2016-05-04T20:41:22-05:00 2015-06-30 ERNST & YOUNG US LLP 370 17TH STREET 3300 DENVER CO 80202 990 2014-07-01 990260423 North Hawaii Community Hospital % SHANNON OLSEN NORT 8088814400 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 LILINOE WATANABE TREASURER 8088814400 2016-05-03 true KELLEY SIMON P00791436 7209314000 2014 2016-08-17 19:52:53Z KENNETH GRAHAM 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 51687022 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 9 430 61 13370 12019 482252 930512 27642647 49905421 -103920 -46084 405229 773703 28426208 51563552 0 0 0 0 14408120 27615471 10018 17500 130839 11959630 28525729 26377768 56158700 2048440 -4595148 177406425 179837736 13809280 20216824 163597145 159620912 X ACUTE CARE HOSPITAL WITH THE MISSION TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII. false false 39869046 0 49905421 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 7/1/2014 - 6/30/2015 THROUGH OUTPATIENT VISITS WAS 37,208 (19,941 CLINIC) AND THE NUMBER OF ADMISSIONS WAS 1,754. 39869046 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 true true true false false true 77 0 true 430 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 967430496 MAENETTE BENHAM EDD TRUSTEE 1.0 2.0 X 0 0 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 2.0 X 0 0 0 ERIC YEAMAN TRUSTEE 1.0 6.0 X 0 0 0 ARTHUR USHIJIMA CHAIR/TRUSTEE 3.0 62.0 X X 0 1608484 186028 KENNETH GRAHAM PRESIDENT/TRUSTEE 54.0 1.0 X X 0 237524 0 MARILYNN HATA ASST TREASURER (PART YR) 55.0 0.0 X 0 145813 0 ROBERT NOBRIGA TREASURER (PART YEAR) 1.0 59.0 X 0 462437 78779 SUSAN HUNT VICE PRESIDENT 40.0 0.0 X 37831 0 0 SHARLENE TSUDA SECRETARY 1.0 54.0 X 0 281766 67474 SHARIANN GONSALVES ASSISTANT SECRETARY 40.0 0.0 X 62316 0 6250 LILINOE WATANABE TREASURER 3.0 52.0 X 0 186779 34774 WILLIAM HILLER PHYSICIAN 40.0 0.0 X 499842 0 23223 JOHN BELLATTI PHYSICIAN 40.0 0.0 X 471965 0 25287 HOWARD WONG PHYSICIAN 40.0 0.0 X 391245 0 12686 JENNIFER S REAL PHYSICIAN 40.0 0.0 X 331039 0 16465 JONATHAN ZARLEY PHYSICIAN 40.0 0.0 X 267481 0 23132 2061719 2922803 474098 42 false true false CLINICAL LABS OF HAWAII LLP MAIL CODE 60300 PO BOX 1300 HONOLULU HI 96807 LAB SERVICES 950030 CA INDUSTRIES INC PO BOX 3037 OMAHA NE 68103 STAFFING 799788 COMHEALTH MEDICAL STAFFING INC 6440 SOUTH MILLROCK DRIVE STE 175 SALT LAKE CITY UT 84121 STAFFING 789981 INFINIPRISE TECHNOLOGIES LLC 5950 CARMICHAEL PLACE STE 104 MONTGOMERY AL 36117 IT SERVICES 511443 PAN PACIFIC PATHOLOGISTS LLC 2230 LILIHA STREET HONOLULU HI 96817 PATHOLOGY SERVICES 336469 14 0 399898 530614 0 930512 Patient Service Revenue 900099 45903908 45903908 0 0 STATE OF HAWAII SUSTAINABILITY 900099 3872742 3872742 0 0 E.H.R. Meaningful Use 900099 128771 128771 0 0 49905421 25724 13370 12354 0 0 252319 252319 0 252319 252319 195 51467 123470 195 -72003 -71808 -71808 0 0 0 Medical Abstracts 900099 9467 0 0 9467 Vending Machine/Cafeteria 900099 370062 0 0 370062 Miscellaneous Revenue 900099 141855 0 0 141855 521384 51563552 49905421 13370 714249 X 0 0 0 0 0 0 0 0 181114 181114 0 0 82284 0 82284 0 22580009 17440334 5078327 61348 396938 304612 91128 1198 2796186 2097304 668989 29893 1578940 1207792 366560 4588 991462 50193 941269 0 105045 0 105045 0 87635 0 87635 0 2982 0 2982 0 17500 17500 0 0 0 0 8522215 6723701 1797235 1279 17568 0 17568 0 391946 240327 148873 2746 1023513 0 1023513 