2017-05-08T12:57:08-05:00 2016-06-30 ERNST & YOUNG US LLP 370 17TH STREET 3300 DENVER CO 80202 990 2015-07-01 990260423 NORTH HAWAII COMMUNITY HOSPITAL % SHANNON OLSEN NORT 8088814400 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 MONEY ATWAL TREASURER 2017-05-03 true KELLEY SIMON P00791436 7209314000 2015 2021-01-29 14:40:06Z CYNTHIA KAMIKAWA 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 58849483 false X WWW.NHCH.COM X 1989 HI ACUTE CARE HOSPITAL WITH THE MISSION TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII. 11 9 477 62 20013 16712 0 846533 49905421 57204021 -46084 29518 773703 763127 50633040 58843199 0 0 0 0 27615471 31539925 17500 20012 118435 28525729 36275252 56158700 67835189 -5525660 -8991990 179837736 195066195 20216824 44565934 159620912 150500261 X ACUTE CARE HOSPITAL WITH THE MISSION TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII. false false 48834909 57378023 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 7/1/2015 - 6/30/2016 THROUGH OUTPATIENT VISITS WAS 42,158 (27,493 CLINIC) AND THE NUMBER OF ADMISSIONS WAS 1,707. 48834909 true true false true false false false false false true true false false true true false 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 false false false false false true true true false false true 75 0 true 477 true true true false false false false false false false false false X 11 9 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 X Maenette Benham EDD Trustee 1.0 2.0 X 0 0 0 Kenneth Graham President/Trustee 54.0 1.0 X X 0 387170 0 Lyle Harada Trustee 1.0 2.0 X 0 0 0 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 Lindsey 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 4.0 X 0 0 0 Arthur Ushijima Chair/Trustee 3.0 62.0 X X 0 1570750 150484 Eric Yeaman Trustee 1.0 6.0 X 0 0 0 Shariann Gonsalves Assistant Secretary 40.0 0.0 X 60868 0 12066 Miquel Simms Vice President 55.0 0.0 X 105120 0 12803 Sharlene Tsuda Secretary 1.0 54.0 X 0 272874 65715 Lilinoe Watanabe Treasurer 3.0 52.0 X 0 174161 33062 SUSAN HUNT VICE PRESIDENT (PART YEAR) 40.0 0.0 X 52816 0 4719 William Hiller MD Physician 50.0 0.0 X 522049 0 20832 John Bellatti MD Physician 50.0 0.0 X 499972 0 38196 Howard Wong MD Physician 50.0 0.0 X 390362 0 12958 Alistair Bairos MD Physician 50.0 0.0 X 361050 0 12563 Jennifer S Real MD Physician 50.0 0.0 X 298233 0 20278 2290470 2404955 383676 43 false true false SODEXO AMERICA LLC Dept 880328 LOS ANGELES CA 90088 CAFETERIA MANAGEMENT 685434 INFINIPRISE TECHNOLOGIES LLC 5950 CARMICHAEL PLACE STE 104 MONTGOMERY AL 36117 IT SERVICES 479244 ANESTHESIA RELIEF LLC 82-1175 Kinue Road CAPTAIN COOK HI 96704 MEDICAL SERVICES 222957 ROGER M BRECHEEN MD 745 Buena Vista Dr LANDER WY 82520 MEDICAL SERVICES 210140 BONNIE L CONRAD 302 FAIRWAYS DRIVE WARNER ROBINS GA 31088 CONSULTING SERVICES 179297 9 0 22581 384255 439697 8297 846533 NET PATIENT SERVICE REVENUE 900099 51647699 51647699 0 0 STATE OF HAWAII SUSTAINABILITY 900099 5215098 5215098 0 0 E.H.R. MEANINGFUL USE 900099 341224 341224 0 0 57204021 20327 20013 314 0 0 146162 146162 0 146162 146162 -1223 16698 6284 -1223 10414 9191 9191 0 0 0 MEDICAL ABSTRACTS 900099 14005 0 0 