QUEENS NORTH HAWAII COMMUNITY HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- QUEENS NORTH HAWAII COMMUNITY HOSPITAL (EIN 99-0260423)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201223209349305137
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T13:22:50-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 920088037 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MIKUNDA COTTRELL & CO CPA'S | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3601 C STREET SUITE 600 | AddressLine1 |
| City | ANCHORAGE | City |
| State | AK | State |
| ZIP Code | 99503 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 990260423 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH HAWAII COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORT | NameControl |
| Phone | 8088814400 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 67-1125 MAMALAHOA HIGHWAY | AddressLine1 |
| City | KAMUELA | City |
| State | HI | State |
| ZIP Code | 967438496 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JASON PARET | Name |
| Title | CFO | Title |
| Phone | 8088814400 | Phone |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KEY E GETTY CPA | Name |
| PTIN | P00121200 | PTIN |
| Phone | 9072788878 | Phone |
| Date Prepared | 2012-11-13 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | WILLIAM BROWN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 67-1125 MAMALAHOA HIGHWAY | AddressLine1 |
| City | KAMUELA | City |
| State | HI | State |
| ZIP Code | 967438496 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 50070804 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | HTTP://WWW.NHCH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1989 | YearFormation |
| State Legal Domicile | HI | StateLegalDomicile |
| Activity Or Mission Description | ACUTE CARE HOSPITAL | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 417 | TotalNbrEmployees |
| Total Nbr Volunteers | 55 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 6049371 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 3658004 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 39664994 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 44984216 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 634876 | InvestmentIncomePriorYear |
| Investment Income Current Year | 22690 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 5566275 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1308880 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 51915516 | TotalRevenuePriorYear |
| Total Revenue Current Year | 49973790 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 23178835 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 27301915 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 200000 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 571453 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 22973660 | OtherExpensePriorYear |
| Other Expenses Current Year | 23220217 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 46352495 | TotalExpensesPriorYear |
| Total Expenses Current Year | 50522132 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 5563021 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -548342 | RevenuesLessExpensesCY |
| Total Assets BOY | 189501488 | TotalAssetsBOY |
| Total Assets EOY | 187907766 | TotalAssetsEOY |
| Total Liabilities BOY | 14328240 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 14738773 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 175173248 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 173168993 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | ACUTE CARE HOSPITAL | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 35459648 | Expense |
| Revenue | 44984216 | Revenue |
| Description | 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 39 BEDS. ADMITTING PHYSICIANS ARE PRACTITIONERS IN THE LOCAL AREA. TOTAL OUTPATIENT VISITS FOR 2011 WERE: 54,459. TOTAL ADMISSIONS FOR 2011 WERE: 2,687. | Description |
| Total Program Service Expense | 35459648 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 82 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 417 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHANNON OLSEN DIRECTOR OF FINANCIAL SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8088814675 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 67-1125 MAMALAHOA HIGHWAY | AddressLine1 |
| City | KAMUELA | City |
| State | HI | State |
| ZIP Code | 967438496 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| ROBERT MOMSEN | ||||||||
| CHAIR | 6.00 | X | 0 | 0 | 0 | |||
| DR VIRGINIA PRESSLER | ||||||||
| VICE CHAIR/TREASURER | 3.00 | X | 0 | 0 | 0 | |||
| DR SHARON VITOUSEK | ||||||||
| VICE CHAIR | 3.00 | X | 0 | 0 | 0 | |||
| WILLIAM HUTCHINSON | ||||||||
| TREASURER UNTIL 5/11 | 3.00 | X | 0 | 0 | 0 | |||
| ROBERT HASTINGS II | ||||||||
| SECRETARY | 3.00 | X | 0 | 0 | 0 | |||
| DR DANA LEE | ||||||||
| BOARD MEMBER UNTIL 1/5/11 | 3.00 | X | 0 | 0 | 0 | |||