0 0 0 0 0 2065912 84604 1981308 0 217984 112815 104308 861 0 0 0 0 37292 24776 12516 0 185384 131611 53341 432 0 0 0 0 2887803 1936527 948388 2888 1165692 441160 723084 1448 SUPPLIES 6948912 6549725 398885 302 PROVIDER TAX 374028 0 374028 0 INTERCOMPANY PAYMENTS 2433205 1727418 700118 5669 GENERAL EXCISE TAX 237140 201366 35609 165 830011 413667 415822 522 56158700 39869046 16158815 130839 0 833606 836097 1904903 2048184 1170835 1096285 7103380 10540137 0 0 0 0 174080 62919 1350205 1273492 851110 478428 67183701 22637051 44214330 44546650 0 0 0 0 0 0 0 0 119803976 118955544 177406425 179837736 4242050 5564034 0 0 0 0 0 6000000 0 0 0 0 0 0 0 0 9567230 8652790 13809280 20216824 X 43675458 40409627 9345189 9222824 110576498 109988461 163597145 159620912 177406425 179837736 X -4595148 163 618752 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true 2982 2982 SCHEDULE A, PART II-B, LINE 1I LOBBYING 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. 5093346 12488 170059 274520 22355 48191 4930827 5136099 0 248000 226771 6887 57095 5093346 5020278 0 565011 381643 33492 34055 5136099 4911169 123000 519199 476608 37584 18898 5020278 0.00000 0.84932 0.15068 true true true 12210000 12210000 27302784 1443987 25858797 26982272 21193064 5789208 688645 688645 44546650 EQUITY IN PARKER RANCH FDN TRU 106750591 INVESTMENT IN LIBERTY DIALYSIS 42106 BENEFICIAL INTERESTS 4930828 CONTRIBUTED USE OF LAND 7232019 118955544 0 CAPITAL LEASE OBLIGATION 1043216 DUE TO QHS 7244829 DUE TO QIE 184962 DUE TO QMC 122051 DUE TO DLS 57732 8652790 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(ASC740) Footnote NORTH HAWAII COMMUNITY HOSPITAL EVALUATES ITS UNCERTAIN TAX POSITIONS AND HAS NO MATERIAL UNRECOGNIZED TAX BENEFITS AS OF JUNE 30, 2015. true true X true X true X true true true false true true 93395 93395 0.00170 11418126 7679225 3738901 0.06660 11511521 7679225 3832296 0.06830 113088 33305 99783 0.00180 113088 33305 99783 0.00180 11624609 7712530 3932079 0.07010 true 2645576 185190 7416484 10290623 -2874139 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 13 true true true true X SEE SECTION C X true 13 false true false true X 200. 400. X X X X true true X X X X true X X X X X true X false X X true X false false Schedule H, Part V, Section B, Line 5 INPUT 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 6A TWENTY-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 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/COMMUNITYBENEFIT 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 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 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 NHCH'S 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 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 8 TREATMENT OF MEDICARE SHORTFALL COMMUNITY BENEFIT THE HOSPITAL MUST TREAT PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE GOVERNMENT SETS NON-NEGOTIABLE MEDICARE RATES AND THE REIMBURSEMENT HAS NOT KEPT PACE WITH THE RISING COSTS OF PROVIDING THESE SERVICES. DUE TO THE REQUIREMENT TO PROVIDE CARE AND THE INABILITY OF THE MEDICARE REIMBURSEMENT TO KEEP PACE WITH THE COST OF PROVIDING SERVICES, WE FEEL THAT THE LOSS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES IS PART OF NHCH'S MISSION AND IS A BENEFIT TO THE COMMUNITY. MEDICARE COSTING METHODOLOGY THE MEDICARE AMOUNTS ABOVE ARE CALCULATED