2022-05-12T18:35:27-05:00 2021-06-30 ERNST & YOUNG US LLP 4365 EXECUTIVE DRIVE STE 1600 SAN DIEGO CA 92121 990 2020-07-01 990260423 QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL % SHANNON OLSEN QUEE 8088814400 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 MONEY ATWAL TREASURER 8088814400 2022-05-06 true MONEY ATWAL 999009999 JOCELYNE MILLER P00634378 8585357200 2022-04-22 2 2020 2022-09-23 18:48:47Z CYNTHIA KAMIKAWA 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 86515266 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 7 445 23 113789 105893 11593977 5246404 73038864 80627775 219791 149410 749394 491677 85602026 86515266 0 0 0 0 35455778 35612984 337 8125 87919 44502178 49481389 79958293 85102498 5643733 1412768 241972998 240269003 83639987 76986714 158333011 163282289 ACUTE CARE HOSPITAL WITH THE MISSION TO IMPROVE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII. false false 61181658 0 80654538 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 7/1/2020 - 6/30/2021 THROUGH OUTPATIENT VISITS WAS 98,406 AND THE NUMBER OF ADMISSIONS WAS 1,561. 61181658 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 false false true true false false false false false false false false false false true false false false false true true true false false true 0 0 445 true true true false false false false false false false false false false false false X 10 7 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 96743 JILL HOGGARD GREEN CHAIR/TRUSTEE 3.0 62.0 X X 0 1409691 204929 JASON CHANG TRUSTEE 1.0 54.0 X 0 978673 138792 ARTHUR USHIJIMA FORMER OFFICER 0.0 0.0 X 0 1005073 61974 CYNTHIA KAMIKAWA PRESIDENT/TRUSTEE 54.0 1.0 X X 0 650971 67128 DARRIN KUCZYNSKI MD PHYSICIAN 50.0 0.0 X 581337 0 23669 SHARLENE TSUDA SECRETARY - PART YEAR 1.0 54.0 X 0 410117 87185 HOWARD WONG MD PHYSICIAN 50.0 0.0 X 462837 0 16697 TY CHUN MD PHYSICIAN 50.0 0.0 X 446794 0 31325 MICHAEL SZE MD PHYSICIAN 50.0 0.0 X 393735 0 31311 ANTHONY DESALVO MD PHYSICIAN 50.0 0.0 X 398356 0 22699 MONEY ATWAL TREASURER 45.0 10.0 X 0 232768 39584 LILINOE WATANABE FORMER OFFICER 0.0 55.0 X 0 216537 48171 SHARIANN GONSALVES SECRETARY 40.0 0.0 X 68707 0 15456 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 ROBERT LINDSAY TRUSTEE - PART YEAR 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 6.0 X 0 0 0 MAENETTE BENHAM EDD TRUSTEE - PART YEAR 1.0 2.0 X 0 0 0 KYLE CHOCK TRUSTEE 1.0 3.0 X 0 0 0 2351766 4903830 788920 76 true true false 0 2459166 2787238 627553 5246404 PATIENT SERVICE REVENUE 622110 74337834 74337834 STATE OF HI SUSTAINABILITY 900099 5714230 5714230 VACCINE CLINIC - STATE PAYMENT 622110 240862 240862 COVID TESTING - RURAL MITIGATION 622110 200000 200000 INTERCOMPANY INCOME 561000 134849 134849 80627775 139111 113789 25322 0 0 294371 294371 0 294371 294371 10299 10299 10299 10299 0 0 0 0 0 0 0 0 0 VENDING MACHINE/CAFETERIA 900099 170543 170543 ALL OTHER REVENUE 900099 26763 26763 197306 86515266 80654538 113789 500535 0 0 0 0 66548 66548 0 29349564 23538000 5751212 60352 592457 552584 38460 1413 3762336 2745056 1005548 11732 1842079 1449964 387739 4376 201116 201116 56963 56963 51555 51555 3796 3796 8125 8125 6466 6466 13817856 11985528 1832328 102916 13481 88967 468 281266 218007 61823 1436 419544 72200 347344 0 2728935 479704 2249231 103233 99673 3560 0 95011 29836 65175 100002 100002 0 5800782 4588100 1212682 708538 708538 SUPPLIES 14283208 13896848 386360 PROVIDER TAX 1371081 1371081 INTERCOMPANY PAYMENTS 8983520 8983520 DUES & SUBSCRIPTIONS 190028 85079 104949 175573 56517 119039 17 85102498 61181658 23832921 87919 9869342 6147629 18709175 13605309 3035656 2143984 4447696 