2023-05-12T05:39:12-05:00 2022-06-30 ERNST & YOUNG US LLP 370 17TH STREET SUITE 4800 DENVER CO 80202 990 2021-07-01 990260423 QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL % SHANNON OLSEN QUEE 8088814400 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 MONEY ATWAL TREASURER 8088814400 2023-05-08 true MONEY ATWAL 999009999 ANDREW JAMESON P01894820 7209314000 2023-05-05 3 2021 2023-04-26 12:10:37Z CYNTHIA KAMIKAWA 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 91648031 false X www.nhch.com X 1989 HI ACUTE CARE HOSPITAL WITH THE MISSION TO TO IMPROVE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII. 10 5 453 23 76819 62865 5246404 5629601 80627775 85274677 149410 109373 491677 634380 86515266 91648031 0 49294022 0 0 35612984 38594691 8125 395 96040 49481389 50474458 85102498 138363566 1412768 -46715535 240269003 242215242 76986714 127426012 163282289 114789230 X ACUTE CARE HOSPITAL WITH THE MISSION TO IMPROVE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII. false false 114634705 49294022 85407319 QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL (THE HOSPITAL), LOCATED IN KAMUELA, HAWAII ON THE ISLAND OF HAWAII, IS A NOT-FOR-PROFIT, ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR THE RESIDENTS AND VISITORS OF NORTH HAWAII. THE HOSPITAL WAS CHARTERED IN NOVEMBER 1987 AND COMMENCED OPERATIONS IN MAY 1996. THE HOSPITAL IS CURRENTLY LICENSED FOR 35 BEDS. ADMITTING PHYSICIANS ARE PRACTITIONERS IN THE LOCAL AREA. THE NUMBER OF PATIENTS SERVED FROM 7/1/2021 - 6/30/2022 THROUGH OUTPATIENT VISITS WAS 98,794 AND THE NUMBER OF ADMISSIONS WAS 1,679. SEE SCHEDULE O FOR MORE INFORMATION. 114634705 true true false true false false false false false true true false false true true true false true false false false false false false false false true true true false true true false false false false false false false false false false true true false false false true true true false false true 0 0 453 true true true false false false false false false false false false false false X 10 5 false false false false true true true true true false false true false false false false false true false X SHANNON OLSEN 8088814675 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 JILL HOGGARD GREEN CHAIR/TRUSTEE 3.0 62.0 X X 0 1520980 270173 JASON CHANG TRUSTEE 1.0 54.0 X 0 947366 146632 DARRIN KUCZYNSKI MD PHYSICIAN 50.0 0.0 X 612288 0 24577 CYNTHIA KAMIKAWA PRESIDENT/TRUSTEE 54.0 1.0 X X 0 551355 62302 HOWARD WONG MD PHYSICIAN 50.0 0.0 X 476788 0 17246 SHARLENE TSUDA FORMER OFFICER 0.0 0.0 X 0 436943 47345 TY CHUN MD PHYSICIAN 50.0 0.0 X 451738 0 24923 DAVID PARK MD PHYSICIAN 50.0 0.0 X 399407 0 34455 ARUN RAJAGOPAL MD PHYSICIAN 50.0 0.0 X 371787 0 33220 MONEY ATWAL TREASURER 45.0 10.0 X 0 223597 35182 LILINOE WATANABE FORMER OFFICER 0.0 55.0 X 0 205135 34241 SHARIANN GONSALVES SECRETARY 40.0 0.0 X 67300 0 15914 ROBERT HASTINGS II TRUSTEE 1.0 0.0 X 0 0 0 NEIL KUYPER TRUSTEE 1.0 0.0 X 0 0 0 RICHARD LEVY PHD TRUSTEE 1.0 0.0 X 0 0 0 KAHU BILLY MITCHELL TRUSTEE 1.0 0.0 X 0 0 0 ROBERT MOMSEN TRUSTEE 1.0 3.0 X 0 0 0 JENAI WALL TRUSTEE 1.0 7.0 X 0 0 0 KYLE CHOCK TRUSTEE 1.0 3.0 X 0 0 0 2379308 3885376 746210 77 true true false 0 2220344 3409257 85193 5629601 PATIENT SERVICE REVENUE 622110 79532135 79532135 STATE OF HI SUSTAINABILITY 900099 4988068 4988068 VACCINE CLINIC - STATE PAYMENT 622110 84317 84317 COVID TESTING - RURAL MITIGATION 622110 471963 471963 INTERCOMPANY INCOME 561000 198194 198194 85274677 106255 76819 29436 0 0 314343 314343 0 314343 314343 3118 3118 3118 3118 0 0 0 0 0 0 0 0 0 VENDING MACHINE/CAFETERIA 900099 187395 187395 FINANCE SERVICE CHARGE 900099 59794 59794 COMMON AREA MAINT - REIMBURSEMENT 900099 40748 40748 32100 32100 320037 91648031 85407319 76819 534292 X 49294022 49294022 0 0 0 72839 72839 0 32172314 26477910 5620893 73511 663830 592960 68895 1975 3687279 2804674 869712 12893 1998429 1565442 427839 5148 240676 240676 123658 123658 50056 50056 6293 6293 395 395 898 898 14663027 12745255 1917772 62488 1851 60637 351987 291303 58584 2100 230218 44891 185327 0 3147700 536398 2611302 132357 99608 32749 0 133946 40948 92998 525286 525286 0 5742683 4792565 950118 888374 888374 SUPPLIES 14076733 13694067 382666 PROVIDER TAX 1386535 1386535 INTERCOMPANY PAYMENTS 7933923 7933923 BANK FEES 298315 298315 479305 266276 213011 18 138363566 114634705 23632821 96040 6147629 13985370 13605309 7295491 2143984 2918160 10951536 9448056 0 0 0 0 0 0 1611970 1719536 449432 518823 120014266 49966498 67624533 70047768 167994 710621 0 0 0 0 0 0 137566616 135571417 240269003 242215242 10351019 10738307 0 0 0 0 4656743 4403294 0 0 0 0 0 51416440 0 0 61978952 60867971 76986714 127426012 X 26772905 -18876069 136509384 133665299 163282289 114789230 240269003 242215242 X -46715535 -2452 -1775072 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 6293 6293 false SCHEDULE C, PART II-B, LINE 1I LOBBYING EXPENSES ARE THE PORTION OF DUES PAID TO HEALTHCARE ASSOCIATIONS ALLOCATED TO LOBBYING ACTIVITIES. 