WITH DATA FROM THE JUNE 30, 2015 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 2014 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 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 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 ARTHUR USHIJIMA CHAIR/TRUSTEE 0 811198 0 303171 0 494115 0 172690 0 13338 0 1794512 0 0 KENNETH GRAHAM PRESIDENT/TRUSTEE 0 237524 0 0 0 0 0 0 0 0 0 237524 0 0 ROBERT NOBRIGA TREASURER (PART YEAR) 0 391677 0 54031 0 16729 0 57000 0 21779 0 541216 0 0 SHARLENE TSUDA SECRETARY 0 210401 0 50138 0 21227 0 54359 0 13115 0 349240 0 0 LILINOE WATANABE TREASURER 0 157114 0 16000 0 13665 0 25014 0 9760 0 221553 0 0 WILLIAM HILLER PHYSICIAN 499842 0 0 0 0 0 0 0 23223 0 523065 0 0 0 JOHN BELLATTI PHYSICIAN 471965 0 0 0 0 0 4546 0 20741 0 497252 0 0 0 HOWARD WONG PHYSICIAN 391245 0 0 0 0 0 4201 0 8485 0 403931 0 0 0 JENNIFER S REAL PHYSICIAN 331039 0 0 0 0 0 2379 0 14086 0 347504 0 0 0 JONATHAN ZARLEY PHYSICIAN 267481 0 0 0 0 0 4679 0 18453 0 290613 0 0 0 Schedule J, Part I, Line 3 The 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 4B The 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 7 Other 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 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 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. A DEPT OF BUDGET & FINANCE STATE OF HI SERIES ABC 990266961 419800LM7 2015-01-29 350356476 SEE PART VI false false false A 0 0 350362507 0 0 0 4726000 0 0 114000000 8116086 89541979 true false false true A false false false true true 0.00000 0.00000 0.00000 false 0.00000 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 (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 FORM 990, PART III, LINE 4A TO 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 6 DESCRIPTION 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 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 DESCR 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 11B DESCRIBE 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 & 14 THE CONFLICT OF INTEREST, WHISTLEBLOWER AND DOCUMENT RETENTION POLICIES HAVE BEEN APPROVED BY QHS ON BEHALF OF THE NHCH BOARD OF TRUSTEES BUT HAVE NOT BEEN SEPARATELY APPROVED BY THE NHCH BOARD. AS SUCH, LINES 12, 13 AND 14 HAVE BEEN CHECKED 'NO'. FORM 990, PART VI, LINE 12C 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 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 19 AVAIL 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 11G OTHER 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 9 OTHER CHANGES IN NET ASSETS CHANGE IN BENEFICIAL INTEREST 649,462 LOSS ON DEBT REFUNDING (30,710) ---------- TOTAL 618,752 FORM 990, PART XII, LINE 2C NORTH 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. MOLOKAI GENERAL HOSPITAL PO BOX 408 KAUNAKAKAI MOLOKAI HI 96748 990251372 MEDICAL SVCS HI 501(c)(3) 3 QHS true LUCY K 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) 11b NA false QUEEN EMMA LAND COMPANY 1301 PUNCHBOWL STREET HONOLULU HI 96813 990183769 SUPPORT SVCS HI 501(c)(3) 11c 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 CENTER LL 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 false false false false false false false false false false true false false false false false false THE QUEEN'S MEDICAL CENTER M 56380 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