2011-05-09T09:28:37-04:00 2010-06-30 ERNST & YOUNG US LLP 55 MERCHANT ST SUITE 1900 C-120 HONOLULU HI 96813 990 2009-07-01 990074365 WILCOX MEMORIAL HOSPITAL WILC 8082451100 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 EARL INOUYE 8085272595 2011-05-09 8085312037 2009 2016-02-24 21:20:13Z KATHLEEN CLARK 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 87693461 false X WWW.WILCOXHEALTH.ORG X 1936 HI WILCOX MEMORIAL HOSPITAL'S MISSION IS TO SERVE THE KAUA'I COMMUNITY WITH ACCESSIBLE, QUALITY HEALTHCARE THAT SURPASSES EXPECTATIONS. 11 7 557 76 0 533582 628670 80001837 84429511 246580 124719 1992305 2353904 82774304 87536804 0 33072 0 0 32682897 34392682 0 0 0 42161095 43267609 74843992 77693363 7930312 9843441 63975275 64333099 25502189 25607474 38473086 38725625 WILCOX MEMORIAL HOSPITAL IS A NONPROFIT HOSPITAL WHOSE MISSION IS TO SERVE THE KAUA'I COMMUNITY WITH ACCESSIBLE, QUALITY HEALTHCARE THAT SURPASSES EXPECTATIONS. false false 9304070 12786305 OUTPATIENT E.R. - WILCOX MEMORIAL HOSPITAL ("WILCOX) HAS A 20-BED EMERGENCY DEPARTMENT THAT SERVES ALL KAUA'I RESIDENTS AND VISITORS. IN FISCAL YEAR 2010, IT HAD 22,223 ER VISITS, AND IS ON TRACK TO BE THE FIRST NEIGHBOR ISLAND FACILITY TO OBTAIN A TRAUMA III DESIGNATION. ALSO IN FY10, WILCOX SUCCESSFULLY IMPLEMENTED A TRIAGE BEST PRACTICE CALLED "RAPID TRIAGE AND IMMEDIATE BED PLACEMENT" TO DECREASE BOTH DOOR-TO-BED AND DOOR-TO-DOC TIMES. THIS ALLOWS NEWLY ARRIVING PATIENTS TO BYPASS THE TRIAGE AREA, AS WELL AS NURSE ASSESSMENT AND ER PHYSICIAN EVALUATION TO OCCUR SIMULTANEOUSLY. THE PHILOSOPHY IMPROVES SERVICE, QUALITY AND SAFETY FOR PATIENTS NEEDING EMERGENCY CARE. 8346175 8393042 OUTPATIENT OR - WILCOX IS EQUIPPED WITH A STATE-OF-THE-ART SURGICAL CENTER WITH SIX SURGICAL SUITES, 20 SAME-DAY SURGERY BEDS, VOICE-ACTIVATED ROBOTICS AND COMPUTER-ASSISTED TECHNOLOGY. IN FISCAL YEAR 2010, THE WILCOX SURGICAL CENTER INCREASED ITS OUTPATIENT SURGERIES TO 5,870. THE CENTER OPENED IN THE SPRING OF 2006, PART OF A $10 MILLION PROJECT AND CAPITAL CAMPAIGN. 6325218 4531431 OUTPATIENT INFUSION SERVICES - THE INFUSION CENTER AT WILCOX PROVIDES COMPREHENSIVE, CUSTOMIZED TREATMENT REGIMENS AND PROCEDURES, INCLUDING CHEMOTHERAPY AND PALLIATIVE CARE FOR ONCOLOGY AND OTHER SERVICES, SUCH AS BLOOD/PLATELET TRANSFUSIONS; IV INFUSIONS OF IV ANTIBIOTICS, ALBUMIN, IRON, REMICAIDE, RECLAST AND IVIG; IV HYDRATION; AND PHLEBOTOMY. THE HIGHLY TRAINED AND CARING STAFF HAS ACQUIRED ADVANCED CERTIFICATIONS IN ONCOLOGY AND/OR PALLIATIVE SUPPORT AND COORDINATES MEDICAL CARE WITH PRIMARY CARE PHYSICIANS, ONCOLOGISTS, NURSES, AND COMMUNITY RESOURCES. 45887122 61028068 69862585 true true false true false false false false false true false true false false false false false true false false true true false true false false false false false false false false false false false false false true true false false true 50 0 true 557 true false false false false false false false false false 11 7 false false false false true true true true true false false true true true true true true true true false X X DEBRA TUQUERO 8085357284 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 PAUL DOUGLASS 0.2 X X 0 0 0 LYLE TABATA 0.2 X X 0 0 0 SHIRLEY AKITA 0.2 X 0 0 0 TERENCE CAROLAN MD 0.2 X 0 0 0 KATHLEEN CLARK 60.0 X X 0 295251 17320 JOHN CULLINEY MD 0.2 X 0 564442 24184 RAMON DE LA PENA 0.2 X 0 0 0 DOUGLAS DUVAUCHELLE MD 0.2 X 0 0 0 CHRISTOPHER JORDAN 0.2 X 0 327504 19573 CHARLES A STED 8.0 X 0 2010991 283726 ELLIOT MILLS 0.2 X 0 0 0 LYNN McCRORY 0.2 X 0 0 0 DAVID OKABE 3.0 X 0 828139 109283 KENNETH B ROBBINS MD 0.1 X 0 861367 126959 GAIL LERCH 1.0 X 0 623021 100175 VIRGINIA PRESSLER-FISHER MD 2.0 X 0 587408 106744 CHARLES R CHING 5.0 X 0 545613 79218 STEVEN ROBERTSON 8.0 X 0 447932 93805 EARL INOUYE 12.0 X 0 338063 33176 ARTHUR GLADSTONE 0.5 X 0 397128 43542 HILTON RAETHEL 5.0 X 0 304447 14689 SUSAN MASUMOTO-NONAKA 9.0 