4790211 239949 192494 25428 4812238 4129637 860882 177845 22463 4790211 4391892 -44257 195249 22749 4129637 4533839 140572 272942 9577 4391892 4661526 314819 409523 32983 4533839 1.00000 true true true 12210000 12210000 69854982 22725257 47129725 1141924 502364 639560 34979475 26738877 8240598 1827885 1827885 70047768 EQUITY IN PARKER RANCH FDN TRU 119555241 INVESTMENT IN LIBERTY DIALYSIS 42106 BENEFICIAL INTERESTS 4812238 CONTRIBUTED USE OF LAND 6494774 DUE FROM AFFILIATES 718943 OTHER RECEIVABLES 128339 ROU ASSETS 1967026 NMTC FEE RESERVE 1852750 135571417 0 LEASE LIABILITY 2127608 GENERAL AND PROF TAIL LIABILITY 77886 DUE TO GOVT PROGRAMS 4945642 DUE TO AFFILIATES 53716835 60867971 X SCHEDULE D, PART V, LINE 4 INTENDED USE OF ENDOWMENT FUNDS THE ORGANIZATION HAS BENEFICIAL INTERESTS IN SEVERAL ENDOWMENTS, ALL WITH THE PURPOSE OF PROVIDING RESOURCES TO BE USED TO ENHANCE HEALTH CARE SERVICES IN NORTH HAWAII. SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) FOOTNOTE QHS EVALUATES ITS UNCERTAIN TAX POSITIONS AND HAS NO MATERIAL UNRECOGNIZED TAX POSITIONS AS OF JUNE 30, 2022. true true X true X 250. true X true true true false true true 51007 51007 0.00040 16317970 10904243 5413727 0.03910 16368977 10904243 5464734 0.03950 498868 1604610 498868 1604610 16867845 12508853 5464734 0.03950 true 2841601 167674 13172271 15423266 -2250995 X true true 1 1 QUEEN'S NORTH HAWAII COMM HOSPITAL 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 www.nhch.com 39-H X X X NORTH HAWAII MEDICAL GROUP AND KOHALA HOME HEALTH AGENCY QUEEN'S NORTH HAWAII COMM HOSPITAL 1 false false true X X X X X X X X X 21 true true true true X SEE PART V, SECTION C X true 21 true SEE PART V, SECTION C false true X 250. 400. X X X X X X true true X X X true X SEE SECTION C, PART V X SEE SECTION C, PART V X SEE SECTION C X X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3E THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 5 Input from Community Representatives Community Meetings - Organizations throughout the state, called "community connectors," helped to reach individuals from key communities for group talk story sessions. These organizations were invaluable partners, each trusted and recognized within their target communities, and willing both to provide input from their own work as well as create space and encourage their clients, partners, staff, and stakeholders to participate. Each meeting focused on both a geographic region and either an ethnic community or a vulnerable population. Key Informant Interviews - The Ward Team conducted 80 key informant interviews with individuals in key stakeholder positions able to provide input and insight on behalf of a target population. These tended to be organizational leaders serving stakeholder communities versus members of those actual populations that joined community meetings. Interviews were typically one on one between an interviewer and a key informant, lasting anywhere from 45 to 90 minutes. Small Groups - The Ward Team also held a series of private small group meetings with key leaders in three of these areas (food security, mental health, and housing). (Note that two of these necessitated additional one-on-one interviews, rather than small groups, given scheduling difficulties and the desire to speak with key individuals). These interviews followed the completion of most of the key informant interviews and community meetings and benefitted from that learning to date. The focus of discussion was around identifying COVID-19 adaptation strategies that worked and how that learning can be carried forward and built upon. Much of this discussion has augmented the Best Practice strategies highlighted in the report Community Advisory Committee - In 2021, the Community Advisory Committee (CAC) was composed of community leaders serving various target communities. CAC members were especially generous with their time, input, and expertise throughout the process. In addition to being key informants, they also participated in meetings during the last phase of the assessment and report and helped to make critical connections where there were