2014-11-13T15:57:35-06:00 2013-12-31 ERNST & YOUNG US LLP 370 17TH STREET SUITE 3300 DENVER CO 80202 990 2013-01-01 990260423 NORTH HAWAII COMMUNITY HOSPITAL % SHANNON OLSEN NORT 8088814400 67-1125 MAMALAHOA HIGHWAY Suite KAMUELA HI 967438496 NEIL T KUYPER TREASURER 2014-11-10 KELLEY SIMON P00791436 2013 2015-11-30 17:44:51Z DENNIS STILLMAN SAME AS C ABOVE KAMUELA HI 967438496 52252062 false X HTTP://WWW.NHCH.COM X 1989 HI ACUTE CARE HOSPITAL WITH THE MISSION TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII. 12 7 431 74 15428 14428 1857667 1575490 51574945 49715736 -153751 -30106 1571110 924531 54849971 52185651 0 0 0 0 28293970 28821176 0 3409 416034 28807598 31662669 57101568 60487254 -2251597 -8301603 161337747 177455257 15277443 15130616 146060304 162324641 ACUTE CARE HOSPITAL WITH THE MISSION TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE OF NORTH HAWAII. false false 39260844 49715736 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. IN 2013, THE HOSPITAL SERVED PATIENTS THROUGH 70,022 OUTPATIENT VISITS AND 1,687 ADMISSIONS. 39260844 true true false false false false false false false true true false false true true false false false false false false false false false false false true true false false true false false false false false false false false true false false false false true true true false false true 110 0 true 431 true true true false false false false false false false false false X 12 7 false false true false true true true true true false false true true true false true true true true false X X SHANNON OLSEN 8088814400 67-1125 MAMALAHOA HIGHWAY KAMUELA HI 967438496 ROBERT R MOMSEN CHAIR 6.0 0.0 X X 0 0 0 VIRGINIA PRESSLER VICE CHAIR 3.0 0.0 X X 0 0 0 NEIL T KUYPER TREASURER 3.0 0.0 X X 0 0 0 ROBERT W HASTINGS III SECRETARY 3.0 0.0 X X 0 0 0 RICHARD M LEVY BOARD MEMBER 3.0 0.0 X 0 0 0 ROBERT K LINDSEY BOARD MEMBER 3.0 0.0 X 0 0 0 KAHU BILLY MITCHELL BOARD MEMBER 3.0 0.0 X 0 0 0 WILLIAM PARK MD BOARD MEMBER/PHYSICIAN 40.0 0.0 X 427250 0 18911 WILLIAM D HILLER MD BOARD MEMBER/CHIEF OF STAFF 40.0 0.0 X 524956 0 19594 LOWELL JOHNSON INTERIM CEO 40.0 0.0 X X 396000 0 0 HOWARD WONG MD BOARD MEMBER/CHIEF OF STAFF 40.0 0.0 X 352696 0 15266 PATRICIA GUNTER MD BOARD MEMBER/PHYSICIAN 40.0 0.0 X 287577 0 24402 JASON PARET CFO 40.0 0.0 X 109264 0 18538 WAYNE S HIGAKI VP PUBLIC AFFAIRS/CDO 40.0 0.0 X 185091 0 11381 WILLIAM BROWN VP HUMAN RESOURCES 40.0 0.0 X 184057 0 17069 LORIE ANN MORTENSEN VP PATIENT CARE 40.0 0.0 X 172335 0 11263 KERRY HOWELL VP-DEVELOPMENT, MARKETING 40.0 0.0 X 31935 6717 DIANE ES PAYNE PHYSICIAN 40.0 0.0 X 382193 0 17167 JENNIFER S REAL PHYSICIAN 40.0 0.0 X 261568 0 18839 MALCOM MACDONALD PHYSICIAN 40.0 0.0 X 252380 0 17835 JONETTE L CRAWFORD PHYSICIAN 40.0 0.0 X 199050 0 20519 ELISE FULSANG PHYSICIAN 40.0 0.0 X 149885 10286 KENNETH F WOOD PRESIDENT/CEO - FORMER 0.0 0.0 X 356562 0 16545 4272799 0 244332 44 true true false HURON CONSULTING SERVICES LLC 3005 MOMENTUM PLACE CHICAGO IL 