2015-05-12T16:22:48-05:00 2014-06-30 ERNST & YOUNG US LLP 2901 DOUGLAS BLVD SUITE 300 ROSEVILLE CA 95661 990 2013-07-01 383840327 Pali Momi Foundation % ANN HO PALI 8085357100 55 MERCHANT STREET 24TH FLOOR Suite HONOLULU HI 968134333 EARL INOUYE VICE PRESIDENT 2015-05-12 CINDY WHITE P01396368 2013 2016-03-07 17:11:31Z MICHAEL ROBINSON 55 MERCHANT STREET 26TH FLOOR HONOLULU HI 96813 335700 false X WWW.PALIMOMIGIFT.ORG X 2010 HI THE MISSION OF THE PALI MOMI FOUNDATION IS TO IMPROVE THE HEALTH OF HAWAI'I'S PEOPLE THROUGH FUNDING OF MEDICAL CARE, HEALTH EDUCATION & RESEARCH AT PALI MOMI MEDICAL CENTER. 7 6 0 7 0 400178 247846 0 0 6907 10328 27589 50610 434674 308784 344627 232118 0 0 0 0 0 0 9793 60603 41737 405230 273855 29444 34929 539865 664569 2836 68860 537029 595709 X THE MISSION OF THE PALI MOMI FOUNDATION IS TO IMPROVE THE HEALTH OF HAWAI'I'S PEOPLE THROUGH FUNDING OF MEDICAL CARE, HEALTH EDUCATION & RESEARCH AT PALI MOMI MEDICAL CENTER. false false 233817 232118 0 SEE SCHEDULE O. 233817 true true false false false false false false false false false true false false true false false true false false false false false false true false false true false true false false false false false false false false false false false false false true true true false false true 5 0 true 0 false false false false false true true false false false false X 7 6 false false false false true true true true true false false true true true true true true false false false HI X X ANN HO 8085272520 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 968134333 VIOLETA ARNOBIT RN Board of Director 0.1 0.2 X 0 0 0 VICKI GAYNOR Board of Director 0.1 0.0 X 0 0 0 RENEE GOMES Board of Director 0.1 0.0 X 0 0 0 BETH HOBAN RN Board of Director, Chair 0.1 0.2 X X 0 0 0 GREGG T KOKAME MD Board of Director 0.1 0.2 X 0 0 0 EMILY KURAOKA Board of Director 0.1 0.0 X 0 0 0 RAYMOND P VARA JR Board of Director 1.0 64.0 X 0 1490728 393474 MICHAEL ROBINSON President 1.0 40.0 X 0 208380 22142 VIRGINIA PRESSLER-FISHER MD Vice President 0.1 59.0 X 0 586997 184338 DAVID OKABE Treasurer 0.1 55.0 X 0 783672 175363 EARL INOUYE Assistant Treasurer 0.1 55.0 X 0 317690 79385 CHARLES R CHING Secretary 0.1 60.0 X 0 659823 160550 JESSICA LEWIS Assistant Secretary 0.1 40.0 X 0 122539 27300 0 4169829 1042552 0 false true false 0 1950 245896 22253 247846 0 10312 10312 0 0 0 0 0 1102 1086 16 16 16 76440 1950 25830 50610 50610 0 0 0 308784 60938 232118 232118 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 348 348 0 0 0 0 0 0 0 292 292 17106 0 15864 1242 628 0 0 628 3107 0 3078 29 6951 0 0 6951 0 0 0 0 0 0 0 0 743 0 0 743 0 0 0 0 200 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 7887 0 7887 0 PROGRAM SERVICE EXPENSES 1699 1699 0 0 Corporate Allocation 2776 0 2776 0 273855 233817 30245 9793 0 0 0 275291 406131 0 0 134721 121806 0 0 0 0 0 0 0 0 0 0 0 0 0 0 76377 76806 40991 54780 0 0 0 0 12485 5046 539865 664569 2836 9404 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 59456 2836 68860 X -110872 -177970 647901 773679 0 0 537029 