gaps, ensure that things were ground-truthed with what they saw in their communities, and provided input as to how the priorities could be helpful both within the clinical and community-based contexts. SEE APPENDIX F OF THE CHNA FOR A LIST OF KEY INFORMANTS AND THEIR RESPECTIVE ORGANIZATIONS. SCHEDULE H, PART V, SECTION B, LINE 6A CHNA HOSPITAL FACILITIES NINETEEN HEALTHCARE ASSOCIATION OF HAWAII (HAH) MEMBER HOSPITALS CONTRIBUTED TO THE PRODUCTION OF THIS CHNA: ADVENTIST HEALTH CASTLE KAHUKU MEDICAL CENTER KAISER FOUNDATION HOSPITAL - HONOLULU KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN KUAKINI MEDICAL CENTER KULA HOSPITAL LANA'I COMMUNITY HOSPITAL MAUI MEMORIAL MEDICAL CENTER MOLOKAI GENERAL HOSPITAL QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL PALI MOMI MEDICAL CENTER THE QUEEN'S MEDICAL CENTER THE QUEEN'S MEDICAL CENTER - WEST O'AHU REHABILITATION HOSPITAL OF THE PACIFIC SHRINERS HOSPITALS FOR CHILDREN - HONOLULU STRAUB MEDICAL CENTER SUTTER HEALTH KAHI MOHALA WAHIAWA GENERAL HOSPITAL WILCOX MEDICAL CENTER SCHEDULE H, PART V, SECTION B, LINE 6B CHNA OTHER THAN HOSPITAL FACILITIES THE HEALTHCARE ASSOCIATION OF HAWAII PARTNERED WITH SOLUTIONS PACIFIC AND WARD RESEARCH TO CONDUCT A CHNA FOR THE STATE OF HAWAII. IN ADDITION, THE REPORT INVOLVED NUMEROUS OTHER HEALTH CARE FACILITIES AND RESOURCES WITHIN THE COMMUNITY THAT WERE ABLE TO RESPOND TO THE HEALTHCARE NEEDS IN THE COMMUNITY. THESE RESOURCES ARE LISTED ON PAGE 94 OF THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 7A and 10A WEBSITE WHERE THE CHNA AND IMPLEMENTATION PLAN CAN BE ACCESSED: https://www.queens.org/about/community-benefit-qhs/ SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS ASSESSED TOGETHER, THE HEALTHCARE ASSOCIATION OF HAWAII (HAH) MEMBER HOSPITALS PRIORITIZED THE AREAS OF NEED FOR THE STATE. THE TOP RANKED GOALS WERE: . Financial Security . Food Security . Mental and Behavioral Health . Housing . Trust and Equitable Access IN ADDITION, THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED: . Work together for equity and justice . Strengthen safe families . Prepare for emergencies . Restore environment and sense of place . Shift kupuna care away from "sick care" . Nurture community identity and cohesiveness . Invest in teenagers and healthy starts SENIOR MANAGEMENT OF THE QUEEN'S HEALTH SYSTEMS (QUEEN'S), THE NONPROFIT PARENT COMPANY OF A FAMILY OF HEALTH CARE-RELATED COMPANIES THAT INCLUDES THE QUEEN'S MEDICAL CENTER (QMC), QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL (NHCH) AND MOLOKAI GENERAL HOSPITAL (MGH), DISCUSSED THE COMMUNITY HEALTH NEEDS AND AGREED TO ADDRESS THE FOLLOWING PRIORITIES FOR THE SYSTEM: . Financial Security . Food Security . Mental and Behavioral Health . Housing . Trust and Equitable Access Through the Queen's Health System's Native Hawaiian Health program, QHS and affiliates worked to address many of the priorities included in the CHNA. Demonstrated Results in Improved Health Outcomes: The growth of seven culturally safe clinical programs within primary and specialty care settings across the health system resulted in the following improved outcomes (as of the end of FY 2022): . 219 unique patient encounters (FY 2022 target = 174) . A reduced inpatient readmissions to 42, exceeding the goal of greater or equal 71 and an improvement from 73 in FY21. . 1,004 NH no shows or cancellations in primary care/wound care settings exceeding the goal of greater or equal 2,391 and 1,004 less than FY21. . 103 new NH patients, far exceeding the goal of 80 and 12 more than FY 21. . 9.738 patient encounters, exceeding FY22 target of 9,471 and 540 more than FY 21. . 5% improvement of NH wound healing rate through appointment compliance exceeding target of greater or equal 3.24% and 1.76% more than FY21. Three phase-one projects treating high-risk diabetic patients while assessing the effectiveness of culture-responsive interventions showed proof-of-concept and achieved these positive outcomes: Queen Emma Clinics' Kilolani Project: . Increased Native Hawaiian encounters in FY22 by 1,400. . Included 128 high risk diabetes patients. Queen's Medical Center - West O'ahu's Na Pua Kaiona Project: . Decreased no show/cancellations by 43%. . Increased the number of Native Hawaiian visits by 14%. . Decreased emergency room visits by 0.44%. . Improved wound healing rate by 5.37%. Queen's North Hawaii Community Hospital's Kahu a Ola Project: . Provides interdisciplinary team care for 125 high risk Native Hawaiian patients . Hula is used as a culture-based intervention