60689 CONSULTING SERVICES 2873593 CLINICAL LABS OF HAWAII LP MAIL CODE 60300 PO BOX 1300 HONOLULU HI 96807 LAB SERVICES 943222 CA INDUSTRIES INC PO BOX 3037 OMAHA NE 68103 STAFFING 440615 INFINIPRISE TECHNOLOGIES LLC 5950 CARMICHAEL PLACE STE 104 MONTGOMERY AL 36117 IT SERVICES 436501 ANESTHESIA RELIEF LLC PO BOX 1840 KAILUA KONA HI 96745 ANESTHESIA SERVICES 322028 27 447892 1127598 155247 1575490 PATIENT SERVICE REVENUE 900099 45579598 45579598 STATE OF HAWAII SUSTAINABILITY 900099 3488370 3488370 E.H.R MEANINGFUL USE 900099 647768 647768 49715736 17678 15428 2250 0 0 306116 306116 0 306116 306116 18627 66411 -47784 -47784 -47784 0 0 0 MEDICAL ABSTRACTS 900099 12324 12324 VENDING MACHINE/CAFETERIA SALES 900099 345780 345780 MISCELLANEOUS REVENUE 900099 260311 260311 618415 52185651 49715736 15428 878997 0 0 0 0 2457740 2105302 352438 373107 373107 21063943 15960599 4820682 282662 386644 304185 77676 4783 2908930 2160400 708124 40406 1630812 1235129 376592 19091 722968 722968 1176020 1176020 147026 147026 0 3409 3409 0 9881945 5018425 4847249 16271 26430 3821 22586 23 408929 246202 152588 10139 1087785 1087785 0 2247357 28701 2211154 7502 138689 91667 46977 45 0 51852 25894 25958 526348 343534 179038 3776 0 2886810 1839916 1040840 6054 2429063 1587574 824125 17364 SUPPLIES 6487877 6275402 211994 481 BAD DEBT 1407674 1407674 LAND LEASE AMORTIZATION 40003 26110 13606 287 FIXED ASSET ABANDONMENT LOSS 1082642 1082642 913251 600309 309201 3741 60487254 39260844 20810376 416034 530166 600797 1761693 2032390 2755005 1011984 7493288 5509406 0 0 0 0 356016 252051 1203955 1248054 367392 285479 85956415 36865303 25244841 49091112 0 0 0 0 0 0 0 0 121625391 117423984 161337747 177455257 5008158 5516580 0 0 0 0 0 0 0 0 0 0 8277087 7190619 0 0 1992198 2423417 15277443 15130616 X 25727997 43657505 6663385 6130769 113668922 112536367 146060304 162324641 161337747 177455257 X -8301603 24565940 X false false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5020278 0 565011 381643 33492 34055 5136099 4911169 123000 519199 476608 37584 18898 5020278 0.81720 0.18280 true true true 16793374 16793374 3909896 3237040 672856 38412936 12828991 25583945 26078957 20163362 5915595 761250 635908 125342 49091112 EQUITY PARKER RANCH FDN TRUST 109299121 CONSTRUCTION IN PROGRESS 79419 INVESTMENT IN LIBERTY DIALYSIS 42106 LOAN ISSUE COSTS - UNAMORTIZED 60615 BENEFICIAL INTERESTS 5136098 CONTRIBUTED USE OF LAND 2806625 117423984 0 CAPITAL LEASE OBLIGATION 1563517 HMSA ADVANCE 826923 OTHER LIABILITIES 32977 2423417 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. true true X true X true X true true false false 61818 61818 0.00100 11914842 8275727 3369115 0.05670 11976660 8275727 3430933 0.05770 9950 9950 0.00020 639822 424920 214902 0.00360 649772 424920 224852 0.00380 12626432 8700647 3655785 0.06150 true 1407673 201677 6694404 9225039 -2530635 X true true 1 1 NORTH HAWAII COMMUNITY HOSPITAL 67-1125 MAMALAHOA HWY KAMUELA HI 96743 WWWW.NHCH.COM 39-H X X X NORTH HAWAII MEDICAL GROUP AND KOHALA HOME HEALTH AGENCY NORTH HAWAII COMMUNITY HOSPITAL 1 true X X X X X X X X X 13 true true true X SEE SECTION C X X X X X X X X false false true true 200. true 400. true X X X X X X true true X X true false X X X true X false false LINE 3 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 SPECIFIC TO HAWAII COUNTY, FINDINGS FROM THE STATEWIDE PERSPECTIVE WERE INCLUDED. 