14005 VENDING MACHINE/CAFETERIA 900099 428958 0 0 428958 MISCELLANEOUS REVENUE 900099 174002 174002 0 0 616965 58843199 57378023 20013 598630 X 0 0 0 0 0 0 0 0 250904 180779 70125 0 0 0 0 0 26231612 20290965 5881375 59272 448999 347000 100767 1232 2770051 2014525 745622 9904 1838359 1385189 448612 4558 1371003 296617 1074386 0 77278 514 76764 0 61218 0 61218 0 0 0 0 0 20012 20012 0 0 0 0 12654593 9138383 3511831 4379 31694 0 31694 0 430110 261818 162537 5755 1010282 0 1010282 0 0 0 0 0 2141868 207411 1934457 0 353450 213872 137966 1612 0 0 0 0 81153 39989 41164 0 595986 423652 171293 1041 0 3143351 2137811 1003306 2234 935532 399411 535154 967 SUPPLIES 8094283 7649704 443799 780 INTERCOMPANY PAYMENTS 3555005 2524454 1024351 6200 PROVIDER TAX 614767 614767 0 0 FOOD 402307 401053 1254 721372 306995 413888 489 67835189 48834909 18881845 118435 0 836097 1180519 2048184 347543 1096285 1485662 10540137 18772695 0 0 0 0 62919 18069 1273492 1926396 478428 499111 78965517 25364036 44546650 53601481 0 0 0 0 0 0 0 0 118955544 117234719 179837736 195066195 5564034 8332856 0 0 0 0 6000000 6000000 0 0 0 0 0 0 0 0 8652790 30233078 20216824 44565934 X 40409627 32991078 9222824 8928252 109988461 108580931 159620912 150500261 179837736 195066195 X -8991990 -971 0 0 0 -127690 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 false 0 false 0 true 3651 3651 false SCHEDULE C, PART II-B, LINE 1I LOBBYING EXPENSES ARE THE PORTION OF DUES PAID TO HEALTHCARE ASSOCIATIONS ALLOCATED TO LOBBYING ACTIVITIES. 4930827 440000 -195847 0 423897 35160 4715923 5093346 12488 170059 0 296875 48191 4930827 5136099 0 248000 0 233658 57095 5093346 5020278 0 565011 0 415135 34055 5136099 4911169 123000 519199 0 514192 18898 5020278 0.88656 0.11344 true true true 12210000 12210000 28468166 2476375 25991791 0 30311421 22887661 7423760 7975930 7975930 53601481 EQUITY IN PARKER RANCH FDN TRU 105349992 INVESTMENT IN LIBERTY DIALYSIS 42106 BENEFICIAL INTERESTS 4715923 CONTRIBUTED USE OF LAND 7126698 117234719 0 DUE TO AFFILIATES 29808788 CAPITAL LEASE OBLIGATION 424290 30233078 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 BENEFITS AS OF JUNE 30, 2016. true true X true X true X true true true false false 145321 145321 0.00210 13276175 8691139 4585036 0.06760 13421496 8691139 4730357 0.06970 444231 350000 94231 0.00140 444231 350000 94231 0.00140 13865727 9041139 4824588 0.07110 true 3449806 230036 8101296 10290623 -2189327 X true true 1 1 NORTH HAWAII COMMUNITY HOSPITAL 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 WWWW.NHCH.COM 39-H X X X NORTH HAWAII MEDICAL GROUP AND KOHALA HOME HEALTH AGENCY NORTH HAWAII COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 15 true true true true X SEE PART V, SECTION C X true 15 false true false true X 150. 