QUEENS NORTH HAWAII COMMUNITY HOSPITAL: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
QUEENS NORTH HAWAII COMMUNITY HOSPITAL (EIN 99-0260423)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-05-04
IRS object ID
201601259349301640
Schema version
2014v6.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-05-04T20:41:22-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1370 17TH STREET 3300AddressLine1Txt
CityDENVERCityNm
State AbbreviationCOStateAbbreviationCd
ZIP80202ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN990260423EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1North Hawaii Community HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% SHANNON OLSENInCareOfNm
Business Name ControlNORTBusinessNameControlTxt
Phone8088814400PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line167-1125 MAMALAHOA HIGHWAYAddressLine1Txt
CityKAMUELACityNm
State AbbreviationHIStateAbbreviationCd
ZIP967438496ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonLILINOE WATANABEPersonNm
Person TitleTREASURERPersonTitleTxt
Phone8088814400PhoneNum
Signature2016-05-03SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKELLEY SIMONPreparerPersonNm
PTINP00791436PTIN
Phone7209314000PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKENNETH GRAHAMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line167-1125 MAMALAHOA HIGHWAYAddressLine1Txt
CityKAMUELACityNm
State AbbreviationHIStateAbbreviationCd
ZIP967438496ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$51,687,022GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.NHCH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1989FormationYr
Legal Domicile StateHILegalDomicileStateCd
Activity Or MissionACUTE CARE HOSPITAL WITH THE MISSION TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee430TotalEmployeeCnt
Total Volunteers61TotalVolunteersCnt
Total Gross UBI$13,370TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$12,019NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$482,252PYContributionsGrantsAmt
CY Contributions Grants$930,512CYContributionsGrantsAmt
PY Program Service Revenue$27,642,647PYProgramServiceRevenueAmt
CY Program Service Revenue$49,905,421CYProgramServiceRevenueAmt
PY Investment Income-$103,920PYInvestmentIncomeAmt
CY Investment Income-$46,084CYInvestmentIncomeAmt
PY Other Revenue$405,229PYOtherRevenueAmt
CY Other Revenue$773,703CYOtherRevenueAmt
PY Total Revenue$28,426,208PYTotalRevenueAmt
CY Total Revenue$51,563,552CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$14,408,120PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$27,615,471CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$10,018PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$17,500CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$130,839CYTotalFundraisingExpenseAmt
PY Other Expenses$11,959,630PYOtherExpensesAmt
CY Other Expenses$28,525,729CYOtherExpensesAmt
PY Total Expenses$26,377,768PYTotalExpensesAmt
CY Total Expenses$56,158,700CYTotalExpensesAmt
PY Revenues Less Expenses$2,048,440PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$4,595,148CYRevenuesLessExpensesAmt
Total Assets BOY$177,406,425TotalAssetsBOYAmt
Total Assets EOY$179,837,736TotalAssetsEOYAmt
Total Liabilities BOY$13,809,280TotalLiabilitiesBOYAmt
Total Liabilities EOY$20,216,824TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$163,597,145NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$159,620,912NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionACUTE CARE HOSPITAL WITH THE MISSION TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$39,869,046ExpenseAmt
Grant$0GrantAmt
Revenue$49,905,421RevenueAmt
DescNORTH 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 7/1/2014 - 6/30/2015 THROUGH OUTPATIENT VISITS WAS 37,208 (19,941 CLINIC) AND THE NUMBER OF ADMISSIONS WAS 1,754.Desc
Total Program Service Expenses$39,869,046TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document77IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee430EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyfalseConflictOfInterestPolicyInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedurefalseWrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSHANNON OLSENPersonNm
