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KAPIOLANI MEDICAL SPECIALISTS: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
KAPIOLANI MEDICAL SPECIALISTS (EIN 99-0322406)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-01
IRS object ID
201231229349300878
Schema version
2010v3.7
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-01T16:28:02-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line155 MERCHANT ST SUITE 1900 C-120AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96813ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN990322406EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1KAPI'OLANI MEDICAL SPECIALISTSBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlKAPINameControl
Phone8089838986Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameEARL INOUYEName
TitleVP & SYSTEM CONTROLLERTitle
Date Signed2012-05-01DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone8085312037Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11319 PUNAHOU STREETAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96826ZIPCode
FieldValueIRS element (for citing)
Gross Receipts21891353GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HAWAIIPACIFICHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileHIStateLegalDomicile
Activity Or Mission DescriptionKAPI'OLANI MEDICAL SPECIALISTS IS A SPECIALITY PHYSICIAN GROUP DEDICATED TO PROVIDING WORLD-CLASS CARE FOR HAWAI'I'S WOMEN AND CHILDREN THROUGH ACADEMICS, RESEARCH, AND CLINICAL CARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members2NbrIndependentVotingMembers
Total Nbr Employees156TotalNbrEmployees
Total Nbr Volunteers2TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year125521ContributionsGrantsPriorYear
Contributions Grants Current Year112089ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21244574ProgramServiceRevenuePriorYear
Program Service Revenue CY21775603ProgramServiceRevenueCY
Investment Income Prior Year4893InvestmentIncomePriorYear
Investment Income Current Year3661InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year21374988TotalRevenuePriorYear
Total Revenue Current Year21891353TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year17677691SalariesEtcPriorYear
Salaries Etc Current Year19826986SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8388295OtherExpensePriorYear
Other Expenses Current Year7556214OtherExpensesCurrentYear
Total Expenses Prior Year26065986TotalExpensesPriorYear
Total Expenses Current Year27383200TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-4690998RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-5491847RevenuesLessExpensesCY
Total Assets BOY4090555TotalAssetsBOY
Total Assets EOY4643083TotalAssetsEOY
Total Liabilities BOY3221285TotalLiabilitiesBOY
Total Liabilities EOY3751823TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY869270NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY891260NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE O.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense23605176Expense
Grants0Grants
Revenue21775603Revenue
DescriptionSEE SCHEDULE O.Description
Total Program Service Expense23605176TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109625NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees156NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members2NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicyfalseConflictOfInterestPolicy
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

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

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
MARTHA SMITH
CHAIR, BOARD OF DIRECTOR5.0XX049838976327
ANTHONY GUERRERO MD
BOARD OF DIRECTOR0.2X517580906
RICHARD KASUYA MD
BOARD OF DIRECTOR0.2X000
KEITH MATSUMOTO MD
BOARD OF DIRECTOR0.2X000
KENNETH B ROBBINS MD
BOARD OF DIRECTOR0.2X0774200131328
CHARLES A STED
BOARD OF DIRECTOR1.0X01741906370246
KENNETH T NAKAMURA MD
VICE CHAIR & CMO40.0X039905935556
CHERYL HETRICK
DIRECTOR OF OPERATIONS40.0X14141401544
DAVID OKABE
EVP, CFO & TREASURER1.0X079521894276
CHARLES R CHING
EVP, GEN COUNSEL, SECRETARY3.0X059931975805
GAIL LERCH
EVP1.0X060408993486
STEVEN ROBERTSON
EVP & CIO1.0X062324290575
VIRGINIA PRESSLER-FISHER MD
EVP0.2X0615632112590
SUSAN MASUMOTO-NONAKA
VP0.2X026644937491
WARREN CHAIKO
VP1.0X029604030527
EARL INOUYE
VP & CONTROLLER2.0X032570451543
ANN MK PETERS
VP0.2X018538621006
KATIE SHIGEMITSU
HPH COMPLIANCE OFFICER0.8X016772617128
JESSICA LEWIS
ASSISTANT CORPORATE SECRETARY1.3X010866810465
KEKA SANBORN
VP0.2X01033186758
MELINDA ASHTON MD
VP1.0X040233644902
SIDNEY JOHNSON MD
PHYSICIAN40.0632052031306X
DEVIN PUAPONG MD
PHYSICIAN40.0520356024113X
ROBERT DURKIN MD
PHYSICIAN40.0486199032133X
RUSSELL WOO MD
PHYSICIAN40.0467996029632X
WILLIAM BURKHALTER MD
PHYSICIAN40.0448701034383X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2748476TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs8506681TotalReportableCompFrmRltdOrgs
Total Other Compensation1454026TotalOtherCompensation
Number Individuals GT100 K66NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonUNIVERSITY OF HAWAI'INamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12530 DOLE STREETAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96822ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesPhysician ServicesDescriptionOfServices
Compensation1862728Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Related Organizations112089RelatedOrganizations
Total Contributions112089TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE9000991340892313408923
SERVICE CONTRACTS90009983666808366680
FieldValueIRS element (for citing)
Total Program Service Revenue21775603TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3661TotalRevenueColumn
Exclusion$3,661ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