250. X X X X X true true X 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 true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 INPUT FROM COMMUNITY REPRESENTATIVES THE QUALITATIVE DATA USED IN THIS ASSESSMENT CONSISTS OF KEY INFORMANT INTERVIEWS COLLECTED BY STORYLINE CONSULTING. KEY INFORMANTS ARE INDIVIDUALS RECOGNIZED FOR THEIR KNOWLEDGE OF COMMUNITY HEALTH IN ONE OR MORE HEALTH AREAS, AND WERE NOMINATED AND SELECTED BY THE HEALTHCARE ASSOCIATION OF HAWAII (HAH) ADVISORY COMMITTEE IN SEPTEMBER 2014. FIFTEEN KEY INFORMANTS WERE INTERVIEWED FOR THEIR KNOWLEDGE ABOUT COMMUNITY HEALTH NEEDS, BARRIERS, STRENGTHS, AND OPPORTUNITIES (INCLUDING NEEDS FOR VULNERABLE AND UNDERSERVED POPULATIONS AS REQUIRED BY IRS REGULATIONS). INTERVIEW TOPICS WERE NOT RESTRICTED TO THE HEALTH AREA FOR WHICH A KEY INFORMANT WAS NOMINATED. KEY INFORMANTS INCLUDED REPRESENTATIVES FROM: AMERICAN DIABETES ASSOCIATION CATHOLIC CHARITIES HAWAII HAWAII DEPARTMENT OF EDUCATION HAWAII DEPARTMENT OF HEALTH, BEHAVIOR HEALTH SERVICES HAWAII DEPARTMENT OF HEALTH, DISEASE OUTBREAK AND CONTROL DIVISION HAWAII DEPARTMENT OF HUMAN SERVICES EXECUTIVE OFFICE OF AGING HAWAII GOVERNORS OFFICE HAWAII DENTAL SERVICES HAWAII MEDICAL SERVICE ASSOCIATION HAWAII PRIMARY CARE ASSOCIATION HAWAII STATE DEPARTMENT OF HEALTH HOMELESS PROGRAMS OFFICE JOHN A. BURNS SCHOOL OF MEDICINE STATE SENATE EXCERPTS FROM THE INTERVIEW TRANSCRIPTS WERE CODED BY RELEVANT TOPIC AREAS AND OTHER KEY TERMS USING THE QUALITATIVE ANALYTIC TOOL DEDOOSE. THE FREQUENCY WITH WHICH A TOPIC AREA WAS DISCUSSED IN KEY INFORMANT INTERVIEWS WAS ONE FACTOR USED TO ASSESS THE RELATIVE URGENCY OF THAT TOPIC AREAS HEALTH AND SOCIAL NEEDS. Schedule H, Part V, Section B, Line 6A FIFTEEN HOSPITALS, LOCATED ACROSS THE STATE, PARTICIPATED IN THE CHNA PROJECT: CASTLE MEDICAL CENTER SUTTER HEALTH KAHI MOHALA BEHAVIORAL HEALTH (SERVES HAWAII COUNTY RESIDENTS) KAISER PERMANENTE MEDICAL CENTER (SERVES HAWAII COUNTY RESIDENTS) KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN (SERVES HAWAII COUNTY RESIDENTS) KUAKINI MEDICAL CENTER MOLOKAI GENERAL HOSPITAL NORTH HAWAII COMMUNITY HOSPITAL (HAWAII COUNTY) PALI MOMI MEDICAL CENTER REHABILITATION HOSPITAL OF THE PACIFIC (SERVES HAWAII COUNTY RESIDENTS) SHRINERS HOSPITAL FOR CHILDREN HONOLULU (SERVES HAWAII COUNTY RESIDENTS) STRAUB CLINIC & HOSPITAL THE QUEENS MEDICAL CENTER (SERVES HAWAII COUNTY RESIDENTS) THE QUEENS MEDICAL CENTER WEST OAHU WAHIAWA GENERAL HOSPITAL WILCOX MEMORIAL HOSPITAL Schedule H, Part V, Section B, Line 6B CHNA OTHER THAN HOSPITAL FACILITIES THE HEALTHCARE ASSOCIATION OF HAWAII PARTNERED WITH HEALTHY COMMUNITIES INSTITUTE TO CONDUCT A CHNA FOR HAWAII COUNTY. Schedule H, Part V, Section B, LINE 7A THE CHNA CAN BE FOUND AT: http://www.nhch.com/cms/View.aspx/Show/Assessment-Report Schedule H, Part V, Section B, Line 11 NEEDS NOT ASSESSED THE CHNA IDENTIFIED 20 AREAS OF COMMUNITY HEALTH NEEDS. NORTH HAWAII COMMUNITY HOSPITAL RECOGNIZES THE IMPORTANCE OF THESE NEEDS AND HAS SUPPORTED EFFORTS TO ADDRESS MANY OF THEM, IT IS ALSO RECOGNIZED THAT THERE ARE HEALTH NEEDS THAT NHCH WILL NOT DIRECTLY BE ADDRESSING DUE TO RESOURCE CONSTRAINTS. NHCH PLANS TO ADDRESS THE EXERCISE, NUTRITION AND WEIGHT COMMUNITY HEALTH NEED INCLUDED IN THE CHNA. NHCH WILL IMPLEMENT A STRATEGY TO CREATE COMMUNITY AWARENESS OF THE RELATIONSHIP BETWEEN AND THE IMPACT OF EXERCISE, WEIGHT AND NUTRITION ON CHRONIC DISEASES SUCH AS DIABETES AND HEART DISEASE AND TO ENCOURAGE COMMUNITY PARTICIPATION IN ACTIVITIES THAT PROMOTE HEALTHY NUTRITION AND EXERCISE. 