595709 539865 664569 X 34929 5442 18309 X false true X true false X 0 0 399428 400178 247846 1047452 0 0 0 0 399428 400178 247846 1047452 88727 958725 2258 6837 10312 19407 0 0 0 1066859 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED UNRESTRICTED INVESTMENTS 54780 F 54780 0 HAWAI'I PACIFIC HEALTH 35664 KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN 789 PALI MOMI MEDICAL CENTER 22939 WILCOX HEALTH FOUNDATTION 64 59456 GOLF TOURNAMENT 78390 1950 76440 4600 9856 5926 5448 0 0 0 78390 1950 76440 4600 9856 5926 5448 25830 50610 true Pali Momi Medical Center 55 Merchant Street 24th Floor Honolulu HI 96813 990274038 501(c)(3) 218088 1096 FMV STOCK DONATIONS GENERAL SUPPORT 1 FORM 990, SCHEDULE I DESCR OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS TEMPORARILY RESTRICTED FUNDS RELEASED (& GRANTED) TO THE AFFILIATED ORGANIZATIONS ARE RELEASED AFTER THE SPECIFIC PURPOSE OF THE FUND HAS BEEN MET. ONCE THE AFFILIATED ORGANIZATION COMMUNICATES THE EXPENSE AND SATISFIES THE SUBSTANTIATION OF THE EXPENSE FOR THE PURPOSE THAT THE FUNDS WERE CONTRIBUTED FOR, THE FOUNDATION RELEASES THE RESTRICTION AND RECORDS THE GRANT TO THE AFFILIATED ORGANIZATION. NO FURTHER MONITORING OF THE FUNDS AFTER DISTRIBUTION IS NECESSARY. false true false false false false false false false MICHAEL ROBINSON President 0 186726 0 18572 0 3082 0 15156 0 6986 0 230522 0 0 RAYMOND P VARA JR Board of Director 0 780906 0 445327 0 264495 0 372504 0 20970 0 1884202 0 267684 VIRGINIA PRESSLER-FISHER MD Vice President 0 332773 0 137886 0 116338 0 164622 0 19716 0 771335 0 116500 DAVID OKABE Treasurer 0 429188 0 177313 0 177171 0 161473 0 13890 0 959035 0 131479 EARL INOUYE Assistant Treasurer 0 236093 0 41827 0 39770 0 59398 0 19987 0 397075 0 25156 CHARLES R CHING Secretary 0 325455 0 173692 0 160676 0 155468 0 5082 0 820373 0 103184 Form 990, Schedule J, Part I, Line 3 SUPPLEMENTAL COMPENSATION INFORMATION THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, HAWAI'I PACIFIC HEALTH ('HPH'), AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O FORM 990 PART VI, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. Form 990, Schedule J, Part I, Line 4b SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERNAL REVENUE CODE ON COMPENSATION CONSIDERED UNDER SUCH PLANS. THE CAPITAL ACCUMULATION ACCOUNT (CAA) IS A SECTION 457(F) PROGRAM THAT WAS PREVIOUSLY AFFORDED TO EXECUTIVE OFFICERS OF THE ORGANIZATION TO PROVIDE BENEFITS ON A TAX DEFERRED PROVIDE BENEFITS ON A TAX DEFERRED BASIS. AMOUNTS PAID OUT BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR - $70,020 VIRGINIA PRESSLER-FISHER, MD - $47,557 DAVID OKABE - $42,822 EARL INOUYE - $4,242 CHARLES R. CHING - $36,337 LONG TERM INCENTIVE PLAN THE LONG TERM INCENTIVE PLAN IS AFFORDED TO EXECUTIVES BASED ON ANNUAL AND LONG TERM SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. AMOUNTS PAID OUT BY RELATED ORGANIZATIONS: RAYMOND P. VARA JR - $395,327 VIRGINIA PRESSLER-FISHER, MD - $137,886 DAVID OKABE - $177,313 EARL INOUYE - $41,827 CHARLES R. CHING - $133,692 FORM 990, PART III, LINE 4 PROGRAM SERVICE ACCOMPLISHMENTS THE MISSION OF PALI MOMI FOUNDATION THE MISSION OF THE PALI MOMI FOUNDATION (THE FOUNDATION) IS TO IMPROVE THE HEALTH OF HAWAI'I'S PEOPLE BY FUNDING MEDICAL CARE, HEALTH EDUCATION AND RESEARCH AT PALI MOMI MEDICAL CENTER (PALI MOMI). PALI MOMI IS A NOT-FOR-PROFIT HOSPITAL LOCATED IN WEST O'AHU AND DEDICATED TO THE HEALTH AND WELL-BEING OF ALL HAWAI'I RESIDENTS. WITH 128 BEDS, MORE THAN 1,200 EMPLOYEES AND MORE THAN 400 AFFILIATED PHYSICIANS, PALI MOMI OFFERS A FULL RANGE OF SERVICES. PALI MOMI OPENED ON JULY 31, 1989. SINCE ITS OPENING, THE HOSPITAL HAS DELIVERED MANY MEDICAL FIRSTS FOR CENTRAL AND WEST OAHU, INCLUDING: - THE FIRST INTERVENTIONAL CARDIAC CATHETERIZATION UNIT TO DETECT AND TREAT HEART DISEASE - FIRST RETINA CENTER IN HAWAII - MINIMALLY INVASIVE SURGICAL TECHNOLOGY FEATURING THE DA VINCI ROBOT-AIDED SYSTEM - A COMPREHENSIVE WOMEN'S CENTER - HAWAII'S ONLY TEAM TRIAGE APPROACH TO EMERGENCY MEDICINE - A COMPLETE BARIATRIC SURGERY PROGRAM - THE MOST ADVANCED DIAGNOSTIC IMAGING TECHNOLOGY AVAILABLE PALI MOMI IS THE ONLY FACILITY IN HAWAI'I THAT USES A TEAM TRIAGE APPROACH IN ITS EMERGENCY ROOM, WHERE PATIENTS ARE PROMPTLY EVALUATED BY AN EMERGENCY PHYSICIAN. TODAY, PALI MOMI CONTINUES TO PROVIDE AWARD-WINNING CARE TO THOUSANDS OF PATIENTS EACH YEAR. PALI MOMI HAS BEEN RECOGNIZED BY THE AMERICAN HEART ASSOCIATION AND AMERICAN STROKE ASSOCIATION FOR ITS STROKE CARE PROGRAM. THE BARIATRIC SURGERY PROGRAM OFFERS COMPLETE PATIENT CARE, LIFESTYLE TRANSITION AND SUPPORT, AND HAS RECEIVED METABOLIC AND BARIATRIC SURGERY ACCREDITATION AND IS RECOGNIZED AS A QUALITY IMPROVEMENT PROGRAM ACCREDITED CENTER, A JOINT PROGRAM OF THE AMERICAN COLLEGE OF SURGEONS AND THE AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY. PALI MOMI IS A NOT-FOR-PROFIT HOSPITAL AND AN AFFILIATE OF HAWAI'I PACIFIC HEALTH, THE STATE'S LARGEST HEALTH CARE PROVIDER. AS A NOT-FOR-PROFIT HOSPITAL, PALI MOMI RELIES ON COMMUNITY SUPPORT TO FULFILL ITS MISSION AND CARE FOR PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN FISCAL YEAR 2014, THE FOUNDATION FOCUSED ITS FUNDRAISING EFFORTS ON CRITICAL PROGRAMS AND UNRESTRICTED SUPPORT OF THE HOSPITAL. AREAS WITH THE GREATEST NEED WERE INNOVATION AND NEW TECHNOLOGY, THE PALI MOMI WOMEN'S CENTER AND THE OHANA FUND. INNOVATION AND TECHNOLOGY FUNDS SUPPORT NEW STATE-OF-THE-ART INITIATIVES, EQUIPMENT AND SPECIAL PROJECTS THAT ADVANCE INNOVATIONS IN HEALTH CARE. WITH YOUR HELP, OUR PATIENTS WILL CONTINUE TO HAVE THE BEST MEDICAL CARE POSSIBLE USING SOME OF THE LATEST TECHNOLOGY AVAILABLE. KEEPING PALI MOMI AT THE CUTTING EDGE OF INNOVATION IS ESSENTIAL TO ENSURING HIGH-QUALITY CARE FOR ITS PATIENTS. UNTIL RECENTLY, THERE WERE ONLY TWO TRADITIONAL OPTIONS FOR PATIENTS REQUIRING SURGERY - A LARGE OPEN INCISION, OR LAPAROSCOPY. PHILANTHROPIC GIFTS HELPED TO PROVIDE A MINIMALLY INVASIVE CHOICE FOR UROLOGY, THORACIC AND GENERAL SURGERIES. THE DA VINCI FIREFLY SURGICAL ROBOT-AIDED SYSTEM ALLOWS SURGEONS TO PERFORM