10951536 0 0 0 0 0 0 1782097 1611970 533956 449432 111848349 44223816 68343264 67624533 171960 167994 0 0 0 0 0 0 135079852 137566616 241972998 240269003 7147239 10351019 0 0 0 0 4910221 4656743 0 0 0 0 0 0 0 0 71582527 61978952 83639987 76986714 X 23239608 26772905 135093403 136509384 158333011 163282289 241972998 240269003 X 1412768 3603 3532907 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3796 3796 false SCHEDULE C, PART II-B, LINE 1I LOBBYING EXPENSES ARE THE PORTION OF DUES PAID TO HEALTHCARE ASSOCIATIONS ALLOCATED TO LOBBYING ACTIVITIES. 4129637 860882 177845 22463 4790211 4391892 -44257 195249 22749 4129637 4533839 140572 272942 9577 4391892 4661526 314819 409523 32983 4533839 4715923 1217 385499 414534 26579 4661526 0.00000 1.00000 0.00000 true true true 12210000 12210000 62637958 19360144 43277814 1141924 462151 679773 33590380 24401521 9188859 2268087 2268087 67624533 EQUITY IN PARKER RANCH FDN TRU 123256892 INVESTMENT IN LIBERTY DIALYSIS 42106 BENEFICIAL INTERESTS 4790211 CONTRIBUTED USE OF LAND 6600095 DUE FROM AFFILIATES 390376 OTHER RECEIVABLES 151617 ROU ASSETS 2335319 137566616 0 LEASE LIABILITY 2497761 GENERAL AND PROF TAIL LIABILITY 77886 DUE TO GOVT PROGRAMS 7466577 DUE TO AFFILIATES 51936728 61978952 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, 2021. true true X true X 250. true X true true true false true true 136391 136391 0.00160 16788587 12072477 4716110 0.05540 16924978 12072477 4852501 0.05700 539885 1406694 539885 1406694 17464863 13479171 4852501 0.05700 true 3690764 407293 12884764 15975971 -3091207 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 18 true true true true X SEE PART V, SECTION C X true 18 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 OUR CONSULTANT, ISLANDER INSTITUTE CREATED AN INITIAL LIST OF PEOPLE WHO COULD SHED LIGHT ON QUESTIONS OF HEALTH, SOCIAL DETERMINANTS, AND THE CIRCUMSTANCES IN VARIOUS COMMUNITIES. THE INITIAL LIST INCLUDED EXPERTS AND AUTHORITIES WITH WHOM ISLANDER INSTITUTE HAD EXISTING RELATIONSHIPS BASED ON ITS MANY YEARS OF WORKING IN HAWAII. THROUGHOUT THE MONTHS OF CONVERSATIONS, PEOPLE SUGGESTED OTHERS TO TALK TO AND HELPED MAKE CONNECTIONS. IN TOTAL, ISLANDER INSTITUTE SPOKE WITH ROUGHLY 200 PEOPLE FROM SIX ISLANDS IN PERSON OR OVER THE PHONE, IN A ONE-ON-ONE FORMAT OR IN SMALL GROUPS, AND IN FORMAL OR INFORMAL SETTINGS. A FULL LIST OF KEY INFORMANTS WHOSE VIEWS INFLUENCED THIS REPORT CAN BE FOUND IN APPENDIX E OF THE CHNA. THE CONVERSATIONS BEGAN WITH A FEW GENERAL QUESTIONS, AND KEY INFORMANTS WERE ENCOURAGED TO DELVE INTO WHATEVER THEY FELT WAS MOST IMPORTANT TO SHARE. WHEN APPROPRIATE, THEY SHARED ABOUT THEIR OWN PERSONAL EXPERIENCES AND/OR PROFESSIONAL CONNECTION TO HEALTH. AMONG THE KEY INFORMANTS, ISLANDER INSTITUTE ALSO MET WITH REPRESENTATIVES OF EACH OF THE 19 PARTICIPATING HOSPITAL FACILITIES TO BEST UNDERSTAND THEIR ENGAGEMENT WITH THE CHNA AND THE COMMUNITIES THEY SERVE. THESE CONVERSATIONS HELPED ILLUMINATE INTERESTS, CAPACITIES, AND MISSIONS OF EACH FACILITY AND SHED LIGHT ON LIMITATIONS AND USES OF PREVIOUS CHNAS AND THE POTENTIAL FOR THIS CHNA. AS PART OF THE 2013 AND 2015 CHNAS, KEY INFORMANTS WERE ALSO INTERVIEWED. A FEW OF THE SAME PERSONS PARTICIPATED IN THE 2018 CHNA PROCESS, WHILE OTHERS FELT THEY HAD ALREADY SHARED WHAT THEY HAD TO SAY IN THE PREVIOUS PROCESS(ES). RATHER THAN RE-INTERVIEW MANY OF THE SAME PEOPLE IN THE SAME POSITIONS, ISLANDER INSTITUTE OBTAINED THE INFORMANT INTERVIEW NOTES FROM THE PAST TWO CHNAS, REVIEWED THEM, AND INCORPORATED THOSE VIEWS THAT WERE STILL TIMELY INTO THIS PROCESS. A FULL LIST OF THE REVIEWED PAST INTERVIEWS CAN BE FOUND IN APPENDIX F OF THE CHNA. 