Phone8088814675PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line167-1125 MAMALAHOA HIGHWAYAddressLine1Txt
CityKAMUELACityNm
State AbbreviationHIStateAbbreviationCd
ZIP967430496ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
MAENETTE BENHAM EDD
TRUSTEE1.02.0Yes (X)$0$0$0
LYLE HARADA
TRUSTEE1.02.0Yes (X)$0$0$0
ROBERT HASTINGS II
TRUSTEE1.00.0Yes (X)$0$0$0
NEIL KUYPER
TRUSTEE1.00.0Yes (X)$0$0$0
RICHARD LEVY PHD
TRUSTEE1.00.0Yes (X)$0$0$0
ROBERT LINDSEY
TRUSTEE1.00.0Yes (X)$0$0$0
KAHU BILLY MITCHELL
TRUSTEE1.00.0Yes (X)$0$0$0
ROBERT MOMSEN
TRUSTEE1.02.0Yes (X)$0$0$0
ERIC YEAMAN
TRUSTEE1.06.0Yes (X)$0$0$0
ARTHUR USHIJIMA
CHAIR/TRUSTEE3.062.0Yes (X)$0$1,608,484$186,028Yes (X)
KENNETH GRAHAM
PRESIDENT/TRUSTEE54.01.0Yes (X)$0$237,524$0Yes (X)
MARILYNN HATA
ASST TREASURER (PART YR)55.00.0$0$145,813$0Yes (X)
ROBERT NOBRIGA
TREASURER (PART YEAR)1.059.0$0$462,437$78,779Yes (X)
SUSAN HUNT
VICE PRESIDENT40.00.0$37,831$0$0Yes (X)
SHARLENE TSUDA
SECRETARY1.054.0$0$281,766$67,474Yes (X)
SHARIANN GONSALVES
ASSISTANT SECRETARY40.00.0$62,316$0$6,250Yes (X)
LILINOE WATANABE
TREASURER3.052.0$0$186,779$34,774Yes (X)
WILLIAM HILLER
PHYSICIAN40.00.0$499,842$0$23,223Yes (X)
JOHN BELLATTI
PHYSICIAN40.00.0$471,965$0$25,287Yes (X)
HOWARD WONG
PHYSICIAN40.00.0$391,245$0$12,686Yes (X)
JENNIFER S REAL
PHYSICIAN40.00.0$331,039$0$16,465Yes (X)
JONATHAN ZARLEY
PHYSICIAN40.00.0$267,481$0$23,132Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,061,719TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,922,803TotReportableCompRltdOrgAmt
Total Other Compensation$474,098TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K42IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CLINICAL LABS OF HAWAII LLP
MAIL CODE 60300 PO BOX 1300HONOLULUHI96807LAB SERVICES$950,030
CA INDUSTRIES INC
PO BOX 3037OMAHANE68103STAFFING$799,788
COMHEALTH MEDICAL STAFFING INC
6440 SOUTH MILLROCK DRIVE STE 175SALT LAKE CITYUT84121STAFFING$789,981
INFINIPRISE TECHNOLOGIES LLC
5950 CARMICHAEL PLACE STE 104MONTGOMERYAL36117IT SERVICES$511,443
PAN PACIFIC PATHOLOGISTS LLC
2230 LILIHA STREETHONOLULUHI96817PATHOLOGY SERVICES$336,469
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K14CntrctRcvdGreaterThan100KCnt
Fundraising$0FundraisingAmt
Government Grants$399,898GovernmentGrantsAmt
All Other Contributions$530,614AllOtherContributionsAmt
Noncash Contributions$0NoncashContributionsAmt
Total Contributions$930,512TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
Patient Service Revenue900099$45,903,908$45,903,908$0$0
STATE OF HAWAII SUSTAINABILITY900099$3,872,742$3,872,742$0$0
E.H.R. Meaningful Use900099$128,771$128,771$0$0
FieldValueIRS element (for citing)
Total Program Service Revenue$49,905,421TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$25,724TotalRevenueColumnAmt
Unrelated Business Revenue$13,370UnrelatedBusinessRevenueAmt
Exclusion$12,354ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$252,319RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$252,319RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$252,319TotalRevenueColumnAmt
Exclusion$252,319ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$195SecuritiesAmt
Other$51,467OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$123,470OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$195SecuritiesAmt
Other-$72,003OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$71,808TotalRevenueColumnAmt
Exclusion-$71,808ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
Medical Abstracts900099$9,467$0$0$9,467
Vending Machine/Cafeteria900099$370,062$0$0$370,062
Miscellaneous Revenue900099$141,855$0$0$141,855
FieldValueIRS element (for citing)
Other Revenue Total$521,384OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$51,563,552TotalRevenueColumnAmt
Related Or Exempt Func Income$49,905,421RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$13,370UnrelatedBusinessRevenueAmt
Exclusion$714,249ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$181,114TotalAmt
Program Services$181,114ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$82,284TotalAmt
Program Services$0ProgramServicesAmt
