2013-05-09T20:34:09-05:00 2012-06-30 ERNST & YOUNG US LLP 4370 LA JOLLA VILLAGE DR STE 500 SAN DIEGO CA 92122 990 2011-07-01 990251372 MOLOKAI GENERAL HOSPITAL % ZESSICA APIKI MOLO 8085533125 PO BOX 408 KAUNAKAKAI MOLOKAI HI 96748 RICHARD KEENE 2013-05-07 8585357200 2011 2016-02-25 16:41:14Z Janice Kalanihuia PO BOX 408 KAUNAKAKAI MOLOKAI HI 96748 11010772 false X www.molokaigeneralhospital.org X 1987 HI To provide quality healthcare services to the island of Molokai. 7 4 102 121 -2088 -2398 4228503 2460646 7370473 7823430 15434 99569 506841 590292 12121251 10973937 0 0 0 0 5769055 5716662 0 0 0 6400710 6525720 12169765 12242382 -48514 -1268445 20778135 19322477 2684188 2930807 18093947 16391670 X To provide quality healthcare services to the island of Molokai. false false 8150101 7986423 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. 8150101 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 40 0 true 102 true true true false false false false false false false false false X 7 4 false false false false true true true true true false false true false false false true true false X ZESSICA APIKI 8085533125 PO BOX 408 KAUNAKAKAI HI 96748 X ARTHUR A USHIJIMA 1.0 X X 0 835524 621099 LANCE DUNBAR 1.0 X X 0 0 0 NEIL J HANNAHS 1.0 X 0 0 0 STEPHEN PETRO 1.0 X 0 0 0 PAUL STEVENS MD 1.0 X 0 0 0 NALEEN N ANDRADE MD 1.0 X 0 0 0 JUDY EGUSA 1.0 X 0 0 0 ERIC YEAMAN 1.0 X 0 0 0 PUNAHELE ALCON 40.0 X 66534 0 13993 JANICE KALANIHUIA 54.0 X 0 223211 53563 RANDY LITE 55.0 X 90018 0 24479 RICHARD C KEENE 2.0 X 0 492932 65337 WILLIAM L THOMAS JR MD 55.0 X 222448 0 24901 SANDRA BRAZZEL MD 55.0 X 164166 0 26454 DINO FONTES 40.0 X 151724 0 21563 694890 1551667 851389 3 false true false JT POWER MD PO BOX 682 KAPAA HI 96755 EMERGENCY PHYSICIAN 107192 1 322790 2085756 52100 2460646 NET PATIENT SERVICE REVENUES 623000 7823430 7823430 7823430 55933 -2088 58021 0 0 156635 156635 156635 156635 77296 3175 36835 40461 3175 43636 43636 0 0 0 Cafeteria Revenue 624200 73040 73040 Meals on Wheels 624200 109467 109467 Alu Like Program 624200 53526 53526 197624 197624 433657 10973937 7986423 -2088 528956 0 0 0 0 440168 440168 0 4086823 2879118 1207705 235717 207586 28131 648709 330287 318422 305245 201224 104021 0 199031 199031 25530 25530 549 549 0 0 1456112 962070 494042 11624 7876 3748 365158 165832 199326 28211 6468 21743 0 434070 35991 398079 136178 99771 36407 0 4238 267 3971 0 0 1161563 1134975 26588 153444 144986 8458 INTERCOMPANY CHARGES 1345472 1340515 4957 MEDICAL SUPPLIES 406016 406016 BAD DEBT EXPENSE 142145 142145 GRANT EXPENSE 21135 21135 635244 63839 571405 12242382 8150101 4092281 0 700 650 3195754 1407222 0 0 911269 1192344 0 0 0 0 0 0 110195 101113 78658 77355 23659420 10226797 13421326 13432623 3060233 3111170 0 0 0 0 0 0 0 0 20778135 19322477 805158 836353 0 0 8712 39378 0 0 0 0 0 0 0 0 0 0 1870318 2055076 2684188 2930807 X 18093947 16391670 0 0 0 0 18093947 16391670 20778135 19322477 X -1268445 -433832 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 549 55188 549 55188 12241833 780940655 12242382 780995843 762119 1000000 190530 250000 false 1000000 1000000 1000000 1000000 4000000 6000000 134730 31942 46088 55188 267948 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 17240920 800818 10958210 5928305 320094 2212062 490195 40651 262351 13432623 0 LONG TERM PENSION LIABILITY 950198 DUE TO GOVERNMENT REIMBURSEMENT PROGRAM 831682 DUE TO QUEEN'S HEALTH SYSTEMS 152396 GENERAL AND PROFESSIONAL TAIL LIABILITY 55276 DUE TO QIE 50748 DUE TO QUEEN'S MEDICAL CENTER 14776 2055076 ASC 740 Footnote SCHEDULE D, PART X, LINE 2 MGH EVALUATES ITS UNCERTAIN TAX POSITIONS AND HAS NO MATERIAL UNRECOGNIZED TAX BENEFITS AS OF JUNE 30, 2012. true true X true X true X true true true false true true 75290 0 75290 0.00620 3568735 1984386 1584349 0.13090 0 0 0 3644025 1984386 1659639 0.13710 27417 0 27417 0.00230 0 0 0 441911 371547 70364 0.00580 0 0 0 36000 0 36000 0.00300 505328 371547 133781 0.01110 4149353 2355933 1793420 0.14820 true 139302 0 1785444 1743961 41483 X true true 1 1 MOLOKAI GENERAL HOSPITAL

280 HOMEOLU STREET KAUNAKAKAI HI 96748