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. LINE 4 TWENTY-SIX OF 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 HOSPITALS 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 LINE 5A THE CHNA CAN BE FOUND AT: http://www.nhch.com/cms/View.aspx/Show/communitybenefit LINE 7 THE CHNA IDENTIFIED 20 AREAS OF COMMUNITY HEALTH NEEDS. NORTH HAWAII COMMUNITY HOSPITAL (NHCH) 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. LINE 9 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. LINE 14G MEASURES TO PUBLICIZE THE POLICY 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. PART III, LINE 4 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 PROGRAMS. BAD DEBT FINANCIAL STATEMENT FOOTNOTE - BAD DEBT PROVISIONS ARE MADE FOR THE AMOUNT OF REVENUE THAT WILL NOT BE COLLECTED FROM PATIENTS TO WHOM SERVICES WERE BILLED BUT NOT PAID. THE HOSPITAL HAS DETERMINED THESE PATIENTS ARE NOT FINANCIALLY INDIGENT AND DO NOT QUALIFY FOR THE HOSPITAL'S CHARITY CARE PROGRAM. BAD DEBT PROVISIONS ARE DETERMINED BY MANAGEMENT'S ASSESSMENT WITH CONSIDERATION OF BUSINESS AND ECONOMIC CONDITIONS, CHANGES AND TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE ADEQUECY OF THIS PROVISION IS PERIODICALLY REVIEWED AND FURTHER MODIFIED BASED UPON THE ACCOUNTS RECEIVABLE PAYOR COMPOSITION AND AGING AND HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. PART III, LINE 9B 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 SERVICES AT THE TIME OF TREATMENT. THE CAREPAYMENT PROGRAM IS AVAILABLE FOR ELIGIBLE PATIENTS AND PROVIDES LOW MONTHLY PAYMENTS WITH 0% INTEREST. PART VI, LINE 2 NEEDS ASSESMENT 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 INPROVEMENT 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 2013 TAX YEAR, NORTH HAWAII COMMUNITY HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE ASSISTANCE OF THE HEALTHCARE ASSOCIATION OF HAWAII. 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. APPRORIATE STAFF MEMBERS THAT COMMUNICATE WITH THE PUBLIC REGARDING THEIR BILLS ARE TRAINED AND KNOWLEDGEABLE ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES. PART VI, LINE 4 COMMUNITY INFORMATION NORTH HAWAII COMMUNITY HOSPITAL ("THE HOSPITAL") IS LOCATED IN KAMUELA, HI, ALSO KNOWN AS WAIMEA, HI, 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 1000 SQUARE MILES, OF THE BIG ISLAND'S 4028 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. 