSISTANCE. MGH SPONSORS AN ANNUAL HEALTH FAIR(S) AND OTHER HEALTH-RELATED EVENTS FOR THE COMMUNITY'S BENEFIT. MGH PROVIDES FREE FLU CLINICS IN AREAS OUTSIDE OF THE MAIN TOWN. MGH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL (CAH). | SCHEDULE H, PART VI, LINE 4 |
| PROMOTION OF COMMUNITY HEALTH | SEE EXPLANATION OF "COMMUNITY INFORMATION". | SCHEDULE H, PART VI, LINE 5 |
| AFFILIATED HEALTH CARE SYSTEM | MGH is a member of the Queen's Health Systems ("QHS") affiliated group. The group includes Queen's Medical Center ("QMC"), Queen Emma Land Company ("QEL"), Queen's Insurance Exchange ("QIE") and Queen's Development Corporation ("QDC). Through June 30, 2012, 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. | SCHEDULE H, PART VI, LINE 6 |
| STATE FILING OF COMMUNITY BENEFIT REPORT | N/A | SCHEDULE H, PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ARTHUR A USHIJIMA | |||||||||||||
| 0 | 631103 | 0 | 52045 | 0 | 152376 | 0 | 608467 | 0 | 12632 | 0 | 1456623 | 0 | 0 |
| JANICE KALANIHUIA | |||||||||||||
| 0 | 171577 | 0 | 12623 | 0 | 39011 | 0 | 41962 | 0 | 11601 | 0 | 276774 | 0 | 0 |
| RICHARD C KEENE | |||||||||||||
| 0 | 394315 | 0 | 26852 | 0 | 71765 | 0 | 58892 | 0 | 6445 | 0 | 558269 | 0 | 0 |
| WILLIAM L THOMAS JR MD | |||||||||||||
| 207449 | 0 | 13757 | 0 | 1242 | 0 | 18774 | 0 | 6127 | 0 | 247349 | 0 | 0 | 0 |
| SANDRA BRAZZEL MD | |||||||||||||
| 156852 | 0 | 5500 | 0 | 1814 | 0 | 15881 | 0 | 10573 | 0 | 190620 | 0 | 0 | 0 |
| DINO FONTES | |||||||||||||
| 105767 | 0 | 41600 | 0 | 4357 | 0 | 6363 | 0 | 15200 | 0 | 173287 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 2011. | |
| COMPENSATION PAID FOR SERVICES | JANICE KALANIHUIA MS. KALANIHUIA SERVES AS VP FOR THE QUEEN'S HEALTH SYSTEMS (PARENT COMPANY) AND PRESIDENT OF MGH. SHE IS NOT SEPARATELY COMPENSATED FOR THESE VARIOUS SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR ALL HER SERVICES. ARTHUR A. USHIJIMA MR. USHIJIMA SERVES AS A TRUSTEE FOR THE QUEEN'S HEALTH SYSTEMS AND SEVERAL OTHER QUEEN'S RELATED AFFILIATES. HE IS A VOLUNTEER TRUSTEE AND IS NOT COMPENSATED FOR THESE SERVICES. HIS HOURS SERVED AS A TRUSTEE FOR MGH IS 1 HOUR PER WEEK. MR. USHIJIMA ALSO SERVES AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE QUEEN'S HEALTH SYSTEMS (PARENT COMPANY) AND AS PRESIDENT OF QMC. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL HIS SERVICES. RICHARD C. KEENE MR. KEENE SERVES AS QMC TREASURER, SVP/CFO AND TREASURER FOR THE QUEEN'S HEALTH SYSTEMS (PARENT COMPANY), TREASURER OF QEL AND TREASURER OF MGH. HE IS NOT SEPARATELY COMPENSATED FOR THESE VARIOUS SERVICES. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL HIS SERVICES. | SCHEDULE J, PART II |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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 $1.9M FOR THE YEAR ENDED JUNE 30, 2012. 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, 2012, THE ESTIMATED LOSSES FROM PROVIDING CHARITY CARE, AS WELL AS THE ESTIMATE OF CHARITY CARE CURRENTLY CLASSIFIED AS BAD DEBTS WAS $75,290 AND $139,302 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 $70,364 FOR THE YEAR ENDED JUNE 30, 2012. 