to lower risk factors such as hypertension, obesity, and hemoglobin A1c. . Decrease Hemoglobin A1c - average for 3 quarters was 7.2 . Decrease Body Mass Index - average for 3 quarters was 34.7 . Decrease Blood Pressure - average for 3 quarters was 139/81 Additionally, while COVID-19 vaccinations among Native Hawaiians lagged behind non Hawaiians, the Mobile Vaccine Clinic, supported by the Native Hawaiian Health team, created community access and culture-responsive networking. In FY22, it showed a promising trend to increase Native Hawaiian vaccinations as seen in the outcomes below: . Mobile vaccinations: 1,825 (25%) Native Hawaiians to 5475 (75%) non-Hawaiians. . West O'ahu Vaccine Clinic: 6,257 (18%) Native Hawaiians to 27,628 (82%) non-Hawaiians. . Blaisdell Vaccine Clinic: 4,220 (11%) Native Hawaiians to 33,758 (89%) non-Hawaiians. Future Goals: . The Native Hawaiian Health Program seeks to develop new models of care that focus on illness prevention, coordinated care and proactive health management. . Preparations are underway to enter several risk-based arrangements with different payers. . Queen's also strives to improve data analytics to better understand the population's healthcare needs and to optimize care and support. NEEDS NOT ADDRESSED ALTHOUGH NHCH WILL NOT DIRECTLY BE ADDRESSING ALL OF THE AREAS OF NEED LISTED ON THE CHNA REPORT, WE HAVE SUPPORTED AND PARTNERED WITH OTHERS TO ADDRESS SEVERAL OF THEM AND WILL CONTINUE TO SUPPORT OPPORTUNITIES TO ADDRESS COMMUNITY HEALTH NEEDS IN COLLABORATION WITH OTHERS. SCHEDULE H, PART V, SECTION B, LINE 13B INCOME LEVEL OTHER THAN FPG FOR CITIZENS OF FOREIGN COUNTRIES, THE INCOME QUALIFYING LEVEL IS BASED ON THE RESIDENT'S COUNTRY'S MINIMUM WAGE. SCHEDULE H, PART V, SECTION B, LINE 13H OTHER ELIGIBILITY CRITERIA MEDICARE OR MEDICAID/QUEST ELIGIBILITY SCHEDULE H, PART V, LINES 16A, 16B & 16C THE FINANCIAL ASSISTANCE POLICY AND PLAIN LANGUAGE SUMMARY ARE WIDELY AVAILABLE ON QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL'S WEBSITE AT: https://www.queens.org/locations/hospitals/north-hawaii/pay-your-bill/ THE FINANCIAL ASSISTANCE POLICY'S APPLICATION FORM AND TRANSLATIONS ARE WIDELY AVAILABLE ON QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL'S WEBSITE AT: https://www.queens.org/locations/hospitals/north-hawaii/pay-your-bill/fina ncial-assistance/ SCHEDULE H, PART V, SECTION B, LINE 16J OTHER METHOD FOR PUBLICIZING POLICIES NOTICES THAT FINANCIAL ASSISTANCE IS AVAILABLE ARE POSTED IN ALL PATIENT REGISTRATION, BILLING OFFICE AND EMERGENCY DEPARTMENT AREAS. THESE NOTICES DO NOT CONTAIN THE FULL DETAILED TEXT OF THE POLICY. REGISTRATION PERSONNEL ARE KNOWLEDGEABLE TO ASSIST PATIENTS WITH QUESTIONS AND ARE ABLE TO GIVE THEM THE FINANCIAL ASSISTANCE APPLICATION. 2 HALE OLA PONO 65-1267 KAWAIHAE ROAD WAIMEA HI 96743 PRIMARY CARE CLINIC N HAWAII COM HOSP SPECIALTY CARE CLINIC 67-1185 MAMALAHOA HIGHWAY KAMUELA HI 96743 SPECIALTY CARE CLINIC SCHEDULE H, PART I, LINE 6 COMMUNITY BENEFIT REPORT - RELATED ORGANIZATION COMMUNITY BENEFITS ARE REPORTED ANNUALLY AS PART OF THE 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 THE QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL. THIS REPORT IS PUBLISHED PERIODICALLY AND IS SEPARATELY AVAILABLE TO THE PUBLIC. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY THE COSTING METHODOLOGY CONSIDERS ALL PATIENT SEGMENTS. AMOUNTS REPRESENT THE NET COSTS FOR THE VARIOUS PROGRAMS AND OPERATIONS, CONSIDERING ACTUAL AMOUNTS INCURRED AND CALCULATED BENEFITS BASED ON COST-TO-CHARGE RATIOS AND AVERAGE RATES (I.E. WAGE RATES). SCHEDULE H, PART III, LINE 2 BAD DEBT METHODOLOGY NHCH PROVIDES 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. NHCH ESTIMATES THE ALLOWANCE BASED ON THE AGING OF THE ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE BY PAYOR AND OTHER RELEVANT FACTORS. NHCH 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 NHCH'S FINANCIAL ASSISTANCE POLICY IS CALCULATED BASED ON THE COST-TO-CHARGE RATIO. THE HOSPITAL ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD'S ACCOUNTING STANDARDS UPDATE 2014-09 TOPIC 606 (ASU 606) EFFECTIVE JULY 1, 2018. ASU 606 AND THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA) DIFFERENTIATE BAD DEBT FROM IMPLICIT PRICE CONCESSIONS. THE HOSPITAL MAKES A DETERMINATION REGARDING A PRICE CONCESSION TO STANDARD PRICING ON A PORTFOLIO BASIS PRIOR TO ASSESSING THE CREDIT RISK OF INDIVIDUALS WITHIN THE PORTFOLIO. PATIENT SERVICE REVENUE IS RECORDED NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS, INCLUDING AN ESTIMATE FOR