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

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column21891353TotalRevenueColumn
Related Or Exempt Function Income21775603RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$3,661ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total212917Total
Program Services212917ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total16465549Total
Program Services16193582ProgramServices
Management And General271967ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1335261Total
Program Services1275166ProgramServices
Management And General60095ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total924539Total
Program Services877944ProgramServices
Management And General46595ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total888720Total
Program Services862426ProgramServices
Management And General26294ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total53962Total
Management And General53962ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total137281Total
Management And General137281ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2945797Total
Program Services1849532ProgramServices
Management And General1096265ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total6284Total
Management And General6284ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total141584Total
Program Services116015ProgramServices
Management And General25569ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total375576Total
Program Services354232ProgramServices
Management And General21344ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total108842Total
Program Services97564ProgramServices
Management And General11278ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total35Total
Program Services35ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total170164Total
Program Services168328ProgramServices
Management And General1836ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1266688Total
Program Services1252506ProgramServices
Management And General14182ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT316307316307
CORPORATE ALLOCATION18428281842828
OTHER PURCHASES419112067421237
PROGRAM SERVICE EXPENDITURES41214121
ALL OTHER EXPENSES1448343827141007

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total27383200Total
Program Services23605176ProgramServices
Management And General3778024ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY170009BOY
EOY556683EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1378104BOY
EOY1245415EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY43163BOY
EOY54388EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2016803LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1407437LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY275634BOY
EOY609366EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2223645BOY
EOY2177231EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4090555BOY
EOY4643083EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2305645BOY
EOY2852272EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY915640BOY
EOY899551EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3221285BOY
EOY3751823EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY832239BOY
EOY841264EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY37031BOY
EOY49996EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY869270BOY
EOY891260EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4090555BOY
EOY4643083EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-5491847ReconcilationRevenueExpenses
Reconcilation Other Changes5513837ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years55884CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year125521CurrentTaxYearMinus1Year
Current Tax Year112089CurrentTaxYear
Total293494Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14024534CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16789539CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20360418CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21244574CurrentTaxYearMinus1Year
Current Tax Year21775603CurrentTaxYear
Total94194668Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14080418CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16789539CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20360418CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21370095CurrentTaxYearMinus1Year
Current Tax Year21887692CurrentTaxYear
Total94488162Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years915871CurrentTaxYearMinus4Years
Current Tax Year726199CurrentTaxYear
Total1642070Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years915871CurrentTaxYearMinus4Years
Current Tax Year726199CurrentTaxYear
Total1642070Total
FieldValueIRS element (for citing)
Public Support Total50992846092PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11706CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6139CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13916CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4893CurrentTaxYearMinus1Year
Current Tax Year3661CurrentTaxYear
Total40315Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11706CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6139CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13916CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4893CurrentTaxYearMinus1Year
Current Tax Year3661CurrentTaxYear
Total40315Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14092124CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16795678CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20374334CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21374988CurrentTaxYearMinus1Year
Current Tax Year21891353CurrentTaxYear
Total94528477Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98220PublicSupportPercentage509
Prior Year Support Percentage0.98187PriorYearSupportPercentage
Investment Income Percentage0.00043InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00056PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