X 0 260504 40022 WARREN CHAIKO 5.0 X 0 287396 30757 THERESA RAMEY 20.0 X 0 113223 16116 MELINDA ASHTON MD 1.0 X 0 328748 35227 DAVID FOX 4.2 X 0 111240 17249 JESSICA LEWIS 3.9 X 0 98248 11015 TERRY LONG 4.0 X 0 250732 35958 KENT KIKUCHI 34.0 X 0 167975 21557 LINDA ROZELLE 40.0 X 167242 0 10609 BONNIE J CLARK 40.0 X 148468 0 11684 LINDA LEAVITT 40.0 X 146438 0 19521 CLYDE MILLER 40.0 X 139434 0 12728 TERRY TAYLOR 40.0 X 136166 0 12959 JOHN HARLACHER 0.0 X 108201 0 19651 KEOKI CLEMENTE 0.0 X 0 103335 15916 PAULA DIAS 0.0 X 0 270249 25517 LYNNE JOSEPH 0.0 X 0 207562 33183 845949 10330518 1422063 40 true true false CLINICAL LABORATORIES OF HAWAI'I L PO BOX 1882 HILO HI 967211882 MEDICAL LAB TESTING 2045084 SHIOI CONSTRUCTION INC 4023 HALAU ST LIHUE HI 96766 CONSTRUCTION 943796 UP TO DATE CLEANERS KAUA'I 3145 HIKINA ROAD KOLOA HI 96756 COMMERCIAL LAUNDRY 761760 PHILIPS MEDICAL SYSTEMS 3000 MINUTEMAN ROAD MS 0400 ANDOVER MA 01810 IMAGING EQUIP MAINT 609611 GE HEALTHCARE 150 WEST CERRITOS AVENUE ANAHEIM CA 92805 MEDICAL EQUIP MAINT 287100 15 533159 95511 628670 NET PATIENT REVENUES 622110 47118229 47118229 MEDICARE / MEDICAID REVENUE 622110 36169150 36169150 RENTAL INCOME FROM AFFILIATES 531120 779757 779757 RENTAL INCOME RELATED TO PROGRAM SERVICES 531120 362375 362375 84429511 40529 40529 0 0 135366 30925 104441 104441 104441 187937 21985 163619 -37887 24318 59872 84190 59872 0 24318 0 0 0 CAFETERIA SALES 722110 1019391 1019391 SPECIAL EVENTS/CATERING 722320 833199 833199 PLANT OPERATIONS 900099 292993 292993 103880 103880 2249463 87536804 86738846 0 169288 33072 33072 0 0 0 0 127574 127574 27390155 27329641 60514 901074 898911 2163 3920914 3745528 175386 2052965 2048707 4258 0 0 258011 258011 1061 1061 0 30916 30916 9896275 8409422 1486853 69566 69566 12436342 12354072 82270 1058928 253312 805616 0 2337046 2168067 168979 46039 31849 14190 0 2426 2426 1501463 1501463 0 5077232 4994451 82781 1336817 1283498 53319 CORPORATE ALLOCATION 4402596 4402596 PROVISION FOR BAD DEBT 3512760 3512760 OTHER PURCHASES 1270932 1166968 103964 ALL OTHER EXPENSES 29199 864 28335 77693363 69862585 7830778 0 -492793 -441540 9131947 9269825 2048575 2359363 78299 103101224 63244501 40118244 39856723 5671630 5748772 484952 547962 7012720 6913695 63975275 64333099 3051346 8354748 22450843 17252726 25502189 25607474 X 32433649 32583425 3121769 2960816 2917668 3181384 38473086 38725625 63975275 64333099 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1061 1061 false false LOBBYING ACTIVITY FORM 990, SCHEDULE C, PART II-B, LINE 1I LOBBYING FEES WERE INCLUDED IN THE ANNUAL MEMBERSHIP DUES PAID TO HEALTHCARE ASSOCIATION OF HAWAI'I. 0 1112105 1112105 0 66580668 35938403 30642265 0 417000 417000 0 0 26587081 22130355 4456726 0 8404370 4758743 3645627 39856723 BENEFICIAL INT IN N.A. OF FDN 3547417 BENEFICIAL INT IN PERP TRUST 2594783 OTHER RECEIVABLES 314691 UNAMORTIZED BOND COSTS 206105 DUE FROM KAPI'OLANI FOUNDATION 43212 DUE FROM WILCOX FOUNDATION 207486 6913695 0 DUE TO GOVERNMENTAL AGENCIES 423923 OTHER LONG TERM LIABILITIES 24425 ALLOC OF OBLIG GRP TAX EXEMPT BONDS 16707848 DEFERRED CHARGES 350 DUE TO PROVIDERS INSURANCE 87253 DUE TO HAWAI'I PACIFIC HEALTH PTRS 135 DUE TO KEAHONUIOKALANI 8487 DUE TO STRAUB FOUNDATION 305 17252726 SCHEDULE D - FIN 48 FOOTNOTE PART X, LINE 2 FOLLOWING IS THE FIN 48 FOOTNOTE FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF HAWAI'I PACIFIC HEALTH, THE FILING ORGANIZATION'S PARENT. THE TAXABLE AFFILIATES OF THE COMPANY UTILIZE THE LIABILITY METHOD OF ACCOUNTING FOR INCOME TAXES. UNDER THIS METHOD, DEFERRED INCOME TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON DIFFERENCES BETWEEN THE FINANCIAL REPORTING AND TAX BASIS OF ASSETS AND LIABILITIES, AND ARE MEASURED USING THE CURRENTLY EXACTED TAX RATES AND LAWS. VALUATION ALLOWANCES ARE USED TO REDUCE DEFERRED TAX ASSETS TO THEIR ESTIMATED NET REALIZABLE VALUES WHEN MANAGEMENT DETERMINES ULTIMATE RECOVERY OF THE DEFERRED TAX ASSETS IS NOT MORE LIKELY THAN NOT TO OCCUR. true true X true X true X true true false true true 986 338426 338426 0.00460 10785 10343507 7816546 2526961 0.03410 11771 10681933 7816546 2865387 0.03870 63 88856 23798 65058 0.00090 10646 10646 0.00010 4727047 3385519 1341528 0.01810 18238 18238 0.00020 63 4844787 3409317 1435470 0.01930 11834 15526720 11225863 4300857 0.05800 23306 23306 0.00030 23306 23306 0.00030 false 1123732 86435 22459412 19813927 2645485 true true WILCOX MEMORIAL HOSPITAL

