2013-05-09T20:42:13-05:00 2012-06-30 ERNST & YOUNG US LLP 4370 LA JOLLA VILLAGE DR STE 500 SAN DIEGO CA 92122 990 2011-07-01 990326099 KAUA'I MEDICAL CLINIC % DEBRA TUQUERO KAUA 8082451500 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 EARL INOUYE 2013-05-07 8585357200 2011 2016-02-25 16:41:14Z RAYMOND VARA 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 34815373 false X WWW.WILCOXHEALTH.ORG X 1967 HI KAUA'I MEDICAL CLINIC IS AN AFFILIATE OF HAWAI'I PACIFIC HEALTH. IT IS A FOUR-LOCATION, MULTISPECIALTY CLINIC WHOSE NONPROFIT MISSION IS TO SERVE THE KAUA'I COMMUNITY WITH ACCESSIBLE QUALITY HEALTH CARE. 7 3 252 0 0 0 0 34237416 34714831 268 12377 93838 87700 34331522 34814908 0 0 0 0 31883708 32809610 0 0 0 16355806 14818116 48239514 47627726 -13907992 -12812818 6715966 6928697 5075064 4627877 1640902 2300820 X THE KAUA'I MEDICAL CLINIC (KMC) IS A NONPROFIT MULTI-SPECIALTY CLINIC WHOSE MISSION IS TO SERVE THE KAUA'I COMMUNITY WITH ACCESSIBLE, QUALITY HEALTH CARE THAT SURPASSES EXPECTATIONS. false false 41429639 0 34814326 SEE SCHEDULE O. 41429639 true false false false false false false false false false true false false true true false false true false false false false false false false false false false false true false false false false false false true false false false false false false true true true false false true 30 0 true 252 true false false false false false false false false false false X 7 3 false false false false true true true true true false false true true true true true true false true false HI X X DEBRA TUQUERO 8085357284 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 X MARK MAGELSSEN MD 40.0 X X 329497 0 44531 MALVIN DOHRMAN 0.2 X X 0 0 0 TOM CANUTE 0.2 X 0 0 0 SAM CHEN MD 40.0 X 351555 0 38608 SANDI KATO-KLUTKE 0.2 X 0 0 0 MIKE MURAKOSHI 0.2 X 0 0 0 CHARLES A STED 2.0 X 0 1555410 597643 DAVID ROVINSKY MD 40.0 X 276595 0 42640 RAYMOND P VARA JR 5.0 X 0 1056346 274172 GERI YOUNG MD 40.0 X 0 417777 63266 MELINDA ASHTON MD 1.0 X 0 379697 69014 WARREN CHAIKO 1.0 X 0 280639 59425 CHARLES R CHING 4.0 X 0 476486 108462 ARTHUR GLADSTONE 0.2 X 0 382873 76740 EARL INOUYE 1.0 X 0 300820 77938 GAIL LERCH 0.2 X 0 545501 144607 SUSAN MASUMOTO-NONAKA 1.0 X 0 242748 45576 DAVID OKABE 1.0 X 0 624519 140845 ANN PETERS 1.0 X 0 216584 44780 VIRGINIA PRESSLER-FISHER MD 0.2 X 0 557313 154090 KENNETH B ROBBINS MD 10.0 X 0 684384 203029 STEVEN ROBERTSON 1.0 X 0 549278 142203 KEKA SANBORN 0.2 X 0 257300 34458 DAVID FOX 4.8 X 0 112370 34869 JESSICA LEWIS 2.4 X 0 111856 21557 THERESA RAMEY 16.0 X 0 111832 33218 JOHN J CULLINEY MD 40.0 X 485590 0 48908 STEPHEN P KEITH MD 40.0 X 882659 0 42439 MICHAEL LEE MAY MD 40.0 X 471138 0 37781 JOSEPH M MURRAY MD 40.0 X 487753 0 48140 SURENDRA D RAO MD 40.0 X 690783 0 42640 TERRY LONG 0.0 X 0 144440 2528 KEOKI CLEMENTE 0.0 X 0 138104 18640 3975570 9146277 2692747 8 true true false SHIOI CONSTRUCTION