| KAHU BILLY MITCHELL | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| CAROLYN QUICK | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| DR WILLIAM PARK | ||||||||
| BOARD MEMBER/PHYSICIAN/CHIEF MEDICAL OFFICER | 40.00 | X | 447041 | 0 | 16100 | |||
| NIEL KUYPER | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| RICHARD LEVY | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| KENNETH F WOOD | ||||||||
| CEO | 40.00 | 250000 | 0 | 18284 | X | |||
| WAYNE CHARLES ALLEN UNTIL 51511 | ||||||||
| CFO | 40.00 | 155385 | 0 | 8499 | X | |||
| JASON D PARET EFF 9122011 | ||||||||
| CFO | 40.00 | 70673 | 0 | 10449 | X | |||
| GERARD SZCZYGIEL | ||||||||
| PHYSICIAN/CHIEF OF STAFF MAY-DEC2011 | 40.00 | 260000 | 0 | 16609 | X | |||
| LORRIE ANN MORTENSEN | ||||||||
| CNO, VP PATIENT CARE | 40.00 | 165781 | 0 | 17220 | X | |||
| KERRY L HOWELL | ||||||||
| VP-DEVELOPMENT, MARKETING, COMMUNICATIONS | 40.00 | 152884 | 0 | 7190 | X | |||
| DIANE PAYNE | ||||||||
| PHYSICIAN | 40.00 | 560625 | 0 | 20693 | X | |||
| HOWARD WONG | ||||||||
| PHYSICIAN | 40.00 | 355284 | 0 | 7438 | X | |||
| WILLIAM HILLER | ||||||||
| PHYSICIAN | 40.00 | 344231 | 0 | 9317 | X | |||
| PATRICIA GUNTER | ||||||||
| PHYSICIAN | 40.00 | 271384 | 0 | 19002 | X | |||
| ASHLEY BYNO | ||||||||
| PHYSICIAN | 40.00 | 240252 | 0 | 15060 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3273540 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 165861 | TotalOtherCompensation |
| Number Individuals GT100 K | 35 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CLINICAL LABS OF HAWAII LLP | |||||
| 33 LANIHULI ST | HILO | HI | 96720 | LAB SERVICES FOR ENTIRE HOSPITAL | 813502 |
| EDWARD D HON MD | |||||
| PO BOX 6629 | KAMUELA | HI | 96743 | MEDICAL STAFF | 455208 |
| QUORUM HEALTH RESOURCES LLC | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 37027 | INTERIM DIRECTOR | 421051 |
| SANDWICH ISLES DEVELOPMENT LLC | |||||
| 3159 OAHU AVENUE | HONOLULU | HI | 96822 | CONSTRUCTION ARCHITECT AND PROJECT MANA | 375449 |
| C&A INDUSTRIES INC | |||||
| 13609 CALIFORNIA ST | OMAHA | NE | 68154 | LOCUMS | 371121 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 19 | NumberOfContractorsGT100K |
| Government Grants | 353500 | GovernmentGrants |
| All Other Contributions | 3304504 | AllOtherContributions |
| Noncash Contributions | 78573 | NoncashContributions |
| Total Contributions | 3658004 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 622100 | BusinessCode |
| Total Revenue Column | 44984216 | TotalRevenueColumn |
| Related Or Exempt Function Income | 44984216 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 44984216 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19067 | TotalRevenueColumn |
| Exclusion | $19,067 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 309005 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 309005 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 309005 | TotalRevenueColumn |
| Exclusion | $309,005 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 67936 | Securities |
| Other | 32701 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 67936 | Securities |
| Other | 29078 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 3623 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3623 | TotalRevenueColumn |
| Exclusion | $3,623 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 285312 | GrossSalesOfInventory |
| Cost Of Goods Sold | 0 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 285312 | TotalRevenueColumn |
| Exclusion | $285,312 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MISCELLANEOUS | 900099 | 698813 | $698,813 |
| INV IN LIBERTY DIALYSI | 900099 | 15750 | $15,750 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 714563 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 49973790 | TotalRevenueColumn |
| Related Or Exempt Function Income | 44984216 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,331,570 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1596115 | Total |
| Program Services | 739750 | ProgramServices |
| Management And General | 696291 | ManagementAndGeneral |
| Fundraising | 160074 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21626605 | Total |
| Program Services | 16961936 | ProgramServices |
| Management And General | 4561371 | ManagementAndGeneral |
| Fundraising | 103298 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41646 | Total |
| Program Services | 30582 | ProgramServices |
| Management And General | 10291 | ManagementAndGeneral |
| Fundraising | 773 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2539451 | Total |
| Program Services | 1933759 | ProgramServices |
| Management And General | 576371 | ManagementAndGeneral |
| Fundraising | 29321 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1498098 | Total |
| Program Services | 1164648 | ProgramServices |
| Management And General | 319122 | ManagementAndGeneral |
| Fundraising | 14328 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2531621 | Total |
| Program Services | 1469868 | ProgramServices |