Management And General$82,284ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$22,580,009TotalAmt
Program Services$17,440,334ProgramServicesAmt
Management And General$5,078,327ManagementAndGeneralAmt
Fundraising$61,348FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$396,938TotalAmt
Program Services$304,612ProgramServicesAmt
Management And General$91,128ManagementAndGeneralAmt
Fundraising$1,198FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,796,186TotalAmt
Program Services$2,097,304ProgramServicesAmt
Management And General$668,989ManagementAndGeneralAmt
Fundraising$29,893FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,578,940TotalAmt
Program Services$1,207,792ProgramServicesAmt
Management And General$366,560ManagementAndGeneralAmt
Fundraising$4,588FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$991,462TotalAmt
Program Services$50,193ProgramServicesAmt
Management And General$941,269ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$105,045TotalAmt
Program Services$0ProgramServicesAmt
Management And General$105,045ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$87,635TotalAmt
Program Services$0ProgramServicesAmt
Management And General$87,635ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$2,982TotalAmt
Program Services$0ProgramServicesAmt
Management And General$2,982ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$17,500TotalAmt
Fundraising$17,500FundraisingAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$8,522,215TotalAmt
Program Services$6,723,701ProgramServicesAmt
Management And General$1,797,235ManagementAndGeneralAmt
Fundraising$1,279FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$17,568TotalAmt
Program Services$0ProgramServicesAmt
Management And General$17,568ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$391,946TotalAmt
Program Services$240,327ProgramServicesAmt
Management And General$148,873ManagementAndGeneralAmt
Fundraising$2,746FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,023,513TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,023,513ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,065,912TotalAmt
Program Services$84,604ProgramServicesAmt
Management And General$1,981,308ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$217,984TotalAmt
Program Services$112,815ProgramServicesAmt
Management And General$104,308ManagementAndGeneralAmt
Fundraising$861FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$37,292TotalAmt
Program Services$24,776ProgramServicesAmt
Management And General$12,516ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$185,384TotalAmt
Program Services$131,611ProgramServicesAmt
Management And General$53,341ManagementAndGeneralAmt
Fundraising$432FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,887,803TotalAmt
Program Services$1,936,527ProgramServicesAmt
Management And General$948,388ManagementAndGeneralAmt
Fundraising$2,888FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,165,692TotalAmt
Program Services$441,160ProgramServicesAmt
Management And General$723,084ManagementAndGeneralAmt
Fundraising$1,448FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
SUPPLIES$6,948,912$6,549,725$398,885$302
PROVIDER TAX$374,028$0$374,028$0
INTERCOMPANY PAYMENTS$2,433,205$1,727,418$700,118$5,669
GENERAL EXCISE TAX$237,140$201,366$35,609$165

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$830,011TotalAmt
Program Services$413,667ProgramServicesAmt
Management And General$415,822ManagementAndGeneralAmt
Fundraising$522FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$56,158,700TotalAmt
Program Services$39,869,046ProgramServicesAmt
Management And General$16,158,815ManagementAndGeneralAmt
Fundraising$130,839FundraisingAmt

Total Joint Costs TotalJointCostsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$833,606BOYAmt
EOY$836,097EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,904,903BOYAmt
EOY$2,048,184EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,170,835BOYAmt
EOY$1,096,285EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$7,103,380BOYAmt
EOY$10,540,137EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$174,080BOYAmt
EOY$62,919EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,350,205BOYAmt