3-3420 KUHIO HIGHWAY LIHUE HI 967661099

X X X WILCOX MEMORIAL HOSPITAL ADULT DAYCARE

2943 KRESS STREET LIHUE HI 96766

ADULT DAYCARE CLINIC WILCOX MEMORIAL HOSPITAL REHAB

4366 KUKUI GROVE STREET SUITE 202 LIHUE HI 96766

REHAB THERAPY CLINIC N/A COMMUNITY BENEFITS ARE INCLUDED IN A REPORT PREPARED BY HAWAI'I PACIFIC HEALTH, THE FILING ORGANIZATION'S PARENT. COST TO CHARGE RATIO AND SCHEDULE H WORKSHEET WAS USED SUBSIDIZED HEALTH SERVICES INCLUDES COSTS ASSOCIATED WITH WILCOX MEMORIAL HOSPTIAL'S INFUSION AND DAYCARE SERVICES BAD DEBT EXPENSE OF $3,512,760 WAS SUBTRACTED FROM TOTAL EXPENSES TO COMPUTE PERCENTAGES THE ESTIMATE OF BAD DEBT COST IS BASED ON THE COST TO CHARGE RATIO AND THE ESTIMATE OF CHARITY CARE COST IS BASED ON THE COST TO CHARGE RATIO ATTRIBUTED TO MANAGEMENT'S ESTIMATE OF THE PORTION OF THE UN-INSURED PATIENTS THAT COULD HAVE QUALIFIED FOR CHARITY CARE. PER THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF HAWAI'I PACIFIC HEALTH FILING ORGANIZATION'S PARENT: THE PROVISION FOR BAD DEBTS EXPENSE IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, TAKING INTO CONSIDERATION HISTORICAL BUSINESS AND ECONOMIC TRENDS, TRENDS IN HEALTHCARE COVERAGES AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. BAD DEBT CONSISTS OF SERVICES FOR WHICH THE COMPANY ANTICIPATED BUT DID NOT RECEIVE PAYMENT BECAUSE OF PATIENTS' UNWILLINGNESS TO PAY. BAD DEBT ALSO INCLUDES SERVICES FOR MEDICALLY INDIGENT AND/OR UNINSURED PATIENTS WHO ARE UNABLE TO PAY AND WHO MIGHT HAVE QUALIFIED FOR CHARITY CARE HAD THE PATIENT SELF-IDENTIFIED THEMSELVES AS MEDICALLY INDIGENT ALONG WITH PROVIDING INFORMATION SO THAT PROPER MEANS TESTING COULD HAVE BEEN ACCOMPLISHED TO QUALIFY THE PATIENT FOR CHARITY CARE. COLLECTION PROCEDURES FOR PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE FOLLOW THE SAME POLICY AS ALL OTHER PATIENTS. IN GENERAL THE POLICY INVOLVES SENDING FOLLOW UP STATEMENTS AND DOING FOLLOW UP PHONE CALLS. PAYMENT OPTIONS ARE ALSO PRESENTED TO THE PATIENT AS PART OF THE COLLECTION PROCESS. ACCOUNTS NOT COLLECTED WITHIN THE SPECIFIED TIME PERIOD OUTLINED IN THE POLICY (HOSPITAL AND PHYSICIAN CLAIMS) ARE SENT TO A COLLECTION AGENCY FOR COLLECTIONS. 1 REHAB THERAPY CLINIC AND 1 ADULT DAYCARE CLINIC THE ORGANIZATION IS CURRENTLY IN THE PROCESS OF DEVELOPING A PLAN TO ASSESS THE COMMUNITY NEEDS IN ACCORDANCE WITH IRC SECTION 501(R) WHEN A PATIENT PRESENTS FOR SERVICES AND THE PATIENT DOES NOT HAVE INSURANCE COVERAGE FOR SERVICES TO BE PROVIDED, THE PATIENT OR GUARANTOR IS ASKED TO SIGN THE "SELF PAY ACKNOWLEDGEMENT" LETTER. THIS LETTER DESCRIBES THE TERMS OF THE HAWAI'I PACIFIC HEALTH ("HPH") UNINSURED DISCOUNT PROGRAM, AND BY SIGNING THE LETTER, THE PATIENT ACKNOWLEDGES THAT HE/SHE UNDERSTANDS AVAILABLE UNINSURED PAYMENT TERMS. IN MOST UNINSURED CASES, THE PATIENT WILL BE OFFERED A HAWAII STATE MEDICAL ASSISTANCE APPLICATION. THIS IS THE APPLICATION FOR THE HAWAII STATE MEDICAID/QUEST PROGRAM. THE HOSPITAL CONTRACTS WITH SERVICE PROVIDERS WHO SPECIALIZE IN ASSISTING PATIENTS WITH THE MEDICAID/QUEST PROGRAM APPLICATION PROCESS. IF THE PATIENT'S APPLICATION FOR MEDICAID/QUEST IS DENIED OR IT IS DETERMINED THAT THE PATIENT IS INELIGIBLE TO APPLY FOR MEDICAID/QUEST, THE PATIENT MAY APPLY FOR HPH FINANCIAL ASSISTANCE EITHER IN THE HOSPITAL FINANCIAL SERVICES DEPARTMENT OR BY MAIL DIRECTLY