| Management And General | 1061753 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 167053 | Total |
| Management And General | 167053 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 248023 | Total |
| Management And General | 248023 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3928650 | Total |
| Program Services | 2613882 | ProgramServices |
| Management And General | 1247709 | ManagementAndGeneral |
| Fundraising | 67059 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 106051 | Total |
| Program Services | 6757 | ProgramServices |
| Management And General | 30550 | ManagementAndGeneral |
| Fundraising | 68744 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 379539 | Total |
| Program Services | 145455 | ProgramServices |
| Management And General | 206782 | ManagementAndGeneral |
| Fundraising | 27302 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1090551 | Total |
| Management And General | 1090551 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1803110 | Total |
| Program Services | 122792 | ProgramServices |
| Management And General | 1672463 | ManagementAndGeneral |
| Fundraising | 7855 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 137227 | Total |
| Program Services | 99687 | ProgramServices |
| Management And General | 34040 | ManagementAndGeneral |
| Fundraising | 3500 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69679 | Total |
| Program Services | 38642 | ProgramServices |
| Management And General | 26735 | ManagementAndGeneral |
| Fundraising | 4302 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 618382 | Total |
| Program Services | 440172 | ProgramServices |
| Management And General | 169193 | ManagementAndGeneral |
| Fundraising | 9017 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2658770 | Total |
| Program Services | 1878018 | ProgramServices |
| Management And General | 765412 | ManagementAndGeneral |
| Fundraising | 15340 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 960002 | Total |
| Program Services | 700545 | ProgramServices |
| Management And General | 247168 | ManagementAndGeneral |
| Fundraising | 12289 | Fundraising |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| SUPPLIES | 6148416 | 5724192 | 404457 | 19767 |
| BAD DEBT EXPENSE | 422146 | 422146 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1950997 | Total |
| Program Services | 1388963 | ProgramServices |
| Management And General | 533550 | ManagementAndGeneral |
| Fundraising | 28484 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50522132 | Total |
| Program Services | 35459648 | ProgramServices |
| Management And General | 14491031 | ManagementAndGeneral |
| Fundraising | 571453 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2850 | BOY |
| EOY | 92269 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6748536 | BOY |
| EOY | 4735373 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1343982 | BOY |
| EOY | 2825270 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4877068 | BOY |
| EOY | 6283153 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 427915 | BOY |
| EOY | 586765 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1143756 | BOY |
| EOY | 1389949 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 734747 | BOY |
| EOY | 464187 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 59754051 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 35006240 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25169239 | BOY |
| EOY | 24747811 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 149053395 | BOY |
| EOY | 146782989 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 189501488 | BOY |
| EOY | 187907766 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3261153 | BOY |
| EOY | 4152597 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10816975 | BOY |
| EOY | 9624232 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 250112 | BOY |
| EOY | 961944 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14328240 | BOY |
| EOY | 14738773 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24189085 | BOY |
| EOY | 23405880 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8907899 | BOY |
| EOY | 10276805 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 142076264 | BOY |
| EOY | 139486308 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 175173248 | BOY |
| EOY | 173168993 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 189501488 | BOY |
| EOY | 187907766 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -548342 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1455913 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7694551 | OtherCostOrOtherBasis |
| Book Value | 7694551 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20981869 | OtherCostOrOtherBasis |
| Depreciation | 11762932 | Depreciation |
| Book Value | 9218937 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3289029 | OtherCostOrOtherBasis |
| Depreciation | 3180574 | Depreciation |