INC 98-724 KUAHAO PLACE PEARL CITY HI 96782 CONSTRUCTION 379236 COMPHEALTH INC PO BOX 972651 DALLAS TX 753972651 HEALTHCARE STAFFING 320088 OTIS ELEVATOR COMPANY DEPT LA 21684 PASADENA CA 911851684 ELEVATOR MAINTENANCE 124883 VRP OF CA PA 25983 NETWORK PLACE CHICAGO IL 606731259 PATIENT CARE 116727 FUJIFILM MEDICAL SYSTEMS USA INC 29012 N HANCOCK PKWY BLDG 7 VALENCIA CA 913551007 MED. IMAGE PRODUCTS 115072 10 0 NET PATIENT REVENUE 622110 29556782 29556782 PREMIUM REVENUE 622110 4491439 4491439 RENTAL INCOME 900099 87634 87634 OTHER HEALTH CARE REVENUE 622110 578976 578976 34714831 582 582 0 0 12260 465 11795 11795 11795 0 0 0 ALL OTHER REVENUE 900099 87700 87700 87700 34814908 34814326 582 0 0 0 0 961345 961345 133000 133000 27566028 26947673 618355 725976 688222 37754 2061791 1952215 109576 1361470 1319621 41849 0 0 222506 222506 0 0 0 4465283 3136618 1328665 38636 -108 38744 2208033 2112740 95293 804481 804481 0 1458130 1375052 83078 174664 150506 24158 0 0 0 0 644360 629308 15052 883099 816166 66933 BAD DEBT 1090873 1090873 CORPORATE ALLOCATION 2510640 2510640 OTHER PURCHASES 173428 113359 60069 ALL OTHER EXPENSES 143983 3049 140934 47627726 41429639 6198087 0 -70227 -15728 571533 22 0 0 2043470 2182428 0 0 0 0 0 0 0 0 0 0 8960582 5638257 2357897 3322325 0 0 0 0 0 0 0 0 1813293 1439650 6715966 6928697 4170031 3642629 0 0 0 0 0 0 0 0 0 0 0 0 0 0 905033 985248 5075064 4627877 X 1640902 2300820 0 0 0 0 1640902 2300820 6715966 6928697 X -12812818 13472736 X false true true X false X 1659427 600984 1058443 6319873 5037273 1282600 981282 0 981282 3322325 DEPOSITS AND OTHER NON-CURRENT 939019 DUE FROM GOVERNMENT AGENCIES 319777 OTHER RECEIVABLES 58795 PROVIDERS INSURANCE CORP 45478 HPH RESEARCH INSTITUTE 36225 PALI MOMI MEDICAL CENTER 610 KAPI'OLANI MEDICAL SPECIALISTS 39747 1439650 0 457(B) LIABILITY 887889 ESCHEAT LIABILITY 3005 KAPI'OLANI WOMEN 14490 KAPI'OLANI HEALTH FDN 8851 STRAUB FOUNDATION 127 STAUB CLINIC 26580 WILCOX HEALTH FDN 44306 985248 false true false false false false false false false MARK MAGELSSEN MD 85216 0 6462 0 237819 0 31800 0 12731 0 374028 0 0 0 SAM CHEN MD 349363 0 2192 0 0 0 31800 0 6808 0 390163 0 0 0 CHARLES A STED 0 761348 0 364623 0 429439 0 580822 0 16821 0 2153053 0 379514 DAVID ROVINSKY MD 275787 0 808 0 0 0 26300 0 16340 0 319235 0 0 0 RAYMOND P VARA JR 0 609758 0 255393 0 191195 0 249130 0 25042 0 1330518 0 153268 GERI YOUNG MD 0 331536 0 27160 0 59081 0 46471 0 16795 0 481043 0 22134 MELINDA ASHTON MD 0 299284 0 42248 0 38165 0 47754 0 21260 0 448711 0 14412 WARREN CHAIKO 0 209882 0 37492 0 33265 0 37603 0 21822 0 340064 0 4264 CHARLES R CHING 0 322983 0 102681 0 50822 0 105967 0 2495 0 584948 0 69790 ARTHUR GLADSTONE 0 287513 0 53986 0 41374 0 56820 0 19920 0 459613 0 16048 EARL INOUYE 0 230688 0 35169 0 34963 0 56567 0 21371 0 378758 0 7137 GAIL LERCH 0 316885 0 107318 0 121298 0 126657 0 17950 0 690108 0 65499 SUSAN