2026-05-14T21:29:30+00:00 2025-06-30 346565596 ERNST & YOUNG US LLP 2005 MARKET STREET PHILADELPHIA PA 19103 990 2024-07-01 990326099 Kaua'i Medical Clinic KAUA 8082451500 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 JENNIE CHAHANOVICH CEO 8082451500 2026-05-15 true Lauren E Bennett P01787029 2154485000 2026-05-11 2024 2025-03-06 01:10:19Z JENNIE CHAHANOVICH 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 71385897 false X WWW.HAWAIIPACIFICHEALTH.ORG/WILCOX X 1967 HI KAUA'I MEDICAL CLINIC, AN AFFLIATE OF HAWAI'I PACIFIC HEALTH, IS A MULTI-SPECIALTY CLINIC THAT SERVES HAWAI'I PACIFIC HEALTH THROUGH ACADEMICS, RESEARCH AND CLINICAL CARE, IN PARTNERSHIP WITH KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN (KAPI'OLANI), PALI MOMI MEDICAL CENTER (PALI MOMI), STRAUB CLINIC AND HOSPITAL (STRAUB), AND WILCOX MEMORIAL HOSPITAL (WILCOX). 7 3 220 0 0 498136 69911722 70442728 248631 195035 249998 70160353 71385897 0 0 12245340 13403095 0 0 58078113 58148802 70323453 71551897 -163100 -166000 22542787 21696090 10866675 10185854 11676112 11510236 KAUA'I MEDICAL CLINIC, AN AFFLIATE OF HAWAI'I PACIFIC HEALTH, IS A MULTI-SPECIALTY CLINIC DEDICATED TO PROVIDING WORLD-CLASS CARE FOR ADULTS AND CHILDREN ACROSS HAWAI'I AND THE PACIFIC REGION IN PARTNERSHIP WITH KAPI'OLANI MEDICAL CENTER FOR WOMEN AND CHILDREN (KAPI'OLANI), PALI MOMI MEDICAL CENTER (PALI MOMI), STRAUB CLINIC AND HOSPITAL (STRAUB), AND WILCOX MEMORIAL HOSPITAL (WILCOX). THE GROUP'S MISSION IS TO CREATE A HEALTHIER HAWAI'I. false false 70066224 0 70442728 SEE SCHEDULE O 70066224 true false false false false false false true false false true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false false false false true true true false false true X 0 0 220 true false false false false false false false false false false false false X 7 3 true false false false true true true true true false false false true true true true true true false false false false CA HI X X KERIANN ERNST 8085357890 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 Jay Murphy MD Board of Director, Vice Chair 0.2 40.0 X X 0 441224 32877 Raymond P Vara Jr Board of Director, President 2.0 60.1 X X 0 3043387 2402439 Robert Wotring II MD Board of Director, Chair 0.2 40.6 X X 0 336557 21428 Denise Roberts Board of Director 0.2 0 X 0 0 0 Eugene Tareshawty MD Board of Director 0.2 40.2 X 0 248009 24814 Helen Cox Board of Director 0.2 0 X 0 0 0 Mike Murakoshi Board of Director 0.2 0 X 0 0 0 Arthur Gladstone EVP & CSO 0.0 55.0 X 0 925130 456766 Carrie Ann Tsutsui VP & System Controller 0.1 48.3 X 0 325583 88491 Charles R Ching EVP, General Counsel & Secretary 0.1 39.9 X 0 822744 397894 Claire Tong VP 2.0 38.0 X 0 162327 42665 David Okabe EVP, CFO & Treasurer 1.0 49.0 X 0 1305584 568803 David Stumbaugh VP 1.5 38.5 X 0 346794 106754 Dawn Dunbar SVP 0.0 45.0 X 0 459578 133114 Dean Tateyama VP 1.0 39.0 X 0 326450 47152 Douglas Kwock MD VP 1.0 39.0 X 0 563911 134462 James Lin MD VP 0.1 47.6 X 0 367457 110369 Jan Boivin SVP 0.5 50.5 X 0 212332 9721 Jennie Chahanovich CEO 10.0 46.5 X 0 737536 329800 Jessica Lewis Assistant Corporate Secretary 2.5 37.5 X 0 190855 47962 John McNamara SVP & CMO (part year) 2.0 38.0 X 0 476990 120553 Katie Shigemitsu Compliance Officer (PART YEAR) 0.5 39.5 X 0 248126 