EOY$1,273,492EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$851,110BOYAmt
EOY$478,428EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$67,183,701LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$22,637,051LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$44,214,330BOYAmt
EOY$44,546,650EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$119,803,976BOYAmt
EOY$118,955,544EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$177,406,425BOYAmt
EOY$179,837,736EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,242,050BOYAmt
EOY$5,564,034EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$6,000,000EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$9,567,230BOYAmt
EOY$8,652,790EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,809,280BOYAmt
EOY$20,216,824EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$43,675,458BOYAmt
EOY$40,409,627EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$9,345,189BOYAmt
EOY$9,222,824EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$110,576,498BOYAmt
EOY$109,988,461EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$163,597,145BOYAmt
EOY$159,620,912EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$177,406,425BOYAmt
EOY$179,837,736EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$4,595,148ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$163NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$618,752OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$2,982OtherActivitiesAmt
Total Lobbying Expenditures$2,982TotalLobbyingExpendituresAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART II-B, LINE 1IFormAndLineReferenceDesc
ExplanationLOBBYING EXPENSES ARE THE PORTION OF DUES PAID TO HEALTHCARE ASSOCIATIONS ALLOCATED TO LOBBYING ACTIVITIES AND EMPLOYEE TIME/IN HOUSE COUNSEL TIME SPENT ATTENDING LEGISLATIVE SESSIONS, MEETING WITH LEGISLATORS OR GIVING ORAL TESTIMONY.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$5,093,346BeginningYearBalanceAmt
Contributions$12,488ContributionsAmt
Investment Earnings Or Losses$170,059InvestmentEarningsOrLossesAmt
Grants Or Scholarships$274,520GrantsOrScholarshipsAmt
Other Expenditures$22,355OtherExpendituresAmt
Administrative Expenses$48,191AdministrativeExpensesAmt
End Year Balance$4,930,827EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$5,136,099BeginningYearBalanceAmt
Contributions$0ContributionsAmt
Investment Earnings Or Losses$248,000InvestmentEarningsOrLossesAmt
Grants Or Scholarships$226,771GrantsOrScholarshipsAmt
Other Expenditures$6,887OtherExpendituresAmt
Administrative Expenses$57,095AdministrativeExpensesAmt
End Year Balance$5,093,346EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$5,020,278BeginningYearBalanceAmt
Contributions$0ContributionsAmt
Investment Earnings Or Losses$565,011InvestmentEarningsOrLossesAmt
Grants Or Scholarships$381,643GrantsOrScholarshipsAmt
Other Expenditures$33,492OtherExpendituresAmt
Administrative Expenses$34,055AdministrativeExpensesAmt
End Year Balance$5,136,099EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,911,169BeginningYearBalanceAmt
Contributions$123,000ContributionsAmt
Investment Earnings Or Losses$519,199InvestmentEarningsOrLossesAmt
Grants Or Scholarships$476,608GrantsOrScholarshipsAmt
Other Expenditures$37,584OtherExpendituresAmt
Administrative Expenses$18,898AdministrativeExpensesAmt
End Year Balance$5,020,278EndYearBalanceAmt
FieldValueIRS element (for citing)
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.84932PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.15068TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (true)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (true)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (true)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,210,000OtherCostOrOtherBasisAmt
Book Value$12,210,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$27,302,784OtherCostOrOtherBasisAmt
Depreciation$1,443,987DepreciationAmt
Book Value$25,858,797BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$26,982,272OtherCostOrOtherBasisAmt
Depreciation$21,193,064DepreciationAmt
Book Value$5,789,208BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$688,645OtherCostOrOtherBasisAmt