MAJOR SURGERY THROUGH SMALL INCISIONS. PATIENTS EXPERIENCE DECREASED BLOOD LOSS, LESS PAIN AND A FASTER RECOVERY TIME. THE SYSTEM IS ALSO A RECRUITING TOOL FOR PHYSICIANS WHO SPECIALIZE IN THIS NEW TECHNOLOGY. PALI MOMI WOMEN'S CENTER THE PALI MOMI WOMEN'S CENTER IS LOCATED IN THE PALI MOMI MEDICAL PAVILION, WHICH WAS BUILT IN 2012 TO HELP MEET THE HEALTH CARE NEEDS OF THE GROWING POPULATION IN CENTRAL AND WEST O'AHU. IT PROVIDES SERVICES THAT ADDRESS WOMEN'S UNIQUE HEALTH CARE NEEDS. FUNDS HELP US CONTINUE PROVIDING IMPORTANT SERVICES AND PROGRAMS INCLUDING SOME OF THE LATEST TECHNOLOGY IN 3-D BREAST IMAGING AND BREAST MRI. DONATIONS ALSO FUND PATIENT EDUCATIONAL MATERIALS, FROM BREAST SELF-EXAM TEACHING MODELS TO GUIDED IMAGERY CDS FOR RELAXATION DURING CHEMOTHERAPY. THE OHANA FUND PALI MOMI'S DONOR-SUPPORTED OHANA FUND IMPACTS THE LIVES OF PATIENTS WHO ARE NOT COVERED BY INSURANCE, OR WHO ARE WAITING TO BE APPROVED FOR INSURANCE. UPON DISCHARGE, THIS FUND PROVIDES PATIENTS WITH A 30-DAY SUPPLY OF MEDICINE IF THEY ARE UNABLE TO AFFORD THE COST. THE FUND ALSO ASSISTS PATIENTS WITH TRANSPORTATION BETWEEN MEDICAL FACILITIES AND TO THEIR HOME. FUNDS ALSO PAY FOR EQUIPMENT THAT PATIENTS MIGHT NEED INCLUDING WHEELCHAIRS, WALKERS AND BEDSIDE COMMODES. THESE SERVICES ENABLE PATIENTS TO MOVE FORWARD QUICKLY WITH THEIR TREATMENTS AND RECOVERY AND AVOID POSSIBLE REENTRY INTO THE HOSPITAL. OTHER MEANINGFUL PROGRAMS AND EVENTS SUPPORTED BY DONOR CONTRIBUTIONS INCLUDE THE MAUDE NISHIMOTO GOLF TOURNAMENT, WHICH FUNDS EMPLOYEE SCHOLARSHIPS; AN ANNUAL BREAST CANCER SURVIVOR TREE TRIMMING CEREMONY; THE DA VINCI ROBOT COMMUNITY- NAMING PROJECT AND THE EMERGENCY ROOM EXPANSION PLAN. Form 990, Part VI, Line 6 MEMBERS AND RIGHTS HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE WITH THE RIGHT TO ELECT THE MEMBERS OF THE GOVERNING BODY AND/OR APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BOARD. Form 990, Part VI, Line 7a DESCRIPTION OF CLASSES OF PERSON AND THE NATURE OF THEIR RIGHTS HAWAI'I PACIFIC HEALTH IS THE SOLE MEMBER, AND HAS THE POWER TO APPROVE THE ELECTION OF MEMBERS OF THE GOVERNING BODY. HAWAI'I PACIFIC HEALTH, AS MEMBER, ALSO HAS THE POWER TO ELECT ONE OR MORE EX OFFICIO VOTING MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, LINE 7B DESCR CLASSES OF PERSONS, DECISIONS REQ APPROVAL & TYPE OF VOTING RIGHTS HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS EXCLUSIVE POWER TO TAKE AND DIRECT THE FOLLOWING ACTIONS OF THE CORPORATION: (I) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: PRESIDENT, VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE CHAIR AND VICE-CHAIR OF THE BOARD; (II) AFTER CONSULTATION WITH THE BOARD, REMOVE THE PRESIDENT, VICE-PRESIDENT(S), TREASURER, SECRETARY, ASSISTANT TREASURERS AND SECRETARIES, AND ANY OTHER OFFICER, EXCEPT THE CHAIR AND VICE-CHAIR; (III) REMOVE A DIRECTOR FROM THE BOARD; (IV) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER; (V) AMEND THESE BYLAWS; (VI) CAUSE THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1) YEAR