MASUMOTO-NONAKA 0 200568 0 27173 0 15007 0 25452 0 20124 0 288324 0 927 DAVID OKABE 0 424596 0 138755 0 61168 0 133328 0 7517 0 765364 0 88765 ANN PETERS 0 168717 0 27117 0 20750 0 24396 0 20384 0 261364 0 0 VIRGINIA PRESSLER-FISHER MD 0 345564 0 98374 0 113375 0 132910 0 21180 0 711403 0 87201 KENNETH B ROBBINS MD 0 410438 0 133215 0 140731 0 182987 0 20042 0 887413 0 105027 STEVEN ROBERTSON 0 345271 0 113069 0 90938 0 120523 0 21680 0 691481 0 70437 KEKA SANBORN 0 207841 0 24234 0 25225 0 14448 0 20010 0 291758 0 0 JOHN J CULLINEY MD 463790 0 21800 0 0 0 31800 0 17108 0 534498 0 0 0 STEPHEN P KEITH MD 882659 0 0 0 0 0 26300 0 16139 0 925098 0 0 0 MICHAEL LEE MAY MD 471138 0 0 0 0 0 31800 0 5981 0 508919 0 0 0 JOSEPH M MURRAY MD 478321 0 72 0 9360 0 31800 0 16340 0 535893 0 0 0 SURENDRA D RAO MD 688063 0 0 0 2720 0 26300 0 16340 0 733423 0 0 0 TERRY LONG 0 144440 0 0 0 0 0 2528 0 0 0 146968 0 0 KEOKI CLEMENTE 0 127511 0 10593 0 0 0 2448 0 16192 0 156744 0 0 SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 3 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 FOR 990 PART VI, LINE 15A FOR THE PROCESS USED BY HPH TO DETERMINE COMPENSATION. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B 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 DERERRED BASIS. AMOUNT PAID OUT DURING THE YEAR BY RELATED ORGANIZATION: MELINDA ASHTON $14,412 WARREN CHAIKO $4,264 CHARLES CHING $41,641 ARTHUR GLADSTONE $16,048 EARL INOUYE $7,137 GAIL LERCH $36,407 SUSAN MASUMOTO-NONAKA $927 DAVID OKABE $51,432 VIRGINIA PRESSLER-FISHER $57,884 STEVEN ROBERTSON $40,015 KENNETH B. ROBBINS $67,793 CHARLES A. STED $277,790 RAYMOND VARA $85,005 GERI YOUNG $22,134 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. AMOUNT PAID OUT DURING THE YEAR BY RELATED ORGANIZATION: CHARLES A. STED $101,724 RAYMOND VARA $68,263 CHARLES CHING $28,149 VIRGINIA PRESSLER FISHER $29,317 GAIL LERCH $29,092 DAVID OKABE $37,333 KENNETH B. ROBBINS $37,234 STEVEN ROBERTSON $30,422 AMY HUTSON FAMILY MEMBER OF DIRECTOR 133000 COMPENSATION false STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A ESTABLISHED IN 1967, KAUA'I MEDICAL CLINIC (KMC) HAS PROVIDED THE RESIDENTS AND VISITORS OF KAUA'I WITH PRIMARY AND SPECIALTY CARE FOR MORE THAN 40 YEARS. KMC PARTNERS WITH WILCOX MEMORIAL HOSPITAL AS PART OF WILCOX HEALTH. KMC OFFERS MORE THAN 20 SPECIALTIES AT FOUR LOCATIONS: THE MAIN CLINIC IN LIHUE AND THREE SATELLITE CLINICS IN KAPAA, KOLOA AND ELEELE. KMC EMPLOYS 90 PROVIDERS AND 144 DIRECT SUPPORT STAFF. IN FISCAL YEAR 2012, CLINIC VISITS WERE 222,064 AND TOTAL PATIENT ENCOUNTERS WERE 309,499. SPECIALTY UNITS: KMC IS KAUAI'S ONLY MULTI-SPECIALTY GROUP. IT PROVIDES CARE IN CARDIOLOGY, FAMILY MEDICINE, GASTROENTEROLOGY, GENERAL MEDICINE, GENERAL SURGERY, HEMATOLOGY, INFECTIOUS DISEASES, INTERNAL MEDICINE, NEUROLOGY, OBSTETRICS AND GYNECOLOGY, ONCOLOGY, ORTHOPEDIC