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 C, LINE 13B INCOME LEVEL OTHER THAN FPG FOR CITIZENS OF FOREIGN COUNTRIES, THE INCOME QUALIFYING LEVEL IS BASED ON THE RESIDENTS COUNTRYS MINIMUM WAGE. SCHEDULE H, PART V, SECTION B, LINES 16A, 16B & 16C THE FINANCIAL ASSITANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE WIDELY AVAILABLE ON THE NORTH HAWAII COMMUNITY HOSPITAL WEBSITE AT: HTTP://WWW.NHCH.COM/CMS/VIEW.ASPX/SHOW/FINANCIALOPTIONS SCHEDULE H, PART V, SECTION B, LINE 16I 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. 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. 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 NHCHS MISSION, PATIENTS RECEIVE CARE REGARDLESS OF WHETHER NHCH COLLECTS PAYMENT FOR SERVICES PERFORMED. SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE BAD DEBT EXPENSE IS SHOWN AS A PERCENTAGE OF TOTAL EXPENSE OF THE HOSPITAL AND REPRESENTS THE PORTION OF UNREIMBURSED EXPENSE FROM THE HOSPITALS APPLICABLE CHARITY CARE PROGRAM. THERE IS NO FOOTNOTE CONTAINED IN THE FINANCIAL STATEMENTS FOR BAD DEBT EXPENSE. PURSUANT TO ASU 2011-07, NHCH REPORTS ITS PROVISION FOR BAD DEBTS RELATED TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM REVENUE, SIMILAR TO CONTRACTUAL DISCOUNTS. 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 NHCHS MISSION AND IS A BENEFIT TO THE COMMUNITY. MEDICARE COSTING METHODOLOGY THE MEDICARE AMOUNTS ABOVE ARE CALCULATED WITH DATA FROM THE JUNE 30, 2016 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 2015 TAX YEAR, 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 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 1995. 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 APPROXIMATELY 16 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. TOTAL COMMUNITY PEOPLE REACHED WAS APPROXIMATELY 2,000. 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 true false false false false false true false Kenneth Graham President/Trustee 0 387170 0 0 0 0 0 0 0 0 0 387170 0 0 Sharlene Tsuda Secretary 0 217015 0 33070 0 22789 0 51428 0 14287 0 338589 0 0 Arthur Ushijima Chair/Trustee 0 828804 0 741946 0 0 0 135496 0 14988 0 1721234 0 0 Lilinoe Watanabe Treasurer 0 160615 0 6600 0 6946 0 22027 0 11035 0 207223 0 0 William Hiller MD Physician 508238 0 0 0 13811 0 0 0 20832 0 542881 0 0 0 John Bellatti MD Physician 470726 0 0 0 29246 0 14588 0 23608 0 538168 0 0 0 Howard Wong MD Physician 388660 0 0 0 1702 0 5300 0 7658 0 403320 0 0 0 Alistair Bairos MD Physician 348159 0 0 0 12891 0 5300 0 7263 0 373613 0 0 0 Jennifer S Real MD Physician 278333 0 10000 0 9900 0 5300 0 14978 0 318511 0 0 0 Schedule J, Part I, Line 3 The organization relied on the Queen's Health System (QHS) 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 4B The CEO participates in a Supplemental Executive Retirement Plan (SERP) that provides for an umbrella benefit equal to a life annuity of 60% of final average salary at normal retirement age (which benefit is offset however by the benefit provided to the CEO under the QHS pension plan, the QHS 401(k) Plan for matching contributions only, the QHS Pension Restoration Plan, and 50% of estimated social security retirement benefits). Normal retirement age is defined as age 65 and the benefit vests and is paid out as a lump sum at that point regardless if employment is continued past age 65. There were no payouts made in 2015. Schedule J, Part I, Line 7 Other Non-Fixed Payments Recognition awards were paid to all listed employees based on accomplishments of predetermined goals set forth in the incentive and strategic plans and because they met defined eligibility requirements. 