X X X X MOLOKAI GENERAL HOSPITAL 1 true true 100 true 250. true X true false true false true X false false SCHEDULE H, PART I, LINE 6A COMMUNITY BENEFITS ARE REPORTED ANNUALLY AS PART OF FORM 990. THIS IS NOT SEPARATELY AVAILABLE TO THE PUBLIC. A FORMAL REPORT ISSUED BY THE PARENT COMPANY, THE QUEEN'S HEALTH SYSTEMS, INCLUDES THE COMMUNITY BENEFITS OF MOLOKAI GENERAL HOSPITAL (MGH). THIS REPORT IS PUBLISHED PERIODICALLY AND IS SEPARATELY AVAILABLE TO THE PUBLIC. SCHEDULE H, PART I, LINE 7, 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 SCHEDULE H, PART VI, LINE 2 EVALUATION AND SURVEYS ARE COMPLETED AS NEEDED BY COST CENTERS OR DEPARTMENTS. PATIENT EDUCATION AND ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 MGH HAS AN ON-STAFF SOCIAL WORKER WHO ASSISTS PATIENTS AND THEIR FAMILIES BY PROVIDING EDUCATION AND ASSISTANCE IN APPLYING FOR ASSISTANCE UNDER FEDERAL, STATE AND LOCAL PROGRAMS, INCLUDING MGH'S CHARITY CARE POLICY. ADDITIONALLY, THE REGISTRATION STAFF AND BUSINESS OFFICE STAFF PROVIDE WRITTEN AND VERBAL INFORMATION REGARDING THE HOSPITAL'S CHARITY CARE POLICIES DURING INTAKE AND DISCHARGE. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 MGH, PART OF THE QUEEN'S HEALTH SYSTEMS, IS THE ONLY HOSPITAL ON THE ISLAND OF MOLOKA'I, PROVIDING 24-HOUR CARE SERVICES FOR A POPULATION OF 7,400. MOLOKA'I IS DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA IN PRIMARY CARE, DENTAL AND MENTAL HEALTH SERVICES. ADDITIONALLY, THE ISLAND IS LISTED AS A FEDERAL MEDICALLY UNDER-SERVED AREA (MUA). THE AVERAGE HOUSEHOLD INCOME IS $46,000 WITH 63% OF THE POPULATION REPORTING THEY ARE OF NATIVE HAWAIIAN ANCESTRY (MULTIPLE RACE) IN 2010. ON AVERAGE, THIRTY PERCENT (30%) OF FAMILY HOUSEHOLDS REPORT RECEIVING SOME FORM OF GOVERNMENT ASSISTANCE. MGH SPONSORS AN ANNUAL HEALTH FAIR(S) AND OTHER HEALTH-RELATED EVENTS FOR THE COMMUNITY'S BENEFIT. MGH PROVIDES FREE FLU CLINICS IN AREAS OUTSIDE OF THE MAIN TOWN. MGH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL (CAH). PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 SEE EXPLANATION OF "COMMUNITY INFORMATION". AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 MGH is a member of the Queen's Health Systems ("QHS") affiliated group. The group includes Queen's Medical Center ("QMC"), Queen Emma Land Company ("QEL"), Queen's Insurance Exchange ("QIE") and Queen's Development Corporation ("QDC). Through June 30, 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. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 N/A false true false false false false false false false 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 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 SCHEDULE J, PART II JANICE KALANIHUIA MS. KALANIHUIA SERVES AS VP FOR THE QUEEN'S HEALTH SYSTEMS (PARENT COMPANY) AND PRESIDENT OF MGH. SHE IS NOT SEPARATELY COMPENSATED FOR THESE VARIOUS SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR ALL HER SERVICES. ARTHUR A. USHIJIMA MR. USHIJIMA SERVES AS A TRUSTEE FOR THE QUEEN'S HEALTH SYSTEMS AND SEVERAL OTHER QUEEN'S RELATED AFFILIATES. HE IS A VOLUNTEER TRUSTEE AND IS NOT COMPENSATED FOR THESE SERVICES. HIS HOURS SERVED AS A TRUSTEE FOR MGH IS 1 HOUR PER WEEK. MR. USHIJIMA ALSO SERVES AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE QUEEN'S HEALTH SYSTEMS (PARENT COMPANY) AND AS PRESIDENT OF QMC. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL HIS SERVICES. RICHARD C. KEENE MR. KEENE SERVES AS 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. 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) 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 HAMAMATSUPET 1301 PUNCHBOWL STREET HONOLULU HI 96813 943266916 PET IMAGING HI NA THE QUEEN'S DEVELOPMENT CORPORATION 1301 PUNCHBOWL STREET HONOLULU HI 96813 990240109 DEVELOPMENT HI NA C CORP QUEEN'S INSURANCE EXCHANGE INC 1301 Punchbowl Street Honolulu HI 96813 911913839 INSURANCE HI NA C CORP DIAGNOSTIC LABORATORY SERVICES INC 99-859 Iwaiwa Street Aiea HI 96701 990240499 MEDICAL LAB SVCS HI NA C CORP false false true false false false false false false false false false false false true true false DIAGNOSTIC LABORATORY SERVICES INC O 658015 FMV THE QUEEN'S MEDICAL CENTER O 326040 FMV QUEEN EMMA LAND COMPANY C 322790 FMV IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP SCHEDULE R, PART III HAMAMATSU/QUEEN'S PET IMAGING CENTER, LLC EIN: 94-3266916 ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 Name: Queen Emma Land Company Address: 1301 Punchbowl Street Honolulu, HI 96813 EIN: 99-0183769 Expenses: $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