2021-05-14T17:18:16-05:00 2020-06-30 ERNST & YOUNG US LLP 4365 EXECUTIVE DR STE 1600 SAN DIEGO CA 92121 990 2019-07-01 383840327 Pali Momi Foundation % DONNA MASUDA-KAM PALI 8085357100 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 CARRIE ANN TSUTSUI vice president 8085357100 2021-05-14 true JOCELYNE MILLER P00634378 8585357200 2019 2022-09-23 18:48:47Z DAWN DUNBAR 55 MERCHANT STREET 26TH FLOOR HONOLULU HI 96813 538588 false X https://giving.hawaiipacifichealth.org X 2010 HI THE MISSION OF PALI MOMI FOUNDATION IS TO CREATE A HEALTHIER HAWAI'I. 10 9 0 17 0 0 673857 527187 0 0 10330 4715 0 0 684187 531902 616252 568684 0 0 0 0 0 0 563860 789691 827335 1405943 1396019 -721756 -864117 902983 770659 180776 151669 722207 618990 X THE MISSION OF PALI MOMI FOUNDATION IS TO CREATE A HEALTHIER HAWAI'I. false false 562874 568684 0 SEE SCHEDULE O. 562874 true true false false false false false false false true false true true true true false false true false false false false false false false false false true false true false false false false false false false false false false false false false true true true false false true X 0 0 0 false false false false false false false false false false false false X 10 9 false false false false true true true true true false false true true true true true true false false false HI X X DONNA MASUDA-KAM 8085357355 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 RAYMOND P VARA JR Board of Director 0.1 62.0 X 0 2726020 809070 DAVID OKABE Treasurer 0.1 49.9 X 0 1137967 324115 CHARLES R CHING Secretary 0.1 39.9 X 0 882738 259467 DAWN DUNBAR President 5.0 40.0 X 0 386847 109851 EARL INOUYE Assistant Treasurer (part yr) 0.1 47.9 X 0 362232 91604 MICHAEL ROBINSON Former Officer 0.0 50.0 X 0 310671 80378 JESSICA LEWIS Assistant Secretary 0.5 39.5 X 0 160085 38697 CARRIE ANN TSUTSUI Assistant Treasurer 0.1 47.9 X 0 168392 28870 AARON AKAU Board of Director 0.1 0.0 X 0 0 0 WADE GESTEUYALA Board of Director 0.1 0.0 X 0 0 0 BETH HOBAN RN Board of Director 0.1 0.0 X 0 0 0 KEITH HORITA Board of Director, Vice Chair 0.1 0.0 X X 0 0 0 GREGG T KOKAME MD Board of Director (PART YEAR) 0.1 0.0 X 0 0 0 EMILY KURAOKA Board of Director, Chair 0.5 0.2 X X 0 0 0 MIKE LAM Board of Director 0.1 0.0 X 0 0 0 MICHELE OTAKE Board of Director 0.1 0.0 X 0 0 0 DARRYL TURNER Board of Director 0.1 0.0 X 0 0 0 LUKE YEH Board of Director 0.1 0.0 X 0 0 0 0 6134952 1742052 0 true true false 0 527187 16859 527187 0 4778 4778 0 0 0 0 0 6623 6686 -63 -63 -63 0 0 0 0 0 0 0 0 0 0 531902 4715 X 568684 568684 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11779 0 11779 0 0 0 0 0 0 0 0 0 0 0 641070 0 197241 443829 8888 0 0 8888 8489 0 5267 3222 12930 0 0 12930 0 0 0 0 17668 0 0 17668 4975 0 0 4975 0 0 0 0 125 0 0 125 0 0 0 0 0 0 0 0 0 0 0 0 6563 0 6563 0 CORPORATE ALLOCATION 48435 0 48435 0 PRINTING & DESIGN SVCS 41564 0 0 41564 GRANT WRITING 8190 0 0 8190 OTHER EXPENSES 16659 -5810 0 22469 1396019 562874 269285 563860 0 0 0 171339 40790 250506 230408 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 214943 90292 176898 132003 50000 234660 0 0 39297 42506 902983 