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 Compensation Paid for Services Arthur A. Ushijima Mr. Ushijima serves as a trustee for the Queen's Health Systems and several other Queen's related affiliates. Mr. Ushijima also serves 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). His hours served as a trustee of North Hawaii Community Hospital (NHCH) are 3 hours per week. He is a volunteer trustee and is not compensated for these services. The compensation listed is his total compensation for his various services he performs in those roles. Kenneth Graham Mr. Graham serves as President of NHCH and VP of QHS. He is not separately compensated for these services. The compensation listed is his total compensation for all services. Sharlene Tsuda Ms. Tsuda serves as Secretary for QHS, QMC and NHCH and VP of Community Development of QHS. She is not separately compensated for these services. The compensation listed is her total compensation for all services. Lilinoe Watanabe Ms. Watanabe serves as Director of Corporate Planning and Analysis for QMC and Treasurer of NHCH. She is not separately compensated for these services. The compensation listed is her 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 0 0 350362507 0 0 0 4726000 0 0 147627222 8116086 55914757 true false false true A false false false true true 0 false false true A false true false false true true ML CAPITAL SERVICES 6.5 false false false 0 false true A true SCHEDULE K NORTH HAWAII COMMUNITY HOSPITAL'S (NHCH) SOLE CORPORATE MEMBER, THE QUEEN'S HEALTH SYSTEMS (QHS) BORROWED ON BEHALF OF ITSELF AND ITS AFFILIATES, NHCH AND THE QUEEN'S MEDICAL CENTER (QMC). INFORMATION REPORTED ON SCHEDULE K IS FOR THE ENTIRE BOND ISSUE. THE OUTSTANDING BOND LIABILITY IS ALLOCATED BETWEEN THE ENTITIES AND REPORTED SEPERATELY ON FORM 990, PART X. NHCH'S SHARE OF THE OUTSTANDING LIABILITY IS $6,000,000. 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 CENTERH AND 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 BENEFITING THE OBLIGATED GROUP MEMBERS AND PAY COSTS OF ISSUANCE OF THE BONDS. THE ISSUE DATES FOR THE REFUNDED BONDS WERE: 12/11/2003 5/6/2009 3/16/2006 FORM 990, PART III, LINE 4A TO SUPPORT THE NHCHS MISSION AND TO FULFILL THE TAX EXEMPT PURPOSE AS A CHARITABLE HOSPITAL, NHCH PROVIDED THE FOLLOWING COMMUNITY BENEFITS, TOTALING APPROXIMATELY $7,243,000 FOR THE YEAR ENDED JUNE 30, 2016. 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, 2016, THE ESTIMATED COST OF PROVIDING CHARITY CARE AND FOR SERVICES THAT WERE BAD DEBTS WAS $145,000 AND $230,000, 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 $4,585,000 DURING THE YEAR ENDED JUNE 30, 2016. 