SURGERY, OTOLARYNGOLOGY, PEDIATRICS, PHYSIATRY, PODIATRY, RHEUMATOLOGY AND UROLOGY. THIS RANGE OF SPECIALTIES, MULTIPLE LOCATIONS, AND AFFILIATION WITH HAWAII PACIFIC HEALTH SIGNIFICANTLY INCREASES ACCESS TO CARE FOR KAUA'I RESIDENTS AND VISITORS. KMC PATIENTS ENJOY EASY APPOINTMENT SCHEDULING, URGENT CARE SERVICES, CHRONIC DISEASE MANAGEMENT, DIABETES CONSULTATION AND EDUCATION, DIAGNOSTIC IMAGING, FINANCIAL COUNSELING, AND A PHARMACY. COMMUNITY: KAUA'I MEDICAL CLINIC IS AN ACTIVE COMMUNITY PARTNER. IN FISCAL 2012, ITS HEALTH EDUCATION, PREVENTION PROGRAMS AND SUPPORT GROUPS FOCUSED ON DIABETES, SPORTS MEDICINE, WATER SAFETY, INJURY PREVENTION, AND HEALTH FAIRS. TOGETHER WITH WILCOX MEMORIAL HOSPITAL, THE CLINIC HOSTED OR SPONSORED A VARIETY OF COMMUNITY HEALTH EDUCATION EVENTS, AND STAFF SUPPORTED THEIR COMMUNITY BY PARTICIPATING IN ANNUAL CHARITABLE ENDEAVORS. THESE INCLUDED KIDS' SUMMER FEST, THE WOMEN'S 10K RACE, THE OLD KOLOA SUGAR MILL RUN, PARADE OF LIGHTS, RELAY FOR LIFE, KAUAI LIFE GUARD ASSOCIATION'S "FIRST WAVE," KAUAI DIABETES TODAY'S SUMMER BASH AND MALAMA PONO HEALTH SERVICES' PARADISE RIDE. KAUAI MEDICAL CLINIC ALSO PROVIDED PHYSICIAN SUPPORT FOR LOCAL HIGH SCHOOL FOOTBALL TEAMS. KAUA'I MEDICAL CLINIC TREATS ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THUS SERVING (WITH WILCOX MEMORIAL HOSPITAL) AS ONE OF THE COMMUNITY'S SAFETY NET PROVIDERS OF HEALTH CARE. IN FISCAL YEAR 2012, KMC PROVIDED $3,586,553 WORTH OF CARE TO PATIENTS WHO WERE UNINSURED OR UNABLE TO PAY FOR THEIR CARE, AS WELL AS OTHER COMMUNITY BENEFITS. MEMBERS AND RIGHTS FORM 990, PART VI, LINE 6 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 BODY. ORGANIZATION ELECTS ONE OR MORE MEMBERS OF THE GOVERNING BODY FORM 990, PART VI, LINE 7A 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. DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, LINE 7B THE MEMBER SHALL HAVE THE EXCLUSIVE POWER TO TAKE AND DIRECT THE FOLLOWING ACTIONS OF THE CORPORATION: (1) NOMINATE CANDIDATES TO THE BOARD FOR THE FOLLOWING POSITIONS: THE PRESIDENT/CHIEF EXECUTIVE OFFICER, TREASURER, SECRETARY, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, OTHER EXECUTIVE VICE-PRESIDENTS, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE OPERATING UNIT VICE-PRESIDENTS, AS SUCH TERM IS DEFINED IN THE BYLAWS; (2) DELEGATE MANAGEMENT AUTHORITIES FROM THE BOARD TO OFFICERS OR COMMITTEES OF THE CORPORATION IN ACCORDANCE WITH A DELEGATED AUTHORITIES MATRIX ADOPTED BY THE MEMBER BOARD; (3) AMEND THE BYLAWS; (4) DETERMINE AND EFFECT THE CORPORATION'S PARTICIPATION IN ALL LONG TERM FINANCING TRANSACTIONS WHICH ARE IN EXCESS OF ONE (1)YEAR AND/OR FOR ONE MILLION DOLLAR ($1,000,000) OR MORE; (5) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (6) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (7) EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (8) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S