770659 5843 5324 0 0 0 0 0 0 0 0 0 0 0 0 0 0 174933 146345 180776 151669 X -1126301 -1268901 1848508 1887891 722207 618990 902983 770659 X -864117 9386 0 0 0 751514 X false true X true false X 280026 907719 395532 673857 527187 2784321 0 0 280026 907719 395532 673857 527187 2784321 296942 2487379 -6712 7244 15956 10291 4778 31557 0 0 2815878 0.88334 0.84253 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 234660 234660 50000 184660 234660 30000 20000 50000 0 30000 30000 1.00000 false false COMBINED INVESTMENT POOL 132003 F 132003 LIMITED PARTNERSHIPS 138335 F EQUITY SECURITIES 79003 F DEBT SECURITIES 15621 F CASH AND SHORT-TERM INVESTMENT 1701 F 234660 STRAUB FOUNDATION 21642 WILCOX HEALTH FOUNDATION 12559 KAPI'OLANI HEALTH FOUNDATION 6757 STRAUB CLINIC & HOSPITAL 1439 KAPI'OLANI MED SPECIALISTS 100 KAUA'I MEDICAL CENTER 9 42506 0 DUE TO: 0 HAWAI'I PACIFIC HEALTH 68061 KAPI'OLANI MED CTR WOMEN & CHILDREN 41560 HAWAI'I PACIFIC HEALTH RSRCH 23255 PALI MOMI MEDICAL CENTER 13333 WILCOX MEMORIAL HOSPITAL 136 146345 SCHEDULE D, PART V, LINE 4 DESCRIPTION OF INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS ENDOWMENT FUNDS ARE MANAGED TO ENSURE THAT THE RETURNS SUPPORT THE MEDICAL CENTER'S OPERATIONS; HIRING OF STAFF; IMPLEMENTATION OF PROGRAMS; RESEARCH AND EDUCATION; AND PROVIDE QUALITY CARE FOR PATIENTS, ALL IN ACCORDANCE WITH THE DONOR'S INTENT AND THE ORGANIZATION'S MISSION. true PALI MOMI MEDICAL CENTER 55 MERCHANT ST 24TH FL HONOLULU HI 96813 990274038 501(c)(3) 558511 10173 FMV GIFT IN KIND GENERAL SUPPORT 1 FORM 990, SCHEDULE I DESCR OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS TEMPORARILY RESTRICTED FUNDS RELEASED (& GRANTED) TO THE AFFILIATED ORGANIZATIONS ARE RELEASED AFTER THE SPECIFIC PURPOSE OF THE FUND HAS BEEN MET. ONCE THE AFFILIATED ORGANIZATION COMMUNICATES THE EXPENSE AND SATISFIES THE SUBSTANTIATION OF THE EXPENSE FOR THE PURPOSE THAT THE FUNDS WERE CONTRIBUTED FOR, THE FOUNDATION RELEASES THE RESTRICTION AND RECORDS THE GRANT TO THE AFFILIATED ORGANIZATION. NO FURTHER MONITORING OF THE FUNDS AFTER DISTRIBUTION IS NECESSARY. false true false false false false false false false RAYMOND P VARA JR Board of Director 0 1033137 0 1243254 0 449629 0 783086 0 25984 0 3535090 0 1164033 DAVID OKABE Treasurer 0 520205 0 406003 0 211759 0 309351 0 14764 0 1462082 0 413043 CHARLES R CHING Secretary 0 409868 0 297161 0 175709 0 236489 0 22978 0 1142205 0 306902 DAWN DUNBAR President 0 281633 0 71604 0 33610 0 86358 0 23493 0 496698 0 55170 EARL INOUYE Assistant Treasurer (part yr) 0 268741 0 51409 0 42082 0 76325 0 15279 0 453836 0 51704 MICHAEL ROBINSON Former Officer 0 241022 0 48215 0 21434 0 70610 0 9768 0 391049 0 41364 JESSICA LEWIS Assistant Secretary 0 160085 0 0 0 0 0 13865 0 24832 0 198782 0 0 CARRIE ANN TSUTSUI Assistant Treasurer 0 155055 0 13337 0 0 0 17786 0 11084 0 197262 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 SUPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S PRESIDENT 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, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. FORM 990, SCHEDULE J, PART