Book Value$688,645BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$44,546,650TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
EQUITY IN PARKER RANCH FDN TRU$106,750,591
INVESTMENT IN LIBERTY DIALYSIS$42,106
BENEFICIAL INTERESTS$4,930,828
CONTRIBUTED USE OF LAND$7,232,019
FieldValueIRS element (for citing)
Total Book Value Other Assets$118,955,544TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
CAPITAL LEASE OBLIGATION$1,043,216
DUE TO QHS$7,244,829
DUE TO QIE$184,962
DUE TO QMC$122,051
DUE TO DLS$57,732
FieldValueIRS element (for citing)
Total Liability$8,652,790TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART V, LINE 4INTENDED 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 2FIN 48(ASC740) Footnote NORTH HAWAII COMMUNITY HOSPITAL EVALUATES ITS UNCERTAIN TAX POSITIONS AND HAS NO MATERIAL UNRECOGNIZED TAX BENEFITS AS OF JUNE 30, 2015.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$93,395TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$93,395NetCommunityBenefitExpnsAmt
Total Expense0.00170TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,418,126TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,679,225DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,738,901NetCommunityBenefitExpnsAmt
Total Expense0.06660TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,511,521TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,679,225DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,832,296NetCommunityBenefitExpnsAmt
Total Expense0.06830TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$113,088TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$33,305DirectOffsettingRevenueAmt
Net Community Benefit Expns$99,783NetCommunityBenefitExpnsAmt
Total Expense0.00180TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$113,088TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$33,305DirectOffsettingRevenueAmt
Net Community Benefit Expns$99,783NetCommunityBenefitExpnsAmt
Total Expense0.00180TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,624,609TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,712,530DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,932,079NetCommunityBenefitExpnsAmt
Total Expense0.07010TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$2,645,576BadDebtExpenseAmt
Bad Debt Expense Attributable$185,190BadDebtExpenseAttributableAmt
Reimbursed By Medicare$7,416,484ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$10,290,623CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$2,874,139MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1NORTH HAWAII COMMUNITY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line167-1125 MAMALAHOA HIGHWAYAddressLine1Txt
CityKAMUELACityNm
State AbbreviationHIStateAbbreviationCd
ZIP967438496ZIPCd
FieldValueIRS element (for citing)
Website AddressWWWW.NHCH.COMWebsiteAddressTxt
State License39-HStateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherNORTH HAWAII MEDICAL GROUP AND KOHALA HOME HEALTH AGENCYOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NORTH HAWAII COMMUNITY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE SECTION COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted WebsitefalseStrategyPostedWebsiteInd
Strategy AttachedYes (true)StrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Medicare RatesYes (X)MedicareRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part V, Section B, Line 5INPUT FROM COMMUNITY REPRESENTATIVES FOR THE HAWAII COUNTY REPORT, 15 KEY INFORMANTS WERE INTERVIEWED FOR THEIR SPECIFIC KNOWLEDGE OF THE HEALTH NEEDS OF THE COMMUNITY. WHEN CERTAIN TOPIC AREAS WERE LACKING AN INTERVIEW WITH PERSPECTIVE SPECIFIC TO HAWAII COUNTY, FINDINGS FROM THE STATEWIDE PERSPECTIVE WERE USED. THE INFORMATION OBTAINED FROM THESE INTERVIEWS WAS INCORPORATED INTO THE REPORT IN THREE WAYS. A SUMMARY QUALITATIVE ANALYSIS TOOL CALLED A "WORD CLOUD" WAS PRODUCED USING TAGCROWD.COM TO IDENTIFY THE MOST COMMON THEMES AND TOPICS. WORDS OR PHRASES THAT WERE MENTIONED MOST OFTEN DISPLAY IN THE WORD CLOUD IN THE LARGEST AND DARKEST FONT. NEXT, INPUT FROM THE KEY INFORMANTS WAS INCLUDED IN EACH RELEVANT TOPIC AREA IN SECTION 3.2 OF THE CHNA.