PHYSICIAN AND EXECUTIVE COMPENSATION AND BENEFIT PLANS; (9) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, OR PARTNERSHIP OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (10) EXCEPT AS OTHERWISE PROVIDED IN THE BYLAWS OR AS REQUIRED BY THE LAW OF THE STATE OF HAWAI`I, SELL, LEASE OR OTHERWISE TRANSFER FIFTY PERCENT (50%) OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY WILCOX MEMORIAL HOSPITAL, KAUAI MEDICAL CLINIC AND WILCOX HEALTH FOUNDATION (THE "WILCOX AFFILIATES"); (11) EXCEPT AS PROVIDED IN THE BYLAWS OR AS REQUIRED BY THE LAWS OF THE STATE OF HAWAI`I, SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE WILCOX AFFILIATES WHICH GENERATE FIFTY PERCENT (50%) OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE WILCOX AFFILIATES DURING THE PRIOR FISCAL YEAR; (12) CLOSE THE CLINICAL FACILITIES OWNED AND OPERATED BY THE CORPORATION; PROVIDED, THAT, AFTER THE EFFECTIVE DATE OF THE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORPORATION MUST ALSO BE APPROVED BY THE BOARD; (13) CONVERT THE CLINIC OWNED AND OPERATED BY THE CORPORATION INTO A FACILITY NO LONGER OFFERING MEDICAL SERVICES; PROVIDED, THAT, AFTER THE EFFECTIVE DATE OF THE BYLAWS, ANY ELIMINATION OF A CLINICAL SERVICE PROVIDED BY THE CORPORATION MUST ALSO BE APPROVED BY THE BOARD; (14) AFTER CONSULTING WITH THE BOARD, REMOVE THE PRESIDENT/CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE-PRESIDENT/CHIEF FINANCIAL OFFICER, TREASURER, SECRETARY, OTHER EXECUTIVE VICE-PRESIDENTS, SENIOR VICE-PRESIDENTS, ASSISTANT SECRETARIES, AND ALL VICE-PRESIDENTS EXCEPT THE OPERATING UNIT VICE-PRESIDENTS; PROVIDED, HOWEVER, THAT TO REMOVE OR TERMINATE THE PRESIDENT/CHIEF EXECUTIVE OFFICER WILL REQUIRE THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE MEMBER TO FULLY COLLABORATE AND CONSULT WITH THE BOARD AND SEEK THE BOARD'S ADVANCE CONSENT FOR SUCH REMOVAL OR TERMINATION. IF THE BOARD DOES NOT CONCUR WITH THE PROPOSED REMOVAL OR TERMINATION OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER, SUCH REMOVAL OR TERMINATION WILL REQUIRE THE APPROVAL OF A MAJORITY OF THE MEMBERS ON THE MEMBER BOARD; (15) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORPORATE GOALS AND THE LONG RANGE AND STRATEGIC PLANS OF THE CORPORATION; AND (16) AFTER CONSULTING WITH THE BOARD, DEVELOP AND IMPLEMENT THE ANNUAL CAPITAL, OPERATING, AND CASH FLOW BUDGETS. THE CORPORATION SHALL NOT TAKE THE FOLLOWING ACTIONS WITHOUT FIRST OBTAINING MEMBER BOARD APPROVAL: (1) ADD ANY DIRECTOR TO THE BOARD; (2) REMOVE ANY DIRECTOR FROM THE BOARD; (3) AMEND THE ARTICLES; (4) ENTER INTO ANY UNBUDGETED CONTRACTS ON BEHALF OF THE CORPORATION WHICH REQUIRE ANNUAL PAYMENTS ON BEHALF OF THE CORPORATION EXCEEDING ONE MILLION DOLLARS ($1,000,000) IN VALUE; (5) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000); (6) ACQUIRE SHARES IN ANOTHER CORPORATION; (7) SELL, LEASE OR OTHERWISE TRANSFER FIFTY