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 34 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 13,740. PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM NHCH BECAME A MEMBER OF THE QUEEN'S HEALTH SYSTEMS ("QHS") AFFILIATED GROUP IN DECEMBER 2013. THE GROUP INCLUDES QUEEN'S MEDICAL CENTER ("QMC"), MOLOKAI GENERAL HOSPITAL ("MGH"), QUEEN EMMA LAND COMPANY ("QEL"), QUEEN'S INSURANCE EXCHANGE ("QIE") AND QUEEN'S DEVELOPMENT CORPORATION ("QDC). QHS WILL PROVIDE LEGAL, ACCOUNTING AND ADMINISTRATIVE SUPPORT SERVICES TO NHCH AND QIE WILL PROVIDE MEDICAL MALPRACTICE INSURANCE TO NHCH. IN RETURN, NHCH WILL ASSIST QMC IN FULFILLING ITS MISSION TO PROVIDE IN PERPETUITY QUALITY HEALTH CARE SERVICES TO IMPROVE THE WELL-BEING OF NATIVE HAWAIIANS AND ALL OF THE PEOPLE OF HAWAII X true false false false false false false false false WILLIAM PARK MD BOARD MEMBER/PHYSICIAN 423998 0 0 0 3252 0 4784 0 14127 0 446161 0 0 0 WILLIAM D HILLER MD BOARD MEMBER/CHIEF OF STAFF 520048 0 0 0 4908 0 385 0 19209 0 544550 0 0 0 LOWELL JOHNSON INTERIM CEO 396000 0 0 0 0 0 0 0 0 0 396000 0 0 0 HOWARD WONG MD BOARD MEMBER/CHIEF OF STAFF 351259 0 0 0 1437 0 7020 0 8246 0 367962 0 0 0 PATRICIA GUNTER MD BOARD MEMBER/PHYSICIAN 285567 0 0 0 2010 0 5690 0 18712 0 311979 0 0 0 WAYNE S HIGAKI VP PUBLIC AFFAIRS/CDO 184134 0 0 0 957 0 3662 0 7719 0 196472 0 0 0 WILLIAM BROWN VP HUMAN RESOURCES 182495 0 0 0 1562 0 3631 0 13438 0 201126 0 0 0 LORIE ANN MORTENSEN VP PATIENT CARE 171560 0 0 0 775 0 3436 0 7827 0 183598 0 0 0 DIANE ES PAYNE PHYSICIAN 381609 0 0 0 584 0 7615 0 9552 0 399360 0 0 0 JENNIFER S REAL PHYSICIAN 261176 0 0 0 392 0 5202 0 13637 0 280407 0 0 0 MALCOM MACDONALD PHYSICIAN 224723 0 27000 0 657 0 4486 0 13349 0 270215 0 0 0 JONETTE L CRAWFORD PHYSICIAN 198708 0 0 0 342 0 2056 0 18463 0 219569 0 0 0 KENNETH F WOOD PRESIDENT/CEO - FORMER 0 0 0 0 356562 0 0 0 16545 0 373107 0 0 0 ELISE FULSANG PHYSICIAN 139374 10000 511 2444 7842 160171 PART I, LINE 3 SEE SCHEDULE O, PART VI, LINE 15A. PART I, LINE 4A KENNETH WOOD: SEVERANCE AGREEMENT INCLUDES BI-WEEKLY COMPENSATION OF $13,713.94 FROM 10/1/2012 FOR 24 MONTHS AND COVERAGE FOR MEDICAL AND DENTAL BENEFITS AT A COST OF $529.08 PER MONTH FOR 18 MONTHS. X 9 155247 FMV 0 false false false FORM 990, PART VI, LINE 4 DESCRIPTION OF SIGNIFICANT CHANGES TO ORGANIZING OR ENABLING DOCUMENT THE QUEEN'S HEALTH SYSTEMS ("QUEEN'S"), CORPORATE PARENT OF THE QUEEN'S MEDICAL CENTER ("QMC") ANNOUNCED ON DECEMBER 16, 2013 THAT IT HAD OFFICIALLY ENTERED INTO AN AFFILIATION AGREEMENT WITH NORTH HAWAII COMMUNITY HOSPITAL ("NHCH"). ON THAT DAY, NHCH AMENDED ITS ARTICLES OF INCORPORATION AND BYLAWS TO REFLECT THE AFFILIATION. THE AMENDED ARTICLES AND BYLAWS NAME THE QUEEN'S HEALTH SYSTEMS (QHS) AS THE SOLE CORPORATE MEMBER AND PROVIDE THEM THE POWER TO ELECT AND REMOVE THE TRUSTEES OF NHCH, AND TO VOTE ON ALL MATTERS. 