IMPLICIT PRICE CONCESSIONS. BAD DEBT IS RECORDED AS AN OPERATING EXPENSE AND RESULTS WHEN A PATIENT, DETERMINED TO HAVE THE FINANCIAL CAPACITY TO PAY FOR HEALTHCARE SERVICES, IS UNWILLING TO DO SO. THE AMOUNT SHOWN ON PART III, LINE 2 IS THE PRICE CONCESSION AMOUNT FOR THE TAX YEAR ENDED JUNE 30, 2022. SCHEDULE H, PART III, LINE 3 BAD DEBT AS COMMUNITY BENEFIT THE PORTION OF THE BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS CALCULATED BY APPLYING THE COST TO CHARGE RATIO TO THE TOTAL BAD DEBT EXPENSE. BAD DEBT PERTAINING TO PATIENT CARE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE, CONSISTENT WITH NHCH'S MISSION, PATIENTS RECEIVE CARE REGARDLESS OF WHETHER NHCH COLLECTS PAYMENT FOR SERVICES PERFORMED. SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE FOOTNOTE NHCH 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 AUDITED FINANCIAL STATEMENTS DO NOT DESCRIBE BAD DEBT EXPENSE. THE AUDITED FINANCIAL STATEMENTS DO DESCRIBE THE RECEIVABLES FOR PATIENT SERVICES. "ACCOUNTS RECEIVABLE PRIMARILY COMPRISE AMOUNTS DUE FOR HEALTHCARE SERVICES FROM PATIENTS AND THIRD-PARTY PAYORS AND ARE RECORDED NET OF AMOUNTS FOR CONTRACTUAL ADJUSTMENTS, IMPLICIT PRICE CONCESSIONS AND BAD DEBTS." SCHEDULE H, PART III, LINE 8 TREATMENT OF MEDICARE SHORTFALL COMMUNITY BENEFIT THE HOSPITAL MUST TREAT PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE GOVERNMENT SETS NON-NEGOTIABLE MEDICARE RATES AND THE REIMBURSEMENT HAS NOT KEPT PACE WITH THE RISING COSTS OF PROVIDING THESE SERVICES. DUE TO THE REQUIREMENT TO PROVIDE CARE AND THE INABILITY OF THE MEDICARE REIMBURSEMENT TO KEEP PACE WITH THE COST OF PROVIDING SERVICES, WE FEEL THAT THE LOSS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES IS PART OF NHCH'S MISSION AND IS A BENEFIT TO THE COMMUNITY. MEDICARE COSTING METHODOLOGY THE MEDICARE AMOUNTS ABOVE ARE CALCULATED WITH DATA FROM THE JUNE 30, 2022 COST REPORT USING THE STEP DOWN METHOD. SCHEDULE H, PART III, LINE 9B APPLICATION OF THE COLLECTION PRACTICES TO THOSE QUALIFYING FOR FINANCIAL ASSISTANCE CHARITY CARE WILL BE GRANTED TO ALL UNDERINSURED AND UNINSURED PATIENTS. THE SCREENING PROCESS WILL OPTIMALLY OCCUR AT THE TIME OF SERVICE, BUT MAY OCCUR ANYTIME DURING THE COLLECTION PROCESS INCLUDING POST ASSIGNMENT TO AN OUTSIDE COLLECTION AGENCY. ACCOUNTS FOR PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE IDENTIFIED FOR A YEAR AND ASSESSED ANNUALLY AND/OR DURING SUBSEQUENT VISITS TO THE HOSPITAL. PROMPT PAYMENT DISCOUNTS ARE AVAILABLE FOR PATIENTS WHO PAY FOR SERVICE AT THE TIME OF TREATMENT. THE CARE PAYMENT PROGRAM IS AVAILABLE FOR ELIGIBLE PATIENTS AND PROVIDES LOW MONTHLY PAYMENTS WITH 0% INTEREST. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT ADMITTING PHYSICIANS ARE PRACTITIONERS IN THE LOCAL AREA AND THE BOARD IS COMPRISED OF COMMUNITY MEMBERS. THIS ALLOWS THE HOSPITAL TO ASSESS THE NEEDS OF THE COMMUNITY THAT IT SERVES. IN ADDITION, MANY COMMUNITY HEALTH SERVICES ARE OFFERED IN THE FORMS OF ACTIVITIES OR PROGRAMS THAT HELP TO ASSESS AND IMPROVE COMMUNITY HEALTH. AS REPORTED IN SCHEDULE H, PART V, SECTION B, FOR THE 2021 TAX YEAR, QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL COMPLETED A CHNA WITH THE ASSISTANCE OF THE HEALTHCARE ASSOCIATION OF HAWAII. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE NOTICES ARE POSTED IN ALL PATIENT REGISTRATION, BILLING OFFICE AND EMERGENCY DEPARTMENT AREAS REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE TO LOW-INCOME AND UNINSURED PATIENTS. THIS INFORMATION IS ALSO POSTED ON THE HOSPITAL WEBSITE AND ON PATIENT BILLING STATEMENTS. APPROPRIATE STAFF MEMBERS THAT COMMUNICATE WITH THE PUBLIC REGARDING THEIR BILLS ARE TRAINED AND KNOWLEDGEABLE ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL IS LOCATED IN KAMUELA, HAWAII, ALSO KNOWN AS WAIMEA, HAWAII, IN THE KOHALA DISTRICT OF THE NORTHEASTERN REGION OF THE ISLAND OF HAWAII. IT IS A NOT-FOR-PROFIT, ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR ABOUT 30,000 RESIDENTS AND VISITORS OF NORTH HAWAII. THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF APPROXIMATELY ONE-FOURTH, OR 1,000 SQUARE MILES, OF THE BIG ISLAND'S 4,028 TOTAL SQUARE MILES. THERE ARE CURRENTLY NO OTHER GENERAL ACUTE CARE HOSPITALS IN THE PRIMARY SERVICE AREA. THE HOSPITAL WAS CHARTERED IN NOVEMBER 1987 AND COMMENCED OPERATIONS IN MAY 1996. THE HOSPITAL IS CURRENTLY LICENSED FOR 35 BEDS. ADMITTING PHYSICIANS ARE PRACTITIONERS IN THE LOCAL AREA. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH THE MAJORITY OF THE ORGANIZATION'S BOARD IS COMPRISED OF COMMUNITY MEMBERS FROM THE NORTHERN HAWAII AREA AND HAS AN OPEN MEDICAL STAFF. THE HOSPITAL CONDUCTED DIFFERENT EVENTS INCLUDING HEALTH FAIRS AND EDUCATION DAYS IN THE LOCAL COMMUNITY, HOTELS AND SCHOOLS OF THE AREA AS WELL AS TAKING A LEAD ROLE IN BREAST CANCER AWARENESS MONTH. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM NHCH 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), QUEEN'S DEVELOPMENT CORPORATION (QDC), MOLOKAI GENERAL HOSPITAL (MGH) AND QUEEN'S UNIVERSITY MEDICAL GROUP (QUMG). QHS PROVIDED LEGAL, ACCOUNTING AND ADMINISTRATIVE SUPPORT SERVICES TO NHCH AND QIE PROVIDED MEDICAL MALPRACTICE INSURANCE TO NHCH. IN RETURN, NHCH ASSISTED QMC IN FULFILLING ITS MISSION TO PROVIDE IN PERPETUITY QUALITY HEALTH CARE SERVICES TO IMPROVE THE WELL-BEING OF NATIVE HAWAIIANS AND ALL THE PEOPLE OF HAWAII. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT N/A true THE QUEEN'S HEALTH SYSTEMS 1301 PUNCHBOWL STREET HONOLULU HI 96813 990238120 501(C)(3) 49294022 GENERAL SUPPORT 1 0 SCHEDULE I, PART I, LINE 2 DESRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS FOR THE YEAR ENDED JUNE 30, 2022, QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL MADE A DONATION TO THE QUEEN'S HEALTH SYSTEMS RELATED TO THE NEW MARKET TAX CREDIT. THERE WERE NO RESTRICTIONS PLACED ON THE USE OF THOSE DONATIONS AND THE RECEIVING ORGANIZATION MAY USE THE DONATIONS AT THEIR DISCRETION IN ORDER TO FURTHER THEIR EXEMPT PURPOSE. false false false false false false false true false JILL HOGGARD GREEN CHAIR/TRUSTEE 0 1012265 0 501851 0 6864 0 253215 16958 0 1791153 JASON CHANG TRUSTEE 0 673130 0 273696 0 540 122534 0 24098 0 1093998 DARRIN KUCZYNSKI MD PHYSICIAN 505704 0 106584 0 0 0 8700 0 15877 0 636865 0 CYNTHIA KAMIKAWA PRESIDENT/TRUSTEE 0 430728 0 113769 0 6858 0 46549 0 15753 0 613657 HOWARD WONG MD PHYSICIAN 420205 0 38280 0 18303 0 8700 0 8546 0 494034 0 SHARLENE TSUDA FORMER OFFICER 0 306584 0 61054 0 69305 0 43277 0 4068 0 484288 TY CHUN MD PHYSICIAN 400876 0 31899 0 18963 0 8700 0 16223 0 476661 0 DAVID PARK MD PHYSICIAN 359886 0 38279 0 1242 0 8700 0 25755 0 433862 0 ARUN RAJAGOPAL MD PHYSICIAN 350919 0 20868 0 0 0 8700 0 24520 0 405007 0 MONEY ATWAL TREASURER 0 202436 0 20510 0 651 0 17832 0 17350 0 258779 LILINOE WATANABE FORMER OFFICER 0 183932 0 18640 0 2563 0 25633 0 8608 0 239376 SCHEDULE J, PART I, LINE 3 THE ORGANIZATION RELIED ON THE QUEEN'S HEALTH SYSTEMS ("QHS", PARENT COMPANY) TO DETERMINE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL. QHS USED A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY AND STUDY, FORM 990 OF OTHER ORGANIZATIONS AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SCHEDULE J, PART I, LINE 7 OTHER NON-FIXED PAYMENTS RECOGNITION AWARDS WERE PAID TO EMPLOYEES BASED ON ACCOMPLISHMENTS OF PREDETERMINED GOALS SET FORTH IN THE INCENTIVE AND STRATEGIC PLANS AND DEFINED ELIGIBILITY OF THE EMPLOYEE. RECOGNITION AWARDS ARE DISCRETIONARY AND CONSIDER QUALITY THRESHOLDS WHICH INCLUDE ANNUAL ACCREDITATION AND MINIMUM OPERATING INCOME LEVEL CRITERIA. IN ADDITION, EXECUTIVE AWARDS ARE WEIGHTED BASED ON INDIVIDUAL GOALS ESTABLISHED FOR EACH EXECUTIVE. SCHEDULE J, PART II & FORM 990 PART VII COMPENSATION PAID FOR SERVICES JILL HOGGARD GREEN MS. HOGGARD GREEN SERVES AS A TRUSTEE FOR THE QUEEN'S HEALTH SYSTEMS AND SEVERAL OTHER QUEEN'S RELATED AFFILIATES. MS. HOGGARD GREEN ALSO SERVES AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE QUEEN'S HEALTH SYSTEMS ("QHS", PARENT COMPANY) AND CHAIR OF MGH, QEL AND NHCH. SHE IS A VOLUNTEER TRUSTEE AND IS NOT COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR HER VARIOUS SERVICES. CYNTHIA KAMIKAWA MS. KAMIKAWA SERVES AS VP OF QHS AND AS PRESIDENT AND TRUSTEE OF QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL ("NHCH"). SHE IS NOT SEPARATELY COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR ALL SERVICES. JASON CHANG MR. CHANG SERVES AS COO AND EVP OF QHS, PRESIDENT AND TRUSTEE OF QMC AND TRUSTEE OF QEL, MGH AND NHCH. HE IS NOT SEPARATELY COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL SERVICES. SHARLENE TSUDA MS. TSUDA SERVED AS SECRETARY FOR QHS, QMC AND NHCH AND VP OF COMMUNITY DEVELOPMENT OF QHS THROUGH NOVEMBER 2020. SHE WAS NOT SEPARATELY COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR ALL SERVICES. MONEY ATWAL MR. ATWAL SERVES DIRECTOR OF FINANCE AND INFORMATION TECHNOLOGY FOR MOLOKAI GENERAL HOSPITAL ("MGH") AND NHCH AND TREASURER OF NHCH. HE IS NOT SEPARATELY COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HIS TOTAL COMPENSATION FOR ALL SERVICES. A DEPT OF BUDGET & FINANCE