TO THE HPH BUSINESS SERVICES OFFICE. FINANCIAL COUNSELORS ARE AVAILABLE ON SITE TO REVIEW PAYMENT OPTIONS WITH THE PATIENT OR THE GUARANTOR. THESE OPTIONS INCLUDE THE AFOREMENTIONED HPH UNINSURED DISCOUNT PROGRAM. THE HAWAII STATE MEDICAID/QUEST PROGRAM, THE HPH FINANCIAL ASSISTANCE PROGRAM, PAYMENT PLANS AND ANY GRANT OF FUNDING SOURCE THAT MAY BE APPROPRIATE FOR THE SERVICES PROVIDED. IN SOME CASES, HPH DETERMINES THAT A PATIENT OR GUARANTOR MAY NEED ASSISTANCE AFTER SERVICES ARE PROVIDED AND FINANCIAL ASSISTANCE INFORMATION IS MAILED TO THE PATIENT. EDUCATION AND ASSISTANCE IS OFTEN PROVIDED VIA PHONE CONTACT IN THESE CASES. PAYMENT PLAN ARRANGEMENTS ARE HANDLED VIA PHONE CONTACT WITH THE PATIENT. WILCOX MEMORIAL HOSPITAL ("WILCOX") HAS BEEN SERVING RESIDENTS AND VISITORS OF KAUA'I FOR MORE THAN 70 YEARS. THE LARGEST MEDICAL FACILITY ON THE ISLAND, IT IS AN ACUTE-CARE FACILITY WITH MORE THAN 22 SPECIALTIES AND A FULL SUITE OF SERVICES RANGING FROM EMERGENCY, OB/GYN AND PEDIATRICS TO CARDIOLOGY, GASTROENTEROLOGY, OPHTHALMOLOGY, PULMONOLOGY, NEPHROLOGY, COSMETIC SURGERY, INTERNAL MEDICINE, FAMILY PRACTICE, AND WOMEN'S SERVICES. IN FISCAL YEAR 2010, WILCOX HAD MORE THAN 63,000 IMAGING PROCEDURES, 22,223 ER VISITS, AND ALMOST 3,700 INPATIENT ADMISSIONS. IT TREATS ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THUS SERVING AS ONE OF THE COMMUNITY'S SAFETY NET PROVIDERS OF HEALTH CARE. WILCOX'S GEOGRAPHIC SERVICE AREA IS THE ISLAND OF KAUA'I. DEMOGRAPHICS OF THE COMMUNITY IN FISCAL 2010 INCLUDE A KAUA'I POPULATION OF 67,091 (AND MORE THAN 900,000 VISITORS ANNUALLY), WITH 10.5 PERCENT OF RESIDENTS HAVING INCOMES BELOW THE FPG, 10.5 PERCENT OF WILCOX PATIENTS ARE UNINSURED AND 15.6 PERCENT ARE MEDICAID RECIPIENTS. THERE ARE TWO OTHER HOSPITALS IN THE COMMUNITY, AND FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS AND POPULATIONS ARE PRESENT. WHEN DISCHARGING PATIENTS, WILCOX MEMORIAL HOSPITAL ("WILCOX") FOLLOWS THE GUIDELINES OF THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES. THE HOSPITAL ENSURES THAT A SAFE DISCHARGE PLAN IS PROVIDED TO ALL PATIENTS. THIS MAY NECESSITATE PROVIDING PATIENTS WHO ARE LEAVING THE HOSPITAL WITH TRANSPORTATION TO A PERMANENT OR TRANSITIONAL DESTINATION. IN SOME CASES, INDIGENT PATIENTS ARE READY FOR DISCHARGE, BUT DO NOT HAVE THE ABILITY TO PAY FOR TRANSPORTATION FROM THE HOSPITAL, HOUSING, MEDICATIONS AND MEDICAL EQUIPMENT, AND/OR SPECIFIC FOODS REQUIRED AS PART OF A RESTRICTED DIET. IN THOSE SPECIAL CIRCUMSTANCES, WILCOX WILL TEMPORARILY COVER THESE COSTS. IN FISCAL 2010, WILCOX'S PAYMENTS FOR INDIGENT PATIENTS WAS $23,306. IN SOME CASES, TRANSPORTATION COSTS INCLUDED A NURSE PROVIDING MEDICALLY NECESSARY ESCORT SERVICES FOR THE PATIENT. IN ANOTHER CASE, WILCOX PURCHASED SPECIAL BABY FORMULA THAT COULD BE TOLERATED BY A NEWBORN. BY HELPING ITS MOST VULNERABLE PATIENTS OVERCOME THESE FINANCIAL BARRIERS, WILCOX IS HELPING TO ENSURE A SAFE DISCHARGE AND SMOOTH TRANSITION TO AN APPROPRIATE CARE SETTING FOR ALL PATIENTS, AS WELL AS MAKING AVAILABLE A HOSPITAL BED FOR AN ACUTE OR CRITICALLY ILL PATIENT WHO REQUIRES HOSPITAL-GRADE CARE. WILCOX MEMORIAL HOSPITAL ("WILCOX") IS DEDICATED TO PROVIDING KAUA'I WITH AFFORDABLE AND ACCESSIBLE HEALTH CARE. IN 2010, THE AMERICAN HEART ASSOCIATION RECOGNIZED WILCOX IN THREE AREAS OF EXCELLENCE: CORONARY ARTERY DISEASE - GOLD AWARD, STROKE - SILVER AWARD, AND HEART FAILURE - SILVER AWARD. WILCOX MAINTAINS AN OPEN MEDICAL STAFF IN 22 SPECIALTIES. THIS ARRANGEMENT, WHICH GRANTS HOSPITAL PRIVILEGES TO NONAFFILITATED PHYSICIAN SPECIALISTS, ALSO BROADENS WILCOX'S ABILITY TO OFFER HIGH-QUALITY, SPECIALIZED CARE TO THE COMMUNITY. WILCOX IS GOVERNED BY A COMMUNITY BOARD COMPRISED OF PHYSICIANS, COMMUNITY MEMBERS AND KEY LEADERSHIP WITHIN HAWAI'I PACIFIC HEALTH. THESE VOLUNTEER, UNPAID MEMBERS ENSURE THAT WILCOX FULFILLS ITS MISSION-DRIVEN GOALS. AS AN AFFILIATE