AND/OR ONE MILLION DOLLARS ($1,000,000) OR MORE; (VII) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (VIII) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE, AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (IX) DETERMINE AND EFFECT INTER-CORPORATE FUND TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (X) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S EXECUTIVE COMPENSATION AND BENEFIT PLANS; (XI) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (XII) DEVELOP AND PROMULGATE OVERALL CORPORATE GOALS AND THE LONG-RANGE AND STRATEGIC PLAN OF THE CORPORATION; AND (XIII) DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. THE CORPORATION SHALL NOT TAKE THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING MEMBER APPROVAL: (I) ELECT ANY DIRECTOR TO THE BOARD; (II) AMEND THE ARTICLES; (III) MERGE THE CORPORATION WITH ANY ENTITY; (IV) DISSOLVE THE CORPORATION; (V) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS BY OR ON BEHALF OF THE CORPORATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (VI) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000) EXCEPT FOR THOSE ASSETS ACQUIRED BY GIFTS, GRANT, OR DONATION; (VII) ACQUIRE SHARES IN ANOTHER CORPORATION; (VIII) SELL, LEASE, EXCHANGE, ENCUMBER OR DISPOSE OF TWENTY-FIVE PERCENT (25%) OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION TO ANY ENTITY THAT IS NOT AN AFFILIATE; (IX) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (X) FORM A JOINT VENTURE OR OTHER BUSINESS RELATIONSHIP (OTHER THAN THE ORDINARY COURSE OF BUSINESS CONTRACTS) BETWEEN THE CORPORATION AND ANY PERSON OR ENTITY; AND (XI) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE. Form 990, Part VI, Line 11b REVIEW OF THE 990S BY THE ORGANIZATION'S GOVERNING BODY VARIOUS SCHEDULES OF THE 990S ARE PREPARED PRIMARILY BY STAFF WITHIN THE ACCOUNTING AREA OF THE ORGANIZATION WORKING WITH VARIOUS OTHER AREAS OF THE ORGANIZATION SUCH AS MANAGEMENT OF OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPLETED INTERNALLY BASED ON INPUT AND DISCUSSION WITH FINANCIAL ANALYSTS AND THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF THE REPORTING ENTITY. THE CHIEF OPERATING OFFICER/EXECUTIVE DIRECTOR OF EACH REPORTING ENTITY REVIEWS AND APPROVES THE DISCLOSURE NARRATIVES WHICH DESCRIBE THE MISSION/PURPOSE AND PROGRAM ACCOMPLISHMENTS OF THEIR ORGANIZATION. SENIOR MANAGEMENT OF THE HEALTH CARE SYSTEM REVIEWS THE 990S OF EACH FILING ORGANIZATION WITHIN THE HEALTH CARE SYSTEM. ONCE SENIOR MANAGEMENT HAS COMPLETED ITS REVIEW, THE 990S ARE THEN PROVIDED TO THE GOVERNANCE AND NOMINATING COMMITTEE OF THE HEALTH CARE SYSTEM'S BOARD OF DIRECTORS FOR THEIR REVIEW. THE GOVERNANCE AND NOMINATING COMMITTEE OF THE PARENT ENTITY'S (HAWAI'I PACIFIC HEALTH "HPH") BOARD PROVIDES OVERSIGHT FOR THE 990 REPORTING AND REVIEWS THE 990S FOR EACH ENTITY PRIOR TO FILING. IN ADDITION, THE 990S FOR EACH ENTITY ARE MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND THE HPH BOARD OF DIRECTORS THROUGH A BOARD MEMBER PORTAL FOR REVIEW PRIOR TO THE FILING