Schedule H, Part V, Section B, Line 6ATWENTY-SIX OF THE TWENTY-EIGHT HAWAII HOSPITALS, LOCATED ON ALL ISLANDS, PARTICIPATED IN THE CHNA PROJECT: CASTLE MEDICAL CENTER HALE HO'OLA HAMAKUA (HAWAII COUNTY) HILO MEDICAL CENTER (HAWAII COUNTY) KAHI MOHALA BEHAVIORAL HEALTH (SERVES HAWAII COUNTY RESIDENTS) KAHUKU MEDICAL CENTER KAISER PERMANENTE MEDICAL CENTER (SERVES HAWAII COUNTY RESIDENTS) KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN (SERVES HAWAII COUNTY RESIDENTS) KA'U HOSPITAL (HAWAII COUNTY) KAUAI VETERANS MEMORIAL HOSPITAL KOHALA HOSPITAL (HAWAII COUNTY) KONA COMMUNITY HOSPITAL (HAWAII COUNTY) KUAKINI MEDICAL CENTER KULA HOSPITAL LANA'I COMMUNITY HOSPITAL LEAHI HOSPITAL MAUI MEMORIAL MEDICAL CENTER MOLOKAI GENERAL HOSPITAL NORTH HAWAII COMMUNITY HOSPITAL (HAWAII COUNTY) PALI MOMI MEDICAL CENTER REHABILITATION HOSPITAL OF THE PACIFIC (SERVES HAWAII COUNTY RESIDENTS) SAMUEL MAHELONA MEMORIAL HOSPITAL SHRINERS HOSPITAL FOR CHILDREN - HONOLULU (SERVES HAWAII COUNTY RESIDENTS) STRAUB CLINIC & HOSPITAL THE QUEEN'S MEDICAL CENTER (SERVES HAWAII COUNTY RESIDENTS) WAHIAWA GENERAL HOSPITAL WILCOX MEMORIAL HOSPITAL
Schedule H, Part V, Section B, Line 6BCHNA 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 7ATHE CHNA CAN BE FOUND AT: HTTP://WWW.NHCH.COM/CMS/VIEW.ASPX/SHOW/COMMUNITYBENEFIT
Schedule H, Part V, Section B, Line 11NEEDS 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 B, Line 16IOTHER 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.

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7COSTING 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 2NHCH 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 3BAD 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 4BAD 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 HOSPITAL'S 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 8TREATMENT 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, 2015 COST REPORT USING THE STEP DOWN METHOD.
SCHEDULE H, PART III, LINE 9BAPPLICATION 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 2NEEDS 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 2014 TAX YEAR, NORTH HAWAII COMMUNITY HOSPITAL COMPLETED A CHNA WITH THE ASSISTANCE OF THE HEALTHCARE ASSOCIATION OF HAWAII.
SCHEDULE H, PART VI, LINE 3PATIENT 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 4COMMUNITY 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 5PROMOTION 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 103 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 8,375.