35368 Keoki Clemente Compliance Officer 0.5 39.5 X 0 182524 46630 Leslie Chun MD EVP 1.0 59.0 X 0 930474 441620 Lorrie-Ann Luke VP 0.5 41.0 X 0 337450 104800 Louise Fukumoto VP 0.0 40.0 X 0 317587 89707 Michael Robinson VP 0.2 49.8 X 0 396265 93346 Peter Lewis VP & Chief Information Security Officer 0.1 39.9 X 0 371348 27754 Reina France Graves Privacy Officer 1.5 38.5 X 0 161130 43657 Shilpa Patel MD SVP & CQO 0.8 39.7 X 0 540119 142995 Steven Robertson EVP & CIO 0.0 52.5 X 0 837344 416252 Troy Branstetter VP 1.0 57.0 X 0 362848 85817 Warren Chaiko SVP 0.5 39.5 X 0 442278 135712 William Burke VP 0.0 52.0 X 0 344107 100289 Amithea Love Psychologist 40.0 0 X 109101 0 16463 Ashley Shimono Clinical Supervisor 40.0 0 X 122088 0 33854 Dana Gutzman RN 40.0 0 X 132739 0 19237 Shari Gallagher Clinical Supervisor 40.0 0 X 122063 0 22421 Sunshine Topping Former Officer 0.0 0.0 X 0 276869 102844 485991 17040917 7034830 4 true true false 0 498136 498136 NET PATIENT SERVICE REVENUE 622110 39781445 39781445 PREMIUM REVENUE 622110 9179296 9179296 INTER-ENTITY SERVICE REVENUE 561000 20832039 20832039 OTHER HEALTH CARE REVENUE 622110 490482 490482 RENTAL INCOME 531120 146305 146305 13161 13161 0 0 70442728 195035 195035 0 0 0 0 MDX settlement 900099 249998 0 0 249998 0 0 0 0 249998 71385897 70442728 0 445033 0 0 10222495 9675179 547316 557166 540145 17021 1863151 1463493 399658 760283 719648 40635 15404 15404 937570 781162 156408 0 1293 1293 229220 199853 29367 166315 166315 1314126 1200605 113521 55397 52872 2525 16159 16159 1068846 1068846 71670 142 71528 INTER ENTITY PURCHASED SVCS. 50750736 50750736 MEDICAL SUPPLIES 3430583 3404353 26230 Other Purchases 53697 19200 34497 F&N CATERING CHARGES 24163 1423 22740 13623 4800 8823 0 71551897 70066224 1485673 0 1166937 1182405 3744647 4503131 3228273 2755677 0 0 0 0 92189 87618 19833472 11461484 9332149 8371988 0 0 4978592 4795271 22542787 21696090 1549879 1641720 0 0 9316796 8544134 10866675 10185854 X 11676112 11510236 11676112 11510236 22542787 21696090 X -166000 124 X false true true false X 45768 X false 634097 634097 3498415 1049088 2449327 8935444 5323813 3611631 6660260 5079027 1581233 105256 9556 95700 8371988 OPERATING LEASE 4446267 OTHER RECEIVABLES 98306 DEPOSITS AND OTHER NON-CURRENT 54930 DECORATIVE ARTWORK 45768 DUE FROM Hawai'i Health Partners DUE FROM GOVERNMENT AGENCIES 150000 4795271 Federal Income Taxes LT OPERATING LEASE LIABILITY 4509009 DUE TO KAPI'OLANI MEDICAL SPECIALISTS 2849980 ST OPERATING LEASE LIABILITY 604827 DUE TO HAWAI'I PACIFIC HEALTH 338190 DUE TO WILCOX MEMORIAL HOSPITAL 127460 DUE TO STRAUB CLINIC & HOSPITAL 52627 DUE TO KAPI'OLANI MEDICAL CENTER WOMEN AND CHILDREN 16236 DUE TO GOVERNMENT AGENCIES DUE TO PALI MOMI MEDICAL CENTER 35763 DUE TO KAPI'OLANI HEALTH FOUNDATION 8909 ESCHEAT LIABILITY 914 DUE TO STRAUB FOUNDATION 188 DUE TO WILCOX HEALTH FOUNDATION 22 DUE TO PALI MOMI FOUNDATION 9 8544134 X 0 0 0 0 0 0 0 0 0 0 0 0 Schedule D, Part III, Line 4 Collections of art - description of collections KAUA'I MEDICAL CLINIC'S (KMC) COLLECTION OF ARTWORK INCLUDES PAINTINGS AND SIMILAR WORKS THAT ARE DISPLAYED IN PUBLIC WAITING/HALLWAY AREAS TO IMPROVE PATIENT EXPERIENCE IN KMC'S FACILITIES. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote UNCERTAIN TAX POSITIONS AUDITED FINANCIAL STATEMENT FOOTNOTE THE COMPANY HAS NOT RECORDED ANY EXPENSE OR ACCRUED FOR ANY RELATED EXPENSE FOR ANY UNCERTAIN TAX POSITIONS. false true false false false false false false false Jay Murphy MD Board of Director, Vice Chair 0 411222 0 0 0 30002 0 13800 0 19077 0 474101 0 0 Raymond P Vara Jr Board of Director, President 0 1260109 0 838646 0 944632 0 2382431 0 20008 0 5445826 0 709655 Robert Wotring II MD Board of Director, Chair 0 296276 0 0 0 40281 0 13073 0 8355 0 357985 0 0 Eugene Tareshawty MD Board of Director 0 236754 0 0 0 11255 0 9599 0 15215 0 272823 0 0 Sunshine Topping Former Officer 0 145231 0 97406 0 34232 0 91623 0 11221 0 379713 0 74815 Troy Branstetter VP 0 270194 0 57896 0 34758 0 77119 0 8698 0 448665 0 37180 William Burke VP 0 257950 0 52998 0 33159 0 79608 0 20681 0 444396 0 39783 Jennie Chahanovich CEO 0 418880 0 159613 0 159043 0 315241 0 14559 0 1067336 0 157174 Warren Chaiko SVP 0 291616 0 79851 0 70811 0 105591 0 30121 0 577990 0 59938 Charles R Ching EVP, General Counsel & Secretary 0 492816 0 166082 0 163846 0 380936 0 16958 0 1220638 0 189528 Leslie Chun MD EVP 0 615100 0 205459 0 109915 0 414397 0 27223 0 1372094 0 211855 Dawn Dunbar SVP 0 326138 0 88166 0 45274 0 105915 0 27199 0 592692 0 66180 Louise Fukumoto VP 0 238673 0 48057 0 30857 0 73027 0 16680 0 407294 0 36074 Arthur Gladstone EVP & CSO 0 565932 0 190996 0 168202 0 431337 0 25429 0 1381896 0 213071 Reina France Graves Privacy Officer 0 159693 0 0 0 1437 0 17388 0 26269 0 204787 0 0 Douglas Kwock MD VP 0 423818 0 86133 0 53960 0 107599 0 26863 0 698373 0 64656 Jessica Lewis Assistant Corporate Secretary 0 182430 0 7827 0 598 0 18897 0 29065 0 238817 0 0 Peter Lewis VP & Chief Information Security Officer 0 290129 0 57057 0 24162 0 25875 0 1879 0 399102 0 42830 James Lin MD VP 0 283193 0 58207 0 26057 0 83339 0 27030 0 477826 0 43693 Lorrie-Ann Luke VP 0 253631 0 51171 0 32648 0 77170 0 27630 0 442250 0 38412 John McNamara SVP & CMO (part year) 0 331481 0 97126 0 48383 0 110392 0 10161 0 597543 0 66901 David Okabe EVP, CFO & Treasurer 0 624373 0 209979 0 471232 0 551845 0 16958 0 1874387 0 253888 Shilpa Patel MD SVP & CQO 0 403174 0 96598 0 40347 0 115796 0 27199 0 683114 0 63839 Steven Robertson EVP & CIO 0 507874 0 171107 0 158363 0 399294 0 16958 0 1253596 0 207799 Michael Robinson VP 0 300828 0 59356 0 36081 0 82284 0 11062 0 489611 0 44127 Katie Shigemitsu Compliance Officer (PART YEAR) 0 237675 0 0 0 10451 0 25179 0 10189 0 283494 0 0 Jan Boivin SVP 0 166340 0 7500 0 38492 0 0 0 9721 0 222053 0 0 Dean Tateyama VP 0 238720 0 48057 0 39673 0 30535 0 16617 0 373602 0 36074 Carrie Ann Tsutsui VP & System Controller 0 249774 0 50341 0 25468 0 75717 0 12774 0 414074 0 37789 David Stumbaugh VP 0 266440 0 53633 0 26721 0 80775 0 25979 0 453548 0 38755 Keoki Clemente Compliance Officer 0 169096 0 12155 0 1273 0 19811 0 26819 0 229154 0 0 Claire Tong VP 0 144518 0 14644 0 3165 0 16520 0 26145 0 204992 0 0 Ashley Shimono Clinical Supervisor 108812 0 0 0 13276 0 9547 0 24307 0 155942 0 0 0 Dana Gutzman RN 119379 0 0 0 13360 0 11140 0 8097 0 151976 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE 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, FORM 990, PART VI, SECTION B, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN 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. AMOUNTS PAID OUT DURING THE YEAR BY THE ORGANIZATION: RAYMOND P. VARA JR. - $236,450 DAVID OKABE - $89,681 STEVEN ROBERTSON - $61,201 ARTHUR GLADSTONE - $56,841 CHARLES R. CHING - $52,702 LESLIE CHUN, M.D. - $49,140 JENNIE CHAHANOVICH - $28,518 ANNUAL INCENTIVE PLAN THE ANNUAL INCENTIVE PLAN IS AFFORDED TO EXECUTIVES BASED ON ANNUAL SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. AMOUNTS PAID OUT DURING THE YEAR BY THE ORGANIZATION: RAYMOND P. VARA JR. - $763,646 DAVID OKABE - $209,979 LESLIE CHUN, M.D. - $205,459 ARTHUR GLADSTONE - $190,996 STEVEN ROBERTSON - $171,107 CHARLES R. CHING - $166,083 JENNIE CHAHANOVICH - $144,613 SHILPA PATEL, M.D. - $91,598 SUNSHINE TOPPING - $89,906 DAWN DUNBAR - $88,166 DOUGLAS KWOCK, M.D. - $86,133 WARREN CHAIKO- $79,850 MICHAEL ROBINSON - $59,356 JAMES LIN, M.D. - $58,207 PETER LEWIS - $57,057 DAVID STUMBAUGH - $53,633 WILLIAM BURKE- $52,998 TROY BRANSTETTER - $52,896 LORRIE-ANN LUKE - $51,171 CARRIE ANN TSUTSUI - $50,341 LOUISE FUKUMOTO - $48,057 DEAN TATEYAMA - $48,057 JOHN McNAMARA - $40,965 RETENTION INCENTIVE PLAN THE RETENTION INCENTIVE PLAN WAS DESIGNED TO ENCOURAGE CONTINUED INTEREST IN THE SUCCESS OF THE ORGANIZATION AND PROVIDE COMPETITIVE RETIREMENT BENEFITS. THE PLAN DOES NOT REPLACE THE ANNUAL AND LONG-TERM INCENTIVE PLAN NOR THE SERP RESTORATION PLAN. Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS IN FISCAL YEAR 2025 KAUA'I MEDICAL CLINIC, AN AFFLIATE OF HAWAI'I PACIFIC HEALTH, HAD 261 EMPLOYED AND CONTRACTED STAFF AND PROVIDERS WHO PROVIDED EXPERTISE AND SERVICE TO THE COMMUNITY IN 19 SPECIALTIES. THE MULTI-SPECIALTY CLINIC IS ORGANIZED BY THE FOLLOWING SPECIALTIES: PRIMARY CARE, MEDICAL SUBSPECIALTIES, SURGERY, WOMEN'S HEALTH, HOSPITAL BASED MEDICINE, AND PEDIATRICS. IN FISCAL YEAR 2025, KAUA'I MEDICAL CLINIC HAD 289,230 PATIENT ENCOUNTERS. KAUA'I MEDICAL CLINIC ALLIES WITH THE UNIVERSITY OF HAWAI'I JOHN A. BURNS SCHOOL OF MEDICINE, IN ADHERENCE TO ITS CORE VALUES OF WORLD-CLASS HEALTH CARE, PHYSICIAN TRAINING, AND MEDICAL RESEARCH. THIS PARTNERSHIP PROVIDES A UNIQUE ACADEMIC AFFILIATION FOR HAWAI'I PACIFIC HEALTH AND FURTHERS ITS COMMITMENT TO EFFECTIVE HEALTH CARE THROUGH MEDICAL RESEARCH AND BY TRAINING TOMORROW'S HEALTH CARE PROVIDERS. KAUA'I MEDICAL CLINIC HAS DEVELOPED A VARIETY OF WAYS TO IDENTIFY AND MEET THE UNIQUE HEALTH CARE NEEDS OF HAWAI'I. KAUA'I MEDICAL CLINIC CONTRACTED PHYSICIANS PROVIDE ESSENTIAL SERVICES ON KAUA'I AND ARE AN ADDITIONAL RESOURCE WHEN NEEDED FOR HEALTH CARE NEEDS STATEWIDE AS PART OF HAWAI'I PACIFIC HEALTH'S OVERALL MEDICAL RESPONSE. ADDITIONALLY, THEY PROVIDE PATIENT CARE AT OUTREACH CLINICS AND COMMUNITY HEALTH CENTERS THROUGHOUT HAWAI'I, 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 KAUA'I MEDICAL CLINIC. IN FISCAL YEAR 2025, KAUA'I MEDICAL CLINIC PROVIDED $50,358,824 IN MEDICAL CARE TO PATIENTS IN NEED OF MEDICAL SERVICES. Form 990, Part V, Line 1a FORM 1096 REPORTING HAWAI'I PACIFIC HEALTH (HPH), THE ORGANIZATION'S TAX-EXEMPT PARENT, PAYS ALL VENDORS. THEREFORE, HPH ISSUES FORMS 1099 UNDER ITS TAX ID. Form 990, Part VI, Line 15 THE CEO OF THE ORGANIZATION IS NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER BY THE TAX-EXEMPT PARENT