| Book Value | 108455 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 26616518 | OtherCostOrOtherBasis |
| Depreciation | 19612229 | Depreciation |
| Book Value | 7004289 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1172084 | OtherCostOrOtherBasis |
| Depreciation | 450505 | Depreciation |
| Book Value | 721579 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 24747811 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (9 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DISTRIBUTION RECEIVABLE - PARKER RANCH FOUNDATION TRUST | 960000 |
| INTEREST IN EQUITY OF PARKER RANCH FOUNDATION TRUST | 136494600 |
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | 79664 |
| CONSTRUCTION IN PROGRESS | 1709572 |
| INVESTMENT IN LIBERTY DLYS | 42106 |
| LOAN ISSUE COSTS - UNAMORTIZED | 120423 |
| BENEFICIAL INTERESTS | 4371934 |
| CONTRIBUTED USE OF LAND | 2886625 |
| OTHER RECEIVABLES | 118065 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 146782989 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAPITAL LEASE OBLIGATION | Description |
| Amount | $961,944 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 961944 | TotalOfAmounts |
| Total Revenue | 49973790 | TotalRevenue |
| Total Expenses | 50522132 | TotalExpenses |
| Excess Or Deficit For Year | -548342 | ExcessOrDeficitForYear |
| Other | -$1,455,913 | OtherAmount |
| Total Adjustments | -1455913 | TotalAdjustments |
| Excess Or Deficit Per FS | -2004255 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 48095731 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -1455913 | OtherRevenues |
| Revenue Not Rptd F990 | -1455913 | RevenueNotRptdF990 |
| Revenue Subtotal | 49551644 | RevenueSubtotal |
| Other Revenues Not Included | 422146 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 422146 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 49973790 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 50099986 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 50099986 | ExpensesSubtotal |
| Other Expenses Not Included | 422146 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 422146 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 50522132 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN VALUE OF INT IN PARKER RACH FOUNDATION TRUST -1,442,481. CHANGE IN VALUE OF OTHER BENEFICIAL INTERESTS -13,432. TOTAL TO SCHEDULE D, PART XI, LINE 8: -1,455,913. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN VALUE OF INT IN PARKER RACH FOUNDATION TRUST -1,442,481. CHANGE IN VALUE OF OTHER BENEFICIAL INTERESTS -13,432. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT RECLASSED FROM REVENUE TO EXPENSE 422,146. |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT RECLASSED FROM REVENUE TO EXPENSE 422,146. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 135114 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 135114 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10129737 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4510912 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5618825 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11120 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10264851 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4510912 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5753939 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11390 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5650 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5650 | DirectOffsettingRevenue |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5650 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5650 | DirectOffsettingRevenue |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10270501 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4516562 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5753939 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11390 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $442,146 | BadDebtExpenseAmount |
| Amount Attributable To | 128820 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6673334 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6244634 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 428700 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH HAWAII COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 67-1125 MAMALAHOA HWY | AddressLine1 |
| City | KAMUELA | City |
| State | HI | State |
| ZIP Code | 96743 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | INCLUDES NORTH HAWAII MEDICAL GROUP AND KOHALA HOME HEALTH AGENCY. | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH HAWAII COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 0 | NondiscrimEmergencyCarePolicy |
| No Emergency Policy | X | NoEmergencyPolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 ADEQUACY 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. | ||
| THE HOSPITAL PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. SINCE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS NET PATIENT REVENUE. THE CHARGES AT ESTABLISHED RATES FOREGONE FOR SERVICES AND SUPPLIES PROVIDED BY THE HOSPITAL IN 2010 AND 2009 FOR CHARITY CARE TOTALED $283,293 AND $643,551, RESPECTIVELY. | BAD DEBT EXPENSE | PART III LINE 4 |