OF THE NON-PROFIT HAWAI'I PACIFIC HEALTH NETWORK, WILCOX REINVESTS ALL SURPLUS RESOURCES BACK INTO PATIENT CARE AND TO SUBSIDIZE THOSE WHO CANNOT PAY. IN ADDITION, WILCOX PLAYS AN ACTIVE ROLE IN KAUA'I'S COMMUNITY. IN FISCAL YEAR 2010, IT HOSTED VALENTINE IN PARADISE, A TELECONFERENCE ON HEART DISEASE PREVENTION AND THE WOMEN'S HEALTH SYMPOSIUM, WHICH ATTRACTED MORE THAN 200 ATTENDEES. WILCOX CO-SPONSORS THE ARTHRITIS WALK AND OLD KOLOA SUGAR MILL WALK/RUN, AND SUPPORTS THE PARADE OF LIGHTS, AMERICAN CANCER SOCIETY/RELAY FOR LIFE, KAUA'I FOOD BANK, KAUA'I LIFEGUARD ASSOCIATION, TOYS FOR TOTS, VISITOR INDUSTRY CHARITY WALK, ALZHEIMER'S MEMORY WALK AND MANY MORE COMMUNITY EVENTS. THE HAWAI'I PACIFIC HEALTH CARE SYSTEM INCLUDES FOUR AFFILIATED HOSPITALS, 49 OUTPATIENT CLINICS AND SERVICE SITES, AND MORE THAN 1,300 PHYSICIANS. THE FOUR HOSPITALS PROVIDE ACUTE AND SPECIALTY CARE WITH 553 BEDS AND BASSINETS, AND HANDLE MORE THAN 34,000 ADMISSIONS ANNUALLY. HAWAI'I PACIFIC HEALTH, THE STATE'S LARGEST HEALTH CARE PROVIDER, IS COMMITTED TO PROVIDING THE HIGHEST QUALITY AND MOST ACCESSIBLE MEDICAL CARE AND SERVICES TO THE PEOPLE OF HAWAI'I AND THE PACIFIC REGION. true X DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE I THE HAWAI'I PACIFIC HEALTH DONATIONS COMMITTEE REVIEWS AND APPROVES DONATIONS TO 501(C)(3) ORGANIZATIONS ON AN ANNUAL BASIS. NO FURTHER MONITORING IS NECESSARY SINCE DONATIONS ARE ONLY MADE TO 501(C)(3) ORGANIZATIONS. false true false false false false false true false KATHLEEN CLARK 0 199624 0 30774 0 64853 0 11638 0 5682 0 312571 0 37991 JOHN CULLINEY MD 0 541042 0 23400 0 0 0 9800 0 14384 0 588626 0 0 CHRISTOPHER JORDAN 0 292504 0 35000 0 0 0 9800 0 9773 0 347077 0 0 CHARLES A STED 0 753034 0 189314 0 1068643 0 271408 0 12318 0 2294717 0 927278 DAVID OKABE 0 410893 0 83331 0 333915 0 94274 0 15009 0 937422 0 263953 KENNETH B ROBBINS MD 0 407086 0 83109 0 371172 0 109190 0 17769 0 988326 0 301378 GAIL LERCH 0 320190 0 69507 0 233324 0 82010 0 18165 0 723196 0 185756 VIRGINIA PRESSLER-FISHER MD 0 322660 0 63901 0 200847 0 76480 0 30264 0 694152 0 145627 CHARLES R CHING 0 309809 0 61739 0 174065 0 68962 0 10256 0 624831 0 129699 STEVEN ROBERTSON 0 306299 0 66491 0 75142 0 66642 0 27163 0 541737 0 25048 EARL INOUYE 0 229057 0 28589 0 80417 0 30186 0 2990 0 371239 0 52775 ARTHUR GLADSTONE 0 279978 0 43298 0 73852 0 21015 0 22527 0 440670 0 46593 HILTON RAETHEL 0 203431 0 24396 0 76620 0 11638 0 3051 0 319136 0 75187 SUSAN MASUMOTO-NONAKA 0 197875 0 24444 0 38185 0 11638 0 28384 0 300526 0 23460 WARREN CHAIKO 0 210889 0 26472 0 50035 0 11654 0 19103 0 318153 0 26874 MELINDA ASHTON MD 0 262570 0 29981 0 36197 0 14152 0 21075 0 363975 0 0 TERRY LONG 0 162112 0 26010 0 62610 0 28138 0 7820 0 286690 0 46971 KENT KIKUCHI 0 157004 0 10971 0 0 0 8038 0 13519 0 189532 0 0 LINDA ROZELLE 156836 0 9206 0 1200 0 9508 0 1101 0 177851 0 0 0 BONNIE J CLARK 140735 0 7733 0 0 0 2163 0 9521 0 160152 0 0 0 LINDA LEAVITT 137429 0 9009 0 0 0 9846 0 9675 0 165959 0 0 0 CLYDE MILLER 139370 0 64 0 0 0 7944 0 4784 0 152162 0 0 0 JOHN HARLACHER 105163 0 3038 0 0 0 6276 0 13375 0 127852 0 0 0 PAULA DIAS 0 191240 0 24224 0 54785 0 11638 0 13879 0 295766 0 35942 LYNNE JOSEPH 0 163920 0 25974 0 17668 0 13564 0 19619 0 240745 0 0 KEOKI CLEMENTE 0 102087 0 1248 0 0 0 1848 0 14068 0 119251 0 0 QUESTIONS REGARDING COMPENSATION 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 SCHEDUEL J, PART I, LINE 4B AMOUNTS PAID OUT DURING THE YEAR BY RELATED ORGANIZATION: WARREN CHAIKO $ 26,874 CHARLES R. CHING $129,699 KATHLEEN CLARK $ 37,991 ARTHUR GLADSTONE $ 46,593 EARL INOUYE $ 52,775 GAIL LERCH $185,756 TERRY LONG $ 46,971 SUSAN MASUMOTO-NONAKA $ 23,460 DAVID OKABE $263,953 VIRGINIA PRESSLER-FISHER, M.D. $145,627 STEVEN ROBERTSON $ 25,048 HILTON RAETHEL $ 75,187 KENNETH B. ROBBINS, M.D. $301,378 CHARLES A. STED $927,278 PAULA DIAS $ 35,942 IN RESPONSE TO NEW