OF THE 990. THE 990S WILL BE POSTED TO HPH'S WEBSITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURN WITH THE IRS. Form 990, Part VI, Line 12c MONITORING & ENFORCING OF CONFLICT OF INTEREST POLICY ANNUALLY, EACH DIRECTOR, OFFICER, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) RECEIVED A COPY OF THE CONFLICT OF INTEREST ("COI") POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) AGREES TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION, AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, THE ORGANIZATION MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. THE IN-HOUSE LEGAL DEPARTMENT DISTRIBUTES THE STATEMENT REQUEST AND REVIEWS THE COI STATEMENTS RETURNED. IDENTIFIED CONFLICTS OF INTEREST ARE PRESENTED TO THE BOARD FOR REVIEW, DELIBERATION AND CONFIRMATION /REFUTATION THAT A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST HAS BEEN FOUND, THE INDIVIDUAL MAY ADDRESS THE BOARD AND EXPLAIN THE TRANSACTION OR ARRANGEMENT CAUSING THE CONFLICT. AFTER THE PRESENTATION, THE INDIVIDUAL IS EXCUSED FROM THE MEETING AND SHALL NOT PARTICIPATE WITH ANY DISCUSSION OR VOTE ON MATTERS PERTAINING TO THE TRANSACTION OR ARRANGEMENT. IN MEETINGS WHERE APPLICATION OF THE COI POLICY OCCURS, THE MEETING MINUTES INCLUDE NATURE OF THE FINANCIAL INTEREST/CONFLICT, NAME(S) OF THE PERSON(S) WITH THE POTENTIAL OR ACTUAL CONFLICT, ANY ACTION TAKEN TO ASSIST IN THE DETERMINATION OF WHETHER A CONFLICT EXISTED, INCLUDING ANY DISCUSSION OF ALTERNATIVE ARRANGEMENTS, THE BOARD'S DECISION(S) REGARDING THE CONFLICT AND NAMES OF PERSON PRESENT IN THE DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT. BOARD'S DECISION(S) REGARDING THE CONFLICT AND NAMES OF PERSON PRESENT IN THE DISCUSSION AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, LINES 15A & 15B OFFICES & POSITIONS WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUN THE CEO, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER BY THE TAX EXEMPT PARENT HAWAI'I PACIFIC HEALTH ("HPH"). FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE CEO, OFFICERS AND KEY EMPLOYEES' COMPENSATION. COMPENSATION FOR HAWAI'I PACIFIC HEALTH ("HPH") EXECUTIVES (VICE PRESIDENT AND ABOVE) IS SET BY THE HPH COMPENSATION COMMITTEE, WHICH IS COMPOSED SOLELY OF INDEPENDENT, COMMUNITY-BASED MEMBERS OF THE HPH BOARD OF DIRECTORS. ON AN ANNUAL BASIS THE HPH BOARD CHAIRPERSON (WHO IS INDEPENDENT) SELECTS A NEUTRAL THIRD PARTY EXECUTIVE COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVES' COMPENSATION AND BENEFITS. THE CONSULTANT PROVIDES A WRITTEN REPORT TO THE COMPENSATION COMMITTEE AT ITS ANNUAL MEETING. INCLUDED IN THE REPORT IS MARKET BASED DATA FROM LIKE ORGANIZATIONS. THE COMPENSATION COMMITTEE MAKES FINAL DECISIONS REGARDING COMPENSATION AND BENEFITS AT THE MEETING AFTER REVIEW AND DISCUSSION OF THE CONSULTANT'S REPORT, AND SUCH DECISIONS ARE DOCUMENTED IN THE COMPENSATION COMMITTEE MEETING MINUTES. COMMUNITY BASED DIRECTORS OF THE ORGANIZATION ARE NOT COMPENSATED. CERTAIN EMPLOYED PHYSICIANS MAY BE OFFICERS OR AN IDENTIFIED KEY