HAWAI'I PACIFIC HEALTH ("HPH"). FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE CEO'S COMPENSATION. COMPENSATION FOR HAWAI'I PACIFIC HEALTH ("HPH") EXECUTIVES (VICE PRESIDENT AND ABOVE) IS SET BY THE HPH COMPENSATION COMMITTEE, WHICH IS COMPOSED SOLELY OF INDEPENDENT, COMMUNITY-BASED MEMBERS OF THE HPH BOARD OF DIRECTORS. ON AN ANNUAL BASIS, THE HPH BOARD CHAIRPERSON (WHO IS INDEPENDENT) SELECTS A NEUTRAL THIRD-PARTY EXECUTIVE COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVES' 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, AND SUCH DECISIONS ARE DOCUMENTED IN THE COMPENSATION COMMITTEE MEETING MINUTES. 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 COMPLETED ON FEBRUARY 27, 2025 TO REVIEW PHYSICIAN COMPENSATION, AND ON JUNE 23, 2025 TO REVIEW EXECUTIVE COMPENSATION WITH APPROVAL TAKING PLACE AUGUST 8, 2025. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons PETER LEWIS AND JESSICA LEWIS - Family relationship Form 990, Part VI, Line 6 Classes of members or stockholders HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO ELECT THE MEMBERS OF THE GOVERNING BODY AND/OR APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER AND HAS THE POWER TO APPROVE THE ELECTION OF MEMBERS OF THE GOVERNING BODY. HAWAI'I PACIFIC HEALTH, AS MEMBER, ALSO HAS THE POWER TO ELECT ONE OR MORE EX-OFFICIO VOTING MEMBERS OF THE GOVERNING BODY. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE MEMBER SHALL HAVE THE EXCLUSIVE POWER TO TAKE AND DIRECT THE FOLLOWING ACTIONS OF THE CORPORATION: (1) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE PRESIDENT, CHIEF EXECUTIVE OFFICER, TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, OTHER EXECUTIVE VICE-PRESIDENTS, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE OPERATING UNIT VICE-PRESIDENTS, AS SUCH TERM IS DEFINED IN THE BYLAWS; (2) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER BOARD; (3) AMEND THE BYLAWS; (4) CAUSE THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1)YEAR AND/OR FOR ONE MILLION DOLLARS ($1,000,000) OR MORE; (5) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (6) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (7) EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (8) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S EXECUTIVE COMPENSATION AND BENEFIT PLANS; (9) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, OR PARTNERSHIP OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (10) EXCEPT AS OTHERWISE PROVIDED IN THE BYLAWS OR AS REQUIRED BY THE LAW OF THE STATE OF HAWAI'I, SELL, LEASE OR OTHERWISE TRANSFER FIFTY PERCENT (50%) OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY WILCOX MEMORIAL HOSPITAL, KAUA'I MEDICAL CLINIC AND WILCOX HEALTH FOUNDATION (THE WILCOX AFFILIATES); (11) EXCEPT AS PROVIDED IN THE BYLAWS OR AS REQUIRED BY THE LAWS OF THE STATE OF HAWAI'I, SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE WILCOX AFFILIATES WHICH GENERATE FIFTY PERCENT (50%) OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE WILCOX AFFILIATES DURING THE PRIOR FISCAL YEAR; (12) CLOSE THE CLINICAL FACILITIES OWNED AND OPERATED BY THE CORPORATION; PROVIDED, THAT, AFTER THE EFFECTIVE DATE OF THE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORPORATION MUST ALSO BE APPROVED BY THE