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

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis15705OtherCostOrOtherBasis
Depreciation1446Depreciation
Book Value14259BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis722911OtherCostOrOtherBasis
Depreciation584559Depreciation
Book Value138352BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1278187OtherCostOrOtherBasis
Depreciation821432Depreciation
Book Value456755BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings609366TotalOfBookValueLandBuildings

Other Assets OtherAssets (9 entries)

DescriptionDescriptionBook ValueBookValue
VARIOUS DEFERRED CHARGES146358
OTHER RECEIVABLES417077
LIFE INSURANCE - CSV850478
DUE FROM GOVERNMENT AGENCIES125312
DUE FROM KAPI'OLANI WOMEN506683
DUE FROM PROVIDERS INSURANCE259
DUE FROM HPH RESEARCH INST54792
DUE FROM KAPI'OLANI HEALTH FDN35858
DUE FROM STRAUB FOUNDATION40414
FieldValueIRS element (for citing)
Total Book Value Other Assets2177231TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (8 entries)

DescriptionDescriptionAmountAmount
L/T LIAB - CAPITAL ACCUMULATION$97,365
L/T LIAB - MCGF INS ADV$246,011
L/T LIAB - ESCHEAT LIAB$2,647
DUE TO HAWAI'I PACIFIC HEALTH$472,057
DUE TO PALI MOMI$18,854
DUE TO STRAUB CLINIC$59,865
DUE TO WILCOX HEALTH FDN$12
DUE TO KAUA'I MEDICAL CLINIC$2,740
FieldValueIRS element (for citing)
Total Of Amounts899551TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierFIN 48 (ASC 70) FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PART X, LINE 2ReturnReference
ExplanationFOLLOWING IS THE FIN 48 (ASC 70) FOOTNOTE FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF HAWAI'I PACIFIC HEALTH, THE FILING ORGANIZATION'S PARENT: THE TAXABLE AFFILIATES OF THE COMPANY UTILIZE THE LIABILITY METHOD OF ACCOUNTING FOR INCOME TAXES. UNDER THIS METHOD, DEFERRED INCOME TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON DIFFERENCES BETWEEN THE FINANCIAL REPORTING AND TAX BASIS OF ASSETS AND LIABILITIES, AND ARE MEASURED USING THE CURRENTLY ENACTED TAX RATES AND LAWS. VALUATION ALLOWANCES ARE USED TO REDUCE DEFERRED TAX ASSETS TO THEIR ESTIMATED NET REALIZABLE VALUES WHEN MANAGEMENT DETERMINES ULTIMATE RECOVERY OF THE DEFERRED TAX ASSETS IS NOT MORE LIKELY THAN NOT TO OCCUR.Explanation

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII (20 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARTHA SMITH
032727301083010628150562180201090574716033498
KENNETH T NAKAMURA MD
0236235063630099194023330012226043461506624
KENNETH B ROBBINS MD
040778402660320100384011564601568209055280156082
CHARLES A STED
0742711073489702642980359765010481021121520448157
DAVID OKABE
04088720274875011147108284001143608894940157867
CHARLES R CHING
03082850205141085893068009077960675124093424
GAIL LERCH
031861502157820696920799530135330697575093486
STEVEN ROBERTSON
03125460202187010850906613102444407138170110115
VIRGINIA PRESSLER-FISHER MD
0321073021585007870908504402754607282220123927
SUSAN MASUMOTO-NONAKA
0195503056295014651012565024926030394000
WARREN CHAIKO
02098520604270257610159010146260326567016
EARL INOUYE
0228359064393032952035275016268037724702048
ANN MK PETERS
013837202503202198208373012633020639200
KATIE SHIGEMITSU
016516602560000802609102018485400
SIDNEY JOHNSON MD
550394000816580116380196680663358000
DEVIN PUAPONG MD
394493000125863088540152590544469000
ROBERT DURKIN MD
3967790100900793300116380204950518332000
RUSSELL WOO MD
39449300073503069070227250497628000
WILLIAM BURKHALTER MD
3899170100900486940116380227450483084000
MELINDA ASHTON MD
0287982079716034638026050018852044723802514