EMPLOYEE OF THE REPORTING OR RELATED ORGANIZATION. PHYSICIAN COMPENSATION IS ALSO HANDLED IN THE SAME MANNER AS EXECUTIVE COMPENSATION, WITH THE HPH COMPENSATION COMMITTEE RECEIVING A REPORT FROM A NEUTRAL CONSULTANT AND FOLLOWING THE SAME PROCESS AS DESCRIBED ABOVE ON AN ANNUAL BASIS. THIS PROCESS WAS LAST COMPLETED ON MARCH 5, 2014 TO REVIEW PHYSICIAN COMPENSATION AND ON AUGUST 7, 2014 TO REVIEW EXECUTIVE COMPENSATION. FORM 990, PART VI, LINE 19 DISCLOSURE OF GOV DOCS, CONFLICT OF INTEREST POLICY & FINANCIAL STMTS THE CONFLICT OF INTEREST POLICY AND STANDARDS OF CONDUCT ARE AVAILABLE ON THE HAWAI'I PACIFIC HEALTH WEBSITE. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC VIA THE HAWAI'I PACIFIC HEALTH WEBSITE. FORM 990, PART XI, LINE 5 OTHER CHANGES IN NET ASSETS $ (1,537) - EQUITY TRANSFER WITH HPH $ (182) - OTHER CHANGES IN TR NET ASSETS $ 20,028 - EQUITY TRANSFER WITH AFFILIATES ---------- $ 18,309 - TOTAL ========== Hawai'i Pacific Health 55 Merchant Street 24th Floor Honolulu HI 96813 990246363 holding co HI 501(c)(3) 11b TYPE II NA false Kapi'olani Medical Center for Women & Ch 55 Merchant Street 24th Floor Honolulu HI 96813 990177350 hospital HI 501(c)(3) 3 NA true Kapi'olani Health Foundation 55 Merchant Street 24th Floor Honolulu HI 96813 990246364 fundraising HI 501(c)(3) 7 NA true Pali Momi Medical Center 55 Merchant Street 24th Floor Honolulu HI 96813 990274038 hospital HI 501(c)(3) 3 NA true Straub Foundation 55 Merchant Street 24th Floor Honolulu HI 96813 990109350 research/educ HI 501(c)(3) 7 NA true PROVIDERS INSURANCE COMPANY 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 NFP INSURANCE HI 501(C)(3) 11B TYPE II NA true KAPI'OLANI MEDICAL SPECIALISTS 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990322406 HEALTHCARE HI 501(C)(3) 9 NA true WILCOX MEMORIAL HOSPITAL 55 MERHCANT STREET 24TH FLOOR HONOLULU HI 96813 990074365 HOSPITAL HI 501(C)(3) 3 NA true KAUA'I MEDICAL CLINIC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990326099 HOPSITAL HI 501(C)(3) 3 NA true STRAUB CLINIC & HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 912151670 HOSPITAL HI 501(C)(3) 3 NA true PALI MOMI FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 383840327 FUNDRAISING HI 501(C)(3) 7 NA true ASC PACIFIC VENTURES LLC 3000 RIVERCHASE GALLERIA SUITE 500 BIRMINGHAM AL 35244 270540034 AMBU. SURG. CNTR AL NA N/A HAWAI'I PACIFIC HEALTH PARTNERS INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990318588 HOLDING COMPANY HI HPH C CORP STRAUB PHARMACY 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990145107 INACTIVE HI NA C CORP HICORD INC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990251496 INVESTMENT HI NA C CORP false true false false false false false false false false false false false false true false true true false PALI MOMI MEDICAL CENTER R 73034 FMV PALI MOMI MEDICAL CENTER B 219184 FMV SCHEDULE R, PART III RELATED ORG. TAXABLE AS PARTNERSHIP ASC PACIFIC VENTURES, LLC EIN: 27-0540034 ADDRESS: 3000 RIVERCHASE GALLERIA, STE 500 BIRMINGHAM, AL 35244