PERCENT (50%) OR MORE OF THE THEN CURRENT AMOUNT, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE TOTAL ASSETS HELD BY THE WILCOX AFFILIATES; (8) SELL, LEASE, EXCHANGE OR DISPOSE OF FIFTY PERCENT (50%) OR MORE OF THE PROPERTY AND ASSETS HELD BY THE CORPORATION TO ANY ENTITY THAT IS NOT AN AFFILIATE; (9) SELL, LEASE OR TRANSFER OF OPERATIONS OR ACTIVITIES OF THE WILCOX AFFILIATES WHICH GENERATE FIFTY PERCENT (50%) OR MORE OF THE TOTAL NET REVENUES, AS REPORTED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, OF THE WILCOX AFFILIATES DURING THE PRIOR FISCAL YEAR; (10) MERGE THE CORPORATION WITH ANY ENTITY; (11) DISSOLVE OR LIQUIDATE THE CORPORATION; (12) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (13) 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 (14) DEVELOP A NEW LINE OF BUSINESS OR A NEW SERVICE. REVIEW OF THE 990S BY THE ORGANIZATION'S GOVERNING BODY FORM 990, PART VI, LINE 11B 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 THE OPERATING UNITS, HR, LEGAL, ETC. DISCLOSURE NARRATIVES ARE WRITTEN AND COMPILED 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 DESCRIBES 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 WEB SITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURN WITH THE IRS. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICT OF INTEREST FORM 990, PART VI, LINE 12C 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. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED AND YEAR PROCESS WAS LAST COMPLETED FORM 990, PART VI, LINE 15B THE CEO OF THE ORGANIZATION IS 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'S 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 FEBRUARY 24, 2012 TO REVIEW PHYSICIAN COMPENSATION, AND ON JULY 12, 2011 AND AUGUST 9, 2012 TO REVIEW EXECUTIVE COMPENSATION. DISCLOSURE GOV DOCS, CONFLICT OF INTEREST POLICY, & FINANCIAL STMTS FORM 990, PART VI, LINE 19 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. STATEMENTS ARE AVAILABLE TO THE PUBLIC VIA THE HAWAI'I PACIFIC HEALTH WEBSITE. HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII INDIVIDUALS LISTED ON PART VII ALSO DEVOTE TIME TO THE FOLLOWING RELATED ORGANIZATIONS AS LISTED BELOW: KAPI'OLANI HEALTH FOUNDATION CHARLES A. STED 2 CHARLES R. CHING 0.1 DAVID OKABE 1 EARL INOUYE 0.2 JESSICA LEWIS 0.1 VIRGINIA PRESSLER-FISHER, M.D. 1 WILCOX HEALTH FOUNDATION CHARLES A. STED 1 CHARLES R. CHING 0.1 DAVID OKABE 0.1 EARL INOUYE 0.1 JESSICA LEWIS 0.2 VIRGINIA PRESSLER-FISHER, M.D. 1 STRAUB FOUNDATION CHARLES A. STED 1 CHARLES R. CHING 0.1 DAVID OKABE 0.1 EARL INOUYE 0.1 JESSICA LEWIS 0.1 KENNETH B. ROBBINS, M.D. 0.1 VIRGINIA PRESSLER-FISHER, M.D. 1 HAWAI'I PACIFIC HEALTH ANN PETERS 45 ARTHUR GLADSTONE 5 CHARLES A. STED 40 CHARLES R. CHING 30 DAVID FOX 2.4 DAVID OKABE 35 EARL INOUYE 30 GAIL LERCH 40 GERI YOUNG, M.D. 0.4 JESSICA LEWIS 0.6 KEKA SANBORN 50 KENNETH T. NAKAMURA, M.D. 1 MELINDA ASHTON, M.D. 40 