REGULATORY REQUIREMENTS ASSOCIATED WITH INTERNAL REVENUE CODE SECTIONS 409A AND 457(F). HPH PROVIDED AN OPTION TO ITS OFFICERS ON PAYING OUT ACCUMULATED BALANCES ON ITS VARIOUS NON-QUALIFIED DEFERRED COMPENSATION ARRANGEMENTS IN 2009 OR TO DEFER ITS DISTRIBUTION SUBJECT TO CLIFF VESTING IN ACCORDANCE WITH THE IRS APPROVED ONE TIME 409A TRANSITION RULE. CERTAIN OFFICERS SELECTED THE PAY OUT OPTION ON THE ACCUMULATED BALANCE ASSOCIATED WITH THE CAPITAL ACCUMULATION PLAN AND ITS RESTORATION PLAN DURING 2009. THE AMOUNTS PAID OUT HAVE BEEN INCLUDED IN THE W-2 OF THOSE PARTICIPANTS ELECTING THE PAYOUT OPTION. THE RESTORATION PLAN WAS DESIGNED TO RESTORE BENEFITS THAT ARE LOST DUE TO LIMITS IMPOSED BY SECTIONS 401 AND 415 OF THE INTERNAL REVENUE CODE ON COMPENSATION CONSIDERED UNDER SUCH PLANS. THE CAPITAL ACCUMULATION ACCOUNT (CAA) IS A SECTION 457(F) PROGRAM THAT WAS PREVIOUSLY AFFORDED TO EXECUTIVE OFFICERS OF THE ORGANIZATION TO PROVIDE BENEFITS ON A TAX DEFERRED BASIS. NON-FIXED PAYMENTS TO PERSONS LISTED ON PART VII, SECTION A, LINE 1A SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS ARE MADE TO EMPLOYEES BASED ON SYSTEM GOALS THAT ARE NOT BASED ON A PERCENTAGE OF NET EARNINGS. NON-FIXED PAYMENTS MADE TO PHYSCIANS ARE BASED ON CLINICAL PERFORMANCE MEASURES. SUPPLEMENTAL INFORMATION TOTAL OTHER PROGRAM EXPENSES FORM 990, PART III, LINE 4D WILCOX MEMORIAL HOSPITAL ("WILCOX") WAS FOUNDED IN 1938 AND HAS BEEN TREATING THE ISLAND'S RESIDENTS AND VISITORS FOR MORE THAN SEVEN DECADES. AN AFFILIATE OF HAWAI'I PACIFIC HEALTH, THE STATE'S LARGEST HEALTH CARE PROVIDER, WILCOX IS AN ACUTE CARE HOSPITAL WITH A FULL SUITE OF SERVICES FROM EMERGENCY, OB/GYN AND PEDIATRICS TO CARDIOLOGY, GASTROENTEROLOGY, OPHTHALMOLOGY, PULMONOLOGY, NEPHROLOGY, COSMETIC SURGERY, INTERNAL MEDICINE, FAMILY PRACTICE, AND WOMEN'S SERVICES. IT HAS 71 BEDS, INCLUDING SEVEN INTENSIVE CARE BEDS, 10 BASSINETS, FIVE BIRTHING SUITES AND A 20-BED EMERGENCY DEPARTMENT. IT HAS A MEDICAL STAFF OF 169 PHYSICIANS. DURING FISCAL YEAR 2010, THE HOSPITAL ADMITTED 3,699 ACUTE CARE PATIENTS FOR A TOTAL OF 16,072 PATIENT DAYS, WITH 22,223 EMERGENCY ROOM VISITS. WILCOX CONDUCTED 1,276 INPATIENT SURGERIES, INCREASED ITS OUTPATIENT SURGERIES TO 5,870 AND PROVIDED INFUSION SERVICES TO 3,647 PATIENTS. WILCOX MEMORIAL HOSPITAL IS KAUAI'S LARGEST MEDICAL FACILITY. IT IS THE ONLY HOSPITAL IN HAWAI'I TO RECEIVE THREE QUALITY PERFORMANCE AWARDS IN ONE YEAR FROM THE AMERICAN HEART ASSOCIATION'S GET WITH THE GUIDELINES PROGRAM. THE WILCOX FAMILY IMAGING CENTER PROVIDES MRI, CT, NUCLEAR MEDICINE, ULTRASOUND, TELEMEDICINE, MAMMOGRAPHY, AND BONE DENSITOMETRY. A STATE-OF-THE-ART SURGICAL CENTER HAS SIX SURGICAL SUITES, 20 SAME-DAY SURGERY BEDS AND MORE THAN 22 SPECIALTIES. CARDIO-PULMONARY OFFERS STRESS TESTING AND RESPIRATORY THERAPY. REHABILITATION SERVICES ARE OFFERED IN PHYSICAL, SPEECH AND OCCUPATIONAL THERAPY. HOSPITALISTS ARE ON STAFF AT ALL TIMES. ALSO, PATIENTS HAVE ACCESS TO ENDOSCOPY, CARDIOVERSION, BRONCHOSCOPY AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND OTHER SPECIALTY PROCEDURES. WILCOX PLAYS AN ACTIVE ROLE IN KAUAI'S COMMUNITY. IT IS COMMITTED TO HEALTH EDUCATION, PREVENTION AND SUPPORT. IN FISCAL YEAR 2010, THE HOSPITAL HOSTED A VARIETY OF COMMUNITY HEALTH EDUCATION EVENTS. IN ADDITION, WILCOX SPONSORS THE ARTHRITIS WALK AND SUPPORTS THE PARADE OF LIGHTS, AMERICAN CANCER SOCIETY/RELAY FOR LIFE, KAUA'I FOODBANK, KAUA'I LIFEGUARD ASSOCIATION, TOYS FOR TOTS, VISITOR INDUSTRY CHARITY WALK, ALZHEIMER'S MEMORY WALK AND MANY MORE COMMUNITY EVENTS. WILCOX TREATS ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THUS SERVING AS THE COMMUNITY'S SAFETY NET PROVIDER OF HEALTH CARE. AN ESTABLISHED CHARITY CARE POLICY SETS GUIDELINES ON WHICH PATIENTS QUALIFY FOR FREE OR DISCOUNTED CARE. IN FISCAL 2010, THE HOSPITAL PROVIDED MORE THAN $4.3 MILLION WORTH OF CARE TO PATIENTS WHO WERE UNINSURED OR UNABLE TO PAY FOR THEIR CARE, AS WELL AS IN OTHER COMMUNITY BENEFITS. TAX-EXEMPT BONDS FORM 990, PART IV, LINE 24A WILCOX MEMORIAL HOSPITAL IS A MEMBER OF THE HAWAI'I PACIFIC HEALTH OBLIGATED GROUP, WHICH HAS ISSUED VARIOUS BOND ISSUES AND IS REPORTED ON THE HAWAI'I PACIFIC HEALTH FORM 990. 