I, LINE 4B 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. AMOUNT PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $173,419 DAVID OKABE - $72,787 CHARLES R. - CHING $44,640 ANNUAL AND LONG TERM INCENTIVE PLAN THE ANNUAL AND LONG TERM INCENTIVE PLANS ARE AFFORDED TO EXECUTIVES BASED ON ANNUAL AND LONG TERM SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. AMOUNT PAID OUT DURING THE YEAR BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR. - $1,093,254 DAVID OKABE - $381,003 EARL INOUYE - $51,409 CHARLES R. CHING - $297,161 MICHAEL ROBINSON - $48,215 DAWN DUNBAR - $71,604 FORM 990, PART III, LINE 4 PROGRAM SERVICE ACCOMPLISHMENTS THE MISSION OF PALI MOMI FOUNDATION (THE FOUNDATION) IS TO CREATE A HEALTHIER HAWAI'I. PALI MOMI MEDICAL CENTER (PALI MOMI) IS A NOT-FOR-PROFIT MEDICAL CENTER LOCATED IN WEST O'AHU THAT IS DEDICATED TO THE HEALTH AND WELL-BEING OF ALL HAWAI'I RESIDENTS. PALI MOMI HAS DELIVERED MANY MEDICAL FIRSTS FOR CENTRAL AND WEST O'AHU OFFERING A FULL RANGE OF SERVICES. PALI MOMI IS PART OF THE HAWAI'I PACIFIC HEALTH SYSTEM, ONE OF THE STATE'S LARGEST HEALTH CARE PROVIDERS. AS A NOT-FOR-PROFIT MEDICAL CENTER, PALI MOMI RELIES ON PHILANTHROPIC SUPPORT FROM THE COMMUNITY TO FULFILL ITS MISSION AND CARE FOR PATIENTS REGARDLESS OF THE PATIENT'S ABILITY TO PAY. CONTRIBUTIONS, BOTH UNRESTRICTED AND DESIGNATED, HELP THE MEDICAL CENTER PROVIDE EXCEPTIONAL MEDICAL CARE. GENEROUS DONATIONS ASSIST, AND ARE NOT LIMITED TO, THESE AREAS: PATIENT AND SPECIALITY CARE, CAPITAL IMPROVEMENTS, EDUCATION AND RESEARCH, COMMUNITY HEALTH AND UNCOMPENSATED CARE. PATIENT AND SPECIALTY CARE CANCER CENTER THE HAWAI'I PACIFIC HEALTH CANCER CENTER AT PALI MOMI MEDICAL CENTER OFFERS DIAGNOSIS, TREATMENT AND SUPPORT SERVICES FOR CANCER PATIENTS AND FAMILIES. THE 24,000 SQUARE-FOOT-CENTER PROVIDES COMPREHENSIVE AND COORDINATED CANCER CARE. RECENT CANCER CARE FUNDED PROJECTS INCLUDE THE CANCER SURVIVORSHIP PROGRAM THAT PROVIDES FREE YOGA CLASSES FOR PATIENTS UNDERGOING CANCER CARE AS WELL AS CAPITAL IMPROVEMENTS TO THE FACILITY. EDUCATION AND RESEARCH SIMULATION TRAINING THE INNOVATION AND NEW TECHNOLOGY FUND IS HELPING TO SUPPORT THE HAWAII PACIFIC HEALTH CENTER FOR SIMULATION AT PALI MOMI MEDICAL CENTER. THIS SIMILATION LAB OFFERS CLINICAL TRAINING AND CONTINUING EDCUATION FOR MEDICAL PROFESSIONALS IN CENTRAL AND WEST OAHU. FUNDING HAS INCREASED ACCESS AND CAPABILITIES OF THESE TRAININGS AS WELL AS IMPROVED TEAMWORK, EFFICIENCIES, AND OVERALL PATIENT OUTCOMES AT THE MEDICAL CENTER. COMMUNITY HEALTH AND UNCOMPENSATED CARE PATIENT ASSISTANCE FUND: OHANA FUND THE PURPOSE OF THE PATIENT ASSISTANCE FUND IS TO ASSIST MEDICAL CENTER PATIENTS AND/OR THEIR SUPPORT SYSTEM RECEIVING SERVICES, INCLUDING EMERGENCY ROOM AND OUTPATIENT SERVICES AT THIS FACILITY. THE MANAGEMENT AND DISBURSEMENT OF THE PATIENT ASSISTANCE FUND, OR OHANA FUND, IS LEFT TO THE DISCRETION OF THIS FACILITY TO MEET SPECIFIC PATIENT CARE NEEDS. THE FUNDS MAY BE USED FOR PATIENTS AND/OR THEIR SUPPORT SYSTEM THAT HAVE FINANCIAL BARRIERS AND NEED CONTINUED MEDICAL OR PSYCHOSOCIAL SUPPORT OR TO FACILITATE