SCHEDULE H, PART VI, LINE 6AFFILIATED 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 7STATE FILING OF COMMUNITY BENEFIT REPORT N/A

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
ARTHUR USHIJIMA
CHAIR/TRUSTEE$0$811,198$0$303,171$0$494,115$0$172,690$0$13,338$0$1,794,512$0$0
KENNETH GRAHAM
PRESIDENT/TRUSTEE$0$237,524$0$0$0$0$0$0$0$0$0$237,524$0$0
ROBERT NOBRIGA
TREASURER (PART YEAR)$0$391,677$0$54,031$0$16,729$0$57,000$0$21,779$0$541,216$0$0
SHARLENE TSUDA
SECRETARY$0$210,401$0$50,138$0$21,227$0$54,359$0$13,115$0$349,240$0$0
LILINOE WATANABE
TREASURER$0$157,114$0$16,000$0$13,665$0$25,014$0$9,760$0$221,553$0$0
WILLIAM HILLER
PHYSICIAN$499,842$0$0$0$0$0$0$0$23,223$0$523,065$0$0$0
JOHN BELLATTI
PHYSICIAN$471,965$0$0$0$0$0$4,546$0$20,741$0$497,252$0$0$0
HOWARD WONG
PHYSICIAN$391,245$0$0$0$0$0$4,201$0$8,485$0$403,931$0$0$0
JENNIFER S REAL
PHYSICIAN$331,039$0$0$0$0$0$2,379$0$14,086$0$347,504$0$0$0
JONATHAN ZARLEY
PHYSICIAN$267,481$0$0$0$0$0$4,679$0$18,453$0$290,613$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3The organization relied on the Queen's Health System 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 4BThe Supplemental Executive Retirement Plan (SERP) 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 2014.
Schedule J, Part I, Line 7Other Non-Fixed Payments Recognition awards were paid to all 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 IICompensation 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 NHCH is 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. 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.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1DEPT OF BUDGET & FINANCE STATE OF HI SERIES ABCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN990266961BondIssuerEIN
CUSIP419800LM7CUSIPNum
Bond Issued2015-01-29BondIssuedDt
Issue Price$350,356,476IssuePriceAmt
PurposeSEE PART VIPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$0RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$350,362,507TotalProceedsAmt
In Reserve Fund$0InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$4,726,000IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$114,000,000CapitalExpendituresAmt
Other Spent Proceeds$8,116,086OtherSpentProceedsAmt
Unspent$89,541,979UnspentAmt
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadefalseFinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsYes (true)AnyResearchAgreementsInd
Engage Bond Counsel ResearchYes (true)EngageBondCounselResearchInd
Private Bus Use By Others0.00000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00000TotalPrivateBusinessUsePct
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Change In Use Bond Financed Prop0.00000ChangeInUseBondFinancedPropPct
Remedial Action TakenfalseRemedialActionTakenInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetYes (true)RebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssueYes (true)VariableRateIssueInd
Hedge Identified In Bks And RecYes (true)HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line1ML CAPITAL SERVICESBusinessNameLine1Txt
FieldValueIRS element (for citing)
Term Of Hedge6.5TermOfHedgePct
Superintegrated HedgefalseSuperintegratedHedgeInd
Hedge TerminatedfalseHedgeTerminatedInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE KNORTH HAWAII COMMUNITY HOSPITAL'S (NHCH) SOLE CORPORATE MEMBER, THE QUEEN'S HEALTH SYSTEMS (QMC), BORROWED ON BEHALF OF ITSELF AND 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 SEPARATELY 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 CENTER, MOLOKA'I GENERAL HOSPITAL 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

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 4ATO SUPPORT THE NHCH'S MISSION AND TO FULFILL THE TAX EXEMPT PURPOSE AS A CHARITABLE HOSPITAL, NHCH PROVIDED THE FOLLOWING COMMUNITY BENEFITS, TOTALING APPROXIMATELY $6,991,000, FOR THE YEAR ENDED JUNE 30, 2015. 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, 2015, THE ESTIMATED COST OF PROVIDING CHARITY CARE AND FOR SERVICES THAT WERE BAD DEBTS WAS $93,000 AND $185,000, 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 $3,739,000 DURING THE YEAR ENDED JUNE 30, 2015. 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 $2,874,000 DURING THE YEAR ENDED JUNE 30, 2015. 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 $100,000 FOR THE YEAR ENDED JUNE 30, 2015.
FORM 990, PART VI, LINE 6DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS NHCH HAS A SOLE MEMBER, WHICH IS THE QUEEN'S HEALTH SYSTEMS, A HAWAII NONPROFIT CORPORATION.