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 KAHI MOHALA 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 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 ISLANDER INSTITUTE TO CONDUCT A CHNA FOR HAWAII COUNTY. SCHEDULE H, PART V, SECTION B, LINE 7A & 10A WEBSITE WHERE THE CHNA AND MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY 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: 1. SECURE THE BASIC FOUNDATIONS SO THAT PEOPLE CAN HAVE MORE CONTROL OVER THEIR OWN HEALTH; 1.1 ADDRESS FINANCIAL INSECURITY 1.2 WORK TOGETHER FOR EQUALITY AND JUSTICE 1.3 STRENGTHEN FAMILIES 1.4 PREPARE FOR EMERGENCIES 1.5 BUILD GOOD FOOD SYSTEMS 2. PRESERVE, NURTURE, EXPAND, AND EMPLOY THE HEALING PROPERTIES OF COMMUNITY; 2.1 RESTORE ENVIRONMENT AND SENSE OF PLACE 2.2 NURTURE COMMUNITY IDENTITY AND COHESIVENESS 2.3 INVEST IN TEENAGERS AND HEALTHY STARTS 2.4 SHIFT KUPUNA AWAY FROM "SICK CARE" 3. IMPROVE THE RELATIONSHIP BETWEEN PEOPLE AND THE HEALTHCARE SYSTEM 3.1 STRENGTHEN TRUST IN HEALTHCARE 3.2 PROVIDE ACCESSIBLE, PROACTIVE SUPPORT FOR THOSE WITH HIGH NEEDS 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 IDENTIFIED IN THIS ASSESSMENT AND SELECTED GOAL 3.2 AS THE GOAL FOR THE SYSTEM. (QUEEN'S SENIOR MANAGEMENT TEAM INCLUDES THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, OPERATING ENTITY HEADS, CLINICAL LEADERS [PHYSICIANS AND SERVICE LINES], AND THOSE RESPONSIBLE FOR SYSTEM-WIDE FUNCTIONS SUCH AS HUMAN RESOURCES, FINANCE, ENDOWMENT, LEGAL, CORPORATE DEVELOPMENT, INFORMATION TECHNOLOGY, AND COMMUNITY DEVELOPMENT). WITH THE VASTNESS OF HAWAII ISLAND, IT IS EASY FOR PEOPLE AND PROBLEMS,LIKE HOUSELESSNESS, SEVERE MENTAL ILLNESS, AND SUBSTANCE ABUSE, TO REMAIN HIDDEN AND FORGOTTEN. SOME PREFER NOT TO GO TO THE DOCTOR BECAUSE THEY DO NOT TRUST THEM, THEY FEEL DISRESPECTED AND DISCRIMINATED AGAINST, AND THEY LACK THE MONEY NEEDED FOR PRESCRIPTIONS. MANY JUST WAIT UNTIL THE POINT WHERE THEY ARE SENT TO URGENT CARE OR THE EMERGENCY ROOM. A DIFFICULT AND COMMON BARRIER IS RETURNING TO THE DOCTOR FOR FOLLOW-UPS, WHICH OFTEN DOES NOT HAPPEN BECAUSE OF THE INCONVENIENCE AND LACK OF TRANSPORTATION. THERE ARE DISPARITIES WITHIN THE WAIMEA COMMUNITY, SUCH AS HIDDEN POVERTY THAT REVEALS ITSELF IN THE SCHOOLS. QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL DEVELOPED THE FOLLOWING STRATEGIES TO IMPROVE ACCESS TO CARE AND PROVIDE HIGH QUALITY SERVICES AT A REASONABLE COST: PRIORITIES: 1. IMPROVE HEALTH CARE BY FOCUSING ON AVAILABILITY OF CARE. 2019 - 2020: RECRUIT AND HIRE SPECIALTY PHYSICIANS AND STAFF. 2019 - 2020: DEVELOP WOUND CARE SERVICES. 2019 - 2020: EXPAND PULMONARY SERVICES. 2. SUPPORT NAVIGATION OF ALL PATIENTS AS A WAY TO PROACTIVELY ENSURE ACCESS TO CLINICAL CARE, TRAVEL SUPPORT, FINANCIAL INFORMATION. 2019 - 2020: EXPAND CHILD/ADOLESCENT PSYCHIATRIC SERVICES TO CARE FOR THIS POPULATION'S MENTAL HEALTH NEEDS. 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, APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY IS WIDELY AVAILABLE ON THE QUEEN'S MEDICAL CENTER 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, 2021. 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 RECEIVEABLES 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, 2021 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 2018 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) AND MOLOKAI GENERAL HOSPITAL (MGH). 