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. DESCRIPTION OF CLASSES OF PERSONS AND NATURE OF THEIR RIGHTS 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. DESCRIBE CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, LINE 7B HAWAI'I PACIFIC HEALTH, AS MEMBER, HAS RESERVED POWERS TO APPROVE THE FOLLOWING: (I) 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; (II) 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; (III) AMEND THE BYLAWS; (IV) 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; (V) SELECT BANKS, TRUST COMPANIES, OR OTHER DEPOSITORIES TO WHICH THE CORPORATION'S FUNDS SHALL BE DEPOSITED; (VI) DIRECT, MANAGE AND CONTROL THE CUSTODY, ADVISORY SERVICE AND ASSET MANAGEMENT OF THE FINANCIAL ASSETS OF THE CORPORATION; (VII) EFFECT INTER-CORPORATE TRANSFERS BY AND BETWEEN THE CORPORATION AND ANY AFFILIATE; (VIII) DEVELOP AND IMPLEMENT THE GENERAL POLICIES REGARDING THE CORPORATION'S PHYSICIAN AND EXECUTIVE COMPENSATION AND BENEFIT PLANS; (IX) FORM A NEW CORPORATION, LIMITED LIABILITY COMPANY, OR PARTNERSHIP OR OTHER ORGANIZATION THAT IS OWNED SOLELY BY THE CORPORATION; (X) 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, KAUA'I MEDICAL CLINIC AND WILCOX HEALTH FOUNDATION (THE "WILCOX AFFILIATES"); (XI) 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; (XII) 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; (XIII) 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; (XIV) 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; (XV) AFTER CONSULTING WITH THE BOARD, DEVELOP AND PROMULGATE THE CORPORATE GOALS AND THE LONG RANGE AND STRATEGIC PLANS OF THE CORPORATION; AND (XVI) 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: (I) ADD ANY DIRECTOR TO THE BOARD; (II) REMOVE ANY DIRECTOR FROM THE BOARD; (III) AMEND THE ARTICLES; (IV) 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; (V) ACQUIRE ASSETS WORTH OVER ONE MILLION DOLLARS ($1,000,000); (VI) ACQUIRE SHARES IN ANOTHER CORPORATION; (VII) 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; (VIII) 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; (IX) 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; (X) MERGE THE CORPORATION WITH ANY ENTITY; (XI) DISSOLVE OR LIQUIDATE THE CORPORATION; (XII) ISSUE THE CORPORATION'S MEMBERSHIP TO ANYONE OTHER THAN THE MEMBER; (XIII) 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 (XIV) 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 11A 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 HPH BOARD OF DIRECTORS THROUGH A BOARD MEMBER PORTAL FOR REVIEW PRIOR TO THE FILING OF THE 990. COPIES OF THE 990S ARE MADE AVAILABLE TO THE BOARD MEMBERS OF EACH SUBSIDIARY UNIT OF HPH AND ARE PHYSICALLY LOCATED AT EACH FACILITY'S SITE FOR THE BOARD MEMBER TO REVIEW PRIOR TO FILING. THE 990S WILL BE POSTED TO HPH'S WEB SITE FOR PUBLIC ACCESS AFTER THE FILING OF THE RETURN WITH THE IRS. MONITORING & ENFORCING OF CONFLICT OF INTERST POLICY 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: - RECEIVED A COPY OF THE CONFLICT OF INTEREST ("COI") POLICY; - HAS READ AND UNDERSTANDS THE POLICY; - AGREES TO COMPLY WITH THE POLICY; AND - 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 AND POSITIONS FOR WHICH PROCESS WAS USED, AND YEAR PROCESS WAS LAST COMPLETED FORM 990, PART VI, LINE 15A & 15B COMPENSATION FOR HPH EXECUTIVES (VICE PRESIDENT AND ABOVE) IS SET BY THE HAWAI'I PACIFIC HEALTH ("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. DISCLOSURE OF 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 WILL BE MADE AVAILABLE TO THE PUBLIC VIA THE HAWAI'I PACIFIC HEALTH