BOARD; (13) CONVERT THE CLINIC OWNED AND OPERATED BY THE CORPORATION INTO A FACILITY NO LONGER OFFERING MEDICAL SERVICES; PROVIDED, THAT, AFTER THE EFFECTIVE DATE OF THE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORPORATION MUST ALSO BE APPROVED BY THE BOARD; (14) AFTER CONSULTING WITH THE BOARD, REMOVE THE PRESIDENT, CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, TREASURER, SECRETARY, OTHER EXECUTIVE VICE-PRESIDENTS, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE OPERATING UNIT VICE-PRESIDENTS; PROVIDED, HOWEVER, THAT TO REMOVE OR TERMINATE THE PRESIDENT AND/OR THE CHIEF EXECUTIVE OFFICER WILL REQUIRE THE CHIEF EXECUTIVE 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 PRESIDENT AND/OR THE CHIEF EXECUTIVE OFFICER, SUCH REMOVAL OR TERMINATION WILL REQUIRE THE APPROVAL OF A MAJORITY OF THE MEMBERS ON THE MEMBER BOARD; (15) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORPORATE GOALS AND THE LONG RANGE AND STRATEGIC PLANS OF THE CORPORATION; AND (16) AFTER CONSULTING WITH THE BOARD, DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. THE CORPORATION SHALL NOT TAKE THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING MEMBER BOARD APPROVAL: (1) ADD ANY DIRECTOR TO THE BOARD; (2) REMOVE ANY DIRECTOR FROM THE BOARD; (3) AMEND THE ARTICLES; (4) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS ON BEHALF OF THE CORPORATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (5) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000); (6) ACQUIRE SHARES IN ANOTHER CORPORATION; (7) SELL, LEASE OR OTHERWISE TRANSFER FIFTY PERCENT (50%) OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY THE WILCOX AFFILIATES; (8) SELL, LEASE, EXCHANGE OR DISPOSE OF FIFTY PERCENT (50%) OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION TO ANY ENTITY THAT IS NOT AN AFFILIATE; (9) SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE WILCOX AFFILIATES WHICH GENERATE FIFTY PERCENT (50%) OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE WILCOX AFFILIATES DURING THE PRIOR FISCAL YEAR; (10) MERGE THE CORPORATION WITH ANY ENTITY; (11) DISSOLVE OR LIQUIDATE THE CORPORATION; (12) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER (13) FORM A JOINT VENTURE OR OTHER BUSINESS RELATIONSHIP (OTHER THAN THE ORDINARY COURSE OF BUSINESS CONTRACTS) BETWEEN THE CORPORATION AND ANY PERSON OR ENTITY; AND (14) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE. Form 990, Part VI, Line 11b Review of form 990 by governing body VARIOUS SCHEDULES OF THE FORM 990 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 SYSTEM REVIEWS THE FORMS 990 OF EACH FILING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE FORMS 990 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 FORM 990 REPORTING AND REVIEWS THE FORM 990 FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE FORM 990 FOR EACH ENTITY IS MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND THE HPH BOARD OF DIRECTORS THROUGH A BOARD MEMBER PORTAL FOR REVIEW PRIOR TO THE FILING OF THE FORM 990. THE FORMS 990 WILL BE POSTED TO HPH'S WEBSITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURNS WITH THE IRS. Form 990, Part VI, Line 12c Conflict of interest policy 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 UNDERSTANDS 