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL COMPENSATION INFORMATIONIdentifier
Return ReferenceSCHEDULE J, PART I, LINE 3ReturnReference
ExplanationTHE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, HAWAI'I PACIFIC HEALTH ("HPH"), 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 HPH TO DETERMINE COMPENSATION. SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B THE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERNAL 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 DERERRED BASIS. AMOUNT PAID OUT DURING THE YEAR BY RELATED ORGANIZATION: MELINDA ASHTON, M.D. $2,514 WARREN CHAIKO $16 EARL INOUYE $2,048 GAIL LERCH $14,788 KENNETH T. NAKAMURA, M.D. $6,624 DAVID OKABE $32,476 VIRGINIA PRESSLER-FISHER, M.D. $25,459 KENNETH B. ROBBINS, M.D. $31,025 STEVEN ROBERTSON $18,273 MARTHA SMITH $33,498 CHARLES A. STED $106,674 NON FIXED PAYMENTS TO PERSONS LISTED ON PART VII, SECTION A, LINE 1A SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS ARE MADE TO EMPLOYEES BASED ON SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. NON-FIXED PAYMENTS MADE TO PHYSICIANS ARE BASED ON CLINICAL PERFORMANCE MEASURES. 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: DAVID OKABE $125,391 KENNETH B. ROBBINS, M.D. $125,057 GAIL LERCH $97,713 STEVEN ROBERTSON $91,842 CHARLES CHING $93,424 VIRGINIA PRESSLER-FISHER $98,468 CHARLES A. STED $341,483Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF ORGANIZATION'S MISSIONFORM 990, PART III, LINE 1KAPI'OLANI MEDICAL SPECIALISTS (KMS) IS A SPECIALTY PHYSICIAN GROUP DEDICATED TO PROVIDING WORLD-CLASS CARE FOR HAWAII'S WOMEN AND CHILDREN THROUGH ACADEMICS, RESEARCH AND CLINICAL CARE. WORKING IN PARTNERSHIP WITH KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN, THE GROUP'S MISSION IS CARING FOR THE COMMUNITY THROUGH MEDICAL AND ACADEMIC EXCELLENCE. PROGRAM SERVICE ACTIVITY #1 FORM 990, PART III, LINE 4A AFFILIATE OF HAWAI'I PACIFIC HEALTH, KAPI'OLANI MEDICAL SPECIALISTS ("KMS") HAS ALMOST 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 AND PALLIATIVE CARE. IN FISCAL YEAR 2011, KMS HAD 69,880 PATIENT VISITS AND 318,535 PATIENT ENCOUNTERS. KAPI'OLANI MEDICAL SPECIALISTS IS ALLIED WITH THE UNIVERSITY OF HAWAII'S JOHN A. BURNS SCHOOL OF MEDICINE, AS PART OF ADHERENCE TO ITS CORE VALUES OF WORLD-CLASS HEALTH CARE, PHYSICIAN TRAINING, AND MEDICAL RESEARCH. THIS PARTNERSHIP PROVIDES A UNIQUE ACADEMIC AFFILIATION WITHIN HAWAI'I PACIFIC HEALTH, ALLOWING THE NETWORK TO FURTHER ITS COMMITMENT TO EFFECTIVE HEALTH CARE THROUGH MEDICAL RESEARCH AND THE TRAINING OF TOMORROW'S HEALTH CARE PROVIDERS. KAPI'OLANI MEDICAL SPECIALISTS 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 COUNTRY 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 2011, THE GROUP PROVIDED $6,134,600 IN MEDICAL CARE TO PATIENTS WHO WERE UNINSURED OR UNABLE TO PAY FOR THEIR CARE.
MEMBERS AND RIGHTSFORM 990, PART VI, LINE 6HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY. DESCRIBE CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & 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. PERSON OR ENTITY; AND (XIV) DEVELOP A NEW LINE OF BUSINESS.