WEBSITE. SCHEDULE J-2, COLUMN B INDIVIDUALS LISTED ON SCHEDULE J-2 ALSO DEVOTE TIME TO RELATED ORGANIZATION AS LISTED BELOW: HAWAI'I PACIFIC HEALTH ASHTON 40.0 C.R. CHING 30.0 CHAIKO 15.0 FOX 4.0 GLADSTONE 5.0 INOUYE 25.0 LERCH 40.0 LEWIS .3 LONG 32.0 MASUMOTO-NONAKA 20.0 OKABE 35.0 PRESSLER-FISHER 45.0 RAETHAL 15.0 ROBBINS 10.0 ROBERTSON 15.0 STED 32.0 KAPI'OLANI HEALTH FOUNDATION C.R. CHING .5 INOUYE .5 LEWIS .2 LONG .5 OKABE 1.0 PRESSLER-FISHER 1.0 STED 3.0 KAUA'I MEDICAL CLINIC ASHTON 2.0 C.R. CHING 1.0 CHAIKO 1.0 CULLINEY 40.0 INOUYE 4.0 JOHNSON-JOSEPH 5.0 LEWIS 2.4 LONG 4.0 MASUMOTO-NONAKA 1.0 OKABE 1.0 RAETHAL 5.0 RAMEY 20.0 ROBBINS 10.0 ROBERTSON 1.0 STED 6.0 KAPI'OLANI MEDICAL CENTER AT PALI MOMI ASHTON 2.0 C.R. CHING 1.0 CHAIKO 10.0 FOX 6.0 GLADSTONE .5 INOUYE 1.0 LERCH 6.0 LEWIS 6.0 MASUMOTO-NONAKA 8.0 OKABE 3.0 PRESSLER-FISHER 1.0 RAETHAL 5.0 ROBERTSON 8.0 STED 2.0 KAPI'OLANI MEDICAL CENTER FOR WOMEN & CHILDREN ASHTON 2.0 C.R. CHING 4.0 CHAIKO 15.0 DIAS 30.0 FOX 10.4 GLADSTONE .5 INOUYE 5.0 LERCH 6.0 LEWIS 10.8 MASUMOTO-NONAKA 10.0 OKABE 4.0 PRESSLER-FISHER 1.0 RAETHAL 10.0 ROBERTSON 12.0 STED 2.0 KAPI'OLANI MEDICAL SPECIALISTS C.R. CHING 3.0 CHAIKO 1.0 INOUYE 2.0 LERCH 1.0 LEWIS 1.3 MASUMOTO-NONAKA 8.0 OKABE 1.0 RAETHAL 5.0 ROBBINS .2 ROBERTSON 1.0 STED 1.0 PROVIDERS INSURANCE CORPORATION ASHTON .1 OKABE 1.0 STED 1.0 STRAUB CLINIC & HOSPITAL ASHTON 2.0 C.R. CHING 3.0 CHAIKO 5.0 DIAS 2.0 FOX 10.0 GLADSTONE 50.0 INOUYE 6.0 LERCH 6.0 LEWIS 15.0 MASUMOTO-NONAKA 12.0 OKABE 6.0 PRESSLER-FISHER 2.0 RAETHAL 10.0 ROBBINS 40.0 ROBERTSON 15.0 STED 3.0 STRAUB FOUNDATION C.R. CHING .5 LEWIS .5 OKABE .5 ROBBINS .1 STED 1.0 WILCOX HEALTH FOUNDATION C.R. CHING .5 INOUYE .5 K. CLARK 1.0 LEWIS .5 OKABE .5 PRESSLER-FISHER 1.0 STED 1.0 SCHEDULE R, PART V, LINE 2 REASONABLE METHOD TO DETERMINE VALUE OF SERVICES, CASH & OTHER SERVICES IN GENERAL, AMOUNTS REPORTED WITH RELATED ORGANIZATIONS ARE DETERMINED BASED ON MARKET VALUES FOR SIMILAR ITEMS OR SERVICES. HAWAI'I PACIFIC HEALTH 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246363 HOLDING CO. HI 501 (C)(3) 11B TYPE II NA PROVIDERS INSURANCE CORPORATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 710893000 NFP INSURANCE HI 501 (C)(3) 11B TYPE II NA KAPI'OLANI MEDICAL CTR WOMEN & CHILDREN 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990177350 HOSPITAL HI 501 (C)(3) 3 NA KAPI'OLANI HEALTH FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990246364 FUNDRAISING HI 501 (C)(3) 7 NA KAPI'OLANI MEDICAL SPECIALISTS 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990322406 HEALTHCARE HI 501 (C)(3) 9 NA KAPI'OLANI MEDICAL CENTER AT PALI MOMI 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990274038 HOSPITAL HI 501 (C)(3) 3 NA WILCOX HEALTH FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990204242 FUNDRAISING HI 501 (C)(3) 7 NA KAUA'I MEDICAL CLINIC 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990326099 HOSPITAL HI 501 (C)(3) 3 NA STRAUB CLINIC & HOSPITAL 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 912151670 HOSPITAL HI 501 (C)(3) 3 NA STRAUB FOUNDATION 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990109350 FUNDRAISING HI 501 (C)(3) 7 NA HAWAI'I PACIFIC HEALTH PARTNERS INC&SUB 55 MERCHANT STREET 24TH FLOOR HONOLULU HI 96813 990318588 HOLDING COMPANY HI NA C CORP 0 0 false true true false false false false false true true false false false true true true true true KAPI'OLANI MEDICAL CTR FOR WOMEN & CHILDREN P 277111 PROVIDERS INSURANCE CORPORATION Q 1241320 KAPI'OLANI MEDICAL CENTER AT PALI MOMI P 65984 KAPI'OLANI MEDICAL CENTER AT PALI MOMI Q 130556 STRAUB CLINIC & HOSPITAL P 243312 WILCOX HEALTH FOUNDATION C 678707 WILCOX HEALTH FOUNDATION O 63311 KAUA'I MEDICAL CLINIC R 108944 KAUA'I MEDICAL CLINIC O 1725780 HAWAI'I PACIFIC HEALTH PARTNERS INC & SUB 0 KAPI'OLANI HEALTH FOUNDATION 0 KAPI'OLANI MEDICAL SPECIALISTS 0 STRAUB FOUNDATION 0