FORM 990, PART VI, LINE 7ADESCRIPTION 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 7BDESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & 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 ACQUISITION; 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 11BDESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 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 & 14THE 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 12CALL 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 & 15BPROCESS FOR DETERMINING COMPENSATION ALTHOUGH NOT COMPENSATED BY 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 SEPTEMBER 2015. OUTSIDE COUNSEL ASSISTS WITH THE REVIEW PROCESS AND DOCUMENTS THE DECISIONS OF THE COMMITTEE.
FORM 990, PART VI, LINE 19AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN 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 ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 11GOTHER FEES FOR SERVICES PROGRAM MANAGEMENT FUNDRAISING PURCHASED SERVICES 2,568,488 1,797,235 1,279 MEDICAL SERVICES 4,155,213 ----------------------------------------------------- TOTAL 6,723,701 1,797,235 1,279
FORM 990, PART XI, LINE 9OTHER CHANGES IN NET ASSETS CHANGE IN BENEFICIAL INTEREST 649,462 LOSS ON DEBT REFUNDING (30,710) ---------- TOTAL 618,752
FORM 990, PART XII, LINE 2CNORTH HAWAII COMMUNITY HOSPITAL (NHCH) IS NOW INCLUDED WITHIN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF THE QUEEN'S HEALTH SYSTEMS (QHS). NHCH FOLLOWS QHS'S PROCESSES FOR OVERSIGHT AND SELECTION FOR THE FINANCIAL STATEMENT AUDIT.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
MOLOKAI GENERAL HOSPITAL
PO BOX 408KAUNAKAKAI MOLOKAIHI96748990251372MEDICAL SVCSHI501(c)(3)3QHSYes (true)
LUCY K HENRIQUES TRUST
PO BOX 3170 DEPT 715HONOLULUHI96802996002291SUPPORTHI501(c)(3)11cNAfalse
PARKER RANCH FOUNDATION TRUST
66-1304 MAMALAHOA HIGHWAYKAMUELAHI96743996064620PROPERTY MGMTHI501(c)(3)11aNAfalse
THE QUEEN'S HEALTH SYSTEMS
1301 PUNCHBOWL STREETHONOLULUHI96813990238120ADMIN SERVICEHI501(c)(3)11bNAfalse
QUEEN EMMA LAND COMPANY
1301 PUNCHBOWL STREETHONOLULUHI96813990183769SUPPORT SVCSHI501(c)(3)11cQHSYes (true)
THE QUEEN'S MEDICAL CENTER
1301 PUNCHBOWL STREETHONOLULUHI96813990073524MEDICAL SVCSHI501(c)(3)3QHSYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1HAMAMATSUQUEEN'S PET IMAGING CENTER LLBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 PUNCHBOWL STREETAddressLine1Txt
CityHONOLULUCityNm
State AbbreviationHIStateAbbreviationCd
ZIP96813ZIPCd
FieldValueIRS element (for citing)
EIN943266916EIN
Primary ActivitiesPET IMAGINGPrimaryActivitiesTxt
Legal Domicile StateHILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
THE QUEEN'S DEVELOPMENT CORPORATION
1301 PUNCHBOWL STREETHONOLULUHI96813990240109DEVELOPMENTHIQHSC CorpYes (true)
QUEEN'S INSURANCE EXCHANGE
1301 PUNCHBOWL STREETHONOLULUHI96813911913839INSURANCEHIQHSC CorpYes (true)
DIAGNOSTIC LABORATORY SERVICES INC
99-859 IWAIWA STREETAIEAHI96701990240499MEDICAL LAB SVCSHIQDCC CorpYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1THE QUEEN'S MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeMTransactionTypeTxt
Involved$56,380InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE R, PART IIIFormAndLineReferenceDesc
ExplanationIDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP HAMAMATSU/QUEEN'S PET IMAGING CENTER, LLC EIN:94-3266916 ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813ExplanationTxt

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