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 ("QHS") 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 DESCRIBE CLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS CERTAIN MAJOR DECISIONS APPROVED BY THE NHCH BOARD OF TRUSTEES MUST ALSO BE APPROVED BY QHS. SUCH DECISIONS INCLUDE: 1. A CHANGE TO THE PURPOSE OF THE COMPANY; 2. A FINANCING TRANSACTION IN EXCESS OF $50,000; 3. A LEASE TRANSACTION THAT HAS A TERM THAT IS LONGER THAN 3 YEARS OR HAS A RENT OBLIGATION IN EXCESS OF $1,000,000 OVER THE LEASE TERM; 4. A TRANSACTION INVOLVING THE SALE, LEASE, DISPOSITION, OR HYPOTHECATION OF REAL PROPERTY; 5. ANNUAL OPERATIONAL AND CAPITAL BUDGETS; 6. STRATEGIC PLANS; 7. MERGER OR MAJOR ACQUISITIONS; 8. CREATION OF A NEW ENTITY OR JOINT VENTURE; 9. SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS; 10. DISSOLUTION; 11. AMENDMENT OF BYLAWS; 12. ADOPTION, AMENDMENT OR RESCISSION OF A BOARD POLICY; 13. CAPITAL EXPENDITURES IN EXCESS OF $1,000,000 FOR NHCH FORM 990, PART VI, LINE 11 DESCRIPTION OF THE PROCESS USED TO REVIEW THE FORM 990 AS OF JANUARY 15, 2014, NORTH HAWAII COMMUNITY HOSPITAL ("NHCH") HAS A SOLE MEMBER, WHICH IS THE QUEEN'S HEALTH SYSTEMS, A HAWAII NONPROFIT CORPORATION ("QHS"). THE FORM 990 FOR NHCH WAS REVIEWED BY THE GOVERNING BODY OF QHS PRIOR TO THE FILING OF THE RETURNS. THE QHS FINANCE 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. ALSO, A COPY OF THE 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 15A OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN THE HOSPITAL OBTAINED SALARY MARKET STUDIES FROM A CONTRACTED MANAGEMENT COMPANY TO REVIEW ALL EXECUTIVES' SALARIES. THEY ALSO COMPARED SALARIES OF APPLICANTS AND FORMER CHIEF EXECUTIVE OFFICERS OF THE ORGANIZATION. 2012 WAS THE LAST TIME THE PROCESS WAS COMPLETED. FORM 990, PART VI, LINE 19 DOCUMENTATION AVAILABLE TO PUBLIC THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL SERVICES PURCHASED SERVICES $4,671,058 MEDICAL SERVICES $5,210,887 ---------- TOTAL $9,881,945 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS ADJUSTMENT TO NET ASSETS $25,042,159 CHANGE IN VALUE OF BENEFICIAL INTEREST 24,578 RECLASS UNCOLLECTIBLE PLEDGES FROM PRIOR YEAR (500,758) ROUNDING (39) ------------- TOTAL $24,565,940 LUCY K HENRIQUES TRUST PO BOX 3170 DEPT 715 HONOLULU HI 968023170 996002291 SUPPORT AK 501(C)(3) 11C, III-FI NA false THE QUEEN'S HEALTH SYSTEMS 1301 PUNCHBOWL STREET HONOLULU HI 96813 990238120 ADMIN SERVICE HI 501(C)(3) 11 TYPE II NA false THE QUEEN'S MEDICAL CENTER 1301 PUNCHBOWL STREET HONOLULU HI 96813 990073524 MEDICAL SVCS HI 501(C)(3) 3 QHS true QUEEN EMMA LAND COMPANY 1301 PUNCHBOWL STREET HONOLULU HI 96813 990183769 SUPPORT SVCS HI 501(C)(3) 11 TYPE II QHS true HAMAMATSUPET 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 NA C CORP QUEEN'S INSURANCE EXCHANGE INC 1301 PUNCHBOWL STREET HONOLULU HI 96813 911913839 INSURANCE HI NA C CORP DIAGNOSTIC LABORATORY SERVICES INC 99-859 IWAIWA STREET AIEA HI 96701 990240499 MEDICAL LAB SVCS HI NA C CORP false false true false false false false false false false false false false false false false false false true LUCY K HENRIQUES TRUST S 84000 FMV SCHEDULE R, PART III HAMAMATSU/QUEEN'S PET IMAGING CENTER, LLC EIN:94-3266916 ADDRESS: 1301 PUNCHBOWL STREET HONOLULU, HI 96813