STATE OF HI 990266961 419800LM7 2015-01-29 350356476 SEE PART VI false false false A 16245000 0 350362507 0 0 0 4726000 0 0 185627500 160009007 0 2019 true false true true A false false false true true 0 false false true A false false false true true true ML CAPITAL SERVICES 6.5 false false false 0 false true A true Form 990, Schedule K, Part I-V-19, Line 1 DESCRIPTION OF ARRANGEMENT RELATED ORGANIZATION REPORTING QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL'S (NHCH) SOLE CORPORATE MEMBER, THE QUEEN'S HEALTH SYSTEMS (QHS) BORROWED ON BEHALF OF ITSELF AND ITS AFFILIATES, THE QUEEN'S MEDICAL CENTER (QMC) AND QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL (NHCH). INFORMATION REPORTED ON SCHEDULE K IS FOR THE ENTIRE BOND ISSUE. THE OUTSTANDING BOND LIABILITY IS ALLOCATED BETWEEN ENTITIES AND REPORTED SEPERATELY ON FORM 990, PART X. NHCH'S SHARE OF THE OUTSTANDING LIABILITY IS $4,403,294. PART I, LINE A, COLUMN (F) DESCRIPTION OF PURPOSE THE BONDS ARE ISSUED FOR THE BENEFIT OF THE BORROWER (THE QUEEN'S HEALTH SYSTEMS) AND THE FOLLOWING ORGANIZATIONS, EACH OF WHICH IS CONTROLLED BY THE BORROWER AND WHICH IS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE: THE QUEEN'S MEDICAL CENTER AND QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL (TOGETHER WITH THE BORROWER, THE "OBLIGATED GROUP MEMBERS"). ON JANUARY 23, 2015, QHS ISSUED SPECIAL PURPOSE REVENUE BONDS 2015 SERIES A, 2015 SERIES B AND 2015 SERIES C. THE PURPOSE OF THIS ISSUE WAS TO REFUND ALL DEBT OBLIGATIONS PREVIOUSLY ISSUED UNDER THE MASTER TRUST INDENTURE DATED JULY 1, 1996, AS AMENDED AMONG THE BORROWER, THE QUEEN'S MEDICAL CENTER, AND OTHER AFFILIATED CORPORATIONS, AND THE MASTER TRUSTEE NAMED THEREIN, FINANCE, REFINANCE OR REIMBURSE THE COSTS OF ACQUIRING, CONSTRUCTING, RENOVATING AND EQUIPPING FACILITIES BENEFITTING THE OBLIGATED GROUP MEMBERS AND PAY COSTS OF ISSUANCE OF THE BOND'S OBLIGATED GROUP MEMBERS AND PAY COSTS OF ISSUANCE ON BONDS. THE ISSUANCE DATES FOR THE BONDS WERE: 12/11/2003 05/06/2009 03/16/2006 PART IV, LINE 2C THE REBATE CALCULATION WAS PERFORMED ON JANUARY 29, 2020. X 1 2750 FMV X 1733 FMV X 3 80190 FMV X 3 520 FMV 0 false false false SCHEDULE M, PART I, COLUMN B THE AMOUNTS REPORTED IN COLUMN B REPRESENT THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART III, LINE 4A TO SUPPORT THE QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL'S (NHCH) MISSION AND TO FULFILL THE TAX EXEMPT PURPOSE AS A CHARITABLE HOSPITAL, NHCH PROVIDED THE FOLLOWING COMMUNITY BENEFITS, TOTALING APPROXIMATELY $7,883,403 FOR THE YEAR ENDED JUNE 30, 2022. 1. UNCOMPENSATED CARE - NHCH 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, 2022, THE ESTIMATED COST OF PROVIDING CHARITY CARE AND FOR SERVICES THAT WERE BAD DEBTS WAS $51,007 AND $167,674 RESPECTIVELY. 2. MEDICAID SHORTFALL IN PAYMENTS - NHCH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO MEDICAID PATIENTS IN THE STATE OF HAWAII. NHCH INCURRED COSTS IN EXCESS OF REIMBURSEMENT OF APPROXIMATELY $5,413,727 DURING THE YEAR ENDED JUNE 30, 2022. 3. MEDICARE SHORTFALL IN PAYMENTS - NHCH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO MEDICARE PATIENTS IN THE STATE OF HAWAII. NHCH INCURRED COSTS IN EXCESS OF REIMBURSEMENT BASED ON MEDICARE COST REPORTS OF APPROXIMATELY $2,250,995 DURING THE YEAR ENDED JUNE 30, 2022. CONSISTENT WITH COST REPORT REQUIREMENTS, THERE ARE AMOUNTS THAT ARE EXCLUDED FROM THE COSTS ABOVE. 4. COMMUNITY OUTREACH PROGRAMS - NHCH PROVIDES MEDICAL NUTRITION THERAPY FREE OF CHARGE TO ANYONE ON THE BIG ISLAND. IN ADDITION, NUTRITION CLASSESWERE TAUGHT AT AN ONCOLOGY SUPPORT GROUP, LOCAL SCHOOL AND SENIOR CENTER AND OTHER ACTIVITIES WERE PROVIDED TO COMMUNITY TO SUPPORT NUTRITION EDUCATION. FORM 990, PART VI, LINE 6 MEMBERS OR STOCKHOLDERS NHCH HAS A SOLE MEMBER, WHICH IS THE QUEEN'S HEALTH SYSTEMS (QHS), A HAWAII NONPROFIT CORPORATION. FORM 990, PART VI, LINE 7A DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS QHS ELECTS ALL OF THE BOARD MEMBERS OF THE NHCH BOARD OF TRUSTEES. FORM 990, PART VI, LINE 7B DESCRIPTION OF CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS CERTAIN MAJOR DECISIONS APPROVED BY THE NHCH 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 $500,000; 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 NHCH. FORM 990, PART VI, LINE 11B PROCESS USED TO REVIEW THE FORM 990 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 PRIOR TO THE FILING OF THE TAX RETURN. THE QHS RISK MANAGEMENT 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 REVIEWED THE RETURNS. IN ADDITION, COMPENSATION