| THE ENTIRE SHORTFALL IS ATTRIBUTABLE TO COMMUNITY BENEFIT. | EXPLANATION OF SHORTFALL AS COMMUNITY BENEFIT | PART III LINE 8 |
| 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 IMPROVEMENT SERVICES ARE OFFERED IN THE FORMS OF ACTIVITIES OR PROGRAMS THAT HELP TO ASSESS AND IMPROVE COMMUNITY HEALTH. | NEEDS ASSESSMENT | PART VI |
| HOSPITAL ADMITTING STAFF MEMBERS ADVISE AND ASSIST ALL SELF-PAY PATIENTS OF THE OPTIONS FOR AVAILABLE ASSISTANCE. | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI |
| NORTH HAWAII COMMUNITY HOSPITAL (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 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 1996. THE HOSPITAL IS CURRENTLY LICENSED FOR 39 BEDS. ADMITTING PHYSICIANS ARE PRACTITIONERS IN THE LOCAL AREA. | COMMUNITY INFORMATION | PART VI |
| N/A | PART VI | |
| N/A | AFFILIATED HEALTH CARE SYSTEM ROLES AND PROMOTION | PART VII |
| HI | STATES WHERE COMMUNITY BENEFIT REPORT FILED | PART VI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR WILLIAM PARK | |||||||||||||
| 447041 | 0 | 0 | 0 | 0 | 0 | 4499 | 0 | 11601 | 0 | 463141 | 0 | 0 | 0 |
| KENNETH F WOOD | |||||||||||||
| 250000 | 0 | 0 | 0 | 0 | 0 | 2524 | 0 | 15760 | 0 | 268284 | 0 | 0 | 0 |
| WAYNE CHARLES ALLEN UNTIL 51511 | |||||||||||||
| 155385 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 8499 | 0 | 163884 | 0 | 0 | 0 |
| GERARD SZCZYGIEL | |||||||||||||
| 260000 | 0 | 0 | 0 | 0 | 0 | 2650 | 0 | 13959 | 0 | 276609 | 0 | 0 | 0 |
| LORRIE ANN MORTENSEN | |||||||||||||
| 165781 | 0 | 0 | 0 | 0 | 0 | 1679 | 0 | 15541 | 0 | 183001 | 0 | 0 | 0 |
| KERRY L HOWELL | |||||||||||||
| 152884 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7190 | 0 | 160074 | 0 | 0 | 0 |
| DIANE PAYNE | |||||||||||||
| 560625 | 0 | 0 | 0 | 0 | 0 | 5627 | 0 | 15066 | 0 | 581318 | 0 | 0 | 0 |
| HOWARD WONG | |||||||||||||
| 355284 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7438 | 0 | 362722 | 0 | 0 | 0 |
| WILLIAM HILLER | |||||||||||||
| 344231 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 9317 | 0 | 353548 | 0 | 0 | 0 |
| PATRICIA GUNTER | |||||||||||||
| 271384 | 0 | 0 | 0 | 0 | 0 | 2743 | 0 | 16259 | 0 | 290386 | 0 | 0 | 0 |
| ASHLEY BYNO | |||||||||||||
| 240252 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 15060 | 0 | 255312 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 3 | A BOARD RESOLUTION IS REQURED. |
| PART I, LINE 4A | PART I, LINE 4A: MICHAEL KENDALL: 55,000 SEVERANCE PAYMENT 1,500 CAREER TRANSITION ASSISTANCE 6 MONTHS COBRA BENEFITS PAID BY HOSPITAL WAYNE ALLEN 97,500 SEVERANCE PAYMENT 9 MONTHS COBRA BENEFITS PAID BY HOSPITAL |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTraded
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 6 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 78573 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FMV AT TIME OF SALE | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | A NEW NATIVE HAWAIIAN CLINIC WAS INCORPORATED INTO THE PROGRAM IN SEPTEMBER 2011. THIS IS A CLINIC THAT WORKS WITH NATIVE HAWAIIANS TO INTEGRATE CULTURAL ISSUES INTO MEDICAL TREATMENT AS WELL AS BEHAVIORAL TREATMENT. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS PREPARED BY THE CPA FIRM, AND REVIEWED BY THE CFO, DIRECTOR OF FINANCIAL SERVICES, BOARD FINANCE COMMITTEE, AND BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE POLICY IS REVIEWED EACH YEAR BY ADMINISTRATION. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE HOSPITAL OBTAINED SALARY MARKET STUDIES FROM A CONTRACTED MANAGEMENT COMPANY. THEY ALSO COMPARED SALARIES OF APPLICANTS AND FORMER CHIEF EXECUTIVE OFFICERS OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | CHANGE IN VALUE OF INT IN PARKER RACH FOUNDATION TRUST -1,442,481. CHANGE IN VALUE OF OTHER BENEFICIAL INTERESTS -13,432. TOTAL TO FORM 990, PART XI, LINE 5: -1,455,913. |
| AUDIT OVERSIGHT | FORM 990 PART XII, LINE 2C | FINAL SIGN OFF OF THE AUDIT IS BY THE BOARD, BASED ON RECOMMENDATIONS FROM THE FINANCE COMMITTEE. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LUCY K HENRIQUES TRUST | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O BANK OF HAWAII PO BOX 3170 DEPT | AddressLine1 |
| City | HONOLULU | City |
| State | HI | State |
| ZIP Code | 968023170 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 996002291 | EIN |
| Primary Activities | PROVIDE SUPPORT FOR NORTH HAWAII COMMUNITY HOSPITAL | PrimaryActivities |
| Legal Domicile State | AK | LegalDomicileState |
| Exempt Code Section | 501C3 | ExemptCodeSection |
| Public Charity Status | LINE 11C, III-FI | PublicCharityStatus |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LUCY K HENRIQUES TRUST | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 87000 | AmountInvolved |
| Method Of Amt Determination | CASH | MethodOfAmtDetermination |
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