REVIEW OF THE 990S BY THE ORGANIZATION'S GOVERNING BODYFORM 990, PART VI, LINE 11BVARIOUS SCHEDULES OF THE 990S ARE PREPARED PRIMARILY BY STAFF WITHIN THE ACCOUNTING AREA OF THE ORGANIZATION WORKING WITH VARIOUS OTHER AREAS OF THE ORGANIZATION SUCH AS MANAGEMENT OF THE OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPILED INTERNALLY BASED ON INPUT AND DISCUSSION WITH FINANCIAL ANALYSTS AND THE CHIEF OPERATING OFFICER / EXECUTIVE DIRECTOR OF THE REPORTING ENTITY. THE CHIEF OPERATING OFFICER / EXECUTIVE DIRECTOR OF EACH REPORTING ENTITY REVIEWS AND APPROVES THE DISCLOSURE NARRATIVES WHICH DESCRIBES THE MISSION / PURPOSE AND PROGRAM ACCOMPLISHMENTS OF THEIR ORGANIZATION. SENIOR MANAGEMENT OF THE HEALTH CARE SYTEM REVIEWS THE 990S OF EACH FILLING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE 990S ARE THEN PROVIDED TO THE GOVERNANCE AND NOMINATING COMMITTEE OF THE HEALTH CARE SYSTEM'S BOARD OF DIRECTORS FOR THEIR REVIEW. THE GOVERNANCE AND NOMINATING COMMITTEE OF THE PARENT'S ENTITY (HAWAI'I PACIFIC HEALTH "HPH") BOARD PROVIDES OVERSIGHT FOR THE 990 REPORTING AND REVIEWS THE 990S FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE 990S FOR EACH ENTITY IS MADE AVAILABLE TO THE HPH BOARD OF DIRECTORS THROUGH A BOARD PORTAL FOR REVIEW PRIOR TO THE FILING OF THE 990. COPIES OF THE 990S ARE MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND ARE PHYSICALLY LOCATED AT EACH FACILITY'S SITE FOR THE BOARD MEMBER TO REVIEW PRIOR TO FILING. THE 990S WILL BE POSTED TO HPH'S WEB SITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURNS WITH THE IRS. ADOPTION OF POLICIES FORM 990, PART VI, LINES 12A, 13, 14 AND 16B THE POLICIES IDENTIFIED IN PART VI WERE FORMALLY ADOPTED BY THE BOARD OF HAWAI'I PACIFIC HEALTH ("HPH"), THE SOLE MEMBER OF THE ORGANIZATION. AS THE SOLE MEMBER, THE POLICIES ADOPTED BY HPH MUST BE FOLLOWED BY ALL HPH ORGANIZATIONS. THE POLICIES ARE CURRENTLY BEING ADOPTED BY THE ORGANIZATION'S BOARD. - LINE 12A - WRITTEN CONFLICT OF INTEREST POLICY WAS FORMALLY ADOPTED 12/3/07 BY HPH - LINE 13 - WRITTEN WHISTLEBLOWER POLICY WAS FORMALLY ADOPTED 5/26/11 BY HPH - LINE 14 - WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY WAS FORMALLY ADOPTED 5/26/11 BY HPH - LINE 16B - WRITTEN POLICY REGARDING PARTICIPATION IN JOINT VENTURE ARRANGEMENTS WAS FORMALLY ADOPTED 5/26/11 BY HPH 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: 1) RECEIVED A COPY OF THE CONFLICT OF INTEREST ("COI") POLICY; 2) HAS READ AND UNDERSTAND THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; AND 4) 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 AND YEAR PROCESS WAS LAST COMPLETED FORM 990, PART VI, LINE 15A & 15B 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 MARCH 1, 2011 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 TO THE PUBLIC VIA THE HAWAI'I PACIFIC HEALTH WEBSITE.