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 false false false false false false false true false JILL HOGGARD GREEN CHAIR/TRUSTEE 0 961592 0 444535 0 3564 0 189281 0 15648 0 1614620 JASON CHANG TRUSTEE 0 668494 0 309639 0 540 0 115829 0 22963 0 1117465 ARTHUR USHIJIMA FORMER OFFICER 0 814837 0 0 0 190236 0 56866 0 5108 0 1067047 CYNTHIA KAMIKAWA PRESIDENT/TRUSTEE 0 506104 0 138009 0 6858 0 52135 0 14993 0 718099 DARRIN KUCZYNSKI MD PHYSICIAN 509837 0 71500 0 0 0 8550 0 15119 0 605006 0 SHARLENE TSUDA SECRETARY - PART YEAR 0 295145 0 111038 0 3934 0 71472 0 15713 0 497302 HOWARD WONG MD PHYSICIAN 425181 0 35334 0 2322 0 8550 0 8147 0 479534 0 TY CHUN MD PHYSICIAN 404701 0 38529 0 3564 0 8550 0 22775 0 478119 0 MICHAEL SZE MD PHYSICIAN 336094 0 55319 0 2322 0 8550 0 22761 0 425046 0 ANTHONY DESALVO MD PHYSICIAN 319043 0 77679 0 1634 0 8550 0 14149 0 421055 0 MONEY ATWAL TREASURER 0 206247 0 25886 0 635 0 23017 0 16567 0 272352 LILINOE WATANABE FORMER OFFICER 0 187739 0 26291 0 2507 0 39992 0 8179 0 264708 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). SHE IS A VOLUNTEER TRUSTEE AND IS NOT COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED IS HER TOTAL COMPENSATION FOR HER VARIOUS SERVICES. ARTHUR A. USHIJIMA MR. USHIJIMA SERVED AS A TRUSTEE FOR THE QUEEN'S HEALTH SYSTEMS AND SEVERAL OTHER QUEEN'S RELATED AFFILIATES THROUGH SEPTEMBER 2019. MR. USHIJIMA ALSO SERVED AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE QUEEN'S HEALTH SYSTEMS ("QHS", PARENT COMPANY) AND AS PRESIDENT OF THE QUEEN'S MEDICAL CENTER ("QMC"). HE WAS A VOLUNTEER TRUSTEE AND WAS NOT COMPENSATED FOR THESE SERVICES. THE COMPENSATION LISTED WAS HIS TOTAL COMPENSATION FOR HIS VARIOUS SERVICES. CYNTHIA KAMIKAWA MS. KAMIKAWA SERVES AS VP OF QHS AND IS PRESIDENT OF QUEEN'S NORTH HAWAII COMMUNITY HOSPITAL. 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 OF QMC AND TRUSTEE OF QEL, MGH AND QNHCH. 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 QNHCH 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 QNHCH. 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 5310000 0 350362507 0 0 0 4726000 0 0 185627500 160009007 0 2019 true false false 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 $4,656,743. 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 1500 FMV X 650 FMV X 5 625328 FMV X 1 75 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 $8.4M FOR THE YEAR ENDED JUNE 30, 2021. 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, 2021, THE ESTIMATED COST OF PROVIDING CHARITY CARE AND FOR SERVICES THAT WERE BAD DEBTS WAS $136,391 AND $407,293 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 $4,716,110 DURING THE YEAR ENDED JUNE 30, 2021. 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 $3,091,207 DURING THE YEAR ENDED JUNE 30, 2021. 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 CLASSES WERE 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 AUDIT 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 2021. 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 $ 3,532,906 ROUNDING $ 1 ------------ TOTAL $ 3,532,907 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:6169628 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:7580038 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING SERVICES TOTAL FEES:68190 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 HAMAMATSUQUEEN'S PET IMAGING CENTER LL 1301 PUNCHBOWL STREET HONOLULU HI 96813 943266916 PET IMAGING HI NA N/A PRIMARY CARE PHYSICIAN ENTERPRISE LLC 1301 PUNCHBOWL STREET HONOLULU HI 96813 834591861 MEDICAL SERVICES HI NA N/A 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 false false false false false false false false true false false true false false true false false false DIAGNOSTIC LABORATORY SERVICES INC j 134200 FMV THE QUEEN'S MEDICAL CENTER m 272624 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