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 $2,189,000 DURING THE YEAR ENDED JUNE 30, 2016. CONSISTENT WITH COST REPORT REQUIREMENTS, THERE ARE AMOUNTS THAT ARE EXCLUDED FROM THE COSTS ABOVE. 4. COMMUNITY HEALTH IMPROVEMENT NHCH PROVIDES SERVICES AND PROGRAMS TO THE COMMUNITY IN AN EFFORT TO PROMOTE HEALTHY LIFESTYLES. PROGRAMS INCLUDE HEALTH & SAFETY FAIRS, HEALTHY EATING PROGRAMS FOR THE LOCAL COMMUNITY AND AFTER SCHOOL PROGRAMS AT A LOCAL CHARTER SCHOOL. THE COST OF PROVIDING THESE SERVICES WAS $94,000 FOR THE YEAR ENDED JUNE 30, 2016. FORM 990, PART VI, LINE 6 DESCRIPTION OF CLASSES OF 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; AND 13. CAPITAL EXPENDITURES IN EXCESS OF $1,000,000 FOR NHCH. FORM 990, PART VI, LINE 11B DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR THE GOVERNING BODY TO REVIEW 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 PREPARED 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 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, LINE 12, 13 & 14 NHCH ABIDES BY THE CONFLICT OF INTEREST, WHISTLEBLOWER AND DOCUMENT RETENTION POLICIES THAT 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 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 MANAGER 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, LINE 15A & 15B PROCESS FOR DETERMINING COMPENSATION ALTHOUGH NOT COMPENSATED BY THE QUEEN'S MEDICAL CENTER, 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. NHCHS 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 2016. 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 NHCHS 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 ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS CHANGE IN BENEFICIAL INTEREST (127,682) ROUNDING ( 8) --------- TOTAL (127,690) FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:6461704 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:6192889 MOLOKAI GENERAL HOSPITAL PO BOX 408 KAUNAKAKAI MOLOKAI HI 96748 990251372 MEDICAL SVCS HI 501(c)(3) 3 QHS true LUCY C HENRIQUES TRUST PO BOX 3170 DEPT 715 HONOLULU HI 96802 996002291 SUPPORT HI 501(c)(3) 11c NA false PARKER RANCH FOUNDATION TRUST 66-1304 MAMALAHOA HIGHWAY KAMUELA HI 96743 996064620 PROPERTY MGMT HI 501(c)(3) 11a NA false THE QUEEN'S HEALTH SYSTEMS 1301 PUNCHBOWL STREET HONOLULU HI 96813 990238120 ADMIN SERVICE HI 501(c)(3) 11c NA false QUEEN EMMA LAND COMPANY 1301 PUNCHBOWL STREET HONOLULU HI 96813 990183769 SUPPORT SVCS HI 501(c)(3) 11B QHS true THE QUEEN'S MEDICAL CENTER 1301 PUNCHBOWL STREET HONOLULU HI 96813 990073524 MEDICAL SVCS HI 501(c)(3) 3 QHS true HAMAMATSUQUEEN'S PET IMAGING 1301 PUNCHBOWL STREET HONOLULU HI 96813 943266916 PET IMAGING HI NA THE QUEEN'S DEVELOPMENT CORPORATION 1301 PUNCHBOWL STREET HONOLULU HI 96813 990240109 DEVELOPMENT HI QHS C Corp true QUEEN'S INSURANCE EXCHANGE 1301 PUNCHBOWL STREET HONOLULU HI 96813 911913839 INSURANCE HI QHS C Corp true DIAGNOSTIC LABORATORY SERVICES INC 99-859 IWAIWA STREET AIEA HI 96701 990240499 MEDICAL LAB SVCS HI QDC C Corp true false false true false false false false false false false false false true false false false false false false THE QUEEN'S MEDICAL CENTER m 562370 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