RELATED DISCLOSURES IN THE RETURNS WERE REVIEWED BY THE CHAIRPERSON OF THE COMPENSATION COMMITTEE PRIOR TO FILING THE RETURNS. ALSO, A COPY OF THE QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL (NHCH) RETURN WAS MADE AVAILABLE TO EACH OF THE MEMBERS OF THE NHCH BOARD OF TRUSTEES PRIOR TO THE RETURNS BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, LINES 12, 13 & 14 APPROVED POLICIES THE CONFLICT OF INTEREST, WHISTLEBLOWER AND DOCUMENT RETENTION POLICIES HAVE BEEN APPROVED BY QHS ON BEHALF OF THE NHCH BOARD OF TRUSTEES BUT HAVE NOT BEEN SEPARATELY APPROVED BY THE NHCH BOARD. AS SUCH, LINES 12, 13 AND 14 HAVE BEEN CHECKED 'NO'. FORM 990, PART VI, LINE 12C MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY 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 AND 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 CONTRACTS MANAGEMENT DEPARTMENT AND LEGAL DEPARTMENT HAVE THE CONFLICT OF INTEREST SUMMARIES AND CHECK FOR CONFLICTS OF INTEREST AT THE BEGINNING OF THE CONTRACT PROCESS. ANY CONFLICT OF INTEREST INVOLVING A TRUSTEE IS PRESENTED TO THE BOARD OF TRUSTEES. ANY CONFLICT OF INTEREST 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. FORM 990, PART VI, LINES 15A & 15B PROCESS FOR DETERMINING COMPENSATION ALTHOUGH NOT COMPENSATED BY QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL, A RELATED ORGANIZATION, THE QUEEN'S HEALTH SYSTEMS GOES THROUGH THE FOLLOWING PROCEDURES FOR DETERMINING THE CEO'S COMPENSATION. A COMMITTEE OF THE BOARD OF TRUSTEES CALLED THE COMPENSATION COMMITTEE MEETS REGULARLY TO REVIEW THE COMPENSATION OF ALL EXECUTIVES OF ALL COMPANIES WITHIN QHS. NHCH'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 ANNUAL PERFORMANCE REVIEWS AND COMPARISON TO COMPARABLE COMPENSATION DATA PREPARED BY A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT. THE MOST RECENT REVIEW TOOK PLACE IN OCTOBER 2022. OUTSIDE COUNSEL ASSISTS WITH THE REVIEW PROCESS AND DOCUMENTS THE DECISIONS OF THE COMMITTEE. FORM 990, PART VI, LINE 19 AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, & FINANCIAL STATEMENTS TO THE GENERAL PUBLIC NHCH'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST AND THE QHS' CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THIS TAX RETURN, AS REQUIRED. NHCH DOES NOT MAKE THE CONFLICT OF INTEREST POLICY THAT IT FOLLOWS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS CHANGE IN BENEFICIAL INTEREST ($ 1,775,072) ------------ TOTAL ($ 1,775,072) FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:6585325 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:8021535 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING SERVICES TOTAL FEES:56167 LUCY K HENRIQUES TRUST 1301 PUNCHBOWL STREET HONOLULU HI 96813 996002291 SUPPORT HI 501(c)(3) 12c NA false PARKER RANCH FOUNDATION TRUST 66-1304 MAMALAHOA HIGHWAY KAMUELA HI 96743 996064620 PROPERTY MGMT HI 501(c)(3) 12a NA false THE QUEEN'S HEALTH SYSTEMS 1301 PUNCHBOWL STREET HONOLULU HI 96813 990238120 ADMIN SERVICE HI 501(c)(3) 12c NA false QUEEN EMMA LAND COMPANY 1301 PUNCHBOWL STREET HONOLULU HI 96813 990183769 SUPPORT SVCS HI 501(c)(3) 12a QHS true THE QUEEN'S MEDICAL CENTER 1301 PUNCHBOWL STREET HONOLULU HI 96813 990073524 MEDICAL SVCS HI 501(c)(3) 3 QHS true MOLOKAI GENERAL HOSPITAL PO BOX 408 KAUNAKAKAI HI 96748 990251372 MEDICAL SVCS HI 501(c)(3) 3 QHS true QUEEN'S UNIVERSITY MEDICAL GROUP 1301 PUNCHBOWL STREET HONOLULU HI 96813 880820406 MEDICAL SVCS HI 501(C)(3) 10 QHS true HAMAMATSUQUEEN'S PET IMAGING CENTER LL 1301 PUNCHBOWL STREET HONOLULU HI 96813 943266916 PET IMAGING HI NA PRIMARY CARE PHYSICIAN ENTERPRISE LLC 1301 PUNCHBOWL STREET HONOLULU HI 96813 834591861 MEDICAL SERVICES HI NA THE QUEEN'S DEVELOPMENT CORPORATION 1301 PUNCHBOWL STREET HONOLULU HI 96813 990240109 DEVELOPMENT HI NA C Corp true QUEEN'S INSURANCE EXCHANGE 1301 PUNCHBOWL STREET HONOLULU HI 96813 911913839 INSURANCE HI NA C Corp true DIAGNOSTIC LABORATORY SERVICES INC 99-859 IWAIWA STREET AIEA HI 96701 990240499 MEDICAL LAB SVCS HI NA C Corp true false true false false false false false false false true false false true false false true false false false DIAGNOSTIC LABORATORY SERVICES INC j 157930 FMV THE QUEEN'S MEDICAL CENTER m 337902 FMV THE QUEEN'S HEALTH SYSTEMS B 49294022 FMV SCHEDULE R, PART III IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP HAMAMATSU/QUEEN'S PET IMAGING CENTER, LLC EIN: 94-3266916 ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813 PRIMARY CARE PHYSICIAN ENTERPRISE LLC EIN: 83-4591861 ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813