OTHER CHANGES IN NET ASSETS OR FUND BALANCESFORM 990, PART XI, LINE 5FY10 PR ACCRUAL DIFFERENCE: ($1,491,384) - FY10 B/S - PAYROLL & RELATED LIAB BALANCE $1,465,466 - FY10 TB - ACCRUED PAYROLL BALANCE -------------------- ($25,918) - SUBTOTAL - FY10 PR ACC DIFFERENCE $5,539,755 - EQUITY TRANSFER WITH HPH ------------------- $5,513,837 - TOTAL OTHER CHANGES IN NET ASSETS HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII, COLUMN B INDIVIDUALS LISTED ON PART VII ALSO DEOVTE TIME TO THE ORGANIZATIONS AS LISTED BELOW: WILCOX HEALTH FOUNDATION CHARLES CHING 0.5 CHARLES STED 1.0 DAVID FOX 0.4 DAVID OKABE 0.5 EARL INOUYE 0.5 JESSICA LEWIS 0.5 VIRGINIA PRESSLER-FISHER 1.0 KAPI'OLANI HEALTH FOUNDATION CHARLES CHING 0.5 CHARLES STED 3.0 DAVID FOX 0.4 DAVID OKABE 1.0 EARL INOUYE 0.5 JESSICA LEWIS 0.1 VIRGINIA PRESSLER-FISHER 1.0 STRAUB FOUNDATION CHARLES CHING 0.5 CHARLES STED 1.0 DAVID FOX 0.4 DAVID OKABE 0.5 EARL INOUYE 0.1 JESSICA LEWIS 0.5 KENNETH ROBBINS 0.1 VIRGINIA PRESSLER-FISHER 1.0 HAWAI'I PACIFIC HEALTH ANN PETERS 45.0 CHARLES CHING 30.0 CHARLES STED 32.0 DAVID FOX 2.4 DAVID OKABE 35.0 EARL INOUYE 25.0 GAIL LERCH 40.0 JESSICA LEWIS 0.5 KEKA SANBORN 50.0 KENNETH ROBBINS 10.0 MARTHA SMITH 0.5 MELINDA ASHTON 40.0 STEVEN ROBERTSON 15.0 SUSAN MASUMOTO-NONAKA 20.0 VIRGINIA PRESSLER-FISHER 45.0 WARREN CHAIKO 15.0 KAUA'I MEDICAL CLINIC ANN PETERS 1.0 CHARLES CHING 4.0 CHARLES STED 6.0 DAVID FOX 4.8 DAVID OKABE 1.0 EARL INOUYE 4.0 GAIL LERCH 0.1 JESSICA LEWIS 2.5 KATIE SHIGEMITSU 2.4 KEKA SANBORN 0.5 KENNETH ROBBINS 10.0 MELINDA ASHTON 1.0 STEVEN ROBERTSON 1.0 SUSAN MASUMOTO-NONAKA 1.0 VIRGINIA PRESSLER-FISHER 0.1 WARREN CHAIKO 1.0 PROVIDERS INSURANCE CHARLES CHING 2.0 CHARLES STED 1.0 DAVID FOX 0.4 DAVID OKABE 1.0 EARL INOUYE 0.5 MELINDA ASHTON 0.1 STRAUB CLINIC & HOSPITAL ANN PETERS 1.0 CHARLES CHING 3.0 CHARLES STED 3.0 DAVID FOX 10.0 DAVID OKABE 6.0 EARL INOUYE 6.0 GAIL LERCH 6.0 JESSICA LEWIS 15.0 KATIE SHIGEMITSU 20.0 KEKA SANBORN 2.0 KENNETH ROBBINS 38.5 MELINDA ASHTON 2.0 STEVEN ROBERTSON 15.0 SUSAN MASUMOTO-NONAKA 12.0 VIRGINIA PRESSLER-FISHER 2.0 WARREN CHAIKO 5.0 PALI MOMI MEDICAL CENTER ANN PETERS 1.0 CHARLES CHING 1.0 CHARLES STED 2.0 DAVID FOX 6.0 DAVID OKABE 3.0 EARL INOUYE 1.0 GAIL LERCH 6.0 JESSICA LEWIS 6.6 KATIE SHIGEMITSU 5.2 KEKA SANBORN 2.0 KENNETH ROBBINS 10.0 MELINDA ASHTON 2.0 STEVEN ROBERTSON 8.0 SUSAN MASUMOTO-NONAKA 3.0 VIRGINIA PRESSLER-FISHER 1.0 WARREN CHAIKO 10.0 KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN ANN PETERS 1.0 CHARLES CHING 4.0 CHARLES STED 2.0 DAVID FOX 10.0 DAVID OKABE 4.0 EARL INOUYE 5.0 GAIL LERCH 6.0 JESSICA LEWIS 10.8 KATIE SHIGEMITSU 8.8 KEKA SANBORN 2.0 MARTHA SMITH 54.5 MELINDA ASHTON 2.0 STEVEN ROBERTSON 12.0 SUSAN MASUMOTO-NONAKA 8.0 VIRGINIA PRESSLER-FISHER 1.0 WARREN CHAIKO 15.0 WILCOX MEMORIAL HOSPITAL ANN PETERS 1.0 CHARLES CHING 5.0 CHARLES STED 8.0 DAVID FOX 4.8 DAVID OKABE 3.0 EARL INOUYE 12.0 GAIL LERCH 1.0 JESSICA LEWIS 4.1 KATIE SHIGEMITSU 2.8 KEKA SANBORN 2.0 KENNETH ROBBINS 0.5 MARTHA SMITH 0.5 MELINDA ASHTON 1.0 STEVEN ROBERTSON 8.0 SUSAN MASUMOTO-NONAKA 16.0 VIRGINIA PRESSLER-FISHER 2.0 WARREN CHAIKO 5.0 VIRGINIA PRESSLER-FISHER 2.0 WARREN CHAIKO 5.0