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 ACTIVITIES 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. Form 990, Part VI, Line 19 Required documents available to the public DISCLOSURE OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS 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. Form 990, Part VIII, Line 2f Other Program Service Revenue ALL OTHER REVENUE - Total Revenue: 13161, Related or Exempt Function Revenue: 13161, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances TRANFERS TO AFFILIATES - 144; OTHER CHANGES IN NET ASSETS - -20; Total - 124; HAWAI'I PACIFIC HEALTH 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246363 ADMIN SVCS. HI 501(c)(3) Type III-FI NA false KAPI'OLANI HEALTH FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246364 FUNDRAISING HI 501(c)(3) 7 HPH true KAPI'OLANI MED CTR FOR WOMEN & CHILDREN 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990177350 HOSPITAL HI 501(c)(3) 3 HPH true KAPI'OLANI MEDICAL SPECIALISTS 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990322406 HEALTHCARE HI 501(c)(3) 3 HPH true PALI MOMI FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 383840327 FUNDRAISING HI 501(c)(3) 7 HPH true PALI MOMI MEDICAL CENTER 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990274038 HOSPITAL HI 501(c)(3) 3 HPH true PROVIDERS INSURANCE COMPANY 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 INSURANCE HI 501(c)(3) Type II HPH true STRAUB CLINIC & HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 912151670 HOSPITAL HI 501(c)(3) 3 HPH true STRAUB FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990109350 FUNDRAISING HI 501(c)(3) 7 HPH true WILCOX HEALTH FOUNDATION 3-3420 KUHIO HIGHWAY LIHUE HI 96766 990204242 FUNDRAISING HI 501(c)(3) 7 HPH true WILCOX MEMORIAL HOSPITAL 3-3420 KUHIO HIGHWAY LIHUE HI 96766 990074365 HOSPITAL HI 501(c)(3) 3 HPH true ACADEMY FOR HEALTHCARE INNOVATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 334642134 EDUCATION HI 501(c)(3) 2 HPH true Honolulu Surgery Center LP 55 Merchant Street 24th Floor HONOLULU HI 96813 621506645 AMBU. SURG. CTR. TN NA N/A Specialty Surgical Suites LLC 1401 S Beretania St STE 750 Honolulu HI 96814 461674512 AMBU. SURG. CTR. HI NA N/A HONOLULU IMAGING CENTER LLC 55 MERCHANT STREET 27TH FLOOR HONOLULU HI 96813 871602945 DIAG. IMAGING CTR DE NA N/A HAWAI'I ISOTOPE TECHNOLOGY LLC 55 MERCHANT STREET 27TH FLOOR HONOLULU HI 96813 991995020 PHARMACEUTICAL MANUFACTURING HI NA N/A ALL ACCESS ORTHO OAHU LLC 1401 S BERETANIA ST SUITE 102 HONOLULU HI 96814 934678472 URGENT CARE CLINICS HI NA N/A HAWAI'I PACIFIC HEALTH PARTNERS INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990318588 HOLDING COMPANY HI NA C Corporation STRAUB PHARMACY INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990145107 INACTIVE HI NA C Corporation HICORD INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990251496 INVESTMENT HI NA C Corporation false false false false false false false false false false false false false false true true true true true KAPI'OLANI MED CTR FOR WOMEN & CHILDREN Q 147301 FMV STRAUB CLINIC & HOSPITAL S 570383 FMV WILCOX MEMORIAL HOSPITAL Q 934131 FMV WILCOX MEMORIAL HOSPITAL S 344525 FMV KAPIOLANI MEDICAL SPECIALISTS Q 29918696 FMV KAPIOLANI MEDICAL SPECIALISTS P 72088 FMV