DISCHARGE. FORM 990, PART V, LINE 1A HAWAI'I PACIFIC HEALTH (HPH), THE ORGANIZATION'S TAX EXEMPT PARENT, PAYS ALL VENDORS. THEREFORE, HPH ISSUES FORM 1099S UNDER ITS TAX ID. FORM 990, PART VI, LINE 6 MEMBERS AND RIGHTS 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 BOARD. FORM 990, PART VI, LINE 7A DESCRIPTION OF CLASSES OF PERSON AND THE NATURE OF THEIR RIGHTS 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 DESCRIPTION OF CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS EXCLUSIVE POWER TO TAKE AND DIRECT THE FOLLOWING ACTIONS OF THE CORPORATION: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: PRESIDENT, VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE CHAIR AND VICE-CHAIR OF THE BOARD; (II) AFTER CONSULTATION WITH THE BOARD, REMOVE THE PRESIDENT, VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE CHAIR AND VICE-CHAIR; (III) REMOVE A DIRECTOR FROM THE BOARD; (IV) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER; (V) AMEND THESE BYLAWS; (VI) CAUSE THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1) YEAR AND/OR ONE MILLION DOLLARS ($1,000,000) OR MORE; (VII) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (VIII) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE, AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (IX) DETERMINE AND EFFECT INTER-CORPORATE FUND TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (X) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S EXECUTIVE COMPENSATION AND BENEFIT PLANS; (XI) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (XII) DEVELOP AND PROMULGATE OVERALL CORPORATE GOALS AND THE LONG-RANGE AND STRATEGIC PLAN OF THE CORPORATION; AND (XIII) DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. THE CORPORATION SHALL NOT TAKE THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING MEMBER APPROVAL: (I) ELECT ANY DIRECTOR TO THE BOARD; (II) AMEND THE ARTICLES; (III) MERGE THE CORPORATION WITH ANY ENTITY; (IV) DISSOLVE THE CORPORATION; (V) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS BY OR ON BEHALF OF THE CORPORATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (VI) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000) EXCEPT FOR THOSE ASSETS ACQUIRED BY GIFTS, GRANT, OR DONATION; (VII) ACQUIRE SHARES IN ANOTHER CORPORATION; (VIII) SELL, LEASE, EXCHANGE, ENCUMBER OR DISPOSE OF TWENTY-FIVE PERCENT (25%) OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION TO ANY ENTITY THAT IS NOT AN AFFILIATE; (IX) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (X) 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 (XI) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE. FORM 990, PART VI, LINE 11B REVIEW OF THE 990 BY THE ORGANIZATION'S GOVERNING BODY VARIOUS SCHEDULES OF THE 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 OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPLETED 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 DESCRIBE THE MISSION/PURPOSE AND PROGRAM ACCOMPLISHMENTS OF THEIR ORGANIZATION. SENIOR MANAGEMENT OF THE HEALTH CARE SYSTEM REVIEWS THE 990S OF EACH FILING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE 990S ARE THEN PROVIDED TO THE GOVERNANCE AND NOMINATING COMMITTEE OF THE HEALTH CARE SYSTEM'S BOARD OF DIRECTORS FOR THEIR REVIEW. THE GOVERNANCE AND NOMINATING COMMITTEE OF THE PARENT ENTITY'S (HAWAI'I PACIFIC HEALTH "HPH") BOARD PROVIDES OVERSIGHT FOR THE 990 REPORTING AND REVIEWS THE 990S FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE 990S FOR EACH ENTITY ARE 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 990. THE 990S WILL BE POSTED TO HPH'S WEBSITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURN WITH THE IRS. FORM 990, PART VI, LINE 12C MONITORING & ENFORCING OF 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; 4) HAS DISCLOSED ANY CONFLICTS OR POTENTIAL CONFLICTS OR ECONOMIC INTERESTS AS REQUIRED; AND 5) 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 PERSONS PRESENT IN THE DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, LINES 15A & 15B PROCESS OF DETERMINING COMPENSATION THE PRESIDENT, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE 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 PRESIDENT, OFFICERS AND KEY EMPLOYEES' 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 LAST COMPLETED ON MARCH 9, 2020 TO REVIEW PHYSICIAN COMPENSATION AND ON JULY 29, 2020 TO REVIEW EXECUTIVE COMPENSATION. FORM 990, PART VI, LINE 19 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 XI, LINE 9 OTHER CHANGES IN NET ASSETS $ 690,563 - EQUITY TRANSFERS WITH HPH $ 60,951 - INTERCOMPANY TRANSFERS BETWEEN FOUNDATIONS -------------- $ 751,514 - TOTAL FORM 990 PART IX LINE 11G DESCRIPTION:INTERNAL SVC PROVIDER EXPENSE TOTAL FEES:603093 FORM 990 PART IX LINE 11G DESCRIPTION:MGR/DIR BONUS TOTAL FEES:35475 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULT. SVCS FUNDR. STRATEGY TOTAL FEES:2502 HAWAI'I PACIFIC HEALTH 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990318588 ADMIN SVCS HI 501(c)(3) 12B, 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) 10 HPH true KAUA'I MEDICAL CLINIC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990326099 HOSPITAL HI 501(c)(3) 3 HPH true PALI MOMI MEDCIAL 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) 12B, 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 26TH FLOOR HONOLULU HI 96813 990109350 RESEARCH/EDUC 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 ASC PACIFIC VENTURES LLC 55 Merchant St 27th floor Honolulu HI 96813 270540034 AMBU. SURG. CTR AL NA N/A HAWAI'I PACIFIC HEALTH PARTNERS INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990318588 HOLDING COMPANY HI HPH C CORP STRAUB PHARMACY 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990145107 INACTIVE HI NA C CORP HICORD INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990251496 INVESTMENT HI NA C CORP false true false false false false false false false false false false false false true true true true true PALI MOMI MEDICAL CENTER b 353342 FMV KAPI'OLANI HEALTH FOUNDATION q 75588 FMV KAPI'OLANI HEALTH FOUNDATION r 60381 FMV SCHEDULE R, PART III RELATED ORG. TAXABLE AS PARTNERSHIP ASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 55 MERCHANT ST., 27TH FLOOR, HONOLULU, HI 96813