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
HAWAI'I PACIFIC HEALTH
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990246363HOLDING COHI501(C)(3)11B TYPE IINA
KAPI'OLANI MEDICAL CENTER WOMEN CHILDREN
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990177350HOSPITALHI501(C)(3)3NA
KAPI'OLANI HEALTH FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990246364FUNDRAISINGHI501(C)(3)7NA
PALI MOMI MEDICAL CENTER
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990274038HOSPITALHI501(C)(3)3NA
WILCOX MEMORIAL HOSPITAL
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990074365HOSPITALHI501(C)(3)3NA
WILCOX HEALTH FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990204242FUNDRAISINGHI501(C)(3)7NA
KAUA'I MEDICAL CLINIC
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990326099HOSPITALHI501(C)(3)3NA
STRAUB CLINIC & HOSPITAL
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813912151670HOSPITALHI501(C)(3)3NA
STRAUB FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813990109350FUNDRAISINGHI501(C)(3)7NA
PROVIDERS INSURANCE CORPORATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813710893000NFP INSURANCEHI501(C)(3)11B TYPE IINA
PALI MOMI FOUNDATION
55 MERCHANT STREET 24TH FLOORHONOLULUHI96813383840327FUNDRAISINGHI501(C)(3)7NA

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

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

Address US AddressUS

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

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CORPTypeOfEntity
Share Of Total Income0ShareOfTotalIncome
Share Of EOY Assets0ShareOfEOYAssets
Percentage Ownership0.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (9 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN
n61735
KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN
p352772
KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN
r96426
KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN
o6291492
KAPI'OLANI MEDICAL CNTR FOR WOMEN & CHILDREN
q98555
PROVIDERS INSURANCE CORPORATION
q1195421
PALI MOMI MEDICAL CENTER
r70313
STRAUB CLINIC AND HOSPITAL
r60283
KAPI'OLANI HEALTH FOUNDATION
c95004