RAYMOND P. VARA JR. 15 STEVEN ROBERTSON 15 SUSAN MASUMOTO-NONAKA 20 VIRGINIA PRESSLER-FISHER, M.D. 45 WARREN CHAIKO 15 KAPI'OLANI MEDICAL SPECIALISTS CHARLES A. STED 2 CHARLES R. CHING 3 DAVID FOX 0.4 DAVID OKABE 1 EARL INOUYE 1 GAIL LERCH 1 JESSICA LEWIS 1.3 KEKA SANBORN 0.2 KENNETH B. ROBBINS, M.D. 0.2 MELINDA ASHTON, M.D. 1 STEVEN ROBERTSON 1 SUSAN MASUMOTO-NONAKA 0.2 VIRGINIA PRESSLER-FISHER, M.D. 0.2 WARREN CHAIKO 1 PROVIDERS INSURANCE CORPORATION CHARLES A. STED 1 CHARLES R. CHING 2 DAVID OKABE 1 EARL INOUYE 0.5 JESSICA LEWIS 0.1 MELINDA ASHTON, M.D. 0.1 RAYMOND P. VARA JR. 2 PALI MOMI FOUNDATION CHARLES A. STED 1 CHARLES R. CHING 0.1 DAVID OKABE 0.1 EARL INOUYE 0.1 JESSICA LEWIS 0.1 VIRGINIA PRESSLER-FISHER, M.D. 0.1 HAWAI'I PACIFIC HEALTH GROUP RETURN ANN PETERS 4 ARTHUR GLADSTONE 50 CHARLES A. STED 10 CHARLES R. CHING 13 DAVID FOX 30.8 DAVID OKABE 16 EARL INOUYE 10 GAIL LERCH 19 JESSICA LEWIS 36.3 JOHN CULLINEY, M.D. 0.2 KEKA SANBORN 8 KENNETH B. ROBBINS, M.D. 40 MELINDA ASHTON, M.D. 7 RAYMOND P. VARA JR. 39 STEVEN ROBERTSON 43 SUSAN MASUMOTO-NONAKA 39 THERESA RAMEY 24 VIRGINIA PRESSLER-FISHER, M.D. 6 WARREN CHAIKO 35 OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 $13,472,736 - EQUITY TRANSFER WITH HPH HAWAI'I PACIFIC HEALTH 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246363 HOLDING CO. HI 501(C)(3) 11B TYPE II NA false STRAUB CLINIC & HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 912151670 HOSPITAL HI 501(C)(3) 3 NA true STRAUB FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990109350 RESEARCH/EDU HI 501(C)(3) 7 NA true PROVIDERS INSURANCE CORPORATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 NFP INSURANCE HI 501(C)(3) 11B TYPE II NA true PALI MOMI FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 383840327 FUNDRAISING HI 501(C)(3) 7 NA true KAPI'OLANI MEDICAL CTR WOMEN & CHILDREN 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 KAPI'OLANI MEDICAL SPECIALIST 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990322406 HEALTH CARE HI 501(C)(3) 9 NA true PALI MOMI MEDICAL CENTER 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990274038 HOSPITAL HI 501(C)(3) 3 NA true WILCOX MEMORIAL HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990074365 HOSPITAL HI 501(C)(3) 3 NA true WILCOX HEALTH FOUNDATION 990204242 FUNDRAISING HI 501(C)(3) 7 NA true HAWAI'I PACIFIC HEALTH PARTNERS INC & SU 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990318588 HOLDING COMPANY HI NA C CORP 0 0 0.00000 false false true false false false false false false false false false false true true true true true STRAUB CLINIC & HOSPITAL N 63701 FMV WILCOX MEMORIAL HOSPITAL P 1636093 FMV WILCOX MEMORIAL HOSPITAL Q 52536 FMV KAPI'OLANI MEDICAL CTR FOR WOMEN & CHILDREN R 106658 FMV PROVIDERS INSURANCE CORPORATION Q 839421 FMV PALI MOMI MEDICAL CENTER P 82214 FMV HAWAI'I PACIFIC HEALTH RESEACH INSTITUTE O 145928 FMV