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, 2012, LOSSES RELATED TO PROVIDING HEALTH AND WELLNESS EDUCATION WERE $27,417. 4. CHARITABLE CONTRIBUTIONS - MGH PROVIDED IN-KIND CONTRIBUTIONS (HOSPITAL SPACE) TO OUTSIDE CHARITABLE ORGANIZATIONS. FOR THE YEAR ENDED JUNE 30, 2012, THE FAIR MARKET VALUE OF RENT PROVIDED TO OUTSIDE CHARITABLE ORGANIZATIONS WAS $36,000 5. MEDICAID SHORTFALL IN PAYMENTS - MGH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO MEDICAID PATIENTS IN THE STATE OF HAWAII. MGH INCURRED COSTS IN EXCESS OF REIMBURSEMENT OF APPROXIMATELY $1,584,349 DURING THE YEAR ENDED JUNE 30, 2012. |
| 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 AND 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. |
| RELATED HOURS | Form 990, Part VII | LANCE DUNBAR DEVOTES 2 HOURS PER WEEK TO RELATED ORGANIZATIONS. NEIL J. HANNAHS DEVOTES 2 HOURS PER WEEK TO RELATED ORGANIZATIONS. ERIC YEAMAN DEVOTES 5 HOURS PER WEEK TO RELATED ORGANIZATIONS. JANICE KALANIHUIA DEVOTES 1 HOUR PER WEEK TO RELATED ORGANIZATIONS. ARTHUR A. USHIJIMA DEVOTES 64 HOURS PER WEEK TO RELATED ORGANIZATIONS. RICHARD C. KEENE DEVOTES 53 HOURS PER WEEK TO RELATED ORGANIZATIONS. WILLIAM L. THOMAS JR., MD DEVOTES 1 HOUR PER WEEK TO RELATED ORGANIZATIONS. NALEEN N. ANDRADE DEVOTES 3 HOURS PER WEEK TO RELATED ORGANIZATIONS. |
| OTHER CHANGES IN NET ASSETS OR FUND BALANCES | Form 990, Part XI, Line 5 | PENSION ADJUSTMENT $(390,394) UNREALIZED LOSS ON INVESTMENTS $ (43,203) FUND TRANSFER $ (235) ---------- $(433,832) |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | MEDICAL SVCS | HI | 501(C)(3) | 11 TYPE II | QHS | true |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HAMAMATSUPET | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 PUNCHBOWL STREET | AddressLine1 |
| City | HONOLULU | City |
| State | HI | State |
| ZIP Code | 96813 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 943266916 | EIN |
| Primary Activity | PET IMAGING | PrimaryActivity |
| Legal Domicile State | HI | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| DIAGNOSTIC LABORATORY SERVICES INC | ||
| O | 658015 | FMV |
| THE QUEEN'S MEDICAL CENTER | ||
| O | 326040 | FMV |
| QUEEN EMMA LAND COMPANY | ||
| C | 322790 | FMV |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP | Identifier |
| Return Reference | SCHEDULE R, PART III | ReturnReference |
| Explanation | HAMAMATSU/QUEEN'S PET IMAGING CENTER, LLC EIN: 94-3266916 ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 | Explanation |
Affiliated Group Attachment AffiliatedGroupAttachment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Name: Queen Emma Land Company Address: 1301 Punchbowl Street Honolulu, HI 96813 EIN: 99-0183769 Expenses: $66,083,431 Share of excess Lobbying Expenditures: $0 Name: The Queen's Health Systems Address: 1301 Punchbowl Street Honolulu, HI 96813 EIN: 99-0238120 Expenses: 23,818,992 Share of excess Lobbying Expenditures: $0 Name: The Queen's Medical Center Address: 1301 Punchbowl Street Honolulu, HI 96813 EIN: 99-0073524 Expenses: $702,093,291 Share of excess Lobbying Expenditures: $0 Name: Molokai General Hospital Address: P.O. Box 408 Kaunakakai, HI 96748 EIN: 99-0251372 Expenses: $12,242,382 Share of excess Lobbying Expenditures: $0 | Explanation |